Year 2020 Vol. 28 No 5

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

A.P. TRUKHAN 1, D.G. TERESHKO 2, T.A. LETKOVSKAYA 2

COMPARATIVE EVALUATION OF EFFECTIVITY OF THE INTRAPERITONEAL AND INTRAMUSCULAR ADMINISTRATION OF METHYLETHYL PYRIDINOL HYDROCHLORIDE (EMOXYPINE) IN TRAUMATIC DAMAGE OF EXTREMITY MUSCLES

432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus 1
Belorussian State Medical University 2, Minsk,
The Republic of Belarus

Objective. To evaluate the effectiveness of intraperitoneal and intramuscular administration of methylethylpyridinol hydrochloride (emoxypine) for traumatic injuries of the extremity muscles.
Methods. The studies were carried out on the white outbred rats (n=32). After the experimental animals were subjected to the ether anesthesia, the destruction of the striated muscles was achieved by compressing the gastrocnemius muscle in its middle third using a needle holder. 1 hour after the injury all animals underwent fasciotomy of the injured limb segment, anesthesia and emoxypine administration. The animals were divided into 4 groups (n=8 per group). To the first and third groups emoxypine was administered daily intraperitoneally once day, the second and fourth groups intramuscularly (paravulnary into the gastrocnemius muscle). The first and second groups of animals were withdrawn from the experiment on the third day, the third and fourth on the gerenth day. Subsequently, material was taken for the research, paraffin blocks were prepared and sections were made with hematoxylin and eosin staining. The assessment of morphological changes was carried out using the index of morphological changes in muscles.
Results. When assessing the severity of cell infiltration on the third day, statistically significant differences were determined in animals of the first and second groups for this indicator (U=11.5, p=0.0357). The index of morphological changes in muscles in the fourth group was 3.0 (2.5; 4.0) and significantly differed from the second (8.0 (6.0; 9.0); U=5.5, p=0, 0063). On the seventh day, the animals of the third and fourth groups also showed statistically significant differences (U=4.5, p=0.0046) in favor of intramuscular administration. Thus, on the third day with intramuscular administration of emoxypine, more pronounced cellular infiltration and less pronounced necrotic changes in the wound on the seventh day are observed, which leads to a faster wound process as a whole healing.
Conclusion. Intramuscular administration of emoxypine has a more pronounced therapeutic effect in traumatic injuries of limb muscles compared with intraperitoneal administration.

Keywords: muscle injury, antihypoxants, wound healing, reactive oxygen species, oxidative stress
p. 491-497 of the original issue
References
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Address for correspondence:
220034, Republic of Belarus,
Minsk, Azgur str., 4,
Belorussian State Medical University,
the Military Medical Faculty,
mobile tel.: 8-029-776-91-06,
e-mail:dmitriy-blr@mail.ru,
Tereshko Dmitry G.
Information about the authors:
Trukhan Alexey P., PhD, Associate Professor, Leading Surgeon of the Medical Unit of 432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-7422-8014.
Tereshko Dmitry G., Assistant of the Military Field Surgery of the Military Medical Faculty, the Military Medical Faculty, Belorussian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-0235-7498.
Letkovskaya Tatyana A., PhD, Associate Professor, Head of the Pathologic Anatomy Department, Belorussian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-9086-2867

D.I. VARFOLOMEEV, V.G. SAMODAY

ASSESSMENT OF HIP JOINT SPACER FOR TREATING PATIENTS WITH PERIPROSTHETIC INFECTION

Voronezh State Medical University named after N.N. Burdenko, Voronezh,
Russian Federation

Objective. Assessment of the possibility to use the developed spacer device while treating infectious complications after the hip replacement surgery.
Methods. The hip spacer has been developed to improve the outcomes of periprosthetic infection treatment. The spacer consists of the head, neck and a stem, made of bone cement. The carcass connected with the micropump is located inside it. The carcass is made in the form of four metal tubes which hold a liquid solution of drugs. The pump pistons are made of ferromagnet to interact with a magnet brought to the surface of the body. Drugs are released from the spacer under the external manetic field exposure in the postoperative period. The working spacer model was developed on the basis of the department of traumatology and orthopedics of Voronezh State Medical University named after N.N. Burdenko. Experimental studies on rabbits were conducted to evaluate the functionality of the spacer device. An implant containing Pyrogenalum solution was inserted in the abdominal cavity of animals under the intravenous anesthesia. In the test group the average temperature was estimated prior to and after the introduction of Pyrogenalum (under the magnetic field exposure).
Results. The temperature measured after the onset of the spacer operation differed trustworthy from those measured prior to the onset of the experiment (T-test 17.17, p<0.05). This can be explained by the inoculation of Pyrogenalum contained in the spacer into the blood of animals. Experimental studies demonstrated the possibility of drugs release from the spacer into the wound under the magnetic field exposure on the spacer.
Conclusion. The proposed implant allows increasing the volume and quantity of drugs released from it into the wound. Surgeons can non-invasively control the rate of drugs inoculated directly into blood of the periprosthetic space in postoperative period. This provides the required concentration of drugs to help eradicate infection.

Keywords: hip endoprosthesis, periprosthetic infection, bone cement spacer, revision endoprosthesis
p. 498-504 of the original issue
References
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  11. Atıcı T, Şahin N, Çavun S, Özakin C, Kaleli T. Antibiotic release and antibacterial efficacy in cement spacers and cement beads impregnated with different techniques: In vitro study. Eklem Hastalik Cerrahisi. 2018 Aug;29(2):71-78. doi: 10.5606/ehc.2018.59021
  12. Murylev VYu, Kukovenko GA, Elizarov PM, Ivanenko LR, Sorokina GL, Rukin YA, Alekseev SS, Germanov V.G. The first-stage treatment lgorithm for deep infected total hip arthroplasty.Traumatology and Orthopedics of Russia. 2018;24(4):95-104. doi: 10.21823/2311-2905-2018-24-4-95-104 (In Russ.)
  13. Marczak D, Synder M, Sibiński M, Polguj M, Dudka J, Kowalczewski J. Two stage revision hip arthroplasty in periprosthetic joint infection. Comparison study: with or without the use of a spacer. Int Orthop. 2017 Nov;41(11):2253-58. doi: 10.1007/s00264-017-3500-8
  14. Faschingbauer M, Reichel H, Bieger R, Kappe T. Mechanical complications with one hundred and thirty eight (antibiotic-laden) cement spacers in the treatment of periprosthetic infection after total hip arthroplasty. Int Orthop. 2015 May;39(5):989-94. doi: 10.1007/s00264-014-2636-z
  15. van Vugt TAG, Arts JJ, Geurts JAP. Antibiotic-loaded polymethylmethacrylate beads and spacers in treatment of orthopedic infections and the role of biofilm formation. Front Microbiol. 2019 Jul 25;10:1626. doi: 10.3389/fmicb.2019.01626. eCollection 2019.
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Address for correspondence:
394036, Russian Federation,
Voronezh, Studencheskaya str., 10,
Voronezh State Medical University
Named after N.N. Burdenko,
the Department of Traumatology and Orthopedics,
tel. +7 4732 57-96-67
e-mail: v_samoday@mail.ru,
Valery G. Samoday
Information about the authors:
Varfolomeev Denis I., Traumatologist-Orthopedist, Attendee of the Department of Traumatology and Orthopedics, Voronezh State Medical University Named after N.N. Burdenko, Voronezh, Russian Federation.
https://orcid.org/0000-0002-2133-6510
Samoday Valery G., MD, Professor, Head of the Department of Traumatology and Orthopedics, Voronezh State Medical University named after N.N. Burdenko, Voronezh, Russian Federation.
https://orcid.org/0000-0003-1414-0832

GENERAL & SPECIAL SURGERY

S.Y.GOROKHOVSKY 1, 2, A.A. LYZIKOV 1, M.L. KAPLAN 1, V.E. TIHMANOVICH 1

EXPEDIENCY AND OPTIONS FOR FUNCTIONAL CONTROL IN DETERMINING THE EXTENT OF SURGERY FOR OCCLUSIVE LESIONS OF THE LOWER EXTREMITY ARTERIES

Gomel State Medical University 1,
Gomel Regional Clinical Cardiology Center 2, Gomel,
Republic of Belarus

Objectives. To analyze and assess the efficiency of different strategies of the endovascular revascularization in patients with multilevel affection of lower extremity peripheral arteries based on angiographic and functional criteria.
Methods. The patients (n=114) with chronict multilevel of chronic lower extremity peripheral arteries were included in the study. The first group (n=60) comprised patients who underwent revascularization based on the angiographic criteria; the second one (n=40) included patients in whom the surgery was performed under both angiographic control and invasive intraoperative hemodynamic monitoring of the peripheral circulation; patients of the third group (n=14) were operated on the basis of peripheral fraction blood flow reserve (pFFR) determination in addition to the conventional angiography. Surgery results were assessed depending on value of ankle-brachial index (ABI); to compare the volume of intervention the estimated coefficient of revascularization was expressed as the ratio of the number of the treated segments to the number of affected ones.
Results. In all groups, the performed treatment resulted in the statistically significant (p<0,05) changes of ABI which was the evidence of therapy effectiveness. In the study groups ABI values after the operation amounted 0,8 (0,75; 0,8), 0,9 (0,8; 1) and 0,9 (0,9; 1), respectively, which is associated with a satisfactory result of treatment and prognosis of the disease. The given results were achieved in the presence of the statistically significant difference between groups in length of segments underwent angioplasty (mm) 170 (120; 200), 100 (80; 120) and 130 (115; 155), p=0,00007, stented segment length (mm) 100 (60; 145), 60 (40; 100), 40 (30;40), =0,00063 and revascularization coefficient: 1 (0,67; 1), 0,5 (0,5; 0,66) and 0,5 (0,5; 0,575), p<0,0001.
Conclusion. Methods of invasive functional assessment of the peripheral circulation in addition to the angiographic criteria allow reducing the volume of intervention with an optimal clinical result.

Keywords: chronic lower extremity ischemia, multilevel lesion, revascularization, angiography, hemodynamical monitoring
p. 505-514 of the original issue
References
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  2. Lotfi A, Jeremias A, Fearon WF, Feldman MD, Mehran R, Messenger JC, Grines CL, Dean LS, Kern MJ, Klein LW; Society of Cardiovascular Angiography and Interventions. Expert consensus statement on the use of fractional flow reserve, intravascular ultrasound, and optical coherence tomography: a consensus statement of the Society of Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv. 2014 Mar 1;83(4):509-18. doi: 10.1002/ccd.25222
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  4. Xaplanteris P, Fournier S, Pijls NHJ, Fearon WF, Barbato E, Tonino PAL, Engstrøm T, Kääb S, Dambrink JH, Rioufol G, Toth GG, Piroth Z, Witt N, Fröbert O, Kala P, Linke A, Jagic N, Mates M, Mavromatis K, Samady H, Irimpen A, Oldroyd K, Campo G, Rothenbühler M, Jüni P, De Bruyne B; FAME 2 Investigators. Five-year outcomes with pci guided by fractional flow reserve. N Engl J Med. 2018 Jul 19;379(3):250-59. doi: 10.1056/NEJMoa1803538
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Address for correspondence:
246046, Republic of Belarus,
Gomel, Meditsinskaya str., 4,
Gomel State Medical University,
Department of Surgical Diseases No1,
Tel./fax: +375 232 49-19-54
e-mail: surgery_1@gsmu.by
Gorokhovsky Sergey Yu.
Information about the authors:
Lyzikov Alexey A., MD, Professor, Head of the Department of Surgical Diseases No1 with the Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0003-0639-121X
Gorokhovsky Sergey Yu., Roentgen-Endovascular Surgeon, Head of the Interventional Radiology Ward, Gomel Regional Clinical Cardiology Center, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-0596-1391
Kaplan Mark L., PhD, Associate Professor of the Department of Surgical Diseases No1 with the Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0001-7782-3281
Tihmanovich Victor E., Assistant Lecturer of the Department of Surgical Diseases No1 with the Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-3486-9113

Z.B. KARDANAKHISHVILI 1, 2, A.B. ZULKARNAEV 1, V.V. ROGOZIN 3, V.A. STEPANOV 1

STENTING AND ISOLATED BALLOON ANGIOPLASTY FOR CENTRAL VENOUS STENOSIS IN PATIENTS UNDERGOING HEMODIALYSIS

Moscow Regional Research and Clinical Institute Named after M.F.Vladimirsky 1
M. E. Zhadkevich Moscow City Clinical Hospital of the Department of Health Care of Moscow 2
Moscow Hospital No2 for War Veterans of the Department of Health Care of Moscow 3, Moscow,
The Russian Federation

Objective. To carry out comparative analysis of the results of isolated balloon angioplasty (BA) and BA with stenting of the central venous stenosis (CVS) in patients undergoing hemodialysis .
Methods. A retrospective study included patients (n=62) with CVS. The isolated BA was performed in 39 patients. Stenting was added to isolated BA in 23 patients.
Results. Primary functional patency of the arteriovenous fistula after 1 and 3 years in the BA group was 89.7% [95%CI 74.9; 96] and 30.8% [95%CI 17.3; 45.4]; after stenting: 100% and 30.4% [95%CI 13.5; 49.3]; HR=0.8756 [95%CI 0.527; 1455], p=0.5994. Primary patency after 6 and 12 months in the BA group was 61.5% [95%CI 44.5; 74.7] and 15.4% [95%CI 6.2; 28.3]; after stenting: 82.6% [95%CI 60.1; 93.1] and 47.8% [95%CI 26.8; 66.1]; HR=0.4845 [95%CI 0.2938; 0.799], p=0.0017. Secondary functional patency after 1, 3 and 5 years in the BA group was 100%, 74.4% [95%CI 57.6; 85.3] and 12.8% [95%CI 4.7; 25.2]; after stenting: 100%, 91.3% [95%CI 69.5; 97.8] and 34.8% [95%CI 16.6; 53.7]; HR=0.4764 [95% CI 0.2888; 0.786], p=0.0016. Secondary patency after 6, 12 and 24 months in the BA group was 84.6% [95%CI 68.9; 92.8], 66.7% [95%CI 49.6; 79.1] and 17.9% [95%CI 7.9; 31.3]; after stenting: 91.3% [95%CI 69.5; 97.8], 78.3% [95%CI 55.4; 90.3] and 43.5% [95%CI 23.3; 62.1]; HR=0.4925 [95%CI 0.2988; 0.8119], p=0.0021. Correlation between primary functional patency and primary patency was r= -0.627; p<0.0001, between primary functional patency and secondary patency r= -0.53; p=0.0005 in the BA group; after stenting: r= -0.351; p=0.101 and r= -0.304; p=0.159, respectively.
Conclusion. The results of BA significantly depend on the stage stenosis. The use of stenting can slightly improve the results regardless the CVS terms.

Keywords: vascular access, central veinous stenosis, hemodialysis, chronic kidney disease, endovascular surgery, balloon angioplasty, stenting
p. 515-526 of the original issue
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  6. Schwab SJ, Quarles LD, Middleton JP, Cohan RH, Saeed M, Dennis VW. Hemodialysis-associated subclavian vein stenosis. Kidney Int. 1988 Jun;33(6):1156-59. doi: 10.1038/ki.1988.124
  7. Kouvelos GN, Spanos K, Antoniou GA, Vassilopoulos I, Karathanos C, Matsagkas MI, Giannoukas AD. Balloon angioplasty versus stenting for the treatment of failing arteriovenous grafts: a meta-analysis. Eur J Vasc Endovasc Surg. 2018 Feb;55(2):249-256. doi: 10.1016/j.ejvs.2017.11.011
  8. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, Haage P, Hamilton G, Hedin U, Kamper L, Lazarides MK, Lindsey B, Mestres G, Pegoraro M, Roy J, Setacci C, Shemesh D, Tordoir JHM, van Loon M, Esvs Guidelines Committee, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Naylor R, Vega de Ceniga M, Vermassen F, Verzini F, Esvs Guidelines Reviewers, Mohaupt M, Ricco JB, Roca-Tey R. Editors Choice Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018 Jun;55(6):757-18. doi: 10.1016/j.ejvs.2018.02.001
  9. Agarwal AK. Central vein stenosis. Am J Kidney Dis. 2013 Jun;61(6):1001-15. doi: 10.1053/j.ajkd.2012.10.024
  10. Stern AB, Klemmer PJ. High-output heart failure secondary to arteriovenous fistula. Hemodial Int. 2011 Jan;15(1):104-7. doi: 10.1111/j.1542-4758.2010.00518.x
  11. Browne LD, Bashar K, Griffin P, Kavanagh EG, Walsh SR, Walsh MT. The Role of Shear Stress in Arteriovenous Fistula Maturation and Failure: A Systematic Review. PLoS One. 2015 Dec 30;10(12):e0145795. doi: 10.1371/journal.pone.0145795. eCollection 2015.
  12. Oguzkurt L, Tercan F, Yildirim S, Torun D. Central venous stenosis in haemodialysis patients without a previous history of catheter placement. Eur J Radiol. 2005 Aug;55(2):237-42. doi: 10.1016/j.ejrad.2004.11.006
  13. Haskal ZJ, Saad TF, Hoggard JG, Cooper RI, Lipkowitz GS, Gerges A, Ross JR, Pflederer TA, Mietling SW. Prospective, randomized, concurrently-controlled study of a stent graft versus balloon angioplasty for treatment of arteriovenous access graft stenosis: 2-year results of the RENOVA study. J Vasc Interv Radiol. 2016 Aug;27(8):1105-14.e3. doi: 10.1016/j.jvir.2016.05.019
  14. Khawaja AZ, Cassidy DB, Al Shakarchi J, McGrogan DG, Inston NG, Jones RG. Systematic review of drug eluting balloon angioplasty for arteriovenous haemodialysis access stenosis. J Vasc Access. 2016 Mar-Apr;17(2):103-10. doi: 10.5301/jva.5000508
  15. Hongsakul K, Bannangkoon K, Rookkapan S, Boonsrirat U, Kritpracha B. Paclitaxel-coated balloon angioplasty for early restenosis of central veins in hemodialysis patients: a single center initial experience. Korean J Radiol. 2018 May-Jun;19(3):410-16. doi: 10.3348/kjr.2018.19.3.410
Address for correspondence:
129110, Russian Federation,
Moscow, Shchepkin str, 61/2, 6,
tel.: +7-916-705-98-99,
e-mail: 7059899@gmail.com,
Zulkarnaev Alexey B.
Information about the authors:
Kardanakhishvili Zurab B., Post-Graduate Student of the Department of Transplantation, Nephrology and Artificial Organs of the Faculty of Advanced Training, Moscow Regional Research and Clinical Institute named after M.F.Vladimirsky, Surgeon of the Department of Vascular Surgery, M. E. Zhadkevich Moscow City Clinical Hospital, Moscow, Russian Federation.
https://orcid.org/0000-0001-9739-6432
Zulkarnaev Alexey B., Leading Researcher, the Surgical Department of Kidney Transplantation, Moscow Regional Research and Clinical Institute Named after M.F.Vladimirsky, Moscow, Russian Federation.
https://0000-0001-5405-7887
Rogozin Vasily V., Surgeon of the Department of Vascular Surgery, Moscow Hospital No2 for War Veterans of the Department of Health Care of Moscow, Moscow, Russian Federation.
https://0000-0003-4870-6400
Stepanov Vadim A., Senior Researcher of the Surgical Department of Kidney Transplantation, Moscow Regional Research and Clinical Institute named after M.F.Vladimirsky, Moscow, Russian Federation.
https://0000-0002-0881-0599

V.E. FEDOROV, K.A. PODELYAKIN

SPECIFICITY OF THE CONFLICT "PATIENT-SURGEON"

Saratov State Medical University Named after V.I. Razumovsky, Saratov,
The Russian Federation

Objective. Analysis of the causes, nature of complaints against surgeons, studying of problems of protecting the professional activities of a physician.
Methods. According to information provided by the Territorial Authority to monitor the health service quality in Saratov Region, for the period of 2018 5 months of 2019, 1699 citizens complaints were received. 42 complaints were received regarding the quality of medical care in the medical institutions of the region in the surgery profile, which accounted for 9.3% of the total number of complaints.
Results. According to the information received, the most claims against surgeons was registered in Central Regional Hospitals (CRH) 10 (23.8%) complaints. The first place in terms of the number of complaints is taken by surgical departments of hospitals 16 (38.1%) cases, the second place outpatient clinics of the Central Regional Hospital and polyclinics [14 (33.3%) cases], the third place private clinics [7 (16.7 %) cases].
The essence of many complaints, first of all, consists in appealing for professional analysis of treatment case with an unfavorable outcome. In case of unsuccessful treatment, the majority of patients and their relatives most often [24 (57.1%) cases] demanded simply an examination of the treatment case and / or medical institution, and not criminal punishment. In 1 (2.4%) case, the patient simply wanted to report a problem related to the diagnosis and treatment of his disease. There was no information about any criminal punishment of the surgeons in the text of their complaints.
Conclusion. The surgeon-patient conflict in the form of a complaint is a structurally complex process with objective and subjective components that are influenced by a wide variety of risk factors. The growing discrepancy between the protection of a patient and a surgeon during the transfer of complaints to supervisory and legal authorities gradually increases the distortion of their analysis.

Keywords: surgery, medical error, conflict, law, complaint
p. 527-535 of the original issue
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  12. Shevtsova YuV, Emelina AV, Zaharova EA. To the issue about the conflicts between doctors and patients and psychological preparation of doctors for work. Med Alm. 2011;(5):36-39. ( In Russ.)
  13. Bobrov OE. Vrachebnaia oshibka ili professionalnoe nevezhestvo? Mify, illiuzii, realnost [Elektronnyi resurs]. TRIGGER. 2016 Mart 13 [data obrashcheniia: 2019 Okt 20]. Rezhim dostupa: https://trigger.in.ua/analitika/vrachebnaya-oshibka-ili-professionalnoe-nevezhestvo-mifyi-illyuzii-realnost.html (In Russ.)
Address for correspondence:
410012, Russian Federation,
Saratov, Bolshaya Kazachya str., 112,
Saratov State Medical University Named
after V.I. Razumovsky of the Ministry of Health,
the Department of Surgery and Oncology
tel. mobile: +7 937 969-59-53,
e-mail: nothingexcept@gmail.com
Podelyakin Konstantin A.
Information about the authors:
Fedorov Vladimir E., MD, Professor of the Department of Surgery and Oncology, Saratov State Medical University Named after V.I. Razumovsky, Saratov, Russian Federation.
https://orcid.org/0000-0003-4980-0829
Podelyakin Konstantin A., Resident of the Department of Surgery and Oncology, Saratov State Medical University Named after V.I. Razumovsky, Saratov, Russian Federation.
https://orcid.org/0000-0002-1583-3318

M.I. MIKHAILICHENKO, K.G. SHAPOVALOV, S.A. FIGURSKI, V.A. MUDROV, S.I. MIKHAILICHENKO

PERIPHERAL NEURODESTRUCTION IN PATIENTS WITH LOCAL COLD INJURY

Chita State Medical Academy, Chita,
The Russian Federation

Objective. To determine the peripheral neurofilament H level in patients and to evaluate the changes of bioelectrical muscle potentials of the affected persons in different periods of cryodamage.
Methods. The study included 30 patients. The victims were hospitalized to the regional thermal trauma center on the basis of the city hospital No1 in Chita with local cold injury of the distal segments of the feet in the period from 2018 to 2019. On the 5th and 30th days from the moment of injury the measurement of bioelectric activity was performed. The method of cutaneous electroneuromyography was used to assess the bioelectrical muscle activity. On the 5th and 30th days after cryotrauma the concentration of peripheral neurofilament H in the blood serum was determined by the IEA method using Vector-best reagents.
Results. On the 5th day from the moment of cryotrauma in the study group, the level of peripheral neurofilament was higher relative to the control indicators The amplitude of the M-response, the residual latency and the rate of propagation of excitation were significantly lower relative to the control. On the 30th day compared to the earlier period there was a reduction of the peripheral neurofilament level but the value remains higher than the control ones. At the same time, the studied electroneuromyography indicators elevated in comparison with the data in the early stages of cryotrauma, but they were still lower than the control group. An increase in neuromuscular activity was revealed in the victims relative to an earlier period of cryoinjury, which indicates the restoration of nerve conduction.
Conclusion. In patients with frostbite of II-IV degree, a sharp elevation in phosphorylated peripheral neurofilament was detected in the blood within different periods of cryodamage. At different times of local cold injury (II-IV degree) a reduction in the bioelectric activity of the muscles was observed. On the 30th day of complex treatment, relatively earlier period, the elevation of the bioelectrical muscle activity and a reduction of the level of neurophilament H were noted.

Keywords: local cold injury, peripheral neurodestruction, endothelial dysfunction, phosphorylated neurofilament N, violation of microcirculation
p. 536-542 of the original issue
References
  1. Mikhailichenko M.I., Shapovalov K.G. Microcirculatory disturbances in the pathogenesis of local cold injuries. Regional blood circulation and microcirculation. 2019;18(2):4-11. doi: 10.24884/1682-6655-2019-18-2-4-11 (In Russ.)
  2. Vinnik JuS, Jureva MJu, Tepljakova OV, Salmina AB, Tretjakova NG. Znachenie jendotelialnoj disfunkcii v patogeneze lokalnoj holodovoj travmy. RMZh. Med Obozrenie. 2014;22(31):2204-06. https://www.rmj.ru/articles/khirurgiy a/Znachenie_endotelialynoy _disfunkcii_v_patogeneze_lokalynoy_holodovoy_travmy/ (In Russ.)
  3. Shapkin JuG, Stekolnikov NJu, Gamzatova PK, Odnokozova JuS. Jendotelialnaja disfunkcija v otdaljonnom periode holodovoj travmy. Vestn Jeksperim i Klin Hirurgii. 2014;(4):359-63. https://elibrary.ru/item.asp?id=23435577/ (In Russ.)
  4. Metabolism in the hand tissues and functional microcirculation recourses in patients with sequelae of cold injury treated with the Ilizarov method. Genij Ortopedii. 2017;23(4):460-66. doi: 10.18019/1028-4427-2017-23-4-460-466 (In Russ.)
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  10. Vasina LV, Vlasov TD, Petrishchev NN. Functional heterogeneity of the endothelium (the review). Arterial Hypertension. 2017;23(2):88-102. doi: 10.18705/1607-419X-2017-23-2-88-102 (In Russ.)
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  12. Li H, Jia J, Min Xu, Zhang L. Changes in the blood-nerve barrier after sciatic nerve cold injury: indications supporting early treatment. Neural Regen Res. 2015 Mar; 10(3):419-24. doi: 10.4103/1673-5374.153690
  13. Kovrazhkina EA, Stahovskaya LV, Razinskaya OD. Axonal degeneration and secondary demyelization in the central and peripheral nervous system. Consilium Medicum. 2016;18(9):87-91. https://cyberleninka.ru/article/n/aksonalnaya-degeneratsiya-i-vtorichnaya-demielinizatsiya (In Russ.)
  14. Li H, Zhang L, Xu M. Dexamethasone prevents vascular damage in early-stage non-freezing cold injury of the sciatic nerve. Neural Regen Res. 2016 Jan;11(1):163-67. Doi: 10.4103/1673-5374.175064
Address for correspondence:
672000, Russian Federation,
Chita, Gorkii str., 39 .
Chita State Medical Academy,
the Department of Faculty Surgery
with the Course of Urology,
tel.: 8 9145 22 29 22,
e-mail: angelo999@yandex.ru,
Mikhailichenko Maxim I.
Information about the authors:
Mikhailichenko Maxim I., PhD, Assistant of the Department of Faculty Surgery with the Course of Urology, Chita State Medical Academy, Chita, Russian Federation.
https://orcid.org/0000-0001-8660-2982
Shapovalov Konstantin G., MD, Professor, Head of the Department of Anesthesiology, Resuscitation and Intensive Care, Chita State Medical Academy, Chita, Russian Federation.
https://orcid.org/0000-0002-3485-5176
Mudrov Victor A., PhD, Associate Professor of the Department of Obstetrics and Gynecology, the Medical Faculty, the Dental Faculty, Chita State Medical Academy, Chita, Russian Federation.
https://orcid.org/0000-0002-5961-5400
Figurski Sergei A., Clinical Resident of the Department of Faculty Surgery with the Course of Urology, Chita State Medical Academy, Chita, Russian Federation.
https://orcid.org/0000-0002-3959-9503
Mikhailichenko Sergei I., PhD, Cardiac Surgeon, the Main Out-Of-Staff Hospital Named after N.N. Burdenko, Moscow, Russian Federation
https://orcid.org/0000-0003-1156-9211

A.M. KUZMINOV 1, S.A. FROLOV 1, D.V. VYSHEGORODTSEV 1, V.YU. KOROLIK 1, N.V. TUKTAGULOV 1, M.A. SUKHINA 1, I.V. VOROBYEVA 2

THE FIRST EXPERIENCE OF LOW-TEMPERATURE ARGON PLASMA APPLICATION IN THE TREATMENT OF WOUNDS AFTER OPEN HEMORRHOIDECTOMY

A.N.Ryzhikh National Medical Research Center of Coloproctology of the Ministry of Health of Russia 1, Moscow,
N.F.Gamaleya Federal Research Center of Epidemiology and Microbiology 2, Moscow,
The Russian Federation

Objective. To study the effect of low-temperature argon plasma in the wound treatment after open hemorrhoidectomy.
Methods. The patients (n=30) with combined grade IV hemorrhoids were included in the study and ran-domized into the main and control groups. The age and gender in both groups were homogeneous.
Patients underwent the open hemorrhoidectomy using monopolar electrocoagulation during the postoperative period. Cold atmospheric plasma (CAP) was used as an addition physiotherapy in the main group. Cytological and bacteriological examination taken from the surface of the wound was carried out on days 2nd, 4th, 6th, 8th, 14th, 21st, 30th. Visual analogue scale (VAS, 0 to 10 points) was used to determine pain syndrome. Quality of life was assessed before surgery, on the 8th and 30th days since using the SF-36 questionnaire.
Results. By the 30th day, wound healing in the main group had occurred in 12/15 (80%) patients versus only 3/15 (20%) in the control group (p=0.003). On the 8th day after surgery the first signs of wound repair were determined in the main group, while only the signs of inflammation were detected in the control group according to the cytological study. On the 21st day the epithelial cells appeared in the main group versus wound repair process in the control group. On the 21st day the number of gram-negative bacteria was 105 versus 107 CFU, p<0.05, respectively) and the number of gram-positive bacteria was 107 CFU versus 108, (p>0.05) in the main and control groups, respectively. One established a t rialable difference in the microbial load of gram-negative bacteria in the CAP and control groups (105 versus 107 CFU, p<0.05, respectively). Microbial load of gram-positive bacteria in the CAP group was 107 CFU versus 108 in the control group (p>0.05). On the 6th day after surgery VAS score was 4 and 6 points, respectively (=0,01) in the main and control groups. Quality of life was measured on the 8th and 30th days after surgery. The reliable difference was found in the physical component assessment (p<0.05). There were no relevant differences in levels of psychological component between groups (p>0.05).
Conclusion. CAP application leads to accelerated wound healing and reduction of pain syndrome which has been observed.

Keywords: hemorrhoids, hemorrhoidectomy, cold argon plasma, plasma scalpel, plasma flow, wound healing
p. 543-550 of the original issue
References
  1. Shelygin JuA, Blagodarnyj LA, red. Spravochnik po koloproktologii. Moscow, RF: Littera; 2012. 596 p. (In Russ.)
  2. Chuangsuwanich A, Assadamongkol T, Boonyawan D. The Healing effect of low-temperature atmospheric-pressure plasma in pressure ulcer: a randomized controlled trial. Int J Low Extrem Wounds. 2016 Dec;15(4):313-19. doi: 10.1177/1534734616665046
  3. Shulutko AM, Kachikin AS, Yasnogorodsky OO, Aldykin MV, Gandybina EG, Semikov VI, Vinarskaya VA. The use of the plasmajet system in chest surgery. Moskov Hirurg Zhurn. 2011;(5):34-38. (In Russ.)
  4. Vorobev GI, Shelygin JuA, Blagodarnyj LA. Gemorroj: ruk. Moscow, RF: Littera; 2010. 200 p. (In Russ.)
  5. Kuzin MI. Rany i ranevaja infekcija: ruk dlja vrachej. Moscow: Medicina; 1990: 592 p. (In Russ.)
  6. Friedman G, Gutsol A, Shekhter AV, Vasilets VN, Fridman A. Applied plasma medicine. Plasma Process Polymers. 2008;5(6):503-33. doi: 10.1002/ppap.20070015
  7. Traba C, Liang JF. The inactivation of Staphylococcus aureus biofilms using low-power argon plasma in a layer-by-layer approach. Biofouling. 2015;31(1):39-48. doi: 10.1080/08927014.2014.995643
  8. Joshi SG, Cooper M, Yost A, Paff M, Ercan UK, Fridman G, Friedman G, Fridman A, Brooks AD. Nonthermal dielectric-barrier discharge plasma-induced inactivation involves oxidative DNA damage and membrane lipid peroxidation in Escherichia coli. Antimicrob Agents Chemother. 2011 Mar;55(3):1053-62. doi: 10.1128/AAC.01002-10
  9. Mai-Prochnow A, Clauson M, Hong J, Murphy AB. Gram positive and Gram negative bacteria differ in their sensitivity to cold plasma. Scientific Reports. 2016 Dec;6:38610. doi: 10.1038/srep3861
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  11. Moisan M, Barbeau J, Moreau S, Pelletier J, Tabrizian M, Yahia LH. Low-temperature sterilization using gas plasmas: a review of the experiments and an analysis of the inactivation mechanisms. Int J Pharm. 2001 Sep 11;226(1-2):1-21. doi: 10.1016/s0378-5173(01)00752-9
Address for correspondence:
123154,Russian Federation,
Moscow, Salyam Adil str., 2,
A.N. Ryzhikh National Medical
Research Center of Coloproctology
of the Ministry of Health of Russia,
Department of General Coloproctology
with a Group Studying Familial the Colon Adenomatosis,
tel.: 8 926 188-31-29,
e-mail: dr.tuktagulov@gmail.com,
Tuktagulov Nikita V.
Information about the authors:
Kuzminov Alexander M., MD, Professor, Head of the Department of General Coloproctology with a Group Studying Familial Colon Adenomatosis, A.N. Ryzhikh National Medical Research Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0002-7544-4752.
Frolov Sergey A., MD, Deputy Director, A.N. Ryzhikh National Medical Research Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0002-4697-2839.
Vyshegorodtsev Dmitry V., PhD, Senior Researcher of the Department of General Coloproctology with a Group Studying Familial Colon Adenomatosis, A.N. Ryzhikh National Medical Research Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0001-6679-1843
Korolik Vyacheslav Yu., PhD, Researcher of the Department of General Coloproctology with a Group Studying Familial Colon Adenomatosis, A.N. Ryzhikh National Medical Research Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0003-2619-5929
Tuktagulov Nikita V., Post-Graduate Student of the Coloproctology Department, A.N. Ryzhikh National Medical Research Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0001-7823-8770
Sukhina Marina A., PhD, Head of the Department of Studying Microbiological and Immunological Researches, A.N. Ryzhikh National Medical Research Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0003-4795-0751.
Vorojebva Irina V., PhD, Senior Researcher, N.F.Gamaleya Federal Research Center of Epidemiology and Microbiology, Moscow, Russian Federation.
https://orcid.org/0000-0003-1153-4510

UROLOGY

S.S. DUNAEVSKAYA, YU.S. VINNIK, A.G. BEREZHNOI

FEATURES OF ENDOTHELIAL DYSFUNCTION IN THE DEVELOPMENT OF HEMORRHAGIC COMPLICATIONS IN PATIENTS WITH UROLITHIASIS IN THE POSTOPERATIVE PERIOD

Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk,
The Russian Federation

Objective. To identify features of the endothelial dysfunction in the development of postoperative hemorrhagic complications in patients with urolytiasis.
Methods. A study of patients (n=174) with urolithiasis was conducted. Patients were divided into two clinical groups: group I 93 patients, with an uncomplicated postoperative course; group II 81 patients with the developed hemorrhagic complications. In the preoperative period and 3 days after the operation, the expression of CD38 and CD31 on lymphocytes was evaluated; counting the number of membranes of released microparticles, and also estimating blebbing of peripheral blood lymphocytes.
Results. In the preoperative period, an increase in expression of CD 38 and CD 31 lymphocytes was recorded, it was more pronounced in the II clinical group. In patients of clinical group I, the number of lymphocytes in the initial and terminal blebbing state was within the mean values of the control group. In clinical group II, there was a significant increase in these indicators. The number of free lymphocyte-derived microparticles in the peripheral blood of patients was statistically increased in clinical group II and was 874 [643; 1095]. Analyzing the data obtained in the postoperative period, a statistically significant increase in expression of CD 38 and CD 31 lymphocytes prevailing in the II clinical group was revealed, the number of lymphocytes with an initial blebbing state was increased (7.61 and 9.26, respectively). The end-state blebbing lymphocyte score was increased in both clinical groups (8.55 and 19.17, respectively).
Conclusion. Thus, the endothelial insufficiency develops inpatients uitiurolithiasis in the postoperative period patients with urolithiasis. However, in the development of hemorrhagic complications, the mechanism and expression of intercellular communication in the pathogenesis of endothelium dysfunction formation is considered to be significantly different, which should be taken into account in the course of operative treatment and administration of hemostatic therapy in the early postoperative period.

Keywords: urolytiasis, hemorrhagic complications, endothelial dysfunction, blebbing, membranes released microparticles
p. 551-557 of the original issue
References
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Address for correspondence:
660077, Russian Federation,
Krasnoyarsk, Partizan Zheleznyak str., 1,
Voino-Yasenetsky Krasnoyarsk
State Medical University,
the General Surgery Department
Named after pr. M.I. Gulman,
tel. office:+963-191-29-70,
e-mail: Vikto-potapenk@yandex.ru,
Dunaevskaya Svetlana S.
Information about the authors:
Dunaevskaya Svetlana S., MD, Professor, the General Surgery Department Named after pr. M.I. Gulman, Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation.
http://orcid.org/0000-0003-2820-4737
Vinnik Yurii S., MD, Professor, Head of the General Surgery Department Named after pr.M.I.Gulman, Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation.
http://orcid.org/0000-0002-8995-2862
Berezhnoi Alexandr G., PhD, Associate Professor of the Department of Urology, Andrology and Sexology, Institute of Post-Educational Training, Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation.
https://orcid.org/0000-0002-7487-8671.

ANESTHESIOLOGY-REANIMATOLOGY

.V.MAROCHKOV 1, 3, A.L. LIPNITSKI 1, 3, D.S. TSOPAU 2, I.A. KUPREYEVA 1, V.U. DAZORTSAVA 1

FEATURES OF PLATELET AGGREGATION IN PATIENTS WITH COVID-19 INFECTION. PRELIMINARY RESULTS

Mogilev Regional Clinical Hospital 1,
Mogilev Hospital No1 2, Mogilev,
Vitebsk State Medical University 3, Vitebsk ,
The Republic of Belarus

Objectives. To determine changes in platelet aggregation during intensive care of critically ill patients with COVID-19 infection.
Methods. A pilot non-randomized prospective clinical study of platelet aggregation in patients admitted to the intensive care unit with acute respiratory distress syndrome with the diagnosis of COVID-19 (group 1, n=15) was carried out. A control group (group 2, n=15) included healthy people who have ambulatory study of platelet aggregation. In the 1st-3d days of hospitalization at the intensive care blood sampling was carried out in the group 1. The study was performed on a platelet aggregation analyzer AR 2110 (ZAO SOLAR, Republic of Belarus).
Results. When platelet aggregation was induced by high doses of ADP (1.25 and 2.5 μg/ml), a lower degree of aggregation was observed in patients with COVID-19 (58.7 (34.2; 63.2)% and 66.5 (59.6; 70.9)% vs 67.2 (64.1; 70.3)% and 77.5 (71.8; 80.3)% in group 2, respectively, (p<0.05)), which occurred significantly faster (161.5 (103; 214) s and 197 (127; 309) s compared to 413 (325; 465) s and 362.5 (296.5; 422) s in group 2, respectively, (p<0.05)). With the inducer adrenaline at doses of 2.5 and 5 μM the degree of aggregation was also significantly lower in patients with COVID-19 (40.8 (26.1; 63.9)% and 38.7 (29.4; 66.8 )%, respectively). Single-phase irreversible platelet aggregation with an aggregation degree of 75.2 (71.9; 83.2) % was observed with a collagen inducer in patients with COVID-19 infection.
Conclusion. The degree of platelet aggregation with ADP and adrenaline was significantly reduced in patients with COVID-19 infection due to receiving anticoagulant and antiplatelet therapy (by main and concomitant pathologies).

Keywords: platelet aggregation, Covid-19, SARS-CoV-2, platelets, platelet aggregation, hypercoagulation, coagulation balance
p. 558-564 of the original issue
References
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Address for correspondence:
212016, Republic of Belarus,
Mogilev, Belynickij-Biruli str., 12,
Mogilev Regional Clinical Hospital,
the Department for Coordinating
the Collection of Organs and Tissues
for Transplantation,
tel.: +375 222 62-75-95,
e-mail:Lipnitski.al@gmail.com,
Lipnitski Artur Leonidovich
Information about the authors:
Marochkov Alexey V., MD, Professor, Anesthesiologist-Resuscitator, the Intensive Care Unit, Mogilev Regional Clinical Hospital, the Affiliate of the Department of Anesthesiology and Reanimatology with the Course of the Faculty of Advanced Training and Retraining of Specialists and the Surgery Department of the Faculty of Advanced Training and Retraining of Specialists, Vitebsk State Medical University, Mogilev, Republic of Belarus.
https://orcid.org/0000-0001-5092-8315
Lipnitski Artur L., PhD, Anesthesiologist-Resuscitator, Head of the Department for Coordinating the Collection of Organs and Tissues intended for Transplantation, Mogilev Regional Clinical Hospital, the Affiliate of the Department of Anesthesiology and Reanimatology, with the Course of the Faculty of Advanced Training and Retraining of Specialists and the Surgery Department of the Faculty of Advanced Training and Retraining of Specialists, Vitebsk State Medical University, Mogilev, Republic of Belarus.
https://orcid.org/0000-0002-2556-4801
Tsopau Dmitry S., Anesthesiologist-Resuscitator, the Intensive Care Unit, Mogilev Hospital No1, Mogilev, Republic of Belarus.
https://orcid.org/0000-0001-8286-0036;
Kupreyeva Irina A., Head of the Centralized Laboratory of Clinical Biochemistry, Mogilev Regional Clinical Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0002-5745-1203
Dazortsava Olga V., Physician of Laboratory Diagnostics of the Centralized Laboratory of Clinical Biochemistry, Mogilev Regional Clinical Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0002-4059-8321

LECTURES, REVIEWS

I.A. KRYVORUCHKO, T.M. FIRSYK

MODERN MINIMALLY INVASIVE SPHINCTER-SPARING TECHNIQUES OF SURGICAL TREATMENT OF ANAL FISTULAS

Kharkov National Medical University of the Ministry of Health of Ukraine, Kharkov,
Ukraine

Many surgical treatment techniques of anal fistulas are not effective enough, since many of them negatively affect the quality of life of operated patients due to the development of partial or complete disorders including functional urinary and fecal incontinence and accompanied by a significant percentage of recurrent fistulas. Therefore usually requires a repeat operation. There are a number of publications and recommendations for the treatment of rectal fistulas, but many of them are controversial, making practical treatment decisions extremely difficult. Trying to achieve three main aims of treatment (closing the fistula, preserving the sphincter function and minimizing the healing time), various minimally invasive methods of preserving the sphincter have been proposed over the past decades: such as endorectal flap advancement, intrafistular injection of fibrin glue, or the insertion of hermetic swabs, injection of autologous stem cells in the fistulous tract, ligation of the intersphincteric fistula tract (LIFT), video-assisted anal fistula treatment and other techniques. Despite such a large arsenal of the proposed minimally invasive technologies in the treatment of anal fistulas, many unclear questions still remain concerning adapting the existing surgical options to more complex clinical cases.

Keywords: anal fistulas, minimally invasive methods of treatment, recommendations, advantages, disadvantages
p. 565-576 of the original issue
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Address for correspondence:
61022, Ukraine, Kharkov,
Nauki av., 4
Kharkov National Medical University
of the Ministry of Health of Ukraine,
the Surgery Department No2,
tel.: +38-050-301-90-90,
e-mail:ikryvoruchko60@gmail.com
Kryvoruchko Igor A.
Information about the authors:
Kryvoruchko IgorA., MD, Professor, Head of the Surgery Department No2, Kharkov National Medical University of the Ministry of Health of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0002-5525-701
Firsyk Tetiana M., Post-Graduate Student of the Surgery Departmet No2, Kharkov National Medical University of the Ministry of Health of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-6823-7416

R.N. KOMAROV, N.O. KURASOV, A.M. ISMAILBAEV, A.O. DANACHEV

SYNDROME OF PERICARDIAL EXTENSION AND CARDIAC TAMPONADE AFTER OPEN CARDIOSURGICAL INTERVENTIONS

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

Postoperative effusion in the pericardium, which is also defined as postpericardial syndrome, is a common complication after open heart surgery. This condition directly affects the duration of hospitalization and the costs spent on treatment, and can also lead to life-threatening complications. Postoperative effusion in the pericardium can vary from slight (66-84%) to severe, defined as a cardiac tamponade (2.6%). The aim of this review is to consider etiopathogenesis, major risk factors, prevention and treatment of postoperative pericardial effusion. The development of cardiac tamponade is directly correlated with the type of intervention: 1.3% after coronary artery bypass graft, 6.6% after 1 valve replacement, 4.3% after several valves replacement, 2.5% after combined valve replacement and coronary artery bypass graft, 9.3% after thoracic aorta surgeries. The highest risk for developing cardiac tamponade accompanies patients after heart transplantation, interventions on the thoracic aorta and mechanical valve prosthetics. A proven and effective drug treatment strategy for the postoperative pericardial effusion syndrome is a combination of NSAIDs and colchicine. The posterior pericardiotomy is an effective and safe method for the prevention of this complication, and the most priority way to treat cardiac tamponade is echocardiographically controlled pericardiocentesis.

Keywords: postoperative pericardial effusion, postpericardiotomy syndrome, cardiac tamponade, posterior pericardiotomy, pericardiocentesis
p. 577-590 of the original issue
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Address for correspondence:
119435, Russian Federation,
Moscow, Bolshaya Pirogovskaya str., 6-1,
I.M. Sechenov First Moscow
State Medical University,
the Faculty Surgery Department No1,
tel. +7 926 816-47-37,
e-mail: danachev@gmail.com,
Danachev Alexander O.
Information about the authors:
Komarov Roman N., MD, Head of the Faculty Surgery Department No1, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-3904-6415
Kurasov Nikolay O., Assistant of the Faculty Surgery Dpartment No1, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-6269-2207
Ismailbaev Alisher M., PhD, Assistant of the Faculty Surgery Department No1, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-8545-3276
Danachev Alexander O., the Three-Year Post-Graduate Student, the Faculty Surgery Department No1, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-9296-3119

CASE REPORTS

L.P. KOTELNIKOVA 1, 2, A.N. FEDACHUK 2, A.V. SHVAREV 2

EXPERIENCE IN THE TREATMENT OF LATE MECHANICAL SUTURE FAILURE AFTER LONGITUDINAL LAPAROSCOPIC SLEEVE GASTRECTOMY USING MINIMALLY INVASIVE TECHNIQUES

E.A.Vagner Perm State Medical University 1,
Perm Regional Clinical Hospitall 2, Perm,
The Russian Federation

Over the last decade laparoscopic sleeve gastrectomy has taken a leading position among bariatric operations. The failure of the mechanical suture of the gastric stump is considered to be the most severe complication in the postoperative period. The purpose of this report is to demonstrate a case of successful treatment of the late leakage of the gastric sleeve staple line with interventional methods. A 56-year-old patient with a body mass index of 50 underwent laparoscopic sleeve gastrectomy using a 36 Fr calibration probe. Check of the mechanical staple line for leak-tightness was carried out by the introduction of 150 ml of liquid colored methylene blue. On the 12th day after the operation computed tomography revealed suture incompetence. X-ray stomach examination was conducted twice, it was impossible to detect swelling of the contrast agent. To close the site of leakage, a fully covered self-expanding stent was installed endoscopically, and the zone of abscess was drained by relaparoscopy. When the stent removed below the cardiac pulp, it was reinstalled. After 4 weeks the fistula closed, and no swelling was detected on CT. The stent was removed and the patient was discharged from hospital in satisfactory condition.

Keywords: laparoscopic sleeve gastrectomy, leakage, self-expanding stent
p. 591-596 of the original issue
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Address for correspondence:
614000, Russian Federation,
Perm, Kuybyshev str., 43,
E.A. Vagner Perm State Medical University,
the Surgery Department with the Course
of the Cardiovascular Surgery
and Invasive Cardiology,
tel.: +7902 83 569 65,
e-mail: splaksin@mail.ru,
Kotelnikova Ludmila P.
Information about the authors:
Kotelnikova Liudmila P., MD, Professor, Head of the Surgery Department with the Course of the Cardiovascular Surgery and Invasive Cardiology, E.A.Vagner Perm State Medical University, Perm, Russian Federation.
https://orcid.org/0000-0002-8602-1405
Fedachuk Alexey N., PhD, Surgeon of the 1st Surgical Unit, Perm Regional Clinical Hospital, Perm, Russian Federation.
https://orcid.org/000-0001-5756-8981
Sharev Andrey V., Endoscopist, Head of the Endoscopy Unit, Perm Regional Clinical Hospital, Perm, Russian Federation
https://orcid.org/0000-0002-2853-7040

I. VYNNYCHENKO 1, M. KONONENKO 1, O. SMORODSKA 1, 2, S. IVANOV 2, Y. MOSKALENKO 1, O. VYNNYCHENKO 1, V. SIKORA 1, M. LYNDIN 1, A. ROMANIUK 1

CASE REPORT OF GIANT NONMETASTATIC GASTROINTESTINAL SOLID TUMOR WITHOUT CLINICAL MANIFESTATIONS IN A MIDDLE-AGED MALE PATIENT

Sumy State University 1,
Utility Non-Profit Enterprise Clinical Hospital No5 of Sumy Municipal Council 2, Sumy,
Ukraine

Gastrointestinal stromal tumors (GIST) are one of the most common mesenchymal tumors that originate from the intestinal cells of Cajal. The most common localization of GIST is the gastrointestinal tract, however, extragastrointestinal forms are sometimes found. Most GISTs are small in size, which most often does not exceed 5 - 8 cm in maximum dimension. This article describes the case of a patient with a non-metastatic giant tumor of the stomach without any clinical manifestations. The tumor was localized in the abdominal cavity, occupying almost all of it, squeezing and displacing the surrounding organs. Due to the cystic-solid structure, its gigantic size and intimate adherence to the surrounding organs, it was not possible to carry out an accurate differential diagnosis before surgery. Intraoperative imaging of the tumor, further histological and immunohistochemical (CD117, CD34, S100, CD45, PanCK; Ki-67) studies made possible to establish the diagnosis of gastric GIST T4N0M0 stage II. Based on the data obtained, despite the gigantic size, the prognosis of the disease was considered favorable (low mitotic index, no metastasis). During the period of clinical observation, within 1.5 years after surgery, no relapse or disease progression was recorded, which indicates a favorable prognosis for the patient.

Keywords: gastric tumor, gastrointestinal stromal tumor, giant tumor, operative treatment
p. 597-602 of the original issue
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Address for correspondence:
40022, Ukraine,
Sumy, Privokzalnaya str., 31,
Medical Institute of Sumy State
Medical University, the Department
of Oncology and Radiology,
tel.: +38 095 8 000 489,
e-mail: smorodska1991@gmail.com,
Smorodska Olga N.
Information about the authors:
Vynnychenko Ihor A., PhD, Associate Professor, Head of the Department of Oncology and Radiology, Medical Institute of Sumy State Medical University, Sumy, Ukraine.
http://orcid.org/0000-0002-2339-6509
Kononenko Mykola G., MD, Professor of the Surgery Department, Medical Institute of Sumy State Medical University, Sumy, Ukraine.
http://orcid.org/0000-0003-3068-1751
Smorodska Olga N., Post-Graduate Student of the Department of Oncology and Radiology, Medical Institute of Sumy State Medical University, Surgeon, Clinical Hospital No5, Sumy, Ukraine.
http://orcid.org/0000-0002-9028-3379
Ivanov StanislavS., Surgeon, Clinical Hospital No5, Sumy, Ukraine.
http://orcid.org/0000-0001-8897-0041
MoskalenkoYuliia V., PhD, Assistant of the Department of Oncology and Radiology, Medical Institute of Sumy State Medical University, Sumy, Ukraine.
http://orcid.org/0000-0002-5398-0298
Vynnychenko Oleksandr I., PhD, Assistant of the Department of Oncology and Radiology, Medical Institute of Sumy State Medical University, Sumy, Ukraine.
http://orcid.org/0000-0001-5651-0323
Sikora Vladyslav V., PhD, Assistant of the Pathologic Anatomy Department, Medical Institute of Sumy State Medical University, Sumy, Ukraine.
http://orcid.org/0000-0002-4147-6879
Lyndin Mykola S., PhD, Assistant of the Pathologic Anatomy Department, Medical Institute of Sumy State Medical University, Sumy, Ukraine.
http://orcid.org/0000-0003-4385-3903
Romaniuk Anatolii N., MD, Professor, Head of the Pathologic Anatomy Department, Medical Institute of Sumy State Medical University, Sumy, Ukraine.
http://orcid.org/0000-0003-2560-1382
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