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Khirurgii

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Year 2021 Vol. 29 No 1

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

A.A. EMANOV, M.V. STOGOV, E.A. KIREEVA, N.V. TUSHINA

CONSOLIDATION OF FEMORAL FRACTURES AT APPLICATION OF DIFFERENT TREATMENT METHODS TAKING INTO CONSIDERATION DURATION OF THE PERIOD FROM TRAUMA TO OSTEOSYNTHESIS

National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan,
The Russian Federation

Objective. To study the characteristics and healing duration of the diaphyseal femoral fractures, depending on the technologies used for osteosynthesis and the time between trauma and osteosynthesis.
Methods. The study was performed on bred dogs (n=24). In the operating theatre all animals were modeled the transverse fracture of the femoral diaphysis in the middle third using a chisel. The animals were divided into 4 groups (6 per group). Animals of group 1 (one hour after the fracture) underwent transosseousosteosynthesis with a pin-rod external fixation device (PREF). In group 2, PREF was performed on the fourth day after the injury. In group 3 (one hour after the injury) blockable intramedullary osteosynthesis (BIOS) was performed. In group 4, the similar BIOS was performed on the fourth day after the fracture. To assess the results of treatment, the clinical, radiological and laboratory research methods were used. The duration of post-operative observation of the animals was 100 days.
Results. It has been found out that the dynamics of osteoreparative processes in the studied groups was similar and did not depend on the time between trauma and osteosynthesis.
The median time for the femoral shaft fracture healing in animals of group 1 was 46 days (Q1-Q3: 38-57), in group 2 – 73 days (Q1-Q3: 71-78) (differences between groups are significant at p=0.004); in group 3 – 49 days (Q1-Q3: 44-60), in group 4 – 72 days (Q1-Q3: 70-93) (differences between groups are significant at p=0.008). It is shown that the reason for the increase in fixation terms in dogs with the delayed osteosynthesis is the long-term persistence of the acute phase reaction caused by trauma (using the growth of C-reactive protein as an example).
Conclusion. The healing terms of a femoral shaft fracture with the use of PREF technology and BIOS technology are comparable, both in the conditions of urgent and delayed osteosynthesis.

Keywords: femoral fracture, osteosynthesis, fracture fixation, external fixators
p. 5-12 of the original issue
References
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  14. Koso RE, Terhoeve C, Steen RG, Zura R. Healing, nonunion, and re-operation after internal fixation of diaphyseal and distal femoral fractures: a systematic review and meta-analysis. Int Orthop. 2018 Nov;42(11):2675-83. doi: 10.1007/s00264-018-3864-4
  15. Zuev PP. Comparative analysis of surgical outcomes for patients with femural ununited midshaft fractures. Sarat Nauch-Med Zhurn. 2019;15(3):641-43. http://ssmj.ru/system/files/2019_03_641-643.pdf (In Russ.)
  16. Barabash AP, Shpinyak SP, Barabash JA.. Comparative characteristics of osteosynthesis techniques in patients with comminuted diaphyseal femoral fractures. Traumatology and Orthopedics of Russia. 2013;(2):116-24. doi: 10.21823/2311-2905-2013--2-116-124 (In Russ.)
Address for correspondence:
640014, Russian Federation,
Kurgan, M.Ulyanova Str., 6
National Ilizarov Scientific Center
for Traumatology and Orthopedics,
Ministry of Health of Russia,
tel. +7 352 245-05-38,
e-mail: stogo_off@list.ru,
Stogov Maxim V.
Information about the authors:
Emanov Andrei A., PhD(Vet) Leading Researcher of the Experimental Laboratory, National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan. Russian Federation.
https://orcid.org/0000-0003-2890-3597
Stogov Maxim V., DS(Biol) Associate Professor, Leading Researcher of the Biochemistry Laboratory, National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan. Russian Federation.
https://orcid.org/0000-0001-8516-8571
Kireeva Elena A., PhD(Biol), Senior Researcher of the Biochemistry Laboratory, National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan. Russian Federation.
https://orcid.org/0000-0002-1006-5217
Tushina Natalya V., PhD(Biol), Researcher of the Biochemistry Laboratory, National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan. Russian Federation.
https://orcid.org/0000-0002-1322-608X

GENERAL & SPECIAL SURGERY

M.ZH. ALIEV 1, L.M. ZUBEKHINA 2, K.I. NIIAZBEKOV 2

SIMULTANEOUS OPERATIONS FOR LIVER ECHINOCOCCOSIS

City Clinical Hospital No1 1
Kyrgyz State Medical Academy named after I.K. Akhunbaev 2, Bishkek
The Republic of Kyrgyzstan

Objective. To evaluate the results and effectiveness of simultaneous operations for echinococcosis of the liver.
Methods. Surgical diseases requiring surgical treatment (cholelithiasis: calculus cholecystitis, choledocholithiasis, nodular goiter, ventral postoperative hernia) were detected in 38 patients with echinococcosis of the liver. 23 patients underwent organ-preserving operations for echinococcosis, and 15 patients underwent radical operations, all operations were perfomed in combined with cholecystectomy, choledocholitotomy, thyroidectomy, and herniotomy (coating of a polypropylenemesh for hernia gate).Immediate and remote results were studied. Patients were reexamined 6 months after surgery within a 3-year period. The examination included the checkup, general blood test, liver and kidney tests, an ultrasound examination of the abdominal organs, and a chest x-ray once a year.
Results. During the immediate postoperative period 4 patients out of 38 (10.5%) had complications. After simultaneous operations using organ-preserving methods of echinococcectomy, 2 patients out of 23 (8.7%) had complications (pleuritis, wound suppuration), and 2 – out of 15 had radical operations (bile leakage, pleuritis). All complications had been cured by the time of discharge. The remote results were studied over a period of 6 months to 3 years. 34 patients were examined up to 1 year, 31 – from 1 to 2 years, 26 – from 2 to 3 years. Within the examination and follow-up periods no recurrence of echinoccosis was observed.
Conclusion. During simultaneous operations and the echinococcectomy of the liver it is necessary to observe accurately the rules of aparasiticity and antiparasiticity.Simultaneous operations for the liver echinococcosis should be performed according to strict indications and by a highly experienced and qualified surgeon. Patients who have undergone simultaneous operations was asked to undergo a medical control examination at least once a year.

Keywords: echinococcosis of the liver, simultaneous operations, complication, radical operations, organ-preserving operations
p. 13-19 of the original issue
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Address for correspondence:
720054, Kyrgyzstan, Bishkek,
Yu. Fuchik Str., 15,
City Clinical Hospital No1
The Surgery Unit No1,
tel.mob. +996 550 65 00 08,
e-mail: musa-aliev-69@mail
Aliev Musabai Z.
Information about the authors:
Aliev Musabai Zh., PhD, Physician, Surgical Unit No1, City Clinical Hospital No1, Bishkek, Kyrgyz Republic.
http://orcid.org/0000-0003-0771-245X
Zubekhina Lyubov M., PhD, Honorary Professor, Associate Professor of the Department of the Faculty Surgery, Kyrgyz State Medical Academy Named after I. K. Akhunbayev, Bishkek, Kyrgyz Republic.
http://orcid.org/0000-0001-8827-1021
Niiazbekov Kubat I., PhD, Associate Professor of the Department of General Practice Surgery with a Course of Combustiology, Kyrgyz State Medical Academy Named after I. K. Akhunbayev, Bishkek, Kyrgyz Republic.
http://orcid.org/0000-0002-4103-3138

V.V. BOYKO 1, A.V. MALOSHTAN 1, R.M. SMACHYLO 1, A.M. TYSHCHENKO 1, A.A. NEKLIUDOV 1, V.A. VOVK 2, M.A. KLOSOVA 1, O.V. VOLCHENKO 1

PHYSICAL AND CHEMICAL PROPERTIES OF BILE DURING THE ONSET AND MANIFESTATION OF CHOLANGITIS. ACUTE CHOLANGITIS: POSSIBLE TRIGGERING MECHANISMS

V. T. Zaytsev Institute of General and Urgent Surgery of the National Academy of Medical Sciences of Ukraine 1,
Regional Clinical Hospital 2, Kiev,
Ukraine

Objective. To determine the possible triggering mechanism for the development and manifestation of acute suppurative cholangitis based on the study of the rheological, physical and chemical properties of bile.
Methods. The bile of choledoch was studied in patients (n=41) with calculous obstruction of the biliary tract, 25 of them had clinical picture of cholangitis. For comparison, 32 patients with asymptomatic choledocholithiasis were examined. Bile sampling was performed in each patient twice: the first bile intake was obtained during duodenoscopy and cannulation of the major papilla of the duodenum and endoscopic papillosphincterotomy and the second portion – during a follow-up examination three days after the endoscopic papillotomy. The biliary pH, viscosity, the amount of solids in it, the concentration of primary bile acids, microbial contamination and the intraductal pressure were studied.
Results. For the first time, it has been hypothesized that a reduced concentration of bile acids in the bile causes a subsequent chain of triggering and manifestation of acute cholangitis. In the first bile intake the concentration of bile acids is three fold decreased in patients with acute cholangitis in comparison with the patients of control group, and in the second case it reliable increased but was lower than in the control group. It was a small amount of bile acids caused sedimentation of a colloidal bile solution, increased its viscosity and amount of dry sediment, caused precipitation and sludge. This chain process caused the instantaneous inclusion of concretion in sludge and acute obstruction of the choledoch. As a result of bacterial contamination, the microbial dissemination of bile increases by 103-104 times, the choledoch becomes like an abscess. Endoscopic papillosphincterotomy breaks this chain and surgical management is the definitive mode of treatment for decompression and biliary track sanitation.
Conclusion. A decrease of bile acids in the content of the bile causes a chain process of sedimentation, the formation of sludge and a complete block of the choledoch, which is the primary trigger for cholangitis.

Keywords: choledocholithiasis, acute cholangitis, primary bile acids, pathogenesis, endoscopic papillosphincterotomy
p. 20-27 of the original issue
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Address for correspondence:
61103, Ukraine, Kharkov,
Balakirev Str., 1
V. T. Zaytsev Institute of General and Urgent Surgery of the National Academy of Medical Sciences
of Ukraine, the Department
of the Liver and Bile Ducts Surgery,
tel. +380 57349-41-20,
e-mail: andrey.aleksandrovich@googlemail.com
Nekliudov Andrey A.
Information about the authors:
Boyko Valeriy V., MD, Professor, Corresponding Member of the National Academy of Medical Sciences of Ukraine, Director of V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0003-4771-9699
Maloshtan Aleksandr V., MD, Chief Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-5205-8480
Smachylo Rostyslav M., MD, Professor, Head of the Department of the Liver and Bile Ducts Surgery, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0003-1237-0255
Nekliudov Andrey A., PhD, Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-5567-2419
Tishchenko Alexand M., MD, Professor, Chief Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0002-9151-778X
Vovk Valerii A., MD, Surgeon, Regional Clinical Hospital, Kharkov, Ukraine
https://orcid.org/0000-0003-0888-1837
Klosova Maria A., PhD, Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-6048-4084
Volchenko Oleg V., Junior Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-7818-2359

R.E. KALININ, I.A. SUCHKOV, I.N. SHANAEV

CLINICAL ANATOMY OF THE PERFORATING VEINS OF THE PROXIMAL LOWER LIMBS

Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan,
The Russian Federation

Objective. To clarify the topographic and anatomical feature of the perforating veins (PVs) in the proximal part of the lower extremity.
Methods. 70 amputated lower extremities from the patients with severe ischemia were subjected to sectional anatomical study; 2800 patients with varicose disease underwent lower extremity sonography.
Results. PVs were primarily located on the medial surface of the thigh. In the upper third of the thigh PVs drain into superficial femoral vein. It was detected that one or two PVs occur in the lower third of the hip draining into superficial femoral vein and originating from the great saphenous vein in 73.6% cases. All PVs were accompanied by an arterial branch from the superficial femoral artery. Anatomical sectional study revealed that a nervous branch accompanied PVs in the lower third of the thigh. Two or four PVs were detected on the lateral surface of the thigh. PVs in the popliteal fossa could be referred to as “atypical” due to their rare occurence (0.4% of cases at sonography) in combination with absent typical sapheno-popliteal junction. PVs in this area were not supported by the intermuscular septa. PVs drained laterally into popliteal vein of the lower limb in 100% cases, while small saphenous vein drained into great saphenous vein in the upper third of the leg or into the intersaphenous vein.
Conclusion. Perforating veins constitute perforating bundles (PV, arterial branch, nervous branch), which are predominantly located along the intermuscular septa, which create a constant and strong orientation along the direction of the great vessels. This ensures stable hemodynamics of great vessels and perforating complexes and does not allow squeezed tham togeter during physical exertion.

Keywords: perforating veins, neurovascular bundle, anatomical features
p. 28-37 of the original issue
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  9. Sherman RS. Varicose veins: a suggested operative procedure. An operation for varicose veins based on anatomical studies of incompetent thigh perforators. Cal West Med. 1942 Sep;57(3):192-96. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1634545/
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  12. Kalinin RE, Suchkov IA, Shanaev IN. Rare variants of formation of collateral circulation in patients with obliterating atherosclerosis of lower limb arteries. Nauka Molodyh(Eruditio Juvenium). 2019;7(1):113-21. doi: 10.23888/HMJ201971113-121 (In Russ.)
  13. Kusagawa H. Surgery for varicose veins caused by atypical incompetent perforating veins. Ann Vasc Dis. 2019 Dec 25;12(4):443-48. doi: 10.3400/avd.oa.19-00083
  14. Engelhorn CA, Escorsin JKS, Costa KCO, Miyashiro L, Silvério MM, da Costa RCG. Location and hemodynamic role of perforating veins independent of saphenous veins. J Vasc Bras. 2018 Apr-Jun;17(2):104-108. doi: 10.1590/1677-5449.009117
  15. Gaibov AD, Nematzoda O, Burieva ShM, KalmykovEL. Experience of application of mechanochemical scleroobliteration in treatment for recurrence of lower extremity varicose vein disease. Ros Med-Biol Vestn im Akad IP Pavlova. 2020;28(1):57-66. doi: 10.23888/PAVLOVJ202028157-66 (In Russ.)
  16. Uhl J, Gillot C. Anatomy of the Hunter’s canal and its role in the venous outlet syndrome of the lower limb. Phlebology. 2015 Oct;30(9):604-11. doi: 10.1177/0268355514551086
Address for correspondence:
390026, Russian Federation,
Ryazan, Vysokovoltnaya Str., 9,
Ryazan State Medical University,
the Depatment of Cardiovascular,
Roentgen-Endovascular,
Operative Surgery and Topographic Anatomy.
tel. +7-4912-97-18-03
e-mail: Suchkov_med@mail.ru
Suchkov Igor A.
Information about the authors:
Kalinin Roman E., MD, PhD, Professor, Head of the Department of Cardiovascular, Roentgen-Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University Named after Academician I.P.Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-0817-9573
Suchkov Igor A., MD, PhD, Professor of the Department of Cardiovascular, Roentgen-Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University named after Academician I.P.Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-1292-5452
Shanaev Ivan N., PhD, Assistant of the Department of Cardiovascular, Roentgen-Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University named after Academician I.P.Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-8967-3978

PEDIATRIC SURGERY

A.N. VORONETSKY 1, A.E. DANOVICH 2

NEODYMIUM LASER IN LARINGOTRACHEOSTENOSIS TREATMENT AFTER TRACHEOSTOMY IN CHILDREN


Belarusian State Medical University 1,
The 6th City Clinical Hospital 2, Minsk,
The Republic of Belarus

Objective. To evaluate the effect of neodymium laser application for successful decannulation in infants with a congenital and acquired tracheal stenosis and tracheostomy.
Methods. 6 children were being treated in the 1st City Clinical Hospital of Minsk in 2011-2014. All children underwent tracheostomy with a prolonged tracheal intubation and subsequent development of tracheostenosis. The children were examined using X-ray, esophagogastroscopy (PentaxEG-16K10), and bronchoscopy (Olympus MAF TYPE GM). Tracheal stenosis was treated using a medical multifunctional laser complex Multiline (“Linline Medical systems” Ltd, Belarus) equipped with a high-energy neodymium laser emitter. Children with excessive growth of granulations in the lumen of the trachea underwent vaporization of granulations by means of a bulbous probe with a neodymium laser emitter (wavelength of 1340 nm, power: 15 W, 2 sec. exposure). In cicatricial tracheal stenosis, incisions were made with a laser scalpel (the wavelength of 1064 nm, power of 20 W).
Results. Effective decannulation was observed in 5 children, including 4 children who underwent 3-5 treatment sessions. In 1 child with the congenital subglottic larynx stenosis, to perform the decannulation became possible after 2 years and 24 sessions of laser recanalization of stenosis and ablation of granulations. One child, after 9 treatment sessions, dropped out of observation, the result has not been defined.
Conclusion. Tracheostomy in children promotes the formation of granulations in the tracheal lumen with the formation of stenosis, which subsequently hinders a successful decannulation. The neodymium laser application with the endoscopic access provides the visual direct approach to the focus of impact with the aim of laser-induced vaporization of soft tissues and recanalization of the tracheal mass in children with short tracheal stenosis leads to successful decannulation.

Keywords: Tracheostomy, tracheal stenosis, neodymium laser, endoscopy, infants
p. 38-45 of the original issue
References
  1. Ozturk K, Erdur O, Sofiyev F, Onal IO, Annagur A. Noninvasive treatment of acquired subglottic stenosis. J Craniofac Surg. 2016 Jul;27(5):e492-e493. DOI: 10.1097/SCS.0000000000002809
  2. Wai KC, Keller RL, Lusk LA, Ballard RA, Chan DK. Characteristics of extremely low gestational age newborns undergoing tracheotomy: a secondary analysis of the trial of late surfactant randomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2017 Jan 1;143(1):13-19. doi: 10.1001/jamaoto.2016.2428
  3. Watters KF. Tracheostomy in infants and children. Respir Care. 2017;62(6):799-25. doi: 10.4187/respcare.05366
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  5. Voronetsky AN, Danovich ËÅ. Neodymium laser in treatment of congenital tracheoesophageal fistula in children. Novosli Khinirgii. 2018 Jan-Feb; Vol 26 (1): 60-65. Novosti Khirurgii. 2018;26(1):60-65. doi: 10.18484/2305-0047.2018.1.60 (In Russ.)
  6. Mahida JB, Asti L, Boss EF, Shah RK, Deans KJ, Minneci PC, Jatana KR. Tracheostomy Placement in Children Younger Than 2 Years: 30-Day Outcomes Using the National Surgical Quality Improvement Program Pediatric. JAMA Otolaryngol Head Neck Surg. 2016 Mar;142(3):241-46. doi: 10.1001/jamaoto.2015.3302
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  8. Pullens B, Hoeve LJ, Timmerman MK, van der Schroeff MP, Joosten KFM. Characteristics and surgical outcome of 98 infants and children surgically treated for a laryngotracheal stenosis after endotracheal intubation: excellent outcome for higher grades of stenosis after SS-LTR. Int J Pediatr Otorhinolaryngol. 2014 Sep;78(9):1444-48. doi: 10.1016/j.ijporl.2014.05.034
  9. Bowen AJ, Nowacki AS, Benninger MS, Lamarre ED, Bryson PC. Is tracheotomy on the decline in otolaryngology? A single institutional analysis. Am J Otolaryngol. 2018 Mar-Apr;39(2):97-100. doi: 10.1016/j.amjoto.2017.12.017
  10. Resen MS, Grønhøj C, Hjuler T. National changes in pediatric tracheotomy epidemiology during 36 years. Eur Arch Otorhinolaryngol. 2018 Mar;275(3):803-808. doi: 10.1007/s00405-018-4872-0
  11. D’Souza JN, Levi JR, Park D, Shah UK. Complications Following Pediatric Tracheotomy. JAMA Otolaryngol Head Neck Surg. 2016 May 1;142(5):484-88. doi: 10.1001/jamaoto.2016.0173
  12. Ha TA, Goyal M, Ongkasuwan J. Duration of tracheostomy dependence and development of tracheocutaneous fistula in children. Laryngoscope. 2017 Dec;127(12):2709-12. doi: 10.1002/lary.26718
  13. Fastenberg JH, Roy S, Smith LP. Coblation-assisted management of pediatric airway stenosis. Int J Pediatr Otorhinolaryngol. 2016 Aug;87:213-18. doi: 10.1016/j.ijporl.2016.06.035
  14. Cevizci R, Dilci A, Can IH, Kersin B, Bayazit Y. Flexible CO2 laser treatment for subglottic stenosis. J Craniofac Surg. 2017 Jun;28(4):983-84. doi: 10.1097/SCS.0000000000003549
  15. Tóbiás Z, Pálinkó D, Sztanó B, Csanády M, Gál P, Rovó L. Endoscopic ultra dream pulse laser surgery of laryngomalacia. Our experiences gained during the introduction of the method in Hungary. Orv Hetil. 2017 Aug;158(33):1288-92. doi: 10.1556/650.2017.30722 [Article in Hungarian]
  16. Szabó L, Szakács L, Rovó L. Minimally invasive treatment of postintubation stenosis by use of Ultra Dream Pulse Laser and steroid-mitomycin in a 4-year-old girl. Orv Hetil. 2019 May;160(20):792-96. doi: 10.1556/650.2019.31361 [Article in Hungarian]
Address for correspondence:
220116, Republic of Belarus,
Minsk, Dzerzhinsky Av., 83,
Belarusian State Medical University,
the Pediatric Surgery Department,
tel. mob.: +375 029 32-902-32,
e-mail: anvoron@mail.ru,
Voronetsky Alexandr N.
Information about the authors:
Voronetsky Alexandr N., PhD, Associate Professor of the Pediatric Surgery Department, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-7091-376X
Danovich Alexandr E., Head of the Endoscopy Unit, the 6th City Clinical Hospital, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-8149-2363

TRAUMATOLOGY AND ORTHOPEDICS

N.L. ANKIN 1, 2, T.M. PETRYK 1, 2, V.V. ROIENKO 1, V.O. LADYKA 1, 2

FEATURES OF HIP JOINT ARTHROPLASTY IN PATIENTS AFTER OSTEOSYNTHESIS OF THE ACETABULAR FRACTURES

Kiev Regional Clinical Hospital 1,
P.L. Shupyk National Medical Academy of Postgraduate Education 2, Kiev,
Ukraine

Objective. To analyze the late complications after osteosynthesis of the acetabular fractures that led to reoperations; to determine the features of surgical intervention and the choice of the acetabular component during endoprosthetics in these patients.
Methods. From 2009 to 2015, the results of endoprosthetics in patients (n=35) who underwent primary osteosynthesis of the acetabulum and subsequently hip arthroplasty were evaluated at the Orthopedic and Trauma Center of Kiev Regional Clinical Hospital. To assess damage volume, the Letournel-Judet classification was used. 5 years after the endoprosthetics to evaluate functional outcomes the the Harris Hip Scale (HHS) and radiographic method have been used.
Results. The initial preoperative assessment in 35 patients using Harris Hip Scale showed results: 64 (58-71) Ìå (LQ; UQ) points. A year after endoprosthetics when examining 33 (94.3%) patients the Harris scale improved the results to 81 (74-88) points (p0-1<0.001). 5 years after arthroplasty the Harris scale was 85 (77-92) points (p0-5<0.001). After 5 years in 31 (88.6%) patients a radiographic evaluation showed stable integration of the acetabular component without any signs of attenuation in 1-3 zones according to the De Lee and Charnley classification.
Conclusion. The most effective way to treat the recent acetabular fractures with fragment displacement is considered to be the early osteosynthesis with anatomical reposition of fragments, which with the development of degenerative changes in the operated joint, makes it possible to perform endoprosthetics using a full-fledged bone mass for immersion of the acetabular component. Careful planning of the operation, preliminary removal of metal fixators, which can affect the placement of the acetabular component, as well as increase the risk of postoperative complications, allows achieving good results.

Keywords: hip joint, àcetabular fractures, primary total hip replacement, osteosynthesis of the àcetabular fractures, classification of Letournel-Judet, De Lee and Charnley classification
p. 46-52 of the original issue
References
  1. Letournel E, Judet R (eds). Fractures of the acetabulum. Springer Science & Business Media; 2012. 524 ð.
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  3. Matta JM. The anterior approach for total hip replacement: background and operative technique. In: MIS Techniques in Orthopedics. Springer, New York, NY; 2006. p. 121-40. doi: 10.1007/978-0-387-29300-4_8
  4. Carroll EA, Huber FG, Goldman AT, Virkus WW, Pagenkopf E, Lorich DG, Helfet DL. Treatment of acetabular fractures in an older population. J Orthop Trauma. 2010 Oct;24(10):637-44. doi: 10.1097/BOT.0b013e3181ceb685
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  6. Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am. 1964 Dec;46:1615-46.
  7. Rogers JC, Irrgang JJ. Measures of adult lower extremity function: The American Academy of Orthopedic Surgeons Lower Limb Questionnaire, The Activities of Daily Living Scale of the Knee Outcome Survey (ADLS), Foot Function Index (FFI), Functional Assessment System (FAS), Harris Hip Score (HHS), Index of Severity for Hip Osteoarthritis (ISH), Index of Severity for Knee Osteoarthritis (ISK), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC™). Arthritis & Rheumatism (Arthritis Care & Research). 2003 Oct 15;49(5S):S67-S84. doi: 10.1002/art.11401
  8. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976 Nov-Dec;(121):20-32.
  9. Berger RA, Jacobs JJ, Quigley LR, Rosenberg AG, Galante JO. Primary cementless acetabular reconstruction in patients younger than 50 years old. 7- to 11-year results. Clin Orthop Relat Res. 1997 Nov;(344):216-26.
  10. Berry DJ, Halasy M. Uncemented acetabular components for arthritis after acetabular fracture. Clin Orthop Relat Res. 2002 Dec;(405):164-67. doi: 10.1097/00003086-200212000-00020
  11. Sierra RJ, Mabry TM, Sems SA, Berry DJ. Acetabular fractures: the role of total hip replacement. Bone Joint J. 2013 Nov;95-B(11 Suppl A):11-16. doi: 10.1302/0301-620X.95B11.32897
  12. Stibolt RD Jr, Patel HA, Huntley SR, Lehtonen EJ, Shah AB, Naranje SM. Total hip arthroplasty for posttraumatic osteoarthritis following acetabular fracture: A systematic review of characteristics, outcomes, and complications. Chin J Traumatol. 2018 Jun;21(3):176-81. doi: 10.1016/j.cjtee.2018.02.004
  13. Bellabarba C, Berger RA, Bentley CD, Quigley LR, Jacobs JJ, Rosenberg AG, Sheinkop MB, Galante JO. Cementless acetabular reconstruction after acetabular fracture. J Bone Joint Surg Am. 2001 Jun;83(6):868-76. doi: 10.2106/00004623-200106000-00008
  14. Ranawat A, Zelken J, Helfet D, Buly R. Total hip arthroplasty for posttraumatic arthritis after acetabular fracture. J Arthroplasty. 2009 Aug;24(5):759-67. doi: 10.1016/j.arth.2008.04.004
  15. Tile M, Helfet D, Kellam J (eds). Fractures of the pelvis and acetabulum. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003. 850 p.
  16. Danilyak VV. Comment to the article “Classifications of acetabular defects: do they provide an objective evidence for complexity of revision hip joint arthroplasty? (Critical literature review and own cases)”. Traumatology and Orthopedics of Russia. 2019;25(2):166-69. doi: 10.21823/2311-2905-2019-25-2-166-169 (In Russ.)
Address for correspondence:
04107, Ukraine, Kiev,
Baggoutovskaya Str., 1,
Kiev Clinical Hospital,
the Department of Orthopedics and Traumatology No2 of P.L. Shupyk of the National Medical Academy of Postgraduate Education
tel. +3 8096 258 37 05,
e-mail: ladika084@gmail.com,
Ladyka Victoria A.
Information about the authors:
Ankin Mykola L., MD, PhD, Professor, Acting General Director, Kiev Clinical Hospital, Head of the Department of Orthopedics and Traumatology No2, P.L. Shupyk of the National Medical Academy of Postgraduate Education, Kiev Ukraine.
https://orcid.org/0000-0001-9795-0931
Petryk Taras M., PhD, Head of the Orthopedics And Traumatology Center, Kiev Clinical Hospital, Associate Professor of the Department of Orthopedics and Traumatology No2, P.L. Shupyk of the National Medical Academy of Postgraduate Education, Kiev Ukraine.
https://orcid.org/0000-0002-5319-3921
Roienko Vadym V., Traumatic Surgeon of the Orthopedics and Traumatology Center, Kiev Clinical Hospital, Kiev, Ukraine.
https://orcid.org/0000-0002-1220-4049
Ladyka Victoria A., Assistant of the Department of Orthopedics and Traumatology No2, P.L. Shupyk of the National Medical Academy of Postgraduate Education, Traumatic Surgeon of the Orthopedics and Traumatology Center, Kiev Clinical Hospital, Kiev Ukraine.
https://orcid.org/0000-0002-3796-428X

UROLOGY

V.I. DUBROV 1, 2, A.V. STROTSKY 2

THE RESULTS OF LAPAROSCOPIC HEMINEPHRURETERECTOMY AND URETEROPYELOANASTOMOSIS (URETEROURETEROANASTOMOSIS) FOR DUPLEX KIDNEY IN CHILDREN

The 2nd City Children's Clinical Hospital 1,
Belarusian State Medical University2, Minsk
The Republic of Belarus

Objective. To study the results of laparoscopic heminephrureterectomy (LHNE), ureteropyelostomy (LUPS) and ureteroureterostomy (LUUS) in the laparoscopic treatments of megaurete of a duplex system in children.
Methods. The records of patients (n=102) who underwent LHNE and LUPS (LUUS) were retrospectively analyzed (26 (25,5%) boys and 76(74,5%) girls). The age of patients was from 3 months to 17 years (median – 17.9 months). Megaureter of the upper pole was observed in 82 (80.4%) patients, of the lower pole – in 20 (19.6%). LHNE was performed in 68 patients (66.7%), LUPA (LUUA) – in 34 (33.3%).
Results. Intraoperative complications occurred in 2 patients (2.0%), conversion was required in both cases. Median operative LHNE time was 146,0±46,2 minutes (median – 120 minutes); in LUPS(LUUS) – 160,1±44,7 minutes (median – 150 minutes). One patient after LUUA developed the urinary leakage due to stent obstruction and required nephrostomy (IIIb, Clavien–Dindo classification). The remote results were traced for a period from 10 months to 6 years.The patients after LHNE (n=15) (22.1%) had a significant decrease of kidney function (>5%), including one patient (1.5%) with a complete loss of the function. An inflammatory process after partial ureteral resection was observed in the stump , which required relaparoscopy in 3 children (6.5%). The ipsilateral ureter injury during the total ureterectomy in the lateral position occurred in 2 children (6.9%).
Conclusion. LHNE and LUPA (LUUA) are considered to be the effective surgical methods of duplex system megaureter in children. The disadvantage of LHNE is the high risk of significant decrease of kidney function; LUPA (LUUA) are the safer methods. Total ureterectomy in the supine position of a patient can prevent the complications associated with the healthy ureter injury and leaving the ureteral stump.

Keywords: laparoscopy, duplex kidney, heminephrectomy, ureteropyelostomy, ureteroureterostomy
p. 53-61 of the original issue
References
  1. Nation EF. Duplication of the kidney and ureter: a statistical study of 230 new cases. J Urol. 1944 May 1;51(5):456-65. doi: 10.1016/s0022-5347(17)70379-5
  2. Taghavi K, Mushtaq I. Retroperitoneoscopic Hemi Nephrectomy. J Pediatr Urol. 2018 Apr;14(2):196-97. doi: 10.1016/j.jpurol.2018.02.010
  3. Villanueva CA. Open vs robotic infant ureterou-reterostomy. J Pediatr Urol. 2019 Aug;15(4):390.e1-390.e4. doi: 10.1016/j.jpurol.2019.05.003
  4. Smith FL, Ritchie EL, Maizels M, Zaontz MR, Hsueh W, Kaplan WE, Firlit CF. Surgery for duplex kidneys with ectopic ureters: ipsilateralureteroureterostomy versus polar nephrectomy. J Urol. 1989 Aug;142(2 Pt 2):532-34. doi: 10.1016/s0022-5347(17)38806-7
  5. Bolduc S, Upadhyay J, Sherman C, Farhat W, Bagli DJ, McLorie GA, Khoury AE, El-Ghoneimi A. Histology of upper pole is unaffected by prenatal diagnosis in duplex system ureteroceles. J Urol. 2002 Sep;168(3):1123-26. doi: 10.1097/01.ju.0000025866.15856.0f
  6. Cabezali D, Maruszewski P, López F, Aransay A, Gomez A. Complications and late outcome in transperitoneal laparoscopic heminephrectomy for duplex kidney in children. J Endourol. 2013 Feb;27(2):133-38. doi: 10.1089/end.2012.0379
  7. Jayram G, Roberts J, Hernandez A, Heloury Y, Manoharan S, Godbole P, LeClair M, Mushtaq I, Gundeti MS. Outcomes and fate of the remnant moiety following laparoscopic heminephrectomy for duplex kidney: a multicenter review. J Pediatr Urol. 2011 Jun;7(3):272-75. doi: 10.1016/j.jpurol.2011.02.029
  8. Michaud JE, Akhavan A. Upper pole heminephrectomy versus lower pole ureteroureterostomy for ectopic upper pole ureters. CurrUrol Rep. 2017 Mar;18(3):21. doi: 10.1007/s11934-017-0664-0
  9. Malashenko AS, Poddubnyi IV, Faizulin AK, Fedorova EV, Tolstov KN, Petrova MG. Laparoscopic and open heminephrectomy in children: results comparison. KhirurgiiaZhurnim NI Pirogova.2014;(10):68-72.https://www.mediasphera.ru/issues/khirurgiya-zhurnal-im-n-i-pirogova/2014/10 (In Russ.)
  10. Mushtaq I, Haleblian G. Laparoscopic hemine-phrectomy in infants and children: first 54 cases. J Pediatr Urol. 2007 Apr;3(2):100-03. doi: 10.1016/j.jpurol.2006.05.011
  11. Husmann DA. Renal dysplasia: the risks and consequences of leaving dysplastic tissue in situ. Urology. 1998 Oct;52(4):533-36. doi: 10.1016/s0090-4295(98)00289-1
  12. Casale P, Lambert S. Robotic ureteroureterostomy in children with a duplex collecting system. J Robot Surg. 2009 Oct;3(3):161-14. doi: 10.1007/s11701-009-0153-7
  13. Grimsby GM, Merchant Z, Jacobs MA, Gargollo PC. Laparoscopic-assisted ureteroureterostomy for duplication anomalies in children. J Endourol. 2014 Oct;28(10):1173-77. doi: 10.1089/end.2014.0113
  14. Casale P, Grady RW, Lee RS, Joyner BD, Mitchell ME. Symptomatic refluxing distal ureteral stumps after nephroureterectomy and heminephroureterectomy. What should we do? J Urol. 2005 Jan;173(1):204-06. doi: 10.1097/01.ju.0000147849.80627.41
  15. Ade-AjayiN, WilcoxDT, DuffyPG, RansleyPG. Upper pole heminephrectomy: is complete ureterectomy necessary? BJU Int. 2001 Jul; 88(1):77-79. doi: 10.1046/j.1464-410x.2001.02249.x
  16. Chandrasekharam V, Jayaram H. Laparoscopic ipsilateralureteroureterostomy for the management of children with duplication anomalies. J Indian Assoc Pediatr Surg. 2015 Jan;20(1):27-31. doi: 10.4103/0971-9261.145442
  17. Husmann D, Strand B, Ewalt D, Clement M, Kramer S, Allen T. Management of ectopic ureterocele associated with renal duplication: a comparison of partial nephrectomy and endoscopic decompression. J Urol. 1999 Oct;162(4):1406-09. doi: 10.1016/s0022-5347(05)68322-x
Address for correspondence:
220020, Republic of Belarus,
Minsk, Narochanskaya Str. 17,
the 2nd City Children’s Clinical Hospital,
the Urology Department,
Tel. +375 29 674-42-49,
e-mail: dubroff2000@mail.ru,
Dubrov Vitaly I.
Information about the authors:
Dubrov Vitaly I., PhD, Head of the Urology Department, the 2nd City Children’s Clinical Hospital, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-3705-1288
Strotsky Alexander V., MD, Professor, Head of the Urology Department, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-1640-5857

ANESTHESIOLOGY-REANIMATOLOGY

D.S. TRATSIAK, K.A. ABDIN, A.A. MAKAROV, A.P. TRUKHAN, A.I. DOBRYANETS

AUTOMATIC PLASMAPHERESIS IN PATIENTS WITH COVID-19-ASSOCIATED PNEUMONIA. THE FIRST EXPERIENCE OF APPLICATION

432nd Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk,
The Republic of Belarus

Objective. To determine the possibility of using automatic plasmapheresis in patients with COVID-19- associated bilateral polysegmental pneumonia.
Methods. The treatment of three patients with COVID-19-associated pneumonia with application of the Autopheresis-C™ automatic plasmapheresis machine (the USA) has been analyzed. The patients’ age was 47. 49 and 55 years. The patients’ case histories included factors aggravating the course of pneumonia (diabetes mellitus, chronic cardiovascular pathology with heart failure, obesity). The condition of all patients was severe. The effectiveness estimation of the given technique was carried out 6 hours after the manipulation and included a general clinical blood test, a biochemical blood test, hemodynamic parameters, and objective data.
Results. After the first application of automatic plasmapheresis, all patients occurred a decrease in temperature and the level of respiratory failure, which was accompanied by an increase in hemoglobin saturation; a decrease in the severity of dyspnea was also reported, which was the reason for the changing patient position from prone to supine. All patients had a blood pressure reduction. Positive changes in the hemodynamic situation were the basis for reducing the dosage of antihypertensive drugs. Along with this, in the course of manipulation, a gradual decrease in the severity of tachycardia was noted in all patients: a reduction of heart rate was recorded. On the second day after the manipulation, the main blood parameters (leukocytosis, c-reactive protein) decreased. The observed positive effects contributed to the early transfer (by 10-15 days) of patients from the intensive care unit to the general somatic departments.
Conclusion. The early inclusion of automatic plasmapheresis in the complex therapy of patients with COVID-19- associated bilateral polysegmental pneumonia leads to the stabilization of hemodynamic parameters, decline of the severity of respiratory failure, which made it possible to avoid the mechanical ventilation.

Keywords: COVID-19, bilateral polysegmental pneumonia, automatic plasmapheresis, functional and metabolic disorders, SARS-CoV-2
p. 62-66 of the original issue
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Address for correspondence:
220123, Republic of Belarus,
Minsk, Masherov Avenue, 26,
432 Main Military Clinical Medical
Center of the Armed Forces
of the Republic of Belarus,
tel. mob.: +375 (29) 755-77-62,
e-mail: tds2006@yandex.ru,
Tratsiak Dmitry S.
Information about the authors:
Tratsiak Dmitry S., PhD, Head of the Blood Transfusion Center, 432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-2731-4777.
Abdin Konstantin A., Head of the Intensive Care Unit, 432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-60-76-6495
Makarov Alexandr A., Deputy Head, Head of the Medical Unit, 432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-0804-4422.
Trukhan Alexey P., PhD, Associate Professor, Leading Surgeon of the 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
Dobryanets Alexandr I., Head of the Gravitational Blood Surgery Unit, 432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-0291-9593

INFORMATION TECHNOLOGIES IN SURGERY

I.Y. ZHERKA 1, E.P. ZHILIAYEVA 1, L.V. NAUMENKA 1, ZH.V. KALIADZICH 1, D.L. ENA 1, I.D. ZAMOTIN 2, P.A. ARLOU 2

THE APPLICATION OF NAVIGATION SYSTEM BASED ON THE AUGMENTED REALITY TECHNOLOGY FOR THE SURGICAL TREATMENT OF ORBITAL TUMORS

N.N. Alexandrov National Cancer Center of Belarus 1,
International Software Development Company Innowise 2, Minsk,
The Republic of Belarus

Objective. To assess the effectiveness and feasibility of using an intraoperative navigation system based on augmented reality technology in the surgical treatment of intra-orbital tumors.
Methods. Two patients with intra-orbital tumors were operated on with the application of the intraoperative navigation system. The virtual volumetric model was designed on the basis of files in the Digital Imaging and Communications in Medicine (DICOM) format, taking into account the fact that the quality of reconstruction depends on the quality of the input data and the accuracy of the reconstruction system. The required structures and parameters of color rendering for inclusion in the model were selected taking into consideration a specific clinical situation. Then the model was subjected to processing and modification to facilitate visualization. The prepared and optimized model was loaded into Microsoft HoloLens2 augmented reality glasses. In the preoperative period, using the possibilities of full screen image zoom and rotation of 3D model, the planning of the surgical intervention was carried out with the participation of all members of the surgical team. Intraoperatively, a 3D skull model was superimposed on the patient along bony landmarks (lower orbital edge and nasal bones). Surgical access and surgery were performed in the projection of the visualized tumor.
Results. In the first case, the surgical planning as the preoperative method of pre-visualising a surgical intervention was used by means of the possibilities of model zooming and rotating; a detailed preoperative tumor assessment was made. In the second case, the navigation system was used in the process of diagnostic orbitotomy to facilitate the access to the tumor.
Conclusion. Augmented reality allows highly detail visualization of individual anatomical models. Models are interactive, adaptive to real time and manipulating does not require the special skills. The technologies are flexible and can be programmed to perform a number of tasks (diagnostics, preoperative planning and intraoperative navigation). Models might be used for surgical training of surgeons to possess the skills.

Keywords: orbit tumors, augmented reality, mixed reality, computer-guided surgery, head and neck tumors, intraoperative navigation system
p. 67-74 of the original issue
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Address for correspondence:
223040 Belarus, Minsk region, ag Lesnoy,
N.N. Alexandrov National Cancer Center
of Belarus, the Laboratory of the Head and Neck Oncopathology with the Group of the Central Nervous System Oncopathology,
tel. +37533699-05-33,
e-mail: zherko.irina@mail.ru,
Zherka Irina Yu.
Information about the authors:
Zherka IrinaY., Ophthalmologist, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-5134-3666
Zhyliayeva Ekaterina P., Ophthalmologist, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-2964-6895
Naumenko Larisa V., PhD, Leading Researcher of the Laboratory of the Head and Neck Oncopathology with the Group of the Central Nervous System Oncopathology, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-1875-9176
Kaliadzich ZhannaV., MD, Head of the Laboratory of the Head and Neck Oncopathology with the Group of the Central Nervous System Oncopathology, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-3759-141Õ
Ena Dmitry L., Oncologist-surgeon, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-0601-983Õ
Zamotin Ilya D., Medical Consultant, International Software Development Company Innowise, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-2719-4100
Arlou Pavel A., Vice-Director, International Software Development Company Innowise, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-9550-9966

REVIEWS

S.E. KATORKIN 1, S.A. SUSHKOU 2, M.Y. KUSHNARCHUK 1

CURRENT STANDARDS OF SURGICAL TREATMENT FOR VENOUS TROPHIC ULCERS OF THE LOWER EXTREMITIES

Samara State Medical University 1, Samara,
The Russian Federation
Vitebsk State Medical University 2, Vitebsk,
The Republic of Belarus

Today, a wide spectrum of surgical techniques for the treatment of patients with refractory persistent venous trophic ulcers of the lower extremities based on the generally accepted standards are proposed. The main aim of surgical therapy is the elimination of the lower extremity venous reflux so that the solution of this problem significantly reduces the incidence rate of recurrent ulceration in comparison with the conservative therapy alone. In addition to classical varicose vein surgery, the current options of the endovenous interventions are available: endovenous laser ablation (EVLA), radiofrequency ablation (RFA), mechanochemical ablation (MOCA), foam sclerotherapy or cyanoacrylate embolization. The most preferable method of a local surgical correction of the refractory venous trophic ulcers is layer-by-layer dermatolypectomy (shave therapy) in combination with simultaneous autodermoplasty with free split perforated cutaneous flap. The remote results with a healing rate of over 80% cannot be achieved with any other method. Subfascial endoscopic perforator surgery (SEPS) in the presence of an epithelialized or open trophic ulcer is used for correction of pathological venous reflux in the case when endovasal and minimally invasive techniques of obliteration cannot be applied. The shin fasciotomy is used to relieve pressure in the diagnosed muscle compartment. Lower extremity fasciotomy for acute compartment syndrome is currently performed in case of special indications for the treatment of deep transfascial necrosis, recurrence of trophic ulcers after shave therapy, severe calcification of the shin tissues and correction of chronic venous compartment syndrome. Apart from the optimal choice of surgical treatment the remote healing rates of venous trophic ulcers depend on standardized in-patient treatment and care for wound in the postoperative period, followed by outpatient medical rehabilitation.

Keywords: chronic venous diseases, venous trophic ulcers of the lower limbs, chronic venous compartment syndrome, vein surgery, endovenous therapy, shave therapy, endoscopic dissection of perforating veins, fasciotomy
p. 75-89 of the original issue
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Address for correspondence:
443013, Russian Federation,
Samara, Karl Marks pr., 165b,
Samara State Medical University,
the Department and Clinic of Hospital Surgery
Tel. +7 927 206-71-02,
e-mail:katorkinse@mail.ru
Katorkin Sergei E.
Information about the authors:
Katorkin Sergei E., MD, Associate Professor, Head of the Department and Clinic of Hospital Surgery, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
https://orcid.org/0000-0001-7473-6692
Sushkou Siarhei A., PhD, Associate Professor, Vice-Rector of Scientific and Research Affairs, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0002-7524-6182
Kushnarchuk Mikhail Y., Cardiovascular Surgeon, the Department of Vascular Surgery of the Department and Clinic of Hospital Surgery, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation. https://orcid.org/0000-0001-8764-2054

YU.P. ORLOV, O.V. KORPACHEVA, N.V. GOVOROVA, V.N. LUKACH, E.N. KAKULYA, G.A. BAJTUGAEVA

EVOLUTION OF POINTS OF VIEW ON HEMOTRANSFUSION FROM THE POSITION OF A PATHOPHYSIOLOGIST

Omsk State Medical University, Omsk,
The Russian Federation

A careful assessment of the risks and benefits should precede each decision to transfusion allogeneic erythrocytes. Currently, a number of important problem in transfusion medicine is very controversial, most importantly the influence of different transfusion thresholds on clinical outcome. The purpose of this article is to highlight some features regarding to effectiveness, outcomes and risks, as well as to present a new trend in the recommendations for blood transfusion. In our days there is a general consensus about the decision to transfuse blood to a specific patient should be based primarily on his/her need for global and regional oxygen delivery and consumption, i.e. on clinical assessment of signs of insufficient global and regional tissue oxygenation, which can vary significantly depending on the individual characteristics of the patient (reactivity features). Evaluation of these signs – physiological triggers of transfusion – requires a deep knowledge of the physiology and pathophysiology of blood transfusions and clinical experience. Actualization of theoretical knowledge and the formation of clinical experience on this problem will permit a physician to make decisions about blood transfusion with the lowest risk for the patient. However, quantitative criteria for individual blood indicators – numerical triggers of transfusion – can be useful in some situations, for example, when monitoring is insufficient or due to the lack of adequate sufficient experience of medical personnel.

Keywords: anemia, hemoglobin, blood transfusion, red blood cell transfusion, adverse effects, complications
p. 90-100 of the original issue
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Address for correspondence:
644119, Russian Federation,
Omsk, Perelet Str., 9,
City Emergency Clinical Hospital No1,
the Department of Anesthesiology
and Reanimatology,
Omsk State Medical University
tel.: +381-2-75-32-64,
å-mail: orlov-up@mail.ru,
Orlov Yurij P.
Information about the authors:
Orlov Yurij P., MD, Professor of the Department of Anesthesiology and Reanimatology, Omsk State Medical University, Omsk, Russian Federation.
http://orcid.org/0000-0002-6747-998X
Govorova Natal’ya V., MD, Professor, Head of the Department of Anesthesiology and Reanimatology, Omsk State Medical University, Omsk, Russian Federation.
http://orcid.org/0000-0002-0495-902X
Korpacheva Ol’ga V., MD, Associate Professor, Head of the Department of Pathological Physiology, Clinical Physiology, Omsk State Medical University, Omsk, Russian Federation.
http://orcid.org/0000-0001-6110-3933
Lukach Valerij N., MD, Professor of the Department of Anesthesiology and Reanimatology, Omsk State Medical University, Omsk, Russian Federation.
https://orcid.org/0000-0002-9440-3235
Kakulya Evgenij N., PhD, Assistant of the Department of Anesthesiology and Reanimatology, Omsk State Medical University, Omsk, Russian Federation.
http://orcid.org/0000-0002-2811-6051
Bajtugaeva Galina A., PhD, Associate Professor of the Department of Anesthesiology and Reanimatology, Omsk State Medical University, Omsk, Russian Federation.
https://orcid.org/0000-0002-6479-7915

A.M. OVECHKIN, S.V. SOKOLOGORSKY, M.E. POLITOV

SPINAL ANESTHESIA AND HYPOTENSION: MECHANISMS, RISK FACTORS, PROPHYLAXIS AND CORRECTION

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

Hypotension is the most common adverse effect of spinal anesthesia (SA). The insidence of SA-induced hypotension in the total population is 15-33%, in patients of older age groups it reaches 80%. At young and middle ages, the main determinant of SA-induced hypotension is considered to be a reduction of postload and venous reflux, due to blood deposition in capacitance vessels of the lower extremities. The aortocaval compression syndrome plays a significant role in obstetric practice, cardiac output does not change. In elderly patients, the main prerequisite for the development of hypotension is an enhanced basal sympathetic tone on the background of SA. In patients of this category, in addition to reducing the total peripheral vascular resistance (TPVR), a decline in cardiac output also plays a role. Risk factors for anesthesia-induced hypotension are the followings: (chronic alcohol consumption, history of hypertension, sensory block upper than Th6, and urgency of surgery). To prevent SA-induced hypotension it is advisable to reduce the doses of local anesthetics. Data from the most studies do not confirm the effectiveness of extended infusion therapy in the prevention and correction of hypotension. Vasopressors - phenylephrine in obstetric practice, ephedrine or dopamine in elderly patients are effective for preventing hypotension.

Keywords: spinal anesthesia, subarachnoid block, hypotension, phenylephrine, ephedrine, dopamine
p. 101-115 of the original issue
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Address for correspondence:
119991, Russian Federation,
Moscow, Trubetskaya Str., 8-2,
Sechenov First Moscow
State Medical University (Sechenov University),
the Department of Anesthesiology
and Reanimatology,
Sklifosovsky Institute of Clinical Medicine
tel.: +7 (916) 143-96-21,
e-mail: ovechkin_alexei@mail.ru
Ovechkin Àlexei M.
Information about the authors:
Ovechkin Àlexei M., MD, Professor of the Department of Anesthesiology and Reanimatology, Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0002-3453-8699
Sokologorskiy Sergei V., MD, Professor of the Department of Anesthesiology and Reanimatology, Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0001-6805-9744
Politov Mikhail E., PhD, Associate Professor of the Department of Anesthesiology and Reanimatology, Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0003-0623-4927

CASE REPORTS

K.V. LIPATOV 1, A.G. ASATRYAN 2, G.G. MELKONYAN 2, A.V. KIRILLIN 2, I.V. GORBACHEVA 1, E.I. DEKHISSI 1

THE APPLICATION OF NPWT TECHNIQUE IN TREATMENT OF AN EXTENSIVE INFECTED SUBGALEAL HEMATOMA IN AN ADULT

Sechenov First MoscowState Medical University (Sechenov University), Moscow,
4th Moscow Clinical Hospital, Moscow, Russian Federation2 , Moscow,
The Russian Federation

Negative pressure wound therapy (NPWT) has been proven to be one of the most effective techniques in the treatment of severely infected wounds of various origins and localizations. At the same time, the prospects for its application are constantly expanding. This clinical observation demonstrates the use of NPWT in the treatment of an adult patient hospitalized in severe condition with a picture of extensive post-traumatic infected subgaleal hematoma. The development of a generalized suppurative process was contributed both by the patient’s late request for medical help (18th day after the injury) and, as a consequence, the lack of primary surgical treatment of the scalp soft tissue injury, as well as the anatomical features of this area. The magnetic resonance tomography as instrumental examination methods played a significant role in the diagnosis of complications in addition to clinical data. Medical tactics was based on the surgical treatment of the infected focus, the application of antibacterial therapy, taking into consideration the isolated microbial flora (Streptococcus pyogenes). To eliminate severe inflammatory changes in the tissues and to reduce the size of the vast subaponeurotic cavity, NPWT technique was applied, which made it possible in short time to prepare a postoperative wound for surgical closure. The early secondary suturing at the final stage of treatment allowed obtaining a good result.

Keywords: infected subgaleal hematoma, surgical treatment, group A streptococcus, VAC-therapy, NPWT negative-pressure wound therapy
p. 116-120 of the original issue
References
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Address for correspondence:
119991, Russian Federation,
Moscow, Bolshaya Pirogovskaya Str., 2-4,
I.M. Sechenov First Moscow
State Medical University,
The General Surgery Department.
tel. mobile +7 (916) 635-89-88,
e-mail: k_lipatov@mail.ru,
Lipatov Konstantin V.
Information about the authors:
Lipatov Konstantin V., MD, Professor of the General
Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-9902-2650
Asatryan Artur G., PhD, Head of the Purulent Surgery Unit, 4th Moscow Clinical lHospital, Moscow, Russian Federation.
http://orcid.org/0000-0002-8409-2605
Melkonyan George G., MD, Professor, Head Physician of the 4th Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0001-7234-4185
Kirillin Alexey V., PhD, Deputy Head Physician for Surgery, 4th Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0003-0585-9941
Gorbacheva Irina V., PhD, Associate Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-1060-1163
Dekhissii Ekaterina I., PhD, Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0003-4143-3593

M.D. ROMANOV 1, V.I. DAVYDKIN 1, E.M. KIREEVA 1, 2, A.V. PIGACHEV 1

FEATURES OF DIAGNOSIS AND TREATMENT OF PANCREATICOPLEURAL FISTULA

National Research Mordovia State University 1,
State Budgetary Healthcare Institution of the Republik of Mordovia
«Republican Clinical Hospital No4" 2, Saransk,
Russian Federation

The analysis of features of diagnosis and treatment of pancreaticopleural fistulas according to the materials of publications and own clinical observation of a 44-year-old patient with fistula between a false pancreas cyst and both pleural cavities is presented. Diagnosis in the debut of this disease was complicated by the prevalence of pleural pulmonary pathology, lack of characteristic clinical signs of pancreatic lesion and lack of references to them in the anamnesis. The sudden color change of pleural exudates from straw yellow to red-brown and comparison of the results of blood serum and pleural fluid analysis for amylase content allowed suspecting pancreatogenic origin of bilateral hydrothorax, which served as a basis for instrumental examination of the pancreas. The nature and prevalence of the process in the pancreas, abdominal cavity and the presence of pancreaticopleural fistula with bilateral hydrothorax were established by ultrasound and multispiral computer tomography of the thoracic and abdominal cavities; specification – by magnetic resonance imaging in the modes of T1-BI, T2-BI and magnetic resonance cholangiopancreatography (MRCP). Conservative treatment of acute inflammation of the pancreas in combination with puncture method of sanation of pleural cavities led to the elimination of pancreatic pleural fistula and bilateral hydrothorax. The choice of the method for the rehabilitation of pleural cavities should be justified by the nature, volume, rate of exudates accumulation and its infection. Magnetic resonance cholangiopancreatography (MRCP) is being used routinely to determine the expediency, possibility and the choice of method and volume of surgical treatment of pancreas pathology.

Keywords: pancreaticopleural fistula, hydrothorax, false pancreatic cyst, diagnostic features, therapeutic tactics
p. 121-127 of the original issue
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Address for correspondence:
430032, Russian Federation,
Saransk, Ulyanov Str., 32,
Medical Institute of National Research Mordovia State University Named after N.P.Ogarev,
the Hospital Surgery Department,
tel. +7 927 971-02-37,
å-mail:mdromanov@yandex.ru,
Romanov Mikhail D.
Information about the authors:
Romanov Mikhail D., MD, Professor, Professor of the Hospital Surgery Department, National Research Mordovia State University Named after N.P.Ogarev, Saransk, Russian Federation.
https://orcid.org/0000-0002-9646-4007
Davydkin Vasily I., PhD, Head of the Hospital Surgery Department, National Research Mordovia State University Named after N.P.Ogarev, Saransk, Russian Federation.
https://orcid.org/0000-0002-4201-9661;
Kireeva Ekaterina M., PhD, Associate Professor of the Hospital Surgery Department, National Research Mordovia State University Named after N.P.Ogarev; Thoracic Surgeon, Republican Clinical Hospital No4, Saransk, Russian Federation.
https://orcid.org/0000-0003-1034-167X
Pigachev Andrey V., PhD, Associate Professor of the Hospital Surgery Department, National Research Mordovia State University Named after N.P.Ogarev, Saransk, Russian Federation.
https://orcid.org/0000-0001-7557-7910
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