Year 2022 Vol. 30 No 3

SCIENTIFIC PUBLICATIONS

E.E. ABDUROZIKOV 1, O.N. DZHIOEVA 2, 3, V.A. SHVARTZ 4, A.R. KISELEV 2, E.A. ROGOZHKINA 1, O.M. DRAPKINA 2

PREDICTORS OF MORTALITY AND POSTOPERATIVE ATRIAL FIBRILLATION AFTER NON-CARDIAC SURGERY

State Budgetary Health Institution, City Clinical Hospital
named after V.V. Veresaev of the Department of Health of Moscow 1,
"National Medical Research Center for Therapy and Preventive Medicine"
of the Ministry of Health of Russian Federation 2,
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
of the Ministry of Health of Russian Federation 3,
National Medical Research Center for Cardiovascular Surgery named after A.N. Bakulev
of the Ministry of Health of Russian Federation 4, Moscow,
Russian Federation

Objective. This paper specifically focuses on the study of determination of the predictors associated with the development of postoperative atrial fibrillation (POAF) and mortality rate after major abdominal non-cardiac surgical interventions.
Methods. The methodology Case-control study has been used. The study included 226 patients: 83 - with a fatal outcome (cases) and 143 without a fatal outcome (control group).
Results. Independent predictors increasing risk of POAF developing were considered to be the followings: myocardial infarction in the anamnesis (MI) (OR 4.7, CI 2.2-10.1), cardiac arrhythmias (OR 5.0, CI 2.5-10.3), chronic kidney disease (CKD) (OR 8.7, CI 4.6-16.5), congestive heart failure (CHF) (OR 9.9, CI 5.2-19.1), diabetes (OR 4.0, CI 2-8), chronic obstructive pulmonary disease (COPD) (OR 8.6, CI 1.7-42.3), intraoperative infusion of more than 3 liters (OR 3.4, CI 1.6-7,4). Independent predictors increasing the risk of mortality rate were the followings: cardiac arrhythmias in the anamnesis (OR 3,4, CI 1.7-6,9), CKD (OR 248, CI 80-764), CHF 2-3 class (OR 6,8, CI 3,7-12,6), diabetes (OR 4.9, CI 2.3-9,6), COPD (OR CI 6,5, 1,3-32), intraoperative infusion of more than 3 liters (OR 2.9, CI 1.46-5.7), post-surgery fluid therapy of 3-5 liters (OR 2,9 1,6-5,0), POAF (OR 14,8, CI 7,4-29,4), thromboembolic complications (OR 37,9, CI 8,7-164). Age (>72 years) was statistically significant (p<0.001) was associated with POAF and with mortality rate.
Conclusion. In abdominal non-cardiac surgical interventions. the development of POAF is a common complication of cardiac surgery. In patients with POAF, the risk of in-hospital mortality is significantly higher. Independent factors that increase the risk of mortality rate and POAF are largely similar and in this study were the followings: myocardial infarction in the anamnesis, heart rate variabily, chronic heart failure, chronic renal failure, diabetes, chronic obstructive pulmonary disease, as well as relaporotomy, inflammation and pneumonia. The quantitative component of the extra volume of infusion therapy associated with perioperative complications was also recorded.

Keywords: postoperative atrial fibrillation, new onset atrial fibrillation, non-cardiac surgery, cardiovascular complications, mortality, surgery, inflammation
p. 245-254 of the original issue
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  6. Liu MH, Chiou AF, Wang CH, Yu WP, Lin MH. Relationship of symptom stress, care needs, social support, and meaning in life to quality of life in patients with heart failure from the acute to chronic stages: a longitudinal study. Health Qual Life Outcomes. 2021 Nov 6;19(1):252. doi: 10.1186/s12955-021-01885-8
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  8. Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, Ford I, Gonzalez-Juanatey JR, Gorenek B, Heyndrickx GR, Hoeft A, Huber K, Iung B, Kjeldsen KP, Longrois D, Lüscher TF, Pierard L, Pocock S, Price S, Roffi M, Sirnes PA, Sousa-Uva M, Voudris V, Funck-Brentano C; Authors/Task Force Members. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014 Sep 14;35(35):2383-431. doi: 10.1093/eurheartj/ehu282
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Address for correspondence:
Russian Federation, Moscow,
Rublevskoe highway 135,
Federal State Budgetary Institution National Medical
Research Center for Cardiovascular Surgery named
after N.N. A.N. Bakulev of the Ministry of Health
of Russian Federation.. Department of Surgical
Treatment of Interactive Pathology,
Tel. +79032619292
e-mail: shvartz.va@ya.ru
Shvartz Vladimir A.
Information about the authors:
Abdurozikov Eldor E., Physician of Functional Diagnostics, State Budgetary Health Institution, City Clinical Hospita named after V.V. Veresaev of the Department of Health of Moscow, Moscow, Russian Federation
https://orcid.org/0000-0002-5276-4032
Dzhioeva Olga N., MD, Senior Researcher, Department of Fundamental and Applied Aspects of Obesity, Federal State Budgetary Institution National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia; Associate Professor, Department of Therapy and Preventive Medicine, Federal State Budgetary Institution of Higher Education, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov of the Ministry of Health of Russian Federation, Moscow, Russian Federation
https://orcid.org/0000-0002-5384-3795
Shvartz Vladimir A., MD, Researcher at the Department of Surgical Treatment of Interactive Pathology, Associate Professor of the Department of Cardiovascular Surgery with a Course in Arrhythmology and Clinical Electrophysiology, Federal State Budgetary Institution National Medical Research Center for Cardiovascular Surgery named after A.N. Bakulev of the Ministry of Health of Russian Federation,. Moscow, Russian Federation
https://orcid.org/0000-0002-8931-0376
Kiselev Anton R., MD, Head of the Center for the Coordination of Fundamental Scientific Activities, Federal State Budgetary Institution National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia, Moscow, Russian Federation
https://orcid.org/0000-0003-3967-3950
Rogozhkina Elizaveta A., Trainee Physician, City Clinical Hospital Named after V.V. Veresaev of the Department of Health of Moscow, Moscow, Russian Federation.
https://orcid.org/0000-0001-8993-7892
Drapkina Oksana M., Corresponding Member RAS, MD, Professor, Director Federal State Budgetary Institution National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russian Federation, Head of the Department of Therapy and Preventive Medicine of Federal State Budgetary Institution of Higher Education, Moscow State University of Medicine and Dentistry Named after A.I. Evdokimov of the Ministry of Health of Russian Federaration, Moscow, Russian Federation.
https://orcid.org/0000-0002-4453-8430

R.E. KALININ, I.A. SUCHKOV, V.O. POVAROV, N.D. MZHAVANADZE, O.N. ZHURINA

THE STATE OF PRIMARY HEMOSTASIS IN PATIENTS WITH PACEMAKERS IN THE EARLY POSTOPERATIVE PERIOD<

Ryazan State Medical University, Ryazan,
Russian Federation

Objective. To assess dynamics of primary hemostasis markers in patients with pacemakers (PM) in the early postoperative period. Methods. The study included 94 patients (49 men) with an average age of 72 (67-81) years with indications for pacemaker implantation. 43 patients (45.7%) were underwent management of antiplatelet agents (acetylsalicylic acid in a standard dosage) and 51 (54.3%) patients anticoagulants due to the presence of atrial fibrillation. Before implantation, after 7 days and after 1 month, samples of blood were taken to determine the number of platelets, thrombocrit, platelet distribution width, mean platelet volume, von Willebrand factor (vWF) activity, and the level of soluble P-selectin (sP-selectin). Results. The number of platelets decreased 7 days after the pacemaker implantation (p<0.001), recovering to the initial values after 1 month (p=0.002). Thrombocrit significantly decreased 7 days after surgery (p=0.003). The mean platelet volume decreased after 1 month compared to baseline values (p=0.016) and 7 days values after implantation (p=0.01). The level of sP-selectin increased on the 7th day of the postoperative period (p=0.006). The mean values of the platelet distribution width, vWF, and other changes not described above were statistically hegligibl (p>0.05). The number of platelets 7 days after implantation of a pacemaker requiring puncture of the subclavian vein was lower than in the case of using the cephalic vein (p=0.02). When analyzing subgroups, these changes were noted primarily in patients underwent antiplatelet therapy. Conclusion. The changes in the investigated parameters after implantation of the pacemaker may indicate the activation of the primary hemostasis in patients underwent antiplatelet therapy, but not anticoagulant therapy. A more pronounced activation of the primary hemostasis has occurred in the case of subclavian vein puncture. The mean platelet volume decreases 1 month after pacemaker implantation, which may be associated with the relief of bradyarrhythmia and the elimination of its role in the pathogenesis of heart failure.

Keywords: cardiac implantable electronic devices, pacemaker, hemostasis system, primary hemostasis, platelets
p. 255-263 of the original issue
References
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  19. . Kanagala P, Arnold JR, Khan JN, Singh A, Gulsin GS, Squire IB, McCann GP, Ng LL. Plasma P-selectin is a predictor of mortality in heart failure with preserved ejection fraction. ESC Heart Fail. 2021;8(3):2328-33. doi: 10.1002/ehf2.13280
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Address for correspondence:
390026, Russian Federation,
Ryazan, st. Vysokovoltnaya, 9,
Ryazan State Medical
University Named by Acad. I.P. Pavlov,
Department of Cardiovascular,
X-ray Endovascular Surgery
with a Course of Radiation Diagnostics,
phone: +7-903-836-24-17,
e-mail: suchkov_med@mail.ru,
Suchkov Igor A.
Information about the authors:
Kalinin Roman E., MD, Professor, Head of the Department of Cardiovascular, Endovascular Surgery and Radiology, Ryazan State Medical University Named by Acad. I.P. Pavlova, Ryazan, Russian Federation.
https://orcid.org/0000-0002-0817-9573
Suchkov Igor A., MD, Professor, Professor of the Department of Cardiovascular, Endovascular Surgery and Radiology, Ryazan State Medical University Named by Acad. I.P. Pavlova, Ryazan, Russian Federation.
https://orcid.org/0000-0002-1292-5452.
Povarov Vladislav O., PhD., Junior Researcher of the Scientific and Educational Center, Ryazan State Medical University Named by Acad. I.P. Pavlova, Ryazan, Russian Federation.
https://orcid.org/0000-0001-8810-9518
Mzhavanadze Nina D., PhD., Assistant Professor of the Department of Cardiovascular, Endovascular Surgery and Radiology, Ryazan State Medical University Named by Acad. I.P. Pavlova, Ryazan, Russian Federation.
https://orcid.org/0000-0001-5437-1112
Zhurina Olga N., Researcher of the Department of Clinical Laboratory Diagnostics, Ryazan State Medical University Named by Acad. I.P. Pavlova, Ryazan, Russian Federation.
https://orcid.org/0000-0002-2159-582X

PEDIATRIC SURGERY

M.A. AKSELROV 1, 2, S.N. SUPRUNETS 1, 2, .V. SERGIENKO 2, D.I. SUDAREVA 2, A.V. TANZYBAEV 2, V.. EMELYANOVA 1, 2

SUCCESSFUL USE OF INTRATHORACIC THORACOSCOPIC TRACTION ELONGATION OF THE ESOPHAGUS FOLLOWED BY DELAYED ANASTOMOSIS AND LAPAROSCOPIC LEDDS OPERATION IN A NEONATE WITH MULTIPLE MALFORMATIONS

Tyumen State Medical University 1,
Regional Clinical Hospital 2 2, Tyumen,
Russian Federation

Esophageal atresia is a malformation with an incidence of 1: 2500-1: 3000 newborns. Duodenal obstruction occurs in 1: 7000-10000 neonates. The combination of congenital esophageal atresia and duodenal obstruction is less frequent than 1-6% of all cases of esophageal atresia. The article is devoted to the choice of treatment tactics of a neonate with a rare combination of gastrointestinal malformations: esophageae without associated tracheoesophageae fistula atresia of type A (R. Gross classification) and duodenal obstruction caused by a violation of intestinal rotation and fixation. The variability of surgical approaches is shown and the technique of intrathoracic thoracoscopic tractional elongation of the esophagus is demonstrated, which allowed perfoming esophago-esophagoanastomosis in 10 days thoracoscopically and preserve the childs esophagus. The uniqueness of the case is that laparoscopy was performed simultaneously with the primary esophageal surgery, aimed at eliminating the midgut volvulus which caused high intestinal obstruction. Gastrointestinal passage was fully restored 14 days after the second stage of esophageal plastic surgery. Subsequently, stenosis was recorded in the place of esophageal anastomosis, resolved by esophageal bougienage conducted by string-guide under esophagoscopy control. The chosen endoscopic treatment of the correction of combined malformations of the gastrointestinal tract allowed saving the childs esophagus and discharging him to out-patient observation in a satisfactory condition.

Keywords: esophageal atresia, duodenal obstruction, Ledds syndrome, intestinal malrotation, thoracoscopy, laparoscopy, malformations, anastomosis, internal traction, long-gap
p. 264-269 of the original issue
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    5.Kozlov YA, Rasputin AA, Baradieva PJh, Ochirov CB, Cheremnov VS. Staged thoracoscopic treatment of long-gap esophageal atresia without the need for a gastrostomy. Ros Vestn Det Khirurgii Anesteziologii i Reanimatologii. 2019:9(4):43-49. doi: 10.30946/2219-4061-2019-9-4-43-49 (In Russ.)
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  7. Akselrov M, Emeljanova V, Minaev S, Suprunec S, Sergienko T, Kiseleva N, Karlova M, Stolyar A. Successful application toracoskopy (elongation by Focker and formation deferred anastomosis ) in a child with multiple malformations, including esophageal atresia with irresistible diastase. Med Vestn Sever Kavkaza. 2017;12(2):138-41 doi: 10.14300/mnnc.2017.12039 (In Russ.)
  8. Tainaka T, Uchida H, Tanano A, Shirota C, Hinoki A, Murase N, Yokota K, Oshima K, Shirotsuki R, Chiba K, Amano H, Kawashima H, Tanaka Y. Two-Stage Thoracoscopic repair of long-gap esophageal atresia using internal traction is safe and feasible. J Laparoendosc Adv Surg Tech A. 2017 Jan;27(1):71-75. doi: 10.1089/lap.2016.0207
  9. Hayden CK Jr, Schwartz MZ, Davis M, Swischuk LE. Combined esophageal and duodenal atresia: sonographic findings. AJR Am J Roentgenol. 1983 Feb;140(2):225-26. doi: 10.2214/ajr.140.2.225
Address for correspondence:
625039, Russian Federation,
Tyumen, st. Melnikayte, 75 bldg. 2,
Regional Clinical Hospital No. 2,
Department of Anesthesiology,
Resuscitation and Intensive Care,
Tel. +7 912 997 01 82,
e-mail: novostruevadaniela@gmail.com,
Sudareva Daniela I.
Information about the authors:
Akselrov Mikhail A., MD, Head of the Department of Pediatric Surgery, Tyumen State Medical University, Head of the Surgical Department No. 1, Regional Clinical Hospital No. 2, Tyumen, Russian Federation.
https://orcid.org/0000-0001-6814-8894
Suprunets Svetlana N., PhD, Associate Professor of the Department of Childrens Diseases, Tyumen State Medical University, Head of the Department of Anesthesiology, Resuscitation and Intensive Care of Newborns, Regional Clinical Hospital No. 2, Tyumen, Russian Federation.
https://orcid.org/0000-0001-8579-1857
Sergienko Tatyana V., Pediatric Surgeon, Regional Clinical Hospital No. 2, Tyumen, Russian Federation.
https://orcid.org/0000-0003-3338-1260
Sudareva Daniela I., Neonatologist, Department of Anesthesiology, Resuscitation and Intensive Care of Newborns, Regional Clinical Hospital No. 2, Tyumen, Russian Federation.
https://orcid.org/0000-0001-5956-0385
Tanzybaev Anton V., Anesthesiologist, Department of Anesthesiology, Resuscitation and Intensive Care of Newborns, Regional Clinical Hospital No. 2, Tyumen, Russian Federation.
https://orcid.org/0000-0003-1320-2798
Emelyanova Victoria Alexandrovna, Head of the Medical Care Service for Children Regional Clinical Hospital No. 2, Assistant of the Department of Pediatric Surgery, Tyumen State Medical University, Tyumen, Russian Federation.
https://orcid.org/0000-0002-9857-9174

A.N. VORONETSKY 1, A.V. HULENKA 2

CAUSTIC ESOPHAGEAL INJURY IN CHILDREN, DELAYED OUTCOMES AND SUBSEQUENT SURGICAL INTERVENTION

Belarusian State Medical University 1, Minsk, Belarus
N. N. Alexandrov National Nancer Centre of Belarus 2, Minsk,
Republic of Belarus

Objective. To find out the reasons of the ineffectiveness of dilatation therapy for post-burn stricture of the esophagus in children on the basis of pathohistological examination of esophageal samples after its subtotal resection or extirpation
Methods. The article comprises five clinical cases of children aged 1 year 3 months to 2 years 10 months with a chemical burn of the esophagus as a result of accidental swallowing of caustic materials. In all children a complication of a caustic burn resulted in refractory esophageal stricture (a length of 3.0 to 9.0 cm). The method of treatment of stricture dilatation were the followings: balloon dilatation, suture bougienage, laser recanalization, and esophageal stent insertion. Due to balloon dilation is largely ineffective in the treatment of corrosive strictures, the children underwent a surgical operation esophageal subtotal resection in 2 children and esophageal extirpation - in 3 children. The operation was performed in the period from 2 years 20 months to 4 years 7 months from onset disease. Esophageal surgical specimens were examined histologically with hematoxylin-eosin staining and Massons method.
Results. Sodium (potassium) hydroxide and sodium hypochlorite are considered to be the most common aggressive caustic substances of household cleaning agents, that cause refractory esophageal burns in children. A severe caustic burn of the esophagus results in an extended severe esophageal stricture resistant to dilatation therapy. Pathohistological examination of esophageal tissue samples after subtotal resection or extirpation of the esophagus in children with extended post-burn esophageal stricture detected displacement of the muscle layer of the esophageal wall by connective tissue, glands atrophy, epithelial necrosis, mucosal atrophy, and diffuse sclerosis with increased wall thickness of entire organ.
Conclusion. Sclerosis of the esophageal wall due to caustic burn is considered to be the reason of failed dilatation in patients with acid-induced corrosive esophageal stricture and is associated with significant morphological, anatomical and functional disorders of the esophagus.

Keywords: caustic, stricture, endoscopy, esophagoplasty, children
p. 270-280 of the original issue
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Address for correspondence:
220116, Republic of Belarus, Minsk,
Dzerzhinsky Ave., 83,
Belarusian State Medical University,
Department of Pediatric Surgery,
tel. mob.: +375 029 32-902-32,
e-mail: anvoron@mail.ru,
Voronetsky Alexander N.
Information about the authors:
Voronetsky Alexandr N., PhD, Associate Professor of the Department of Pediatric Surgery, Belarusian State Medical University, Minsk, Republic of Belarus
https://orcid.org/0000-0001-7091-376X
Hulenka Aleh V., Pathologist, Department of Pathology, Republican Scientific and Practical Center of Oncology and Medical Radiology named after A.I. N.N. Aleksandrova, Minsk, Republic of Belarus
https://orcid.org/0000-0003-3753-4340

TRAUMATOLOGY AND ORTHOPEDICS

E.L. MATVEEVA, A.G. GASANOVA, S.N. LUNEVA, A.M. ERMAKOV

CARBOHYDRATE METABOLISM DISORDERS IN THE STRUCTURE OF PRIMARY AND REVISIONAL ENDOPROSHETICS OF THE HIP JOINT

Federal State Budgetary Institution "Scientific Research Center Named after Academician G. Ilizarova Ministry of Health of the Russian Federation, Kurgan,
Russian Federation

Objective. To analyze the incidence of various disorders of carbohydrate metabolism (aseptic and septic) in patients with primary and revision hip arthroplasty.
Methods. The paper analyzes the data of anamnesis, morphometry and basic indicators of carbohydrate metabolism in the blood of patients prior the revision hip surgery. The first group (n=236) included patients with revision hip arthroplasty without infectious complications after primary arthroplasty. The second group (n=141) included the patients with serologically confirmed periprosthetic infection. The comparison group (n=188) included patients examined prior primary hip arthroplasty. Statistical methods were used to assess the incidence of type 1 and type 2 diabetes mellitus, impaired glucose tolerance and obesity - a preclinical form of impaired carbohydrate metabolism.
Results. The highest incidence of carbohydrate metabolism disorders was found in patients with periprosthetic hip joint infection. In patients with revision hip arthroplasty, the incidence of carbohydrate metabolism disorders is higher than in patients with primary arthroplasty.
Conclusion. Incidence evaluation of carbohydrate metabolism disorders in patients with revision hip arthroplasty showed the need to develop the additional laboratory criteria for preoperative preparation, examination and postoperative management in patients with periprosthetic infection. Since it is a known fact that in patients with disorders of carbohydrate metabolism, infections join faster, and infectious diseases are more severe to reduce the risk of developing instability of the hip joint endoprosthesis for this category of patients; a set of measures is required that involve the use of routine laboratory tests (glycemic monitoring) as well as the development of new approaches in protocols and clinical guidelines.

Keywords: revision hip arthroplasty, periprosthetic infection, diabetes mellitus, impaired glucose tolerance, body mass index
p. 281-287 of the original issue
References
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  18. Dedov II (red), Shestakova MV (red), Galstyan GR, Grigoryan OR, Esayan RM, Kalashnikov VYu, Kuraeva TL, Lipatov DV, Mayorov AYu, Peterkova VA, Smirnova OM, Starostina EG, Surkova EV, Sukhareva OYu, Tokmakova AYu, Shamkhalova MS, Jarek-Martynowa IR. Standards of specialized diabetes care. Diabetes Mellitus. (7th ed.). 2015;18(1S):1-112. doi: 10.14341/DM7078 (In Russ.)
Address for correspondence:
640014, Russian Federation,
Kurgan. M.Ulyanova Street, 6,
Federal State Budgetary Institution Scientific Research Center named after Academician G.A.Ilizarov of the Ministry of Health
of the Russian Federation,
tel. 8 (3522) 45-05-38,
e-mail: gasanova.08@mail.ru,
Gasanova Anna G.
Information about the authors:
Matveeva Elena L., MD (Biol.), Leading Researcher of the Department of Preclinical and Laboratory Reseach of the Federal State Budgetary Institution Scientific Research Center Named after Academician G.A. Ilizarov of the Ministry of Health of the Russian Federation, Kurgan, Russian Federation.
http://orcid.org/0000-0002-7444-2077
Gasanova Anna G., Junior Researcher of the Department of Preclinicla and Laboratory Reseach of the Federal State Budgetary Institution Scientific Research Center Named after Academician G.A. Ilizarov of the Ministry of Health of the Russian Federation, Kurgan, Russian Federation.
http://orcid.org/0000-0001-7734-2808
Luneva Svetlana N., MD (Biol.), Professor, Leading Reseacher of the Department of Preclinicla and Laboratory Reseach of the Federal State Budgetary Institution Scientific Research Center Named after Academician G.A. Ilizarov of the Ministry of Health of the Russian Federation, Kurgan, Russian Federation.
https://orcid.org/0000-0002-0294-2398
Ermakov Artem M., PhD, Researcher of the Laboratory of the Clinic of Purulent Osteology, Physician of the Purulent Traumatology and Orthopedic Department No 1 of the Federal State Budgetary Institution National Medical Research Center for Traumatology and Orthopedics Named after Academician G.A. Ilizarov of the Ministry of Health of the Russian Federation, Kurgan, Russian Federation.
https://orcid.org/0000-0002-5420-4637

REVIEWS

.N. REDKIN, M.V. SOROKINA, E.YU. USTINOVA, O. V. MANUKOVSKAYA, YU. S. KONOPLINA, S. S. POPOV

SPECIFICITY OF DIAGNOSTICS OF PATIENTS WITH METASTASES OF SQUAMOUS CELL CARCINOMA OF UNKNOWN PRIMARY ORIGIN IN THE LYMPH NODES OF THE NECK

Voronezh state medical University named after N. N. Burdenko, Voronezh,
Russian Federation

Throughout the world cancer of unknown primary origin occures the 7th place according to morbidity, which is 2.3-5% of all malignant neoplasms and ranks the 4th according to mortality. In a certain proportion of patients, these metastases are determined independently, without identifying the primary focus. This nosological form of cancer is a heterogeneous disease and usually manifests a pronounced aggressive character in case of progression of the process in the absence of a primary tumor focus. The search for the primary focus and further tactics of treating patients is an embarrassing and under-researched problem that requires numerous studies in future. In addition to standard diagnostic methods, immunohistochemical and virological examinations are used to examine such patients. Most often, patients with metastases in the cervical lymph nodes without a primary identified focus, associated with human papillomavirus (HPV) and Epstein-Barr virus (EBV), which in turn helps to predict the primary localization of cancer. Also diagnostic bilateral tonsillectomy and panendoscopy play the important role. In most cases cancer of unknown primary origin is located in the head and neck. Currently, a search is underway for new diagnostic methods to eliminate delays in treatment and increase the life expectancy of patients. This issue is in demand among researchers around the world. Therefore, further studies are necessary to advance the knowledge of this area.

Keywords: squamous cell carcinoma, metastases without identified primary focus, lymph nodes of the neck, positron emission tomography, human papillomavirus
p. 288-297 of the original issue
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Address for correspondence:
394036, Russian Federation,
Voronezh, Kalyaev Street, 2,
Voronezh State Medical University
Named after N. N. Burdenko,
the Oncology Department.
tel.: +7 9066082061,
e-mail: wwwdelicious@rambler.ru,
Sorokina Margarita V.
Information about the authors:
Redkin Alexander N., MD, Professor of the Oncology Department of Voronezh State Medical University Named after N. N. Burdenko, Voronezh, Russian Federation.
https://orcid.org/0000-0001-7901-0751
Sorokina Margarita V., Post-Graduate Student of the Oncology Department of Voronezh State Medical University Named after N. N. Burdenko, Voronezh, Russian Federation.
https://orcid.org/0000-0002-4436-8101
Ustinova Elena Yu., MD, Professor of the Oncology Department of Voronezh State Medical University Named after N. N. Burdenko, Voronezh, Russian Federation.
https://orcid.org/0000-0002-6893-4657
Manukovskaya Olga V., PhD, Associate Professor of the Oncology Department of Voronezh State Medical University Named after N. N. Burdenko, Voronezh, Russian Federation.
https://orcid.org/0000-0002-6698-5901
Konoplina Juliya S., PhD, Associate of the Oncology Department of Voronezh State Medical University Named after N. N. Burdenko, Voronezh, Russian Federation.
https://orcid.org/0000-0003-1204-7001
Popov Sergey S., PhD, Associate Professor of the Oncology Department of Voronezh State Medical University Named after N. N. Burdenko, Voronezh, Russian Federation.
https://orcid.org/0000-0002-9826-616X

M.D. LEVIN 1, 2, V.I. AVERIN 1, 3, YU.G. DEGTYAREV 1, 3

PATHOLOGICAL PHYSIOLOGY OF ANORECTAL MALFORMATIONS (ARM) WITHOUT VISIBLE FISTULAS. LITERATURE REVIEW

State Institution "Republican Scientific and Practical Center for Pediatric Surgery" ¹, Minsk,
Republic of Belarus
Dorot. State Geriatric Center, Netanya, Israel ²,
EE "Belarusian State Medical University" ³, Minsk,
Republic of Belarus

Objective. Until 1982, pediatric surgeons came to the consensus that in patients with anorectal malformations (ARM), the intestine located caudal to the pubococcygeal line is the anal canal and must be preserved to achieve the best functional result. Simultaneously with the publication of the posterior sagittal anorectoplasty, it was stated that most patients with ARM do not have anal canal. The part of the intestine that is located caudal to the pubococcygeal line began to be called the rectal sac or fistula, which was recommended to be removed, since it was believed that it was not functioning well. Analysis of the literature to determine the anatomy and physiology of ARM without visible fistulas.
Methods. The authors analyzed 32 articles, including 4 of own studies, which reflect the entire palette of ideas about the pathological anatomy and physiology of ARM without visible fistula (boys and girls without fistula, and boys with urethral fistula).
Results. During histological examination of the so-called fistula, the internal anal sphincter and the mucous membrane characteristic of the anal canal are determined. In a manometric study, the normal basal pressure and the rectoanal inhibitory reflex are determined. In radiological studies, in most patients at rest, the distal colon is constantly in a contracted state and opens wide at high pressure in the rectum, which is characteristic of a normally functioning anal canal.
Conclusion This literature review proves that most ARM patients without visible fistula have a functioning anal canal that must be preserved to support normal anorectal function.

Keywords: anorectal malformations; anorectal physiology; pathophysiology anorectum; urethral fistula; without fistula
p. 298-305 of the original issue
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Address for correspondence:
4220200, Dorot.
State Geriatric Center, Netanya,
Amnon ve-Tamar 1, Israel.
. 972-53-8281393,
nivel70@hotmail.com.
Levin Michael
Information about the authors:
Levin Mikhail D., MD, Radiologist, State Geriatric Center (Dorot), Netanya, Israel.
https://orcid.org/0000-0001-7830-1944
Averin Vasily I., MD, Professor, Head of the Department of Pediatric Surgery, Belarusian State Medical University, Minsk, Republic of Belarus,
https://orcid.org/0000-0003-3343-8810
Degtyarev Yury G., MD, Professor of the Department of Pediatric Surgery Belarusian State Medical University, Minsk, Republic of Belarus
https://orcid.org/0000-0002-2696-4989

Y.S. VINNIK, O.V. TEPLYAKOVA, A.D. ERGULEEVA

RELEVANCE OF PREVENTION OF THE INFECTIOUS COMPLICATIONS IN ACUTE PANCREATITIS

Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University
Krasnoyarsk, Russian Federation

The failed outcomes of infected necrotizing pancreatitis treatment make the prevention of infectious complications particularly relevance. Despite the objective benefits of non-surgical management in patients with sterile pancreatic necrosis, pharmacologic therapies facilities in the early period of the disease remain limited. Concordantly to available evidence the efficiency of fluid resuscitation, anticoagulants, antioxidants, epidural blockade, hyperbaric oxygen therapy, antisecretory agents, protease inhibitors, antibiotics, immunomodulators, enteral nutrition and minimally invasive surgical approaches to prevent infectious complications in predicted severe acute pancreatitis is considered in this review. Preventive strategies for septic complications of acute necrotizing pancreatitis such as intravenous fluid resuscitation, use of anticoagulants, epidural analgesia and early enteral feeding the evidence is strong. Advantages of enteral nutrition cannot be overemphasized from the standpoint of the trigger role of intestinal contents in the pathogenesis of pancreatogenic infection, as well as the level of evidence of relevant clinical studies.

Keywords: acute severe pancreatitis, infected necrotizing pancreatitis, early enteral nutrition, epidural blockade, antibiotics
p. 306-316 of the original issue
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Address for correspondence:
660022, Russian Federation,
Krasnoyarsk, Partizan Zheleznyan st.,1,
Krasnoyarsk State Medical University
named after Professor V.F. Voyno-Yasenetsky,
tel. +7 (391) 220-19-09,
-mail: teplyakova-olga@ya.ru
Teplyakova Olga V.
Information about the authors:
Vinnik Yurii S., MD, Professor, Head of the Department of General Surgery Named Professor M. I. Gulman, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation. https://orcid.org/0000-0002-8995-2862
Teplyakova Olga V., MD, Associate Professor, Professor of the Department of General Surgery Named Professor M. I. Gulman, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation.
https://orcid.org/0000-0003-0005-3316
Erguleeva Anna D., Resident of the Department of General Surgery Named Professor M. I. Gulman, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation.
https://orcid.org/0000-0002-7000-4467

D.V. GARBUZENKO 1, D.V. BELOV 1, 2, A.L. KOSHARNOVA 1, S.S. ANUFRIEVA 1, N.A. DANKO 2

GALLBLADDER HERNIATION AS A RARE COMPLICATION OF ABDOMINAL DRAINAGE

FGBOU VO South Ural State Medical University 1,
FGBU Federal Center for Cardiovascular Surgery 2, Chelyabinsk,
Russian Federation

Although abdominal drainage is a routine method of completing abdominal surgery, the feasibility and validity of this approach are widely discussed. The opponents of using drainages argue that they have low efficiency and may cause negative consequences, thereby prolonging the hospitalization period and increasing the risk of complications. In most cases, these complications do not pose any danger, but sometimes they may pose an immediate threat to the patients life and require repeated interventions. It is believed that abdominal drainage should be performed according to strict indications and if necessary in compliance with techniques that exclude the occurrence of adverse events. The care of drainages in the postoperative period is equally important. The presented rare case of herniation gallbladder reminds us that such hernias may form at the sites of abdominal drainage. According to the literature their frequency does not exceed 3.4%. These hernias are often subject to insidious and diagnostically difficult strangulation because of the narrow gates. Ultrasound is consided as a good help highly, but the informative method of choice in the diaguosis is multispiral computed tomography (multigpiral CT) of the abdominal organs.

Keywords: gallbladder, drainage, incisional hernia, complications
p. 317-321 of the original issue
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Address for correspondence:
454033, Russian Federation,
Chelyabinsk pr. Geroi
Rossii Y. Rodionov, 2,
Federal Center for Cardiovascular
Surgery (Chelyabinsk),
Cardiac Surgery Department N 1,
Tel. +7 908 576 84 55,
e-mail: belof20@ya.ru,
Belov Dmitry Vladimirovich
Information about the authors:
Garbuzenko Dmitry V., MD, Professor, Professor of the Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation.
http://orcid.org/0000-0001-9809-8015
Belov Dmitry V., PhD, Associate Professor of the Department of Hospital Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation, Cardiovascular Surgeon, Federal Center for Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Chelyabinsk, Russian Federation. http://orcid.org/0000-0003-4985-9716
Kosharnova Anastasia L., Department of Hospital Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation.
https://orcid.org/0000-0002-0236-9050
Anufrieva Svetlana S., MD, Associate Professor, Head of the Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation.
https://orcid.org/0000-0002-3921-5266
Danko Natalya A., PhD, Radiologist, Federal Center for Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Chelyabinsk, Russian Federation.
http://orcid.org/0000-0003-1638-8700
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