Year 2018 Vol. 26 No 4




Belarusian Medical Academy of Postgraduate Education1
Minsk Regional Clinical Hospital2, Minsk,
The Republic of Belarus

The article is devoted the history of anatomical, experimental and clinical trials permitting the prognosis and improvement the blood flow in the cervical part of the intestinal grafts to perform the one-stage shunting esophagoplasty.
In the second half of the twentieth century, on the corpses, and then during angiography using the method of Seldinger, the architectonics of the basins of the upper and lower mesenteric arteries, supplying the colon, was studied in detail. Based on the results obtained, original methods for the prevention of ischemia and venous stasis in the retrospective esophagocolotransplant were proposed.
Almost simultaneously H. Shumacker and J. Battersby in London, and A. Shalimov in Kiev developed in 1950-1951 in the experiment and introduced into the clinic the technique of «training» of the vascular collaterals of the jejunal graft. It found application in the twenty-first century. A. Carrel in 1907 in Baltimore, and E. Kramarenko in 1921 in Odessa carried out in experiment the direct revascularization of the intestinal graft. In the clinic, this idea was embodied by W. Longmire in Baltimore in 1946. P. Androsov in Moscow since 1950 has begun to form direct arterial anastomoses with V. Gudov mechanical vasoconstrictor apparatus. In 1976 in Minsk I. Grishin performed a direct revascularization of the jejunal graft from the thoracic aorta. Due to the development of microvascular technologies, the hypervascularization of the esophagus is finding more and more supporters. Today, Belarusian surgeons widely use this technology in difficult anatomical situations to perform a one-step retrosternal esophagogastroplasty.

Keywords: esophagoplasty, mesenteric vessels, esophagocolotransplant, intravascular graft hypervascularization
p. 389-401 of the original issue
  1. Heller A. Uber die Blutgefässe des Dünndarmes. In: Berichte über die Verhandlungen der Königlich Sächsischen Gesellschaft der Wissenschaften zu Leipzig: Mathematisch-Physische Classe. 1872;24. p. 165-71.
  2. Michels NA. Blood Supply and anatomy of upper abdominal organs with Descriptive atlas. Philadelphia: JB Lippin-Cott; 1955. 581 ð.
  3. Michels NA, Siddharth P, Kornblith PL, Parke WW. The variant blood supply to the small and large intestines: its import in regional resections. A new anatomic study based on four hundred dissections, with a complete review of the literature. J Int Coll Surg. 1963;39:127-70.
  4. Griffiths JD. Extramural and intramural blood-supply of colon. Br Med J. 1961 Feb 4;1(5222):323-26. doi: 10.1136/bmj.1.5222.323
  5. Spjut HJ, Margulis AR, McAlister WH. Microangiographic study of gastrointestinal lesions. Am J Roentgenol Radium Ther Nucl Med. 1964 Nov;92:1173-87.
  6. Stel’mashonok IM. Operativnoe lechenie rubtsovykh suzhenii pishchevoda i zheludka. Minsk: Belarus’;1970. 272 p. (in Russ.)
  7. Petrov BA, Svytnik AP. Iskusstvennyi pishchevod iz tonkoi i tolstoi kishki. Moscow SSSR: Meditsina; 1972. 184 p. (in Russ.)
  8. Sonneland J, Anson BJ, Beaton LE. Surgical anatomy of the arterial supply to the colon from the superior mesenteric artery based upon a study of 600 specimens. Surg Gynecol Obstet. 1958 Apr;106(4):385-98.
  9. Baum S. Normal anatomy and collateral pathways of the mesenteric circulation. In: Boley SI, ed. Vascular disorders of the intestine. New York, London: Appleton-Century-Crofts; 1971. p. 3-18.
  10. Beck AR, Baranofsky ID. A study of the left colon as a replacement for the resected esophagus. Surg. 1960 Sep;48(3):499-509.
  11. Pouyet M, Berard PH, Bousquet G. Documents anatomiques sur L’emploi du colon transverse isoperistaltique pour oesophagoplastie. Lyon Chir. 1967;63(2):199-206.
  12. Kralik J,Turek K. Die Wichtigkeit des Venosen Abflusses aus dem zur osophagoplastik verwendeten kolon-transplantat. Zentralbl Chir. 1967;44:2772-76.
  13. Nick R. Colonic replacement of the oesophagus. Some observations on infarction and wound leakage. Br J Surg. 1967 Feb;54(2):124-28. doi: 10.1002/bjs.1800540211
  14. Seldinger SI. Catheter replacement of the needle in percutaneous arteriography: a new technique. Acta Radiol. 1953 May;39(5):368-76. doi: 10.1177/028418515303900502
  15. Marston A. Vascular Disease of the Gut: Pathophysiology, Recognition and Management. London: E. Arnold; 1985. 304 ð.
  16. Ventemiglia R, Khalil KG, Frazier OH, Mountain CF. The role of preoperative mesenteric arteriography in colon interposition. J Thorac Cardiovasc Surg. 1977 Jul;74(1):98-104.
  17. Thomas P, Fuentes P, Giudicelli R, Reboud E. Colon interposition for esophageal replacement: current indications and long-term function. Ann Thorac Surg. 1997 Sep;64(3):757-64. doi: 10.1016/s0003-4975(97)00678-4
  18. De Meester TR. Esophageal replacement with colon interposition. Oper Tech Cardiac Thorac Surg. 1997 Feb;2(Is 1):73-86. doi: 10.1016/s1085-5637(07)70090-6
  19. Peters JH, Kronson JW, Katz M, De Meester TR. Arterial anatomic considerations in colon interposition for esophageal replacement. Arch Surg. 1995 Aug;130(8):858-62; discussion 862-63. doi: 10.1001/archsurg.1995.01430080060009
  20. Fisher DF Jr, Fry WJ. Collateral mesenteric circulation. Surg Gynecol Obstet. 1987 May;164(5):487-92.
  21. Thomas PA, Gilardoni A, Trousse D, D’Journo XB, Avaro JP, Doddoli C, Giudicelli R, Fuentes P. Colon interposition for oesophageal replacement. Multimed Man Cardiothorac Surg. 2009 Jan 1;2009(603):mmcts.2007.002956. doi: 10.1510/mmcts.2007.002956
  22. Ahmed A, Spitz L. The outcome of colonic replacement of the esophagus in children. Prog Pediatr Surg. 1986;19:37-54. doi: 10.1007/978-3-642-70777-3_4
  23. Freeman NV, Cass DT. Colon interposition: a modification of the Waterston technique using the normal esophageal route. J Pediatr Surg. 1982 Feb;17(1):17-21. doi: 10.1016/s0022-3468(82)80318-7
  24. De Meester TR, Johansson KE, Franze I, Eypasch E, Lu CT, Megill JE, Zaninotto G. Indications, surgical technique and Long-term functional results of colon interposition or bypass. Ann Surg. 1988 Nov;208(4):460-74. doi: 10.1097/00000658-198810000-00008
  25. Wain JC, Wright CD, Kuo EY, Moncure AC, Wilkins EW Jr, Grillo HC, Mathisen DJ. Long-segment colon interposition for acquired esophageal disease. Ann Thorac Surg. 1999 Feb;67(2):313-17; discussion 317-18. doi: 10.1016/s0003-4975(99)00029-6
  26. DeMeester TR, Kauer WK. Esophageal reconstruction. The colon as an esophageal substitute. Dis Esophagus. 1995;8:20-29.
  27. Loinaz C, Altorki NK. Pitfalls and complications of colon interposition. Chest Surg Clin N Am. 1997 Aug;7(3):533-49; discussion 550
  28. Wilkins EW Jr. Long-segment colon substitution for the esophagus. Ann Surg. 1980 Dec;192(6):722-25.
  29. Yasuda T, Shiozaki H. Esophageal reconstruction using a pedicled jejunum with microvascular augmentation. Ann Thorac Cardiovasc Surg. 2011;17(2):103-109. doi: 10.5761/atcs.ra.10.01648
  30. Furst H, Hartl WH, Lohe F, Schilberg FW. Colon interposition for esophageal replacement. Ann Surg. 2000;231(2):173-78. doi: 10.1097/00000658-200002000-00004
  31. Vorobei AV, Averin VI, Mal’kevich VT, i dr. Ezofagokoloplastika. Minsk, RB: Stroimediaproekt; 2017. 382 p. (in Russ.)
  32. Chang AC. Colon interposition for staged esophageal reconstruction. Oper Tech Thorac Cardiovasc Surg. 2010 Autumn;15(Is 3):231-42. doi: 10.1053/j.optechstcvs.2010.08.003
  33. Orringer MB. Reversing esophageal discontinuity. Semin Thorac Cardiovasc Surg. 2007 Spring;19(1):47-55. doi: 10.1053/j.semtcvs.2006.11.004
  34. Wormuth JK, Heitmiller RF. Esophageal conduit necrosis. Thorac Surg Clin. 2006 Feb;16(1):11-22. doi: 10.1016/j.thorsurg.2006.01.003
  35. Ashizawa I, Nishihira T, Kasai M. Improvement of circulation in pedicled intestinal grafts: hemodynamics of the intestine after preparation of a sacrificial colonic graft. J Am Coll Surg. 1997 Apr;184(4):346-52.
  36. Lees W. Colonic replacement after pharyngolaryngectomy. Br J Surg. 1967 Jun;54(6):541-47. doi: 10.1002/bjs.1800540610
  37. Amosov NM. Ocherki torakal’noi khirurgii. Kiev: Gosmedizdat; USSR. 1958.777 p.
  38. Androsov PI. Iskusstvennyi pishchevod iz tolstoi kishki. Vestn Khirurgii im II Grekova. 1959;82(2):9-17. (in Russ.)
  39. Rogacheva VS. Rak pishchevoda i ego khirurgicheskoe lechenie. Moscow, SSSR: Meditsina;1968. 328 p. (in Russ.)
  40. Filatov VP. Plastika na kruglom steble. Vestn Oftal’mologii. 1917;(4-5):149. (in Russ.)
  41. Iudin SS. Vosstanovitel’naia khirurgiia pri neprokhodimosti pishchevoda. Moscow: SSSR: Medgiz; 1954. 271 p. (in Russ.)
  42. Abakumov MM, Kabanova SA, Bogopol’skii PM. History of small bowel plasty of oesophagus. To 100 years of Roux-Gertsen operation. Part I. Khirurgiia Zhurn im NI Pirogova. 2007(12):70-73. (in Russ.)
  43. Longmire WP Jr, Ravitch MM. A new method for consrructing an artificial oesophagus. Ann Surg. 1946 May;123(5):819-34.
  44. Pettersson G. Experiences in esophageal reconstruction. Arch Dis Child. 1962 Apr;37(192):184-89. doi: 10.1136/adc.37.192.184
  45. Veksner BG. Predgrudinnyi pishchevod. Dnepropetrovsk: Novaia Khirurgiia; 1931. 248. (in Russ.)
  46. Shumacker HB, Battersby JS. The problem of esophageal replacement by jejunum with particular reference to influence upon circulation of staging the division of mesenteric vessels: experimental study and case report. Ann Surg. 1951 Apr;133(4):463-71.
  47. Shalimov AA. Sozdanie iskusstvennogo pishchevoda pri rubtsovoi neprokhodimosti. Khirurgiia Zhurn im NI Pirogova. 1951;(9):24-28. (in Russ.)
  48. Stel’mashonok IM. Taktika khirurga pri kombinirovannykh rubtsovykh suzheniiakh pishchevoda i zheludka. Vestn Khirurgii im II Grekova. 1969;(3):48-51. (in Russ.)
  49. Hadidi A. A technique to improve vascularity in colon replacement of the esophagus. Eur J Pediatr Surg. 2006 Feb;16(1):39-44. doi: 10.1055/s-2006-923925
  50. Vorobey AV, Vizhinis EI, Popel GA, Chepik DA, Maskalik ZG, Makhmudov AM. Cicatrical post-burn stricture of the esophagus: a repeated esophagocoloplasty. Novosti Khirurgii. 2016;24(3):290-97. doi: 10.18484/2305-0047.2016.3.290 (in Russ.)
  51. Vorobeii AV, Chepik DA, Vizhinis VI. One-stage retrosternal colonic esophagoplasty in treatment of patients with scar burn stricture of esophagus. Khirurgiia Zhurn im NI Pirogova. 2014;(7):26-33. (in Russ.)
  52. Carrel A. The surgery of blood vessels etc. John Hopkins Hosp Bull. 1907;190:18-28.
  53. Kramarenko EIu. Vystuplenie v preniiakh po dokladam o probleme iskusstvennogo pishchevoda. Materialy XVIII s”ezda ros khirurgov, Moscow, 27-30 maia 1926 g. Moscow, 1927. p. 182. (in Russ.)
  54. Longmire WP Jr. A modification of the Roux technique for antethoracic esophageal reconsruction. Surgery. 1947 Jul;22(1):94-100.
  55. Longmire WP Jr. Congenital atresia and tracheoesophageal fistula four consecutive cases of successful primary esophageal anastomosis. Arch Surg. 1947 Sep;55(3):330-38. doi: 10.1001/archsurg.1947.01230080336008
  56. Gudov VF. Metodika nalozheniia sosudistogo shva mekhanicheskim sposobom. Khirurgiia Zhurn im NI Pirogova. 1950;(12):58. (in Russ.)
  57. Androsov PI. Sosudistoe soust’e kak metod dobavochnogo krovosnabzheniia kishki pri sozdanii iskusstvennogo pishchevoda. Khirurgiia Zhurn im NI Pirogova. 1952;(2):15-22. (in Russ.)
  58. Androsov PJ. Blood supply of mobilized intestine used for artificial esophagus. AMA Arch Surg. 1956 Dec;73(6):917-26. doi: 10.1001/archsurg.1956.01280060017004
  59. Seidenberg B, Rosenak SS, Hurwitt ES, Som ML. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg. 1959 Feb;149(2):162-71. doi: 10.1097/00000658-195902000-00002
  60. Popov VI, Filin VI. Vosstanovitel’naia khirurgiia pishchevoda. 2 izd. Leningrad: Meditsina; 1973. 304 p. (in Russ.)
  61. Grishin IN, Savchenko AN, Khomchenko MN. Total’naia transplevral’naia plastika pishchevoda s dobavochnoi arterializatsiei transplantanta vetviami grudnoi aorty. Khirurgiia Zhurn im NI Pirogova. 1978;(2):124-26. (in Russ.)
  62. Schwabegger AH, Ninković MM, Moriggl B, Waldenberger P, Brenner E, Wechselberger G, Anderl H. Internal mammary veins: classification and surgical use in free-tissue transfer. J Reconstr Microsurg. 1997 Jan;13(1):17-23. doi: 10.1055/s-2008-1063936
  63. Ascioti AJ, Hofstetter WL, Miller MJ, Rice DC, Swisher SG, Vaporciyan AA, Roth JA, Putnam JB, Smythe WR, Feig BW, Mansfield PF, Pisters PW, Torres MT, Walsh GL. Long-segment, supercharged, pedicled jejunal flap for total esophageal reconstruction. J Thorac Cardiovasc Surg. 2005 Nov;130(5):1391-98. doi: 10.1016/j.jtcvs.2005.06.032
  64. Heitmiller RF, Gruber PJ, Swier P, Singh N. Long-segment substernal jejunal esophageal replacement with internal mammary vascular augmentation. Dis Esophagus. 2000;13(3):240-42. doi: 10.1046/j.1442-2050.2000.00118.x
  65. Maier A, Pinter H, Tomaselli F, Sankin O, Gabor S, Ratzenhofer-Komenda B, Smolle-Jüttner FM. Retrosternal pedicled jejunum interposition: an alternative for reconstruction after total esophago-gastrectomy. Eur J Cardiothorac Surg. 2002 Nov;22(5):661-65. doi: 10.1016/s1010-7940(02)00522-5
  66. Swisher SG, Hofstetter WL, Miller MJ. The supercharged microvascular jejunal interposition. Semin Thorac Cardiovasc Surg. 2007 Spring;19(1):56-65. doi: 10.1053/j.semtcvs.2006.11.003
  67. Chana JS, Chen HC, Sharma R, Gedebou TM, Feng M. Microvascular reconstruction of the esophagus using supercharged pedicled jejunum flaps: special indication and pitfalls. Plast Reconst Surg. 2002 Oct;110:742-48. discussion 749-50. doi: 10.1097/00006534-200209010-00003
  68. Fujita H, Yamana H, Sueyoshi S, Shima I, Fujii T, Shirouzu K, Inoue Y, Kiyokawa K, Tanabe HY, Tai Y, Inutsuka H. Impact on outcome of additional microvascular anastomosis-supercharge-on colon interposition for esophageal replacement: comparative and multivariate analysis. World J Surg. 1997 Nov-Dec;21(9):998-1003. doi: 10.1007/s002689900339
  69. Golshani S, Lee C, Cass D, Thomas A, Mandpe AH. Microvascular “supercharged” cervical colon: minimizing ischemia in esophageal reconstruction. Ann Plast Surg. 1999 Nov;43(5):533-38. doi: 10.1097/00000637-199911000-00012
  70. O'Rourke J C, Threlfall G N. Colonic interposition for esophageal reconstruction with special reference to microvascular reinforcement of graft circulation. Aust N Z J Surg. 1986 Oct;56(10):767-71. doi: 10.1111/j.1445-2197.1986.tb02323.x
  71. Shirakawa Y, Naomoto Y, Noma K, Sakurama K, Nishikawa T, Nobuhisa T, Kobayashi M, Okawa T, Asami S, Yamatsuji T, Haisa M, Matsuoka J, Hanazaki M, Morita K, Hiraki T, Tanaka N. Colonic interposition and supercharge for esophageal reconstruction. Langenbecks Arch Surg. 2006 Feb;391(1):19-23. doi: 10.1007/s00423-005-0010-8
  72. Averin VI, Podgaysky VN, Nesteruk LN, Grinevich YuM, Rylyuk AF. First experience of graft revascularization at esophagoplasty in children in non-standard cases. Novosti Khirurgii. 2012;20(1):80-84. (in Russ.)
Address for correspondence:
223040, The Republic of Belarus,
Minsk region, Lesnoy-1,
Minsk Regional Clinical Hospital,
Department of Surgery,
Tel. office.: +375 17 265-22-13,
Aliaksandr V. Varabei
Information about the authors:
Varabei Aliaksandr V., Corresponding Member of NAS of Belarus, MD, Professor, Head of the Deparment of Surgery, Head of the Republican Center for Reconstructive Surgical Gastroenterology and Coloproctology, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
Chepik Dmitriy A., Head of the Surgical Unit ¹1, Minsk Regional Clinical Hospital, Mihsk region, Borovlyany, Republic of Belarus.
Vizhinis Egi I., PhD, Associate Professor, the Department of Surgery, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
Makhmudov Anvar M., Associate Professor, the Department of Surgery, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.




Kursk State Medical University 1, Kursk
Saint-Petersburg State University of Industrial Technologies and Design 2, Saint-Petersburg,
The Russian Federation

Objective. To study the changes of anterior abdominal wall tissues in experimental animals with implantation of new light strengthened endoprosthesis for hernioplasty.
Methods. Experimental studies were conducted on 60 rabbits of “Chinchilla” breed. All animals were divided into 2 series of experiments. In the first (control) group animals were implanted with a light polypropylene endoprosthesis, in the second (experimental) group animals were implanted a new net endoprosthesis from monofilament polypropylene, which consisted of the basic and strengthened zones in the form of horizontally located stripes, alternating with each other mono-thread with a larger diameter. In the experiment the tissue response of abdominal wall with implantation of endoprosthesis in the position “onlay” was studied on the 7th, 30th, 60th, 90th and 180th days.
Results. It was found out, that the light strengthened endoprosthesis was identical to the light endoprosthesis by the severity and amount of inflammatory response in late periods (90 and 180 days), as well as by cellular structure and cellular index, reflecting the character of wound process during the whole experiment (from the 7th till 180th day). Histological study showed that the use of the both materials does not lead to deterioration of morpho-functional condition of the muscle layer of the abdominal wall. Using morphometrical study from the 7th till the 30th days we detected that cellular infiltration area decreased by 3.9 times in a control group and by 4.1 times in an experimental group. From the 30th till the 180th days the size of the capsule area increased by 1.6 times in a control and by 1.2 times in experimental series. At late periods (on the 90th and 180th days) statistically significant differences of all these indicators between the series of experiment were not detected.
Conclusions. Introduction of the strengthened zone to the structure of the light endoprosthesis, including monofilaments of the larger diameter, does not lead to deterioration of abdominal tissue response to the implanted material, that presents prospective for its use in hernioplasty.

Keywords: light endoprosthesis, light strengthened endoprosthesis, hernioplasty, cellular infiltration area, area of connective tissue capsule, cellular index, polypropylene endoprosthesis
p. 402-411 of the original issue
  1. Shestakov AL, Inakov AG, Ckhovrebov AT. Estimation of the effectiveness of hernioplasty in patients with hernias of the anterior abdominal wall using the sf-36. Vestn nats med-khirurg tsentra im NI pirogova. 2017;(3):50-53. (in Russ.)
  2. Anurov MV, Titkova SM, Ettinger AP. Sravnenie rezul’tatov plastiki gryzhevogo defekta standartnymi i legkimi setchatymi endoprotezami s odinakovym trikotazhnym perepleteniem. Biul Eksperim Biologii i Meditsiny. 2010;150(10):433-39. (in Russ.)
  3. Timerbulatov MV, Timerbulatov ShV, Gataullina EZ, Valitova ER. Postoperative ventral hernias: current state of the problem. Med Vestn Bashkortostana. 2013;8(5):101-107. (in Russ.)
  4. Junge K, Binnebösel M, von Trotha KT, Rosch R, Klinge U, Neumann UP, Lynen Jansen P. Mesh biocompatibility: effects of cellular inflammation and tissue remodelling. Langenbecks Arch Surg. 2012 Feb;397(2):255-70. doi: 10.1007/s00423-011-0780-0
  5. Klinge U, Klosterhalfen B. Modified classification of surgical meshes for hernia repair based on the analyses of 1,000 explanted meshes. Hernia. 2012 Jun; 16(3):251-58. doi: 10.1007/s10029-012-0913-6
  6. Bringman S, Wollert S, Osterberg J, Smedberg S, Granlund H, Heikkinen TJ. Three-year results of a randomized clinical trial of lightweight or standard polypropylene mesh in Lichtenstein repair of primary inguinal hernia. Br J Surg. 2006 Sep;93(9):1056-59. doi: 10.1002/bjs.5403
  7. Smietanski M, Bury K, Smietanska IA, Owczuk R, Paradowski T. Five-year results of a randomised controlled multi-centre study comparing heavy-weight knitted versus low-weight, non-woven polypropylene implants in Lichtenstein hernioplasty. Hernia. 2011 Oct;15(5):495-501. doi: 10.1007/s10029-011-0808-y
  8. Cobb WS, Burns JM, Peindl RD, Carbonell AM, Matthews BD, Kercher KW, Heniford BT. Textile analysis of heavy weight, mid-weight, and light weight polypropylene mesh in a porcine ventral hernia model. J Surg Res. 2006 Nov;136(1):1-7. doi: 10.1016/j.jss.2006.05.022
  9. Lintin LAD, Kingsnorth AN. Mechanical failure of a lightweight polypropylene mesh. Hernia. 2014 Feb;18(1):131-33. doi: 10.1007/s10029-012-0959-5
  10. Petro CC, Nahabet EH, Criss CN, Orenstein SB, von Recum HA, Novitsky YW, Rosen MJ. Central failures of lightweight monofilament polyester mesh causing hernia recurrence: a cautionary note. Hernia. 2015 Feb;19(1):155-59. doi: 10.1007/s10029-014-1237-5
  11. Zuvela M, Galun D, Djurić-Stefanović A, Palibrk I, Petrović M, Milićević M. Central rupture and bulging of low-weight polypropylene mesh following recurrent incisional sublay hernioplasty. Hernia. 2014 Feb;18(1):135-40. doi: 10.1007/s10029-013-1197-1
  12. Anurov MV, Titkova SM, Oettinger AP. Biomechanical compatibility of surgical mesh and fascia being reinforced: dependence of experimental hernia defect repair results on anisotropic surgical mesh positioning. Hernia. 2012 Apr;16(2):199-10. doi: 10.1007/s10029-011-0877-y (in Russ.)
  13. Sukovatykh BS, Ivanov AV, Valuskaya NM, Gerasimchuk EV. The influence of late implantation fabric reaction on the choice of polypropylene endoprosthesis for preventive subaponeurotic plasty of the abdominal wall. Novosti Khirurgii. 2013;21(5):11-17. doi: 10.18484/2305-0047.2013.5.11 (in Russ.)
  14. Shestakov AL, Fedorov DN, Ivanchik IJ, Boeva IA, Bitarov TT. Comparative evaluation of standard, composite and “lightweight” synthetic prostheses for hernioplasty (experimental work). Kursk Nauch-Prakt Vestn “Chelovek i Ego Zdorov’e”. 2017;(2):81-87. doi: 10.21626/vestnik/2017-2/14 (in Russ.)
  15. Netiaga, AA, Parfenov AO, Nutfullina GM, Zhukovskii VA. Vliianie razlichnykh vidov endoprotezov dlia gernioplastiki na sostoianie myshts razlichnykh otdelov briushnoi stenki (eksperimental’noe issledovanie). Kursk Nauch-Prakt Vestn “Chelovek i Ego Zdorov’e”. 2013;(4):26-32. (in Russ.)
Address for correspondence:
305041, The Russian Federation,
Kursk, K.Marx Str., 3,
Kursk State Medical University,
Department of General Surgery,
Tel. (4712) 52-98-62,
Boris S. Sukovatykh
Information about the authors:
Sukovatykh Boris S., MD, Professor, Head of the Department of General Surgery, Kursk State Medical University, Kursk, Russian Federation.
Polevoy Yuri Yu., Applicant for Candidate’s degree of the Department of General Surgery, Kursk State Medical University, Kursk, Russian Federation.
Netyaga Andrej A., PhD, Associate Professor of the Department of Operative Surgery and Topographic Anatomy, Kursk State Medical University, Kursk, Russian Federation.
Blinkov Yurij Yu., MD, Professor of the Department of General Surgery, Kursk State Medical University, Kursk, Russian Federation.
Zhukovskiy Valeriy A., DS, Professor of the Department of Nanostructured, Fibrous and Composite Materials named after A.I. Meos, Supervisor of the Laboratory of Polymer Materials, Saint-Petersburg State University of Industrial Technologies and Design, Saint-Petersburg, Russian Federation.



Pyatigorsk Medical and Pharmaceutical Institute 1, Pyatigorsk
Volgograd State Medical University 2, Volgograd
Central Military Clinical Hospital named after P.V. Mandryk 3, Moscow,
The Russian Federation

Objective. To substantiate stimulation of adhesiogenesis in the treatment of chronic pleural empyema.
Methods. The results of stimulation of adhesiogenesis in the pleural cavity for the treatment of residual cavities against the background of chronic pleural empyema in 270 nonlinear white male rats divided into 3 groups of 90 animals in each were analyzed. Chronic pleural empyema followed by formation of a residual cavity was modeled by weekly intrapleural injection of 1 billion E. coli suspension during two months. In the control group, no treatment was performed. In the comparison group, doxycycline was administered intracavitary at a rate of 40 mg/kg of body weight, in the experimental group – intracavitary injection of platelet-rich plasma (PRP) was performed The effectiveness of treatment was assessed by changes in biochemical markers of endogenous intoxication, general microbial contamination of pleural exudate. When revising the residual cavity, its volume, intensity of adhesion, histopathography of pleural adhesions with subsequent histological examination were determined.
Results. It was established that stimulation of adhesion using PRP against the background of chronic pleural empyema significantly reduces the severity of endogenous intoxication (by 1.2 times). The number of microorganisms colonizing the pleural cavity in the rats of the experimental group was also significantly less than in the control group, but higher than in the rats of the comparison group. In the study of pleural adhesions in the rats of the experimental group on the 20th day, together with adhesions between the visceral and parietal pleura, multiple interlobar adhesions of different degree of maturity were determined. The technique of PRP injection proved to be more effective method of stimulating adhesion formation in the pleural cavity, so by the end of the experiment obliteration of residual cavities had been recorded in 41.1% of cases, the mature connective tissue was histologically determined.
Conclusions. The method of stimulating adhesiogenesis in the treatment of residual pleural cavities in case of chronic pleural empyema with the use of PRP is pathogenetically substantiated and effective.

Keywords: stimulation of adhesion, chronic pleural empyema, residual pleural cavity, PRP-therapy, pleural cavity adhesions, platelet-rich plasma, thoracic surgery
p. 412-420 of the original issue
  1. Sakakura N, Mizuno T, Kuroda H, Sakao Y, Uchida T. Surgical treatment of empyema after pulmonary resection using pedicle skeletal muscle plombage, thoracoplasty, and continuous cavity ablution procedures: a report on three cases. J Thorac Dis. 2016 Jun;8(6):1333-39. doi: 10.21037/jtd.2016.04.04
  2. Botianu PV, Botianu AM, Bacarea VC. Muscle flaps and thoracomyoplasty as a re-redo procedure for postoperative empyema. Thorac Cardiovasc Surg. 2016 Apr;64(3):252-57. doi: 10.1055/s-0034-1387820
  3. Zurek W, Makarewicz W, Bobowicz M, Sawicka W, Rzyman W. The treatment of chronic pleural empyema with laparoscopic omentoplasty. Initial report. Wideochir Inne Tech Maloinwazyjne. 2014 Dec;9(4):548-53. doi: 10.5114/wiitm.2014.45129
  4. Zhestkov KG, Barskii BG, Atiukov MA, Pichurov AA. Natsional’nye klinicheskie rekomendatsii po lecheniiu spontannogo pnevmotoraksa [Elektronnyi resurs]. Moskva, RF; 2014. 23 p. Available from: (in Russ.)
  5. MacDuff À, Arnold À, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax. 2010 Aug;65;2:ii18-31. doi: 10.1136/thx.2010.136986
  6. Song KS, Keum D, Kim JB. Chemical pleurodesis using doxycycline and viscum album extract. Korean J Thorac Cardiovasc Surg. 2017 Aug;50(4):281-86. doi: 10.5090/kjtcs.2017.50.4.281
  7. Thomas R, Piccolo F, Miller D, MacEachern PR, Chee AC, Huseini T, Yarmus L, Bhatnagar R, Lee HJ, Feller-Kopman D, Maskell NA, Tremblay A, Lee YCG. Intrapleural fibrinolysis for the treatment of indwelling pleural catheter-related symptomatic loculations: a multicenter observational study. Chest. 2015 Sep;148(3):746-51. doi: 10.1378/chest.14-2401
  8. Boshuizen RC, Vd Noort V, Burgers JA, Herder GJM, Hashemi SMS, Hiltermann TJN, Kunst PW, Stigt JA, van den Heuvel MM. A randomized controlled trial comparing indwelling pleural catheters with talc pleurodesis (NVALT-14). Lung Cancer. 2017 Jun;108:9-14. doi: 10.1016/j.lungcan.2017.01.019
  9. Akhmerov RR, Zarudii RF, Aminova ZM, Emelin AL, Ovechkina MV. Primenenie trombotsitarnoi autoplazmy pri lechenii gonartrozov i koksartrozov. Prakt Meditsina. 2013; (1-2-2):17-20. (in Russ.)
  10. Fernández-Barbero JE, Galindo-Moreno P, Avila-Ortiz G, Caba O, Sánchez-Fernández E, Wang HL. Flow cytometric and morphological characterization of platelet-rich plasma gel. Clin Oral Implants Res. 2006 Dec;17(6):687-93. doi: 10.1111/j.1600-0501.2006.01179.x
  11. Jhang JF, Wu SY, Lin TY, Kuo HC. Repeated intravesical injections of platelet-rich plasma are effective in the treatment of interstitial cystitis: a case control pilot study. Low Urin Tract Symptoms. 2017 Dec 19. doi: 10.1111/luts.12212
  12. Cieslik-Bielecka A, Skowroński R, Jędrusik-Pawłowska M, Pierchała M. The application of L-PRP in AIDS patients with crural chronic ulcers: a pilot study. Adv Med Sci. 2017 Nov 6;63(1):140-46. doi: 10.1016/j.advms.2017.10.002
  13. Vorob’ev AA, Beburishvili A.G. Khirurgicheskaia anatomiia operirovannogo zhivota i laparoskospicheskaia khirurgiia spaek: monogr. Volgograd, RF: Izdatel’; 2001. 230 p. (in Russ.)
  14. Korymasov EA, Iablonskii PK, Sokolovich EG, Lishenko VV, Motus IIa, Skriabin SA. Natsional’nye klinicheskie rekomendatsii «Empiema plevry» [Elektronnyi resurs]. 2015. 33 s. Available from: (in Russ.)
  15. Achkasov EE, Bezuglov EN, Ul’yanov AA, Kurshev VV, Repetyuk AD, Egorova ON. Application platelet-rich plasma in clinical practice. Biomeditsina. 2013. (4):46-59. (in Russ.)
Address for correspondence:
357532, The Russian Federation,
Pyatigorsk, Kalinin Ave., 11,
Pyatigorsk Medical and Pharmaceutical Institute,
Department of Morphology,
Tel.: +7 928-335-94-30,
Svetlana A. Kalashnikova
Information about the authors:
Kalashnikov Anton V., PhD, Associate Professor, Acting Head of the Department of Surgical Disciplines, Pyatigorsk Medical and Pharmaceutical Institute, Branch of Volgograd State Medical University, Pyatigorsk, Russian Federation.
Salimov Dmitriy Sh., PhD, Surgeon, II Surgical Department of the General Surgery Center, Central Military Clinical Hospital named after PV. Mandryk, Moscow, Russian Federation.
Vorobyev Alexander A., MD, Professor, Head of the Department of Operative Surgery and Topographic Anatomy, Volgograd State Medical University, Volgograd, Russian Federation.
Kalashnikova Svetlana A., MD, Associate Professor, Head of the Department of Morphology, Pyatigorsk Medical and Pharmaceutical Institute, Branch of Volgograd State Medical University, Pyatigorsk, Russian Federation.
Aidaeva Salihat Sh., Postgraduate Student of the Department of Morphology, Pyatigorsk Medical and Pharmaceutical Institute, Branch of Volgograd State Medical University, Pyatigorsk, Russian Federation.



Russian Ilizarov Scientific Center «Restorative Traumatology and Orthopaedics», Kurgan,
The Russian Federation

Objective. To reveal the anatomic-histological characteristics of the anterior tibial muscle in automatic combined distraction osteosynthesis with a rate of three millimeters (mm) per day.
Methods. The anatomical and histological characteristics of the anterior tibial muscle were studied in the elongation of the tibia of the dogs (n = 8) using the technique of transosseous distraction osteosynthesis according to Ilizarov combined with tibial intramedullary reinforcement with hydroxyapatite-coated titanium rod. Distraction rate: three mm per day for 120 sessions automatically. Consolidation of the distraction regenerated bone occurred after 13.83±4.02 days. The device fixation was discontinued in this period. At the end of the distraction period and 90 days after cessation of fixation with the apparatus, a macroscopic and histological examination of the anterior tibial muscle of the elongated segment and contralateral muscle of the same type was performed. Additionally, the general condition of the animals and the function of the limb were evaluated.
Results. During the experiments, complications of an infectious and neurological nature, the death of animals was not revealed. The supporting function of the limb was preserved. There was no formation of equinus setting of the foot. Under the new conditions of distraction, there were no irreversible destructive changes in the anterior tibial muscle. Histologically, the polygonality of the muscle fiber profiles and transverse striation persisted. There was no pathological increase in the width of connective tissue layers. The signs of activization of angio- and neomyohistogenesis were revealed as evidenced by the presence of myosatellite cells, the appearance of a large number of microvessels, newly formed muscle fibers. Macroscopically, the volume and length of the muscle belly were increased at all the stages of the experiment, and the color corresponded to the not lengthened muscle.
Conclusions. With automatic lengthening of limb bones at an increased rate and with high fractionality in combination with intramedullary bioactive reinforcement, favorable conditions are created not only for osteogenesis, but also for the growth and adaptation of soft tissues.

Keywords: experiment on animals, lengthening, osteogenesis, bioactive implant, skeletal muscle, histology
p. 421-430 of the original issue
  1. Yun AG, Severino R, Reinker K. Attempted limb lengthenings beyond twenty percent of the initial bone length: results and complications. J Pediatr Orthop. 2000 Mar-Apr;20(2):151-59. doi: 10.1097/01241398-200003000-00004
  2. Aranovich AM, Dindiberia EV, Klimov OV, Novikov KI. Oshibki i oslozhneniia pri udlinenii goleni u bol’nykh akhondroplaziei. Travmatologiia i Ortopediia Rossii. 2005;(1):36-37. (in Russ.)
  3. Song HR, Myrboh V, Oh CW, Lee ST, Lee SH. Tibial lengthening and concomitant foot deformity correction in 14 patients with permanent deformity after poliomyelitis. Acta Orthop. 2005 Apr;76(2):261-69. doi: 10.1080/00016470510030670
  4. Yang L, Cai G, Coulton L, Saleh M. Knee joint reaction force during tibial diaphyseal lengthening: a study on a rabbit model. J Biomech. 2004 Jul;37(7):1053-59. doi: 10.1016/j.jbiomech.2003.11.020
  5. Zak L, Wozasek GE. Impaired joint motion and contractures in callus distraction and segment transport: a retrospective data analysis. Wien Klin Wochenschr. 2013 Nov;125(21-22):709-13. doi: 10.1007/s00508-013-0432-1
  6. Shchudlo NA, Shchudlo MM, Borisova IV, Filimonova GN. Histological changes in the anterior tibial muscle for canine leg lengthening with he increased daily rate of different-division distraction. Genii Ortopedii. 2013;(3):71-76. (in Russ.)
  7. Kononovich NA, Popkov AV, Stepanov MA. X-ray dynamics of osteogeny in case of combined distraction osteosynthesis of dog lower thigh in automatic mode with the rate of 3 mm a day (experimental research). Vestn Ul’ian Gos Sel’skokhoziaistv Akad. 2016;(4):116-22. (in Russ.)
  8. Abu Nemer Dzhamal’ AM. Sposob osteotomii kostei goleni pri vnutrikostnom distraktsionnom osteosinteze. Tavr Med-Biol Vestn. 2010;13(3):63-68. (in Russ.)
  9. Rader EP, Layner K, Triscuit AM, Chetlin RD, Ensey J, Baker BA. Age-dependent muscle adaptation after chronic stretch-shortening contractions in rats. Aging Dis. 2016 Jan 2;7(1):1-13. doi: 10.14336/AD.2015.0920. eCollection 2016 Jan.
  10. Rader EP, Naimo MA, Ensey J, Baker BA. Agonist muscle adaptation accompanied by antagonist muscle atrophy in the hindlimb of mice following stretch-shortening contraction training. BMC Musculoskelet Disord. 2017 Feb 2;18(1):60. doi: 10.1186/s12891-017-1397-4
  11. Gorbach YeN, Stepanov MA. Peculiarities of bone tissue morphogenesis during shin lengthening using the method of transosseous distraction osteosynthesis with the increased daily rate. Morfologiia. 2015;147(2):69-74. (in Russ.)
  12. Shreiner AA, Erofeev SA, Shchudlo MM, Chirkova AM, Karymov NR. Teoreticheskie aspekty distraktsionnogo osteosinteza. Znachenie rezhima distraktsii. Genii Ortopedii. 1999;(2):13-17. (in Russ.)
  13. Anderson JE. A role for nitric oxide in muscle repair: nitric oxide-mediated activation of muscle satellite cells. Mol Biol Cell. 2000 May;11(5):1859-74.
  14. Christov C, Chrétien F, Abou-Khalil R, Bassez G, Vallet G, Authier FJ, Bassaglia Y, Shinin V, Tajbakhsh S, Chazaud B, Gherardi RK. Muscle satellite cells and endothelial cells: close neighbors and privileged partners. Mol Biol Cell. 2007 Apr;18(4):1397-409. doi: 10.1091/mbc.E06-08-0693
  15. Stogov MV, Luniova SN, Yemanov AA. The characteristic features of tissue metabolism for limb lengthening by the llizarov method with the distraction rate of 3 mm per day in the automatic mode. Genii Ortopedii. 2008;(1):85-89. (in Russ.)
Address for correspondence:
640014, The Russian Federation,
Kurgan, M. Ulyanova Str., 6,
Russian Ilizarov Scientific Center
“Restorative Traumatology and Orthopaedics”, Experimental Laboratory,
Tel. office: +7(3522) 41-52-73,
Natalia A. Kononovich
Information about the authors:
Popkov Arnold V., MD, Professor, Chief Researcher of the Laboratory of Correction of Deformities and Lengthening of Limbs, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan, Russian Federation.
Filimonova Galina N., PhD, Chief Researcher of the Morphology Laboratory, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan, Russian Federation.
Kononovich Natalia A., PhD, Leading Researcher of the Experimental Laboratory, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan, Russian Federation.
Popkov Dmitry A., MD, Head of the Clinic of Neuroorthopaedics, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan, Russian Federation.




Almazov National Medical Research Centre, Saint-Petersburg,
The Russian Federation

Objective. To analyze the concentration of the heart-type fatty acid-binding protein (H-FABP) in patients with cardiovascular disease (CVD) before percutaneous coronary intervention (PCI) and within a year after coronary stenting.
Methods. This article presents the data collected through annual (one-year) observation of 71 patients after they had undergone PCI (58 patients, who didn’t have any complications and 13 with restenosis or clinical significant stenosis of a new localization). All participants of the study had their H-FABP investigated before the operation as well as 3, 6 and 12 months after PCI.
Results. The H-FABP concentration values in the group of patients with CVD were significantly higher than in the control group (p <0.05). Three months after myocardial revascularization H-FABP concentration decreased significantly (p <0.05) in comparison with its initial value. Over one-year follow-up period H-FABP concentration showed the tendency to increase and by the end of the observation exceeded the baseline. In the group of patients with favorable course of postoperative period before the operation this marker level was significantly higher (p<0,05) than in patients with stenting complications. The correlation between the concentration of H-FABP and the accumulation of risk factors (R2=0,8, p<0,05) for cardiovascular diseases has been established. Presurgery period revealed a positive correlation between the concentration of H-FABP and the serum creatinine level (r = 0.36, p <0.05), as well as a negative correlation between H-FABP value and high-density lipoproteins (HDL) (r =-0.31, p<0.05), but none of these correlations were detected during other discreet observation moments.
Conclusions. There is a detected increase in H-FABP value in patients with chronic coronary heart disease, compared to healthy donors. The cumulation of cardiovascular risk factors leads to an increase in this marker level. There is no detected correlation between H-FABP concentration and clinical outcomes for patients after PCA throughout a year period.

Keywords: heart-type fatty acid-binding protein, percutaneous coronary intervention, coronary stenting, coronary artery disease, cardiac markers, cardiovascular disease
p. 431-439 of the original issue
  1. Dianov MA, Nikitina SIu, Ageeva LI, Aleksandrova GA, Zaichenko NM, Kirillova GN, Leonov SA, Mukhina TV, Ogryzko EV, Khar’kova TL, Chumarina VZh, Shubochkina EM. Zdravookhranenie v Rossii. 2015: stat sb. Moscow, RF: Rosstat; 2015. 174 p. (in Russ.)
  2. Karpov IuA. Khronicheskaia ishemicheskaia bolezn’ serdtsa: novosti lecheniia. Consilium Medicum. 2016;18(1):38-44. (in Russ.)
  3. Task Force Members, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Taggart DP, van der Wall EE, Vrints CJ; ESC Committee for Practice Guidelines, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S; Document Reviewers, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013 Oct;34(38):2949-3003. doi: 10.1093/eurheartj/eht296
  4. Undurti ND. Heart-type fatty acid-binding protein (H-FABP) and coronary heart disease. Indian Heart J. 2016 Jan-Feb;68(1):16-18. Published online 2016 Jan 12. doi: 10.1016/j.ihj.2015.07.030
  5. Tanaka T, Hirota Y, Sohmiya K, Nishimura S, Kawamura K. Serum and urinary human heart fatty acid-binding protein in acute myocardial infarction. Clin Biochem. 1991 Apr;24(2):195-201. doi: 10.1016/0009-9120(91)90571-U
  6. Morrow DA, Cannon CP, Jesse RL, Newby LK, Ravkilde J, Storrow AB, Wu AH, Christenson RH. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical characteristics and utilization of biochemical markers in acute coronary syndromes. Circulation. 2007 Apr 3;115(13):e356-75. doi: 10.1161/CIRCULATIONAHA.107.182882
  7. Sato Y, Kita T, Takatsu Y, Kimura T. Biochemical markers of myocyte injury in heart failure. Heart. 2004 Oct;90(10):1110-13. doi: 10.1136/hrt.2003.023895
  8. Niizeki T, Takeishi Y, Arimoto T, Takabatake N, Nozaki N, Hirono O, Watanabe T, Nitobe J, Harada M, Suzuki S, Koyama Y, Kitahara T, Sasaki T, Kubota I. Heart-type fatty acid-binding protein is more sensitive than troponin T to detect the ongoing myocardial damage in chronic heart failure patients. J Card Fail. 2007 Mar;13(2):120-27. doi: 10.1016/j.cardfail.2006.10.014
  9. Storch J, Thumser AE. Tissue-specific functions in the fatty acid-binding protein family. J Biol Chem. 2010 Oct 22;285(43):32679-83. doi: 10.1074/jbc.R110.135210
  10. Olivetti G, Abbi R, Quaini F, Kajstura J, Cheng W, Nitahara JA, Quaini E, Di Loreto C, Beltrami CA, Krajewski S, Reed JC, Anversa P. Apoptosis in the failing human heart. N Engl J Med. 1997 Apr 17;336(16):1131-41. doi: 10.1056/NEJM199704173361603
  11. Flavell SJ, Hou TZ, Lax S, Filer AD, Salmon M, Buckley CD. Fibroblasts as novel therapeutic targets in chronic inflammation. Br J Pharmacol. 2008 Mar;153 (Suppl ):S241-46. doi: 10.1038/sj.bjp.0707487
  12. Shurygina IA, Shurygin MG, Ayushinova NI, Kanya OV. Fibroblasts and their role in the development of connective tissue. Sib Med Zhurn (Irkutsk). 2012;110(3):8-12. (in Russ.)
  13. Kim SJ, Depre C, Vatner SF. Novel mechanisms mediating stunned myocardium. Heart Fail Rev. 2003 Apr;8(2):143-53.
  14. Muehlschlegel JD, Perry TE, Liu KY, Fox AA, Collard CD, Shernan SK, Body SC. Heart-type fatty acid binding protein is an independent predictor of death and ventricular dysfunction after coronary artery bypass graft surgery. Anesth Analg. 2010 Nov;111(5):1101-9. doi: 10.1213/ANE.0b013e3181dd9516
  15. Otaki Y, Watanabe T, Takahashi H, Hirayama A, Narumi T, Kadowaki S1, Honda Y, Arimoto T, Shishido T, Miyamoto T, Konta T, Shibata Y, Fukao A, Daimon M, Ueno Y, Kato T, Kayama T, Kubota I. Association of heart-type fatty acid-binding protein with cardiovascular risk factors and all-cause mortality in the general population: the Takahata study. PLoS One. 2014 May 21;9(5):e94834. doi: 10.1371/journal.pone.0094834. eCollection 2014.
Address for correspondence:
197341, The Russian Federation,
Saint Petersburg, Akkuratova Str., 2,
Almazov National Medical Research Centre,
Central Clinical and Diagnostic Laboratory,
Elena Yu. Vasilyeva
Information about the authors:
Vasilyeva Elena Yu., Post-Graduate Student of the Department of Laboratory Medicine and Genetic, Head of the Clinical and Diagnostic Laboratory, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation.
Kazakova Evgeniya E., Physician of the Clinical Laboratory Diagnostics, Central Clinical and Diagnostic Laboratory, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation.
Vavilova Tatiana V., MD, Professor, Head of the Department of Laboratory Medicine and Genetic, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation.



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

Objective. To study the efficacy and to establish expedience of antibiotic treatment for diverticulitis.
Methods. The retrospective analysis of 141 medical histories was made of patients with acute uncomplicated diverticulitis, who were treated during the period from 2013 to 2016 years. Antibiotics were prescribed to treat 85 (60.3%) patients (the main group), 56 (39.7%) patients (the control group) were not given antibacterial drugs. To assess the treatment effectiveness, a dynamic assessment of the clinical picture and laboratory indicators was performed. In the long-term period, patients were questioned to determine the nature of the course and the occurrence of relapses of diverticulitis.
Results. The duration of hospitalization of the main group patients was 10.8±3.2 days (M±σ), control - 11.2±2.6 days (M±σ), p>0.05. During the treatment, disease progression was registered in none of the patients. In the main group the body temperature was normalized after 1.6 ± 0.4 days, in the control group after 1.7±0.3 days, p>0.05. The level of leukocytes came back to normal in the main group at 2.7±0.8 days, in the control group at 2.9±0.7 days (p>0.05).
Long-term results were evaluated in 82 (96.5%) of patients and 55 (98.2%) in the control group. Use of antibiotic treatment in diverticulitis had no effect in the remote period for redevelopment of complications (OR 1.19; CI 0.58-2.44), the need to seek medical care (OR 1.11; CI 0.52-2.34), need for hospitalization (OR 0.95, CI 0.3-2.96) and surgical treatment (OR 1.36, CI 0.34-7.69).
Conclusions. The use of antibiotic treatment for diverticulitis does not affect the outcome of treatment and does not determine the further course of the disease. Taking into account the increasing resistance of microorganisms to antibiotics and the need to optimize costs with limited funding for health care, it is advisable to exclude the use of antibacterial drugs for the treatment of uncomplicated diverticulitis.

Keywords: acute uncomplicated diverticulitis, anti-bacterial agents, complications, diverticulitis, treatment of diverticulitis, antibiotic-free treatment
p. 440-446 of the original issue
  1. Ivashkin VT, Shelygin IuA, Achkasov SI, Vasil’ev SV, Grigor’ev EG, Dudka VV, Zhukov BN, Karpukhin OIu, Kuz’minov AM, Kulikovskii VF, Lapina TL, Lakhin AV, Maev IV, Moskalev AI, Murav’ev AV, Polovinkin VV, Poluektova EA, Stoiko IuM, Timerbulatov VM, Trukhmanov AS, Frolov SA, Chibisov GI, Shifrin OS, Sheptulin AA, Khalif IL, Efron AG, Ianovoi VV. Rekomendatsii rossiiskoi gastroenterologicheskoi assotsiatsii i assotsiatsii koloproktologov Rossii po diagnostike i lecheniiu vzroslykh bol’nykh divertikuliarnoi bolezn’iu obodochnoi kishki. Ros Zhurn Gastroenterologii Gepatologii Koloproktologii. 2017;26(1):65-80. (in Russ.)
  2. Osadchuk MA, Svistunov AA. Divertikuliarnaia bolezn’ tolstoi kishki: epidemiia 21 veka. Poliklinika. 2014(2):10-16. (in Russ.)
  3. Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD, Rafferty JF. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014 Mar;57(3):284-94. doi: 10.1097/DCR.0000000000000075
  4. Nespoli L, Lo Bianco G, Uggeri F, Romano F, Nespoli A, Bernasconi DP, Gianotti L. Effect of oral mesalamine on inflammatory response in acute uncomplicated diverticulitis. World J Gastroenterol. 2015 Jul 21;21(27):8366-72.doi: 10.3748/wjg.v21.i27.8366
  5. Kruse E, Leifeld L. Prevention and conservative therapy of diverticular disease. Chirurg. 2014 Apr;85(4):299-303. doi: 10.1007/s00104-013-2619-4 [Article in German]
  6. Scarpa CR, Buchs NC, Poncet A, Konrad-Mugnier B, Gervaz P, Morel P, Ris F. Short-term intravenous antibiotic treatment in uncomplicated diverticulitis does not increase the risk of recurrence compared to long-term treatment. Ann Coloproctol. 2015 Apr;31(2):52-56. doi: 10.3393/ac.2015.31.2.52
  7. Suarez Alecha J, Amoza Pais S, Batlle Marin X, Oronoz Martinez B, Balen Ribera E, Yarnoz Irazabal C. Safety of nonoperative management after acute diverticulitis. Ann Coloproctol. 2014 Oct;30(5):216-21. doi: 10.3393/ac.2014.30.5.216
  8. Tursi A, Brandimarte G, Elisei W, Picchio M, Forti G, Pianese G, Rodino S, D’Amico T, Sacca N, Portincasa P, Capezzuto E, Lattanzio R, Spadaccini A, Fiorella S, Polimeni F, Polimeni N, Stoppino V, Stoppino G, Giorgetti GM, Aiello F, Danese S. Randomised clinical trial: mesalazine and/or probiotics in maintaining remission of symptomatic uncomplicated diverticular disease–a double-blind, randomised, placebo-controlled study. Aliment Pharmacol Ther. 2013 Oct;38(7):741-51. doi: 10.1111/apt.12463
  9. Gaston-Johansson F. Measurement of pain: the psychometric properties of the Pain-O-Meter, a simple, inexpensive pain assessment tool that could change health care practices. J Pain Symptom Manage. 1996 Sep;12(3):172-81. doi: 10.1016/0885-3924(96)00128-5
  10. Daniels L, ünlü Ñ, de Korte N, van Dieren S, Stockmann HB, Vrouenraets BC, Consten EC, van der Hoeven JA, Eijsbouts QA, Faneyte IF, Bemelman WA, Dijkgraaf MG, Boermeester MA. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg. 2017 Jan;104(1):52-61. doi: 10.1002/bjs.10309
  11. Unlü C, de Korte N, Daniels L, Consten EC, Cuesta MA, Gerhards MF, van Geloven AA, van der Zaag ES, van der Hoeven JA, Klicks R, Cense HA, Roumen RM, Eijsbouts QA, Lange JF, Fockens P, de Borgie CA, Bemelman WA, Reitsma JB, Stockmann HB, Vrouenraets BC, Boermeester MA. A multicenter randomized clinical trial investigating the cost-effectiveness of treatment strategies with or without antibiotics for uncomplicated acute diverticulitis (DIABOLO trial). BMC Surg. 2010 Jul 20;10:23. doi: 10.1186/1471-2482-10-23
Address for correspondence:
19027, The Russian Federation,
Moscow, Yauzskaya Str., 11/6, b. 1.,
I.M. Sechenov First Moscow
State Medical University,
Department of General Surgery,
Tel.: +7-967-139-36-96,
Mikhail A. Voinov
Information about the authors:
Voinov Mikhail A., PhD, Assistant of the Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
Magnaev Badma V., Clinical Intern of the Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
Zotova Anna R., Student of the Medical Faculty, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.




N.N. Alexandrov National Cancer Center of Belarus, Minsk,
The Republic of Belarus

Objective. To access the predictors and structure of the postoperative Clavien-Dindo grade ≥3 complications in the bladder cancer patients after the radical cystectomy (RC) and to create the model to predict the likelihood of such complications.
Methods. Results of the radical cystectomy series performed in N.N. Alexandrov National Cancer Center of Belarus during the period from 1999 to 2012 (849 patients) were retrospectively analyzed. The information about postoperative Clavien-Dindo grade ≥3 complications during 30 days after the radical cystectomy was obtained from medical records. By means of uni- and multivariate logistic regression analyses, the relationship of severe postoperative complications with perioperative parameters was assessed.
Results. Postoperative complications were registered in 351 patients from 849 (41%). 116 patients had 128 Clavien-Dindo grade ≥3 complications (13.7%, 95% CI 11.4-16.0). Multivariate regression analysis revealed the statistically significant correlation of complications frequency of Clavien-Dindo grade ≥3 with the following factors: surgeon’s experience (<50 versus >200 RC: OR 3.252; 95% CI 1.297-8.157; p=0.011; 50-200 versus >200 RC: OR 2.61; 95% CI 1,456-4,89; p=0.002), patient’s age (<70 versus ≥70: OR 1.779; 95% CI 0.125-2.815; p=0.014), body mass index (BMI) (<25 versus ≥25: OR 1.779; 95% CI 1.117-2.821; ð=0.04), previous open bladder surgery (OR 3.479; 95% CI 1.055-11.409; ð=0.015), preoperative serum creatinine level (<155 mmol/l versus ≥155 mmol/l, OR 2.762, 95% CI 1.415-5.388; p=0.003).
Conclusions. Complication rate is influenced by patient’s parameters (BMI ≥25, age ≥70 and serum creatinine level ≥155 mmol/l) and surgeon experience, which should be taken into account before planning radical cystectomies.

Keywords: urinary bladder neoplasms, radical cystectomy, severe complications, complication grade classification, prognosis
p. 447-456 of the original issue
  1. Witjes JA, Compérat E, Cowan NC, De Santis M, Gakis G, Lebret T, Ribal MJ, Van der Heijden AG, Sherif A. EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol. 2014 Apr;65(4):778-92. doi: 10.1016/j.eururo.2013.11.046
  2. Buscarini M, Pasin E, Stein JP. Complications of radical cystectomy. Minerva Urol Nefrol. 2007 Mar;59(1):67-87.
  3. Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, Raj G, Bochner BH, Dalbagni G, Herr HW, Donat SM. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009 Jan;55(1):164-74. doi: 10.1016/j.eururo.2008.07.031
  4. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13. doi: 10.1097/
  5. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009 Aug;250(2):187-96. doi: 10.1097/SLA.0b013e3181b13ca2
  6. Kursa MB, Rudnicki WR. Feature selection with the boruta package. J Stat Soft. 2010;36(11):1-13. doi: 10.18637/jss.v036.i11
  7. Studer UE, Burkhard FC, Schumacher M, Kessler TM, Thoeny H, Fleischmann A, Thalmann GN. Twenty years experience with an ileal orthotopic low pressure bladder substitute–lessons to be learned. J Urol. 2006 Jul;176(1):161-66. doi: 10.1016/S0022-5347(06)00573-8
  8. Martin RC 2nd, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Ann Surg. 2002 Jun;235(6):803-13.
  9. Novara G, De Marco V, Aragona M, Boscolo-Berto R, Cavalleri S, Artibani W, Ficarra V. Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol. 2009 Sep;182(3):914-21. doi: 10.1016/j.juro.2009.05.032
  10. Svatek RS, Fisher MB, Matin SF, Kamat AM, Grossman HB, Nogueras-González GM, Urbauer DL, Kennedy KA, Dinney CP. Risk factor analysis in a contemporary cystectomy cohort using standardized reporting methodology and adverse event criteria. J Urol. 2010 Mar;183(3):929-34. doi: 10.1016/j.juro.2009.11.038
  11. Fisher MB, Svatek RS, Hegarty PK, McGinniss JE, Hightower C, Grossman HB, Kamat AM, Dinney CP, Matin SF. Cardiac history and risk of post - cystectomy cardiac complications. Urology. 2009;74(5):1085-89. doi: 10.1016/j.urology.2009.04.103
  12. Krasnyi SA, Sukonko OG, Poliakov SL, Rolevich AI, Minich AA, Mavrichev AS, Volkov AN, Mirilenko LV. Prediktory rannikh tiazhelykh oslozhnenii radikal’noi tsistektomii. Onkourologiia. 2010;(4):42-46. (in Russ.)
  13. Ahmed K, Khan SA, Hayn MH, Agarwal PK, Badani KK, Balbay MD, Castle EP, Dasgupta P, Ghavamian R, Guru KA, Hemal AK, Hollenbeck BK, Kibel AS, Menon M, Mottrie A, Nepple K, Pattaras JG, Peabody JO, Poulakis V, Pruthi RS, Redorta JP, Rha KH, Richstone L, Saar M, Scherr DS, Siemer S, Stoeckle M, Wallen EM, Weizer AZ, Wiklund P, Wilson T, Woods M, Khan MS. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2014 Feb;65(2):340-47. doi: 10.1016/j.eururo.2013.09.042
  14. Lee CT, Dunn RL, Chen BT, Joshi DP, Sheffield J, Montie JE. Impact of body mass index on radical cystectomy. J Urol. 2004 Oct;172(4 Pt 1):1281-85. doi: 10.1097/01.ju.0000138785.48347.aa
  15. Moschini M, Simone G, Stenzl A, Gill IS, Catto J. Critical Review of Outcomes from Radical Cystectomy: Can Complications from Radical Cystectomy Be Reduced by Surgical Volume and Robotic Surgery? Eur Urol Focus. 2016 Apr;2(1):19-29. doi: 10.1016/j.euf.2016.03.001
Address for correspondence:
223040, The Republic of Belarus,
Minsk region, Lesnoy-1,
N.N. Alexandrov National Cancer
Center of Belarus,
Oncourological Unit,
Tel. mobile: +375 29 667-09-10,
Aliaksei A. Ryndzin
Information about the authors:
Ryndzin Aliaksei A., Urologist, the Oncourological Unit, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus
Zaitseva Lidya A., Junior Researcher of the Carcinogenesis Laboratory of the Diagnostic Department, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
Shishlo Iosif F., PhD, Oncologist-Surgeon, the Hepatopancreatobiliary Pathology Unit, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
Poluyanchik Andrei V., PhD, Head of the Operative Unit, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
Krasny Sergey A., MD, Professor, Corresponding Member of NAS of RB, Deputy Director for Research, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.




Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

Objective. To evaluate the clinical significance of the expression of BIRC5 and HER2-neu genes in circulating tumor cells as markers of minimal residual disease at the stage of surgical treatment of breast cancer.
Methods. 162 patients with the verified breast cancer of the I–IIIC stage aged 58.16±9.98 years took part in the study. All women underwent surgery in the amount of a Madden radical mastectomy – 113 (69.8%) or radical resection – 49 (30.2%). All patients on the day of surgery and also on the 2nd day after the operation were examined for the presence of circulating tumor cells (CTCs) in the peripheral blood. For the identification of CTCs, expression of the BIRC5 and HER2-neu genes was studied using real-time polymerase chain reaction (RT-PCR).
Results. Positive mRNAs BIRC5 and HER2-neu CTCs before the surgery were detected in 115 women (71%). After the operation, CTCs disappeared in 47 (40.9%) patients, in 59 (51.3%) CTCs were preserved, and in 9 (7.8%) CTCs were first identified in the venous blood. After mastectomy the frequency of preservation of CTCs was significantly lower than after radical resection and was 46.9% compared to 61.8% (p=0.039). The frequency of preservation of CTCs after surgery was significantly higher in the early stages (I–IIA) – 66.2% than in more advanced stages (IIB–IIIC) – 45.0%.
Conclusions. Determination of the expression of the BIRC5 and HER2-neu gene in the enriched peripheral blood sample is a reliable identifier of the CTCs and the minimal residual disease marker. Early dissemination of tumor cells helps maintain CTCs in the peripheral blood of patients to 51.3%, despite the surgical intervention.

Keywords: breast cancer, minimal residual disease, circulating tumor cells, survivin, epidermal growth factor receptor
p. 457-464 of the original issue
  1. Senkus E, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rutgers E, Zackrisson S, Cardoso F. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. ESMO Guidelines Committee. Ann Oncol. 2015;26 (5):v8-30. doi: 10.1093/annonc/mdv298
  2. Cheng L, Swartz MD, Zhao H, Kapadia AS, Lai D, Rowan PJ, Buchholz TA, Giordano SH (2012) Hazard of recurrence among women after primary breast cancer treatment–a 10-year follow- up using data from SEER-Medicare. Cancer Epidemiol Biomark Prev. 2012; 21(5):800-809. doi: 10.1158/1055-9965.EPI-11-1089
  3. Pantel K, Alix-Panabières C, Riethdorf. Cancer micrometastases. Nature Reviews Clinical Oncology. 2009;6(6): 339–51. doi: 10.1038/nrclinonc.2009.44.
  4. Onstenk W, Gratama JW, Foekens JA, Sleijfer S. Towards a personalized breast cancer treatment approach guided by circulating tumor cell (CTC) characteristics. Cancer Treat. Rev. 2013;39(7):691-700. doi: 10.1016/j.ctrv.2013.04.001
  5. Tonak J, Gall FP, Hohenberge W, Hermanek P, Mühe E, Angermann B. Prinzipien der chirurgie maligner tumoren. In: Gall FP, Hermanek P, Tonak J, editors. Chirurgische Onkologie. Springer Link; 1986. p. 131-53.
  6. Miller MC, Doyle GV, Terstappen LW. Significance of Circulating Tumor Cells Detected by the CellSearch System in Patients with Metastatic Breast Colorectal and Prostate Cancer. J Oncol. 2010;2010:617421. doi: 10.1155/2010/617421
  7. Swaby RF, Cristofanilli M. Circulating tumor cells in breast cancer: a tool whose time has come of age. BMC Med. 2011;9:43. doi: 10.1186/1741-7015-9-43
  8. Antonio N, Bønnelykke-Behrndtz ML, Ward LC, Collin J, Christensen IJ, Steiniche T, Schmidt H, Feng Y, Martin1 P. The wound inflammatory response exacerbates growth of pre-neoplastic cells and progression to cancer. EMBO J. 2015;2; 34(17):2219-2236. doi: 10.15252/embj.201490147
  9. Makki J. Diversity of breast carcinoma: histological subtypes and clinical relevance. Clin Med Insights Pathol. 2015;8:23-31. doi: 10.4137/CPath.S31563
  10. Toss A, Cristofanilli M. Molecular characterization and targeted therapeutic approaches in breast cancer. Breast Cancer Res. 2015;17(1):60 doi: 10.1186/s13058-015-0560-9
  11. Sleeman JP, Christofori G, Fodde R, Collard JG, Berx G, Decraene C, Ruegg C. Concepts of metastasis in flux: the stromal progression model. Semin Cancer Biol. 2012; 22(3):174-86. doi: 10.1016/j.semcancer.2012.02.007.
  12. Wu S, Liu S, Liu Z, Huang J, Pu X, Li J, Yang D, Deng H, Yang N, Xu J. Classification of circulating tumor cells by epithelial-mesenchymal transition markers. PLoS One. 2015;24;10(4):e0123976. doi: 10.1371/journal.pone.0123976.
  13. Smerage JB, Barlow WE, Hortobagyi GN, Winer EP, Leyland- Jones B, Srkalovic G, Tejwani S, Schott AF, O’Rourke MA, Lew DL, Doyle GV, Gralow JR, Livingston RB, Hayes DF. Circulating tumor cells and response to chemotherapy in metastatic breast cancer: SWOG S0500. J Clin Oncol. 2014;32(31):3483-89. doi: 10.1200/JCO.2014.56.2561
  14. Patel P, Chen EI. Cancer stem cells, tumor dormancy, and metastasis. Front Endocrinol (Lausanne). 2012;23;3:125. doi: 10.3389/fendo.2012.00125
  15. Saadatmand S, Bretveld R, Siesling S, Tilanus-Linthorst MM. Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173,797 patients. BMJ (Clinical research ed). 2015;351:h4901. doi: 10.1136/bmj.h4901
Address for correspondence:
210023, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Oncology
With the Courses
Of RD, RT, FST and SRT,
Tel. office: +375 212 57-64-16,
Yauheni A. Shliakhtunou
Information about the authors:
Shliakhtunou Yauheni A., PhD, Associate Professor of the Department of Oncology with the Courses of RD, RT, FST and SRT, Vitebsk State Medical University, Vitebsk, Republic of Belarus.




Chita State Medical Academy, Chita,
The Russian Federation

The introduction of modern surgical technologies is often accompanied by negative effects. The use of endoscopic techniques can lead to the development of the phenomenon of intra-abdominal hypertension, which is also found in many pathological processes in the abdominal cavity. One of serious complications is hemodynamic disorder, hemostasis system disorders leading to thrombosis and thromboembolism. Long-term hypertension is accompanied by the development of the abdominal compartment syndrome with the development of multiple organ failure. It is important to prevent complications.
This review presents current data on the disorders in the microcirculation system arising when intra-abdominal pressure increases. Pathophysiological reactions in the hemostatic system are studied. The study of the influence of intraperitoneal hypertension, created as a result of pneumoperitoneum, on coagulation and fibrinolysis under general anesthesia, revealed negative changes in the postoperative period, which led to activation of clotting factors and inhibition of fibrinolysis. Studies of the endothelial function in case of intra-abdominal hypertension are presented. Possible markers with the help of which it is possible to predict pathological reactions are considered.
The conducted literature review shows that shifts of hemocoagulation in patients with calculous cholecystitis can contribute to the development of venous thromboembolism. The root cause of endothelial dysfunction can also be a regional disturbance of microcirculation.

Keywords: intra-abdominal hypertension, hemostasis, endothelium, microcirculation, venous thromboembolism
p. 465-472 of the original issue
  1. Aliev SA. The syndrome of intraabdominal hypertension. Khirurgiia Zhurn im NI Pirogova. 2013;(5):63-67. (in Russ.)
  2. Helfand BR, Protsenko DM, Podachyn PV, Chubchenko SV, Lapshyna IYu. Abdominal Hypertension Syndrome: the State of the Problem. Meditsina Neotlozh Sostoianii. 2015;(7):41-50. (in Russ.)
  3. Zbar AP, Wun L, Chiappa A, Al-Hashemy M, Monteleone M, Ferrari C, Parkes S. Primary intra-abdominal hypertension and abdominal compartment syndrome: pathophysiology and treatment. Emerg Med Open J. 2015;1(2):46-63. doi: 10.17140/EMOJ-1-110
  4. Vinnik IuS, Tepliakova OV. Znachenie intraabdominal’noi gipertenzii u bol’nykh s ostrym pankreatitom. Vestn Khirurgii im II Grekova. 2016;175(5):110-13. doi: 10.24884/0042-4625-2016-175-5-110-113 (in Russ.)
  5. Murphy PB. Intra-abdominal Hypertension and Abdominal Compartment Syndrome [Electronic resource]. Electronic Thesis and Dissertation Repository. 2016. Available:
  6. Malbrain ML, De laet IE. Intra-abdominal hypertension: evolving concepts. Clin Chest Med. 2009 Mar;30(1):45-70, viii. doi: 10.1016/j.ccm.2008.09.003
  7. Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi A, Olvera C, Ivatury R, D’Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions. Intensive Care Med. 2006 Nov;32(11):1722-32. doi: 10.1007/s00134-006-0349-5
  8. Cheatham ML, Safcsak K. Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? Crit Care Med. 2010 Feb;38(2):402-7. doi: 10.1097/CCM.0b013e3181b9e9b1
  9. De Waele JJ, Kimball E, Malbrain M, Nesbitt I, Cohen J, Kaloiani V, Ivatury R, Mone M., Debergh D, Björck M. Decompressive laparotomy for abdominal compartment syndrome. Br J Surg. 2016 May;103(6):709-15. Published online 2016 Feb 18. doi: 10.1002/bjs.10097
  10. Papavramidis TS, Marinis AD, Pliakos I, Kesisoglou I, Papavramidou N. Abdominal compartment syndrome – Intra-abdominal hypertension: Defining, diagnosing, and managing. J Emerg Trauma Shock. 2011 Apr;4(2):279-91. doi: 10.4103/0974-2700.82224
  11. Mcnelis J, Soffer S, Marini CP, Jurkiewicz A, Ritter G, Simms HH, Nathan I. Abdominal compartment syndrome in the surgical intensive care unit. Am Surg. 2002 Jan;68(1):18-23.
  12. Raeburn CD, Moore EE, Biffl WL, Johnson JL, Meldrum DR, Offner PJ, Franciose RJ, Burch JM. The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery. Am J Surg. 2001 Dec;182(6):542-46. doi: 10.1016/S0002-9610(01)00821-2
  13. Eddy V, Nunn C, Morris JA Jr. Abdominal compartment syndrome. The Nashville experience. Surg Clin North Am. 1997 Aug;77(4):801-12. doi: 10.1016/S0039-6109(05)70585-5
  14. Toens C, Schachtrupp A, Hoer J, Junge K, Klosterhalfen B, Schumpelick V. A porcine model of the abdominal compartment syndrome. Shock. 2002 Oct;18(4):316-21. doi: 10.1097/00024382-200210000-00005
  15. Zubritskiy VF, Zabelin MV, Levchuk AL, Pokrovskiy KA, Ryabov AL, Bagdosarov RB. Diagnostics and treatment of intra-abdominal hypertension for patients suffering from abdominal sepsis. Vestn Nats Med-Khirurg Tsentra im NI Pirogova. 2010;5(3):61-64. (in Russ.)
  16. Pelosi P, Quintel M, Malbrain ML. Effect of intra-abdominal pressure on respiratory mechanics. Acta Clin Belg. 2007;62(Suppl 1):78-88. doi: 10.1179/acb.2007.62.s1.011
  17. Latenser BA, Kowal-Vern A, Kimball D, Chakrin A, Dujovny N. A pilot study comparing percutaneous decompression with decompressive laparotomy for acute abdominal compartment syndrome in thermal injury. J Burn Care Rehabil. 2002 May-Jun;23(3):190-95. doi: 10.1097/00004630-200205000-00008
  18. Doty JM, Saggi BH, Blocher CR, Fakhry I, Gehr T, Sica D, Sugerman HJ. Effects of increased renal parenchymal pressure on renal function. J Trauma. 2000 May;48(5):874-77.
  19. Sazhin VP, Fedorov AV, Sazhin AV. Endoskopicheskaia Abdominal’naia Khirurgiia. Moscow, RF: GEOTAR-Media; 2010. 512 p. (in Russ.)
  20. Beckman MG, Abe K, Barnes K, Bartman B, Brady PJ, Hooper WC. Strategies and partnerships toward prevention of Healthcare-Associated Venous Thromboembolism. J Hosp Med. 2016 Dec;11(Suppl 2):S5-S7. doi: 10.1002/jhm.2659
  21. Grishin NA, Starkov IuG, Grigorian RS, Ivanova VE, Rizaev KS, Strekalovskii VP, Shishin KV. Vliianie pnevmoperitoneuma na venoznuiu gemodinamiku nizhnikh konechnostei pri laparoskopicheskoi kholetsistektomii. Endoskop Khirurgiia. 1998;(4):26-29. (in Russ.)
  22. Catheline JM, Turner R, Gaillard JL, Rizk N, Champault G. Thromboembolism in laparoscopic surgery: risk factors and preventive measures. Surg Laparosc Endosc Percutan Tech. 1999 Apr;9(2):135-39. doi: 10.1097/00019509-199904000-00011
  23. Khanina IuS, Lobanov SL, Konovalova OG, Iashnov AA, Dodonova OV, Matuzova EA. Sostoianie mikrotsirkuliatsii u bol’nykh s ozhireniem posle endokhirurgicheskogo lecheniia zhelchnokamennoi bolezni. Vestn Buriat Gos Un-ta. 2013;(12):131-33. (in Russ.)
  24. Donmez T, Uzman S, Yildirim D, Hut A, Avaroglu HI, Erdem DA, Cekic E, Erozgen F. Is there any effect of pneumoperitoneum pressure on coagulation and fibrinolysis during laparoscopic cholecystectomy? Peer J. 2016 Sep 8;4:e2375. doi: 10.7717/peerj.2375. eCollection 2016.
  25. Garg PK, Teckchandani N, Hadke NS, Chander J, Nigam S, Puri SK. Alteration in coagulation profile and incidence of DVT in laparoscopic cholecystectomy. Int J Surg. 2009 Apr;7(2):130-35. doi: 10.1016/j.ijsu.2008.12.036
  26. Ntourakis D, Sergentanis TN, Georgiopoulos I, Papadopoulou E, Liasis L, Kritikos E, Tzardis P, Laopodis V. Subclinical activation of coagulation and fibrinolysis in laparoscopic cholecystectomy: do risk factors exist? Int J Surg. 2011;9(5):374-77. doi: 10.1016/j.ijsu.2011.02.011
  27. Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kashfi A, Kraus T, Büchler MW. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg. 2004;21(2):95-105. doi: 10.1159/000077038
  28. Voronov SN, Miller DA, Golubev AA, Eremeev AG, Kononova AG. Izuchenie trombotsitarnogo gemostaza u bol’nykh khronicheskim kal’kuleznym kholetsistitom dlia otsenki riska razvitiia tromboembolicheskikh oslozhnenii posle laparoskopicheskoi kholetsistektomii. Endoskop Khirurgiia. 2009;15(4):22-27. (in Russ.)
  29. Gasparics &AACUTE;, Rosivall L, Krizbai IA, Sebe A. When the endothelium scores an own goal: endothelial cells actively augment metastatic extravasation through endothelial-mesenchymal transition. Am J Physiol Heart Circ Physiol. 2016 May 1;310(9):H1055-63. doi: 10.1152/ajpheart.00042.2016
  30. Petrishcheva NN. Disfunktsiia endoteliia. Prichiny, mekhanizmy, farmakologicheskaia korrektsiia. S-Peterbrg, RF: SPbGMU; 2003. 184 p. (in Russ.)
  31. August P. Overview: mechanisms of hypertension: cells, hormones, and the kidney. J Am Soc Nephrol. 2004 Aug;15(8):1971-73. doi: 10.1097/01.ASN.0000133197.23478.76
  32. Shibuya M. Vascular endothelial growth factor receptor-1 (VEGFR-1/Flt-1): a dual regulator for angiogenesis. Angiogenesis. 2006;9(4):225-30; discussion 231. doi: 10.1007/s10456-006-9055-8
  33. Vanhoutte PM, Shimokawa H, Feletou M, Tang EH. Endothelial dysfunction and vascular disease – a 30th anniversary update. Acta Physiol (Oxf). 2017 Jan;219(1):22-96. doi: 10.1111/apha.12646
  34. Hein TW, Singh U, Vasquez-Vivar J, Devaraj S, Kuo L, Jialal I. Human C-reactive protein induces endothelial dysfunction and uncoupling of eNOS in vivo. Atherosclerosis. 2009 Sep;206(1):61-8. doi: 10.1016/j.atherosclerosis.2009.02.002
  35. Seta KA, Yuan Y, Spicer Z, Lu G, Bedard J, Ferguson TK, Pathrose P, Cole-Strauss A, Kaufhold A, Millhorn DE. The role of calcium in hypoxia-induced signal transduction and gene expression. Cell Calcium. 2004 Sep-Oct;36(3-4):331-40. doi: 10.1016/j.ceca.2004.02.006
  36. Lobanov IuS, Shapovalov KG. Dinamika perifericheskoi mikrotsirkuliatsii i priznaki venoznoi nedostatochnosti pri razlichnykh rezhimakh intraoperatsionnogo pnevmoperitoneuma. Zabaikal Med Vestn. 2015;(4):87-91. (in Russ.)
  37. Ley K, Laudanna C, Cybulsky MI, Nourshargh S. Getting to the site of inflammation: the leukocyte adhesion cascade updated. Nat Rev Immunol. 2007 Sep;7(9):678-89. doi: 10.1038/nri2156
  38. Ivatury RR. Update on open abdomen management: achievements and challenges. World J Surg. 2009 Jun;33(6):1150-53. doi: 10.1007/s00268-009-0005-7
  39. Pelosi P, Quintel M, Malbrain ML. Effect of intra-abdominal pressure on respiratory mechanics. Acta Clin Belg. 2007;62(Suppl 1):78-88. doi: 10.1179/acb.2007.62.s1.011
  40. Latenser BA, Kowal-Vern A, Kimball D, Chakrin A, Dujovny N. A pilot study comparing percutaneous decompression with decompressive laparotomy for acute abdominal compartment syndrome in thermal injury. J Burn Care Rehabil. 2002 May-Jun;23(3):190-95. doi: 10.1097/00004630-200205000-00008
  41. Lopes AM, Nunes A, Niza MMRE, Dourado A. Intraabdominal pressure is influenced by body position? Am J Clin Med Res. 2016;49(1):11-18. doi: 10.12691/ajcmr-4-1-3
  42. Sun L, Li W, Sun F, Geng Y, Tong Z, Li J. Intra-abdominal pressure in third trimester pregnancy complicated by acute pancreatitis: an observational studal. BMC Pregnancy Childbirth. 2015;15:223. Published online 2015 Sep 22. doi: 10.1186/s12884-015-0651-8
  43. Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, Duchesne J, Bjorck M, Leppaniemi A, Ejike JC, Sugrue M, Cheatham M, Ivatury R, Ball CG, Reintam Blaser A, Regli A, Balogh ZJ, D’Amours S, Debergh D, Kaplan M, Kimball E, Olvera C. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013 Jul;39(7):1190-206. doi: 10.1007/s00134-013-2906-z
  44. O’Malley C, Cunningham AJ. Physiologic changes during laparoscopy. Anesthesiol Clin North America. 2001 Mar;19(1):1-19. doi: 10.1016/S0889-8537(05)70208-X
  45. Malinovskaya NA, Komleva YK, Salmin VV, Morgun AV, Shuvaev AN, Panina YA, Boitsova EB, Salmina AB. Endothelial progenitor cells physiology and metabolic plasticity in brain angiogenesis and blood-brain barrier modeling. Front Physiol. 2016;7:599. Published online 2016 Dec 1. doi: 10.3389/fphys.2016.00599
  46. Oladipupo SS, Smith C, Santeford A, Park C, Sene A, Wiley LA, Osei-Owusu P, Hsu J, Zapata N, Liu F, Nakamura R, Lavine KJ, Blumer KJ, Choi K, Apte RS, Ornitz DM. Endothelial cell FGF signaling is required for injury response but not for vascular homeostasis. Proc Natl Acad Sci USA. 2014 Sep 16;111(37):13379-84. doi: 10.1073/pnas.1324235111
Address for correspondence:
672000, The Russian Federation,
Chita, Gorky Str., 39A,
Chita State Medical Academy,
Department of Faculty Surgery
With the Course of Urology,
Tel.: +7(3022)35-43-24,
Sergey L. Lobanov
Information about the authors:
Lobanov Yuriy S., PhD, Assistant of the Department of Faculty Surgery with the Course of Urology, Chita State Medical Academy, Chita, Russian Federation.
Lobanov Sergey L., MD, Professor, Head of the Department of Faculty Surgery with the Course of Urology, Chita State Medical Academy, Chita, Russian Federation.
Shapovalov Konstantin G., MD, Professor, Head of the Department of Anesthesiology and Resuscitation, Chita State Medical Academy, Chita, Russian Federation.



Tyumen State Medical University, Tyumen
The Russian Federation

The purpose of the review is to analyze the literature concerning varicose eczema, to reveal unsolved issues of diagnosis and current trends in the treatment of this pathology.
Varicose eczema, being a frequent dermatological complication of chronic vein diseases, nevertheless remains an insufficiently studied problem. Varicose eczema is not a dangerous disease, but it significantly reduces the patients’ quality of life. The term «varicose eczema», although it has become common, is ambiguous. The problem of varicose eczema is first of all an organizational one: for effective diagnosis and treatment of varicose eczema the cooperation of surgeons and dermatologists is necessary. There is no unified approach to the diagnosis of skin lesions in chronic venous insufficiency. The difficulty lies in the diversity of the skin changes in this pathology. The proposed algorithm and diagnostic criteria can fill this gap. The tactics of treating varicose eczema is mainly developed. Treatment of varicose eczema includes treatment of chronic venous insufficiency (elimination of venous reflux by surgery or sclerotherapy, phlebotonic drugs, elastic compression) and treatment of skin changes (systemic and topical antibacterial remedies, steroid and immunosuppressive therapy). Elastic compression in case of significant exudation is the subject of discussion. If surgical treatment is impossible, the amount of conservative therapy necessary and sufficient to achieve the remission of varicose eczema is unclear.
Conclusions. Further study of the advantages of modern endovenous methods over classical phlebectomy in treatment of varicose eczema is required.
Keywords: chronic venous insufficiency, dermatologic complications, varicose eczema, differential diagnostics, phlebectomy, sclerotherapy, conservative treatment

Keywords: chronic venous insufficiency, dermatologic complications, varicose eczema, differential diagnostics, phlebectomy, sclerotherapy, conservative treatment
p. 473-481 of the original issue
  1. Rossiiskie klinicheskie rekomendatsii po diagnostike i lecheniiu khronicheskikh zabolevanii ven. Flebologiia. 2013;7(2 vyp 2):1-48. (in Russ.)
  2. Nunn JF. Ancient Egyptian Medicine. University of Oklahoma Press; 2002. 240 ð.
  3. Hebra FR. On diseases of the skin. London, UK: The New Sydenham Society; 1868. Vol. 2.
  4. The seven books of Paulus Aegineta. Translated by Francis Adams: 3 vols [Electronic resource]. London, UK: The Sydenham Society; 1844–1847. Available from:
  5. A Practical Synopsis of cutaneous diseases: according to the arrangement of Dr. Willan, exhibiting a concise view of the diagnostic symptoms and the method of treatment. London: Longman; 1813. 386 p.
  6. Rokitansky KF. Manual of pathological anatomy [Electronic resource]. London; 1852. Vol. 4. 422 p. Available from:
  7. Jackson GT. The ready reference handbook of diseases of the skin. New York-Philadelphia, Lea brothers & co; 1901. 684 p.
  8. Gloviczki P. Handbook of venous disorders. Edward Arnold (Publishers) Ltd; 2009. 723 p.
  9. Beauregard S, Gilchrest BA. A survey of skin problems and skin care regimens in the elderly. Arch Dermatol. 1987 Dec;123(12):1638-43. doi: 10.1001/archderm.1987.01660360066014
  10. Kirienko AI, Zolotukhin IA, Yumin SM, Seliverstov EI. The Effectiveness of specialized phlebological care in Russia: the results of the prospective observanional stude SPECTTUM. Flebologia. 2015;9(2):4-11 doi: 10.17116/flebo2015924-11 (in Russ.)
  11. Petruzzellis V, Florio T, Quaranta D, Troccoli T, Serra MA. Epidemiologic observations on the subject of phlebopathy of the legs and its dermatologic complications. Minerva Med. 1990;81(9):611-16. [Article in Italian]
  12. Weismann K, Krakauer R, Wanscher B. Prevalence of skin diseases in old age. Acta Derm Venereol. 1980;60(4):352-53.
  13. Polat M, Ilhan MN. Dermatological complaints of the elderly attending a dermatology outpatient clinic in Turkey: a prospective study over a one-year period. Acta Dermatovenerol Croat. 2015;23(4):277-81.
  14. Joseph N, B A, Faizan Thouseef M, Devi MU, Abna A, Juneja I. A multicenter review of epidemiology and management of varicose veins for national guidance. Ann Med Surg (Lond). 2016 Apr 30;8:21-27. doi: 10.1016/j.amsu.2016.04.024. eCollection 2016 Jun.
  15. Sundaresan S, Migden MR, Silapunt S. Stasis Dermatitis: Pathophysiology, Evaluation, and Management. Am J Clin Dermatol. 2017 Jun;18(3):383-390. doi: 10.1007/s40257-016-0250-0
  16. Sippel K, Mayer D, Ballmer B, Dragieva G, Läuchli S, French LE, Hafner J. Evidence that venous hypertension causes stasis dermatitis. Phlebology. 2011 Dec;26(8):361-65. doi: 10.1258/phleb.2010.010043
  17. Dormandy JA. Microcirculation in venous disorders: the role of the white blood cells. Int J Microcirc Clin Exp. 1995;15(Suppl 1):3-8. doi: 10.1159/000179087
  18. Dormandy JA. Pathophysiology of venous leg ulceration: an update. J Angiology. 1997;48(1):71-75.
  19. Powell CC, Rohrer MJ, Barnard MR, Peyton BD, Furman MI, Michelson AD. Chronic venous insufficiency is associated with increased platelet and monocyte activation and aggregation. J Vasc Surg. 1999 Nov;30(5):844-51. doi: 10.1016/S0741-5214(99)70009-1
  20. Lee AJ, Lowe GD, Rumley A, Ruckley CV, Fowkes FG. Haemostatic factors and risk of varicose veins and chronic venous insufficiency: Edinburgh Vein Study. Blood Coagul Fibrinolysis. 2000 Dec;11(8):775-81.
  21. Jünger M, Hahn U, Bort S, Klyscz T, Hahn M, Rassner G. Significance of cutaneous microangiopathy for the pathogenesis of dermatitis in venous congestion due to chronic venous insufficiency. Wien Med Wochenschr. 1994;144(10-11):206-10. [Article in German]
  22. Scelsi R, Scelsi L, Cortinovis R, Poggi P. Morphological changes of dermal blood and lymphatic vessels in chronic venous insufficiency of the leg. Int Angiol. 1994 Dec;13(4):308-11.
  23. Elder DE, Elenitsas R, Rubin AI, Ioffreda M, Miller J, Miller OF, eds. Atlas and Synopsis of Lever’s Histopathology of the Skin. 3 ed. Lippincott Williams & Wilkins; 2013. 531 p.
  24. Brook I, Frazier EH. Aerobic and anaerobic microbiology of chronic venous ulcers. Int J Dermatol. 1998 Jun; 37(Is 6):426-28. doi: 10.1046/j.1365-4362.1998.00445.x
  25. Bowler PG, Davies BJ. The microbiology of infected and noninfected leg ulcers. Int J Dermatol. 1999 Aug;38(8):573-78. doi: 10.1046/j.1365-4362.1999.00738.x
  26. Ivanov EV. Microbiology of venous trophic ulcers and varicose eczema. Nepreryvnoe Med Obrazovanie i Nauka. 2015;10(2):15-20. (in Russ.)
  27. Ivanov EV. Varicose eczema: the etiology, pathogenesis and diagnosis. P.IV Angiologiia i Sosudistaia Khirurgiia. 2005;11(1):75-79. (in Russ.)
  28. Rudikoff D, Cohen SR, Scheinfeld N, eds. Atopic dermatitis and eczematous disorders. CRC Press; 2014. 456 p.
  29. Biswas A. Pearls and pitfalls in inflammatory dermatopathology. Cambridge University Press; 2017. 346 p.
  30. Ivanov EV. Algoritmy diagnostiki i lecheniia varikoznoi ekzemy. Ural Med Zhurn. 2006;(9):75-76. (in Russ.)
  31. O’Donnell TF Jr, Passman MA, Marston WA, Ennis WJ, Dalsing M, Kistner RL, Lurie F, Henke PK, Gloviczki ML, Eklöf BG, Stoughton J, Raju S, Shortell CK, Raffetto JD, Partsch H, Pounds LC, Cummings ME, Gillespie DL, McLafferty RB, Murad MH, Wakefield TW, Gloviczki P. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery ® and the American Venous Forum. J Vasc Surg. 2014 Aug;60(2 Suppl):3S-59S. doi: 10.1016/j.jvs.2014.04.049
  32. Kemp N. A synopsis of current international guidelines and new modalities for the treatment of varicose veins. Aust Fam Physician. 2017;46(4):229-33.
  33. Subbarao NT, Aradhya SS, Veerabhadrappa NH. Sclerotherapy in the management of varicose veins and its dermatological complications. Indian J Dermatol Venereol Leprol. 2013 May-Jun;79(3):383-88. doi: 10.4103/0378-6323.110746
  34. Yakovlev VP, Blatun LA, Terekhova RP. Clinical efficacy of a novel antimicrobial combined drug containing ciprofloxacin and tinidazole in the treatment of patients with skin and soft tissue infections. Antibiotiki i Khimioterapiia. 2005;50(2-3):48-51. (in Russ.)
  35. 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
  36. Bush R, Comerota A, Meissner M, Raffetto JD, Hahn SR, Freeman K. Recommendations for the medical management of chronic venous disease: The role of Micronized Purified Flavanoid Fraction (MPFF). Phlebology. 2017 Apr;32(1_suppl):3-19. doi: 10.1177/0268355517692221
  37. Löfmark S, Edlund C, Nord CE. Metronidazole is still the drug of choice for treatment of anaerobic infections. Clin Infect Dis. 2010 Jan 1;50(Suppl 1):S16-23. doi: 10.1086/647939
  38. Dissemond J, Knab J, Lehnen M, Franckson T, Goos M. Successful treatment of stasis dermatitis with topical tacrolimus. Vasa. 2004 Nov;33(4):260-62. doi: 10.1024/0301-1526.33.4.260
  39. Erfurt-Berge C, Geier J, Mahler V. The current spectrum of contact sensitization in patients with chronic leg ulcers or stasis dermatitis - new data from the Information Network of Departments of Dermatology (IVDK). Contact Dermatitis. 2017 Sep;77(3):151-58. doi: 10.1111/cod.12763
  40. Sushkov SA. Compressive therapy at chronic venous insufficiency. Novosti Khirurgii. 2012;20(2):105-17. (in Russ.)
Address for correspondence:
625023, The Russian Federation,
Tyumen, Odesskaya Str., 54,
Tyumen State Medical University,
Department of Surgical Diseases,
Tel. mobile: +7912 922 3054,
Evgeny V. Ivanov
Information about the authors:
Ivanov Evgeny V., PhD, Associate Professor of the Department of Surgical Diseases, Tyumen State Medical University, Tyumen, Russian Federation.



S. Fyodorov Eye Microsurgery Federal State Institution, Moscow,
The Russian Federation

Vitreous floaters are the structural changes of the vitreous body accompanied by formation of vitreous collagen conglomerates that result in light scattering, umbra formation towards the retina and reducing of patients’ life quality and vision quality.
This article is devoted to modern aspects of the anatomy and physiology of the vitreous body, the etiology and pathogenesis of its structure changes, modern imaging and diagnostic techniques of vitreous floaters, assessment of vision quality in patients with vitreous floaters and treatment approaches based on the literature review. At the moment there is no universal solution to the problem of vitreous floaters treatment. In most cases, dynamic observation is proposed to patients. The efficacy of the conservative therapy has not been proven and the elaboration of alternative treatment methods is needed. The analysis of other authors’ publications concerning this pathology treatment testifies to the fact, that current surgical and laser techniques are highly effective but at the same time they have a number of limitations and peculiarities, therefore a further investigation of efficacy and safety issues is required.

Keywords: vitreous floaters, vitreous body, YAG-laser vitreolysis, quality of life, questionnaire, eye diseases
p. 482-490 of the original issue
  1. Webb BF, Webb JR, Schroeder MC, North CS. Prevalence of vitreous floaters in a community sample of smartphone users. Int J Ophthalmol. 2013 Jun 18;6(3):402-5. doi: 10.3980/j.issn.2222-3959.2013.03.27. Print 2013.
  2. Reardon AJ, Le Goff M, Briggs MD, McLeod D, Sheehan JK, Thornton DJ, Bishop PN. Identification in vitreous and molecular cloning of opticin, a novel member of the family of leucine-rich repeat proteins of the extracellular matrix. J Biol Chem. 2000;275(3):2123-29. doi: 10.1074/jbc.275.3.2123
  3. Nasnikova IIu, Kharlap SI, Kruglova EV. Prostranstvennaia ul’trazvukovaia diagnostika zabolevanii glaza i orbity: klin ruk. Moscow: RAMN; 2004. 156 p. (in Russ.)
  4. Sebag J. Age-related changes in human vitreous structure. Graefes Arch Clin Exp Ophthalmol. 1987;225(2):89-93. doi: 10.1007/BF02160337
  5. Sebag J. To see the invisible: the quest of imaging vitreous. In: Meyer CH, ed. Vital Dyes in Vitreoretinal Surgery. Dev Ophthalmol. Basel: Karger; 2008;42. ð. 5-28.
  6. Eisner G. Biomicroscopy of the peripheral fundus. NewYork: Springer Verlag; 1973. 97 p.
  7. Theopold H, Faulborn J. Scanning electron microscopic aspects of the vitreous body: technique of preparation. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1980;214(1):33-38. doi: 10.1007/BF00414534
  8. Wang J, McLeod D, Henson DB, Bishop PN. Age-dependent changes in the basal retinovitreous adhesion. Invest Ophthalmol Vis Sci. 2003 May;44(5):1793-800. doi: 10.1167/iovs.02-0802
  9. Foos RY. Vitreoretinal juncture over retinal vessels. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1977 Dec 31;204(4):223-34. doi: 10.1007/BF00415316
  10. Sebag J. Anatomy and pathology of the vitreo-retinal interface. Eye. 1992; 6(6):541-52. doi: 10.1038/eye.1992.119
  11. Worst J, Los LI, eds. Cisternal anatomy of the vitreous. New York: Kugler Publication – Amsterdam; 1995. 148 p.
  12. Kislitsyna NM, Novikov SV, Kolesnik SV, Veselkova MP. Anatomical and topographical features of anterior vitreous cortex. Oftal’mokhirurgiia. 2017;(1):66-71. doi: 10.25276/0235-4160-2017-1-66-71 (in Russ.)
  13. Sebag J, Yee KM, Wa CA, Huang LC, Sadun AA. Vitrectomy for floaters: prospective efficacy analyses and retrospective safety profile. Retina. 2014 Jun;34(6):1062-68. doi: 10.1097/IAE.0000000000000065
  14. Foos RY, Wheeler NC. Vitreoretinal juncture. Synchysis senilis and posterior vitreous detachment. Ophthalmology. 1982 Dec;89(12):1502-12. doi: 10.1016/S0161-6420(82)34610-2
  15. Saxena S, Jalali S, Verma L, Pathengay A. Management of vitreous haemorrhage. Indian J Ophthalmol. 2003;51(2):189-96.
  16. Spraul CW, Grossniklaus HE. Vitreous Hemorrhage. Surv Ophthalmol. 1997 Jul-Aug;42(1):3-39. doi: 10.1016/S0039-6257(97)84041-6
  17. Coupland SE. The pathologist’s perspective on vitreous opacities. Eye (Lond). 2008 Oct;22(10):1318-29. doi: 10.1038/eye.2008.31
  18. Johnson MW. Posterior vitreous detachment: evolution and complications of its early stages. Am J Ophthalmol. 2010 Mar;149(3):371-82.e1. doi: 10.1016/j.ajo.2009.11.022
  19. Kador PF, Wyman M. Asteroid hyalosis: pathogenesis and prospects for prevention. Eye (Lond). 2008 Oct;22(10):1278-85. doi: 10.1038/eye.2008.35
  20. Mamou J, Wa CA, Yee KM, Silverman RH, Ketterling JA, Sadun AA, Sebag J. Ultrasound-based quantification of vitreous floaters correlates with contrast sensitivity and quality of life. Invest Ophthalmol Vis Sci. 2015 Jan 22;56(3):1611-17. doi: 10.1167/iovs.14-15414
  21. Karickhoff JR, ed. Laser treatment of eye floaters. Washington: Washington medical publishing; 2005. 203 p.
  22. Tsai WF, Chen YC, Su CY. Treatment of vitreous floaters with neodymium YAG laser. Br J Ophthalmol. 1993 Aug;77(8):485-88. doi: 10.1136/bjo.77.8.485
  23. Pedanova EK, Kryl’ LA, Kachalina GF. Pervye rezul’taty YAG-lazernogo vitreolizisa na ustanovke Ultra Q Reflex. Sovrem Tekhnologii v Oftal’mologii. 2016;(1):179-81. (in Russ.)
  24. Schwartz SG, Flynn HW Jr, Fisher YL. “Floater scotoma” demonstrated on spectral-domain optical coherence tomography and caused by vitreous opacification. Ophthalmic Surg Lasers Imaging Retina. 2013 Jul-Aug;44(4):415-18. doi: 10.3928/23258160-20130715-14
  25. Wagle AM, Lim WY, Yap TP, Neelam K, Au Eong KG. Utility values associated with vitreous floaters. Am J Ophthalmol. 2011 Jul;152(1):60-65.e1. doi: 10.1016/j.ajo.2011.01.026
  26. de Nie KF, Crama N, Tilanus MA, Klevering BJ, Boon CJ. Pars plana vitrectomy for disturbing primary vitreous floaters: clinical outcome and patient satisfaction. Graefes Arch Clin Exp Ophthalmol. 2013 May;251(5):1373-82. doi: 10.1007/s00417-012-2205-3
  27. Doga AV, Pedanova EK, Klepinina OB, Buriakov DA, Normaev BA. Analiz funktsional’nykh pokazatelei u patsientov s pomutneniiami steklovidnogo tela posle YAG – lazernogo vitreolizisa. Sovrem Tekhnologii v Oftal’mologii. 2017;(1):73-77. (in Russ.)
  28. Elliott DB, Sanderson K, Conkey A. The reliability of the Pelli-Robson contrast sensitivity chart. Ophthalmic Physiol Opt. 1990 Jan;10(1):21-24. doi: 10.1111/j.1475-1313.1990.tb01100.x
  29. Hohberger B, Laemmer R, Adler W, Juenemann AG, Horn FK. Measuring contrast sensitivity in normal subjects with OPTEC 6500: influence of age and glare. Graefes Arch Clin Exp Ophthalmol. 2007 Dec;245(12):1805-14. doi: 10.1007/s00417-007-0662-x
  30. Bach M. The Freiburg Visual Acuity Test - automatic measurement of visual acuity. Optom Vis Sci. 1996 Jan;73(1):49-53. doi: 10.1007/s00417-006-0474-4
  31. Tan JC, Spalton DJ, Arden GB. The effect of neodymium: YAG capsulotomy on contrast sensitivity and the evaluation of methods for its assessment. Ophthalmology. 1999 Apr;106(4):703-9. doi: 10.1016/S0161-6420(99)90154-9
  32. Woods RL, Tregear SJ, Mitchell RA. Screening for ophthalmic disease in older subjects using visual acuity and contrast sensitivity. Ophthalmology. 1998 Dec;105(12):2318-26. doi: 10.1016/S0161-6420(98)91235-0
  33. Normaev BA, Doga AV, Buriakov DA, Klepinina OB. Sravnitel’naia otsenka energeticheskikh parametrov YAG-lazernogo vozdeistviia pri lechenii razlichnykh tipov pomutnenii steklovidnogo tela. Sovrem Tekhnologii v Oftal’mologii. 2017;(4):153-57. (in Russ.)
  34. Khoshnevis M, Sebag J. Pharmacologic vitreolysis with ocriplasmin: rationale for use and therapeutic potential in vitreo-retinal disorders. BioDrugs. 2015 Apr;29(2):103-12. doi: 10.1007/s40259-015-0120-y
  35. Stalmans P, Benz MS, Gandorfer A, Kampik A, Pakola S, Haller JA. Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes. N Engl J Med. 2012; 367(7): 606-15. doi: 10.1056/NEJMoa1110823
  36. Tan HS, Mura M, Lesnik Oberstein SY, Bijl HM. Safety of vitrectomy for floaters. Am J Ophthalmol. 2011 Jun;151(6):995-98. doi: 10.1016/j.ajo.2011.01.005
  37. Delaney YM, Oyinloye A, Benjamin L. Nd:YAG vitreolysis and pars plana vitrectomy: surgical treatment for vitreous floaters. Eye (Lond). 2002 Jan;16(1):21-26. doi: 10.1038/sj.eye.6700026
  38. Kunimoto DY, Kaiser RS; Wills Eye Retina Service. Incidence of endophthalmitis after 20-and 25-gauge vitrectomy. Ophthalmology. 2007 Dec;114(12):2133-7. doi: 10.1016/j.ophtha.2007.08.009
  39. Little HL, Jack RL. Q-switched neodymium: YAG laser surgery of the vitreous. Graefes Arch Clin Exp Ophthalmol. 1986;224(3):240-46. doi: 10.1007/BF02143063
  40. Vandorselaer T, Van De Velde F, Tassignon MJ. Eligibility criteria for Nd-YAG laser treatment of highly symptomatic vitreous floaters. Bull Soc Belge Ophtalmol. 2001;(280):15-19.
  41. Aron-Rosa D, Greenspan DA. Neodymium:YAG laser vitreolysis. Int Ophthalmol Clin. 1985 Fall;25(3):125-34.
  42. Fankhauser F, Kwasniewska S, van der Zypen E. Vitreolysis with the Q-switched laser. Arch Ophthalmol. 1985 Aug;103(8):1166-71. doi: 10.1001/archopht.1985.01050080078025
  43. Alyeva NI, Kasimov EM. Estimation of the efficiency of the treatment of diabetic vitreous hemophthalmos. Oftal’mologiia. 2013;(3):21-24. (in Russ.)
  44. Ivanov A.N. Creation of optimal conditions by ND-YAG laser destruction before vitrectomy. Vestn Orenburg gos un-ta. 2014;(12):140-42. (in Russ.)
  45. Ivanov AN, Tankovskiy VE, Mizerova OV. YAG laser destruction of exudate in anterior chamber with pseudophakia and yaglaser vitreolysis in patients with uveitis. Vestn Orenburg Gos Un-ta. 2013; (4):102-4. (in Russ.)
Address for correspondence:
127486, The Russian Federation,
Moscow, Beskudnikovsky Boul., 59A,
S. Fyodorov Eye Microsurgery
Federal State Institution,
Department of the Retinal Laser Surgery,
Tel. mobile +79651896925,
Badma A. Normaev
Information about the authors:
Doga Alexander V., MD, Professor, Deputy General Director for Scientific and Clinical Work, S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation.
Buryakov Dmitry A., PhD, Junior Researcher of the Department of the Retinal Laser Surgery, S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation.
Normaev Badma A., Day-Time Post-Graduate Student of the Department of the Retinal Laser Surgery, S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation.




Ulyanovsk State University, Ulyanovsk, The Russian Federation

One of the ways to treat patients with open fractures and infected false joints of long tubular bones is intramedullary osteosynthes is with antimicrobial-coated nails. Among the possible complications of this type of osteosynthesisis the rarely encountered and little-lit migration of the antimicrobial coating of the nail.
A clinical case of treatment of a patient with chronic osteomyelitis of the femur is presented, the recurring course of which was caused by the presence of a cement mantle from an intramedullary nail with antimicrobial coating. With the aim of arresting the osteomyelitic process, radical debridement and removal of the cement mantle from the medullary canal were performed. To further "sterilize" the surgical wound, an ultrasonic cavitation of the wound in a solution of gentamicin was performed, as well as treatment with the pulse-lavage system. Additionally, muscular hernia of m. quadriceps femoris was eliminated by mobilizing and suturing the fascia lata. In order to control the sanitation of the medullary canal, the medulloscopy of the right femur was performed by a flexible video endoscope. The endoscope was introduced in the medullary canal through the exposed and treated osteomyelitiscavity in the middle third of the femur. The patient was examined 1.5 years after the operation. As a result of the treatment, a stable remission of chronic osteomyelitis had been achieved.
Medulloscopy of a long tubular bone is a promising method of quality control of surgical sanitation. Migration of cement mantle is a rare complication, which must be taken into account when implanting and removing the intramedullary nail with antimicrobial coating.

Keywords: medulloscopy, intramedullary nail with antimicrobial coating, cement mantle, osteomyelitis, fracture fixation
p. 491-495 of the original issue
  1. Gurin NN. Lechenie lozhnykh sustavov, oslozhnennykh osteomielitom. S-Petersburg, RF; 2004. 272 p.
  2. Shevtsov VI, Makushin VD, Pozharishchenskii KE. Lechenie bol’nykh s defektom bol’shebertsovoi kosti metodom rekonstruktivnoi tibializatsii malobertsovoi. Kurgan, RF: Periodika; 1994. 256 p.
  3. Ivanov PA, Sokolov VA, Byalik EI, Didenko OA, Nevedrov AV. Use of Intramedullar locking nails with active antibacterial coating for the treatment of severe open fractures and their complications. Vestn Travmatologii i Ortopedii im NN Priorova. 2009;(1):13-18.
  4. Kuropatkin GV, Akhtiamov IF. Kostnyi tsement v travmatologii i ortopedii. 2-e izd. Kazan’, RF: TaGraf; 2014. 188 s.
  5. Mendicino RW, Bowers CA, Catanzariti AR. Antibiotic-coated intramedullary rod. J Foot Ankle Surg. 2009 Mar-Apr;48(2):104-10. doi: 10.1053/j.jfas.2008.06.010
  6. Schnettler R, Steinau HU. Septic Bone and Joint Surgery. Thieme: Stuttgart; 2010. 328 p.
  7. Thonse R, Conway JD. Antibiotic cement-coated nails for the treatment of infected nonunions and segmental bone defects. JBJS. 2008 Nov;90(Is):163-74. doi: 10.2106/JBJS.H.00753
  8. Amiraslanov IuA, Svetukhin AM, Borisov IV, Ushakov AA. Surgical tactics in treatment of osteomyelitis of long bones. Khirurgiia Zhurn im NI Pirogova. 2008;(9):46-50.
  9. Zalavras CG, Singh A, Patzakis MJ. Novel technique for medullary canal débridement in tibia and femur osteomyelitis. Clin Orthop Relat Res. 2007 Aug;461:31-34. doi: 10.1097/BLO.0b013e318098673f
  10. Roberts CS, Walker JA, Statton J, Seligson D. Medulloscopy for sepsis or nonunion: early clinical experience with the tibia and femur. Arthroscopy. 2001 Nov-Dec;17(9):E39. doi: 10.1053/jars.2001.26920
  11. Kwak JH, Sim JA, Yang SH, Kim SJ, Lee BK, Ki YC. The use of medulloscopy for localized intramedullary lesions: review of 5 cases. Arthroscopy. 2009 Dec;25(12):1500-4. doi: 10.1016/j.arthro.2009.01.009
  12. Oberst M, Bosse A, Holz U. Intramedullary fracture reduction of long bone under visual control: experimental results of an endoscopic technique. Arthroscopy. 2006 Jun;22(6):686.e1-5. doi: 10.1016/j.arthro.2006.02.003
  13. Arora S, Maini L, Aggarwal V, Dhal A. Broken guidewire protruding into the hip joint: a bone endoscopic-assisted retrieval method. Indian J Orthop. 2012 Jan;46(1):109-12. doi: 10.4103/0019-5413.91646
  14. Roberts CS, Statton JO, Walker JA, Seligson D, Hempel D. Medulloscopy of the tibia: initial report of a new technique. Arthroscopy. 2000 Nov-Dec;16(8):865-68. doi: 10.1053/jars.2000.19651
  15. Oberst M, Bosse A, Holz U. Intramedullary pressure during endoscopy of the long bone: experimental results of a new endoscopic technique. Arthroscopy. 2004 May;20(5):552-55. doi: 10.1016/j.arthro.2004.03.013
Address for correspondence:
432017, The Russian Federation,
Ulyanovsk, Leo Tolstoy Str., 2,
Ulyanovsk State University,
Department of Hospital Surgery,
Tel.: +7 917 612 41 77,
Ivan M. Efremov
Information about the authors:
Efremov Ivan M., PhD, Senior Researcher, Department of Scientific Research, Associate Professor of the Department of Hospital Surgery, Anesthesiology, Reanimatology, Urology, Traumatology and Orthopedics, Ulyanovsk State University, Ulyanovsk, Russian Federation.
Sibaev Farid Ya., Laboratory Assistant Researcher of the Department of Scientific Research, Ulyanovsk State University, Ulyanovsk, Russian Federation.



West Kazakhstan Marat Ospanov State Medical University,
Aktobe, Kazakhstan

Objective. To assess diagnostic and therapeutic measures in rare malformation of the lungs of a newborn.
Methods. The clinical case of congenital cystic malformation of the lungs in a newborn is given. Clinical symptoms, diagnostics, intraoperative tactics, and postoperative management are described.
Results. The analysis of case history of a newborn with congenital lung malformation denotes the manifestation of respiratory distress syndrome in the first hours of a child’s life. Computed tomography (CT) of the lungs allowed not only to confirm the nature of the changes in the left lung, but also to clarify the localization of the lesion, the condition of not affected areas of the lung, the degree of mediastinum displacement, allowed to make a differential diagnosis with other congenital lung malformations. Removing the affected area of the left lung resulted in a decrease of respiratory failure, elimination of hemodynamic disorders and pulmonary hypertension.
Conclusions. Congenital cystic lung malformation is a rather rare malformation. But if malformation of the lung is not diagnosed during antenatal period, then its diagnostics from the first days of a child’s life could be not a simple task. The manifestation of respiratory distress syndrome in a child with the first days of life, the correct interpretation of the plan X-ray pictures of the chest, CT of the lungs allow to put diagnosis correctly and in proper time. The removal of a faulty lobe of the lung in the neonatal period is a pathogenetically justified method of treatment. In the postoperative period children require long-term follow-up.

Keywords: congenital malformation of the lung, cystic malformation of the lung, ñystic hypoplasia of the lung, respiratory distress syndrome, pneumothorax, diagnosis, surgical treatment
p. 496-501 of the original issue
  1. Karavaeva SA, Nemilova TK, Kotin AN, Patrikeeva TV, Starevskaya SV, Il’ina NA, Borisova NA. Diagnostics and treatment of congenital malformations of the lung and mediastinum in newborn children and infants. Vestn Khirurgii Im II Grekova. 2015;174(1):40-42. (in Russ.)
  2. Chikkannaiah P, Kangle R, Hawal M. Congenital cystic adenomatoid malformation of lung: Report of two cases with review of literature. Lung India. 2013 Jul-Sep;30(3):215-18. doi: 10.4103/0970-2113.116272
  3. Wilson RD, Hedrick HL, Liechty KW, Flake AW, Johnson MP, Bebbington M, Adzick NS. Cystic adenomatoid malformation of the lung: review of genetics, prenatal diagnosis, and in utero treatment. Am J Med Genet A. 2006 Jan 15;140(2):151-55. doi: 10.1002/ajmg.a.31031
  4. Stocker JT, Madewell JE, Drake RM. Congenital cystic adenomatoid malformation of the lung. Classification and morphologic spectrum. Hum Pathol. 1977 Mar;8(2):155-71. doi: 10.1016/S0046-8177(77)80078-6
  5. Galiagina N.A., Khaletskaia O.V. Iskhody vrozhdennykh kistoznykh mal’formatsii legkikh u detei i taktika ikh vedeniia v zavisimosti ot osobennostei klinicheskogo techeniia. Sovr Tekhnol v Meditsine. 2014;6(2):77-84. URL (in Russ.)
  6. Stashuk GA, Vishnyakova MV, Shcherbina VI, Zakharova MO. Congenital adenomatoid lung type 1 malformation in a newborn. Al’m Klin Meditsiny. 2015;(43):127-130. doi: 10.18786/2072-0505-2015-43-127-130 (in Russ.)
  7. Ilina NA. Modern methods of radiology in diagnostics congenital cystic adenomatoid malformation at newborns and children of early age. Med Vizualizatsiia. 2010;(2):88–95. URL: (in Russ.)
Address for correspondence:
030020, Kazakhstan,
Aktobe, Maresyev Str., 68,
West Kazakhstan Marat Ospanov
State Medical University,
Department of Pediatric Surgery,
Tel. mobile: 8-701-559-68-10,
Sagidulla P. Dosmagambetov
Information about the authors:
Dosmagambetov Sagidulla P., PhD, Associate Professor of the Department of Pediatric Surgery, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan.
Dzhenalaev Bulat Ê., MD, Professor of the Department of Pediatric Surgery, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan.
Bisaliev Baurzhan N., PhD, Associate Professor of the Department of Pediatric Surgery, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan.
Tusupkaliev Asylbek B., PhD, Associate Professor, Head of the Department of Pediatric Surgery, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan.
Batyrov Ashat, 3rd Year of Study Resident of the Department of Pediatric Surgery, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan.




Danylo Halytsky Lviv National Medical University 1,
Communal City Clinical Emergency Hospital 2, Lviv,

Objective. To analyze the results of providing aid to the victims with the heart injuries at the general surgery department.
Methods. The retrospective analysis of the treatment results of 21 victims with penetrating injuries of the heart has been performed. There were 5 (23.8%) patients with stable hemodynamic parameters, 11 (52.4%) – with unstable parameters, 5 (23.8%) were delivered to the hospital in the preagony state. According to the criteria of American Association of Surgery Trauma (AAST), the class I of heart injury was diagnosed in 4 (19%) of the victims, III – in 1 (4.8%), IV – in 5 (23.8%), V – 10 (47.6%), VI – in 1 (4.8%) cases. According to the localization of cardiac trauma the left ventricle was most often damaged – in 10 (47.6%) cases, the left atrium – in 6 (28.6%) and the right ventricle – in 5 (23.8%) cases.
Results. For the access to the heart in 20 patients, the anterolateral thoracotomy in the IV-V intercostal space was applied, only in one case, the bilateral thoracosternotomy («clamshell») was used. 7 (33%) patients died, the cause of death in 4 (19%) was the hemorrhagic shock due to massive blood loss, in 2 (9.5%) - cardiac tamponade, 1 (4.7%) patient died of acute myocardial infarction on the second day after the surgery. Overall postoperative mortality made up 33%. As the analysis demonstrates, the condition of the patient’s hemodynamics determines a differentiated approach to the corresponding diagnostic algorithm. The main method of treatment of heart injuries is emergent thoracotomy, temporary bleeding stop with subsequent suturing the wound of the heart against the background of resuscitation measures.
Conclusions. Survival rate of patients with heart injuries depends on the appropriate evacuation and medical measures at the prehospital stage, compliance with the organizational algorithm of providing medical care and qualification of medical personnel.

Keywords: heart injuries, pericardial wound, cardiac tamponade, hemodynamic stability, hemodynamic instability
p. 502-508 of the original issue
  1. Velinović M, Velimirović D, Vranes M, Djukić P, Mikić A, Putnik S, Savic D, Nikolic B. Heart injuries – still a challenge for cardiac surgery. Open Cardiovasc Thorac Surg J. 2009;2:38-42. doi: 10.2174/1876533500902010038
  2. Asensio JA, Stewart M, Murray J, Fox AH, Falabella A, Gomez H, Ortega A, Fuller CB, Kerstein MD. Penetrating cardiac injuries. Surg Clin North Am. 1996;76(4):685-24. doi: 10.1016/S0039-6109(05)70476-X
  3. Baram³ia NM, Roshchin GG, Vorobei OV, B³logrivenko SG, Zaruts’kii IaL, Nov³kov FM Panasenko S², V³tiuk TV, Kuz’min VIu, Gontarenko VO. Pronikn³ poranennia sertsia ³ perikarda. Ukra¿ns’kii Med Chasopis. 2001;(6):132-35. (in Ukrain.)
  4. Korolyov MP, Sagatinov RS, Urakcheev ShK, Pastukhova NK, Spesivtsev YuA, Mezentseva ES. Complications after cardiac injuries. Vestn Khirurgii im II Grekova. 2014;173(3):11-15. (in Russ.)
  5. Asensio JA, Ogun OA, Petrone P, Perez-Alonso AJ, Wagner M, Bertellotti R, Phillips B, Cornell DL, Udekwu AO. Penetrating cardiac injuries: predictive model for outcomes based on 2016 patients from the National Trauma Data Bank. Eur J Trauma Emerg Surg. 2017 Jun 3. doi: 10.1007/s00068-017-0806-6
  6. Morse BC, Mina MJ, Carr JS, Jhunjhunwala R, Dente CJ, Zink JU, Nicholas JM, Wyrzykowski AD, Salomone JP, Vercruysse GA, Rozycki GS, Feliciano DV. Penetrating cardiac injuries: A 36-year perspective at an urban, Level I trauma center. J Trauma Acute Care Surg. 2016 Oct;81(4):623-31. doi: 10.1097/TA.0000000000001165
  7. Byrne JP, Xiong W, Gomez D, Mason S, Karanicolas P, Rizoli S, Tien H, Nathens AB. Redefining «dead on arrival»: Identifying the unsalvageable patient for the purpose of performance improvement. J Trauma Acute Care Surg. 2015 Nov;79(5):850-57. doi: 10.1097/TA.0000000000000843
  8. Isaza-Respero A, Bolívar-Sáenz DJ, Tarazona-Lara M, Tovar JR Penetrating cardiac trauma: analysis of 240 cases from a hospital in Bogota, Colombia. World J Emerg Surg. 2017;12:26. doi: 10.1186/s13017-017-0138-1
  9. Firstenberg MS, ed. Principles and Practice of Cardiothoracic Surgery. InTech; 2013. 422 p. doi: 10.5772/56726
  10. Clancy K, Velopulos C, Bilaniuk JW, Collier B, Crowley W, Kurek S, Lui F, Nayduch D, Sangosanya A, Tucker B, Haut ER. Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012 Nov;73(5 Suppl 4):S301-6. doi: 10.1097/TA.0b013e318270193a
  11. Fedakar R, Türkmen N, Durak D, Gündoğmuş UN. Fatal traumatic heart wounds: review of 160 autopsy cases. Isr Med Assoc J. 2005 Aug;7(8):498-501.
  12. Tokur M, Ergin M, Kurkcuogluc C. Penetrating Heart Injuries and Common Difficulties Encountered During Emergency Surgery. J Curr Surg. 2012;2(3):89-95. doi: 10.4021/jcs86w
  13. Castriconi M, Festa P, Bartone G, Maglio MD, Vicenzo L, Papaleo D, Severino BU, Clemente M, Martino A. Penetrating cardiac injuries. Two case reports. Ann Ital Chir. 2013 Apr 24;84(ePub). pii: S2239253X13020987.
  14. Sanchez GP, Peng EW, Marks R, Sarkar PK. ‘Scoop and run’ strategy for a resuscitative sternotomy following unstable penetrating chest injury. Interact Cardiovasc Thorac Surg. 2010 Mar;10(3):467-8. doi: 10.1510/icvts.2009.219865
  15. El-Chami MF, Nicholson W, Helmy T. Blunt cardiac trauma. J Emerg Med. 2008 Aug;35(2):127-33. doi: 10.1016/j.jemermed.2007.03.018.
  16. Radchenko IuA., Abakumov MM, Vladimirova ES, Danielian ShN, Nikitina OV, Belozerov GE. Postoperative complications of heart and pericardial injuries. Khirurgiia Zhurn im NI Pirogova. 2013;(4):23-28. (in Russ.)
  17. Saranteas T, Mavrogenis AF, Mandila C, Poularas J, Panou F. Ultrasound in cardiac trauma. J Crit Care. 2017 Apr;38:144-51. doi: 10.1016/j.jcrc.2016.10.032
Address for correspondence:
79010, Ukraine,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv
National Medical University,
Department of Surgery and Endoscopy
of the Faculty of Post-Graduate Training,
tel. +38 067 977-36-68,
Volodymyr B. Bochar
Information about the authors:
Matviychuk Bohdan O., MD, Professor, Head of the Department of Surgery and Endoscopy of the Faculty of Post-Graduate Training, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
Holyk Yurij I., PhD, Assistant of the Department of Surgery and Endoscopy of the Faculty of Post-Graduate Training, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
Knysh Jaroslav M., PhD, Surgeon, the 1st Surgical Unit, Communal City Emergency Hospital, Lviv, Ukraine.
Bochar Volodymyr T., PhD, Associate Professor of the Department of Surgery and Endoscopy of the Faculty of Post-Graduate Training, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
Fedoryshyn Taras M., PhD, Surgeon, the 1st Surgical Unit, Communal City Emergency Hospital, Lviv, Ukraine.
Contacts | ©Vitebsk State Medical University, 2007-2023