Novosti
Khirurgii

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Year 2013 Vol. 21 No 2

HISTORY SURGERY

S.A. SUSHKOV, YU.S. NEBYLITSIN, E.N. REUTSKAYA, A.N. RAK

DIFFICULT PATIENT. WOUND OF PYOTR IVANOVICH BAGRATION. PART III

EE “Vitebsk State Medical University”
The Republic of Belarus

The analysis of medical aid rendering to Prince P.I. Bagration wounded during Battle of Borodino has been carried out in the third part. Basing on the documents of the Patriotic War of 1812 as well as memoirs of direct participants and historians of the XIX century the events occurring after injury were restored in stages. Analysis of the military situation at the Battle of Borodino during the retreat of the Russian army up to Moscow showed that the events in the theater of military actions had a significant impact on the process of helping to Prince P.I. Bagration. Due to the unfavorable situation created in the band of the 2nd Western army at Borodino the rapid retreat of the Russian army from Mozhaisk as well as the severe state of the commander the physicians could not make a complete initial wound debridement within the first 48 hours.
The necessity of rapid evacuation of Prince P.I. Bagration from Moscow has prevented the timely implementation of secondary wound treatment at the development of phlegmon around the wound. Further progression of the infection process was followed by addition of putrid infection. Refusal of P.I. Bagration on the proposed surgical intervention led to the development of osteomyelitis, sepsis and anaerobic infection.
Expansion of the wound which P.I. Bagration permitted to perform on arrival at Simi could not change anything. On the next day to perform amputation without any slight chance of recovery was meaningless, it would only exacerbate the suffering of the commander. The cause of death was generalization of infection, accession of the anaerobic infection, prolonged severe intoxication.
Physicians who treated P.I. Bagration performed their duties scrupulously and treated the patient in accordance with the principles in that period and adapted to the evolving situation.
However unfavorable military situation in the theater of military actions and categorical denials of P.I. Bagration from operation did not allow physicians to realize all the possibilities.

Keywords: history of military field surgery, Battle of Borodino, wound of Pyotr Ivanovich Bagration, medical aid rendering
p. 3 – 20 of the original issue
References
  1. Davydov M. Byla li rana smertel'noi [Was the wound fatal?]. Nauka i zhizn'. 2012;(9):26–33.
  2. Larinskii N. Rana byla khorosha i obeshchala spasenie. Istoriia raneniia PI. Bagrationa [The wound was good and promised salvation. Available from: http://webcache.googleusercontent.com.
  3. Budko A. Legkoe ranenie so smertel'nym iskhodom [Slight wound with mortal outcome]. Med Gazeta. 20 iiulia 2012;(52). Áóäêî À. Ëåãêîå ðàíåíèå ñî ñìåðòåëüíûì èñõîäîì. Ìåä Ãàç. 2012 20 èþëÿ;(52).
  4. Budko DIu. K voprosu o ranenii i smerti PI Bagrationa [Some aspects of PI Bagration wound and death]. V: Gorbunov AV, sost. Otechestvennaia voina 1812 g. Istochniki. Pamiatniki. Problemy: materialy X Vseros nauch konf; 2001 Sent 3–5; Borodino. Mosñow, RF: KA-LITA; 2002. p. 58.
  5. Anisimov EV. General Bagration [General Bagration]. Zhizn' i voina. Moscow, RF: Molodaia gvardiia; 2011. 832 p.
  6. Malysheva AD, Loginova EA. Ranenie i smert' generala PI. Bagrationa [Injury and death of General PI Bagration]. Sovet Meditsina. 1954;(6):41–43.
  7. Gritskevich VP, Mefodovskii AF. Okazanie meditsinskoi pomoshchi generalu PI Bagrationu v 1812 g. [Providing medical assistance to general P.I. Bagration in 1812 ]. V: Otechestvennaia voina 1812 g. Rossiia i Evropa: tez nauch konf; 1991; Borodino; Borodino, RF; 1992. p. 12–14.
  8. Sushkov SA, Nebylitsin IuS, Reutskaia EN, Rak AN. Trudnyi patsient. Ranenie Petra Ivanovicha Bagrationa [Difficult patients. Wound of Pyotr Ivanovich Bagration]. Novosti Khirurgii. 2013;21(1 Ch 2):3–14.
  9. Govorov IaI. Poslednie dni zhizni kniazia Petra Ivanovicha Bagrationa [Last days of Prince Pyotr Bagration]. Saint-Petersburg, RF: Ros gos b-ka; 1815. Rezhim dostupa: http://dlib.rsl.ru/viewer. p. 38.
  10. Sushkov SA, Nebylitsin IUS, Reutskaia EN, Rak AN. Trudnyi patsient. Ranenie Petra Ivanovicha Bagrationa [Difficult patients. Wound of Pyotr Ivanovich Bagration]. Novosti khirurgii. 2012;20(6 ch 1):3–11.
  11. Golubov SN, Kuznetsova FE, red. General Bagration [General Bagration]: sb dokumentov i materialov. OGIZ: Gos izd-vo polit lit; 1945. 280 p.
  12. 1812 god. Sobytiia 7 sentiabria. Borodinskoe srazhenie. Khod bitvy do poludnia [1812 year. Events on September 7. The Battle of Borodino. The progress of battle up to noon]. Voennyi obozrevatel'. Available from: http://warsonline.info.
  13. Kovalevskii NF. Istoriia gosudarstva Rossiiskogo: zhizneopisaniia znamenitykh voennykh deiatelei XVIII - nachalo XX v [ History of the Russian State: biographies of famous military leaders of the XVIII - beginning of XX century ]. Moscow, RF: Kn palata; 1997. 414 p.
  14. Zalesskii KA. Napoleonovskie voiny 1799-1815 [The Napoleonic Wars 1799-1815]: biograf entsikloped sl. Moscow, RF: Izd-va: AST, Astrel'; 2003. 832 p.
  15. Tarle EV. Nashestvie Napoleona na Rossiiu. 1812 god. [Napoleon invasion to Russia.1812 year]. Moscow, RF: Voenizdat; 1992. 304 p.
  16. Glinka FN, Lyshkovskaia IN, sost. Ocherki Borodinskogo srazheniia (vos-pominaniia o 1812 gode) [Sketches of Borodino Battle (memories of 1812 year)]. Smolensk, RF: Svitok; 2008. 96 p.
  17. Budko AA, Briniuk NIu, Zhuravlev DA. Voennaia meditsina Rossii pered Otechestvennoi voinoi 1812 goda [Military medicine of Russia before Patriotic War II in 1812]. V: Otechestvennaia voina 1812 g. Istochniki. Pamiatniki. Problemy: materialy XVII Mezhdunar nauch konf; Borodino, 2011 Sent 5–7; Mozhaisk, RF; 2012. s. 209–224.
  18. Kuz'min AA. Nekotoryi opyt lecheniia ranenykh vo vremia Otechestvennoi voiny 1812 g [Some experience in treatment of the wounded patients during the War of 1812]. Vestn Voen Un-ta. 2011;(1):156–60.
  19. Rossiiskii DM. Meditsinskii fakul'tet Moskovskogo universiteta v dni Otechestvennoi voiny 1812 g [Medical faculty of Moscow University during the Patriotic War of 1812 ]. Klin Meditsina. 1953;(2).
  20. Radozhitskii IT. Pokhodnye zapiski artillerista, s 1812 po 1816 g [Marching notes of a gunner (1812 – 1816 yrs)]. Ch 1. 1812 g. Voina v Rossii. Saint-Petersburg, Ros imperiia: tip Lazarevykh in-ta vostochkh iaz; 1835. 286 p.
  21. Villie IaV. Kratkoe nastavlenie o vazhneishikh khirurgicheskikh operatsiiakh [Brief instruction on major surgery]. Saint-Petersburg, Ros imperiia; 1806. 167 p.
  22. Fedorov VN. Mozhaisk v Otechestvennuiu voinu 1812 g [Mozhaisk in the Patriotic War of 1812 ]. V: Otechestvennaia voina 1812 g. Istochniki. Pamiatniki. Problemy: materialy IV i V Vseros nauch konf; 1995-1996 gg; Borodino, RF; 1997. p. 116–128.
  23. Beskrovnyi LG, Meshcheriakov GP, red. Borodino. Dokumenty, pis'ma, vospominaniia [Borodino. Documents, letters and memoirs]. Moscow, RF: Sovet Rossiia; 1962. 412 p.
  24. Meditsinskaia entsiklopediia. Meditsinskaia sluzhba v otechestvennuiu voinu 1812 goda. Evakuatsiia i lechenie ranenykh i bol'nykh [ Medical services during in the Patriotic war of 1812. Evacuation and treatment of wounded and sick wounded and sick patients]. Rezhim dostupa: http://www.medical-enc.ru.
  25. Gangart. Konchina kniazia Bagrationa [The death of Prince Bagration]. V: Vospominaniia o 1812 gode. 1813;(9 Ch 4). p. 227–228.
  26. Lozh'e Ts. Dnevnik ofitsera Velikoi armii v 1812 godu [A diary of an officer of the Grand Army in 1812]. Biblioteka memuarov. Moscow, RF: Pravda-Press; 2005. 280 p.
  27. Kharkevich VI. 1812 god v dnevnikakh, zapiskakh i vospominaniiakh sovremennikov [1812 year in diaries, notes and memoirs of contemporaries]: materialy Voen-uchenogo arkh gl shtaba. Kn II, vyp 4. Saint-Petersburg, RF: Al'faret; 2012. 324 p.
  28. Rastopchin FV. Pis'mo grafa FV Rastopchina k Kniaziu PI Bagrationu ot 12 avgusta 1812 g [A letter of Count F.V. Rostopchin to Prince P.I. Bagration, August 12, 1812 year]. Rezhim dostupa: http://ru.wikisource.org/wiki. s. 53–55.
  29. Sen-Pri EF. Vsepoddanneishii raport Nachal'nika Glavnogo Shtaba 2-oi Zapadnoi Armii general-ad"iutanta Grafa Sen-Pri ot 14 sentiabria 1812 goda [Humbly report to the Chief of General Staff of the 2nd Western Army to adjutant general count de Saint-Prix on September 14, 1812 ]. Rezhim dostupa: http://ru.wikisource.org/wiki. – S.64–65.
  30. Nagumovich LIa. Rukovodstvo k lecheniiu ognestrel'nykh ran po pravilam, predlagaemym znamenitymi v Evrope khirurgami [A guide to the treatment of gunshot wounds according to the rules proposed by the famous surgeon in Europe]. Pokhod tip gl shtaba 1-i armii; 1822. 7 p.
Address for correspondence:
210023, Respublika Belarus, g. Vitebsk, pr. Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra obschey khirurgii,
e-mail: nebylicin.uravgm@mail.ru,
Nebylitsin Yuriy Stanislavovich
Information about the authors:
Sushkov S.A. PhD, associate professor, vice-rector on scientific research work of EE “Vitebsk State Medical University.
Nebylitsin Yu.S. PhD, associate professor of the chair of general surgery of EE “Vitebsk State Medical University”
Reutskaya E.N. A 6-year student of the medical faculty of EE “Vitebsk State Medical University”.
Rak A.N. A 6-year student of the medical faculty of EE “Vitebsk State Medical University”.

EXPERIMENTAL SURGERY

V.G. BOGDAN 1 , S.G. KRYVOROT 2, T.E. VLADIMIRSKAYA 2, I.A. SHVED 2, J.M. GAIN 2

THE INFLUENCE OF ADIPOSE TISSUE-DERIVED MESENCHYMAL STEM CELLS ON COLLAGEN SYNTHESIS AT DIFFERENT WAYS OF PLASTY OF SIMULATED INCISIONAL HERNIA

EE “Belarusian State Medical University”1,
SEE “Belarusian Academy of Post-Graduate
Education” 2, Minsk,
The Republic of Belarus

Objectives. To carry out collagen biosynthesis analysis at different types of abdominal wall plasty with adipose tissue-derived mesenchymal stem cells transplantation (ATMSCs) in a simulated incisional hernia in laboratory animals.
Methods. The incisional hernia by the developed method was modeled in 140 laboratory animals (rats).
Four groups of animals depending on the type of abdominal wall plasty were formed. The plasty using a polypropylene surgical mesh with 2,5% gelatin gel and ATMSCs was carried out in the first group. One’s own tissue with 2,5% gelatin gel and ATMSCs was used in the second group; in the third group - a polypropylene surgical mesh; in the fourth group the interrupted suture was performed and 2,5% gelatin gel was additionally placed. To assess collagen formation processes the immunohistochemical tissue of the abdominal wall was studied in the dynamics with determination of the quantitative expression of biomolecular markers of collagen type I and III, as well as their relationship (I / III).
Results. It has been found out that that the transplantation of ATMSCs in the gelatin gel at the abdominal wall plasty in isolation and combined with a polypropylene surgical mesh leads to a stable high activity of collagen type I (p<0,05) in conjunction with a minimum increase (p<0,05) of the collagen type III expression both within the analyzed period and in comparison with the rates of other variants of plasty, stable elevation (p<0,05) of collagen ratio I / III type during the entire experiment.
Conclusions. The established features of collagen biosynthesis confirm the multifactorial positive impact of ATMSCs on the structural characteristics of connective tissue forming in the hernioplasty area.

Keywords: postoperative hernia, plasty, adipose tissue-derived mesenchymal stem cells transplantation, connective tissue, synthesis of collagen
p. 21 – 28 of the original issue
References
  1. Bogdan VG, Gain IuM. Patogenez posleoperatsionnykh gryzh: izmeneniia metabolizma soedinitel'noi tkani – prichina ili sledstvie [The pathogenesis of postoperative hernias: changes of the connective tissue metabolism - cause or consequence]. Novosti Khirurgii. 2011;19(6):29–35
  2. Gostevskoi AA. Nereshennye voprosy protezirovaniia perednei briushnoi stenki pri gryzhakh (chast' II) [Unresolved problems of prosthetic abdominal wall hernia (part II)]. Vestn Khirurgii im II Grekova. 2007;166(6):93–5.
  3. Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B. Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias. J Invest Surg. 2001 Jan-Feb;14(1):47–54.
  4. White B, Osier C, Gletsu N, Jeansonne L, Baghai M, Sherman M, Smith CD, Ramshaw B, Lin E. Abnormal primary tissue collagen composition in the skin of recurrent incisional hernia patients. Am Surg. 2007 Dec;73(12):1254–58.
  5. Serov VV, Shekhter AB. Soedinitel'naia tkan' (funktsional'naia morfologiia i obshchaia patologiia) [Connective tissue (functional morphology and general pathology)]. Moscow, RF: Meditsina; 1981. 312 p.
  6. Pascual G, Rodriguez M, Gomez-Gil V, Garcia-Honduvilla N, Bujan J, Bellon JM. Early tissue incorporation and collagen deposition in lightweight polypropylene meshes: bioassay in an experimental model of ventral hernia. Surgery. 2008 Sep;144(3):427–35.
  7. Junge K, Klinge U, Rosch R, Mertens PR, Kirch J, Klosterhalfen B, Lynen P, Schumpelick V. Decreased collagen type I/III ratio in patients with recurring hernia after implantation of alloplastic prostheses. Langenbecks Arch Surg. 2004 Feb;389(1):17–22.
  8. Gostevskoi AA, Sedov VM, Khamid AKh, Tarbaev SD, Gorelov AS. Sravnitel'nyi analiz polipropilenovogo i biologicheskogo setchatykh implantatov v eksperimente [Comparative analysis of the polypropylene and biological mesh implants in experiment]. Med Akad Zhurn. 2007;7(3):135–36.
  9. Dubova EA, Shchegolev AI, Filatkina NV, Chizhov DV, Egiev VN. Eksperimental'noe izuchenie dinamiki tkanevoi reaktsii v zone implantatsii polipropilenovykh setchatykh endoprotezov, pokrytykh fibroblastami [Experimental study of the dynamics of tissue reaction in the zone of polypropylene mesh implants coated with fibroblast]. Gerniologiia. 2007;(4):35–40.
  10. Ivanov IS, Ivanov SV, Goriainova GN, Ivanov AV, Tarabrin DV. Ispol'zovanie kletochnykh tekhnologii s tsel'iu uluchsheniia svoistv soedinitel'noi tkani v eksperimente [The application of cell-based technologies to improve the properties of connective tissue in the experiment]. Novosti Khirurgii. 2012;20(4):3–8.
  11. Bogdan VG, Zafranskaia MM, Bagatka SS, Iurkevich MIu, Gain IuM, Demidchik IuE. Kharakteristika mezenkhimal'nykh stvolovykh kletok zhirovoi tkani cheloveka, differentsirovannykh v fibroblastnom napravlenii [Characterization of mesenchymal stem cells of human adipose tissue differentiated in fibroblast direction]. Zdravookhranenie. 2012;(4):19–25.
  12. Zuk PA, Zhu M, Mizuno H, Huang J, Futrell JW, Katz AJ, Benhaim P, Lorenz HP, Hedrick MH. Multilineage cells from human adipose tissue: implications for cell-based therapies. Tissue Eng. 2001 Apr;7(2):211–28.
  13. Heffner JJ, Holmes JW, Ferrari JP, Krontiris-Litowitz J, Marie H, Fagan DL, Perko JC, Dorion HA. Bone marrow-derived mesenchymal stromal cells and platelet-rich plasma on a collagen matrix to improve fascial healing. Hernia. 2012 Dec;16(6):677–87.
  14. Zhao Y, Zhang Z, Wang J, Yin P, Zhou J, Zhen M, Cui W, Xu G, Yang D, Liu Z. Abdominal hernia repair with a decellularized dermal scaffold seeded with autologous bone marrow-derived mesenchymal stem cells. Artif Organs. 2012 Mar;36(3):247–55.
  15. Denisov SD, Morozkina TS. Trebovaniia k nauchnomu eksperimentu s ispol'zovaniem zhivotnykh [Requirements to scientific experiment with animals use]. Zdravookhranenie. 2001;(4):40–42.
Address for correspondence:
220034, Respublika Belarus', g. Minsk, ul. Azgura, d.4, UO «Belorusskii gosudarstvennyi meditsinskii universitet, voenno-polevoi fakul'tet
e-mail:bogdan-5@mail.ru,
Bogdan Vasilii Genrikhovich
Information about the authors:
Bogdan V.G. PhD, associate professor, colonel of medical service, the deputy head of the military medical faculty of EE “BSMU” on educational and scientific affairs.
Kryvorot S.G. A researcher of CSRL of SEE “Belarusian Medical Academy of Post-Graduate Education”.
Vladimirskaya T.E. PhD, leading researcher of CSRL of SEE “Belarusian Medical Academy of Post-Graduate Education”.
Shved I.A. MD, professor, chief researcher of CSRL of SEE “Belarusian Medical Academy of Post-Graduate Education”.
Gain J.M. MD, professor, vice-rector on scientific affairs of SEE “Belarusian Medical Academy of Post-Graduate Education”.

I.V. MAIBORODIN, A.I. SHEVELA, V.A. MATVEEVA, M.N. DROVOSEKOV, M.I. BARANNICK, I.V. KUZNETSOVA

ANGIOGENESIS IN GRANULATION TISSUE AFTER IMPLANTATION OF POLYHYDROXYALKANOATE WITH MESENCHYMAL STEM CELLS

Center of Modern Medical Technology of the Institute of Chemical Biology and Fundamental Medicine of Siberian branch of RAS, Novosibirsk,
The Russian Federation

Objectives. To estimate the processes occurring in various tissues after implantation of polymeric films from polyhydroxyalkanoate (PHA) with the adsorbed autologous multipotent mesenchymal stem cells of the bone marrow origin (AMMSCBM) in experiment.
Methods. The processes occurring in the rat abdominal cavity, muscular and subcutaneous adipose tissues after implantation of PHA with the adsorbed AMMSCBM and transfected DNA of fluorescent protein GFP were studied by the methods of light microscopy.
Results. It was revealed that after implantation of PHA with AMMSCBM the increase of blood vessels number in the surrounding tissues was occurred as a result of neoangiogenesis processes. In this case AMMSCBM don’t migrate and don’t collapse in the site of administration, but form the blood vessels on account of differentiation of their structures in cells. Processes of angiogenesis in tissues around PHA in turn lead to formation of large number of blood vessels in the granulations surrounded the implanted foreign body, larger volume of granulations and thicker capsule, delimiting polymer in the future. However it is possible that formation of a thick capsule with fibrous signs after implantation of PHA with AMMSCBM is considered as the unfavorable prognostic signs indicating to high probability of various complications development afterwards. Administrated AMMSCBM are replaced eventually by their own recipient cells.
Conclusions. The implantation of PHA with AMMSCBM leads to the formation of large number of blood vessels in the granulations forming round the implanted foreign body, larger volume of granulations and thicker capsule delimiting polymer in the future.

Keywords: multipotent mesenchymal stromal cells, polyhydroxyalkanoate, implantation, angiogenesis, granulomatous inflammations
p. 29 – 36 of the original issue
References
  1. Kang JM, Kang SW, La WG, Yang YS, Kim BS. Enhancement of in vivo bone regeneration efficacy of osteogenically undifferentiated human cord blood mesenchymal stem cells. J Biomed Mater Res A. 2010 May;93(2):666–72.
  2. Liu M, Xiang Z, Pei F, Huang F, Cen S, Zhong G, Fan H, Xiao Y, Sun J, Gao Y. Repairing defects of rabbit articular cartilage and subchondral bone with biphasic scaffold combined bone marrow stromal stem cells. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Jan;24(1):87–93.
  3. Xie J, Han Z, Naito M, Maeyama A, Kim SH, Kim YH, Matsuda T. Articular cartilage tissue engineering based on a mechano-active scaffold made of poly(L-lactide-co-epsilon-caprolactone): In vivo performance in adult rabbits. J Biomed Mater Res B Appl Biomater. 2010 Jul;94(1):80–8.
  4. Re'em T, Tsur-Gang O, Cohen S. The effect of immobilized RGD peptide in macroporous alginate scaffolds on TGFbeta1-induced chondrogenesis of human mesenchymal stem cells. Biomaterials. 2010 Sep;31(26):6746–55.
  5. Shishatskaya EI, Voinova ON, Goreva AV, Mogilnya OA, Volova TG. Reaktsiia tkanei na implantatsiiu mikrochastits iz rezorbiruemykh polimerov pri vnutrimyshechnom vvedenii [Tissue reaction to intramuscular injection of resorbable polymer microparticle]. Biul Eksperim Biologii i Meditsiny. 2007; 144(12):635–39.
  6. Shishatskaya EI, Voinova ON, Goreva AV, Mogilnaya OA, Volova TG. Biocompatibility of polyhydroxybutyrate microspheres: in vitro and in vivo evaluation. J Mater Sci Mater Med. 2008 Jun;19(6):2493–502.
  7. Maiborodin IV, Shevela AI, Anishchenko VV, Matveeva VA, Shevela AA, Drovosekov MN, Vlasov VV. Osobennosti reaktsii tkanei krys na vnutribriushinnye implantaty iz biodegradiruemogo poligidroksialkanoata [The peculiarities of rat tissues reactions on biodegradable olyhydroxyalkanoate intraperitoneal implants]. Morfologiia. 2011;139(2):62–6.
  8. Baeke JL. Breast deformity caused by anatomical or teardrop implant rotation. Plast Reconstr Surg. 2002 Jun;109(7):2555–64.
  9. Carmeliet P, Luttun A. The emerging role of the bone marrow-derived stem cells in (therapeutic) angiogenesis. Thromb Haemost. 2001 Jul;86(1):289–97.
  10. Shi Q, Rafii S, Wu MH, Wijelath ES, Yu C, Ishida A, Fujita Y, Kothari S, Mohle R, Sauvage LR, Moore MA, Storb RF, Hammond WP. Evidence for circulating bone marrow-derived endothelial cells. Blood. 1998 Jul 15;92(2):362–67.
  11. Hu X, Yu SP, Fraser JL, Lu Z, Ogle ME, Wang JA, Wei L. Transplantation of hypoxia-preconditioned mesenchymal stem cells improves infarcted heart function via enhanced survival of implanted cells and angiogenesis. J Thorac Cardiovasc Surg. 2008 Apr;135(4):799–808.
  12. Maiborodin IV, Iakimova NV, Matveeva VA., Pekarev OG, Maiborodina EI, Pekareva EO. Angiogenez v rubtse matki krys posle vvedeniia autologichnykh mezenkhimal'nykh stvolovykh kletok kostnomozgovogo proiskhozhdeniia [Angiogenesis in the rat uterine scar after administration of autologous bone marrow-derived mesenchymal stem cells]. Biul Eksperim Biologii i Meditsiny. 2010;150(12):705–11.
  13. Maiborodin IV, Iakimova NV, Matveeva VA, Pekarev OG, Maiborodina EI, Pekareva EO, Tkachuk OK. Morfologicheskii analiz rezul'tatov vvedeniia autologichnykh stvolovykh stromal'nykh kletok kostnomozgovogo proiskhozhdeniia v rubets matki krys [Morphological analysis of the administration of autologous bone marrow-derived mesenchymal stem cells in the rat uterine scar]. Morfologiia. 2010;138(6):47–55.
  14. Chang SH, Tung KY, Wang YJ, Tsao YP, Ni TS, Liu HK. Fabrication of vascularized bone grafts of predetermined shape with hydroxyapatite-collagen gel beads and autogenous mesenchymal stem cell composites. Plast Reconstr Surg. 2010 May;125(5):1393–402.
  15. Rouanet P, Duchene M, Quenet F. Cancer update on breast reconstruction. Bull Cancer. 2002 Jan;89(1):125–9.
Address for correspondence:
630090, Rossiiskaia Federatsiia, g. Novosibirsk, pr. akad. Lavrent'eva, d. 8, Institut khimicheskoi biologii i fundamental'noi meditsiny SO RAN, Tsentr novykh meditsinskikh tekhnologii, laboratoriia stvolovoi kletki,
e-mail: imai@mail.ru,
Maiborodin Igor' Valentinovich
Information about the authors:
Maiborodin I.V. MD, professor, leading researcher of the stem cell laboratory of the Institute of Chemical Biology and Fundamental Medicine of RAS, Novosibirsk.
Shevela A.I. MD, professor, Honored Doctor of RF, deputy director of the Institute of Chemical Biology and Fundamental Medicine of RAS, Novosibirsk.
Matveeva V.A. PhD, a senior researcher of the stem cell laboratory of the Institute of Chemical Biology and Fundamental Medicine of RAS, Novosibirsk.
Drovosekov M.N. PhD, an applicant for Doctor’s degree of the stem cell laboratory of the Institute of Chemical Biology and Fundamental Medicine of RAS, Novosibirsk.
Barannik M.I. PhD, an applicant for Doctor’s degree of the stem cell laboratory of the Institute of Chemical Biology and Fundamental Medicine of RAS, Novosibirsk.
Kuznetsova I.V. PhD, a researcher of the stem cell laboratory of the Institute of Chemical Biology and Fundamental Medicine of RAS, Novosibirsk.

GENERAL AND SPECIAL SURGERY

L.K.KULIKOV1,Î.À.BUSLAEV2,S.V.SHALASHOV2,À.À.SMIRNOV1,A.L.MIKHAYLOV2,I.A.EGOROV3,L.P.SHADAROV2,S.T.SOBOLEV2,V.F.SOBOTOVICH1,U.A.PRIVAL

SURGICAL TREATMENT OF EXTENSIVE AND GIANT VENTRAL INCISIONAL HERNIAS

SBEE APE “Irkutsk State Medical Academy of Post-Graduate Education”1,
NGHA “Railway Clinical Hospital at the station Irkutsk - Passenger” of JSC “Russian Railways”2,
The Russian Federation

Objectives. To evaluate effectiveness of surgical treatment of extensive and giant incisional hernias with the developed method of “the cut mesh prosthesis”.
Methods. Prospective investigation including 48 patients was conducted. Two groups were allocated. 27 patients who were subjected to plasty using the designed “the cut mesh prosthesis” method made up the main group (MG); 21 patients who underwent Shumpelik’s surgery made up the group of clinical comparison (GCC). The designed method differs from the existed ones in the way of endoprosthesis fixation in the tissues. Endoprosthesis is not sewed to the tissues but fixed by means of strips cut to its edges. Multislice computed tomography (MSCT) with hernioabdomenometry and surface electromyography (EMG) were carried out before and after the intervention. The number and character of complications were evaluated in the early postoperative period. Recurrences and life quality were analyzed in long-term period.
Results. Out of 27 main group patients early postoperative complications were revealed in 4 (14,8%) and in the group of clinical comparison (n=21) the complications developed in 6 (28,6%) of patients. At electromyography of the straight abdominal muscles in patients the electropotentials were irregular and low amplitude in both main and clinical comparison groups before the operation. One year after operation more significant restoration of the biopotentials of straight muscles was observed. No recurrences were revealed in the main group in the long-term period up to five years. Two hernia recurrences were revealed in the group of clinical comparison. While evaluating the life quality in the main group patients an increase of physical and psychological components of health was registered in contrast to the comparative group (ð<0,01).
Conclusions. The designed method of “the cut mesh prosthesis” increases effectiveness of patients’ treatment with extensive and giant incisional hernias by reducing of recurrences and reliable improvement of patients’ life quality.

Keywords: incisional ventral hernia, prosthesis plasty, hernioplasty methods
p. 37 – 44 of the original issue
References
  1. Sinenchenko GI, Romashkin-Timanov MV, Kurygin AA. Bezretsidivnoe khirurgicheskoe lechenie posleoperatsionnykh ventral'nykh gryzh kak sotsial'naia problema [Non-recurrent surgical treatment of postoperative ventral hernia as a social problem ]. Vestn Khirurgii im II Grekova. 2006;(1):15–17.
  2. White TJ, Santos MC, Thompson JS. Factors affecting wound complications in repair of ventral hernias. Am Surg. 1998 Mar;64(3):276–80.
  3. Egiev VN. Nenatiazhnaia gernioplastika [Non-tension hernioplasty]. Moscow, RF: MEDPRAKTIKA-M; 2002. 147 p.
  4. Izmailov SG, Maiorov IuA, Troitskii KI, Nechaev KG, Zadov NS. Predoperatsionnaia podgotovka bol'nykh s bol'shimi posleoperatsionnymi gryzhami [Preoperative preparation of patients with large postoperative hernias]. Gerniologiia. 2006;(3):20–21.
  5. Iagudin MK. Rol' etapnoi rekonstruktsii briushnoi stenki pri bol'shikh i gigantskikh posleoperatsionnykh gryzhakh [The role of the gradual reconstruction of the abdominal wall in postoperative large and giant hernias]. Khirurgiia. 2005;(9):69–72.
  6. Zhebrovskii VV, El'bashir MT. Khirurgiia gryzh zhivota i eventratsii [Hernia surgery of abdomen and eventrations]. Simferopol', Ukraina: Biznes-Inform; 2002. 438 p.
  7. Timoshin AD, Iurasov AV, Shestakov AL. Khirurgicheskoe lechenie pakhovykh i posleoperatsionnykh gryzh briushnoi stenki [Surgical treatment of inguinal and postoperative hernias of abdominal wall]. Moscow, RF: Triada-Õ; 2003. 144 p.
  8. Schumpelick V, Klinge U, Rosch R, Conze J, Junge K. How to Treat the Recurrent Incisional Hernia: Open Repair in the Midline. In: Schumpelick V, Fitzgibbons RJ, ed. Recurrent Hernia Prevention and Treatment. Berlin: Springer-Verlag Heidelberg; 2007. p. 191–97.
  9. Shalashov SV, Mikhailov AL, Usol'tsev IuK, Egorov IA. Sposob plastiki pri posleoperatsionnykh ventral'nykh gryzhakh [Method of plasty in postoperative ventral hernias]. Pat. ¹ 2366367 RF, A61B17/00. 2009 Sep 10. Biul;(23).
  10. Kulikov LK, Buslaev OA, Shalashov SV, Egorov IA, Mikhailov AL. Sposob plastiki pri bol'shikh posleoperatsionnykh ventral'nykh gryzhakh [Method of plasty of large postoperative ventral hernias]. Pat ¹ 2458640 RF. 2011 Mar 29. Biul;(23).
  11. Toskin KD, Zhebrovskii VV. Gryzhi briushnoi stenki [Hernias of the abdominal wall]. Moscow, RF. Meditsina; 1990. 272 p.
  12. Nikolaev SG. Praktikum po klinicheskoi elektromiografii [A practical guide on clinical electromyography]. Ivanovo, RF; 2003. 264 p.
  13. Kulikov LK, Smirnov AA. Abdominal'nyi kompartment – sindrom: ucheb posobie [Abdominal compartment – syndrome: a study guide]. Irkutsk, RF: RIO IGIUVa; 2008. 60 p.
  14. Dobrovol'skii SR, Abaurakhmanov IuKh, Azhamynchiev EK, Abaullaeva AA. Issledovanie kachestva zhizni bol'nykh v khirurgii [The study of life quality in surgery]. Khirurgiia Zhurn im NI Pirogova. 2008;12:73–76.
  15. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–83.
Address for correspondence:
664079, Rossiiskaia Federatsiia, g. Irkutsk, m-n. Iubileinyi 100, GBOU DPO «Irkutskaia gosudarstvennaia meditsinskaia akademiia poslediplomnogo obrazovaniia», kafedra khirurgii,
e-mail: giuv.surgery@ya.ru,
Kulikov Leonid Konstantinovich
Information about the authors:
Kulikov L.M. MD, professor, a head of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Post-Graduate Education”.
Buslaev O.A. A head of the surgical department of NGHA “Railway clinical hospital at the station Irkutsk-Passenger ” of JSC “Russian Railways”.
Shalashov S.V. PhD, a surgeon of the surgical department of NGHA “Railway clinical hospital at the station Irkutsk-Passenger” of JSC “Russian Railways”.
Smirnov A.A. PhD, an assistant of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Post-Graduate Education”. Mikhaylov A.L. A surgeon of the surgical department of NGHA “Railway clinical hospital at the station Irkutsk-Passenger ” of JSC “Russian Railways”.
Egorov I.A. A surgeon of the surgical department of NGHA “Railway clinical hospital at the station Irkutsk- Passenger” of JSC “Russian Railways”.
Shadarov l.P. A physician of the functional diagnostics department of NGHA “Railway clinical hospital at the station Irkutsk-Passenger” of JSC “Russian Railways”.
Sobolev S.T. PhD, a physician of the functional diagnostics department of NGHA “Railway clinical hospital at the station Irkutsk- Passenger” of JSC “Russian Railways”.
Sobotovich V.F. PhD, associate professor of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Post-Graduate Education”.
Privalov U.A. PhD, associate professor of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Post-Graduate Education”.

S.V. ALEXANDROV 1,2

POSSIBILITIES OF ENDOSCOPIC LASER LITHOTRIPSY IN PATIENTS WITH CHOLANGIOLITHIASIS

SEE “Belarusian Medical Academy of Post-Graduate Education”1,
ME “Minsk Regional Clinical Hospital”2,
The Republic of Belarus

Objectives. To determine the wave length of laser radiation with the most marked lithotripsy effect concerning the concretions of the extrahepatic bile ducts as well as to find out the optimal parameters of laser radiation to carry out lithotripsy.
Methods. Affecting the concretions of the extrahepatic bile ducts by laser radiation of 1064, 1320 and 1440 nm wavelengths in liquid medium we have ascertained the wavelength with most expressed effect of lithotripsy. Then, changing stepwise the energy of the laser radiation impulse of 1320 and 1440 nm wavelengths we have determined the optimal values of the impulse energy to carry out lithotripsy.
Results. The largest size of the concretion could be destroyed by a single impulse of 1440 nm wavelength of laser radiation at the same parameters.
The minimal lithotripsy effect is found at 1064 nm wavelength. The optimal values of the impulse energy for the performance of extrahepatic bile duct concretions lithotripsy by 1320 nm wavelength radiation are considered to be within the limits of 0.9-1,5 J and 0,5-0,8 J for 1440 nm. Higher values of the impulse energy are considered as dangerous for application in connection with impossibility to control distinctly the process of concretion destruction and damage risk of the adjacent tissues.
Conclusions. A 1440 nm wavelength radiation has the greatest effect of lithotripsy out of three wavelengths (1064, 1320 and 1440 nm) and is considered the most safe and effective for lithotripsy performance at cholangiolithiasis. 1320 nm wavelength radiation can be also applied to destroy large concretions of the extrahepatic bile ducts at laparoscopic and videoendoscopic interventions.

Keywords: cholelithiasis, cholangiolithiasis, laser lithotripsy
p. 45 – 53 of the original issue
References
  1. Tanaka M. Problems inherent to balloon dilation for the treatment of common bile duct stones in comparison with endoscopic sphincterotomy. Digestive Endoscopy. 2000 Apr;12(2):112–15.
  2. Gusev AV, Borovkov IN, Martinsh ChT, Guseva EV, Pokrovskii EZh, Evtikhova EIu. Novye tekhnologii pri mekhanicheskoi zheltukhe dobrokachestvennogo geneza [New technologies in obstructive jaundice of benign origin]. Annaly Khirurg Gepatologii. 2008;13(1):72–75.
  3. Coelho-Prabhu N, Dzeletovic I, Baron TH. Outcome of access sphincterotomy using a needle knife converted from a standard biliary sphincterotome. Endoscopy. 2012 Jul;44(7):711–14.
  4. Snigirev IuV, Troshkin VV, Modzelevskaia SM, Brizh AM, Alekseev NA, Taraskina EB. K voprosu o laparoskopicheskoi kholedokholitotomii [Some aspects of laparoscopic choledocholitotomy]. Endoskop Khirurgiia. 2005;(1):135.
  5. Binmoeller KF, Bruckner M, Thonke F, SoehendraN. Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy. Endoscopy.1993 Mar;25(3):201–6.
  6. Karimov ShI, Kim VL, Alimukhamedova DK, Kurbanov OSh. Litolizis i udarno-volnovaia litotripsiia v lechenii zhelchnokamennoi bolezni [Litholysis and shock wave lithotripsy in the treatment of gallstone disease]. Endoskop Khirurgiia. 2003;(1):27–29.
  7. Ogawa K, Ohkubo H, Abe W, Maekawa T. Percutaneous transhepatic small-caliber choledochoscopic lithotomy: a safe and effective technique for percutaneous transhepatic common bile duct exploration in high-risk elderly patients. J Hepatobiliary Pancreat Surg. 2002;9(2):213–7.
  8. Harris VJ, Sherman S, Trerotola SO, Snidow JJ, Johnson MS, Lehman GA. Complex biliary stones: treatment with a small choledochoscope and laser lithotripsy. Radiology.1996 Apr;199(1):71–7.
  9. Nevorotin AI. Vvedenie v lazernuiu khirurgiiu: ucheb posobie [Introduction to laser surgery: a study guide]. Saint-Petersburg, RF: Spets. Lit; 2000. 175 p.
  10. Juhasz T, Kastis GA, Suarez C, Bor Z, Bron WE. Time-resolved observations of shock waves and cavitation bubbles generated by femtosecond laser pulses in corneal tissue and water. Lasers Surg Med. 1996;19(1):23–31.
  11. Rink K, Delacretaz G, Salathe RP. Fragmentation process of current laser lithotriptos. Laser Surg. Med.1995; 16(2):134–46.
  12. Khriachkov VV, Levchenko NV, Belousov VV. Pritsel'naia kontaktnaia lazernaia litotripsiia – novye vozmozhnosti v lechenii zhelchnokamennoi bolezni [Targeted contact laser lithotripsy - new possibilities in the treatment of gallstone disease]. Uspekhi Sovrem Estestvoznaniia. 2008;(5):152–54.
  13. Jacobs R, Pereira-Lima JC, Schuch AW, Pereira-Lima LF, Eickhoff A, Riemann JF. Endoscopic laser lithotripsy for complicated bile duct stones. Is cholangioscopic guidance necessary? Arq Gastoenterol. 2007 Apr-Jun;44(2):137–40
  14. Grachev SV. Gol'mievyi lazer v meditsine [Application of Holmium laser in medicine]. Moscow, RF: Triada-X; 2003. 240 p.
  15. Kim HI, Moon JH, Choi HJ, Lee JC, Ahn HS, Song AR, Lee TH, Cho YD, Park SH, Kim SJ. Holmium laser lithotripsy under direct peroral cholangioscopy by using an ultra-slim upper endoscope for patients with retained bile duct stones. Gastrointest Endosc. 2011 Nov; 74(5):1127–32
Address for correspondence:
223052, Respublika Belarus', Minskaia oblast', Minskii raion, p. Lesnoi-1; UZ «Minskaia oblastnaia klinicheskaia bol'nitsa», khirurgicheskoe otdelenie ¹2,
e-mail: dr_Alexandrov@tut.by,
Aleksandrov Sergei Vladimirovich
Information about the authors:
Alexandrov S.V. A head of the surgical department ¹2 of ME “Minsk regional clinical hospital”, lecturer of the surgery chair of SEE “Belarusian Medical Academy of Post-Graduate Education”.

S.N. NAVRUZOV1, M.M. MIRZAKHMEDOV2, B.S. NAVRUZOV3, M.A. AHMEDOV3

PECULIARITIES OF CLINICAL COURSE AND CHOICE OF SURGICAL TREATMENT OF HIRSCHPRUNG’S DISEASE IN ADULTS

Republican Oncological Scientific Center of the Ministry of Health of the Republic of Uzbekistan 1,
Coloproctology Scientific Center of the Republic of Uzbekistan 2, Tashkent,
Tashkent Medical Academy 3,
The Republic of Uzbekistan

Objectives. To improve diagnostics and determine the most effective ways of operative treatment in case of Hirschsprung’s disease in adults.
Methods. 82 patients with Hirschsprung’s disease (HD) undergoing examination and treatment during the period of 1990 up to 2013 yrs. in the Scientific Center of Coloproctology of the Ministry of Health of the Republic of Uzbekistan were included in the research. The age of patients varied from 15 up to 46 years. Out of 82 patients, 58 (70,7%) were males, 24 were females (29,3%). All patients underwent clinical and instrumental examination. For the comparative analysis of surgical treatment effectiveness the patients with HD were subdivided into 2 groups. The main group included 28 patients who underwent the abdominal-anal resection (BAR) of the rectum with the relegation of the proximal colon to the anal canal. The control group included 44 patients who underwent Duhamel operation. Outcomes of interventions and complications were analyzed. The long-term results of surgical treatment were evaluated using Visick score.
Results. Out of 82 surveyed patients the supraanal form of hypogangliosis was detected in 46 (56%), rectal one – in 20 (24,4%), recto-sigmoid – in 13 (15,9%), left-side one – in 2 (2,5%) and – 1 (1, 2%) subtotal form. According to Swenson biopsy data agangliosis was revealed in 36 (44%) out of 82 patients, hypogangliosis of the rectum in 46 (56%). In the main group the early postoperative complications were registered in 4 (14, 3%) patients and in the control group – in 14 (31,8%) patients. Lethal outcome was registered in 1 (2,2%) case after Duhamel operation. Late postoperative complications were revealed in 7,1% in the main group and 15% in the control group of patients.
Conclusions. The most adequate and radical way to treat HD in adults is considered to be the abdominal-anal resection of the rectum with relegation of the proximal colonic segments to the anal canal. It is aimed at the removal of hypo-or agangliosis zone and the decompensated segments of the colon and meets the requirements of radicalism.

Keywords: Hirschsprung’s disease, hypogangliosis, agangliosis, megacolon, megarectum
p. 54 – 60 of the original issue
References
  1. Bykov NI, Chepurnoi GI, Kivva AN. Vybor optimal'nogo varianta khirurgicheskogo lecheniia bolezni Girshprunga u detei [The choice of the optimal surgical treatment options of Hirschsprung's disease in children]. Det Khirurgiia. 2007;(5):10–12.
  2. Sansbury FH, Ellard S, Shaw-Smith C, Turnpenny P. Many patients have an identifiable genetic cause of Hirschsprung's disease. BMJ. 2012 Dec 3;345:e8199.
  3. Leonevskaia NM, Erdes SI, Ratnikova MA. Protokol lecheniia bolezni Girshprunga u detei [The protocol of Hirschsprung's disease treatment in children]. Ros Zhurn Gastroenterologii Gepatologii Koloproktologii. 2009;(3):57–62.
  4. Vorobei AV, Makhmudov AM, Vysotskii FM, Tikhon VK, Senkevich OI, Archakova LI, Novakovskaia SA. Sorokàletnii opyt lecheniia bolezni Girshprunga u vzroslykh v Belarusi [Forty years experience in the treatment of Hirschsprung's disease of adults in Belarus]. Vopr Organizatsii i Informatizatsii Zdravookhraneniia. 2010;(4):92–96.
  5. Vorob'ev GI, Zhuchenko AP, Achkasov SI, Biriukov OM. Bolezn' Girshprunga u vzroslykh: 25-letnii opyt kliniki [Hirschsprung's disease in adults: 25 years of experience in the clinic]. Aktual'nye vopr koloproktologii: tez dokl. Samara, RF; 2003. s. 414.
  6. Best KE, Glinianaia SV, Bythell M, Rankin J. Hirschsprung's disease in the North of England: prevalence, associated anomalies, and survival. Birth Defects Res A Clin Mol Teratol. 2012 Jun;94(6):477–80.
  7. Ergashev NSh, Khurramov FM, Khamidov BKh, Markaev AIa. Diagnostika i lechenie bolezni Girshprunga u detei [Diagnosis and treatment of Hirschsprung's disease in children]. Khirurgiia Uzbekistana. 2009;(2):36–40.
  8. Kapuller LL, Achkasov SI, Zhuchenko AP, Biriukov OM. Protiazhennost' zony fiziologicheskogo gipoganglioza u vzroslykh i ee znachenie v diagnostike bolezni Girshprunga [Extension of the zone of physiological hypogangliosis in adults and its importance in the diagnosis of Hirschsprung's disease]. Arkh Patologii. 2008;(1):46–49.
  9. Goslin B, Brown A, Robertson D. Gastroschisis, ileal atresia, and Hirschsprung's disease in a newborn: The first reported case. J Pediatr Surg. 2012 Nov;47(11):2134–36.
Address for correspondence:
100060, Respublika Uzbekistan, g. Tashkent, ul. S. Azimova, d. 74, Respublikanskaia klinicheskaia bol'nitsa ¹1., Respublikanskii nauchnyi tsentr koloproktologii MZ Uzbekistana,
e-mail: myradbek@mail.ru,
Mirzakhmedov Murad Mirkhaidarovich
Information about the authors:
Navruzov S.N. MD, professor, director of the Republican oncological scientific center of the Ministry of Health of the Republic of Uzbekistan.
Mirzakhmedov M.M. PhD, senior researcher of the Coloproctology Scientific center of the Republic of Uzbekistan.
Navruzov B.S. MD, associate professor of the chair of the general profile physician in surgery of Tashkent Medical Academy.
Ahmedov M.A. MD, professor of the chair of the general profile physician in surgery of Tashkent Medical Academy.

E.V. SHAYDAKOV1, V.L. BULATOV1,2, Å.À. ILYUKHIN3, I.N. SONKIN4, A.G. GRIGORYAN1

PREDICTION OF RESULTS AT ENDOVENOUS LASER ABLATION IN PATIENTS OF DIFFERENT AGE GROUPS

FSBE “SII of Experimental Medicine” of the North-west district of RAMS1,
Saint-Petersburg Institute of Bioregulation and Gerontology of the North-west district of RAMS 2,
Clinic “Medalp” 3,
Railway clinical hospital of JSC “Russian railways” 4, Saint-Petersburg
The Russian Federation

Objectives. To work out the prognostic models of results at endovenous laser ablation (EVLA) to treat varicose veins according to the combined ultimate point taking into account the patient’s age on the basis of clinical data of the retrospective cohort multicentre study (RCMS).
Methods. The research was conducted using the data of the retrospective linear cohort multicentre study on the basis of the vascular departments of three specialized clinics of Saint-Petersburg during the period from January, 2010 up to May, 2011. 257 patients with varicose veins of Ñ2 – Ñ3 classes of clinical manifestation according to ÑÅÀÐ were included in the study. The patients were subdivided into 2 cohorts: laser with the wave length of 970 nm was applied in the “H” cohort; 1470 nm and 1560 nm – in “W” cohort. The evaluation was done according to the combined ultimate point including three components: pain, ecchymosis, the presence of recanalization of the great saphenous vein (GSV) in the middle third of the thigh. The results were divided into 4 groups: the best, good, bad and the worst one. Mathematical-statistic packet of the applied programs KNIME (The Konstanz Information Miner), KNIME Desktop, version 2. 6.0 was used for calculations.
Results. The model of the results’ prediction of EVLA for different age groups was designed according to general selection and in case of lasers H and W application.
Conclusions. At W-laser application better results of EVLA are predicted in elderly and senile patients than in young patients. In case of H-laser application the result doesn’t depend on the age. Range of the linear endovenous energy density (LEED) and the diameter of veins influencing the treatment results are wider for W-laser than for H-laser in all age groups. Maximal difference of EVLA H- and W-lasers results regardless of age were revealed in the range of the vein diameters of 8-10 mm that are seen in greater frequency of obtaining the best results at W-laser application.

Keywords: primary varicose veins, endovenous laser ablation, H-laser, W-laser, prediction of resultss
p. 61 – 68 of the original issue
References
  1. Navarro L, Min RJ, Bone C. Endovenous laser: a new minimally invasive method of treatment for varicose veins-preliminary observations using an 810 nm diode laser. Dermatol Surg. 2001 Feb;27(2):117–22.
  2. Siribumrungwong B, Noorit P, Wilasrusmee C, Attia J, Thakkinstian A. A systematic review and meta-analysis of randomised controlled trials comparing endovenous ablation and surgical intervention in patients with varicose vein. Eur J Vasc Endovasc Surg. 2012 Aug;44(2):214–23.
  3. Shevchenko IuL, Stoiko IuM, Mazaishvili KV, Khlevtova TV. Mekhanizm endovenoznoi lazernoi obliteratsii: novyi vzgliad [The mechanism of endovenous laser ablation: a new look]. Flebologiia. 2011;5(1):46–50.
  4. Timperman PE, Sichlau M, Ryu RK. Greater energy delivery improves treatment success of endovenous laser treatment of incompetent saphenous veins. J Vasc Interv Radiol. 2004 Oct;15(10):1061–63.
  5. Proebstle TM, Krummenauer F, Gul D, Knop J. Nonocclusion and early reopening of the great saphenous vein after endovenous laser treatment is fluence dependent. Dermatol Surg. 2004 Feb;30(2 Pt 1):174–78.
  6. Min RJ, Khilnani NM. Endovenous laser ablation of varicose veins. J Cardiovasc Surg (Torino). 2005 Aug;46(4):395–405.
  7. Kaspar S, Siller J, Cervinkova Z, Danek T. Standardisation of parameters during endovenous laser therapy of truncal varicose veins--experimental ex-vivo study. Eur J Vasc Endovasc Surg. 2007 Aug;34(2):224–28.
  8. KNIME (Konstanz Information Miner). Available from: http://www.knime.org.
  9. Berthold MR, Cebron N, Dill F, Gabriel TR, Kotter T, Meinl T, Ohl P, Sieb C, Thiel K, Wiswedel B. KNIME: The Konstanz Information Miner. In Data Analysis, Machine Learning and Applications Proceedings of the 31st Annual Conference of the Gesellschaft fur Klassifikation. Berlin, Germany: Springer; 2007. p. 319–26.
  10. Shaidakov EV, Bulatov VL, Iliukhin EA, Son'kin IN, Grigorian AG, Gal'chenko MI. Optimal'nye rezhimy endovenoznoi lazernoi obliteratsii s dlinoi volny 970 nm, 1470 nm i 1560 nm: Retrospektivnoe prodol'noe kogortnoe issledovanie [Optimal conditions of endovenous laser ablation with 970 nm, 1470 nm and 1560 nm wavelength: a retrospective longitudinal cohort study]. Shaidakov EV, red. Sbornik tez 5 Saint-Petersburg Venoz foruma; 2012 Dek 7; Saint-Petersburg, RF. p. 85–86.
  11. Roggan A, Friebel M, Do Rschel K, Hahn A, Mu Ller G. Optical Properties of Circulating Human Blood in the Wavelength Range 400-2500 nm. J Biomed Opt. 1999 Jan;4(1):36–46.
  12. Disselhoff BC, Rem AI, Verdaasdonk RM, Kinderen DJ, Moll FL. Endovenous laser ablation: an experimental study on the mechanism of action. Phlebology. 2008 Jan;23(2):69–76.
  13. Sokolov AL, Liadov KV, Lutsenko MM, Lavrenko SV, Liubimova AA, Verbitskaia GO, Minaev VP. Primenenie lazernogo izlucheniia 1,56 mkm dlia endovazal'noi obliteratsii ven v lechenii varikoznoi bolezni [The use of laser radiation (1.56 micron) for endovasal ablation in the treatment of varicose veins]. Angiologiia i Sosud Khirurgiia. 2009;15(1):69–75.
  14. Proebstle T, Moehler T, Gul D, Herdemann S. Endovenous treatment of the great saphenous vein using a 1,320 nm Nd:YAG laser causes fewer side effects than using a 940 nm diode laser. Dermatol Surg. 2005 Dec;31(12):1678–83.
  15. Mordon SR, Wassmer B, Zemmouri J. Mathematical modeling of 980-nm and 1320-nm endovenous laser treatment. Lasers Surg Med. 2007 Mar;39(3):256–65.
Address for correspondence:
197376, Rossiiskaia Federatsiia, g. Sankt-Peterburg, ul. Akademika Pavlova, d. 12, FGBU «NII Eksperimental'noi Meditsiny» SZO RAMN,
e-mail:bulatovvas@gmail.com,
Bulatov Vasilii Leonidovich
Information about the authors:
Shaydakov E.V. MD, professor, deputy director of FSBE “SII of Experimental Medicine” of North-West District of RAMS, Saint-Petersburg.
Bulatov V.L. A researcher of the biogerontology laboratory of the Institute of bioregulation and gerontology of North-West District of RAMS, Saint-Petersburg.
Ilyukhin E.A. Chief physician of the clinic “Medalp”, Saint-Petersburg.
Sonkin I.N. PhD, a head of the vascular department of the railway clinical hospital JSC “Russian railways”, Saint-Petersburg.
Grigoryan A.G. Vascular surgeon of FSBE “SII of Experimental Medicine” of North-West District of RAMS, Saint-Petersburg.

I.N. IGNATOVICH1 , G.G. KONDRATENKO1 , D.D. NIKULIN2

JUSTIFICATION FOR THE OPTIMAL TREATMENT METHOD OF PATIENTS WITH DIABETIC NEUROISCHEMIC FOOT SYNDROME BASED ON COMPARISON OF LONG-TERM RESULTS OF VARIOUS METHODS APPLICATION

EE “Belarusian State Medical University”1,
ME “Minsk 11th City Clinical Hospital” 2,
The Republic of Belarus

Objectives. To justify the optimal treatment method of patients with neuroischemic form of diabetic foot syndrome having compared the long-term results (3 years) of two different application methods: conservative or surgical (the lower limb revascularization).
Methods. The data presented in the article are the completion of the research aimed to determine the optimal treatment method in patients with neuroischemic form of diabetic foot syndrome; intermediate results of this research have been published earlier.
Two groups of patients with neuroischemic form of diabetic foot syndrome were singled out to compare the treatment results: the control group and the comparison group. The patients of the control group (numbering 110) underwent only conservative treatment. The lower limb revascularization has performed to stop the critical ischemia in patients of the comparison group (numbering 48).
Results. During 3 years 65 out of 110 persons died in the control group. In 25 out of 45 staying alive patients (55,6%) we managed to save the supporting function of the foot and avoid the lower limb high amputation. During 3 years 9 out of 48 patients died (18,8%) in the comparison group. In 28 out of 39 staying alive patients (71,8%) we managed to save the supporting function of the foot and avoid the lower limb high amputation. The number of major amputations in the control group was reliably higher than in the comparison group. In the long-term results the number of ulcerous-necrotic lesions of the foot and the patients with the pain syndrome at rest condition was reliably higher in the control group. The parameters of life quality were better in the comparison group.
Conclusions. Revascularization is considered as an optimal and effective method of critical ischemia treatment and saving of the limb supporting function at neuroischemic form of diabetic foot syndrome.

Keywords: diabetic foot syndrome, revascularization, amputation, life qualitys
p. 69 – 75 of the original issue
References
  1. Pashkevich LA, Mokhammadi MT, Ignatovich IN, Martyniuk SN. Patomorfologiia diabeticheskoi neiropatii [Pathologic morphology of diabetic neuropathy]. ARS medica. 2010;(9):187–92.
  2. Shor NA, Chumak IuF, Reuka VP, Zhukov OA. Revaskuliarizatsiia nizhnikh konechnostei pri ishemicheskoi forme diabeticheskoi stopy s gnoino-nekroticheskimi porazheniiami tkanei [Revascularization of the lower limbs for ischemic diabetic foot with pyonecrotic tissue lesions ]. Angiologiia i Sosud Khirurgiia. 2004;10(4):85–90.
  3. Chur NN, Grishin IN, Kazlovskii AA, Kokoshko IuI. Etiologiia, patogenez, klassifikatsiia i khirurgicheskoe lechenie sindroma diabeticheskoi stopy [The etiology, pathogenesis, classification and surgical treatment of diabetic foot syndrome]. Khirurgiia Zhurn im NI Pirogova. 2003;(4):42–6.
  4. Malakhov IuS, Aver'ianov DA, Ivanov AV. Analiz rezul'tatov khirurgicheskogo lecheniia bol'nykh s gnoino-nekroticheskimi porazheniiami nizhnikh konechnostei ishemicheskogo geneza [Analysis of the results of surgical treatment of pyonecrotic tissue lesions of the lower limbs ischemic]. Angiologiia i Sosud Khirurgiia. 2009;(1):133–38.
  5. Ol'shanskii MS, Esipenko VV, Ivanov AA, Moshurov IP, Kazanskii DV. Endovaskuliarnaia korrektsiia mnogoetazhnogo porazheniia arterii pri kriticheskoi ishemii nizhnei konechnosti u bol'nogo pozhilogo vozrasta [Endovascular correction of multi-storey arterial lesions in elderly patients with critical limb ischemia]. Angiologiia i Sosud Khirurgiia. 2007;13(2):42–44.
  6. Ignatovich IN, Kondratenko GG, Sergeev GA, Kornievich SN, Khrapov IM. Rezul'taty lecheniia patsientov s khronicheskoi kriticheskoi ishemiei pri neiroishemicheskoi forme sindroma diabeticheskoi stopy [The results of treatment of patients with chronic critical ischemia at diabetic neuroischemic foot]. Khirurgiia Zhurn im NI Pirogova. 2011;(6):51–55.
  7. Ferraresi R, Centola M, Ferlini M, Da Ros R, Caravaggi C, Assaloni R, Sganzaroli A, Pomidossi G, Bonanomi C, Danzi GB. Long-term outcomes after angioplasty of isolated, below-the-knee arteries in diabetic patients with critical limb ischaemia. Eur J Vasc Endovasc Surg. 2009 Mar;37(3):336–42.
  8. Khamitov FF, Dibirov MD, Briskin BS i dr. Vozmozhnosti khirurgicheskoi revaskuliarizatsii pri gnoino-nekroticheskikh oslozhneniiakh sindroma diabeticheskoi stopy [The possibilities of surgical revascularization in necrotic complications of diabetic foot]. Al'm in-ta khirurgii im AV Vishnevskogo. 2009;4(2):209–10.
  9. De Rubertis BG, Chaer RA, Hynecek R, Benjelloun R, Karwowski J. Effect Of Diabetes On Outcome Of Percutaneous Lower Extremity Intervention. NESVS Annual Meeting: Abstracts. 2006. ð. 25.
  10. Gavrilenko AS, Skrylev SI. Khirurgicheskoe lechenie bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei, obuslovlennoi porazheniiami arterii infraingvinal'noi lokalizatsii [Surgical treatment of patients with critical ischemia of the lower limbs due to arterial lesions of infrainguinal localization]. Angiologiia i Sosud Khirurgiia. 2008;14(3):111–17.
  11. Dibirov MD, Briskin BS, Khamitov FF, Proshin AV, Iakobishvili IaI. Rol' rekonstruktivnykh sosudistykh operatsii u bol'nykh diabeticheskoi angiopatiei [The role of reconstructive vascular surgery in patients with diabetic angiopathy]. Khirurgiia Zhurnal im NI Pirogova. 2009;(2):59–63.
  12. Blevins WA, Schneider PA. Endovascular management of critical limb ischemia. Eur J Vasc Endovasc Surg. 2010 Jun;39(6):756–61.
  13. Mofidi R, Flett M, Nagy J, Ross R, Griffiths GD, Chakraverty S, Stonebridge PA. Balloon angioplasty as the primary treatment for failing infra-inguinal vein grafts. Eur J Vasc Endovasc Surg. 2009 Feb;37(2):198–205.
  14. Clair DG, Dayal R, Faries PL, Bernheim J, Nowygrod R, Lantis JC 2nd, Beavers FP, Kent KC. Tibial angioplasty as an alternative strategy in patients with limb-threatening ischemia. Ann Vasc Surg. 2005 Jan;19(1):63–8.
  15. Wolfle KD, Bruijnen H, Loeprecht H, Rumenapf G, Schweiger H, Grabitz K, Sandmann W, Lauterjung L, Largiader J, Erasmi H, Kasprzak PM, Raithel D, Allenberg JR, Lauber A, Berlakovich GM, Kretschmer G, Hepp W, Becker HM, Schulz A. Graft patency and clinical outcome of femorodistal arterial reconstruction in diabetic and non-diabetic patients: results of a multicentre comparative analysis. Eur J Vasc Endovasc Surg. 2003 Mar;25(3):229–34.
  16. Tarakanova OE, Mukhin AS, Smirnov NF. Vliianie kriticheskoi ishemii konechnostei na techenie ranevogo protsessa i chastotu vysokikh amputatsii pri gnoino-nekroticheskikh formakh diabeticheskoi stopy [The influence of critical limb ischemia at the wound process and frequency of high amputations in diabetic pyonecrotic foot]. Angiologiia i Sosud Khirurgiia. 2009;15(4):15–18.
  17. Ignatovich IN, Kondratenko GG, Nikulin DD, Iakovlev AV. Otsenka effektivnosti razlichnykh podkhodov k lecheniiu patsientov s neiroishemicheskoi formoi sindroma diabeticheskoi stopy (promezhutochnye itogi) [Assessment of the effectiveness of different approaches to the treatment of patients with diabetic neuroischemic foot (intermediate outcomes)]. Novosti Khirurgii. 2011;19(2):60–65.
  18. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, Jones DN. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997 Sep;26(3):517–38.
Address for correspondence:
220116, Respublika Belarus', g. Minsk, pr-t. Dzerzhinskogo, d. 83, UO «Belorusskii gosudarstvennyi meditsinskii universitet», 1-ia kafedra khirurgicheskikh boleznei,
e-mail: ini67@inbox.ru,
Ignatovich Igor' Nikolaevich
Information about the authors:
Ihnatovich I.N. PhD, associate professor of the 1st chair of surgical diseases of EE “Belarusian State Medical University”.
Kondratenko G.G. MD, professor, head of the 1st chair of surgical diseases of EE “Belarusian State Medical University”.
Nikulin D.D. A physician of the surgical department of ME “Minsk 11th city clinical hospital”.

TRANSPLANTOLOGY

S.V. SPIRYDONAU1, O.A. YUDINA2, A.P. SHKET1 , Y. M. CHESNOV1 , S.I. DRYK3 , A. V. ADZINTSOU1 , N.N. SHCHATSINKA1 , N.N. ZUE

VARIANTS OF CRYOPRESERVED ALLOGRAFTS PREPARATION BEFORE IMPLANTATION

Objective. To optimize a defrosting regimen of cryopreserved allografts.
Material and methods. 27 cryopreserved allografts of the aortic and pulmonary valves were included in the study. Allograft sterilization was performed in antibiotic solution, containing nutritive media, cefazolin, metronidazole and fluconazole. Cryoconservation was done using program freezer at cooling rate of 1°C per minute until -80°Ñ. Dimethylsulfoxide was used as a cryoprotectant. Three different thawing conditions were applied: 1) at 36-42°Ñ (n=10) within 15 minutes, 2) at 18-20°Ñ (n=7) within 35 minutes, 3) at 8-10°Ñ (n=10) within one hour (modification of RSPC «Ñardiology»). The removal of cryoprotectant was performed with gradual reduction of its concentration.
Results. The diameter and shape of allografts remained the same after completion of defrosting process in comparison with the primary patterns. Defrosted allografts had identically dense consistency at using various defrosting variants. The performed macroscopic evaluation permits to confirm that defrosting at 8-10°Ñ doesn’t lead to allîgraft wall ruptures.
The strength characteristics investigation during hydraulic tests revealed the absence of any differences in allografts durability after thawing in different temperature conditions. Histological evaluation of the allografts defrosted at 8-10°Ñ and at 18-20°Ñ didn’t reveal any structure changes in comparison with native valves.
Conclusions. Defrosting of cryopreserved aortic and pulmonary allografts at the temperature from 8°Ñ to 10°Ñ within 60 minutes turns up to be optimal due to providing allograft integrity, endurance and its histological structure integrity.

Keywords: cryopreserved allografts, preparation of preimplantation
p. 76 – 81 of the original issue
References
  1. Luyet B, Rasmussen D. Study by differential thermal analysis of the temperatures of instability of rapidly cooled solutions of four cryoprotective agents 1. Cryobiology. 1968 Mar–Apr;4(Issue 5):247.
  2. Hopkins RA. Cardiac reconstructions with allograft valves. New York, US: Springer Verlag; 1989. p. 55–58.
  3. Barratt-Boyes BG, Roche AH, Subramanyan R, Pemberton JR, Whitlock RM. Long-term follow-up of patients with the antibiotic-sterilized aortic homograft valve inserted freehand in the aortic position. Circulation. 1987 Apr;75(4):768–77.
  4. O'Brien MF, Stafford EG, Gardner MA, Pohlner PG, Tesar PJ, Cochrane AD, Mau TK, Gall KL, Smith SE. Allograft aortic valve replacement: long-term follow-up. Ann Thorac Surg. 1995 Aug;60(2 Suppl):S65–70.
  5. Shapira OM, Shemin RJ. Aortic valve replacement with cryopreserved allografts: mid-term results. J Card Surg. 1994 May;9(3):292–97.
  6. Wassenaar C, Wijsmuller EG, Van Herwerden LA, Aghai Z, Van Tricht CL, Bos E. Cracks in cryopreserved aortic allografts and rapid thawing. Ann Thorac Surg. 1995 Aug;60(2 Suppl):S165–7.
  7. Angell WW, Angell JD, Oury JH, Lamberti JJ, Grehl TM. Long-term follow-up of viable frozen aortic homografts. A viable homograft valve bank. J Thorac Cardiovasc Surg. 1987 Jun;93(6):815–22.
  8. Armiger LC. Viability studies of human valves prepared for use as allografts. Ann Thorac Surg. 1995 Aug;60(2 Suppl):S118–20.
  9. Thijssen HJM, Bos E, Konertz W, van Suylen RJ. Kryokonservierung humaner Spenderherzklappen in der Herzklappenbank in Rotterdam. Z Herz Thorax Gefasschir. 1992;6:49–55.
  10. Pegg DE. The history and principles of cryopreservation. Semin Reprod Med. 2002 Feb;20(1):5–13.
  11. Bujan J, Pascual G, Lopez R, Corrales C, Rodriguez M, Turegano F, Bellon JM. Gradual thawing improves the preservation of cryopreserved arteries. Cryobiology. 2001 Jun;42(4):256–65.
  12. Oh YM, Sim SB, Sa VJ, Park JK, Kwack MS, Loo SH. Comparison of different thawing methods on cryopreserved aorta. J Korean J Thorac Cardiovasc Surg. 2004 Feb;37(2):113–18.
  13. Birtsas V, Armitage WJ. Heart valve cryopreservation: protocol for addition of dimethyl sulphoxide and amelioration of putative amphotericin B toxicity. Cryobiology. 2005 Apr;50(2):139–43.
  14. 14 Britikov DV. Organizatsiia proizvodstva allograftov, opyt ikh klinicheskogo primeneniia v NTs SSKh im AN Bakuleva i osnovnye napravleniia razvitiia [Organization of allografts production, the experience of their clinical application in SC CVS named by AN Bakulev and the main directions of development]. Med Nauki. 2004;(1):10–17.
  15. Armitage WJ, Dale W, Alexander EA. Protocols for thawing and cryoprotectant dilution of heart valves. Cryobiology. 2005 Feb;50(1):17–20.
Address for correspondence:
220036, Respublika Belarus', g. Minsk, ul. R. Liuksemburg, d. 110, GU RNPTs «Kardiologiia», 2-e kardiokhirurgicheskoe otdelenie,
e-mail: spiridonov@telegraf.by,
Spiridonov Sergei Viktorovich
Information about the authors:
Spirydonau S.V. PhD, cardiosurgeon of RSPC "Cardiology".
Yudina O.A. PhD, a head of the general pathology department of ME “City Pathological-anatomical bureau”.
Shket A.P. PhD, cardiologist, head of the 2nd cardiac surgery department of RSPC "Cardiology".
Chesnov Y.M. MD, cardiosurgeon of RSPC "Cardiology".
Dryk S.I. A head of the department of separation and cryoconservation of the bone marrow of ME “The 9th city clinical hospital”.
Adzintsou A. V. Cardiologist of RSPC "Cardiology".
Shchatsinka N.N. Cardiologist of RSPC "Cardiology".
Zuenok N.N. Physician of the department of separation and cryoconservation of the bone marrow of ME “The 9th city clinical hospital”.
Ostrovsky Y.P. Corresponding member of NAS, MD, professor, a head of the laboratory of cardiac surgery of SE RSPC "Cardiology", head of the cardiac surgery chair of SEE “Belarusian Medical Academy of Post-graduate Education”.

ANESTHESIOLOGY-REANIMATOLOGY

S.A. TACHYLA1, À.V. ÌàRACHKAU1, N.Î. ÌàKSUTA2 , N.V. ÀKULICH2

INFLUENCE OF VARIOUS VARIANTS OF THE MULTICOMPONENT BALANCED ANAESTHESIA ON THE LEUKOCYTE FORMULA AND PHAGOCYTIC ACTIVITY IN BLOOD OF THE PATIENTS

ME "Mogilev Regional Hospital" 1,
ME "Mogilev Regional Hospital named A.A. Kulrshov 2".
The Republic of Belarus

Objectives. To carry out comparative analysis of different variants effects of the multicomponent balanced anesthesia using isoflurane/nitrous oxide/fentanyl, sevoflurane/nitrous oxide/fentanyl and propofol/fentanyl on leukocytes: their number, composition and phagocytic activity of polymorphonuclear leukocytes.
Methods. Analysis of the number and function of leukocytes during general anesthesia at laparoscopic cholecystectomy was performed in 50 patients (3 males and 47 females, aged 51,5±12,4 years, weight 84,5±18,4 kg). At several stages of anesthesia the changes in the quantity of leukocytes, granulocytes and lymphocytes and phagocytic activity of polymorphonuclear leukocytes were determined.
Results. It has been found out that during the multicomponent balanced anesthesia with the use of sevoflurane/nitrous oxide/fentanyl and propofol/fentanyl the number of leukocytes, granulocytes and lymphocytes intraoperatively doesn’t differ from baseline and the multicomponent balanced anesthesia using isoflurane/nitrous oxide/fentanyl decreases the number of leukocytes and granulocytes during surgery. In the postoperative period leukocytosis, granulocytosis and relative lymphopenia were registered. Phagocytic activity of leukocytes decreased during general anesthesia. The intensity of fluorescence was significantly lower in the group with propofol/fentanyl application compared with group of sevoflurane/nitrous oxide/fentanyl application.
Conclusions. During anesthesia the changes of the number of leukocytes, granulocytes and lymphocytes along with stable hemodynamic parameters, oxygenation, ventilation, sufficiently deep anesthesia according to monitoring data of electroencephalography and neuromuscular block characterize an adequate level of anesthesia protection of patients against a operation trauma. In our study all three variants of the multicomponent balanced anesthesia have the ability to reduce the phagocytic index that anesthesiologist should take into account during anesthesia.

Keywords: general anesthesia, isoflurane, sevoflurane, propofol, fentanyl, leukocytes, phagocytosis
p. 82 – 88 of the original issue
References
  1. Bruce DL.Acute and chronic anaesthetic actions on leukocytes. Can Anaesth Soc J. 1973 Jan;20(1):55–63. Review.
  2. Zil'ber AP. Vliianie anestezii i operatsii na osnovnye funktsii organizma. Operatsionnyi stress i puti ego korrektsii [The influence of anesthesia and surgery on the basic functions of the organism. Operational stress and the ways to correct it]. V kn.: Buniatian AA, red. Rukovodstvo po anesteziologii. Moscow, RF: Meditsina; 1994. s. 314–39.
  3. Liu S, Wang B, Li S, Zhou Y, An L, Wang Y, Lv H, Zhang G, Fang F, Liu Z, Han R, Jiang T, Kang X. Immune cell populations decrease during craniotomy under general anesthesia. Anesth Analg. 2011 Sep;113(3):572–77.
  4. Schilling T, Kozian A, Senturk M, Huth C, Reinhold A, Hedenstierna G, Hachenberg T. Effects of volatile and intravenous anesthesia on the alveolar and systemic inflammatory response in thoracic surgical patients. Anesthesiology. 2011 Jul;115(1):65–74.
  5. Nicholson G, Hall GM. Effects of anaesthesia on the inflammatory response to injury. Curr Opin Anaesthesiol. 2011 Aug;24(4):370–74.
  6. Heller A, Heller S, Blecken S, Urbaschek R, Koch T. Effects of intravenous anesthetics on bacterial elimination in human blood in vitro. Acta Anaesthesiol Scand. 1998 May;42(5):518–26.
  7. Mikawa K, Akamatsu H, Nishina K, Shiga M, Maekawa N, Obara H, Niwa Y. Propofol inhibits human neutrophil functions. Anesth Analg. 1998 Sep;87(3):695–700.
  8. Weiss M, Birkhahn A, Krone M, Schneider EM. Do etomidate and propofol influence oxygen radical production of neutrophils? Immunopharmacol Immunotoxicol. 1996 May;18(2):291–307.
  9. Heine J, Jaeger K, Weingaertner N, Scheinichen D, Marx G, Piepenbrock S. Effects of different preparations of propofol, diazepam, and etomidate on human neutrophils in vitro. Acta Anaesthesiol Scand. 2001 Feb;45(2):213–20.
  10. Ji FH, Wang YL, Yang JP. Effects of propofol anesthesia and sevoflurane anesthesia on the differentiation of human T-helper cells during surgery. Chin Med J (Engl). 2011 Feb;124(4):525–29.
  11. Delogu G, Moretti S, Famularo G, Marcellini S, Santini G, Antonucci A, Marandola M, Signore L. Mitochondrial perturbations and oxidant stress in lymphocytes from patients undergoing surgery and general anesthesia. Arch Surg. 2001 Oct;136(10):1190–96.
  12. Urner M, Limbach LK, Herrmann IK, Muller-Edenborn B, Roth-Z'Graggen B, Schlicker A, Reyes L, Booy C, Hasler M, Stark WJ, Beck-Schimmer B. Fluorinated groups mediate the immunomodulatory effects of volatile anesthetics in acute cell injury. Am J Respir Cell Mol Biol. 2011 Sep;45(3):617–24.
  13. Heine J, Jaeger K, Osthaus A, Weingaertner N, Munte S, Piepenbrock S, Leuwer M. Anaesthesia with propofol decreases FMLP-induced neutrophil respiratory burst but not phagocytosis compared with isoflurane. Br J Anaesth. 2000 Sep;85(3):424–30.
  14. Erol A, Reisli R, Reisli I, Kara R, Otelcioglu S. Effects of desflurane, sevoflurane and propofol on phagocytosis and respiratory burst activity of human polymorphonuclear leucocytes in bronchoalveolar lavage. Eur J Anaesthesiol. 2009 Feb;26(2):150–54.
  15. Kim WH, Jin HS, Ko JS, Hahm TS, Lee SM, Cho HS, Kim MH. The effect of anesthetic techniques on neutrophil-to-lymphocyte ratio after laparoscopy-assisted vaginal hysterectomy. Acta Anaesthesiol Taiwan. 2011 Sep;49(3):83–7.
  16. Khaitov PM, Pinegin BV. Izmenenie immuniteta pri khirurgicheskikh vmeshatel'stvakh [Changing of immunity during surgery]. Annaly Khirurg Gepatologii. 1998;3:100–10.
  17. Schneemilch CE, Schilling T, Bank U. Effects of general anaesthesia on inflammation. Best Pract Res Clin Anaesthesiol. 2004 Sep;18(3):493–507.
  18. Ducharme G, Newell EW, Pinto C, Schlichter LC. Small-conductance Cl- channels contribute to volume regulation and phagocytosis in microglia. Eur J Neurosci. 2007 Oct;26(8):2119–30.
  19. Ince C, Coremans JM, Ypey DL, Leijh PC, Verveen AA, van Furth R. Phagocytosis by human macrophages is accompanied by changes in ionic channel currents. J Cell Biol. 1988 Jun;106(6):1873–78.
Address for correspondence:
212016, Respublika Belarus', g. Mogilev, ul. Belynitskogo-Biruli, d. 12, UZ «Mogilevskaia oblastnaia bol'nitsa», reanimatsionno-anesteziologicheskoe otdelenie,
e-mail: tsa80@inbox.ru,
Tochilo Sergei Anatol'evich
Information about the authors:
Tachyla S.A. An anesthesiologist-resuscitator of ME "Mogilev Regional Hospital".
Marachkau A.V. MD, a head of the anesthesiology and intensive care unit of ME "Mogilev Regional Hospital".
Maksuta N.O. A post-graduate student of the biology chair of EE "Mogilev State University named after A.A. Kuleshov”.
Akulich N.V. PhD, a head of the ecological physiology chair of EE "Mogilev State University named after A.A. Kuleshov”.

NEW METHODS

V.V. YURCHENKO

THE METHOD OF POSTPAPILLOTOMY BLEEDINGS PREVENTION

FSEI HPE "Khakassia State University named by NF Katanov", Abakan
The Russian Federation

Objectives. To decrease the incidence of postpapillotomy bleedings in patients with hemostasis system disturbances occurring in the mechanical jaundice.
Methods. The aim was achieved by the two-staged endoscopic papillosphincterotomy (EPST) with the inter-staged biliary ducts stenting. The first stage included slight dissection (up to the separation of the orifices of the common bile and main pancreatic ducts) of the major duodenal papilla and endobiliary stenting. At normalization of biochemical and coagulation parameters, the removal of the endoprosthesis and maximal EPST by cannulation method were performed. Efficacy of the method was assessed by comparing the results in two groups of patients with the mechanical jaundice. In the research group (93 patients) EPST was carried out in two stages. In the group of comparison (91 patients) generally accepted single-staged EPST was applied.
Results. Endoprosthesis displacement in the group of comparison during the first 24 hours was revealed in 5 cases (5,4%), in 3 cases (3,2%) the bile entered the duodenum freely. In these three patients the stent replacement wasn’t carried out as they were functioning. In two cases the endoprosthesis replacement was performed. In the research group the bleeding after EPST developed in 5 (5,3%) patients; in the group of comparison – in 16 (17,6%) cases. Hemostasis resistant forms of postpapillotomy bleedings in the research group were revealed in 1 (1,1%) case; in the group of comparison – in 10 (10,9%).
Conclusions. Two-staged endoscopic papillosphincterotomy with the inter-staged biliary ducts stenting in patients with the planned extensive dissection of the major duodenal papilla on the background of its marked benign stenosis or large concretions of the main bile ducts is considered to be an effective way to decrease incidence of the postpapillotomy bleedings mainly severe and resistant forms to hemostasis.

Keywords: endoscopic papillosphincterotomy, mechanical jaundice, postpapillotomy complications, postpapillotomy bleedingss
p. 89 – 93 of the original issue
References
  1. Bregel' AI, Mutin NA, Andreev VV, Evtushenko VV. Endoskopicheskaia retrogradnaia pankreatokholangiografiia i endoskopicheskaia papillosfinktertomiia u bol'nykh mekhanicheskoi zheltukhoi [Endoscopic retrograde cholangiopancreatography and endoscopic papillosphincterotomy in patients with obstructive jaundice]. Sibir Med Zhurn. 2009;(6):53–55.
  2. Sultanov SA, Arkhipov AA. Modifitsirovannaia dvukhetapnaia taktika lecheniia zhelchnokamennoi bolezni, oslozhnennoi kholedokholitiazom [Modified two-steped approach for treatment of gallstone disease complicated by choledocholithiasis]. Endoskop Khirurgiia. 2004;(4):26–29.
  3. Mallery JS, Baron TH, Dominitz JA, Goldstein JL, Hirota WK, Jacobson BC, Leighton JA, Raddawi HM, Varg JJ 2nd, Waring JP, Fanelli RD, Wheeler-Harbough J, Eisen GM, Faigel DO. Complications of ERCP. Gastrointest Endosc. 2003 May;57(6):633–38.
  4. Eimiller A. Complication of endoscopy. Endoscîpy. 1992 Jan-Feb;24(1–2):176–84.
  5. Podymova SD. Bolezni pecheni: ruk. dlia vrachei [Liver disease: a guide for physicians]. Moscow, RF: Meditsina; 1998. 704 p.
  6. Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A, Prada A, Passoni GR, Testoni PA. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001 Feb;96(2):417–23.
  7. Mueller PR, Ferrucci JT Jr, Teplick SK, vanSonnenberg E, Haskin PH, Butch RJ, Papanicolaou N. Biliary stent endoprosthesis: analysis of complications in 113 patients. Radiology. 1985 Sep;156(3):637–39.
Address for correspondence:
655017, Rossiiskaia Federatsiia, Respublika Khakasiia, g. Abakan, ul. Lenina, d. 92, FGBOU VPO «Khakasskii gosudarstvennyi universitet im. N. F. Katanova», kafedra khirurgii,
e-mail: yurchenkovld@mail.ru,
Iurchenko Vladimir Vladimirovich
Information about the authors:
Yurchenko V.V. MD, professor of the chair of surgery FSBEI HPE "Khakassia State University named by NF Katanov".

REVIEWS

A.S. KARPITSKI, G.A. JURBENKO, A.M. SHESTIUK

VIDEO LAPAROSCOPIC FUNDOPLICATION AS CORRECTION METHOD OF THE LOWER ESOPHAGEAL SPHINCTER INSUFFICIENCY

ME «Brest regional hospital»
The Republic of Belarus

In recent years gastroesophageal reflux disease is one of the most wide spread diseases of the digestive tract. Increase of the number of patients with the given pathology demands to improve the approaches to diagnose and treat this disease.
The main current trends in treatment of gastroesophageal reflux disease have been reflected in the review on the basis of published data.
It is noted that the question regarding indications for surgical treatment of the lower esophageal sphincter insufficiency as well as expediency and efficacy of operations in comparison with conservative therapy is being actively discussed up to present.
The conducted literature analysis has shown that Nissen and Toupet video laparoscopic fundoplications are considered to be the most effective and popular ones in surgical treatment of gastroesophageal reflux disease and hernias of reflux diaphragm esophageal foramen.
The analysis of publications permits to conclude that treatment choice should be always based on the peculiarities of the disease course; surgical and medicamentous procedures should not be oppose, but complement to each other.
In the case of antireflux operations performance by Nissen and Toupet the indications for surgery must be strictly defined that significantly increases the effectiveness as well as selective approach to the choice of the fundoplication depending on the ðÍ- results and manometric examination before operation.
The search and application of new more effective methods of fundoplication permit to improve the long-term results of surgical treatment of gastroesophageal reflux disease.

Keywords: gastroesophageal reflux disease, the lower esophageal sphincter insufficiency, video laparoscopic fundoplication, complications of video laparoscopic fundoplication, esophageal motility failure
p. 94 – 99 of the original issue
References
  1. Moshkowitz M, Horowitz N, Halpern Z, Santo E. Gastroesophageal reflux disease symptoms: prevalence, sociodemographics and treatment patterns in the adult Israeli population. World J Gastroenterol. 2011 Mar 14;17(10):1332–35.
  2. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006 Aug;101(8):1900–20.
  3. Fujimoto K. Review article: prevalence and epidemiology of gastro-oesophageal reflux disease in Japan. Aliment Pharmacol Ther. 2004 Dec;20(Suppl. 8):5–8.
  4. Revicki DA, Wood M, Maton PN, Sorensen S. The impact of gastroesophageal reflux disease on health-related quality of life. Am J Med. 1998 Mar;104(3):252–58.
  5. Shadrin OG, Gerasimiuk SI. Problemy diagnostiki i lecheniia gastroezafageal'noi refliuksnoi bolezni u detei [Problems of diagnosis and treatment of gastrooesophageal reflux disease in children ]. Sovrem Pediatriia. 2011;(1):158–59.
  6. Soresi AL. Diaphragmatic hernia: its unsuspected frequency: diagnosis and technique for radical cure. Ann Surg. 1919 Mar;69:254–70.
  7. Nissen R. A simple operation for control of reflux esophagitis. Schweiz Med Wochenschr. 1956 May 18;86(Suppl. 20):590–92.
  8. Toupet A. Technique d'eosophago-gastroplastie avec phreno-gastropexie dans la cure radicales des hernies hiatales et comme complement de l'operation de Heller dans les cardiospasmes. Mem Acad Chir. 1963;89:394–99.
  9. Mahon D, Rhodes M, Decadt B, Hindmarsh A, Lowndes R, Beckingham I, Koo B, Newcombe RG. Randomized clinical trial of laparoscopic Nissen fundoplication compared with proton-pump inhibitors for treatment of chronic gastro-oesophageal reflux. Br J Surg. 2005 Jun;92(6):695–9.
  10. Mehta S, Bennett J, Mahon D, Rhodes M. Prospective trial of laparoscopic nissen fundoplication versus proton pump inhibitor therapy for gastroesophageal reflux disease: Seven-year follow-up. J Gastrointest Surg. 2006 Nov;10(9):1312–16.
  11. Frazzoni M, Manno M, De Micheli E, et al. Gastrooesophageal reflux disease-spectrum or continuum? QJM. 1997;90:75–78.
  12. Wileman SM. Laparoscopic fundoplication is better than medical management for some quality-of-life measures in GERD. Ann Intern Med. 2010 Sep 21;153(6):JC3–10.
  13. Lubezky N, Sagie B, Keidar A, Szold A. Prosthetic mesh repair of large and recurrent diaphragmatic hernias. Surg Endosc. 2007 May;21(5):737–41.
  14. Puchkov KV, Filimonov VV. Gryzhi pishchevodnogo otverstiia diafragmy [Hiatal hernias ]. Moscow, RF: Medpraktika, 2003. 171 p.
  15. Vasilevskii DI, Luft AV, Priadko AS, Vorob'ev SL, Volkov VG, Mikhal'chenko GV, Filin AV, Kulagin VI, Silant'ev DS. Maloinvazivnye khirurgicheskie tekhnologii v lechenii pishchevodnykh oslozhnenii GERB [Minimally invasive surgical techniques in the treatment of esophageal complications of GERD]. Gastroenterologiia S-Petersburg. 2011;(2–3):34–36.
  16. Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R. Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc. 1991 Sep;1(3):138–43.
  17. Finlayson SR, Laycock WS, Birkmeyer JD. National trends in utilization and outcomes of antireflux surgery. Surg Endosc. 2003 Jun;17(6):864–7.
  18. Hahnloser D, Schumacher M, Cavin R, Cosendey B, Petropoulos P.
  19. Risk factors for complications of laparoscopic Nissen fundoplication. Surg Endosc. 2002 Jan;16(1):43–7.
  20. Oskretkov VI, Gankov VA, Klimov AG, Gur'ianov AA, Fedorov VV, Kazarian VM. Videoendoskopicheskaia khirurgiia pishchevoda [Videoendoscopy of esophageal surgery ]. Barnaul, RF: AzBuka; 2004. 159 p.
  21. Fergiuson MK. Atlas torakal'noi khirurgii [Atlas of thoracic surgery ]. Moscow, RF: GOETAR-Media; 2009. 304 p.
  22. Fomin PD, Grubnik VV. Neopukholevye zabolevaniia pishchevoda [Benign esophageal disease ]. Kiev, Ukraina: Biznes-Intellekt; 2008. 304 p.
  23. Hakanson BS, Thor KB, Thorell A, Ljungqvist O. Open vs laparoscopic partial posterior fundoplication. A prospective randomized trial. Surg Endosc. 2007 Feb;21(2):289–98.
  24. Babak OIa, Fadeenko GD. Gastroezofageal'naia refliuksnaia bolezn' [Gastroesophageal reflux disease]: monografiia. Kiev, Ukraina: Interfarma; 2000. 175 p.
  25. Bammer T, Hinder RA, Klaus A, Klingler PJ. Five- to eight-year outcome of the first laparoscopic Nissen fundoplications. J Gastrointest Surg. 2001 Jan-Feb;5(1):42–8.
  26. Iqbal M, Batch AJ, Moorthy K, Cooper BT, Spychal RT. Outcome of surgical fundoplication for extra-oesophageal symptoms of reflux. Surg Endosc. 2009 Mar;23(3):557–61.
  27. Zaporozhan VN, Grubnik VV, Saenko VF, Nichitailo ME. Videoendoskopicheskie operatsii v khirurgii i ginekologii. [Video-endoscopic operations in surgery and gynecology ]. Kiev, Ukraina: Zdorov'ia; 2000. 304 p.
  28. Linzberger N, Berdah SV, Orsoni P, Faucher D, Grimaud JC, Picaud R. Laparoscopic posterior fundoplication in gastroesophageal reflux: mid-term results. Ann Chir. 2001 Mar;126(2):143–7.
  29. Puchkov KV, Filimonov VB, Rodichenko DS. Eksperimental'naia otsenka effektivnosti razlichnykh vidov fundoplikatsii [Experimental assessment of the effectiveness of different types of fundoplication]. Endoskop Khirurgiia. 2002;8(4):3–7.
  30. Valiati W, Fuchs KH, Valiati L, Freys SM, Fein M, Maroske J, Tigges H, Thiede A. Laparoscopic fundoplication--short- and long-term outcome. Langenbecks Arch Surg. 2000 Aug;385(5):324–28.
  31. Veligotskii NN, Gorbulich AV, Komarchuk VV, Veligotskii AN, Trushin AS. Laparoskopicheskie fundoplikatsii v lechenii gastroezofageal'noi refliuksnoi bolezni [Laparoscopic fundoplication in the treatment of gastroesophageal reflux disease ]. V³sn Khark³v Nats Un-tu ³m VN. Karaz³na. 2004;614(Vip.7):33–37.
  32. DeMeester TR, Stein HJ. Minimizing the side effects of antireflux surgery. World J Surg. 1992 Mar-Apr;16(2):335–6.
  33. Puchkov KV, Filimonov VB, Ivanova TB, Potapova OV, Bubnova LV. Sravnitel'naia otsenka blizhaishikh i otdalennykh rezul'tatov khirurgicheskogo lecheniia bol'nykh gastroezofagal'noi refliuksnoi bolezn'iu i nekotorye aspekty vybora metoda fundoplikatsii [Comparative evaluation of the shot- and long-term results of surgical treatment of gastroesophageal reflux disease and some aspects of the choice of fundoplication method ]. Endoskop Khirurgiia. 2002;(6):31–39.
  34. Horvath KD, Jobe BA, Herron DM, Swanstrom LL. Laparoscopic toupet fundoplication is an inadequate procedure for patients with severe reflux disease. J Gastrointest Surg. 1999 Nov-Dec;3(6):583–91.
  35. Watson DI, Jamieson GG, Lally C, Archer S, Bessell JR, Booth M, Cade R, Cullingford G, Devitt PG, Fletcher DR, Hurley J, Kiroff G, Martin CJ, Martin IJ, Nathanson LK, Windsor JA; Multicenter, prospective, double-blind, randomized trial of laparoscopic nissen vs anterior 90 degrees partial fundoplication. Arch Surg. 2004 Nov;139(11):1160–67.
  36. Ludemann R, Watson DI, Jamieson GG, Game PA, Devitt PG. Five-year follow-up of a randomized clinical trial of laparoscopic total versus anterior 180 degrees fundoplication. Br J Surg. 2005 Feb;92(2):240–3.
Address for correspondence:
224027, Respublika Belarus', g. Brest, ul. Meditsinskaia, d. 7, UZ «Brestskaia oblastnaia bol'nitsa», otdelenie torakal'noi khirurgii,
e-mail: jurbik1@yandex.by,
Zhurbenko Gennadii Anatol'evich
Information about the authors:
Karpitski A.S. MD, professor, a chief physician of ME “Brest regional hospital”.
Jurbenko G.A. A physician of the thoracic surgery department of ME “Brest regional hospital”.
Shestiuk A.M. A head of the transplantation department of ME “Brest regional hospital”.

V.A. KOSINETS

NUTRITIONAL SUPPORT OF THE BODY IN CRITICAL CONDITIONS

SBEE HPE “IM Sechenov First Moscow State Medical University”
The Russian Federation

The literature analysis of pathologic changes in critical conditions and role of nutritional support in providing an organism with energetic and plastic substrates has been carried out. The hypoenergetic status is considered as the starting mechanism of «autocannibalism» processes that entail the subsequent decompensation of all systems of the body with the development of unfavorable outcomes. Nutritional support in critical conditions is of great importance. Pathological changes of metabolic processes testify to the appropriateness of combination of the preparations for enteral and parenteral nutrition together with the agents containing substrates for direct synthesis of macroergic compounds, in particular, the preparations of amber acid. It has been demonstrated that in generalized purulent peritonitis the preparations containing amber acid have a significant positive effect on processes of oxidative phosphorylation and ATP synthesis. Development of multilevel purposeful impact on links of biological oxidation will promote more effective and full-strength nutritive support of organism in the critical conditions.

Keywords: critical condition, peritonitis, nutritional support, parenteral nutrition, amber acid
p. 100 – 104 of the original issue
References
  1. Luft VM, Kostiuchenko AL, Leiderman IN. Rukovodstvo po klinicheskomu pitaniiu bol'nykh [The handbook of clinical nutrition of patients ]. Saint-Petersburg, RF: 2003. 319 p.
  2. Popova TS, Shestopalov AE, Tamazashvili TSh, Leiderman I N. Nutritivnaia podderzhka bol'nykh v kriticheskikh sostoianiiakh [Nutritional support in critically ill patients]. Moscow, RF: Vesti, 2002. 319 p.
  3. Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, Davies NA, Cooper CE, Singer M. Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet. 2002 Jul 20;360(9328):219–23.
  4. Gain IuM, Leonovich SI, Alekseev SA. Sindrom enteral'noi nedostatochnosti pri peritonite: teoreticheskie i prakticheskie aspekty, diagnostika i lechenie [Enteral insufficiency syndrome in peritonitis: theoretical and practical aspects of diagnosis and treatment]. Molodechno, RB: 2001. 265 p.
  5. Popova TS, Tomazashvili TSh, Shestopalov AE. Sindrom kishechnoi nedostatochnosti v khirurgii [Syndrome of intestinal failure in surgery]. Moscow, RF: Meditsina, 1991. 240 p.
  6. Antonsson JB, Fiddian-Green RG. The role of the gut in shock and multiple system organ failure. Eur J Surg. 1991 Jan;157(1):3–12.
  7. Kopylov VA, Nikitenko VI, Zakharov VV, Borodin AV, Simonenko EV, Fomina MV. Rol' translokatsii bakterii v patogeneze khirurgicheskoi infektsii [The role of the translocation of bacteria in the pathogenesis of surgical infection]. Khirurgiia, 2001(2):63–6.
  8. Aliev SA, Sultanov GA, Efendiev MA. Nekotorye aspekty patogeneza gipoksii i nefarmakologicheskie metody ee korrektsii pri gnoinom peritonite [Some aspects of the pathogenesis of hypoxia and non-pharmacological methods of its correction in purulent peritonitis]. Vestn intensiv terapii. 2003. (2): 20–7.
  9. Iliukevich GV, Kanus II, Khalup GIa. Osobennosti narusheniia metabolizma lipidov i vozmozhnost' ikh korrektsii u bol'nykh s rasprostranennym peritonitom [The perculiarities of lipid metabolism change and the possibility of their correction in patients with peritonitis]. Vestn intensiv terapii. 2002 (3): 83–7.
  10. Berger D, Buttenschoen K. Management of abdominal sepsis. Langenbecks Arch Surg. 1998 Mar;383(1):35–43.
  11. De Jonghe B, Appere-De-Vechi C, Fournier M, Tran B, Merrer J, Melchior JC, Outin H. A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Crit Care Med. 2001 Jan;29(1):8–12.
  12. Mullen JL, Buzby GP, Matthews DC, Smale BF, Rosato EF. Reduction of operative morbidity and mortality by combined preoperative and postoperative nutritional support. Ann Surg. 1980 Nov;192(5):604–13.
  13. Aktual'nye voprosy nutritivnoi podderzhki v klinike (kruglyi stol) [Current aspects of nutritional support in the clinic ( a round table)] Vestn intensiv terapii. 2005 (2):76–9.
  14. Bakhman AL. Iskusstvennoe pitanie [An artificial nutrition] (Per. s angl.) Moscow–Saint-Petersburg, RF: BINOM– Nevskii Dialekt, 2001. 192 p.
  15. Istomin NP, Bagdat'eva MG, Lamzina EA. Opyt primeneniia rannego enteral'nogo pitaniia u bol'nykh, operirovannykh na organakh zheludochno-kishechnogo trakta [The experience of early enteral nutrition in patients undergoing surgery on the organs of the gastrointestinal tract]. Vestn intensiv terapii. Moscow, RF; Vitar-Moscow. 2003 (1):71–2.
  16. Kazennov VV, Shishkin MN, Amerov DB, Elagina LV, Matiushov IuS, Ukrainskaia TV, Likhvantsev VV. Vliianie rannego enteral'nogo zondovogo pitaniia na immunnyi status v blizhaishem posleoperatsionnom periode [Effect of early enteral tube feeding on the immune status in the short-term postoperative period ]. Anesteziologiia i reanimatologiia, 2003(5):73–7.
  17. Erpuleva IuV. Preimushchestva i nedostatki rannego enteral'nogo pitaniia [Advantages and disadvantages of early enteral nutrition]. Vestn intensiv terapii. 2005(2):48–55.
  18. Ball MJ. Parenteral nutrition in the critically ill: use of a medium chain triglyceride emulsion. Intensive Care Med. 1993;19(2):89–95.
  19. Bulger EM, Maier RV. Antioxidants in critical illness. Arch Surg. 2001 Oct;136(10):1201–7.
  20. Cohen J, Guyatt G, Bernard GR, Calandra T, Cook D, Elbourne D, Marshall J, Nunn A, Opal S. New strategies for clinical trials in patients with sepsis and septic shock. Crit Care Med. 2001 Apr;29(4):880–86.
  21. Kruger PS. Forget glucose: what about lipids in critical illness? Crit Care Resusc. 2009 Dec;11(4):305–9.
  22. Mayer K, Gokorsch S, Fegbeutel C, Hattar K, Rosseau S, Walmrath D, Seeger W, Grimminger F. Parenteral nutrition with fish oil modulates cytokine response in patients with sepsis. Am J Respir Crit Care Med. 2003 May 15;167(10):1321–28.
  23. Marri R, Grenner D, Meies P, Roduell V. Biokhimiia cheloveka [Human biochemistry]. Moscow, RF; 1993(1-2): 779 p.
  24. Khoroshilov IE, Gavrilin SV, Lebedev VF, Zakharov DA, Makarova NN, Kuleshov OV, Sysoev KA. Pervye rezul'taty mnogotsentrovogo issledovaniia vliianiia Omega-3 zhirnykh kislot na uroven' tsitokinov krovi u bol'nykh s tiazhelym sepsisom [The first results of a multicenter study of the effect of omega-3 fatty acids on cytokines blood levels in patients with severe sepsis]. Vestn intensiv terapii. 2008(3): 47–9.
  25. Calder PC. Long-chain n-3 fatty acids and inflammation: potential application in surgical and trauma patients. Braz J Med Biol Res. 2003 Apr;36(4):433–46.
  26. Martin JM, Stapleton RD. Omega-3 fatty acids in critical illness. Nutr Rev. 2010 Sep;68(9):531–41. doi: 10.1111/j.1753-4887.2010.00313.x.
  27. Singer P, Shapiro H, Theilla M, Anbar R, Singer J, Cohen J. Anti-inflammatory properties of omega-3 fatty acids in critical illness: novel mechanisms and an integrative perspective. Intensive Care Med. 2008 Sep;34(9):1580–92. doi: 10.1007/s00134-008-1142-4.
  28. Lenindzher A. Biokhimiia. Molekuliarnye osnovy struktury i funktsii kletki [Biochemistry. Molecular basis of structure and function of cells]. Moscow, RF: Mir. 1974: 957 p.
  29. Gostishchev VK, Kosinets VA. Korrektsiia izmenenii lipid-transportnoi sistemy pri eksperimental'nom rasprostranennom gnoinom peritonite [Correction changes the lipid transport system in experimental generalized purulent peritonitis]. Vestn eksperiment i klin khirurgii. 2012;5(2): 245–51.
  30. Valentine RC, Valentine DL. Omega-3 fatty acids in cellular membranes: a unified concept. Prog Lipid Res. 2004 Sep;43(5):383–402.
  31. Afanas'ev VV. Klinicheskaia farmakologiia reamberina [Clinical pharmacology of reamberine]. Saint-Petersburg, RF: 2005. 44 p.
  32. Alimova EK, Astvatsatur'ian AT, Zharov AV. Lipidy i zhirnye kisloty v norme i riade patologicheskikh sostoianii [Lipids and fatty acids in normal and in various pathological conditions]. Moscow, RF: 1975. 280 p.
  33. Gel'fand BR, Gologorskii VA, Burnevich SZ, Podachin PV, Gainulin ShM. Selektivnaia dekontaminatsiia i detoksikatsiia zheludochno-kishechnogo trakta v neotlozhnoi abdominal'noi khirurgii i intensivnoi terapii [Selective decontamination and detoxification of the digestive tract in emergency abdominal surgery and intensive care]. Vestn intensiv terapii. 1995; 1: 8-11.
  34. Kondrashova MN. Terapevticheskoe deistvie iantarnoi kisloty [The therapeutic effect of succinic acid]. Pushchino, 1976. 234 p.
  35. Maevskii EI, Rozenfel'd AS, Kondrashova MN. Korrektsiia metabolicheskogo atsidoza putem podderzhaniia funktsii mitokhondrii [Correction of metabolic acidosis by maintaining of mitochondrial function]. Pushchino, 2001. 155 p.
  36. Romantsov MG, Sologub TV, Kovalenko AL. Reamberin 1,5% dlia infuzii — primenenie v klinicheskoi praktike. Rukovodstvo dlia vrachei [Reamberine 1.5% for infusion – the application in clinical practice. A guide for physicians]. Saint-Petersburg, RF: 2000; 158 p.
  37. Kondrashova MN. Gormonopodobnoe deistvie iantarnoi kisloty [Hormone-like effect of succinic acid]. Vopr biolog, meditsin i farmatsevt khimii. 2002 (1):7–12.
  38. Kosinets VA. Vliianie preparata iantarnoi kisloty «Reamberin» na funktsional'nuiu aktivnost' mitokhondrii myshechnogo sloia tonkoi kishki pri rasprostranennom gnoinom peritonite [Influence of preparation of succinic acid "Reamberine" on the functional activity of mitochondria of muscle layer of the small intestine in generalized purulent peritonitis]. Novosti khirurgii. 2007;15(4): 8–15.
Address for correspondence:
119991, Rossiyskaya Federatsiya, g. Moskva, ul. Yauzskaya, d. 11, GBOU VPO «Pervyiy Moskovskiy gosudarstvennyiy meditsinskiy universitet im. I.M. Sechenova», kafedra obschey khirurgii,
e-mail: vkosinets@yandex.ru,
Kosinets Vladimir Aleksandrovich
Information about the authors:
Kosinets V.A. PhD, an applicant for Doctor’s Degree of the General Surgery Chair of SBEE HPE “I.M. Sechenov First Moscow State Medical University”

PRACTICAL CASES

Å.À. SHLYAKHTUNOV1, N.G. LUD1 , I.I. FEDORENKO2 , O.N. VALSHONOK2

OSTEOBLASTOCLASTOMA OF THE THIRD CARPAL BONE IN THE PATIENT WITH THE SECONDARY LYMPHEDEMA OF THE UPPER LIMB

EE "Vitebsk State Medical University ¹",
ME "Vitebsk Regional Clinical Oncology Center ²"
The Republic of Belarus

A clinical case of osteoblastoclastoma treatment of the third carpal bone of the left hand in the patient undergone a special treatment of breast cancer is presented in the article. The tumor of the hand undetected for a long period caused by the developed secondary lymphedema of the upper limb on the side of the operative intervention is considered as the peculiarity of this case. The patient has undergone the surgical treatment of osteoblastoclastoma of the third carpal bone. Tumor scraping and defect plastic replacement with a bone transplant from the eminence of the tibial bone were performed. One year after operation at the radiological control the complete accretion of bone transplants and integrity of locked plates were registered. Three years afterwards no signs of the tumor recurrence were found out. The treatment method of bone benign tumors including scraping and defect replacement by an autotransplants is considered as one of the optimal treatment ones of benign tumors of hand short tubular bones. The most acceptable donor zone for the bone transplant intake is considered to be an eminence of the tibial bone as an optimal combination of the cortical and cancellous bone substance occurs in this site, providing a complete restoration of the post-resection defect of short tubular mesopodial bones of the hand and phalanxes of fingers.

Keywords: osteoblastoclastoma, breast cancer, lymphedemas
p. 105 – 110 of the original issue
References
  1. Usol'tseva EV, Mashkara KI. Khirurgiia zabolevanii i povrezhdenii kisti [Hand injuries and surgery]. 2-e izd pererab i dop. Leningrad, RF: Meditsina; 1978. 336 p.
  2. Biscaglia R, Bacchini P, Bertoni F. Giant cell tumor of the bones of the hand and foot. Cancer. 2000;88(9):2022–32.
  3. O’Brien B, Shatiraff B. Microlymphaticovenous and resectional surgery in obstructive lymphedema. Wld J Surg. 1979;3(1):3–15.
  4. Algoritmy diagnostiki i lecheniia bol'nykh zlokachestvennymi novoobrazovaniiami [Algorithms for diagnosis and treatment of cancer patients ]. Zalutskogo IV, Zhavrida EA, red. Minsk, RB; 2007. 509 p.
  5. Fradkin SZ, Zalutskii IV, red. Klinicheskaia onkologiia: spravoch posobie [Clinical oncology: a reference guide ]. Minsk, RB; 2003. 784 p.
  6. Mikhailov MK, Volodina GI, Lariukova EK. Differentsial'naia rentgenodiagnostika zabolevanii kostei i sustavov: ucheb posobie [Õ-ray differential diagnosis of bone and joint diseases: a tutorial]. Kazan, RF: Kazan gos in-t usovershenstvovaniia vrachei im VI Lenina; 1985. 66 p.
  7. Kuftyrev LM, Borzunov DIu, Zlobin AV, Mitrofanov AI. Autoplastika postrezektsionnykh defektov trubchatykh kostei kisti pri lechenii dobrokachestvennykh opukholei i opukholepodobnykh zabolevanii s ispol'zovaniem chreskostnogo osteosinteza [Autoplasty of post-resection defects of hand long bones in the treatment of benign tumors and tumor-like diseases using transosseous osteosynthesis]. Genii Ortopedii. 2004;(2):20–25.
  8. Deikalo VP, Tolstik AN. Khirurgiia kisti: istoriia, sovremennye dostizheniia, problemy i perspektivy razvitiia [Hand surgery: history, current achievements, problems and prospects of development]. Novosti Khirurgii. 2006; 14(4):26–36.
  9. Athanasian EA, Wold LE, Amadio PC. Giant cell tumors of the bones of the hand. J Hand Surg Am. 1997;22(4):91–98.
  10. Patradul A, Kitidumrongsook P, Parkpian V, Ngarmukos C. Allograft replacement in giant cell tumour of the hand. Hand Surg. 2001;6(1):59–65.
Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr-t Frunze, d. 27, UO «Vitebskii gosudarstvennyi ordena meditsinskii universitet», kafedra onkologii s kursami LD, LT, FPK i PK,
e-mail: Evgenij-shlyakhtunov@yandex.ru,
Shliakhtunov Evgenii Aleksandrovich
Information about the authors:
Shlyakhtunov E.A. PhD, an assistant of oncology chair of EE “Vitebsk State Medical University”. Lud N.G. MD, professor, a head of oncology chair of EE “Vitebsk State Medical University”. Fedorenko I.I. A head of the general oncology department of ME “Vitebsk regional clinical onñological dispensary”. Valshonok O.N. A head of the radiological unit of ME “Vitebsk regional clinical ontological dispensary”.

TO HELP THE PRACTITIONER

V.M. KHOKHA

COLLECTIONS IN ACUTE PANCREATITIS

ME «Mozyr City Hospital»
The Republic of Belarus

Accepted in 1992 at Atlanta Symposium of pancreatologists such terms as acute fluid collection, pancreatic necrosis, pseudocyst and pancreatic abscess are used inconsistently, without proper compliance with the classification.
Better understanding of the pathophysiology of necrotizing pancreatitis, advanced imaging techniques, accumulation of the research results made possible for the Acute Pancreatitis Working Group in 2012 to develop a new classification, dividing collections into 4 types: acute peripancreatic fluid collection, pseudocyst, acute necrotic collection and walled-off pancreatic necrosis. In contrast to the statements of Atlanta Symposium this new classification subdivides acute necrotic collection and walled-off necrosis, emphasizing that acute necrotic collection develops within the first 4 weeks of acute pancreatitis and pancreatic walled-off necrosis develops later. Each type of collections can be sterile or infected. Acute peripancreatic fluid collections develop at the early stage of the disease and most of them can resolve spontaneously. If acute peripancreatic fluid collection exists longer than 4 weeks, it should be called a pseudocyst. Interventions required only in the case of infected collection, otherwise conservative treatment is indicated. Disturbance of the duct integrity supports the existence of all types of collections and affects on the outcome of drainage procedures. Optimal time to perform a surgical intervention is considered within 3-4 weeks after completion of necrosis demarcation. Minimally invasive interventions such as laparoscopic, percutaneous and endoscopic retroperitoneal are considered as an equivalent to open necrosectomy.

Keywords: acute peripancreatic fluid collection, acute necrotic collection, pseudocyst, walled-off necrosiss
p. 111 – 118 of the original issue
References
  1. Revision of the Atlanta classification of acute pancreatitis Acute Pancreatitis Classification Working Group. April 9, 2008. 27 ð.
  2. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Accepted 29 Aug 2012 Published Online First 25 Oct 2012.
  3. Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis; 1992 Sep 11–13; Atlanta, Ga. Arch Surg. 1993 May;128(5):586–90.
  4. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974 Jul;139(1):69–81.
  5. Balthazar EJ, Freeny PC, vanSonnenberg E. Imaging and intervention in acute pancreatitis. Radiology. 1994;193:297–306.
  6. Balthazar EJ, Krinsky G, Role of Imaging Methods in Acute Pancreatitis: Diagnosis, Staging, and Detection of Complications. Clinical Pancreatology: For Practising Gastroenterologists and Surgeons. Oxford, UK: Blackwell Publishing Ltd; 2005. p. 56–80.
  7. Ranson JH, Balthazar E, Caccavale R, Cooper M. Computed tomography and the prediction of pancreatic abscess in acute pancreatitis. Ann Surg. 1985 May;201(5):656–65.
  8. Doherty GM, Lawrence WW. Pancreas. Current Diagnosis and Treatment Surgery. 13th ed. USA: McGraw-Hill Companies; 2010. p. 572–97.
  9. Bradley EL, Gonzalez AC, Clements JL Jr. Acute pancreatic pseudocysts: incidence and implications. Ann Surg. 1976 Dec;184(6):734–37.
  10. Neoptolemos JP, London NJ, Carr-Locke DL. Assessment of main pancreatic duct integrity by endoscopic retrograde pancreatography in patients with acute pancreatitis. Br J Surg. 1993 Jan;80(1):94–9.
  11. Nealon WH, Bhutani M, Riall TS, Raju G, Ozkan O, Neilan R. A unifying concept: pancreatic ductal anatomy both predicts. J Am Coll Surg. 2009; 208:790–99.
  12. O'Malley VP, Cannon JP, Postier RG. Pancreatic pseudocysts: cause, therapy, and results. Am J Surg. 1985 Dec;150(6):680–82.
  13. Aranha GV, Prinz RA, Esguerra AC, Greenlee HB. The nature and course of cystic pancreatic lesions diagnosed by ultrasound. Arch Surg. 1983 Apr;118(4):486–88.
  14. Beebe DS, Bubrick MP, Onstad GR, Hitchcock CR. Management of pancreatic pseudocysts. Surg Gynecol Obstet. 1984 Dec;159(6):562–64.
  15. Bradley EL, Clements JL Jr, Gonzalez AC. The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg. 1979 Jan;137(1):135–41.
  16. Yeo CJ, Bastidas JA, Lynch-Nyhan A, Fishman EK, Zinner MJ, Cameron JL. The natural history of pancreatic pseudocysts documented by computed tomography. Surg Gynecol Obstet. 1990 May;170(5):411–17.
  17. Balthazar EJ. Complications of acute pancreatitis: clinical and CT evaluation. Radiol Clin North Am. 2002 Dec;40(6):1211–27.
  18. Soliani P, Franzini C, Ziegler S, Del Rio P, Dell'Abate P, Piccolo D, Japichino GG, Cavestro GM, Di Mario F, Sianesi M. Pancreatic pseudocysts following acute pancreatitis: risk factors influencing therapeutic outcomes. JOP. 2004 Sep 10;5(5):338–47.
  19. Nguyen BL, Thompson JS, Edney JA, Bragg LE, Rikkers LF. Influence of the etiology of pancreatitis on the natural history of pancreatic pseudocysts. Am J Surg. 1991 Dec;162(6):527–30.
  20. Cannon JW, Callery MP, Vollmer CM Jr. Diagnosis and management of pancreatic pseudocysts: what is the evidence? J Am Coll Surg. 2009 Sep;209(3):385–93.
  21. Brugge WR. Approaches to the drainage of pancreatic pseudocysts. Curr Opin Gastroenterol. 2004 Sep;20(5):488–92.
  22. Mehta AI, McDowell DE. Pancreatic pseudocyst as a cause of jaundice. South Med J. 1978 Dec;71(12):1502–6, 1510.
  23. Pitchumoni CS, Agarwal N. Pancreatic pseudocysts. When and how should drainage be performed? Gastroenterol Clin North Am. 1999 Sep;28(3):615–39.
  24. Curry CA, Eng J, Horton KM, Urban B, Siegelman S, Kuszyk BS, Fishman EK. CT of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment? AJR Am J Roentgenol. 2000 Jul;175(1):99–103.
  25. Gonzalez Obeso E, Murphy E, Brugge W, Deshpande V. Pseudocyst of the pancreas: the role of cytology and special stains for mucin. Cancer. 2009 Apr 25;117(2):101–7.
  26. Cantasdemir M, Kara B, Kantarci F, Mihmanli I, Numan F, Erguney S.
  27. Percutaneous drainage for treatment of infected pancreatic pseudocysts. South Med J. 2003 Feb;96(2):136–40.
  28. Polakow J, Ladny JR, Serwatka W, Walecki J, Puchalski Z, Czech B. Percutaneous fine-needle pancreatic pseudocyst puncture guided by three-dimensional sonography. Hepatogastroenterology. 2001 Sep-Oct;48(41):1308–11.
  29. Morgan DE, Baron TH, Smith JK, Robbin ML, Kenney PJ. Pancreatic fluid collections prior to intervention: evaluation with MR imaging compared with CT and US. Radiology. 1997 Jun;203(3):773–78.
  30. Stringfellow G, Vansonnenberg E, Casola G, Wittich GR, Shankar S, Shamos R. Management of Fluid Collections in Acute Pancreatitis. The Pancreas: An Integrated Textbook of Basic Science, Medicine and Surgery. 2nd ed. Malden, MA: Blackwell Publishing Limited; 2009. p. 344–55.
  31. Werner J, Feuerbach S, Uhl W, Buchler MW. Management of acute pancreatitis: from surgery to interventional intensive care. Gut. 2005 Mar;54(3):426–36.
  32. Brugge WR. Approaches to the drainage of pancreatic pseudocysts. Curr Opin Gastroenterol. 2004 Sep;20(5):488–92.
  33. Natural Orifice Translumenal Endoscopic Surgery (NOTES) Cystgastrostomy for the Treatment of Pancreatic Pseudocysts. Clinical Trials. Available from: http:// www. clinicaltrials.gov.
  34. Morton JM, Brown A, Galanko JA, Norton JA, Grimm IS, Behrns KE. A national comparison of surgical versus percutaneous drainage of pancreatic pseudocysts: 1997-2001. J Gastrointest Surg. 2005 Jan;9(1):15–20.
  35. Barthet M, Lamblin G, Gasmi M, Vitton V, Desjeux A, Grimaud JC. Clinical usefulness of a treatment algorithm for pancreatic pseudocysts. Gastrointest Endosc. 2008 Feb;67(2):245–52.
  36. Cahen D, Rauws E, Fockens P, Weverling G, Huibregtse K, Bruno M. Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and successful treatment. Endoscopy. 2005 Oct;37(10):977–83.
  37. Weckman L, Kylanpaa ML, Puolakkainen P, Halttunen J. Endoscopic treatment of pancreatic pseudocysts. Surg Endosc. 2006 Apr;20(4):603–7.
  38. Sriram PV, Kaffes AJ, Rao GV, Reddy DN. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts complicated by portal hypertension or by intervening vessels. Endoscopy. 2005 Mar;37(3):231–35.
  39. Bergman S, Melvin WS. Operative and nonoperative management of pancreatic pseudocysts. Surg Clin North Am. 2007 Dec;87(6):1447–60, ix.
  40. Cheung MT, Ho CN, Siu KW, Kwok PC. Percutaneous drainage and necrosectomy in the management of pancreatic necrosis. ANZ J Surg. 2005 Apr;75(4):204–7.
  41. Beger HG, Rau B, Mayer J, Pralle U. Natural course of acute pancreatitis. World J Surg. 1997 Feb;21(2):130–5.
  42. Malfertheiner P, Dominguez-Munoz JE. Prognostic factors in acute pancreatitis. Int J Pancreatol. 1993 Aug;14(1):1–8.
  43. Bradley EL 3rd, Allen K. A prospective longitudinal study of observation versus surgical intervention in the management of necrotizing pancreatitis. Am J Surg. 1991 Jan;161(1):19–24.
  44. Bradley EL 3rd. Confusion in the imaging ranks: time for a change? Pancreas. 2006 Nov;33(4):321–22.
  45. Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, Carter R, Di Magno E, Banks PA, Whitcomb DC, Dervenis C, Ulrich CD, Satake K, Ghaneh P, Hartwig W, Werner J, McEntee G, Neoptolemos JP, Buchler MW. IAP Guidelines for the Surgical Management of Acute Pancreatitis. Pancreatology. 2002;2(6):565–73.
  46. Parekh D. Laparoscopic-assisted pancreatic necrosectomy: A new surgical option for treatment of severe necrotizing pancreatitis. Arch Surg. 2006 Sep;141(9):895–902.
  47. Horvath KD, Kao LS, Ali A, Wherry KL, Pellegrini CA, Sinanan MN. Laparoscopic assisted percutaneous drainage of infected pancreatic necrosis. Surg Endosc. 2001 Jul;15(7):677–82.
  48. Rodriguez JR, Razo AO, Targarona J, Thayer SP, Rattner DW, Warshaw AL, Fernandez-del Castillo C. Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg. 2008 Feb;247(2):294–99.
Address for correspondence:
247760, Respublika Belarus', g. Mozyr', ul. Kotlovtsa, d. 14 a, UZ «Mozyrskaia gorodskaia bol'nitsa»,
e-mail: docvladimir@yandex.ru,
Khokha Vladimir Mikhailovich
Information about the authors:
Khokha V.M. Deputy of chief physician on surgery of ME “Mozyr city hospital”.
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