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Year 2016 Vol. 24 No 3

GALLERY OF NATIVE SURGEONS

Y.S. NEBYLITSIN, A.Y. SKVORTSOVA

A PHYSICIAN SHOULD BE AN OPTIMIST. TO THE 100TH ANNIVERSARY OF VLADIMIR MIKHEYEVICH VELICHENKO

EE ''Vitebsk State Medical University'',
The Republic of Belarus

On the twenty-seventh of April 2016 one hundred years have passed since the birth of an outstanding surgeon, Honored Worker of Science of BSSR, Doctor of Medical Sciences, Professor Vladimir Mikheyevich Velichenko. Vladimir Mikheevich has worked in medicine for more than fifty years including about 40 years in Vitebsk State Medical Institute. During this time he made his way from the assistant to the Head of the general surgery chair. Scientific creativity of V.M. Velichenko was characterized by a wide range of issues in medical science; a constant striving for new horizons was typical for him. The diagnosis and treatment of biliary tract and gall bladder disease, acute and chronic pancreatitis, gastric ulcer and duodenal ulcer, phlebology, pulmonology, traumatology, oncology, transplantation were in the center of his interests. Large clinical experience and research results have been summarized in more than one hundred scientific papers, three monographs and sixteen innovations. Under the supervision of Vladimir Mikheyevich three dissertations for scientific degree of Doctor of Science and 14 - for scientific degree of Candidate of Science have been performed. Vladimir Mikheyevich took an active part in social activities. He was a deputy chairman of the National and Regional Society of Surgeons, a member of the administration of international relations of Byelorussian SSR, deputy of the city council of Vitebsk.

Keywords: Vladimir Mikheyevich Velichenko, surgery
p. 213-216 of the original issue
References
  1. Kosinets AN, red. Vitebskii gosudarstvennyi meditsinskii universitet (1934-2004) [Vitebsk State Mediocal University (1934-2004)]. Vitebsk, RB: VGMU; 2004. 547 p.
  2. Kosinets AN, red. Vitebskomu gosudarstvennomu ordena Druzhby narodov meditsinskomu universitetu 65 let [Vitebsk State Order of Peoples' Friendship Medical University – 65 years]. Vitebsk, RB: VGMU; 1999. 160 p.
  3. Bekish OIL, red. Vitebskomu gosudarstvennomu ordena Druzhby narodov meditsinskomu institutu 60 let [Vitebsk State Order of Peoples' Friendship Medical Institute 60 years]. Vitebsk, RB; 1995. 109 p.
  4. Obshchaia informatsiia o kafedre. Istoriia kafedry gospital'noi khirurgii s kursami urologii i detskoi khirurgii [General information about the department. History of the Department of Hospital Surgery with courses of urology and pediatric surgery]. Rezhim dostupa: http://vsmu.by/118-departments/kafedra-gospitalnoj-khirurgii-s-kursami-urologii-i-detskoj-khirurgii/2233-obshchaya-informatsiya-o-kafedre-istoriya-kafedry.html. Data dostupa: 12.03.2016
  5. Obshchaia informatsiia o kafedre. Istoriia kafedry obshchei khirurgii [General information about the department. History of the department of general surgery]. Rezhim dostupa: http://vsmu.by/39-departments/kafedra-obshchej-khirurgii/1204-history-kaf-com-surgery.html. Data dostupa: 12.03.2016.
  6. Velichenko VM, Siparov IN. Obshirnye rezektsii kishechnika [Extensive bowel resections]. Minsk, RB; 1974. 126 p.
  7. Velichenko VM. Ostryi pankreatit v eksperimente i klinike [Acute pancreatitis in experiments and clinics]. Minsk, RB; 1971. 111 p.
  8. Velichenko VM. Zameshchenie defektov tolstoi i priamoi kishok ileotransplantatom [Replacement of defects of the colon and rectum by ileotransplant]. Minsk, RB: Belarus'; 1967. 168 p.
Address for correspondence:
210023, Republic of Belarus, Vitebsk,
pr. Frunze, 27, Vitebskiy gosudarstvennyiy
ordena Druzhbyi narodov meditsinskiy universitet,
kafedra obschey khirurgii, tel. office 375 212 37 80 82,
e-mail: nebylicin.uravgm@mail.ru
Information about the authors:
Nebylitsin Y.S. An associate professor of the general surgery chair of EE ''Vitebsk State Medical University''.
Skvortsova A.Y. A 3-year student of the medical faculty of EE ''Vitebsk State Medical University''.

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

A. L. CHARYSHKIN¹, D. A. MATORKIN²

METHOD OF URETERAL-INTESTINAL ANASTOMOSIS FORMATION

FSBE HPE "Ulyanovsk State University",
The Institute of Medicine, Ecology and Physical Culture¹, Ulyanovsk,
SME "Lipetsk Regional Oncology Center"², Lipetsk,
The Russian Federatio

Objectives. To develop a method for creating ureteral-intestinal anastomosis which lets to provide the impermeability, sufficient valve function of anastomosis, to prevent reflux, to reduce the early and late postoperative complications.
Methods. The study of the results of anastomosis formation on Chinchilla rabbits (n=12) of both sexes had been conducted within 14 days. In the 1st series of experiments on 6 rabbits the ureteral-intestinal anastomosis was performed by the Bricker method. During the 2nd series on 6 rabbits anastomosis was performed by the proposed method. The assessment of valve function of the ureteral-intestinal anastomosis was performed on the isolated preparation of the ureteral-intestinal anastomosis formed by the proposed method and by the Bricker method on the 7th and 14th days after the surgery as well as the removal of rabbits from the experiment.
Results. It was established that in the 2nd series of the experiment intraoperatively after the formation of the ureteral-intestinal anastomosis, bleeding and excretion of urine in the area of the anastomosis were not observed. The pressure at which reflux occurred in the isolated preparation of the ureteral-intestinal anastomosis formed by the Bricker method, made up 58,3±12,2 cm of water column; and by the proposed method it was 75,6±5,4 cm of water column. After 7 days in the macroscopic and microscopic examination the anastomosis failure was revealed in the 1st series of the experiment (n=2), on the 7th and 14th days in the anastomosis area the inflammatory process with the swelling and infiltration of the surrounding tissues, deformation, sequestration of ligatures was obserrved in other animals in this series.
In the 2nd series of the experiment, anastomosis failure was not observed; 7 days afterwards a moderate hyperemia, fibrin formation, lack of deformation in the anastomosis area were determined, 14 days later – the lack of evidence of inflammation, epithelialization of the anastomosis area were detected. The granulation tissue developed in the muscle membrane.
Conclusion. The proposed method of forming an anastomosis creates invaginative ureteral-intestinal anastomosis with sufficient integrity and more effective valve function.

Keywords: bladder cancer, ureteral-intestinal anastomosis, postoperative complications, vesicoureteral reflux, urethral strictures, sufficient integrity, effective valve function
p. 217-221 of the original issue
References
  1. Viktorova TV, Pavlov VN, Izmajlova SM, Izmajlov AA, Ahmadishina LZ, Hrizman JuN, i dr. Rol' polimorfizma genov CYP1A1, GSTM1, GSTP1 v formirovanii predraspolozhennosti k razvitiju raka mochevogo puzyrja [The role of polymorphisms of genes CYP1A1, GSTM1, GSTP1 in formation of predisposition to the development of bladder cancer]. Med Genetika. 2009;8(9):32-37.
  2. Pavlov VN, Izmajlov AA, Viktorova TV, Izmajlova SM, Kutlijarov LM, Urmancev MF, i dr. Vybor obema limfodissekcii u bol'nyh myshechno-invazivnym rakom mochevogo puzyrja [Choosing volume of lymph node dissection in patients with muscle-invasive bladder cancer] Med Vestn Bashkortostana. 2013;8(6):43-46.
  3. Pavlov VN, Izmajlov AA, Izmajlova SM, Viktorova TV, Urmancev MF, Muratov II. Taktika lechenija pacientov myshechno-neinvazivnogo raka mochevogo puzyrja promezhutochnogo riska [The treatment of patients with muscle-invasive bladder cancer at intermediate risk]. Med Vestn Bashkortostana. 2013;8(6):46-51.
  4. Chissov VI, Alekseev BJa, Rusakov IG. Onkourologija [Oncourology]: nac ruk. Moscow, RF: Gjeotar-Media; 2012. 688 p.
  5. Lopatkin NA, Shevcov IP. Operativnaja urologija [Operative urology]: ruk dlja vrachej. Leningrad, USSR; 1986. 480 p.
  6. Uiliss KR, Parker D. Atlas tazovoj hirurgii [Atlas of pelvic surgery]. Moscow, RF: Med lit; 1999. 540 p.
  7. Bassi P, Ferrante GD, Piazza N, Spinadin R, Carando R, Pappagallo G, et al. Prognostic factors of outcome after radical cystectomy for bladder cancer: a retrospective study of a homogeneous patient cohort. J Urol. 1999 May;161(5):1494-97.
  8. Camey M, Richard F, Botto H. Ileal replacement of bladder. In: King LR, Stone AR, Websterm GD, eds. Bladder Reconstruction and Continent Urinary Diversion. 2nd ed. Chicago: Mosby Year Book Inc; 1991. p. 389-10.
  9. Martin-Doyle W, Leow JJ, Orsola A, Chang SL, Bellmunt J. Improving selection criteria for early cystectomy in high-grade T1 bladder cancer: a meta-analysis of 15,215 patients. J Clin Oncol. 2015 Feb 20;33(6):643-50. doi: 10.1200/JCO.2014.57.6967.
  10. Bochner BH, Dalbagni G, Sjoberg DD, Silberstein J, Keren Paz GE, Donat SM, et al. Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol. 2015 Jun;67(6):1042-50. doi: 10.1016/j.eururo.2014.11.043.
Address for correspondence:
432017, Russia,
Ulyanovsk,
ul. L. Tolstogo, d. 42,
FGBOU VO "Ulyanovskiy
gosudarstvennyiy universitet",
kafedra fakultetskoy khirurgii,
tel. mob.: 79510966093,
e-mail: charyshkin@yandex.ru,
Charyshkin Aleksey Leonidovich
Information about the authors:
Charyshkin A.L. MD, a head of the faculty surgery chair of FSBE HPE "Ulyanovsk State University", the Institute of Medicine, Ecology and Physical culture.
Matorkin D.A. A head of the operative unit of SME "Lipetsk Regional Oncology Center", applicant of the faculty surgery chair of FSBE HPE "Ulyanovsk State University", the Institute of Medicine, Ecology and Physical Culture.

V.D. LUCENKO1, A.A. SHAPOSHNIKOV1, U.A. KRUT1, G. F. MAGOLIN1, E.M. LUHANINA2 , K.N. IVANCHIKOVA1, T.S. SHEVCHENKO1

PATHOGENETIC SUBSTANTIATION OF USING BIOACTIVE SORPTION GEL FORMULATIONS FOR TREATMENT OF PYOGENIC WOUNDS

FSAE HE "Belgorod National Research University"1,
Municipal City Hospital ¹1 2 The Russian Federation

Objectives. To assess dynamics of the wound healing process in white Wistar rats using bioactive sorption-gel formulations.
Methods. The experimental animals were divided into five groups in according to the performed treatment. In the first group 0,9% NaCl was used for wound cleansing. In the second group the water extract of Thymus serpylum was used. In the third group the complex treatment scheme was applied: in the first stage of wound healing the rats were treated by the powder of purified clay containing montmorillonite (MCC); in the second stage – by gel of MCC. In the fourth group the complex scheme of dressing was the following: in the first phase – a dry form of MCC modified by the extract of Thymus serpylum (phytomineral sorbent), in the second phase – gel form of phytomineral sorbent (PMS). In the fifth group the wound dressings were carried with gel form of PMS, throughout the whole period of wound healing process.
Results. The performed studies established that in rats of the III, IV and V groups wound healing was more intensive and treatment terms were 7 days less. In animals of the III and IV groups scrap from healthy tissues got off easily, granulation and epithelialization of the wound surface developed. In the group of rats, where dressings were carried out with the gel PMS throughout the period, less noticeable scar formed. By the 13th days it should be noted that the surface of the wound area in rats of groups III and IV significantly decreased by 73,2 and 81,7%, respectively, indicating the active regeneration of tissues.
Conclusion. The performed research has proved the effectiveness of the application of pyoinflammatory in the complex treatment wounds with PMS: in the first phase – with a dry form, in second phase – with the gel form of MCC.

Keywords: purulent wound, wound process, wound healing, treatment of wounds, phytomineral sorbent, montmorillonite containing clay, pathogenesis of the wound defect
p. 222-226 of the original issue
References
  1. Cesca TG, Faqueti LG, Rocha LW, Meira NA, Meyre-Silva C, de Souza MM, et al. Antinociceptive, anti-inflammatory and wound healing features in animal models treated with a semisolid herbal medicine based on Aleurites moluccana L. Willd. Euforbiaceae standardized leaf extract: semisolid herbal. J Ethnopharmacol. 2012 Aug 30;143(1):355-62. doi: 10.1016/j.jep.2012.06.051.
  2. Zuo HY, Chen Y. Retinervus luffae fructus (RLF): a novel material for use in negative pressure wound therapy. J Wound Care. 2014 Feb;23(2):81, 84, 86-87.
  3. Edwards JV, Castro NJ, Condon B, Costable C, Goheen SC. Chromatographic and traditional albumin isotherms on cellulose: a model for wound protein adsorption on modified cotton. J Biomater Appl. 2012 May;26(8):939-61. doi: 10.1177/0885328210390542.
  4. Tomskikh NN, Bogomolov NI, Kriukova VV, Panichev AM. Prirodnye sorbenty v lechenii gnoinykh ran [Natural sorbents in treatment of purulent wounds]. Biul VSNS SO RAMN. 2007;(4):180.
  5. Lieder R, Petersen PH, Sigurjónsson óE. Endotoxins-the invisible companion in biomaterials research. Tissue Eng Part B Rev. 2013 Oct;19(5):391-402. doi: 10.1089/ten.TEB.2012.0636.
  6. Vezentsev AI, Korol'kova SV, Bukhanov VD. Teksturnye kharakteristiki i sorbtsionnye svoistva prirodnoi i magnii-zameshchennoi montmorillonit soderzhashchei gliny [Textural characteristics and sorption properties of natural and magnesium-containing substituted montmorillonite clay]. Nauch Vedomosti BelGU. Ser Estestv Nauki. 2010;9 (11):119-23.
  7. Bukhanov VD, Vezentsev AI, Ponomareva NF, Kozubova LA, Korol'kova SV, Volovicheva NA, i dr. Antibakterial'nye svoistva montmorillonit soderzhashchikh sorbentov [The antibacterial properties of montmorillonite containing sorbents]. Nauch Vedomosti BelG. Cer Estestv nauki. 2011;17(21):57-63.
  8. Bukhanov VD, Shaposhnikov AA, Vezentsev AI. Sravnitel'nyi analiz biokhimicheskikh i morfologicheskikh pokazatelei krovi krys na tret'ei stadii protsessa ranozazhivleniia pri lechenii fitomineralosorbentami [Comparative analysis of biochemical and morphological indices of rat blood in the third stage of the process of wound healing by phytomineralosorbents]. Nauch Vedomosti BelGU. Cer Meditsina Farmatsiia. 2014; 26(11):177-80.
  9. Gavriliuk BK, Gavriliuk VB. Cposob polucheniia sredstva dlia ustraneniia defektov kozhi i lecheniia ran v vide gelia na osnove vodorastvorimykh polisakharidov rastitel'nogo proiskhozhdeniia [A method of producing a medications of reducing skin defects and treatment of wounds in gel form, based on water-soluble polysaccharides of vegetable origin]: patent RF ¹ 2454242. 27.06.2012.
  10. Shapovalov SG. Sovremennye ranevye pokrytiia. Moscow, RF: Farmindeks-Praktik; 2005. 46 p.
  11. Dário GM, da Silva GG, Gonçalves DL, Silveira P, Junior AT, Angioletto E, et al. Evaluation of the healing activity of therapeutic clay in rat skin wounds. Mater Sci Eng C Mater Biol Appl. 2014 Oct;43:109-16. doi: 10.1016/j.msec.2014.06.024.
  12. Gaskell EE, Hamilton AR. Antimicrobial clay-based materials for wound care. Future Med Chem. 2014 Apr;6(6):641-55. doi: 10.4155/fmc.14.17.
  13. Shameli K, Ahmad MB, Yunus WM ZW, Rustaiyan A, Ibrahim NA, Zargar M, et al. Green synthesis of silver/montmorillonite/chitosan bionanocomposites using the UV irradiation method and evaluation of antibacterial activity. J Nanomedicine. 2010;5:877-87. doi: 10.2147/IJN.S13632.
  14. Kasanov KN, Popov VA, Uspenskaia MV, Solov'ev VS, Makin DN, Vezentsev AI, i dr. Razrabotka montmorillonitsoderzhashchei matritsy bioaktivnogo sorbiruiushchego ranevogo pokrytiia [Development of montmorillonite containing the active matrix organic sorbent wound coverage]. Nauch Vedomosti BelGU. Ser Estestv Nauki. 2011;14(3):168-73.
Address for correspondence:
308015, Russian Federation,
Belgorod, ul. Pobedyi, d. 85,
FGAO VO "Belgorodskiy natsionalnyiy issledovatelskiy universitet",
kafedra biohimii,
tel. 7 (4722) 30-21-35,
e-mail: krut@bsu.edu.ru,
Krut Ulyana Aleksandrovna
Information about the authors:
Lucenko V.D. MD, professor, a head of the general surgery chair with the course of operative surgery and topographic anatomy of FSAE HE "Belgorod National Research University".
Shaposhnikov A.A. BD, professor, a head of biochemistry chair of FSAE HE “Belgorod National Research University”.
Krut U.A. A post-graduate student, an assistant of biochemistry chair of FSAE HE "Belgorod National Research University".
Magolin G.F. A technician of the general surgery chair with the course of operative surgery and topographic anatomy of FSAE HE "Belgorod National Research University".
Luhanina E.M. A physician, head of the clinical-diagnostic laboratory of the Municipal City Clinical Hospital ¹1.
Ivanchikova K.N. A student of the medical and pediatrics faculty of FSAE HE "Belgorod National Research University".
Shevchenko T.S. PhD of biological sciences, senior lecturer of biochemistry chair of FSAE HE "Belgorod National Research University".

GENERAL & SPECIAL SURGERY

L.A. BOCKERIA, O.L. BOCKERIA, V.A. SHVARTZ, M.K. SANAKOEV, A.Y. ISPIRYAN, Z.F. FATULAEV, T.G. LE

THE IMMEDIATE RESULTS OF SIMULTANEOUS SURGICAL CORRECTION OF COMPLEX HEART DISEASE WITH CONCOMITANT ATRIAL FIBRILLATION

FSBE "Scientific Center of Cardiovascular Surgery named after A.N. Bakulev"
Ministry of Health of the Russian Federation, Moscow,
The Russian Federation

Objectives. To assess the results of simultaneous surgical correction of the complex surgical pathology of the heart and atrial fibrillation.
Methods. A retrospective analysis for the period 2009-2014 of the patients with simultaneous surgical correction of the atrial fibrillation (AF) and complex heart disease was carried out. The study enrolled 37 patients, aging 52 (49; 58), 51% of males, 49% of females. All patients with chronic heart failure were classified in NYHA class III-IV. The duration of AF composed 36 (24; 60) months. AF types were the following: a persistent one in 75,5%, a paroxysmal one – in 24,5%. The calculated risks comprised: EuroScore II – 4,1 (2,8; 5,9), the risk of in-hospital mortality and total mortality risk by Ambler – 5,5 (3; 7,3) and 8 (6; 9), respectively.
Results. The average number of simultaneous procedures on the heart performed per patient was 4 (4, 4), min – 3, max – 5. In 100% cases the aortic and mitral valve correction, and maze IIIB procedure were performed simultaneously. Coronary artery bypass grafting (CABG) was carried out in 19% of cases and the tricuspid valve repair was performed in 67%. The total duration of operations amounted 6,68±1,53 hours, time of cardiopulmonary bypass (CPB) – 212 (183; 238) min., aortic clamp – 139 (120; 157) min. Hospital mortality rate was 5,4%. In the early incisional period the main non-lethal complications were: acute heart failure, respiratory and renal insufficiency, and transient neurological disorders.
Conclusion. The literature review of such complicated types of cardiac surgical operations is quite meager that associated with the severity of patients and refusal of surgical correction. However, a qualified team of specialists possessing a highly professional approach to this category of patients is able to ensure the success of the surgical treatment of complex heart disease combined with simultaneous performing of 4 or more procedures. In the suggested series of observations, the hospital mortality correlated with the calculated one (5,4%) which is a quite good result in this patient category.

Keywords: atrial fibrillation, multivalve heart diseases, NYHA classification, coronary artery bypass surgery, simultaneous operations, early incisional period, hospital mortality rate

p. 227-233 of the original issue
References
  1. Weimar T, Gaynor SL, Seubert DY, Damiano RJ Jr, Doll N. Performing the left atrial maze ablation pattern without atriotomy. Ann Thorac Surg. 2016 Feb;101(2):777-9. doi: 10.1016/j.athoracsur.2015.05.137.
  2. Lawrance CP, Henn MC, Damiano RJ Jr. Concomitant Cox-Maze IV techniques during mitral valve surgery. Ann Cardiothorac Surg. 2015 Sep; 4(5): 483-86. doi: 10.3978/j.issn.2225-319X.2014.12.06.
  3. Dobrotin SS, Zemskova EN, Chiginev VA, Medvedev AP, Pichugin VV, Gamzaev AB. Khirurgicheskaia taktika pri korrektsii mnogoklapannykh porokov serdtsa [Surgical tactics for the correction of multi-valve heart defects]. Patologiia Krovoobrashcheniia i Kardiokhirurgiia. 2006;(4):21-25.
  4. Novikov VK, Bondarenko BB, Prokopchuk EF. Rezul'taty khirurgicheskogo lecheniia mnogoklapannykh porokov serdtsa u bol'nykh s vysokoi stepen'iu riska [Results of surgical treatment of multi-valve heart defects in patients with a high risk]. Patologiia Krovoobrashcheniia i Kardiokhirurgiia. 1998;(1):31-33.
  5. Dzhoshibaev SD, Bolatbekov BA. Odnomomentnoe primenenie khirurgicheskoi radiochastotnoi ablatsii i atrioplastiki levogo predserdiia pri korrektsiiakh mitral'nogo poroka serdtsa [Simultaneous use of surgical radiofrequency ablation of the left atrium and atrioplastiki the correction of mitral heart defect]. Vestn RAMN. 2015; 70(3): 279-85. doi: 10.15690/vramn.v70i3.1323.
  6. Ad N, Holmes SD, Pritchard G, Shuman DJ. Association of operative risk with the outcome of concomitant Cox Maze procedure: a comparison of results across risk groups. J Thorac Cardiovasc Surg. 2014 Dec;148(6):3027-33. doi: 10.1016/j.jtcvs.2014.05.039.
  7. Weimar T, Gaynor SL, Seubert DY, Damiano RJ Jr, Doll N. Performing the Left Atrial Maze Ablation Pattern Without Atriotomy. Ann Thorac Surg. 2016 Feb;101(2):777-79. doi: 10.1016/j.athoracsur.2015.05.137.
  8. Cox JL. Surgical ablation for atrial fibrillation. N Engl J Med. 2015 Jul 30;373:483-84. doi: 10.1056/NEJMc1506893.
  9. Bokeriia LA, Sergeev AV. Predserdnye aritmii posle khirurgicheskogo lecheniia fibrilliatsii predserdii (obzor literatury) [Atrial fibrillation after surgical treatment of atrial fibrillation (Review of the literature]. Annaly Aritmologii. 2014; 11(2): 87-97. doi: 10.15275/annaritmol.2014.2.3.
  10. Bokeriia LA, Shengeliia LD. Lechenie fibrilliatsii predserdii. Ch II. Segodniashnie realii i zavtrashnie perspektivy [Treatment of atrial fibrillation. P II. Today's realities and tomorrow's prospects]. Annaly Aritmologii. 2014;11(2):76-86. doi: 10.15275/annaritmol.2014.2.2.
  11. Gillinov AM, Gelijns AC, Parides MK, DeRose JJ Jr, Moskowitz AJ, Voisine P, et al. Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med. 2015 9; 372(15): 1399-409. doi: 10.1056/NEJMoa1500528.
  12. Gillinov AM, Bhavani S, Blackstone EH, Rajeswaran J, Svensson LG, Navia JL, et al. Surgery for permanent atrial fibrillation: impact of patient factors and lesion set. Ann Thorac Surg. 2006 Aug;82(2):502-13; discussion 513-14.
  13. Prasad SM, Maniar HS, Camillo CJ, Schuessler RB, Boineau JP, Sundt TM 3rd, et al. The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. J Thorac Cardiovasc Surg. 2003 Dec;126(6):1822-28.
  14. Gaynor SL, Schuessler RB, Bailey MS, Ishii Y, Boineau JP, Gleva MJ, et al. Surgical treatment of atrial fibrillation: predictors of late recurrence. J Thorac Cardiovasc Surg. 2005 Jan;129(1):104-11.
Address for correspondence:
Russian Federation,
121552, Moscow,
Rublevskoe shosse, d. 135,
FGBU "Nauchnyiy tsentr
serdechno-sosudistoy khirurgii im. A.N. Bakuleva",
otdelenie khirurgicheskogo lecheniya interaktivnoy patologii,
tel. office: 79032619292, shvartz.va@ya.ru
Shvartz Vladimir Aleksandrovich
Information about the authors:
Bockeria L.A. MD, professor, an Academician of RAMS and RAS, director of FSBE "SC CVS named after Bakulev", MH RF, cardiovascular surgeon.
Bockeria O.L. MD, professor, a chief researcher, Deputy Head of the department of surgical treatment of interactive pathology of FSBE "SC CVS named after Bakulev".
Shvartz V.A. PhD, junior researcher, cardiologist of the department of surgical treatment of interactive pathology of FSBE "SC CVS named after Bakulev".
Sanakoev M.K. PhD, a junior researcher, cardiovascular surgeon of the department of surgical treatment of interactive pathology of FSBE "SC CVS named after Bakulev".
Ispiryan A.Y. An junior researcher, cardiologist of the department of surgical treatment of interactive pathology of FSBE "SC CVS named after Bakulev".
Fatulaev Z.F. PhD, a researcher, cardiovascular surgeon of the department of surgical treatment of interactive pathology of FSBE "SC CVS named after Bakulev".
Le T.G. An junior researcher, cardiologist of the department of surgical treatment of interactive pathology of FSBE "SC CVS named after Bakulev".

A.V. CHERNYH, E.I. ZAKURDAEV, M.P. ZAKURDAEVA

TO THE QUESTION OF INTERCOSTAL NERVE INJURY PREVENTION AT THE POSTERIOR SEPARATION HERNIOPLASTY OF UMBILICAL HERNIAS

SBEE HPE “Voronezh State Medical University named after N.N. Burdenko”.
The Russian Federation

Objectives. To study the specific features of the topography of the intercostal nerves in the celiac area of the anterior abdominal wall.
Methods. The floating corpses (n=88) of both sexes without any pathology of the anterior abdominal wall were studied. There were 45% of male corpses (mean age – 53,8±11,9 years) and 55% – females (51,9±13,2 years).
The topographic anatomical dissection of the intercostal nerves in the celiac area of the anterior abdominal wall with the determination of the level of their penetration into the rectus abdominis in relation to the inferior edge of the costal arch and the external edge of the rectus abdominis muscle had been performed on each corpse.
Results. In this study the intercostal nerves (1-4 pairs) had been identified in the celiac area of the anterior abdominal wall. Most often 2 pairs of intercostal nerves (71%) met in females, while no statistically significant differences were found in males. Intercostal nerves penetrated into the rectus abdominis often via their external edges (52%), more rarely – via posterior surface (39%). In males the variant of the lateral penetration of the intercostal nerves in the rectus abdominis was more common (60%), while in females no statistically significant differences were found. To reduce the risk of intraoperative trauma of the intercostal nerves, the levels of their penetration into the depth of the rectus abdominis muscle had been determined. It had been found out that the distance from the inferior edge of the costal arch on the site of the penetration of rectus abdominis by intercostal nerves was reliably higher in females. The distance from the external edge of the rectus abdominis muscle on the site of the penetration of the muscle thickness by intercostal nerves was significantly greater in males.
Conclusion. The obtained data can be used to predict the topography of the intercostal nerves in the umbilical hernias plasty.

Keywords: umbilical hernia, topography, rectus abdominis, retromuscular hernia repair, penetration, intercostal nerves, chronic pain syndrom
p. 234-240 of the original issue
References
  1. Baitinger VF, Silkina KA. Chuvstvitel'naia innervatsiia mikrokhirurgicheskikh loskutov, primeniaemykh v rekonstruktivnoi mammoplastike [Sensitive innervation of microsurgical flaps used in reconstructive mammoplasty]. Plast Khirurgiia. 2014;49(2):11-19.
  2. Bernard C, Polliand C, Mutelica L, Champault G. Repair of giant incisional abdominal wall hernias using open intraperitoneal mesh. Hernia. 2007 Aug;11(4):315-20.
  3. Gutarra F, Asensio JR, Kohan G, Quarin C, Petrelli L, Quesada BM. Closure of a contained open abdomen using a bipedicled myofascial oblique rectus abdominis flap technique. J Plast Reconstr Aesthet Surg. 2009 Nov;62(11):1490-96. doi: 10.1016/j.bjps.2008.04.037.
  4. Bezhin AI, Netiaga AA. Sravnitel'noe eksperimental'noe izuchenie novykh polivinilidenftoridnykh endoprotezov s karbinovym pokrytiem dlia gernioplastiki [Comparative experimental study of new polyvinylidene fluoride stents with carbyne coating for hernia repair]. Sistem Analiz i Upravlenie v Biomed Sistemakh. 2006;5(4):802-806.
  5. Vorob'ev AA, Smirnov AV, Alifanov SA. Novaia forma spaechnogo protsessa pri gryzhakh perednebokovoi stenki zhivota [A new form of adhesions during the anterolateral abdominal wall hernias]. Vopr Rekonstrukt i Plast Khirurgii. 2010;10(1):51-53.
  6. Koshelev PI, Glukhov AA, Mukhtiar Kh, Leibovich BE. Innovatsionnye puti sovershenstvovaniia metodov nenatiazhnoi gernioplastiki [Innovative ways to improve methods of pull hernioplastics]. Sistem Analiz i Upravlenie v Biomed Sistemakh. 2007;6(2):528-32.
  7. Paajanen H, Laine H. Operative treatment of massive ventral hernia using polypropylene mesh: a challenge for surgeon and anesthesiologist. Hernia. 2005 Mar;9(1):62-7.
  8. Skipidarnikov AA, Bezhim AI, Netiaga AA, Skipidarnikova AN. Osobennosti innervatsii priamykh myshts zhivota u liudei s razlichnymi tipami teloslozheniia [Features of the innervation of the rectus muscle in people with different body types]. Chelovek i Ego Zdorov'e. 2013;(1):21-26.
  9. Parshikov VV, Khodak VA, Petrov VV, Dvornikov AV, Mironov AA, Samsonov AA, i dr. Retromuskuliarnaia plastika briushnoi stenki setkoi [Retro muscular plasty abdominal wall by mesh]. Fundam Issledovaniia. 2012;(7):159-63.
  10. Awad SS, Bruckner B, Fagan SP. Transperitoneal view of the PROLENE hernia system open mesh repair. Int Surg. 2005;90(3 Suppl):S63-6.
  11. Moore M, Bax T, MacFarlane M, McNevin MS. Outcomes of the fascial component separation technique with synthetic mesh reinforcement for repair of complex ventral incisional hernias in the morbidly obese. Am J Surg. 2008 May;195(5):575-9; discussion 579. doi: 10.1016/j.amjsurg.2008.01.010.
Address for correspondence:
394036, Rossiiskaia Federatsiia,
g. Voronezh, ul. Studencheskaia,
d. 10, GBOU VPO "Voronezhskii
gosudarstvennyi meditsinskii
universitet imeni N.N. Burdenko",
kafedra operativnoi khirurgii s
topograficheskoi anatomiei,
tel.: +7 (951) 566-43-61,
e-mail: ezakurdaev@rambler.ru,
Zakurdaev Evgenii Ivanovich
Information about the authors:
Chernyh AV, MD, professor, a Vice-rector, head of department of operative surgery with topographic anatomy SBEE HPE "Voronezh State Medical Academy named after N.N. Burdenko". The Russian Federation.

Zakurdaev EI. PhD, an assistant of the department of operative surgery with topographic anatomy SBEE HPE "Voronezh State Medical Academy named after N.N. Burdenko". The Russian Federation.

Zakurdaeva MP, a student of medical faculty of operative surgery with topographic anatomy SBEE HPE "Voronezh State Medical Academy named after N.N. Burdenko". The Russian Federation.

B.F. SHEVCHENKO, A.M. BABIY, N.G. GRAVIROVSKAYA, O.P. PETISHKO

THE VALIDITY OF RADIOLOGICAL METHODS IN ASSESSMENT OF INFLAMMATORY ACTIVITY AND FIBROUS TRANSFORMATION OF THE PANCREAS AT CHRONIC PANCREATITIS

SE ''Institute of Gastroenterology of NAMS of Ukraine'',
Dnepropetrovsk
Ukraine

Objectives. To study the validity of radiological methods of diagnosis in assessment of inflammation activity and fibrous transformation degree of the pancreas at chronic pancreatitis.
Methods. The comparison analysis of results of the radiological research methods (CT scan, ultrasound, sonoelastography and sonoelastometry in Shear Wave Elastography mode) with those of morphological assessment of the pancreatic biopsies obtained during surgical interventions due to the complications of chronic pancreatitis had been carried out in 98 patients. Age of patients varied from 26 up to 76, there were 77 (78,6%) males and 21 (21,4%) females.
Results. According to ROC analysis of the non-invasive assessment of inflammation activity and the evaluation of the fibrotic transformation degree of the pancreas, the low sensitivity and specificity of the quantitative and qualitative indices according to ultrasound and computed tomography scan had been established.The high sensitivity, specificity and accuracy of the sonoelastography method with sonoelastometry of the pancreas at chronic pancreatitis in determining rigidity of the anatomical parts of the pancreas in the evaluation of the fibrotic transformation degree of the pancreas according to the data of the conducted ROC-analysis made up in the pancreatic head 83,3%, 88,9% and 85,7% (AUC=0,843 (95% confidence interval (CI) 0,619-0,963), in the pancreas 81,8%, 76,9% and 79,2% (AUC=0,748 (95% CI 0,531-0,901) and it had a high diagnostics value; in the pancreatic tail - 66,7%, 75,0% and 64,3% (AUC=0,604 (95% CI 0,317-0,846), that possessed low diagnostics value.
High prognostic valuation of inflammation activity in the head of pancreas at the early (73,3%, 80,0%, 68,0% (AUÑ=0,727 (95% CI 0,513-0,884) and later (87,5% and 100,0%, 88,2% (AUC=0,972 (95% CI 0,759-1,000) degrees of pancreatic fibrosis at chronic pancreatitis had been determined.
Conclusion. Thus, indices of sonoelastography with sonoelastometry of the pancreas in assessing of fibrotic transformation degree and pancreatic inflammation activity allowed to establish the high informative value of the research methods unlike thoses of the computed tomography scan and ultrasound at chronic pancreatitis.

Keywords: chronic pancreatitis, morphology, sonoelastography, fibrous transformation, inflammation activity, radiological methods of diagnostics, pancreatic parenchyma
p. 240-248 of the original issue
References
  1. Domínguez-Muñoz JE. Latest advances in chronic pancreatitis. Gastroenterol Hepatol. 2013 Oct;36(Suppl 2):86-9. doi: 10.1016/S0210-5705(13)70058-X. [Article in Spanish].
  2. Gal'perin EI. Klassifikatsiia khronicheskogo pankreatita: opredelenie tiazhesti, vybor metoda lecheniia i neobkhodimoi operatsii [Classification of chronic pancreatitis: the definition of severity, treatment options and the desired action]. Annaly Khirurg Gepatologii. 2013;18(4):83-92.
  3. Adham M, Chopin-Laly X, Lepilliez V, Gincul R, Valette PJ, Ponchon T. Pancreatic resection: drain or no drain? Surgery. 2013 Nov;154(5):1069-77. doi: 10.1016/j.surg.2013.04.017.
  4. Kozlov IA, Kubyshkin VA. Rezektsiia golovki podzheludochnoi zhelezy pri khronicheskom pankreatite: obzor [Resection of the head of the pancreas in chronic pancreatitis: a review]. Khirurgiia Zhurn im NI Pirogova. 2004; (11):64-69.
  5. Danilov MV, Fedorov VD. Povtornye i rekonstruktivnye operatsii pri zabolevaniiakh podzheludochnoi zhelezy: ruk dlia vrachei [Repeated and reconstructive surgery for pancreatic diseases: a quide for physicians]. Moscow, RF: Meditsina; 2003. 424 p.
  6. Kriger AG, Kubyshkin VA, Karmazanovskii GG, Svitina KA, Kochatkov AV, Berelavichus SV, i dr. Posleoperatsionnyi pankreatit pri khirurgicheskikh vmeshatel'stvakh na podzheludochnoi zheleze [Postoperative pancreatitis with surgical interventions on the pancreas]. Khirurgiia Zhurn im NI Pirogova. 2012;(4):14-19.
  7. Grinevich VB, Maistrenko NA, Priadko AS, Romashchenko PN, Shcherbina NN. Problema khronicheskogo pankreatita s pozitsii terapevta i khirurga [The problem of chronic pancreatitis from the standpoint of physician and surgeon]. Med Akad Zhurn. 2012;12(2):35-55.
  8. Kubyshkin VA, Kozlov IA, Kriger AG, Chzhao AV. Khirurgicheskoe lechenie khronicheskogo pankreatita i ego oslozhnenii [Surgical treatment of chronic pancreatitis and its complications]. Annaly Khirurg Gepatologii. 2012;(4):24-35.
  9. Paklina OV, Karmazanovskii GG, Setdikova GR. Patomorfologicheskaia i luchevaia diagnostika khirurgicheskikh zabolevanii podzheludochnoi zhelezy [Pathological and X-ray diagnostics of surgical diseases of the pancreas]. Moscow, RF: Vidar-M; 2014. 188 p.
  10. Barannik ЄO, L³ns'ka GV, Dinnik OB., Marusenko A². Artefakti ta metodichn³ pomilki zsuvnokhvil'ovo¿ elastograf³¿ [Artifacts and methodological errors of wave elastography]. Promeneva D³agnostika Promeneva Terap³ia. 2015;(1):61-71.
  11. Morgenroth K, Kozuschek W. Pancreatitis. Berlin-New York: Walter de Gruyter; 1991. 120 p.
  12. Erkan M, Adler G, Apte MV, Bachem MG, Buchholz M, Detlefsen S, åt al. StellaTUM: current consensus and discussion on pancreatic stellate cell research. Gut. 2012;61(2):172-178. doi: 10.1136/gutjnl-2011-301220.
  13. DeWitt J, McGreevy K, LeBlanc J, McHenry L, Cummings O, Sherman S. EUS-guided Trucut biopsy of suspected nonfocal chronic pancreatitis. Gastrointest Endosc. 2005 Jul;62(1):76-84.
  14. Catalano MF, Sahai A, Levy M, Romagnuolo J, Wiersema M, Brugge W, åt al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 2009 Jun;69(7):1251-61. doi: 10.1016/j.gie.2008.07.043.
  15. Carrara S, Arcidiacono PG, Mezzi G, Petrone MC, Boemo C, Testoni PA. Pancreatic endoscopic ultrasound–guided fine needle aspiration: complication rate and clinical course in single center. Dig Liver Dis. 2010 Jul;42(Is 7):520-23. doi: 10.1016/j.dld.2009.10.002.
  16. Park MK, Jo J, Kwon H, Cho JH, Oh JY, Noh MH, et al. Usefulness of acoustic radiation force impulse elastography in the differential diagnosis of benign and malignant solid pancreatic lesions. Ultrasonography. 2014 Jan;33(1):26-33. doi: 10.14366/usg.13017.
Address for correspondence:
49074, Ukraine,
Dnepropetrovsk, pr-t im. Gazetyi ''Pravda'', d. 96,
GU ''Institut gastroenterologii NAMN Ukrainyi'',
otdelenie khirurgii organov pischevareniya,
tel. office: 38 0562 27 05 59,
e-mail: Aleksandr_babiy@ukr.net,
Babiy Aleksandr Mihaylovich
Information about the authors:
Shevchenko B.F. MD, professor, a chief researcher of the surgery department of the digestive organs of SE ''Institute of Gastroenterology of NAMS of Ukraine''.
Babiy A.M. PhD, a senior researcher of the surgery department of the digestive organs of SE ''Institute of Gastroenterology of NAMS of Ukraine''.
Gravirovskaya N.G. PhD, a leading researcher of the department of research-organizational, methodical work and informational technologies of SE ''Institute of Gastroenterology of NAMS of Ukraine''.
Petishko OP. A researcher of the department of research-organizational, methodical work and informational technologies of SE ''Institute of Gastroenterology of NAMS of Ukraine''.

S.N. EROSHKIN, M.G. SACHEK, L.E. KRISHTOPOV, S.D. FEDYANIN, E.S. EROSHKINA

POSSIBILITIES OF TIBIAL REVASCULARIZATION OSTEOTREPANATION IN TREATMENT OF PATIENTS WITH PYO-NECROTIC COMPLICATIONS OF DIABETIC FOOT SYNDROME

EE "Vitebsk State Medical University",
The Republic of Belarus

Objectives. To study the efficacy of the tibial revascularization osteotrepanation (ROT) in the complex treatment of patients with pyo-necrotic complications of diabetic foot syndrome (DFS).
Methods. The studies were carried out in patients (n=109) with a dry gangrene of the fingers. The research enrolled the patients with neuroischemic form of the disease, the inability of the direct revascularization of the limb and the absence of indications to the high limb amputation in emergency situations. The first group (n=42) consisted of patients underwent to ROT repeatedly within 6-12 months after the first operation. As for the second group (n=67) of the patients ROT was performed only once. In each group two subgroups were allocated depending on the preoperative indicators of acid-base balance (pO2, lactate concentration) in the venous blood. The first one included the patients with pO2 in the range of 30-60 mmHg and lactate concentration not higher than 2 mmoles / L.
The second group enrolled the patients in whom pO2 was outside the specified range, and lactate concentration was more than 2 mmol / L. The criterion of assess the efficacy was the number of high amputations of the lower limb.
Results. During the first two follow up years there were no reliable differences in incidence of amputations between the groups. 36 months after the treatment onset the number of high amputations performed in the first subgroup of the first group was significantly lower than in the same subgroup of the second group (p=0,016). The incidence of amputations in the second sub-groups was not differed (P>0,05).
Conclusion. Revascularization osteotrepanation of the tibia, carried out repeatedly within 6-12 months after the first operation, provides a more durable revascularization effect and improves the results of treatment in patients with pyo-necrotic complications of diabetic foot syndrome, in whom pO2 of the venous blood is in the range of 30-60 mm Hg and lactate concentration is not more than 2 mmol/L.

Keywords: diabetic foot syndrome, revascularization, preoperative indicators, osteotrepanation, acid-base balance of the blood, pyo-necrotic complications, incidence of amputations
p. 249-254 of the original issue
References
  1. Morbach S, Müller E, Reike H, Risse A, Rümenapf G, Spraul M. Diabetic foot syndrome. Exp Clin Endocrinol Diabetes. 2014;122:416-24. doi: 10.1055/S-0034.1366455.
  2. Skrepnek GH, Armstrong DG, Mills JL. Open bypass and endovascular procedures among diabetic foot ulcer cases in the United States from 2001 to 2010. J Vasc Surg. 2014 Nov;60(5):1255-64. doi: 10.1016/j.jvs.2014.04.071.
  3. Vogel TR, Kruse RL. Risk factors for readmission after lower extremity procedures for peripheral artery disease. J Vasc Surg. 2013 Jul;58(1):90-7.e1-4. doi: 10.1016/j.jvs.2012.12.031.
  4. Ahmad N, Thomas GN, Gill P, Chan C, Torella F. Lower limb amputation in England: prevalence, regional variation and relationship with revascularisation, deprivation and risk factors. A retrospective review of hospital data. J R Soc Med. 2014;107(12):483-89. doi: 10.1177/0141076814557301.
  5. De Vos B, Vandueren E, Dubois E, Raynal P, Verhelst G. Do surgical distal bypasses still play a role in the treatment of critical limb ischemia? Acta Chir Belg. 2009 Jul-Aug;109(4):465-76.
  6. Êîñèíåö ÀÍ, Çåíüêîâ ÀÀ. Ñèíäðîì äèàáåòè÷åñêîé ñòîïû. Âèòåáñê, ÐÁ: ÂÃÌÓ; 2003. 215 ñ.
  7. Kosul'nikov SO, Besedin AM, Kravchenko KV, Tarnopol'skii SA. Opyt primeneniia metodov nepriamoi revaskuliarizatsii u patsientov s sindromom diabeticheskoi stopy [Experience of indirect methods of revascularization application in patients with diabetic foot syndrome]. Suchasni Medichni Tekhnologii. 2010;(3):81-84.
  8. Eroshkin SN, Sachek MG. Vozmozhnosti ispol'zovaniia pokazatelei kislotno-shchelochnogo sostoianiia venoznoi krovi nizhnei konechnosti dlia prognozirovaniia effektivnosti revaskuliariziruiushchei osteotrepanatsii u patsientov s sindromom diabeticheskoi stopy [The possibility of using indicators of venous blood acid-base balance of the lower limb to predict the effectiveness of revascularization osteotrephination in patients with diabetic foot syndrome]. Vestn Eksperim i Klin Khirurgii. 2013;VI(3):292-98.
  9. Shevtsov VI, Shatokhin VD, Larionov AA, Bunov VS, Pepeliaev AG, Ivanov GP, dr. Sposoby stimuliatsii krovoobrashcheniia v konechnosti pri obliteriruiushchikh zabolevaniiakh arterii [Methods of stimulation of blood circulation in the limb with obliterating diseases of arteries]. Genii Ortopedii. 1996;(4):35-39.
Address for correspondence:
210023, Republic of Belarus,
Vitebsk, pr. Frunze, d. 27, UO "Vitebskiy gosudarstvennyiy
meditsinskiy universitet",
kafedra gospitalnoy khirurgii s
kursami urologii i detskoy khirurgii, tel.office: 375 212 342-1-08,
e-mail:
sergionik2014@gmail.com,
Eroshkin Sergey Nikolaevich
Information about the authors:
Eroshkin S.N. PhD, an assistant of the hospital surgery chair with the courses of urology and pediatric surgery of EE "Vitebsk State Medical University".
Sachek M.G. MD, professor, a head of the hospital surgery chair with the courses of urology and pediatric surgery of EE "Vitebsk State Medical University".
Krishtopov L.E. PhD, an associate professor of the hospital surgery chair with the courses of urology and pediatric surgery of EE "Vitebsk State Medical University".
Fedyanin S.D. PhD, an associate professor of the hospital surgery chair with the courses of urology and pediatric surgery of EE "Vitebsk State Medical University".
Eroshkina E.S. A 6-year student of the medical faculty of EE "Vitebsk State Medical University".

S.E. KATORKIN, M.A. MELNIKOV, P.F. KRAVTSOV, A.A. ZHUKOV, M.J. KUSHNARCHUK, A.A. REPIN

EFFICIENCY OF LAYER DERMATOLIPECTOMY (SHAVE THERAPY) IN COMPLEX TREATMENT OF PATIENTS WITH LOWER LIMBS VENOUS TROPHIC ULCERS

SBEE HPE "Samara State Medical University",
The Russian Federation

Objectives. To assess the efficacy of layer dermatolipectomy application in the complex treatment of patients with persistent refractory venous trophic ulcers.
Methods. The examination and combined treatment of patients C6 class (n=71) was carried out. The mean age was 62,3±7,1 yrs. Women dominated – 45 (63,4%). Duration of the venous ulcers composed 6,8±1,7 yrs. Phlebectomy (n=71) (crossectomy, short stripping on the hip, SEPS) was performed combined with a free autodermaplasty by the split perforated flap. Layer dermatolipectomy was carried out in the 1st group of patients prior to autodermoplasty. In the 2nd group of patients (n=36) shave therapy was not carried out. Statistical differences between the age groups (t=0,2; p=0,831), sex (χ2=0,008; p=0,993), nosology (χ2=0,004; p=0,995), anamnesis (t=0,14; p=0,891), duration (t=0,21; p=0,829) and the area (t=0,18; p=0,863) of the trophic venous ulcers were not recorded. Evaluation of long-term treatment results was carried out in the period from 1 to 12 months.
Results. Time of complete epithelialization of ulcers in the group I made up 31,4±4,7 days, in the group II - 49,4±7,2 days (t=2,09; p=0,044). In 27 (77,1%) patients in the group I a complete engraftment of autodermotransplant had occurred; in group II - in 7 (19,4%) patients (χ2=23,674; p=0.001). Epithelization of the partial graft necrosis (24,3±4,8 cm2) took place in 8 (22.9%) patients in group I at 42,4±4,5 days. In group II, partial necrosis (67,1±10,5 cm2) was in 29 (80,6%) cases, the lack of complete epithelialization was observed in 3 (8,3%) patients.
A statistically significant reduction in the malleolar volume of the affected leg in the 1st group (t±3,6; p±0,001) and in the 2nd group (t=2,2; p=0,035) was registered, more pronounced in the 1st group in 6 and 12 months (p<0,05).
Conclusion. Layer dermatolipectomy with autodermaplasty by the perforated flap and surgical correction of venous hemodynamic insufficiency is considered to be an effective treatment of chronic diseases of veins (C6 class). Shave therapy is the treatment of choice for persistent refractory venous trophic ulcers and lipodermatosclerosis of the lower limbs.

Keywords: chronic diseases of veins, chronic venous insufficiency, venous trophic ulcers, lipodermatosclerosis, shave therapy, treatment of choice, surgical correction
p. 255-264 of the original issue
References
  1. Kistner RL. Etiology and treatment of varicose ulcer of the leg. J Am Coll Surg. 2005 May;200(5):645-47.
  2. Shevchenko IuL, Stoiko IuM, Gudymovich VG, Ivanov AK. Kompleksnyi podkhod v lechenii obshirnykh troficheskikh iazv golenei v mnogoprofil'nom statsionare [A comprehensive approach in the treatment of the leg extensive trophic ulcers in a multidisciplinary hospital]. Vestn Eksperim i Klin Khirurgii. 2014;7(3):221-27.
  3. Hermanns HJ, Gallenkemper G, Kanya S, Waldhausen P. Die Shave-Therapie im Konzept der operativen Behandlung des therapie-resistenten Ulcus cruris venosum Aktuelle L. Phlebologie. 2005;34(4):209-15.
  4. Katorkin S, Sizonenko Y, Nasyrov M. Photodynamic therapy in the treatment of trophic leg ulcers. Vasomed. 2015;27(2):82-84.
  5. Stoffels I, Dissemond J, Klode J. Modern wound surgery – surgical treatment options. Phlebologie. 2013;42(4):199-204. doi: 10.12687/phleb2149-4-2013.
  6. Gohel MS, Barwell JR, Taylor M, Chant T, Foy C, Earnshaw JJ, et al. Long-term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomized controlled trial. BMJ. 2007; 335:83. doi: 10.1136/bmj.39216.542442.
  7. Katorkin SE, Zhukov AA, Kushnarchuk MIu. Kombinirovannoe lechenie vazotroficheskikh iazv pri khronicheskoi venoznoi nedostatochnosti nizhnikh konechnostei [Combined treatment of trophic ulcers in chronic venous insufficiency of the lower limbs]. Novosti Khirurgii. 2014;22(6):701-709. doi: 10.18484/2305-0047.2014.6.701.
  8. Kudykin MN, Izmailov SG, Beschastnov VV, Kletskin AE, Mukhin AS, Vasiagin AN. Kompleksnoe lechenie troficheskikh iazv [Complex treatment of venous ulcers]. Flebologiia. 2008;(3):16-20.
  9. Hermanns HJ, Hermanns A, Waldhausen P. Therapy-resistant Ulcera cruris et pedis in ludicrous foot deformity. Phlebologie. 2011;40(Is 6):334-36.
  10. Schwahn-Schreiber C. Surgery of ulcus cruris venosum. Phlebologie. 2010;39(Is 3):156-62.
  11. Schmeller W. Gaber Y. Die Spätergebnisse nach Shave-Therapie sind abhängig vom Zustand des tiefen Venensystems. Phlebologie. 1998;27(6):195-200.
  12. Braun S, Jünger M. Methoden des Wunddebridements bei venösem Ulcus cruris. Phlebologie. 2003;32(6):152-56.
  13. Hermanns HJ, Schwahn-Schreiber Ch, Waldermann F. Importance of surgical treatment in venous leg ulcers. Consensus document and therapeutical instructions of the study-group Surgical Treatment in Venous Leg Ulcers. Phlebologie. 2006;35(Is 4):199-203.
  14. Bogachev VIu, Bogdanets LI, Zolotukhin IA, Briushkov AIu, Zhuravleva OV. Posloinaia dermatolipektomiia (shave-therapy) pri dlitel'no nezazhivaiushchikh venoznykh troficheskikh iazvakh [Layered dermolipectomy (shave-therapy) with nonhealing venous trophic ulcers]. Angiologiia i Sosudistaia Khirurgiia. 2003;9(4):65-70.
  15. Sushkou SA, Kukhtenkov PA, Khmel'nikov VI. Pervyi opyt primeneniia posloinoi dermatolipektomii (shave-therapy) pri lechenii khronicheskoi venoznoi nedostatochnosti [The first experience of layer dermolipectomy (shave-therapy) in the treatment of chronic venous insufficiency]. Novosti Khirurgii. 2007;15(1):53-57.
Address for correspondence:
443079, Russian Federation,
Samara, pr. Karla Marksa, d. 165 " b",
Kliniki Samarskogo gosudarstvennogo
meditsinskogo universiteta,
kafedra i klinika gospitalnoy khirurgii.
tel. office 8 10 846 276-77-89,
e-mail: katorkinse@mail.ru,
Katorkin Sergey Evgenevich
Information about the authors:
Katorkin S.E. PhD, an associate professor, a head of the chair and clinic of hospital surgery of SBEE HPE "Samara State Medical University".
Melnikov M.A. PhD, an associate professor, a head of the vascular surgery department of the clinic of hospital surgery of SBEE HPE "Samara State Medical University".
Kravtsov P.F. PhD, a cardiovascular surgeon of the vascular surgery department of the clinic and assistant of hospital surgery chair of SBEE HPE "Samara State Medical University".
Zhukov A.A. A cardiovascular surgeon of the vascular surgery department of the clinic of hospital surgery chair of SBEE HPE "Samara State Medical University".
Kushnarchuk M.J. A cardiovascular surgeon of the vascular surgery department of the clinic of hospital surgery chair of SBEE HPE "Samara State Medical University".
Repin A.A. A cardiovascular surgeon of the vascular surgery department of the clinic of hospital surgery chair of SBEE HPE "Samara State Medical University".

TRAUMATOLOGY & ORTHOPEDICS

N.I. KHVISYUK1, S.A. GOLOBOROD’KO1, S.K. RAMALDANOV2

ULTRASOUND DIAGNOSIS AFTER ANTERIOR SUBCUTANEOUS TRANSPOSITION OF THE ULNAR NERVE

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

Objectives. To confirm the absence of dislocation of the ulnar nerve after its anterior subcutaneous transposition.
Methods. Diagnostic ultrasonographic examination of the ulnar nerve after subcutaneous anterior transposition in patients (n=9) had been carried out. There were 4 females and 5 males in the studied group; the average age was 42 years (ranging 25-59 years). The transposition of the ulnar nerve was performed on one right and on eight left upper extremities: in 8 patients with cubital tunnel syndrome and in 1 with old injury of the ulnar nerve. Ultrasonography was performed in all patients after 16 months in average (from 6 to 25) after surgery.
For prevention of dislocation of the ulnar nerve after its subcutane­ous transposition the method of fixation of the ulnar nerve had been worked out. The longitudinal undulating incision with length of 12-14 cm was performed. The top of one of the “waves” section should be turned laterally and placed 1,5-2 cm laterally from the apex of the medial epicondyle of the humerus. After transposition of the nerve in the forearm fascia in the longitudinal direction C-shaped incision that form and location coincides with the peak of the “waves” of skin incision was carried out. In the area of the top “waves” 3-4 vertical mattress skin-subcutaneous-fascial sutures had been imposed.
Diagnostic ultrasonographic examination was performed on an ultrasound diagnostic apparatus Philips HD7 (Austria) with the using of a L 12-3 MHz linear array transducer.
Results. The analysis of transverse and longitudinal ultrasound scannings in all operated patients (n=9) in extension, flexion and upon attempt of forcible displacement of the ulnar nerve the skin-subcutaneous-fascial block scar reliably held the ulnar nerve in the anterior subcutaneous transposition.
Conclusion. Ultrasonographic examination permits to confirm objectively the absence of dislocation of the ulnar nerve after anterior subcutaneous transposition.

Keywords: cubital tunnel syndrome, dislocation of the ulnar nerve, operative treatment, recurrence, ultrasonography, anterior subcutaneous transposition of the ulnar nerve
p. 265-268 of the original issue
References
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Address for correspondence:
61178, Ukraine,
Kharkov, Saltovskoe shosse
d. 266, korpus 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:
Khvisyuk N.I. MD, professor of the chair of traumatology, anesthesiology and military medicine of Kharkov Medical Academy of Postgraduate Education. Ukraine.
Goloborod’ko S.A. PhD, an associate professor of the chair of combustiology, reconstructive and plastic surgery of Kharkov Medical Academy of Postgraduate Education. Ukraine.
Ramaldanov S.K. PhD, a physician of Kharkov Regional Clinical Traumatological Hospital. Ukraine.

ONCOLOGY

A.V. PROCHOROV1, I.N. LABUNETS1, M.N. SHAPETSKA1, V.Y. MAVRICHEV2, A.S. MATYLEVICH1

THE LONG-TERM RESULTS OF SURGICAL TREATMENT OF GASTROESOPHAGEAL CANCER

EE "Belorusian State Medical University"1,
ME "Minsk City Clinical Oncology Dispansery"2,
The Republic of Belarus

Objectives. To study the long-term results of surgical treatment of gastroesophageal cancer in the dependent on the main prognostic factors of the disease, tumor resectability and extent of lymph node dissection.
Methods. The analysis of surgical treatment results was carried out in 329 patients with gastroesophageal cancer who underwent transpleural resection of the stomach and esophagus: gastrectomy with the resection of the lower third of the esophagus by Garlock (n=155); proximal resection of the stomach with the lower third of the esophagus by Garlock (n=96); proximal resection of the stomach with subtotal resection of the esophagus by Lewis (n=78).
Results. Postoperative mortality composed 5,2%: after gastrectomy by Garlock – 3,9%, after proximal gastrectomy by Garlock – 5,2%, after Lewis’s surgery – 7,7%. Overall five-year survival rate was 26.2%. 43.6% of patients without metastatic lymph nodes and 18,4% with nodal metastases had survived this period of observation. Survival of patients didn’t depend of the number of metastatic lymph nodes (N1, N2, N3). Five-year survival after radical resection of the stomach and the esophagus amounted 29,1%, after palliative – 9,4%. After the combined surgeries with the resection of adjacent organs in comparison with those after conventional surgery. After a combiened operations with resection of adjacent organs compared with those afte conventional surgery the survived 5 years (12,5% and 31,3%), respectively. The analysis of treatment results in patients depending on the morphological type of the gastroesophageal tumor didn’t reveal statistically reliable differences in the patients’ survival.
Conclusion. The survival rate of patients after surgical treatment of gastroesophageal cancer remains low. The prognosis depends mainly on the extent of the tumor process. Survival of patients without nodal metastases (all types of operations) is two-fold higher than in those with the regional lymphogenous metastasis. The number of affected groups of lymph nodes doesn’t influence the overall and recurrence-free survival rate. The combined and palliative resections can provide the 5-year relative survival rate only at the level of 10-15%.

Keywords: gastroesophageal cancer, tumor resectability, surgery, metastases, lymphadenectomy, survival rate, lethality rate
p. 269-274 of the original issue
References
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  13. Kim S, Lim DH, Lee J, Kang WK, MacDonald JS, Park CH, et al. An observational study suggesting clinical benefit for adjuvant postoperative chemoradiation in a population of over 500 cases after gastric resection with D2 nodal dissection for adenocarcinoma of the stomach. Int J Radiat Oncol Biol Phys. 2005 Dec 1;63(5):1279-85.
  14. Lee J, Lim do H, Kim S, Park SH, Park JO, Park YS, et al. Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial. J Clin Oncol. 2012 Jan 20;30(3):268-73. doi: 10.1200/JCO.2011.39.1953.
  15. Ohtsu A, Shah MA, Van Cutsem E, Rha SY, Sawaki A, Park SR, et al. Bevacizumab in combination with chemotherapy as first-line therapy in advanced gastric cancer: a randomized, double-blind, placebo-controlled phase III study. J Clin Oncol. 2011 Oct 20;29(30):3968-76. doi: 10.1200/JCO.2011.36.2236.
  16. Fuchs CS, Tomasek J, Cho JY, Tomasello G, Goswami C, dos Santos LV, et al. REGARD: a phase 3, randomized, doubleblinded trial of ramucirumab and best supportive care (BSC) versus placebo and BSC in the treatment of metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma following disease progression onfirst-line platinum- and/or fluoropyrimidine-containing combination therapy: age subgroup analysis. J Clin Oncol. 2014;32(suppl; abstr 4057).
Address for correspondence:
220116, Republic of Belarus,
Minsk, pr. Dzerzhinskogo, d. 83,
UO "Belorusskiy gosudarstvennyiy meditsinskiy universitet",
kafedra onkologii,
tel. office: 375172902971,
e-mail: aprokharau@gmail.com,
Prochorov Aleksandr Viktorovich
Information about the authors:
Prochorov A.V. MD, professor, a head of the oncology chair of EE "Belarusian State Medical University".
Labunets I.N. PhD, an associate professor of the oncology chair of EE "Belarusian State Medical University".
Shapetska M.N. PhD, an associate professor of the oncology chair of EE "Belarusian State Medical University".
Mavrichev V.Y. A head of the oncology-surgical unit ¹4 of ME "Minsk City Clinical Oncology Dispensary".
Matylevich A.S. A 5-year student of the medical faculty of EE "Belarusian State Medical University".

REVIEWS

A.I. PROTASEVICH, A.A. TATUR

EFFICIENCY OF VACUUM THERAPY IN TREATMENT OF POSTOPERATIVE STERNOMEDIASTINITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

EE "Belarusian State Medical University"
The Republic of Belarus

Objectives. Efficacy estimation of vacuum-assisted closure therapy (VAC) in comparison with conventional methods in the treatment of deep sternal infection following cardiothoracic surgery by carrying out systematic review and meta-analysis of study publications devoted to the given problem.
Methods. A systematic search was conducted (PubMed, elibrary.ru, hand search) for studies dedicated to the comparative analysis of vacuum-assisted closure therapy efficacy and a conventional treatment of deep sternal infection (1997-2015 yrs). The Newcastle-Ottawa Scale (NOS) for assessing the quality of methodology of the study was used. Mortality was considered the primary outcome, secondary outcome – duration of therapy and disease recurrences. The results were presented as odds ratios (ORs) 95% of confidence interval (CI). Statistical heterogeneity was assessed using Q-test and I2-test.
Results. For the analysis 26 non-randomized, retrospective, cohort studies published from 1997 to September 2015, including the results of treatment of postoperative sternal infections in 2616 patients were selected. It was found in the case of using the VAC-therapy the lethality was significantly lower than in conventional treatment (2233 patients; OR=0,40; 95% CI 0,28-0,57; ð<0,0001; I2=0%). VAC-therapy use was associated with fewer recurrences (1322 patients; OR=0,27; 95% CI 0,16-0,45; ð<0,0001; I2 =23%). A significant reduction of the therapy duration had been revealed (1577 patients; mean difference -5,86 days; 95% CI -9,40: -1,08; ð=0,02) with high heterogeneity between studies (I2 =87%).
Conclusion. The systematic review and meta-analysis suggest that VAC- therapy might be more effective than a conventional one in treatment of deep sternal infections. However, randomized studies are required to confirm the potential value of this type of treatment.

Keywords: sternomediastinitis, deep sternal infection, vacuum assisted closure, meta-analysis, local negative pressure, lethality
p. 275-284 of the original issue
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Address for correspondence:
220116, Republic of Belarus,
Minsk, pr. Dzerzhinskogo, d. 83,
UO "Belorusskiy gosudarstvennyiy meditsinskiy universitet",
1-ya kafedra khirurgicheskih bolezney,
tel. office: 375 29 771-43-01,
e-mail: aprot@yandex.ru,
Protasevich Aleksey Ivanovich
Information about the authors:
Protasevich A.I. PhD, an associate professor of the 1st chair of surgical diseases of EE "Belarusian State Medical University".
Tatur A.A. MD, professor of the 1st chair of surgical diseases of EE "Belarusian State Medical University".

NEW METHODS

A.D. RAIMKHANOV, M.Z. AYMAGAMBETOV, E.M. ASYLBEKOV, N.B. OMAROV, Z.Y. ZHAGNIYEV

REPAIR OF HERNIA SAC AT COMPLEX INGUINAL HERNIAS

State Medical University, Semey
The Republic of Kazakhstan

Objectives. To assess the effectiveness of hernia sac repair by the worked out method for recurrent inguinal, inguinal and scrotal hernias.
Methods. The surgical treatment analysis of patients (n=77) with recurrent inguinal and inguinal-scrotal hernias was carried out. 26 patients made up the main group (MG). The hernial sac is closely adhered to his spermatic cord; the developed technique of the hernia sac repair was applied. The clinical comparison (CCI) included 51 patients. In the GCS the hernia sac was treated in a conventional manner with suturing, ligation and excision in the neck area. To evaluate the surgical treatment effectiveness of patients of MG and CCI the following criteria were used: the processing time of the hernia sac, the incidence of postoperative complications and recurrences. The results were evaluated after 1-3 years of follow-up.
Results. The mean duration of hernia sac repair in patients with recurrent and complex inguinal hernias requiring to relegate the hernia sac from the elements of the spermatic cord was 23,8±3,9 min in the CCI and – 19,3±2,6 min – in MG. The difference between the duration of hernia repair in the two groups was reliable (p<0,05), no significant difference in the frequency of complications between groups was observed. Recurrence of the disease in the long-term period per time of observation (1-3 years) was not occurred.
Conclusion. The worked out hernia sac repair technique aimed to reduce traumatism and intervention time can be widely used in surgical treatment of inguinal hernias. The proposed method of treatment of hernia sac at oblique inguinal hernia is considered to be justified in all cases when hernia sac is in dense adhesion with spermatic cord. The technique allows reducing the number of early postoperative complications in oblique inguinal hernias. The method is considered to be easily performed and it reduces surgical time.

Keywords: inguinal hernia, hernia sac, spermatic cord, tension-free, hernioplasty, postoperative complications, surgical time
p. 285-289 of the original issue
References
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  11. Bisgaard T, Kehlet H, Bay-Nielsen M, Iversen MG, Rosenberg J, Jørgensen LN. A nationwide study on readmission, morbidity, and mortality after umbilical and epigastric hernia repair. Hernia. 2011 Oct;15(5):541-6. doi: 10.1007/s10029-011-0823-z.
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Address for correspondence:
071400, Republic of Kazakhstan,
Semey, ul. Sechenova d. 1 a,
Meditsinskiy Tsentr Gosudarstvennogo
Meditsinskogo Universiteta g. Semey,
kafedra internaturyi po khirurgii,
tel. mob.: 7-707-332-00-84,
e-mail: aidar_rd@mail.ru,
Raimkhanov Aydar Duysenovich
Information about the authors:
Raimkhanov A.D. A student of the clinical internship chair in surgery of State Medical University.
Aymagambetov M.Z. MD, an associate professor of the clinical internship chair in surgery of State Medical University.
Asylbekov E.M. PhD, a head of the surgery department of the Medical Center of State Medical University.
Omarov N.B. An assistant of the clinical internship chair in surgery of State Medical University.
Zhagniyev Z.Y. An intern of the clinical internship chair in surgery of State Medical University.

CASE REPORTS

A.V. VOROBEY ¹,², E.I. VIZHINIS¹,², G.A. POPEL ¹,², D.A. CHEPIK ²,³, Z.G. MASKALIK ²,³, A.M. MAKHMUDOV¹,²

CICATRICAL POST-BURN STRICTURE OF THE ESOPHAGUS: A REPEATED ESOPHAGOCOLOPLASTY

SEE ''Belarusian Medical Academy of Post-graduate education''¹,
The Republican Center of Surgical Gastroenterology and Coloproctology ²,
ME ''Minsk Regional Clinical Hospital'' ³,
The Republic of Belarus

The clinical case of the patient’s surgical treatment with the cicatricial esophageal stricture is presented. Gastrostomy was done as the initial procedure and later the retrosternal esophagoplasty with the right colon interposition was performed. Postoperative period was complicated by necrosis of the colon transplant, which was removed and the nourishing jejunostomy was applied. Due to the insufficient blood supply of the left colon flank, the patient was carried out the ligation of sigmoid artery for the left side colon revascularization by analogy with the technique of Shumacker H. and Battersby J. (1951) and Shalimov A.A. (1951), proposed by them to develop the vascular collaterals in the jejunum before esophagojejunoplasty. After restoration of an adequate blood supply in colonic transplant, the reconstructive-restorative procedures had been performed (laparotomy and esophagocoloplasty by using of left colon flank). Transpleural movement of transplant from the abdominal cavity to the neck using endoscope was considered the peculiarity of this case. It permitted to avoid thoracotomy. A clinical case is interesting by implementation of idea of revascularization of intestine to enhance blood supply to the colonic segment, allowing successfully to prepare left colon flank for esophagoplasty after right- sided esophageal graft necrosis.

Keywords: esophageal burn, abdominal cavity, cicatricial esophageal stricture, retrosternal and transpleural esophageal replacement, laparotomy, colonic transplant necrosis, esophagus mesentericography, revascularization.
p. 290-297 of the original issue
References
  1. Andrianov VA, Zenger VG, Titov VV. Rezul'taty ezofagofaringoplastiki tolstoi kishkoi pri sochetannykh rubtsovykh strikturakh pishchevoda i glotki [Results esophagopharyngoplasty by colon at combined scar strictures of the esophagus and throat]. Annaly Khirurgii. 2008;(4):18-25.
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  3. Stel'mashonok IM. Taktika khirurga pri kombinirovannykh rubtsovykh suzheniiakh pishchevoda i zheludka [Tactics of the surgeon in combined cicatricial strictures of the esophagus and stomach]. Vestn Khirurgii im II Grekova. 1969;(3):48-51.
  4. Stel'mashonok IM. Operativnoe lechenie rubtsovykh suzhenii pishchevoda i zheludka [Surgical treatment of cicatricial strictures of the esophagus and stomach]. Minsk, RF: Belarus'; 1970. 272 p.
  5. Chernousov AF, Andrianov VA, Zenger VG, Voronov ME. Plastika pishchevoda tolstoi kishkoi [Esophageal plasty by colon]. Moscow, RF: IzdAT; 1999. 176 p.
  6. Matiashin IM. Total'naia plastika pishchevoda tolstoi kishkoi [Total esophageal plasty by colon]. Kiev, Ukraina: Zdorov'ia; 1971. 192 p.
  7. Isolauri J, Harju E, Markkula H. Gastrointestinal symptoms after colon interposition. Am J Gastroenterol. 1986 Nov;81(11):1055-58.
  8. Han Y, Cheng QS, Li XF, Wang XP. Surgical management of esophageal strictures after caustic burns: a 30 years of experience. World J Gastroenterol. 2004 Oct 1;10(19):2846-49.
  9. Chernousov AF, Andrianov VA, Domrachev SA, Bogopol'skii PM. Opyt 1100 plastik pishchevoda [1100 experiences of esophageal plasty]. Khirurgiia Zhurn im NI Pirogova. 1998;(6):21-25.
  10. Sarli L, Iusco D, Violi V, Roncoroni L. Subtotal colectomy with antiperistaltic cecorectal anastomosis. Tech Coloproctol. 2002 Apr;6(1):23-6.
  11. Mumladze RB, Bakirov AA. Ezofagogastroplastika pri strikturakh pishchevoda [Esophagogastroplasty at esophageal strictures]. Annaly Khirurgii. 2000;(6):31-34.
  12. Vorobei AV, Chepik DA, Vizhinis EI. Odnoetapnaia zagrudinnaia ezofagokoloplastika v lechenii bol'nykh s ozhogovoi rubtsovoi strikturoi pishchevoda [One-stage retrosternal colonic esophagoplasty in treatment of patients with scar burn stricture of esophagus]. Khirurgiia Zhurn im NI Pirogova. 2014;(7):26-33.
  13. Shumacker HB Jr, Battersby JS. The problem of esophageal replacement by jegunum with particular reference to influence upon circulation of staging the division of mesenteric vessels. Ann Surg. 1951 Apr;133(4):463-71.
  14. Shalimov AA. Sozdanie iskusstvennogo pishchevoda pri rubtsovoi neprokhodimosti [Creating artificial esophagus in cicatricial.obstruction]. Khirurgiia Zhurn im NI Pirogova. 1951;9:24-28
  15. Vorobei AV, Chepik DA, Vizhinis EI. Klinicheskoe obosnovanie odnoetapnoi zagrudinnoi ezofagoplastipki v lechenii bol'nykh s posleozhogovoi rubtsovoi strikturoi pishchevoda [Clinical justification of one-stage retrosternal colonic esophagoplasty in treatment of patients with scar burn stricture of esophagus]. Meditsina. 2009;(4):52-56.
  16. Vorobei AV, Vizhinis EI, Chepik DA. Puti povysheniia zhiznesposobnosti sheinogo otdela transplantata pri zagrudinnoi ezofagokoloplastike [Ways to improve the viability of the cervical graft in retrosternal esophago- coloplasty]. Materialy pervoi mezhdunar konf po torakoabdominal'noi khirurgii. Moscow, RF; 2008. p. 247.
  17. Dzhafarov ChM, Dzhafarov ECh. Blizhaishie i otdalennye rezul'taty khirurgicheskogo lecheniia bol'nykh s rubtsovymi strikturami pishchevoda posle khimicheskogo ozhoga [Immediate and long-term results of surgical treatment of patients with esophageal cicatricial strictures after chemical burn]. Vestn Khirurgii im II Grekova. 2007;166(5):36-38.
Address for correspondence:
223040, Republic of Belarus,
Minsk region, p. Lesnoy – 1, UZ'' Minskaya
oblastnaya bolnitsa'',
kafedra khirurgii,
tel. office: 375 17 265-22-13,
375 17 265 -22-63
e-mail: dept–surg@hotmail.com,
Vorobey Aleksandr Vladimirovich
Information about the authors:
Vorobey A.V. A Corresponding member of NAS of Belarus, MD, professor, a head of the surgery chair of SEE ''Belarusian Medical Academy of Post-graduate Education'', a chief of the Republican Center of Surgical Gastroenterology and Coloproctology.
Vizhinis E.I. PhD, an associate professor of the surgery chair of SEE ''Belarusian Medical Academy of Post-graduate Education''.
Popel G.A. An assistant of the surgery chair of SEE ''Belarusian Medical Academy of Post-graduate Education''.
Chepik D.A. A head of the surgical department ¹1 of ME ''Minsk Regional Clinical Hospital''.
Maskalik Z.G. An endoscopist of ME ''Minsk Regional Clinical Hospital''.
Makhmudov A.M. A senior lecturer of the surgery chair of SEE ''Belarusian Medical Academy of Post-graduate Education''.

T.G. GULMURADOV, O.N. SADRIEV, Z.Z. ABDURAKHIMOV, R.S. AMINOV

SUCCESSFUL SURGICAL TREATMENT OF PATIENTS WITH ECHINOCOCCOSIS OF THE LEFT VENTRICLE AND LIVER

Republican Scientific Center of Cardiovascular Surgery
Dushanbe
The Republic of Tajikistan

The article presents the case of the successful treatment of a female with concomitant left ventricular and liver hydatid disease. Peculiarities of instrumental diagnosis and the chosen surgical approach are given. The patient was carried out step by step echinococcectomy from the left heart ventricle with swabbing of the residual cavity by the omentum on the vascular pedicle, derived through an incision in the diaphragm and echinococcectomy from the liver without capitonnage of the residual cavity. Echinococcectomy was performed on a beating heart, without capitonnage of the intracardiac portion of the fibrous capsule for the myocardial wall plasty that is of great interest to this clinical case. To prevent the development of the left ventricular aneurysm, the residual cavity was swabbed by the omentum strand on the vascular pedicle, derived through the incision in the diaphragm. During the control ECG and echocardiography in the postoperative period, a positive trend towards the disappearance of ischemic lesion was observed as well as increasing the contractility of the left ventricle. Echinococcectomy of the VIII liver segment was performed after 6 months by laparotomy with good immediate and remote results. In the observed period no signs of disease recurrence were revealed.

Keywords: hydatid disease, myocardium, surgical treatment, myocardial wall plasty, echinococcectomy, laparotomy, immediate and remote results
p. 298-302 of the original issue
References
  1. Ivanov VA, Podchasov DA, Evseev EP, Domnin VV, Popov SO, Iarygin IV. Uspeshnoe khirurgicheskoe lechenie ekhinokokkoza serdtsa [Successful surgical treatment of echinococcosis of heart]. Kardiologiia i Serdech-Sosud Khirurgiia. 2011;(4):89-92.
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  5. Birincioğlu CL, Tarcan O, Bardakci H, Saritaş A, Taşdemir O. Off-pump technique for the treatment of ventricular myocardial echinococcosis. Ann Thorac Surg. 2003 Apr;75(4):1232-37.
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  7. Yan F, Huo Q, Abudureheman M, Qiao J, Ma S, Wen H. Surgical treatment and outcome of cardiac cystic echinococcosis. Eur J Cardiothorac Surg. 2015 Jun;47(6):1053-8. doi: 10.1093/ejcts/ezu323.
  8. Dasbaksi K, Haldar S, Mukherjee K, Mukherjee P. A rare combination of hepatic and pericardial hydatid cyst and review of literature. Int J Surg Case Rep. 2015;10:52-55. doi: 10.1016/j.ijscr.2015.02.052.
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Address for correspondence:
734003, Republic of Tadzhikistan,
Dushanbe, prospekt Rudaki, d. 139,
Tadzhikskiy gosudarstvennyiy
meditsinskiy universitet imeni Abuali ibni Sino,
kafedra khirurgicheskih bolezney ¹2.
tel. office : 992 915 25 00 55;
e-mail: sadriev_o_n@mail.ru,
Sadriev Okildzhon Nemadzhonovich
Information about the authors:
Gulmuradov T.G. A Corresponding Member of the academy of Sciences of Tajikistan, MD, professor, supervisor of the Republican Scientific Center of Cardiovascular Surgery.
Sadriev O.N. A leading researcher of the Republican Scientific Center of Cardiovascular Surgery.
Abdurakhimov Z.Z. MD, professor of the heart surgery department of the Republican Scientific Center of Cardiovascular Surgery.
Aminov R.S. PhD, a physician of the heart surgery department of the Republican Scientific Center of Cardiovascular Surgery.

EXCHANGE OF EXPERIENCE

E.L. KALMYKOV1, Z.S. FAIZIEV2, H.Z. FAIZIEV3

FOREIGN BODIES OF TRACHEA AND BRONCHI

National Scientific Center of Transplantation of Human Organs and Tissues1,
Republican Center of Cardiovascular Surgery 2,
Avicenna Tajik State Medical University3,
Dushanbe,
The Republic of Tajikistan

Objectives. The analysis of the experience in airway (trachea and bronchi) foreign body removal by flexible bronchoscope.
Methods. Removal of foreign bodies from the respiratory tract (FBRT) was performed in 47 patients. There were 27 (57,5%) females, and 20 (42,5%) males. Age of patients ranged from 8 to 72 years. In 46 cases the patients underwent chest X-ray, in one case – CT.
Results. Foreign bodies were located: in the trachea – 2 cases (4,2%), in the right bronchial tree – 26 (55,3%), in the left bronchial tree – 19 (40,4%).
The early admission to the medical establishment with FBRT composed only 74,4% (n=35) out of 47 cases. The symptoms of an acute aspiration were asfollows: an acute respiratory failure in 35 (77,7%) cases, cough – 45 (100%), vomiting - 4 (8,8%), stridulous breathingr – 5 (11,1%), bronchospasm – 4 (11,1%).
In 95,8% (n = 45) of observations, foreign bodies localized in the bronchi on different levels. Radiography may be used to locate foreign bodies for removal. In 37 cases X-ray was able to determine the type of foreign body and its localization; in 10 cases radiography was failed to show the localization of the foreign body. The foreign bodies in the respiratory tract were: the needles – 22 (46,8%); nails / screws – 11 (23,4%); fish bones / animal bones – 8 (17%); tooth / denture (fragments) – 3 (6,3%); dental tool – 1 (2,1%); a thorn from a rose – 1 (2,1%); pistachio shells – 1 (2,1%). In 46 patients the foreign bodies were successfully removed by means of fibrobronchoscopy but in one case thoracotomy was performed.
Conclusion. In recent years the number of cases of foreign bodies in respiratory tract tends to increase. The various changes in the bronchial tree, the severity of the inflammatory response depended on FB length of stay in the respiratory tract can be detected by bronchoscopy. Bronchoscopic foreign body removal is considered to be a safe and effective procedure in 97,8% of cases.

Keywords: foreign-body aspiration, foreign bodies, fibrobronchoscopy, removal, bronchial tree, thoracotomy, radiography
p. 303-308 of the original issue
References
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  14. Rizk N, Gwely NE, Biron VL, Hamza U. Metallic hairpin inhalation: a healthcare problem facing young Muslim females. J Otolaryngol Head Neck Surg. 2014 Aug 2;43:21. doi: 10.1186/s40463-014-0021-y.
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Address for correspondence:
734002, Republic of Tadzhikistan, Dushanbe,
ul. Mayakovskogo, d. 2,
Natsionalnyiy nauchnyiy tsentr
transplantatsii organov i tkaney cheloveka
Ministerstva zdravoohraneniya
i sotsialnoy zaschityi naseleniya Respubliki Tadzhikistan,
tel. 992 90 811-00-18,
e-mail: egan0428@mail.ru,
Kalmykov Egan Leonidovich
Information about the authors:
Kalmykov E.L. PhD, a Deputy Director for Science of National Scientific Center of Transplantation of Human Organs and Tissues of the Ministry of Health and Social Protection of the Population of the Republic of Tadzhikistan.
Faiziev Z.S. PhD, a leading researcher of the Republican Center of Cardiovascular Surgery of the Ministry of Health and Social Protection of the Population of the Republic of Tadzhikistan.
Faiziev H.Z. A post-graduate student of the surgical diseases chair ¹2 of Avicenna Tajik State Medical University
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