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Year 2022 Vol. 30 No 2

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

V.I. LUPALTSOV, S.S. KITCHENKO, I.V. SOROKINA, O.V. KALUZHYNA

LOCAL TRANSPLANTATION OF STROMAL CELLS OF ADIPOSE TISSUE IN THE COMPARATIVE ASSESSMENT OF THE HEALING PARAMETERS OF AN EXPERIMENTAL VENOUS TROPHIC ULCER

Kharkiv National Medical University, Kharkiv
Ukraine

Objective. To study the effectiveness of adipose tissue stromal cells in the restoration of the epidermal layer of an experimental venous trophic ulcer.
Methods. The formation of an experimental trophic ulcer was performed in 14 rabbits of the Chinchilla line. 7 rabbits (main group) in complex treatment underwent autotransplantation of multipotent mesenchymal stromal cells (MMSC) isolated from adipose tissue according to the method of Zuk et al.; 7 rabbits (control group) in local treatment used daily dressings with treatment of ulcers with dioxidine solution and subsequent application of hydrophilic ointment («Levomecol»). In both groups on the 1st, 7th, 14th, and 21st days, morphological (demarcation shaft, relative volume of leukocyte-necrotic zone and granulation tissue) and immunohistochemical (determination of the optical density of immunofluorescence of collagen types I and II, quantitative counting of immune cells producing IL-6 and TNFα) parameters.
Results. On the 7th day in the main group, the indicators of leukocyte-necrotic and leukocyte-demarcation shafts were 49.21 ± 2.0% and 18.03 ± 1.6%, respectively, in the comparison group – 51.09 ± 5.8%. Granulation tissue was 32.55 ± 2.4% in the main group, 29.73 ± 2.9% in the comparison group. The optical luminescence density of type III collagen exceeded that of type I collagen and was 0.069 ± 0.001 conventional units of collagen luminescence in the main group and 0.036 ± 0.001 conventional units of collagen luminescence - in the control group. On the 21st day in the main group there was a decrease in necrotic lesions, granulation tissue contained a large number of microvessels, fibroplastic cells, macrophages, lymphocytes, a large number of giant multinucleated cells. The number of cells expressing interleukin-6 and tumor necrosis factor-α decreased significantly, there was a predominance of young interstitial collagen type III.
Conclusion. The use of cellular therapy by autotransplantation of MMSCs isolated from adipose tissue in the local treatment of experimental «venous» trophic ulcer, accelerates reparative processes and allows to achieve its healing.

Keywords: multipotent mesenchymal stromal cells, «venous» trophic ulcer, cell therapy, chronic venous insufficiency, experiment, morphological study, immunohistochemical studies
p. 135-143 of the original issue
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Address for correspondence:
61022, Ukraine,
Kharkiv, Naukà Avenue, 4,
Kharkiv National Medical University
tel.: +38 057 725-57-74,
å-mail: surgdis@ukr.net
Lupaltsov Vladimir I.
Information about the authors:
Lupaltsov Vladimir I., MD, Professor, Corresponding Member of NAMS of Ukraine, Head of the Surgery Department No3, Kharkiv National Medical University, Kharkiv, Ukraine.
http://orcid.org/0000-0003-2121-529X
Kitchenko Sergey S., Assistant of the Surgery Department No3, Kharkiv National Medical University, Kharkiv, Ukraine.
http://orcid.org/0000-0001-6330-6187
Sorokina Irina V., MD, Professor, Acting Head of the Pathologic Anatomy Department, Kharkiv National Medical University, Kharkiv, Ukraine.
http://orcid.org/0000-0002-5945-2605
Kaluzhyna Oksana V., PhD, Associate Professor of the Pathologic Anatomy Department, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-4181-9704

GENERAL & SPECIAL SURGERY

V.A. LAZARENKO, E.A. BOBROVSKAYA

ANALYSIS OF MICROCIRCULATION PARAMETERS IN PATIENTS WITH THE DEVELOPMENT OF RESTENOSIS IN THE AREA OF ARTERIAL RECONSTRUCTION AFTER FEMORAL-POPLITEAL BYPASS SURGERY

Kursk State Medical University, Kursk,
The Russian Federation

Objective. To identify the features of microcirculation disorders in the development of restenosis of the arterial reconstruction zone in patients with obliterating atherosclerosis after femoral-popliteal stenting.
Methods. The study included patients (n=82) with obliterating atherosclerosis with grade IIB-III chronic arterial insufficiency, who underwent femoral-popliteal stenting. In 21 patients, the postoperative period proceeded without the development of restenosis of the arterial reconstruction zone (group I). Group II included 61 patients who developed restenosis of the arterial reconstruction zone during the year. The parameters of microcirculation were evaluated with the analysis of the amplitude-frequency spectrum (AFS) of blood flow oscillations prior and after revascularization.
Results. The microcirculation index (45.3%, p<0.001) and capillary blood flow reserve (49.2%, p<0.001) were found to be lower in patients of group II both initially prior and after revascularization (30.7%, p<0.001 and 51.4%, p<0.001) with significantly high values of arteriolo-venular bypass prior and post surgery (26.6%, p<0.001 and 41.9%, p<0.001), increasing after occlusion test compared with group I. In the amplitude-frequency spectrum of group II, a violation of the active components was noted due to the initial low value of the myogenic component (47.3%, p<0.001) and high neurogenic (35.5%, p<0.001) component with a significantly high index after the occlusion test (64.3%, p<0.05) compared to group I, not normalized after lower limb revascularization surgery, along with a violation of the function of passive mechanisms of blood flow modulation.
Conclusion. The development of restenosis after femoral-popliteal bypass surgery is accompanied by a pronounced violation of the state of microcirculation and the balance of the mechanisms of blood flow modulation, not normalized after lower limb revascularization surgery. The study of microcirculation indicators with an assessment of the functional activity of microcirculatory blood flow prior and after surgery will allow verifing the existing disorders and personalizing the treatment tactics.

Keywords: microcirculation, atherosclerosis, restenosis, femoral-popliteal bypass surgery, laser Doppler flowmetry
p. 144-151 of the original issue
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  2. Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH, Aboyans V, Aksoy M, Alexandrescu VA, Armstrong D, Azuma N, Belch J, Bergoeing M, Bjorck M, Chakfé N, Cheng S, Dawson J, Debus ES, Dueck A, Duval S, Eckstein HH, Ferraresi R, Gambhir R, Gargiulo M, Geraghty P, Goode S, Gray B, Guo W, Gupta PC, Hinchliffe R, Jetty P, Komori K, Lavery L, Liang W, Lookstein R, Menard M, Misra S, Miyata T, Moneta G, Munoa Prado JA, Munoz A, Paolini JE, Patel M, Pomposelli F, Powell R, Robless P, Rogers L, Schanzer A, Schneider P, Taylor S, De Ceniga MV, Veller M, Vermassen F, Wang J, Wang S; GVG Writing Group for the Joint Guidelines of the Society for Vascular Surgery (SVS), European Society for Vascular Surgery (ESVS), and World Federation of Vascular Societies (WFVS). Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg. 2019 Jul;58(1 Suppl):S1-S109.e33. doi: 10.1016/j.ejvs.2019.05.006
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  14. Vasil’ev AP, Strel’cova NN, Bessonov IS, Korotkih AV. State of microcirculation in patients with atherosclerosis and diabetes mellitus after limb revascularization. Angiologija i Sosudistaja Hirurgija. 2020;26(1):22-29. doi: 10.33529/ANGIO2020112 (In Russ.)
  15. Ruzsa Z, Róna S, Tóth GG, Sótonyi P, Bertrand OF, Nemes B, Merkely B, Hüttl K. Fractional flow reserve in below the knee arteries with critical limb ischemia and validation against gold-standard morphologic, functional measures and long term clinical outcomes. Cardiovasc Revasc Med. 2018 Mar;19(2):175-81. doi: 10.1016/j.carrev.2017.07.007
Address for correspondence:
305041, Russian Federation,
Kursk, K.Marx Street, 3,
Kursk State Medical University,
the Department of Surgical Diseases
of the Institute of Continuing Education,
tel. +7 4712 58-81-32,
e-mail: azaroks@mail.ru,
Lazarenko Victor A.
Information about the authors:
Lazarenko Victor A., MD, Professor, Head of the Department of Surgical Diseases of the Institute of Continuing Education, Kursk State Medical University, Kursk, Russian Federation.
https://orcid.org/0000-0002-2069-7701
Bobrovskaya Elena A., MD, Associate Professor, the Department of Surgical Diseases of the Institute of Continuing Education, Kursk State Medical University, Kursk, Russian Federation.
https://orcid.org/0000-0003-3898-5522

I. V. MAKAROV, N. A. PROKOFIEVA, A.Y. SIDOROV, V.M. GOLUBOVA

METHODS FOR LABORATORY INTEGRATED ASSESSMENT OF PHOSPHORUS AND CALCIUM METABOLISM IN PRIMARY HYPERPARATHYROIDISM DIAGNOSIS

Samara State Medical University, Samara,
Russian Federation

Objective. To develop the methods for laboratory integral assessment of phosphorus-calcium metabolism to obtain reliable information about the functional state of the parathyroid glands (PTG), the probable presence or absence of primary hyperparathyroidism (PHPT) and monitoring the effectiveness of the treatment.
Methods. The study included the examination of 70 patients with PHPT (the first group) and 19 healthy volunteers (the second group). There were 59 (84%) women, 11 (16%) of men in the first group, the average age was 59±12.6 years (M±σ). This group was divided into two equal subgroups: 1A and 1B. In the first group (prior and after surgery) and in the second one, two indicators were calculated: IPHPT and CaPHPT. IPHPT was determined in 1A subgroup and in the second group as the ratio of the product of phosphorus and total calcium to parathyroid hormone (PTH); CaPHPT was calculated in the second group and in the subgroup 1B as the ratio of the product of phosphorus and ionized calcium to PTH. The presence or absence of adenomas of the PTG was confirmed by ultrasound examination of the neck, and, in the case of necessary, PTG scintigraphy, MRT of the neck.
Results. During the determination of IPHPT in the subgroup 1A prior surgery, it was found that its values varied from 0.037 to 2.46 (1.12±0.83); in the second group – from 3.35 to 9.5 (5.6±1.99) (M±σ). On determining CaPHPT in the subgroup 1B prior surgery, it was established that its values varied from 0.017 to 1.95 (0.52±0.36); in the second group – from 2.88 to 6.34 (3.86±1.27). In the first day after the removal of PTG adenomas the average values of indices approached values of healthy people of the second group: IPHPT in the subgroup 1A was 9.7±5.68, and CaPHPT in the subgroup 1B was 3.30±3.34, thus confirmed the effectiveness of the operation.
Conclusion. The proposed methods for laboratory integral assessment of phosphorus calcium metabolism are reliable quantitative assessments of the function in PTG. The values of IPHPT ≥ 2.46 and CaPPHPT > 1.95 indicate the absence of pathology in PTG. The values of IPHPT ≤ 2.46 and CaPHPT ≤ 1.95 indicate the presence of PHPT.

Keywords: primary hyperparathyroidism, phosphorus calcium metabolism, laboratory diagnostics, integral indicators, surgical treatment
p. 152-161 of the original issue
References
  1. Dedov II, Melnichenko GA, Mokrysheva NG, Rozhinskaya LY, Kusnezov NS, Pigarova EA, Eremkina AK, Egshatyan LV, Mamedova EO, Krupinova JA. Primary hyperparathyroidism: the clinical picture, diagnostics, differential diagnostics, and methods of treatment. Problems of Endocrinology. 2016;62(6):40-77. (In Russ.)
  2. Klinicheskie rekomendatsii. Pervichnyi giperparatireoz. 2020. [Elektronnyi resurs]. Ros assotsiatsiia endokrinologov [ssylka aktivna na 2021 Mart 15]. 90 p. Rezhim dostupa: https://rae-org.ru/system/files/documents/pdf/pervichnyy_giperparatireoz.pdf (In Russ.)
  3. De Lucia F, Minisola S, Romagnoli E, Pepe J, Cipriani C, Scillitani A, Parikh N, Rao DS. Effect of gender and geographic location on the expression of primary hyperparathyroidism. J Endocrinol Invest. 2013 Feb;36(2):123-26. doi: 10.3275/8455
  4. Mamedova EO, Mokrysheva NG, Rozhinskaya LY. Characteristics of primary hyperparathyroidism in young patients. Problems of Endocrinology. 2018;64(3):163-169. (In Russ.)
  5. Wang WH, Chen LW, Lee CC, Sun CY, Shyu YC, Hsu HR, Chien RN, Wu IW. Association between Parathyroid Hormone, 25 (OH) Vitamin D, and Chronic Kidney Disease: A Population-Based Study. Biomed Res Int. 2017;2017:7435657. doi: 10.1155/2017/7435657
  6. Catalano A, Chilà D, Bellone F, Nicocia G, Martino G, Loddo I, Morabito N, Benvenga S, Loddo S. Incidence of hypocalcemia and hypercalcemia in hospitalized patients: Is it changing? J Clin Transl Endocrinol. 2018 May 29;13:9-13. doi: 10.1016/j.jcte.2018.05.004. eCollection 2018 Sep.
  7. Bilezikian JP, Silva BC, Cusano NE. Primary hyperparathyroidism – hypercalcemic and normocalcemic variants. Curr Opin Endocr Metab Res. 2018 Dec;3:42-50. doi: 10.1016/j.coemr.2018.03.003
  8. Assadipour Y, Zhou H, Kuo EJ, Haigh PI, Adams AL, Yeh MW. End-organ effects of primary hyperparathyroidism: A population-based study. Surgery. 2019 Jan;165(1):99-104. doi: 10.1016/j.surg.2018.04.088
  9. Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, Doherty GM, Herrera MF, Pasieka JL, Perrier ND, Silverberg SJ, Solórzano CC, Sturgeon C, Tublin ME, Udelsman R, Carty SE. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg. 2016 Oct 1;151(10):959-68. doi: 10.1001/jamasurg.2016.2310
  10. Khan AA, Hanley DA, Rizzoli R, Bollerslev J, Young JE, Rejnmark L, Thakker R, D’Amour P, Paul T, Van Uum S, Shrayyef MZ, Goltzman D, Kaiser S, Cusano NE, Bouillon R, Mosekilde L, Kung AW, Rao SD, Bhadada SK, Clarke BL, Liu J, Duh Q, Lewiecki EM, Bandeira F, Eastell R, Marcocci C, Silverberg SJ, Udelsman R, Davison KS, Potts JT Jr, Brandi ML, Bilezikian JP. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int. 2017 Jan;28(1):1-19. doi: 10.1007/s00198-016-3716-2
Address for correspondence:
443099, Russian Federation,
Samara, Chapaevskaya Str., 89,
Samara State Medical University,
Department of Surgery
of the Institute of Pediatrics,
tel. +79033342259,
e-mail: i.v.makarov@samsmu.ru,
Makarov Igor V.
Information about the authors:
Makarov Igor V., MD, Professor, Head of the Department of Surgery of the Institute of Pediatrics, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-1068-3330
Prokofeva Natalia A., Assistant of the Department of Surgery of the Institute of Pediatrics, Samara State Medical University, Samara, Russian Federation. https://orcid.org/0000-0001-7620-6724
Sidorov Aleksandr Yu., Associate Professor of the Department of Surgery of the Institute of Pediatrics, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0003-3613-4863
Golubova Valentina M., Clinical Intern of the Department of Surgery of the Institute of Pediatrics, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0003-3510-2763

V.I. AVERIN 1, Y.G. DEGTYAREV 1, N.S. PROKOPENYA 2, O.A. GOVORUKHINA 2, S.A. SUKHAREV 2

DIAGNOSIS AND TREATMENT OF SACROCOCCYGEAL TERATOMA IN CHILDREN

Belarusian State Medical University 1,
Republican Scientific and Practical Center of Pediatric Surgery 2, Minsk,
The Republic of Belarus

Objective. To evaluate the diagnostic methods and surgical treatment results in children with sacrococcygeal teratomas (SCT) in the Republic of Belarus during 1994 – 2020 yrs.
Methods. The study included (n=73) patients with SCT, 55 girls (75.3%), 18 boys (24.7%), correspondently. Ultrasound examination, survey radiography of the abdominal cavity and pelvic bones, computed and magnetic resonance imaging, determination of alpha-fetoprotein have been used for diagnostics.
Results. In the Republic of Belarus, SCTs occur with a frequency of 1:37 173 newborns. Antenatally, pathology was detected in 45 (61.6%) cases with gestational age from 20 to 34 weeks (24.7 ± 4.9). I and II types of SCT were detected in 58 (79.5%) patients, III – in 10 (13.7%) and IV – in 5 (6.8%) patients. Mature SCT was diagnosed in 68 (93.2%) patients, immature – in 3 (4.1%) ones , malignant - in 2 (2.7%) patients. 14 patients out of them (19.2%) had multiple congenital anomalies. Radical surgery was performed in 68 children in the first two weeks of life (93.2%). At the age of 2 months 3 children were admitted, at 6 months – 1 child (with recurrent SCP), at 10 months – 1 child, and at 14 months – 1 child. Functional disorders of the pelvic organs (fecal incontinence) were observed in 5 patients. Dysuria disorders were recorded in 16 patients, in the early postoperative period in 9 ones, in the long-term period in 7 patients developed a clinical picture of a neurogenic bladder. Recurrence of SCT was noted after 6 months in one patient (1.4%). Mortality rate out of 72 operated patients died was 4.16%, individuals – 3, morphologically immature tumor was revealed during histological examination of the formation.
Conclusion. With timely diagnosis and radical removal of the SCP, the prognosis is considered to be favorable. However, according to our data there are some problems with functional disorders of the pelvic organs ( 9.58%).

Keywords: sacrococcygeal teratoma, children, epidemiology, prenatal diagnosis, clinical features, surgical treatment
p. 162-170 of the original issue
References
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  11. Chislennost’ naseleniia na 1 ianvaria 2021 g. i srednegodovaia chislennost’ naseleniia za 2020 god po Respublike Belarus’ v razreze oblastei, raionov, gorodov, poselkov gorodskogo tipa Minsk, RB: Nats stat komitet Resp Belarus’; 2021. 25 s. Available from: https://www.belstat.gov.by/upload/iblock/158/1584531a2b89fa1a0945f6dc809ff268.pdf (In Russ.)
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Address for correspondence:
220116, Republic of Belarus,
Minsk, Dzerzhinsky Avenue, 83,
Belarusian State Medical University,
the Pediatric Surgery Department
tel. office: +375 017 290-49-23,
e-mail: averinvi@mail.ru,
Averin Vasily I.
Information about the authors:
Averin Vasily I., MD, Professor, Head of the Pediatric Surgery Department, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-3343-8810
Degtyarev Yu.G., MD, Professor of the Pediatric Surgery Department, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-2696-4989
Prokopenya Natalya S., Pediatric Surgeon, Republican Scientific and Practical Center of Pediatric Surgery, the 2nd Surgery Unit, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-1347-6847
Govorukhina Olga A., PhD, Associate Professor, Head of the Surgery Unit, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-1605-7031
Sukharev Sergey A., Pediatric Surgeon, Republican Scientific and Practical Center of Pediatric Surgery, the 2nd Surgery Unit, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-8295-6919

M.ZH. ALIEV, A.I. MUSAEV, K.I. NIIAZBEKOV

PREVENTION OF POSTOPERATIVE COMPLICATIONS IN LIVER ECHINOCOCCECTOMY

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

Objective. To assess the results of insertion of a hemostatic collagen sponge to prevent the occurrence of residual cavity and application of infrared radiation for a wound to heal successfully in the liver echinococcectomy.
Methods. Operations for the liver echinococcosis were performed in 226 patients. The groups were allocated as follows: control (n=122) patients and main (n=104) patients. The groups were comparable in terms of clinical parameters (gender, age, form of echinococcosis, size of cysts). The conventional methods of the liver echinococcectomy were used in both groups. In the control group, the organ-preserving surgeries were performed in 78 patients, radical ones 0 in 44 patients; all patients received traditional treatment in the postoperative period.
In the main group, 87 patients underwent organ-preserving surgeries, 17 ones - radical echinococcectomy. In the case of impossibility to eliminate completely the fibrous capsule (18 patients out of 87) a hemostatic collagen sponge has been used. Preventing surgical site infections the infrared radiation of the surgical wound area was applied in 104 patients. A white blood cell ( WBC) count, leukocytic index of intoxication, ultrasound examination and measurement of the zone of wound infiltration (echomorphometry) were used to evaluate the results of treatment.
Results. In the control group, a residual cavity was recorded in 12 (9.8%) cases, wound complications - in 6 (4.9%) ones. In the main group the residual cavity was observed in 1 case and wound complications were detected in 2 (1.9%) patients. When evaluating clinical parameters, it was detected that the normalization of body temperature, pain relief, normalization of leukocyte count (WBC) have occurred faster in the main group, who underwent infrared radiation, and in performance of the echomorphometry of the surgical wound, the size of the hypoechoic zone with an elevation of the time in the postoperative period reduced faster.
Conclusion. The hemostatic collagen sponge was found to be applied for the invagination and capitonnage to prevent a substantial risk of postoperative complications. The use of a hemostatic sponge in organ-preserving operations prevents the formation of a residual cavity. It has been shown that the infrared radiation had the potential to improve wound healing and reduce pain and inflammation.

Keywords: liver echinococcosis, surgical treatment, hemostatic collagen sponge, infrared radiation, echomorphometry
p. 171-178 of the original issue
References
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  13. Georgiou GK, Lianos GD, Lazaros A, Harissis HV, Mangano A, Dionigi G, Katsios C. Surgical management of hydatid liver disease. Int J Surg. 2015 Aug;20:118-22. doi: 10.1016/j.ijsu.2015.06.058
  14. Fischer L, Seiler CM, Broelsch CE, de Hemptinne B, Klempnauer J, Mischinger HJ, Gassel HJ, Rokkjaer M, Schauer R, Larsen PN, Tetens V, Büchler MW. Hemostatic efficacy of TachoSil in liver resection compared with argon beam coagulator treatment: an open, randomized, prospective, multicenter, parallel-group trial. Surgery. 2011 Jan;149(1):48-55. doi: 10.1016/j.surg.2010.02.008
  15. Amonov ShSh, Prudkov MI, Orlov OG, Gul’muradov TG, Amonov ShN, Saidov MS. Opyt ispol’zovanija ranevogo pokrytija «Tahokomb» pri jehinokokkoze pecheni. Doklady Akademii nauk Respubliki Tadzhikstan. 2013;56(5):415-19. https://cyberleninka.ru/article/n/opyt-ispolzovaniya-ranevogo-pokrytiya-tahokomb-pri-ehinokokkoze-pecheni (In Russ.)
  16. Musaev US, Tolorov ZhZh, Omorov TB. Prevention of complications of destructive forms of acute cholecystitis. Vestn OshGU . 2018;(3):177-82. https://www.elibrary.ru/item.asp?id=36486895 (In Russ.)
Address for correspondence:
720054, Kyrgyz Republic,
Bishkek, Yu.Fuchik Str., 15,
City Clinical Hospital No1,
tel. +996 550 650008,
å-mail: musa-aliev-69@mail.ru,
Aliev Musabay Zh.
Information about the authors:
Musaev Akylbek I., MD, Professor, Chief Physician of the City Clinical Hospital No1, Bishkek, Kyrgyz Republic.
http://orcid.org / 0000-0002-3915-0300
Aliev Musabay Zh., PhD, Physician of the Surgical Unit No1, City Clinical Hospital No1, Bishkek, Kyrgyz Republic.
http://orcid.org / 0000-0003-0771-245X
Niiazbekov Kubat I., PhD, Associate Professor of the Dpartment of General Practice Surgery with the Course of Combustiology, Kyrgyz State Medical Academy Named after I.K. Akhunbayev, Bishkek, Kyrgyz Republic.
http://orcid.org/ 0000-0002-4103-3138

A.YU. NISHT, N.F. FOMIN

ANATOMICAL AND EXPERIMENTAL APPROACHES TO SUBSTANTIATION OF THE TECHNIQUES OF ACCELERATED SELECTIVE REINNERVATION OF THE THENAR MUSCLES IN PROXIMAL INJURIES OF PERIPHERAL NERVES

S.M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg,
Russian Federation

Objective. To provide a topographical and anatomical justification of techniques of accelerated selective reinnervation of the thenar muscles with high proximal trauma and extensive defects of the median nerve.
Methods. Structural features and topography of the muscular branches of peripheral nerves were studied on 37 upper limbs of cadavers. Modeling of the stages of reconstructive interventions with the connection of nerves according to the technique «end-to-side» was performed on 15 upper limbs in experiment.
Results. Individual differences in the structure of peripheral nerves mainly consist of the unequal quantity and size of bundles of nerve fibers, as well as the severity of intratrunk interfascicular connections and depend on the shape of the limb segments. The ulnar and the median nerves, a potential pair of «donor-recipient» nerves, are located reliably closer to each other on the relatively narrow and long limbs, compared to the wide and short ones. Based on the anatomical material the operative access was developed and tested to create optimal technical conditions for performing early selective reinnervation of the muscles of the first finger elevation in case of high proximal injuries and extensive defects of the median nerve. The essence of the proposed surgical intervention is to mobilize the recurrent motor branch of the median nerve and connect it «end-to-side» with the deep branch of the ulnar nerve.
Conclusion. Performing intra-trunk microsurgical operations on nerves with the formation of "end - to-side" perineural anastomoses allows creating morphological conditions for a directed regeneration of nerve fibers from the deep branch of the ulnar nerve to the tissues of the target zones of the recurrent motor branch of the median nerve.More extended nerve branches with a small number of interfascicular connections, characteristic of relatively narrow and long limbs, contribute to the creation of conditions for less traumatic mobilization and transposition of motor branches with aim to selectively reinnervate tissues with an «end-to-side» peripheral nerve suture.

Keywords: peripheral nerve, nerve injury, «end-to-side» neurorrhaphy, motor innervation, tenar muscles, restoration of thumb opposition
p. 179-185 of the original issue
References
  1. Konofaos P, Bassilios Habre S, Wallace RD. End-to-Side Nerve Repair: Current Concepts and Future Perspectives. Ann Plast Surg. 2018 Dec;81(6):736-40. doi: 10.1097/SAP.0000000000001663
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  7. Geuna S, Papalia I, Ronchi G, d'Alcontres FS, Natsis K, Papadopulos NA, Colonna MR. The reasons for end-to-side coaptation: how does lateral axon sprouting work? Neural Regen Res. 2017 Apr;12(4):529-33. doi: 10.4103/1673-5374.205081
  8. Paiva GR, Viterbo F, Deffune E, Custódio MAD. Stem cells in end-to-side neurorrhaphy. Experimental study in rats. Acta Cir Bras. 2021 Jan 20;35(12):e351207. doi: 10.1590/ACB351207. eCollection 2021.
  9. Nisht AY, Fomin NF, Imelbaev AI, Mikulich AA. Restoration of motor innervation by the «end-to-side» neurorraphia: experimental modeling and clinical and instrumental control of reinnervation. Journal of Experimental and Clinical Surgery. 2020;13(1):24-33. doi: 10.18499/2070-478X-2020-13-1-24-33 (In Russ.)
  10. Ozcelik IB, Yildiran G, Mersa B, Sutcu M, Celik ZE, Ozalp T. A novel nerve transfer: The first palmar interosseous motor branch of the ulnar nerve to the recurrent motor branch of the median nerve. Injury. 2020 Dec;51 Suppl 4:S81-S83. doi: 10.1016/j.injury.2020.02.119
  11. Aman M, Böcker A, Kneser U, Harhaus L. Selective nerve transfers for thenar branch reconstruction. Oper Orthop Traumatol. 2021 Oct;33(5):384-91. doi: 10.1007/s00064-020-00689-1 [Article in German]
Address for correspondence:
194044, Russian Federation,
St. Petersburg, Academician Lebedev, d. 6,
S.M. Kirov Military Medical Academy,
Department of Operative Surgery
(with Topographic Anatomy) Saint Petersburg, Russian Federation,
tel. +7 905 260-49-44,
e-mail: nachmed82@mail.ru,
Nisht Alexey Y.
Information about the authors:
Nisht Aleksey Y., PhD, Associate Professor, Doctoral Student of the Department of Operative Surgery (with Topographic Anatomy), S.M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0002-6696-1897
Fomin Nikolai F., MD, Professor, Head of the Department of Operative Surgery (with Topographic Anatomy), S.M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0003-3961-1987

A.A. LYZIKOV, M.L. KAPLAN, D.A. ZINOVKIN, V.E. TSIKHMANOVICH, Y.K. KULIKOVICH

THE INFLUENCE OF THE STORAGE SOLUTIONS ON MORPHOLOGICAL CHARACTERISTICS OF HUMAN SAPHENOUS VEINS

EI “Gomel State Medical University”,
Republic of Belarus

Objective. To analyze and evaluate the effect of solutions for storage and storage times on the morphological characteristics of the human great saphenous vein.
Methods. 202 specimens of human saphenous veins obtained during phlebectomies or during CABG. The obtained samples immediately after harvesting from the patient were randomly placed into a sterile cardioplegic solution and a physiological solution with heparin and papaverine for further storage in a refrigerator at a temperature of +4°C. Histological, morphological, and immunological studies of the obtained samples were carried out within a period from 1 day to 1 month. To study the effect of varicose transformation, the studied samples were divided into 2 groups: group 1 – 120 sections of the great saphenous vein with varicose transformation; group 2 - 82 veins without varicose transformation. Depending on the solution in which the samples were stored, the veins of the first group were subdivided into 2 subgroups: 40 veins were stored in 0.9% sodium chloride solution with the addition of papaverine and heparin (subgroup 1p) and 80 veins, which were stored in cardioplegic solution (subgroup 1c).
Results. The use of cold cardioplegic solution makes it possible to achieve complete decellularization of the saphenous vein within a period of 1 day to 1 week, while decomposition and homogenization of the conduit wall is observed within a period of two to three weeks, in the case of unchanged conduits, and within three weeks for veins with varicose veins deformation. Preservation of the collagen framework is observed in the period from the first days to three weeks of observation, which correlates with the preservation of the strength characteristics of venous conduits exposed to cold storage in cardioplegic solution. The loss of collagen fibers from their initial amount within 3 weeks for varicose veins is 8.6%, for veins without varicose transformation – 13.5%.
Conclusion. The use of this method of storage of venous conduits makes it possible to achieve an adequate level of vascular decellularization already on the first day of storage, which helps to reduce the likelihood of subsequent rejection of the conduit and inducing of graft rejection reaction of the recipient, and the preservation of the collagen framework within a period up to three weeks makes it possible to use these conduits in vascular tissue engineering and for reconstructive vascular surgery.

Keywords: hypothermic storage, storage solutions, long-term storage of vein allografts, morphology of human saphenous vein, decellulization of veins
p. 186-197 of the original issue
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Address for correspondence:
246046, Republic of Belarus, Gomel,
Meditsinskaya St. 4,
Gomel State Medical University,
Department of Surgery No 1,
tel./fax: òåë. +375 232 49-19-54,
e-mail surgery_1@gsmu.by,
Tsikhmanovich Viktar E.
Information about the authors:
Lyzikov A.A., MD, Professor, Head of the Department of Surgery No 1 with the Course of Cardiovascular Surgery, EI “Gomel State Medical University”, Republic of Belarus.
https://orcid.org/0000-0003-0639-121X
Kaplan M.L., PhD, Associate Professor, Associate Professor of the Department of Surgery No 1 with the course of Cardiovascular Surgery, EI “Gomel State Medical University”, Republic of Belarus.
https://orcid.org/0000-0001-7782-3281
Zinovkin D.A., Assistant of the Department of Pathological Anatomy, EI “Gomel State Medical University”, Republic of Belarus.
https://orcid.org/0000-0002-3808-8832
Tsikhmanovich V.E., Assistant of the Department of Surgery No 1 with the course of Cardiovascular Surgery, EI “Gomel State Medical University”, Republic of Belarus.
https://orcid.org/0000-0002-3486-9113
Kulikovich Y.K., Assistant of the Department of Surgery No.1 with the course of Cardiovascular Surgery, EI “Gomel State Medical University”, Republic of Belarus.
https://orcid.org/0000-0002-1317-4662

REVIEWS

P.S. REMOV

TOPICAL ISSUES OF SURGICAL TREATMENT FOR LUMBAR DORSOPATHY

Republican Research and Practical Center for Travmatology and Orthopedics, Minsk,
Republic of Belarus

This review appraises the available current literature for spinal surgical treatment for lumbar dorsopathy and a number of controversial issues have been identified. The results of studies containing data comparing the effectiveness of decompression and decompression-stabilization interventions are found to be contradictory in many aspects. When using various techniques, in some cases, specialists fail to achieve a favorable result in the long term period. The most significant issue raised in the review of the article is the justification for the spine stabilization. A detailed analysis of factors that should be taken into consideration to apply of posterior spondylodesis and fixation has been performed. Despite the high level of virtual technologies development, today there is no absolute method for diagnosing instability of the functional spinal unit. The ambiguous markers of lumbar instability include the parameters of the intervertebral discs, ligamentous apparatus, facet joints of spine, and ventral osteophytes. Functional spondylography remains the main technique (diagnostic efficiency 63.3%) for detecting hypermobility of the spine at the lumbar level, but due to its shortcomings, it requires comparison with neuroimaging data and clinical parameters. Determination of indications for the use of spondylodesis in degenerative-dystrophic diseases of the spine at the lumbar level requires an integrated approach taking into account pathogenetic, radiological and somatic factors.

Keywords: degenerative stenosis, posterior fusion, spinal instability, functional spondylography, translation, angulation
p. 198-206 of the original issue
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Address for correspondence:
220024, Republic of Belarus,
Minsk, Kizhevatov St., 60-4,
Republican Research and Practical Center
for Travmatology and Orthopedics,
the Laboratory of Traumatic Injuries
of the Spine and Spinal Cord.
tel.mobile: +375 29 334-31-22,
e-mail: neuro_ugokb2013@mail.ru,
Remov Pavel S.
Information about the authors:
Remov Pavel S., Senior Researcher of the Laboratory of Traumatic Injuries of the Spine and Spinal Cord, Republican Research and Practical Center for Travmatology and Orthopedics, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-2194-5233

P.V. ROGOZHKIN 1,2, E.À. BORODULINA 1, V.V. PISKUN 1, E.P. ERYEMENKO 1

SURGICAL TREATMENT OF TUBERCULOSIS IN HIV PATIENTS

Samara State Medical University of the Ministry of Health of RF 1,
Samara Regional Clinical Tuberculosis Dispensary 2, Samara,
The Russian Federation

HIV-positive patients are 100 folds more likely to get TB than HIV-negative ones. The growth of the comorbid disease tuberculosis/HIV (TB/HIV) is accompanied by high rate of mortality, and people of young and able-bodied age are mainly affected by the disease. In recent years, patients with TB/HIV have undergone extensive surgical interventions - radical lung resections, and the most authors found these operations to be highly effective. The analysis of publications (2014-2020 yrs.) was devoted to the surgical treatment of pulmonary tuberculosis in HIV-infected patients. The following features of surgical treatment of patients in this group can be distinguished: a full course of anti-tuberculosis chemotherapy is required in the preoperative period and the resumption of the intensive phase of chemotherapy in the postoperative period; it is necessary to conduct antiretroviral therapy (ART). For the patients with severe immunosuppression and a reduction of CD4 + lymphocytes count less than 200 cells / μl, the preoperative evaluation for a planned operation should be carefully conducted. Video-assisted thoracoscopic surgery came into widespread use with high efficiency. Over the past 7 years despite the high burden of HIV-TB co-infection there appears to be very little published peer-reviewed literature related to describing the long-term results of surgical treatment of pulmonary tuberculosis in HIV-infected patients. The main reason is considered to be the loss of patient monitoring after completion of tuberculosis treatment. Multimodal strategies to improve surgical outcome and reduction of postoperative complications are found to be relevant and perspective.

Keywords: tuberculosis, HIV infection, surgical treatment, CD4+ lymphocytes, postoperative period, video-assisted thoracoscopy
p. 207-213 of the original issue
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Address for correspondence:
443099, Russian Federation,
Samara, Chapayevskaya Street, 89,
Samara State Medical University,
the Department of Phthisiology
and Pulmonology;
tel. +7 917 958 34 82,
e-mail: borodulinbe@yandex.ru,
Borodulina Elena A.
Information about the authors:
Rogozhkin Petr V., Thoracic Surgeon, Samara Regional Clinical Tuberculosis Dispensary Named after N.V.Postnikov, Samara, Russian Federation.
http://orcid.org/0000-0003-2734-6178.
Borodulina Elena A., MD, Head of the Department of Phthisiology and Pulmonology, Samara State Medical University of the Ministry of Health of RF, Samara, Russian Federation.
http://orcid.org/0000-0002-3063-1538
Piskun Vyacheslav V., Student, Samara State Medical University of the Ministry of Health of RF, Samara, Russian Federation.
http://orcid.org/0000-0003-3246-4953
Eryemenko Ekaterina P., PhD, Associate Professor of the Department of Phthisiology and Pulmonology, Samara State Medical University of the Ministry of Health of RF, Samara, Russian Federation.
https://orcid.org/0000-0001-5909-4070

CASE REPORTS

À.V. VARABEI 1, V.F. OREKHOV 2, N.À. LAGODICH 1, À.S. KAPRAN 1, Å.I. VIZHINIS 1

MINIMALLY INVASIVE METHOD OF TREATMENT OF SCAR STRICTURE OF HEPATICO-JEJUNAL ANASTOMOSIS

Belarusian Medical Academy of Postgraduate Education 1,
N.N.Alexandrov National Cancer Centre of Belarus 2, Minsk,
The Republic of Belarus

Strictures of hepatico-jejunal anastomosis (HJA) are a topical problem in the biliary surgery. This pathology is often complicated by recurrent cholangitis, cholangiolithiasis, liver failure and cirrhosis. This observation presents a clinical case of minimally invasive treatment of a 56-year-old patient with cicatricial stricture of hepatico-jejunal-anastomosis, recurrent cholangitis, cholangiolithiasis. The patient underwent gastropancreatoduodenal resection with resection of paranephric tissue and mesocolon for locally distributed stenosing duodenal cancer (T4N0M0-moderately differentiated adenocarcinoma with an average degree of differentiation). In connection with the developed cicatricial stricture of HJA, an attempt to perform the antegrade Rendezvous technique: double-balloon endoscopy has been made. The latter attempt due to the adhesion process around the Roux loop was failed. The percutaneous transhepatic cholangiostomy (PTC) was performed through the left lobe of the liver under US and X-rays control, HJA recanalization, balloon dilatation of the HJA stricture, external – internal bile drainage. Subsequently, second endoscopic balloon dilatation of the HJA stenosis was performed. More later repeated balloon dilation of HJA, mechanical lithotripsy, and lithoextraction were carried out. Cholangiography revealed a rigid HJA stricture. Biliary stenting was performed with a self-expanding nitinol stent «SX-Ella» with a diameter of 8 mm and a length of 40 mm for internal bile drainage. At the control examination after 10 months no complaints were recorded.

Keywords: hepatico-jejunal-anastomosis, stricture, cholangiolithiasis, cholangitis, percutaneous - transhepatic interventions, balloon dilatation, Dormia basket, lithotripsy, lithoextraction, stenting, choledochoscopy
p. 214-220 of the original issue
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Address for correspondence:
223041, Republic of Belarus,
Minsk Region, Lesnoy, 1,
Minsk Regional Clinical Hospital,
Surgical Unit,
tel. office: +375172652213,
e-mail: dept-surg@hotmail.com,
Varabei Aliaksandr V.
Information about the authors:
Varabei Aliaksandr V., Corresponding Member of the National Academy of Sciences of Belarus, MD, Professor, Head of the Surgery Department of Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-9765-2755
Orekhov Vitali F., X-Ray-Endovascular Surgeon, N.N.Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus.
https://orcid.org/ 0000-0002-6056-855X
Lahodzich Natallia A., PhD, Associate Professor of the Surgery Department, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-9870-7204
Kapran Aliaksandr S., Post-Graduate Student, the Surgery Department, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-7570-0509
Vizhinis Ezhi I., PhD, Associate Professor, the Surgery Department, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-9185-7119

A.V. MALOSHTAN, A. A. NEKLIUDOV, V. Y. BROVKIN

SPONTANEOUS SPLENIC RUPTURE AS A FIRST MANIFESTATION OF CHRONIC MYELOLEUKEMIA

V. T. Zaytsev Institute of General and Urgent Surgery,
National Academy of Medical Sciences of Ukraine, Kharkiv,
Ukraine

Spontaneous rupture of the spleen is a rare incident and occurs without visible external mechanical injury. However, the mortality rate is 2-5 folds higher than that of a traumatic rupture, which is usually associated with the underlying disease. In most of these pathological conditions, proliferative processes within the organ, vascular thrombosis, heart attacks and hematomas cause a rapid enlargement of the spleen volume measured by size. At some stage, this volume begins to exceed the permissible volume of the organ, limited by the stretch limit of its capsule. Then breakup occurs.
Two observations are of great interest in the sense of spontaneous rupture of the spleen with massive bleeding (III degree) occurred against the background of complete well-being and was the first symptom of a neglected proliferative blood disease. Before the spontaneous rupture, both patients had no complaints about the general condition of the body and led an active lifestyle. One rupture occurred during diagnostic performance of a contrast-enhanced CT-scan. It was diagnosed not only violation of the integrity of the organ, but also ongoing intra-abdominal arteriovenous bleeding. The second rupture occurred during sleep, when any, even the most insignificant, mechanical injury is completely ruled out. Timely diagnosis and surgical treatments (splenectomy and hemostasis) have prevented the adverse outcomes.

Keywords: spleen, spontaneous rupture, splenectomy, myeloleukemia, blood transfusion
p. 221-227 of the original issue
References
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Address for correspondence:
61103, Ukraine, Kharkiv, Balakirev Entry, 1
V. T. Zaytsev Institute
of General and Urgent Surgery,
the Department of the Liver
and Biliary Ducts, Surgery,
tel. +380 573 49-41-20,
e-mail: andrey.aleksandrovich@googlemail.com,
Nekliudov Andrey A.
Information about the authors:
Maloshtan Aleksandr V., MD, Chief Researcher, “National Academy of Medical Sciences of Ukraine, V. T. Zaytsev Institute of General and Urgent Surgery”, Kharkiv, Ukraine
https://orcid.org/0000-0001-5205-8480
Nekliudov Andrey A., PhD, Researcher, “National Academy of Medical Sciences of Ukraine, V. T. Zaytsev Institute of General and Urgent Surgery”, Kharkiv, Ukraine
https://orcid.org/0000-0001-5567-2419
Brovkin Viacheslav Y., Junior Researcher, “National Academy of Medical Sciences of Ukraine, V. T. Zaytsev Institute of General and Urgent Surgery”, Kharkiv, Ukraine
https://orcid.org/0000-0003-4684-9096

D.V. BATIUKOV 1, Î.À. EROKHINA 2, Î.À. YDZINA 3, V.N. PODGAISKI 4, A.CH. DUBROUSKI 2

IMPLANT-ASSOCIATED ANAPLASTIC LARGE CELL LYMPHOMA. FIRST CASE IN THE REPUBLIC OF BELARUS

Medical Centre “Antes Med” 1,
N.N.Alexandrov National Cancer Centre of Belarus 2,
“Republican Clinical Medical Center" of the Administration of the President of the Republic of Belarus 3,
Belarusian Medical Academy of Postgraduate Education 4, Minsk,
The Republic of Belarus

Breast augmentation with implants is one of the most popular plastic surgery procedures. Experience and clinical observations have revealed an association between breast augmentation with implants and a special type of lymphoma that occurs around them – breast-implant-associated anaplastic large cell lymphoma (BIA-ALCL), which resulted in changing of the selection criteria for implant and restrictive measures in several countries. The authors present the first case of breast-implant-associated anaplastic large-cell lymphoma in Belarus. Breast implant augmentation-mastopexy for cosmetic reasons had been performed 9 years before the diagnosis of lymphoma made. The implants of the 3rd group of texture according to ISO classification were used. The disease manifested with seroma of the right breast. Prior the surgery (capsulectomy and reaugmentation with implants) due to the patient’s refusal to undergo the surgical treatment, several aspirations to obtain fluid for analysis to diagnose were performed. Final diagnosis was BIA-ALCL, stage 1a. The patient has been followed up for 1,5 years and there was no recurrence. This study provides a literature review of recent scientific publications concerning this issue and testifies an increase in the number of cases, the majority of them manifest themselves only as seroma, and total capsulectomy is a sufficient and final treatment. Today the presence of breast implants without definite symptoms is not an indication for implant removal or replacement. The authors consider it rational to create a national registry of implants with the aim of an analytical approach to possible associations with pathological conditions.

Keywords: implant-associated lymphoma, breast augmentation implants, anaplastic large cell lymphoma, late seroma, breast implants, textured implants, capsulectomy
p. 228-235 of the original issue
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Address for correspondence:
220037, Republic of Belarus,
Minsk, Kozlov Lane, 25-6,
Medical Centre “Antes Med”
tel. +375 29 611-49-91,
e-mail: dmitry.batiukov@gmail.com
Batiukov Dmitry V.
Information about the authors:
Batiukov Dmitry V., PhD, Head of the Surgical Department, Medical Centre “Antes Med”, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-0891-4053
Erokhina Oxana A., PhD, Head of the Cytological Laboratory, N.N.Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-9518-5831
Ydzina Olha A., PhD, Associate Professor, Pathologist, “Republican Clinical Medical Center» of the Administration of the President of the Republic of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-7623-0601
Dubrouski Aliaxandr Ch., PhD, Head of the Pathological Unit, N.N.Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-2536-0294
Podgaiski Vladimir N., MD, Professor, Head of the Plastic Surgery and Combustiology Department, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-5112-6506
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