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Year 2020 Vol. 28 No 2

SCIENTIFIC PUBLICATIONS
GENERAL & SPECIAL SURGE

D.V. OSIPENKO 1, S.P. SALIVONCHIK 1, A.A. SKARAKHODAU 1, A.A. SILANAU 1, A.V. MAROCHKOV 2

EFFICIENCY ESTIMATION OF VARIOUS DOSES OF TRANEXAMIC ACID IN CARDIOPULMONARY BYPASS SURGERY

Gomel Regional Clinical Cardiological Center 1, Gomel,
Mogilev Regional Hospital 2, Mogilev,
The Republic of Belarus

Objective. To determine the effectiveness of various doses of tranexamic acid (TA) in the cardiopulmonary bypass surgery (CPB).
Methods. The study included 128 patients who underwent the heart surgery with CPB. Three groups were formed: group 1 (n=30) – a loading dose of TA – 10 mg/kg was administered intravenously with titration – 1 mg/kg/h during CPB; the 2nd group (n=32) – a loading dose of TA was administered intravenously – 12.5 mg/kg with titration – 6.5 mg/kg/h during CPB and 1 mg/kg/h in the first 6 hours after surgery; 3rd group (n=66) – the control one.
Results. The blood loss volume during the period from the operation onset to 42 – 48 hours after it, in the 1st, 2nd and 3rd group of patients was: 20.9 (18.1; 26.7) ml/kg, 19.3 (13.9; 22.5) ml/kg and 22.8 (18.4; 27.6) ml/kg; statistically significant differences were only between the 2nd and 3rd group of patients. The total volume of the chest tube drainage in the first 42-48 hours after the operation was significantly less in the 1st group (475.0 (350.0; 650.0) ml) and the 2nd group (500.0 (350.0; 550.0) ml), compared with the 3rd group (600.0 (500.0; 750.0) ml). The use of TA in the 2nd group of patients, compared with the 3rd group, led to the decrease in the frequency of blood transfusions in the first 42-48 hours after surgery. In the 1st group of patients, statistically significant differences in the frequency of blood transfusions were not found.
Conclusions. Maintenance of TA according to the method – the bolus of 12.5 mg/kg, titration of 6.5 mg/kg/ h during CPB and 1 mg/kg/h in the first 6 hours after surgery (total dose of 2.5 (2.1; 3.0) g) is optimal in the cardiopulmonary bypass heart surgery.

Keywords: tranexamic acid, cardiac surgery, cardiopulmonary bypass, blood loss, blood preparations
p. 133-140 of the original issue
References
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  2. Pagano D, Milojevic M, Meesters MI, Benedetto U, Bolliger D, von Heymann C, Jeppsson A, Koster A, Osnabrugge RL, Ranucci M, Ravn HB, Vonk ABA, Wahba A, Boer C. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. Eur J Cardiothorac Surg. 2018 Jan 1;53(1):79-111. doi: 10.1093/ejcts/ezx325
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Address for correspondence:
246046, Republic of Belarus,
Gomel, Meditsinskaya Str., 4,
Gomel Regional Clinical Cardiological Center,
Department of Anesthesiology and Intensive Care
With the Intensive Care Wards.
Tel.: +375 29 614 65 98,
e-mail: osipenko081081@mail.ru
Dzmitry V. Osipenko
Information about the authors:
Osipenko Dzmitry V., PhD, Anesthesiologist-Resuscitator, the Department of Anesthesiology and Intensive Care with the Intensive Care Wards, Gomel Regional Clinical Cardiological Center, Gomel, Republic of Belarus.
http://orcid.org/0000-0003-4838-1140
Salivonchik Sergey A., PhD, Cardiac Surgeon, Deputy Chief Physician for Surgical Care, Gomel Regional Clinical Cardiological Center, Gomel, Republic of Belarus.
https://orcid.org/0000-0001-6011-9351
Silanau Aliaksandr A., Anesthesiologist-Resuscitator, the Department of Anesthesiology and Intensive Care with the Intensive Care Wards, Gomel Regional Clinical Cardiological Center, Gomel, Republic of Belarus.
http://orcid.org/0000-0002-1849-071X
Skarakhodau Aliaksandr A., Cardiac Surgeon, the Cardiac Surgery Unit, Gomel Regional Clinical Cardiological Center, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-2618-8692
Marochkov Alexey V., MD, Anesthesiologist-Resuscitator, Mogilev Regional Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0001-5092-8315

S.N. POTAKHIN, Y.G. SHAPKIN

COMPARATIVE ANALYSIS OF METHODS FOR PREDICTING OF PEPTIC ULCERS REBLEEDING

Saratov State Medical University, Saratov,
The Russian Federation

Objective. To conduct a comparative analysis of methods for predicting of peptic ulcers rebleeding.
Methods. The research was carried out in 2017-2018 years. In the study, the retrospective analysis of the treatment results of 126 patients with the ulcerative gastrointestinal bleeding and the comparative analysis of nine methods for predicting bleeding recurrence for sensitivity, specificity, accuracy and predictability of a positive result were made. The analysis includes: the classification of J.A. Forrest (1974), the classification of G.P. Giderim (1992) in the author’s modification, Baylor Bleeding score (1993), Rockall score (1996), the method of forecasting by I. I. Zatevakhin et al. (1997), one of the methods of forecasting by M.A. Evseev (2004), the method of M.M. Vinokurov and M.A. Kapitonova (2009), the System for the prediction of bleeding recurrence (Lebedev N.V. et al., 2009), as well as the author’s forecasting methodology for trees classification.
Patients were treated in the surgical department of Saratov City Clinical Hospital ¹ 6 from 2001 to 2009. During this period of time, assistance with this pathology was the most complete and corresponded to all current standards. The analysis included 63 patients with recurrent bleeding and 63 patients without recurrent bleeding.
Results. The optimum ratio of sensitivity and specificity, better accuracy and positive predictive value was revealed for the G.P. Giderim method in our own modification (82.5%; 73%; 78% and 75.4%, respectively) and, somewhat worse, for the author’s forecast method for trees classification (71.2%; 57.1%; 63.9% and 60.9%, respectively).
Conclusions. Classification of J.A. Forrest, traditionally used to assess the risk of recurrence of bleeding, with a high sensitivity (90.5%) has the lowest specificity (20.6%), which significantly reduces the accuracy of the forecast (55.6%). The most effective is the modified classification of G.P. Giderim, which takes into account the characteristic of the ulcerous bottom, the pulse rate, systolic blood pressure and the presence of collapse. Increasing the number of features in other methods does not improve the accuracy of the forecast.

Keywords: bleeding peptic ulcers, predicting of rebleeding, risk assessment, comparative analysis of methods, signs of recurrence high risk
p. 141-149 of the original issue
References
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  9. Giderim GP, Chikala ET, Gutsu VM, Kontsu GI. Taktika pri zheludochno-kishechnykh krovotecheniiakh v usloviiakh sanitarnoi aviatsii. Khirurgiia Zhurn im NI Pirogova. 1992;68(9-10):24-29. (In Russ.)
  10. Saeed ZA, Ramirez FC, Hepps KS, Cole RA, Graham DY. Prospective validation of the Baylor bleeding score for predicting the likelihood of rebleeding after endoscopic hemostasis of peptic ulcers. Gastrointest Endosc. 1995 Jun;41(6):561-65. doi: 10.1016/s0016-5107(95)70191-5
  11. Zatevakhin II, Shchegolev AA, Titkov BE. Sovremennye podkhody k lecheniiu iazvennykh gastroduodenal’nykh krovotechenii. Annaly Khirurgii. 1997;(1):40-46 (In Russ.)\
  12. Gostishchev VK, Evseev MA. Patogenez retsidiva ostrykh gastroduodenal’nykh iazvennykh krovotechenii. Khirurgiia Zhurn im NI Pirogova. 2004;(5):46-51. (In Russ.)
  13. Vinokurov MM, Kapitonova MA. Treatment tactics of the patients with gastroduodenal ulcer bleeding. Khirurgiia Zhurn im NI Pirogova. 2008;(2):33-36. https://www.elibrary.ru/item.asp?id=9947541 (In Russ.)
  14. Lebedev NV, Klimov AE, Barkhudarova TV. Prognosis for relapse of gastroduodenal ulcer bleeding. Khirurgiia Zhurn im NI Pirogova. 2009;(2):32-34. https://www.elibrary.ru/item.asp?id=13122943 (In Russ.)
  15. Vasil‘ev AYu, Malyi AYu, Serov NS. Analiz dannykh luchevykh metodov issledovaniia na osnove printsipov dokazatel‘noi meditsiny: ucheb posobie [Elektronnyi resurs] [data obrashcheniia: 2019 Ianv 03]. Moscow, RF: GEOTAR-Media; 2008. 32 p. Rezhim dostupa: http://vmede.org/sait/?page=3&id=Onkologiya_analiz_vasilev_2008&menu=Onkologiya_analiz_vasilev_2008 (In Russ.)
Address for correspondence:
410012, Russian Federation,
Saratov, Bolshaya Kazachya Str., 112
Saratov State Medical University,
General Surgery Department.
Tel.: +7 927 220 74 51,
e-mail: potakhin_sn@rambler.ru,
Sergey N. Potakhin
Information about the authors:
Potakhin Sergey N., PhD, Associate Professor, General Surgery Department, Saratov State Medical University, Saratov, Russian Federation.
http://orcid.org/0000-0002-4159-3047
Shapkin Yuri G., MD, Professor, Head of the General Surgery Department, Saratov State Medical University, Saratov, Russian Federation.
http://orcid.org/0000-0003-0186-1892

O.O. YASNOGORODSKY, V.K. GOSTISHEV, A.M. SHULUTKO, T.P. PINCHUK, YU.V. STRUCHKOV, M.V. TALDYKIN, F.N. NASIROV, V.A. MOCHALOV

LUNG ABSCESS AND GANGRENE: EVOLUTION OF TREATMENT METHODS

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

Objective. To analyze the effectiveness of treatment methods on the basis of many years of experience in assisting patients with abscesses and pulmonary gangrene.
Methods. The treatment results of 2492 patients with the lung abscesses (99.2%) and pulmonary gangrene (0.8%) for the last 42 years (1977–2018) were evaluated by decades. Diagnostic methods included X-ray examination, CT- scanning, rigid and flexible bronchoscopy, and also bacteriological examination of the bronchial secretions. Surgical treatment applied in 268 patients included pleuropulmonectomy, pneumonectomy, pleurolobectomy, atypical lung resection, thoracoabscessotomy, chest phlegmon drainage. Minimally invasive treatment methods were transthoracic (n=130) or transbronchial (n=485) drainage of the abscess cavity. The frequency of postoperative complications and mortality depending on changes in surgical treatment of purulent-destructive lung diseases for decades and for the past 12 years were analyzed.
Results. In the bacteriological study of 192 patients (70.8%) a predominance of microbial associations of 2 or more microbes was revealed. Transbronchial drainage of the lung abscess was performed in four modifications. It was successful in 437 cases (90.2%). Endoscopic treatment of postoperative bronchopleural fistula was successfully performed in 28 cases.
The significant differences in incidence of lungs destructive diseases for the analyzed periods were not found. However, a significant reduction in total mortality (from 15.9% to 6.8%) and in number of postoperative complications (from 33.5% to zero) was found. The interconnection between the decrease in operational activity (from 15.9% to 1.5%) and wide spreading of transbronchial drainage methods was also revealed. Complications after endoscopic drainage developed in 1.9% of cases.
Conclusions. The widespread use of minimally invasive technologies in the treatment of the lung abscess and postoperative complications led to a significant decrease in overall mortality by 2.3 times over 42 years.

Keywords: lung abscess, pulmonary gangrene, pulmonectomy, bronchoscopy, transbronchial drainage
p. 150-158 of the original issue
References
  1. Grigoryev YeG. Acute abscess and gangrene of the lung. Sib Med Zhurn. 2013;(8):123-29. https://cyberleninka.ru/article/v/ostryy-abstsess-i-gangrena-legkogo (In Russ.)
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  4. Azorin JF, Francisci MP, Tremblay B, Larmignat P, Carvaillo D. Closure of a postpneumonectomy main bronchus fistula using video-assisted mediastinal surgery. Chest. 1996 Apr;109(4):1097-98. doi: 10.1378/chest.109.4.1097
  5. Laennec RTH. Traite de 1’auscultation mediate etdes maladies des poumons et du Coeur [Electronic resource]. Paris; 1819. 516 p. Available from: https://gallica.bnf.fr/ark:/12148/bpt6k987580.pdf
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  10. Shoikhet YaN, Syzdykbaev MK, Kurtukov VA, Kapilulin SY. Selective transtracheal catheterisation bronchi in treatment acute abscesses and gangrene of lung. Sovrem Problemy Nauki i Obrazovaniia. [Elektronnyi zhurnal]. 2014;(3). Rezhim dostupa: https://www.science-education.ru/ru/article/view?id=13257 (In Russ.)
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  12. Unterman A, Fruchter O, Rosengarten D, Izhakian S, Abdel-Rahman N, Kramer MR. Bronchoscopic drainage of lung abscesses using a pig tail catheter. Respiration. 2017;93(2):99-105. doi: 10.1159/000453003
  13. Shlomi D, Kramer MR, Fuks L, Peled N, Shitrit D. Endobronchial drainage of lung abscess: the use of laser. Scand J Infect Dis. 2010;42(1):65-68. doi: 10.3109/00365540903292690
  14. Goudie E, Kazakov J, Poirier C, Liberman M. Endoscopic lung abscess drainage with argon plasma coagulation. J Thorac Cardiovasc Surg. 2013 Oct;146(4):e35-37. doi: 10.1016/j.jtcvs.2013.05.031
Address for correspondence:
115432, Russian Federation,
Moscow, Dovator Str., 15/1,
I.M. Sechenov First Moscow State
Medical University,
University Clinical Hospital No4.
Tel.: 8 926 581 55 93,
e-mail: 196015@ bk.ru,
Tatyana P. Pinchuk
Information about the authors:
Yasnogorodsky Oleg O., MD, Professor of the Faculty Surgery Department No 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0001-8963-0401
Gostishev Viktor K., MD, Professor, Academician of RAS, Head of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-2900-0069
Shulutko Alexandår M., MD, Professor, Head of the Faculty Surgery Department No 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-8001-1601
Pinchuk Tatyana P., MD, Head of the Endoscopy Unit, University Clinical Hospital No 4, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-7928-598X
Struchkov Yuri V., MD, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-7340-7878
Taldykin Mikhail V., Head of the Thoracic Surgery Unit, University Clinical Hospital No 4, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0001-5043-6214
Nasirov Fikret N., Associate Professor of the Faculty Surgery Department No 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0001-8311-8220
Mochalov Vadim A., Physician of the Endoscopy Unit, University Clinical Hospital No 4, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-7857-4384

S.E. KATORKIN, A.A. CHERNOV, A.V. ZHURAVLEV, A.V. KOLSANOV, P.M. ZELTER

DIRECT AND REMOTE RESULTS OF SURGICAL TREATMENT OF RESISTANT FORMS OF ULCERATIVE COLITIS WITH FORMATION OF J-SHAPED SMALL INTESTINAL RESERVOIR

Samara State Medical University, Samara
The Russian Federation

Objective. To evaluate the functional results of coloproctectomy with the formation of a J-shaped small intestinal pelvic reservoir in patients with severe ulcerative colitis by using CT-reservoirography with 3D visualization and sphincterometry.
Methods. Surgical treatment was performed in 87 (31.6%) of 275 patients with severe ulcerative colitis. Coloproctectomy with a primary J-reservoir and ileo-anal anastomosis was performed in 16 (18.4%) patients. The final proctectomy with the formation of a delayed reservoir was performed in 8 (26.7%) of 29 patients 6±3.1 months after colectomy. Before restoration of the small itestine integrity, an endoscopic examination of the reservoir, X-ray contrast reservoirography, CT-reservoirography with the construction of the 3D model and sphincterometry were performed.
Results. In 24 patients, J-reservoirs from the ileum with ileo-anal anastomosis were formed, which made up 22.6% of all 106 operated on for ulcerative colitis. Postoperative complications were registered in 11 (68.8%) patients with primary and 3 (37.5%) patients with delayed reservoir formation. Complications of 3-4 severity according to P. Clavien and D. Dindo were observed in 5 (20.8%) patients. Restoration of the integrity of the small intestine was performed in 13 (81.3%) patients with primary and in 7 (87.5%) with a delayed reservoir. Long-term treatment results were monitored in 17 (85%) patients with a functioning reservoir in terms of 53±6.4 months. The frequency in the daytime of stools was 6±3 times, nighttime bowel movements – from 1 to 2 times. Deficiency of the anal sphincter of the 1st degree according to sphincterometry was detected in 2 (18.2%) patients. The incontinence on the S.D.Wexner scale was 2±1 points.
Conclusions. The three-stage scheme of reconstructive intervention in patients with ulcerative colitis has fewer postoperative complications. The use of CT-reservoirography with the construction of 3D model and sphincterometry allow timely diagnosing the postoperative complications and objectifying the result of surgical intervention.

Keywords: ulcerative colitis, small intestinal pelvic reservoir, ileo-anal anastomosis, CT-reservoirography
p. 159-172 of the original issue
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  15. Kashnikov VN, Achkasov SI, Bolikhov KV, Nazarov IV, Gusev AV. Rezul’taty formirovaniia pervichnykh i vtorichnykh tonkokishechnykh rezervuarov pri iazvennom kolite. Rus J Gastroenterology, Hepatology, Coloproctology. 2014; 5(24):73-7. (In Russ.)
  16. Katorkin SE, Kolsanov AV, Bystrov SA, Zelter PM, Andreev IS. Virtual 3-D modeling in surgical treatment of chronic pancreatitis. Novosti Khirurgii. 2017; 25(5): 503-509. doi: 10.18484/2305-0047.2017.5.503 (In Russ.)
  17. Kariv R, Remzi FH, Lian L, Bennett AE, Kiran RP, Kariv Y, Fazio VW, Lavery IC, Shen B. Preoperative colorectal neoplasia increases risk for pouch neoplasia in patients with restorative proctocolectomy. Gastroenterology. 2010 Sep;139(3):806-12, 812.e1-2. doi: 10.1053/j.gastro.2010.05.085
Address for correspondence:
443013, Russian Federation,
Samara, pr. Karl Marks 165 b,
Samara State Medical University,
the chair and clinic of hospital surgery
tel. +7 927 206-71-02,
e-mail: katorkinse@mail.ru
Sergey E. Katorkin
Information about the authors:
Katorkin Sergey E., PhD, AssociateProfessor, Head of the Chair and Clinic of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-7473-6692
Chernov Andrey A., Candidate of Medical Sciences (PhD), Surgeon of the Coloproctological Unit of the Hospital Surgery Clinic, Assistant of the Chair of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-7622-6095
Zhuravlev Andrey V., Candidate of Medical Sciences (PhD), Head of the Coloproctological Unit of the Hospital Surgery Clinic, Associate Professor of the Chair of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-0353-840x
Kolsanov Alexander V., MD, Professor, Head of the Chair of the Operative Surgery and Clinical Anatomy, Professor RAS, Rector Samara State Medical University, Samara, Russian Federation.
http://orcid.org/0000-0002-4144-7090
Zelter Pavel M., Candidate of Medical Sciences (PhD), Assistant of the Chair of Radiation Diagnostics and Radiation Therapy with a Course in Medical Informatics, Samara State Medical University, Samara, Russian Federation.
http://orcid.org/0000-0003-1346-5942

TRANSPLANTOLOGY

A.O. NYKONENKO 1,2, O.S. NYKONENKO 1, D.A. BUGA 2, I.V. RUSANOV 2, S.R.VILDANOV 1

HEALTH STATUS ASSESSMENT OF RELATED KIDNEY DONORS IN THE LATE POSTOPERATIVE PERIOD

Zaporizhzhya State Medical University 1,
Zaporizhzhya Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine 2, Zaporizhia,
Ukraine

Objective. To analyze the health status of living kidney donors based on the degree of restoration of the kidney function and the general physical status of the donor.
Methods. 37 related kidney donors underwent nephrectomy between 2014 and 2017. The average age was 48.3±9.7 (̱σ) years, with 19 men (51%) and 18 (49%) women. In the late postoperative period (1,9±1,1 years (̱σ)), the levels of proteinuria, and glomerular filtration rate (GFR) were studied. The life quality of kidney donors was assessed using the Medical Outcomes Study-Short Form-36 questionnaire.
Results. The average GFR before the operation was 78,9±24,5 ml/min per 1.73 m2, and fell to 49,8±11,2 ml/min per 1.73 m2 on the 2nd day after the operation. Upon discharge (15,2±7,0 day), average GFR increased to 53,4±8,0 ml/min per 1.73 m2, and almost reached pre-operation levels 1,9±1,1 years after the operation. This suggests that a single normally-functioning kidney is capable of taking on the load from the missing kidney. Furthermore, our study showed that, in the late postoperative period, there was no statistically significant difference in either GFR or quality of life between the donors of different age groups (p>0.05). Our research showed that if adequate protocols are used for living donor selection, donor-recipient kidney transplantation is not only an effective method for treating terminal stage of chronic end stage of renal disease, but is also safe for health and the subsequent renal function of the donor.
Conclusions. In living donors, a gradual restoration of renal function is observed, according to GFR, at discharge (day 15.2±7.0) and in the late postoperative period (1.9±1.1 years), almost reaching the preoperative level. The physical and psychological health components of donors of different age groups were comparable.

Keywords: transplantation, living kidney donor, donor nephrectomy, postoperative period, renal failure
p. 173-179 of the original issue
References
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  2. Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, Gallon L, Garvey CA, Guleria S, Li PK, Segev DL, Taler SJ, Tanabe K, Wright L, Zeier MG, Cheung M, Garg AX. KDIGO clinical practice guideline on the evaluation and care of living kidney donors. Transplantation. 2017 Aug;101(8S Suppl 1):S1-S109. doi: 10.1097/TP.0000000000001769
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Address for correspondence:
69035, Ukraine,
Zaporizhia, pr. Mayakovskii, 26,
Zaporizhzhya State Medical University,
the hospital surgery chair,
tel. +38 (097)-594-54-93,
e-mail: nikonandra@gmail.com,
Nykonenko Andriy A.
Information about the authors:
Nykonenko Andriy O., Doctor of Medical Sciences (MD), Professor, Head of the Hospital Surgery Chair, Zaporizhzhya State Medical University, Zaporizhia, Ukraine.
https://orcid.org/0000-0002-5720-2602
Nykonenko Olexandr S., Doctor of Medical Sciences (MD), Professor, Academician of NAMS of Ukraine, Corresponding Member of NAS of Ukraine, Rector, Zaporizhzhya Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine , Zaporizhia, Ukraine.
https://orcid.org/0000-0001-7333-4165
Buga Dmitrii A., MD, Associate Professor, Head of the Department of Transplantology and Endocrine Surgery with the Courses of the Cardiovascular Surgery, Zaporizhzhya Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine, Zaporizhia, Ukraine.
https://orcid.org/0000-0001-5818-3100
Rusanov Ihor V., Candidate of Medical Sciences (PhD), Associate Professor of the Department of Transplantology and Endocrine Surgery with the Courses of the Cardiovascular Surgery, Zaporizhzhya Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine, Zaporizhia, Ukraine.
https://orcid.org/0000-0002-4363-1158
Vildanov Serhii R., Candidate of Medical Sciences (PhD), Assistant of the Hospital Surgery Department, Zaporizhzhya State Medical University, Zaporizhia, Ukraine.
https://orcid.org/0000-0003-3885-9390

ANESTHESIOLOGY-REANIMATOLOGY

S.A. TACHYLA

PROGNOSTIC VALUE OF TOTAL PROTEIN AND ALBUMIN LEVELS IN ABDOMINAL SURGERY PATIENTS

Mogilev Regional Hospital, Mogilev,
The Republic of Belarus

Objective. To study the dynamics of total protein and albumin levels in abdominal surgery patients, to determine their prognostic significance, sensitivity and specificity for the development of multiple organ dysfunction syndrome and mortality.
Methods. The prospective cohort study included patients with (n=459) previous surgical interventions in the abdominal surgery for the period from 2014 up to 2018. The 1st group consisted of patients without multiple organ dysfunction syndrome (n=280), the 2nd group – patients with multiple organ dysfunction syndrome (n=179). Of these patients, 23 died in the group 2 (12.8%). The levels of total protein and albumin were assessed daily. Logistic regression analysis was performed, receiver operating characteristic curves (ROC curves) were plotted, and the area under the curve (AUC) was also determined.
Results. Patients after the abdominal surgical interventions showed a statistically significant decrease in total protein and albumin. It is established that these markers in the early stages have a prognostic value in relation to multiple organ dysfunction syndrome. Total protein on the 1st and 2nd day after surgery AUC was 0.633 and 0.641, respectively (p<0.05). Albumin on the 1st, 2nd and 3rd day after surgery AUC was 0.673; 0.743 and 0.664, respectively (p<0.05). Albumin level is also a predictor of mortality: AUC – 0.639; 95% confidence interval – 0.584-0.695 (p<0.05). Total protein does not have a prognostic value in relation to mortality.
Conclusions. The studied parameters of total protein and albumin are prognostic markers of average diagnostic efficacy; their evaluation should be carried out in combination with other clinical and laboratory parameters. The level of albumin as a predictor has advantages, since, with a diagnostic value similar to that of a total protein, with respect to the prediction of multiple organ dysfunction syndrome, it is a prognostic marker of mortality.

Keywords: abdominal surgery, multiple organ dysfunction syndrome, mortality, prognosis, total protein, albumin
p. 180-187 of the original issue
References
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  12. Yu X, Wan X, Wan L, Huang Q. Analysis of high risk factors of intensive care unit-acquired weakness in patients with sepsis. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Apr;30(4):355-359. doi: 10.3760/cma.j.issn.2095-4352.2018.04.014 [Article in Chinese]
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  14. Magnussen B, Oren Gradel K, Gorm Jensen T, Kolmos HJ, Pedersen C, Just Vinholt P, Touborg Lassen A. Association between Hypoalbuminaemia and Mortality in Patients with Community-Acquired Bacteraemia Is Primarily Related to Acute Disorders. PLoS One. 2016 Sep 9;11(9):e0160466. doi: 10.1371/journal.pone.0160466. eCollection 2016.
  15. Yin M, Si L, Qin W, Li C, Zhang J, Yang H, Han H, Zhang F, Ding S, Zhou M, Wu D, Chen X, Wang H. Predictive value of serum albumin level for the prognosis of severe sepsis without exogenous human albumin administration: a prospective cohort study. J Intensive Care Med. 2018 Dec;33(12):687-94. doi: 10.1177/0885066616685300
Address for correspondence:
212026, Republic of Belarus,
Mogilev, ul. Belyinitskii-Biruli, 12,
Mogilev Regional Hospital,
the intensive care unit,
tel./fax: +375(222) 50-08-81,
+375(222) 50-03-73,
e-mail: tsa80@inbox.ru,
Tachyla Siarhei A.
Information about the authors:
Tachyla Siarhei A., PhD, Physician of the ICU, Mogilev Regional Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0003-1659-5902

REVIEWS

I.I. BABICH, YU.N. MELNIKOV

SURGICAL ASPECTS OF TREATMENT OF COMPLICATED FORMS OF INTESTINAL OBSTRUCTION IN CHILDREN

Rostov State Medical University, Rostov-on-Don,
The Russian Federation

Bowel (intestinal) obstruction is a very common case in pediatric surgical practice. Intestinal transit disorder among children is caused by organic or functional causes of the congenital origin as well as by an acquired pathology. The degree of incidence for intestinal obstruction is steadily increasing. This is due to the increasing number of cases with congenital gastrointestinal tract malformations, as well as the increasing number and volume of surgical interventions onto the intestine.
The literature review is dedicated to the problem relevance of the bowel obstruction complicated forms treatment among pediatric patients. One of the key stages of surgical treatment is the determination of the intestinal viability involved into the lesion. The determination of viability has a matter of subjectivity if based only on the visual characteristics of the ischemia area, which can lead to an incorrect assessment of the vital properties of the organ. The current instrumental methods are technically difficult to implement and, in most cases, cannot be applied within the conditions of the emergency departments of public health care. The outcomes of surgical treatment largely depend on the development of the most effective method for determination of the local bowel necrosis, as well as the resection sites. The outstanding problem is the level involved into the creation of entero- or colostomy considering the subsequent reconstructive surgery, verification of the agangliosis area in Hirschsprung disease, which are the directions of the future research.

Keywords: intestinal obstruction, Hirschsprung disease, intussusception, necrotizing enterocolitis, intestinal viability, adhesive obstruction
p. 188-196 of the original issue
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Address for correspondence:
344022, Russian Federation,
Rostov-on-Don, Nakhichevansky Lane, 29,
Rostov State Medical University,
Surgical Diseases Department of the
Faculty of the Advanced Training and Staff Retraining.
Tel.: +7 950 849 27 21,
e-mail: pobzder@rambler.ru,
Yuri N. Melnikov
Information about the authors:
Babich Igor I., MD, Professor, Professor of the Surgical Diseases Department of the Faculty of the Advanced Training and Staff Retraining, Rostov State Medical University, Rostov-on-Don, Russian Federation.
https://orcid.org/0000-0001-8282-2785
Melnikov Yuri N., Post-Graduate Student of the Surgical Diseases Department of the Faculty of the Advanced Training and Staff Retraining, Rostov State Medical University, Rostov-on-Don, Russian Federation.
https://orcid.org/0000-0002-7035-0415

N.M. GREKOVA 1 , N.B. SHISHMENCEV 2, Y.V. NAIMUSHINA 2, A.G. BUHVALOV 3

ACUTE PANCREATITIS: MODERN CONCEPTS OF SURGICAL TREATMENT

South Ural State Medical University 1,
Chelyabinsk Railway Clinical Hospital 2, Chelyabinsk,
Central Health Care Unit No15 3, Snezhinsk,
The Russian Federation

The literature review over the past 15 years presents a modern approach to acute pancreatitis and its complications. An up-to-date international classification system for acute pancreatitis, adopted in Atlanta (USA) in 1992 and revised in 2012 (3rd revision) is given. The current principles and trends in the treatment of moderate-to-severe acute pancreatitis and severe acute pancreatitis are reviewed. Particular attention is paid to the integrated, multidisciplinary approach in the diagnosis and surgical treatment planning in acute severe necrotizing pancreatitis and its complications. Algorithms of a modern staged treatment of acute severe pancreatitis, depending on the cause of the disease, on the phases and periods of the disease, the severity of a patient’s condition, and prevalence of the pathological process are presented. Various approaches to the management of patients with the infected pancreatic necrosis, including minimally invasive technologies are analyzed. The maximal effectiveness of the acute severe pancreatitis surgical treatment is provided by a step-by-step strategy that depends on the etiology of the disease. The combination or alternation of minimally invasive puncture-draining interventions with open surgery and retroperitoneoscopy provided all necessary equipment is the most rational.

Keywords: acute pancreatitis, necrotizing pancreatitis, infected necrotizing pancreatitis, unlimited infected retroperitoneal necrosis, retroperitoneoscopy, minimally invasive interventions, percutaneous drainage
p. 197-206 of the original issue
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  41. Bukhvalov AG, Grekova NM, Lebcdeva YV, Bordunovskiy VN. Ways of reduction of mortality and postoperative complications rate in patients with acute severe nonbiliary pancreatitits. Fundam Issledovaniia [Elektronnyi resurs]. 2015 [data obrashcheniia: 2018 Dek 11];(1 ch 1):41-42. Rezhim dostupa: http://www.fundamentalresearch.ru/ru/article/view?id=36762 ( In Russ.)
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    44 . Loveday BP, Petrov MS, Connor S, Rossaak JI, Mittal A, Phillips AR, Windsor JA. A comprehensive classification of invasive procedures for treating the local complications of acute pancreatitis based on visualization, route, and purpose. Pancreatology. 2011;11(4):406-13. doi: 10.1159/000328191
Address for correspondence:
454092, Russian Federation,
Chelyabinsk, Vorovsky Str., 64,
South Ural State Medical University,
Faculty Surgery Department.
Tel. +7 351 902 83 46,
e-mail: grekovanm@mail.ru,
Natalia M Grekova
Information about the authors:
Grekova Natalia M., PhD, Associate Professor of the Faculty Surgery Department, South Ural State Medical University, Chelyabinsk, Russian Federation.
https://orcid.org/0000-0002-3364-7201
Shishmentsev Nikolay B., Surgeon, the Purulent Surgery Department, Chelyabinsk Railway Clinical Hospital, Chelyabinsk, Russian Federation.
https://orcid.org/0000-0003-0997-3442
Naimushina Yuliana V., PhD, Associate Professor of the Faculty Surgery Department, South Ural State Medical University, Chelyabinsk, Russian Federation.
https://orcid.org/0000-0002-6032-3501
Buhvalov Andrey G., MD, Surgeon, the Surgical Unit, Central Health Care Unit No15 of Federal Biomedical Agency, Snezhinsk, Russian Federation.
https://orcid.org/0000-0002-9428-6972

A.L. ISTRANOV, A.A. ZAKIROVA, YU.I. ISAKOVA

MODERN ASPECTS OF FEMINIZING MAMMOPLASTY IN PATIENTS WITH A MALE FORM OF TRANSSEXUALISM

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

The main surgical operations in the birth-assigned male patient being affirmed as female include feminizing of the chest (breast augmentation) and genital reconstruction. Woman-shape breast formation is an important part of feminization for most trans-women, more often augmentation mammoplasty is performed first. Significantly increased requirements for the aesthetic result of any sex reassignment operations in this group of patients should be noted.
The purpose of this review is to summarize modern concepts and standards for augmentation mammoplasty in transgender individuals who want to change their sex from male to female. Knowledge of these aspects is necessary to achieve the best aesthetic result and patients’ satisfaction, ensuring their psychosocial and physical well-being. The following sections have been studied and presented in details: proportions of the ideal breast, breast development in transsexuals under the influence of hormonal therapy, anatomical differences between the male and female chest, size and position of the nipple-areola complex, choice of operative access and the implant position, choosing the volume and shape of the implant, formation and fixation of the inframammary fold, possible complications after augmentation mammoplasty, satisfaction with the results of the operation.

Keywords: transgender, transsexual, breast augmentation, nipple-areola complex, inframammary fold, hormonal therapy, quality of life, sex reassignment surgery
p. 207-221 of the original issue
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Address for correspondence:
119991, Russian Federation,
Moscow, Trubetskaya Str., 8,
I.M. Sechenov First Moscow
State Medical University,
Department of Oncology,
Radiotherapy and Plastic Surgery.
Tel.: +7 917 914 26 06,
e-mail: albinazakirovasno@gmail.com,
Albina A. Zakirova
Information about the authors:
Istranov Andrey L., MD, Professor of the Department of Oncology, Radiotherapy and Plastic Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-0222-2910
Zakirova Albina A., Resident Doctor of the Department of Oncology, Radiotherapy and Plastic Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-1117-9427
Isakova Yuliya I., Resident Doctor of the Department of Oncology, Radiotherapy and Plastic Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-7695-0078

CASE REPORTS

V.A. ZHURAULIOU 1, K.M. KUBRAKOV 2, S.T. AKMYRADOV 3

PITUITARY ABSCESS

Belarusian Medical Academy of Postgraduate Education1, Minsk,
Vitebsk State Medical University 2, Vitebsk,
Republican Research and Clinical Center of Neurology and Neurosurgery3, Minsk,
The Republic of Belarus

The article presents two clinical observations of a rare pathology – pituitary abscess, complicated by the secondary purulent meningitis. Clinical and instrumental examination, as well as hormonal changes indicated a pituitary adenoma. The laboratory tests and magnetic resonance imaging showed no signs of inflammation in the patient’s body. However, when performing the planned transsphenoidal endoscopic operations, pituitary abscesses were diagnosed. The latter were completely removed, purulent cavities washed with antiseptic solutions. In the first observation, liquorrhea was detected intraoperatively, which required plastic closure of the defect of the Turkish saddle with adhesive compositions. The patient developed secondary purulent meningitis, which was cured by the rational antibacterial therapy. In the second observation, the outflow of the cerebrospinal fluid was not observed intraoperatively. The plastic of the bottom of the Turkish saddle was also made. Antibacterial drugs were prescribed. Both patients were discharged from the hospital, the hormonal background improved. Liquorrhea was not detected during the control examinations. Four months after discharge, the second patient developed secondary purulent meningitis, which required emergency hospitalization. The active tactics of patient management with the use of diagnostic test systems «D-lactam» and «Biolactam» allowed quick prescription and correction of effective antibacterial drugs for negative bacteriological analysis. The patient was discharged on the 23rd day without neurologic deficit. These clinical cases are of interest as options for disease-free treatment of rather a rare inflammatory pathology of the pituitary gland.

Keywords: pituitary abscess, meningitis, liquorrhea, antibiotics, beta-lactamase activity, D-lactate
p. 222-232 of the original issue
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Address for correspondence:
210023, Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Neurology and Neurosurgery,
Tel.: +375 29 734 93 36,
e-mail: k-kubrakov@yandex.ru,
Konstantin M. Kubrakov
Information about the authors:
Zhurauliou Vladimir A., PhD, Associate Professor, the Department of Neurology and Neurosurgery, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-5269-3406
Kubrakov Konstantin M., PhD, Associate Professor, the Department of Neurology and Neurosurgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-6723-0589
Akmyradov Selimmyrat T., Neurosurgeon, the 1st Neurosurgical Unit, Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Republic of Belarus
https://orcid.org/0000-0002-8917-7245

T. PUNIT 1, H. KAUR 2, S.S. LEONCHUK 3

SPONTANEOUS RUPTURE OF EXTENSOR POLLICIS LONGUS TENDON: DEMONSTRATION OF EXTENSOR INDICES PROPRIUS TRANSFER TECHNIQUE

Maharishi Markandeshwar Medical College and Hospital Solan 1,
All India Institute of Medical Sciences Bathinda 2,
India,
National Ilizarov Medical Research Center for Traumatology and Orthopedics
of Ministry of Healthcare 3, Kurgan,
The Russian Federation

Till now no single scheme of surgical treatment has gained wide acceptance in rupture of extensor pollicis longus tendon (EPL). The result of treatment of a patient with spontaneous rupture of EPL in IV zone by B.Boichev with ultrasonographic examination is presented in the paper. In surgical treatment we used Pulvertaft technique in transfer of tendon of m. extensor indicis proprius (EIP) to EPL. After 3 months of surgery the patient showed a full range of motions of the thumb joints and functional restoring. Ultrasonography can be considered as an accurate and cost effective diagnostic investigation in evaluation of cases with the suspected extensor pollicis longus tendon rupture and tendinosis. This case report shows that technique of EIP to EPL transfer is effective and reliable surgical option.

Keywords: extensor pollicis longus, tendon rupture, spontaneous, Pulvertaft, surgical technique
p. 233-239 of the original issue
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Address for correspondence:
640014, Russian Federation,
Kurgan, ul. M. Ulyanova, 6,
Russian Ilizarov Scientific
Center for Restorative
Traumatology and Orthopedics,
6th traumatologic-orthopaedic department,
mob. +7 905 8516338,
e-mail: leon4yk@mail.ru
Sergey S. Leonchuk
Information about the authors:
Tiwari Punit, Orthopedic Traumatologist, Assistant Professor,Orthopedics Department, Solan city, Himachal Pradesh state, India.
https://orcid.org/0000-0002-4174-8344
Harmeet Kaur, Radiologist, Assistant Professor, Department of Radial Diagnosis, All India Institute of Medical Sciences, Bathinda city, Punjab state, India https://orcid.org/0000-0001-7962-8463
Leonchuk Sergey S., PhD, Head of the 6th Orthopedic department, National Ilizarov Medical Research Center for Traumatology and Orthopedics of Ministry of Healthcare, Kurgan, Russian Federation.
https://orcid.org/0000-0003-0883-9663
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