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Khirurgii

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Year 2016 Vol. 24 No 2

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

A.O. KOVALCHUK

MORPHOMETRIC INDICATORS OF EXPERIMENTAL BURNS IN ANIMAL MODELS DURING EARLY SURGICAL TREATMENT WITH THE USE OF HYDROGEL DRESSINGS AND POLYURETHANE ADSORBENTS

Ternopol State Medical University Named after I.Y.Gorbachevsky,
Ukraine

Objectives. To carry out the morphometric analysis of the skin layers affected by thermal factor in early necrectomy performance with subsequent wound closure by means of hydrogel dressings and spongy polyurethane adsorbents.
Methods. The study was conductred on mature white outbred rats (n=192), weighing 250-300 g. Due to the European Convention for the Protection of Vertebrate Animals Used for Experimental and other Scientific Purposes, the damage conducted under general ether anaesthesia according to Regas F.C., Ehrlich H.P. (1992). Experimental injury procedure included contact third and fourth degree burns at skin hair free back. The burn was applied by copper plates heated in boiling water to 97-100°C under ether anesthesia within 20 sec. The size of the lesion was 10-15% of the body.
Results. Hydrogel dressings with an additional absorbent layer had been shown to be effective in positive dynamic regenerative process.
At all stages of the experimental study, absolute fixation of the gauze hydrogel covering on the wounds with no disruption and lysis was observed. The perforated structure of primary dressings and high sorbing ability of polyurethane sponge provided active exudate drain, and made favourable conditions for local therapeutic effect of the regenerative substrate, which is manifested by adjacent tissue edema reduction, normal blood circulation and complete restoration of the affected dermis structure. Thus, a burn wound closure by combination of hydrogel dressing and polyurethane sponge promoted active granulation tissue formation, provided wound healing and anti-inflammatory effects.
Conclusion. The performed research has proved the efficacy of early performance of necrectomy, helped to promote wound healing by means of hydrogel dressings and polyurethane adsorbents.

Keywords: burns, morphometry, necrectomy, hydrogel dressings, polyurethane sponge adsorbents, granulation tissue, anti-inflammatory ýôôåêò
p. 109-119 of the original issue
References
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  2. Lohmeyer JA, Liu F, Krüger S, Lindenmaier W, Siemers F, Machens HG. Use of gene-modified keratinocytes and fibroblasts to enhance regeneration in a full skin defect. Langenbecks Arch Surg. 2011 Apr;396(4):543-50. doi: 10.1007/s00423-011-0761-3.
  3. Shupp JW, Nasabzadeh TJ, Rosenthal DS, Jordan MH, Fidler P, Jeng JC. A review of the local pathophysiologic bases of burn wound progression. J Burn Care Res. 2010 Nov-Dec;31(6):849-73.
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  7. Povarikhina OA. Sovremennye ranevye pokrytiia v kombustiologii [Modern wound dressings in combustiology] Novye Med Tekhnologii. Novoe Med Oborudovanie. 2007;(3):31-36.
  8. Ryssel H, Germann G, Kloeters O, Gazyakan E, Radu CA. Dermal substitution with Matriderm(®) in burns on the dorsum of the hand. Burns. 2010 Dec;36(8):1248-53. doi: 10.1016/j.burns.2010.05.003.
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  10. Regas FC, Ehrlich HP. Elucidating the vascular response to burns with a new rat model. J Trauma. 1992 May;32(5):557-63.
  11. Kozinets' GP, Kovalenko ON, Slesarenko SV. Op³kova khvoroba [Burn disease]. Mistetstvo L³kuvannia. 2006;(12):9-15.
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  14. Kornienko VV, Kalshkevich OV, PogorЄlov MV, Oleshko OM. Osoblivost³ morfogenezu op³kovo¿ rani pri zastosuvann³ kh³tozanovikh membran v r³zn³ per³odi op³kovo¿ khvorobi [Features of burn wounds morphogenesis in the application of chitosan membranes at different periods of burn disease]. Morfolog³ia. 2013;7(4):42-50.
Address for correspondence:
46000, Ukraine,
ernopol, ul. Shpitalnaya, d. 2,
Ternopolskiy gosudarstvennyiy meditsinskiy universitet
imeni I.Y. Gorbachevskogo,
kafedra travmatologii i ortopedii s voenno-polevoy khirurgiey,
tel. office: 38 096 7517885,
e-mail: kovalchuk.derm@yandex.ru,
Kovalchuk Andrey Olegovich
Information about the authors:
Kovalchuk A.O. An associate professor of the traumatology and orthopedic chair with military field surgery of Ternopol State Medical University named after I.Y.Gorbachevsky of the Ministry of Health of Ukraine.

GENERAL & SPECIAL SURGERY

K.M. KURBONOV1, F.I. MAKHMADOV 1, N.A. RASULOV 2, K.R. NAZIRBOEV 1, U.U. MANSUROV 1

CAUSES AND TREATMENT TACTICS OF "FRESH" INJURIES OF THE BILE DUCTS

Avicenna Tajik State Medical University1,
SEE "Institute of Post-graduate Education in the field of Public Health of the Republic of Tajikistan"2, Dushanbe,
The Republic of Tajikistan

Objectives. Improvement of treatment results of bile duct injuries.
Methods. The study is based on the analysis of the clinical examination results of patients (n=74) with injuries of bile ducts (IBD). Presence of IBD during surgery was detected in 18 (24,3%) patients, in 56 (75,7%) patients bile duct injuries were revealed in different terms after surgery. The various clinical-laboratory and instrumental methods used for the diagnosis of IBD.
Results. In the majority of cases (41; 55,4%), according to the classification of H. Bismuth and E.I. Galperin the high bile duct injury was observed. A common manifestation of "fresh" injuries was bile expiration along the control drainage, which was noted in 39 (52,7%) cases out of 74 observations of IBD patients. To detect IBD complete ultrasonography was performed in 61 (82,4%) patients, accumulation of bile within the free peritoneal cavity was established in 46 (62%) cases, and the expansion of the intrahepatic bile ducts – in 12 cases. To identify the source and causes of postoperative intraperitoneal bile leakage MR pancreatocholangiography was performed in 14 cases.
The patients (n=21) with IBD underwent to various variants of restorative interventions, including endoscopic stents (n=2). In different incisional periods in 14 (19%) cases the disease was complicated by scar strictures of the bile ducts with cholangitis (n=8), requiring repeated reconstructive operations. In the early postoperative period 8 complications mainly observed after applying interchangeable transhepatic drainages in reconstruction operations: hematobilia (n=3), obstructive abscess (n=3), the migration of drainage from the anastomosis zone (n=2). Lethal outcome occurred in 3 cases.
Conclusion. The bile ducts injuries develop due to the "predisposing" and "contributing" factors. For small injuries it is advisable to use endoscopic stenting, and at high and extended injuries Roux reconstruction seems to be the method of choice.

Keywords: cholecystectomy, complications, iatrogenic trauma, injuries of the bile ducts, biliodigestive anastomoses, drainage, lethal outcome
p. 120-124 of the original issue
References
  1. Borisov AE, Levin LE, Kubachev KG, Lisitsyn AA. Oslozhneniia laparoskopicheskoi kholetsistektomii [Complications of laparoscopic cholecystectomy]. Endoskop Khirurgiia. 2002;(2):25-26.
  2. Katabathina VS, Dasyam AK, Dasyam N, Hosseinzadeh K. Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics. 2014 May-Jun;34(3):565-86. doi: 10.1148/rg.343125211.
    3.Gal'perin EI, Diuzheva TG, Chevokin AIu, Garmaev B. G. Prichiny razvitiia, diagnostika i khirurgicheskoe lechenie striktur dolevykh i segmentarnykh pechenochnykh protokov [The reasons for the development of diagnostics and surgical treatment of stricture of equity and segmental hepatic ducts]. Khirurgiia Zhurn im NI Pirogova. 2005;(8):64-70.
  3. Rusinov VM, Sukhorukov VP, Buldakov VV. Khirurgicheskoe lechenie rubtsovykh striktur proksimal'nykh zhelchevyvodiashchikh protokov [Surgical treatment of cicatricial strictures of the proximal bile ducts]. Fundam Issledovaniia. 2011;(10 ch 2):380-83.
  4. Nechai AI, Novikov KV. Prichiny i predraspolagaiushchie obstoiatel'stva sluchainykh (iatrogennykh) povrezhdenii zhelchnykh protokov pri kholetsistektomii i rezektsii zheludka [Causes and predisposing of circumstances accidental (iatrogenic) lesions of the bile ducts during cholecystectomy, and resection of the stomach]. Vestn Khirurgii im II Grekova. 1991;(1):15-21.
  5. Fedorov IV, Slavin LE, Chugunov AN. Povrezhdeniia zhelchnykh protokov pri laparoskopicheskoi kholetsistektomii [Bile duct injury during laparoscopic cholecystectomy]: monogr. Moscow, RF: Triada-Kh; 2003. 79 p.
    7.Gal'perin EI, Chevokin AIu, Kuzovlev NF, Diuzheva TG, Garmaev BG. Diagnostika i lechenie razlichnykh tipov vysokikh rubtsovykh striktur pechenochnykh protokov [Diagnosis and treatment of various types of high-scarring stricture of hepatic duct]. Khirurgiia Zhurn im NI Pirogova. 2004;(5):26-31.
  6. Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995 Jan;180(1):101-25.
  7. Shapoval'iants SG, Orlov SIu, Myl'nikov AG, Pan'kov AG, Budzinskii SA, Matrosov AL. Endoskopicheskie vozmozhnosti v lechenii «svezhikh» povrezhdenii zhelchnykh protokov [Endoscopic possibilities in the treatment of "fresh" damage to the bile ducts]. Annaly Khirurg Gepatologii. 2005;10(3):50-54.
  8. Bismuth H, Lazorthes F. Les traumatismes opératoires de la voie biliaire principale, Monographies de l'Association Française de Chirurgie. Paris: Masson; 1981.
Address for correspondence:
734003, Republic of Tadzhikistan,
Dushanbe, pr-t. Rudaki, d. 139,
Tadzhikskiy gosudarstvennyiy meditsinskiy universitet imeni Abuali ibni Sino, kafedra khirurgicheskih bolezney ¹1,
tel.: 992 93 405-44-04,
e-mail: dr.hero85@mail.ru,
Nazirboev Kahramon Ruziboevich
Information about the authors:
Kurbonov K.M. MD, professor, an Academician of the Academy of Medical Sciences, an Honored worker of Science and Technology of the Republic of Tajikistan, a head of the chair of surgical diseases ¹1 of Avicenna Tajik State Medical University.
Makhmadov F.I. MD, an associate professor of the chair of surgical diseases ¹1 of Avicenna Tajik State Medical University.
Rasulov N.A. PhD, an associate professor, a head of the surgery chair of SEE "Institute of Post-graduate education in the field of Public Health of the Republic of Tajikistan".
Nazirboev K.R. PhD, an assistant of the chair of surgical diseases ¹1 of Avicenna Tajik State Medical University.
Mansurov U.U. A post-graduate student of the chair of surgical diseases ¹1 of Avicenna Tajik State Medical University.

R.E. KALININ, I.A. SUCHKOV, I.N. RUDAKOVA, A.A. NIKIFOROV

INFLUENCE OF GENETIC FACTORS ON THE COURSE OF POST-THROMBOTIC SYNDROME OF THE LOWER LIMBS

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

Methods. The study included patients (n=60) with deep venous thrombosis (DVT) of the lower limbs. Genetic analysis method using PCR was performed to detect the presence of mutations in factor V gene (blood clotting), also called Leyden Arg506Gln mutation; polymorphism of β-fibrinogen (FGB) 455G-A; mutations of methionine synthase reductase (MTRR) Ile22Met (66 a-g).
All the patients underwent ultrasound duplex scanning of the lower limb veins. 12 months after DVT was ben diagnosed a comprehensive classification system (CEAP) has been applied to estimate PTS of the lower limbs.
Results. Heterozygous carriers of Factor V Leiden gene mutation had been determined to be 15 (25%) patients; homozygous mutant allele was found in 12 (20%) cases. Disease was classified according to the CEAP system. PTS C3-4 had been found to be diagnosed among homozygotes for the mutant gene in 8 (66,7%) of 12 cases.
Heterozygotes for the mutation of fibrinogen gene is observed in 18 (30%) patients with DVT, homozygote – in 3 (5%). It has been noted that PTS C3-4 was found in all 3 (100%) cases of homozygous carrier. Mutation of the gene of methionine synthase reductase in a heterozygous variant was revealed in 25 (41,7%) cases, homozygous variant – in 21 (35%). A high association of MTRR gene mutation with the class C3-4 occurred among homozygotes (16; 76,2%) and heterozygotes (10; 40%).
Conclusion. In the presence of genetic mutations of the hemostatic system and folate cycle enzymes, a patient has a tendency to the development of edemic and trophic forms of PTS. Genotyping permits to choose the correct treatment strategy.

Keywords: postthrombotic syndrome of the lower limbs, genetic mutation, coagulation system, folate cycle, Leiden mutation, fibrinogen, methionine synthase reductase
p. 125-130 of the original issue
References
  1. Feero WG. Genetic thrombophilia. Prim Care. 2004 Sep;31(3):685-709 doi: 10.1016/j.pop.2004.04.014.xi.
  2. Nebylitsin IS, Sushkou SA, Kozlovskii VI. Vnutrisosudistyi gomeostaz pri eksperimental'nom venoznom tromboze [Intravascular hemostasis in experimental venous thrombosis]. Nauka Molodykh - Eruditio Juvenium. 2014;(4):102-13.
  3. Isaeva TN, Sevost'ianova KS, Seriapina IuV, Shevela AI, Morozov VV. Assotsiatsiia izmenenii gemostaza posle endovenoznoi lazernoi koaguliatsii s geneticheskimi polimorfizmami [Association of hemostasis changes after endovenous laser coagulation with genetic polymorphisms]. Nauka Molodykh - Eruditio Juvenium. 2014;(3):72-82.
  4. Kalinin RE, Suchkov IA, Pshennikov AS. Nikiforov AA. Geneticheskii status patsientov s obliteriruiushchim aterosklerozom arterii nizhnikh konechnostei [The genetic status of patients with atherosclerosis obliterans of lower limb arteries]. Novosti Khirurgii. 2012;20(1):42-45.
  5. Kalinin RE, Suchkov IA, Pshennikov AS, Nikiforov AA. Vliianie polimorfizma genov na effektivnost' endoteliotropnoi terapii (klinicheskie nabliudeniia) [Effect of gene polymorphism on the efficacy of endotheliotropic therapy (clinical observations)]. Vrach-Aspirant. 2012;(1.2):318-25.
  6. Khan S, Dickerman JD. Hereditary thrombophilia. Thromb J. 2006;4:15. doi: 10.1186/1477-9560-4-15.
  7. Rosendaal FR. Venous thrombosis: a multicausal disease. Lancet. 1999 Apr 3;353(9159):1167-73.
  8. Sushkou SA, Nebylitsin IS, Samsonova IV, Markautsan PV. Morfologicheskie izmeneniia sosudistoi stenki v raznye stadii eksperimental'nogo venoznogo tromboza [The morphological changes of the vascular wall at different stages of experimental venous thrombosis]. Ros Med-Biol Vestn im Akad IP Pavlova. 2014;(3):17-27.
  9. Tsvetovskaia GA, Chikova ED, Lifshits GI, Kokh NV, Shevela AI, Voronina EN, i dr. Geneticheskie faktory riska trombofilii u zhenshchin reproduktivnogo vozrasta v zapadno-sibirskom regione [Genetic risk factors for thrombophilia in women of reproductive age in the West Siberian region]. Fundam Issledovaniia. 2010;(10):72-79.
  10. Karpenko AA, Cherniavskii AM, Starosotskaia MV, Aliapkina EM, Cherniavskii MA, Solov'ev ON, i dr. Trombofilii u bol'nykh s ostroi i khronicheskoi tromboemboliei legochnykh arterii [Thrombophilia in patients with acute and chronic pulmonary embolism]. Flebologiia. 2010;(2):125-26.
  11. Undas A, Williams EB, Butenas S, Orfeo T, Mann KG. Homocysteine inhibits inactivation of factor Va by activated protein C. J Biol Chem. 2001 Feb 9;276(6):4389-97.
  12. Oszajca K, Wronski K, Janiszewska G, Bienkiewicz M, Panek M, Bartkowiak J, et al. Association analysis of genetic polymorphisms of factor V, factor VII and fibrinogen β chain genes with human abdominal aortic aneurysm. Exp Ther Med. 2012 Sep;4(3):514-18. doi: 10.3892/etm.2012.
  13. Hobbs CA, Sherman SL, Yi P, Hopkins SE, Torfs CP, Hine RJ, et al. Polymorphisms in genes involved in folate metabolism as maternal risk factors for Down syndrome. Am J Hum Genet. 2000 Sep;67(3):623-30.
  14. Ridker PM, Miletich JP, Hennekens CH, Buring JE. Ethnic distribution of factor V Leiden in 4047 men and women. Implications for venous thromboembolism screening. JAMA. 1997 Apr 23-30;277(16):1305-7.
  15. Svensson PJ, Dahlbäck B. Resistance to activated protein C as a basis for venous thrombosis. N Engl J Med. 1994 Feb 24;330(8):517-22.
  16. Dahlbäck B, Carlsson M, Svensson PJ. Familial thrombophilia due to a previously unrecognized mechanism characterized by poor anticoagulant response to activated protein C: prediction of a cofactor to activated protein C. Proc Natl Acad Sci U S A. 1993 Feb 1;90(3):1004-8.
Address for correspondence:
390026, Russian Federation,
Ryazan, ul. Vyisokovoltnaya, d. 9,
GBU VPO "Ryazanskiy gosudarstvennyiy
meditsinskiy universitet imeni akad. I.P. Pavlova",
kafedra angiologii, sosudistoy,
operativnoy khirurgii i topograficheskoy anatomii.
e-mail:Suchkov_med@mail.ru,
Suchkov Igor Aleksandrovich
Information about the authors:
Kalinin R.E. MD, professor, Rector of SBE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", a head of angiology, vascular, operative surgery and topographic anatomy chair.
Suchkov I.A. MD, an associate professor of angiology, vascular, operative surgery and topographic anatomy chair of SBE HPE "Ryazan State Medical University named after Academician I.P. Pavlov".
Rudakova I.N. A post-graduate student of angiology, vascular, operative surgery and topographic anatomy chair of SBE HPE "Ryazan State Medical University named after Academician I.P.Pavlov".
Nikiforov A.A. A head of Scientific Research Laboratory of SBE HPE "Ryazan State Medical University named after Academician I.P.Pavlov".

A.I. RUNDO, V.A. KOSINETS

APPLICATION OF THE COMBINED PHOTOTHERAPY IN COMPLEX TREATMENT OF PATIENTS WITH COMPLICATIONS OF DIABETIC FOOT SYNDROME

EE "Vitebsk State Medical University"
The Republic of Belarus

Objectives. To study the effect of a combined phototherapy on wound healing and the blood flow in vessels of the lower limbs at treatment of patients with diabetic foot syndrome.
Methods. The purulent-necrotic lesions of the foot in patients (n=80) with diabetes mellitus was analyzed. The patients were divided into two groups: the control group (n=50), treatment was carried out according to standard protocols, and the main group (n=30) in which patients additionally received phototherapy by blue light irradiation on skin wounds (0,47±0,03 µm – blue region of the spectrum, 2 mW) and red spectra (0,67±0,02 µm, 2 mW – red region of the spectrum), as well as an intravenous blood irradiation therapy in use red light (0,67±0,02 µm, 2 mW – red region of the spectrum).
Evaluation of wound healing process was carried out on the 1st, 3rd-5th, 7th and 14th days. The duration of each wound healing stage and clinical symptoms had been analyzed. Ultrasonography examination assessed the blood flow velocity in the deep femoral artery.
Results. It was established that in the main group the duration of the cleansing phase reduced by 7th days, an earlier appearance of granulation was observed by 3rd days, creating the conditions of accelerated epithelial regeneration, the preparing of the wounds to a plastic closure occurred 1,9 fold faster.
On 3rd-5th days from the onset of treatment a reliable reduction of swelling, hyperemia, amount of exudate in wounds were observed in the main group.
On the 1st and the 14th days in the control group there was no change in systolic blood flow velocity (Vs) – 83,85 cm/s and 83,3 cm/sec, respectively. In the group, subjected to combined phototherapy, the Vs index fell from 76,4 cm/s to 69,4 cm/sec (p<0,0001) in the specified timeframe.
Conclusion. The use of combined methods of phototherapy in complex treatment of diabetic foot syndrome appears to be extremely promising direction, the proposed methods of treatment promotes aid effectiveness to these patients.

Keywords: diabetic foot syndrome, purulent-necrotic process, angiopathy, neuropathy, phototherapy, blue light, red light
p. 131-137 of the original issue
References
  1. Dedov II, Mel'nichenko GA, red. Endokrinologiia: nats ruk [Endocrinilogy]. Kratkoe izd. Moscow, RF: GEOTAR-Media; 2013. 752 p.
  2. Gaddi A, Galetti C, Illuminati B, Nascetti S. Meta-analysis of some results of clinical trials on sulodexide therapy in peripheral occlusive arterial disease. J Int Med Res. 1996 Sep-Oct;24(5):389-406.
  3. Krivoshchekov EP, Boklin AA, Romanov VE. Diagnostika i lechenie bol'nykh s sindromom diabeticheskoi stopy [Diagnosis and treatment of patients with diabetic foot syndrome]: monogr. Samara, RF: Volgo-Biznes; 2010. p. 22-29.
  4. Safarov SJ, Aliev MA. Taktika hirurgicheskogo lechenija gnojno-nekroticheskih porazhenij pal'cev stopy u bol'nyh saharnym diabetom pri hronicheskih ishemijah [Surgical treatment of necrotic lesions of the toes in diabetic patients with chronic ischemia]. Vestn Novyh Med Tehnologij. 2011;18(1):70-72.
  5. Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012 Jun;54(12):e132-73. doi: 10.1093/cid/cis346.
  6. Bensman VM, Triandafilov KG. Diskussionnye voprosy klassifikacii sindroma diabeticheskoj stopy [Discussion questions of diabetic foot syndrome classification]. Hirurgija. Zhurn im NI Pirogova. 2009;(4):37-41.
  7. Ignatovich IN, Kondratenko GG, Nikulin DD. Obosnovanie optimal'nogo metoda lechenija pacientov s nejroishemicheskoj formoj sindroma diabeticheskoj stopy na osnovanii sravnenija otdalennyh rezul'tatov primenenija razlichnyh metodov [Justification of the optimal method of patients treatment with neuroischemic form of diabetic foot syndrome by comparing the long-term results of different methods]. Novosti Khirurgii. 2013;21(2):69-75.
  8. Kljushkin IV, Fatyhov RI. Sovremennye metody diagnostiki pri sindrome diabeticheskoj stopy [Modern methods of diagnosis for diabetic foot syndrome]. Kazan Med Zhurn. 2012;93(2):298-300.
  9. Ahmetjanov LA, Fatyhov RI, Kljushkin IV, Kolesnikov AE, Naumov VV. Patogeneticheskoe obosnovanie infuzionnoj terapii s primeneniem sovremennyh metodov vizualizacii pri sindrome diabeticheskoj stopy [Pathogenetic substantiation of infusion therapy with the use of modern imaging techniques for diabetic foot syndrome]. Kazan Med Zhurn. 2012;93(2):344-46.
  10. Bereznjakov VI. Osnovnye polozhenija rekomendacij po diagnostike i lecheniju sindroma diabeticheskoj stopy Obshhestva infekcionistov Ameriki 2012 goda [The main provisions of recommendations for the diagnosis and treatment of diabetic foot syndrome of Society infectionists America 2012.]. Bolezni i Antibiotiki. 2013;(1):48-56.
  11. Grekova NM, Bordunovskij VN, Gur'eva IV. Diagnostika i hirurgicheskoe lechenie sindroma diabeticheskoj stopy [Diagnosis and surgical treatment of diabetic foot syndrome]: ucheb posobie. Cheljabinsk, RF; 2010. 142 p.
  12. Dobrokvashin SV, Jahupov RR. Opyt hirurgicheskogo lechenija sindroma diabeticheskoj stopy [Experience of surgical treatment of diabetic foot syndrome]. Kazan Med Zhurn. 2010;91(5):630-33.
  13. Krasnikov VM, Nikulin NL, Tihonov VA. Mnogokomponentnoe lechenie gnojno - nekroticheskih porazhenij pri nejroishemicheskoj forme sindroma diabeticheskoj stopy [The multicomponent treatment of purulent - necrotic lesions of neuroischemic form of diabetic foot syndrome.]. Kazan Med Zhurn. 200;(2):199-201.
  14. Weck M, Rietzsch H, Lawall H, Pichlmeier U, Bramlage P, Schellong S. Intermittent intravenous urokinase for critical limb ischemia in diabetic foot ulceration. Thromb Haemost. 2008 Sep;100(3):475-82.
  15. Ziegler D, Movsesyan L, Mankovsky B, Gurieva I, Abylaiuly Z, Strokov I. Treatment of symptomatic polyneuropathy with actovegin in type 2 diabetic patients. Diabetes Care. 2009 Aug;32(8):1479-84. doi: 10.2337/dc09-0545.
Address for correspondence:
210023, Republic of Belarus,
Vitebsk, pr. Frunze, d. 27,
UO "Vitebskiy gosudarstvennyiy meditsinskiy universitet",
kafedra operativnoy khirurgii i topograficheskoy anatomii,
tel. office: 375 33 645-12-01,
e-mail: qlex2007@yandex.ru,
Rundo Aleksey Ivanovich
Information about the authors:
Rundo A.I. An assistant of the operative surgery and topographic anatomy chair of EE "Vitebsk State Medical University".
Kosinets V.A. MD, professor of the hospital surgery chair with the courses of urology and pediatric surgery of EE "Vitebsk State Medical University".

Ì.Y. GAIN, S.V. SHAKHRAI, Y.M. GAIN

PUNCTURE VACUUM TROMBUS EXTRACTION WITH LASER COAGULATION OF HEMORRHOID NODE IN TREATMENT OF ACUTE EXTERNAL HEMORRHOID THROMBOSIS: A RANDOMIZED TRIAL

SEE "Belarusian Medical Academy of Post-graduate Education",
The Republic of Belarus

Objectives. To estimate the efficacy of puncture vacuum thrombus extraction with laser coagulation of hemorrhoid node in complex treatment of patients with acute thrombosed external hemorrhoids (grade I, 2).
Methods. Depending on surgical intervention the patients were divided into five groups. Minimally-invasive procedure – puncture vacuum thrombus extraction with laser coagulation of cavernous capsule node being an office-based surgery (1 day) had been performed in two main groups (A and B; 30 patients per each).
The incision thrombus extraction procedure was performed in patients of group C (n=24), excision thrombus extraction – in patients of group D (n=27). The patients of group E (n=30) received only conservative treatment. The comparative analysis of the results of treatment had been carried out as a result of the prospective randomized trial.
Results. The least invasive technique of thrombus removal has been established to be an aspiration-puncture method. It allows the quick cupping of pain syndrome and inflammation in comparison with conservative treatment (The Mann-Whitney U Test has been used for the comparative analysis of anal discomfort (p=1,4•10-11, z = −6,6456). Simple incision thrombus extraction without destruction of hemorrhoidal tissue is not considered to be a radical procedure: recurrence disease rate reached 37,5% (p=0,007 Mann-Whitney U-Test). Hemorrhage from an intervention zone after incision thrombus extraction (group C) were noted (p=0,0006 Mann-Whitney U-Test) in 33,3%. The excision thrombus extraction (group D) is the radical procedure preventing recurrence development. However, this type of operation was accompanied by a higher rate of bleeding incidents in the incisional period (22,2%; p=0,0063 Mann-Whitney U-Test).
Conclusion. The combination of active surgical tactics (the developed method of puncture thrombus extraction with coagulation of hemorrhoid node by laser radiation (1,56 microns) under tumescent local anesthesia) permits to prerent a recurrence, to reduce the number of possible complications, to decrease a pain syndrome that can result to a considerable reduction of terms of therapy.

Keywords: laser coagulation, diode, thrombus extraction, hemorrhoids, risk of hemorrhage, randomized, controlled trial
p. 138-145 of the original issue
References
  1. Vorob'ev GI, Blagodarnyi LA, Shelygin IA. Gemorroi [Hemorrhoids]: ruk dlia prakt vrachei. 2-e izd. Moscow, RF: Litterra; 2010. 200 p.
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  3. Chan KK, Arthur JD. External haemorrhoidal thrombosis: evidence for current management. Tech Coloproctol. 2013 Feb;17(1):21-25. doi: 10.1007/s10151-012-0904-8.
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  5. Greenspon J, Williams SB, Young HA, Orkin BA. Thrombosed external hemorrhoids: outcome after conservative or surgical management. Dis Colon Rectum. 2004 Sep;47(9):1493-98.
  6. Gebbensleben O, Hilger Y, Rohde H. Do we at all need surgery to treat thrombosed external hemorrhoids? Results of a prospective cohort study. Clin Exp Gastroenterol. 2009;2:69-74.
  7. Jongen J, Bach S, Stübinger SH, Bock JU. Excision of thrombosed external hemorrhoid under local anesthesia: a retrospective evaluation of 340 patients. Dis Colon Rectum. 2003 Sep;46(9):1226-31.
  8. Cavcić J, Turcić J, Martinac P, Mestrović T, Mladina R, Pezerović-Panijan R. Comparison of topically applied 0.2% glyceryl trinitrate ointment, incision and excision in the treatment of perianal thrombosis. Dig Liver Dis. 2001 May;33(4):335-40.
  9. Giannini I, Amato A, Basso L, Tricomi N, Marranci M, Pecorella G, et al. Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute hemorrhoidal disease: a prospective, randomized, triple-blind, controlled trial. Tech Coloproctol. 2015 Jun;19(6):339-45. doi: 10.1007/s10151-015-1302-9.
  10. Hernández-Bernal F, Castellanos-Sierra G, Valenzuela-Silva CM, Catasús-&AACUTE;lvarez KM, Martínez-Serrano O, Lazo-Diago OC, et al. Recombinant streptokinase vs hydrocortisone suppositories in acute hemorrhoids: a randomized controlled trial. World J Gastroenterol. 2015 Jun 21;21(23):7305-12. doi: 10.3748/wjg.v21.i23.7305.
  11. Johnson C. Measuring pain. Visual analog scale versus numeric pain scale: what is the difference? J Chiropr Med. 2005 Winter; 4(1): 43–44. doi: 10.1016/S0899-3467(07)60112-8.
Address for correspondence:
220013, Republic of Belarus,
Minsk, ul. P. Brovki, d. 3, korp. 3,
GUO "Belorusskaya meditsinskaya akademiya
poslediplomnogo obrazovaniya",
kafedra neotlozhnoy khirurgii,
tel. mob.: 375 44 557-88-15,
e-mail: mishahain@tut.by,
Gain Mikhail Yurevich
Information about the authors:
Gain M.Y. PhD, an assistant of the emergency surgery chair of SEE "Belarusian Medical Academy of Post-graduate Education".
Shakhrai S.V. PhD, an associate professor of the emergency surgery chair of SEE "Belarusian Medical Academy of Post-graduate Education".
Gain Y.M. MD, professor, Vice Rector (Science) of SEE "Belarusian Medical Academy of Post-graduate Education".

TRANSPLANTOLOGY

P.A. ABBASOV, S. YILMAZ

TYPES OF HEPATIC CAVAL ANASTOMOSIS IN LIVER TRANSPLANTATION

Azerbaijan Medical University, Baku,
The Republic of Azerbaijan
Inonu University, Medical Center centre named after T.Ozal, Malatya,
The Turkish Republic

Objectives. To study the results of implementation of various types of hepatic caval anastomosis in the liver transplantation from a living donor.
Methods. The treatment results of patients (n=598) who underwent living donor liver had been analyzed. Patients were divided into 3 groups: the 1st group included patients (n=106) who underwent to the performance of anastomosis between donor hepatic vein and inferior vena cava (IVC).
The 2nd group included patients (n=295), who underwent IVC anastomosis using the autovenous graft. The 3rd group included patients (n=197) subjected to the anastomosis performance with IVC by the vascular grafts implementation.
Results. The right-sided hepatectomy (n=95), and left-sided hepatectomy (n=11) were performed in the 1st group. The right-sided hepatectomy (n=264) and the left-sided hepatectomy (n=31) was carried out in the 2nd group. In patients of the 3rd group the right-sided hepatectomy (n=180) and the left-sided hepatectomy (n=17) were done.
In the 1st group the mean time of the anastomosis formation was 41,6±7,5 min, in the 2nd group – 29,7±8,5 min, and in the 3rd group – 30,1±8,3 min (̱σ). In 9 recipients (8,5%) of the 1st group and in 19 patients (9,6%) of the 3rd group the hepatic caval anastomosis was reperformed due to disturbances in hepatic venous blood flow.
In a month reoperations caused by disorders of the venous system were performed in 2 (1,9%) patients of the 1st group, in 2(0,7%) patients of the 2nd group and in 9 (4,6%) patients of the 3rd group.
Conclusion. In liver transplantation with implementation of autovenous graft (the 2nd group) a shorter warm ischemia time, less incidence of venous thrombosis, far fewer imposition of repeated anastomoses that distinguishes this group from the 3rd one (with the vascular prostheses using) were revealed.

Keywords: liver transplantation, donor autovein, recipient, inferior vena cava, hepatic-caval anastomosis, venous thrombosis, warm ischemia time
p. 146-150 of the original issue
References
  1. Salah T, Sultan AM, Fathy OM, Elshobary MM, Elghawalby NA, Sultan A, et al. Outcome of right hepatectomy for living liver donors: a single Egyptian center experience. J Gastrointest Surg. 2012 Jun;16(6):1181-8. doi: 10.1007/s11605-012-1851-4.
  2. Bhangui P, Lim C, Salloum C, Andreani P, Sebbagh M, Hoti E, et al. Caval inflow to the graft for liver transplantation in patients with diffuse portal vein thrombosis: a 12-year experience. Ann Surg. 2011 Dec;254(6):1008-16. doi: 10.1097/SLA.0b013e31822d7894.
  3. Kasahara M, Takada Y, Fujimoto Y, Ogura Y, Ogawa K, Uryuhara K, et al. Impact of right lobe with middle hepatic vein graft in living-donor liver transplantation. Am J Transplant. 2005 Jun;5(6):1339-46.
  4. Makuuchi M, Sugawara Y. Technical progress in living donor liver transplantation for adults. HPB (Oxford). 2004;6(2):95-8. doi: 10.1080/13651820410032914.
  5. Mali VP, Aw M, Quak SH, Loh DL, Prabhakaran K. Vascular complications in pediatric liver transplantation; single-center experience from Singapore. Transplant Proc. 2012 Jun;44(5):1373-78. doi: 10.1016/j.transproceed.2012.01.129.
  6. Got'e SV. Transplantatsiia pecheni: sovremennoe sostoianie problemy [Liver transplantation: a modern state of the problem]. Al'm In-ta Khirurgii im AV Vishnevskogo. 2008;3(3):9-17.
  7. Steinbrück K, Enne M, Fernandes R, Martinho JM, Balbi E, Agoglia L, et al. Vascular complications after living donor liver transplantation: a Brazilian, single-center experience. Transplant Proc. 2011 Jan-Feb;43(1):196-8. doi: 10.1016/j.transproceed.2010.12.007.
  8. Abbara S. Diagnostic Imaging: Cardiovascular. 2-nd. Wolters Kluwer; 2013. 1000 p.
Address for correspondence:
Republic of Azerbaijan
Baku, ul. Bakihanova d. 23,
Azerbaydzhanskiy meditsinskiy universitet,
kafedra khirurgicheskih bolezney,
tel. mob.: 99450-341-18-22,
e-mail: pabbasov82@rambler.ru,
Abbasov Parviz Ali oglyi
Information about the authors:
Abassov P.A. ogly. PhD, an assistant of the surgical diseases chair, Azerbaijan Medical University.
S. Yilmaz. MD, professor, Director of Medical Center named after T.Ozal, Inonu University.

TRAUMATOLOGY & ORTHOPEDICS

N.V. GOVOROVA1, V.V. GOVOROV 2, M.V. GOVOROV 3, M.V. MURASOV 2

TEMPORARY PELVIC IMMOBILIZATION IN PROVIDING ASSISTANCE TO VICTIMS WITH A HIGH-ENERGY COMBINED TRAUMA DURING TRANSPORT

SBEE HPE "Omsk State Medical University"1,
BME "Omsk City Clinical Hospital ¹1 named after A.N. Kabanov"2,
NME "Road Clinical Hospital named after N.A. Semashko", station Lublino, JSC "Russian Railways"3
The Russian Federation

Objectives. To evaluate the device effectiveness as a temporary immobilization of transporting patients with combined trauma and pelvic fracture (type B and C).
Methods. The patients (n=26) who underwent traffic accident or fell from a height with damages of two or more of the anatomic and functional areas, including pelvic fracture (type B and C) have been analysed. For emergency primary immobilization the authors proposed "Device for temporary immobilizing and transporting of the accident victim" (RF patent utility model N 114849). The comparative study "case-control" of two groups of patients was conducted for effectiveness evaluation of using this "Device". The patients (n=15) underwent to application of "Device" at the early hospital stage were included in the 1st group, the second group (n=11) patients who was provided by traditional assistance without using the immobilization belt.
Results. Both groups were comparable regarding the degree of lesion and shock severity. The traumatic shock of degree II–III of severity against the backdrop of the damage of three or more anatomical and functional areas was diagnosed in 84,6% of patients. It was established that belt application at the in-hospital stage of transport reliably reduced the absolute risk of hemodynamic disturbances. In group 1 at the intensive care unit stage the period of unstable hemodynamics and circulatory disorders decreased and hemoglobin loss reduced. There were no differences in the amount of ongoing infusion-transfusion therapy and hospital length.
Conclusion. Relative temporary non-invasive stabilization of the pelvic ring is achieved at the stage of diagnosis and transport with application of «Device». At the same time strengthening of "biological intrapelvic tamponade" effect occurs as well as the reduction of internal bleeding rate. The "Device" use for temporary immobilization and transport can be recommended as an aid element for patients with a high-energy combined trauma at the prehospital and early hospital stage.

Keywords: pelvis damage, pelvic belt, temporary immobilization, device, transport, high-energy combined trauma, prehospital and early hospital stage
p. 151-156 of the original issue
References
  1. Agadzhanian VV. Organizatsionnye problemy okazaniia pomoshchi postradavshim s politravmami [Organizational problems of the care of patients with multiple injuries]. Politravma. 2012;(1):5-9.
  2. Sokolov VA. Mnozhestvennye i sochetannye travmy [Multiple and combined injuries]. Moscow, RF: GEOTAR-Media; 2006. 512 p.
  3. Baranov AV, Matveev RP, Barachevskii IE. Povrezhdeniia taza kak problema sovremennogo travmatizma [Injuries of the pelvis as a problem of modern trauma]. Ekologiia Cheloveka. 2013;(8):58-64.
  4. Agadzhanian VV, Ust'iantseva IM. Nauchno-prakticheskaia kontseptsiia politravmy [Scientific-practical concept of polytrauma]. Politravma. 2013;(2):5-10.
  5. Tile M. Fractures of the pelvis and acetabulum. Williams & Wilkins; 1995. 480 p.
  6. Gur'ev SO, Maksimenko MA. Kliniko-anatomicheskaia kharakteristika postradavshikh s travmoi taza vsledstvie DTP [Clinical and anatomical characteristics of patients with pelvic trauma as a result of an accident]. Travma. 2013;14(1):13-15.
  7. Shapkin IuG, Seliverstov PA. Taktika lecheniia nestabil'nykh povrezhdenii taza pri politravme [The treatment of unstable pelvic injuries in polytrauma]. Novosti Khirurgii. 2015;23(4):452-59.
  8. Samokhvalov IM, Borisov MB, Denisenko VV, Grebnev AR, Ganin EV. Vremennaia neinvazivnaia stabilizatsiia taza [Temporary non-invasive pelvic stabilization]. Vestn Travmatologii i Ortopedii im NN Priorova. 2014;(4):6-11.
  9. Gumanenko EK, Samokhvalova IM, red. Voenno-polevaia khirurgiia lokal'nykh voin i vooruzhennykh konfliktov [Military surgery of local wars and armed conflicts]: ruk dlia vrachei. Moscow, RF: GEOTAR-Media; 2011. 672 p.
  10. Govorov VV, Mamontov VV, Govorova NV, Govorov MV. Ustroistvo dlia vremennoi immobilizatsii i transportirovki postradavshego [Device for temporary immobilizing and transporting of the accident victim]. Patent RF ¹ 114849. 20.04.2012.
  11. Glants S. Mediko-biologicheskaia statistika [Biomedical statistics]. Moscow, RF: Praktika; 1998. 460 p.
  12. Khanin MIu, Minasov BSh, Minasov TB, Iakupov RR, Zagitov BG. Ortopedicheskii damage-control pri povrezhdeniiakh taza u patsientov s politravmoi [Orthopedic damage-control in pelvic lesions of patients with multiple injuries]. Prakt Meditsina. 2011;54(6):122-25.
  13. Advanced trauma life support for doctors. 8th ed. Chicago IL: American College of Surgeons; 2008. 366 p.
  14. Felichano DV, Mattoks KL, Mur EE. Travma [Trauma]: v 3 t. Moscow, RF; 2013;2. 736 p.
  15. Samokhvalov IM, Borisov MB, Denisenko VV, Grebnev AR, Ganin EV. Vremennaia neinvazivnaia stabilizatsiia taza [Temporary non-invasive pelvic stabilization]. Vestn Travmatologii i Ortopedii im NN Priorova. 2014;(1):6-11.
Address for correspondence:
644099, Russian Federation,
Omsk, ul. Lenina, d. 12,
GBOU VPO "Omskiy gosudarstvennyiy
meditsinskiy universitet",
kafedra anesteziologii i reanimatologii,
tel. mob.: 8 913 977-85-33,
e-mail: nataly12@yandex.ru,
Govorova Natalya Valerevna
Information about the authors:
Govorova N.V. MD, professor, a head of the anesthesiology and intensive care chair of SBEE HPE "Omsk State Medical University".
Govorov V.V. A head of the traumatology and orthopedics department of "Omsk City Clinical Hospital ¹1 named after A.N. Kabanov".
Govorov M.V. A tramatologist-orthopedist of NME "Road Clinical Hospital named after N.A. Semashko", station Lublino, JSC "Russian Railways".
Murasov M.V. An anesthesiologist of the intensive care unit of "Omsk City Clinical Hospital ¹1 named after A.N. Kabanov".

MAXILLOFACIAL SURGERY

T.L. SHEVELA, I.O. POHODENKO-CHUDAKOVA

HELICOBACTER PYLORI AS AN ETIOLOGICAL FACTOR IN THE DEVELOPMENT OF PATHOLOGICAL INFLAMMATION OF THE JAWBONE AFTER DENTAL IMPLANT SURGERY

EE "Belarusian State Medical University",
Minsk,
The Republic of Belarus

Objectives. To determine the features of the clinical course of postoperative inflammatory reaction in the region of implants in patients associated with Helicobacter pylori.
Methods. The patients (n=98; aged 20−48) with partial secondary edentia subjected to installation of dental implants were under observation. All patients were examined for Helicobacter pylori in the endoscopy department. A standard Helpil-test of the tissues biopsy of gastric mucosa taken at esophagogastroduodenoscopy was applied. All examined patients were carried out the dynamic monitoring on the following terms: on the 7th and 14th days and in 4 months after the dental implantation.
Results. In 46 (47%) patients the course of the postoperative period and the osseointegration of implants were without any peculiarities. During the comparative analysis the result of the degree of the contamination of the stomach with Helicobacter pylori in this group of patients had the minimum value (++) in 36 (37%) patients and the medium value (+++) was observed in 10 (10%) patients. Periimplantitis and disintegration of dental implant occured in 6 (6%) patients with a high degree of Helicobacter pylori contamination of the stomach (++++). The failure of sutures, the presence of fistula with purulent discharge, the mobility and disintegration of dental implants had been observed in 4 (4%) patients.
Conclusion. On the basis of the obtained results it’s possible to make the conclusion concerning the presence of certain correlation of the pathological process in the bone tissue of the jaw, immediately adjacent to the dental implant and the nature of the carriage of Helicobacter pylori infection in the examined patients. This indicates the necessity of forming of dispensary groups including the patients of this category (risk factors for periimplantitis) concerning Helicobacter pylori and conduction of individual preventive measures.

Keywords: periimplantitis, mucositis, Helicobacter pylori, inflammation, preventive measures, dispensary observation, risk factors for periimplantitis
p. 157-161 of the original issue
References
  1. Shvarts F, Beker Iu. Periimplantit: etiologiia, diagnostika i lechenie [Peri-implantitis: etiology, diagnosis and treatment]. L'vov, Ukraina: GalDent, 2014. 272 p.
  2. Golovina ES, Kuznetsova EA, Tlustenko VP, Sadykov MI, Tlustenko BC. Kliniko-rentgenologicheskaia diagnostika periimplantitnogo mukozita i dental'nogo periimplantita khronicheskogo techeniia [Clinical and radiological diagnosis of chronic periimplantitis mucositis and dental periimplantitis chronicity]. Izv Samar Nauch Tsentra Ros Akad Nauk. 2014;16(6):330-35.
  3. Hall J, Pehrson NG, Ekestubbe A, Jemt T, Friberg B. A controlled, cross-sectional exploratory study on markers for the plasminogen system and inflammation in crevicular fluid samples from healthy, mucositis and peri-implantitis sites. Eur J Oral Implantol. 2015 Sum;8(2):153-66.
  4. Renvert S, Dzhovan'oli ZL. Periimplantit [Periimplantitis]. Moscow, RF: Azbuka; 2014. 255 p.
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  8. Gazhva SI, Shkarednaia OV. Kompleksnoe lechenie zabolevanii slizistoi obolochki polosti rta u patsientov s patologiei zheludochno-kishechnogo trakta [Comprehensive treatment of diseases of the oral mucosa in patients with disorders of the gastrointestinal tract]. Parodontologiia. 2012;(4):62-65.
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  12. Duttenhoefer F, Nack C, Doll C, Raguse JD, Hell B, Stricker A, et al. Long-term peri-implant bone level changes of non-vascularized fibula bone grafted edentulous patients. J Craniomaxillofac Surg. 2015 Jun;43(5):611-5. doi: 10.1016/j.jcms.2015.02.020.
  13. Kornienko EA, Emanuel' VL, Dmitrienko MA. Khelpil-test i Khelik-test dlia diagnostiki khelikobakterioza: posobie dlia vrachei [HELP-test and Helic-test for the diagnosis Helicobacter pylori infection]. S-Petersburg, RF; 2005. 20 p.
  14. Kosiuga SIu, Lukinykh LM, Varvanina SE. Klinicheskii sluchai deskvamativnogo glossita u patsienta so slaboi stepen'iu obsemenennosti zheludka Helicobacter pylori [Case desquamative glossitis in a patient with a low degree of contamination of gastric Helicobacter pylori]. Klin Stomatologiia. 2015;(2):10-13.
  15. Calvet X, Ramírez Lázaro MJ, Lehours P, Mégraud F. Diagnosis and epidemiology of Helicobacter pylori infection. Helicobacter. 2013 Sep;18(Suppl 1):5-11. doi: 10.1111/hel.12071.
Address for correspondence:
220017, Republic of Belarus,
Minsk, pr. Dzerzhinskogo d. 83,
Belorusskiy gosudarstvennyiy meditsinskiy universitet,
kafedra khirurgicheskoy stomatologii,
tel. office: 37517254-32-44,
e-mail:ip-c@yandex.ru,
Pohodenko-Chudakova Irina Olegovna
Information about the authors:
Shevela T.L. PhD, an associate professor of the surgical dentistry chair of EE "Belarusian State Medical University".
Pohodenko-Chudakova I.O. MD, professor, a head of the surgical dentistry chair of EE "Belarusian State Medical University".

ONCOLOGY

O.P. LUKASHOVA 1, V.I. STARIKOV 2, S.Y. BASYLAISHVILI 2, A.N. BELY 2, I.N. TESLENKO 1

ULTRASTRUCTURE OF NON-SMALL CELL LUNG CANCER AND THE SURROUNDING TISSUES

SE "Institute of Medical Radiology Named after S.P.Grigoryev of National Academy of Medical Sciences of Ukraine"1,
Kharkov National Medical University2,
Ukraine

Objectives. To study the ultrastructure of tumor cells and structural and functional state of the lungs in patients with non-small cell lung cancer.
Methods. The study included patients (n=18) aged from 35 to 68 yrs after pneumonectomy and lobectomy for non-small cell lung cancer stage II-III. To study the ultrastructure the specimens were taken from three sites of the lung: the first site – the tumor itself; the second – the tissue surrounding the tumor; the third – lung tissue located far from the tumor focus. The electron microscopy analysis of specimens was performed using standard methods.
Results. The study of lung adenocarcinoma showed that its characteristic feature was the formation of glandular structures, surrounded by a basement membrane, with a central lumen where cytoplasmic villi of apical part of tumor cells were protruded. Squamous carcinoma cells were arranged in clusters and fields, and sometimes so extensive that the areas of necrosis occurred in them due to the remoteness from the supplying vessels, located in the connective tissue. The main ultrastructural characteristic of those tumor cells was the presence of tonofibrils in the cytoplasm, a quantity of which could vary within fairly wide limits. The distinctive features of bronchoalveolar carcinoma were the presence of large cytoplasmic granules with lamellar content possessing by surfactant properties. It should be noted that in each of the studied NSCLC the tumor population exhibits a unique set of tumor cells with different ultrastructural features.
Conclusion. Individual ultrastructural features of tumor cells in each case of non-small cell lung cancer have been found out. It is established that in the tissues surrounding the tumor, and lung located at a distance, vascular endothelial cells have edematous cytoplasm in 100% of adenocarcinomas cases and only in 16,7 % of cases of squamous cell carcinoma.

Keywords: non-small cell lung cancer, electron microscopy, adenocarcinoma, squamous cell carcinoma, surrounding tissues, lamellar content, surfactant
p. 162-169 of the original issue
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  16. Zhan P, Wang J, Lv XJ, Wang Q, Qiu LX, Lin XQ, et al. Prognostic value of vascular endothelial growth factor expression in patients with lung cancer: a systematic review with meta-analysis. J Thorac Oncol. 2009 Sep;4(9):1094-103. doi: 10.1097/JTO.0b013e3181a97e31.
Address for correspondence:
61024, Ukraine,
Harkov, ul. Pushkinskaya, d. 82,
GU "Institut meditsinskoy radiologii im. S.P. Grigoreva
Natsionalnoy akademii meditsinskih nauk Ukrainyi",
kafedra onkologii,
tel. office: 38 057 704-10-69,
e-mail: stanislav.basylaishvili@gmail.com,
Basylaishvili Stanislav Yurevich
Information about the authors:
Lukashova O.P. PhD, a head of team of electron microscopy of clinical radiobiology department of SE "Institute of Medical Radiology named after S.P.Grigoryev of National academy of Medical Sciences of Ukraine".
Starikov V.I. MD, professor, a head of the oncology chair of Kharkov National Medical University.
Basylaishvili S.Y. A 3rd year post-graduate student of the oncology chair of Kharkov National Medical University.
Bely A.N. PhD, an associate professor of the oncology chair of Kharkov National Medical University.
Teslenko I.N. A laboratory assistant of the team of electron microscopy of clinical radiobiology department of SE "Institute of Medical Radiology named after S.P.Grigoryev of National academy of Medical Sciences of Ukraine".

ANESTHESIOLOGY & REANIMATOLOGY

A.L. LIPNITSKI, A.V. MAROCHKOV

PECULIARITIES OF CISATRACURIUM APPLICATION IN ELDERLY PATIENTS

ME "Mogilev Regional Hospital",
The Republic of Belarus

Objectives. To find out the impact of age on onset times; providing conditions for the tracheal intubation and duration of cisatracurium action.
Methods. The patients (n=78) undergone to laparoscopic cholecystectomy were enrolled in the prospective study. The patients were divided into four groups according to age: group 1 (n=18) 18-39 yrs old; group 2 (n=18) 40-49 yrs old; group 3 (n=21) 50 to 59 yrs old; and group 4 (n=21) – above 60 yrs old. All patients received cisatracurium 0,1-0,15 mg/kg. General anesthesia was maintained with inhalation of sevoflurane and bolus administration of fentanyl. A neuromuscular transmission was measured by kinemiography method.
Results. Onset time of cisatracurium action was significantly shorter in group 1 in comparison with groups 3 and 4: 216,5±88,6 c in group 1 in comparison with group 3 and 4: 284,8±87,4 and 306,0±140,5 c, respectively, p <0,05. All patients underwent tracheal intubation at the first attempt, duration was about 180 seconds.
Duration of action of cisatracurium was not differed between the groups: in group 1 –45,4±9,2 min, in group 2 – 47,6±9,6 min, in group 3 – 50,1±9,8 min, in group 4 – 46,9±9,8 min, p>0,1. Despite the absence of statistically significant differences in the duration of action, the recovery index of the neuromuscular block was significantly longer in groups 3 and 4 in comparison with groups 1 and 2 (group 1 – 12,9±3,3 min, group 2 – 12,6±3,1 min, group 3 – 17,7±6,6 min, group 4 – 17,8±5,9 min, p<0,05).
Conclusion. In elderly patients neuromuscular blockade occurs more slowly and neuromuscular transmission restored at the same time compared with young patients.

Keywords: muscle relaxants, cisatracurium, neuromuscular block, neuromuscular transmission, general anaesthesia, tracheal intubation, inhalation
p. 170-176 of the original issue
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  15. Adamus M, Hrabalek L, Wanek T, Gabrhelik T, Zapletalova J. Influence of age and gender on the pharmacodynamic parameters of rocuronium during total intravenous anesthesia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2011 Dec;155(4):347-53. doi: 10.55.07/bp.2011.050.
Address for correspondence:
212002, the Republic of Belarus,
g. Mogilev, ul. B. Biruli, d. 12,
UZ "Mogilevskaya oblastnaya bolnitsa",
otdelenie anesteziologii i reanimatsii,
tel.office: 375 222 27-87-33,212002,
e-mail: Lipnitski.al@gmail.com,
Lipnitski Artur Leonidovich
Information about the authors:
Marochkov A.V. MD, professor, a head of anaesthesiology and intensive care unit of ME "Mogilev Regional Hospital".
Lipnitski A.L. A head of transplant-coordination unit of ME "Mogilev Regional Hospital".

REVIEWS

A.Z. SHARAFEEV1, L.V. GLUSCHENKO1

MODERN APPROACHES TO IMPLANTATION OF CAVA-FILTERS AT LIFE-THREATENING PULMONARY EMBOLISM

SBEE SPE "Kazan State Medicine Academy"1,
SME "Ulyanovsk Regional Clinical Hospital" 2,
The Russian Federation

A literature review provides information about the prevention of pulmonary embolism and implantation of vena cava filters. For many years pulmonary embolism (PE) is an important clinical entity. Significant prospects for the the prevention pulmonary embolism and treatment of phlebothrombosis in the inferior vena cava have been opened by endovascular catheter intervention and first of all by implantation of vena cava filters. However, these interventions can result in adverse effects. Complications may arise during implantation or extraction of the filter or in the remote period. Complications of implantation are recorded in 4-15% of cases. They include local complications at the access site, improper implantation, migration, perforation of the inferior vena cava. The long-term complications related to the device (if the filter is not removed) include the following: filter migration or fracture fragment embolization (3%-69%), fracture of struts and perforation (9%-24%), the syndrome of the inferior vena cava (thrombosis 6%-30%), post-thrombotic syndrome (5%-70%), deep vein thrombosis (0%-20%) and recurrent pulmonary embolism (3%-7%). Despite a large number of complications, inferior vena cava filters are the popular medical devices for the prevention of pulmonary embolism. However, the amount of complications indicates the need for the development and application of a new generation of vena cava filters. The biodegradable vena cava filter (VCF) is an innovative concept. But due to lack of proper clinical experience the application of these devices requires a detailed analysis.

Keywords: vascular surgery, pulmonary embolism, prevention, postthrombotic syndrome, free-floating thrombus in deer veins of lower limbs, cava filter, complications
p. 177-183 of the original issue
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Address for correspondence:
432048, Russian Federation
Ulyanovsk, ul. Tretego Internatsionala, d. 7,
GUZ "Ulyanovskaya oblastnaya klinicheskaya bolnitsa",
otdelenie rentgen-angiograficheskoy diagnostiki i interventsionnoy khirurgii,
tel. mob.: 7 908 484-19-04,
tel. office: 7 8422 32-61-51,
e-mail: ileo.glu@gmail.com,
Gluschenko Leonid Vitalevich
Information about the authors:
Sharfeev A.Z. MD, an associate professor, a head of the chair of cardiology, X-ray endovascular and cardiovascular surgery of SBEE SPE "Kazan State Medicine Academy", a head of the department of X-ray and surgical methods of diagnostics and treatment of the Medical and sanitary unit of FSEAE HE "Kazan Federal University of the Ministry of Education of Russia".
Gluschenko L.V. A physician of the endovascular diagnostics and treatment of the department of X-ray angiography of diagnostic and interventional surgery of SME "Ulyanovsk Regional Clinical Hospital".

D.M. PASEVICH, S.A. SUSHKOU, V.M. SEMENOV

MOLECULAR GENETIC ASPECTS OF MALIGNANT COLON TUMORS

EE "Vitebsk State Medical University"
The Republic of Belarus

Today colorectal cancer is widely considered to be one of the world leaders in cancer incidence. There are many Colorectal Cancer Screening Programs for the detection of colorectal cancer; however, the identification of this disease in the late stages remains high. It points the disadvantages of the existing methods and seems to testify to a need of the new methods creation for early detection of cancer. This review presents the current literature on the role of genetic factors in colorectal cancer pathogenesis at the molecular level. The characteristics, localization and functions of some genes such as APC, MLH, MSH, PMS, KRAS, NRAS, BRAF, P53, BIRC5, involved in the occurrence of benign tumors of the colon, and then the conversion of normal cells into cancerous cells are presented. The information about the clinical and prognostic value, idetification of treatment effectiveness in choosing the types of chemotherapy drugs is given. Molecular and genetic techniques applied to identify these genes are described. The role of molecular genetics in the early diagnosis of malignancy of benign tumors is defined. The genetic factors, causing genetic predisposition (familial adenomatous polyposis, Lynch syndrome) are described as well as mutations in genes resulting in the appearance of non-inherited forms of colorectal cancer.

Keywords: Colorectal Cancer Screening Programs, colorectal cancer, molecular genetic diagnosis, familial adenomatous polyposis, Lynch syndrome, survivin, genetic factor
p. 184-192 of the original issue
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Address for correspondence:
210023, the Republic of Belarus,
Vitebsk, pr. Frunze, 27,
Vitebskiy gosudarstvennyiy meditsinskiy universitet,
kafedra obschey khirurgii,
e-mail: pasevich-dmitry@mail.ru,
Pasevich Dmitriy Mihaylovich
Information about the authors:
Pasevich D.M. An assistant of the general surgery chair of EE "Vitebsk State Medical University".
Sushkou S.A. PhD, an associate professor, Vice-Rector (Science) of EE "Vitebsk State Medical University".
Semenov V.M. MD, professor, a head of the infectious diseases chair of EE "Vitebsk State Medical University".

CASE REPORTS

S.A. GOLOBOROD’KO1,2

BILATERAL KIENBOCK’S DISEASE IN AN ELDERLY PATIENT

Kharkov Medical Academy of Postgraduate Education1,
Kharkov Regional Clinical Traumatological Hospital2, Ukraine

Kienböck’s disease (avascular necrosis of the lunate carpal bone) occurs most often in men aged 18 to 40 years as for the patients older than 60 yrs it observes extremely rare (especially on both hands) and is described in a few works.
The article presents an extremely rare case of bilateral Kienbock’s disease in the elderly patient. A patient of 63-yr-old complained of a sharp pain in the right wrist when moving and especially during physical activity, reduction of amplitude of the active-passive movements in joint and working ability infringement. Pain and limitation of movement in the right wrist appeared for no reason 7 months ago. The condition gradually deteriorated. Conservative treatment wasn’t carried out. After clinical and radiographic examination Kienbock’s disease stage IIIB was diagnosed.
Proximal row carpectomy was performed. Treatment outcome was assessed 13 months after the surgery. The patient subjectively noted a significant pain relief during physical activity, improvement of limb function and disability. The amplitude of passive movements at the wrist joint was increased. During a follow-up the patient also said that pain without any reason had appeared in the left wrist 2 months ago. X-ray was performed and Kienböck’s disease stage IIIB of the left wrist was found out. The man refused any treatment. Three years after the operation during a telephone survey a patient reported that the state of the operated limb has not worsened.

Keywords: wrist disease, lunate bone, bilateral Kienböck’s disease, avascular necrosis, carpectomy, physical activity, elderly patient
p. 193-196 of the original issue
References
  1. Geutjens GG. Kienböck's disease in an elderly patient. J Hand Surg. 1995 Jan;20(Is 1):42-43.
  2. Taniguchi Y, Yoshida M, Iwasaki H, Otakara H, Iwata S. Kienböck's disease in elderly patients. J Hand Surg Am. 2003 Sep;28(5):779-83.
  3. Thomas AA, Rodriguez E, Segalman K. Kienböck's disease in an elderly patient treated with proximal row carpectomy. J Hand Surg Am. 2004 Jul;29(4):685-88.
  4. Lichtman DM, Lesley NE, Simmons SP. The classification and treatment of Kienbock's disease: the state of the art and a look at the future. J Hand Surg Eur. 2010 Sep;35(7):549-54. doi: 10.1177/1753193410374690.
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Address for correspondence:
61178, Ukraine
Harkov, Saltovskoe shosse d. 266, k. V,
Harkovskaya oblastnaya klinicheskaya
travmatologicheskaya bolnitsa, kafedra kombustiologii,
rekonstruktivnoy i plasticheskoy khirurgii,
e-mail: golosa@ukr.net,
Goloborod’ko Sergey Anatolevich
Information about the authors:
Goloborod’ko S.A. PhD, an associate professor of combustiology, reconstructive and plastic surgery chair of Kharkov Medical Academy of Postgraduate Education.

Y.V. SLABADZIN, S.A. SIDOROV

LAPAROSCOPIC COLON AND RECTUM SURGERY

SE "The Republican Clinical Medical Centre of the Administration of the President of the Republic of Belarus", Minsk,
The Republic of Belarus

Objectives. To analyze the first experience of laparoscopic colon and rectal surgery.
Methods. The laparoscopic surgeries (n=16) of the colon and rectum were performed. There were 6 men and 10 women out of 16 operated patients.
The age of patients was 63±10,4 yrs. The reason for interventions were as follow: 8 cases of colorectal cancer, 1 diverticulitis of the sigmoid colon, four dysplastic villous polyps (grade 3), 1 large lipoma, 1 carcinoid, 1 functional sigmoidostomy. Six sigmoid resections, one lower anterior resection of the rectum, three right-sided and one left-sided hemicolectomy, two resections of the ileocecal angle, two total mesorectumectomies, one closure of sigmoidostomy had been carried out.
Results. Postoperatively patients’ activation began within 12 hours after surgery. Duration of the patient’s stay in the intensive care unit was 24±11,5 hrs. Duration of operations composed 264±88,8 min. Duration of hospital stay in the postoperative period was 8±5,1days. One patient was underwent to relaparotomy due to peritonitis on the 7th postoperative day caused the formed defect of the ileum wall in the deserosation region at adhesiolysis. All patients were discharged with satisfactory results.
Conclusion. The first experience shows that the treatment of surgical pathology of the colon and rectum laparoscopically is justified and highly effective. In performing surgical interventions due to the colorectal cancer, a complete fulfillment of oncological protocols concerning volume of resection and lymphadenectomy is complied. The introduction of laparoscopic surgery for the management of the colon and rectum cancer reduces the amount of intraoperative blood loss, reduces the length of stay of patients and their rehabilitation, and minimizes the development of postoperative complications.

Keywords: laparoscopic surgeries, colon, rectum, mesorectumectomy, mesocolectomy, colorectal cancer, hemicolectomy, interphincter resection, coloanal anastomosis
p. 197-202 of the original issue
References
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  15. Buunen M, Veldkamp R, Hop WCJ, Kuhry E, Jeekel J, Haglind E, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009 Jan;10(1):44-52. doi: 10.1016/S1470-2045(08)70310-3.
Address for correspondence:
220035, the Republic of Belarus,
Minsk, ul. Krasnoarmeyskaya, d. 10, GU "Respublikanskiy klinicheskiy
meditsinskiy tsentr"
Upravleniya delami Prezidenta Respubliki Belarus,
tel. office: 375 017 226-05-36,
e-mail: yurydoc75@gmail.com,
Slobodin Yuriy Valerevich
Information about the authors:
Slobodin Y.V. PhD, a head of the surgical in-patient department of SE "The Republican Clinical Medical Centre of the Administration of the President of the Republic of Belarus".
Sidorov S.A. A surgeon of the surgical in-patient department of SE "The Republican Clinical Medical Centre of the Administration of the President of the Republic of Belarus".
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