Novosti
Khirurgii

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Year 2019 Vol. 27 No 3

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

V.A. LIPATOV 1, S.V. LAZARENKO 1, A.N. BETZ 2, D.A. SEVERINOV 1

CHANGES OF PHYSICO-MECHANICAL PROPERTIES OF VASCULAR PATCHES IN CONDITIONS OF CHRONIC EXPERIMENT IN VIVO

Kursk State Medical University 1,
Kursk Regional Hospital 2, Kursk,
The Russian Federation

Objective. To study the changes of the physical and mechanical properties of the vascular patch canvas (breaking load and tensile elongation at uniaxial tension) in the conditions of a chronic experiment in vivo.
Methods. New samples of vascular patches based on polyethylene terephthalate (PETP) fibers were used for experimental studies. In the group 1 – warp-knitted canvas based on polyethylene terephthalate fibers was used; in the group 2 – woven canvas based on polyethylene terephthalate and fluoronone, additionally impregnated with gelatin; the group 3 – warp knitted canvas based on polyethylene terephthalate fibers, developed by the group of the authors. As a comparison group, the results of the study of the same samples of vascular patches, non-implanted into the tissue of laboratory animals were used.
As the object for implantation, 60 male rats of Wistar line were chosen. Rats were divided into 3 groups (20 in each) according to the number of types of experimental samples and within each group into subgroups (10 according to the time of elimination from the experiment: 15 and 30 days). The test samples were implanted in the paravertebral region to the laboratory animals. Testing of physical-mechanical characteristics was carried out according to standard methods for assessing the strength characteristics using a tensile testing machine REM-0.2-1. The elongation (%) of the implant canals after implantation at 8 N, 16 N was evaluated, the breaking load (N) was recorded.
Results. Samples of vascular patches of polyethylene terephthalate, which do not have additional treatment with gelatin in the production process (group 3), withstood the greatest breaking load - 147 N (on the 15th day of the experiment) and 151 N (30 day), respectively. The percentage of their elongation was from 6% to 49%. In the case of samples with gelatin treatment, it was 66, 5 N and 75 N.
Conclusions. The values of the indices of the studied parameters of the physical mechanical properties of polymeric vascular implants after implantation to laboratory animals are higher in the samples of the group 3 during all periods of the experiment (15 and 30 days).

Keywords: vascular patches, chronic experiment, bursting machine, extensibility, polyethylene terephthalate, implants, vascular surgery
p. 249-255 of the original issue
References
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  2. Antonova LV, Sevostyanova VV, Seifalian AM, Matveeva VG, Velikanova EA, Sergeeva EA, Glushkova TV, Krivkina EO, Nasonova MV, Shishkova DK, Kudryavtseva YuA, Barbarash OL, Barbarash LS. Comparative in vitro testing of biodegradable vascular grafts for tissue engineering applications. Kompleks Problemy Serdech-Sosud Zabolevanii. 2015;(4):34-41. https://www.nii-kpssz.com/jour/article/view/149/144 (in Russ.)
  3. Popryadukhin PV, Popov GI, Dobrovolskaya IP, Yudin VE., Vavilov VN, Yukina GYu, Ivankova EM. Elaboration of matrix for tissue-engineering vascular implant based on aliphatic co-polyamide nano-fibers for children’s vascular surgery. Prakt Meditsina. 2017;(10):82-88. http://pmarchive.ru/el-arxiv/arxiv-za-2017-god/prakticheskaya-medicina-10-111-pediatriya/ (in Russ.)
  4. Zhukovsky VA. Polymer implants for reconstructive surgery. Innova. 2016;(2):51-59. doi: 10.21626/innova/2016.2/05 (in Russ.)
  5. Greenwald SE, Berry CL. Improving vascular grafts: the importance of mechanical and haemodynamic properties. J Pathol. 2000 Feb;190(3):292-99. doi: 10.1002/(SICI)1096-9896(200002)190:3<292::AID-PATH528>3.0.CO;2-S
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  7. Hou LD, Li Z, Pan Y, Sabir M, Zheng YF, Li L. A review on biodegradable materials for cardiovascular stent application. Front Mater Sci. 2016 Sep;10(Is 3):238-59. doi: 10.1007/s11706-016-0344-x
  8. Ivchenko AO, Shvedov AN, Ivchenko OA. Vascular prostheses used in infrainguinal arterial reconstruction. Biul Sib Meditsiny. 2017;16(1):132-39. doi: 10.20538/1682-0363-2017-1-132–139 (in Russ.)
  9. Yatigala NS, Bajwa DS, Bajwa SG. Compatibilization improves physico-mechanical properties of biodegradable biobased polymer composites. Compos Part A Appl Sci Manuf. 2018 Apr;107:315-25. doi: 10.1016/j.compositesa.2018.01.011
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  11. Novikova SP, Salokhedinova RR, Loseva SV, Nikolashina LN, Levkina AYu. Analysis of physico-mechanics and structural characteristics of vascular prostheses. Grudnaia i Serdech-Sosud Khirurgiia. 2012; (4):27-33. https://tcs-journal.com/catalog/detail.php?-SECTION_ID=822&ID=17864 (in Russ.)
  12. Kokorev OV, Khodorenko VN, Anikeev SG, Gunther VE. Biocompatibility Of Textile Titanium Nickel Implants With Fibroblast Culture. Biul Eksperim Biologii i Meditsiny. 2015;159(1):98-102. https://elibrary.ru/item.asp?id=22879593 (in Russ.)
  13. Ivanov AV, Lipatov VA, Lazarenko SV, Zherdev NN, Severinov DA. The influence of mechanical characteristics of vascular patches on the formation of capsules. Klin i Eksperim Khirurgiia. Zhurn im Akad BV Petrovskogo. 2016;4(1):51-57. https://cyberleninka.ru/article/n/vliyanie-mehanicheskih-harakteristik-sosudistoy-zaplaty-na-formirovanie-periproteznoy-kapsuly (in Russ.)
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  15. Glushkova TV, Sevostyanova VV, Antonova LV, Klyshnikov KYu, Ovcharenko EA, Sergeeva EA, Vasyukov JYu, Seifalian AM, Barbarash LS. Biomechanical remodeling of biodegradable small-diameter vascular grafts in situ. Vestn Transplantologii i Iskusstv Organov. 2016;18(2):99-109. doi: 10.15825/1995-1191-2016-2-99-109 (in Russ.)
  16. Vinokur AA, Djakov VÅ, Alukhanjan ÎA. Comparative research of physicomechanical properties of new PTFE patches. Kuban Nauch Med Vestn. 2010;(8):40-46. https://cyberleninka.ru/article/n/sravnitelnoe-issledovanie-fiziko-mehanicheskih-svoystv-novyh-zaplat-iz-politetraftoretilena (in Russ.)
Address for correspondence:
305041, The Russian Federation,
Kursk, Karl Marks Str., 3,
Kursk State Medical University,
Department of Operative Surgery
and Topographic Anatomy,
Tel: +7 920 262-15-55,
e-mail: dmitriy.severinov.93@mail.ru,
Dmitriy A. Severinov
Information about the authors:
Lipatov Viacheslav A., MD, Associate Professor, Professor of the Department of Operative Surgery and Topographic Anatomy, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0001-6121-7412
Lazarenko Sergey V., PhD, Assistant of the Oncology Department, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0002-7200-4508
Betz Alexander N., Cardiovascular Surgeon, Kursk Regional Hospital, Kursk, Russian Federation.
https://orcid.org/0000-0001-6115-1812
Severinov Dmitriy A., Assistant of the Department of Operative Surgery and Topographic Anatomy, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0003-4460-1353

R.A. SADYKOV, B.A. ISMAILOV, O.V. KIM

NEW FILM COATING BASED ON CELLULOSE DERIVATIVES FOR LOCAL HEMOSTASIS

Republican Specialized Scientific and Practical Medical Center of Surgery named after academician V. Vakhidov, Tashkent,
Uzbekistan

Objective. To study hemostatic activity and biocompatibility of new film coating based on cellulose derivatives on the model of the liver injury in experiment.
Methods. The film coating based on cellulose derivatives was used for investigations. Tensile strength, implant structure evaluation, adhesion force were evaluated using “Zwick” apparatus (Germany), Agilent Technologies atomic force microscope (USA). Hemostatic activity was evaluated by the Lee-White method.
Experimental studies were performed on the model of the liver injury in 32 adult mongrel outbred white rats. Operations were performed under inhalation anesthesia. Animals were removed from the experiment after 1, 3, 12 hours and on the 1st, 3rd, 7th, 14th and 30th day after the operation according to the accepted ethical standards. Macroscopic and microscopic studies were conducted.
Results. The adhesion strength of the film coating was 7.3±0.2 kPa (M±m), the breaking strength – 390.4±4.8 kHz/ cm2 (M±m). The coagulation time was 2.4±0.6 minutes (M±m) in the presence of polymer.
The use of the film coating allowed stopping bleeding rather quickly in the parenchyma bleeding from the liver injury (5.3±3.1 seconds). Sequential observations of the animals showed that 1 hour after the operation the implant was kept on the liver surface as a white coating was not separated from the wound surface. No signs of bleeding were noted. Histological studies of the liver biopsy specimens revealed a mild inflammatory disease with complete degradation of the coating on the 14th day after the operation.
Conclusions. The designed new film coating based on cellulose derivatives causes effective hemostasis, has good adhesiveness to the injured liver tissue and sufficient tensile strength. Biodegradation of the implant occurs within 2 weeks after application to the liver wound without a severe inflammatory reaction.

Keywords: biologic coating, hemostasis, morphology, carboxymethylcellulose, oxidized cellulose, hemostatic agent
p. 256-263 of the original issue
References
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  2. Heinze T, Koschella A. Carboxymethyl ethers of cellulose and starch-a review. Macromol Symp. 2005;223(1):13-40. doi: 10.1002/masy.200550502
  3. Parikh DV, Fink T, Rajasekharan K, Sachinvala N, Sawhney APS, Calamari TA, Parikh A. Antimicrobial silver/sodium carboxymethyl cotton dressings for burn wounds. Text Res J. 2005;75(2):134-38. doi: 10.1177/004051750507500208
  4. Porsch B, Wittgren B. Analysis of calcium salt of carboxymethyl cellulose: size distributions of parent carboxymethyl cellulose by size-exclusion chromatography with dual light-scattering and refractometric detection. Carbohydr Polym. 2005;59(1):27-35. doi: 10.1016/j.carbpol.2004.08.019
  5. Hattori H, Amano Y, Nogami Y, Takase B, Ishihara M. Hemostasis for severe hemorrhage with photocrosslinkable chitosan hydrogel and calcium alginate. Ann Biomed Eng. 2010 Dec;38(12):3724-32. doi: 10.1007/s10439-010-0121-4
  6. Lipatov VA, Ershov MP, Sotnikov KA, Ushanov AA, Novikova NV, Konstantinova YuE. The modern trends of using local applicational blood reestablishing instruments of surgery of abdominal organs (literature review). Nauch Elektron Zhurn «Innova». 2016;(2):64-67. http://innova-journal.ru/issues/2016-2-3/files/07.pdf (in Russ.)
  7. Tanaka Y, Tane S, Hokka D, Ogawa H, Maniwa Y. The use of oxidized regenerated cellulose for video-assisted thoracic surgery. Ann Thorac Surg. 2016 Feb;101(2):786-88. doi: 10.1016/j.athoracsur.2015.08.078
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  10. Gottrup F, Cullen BM, Karlsmark T, Bischoff-Mikkelsen M, Nisbet L, Gibson MC. Randomized controlled trial on collagen/oxidized regenerated cellulose/silver treatment. Wound Repair Regen. 2013 May-Jun;21(2):216-25. doi: 10.1111/wrr.12020
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  13. Kim SH, Kim SH, Yoon HS, Kim HK, Kim KS. Efficacy of Oxidized Regenerated Cellulose, SurgiGuard®, in Porcine Surgery. Yonsei Med J. 2017 Jan;58(1):195-205. doi: 10.3349/ymj.2017.58.1.195
  14. Genyk Y, Kato T, Pomposelli JJ, Wright JK Jr, Sher LS, Tetens V, Chapman WC. Fibrin Sealant Patch (TachoSil) vs Oxidized Regenerated Cellulose Patch (Surgicel Original) for the Secondary Treatment of Local Bleeding in Patients Undergoing Hepatic Resection: A Randomized Controlled Trial. J Am Coll Surg. 2016 Mar;222(3):261-68. doi: 10.1016/j.jamcollsurg.2015.12.007
  15. Tarkova AR, Cherniavskii AM, Morozov SV, Grigor’ev IA, Tkacheva NI, Rodionov VI. Gemostaticheskii material mestnogo deistviia na osnove okislennoi tselliulozy. Sib Nauch Med Zhurn. 2015;35(2):11-15. http://sibmed.net/article.php?lang=rus&id_article=329 (in Russ.)
  16. Jaiswal AK, Chhabra H, Narwane S, Rege N, Bellare JR. Hemostatic Efficacy of Nanofibrous Matrix in Rat Liver Injury Model. Surg Innov. 2017 Feb;24(1):23-28. doi: 10.1177/1553350616675799
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Address for correspondence:
100115, Uzbekistan,
Tashkent, Kichik Khalqa Yoli, 10,
Republican Specialized Scientific and Practical
Medical Center of Surgery
Named after Academician V. Vakhidov,
Experimental Surgery Department.
Tel. +99 890 351-03-34,
e-mail: bahodirismailov@gmail.com,
Bakhodir A. Ismailov
Information about the authors:
Sadykov Rustam A., MD, Professor, Head of the Experimental Surgery Department, Republican Specialized Scientific and Practical Medical Center of Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan.
https://orcid.org/0000-0003-4524-1484
Ismailov Bakhodir A., Junior Researcher of the Experimental Surgery Department, Republican Specialized Scientific and Practical Medical Center of Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan.
https://orcid.org/0000-0001-6150-9386
Kim Olga V., Junior Researcher of the Experimental Surgery Department, Republican Specialized Scientific and Practical Medical Center of Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan.
https://orcid.org/0000-0002-1703-1554

GENERAL & SPECIAL SURGERY

S.A. BELOV 1, A.A. GRIGORYUK 2

INFLUENCE OF THORACOPLASTY ON THE EXTERNAL RESPIRATORY FUNCTION

Seaside Regional Antituberculous Dispensary 1,
Pacific State Medical University 2, Vladivostok,
The Russian Federation

Objective. To evaluate the function of external respiration after thoracoplasty using the polypropylene mesh.
Methods. 42 cases of collapse surgical treatment of fibrous-cavernous pulmonary tuberculosis were studied. Patients were divided into 2 groups. The 1st group (n=21) – patients who were performed the author’s method of extrapleural upper-posterior thoracoplasty using the mesh «Surgipro» implant; the 2nd group (n=21) – patients who underwent traditional extrapleural upper-posterior thoracoplasty. The function of external respiration, perfusion of the lungs, dead space ratio and efficiency of surgical method were compared.
Results. Pre-surgery spirographic study revealed the violation of the external respiration function in all patients. There was a change in the gas composition of the blood and ventilation-perfusion relations on the first day after the intervention in both groups. In the second group, there was a significant decrease in lung capacity, forced expiratory volume, the percentage of arterial blood oxygen saturation (p<0.05) and the development of respiratory and metabolic acidosis. In the first group, thoracoplasty using the mesh implant «Surgipro» revealed no violation of the ventilation-perfusion balance and a significant decrease in external respiration compared to the original figures (p>0.05). Clinical and x-ray examination of patients three weeks after the operation indicates that in the group with the use of polypropylene mesh, the occurrence of complications and the preservation of bacterial excretion is much lower. The developed method of extrapleural upper-posterior thoracoplasty using a mesh polypropylene implant can solve the problem of chest reconstruction, reduces the risk of paradoxical breathing and increases the degree of compression necessary to close the defects in the lungs.
Conclusions. Breach of the skeleton of the chest lowers the release of carbon dioxide from the body. The use of the mesh implant in the formation of a new pleural dome reduces the coefficient of dead space and prevents the development of the respiratory imbalance.

Keywords: pulmonary tuberculosis, external respiration, thoracoplasty, polypropylene mesh, implant
p. 264-268 of the original issue
References
  1. Fu Y, Duanmu H, Fu Y. Surgery for Pulmonary Tuberculosis and Its Indications. In: Lu Y, Wang L, Duanmu H, Chanyasulkit C, Strong A, Zhang H. (eds). Handbook of Global Tuberculosis Control. Springer, Boston, MA; 2017. p 225-34 doi: 10.1007/978-1-4939-6667-7_14
  2. Ots ON, Chushkin MI, Struchkov PV. Post tuberculosis lung function impairment. Pul’monologiia. 2017;27(5):656-63. doi: 10.18093/0869-0189-2017-27-3-656-663 (in Russ.)
  3. Dewan RK, Moodley L. Resurgence of therapeutically destitute tuberculosis: amalgamation of old and newer techniques. J Thorac Dis. 2014 Mar;6(3):196-201. doi: 10.3978/j.issn.2072-1439.2013.12.19
  4. Kuhtin O, Veith M, Alghanem M, Martel I, Giller D, Haas V, Lampl L. Thoracoplasty-Current View on Indication and Technique. Thorac Cardiovasc Surg. 2018 May 17. doi: 10.1055/s-0038-1642633
  5. Hicks A, Muthukumarasamy S, Maxwell D, Howlett D. Chronic inactive pulmonary tuberculosis and treatment sequelae: chest radiographic features. Int J Tuberc Lung Dis. 2014 Feb;18(2):128-33. doi: 10.5588/ijtld.13.0360
  6. Korpusenko IV. Application of minimally invasive extapleural thoracoplasty in patients with bilateral tuberculosis of the lungs. Novosti Khirurgii. 2015;23(1):37-43. doi: 10.18484/2305-0047.2015.1.37 (in Russ.)
  7. Vishnevskii AA, Rudakov SS, Milanov NO. Khirurgiia grudnoi stenki: ruk. Moscow, RF: Vidar; 2005. 312 p. http://kingmed.info/knigi/Hiryrgia/Torakalnaya_hirurgiya/book_2032/Hirurgiya_grudnoy_stenki-Vishnevskiy_AA_Rudakov_SS_Milanov_NO-2005-pdf (in Russ.)
Address for correspondence:
690041, The Russian Federation,
Vladivostok, Pyatnadtsataya Str., 2,
Seaside Regional Antituberculous Dispensary,
4th Pulmonary Surgical Department.
Tel. mobile: +7 914 734-35-74,
e-mail: sur_belove@mail.ru,
Sergei A. Belov
Information about the authors:
Belov Sergei A., PhD, Thoracic Surgeon, 4th Pulmonary Surgical Department, Seaside Regional Antituberculous Dispensary, Vladivostok, Russian Federation.
http://orcid.org/0000-0001-5325-2891
Grigoryuk Alexandr A., PhD, Associate Professor, Institute of Surgery, Pacific State Medical University, Vladivostok, Russian Federation.
http://orcid.org/0000-0002-7957-5872

S.N. ZAVGORODNIY, M.A. KUBRAK, M.B. DANYLIUK

SIMULTANEOUS OPERATIONAL INTERVENTIONS IN PATIENTS WITH THYROID PATHOLOGY

Zaporizhzhia State Medical University, Zaporizhzhia,
Ukraine

Objective. To improve the diagnostic of combined surgical diseases and evaluate the results of simultaneous surgical interventions performed in patients with thyroid pathology.
Methods. A retrospective analysis of case histories of 564 patients with the thyroid gland (TG) diseases was performed. The main group consisted of 247 (43.8%) hospitalized patients who were examined according to the developed diagnostic algorithm for combined surgical pathology. The comparison group included 317 (56.2%) patients examined according to the diagnostic and treatment protocols for patients with endocrine pathology approved in Ukraine. The levels of detection of combined surgical pathology, its structure, indicators of simultaneous operations, postoperative complications and mortality in both groups were evaluated using statistical methods of analysis.
Results. In the comparison group, 21 (6.6%) patients had a combined surgical pathology. In the main group – in 61 (24.7%) of the examined. 55 (90.2%) patients of the main group and 18 (85.7%) operated on in the comparison group underwent simultaneous surgical intervention. The level of simultaneous operations in the main group was 22.3%, in the comparison group – 5.7%. In 7 (12.7%) patients of the main group and in 2 (11.1%) of the comparison group, postoperative complications occurred. Lethal cases in both groups were not recorded.
Conclusions. The use of the developed algorithm for examining patients with thyroid pathology allowed an increase in the diagnostic of combined surgical diseases from 6.6% to 24.7%, χ2=9.342, p<0.01. This made it possible to increase the number of simultaneous operations performed from 5.7% to 22.3%, χ2=8.692, p<0.01. An increase in the percentage of simultaneous surgical procedures performed does not increase in mortality rates and postoperative complications.

Keywords: diagnostic techniques, endocrine system, surgical pathology, thyroid diseases, operations
p. 269-275 of the original issue
References
  1. Kravchenko V², Postol SV. Dinam³ka zakhvoriuvanost³ na patolog³iu shchitopod³bno¿ zalozi v Ukra¿n³. Mezhdunar Endokrin Zhurn. 2011;(3):26-31. http://www.mif-ua.com/archive/article/17759 (in Russ.)
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  3. Panarese A, D’Andrea V, Pontone S, Favoriti P, Pironi D, Arcieri S, Filippini A, Sorrenti S. Management of concomitant hyperparathyroidism and thyroid diseases in the elderly patients: a retrospective cohort study. Aging Clin Exp Res. 2017 Feb;29(Suppl 1):29-33. doi: 10.1007/s40520-016-0665-8
  4. Nikonenko AS, Zavgorodnii SN, Golovko NG, Klimenko AV, Gaidarzhi EI, Vil’khovoi SO, Dolia OS, Detsyk DA, Rusanov IV, Podluzhnyi AA. Simul’tannye operatsii pri khirurgicheskom lechenii bol’nykh s endokrinnoi patologiei. Suchasni Medichni Tekhnolog³¿. 2013;(3):137-39. http://www.zmapo-journal.com.ua/uk/arhiv-nomeriv-zhurnalu/2013-rik/vipusk-2-2013 (in Russ.)
  5. Zavgorodniy SM, Kubrak MA, Rylov AI, Danilyk MB. Diagnostic algorithm in combined surgical pathology in patients with diseases of endocrine system. Mezhdunar Endokrin Zhurn. 2017;13(8):591-95. doi: 10.22141/2224-0721.13.8.2017.119276 (in Russ.)
  6. Spanheimer PM, Weigel RJ. Management of patients with primary hyperparathyroidism and concurrent thyroid disease: an evolving field. Ann Surg Oncol. 2012 May;19(5):1428-29. doi: 10.1245/s10434-012-2286-6
  7. Emirikҫi S, Özҫ?nar B, Öner G, Omarov N, Ağcaoğlu O, Soytaş Y, Aksakal N, Yanar F, Barbaros U, Erbil Y. Thyroid cancer incidence in simultaneous thyroidectomy with parathyroid surgery. Ulus Cerrahi Derg. 2015 Aug 18;31(4):214-17. doi: 10.5152/UCD.2015.2666. eCollection 2015
  8. Simsek B, Guldogan CE, Ozden S, Saylam B, Karabeyoglu SM, Tez M. Concomitant thyroid cancer in patients with primary hyperparathyroidism in an endemic goitre region. Ann Ital Chir. 2017;88:15-19. https://www.annaliitalianidichirurgia.it/PDF/2017/03_2622+blocco.pdf
  9. Morris R, Yen TWF, Doffek K, Carr AA, Wilson SD, Evans DB, Wang TS. Concurrent endocrine and other surgical procedures: an institutional experience. J Surg Res. 2017 May 1;211:107-13. doi: 10.1016/j.jss.2016.12.013
Address for correspondence:
69035, Ukraine,
Zaporizhzhia, Mayakovsky Ave., 26,
Zaporizhzhia State Medical University,
Department of Surgery and Anesthesiology
Of the Post-Graduate Training Faculty.
Tel. +38 095 700-78-93,
e-mail: braviorio@gmail.com,
Mykhaylo A. Kubrak
Information about the authors:
Zavgorodniy Sergey N., MD, Professor, Head of the Department of Surgery and Anesthesiology of the Post-Graduate Training Faculty, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine.
http://orcid.org/0000-0003-3082-3406
Kubrak Mykhaylo A., Senior Laboratory Assistant of the Department of Surgery and Anesthesiology of the Post-Graduate Training Faculty, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine.
http://orcid.org/0000-0003-4051-9336
Danyliuk Mykhailo B., PhD, Assistant of the Department of Surgery and Anesthesiology of the Post-Graduate Training Faculty, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine.
http://orcid.org/0000-0003-4515-7522

V. SIHOTSKY 1, 2, I. KOPOLOVETS 1, 3, M. KUBIKOVA 1, 2, P. STEFANIC 1, 2, V. KATUCH 2

RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH AORTOILIAC ATHEROSCLEROSIS

Eastern Slovak Institute of Cardiovascular Diseases 1,
Pavol Jozef Safarik University 2, Kosice,
the Slovak Republic
Uzhhorod National University 3, Uzhhorod,
Ukraine

Objective. To investigate the results of surgical treatment of patients with aortoiliac pathology in the early postoperative period.
Methods. In the study 103 patients with aortoiliac pathology were included, who were referred to the Clinic of Vascular Surgery from 2015 to 2017 years. 53 patients were operated on because of aortoiliac atherosclerosis and 50 patients – because of abdominal aortic aneurysm. The indications for surgery were limiting claudication, critical limb ischemia or acute thrombosis of the aorta in patients with aortoiliac atherosclerosis. The indication for surgery in patients with abdominal aortic aneurysm was the aneurysm over 5.5 cm in the transverse diameter or the ruptured aneurysm. Early results of patients’ surgical treatment were assessed by the frequency of postoperative complications and deaths.
Results. 49 (92.5%) out of 53 patients with aortoiliac atherosclerosis were operated on as planned and 4 (7.5%) patients were operated on urgently. 52 (98.2%) aortobifemoral bypasses and one (1.8%) aortofemoral (unilateral) bypass were performed. Three complications (6.1%) occurred postoperatively in patients operated on according to plan and one complication (25%) – in patients operated urgently. The mortality rate was 25% in urgent patients and 2.0% in planned patients. 28 patients with asymptomatic abdominal aortic aneurysm and 22 with the ruptured abdominal aortic aneurysm were operated on. The mortality in the planned patients was 3.6%. 40.9% mortality rate was registered in the ruptured abdominal aortic aneurysm patients.
Conclusions. Early good and satisfactory results of the routine surgical treatment of symptomatic aortoiliac atherosclerosis in the early postoperative period accounted 98%, asymptomatic aortic aneurysm – 96.4%. Mortality after urgent surgery with aneurysm rupture made up 40.9%. Surgical treatment of aortic aneurysm is indicated in patients with low and moderate surgical risk.

Keywords: atherosclerosis, aortic aneurysms, critical limb ischemia, aortoiliac reconstructions
p. 276-283 of the original issue
References
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  5. Patel R, Sweeting MJ, Powell JT, Greenhalgh RM. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016 Nov 12;388(10058):2366-74. doi: 10.1016/S0140-6736(16)31135-7
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  14. Patel R, Powell JT, Sweeting MJ, Epstein DM, Barrett JK, Greenhalgh RM. The UK EndoVascular Aneurysm Repair (EVAR) randomised controlled trials: long-term follow-up and cost-effectiveness analysis. Health Technol Assess. 2018 Jan;22(5):1-132. doi: 10.3310/hta22050
  15. Kapma MR, Dijksman LM, Reimerink JJ, de Groof AJ, Zeebregts CJ, Wisselink W, Balm R, Dijkgraaf MG, Vahl AC. Cost-effectiveness and cost-utility of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Amsterdam Acute Aneurysm Trial. Br J Surg. 2014 Feb;101(3):208-15. doi: 10.1002/bjs.9356
Address for correspondence:
04001, Slovakia,
Kosice, Ondavska Str., 8,
Eastern Slovak Institute
of Cardiovascular Diseases.
Tel. + 421 055 789-15-10,
e-mail: i.kopolovets@ gmail.com,
Ivan Kopolovets
Information about the authors:
Sihotský Vladimir, PhD, Deputy Head of the Clinic of Vascular Surgery for Pedagogical Work, Vascular Surgeon, Eastern Slovak Institute of Cardiovascular Diseases, Pavol Jozef Safarik University, Medical Faculty, Kosice, Slovak Republic.
https://orcid.org/0000-0002-1446-8216
Kopolovets Ivan, PhD, Vascular Surgeon, Eastern Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic, Researcher of Uzhhorod National University, Uzhhorod, Ukraine.
http://orcid.org/0000-0002-2721-6114
Kubikový Maria, PhD, Vascular Surgeon, Eastern Slovak Institute of Cardiovascular Diseases, Pavol Jozef Safarik University, Medical Faculty, Kosice, Slovak Republic.
https://orcid.org/0000-0001-5628-8814
Stefanic Peter, PhD, Vascular Surgeon, Eastern Slovak Institute of Cardiovascular Diseases, Pavol Jozef Safarik University, Medical Faculty, Kosice, Slovak Republic.
http://orcid.org/0000-0002-0396-3676
Katuch Vladimir, PhD, Head of the Neurosurgery Clinic, Pavol Jozef Safarik University, Medical Faculty, Kosice, Slovak Republic.
http://orcid.org/0000-0001-8044-4012

MAXILLOFACIAL SURGERY

A.A. KABANOVA

VACUUM THERAPY IN COMPLEX TREATMENT OF PATIENTS WITH ODONTOGENIC INFLAMMATORY PROCESS OF THE MAXILLOFACIAL AREA AND NECK

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

Objective. To evaluate the effectiveness of the vacuum system in the complex treatment of patients with odontogenic inflammatory diseases of the maxillofacial area and neck.
Methods. The examination of 178 patients with acute odontogenic osteomyelitis of the jaw, complicated by phlegmon of the adjacent tissue spaces, was conducted. To manage the patients of the main group vacuum system was additionally used. Patients in the comparison group were treated using standard methods. The control group consisted of 50 healthy individuals. The erythrocyte deformability (ED) was evaluated by the time of their suspension passing of a standard distance through a porous filter. The adhesion of leukocyte-platelet suspension (LTS) was investigated by recording the changes in the light transmission of the leukocyte’s suspension before and after incubation with a fibrous substrate using the AR 2110 «SOLAR» aggregometer.
Results. When vacuum therapy was included in the medical complex, in shorter terms (5 (5-6) days) the pain during palpation of the inflammatory focus was stopped; the face configuration was restored on the 7 (5-8) day; the skin redness was stopped on the 5 (5-6) day; purulent exudation from the wound was stopped on the 6 (5-7) day; favorable conditions were created for the beginning of the formation of granulations on the 7 (6-8) day. A decrease in treatment terms (9 (8-10) days) of the main group of patients in relation to the duration of treatment in patients with standard complex treatment (10 (8-12) days) was revealed. Vacuum therapy at the end of treatment helps to reduce microcirculation indices elevated at the beginning of treatment to the level of healthy individuals.
Conclusions. The use of vacuum therapy in the treatment of patients with acute odontogenic osteomyelitis of the jaw, complicated by phlegmon of the adjacent tissue spaces, reduces the wound healing terms and reduces the duration of treatment from 10 (8; 12) days to 9 (8; 10) days. Normalization of the rate and degree of aggregation of LTS, DE in the blood plasma was revealed at the end of patients’ treatment using negative pressure.

Keywords: vacuum therapy, inflammatory diseases, maxillofacial area, wound cleansing, microcirculation
p. 284-290 of the original issue
References
  1. Pinelis IS, Turchina EV. Modern views on antibacterial therapy of póî-inflammatory diseases of maxillofacial area. Zabaikal Med Vestn. 2014;(3):182-88. http://zabmedvestnik.ru/journal/2014/3/28.pdf (in Russ.)
  2. Andrews BT, Smith RB, Goldstein DP, Funk GF. Management of complicated head and neck wounds with vacuum-assisted closure system. Head Neck. 2006 Nov;28(11):974-81. doi: 10.1002/hed.20496
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  6. Qiu Y, Li Y, Gao B, Li J, Pan L, Ye Z, Lin Y, Lin L. Therapeutic efficacy of vacuum sealing drainage-assisted irrigation in patients with severe multiple-space infections in the oral, maxillofacial, and cervical regions. J Craniomaxillofac Surg. 2019 May;47(5):837-41. doi: 10.1016/j.jcms.2019.01.031
  7. Zemljanoj VP, Singaevikij AB, Kozhevnikov VP. Morphological and functional monitoring of the wound healing process in the evaluation of the vacuum therapy of wounos. Vestn Nats Med-Khirurg Tsentra im NI Pirogova. 2016;11(4):51-55. https://cyberleninka.ru/article/n/mor-fologicheskiy-i-funktsionalnyy-monitoring-ranevogo-protsessa-v-otsenke-effektivnosti-vakuum-terapii-ran (in Russ.)
  8. Javia P, Rana A, Shapiro N, Shah P. Machine learning algorithms for classification of microcirculation images from septic and non-septic patients. Proceedings of the 17th IEEE International Conference on Machine Learning and Applications (ICMLA-2018); 2018 Dec 17-20; Orlando, Florida, USA. ð. 165-72. doi: 10.1109/ICMLA.2018.00097
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  10. Kozlovsky VI, Dubas IO. Pathological orthostatic reactions in patients with arterial hypertension and community-acquired pneumonia. Vestn VGMU. 2011;10(10):54-61. http://vestnik.vsmu.by/downloads/2011/vestnikVGMU-10-3-2011.pdf (in Russ.)
  11. Razmakhnin EV, Konovalova OG, Lobanov SL, Shangin VA. Ispol’zovanie vakuum-terapii pri lechenii gnoinykh ran. Zabaikal Med Zhurn. 2015;(2):70-71. http://chitgma.ru/ric/zabajkalskij-meditsinskij-zhurnal/2015-god/3697-zabajkalskij-meditsinskij-zhurnal-2-2015 (in Russ.)
  12. Monakov VA, Savel‘ev AL, Selezneva IA. Tsitologicheskaia dinamika gnoinykh ran cheliustno-litsevoi oblasti pri vakuumno-promyvnom drenirovanii. Mezhdunar Zhurn Priklad i Fundam Issledovanii. 2015;11:41-46. https://www.applied-research.ru/ru/article/view?id=7669 (in Russ.)
  13. Baldwin C, Potter M, Clayton E, Irvine L, Dye J. Topical negative pressure stimulates endothelial migration and proliferation: a suggested mechanism for improved integration of Integra. Ann Plast Surg. 2009 Jan;62(1):92-6. doi: 10.1097/SAP.0b013e31817762fd
  14. Greene AK, Puder M, Roy R, Arsenault D, Kwei S, Moses MA, Orgill DP. Microdeformational wound therapy: effects on angiogenesis and matrix metalloproteinases in chronic wounds of 3 debilitated patients. Ann Plast Surg. 2006 Apr;56(4):418-22. doi: 10.1097/01.sap.0000202831.43294.02
  15. Terskov DV, Cherdantsev DV, Diatlov VIu, Kovalenko AA. Evoliutsiia primeneniia otritsatel’nogo davleniia dlia lecheniia ran. Sovrem Problemy Nauki i Obrazovaniia. 2016;(3). http://www.science-education.ru/ru/article/view?id=24723 (in Russ.)
Address for correspondence:
210023, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Maxillofacial
Surgery and Surgical Dentistry
With a Course of Advanced
Training and Retraining of Medical Specialists.
Tel. +375 29 295-33-54,
e-mail: arinakabanova@mail.ru,
Arina A. Kabanova
Information about the authors:
Kabanova Arina A., PhD, Associate Professor, Head of the Department of Maxillofacial Surgery and Surgical Dentistry with a Course of Advanced Training and Retraining of Medical Specialists, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-0121-1139

ONCOLOGY

YU.V. SLABADZIN, E.A. ADUTCKEVICH, S.A. SIDOROV

LAPAROSCOPIC SURGERY OF COLORECTAL CANCER UNDER THE CONDITIONS OF ADHESIVE PROCESS OF THE ABDOMINAL CAVITY ORGANS

Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus, Minsk,
The Republic of Belarus

Objective. To assess safety and radicality of laparoscopic surgery of colorectal cancer in conditions of adhesive process of the abdominal organs.
Methods. 124 patients took part in the retrospective study, 41 of them were performed against the background of the existing adhesive process of the abdominal organs. Patients were divided into 2 groups: the main group (41 patients) – patients operated on for colorectal cancer on the background of the adhesive process of the abdominal cavity and control group (comparison group) – 83 patients operated on for colorectal cancer and not having any adhesive process in the abdominal cavity. In order to assess the severity of the adhesive process, as well as the places of fixing the intestinal loops to the anterior abdominal wall, to determine the point of possible installation of the first trocar, preoperative ultrasound examination was performed. Places through which it is possible to introduce trocars were marked. The severity of the adhesive process was assessed intraoperatively according to the scale of the peritoneal adhesion index.
Results. When installing the first 10 mm trocar or Veress needle, there was no damage to the internal organs in any case. The duration of surgical interventions was 40-50 minutes longer in the main group, this time was required for adhesiolysis. Mean hemorrhage in the first and the second group was minimal. Adhesive process of the abdominal cavity and laparoscopic method of surgical intervention did not violate the necessary lymph dissection. In the main and control groups in remote macroparts the proximal and distal margins of the resection were negative from the tumor process, which indicates the correct volume of resection and the possibility of performing laparoscopically in conditions of the adhesive process of the abdominal cavity.
Conclusions. Ultrasound examination of the abdominal cavity at the preoperative stage allows choosing the right points of the trocar entrance into the abdominal cavity. Execution of adhesions by laparoscopic method increases the visualization of the operation area and the quality of the conducted adhesiolysis, which increases the safety of the performed surgical intervention.

Keywords: laparoscopy, colorectal cancer, adhesions, adhesion index, adhesiolysis
p. 291-299 of the original issue
References
  1. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, Brenner H, Dicker DJ, Chimed-Orchir O, Dandona R, Dandona L, Fleming T, Forouzanfar MH, Hancock J, Hay RJ, Hunter-Merrill R, Huynh C, Hosgood HD, Johnson CO, Jonas JB, Khubchandani J, Kumar GA, Kutz M, Lan Q, Larson HJ, Liang X, Lim SS, Lopez AD, MacIntyre MF, Marczak L, Marquez N, Mokdad AH, Pinho C, Pourmalek F, Salomon JA, Sanabria JR, Sandar L, Sartorius B, Schwartz SM, Shackelford KA, Shibuya K, Stanaway J, Steiner C, Sun J, Takahashi K, Vollset SE, Vos T, Wagner JA, Wang H, Westerman R, Zeeb H, Zoeckler L, Abd-Allah F, Ahmed MB, Alabed S, Alam NK, Aldhahri SF, Alem G, Alemayohu MA, Ali R, Al-Raddadi R, Amare A, Amoako Y, Artaman A, Asayesh H, Atnafu N, Awasthi A, Saleem HB, Barac A, Bedi N, Bensenor I, Berhane A, Bernabé E, Betsu B, Binagwaho A, Boneya D, Campos-Nonato I, Castañeda-Orjuela C, CatalÁ-López F, Chiang P, Chibueze C, Chitheer A, Choi JY, Cowie B, Damtew S, das Neves J, Dey S, Dharmaratne S, Dhillon P, Ding E, Driscoll T, Ekwueme D, Endries AY, Farvid M, Farzadfar F, Fernandes J, Fischer F, G/Hiwot TT, Gebru A, Gopalani S, Hailu A, Horino M, Horita N, Husseini A, Huybrechts I, Inoue M, Islami F, Jakovljevic M, James S, Javanbakht M, Jee SH, Kasaeian A, Kedir MS, Khader YS, Khang YH, Kim D, Leigh J, Linn S, Lunevicius R, El Razek HMA, Malekzadeh R, Malta DC, Marcenes W, Markos D, Melaku YA, Meles KG, Mendoza W, Mengiste DT, Meretoja TJ, Miller TR, Mohammad KA, Mohammadi A, Mohammed S, Moradi-Lakeh M, Nagel G, Nand D, Le Nguyen Q, Nolte S, Ogbo FA, Oladimeji KE, Oren E, Pa M, Park EK, Pereira DM, Plass D, Qorbani M, Radfar A, Rafay A, Rahman M, Rana SM, Søreide K, Satpathy M, Sawhney M, Sepanlou SG, Shaikh MA, She J, Shiue I, Shore HR, Shrime MG, So S, Soneji S, Stathopoulou V, Stroumpoulis K, Sufiyan MB, Sykes BL, Tabarés-Seisdedos R, Tadese F, Tedla BA, Tessema GA, Thakur JS, Tran BX, Ukwaja KN, Uzochukwu BSC, Vlassov VV, Weiderpass E, Wubshet Terefe M, Yebyo HG, Yimam HH, Yonemoto N, Younis MZ, Yu C, Zaidi Z, Zaki MES, Zenebe ZM, Murray CJL, Naghavi M. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol. 2017 Apr 1;3(4):524-48. doi: 10.1001/jamaoncol.2016.5688
  2. Jemal A, Ward EM, Johnson CJ, Cronin KA, Ma J, Ryerson B, Mariotto A, Lake AJ, Wilson R, Sherman RL, Anderson RN, Henley SJ, Kohler BA, Penberthy L, Feuer EJ, Weir HK. Annual Report to the Nation on the Status of Cancer, 1975-2014, Featuring Survival. J Natl Cancer Inst. 2017 Sep 1;109(9). doi: 10.1093/jnci/djx030
  3. Axel EM. Gastrointestinal cancer statistics. ÑSib Onkol Zhurn. 2017;16(3):5-11. doi: 10.21294/1814-4861-2017-3-5-11
  4. Okeanov AE, Moiseev PI, Levin LF, Sukonko OG (red). Statistika onkologicheskikh zabolevanii v Respublike Belarus’ (2005-2014). Minsk, RB; 2015. 204 p. (in Russ.)
  5. Roscio F, Boni L, Clerici F, Frattini P, Cassinotti E, Scandroglio I. Is laparoscopic surgery really effective for the treatment of colon and rectal cancer in very elderly over 80 years old? A prospective multicentric case-control assessment. Surg Endosc. 2016 Oct;30(10):4372-82. doi: 10.1007/s00464-016-4755-7
  6. Surgical Care and Outcomes Assessment Program (SCOAP) Collaborative, Kwon S, Billingham R, Farrokhi E, Florence M, Herzig D, Horvath K, Rogers T, Steele S, Symons R, Thirlby R, Whiteford M, Flum DR. Adoption of laparoscopy for elective colorectal resection: a report from the Surgical Care and Outcomes Assessment Program. J Am Coll Surg. 2012 Jun;214(6):909-18.e1. doi: 10.1016/j.jamcollsurg.2012.03.010
  7. Pascual M, Salvans S, Pera M. Laparoscopic colorectal surgery: Current status and implementation of the latest technological innovations. World J Gastroenterol. 2016 Jan 14;22(2):704-17. doi: 10.3748/wjg.v22.i2.704
  8. Zaevskaya EV. Prognosis of the complicacy of the laparoscopy in the patients with the adhesive disease of the abdominal cavity. Tavr Med-Biol Vestn. 2009;12(3):134-35. http://dspace.nbuv.gov.ua/bitstream/handle/123456789/25301/33-Zaevskaya.pdf?sequence=1 (in Russ.)
Address for correspondence:
223028, The Republic of Belarus,
Minsk region, Zhdanovichi, 81/5,
Republican Clinical Medical Center
Of the Presidential Administration
of the Republic of Belarus,
Surgery Department.
Tel. mobile.: +375 29 230-66-84,
e-mail: s.i.d.o.r.o.v@mail.ru,
Sergey A. Sidorov
Information about the authors:
Slabadzin Yury V., PhD, Surgeon, Deputy Chief Physician for Surgery, Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-7881-8326
Àdutñkevich Ekaterina A., Oncologist, Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-0127-9042
Sidorov Sergey A., Surgeon, Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-7609-5427

ANESTHESIOLOGY-REANIMATOLOGY

K.V. NIKITSINA

EARLY RESPIRATORY SUPPORT IN PATIENTS WITH ACUTE NECROTIC PANCREATITIS

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

Objective. To analyze the results of carrying out the early respiratory support in patients with acute necrotic pancreatitis.
Methods. 53 patients with acute necrotic pancreatitis in the fermentative phase are surveyed. Patients have been divided into 2 groups: 1 group (n=29) – patients with standard intensive therapy; 2 group (n=24) – patients who were subject to the mechanical ventilation of the lungs from the first day. Patients of both groups had a severe course of the disease (Ranson >4 points and APACHE II >11 points). The research was conducted in 3 stages: the 1st stage – on admission to the intensive care unit; the 2nd stage – 1 day afterwards, 3 stage – after 4 days. The gases indicators of the arterial blood (pCO2, pO2, pO2/FiO2, lactate) were analyzed as well as the respiratory complains, intra-abdominal pressure, duration of respiratory therapy and mortality. The received results were compared in dynamics, between groups; their interrelation was analyzed.
Results. Carrying out of early respiratory support in patients with acute necrotic pancreatitis reduces the level of intra-abdominal pressure and normalizes the respiratory index, complains and the level of lactate. Indications for early respiratory support in patients with acute necrotic pancreatitis are the following: a severe course of the disease ≥4 points on scale Ranson and ≥11 points on APACHE II scale, intra-abdominal hypertension, low level of respiratory index <300 mm hg, high indicators of lactate >3.5 mmol/l.
Conclusions. Development of intra-abdominal hypertension in patients with acute necrotic pancreatitis aggravates the indicators of the respiratory status. Early mechanical ventilation of the lungs reduces the level of intra-abdominal pressure, normalizes the respiratory status indicators in the fermentative phase.

Keywords: acute necrotic pancreatitis, mechanical ventilation of lungs, respiratory index, respiratory complains, lactate, intra-abdominal hypertension
p. 300-306 of the original issue
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Address for correspondence:
210023, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Anesthesiology and Resuscitation
With the Course of Advanced
Training and Retraining of Specialists.
Tel: +375 33 316-10-25,
e-mail: katarinaanaest@gmail.com,
Katsiaryna V. Nikitsina
Information about the authors:
Nikitsina Katsiaryna V, PhD, Associate Professor, Head of the Department of Anesthesiology and Resuscitation with the Course of Advanced Training and Retraining of Specialists, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0003-4744-6838

INFORMATION TECHNOLOGIES IN SURGERY

I.V. MAKAROV, V.V. ZHIROV, A.V. KOLSANOV, R.A. GALKIN, A.Y. SIDOROV, D.O. KHOKHLOVA

USING PREOPERATING 3D-MODELING IN DIAGNOSTICS AND SURGICAL TREATMENT OF TERTIARY HYPERPARATHYROIDISM

Samara State Medical University, Samara,
The Russian Federation

Objective. To design a patient-specific preoperational 3D model of the neck anatomical formations based on MRI study to facilitate the search and removal of parathyroid adenoma in patients with tertiary hyperparathyroidism (THPT).
Methods. Preoperative 3D modeling was done for 7 patients with tertiary hyperparathyroidism. All patients were on the program renal dialysis because of the terminal stage of chronic renal insufficiency. For obtaining the personified 3D model the results MRI and special software were used. Data in DICOM format were loaded in software; at the same time, individual series of MRI studies were recorded and brought to a single coordinate system, they were segmented – the selection on the images of borders of anatomical structures, and three-dimensional polygonal models of the anatomical structures of the anterior surface of the neck and pathological sites – adenomas of the parathyroid glands were designed.
Results. With the use of preoperation 3D modeling the obtained models of the anatomical formations of neck allowed revealing and removing parathyroid adenomas rapidly, with the smallest time interval. The operation time on the average comprised 60±15 the minutes (M±σ). The operation effectiveness was proved by the results of laboratory investigations and clinical picture on the whole. In the postoperative period, during the following day after operation the median of ionized calcium decreased to 0.88 mmol/L (decrease by 0.32 mmol/L or on 26.7%, with r=0.00001), the median of parathyroid hormone – to 98.2 pg/ml (decrease on 2048.8 pg/ml – 95.4% with r=0.00001); the median of phosphorus – to 1.28 mmol/L (it was lowered on 0.33 mmol/L – 20.5%). The pains in the bones and the joints were clinically stopped in patients.
Conclusions. The suggested method is a reliable technique of the preoperative topical diagnosis of the pathological changes of the parathyroid glands. Its use leads to the decrease of operation time and reduces the need for traumatic and time-consuming neck exploration, necessary to find 4 and more adenomas), thus reducing the risk of post-surgery complications. The given method can be used for objective visualization of parathyroid adenomas during the operation and serve as the effectiveness criterion of surgical treatment adequacy.

Keywords: 3D model, magnetic resonance imaging, tertiary hyperparathyroidism, diagnostics, surgical treatment
p. 307-317 of the original issue
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Address for correspondence:
443099, The Russian Federation,
Samara, Chapayevskaya Str., 89,
Samara State Medical University,
Department of Surgical Diseases ¹1.
Tel. +7 903 334-22-59,
e-mail: makarov-samgmu@yandex.ru
Igor V. Makarov
Information about the authors:
Makarov Igor V., MD, Professor, Head of the Department of Surgical Diseases ¹1, Dean of the Pediatric Faculty, Samara State Medical University, Samara, Russian Federation.
http://orcid.org/0000-0002-1068-3330
Zhirov Vladimir V., PhD, Head of the Center for Educational Information Technologies, Programming Engineer of the Augmented Reality Technology Laboratory of the Virtual Technologies Department of the Center for Breakthrough Research “IT in Medicine”, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-3061-1713
Kolsanov Alexander V., MD, Professor of RAMS, Head of the Department of Operative Surgery, Clinical Anatomy with the Course of Innovative Technologies, Samara State Medical University, Samara, Russian Federation.
http://orcid.org/0000-0002-4144-7090
Galkin Rudolf A., MD, Professor of the Department of Surgical Diseases ¹1, Samara State Medical University, Samara, Russian Federation.
http://orcid.org/0000-0003-3665-3161
Sidorov Aleksandr Yu., PhD, Associate Professor of the Department of Surgical Diseases ¹1, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0003-3613-4863
Khokhlova Darya O., Clinical Intern of the Department of Surgical Diseases ¹1, Samara State Medical University, Samara, Russian Federation.
http://orcid.org/0000-0003-2913-5876

REVIEWS

O.A. NAZARCHUK 1, M.O. FAUSTOVA 2, S.A. KOLODII 1

MICROBIOLOGICAL CHARACTERISTICS OF INFECTIOUS COMPLICATIONS, ACTUAL ASPECTS OF THEIR PREVENTION AND TREATMENT IN SURGICAL PATIENTS

National Pirogov Memorial Medical University 1, Vinnitsa,
Ukrainian Medical Stomatological Academy 2, Poltava,
Ukraine

According to the literature data, microbiota of complications in surgical hospitals consists mainly of representatives of Staphylococcus spp., Enterococcus spp., Escherichia spp., Enterobacter spp., Klebsiella spp., and Pseudomonas spp. However, the spectrum of microorganisms differs depending on the location of the lesions, therapy tactics and the type of unit, where a patient is treated. Nowadays the rapid acquisition of resistance to chemotherapeutic agents by pathogens is becoming the most ambitious problem of modern medicine. In hospitals and intensive care units, the situation is aggravated by the emergence of multi-resistant hospital strains of microorganisms. The mechanisms of bacterial resistance to antibiotics are diverse and can be carried out both at the genetic and at the biochemical level.
The incidence of infectious and inflammatory postoperative complications and increase of the problem of antibiotic resistance among microorganisms dictate the need for careful monitoring of the epidemic situation in hospitals and studying the changing tendencies in the spectrum of dominant pathogens. Moreover, developing and introducing into the clinic of new antibiotics and drugs with antimicrobial activity, revision of existing algorithms for the treatment and prevention of complications arising on the background of surgical interventions are necessary.

Keywords: anti-bacterial agents, antibiotic-resistance, infectious-inflammatory, nosocomial, postoperative complications, surgical infection
p. 318-327 of the original issue
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Address for correspondence:
21018, Ukraine,
Vinnitsa, Pirogov Str., 56,
National Pirogov Memorial Medical University,
Microbiology Department,
Tel. +38 097 729-37-61,
e-mail: nazarchukoa@gmail.com,
Oleksandr A. Nazarchuk
Information about the authors:
Nazarchuk Oleksandr A., PhD, Associate Professor of the Microbiology Department, National Pirogov Memorial Medical University, Vinnitsa, Ukraine.
https://orcid.org/0000-0001-7581-0938
Faustova Mariia O., PhD, Lecturer of the Department of Microbiology, Virology and Immunology, Ukrainian Medical Stomatological Academy, Poltava, Ukraine.
https://orcid.org/0000-0001-5327-6324
Kolodii Svetlana A., PhD, Associate Professor of the Microbiology Department, National Pirogov Memorial Medical University, Vinnitsa, Ukraine.
https://orcid.org/0000-0001-7511-8108

V.S. MATSKEVICH 1, A.N. KIZIMENKO 2

FEATURES OF MICROELEMENTS EXCHANGE IN CRITICALLY ILL CHILDREN

Mogilev Regional Children's Hospital 1, Mogilev,
Vitebsk State Medical University 2, Vitebsk,
The Republic of Belarus

Objective. To study the publications, regarding effectiveness and safe usage of microelements during intensive care in children in critical state.
Methods. PubMed databases from January, 1998 to January, 2018 have been analyzed. The number of articles concerning this subject increased every 5 years in the mentioned period, which testifies to the interest to this problem in the scientific field.
Results. ESPEN and ASPEN recommendations as well as WHO regional recommendations for the European Union countries are given in the article regarding the usage of microelement dosage for children in the intensive care units. According to the study data, changes in the concentration of certain elements such as calcium, phosphorus, iron, zinc, selenium in the blood of children subjecting to intensive care therapy were registered. Also, the article presents the changes in the level of microelements in children with certain pathologies such as HIV, burn injury, chronic renal insufficiency, bronchial obstruction, multiple organ failure, septic shock.
Conclusions. The consumption of microelements and their dynamics during the course of illness has been almost unstudied. There are some incomplete works dedicated to the problem of microelement metabolism in healthy children and in pathology. There are no data about the deficiency of some microelements, which have a significant influence on the disease outcome; therefore, they require a constant control.

Keywords: microelements, children, intensive care, enteral nutrition, parenteral nutrition
p. 328-336 of the original issue
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Address for correspondence:
212025, The Republic of Belarus,
Mogilev, Byalynitsky-Birulya Str., 9,
Mogilev Regional Children’s Hospital,
Anesthesiology and Intensive Care Unit.
Tel. office: 8 0222 41-74-69,
e-mail: domenika31@yandex.by,
Veranika S. Matskevich
Information about the authors:
Matskevich Veranika S., Physician of the Anesthesiology and Intensive Care Unit, Mogilev Regional Children’s Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0002-7435-3648
Kizimenko Andrei N., PhD, Associate Professor, Department of Anesthesiology and Resuscitation with the Course of Advanced Training and Retraining of Specialists, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-8468-1269

A. SITNIK

TREATMENT OF THE FRACTURES OF THE NECK OF THE TALUS

Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk,
The Republic of Belarus

Fractures of the talus are rare injuries (up to 2.5% from the foot fractures), but the consequences of incorrect treatment are catastrophic, leading to osteoarthritis and long-lasting function impairment. Fearing complication is avascular necrosis of the body of the talus with previously reported incidence up to 50-75%. The changes of surgical strategy during the last decades have led to significant improvement of results and decrease of complications. Urgent treatment is only indicated in open injuries, as well in cases of fracture-dislocations where the displaced bone fragment threatens with skin necrosis. If closed reduction is successful, internal fixation is better to perform in delayed manner after the resolution of soft-tissue swelling. According to the present-day literature data, such an approach does not lead to the increase of the rate of avascular necrosis, but reduces the rate of wound complications and improves long-term results by thorough pre-operative planning and execution of surgery. The use of double surgical approaches (antero-medial and antero-lateral) provides anatomic fracture reduction with maintenance of the tiny blood supply of talus bone.

Keywords: talus, fracture, treatment terms, osteosynthesis, complications
p. 337-343 of the original issue
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Address for correspondence:
220024, The Republic of Belarus,
Minsk, Kizhevatov Str., 60-4,
Republican Scientific and Practical
Center of Traumatology and Orthopedics,
Laboratory of Adult Traumatology,
Tel. mobile: +375 29 354-00-84,
e-mail: alexandre_sitnik@yahoo.com,
Alexandre A. Sitnik
Information about the authors:
Sitnik Alexandre A., PhD, Associate Professor, Head of the Laboratory of Adult Traumatology, Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus.

CASE REPORTS

T. VYKHTYUK, V. ZHYKOVSKIY

SURGICAL SITE INFECTION IN PATIENTS WITH THE DESTRUCTION OF THE VASCULAR IMPLANT

Danylo Halytsky Lviv National Medical University, Lviv,
Ukraine

Treatment of patients with occlusive-stenotic lesions of the lower limb arteries in the stage of critical limb ischemia and postoperative infectious complications is a pressing issue of modern vascular surgery. If a patient has a vascular prosthesis, the development of a surgical site infection can lead to arrosive bleeding with fatal outcome. The aim of this report is to demonstrate the case of successful surgical treatment of a patient with an infected synthetic vascular implant. The patient, born in 1962, addressed to a vascular surgeon 2 months after the surgical treatment of critical ischemia of the right lower limb with implantation of linear femoropopliteal prosthesis. The patient complained of the development of a wound with discharge and unpleasant odor. After inspection and examination of the patient, the infection of the vascular prosthesis with the formation of the fistula on the medial surface of the lower third of the right thigh was diagnosed. Surgical intervention was performed: removal of the infected femoropopliteal prosthesis with simultaneous autovenous femoropopliteal repeated bypass surgery by the great saphenous vein, performed subcutaneously, extra-anatomically within the healthy soft tissues, bypassing the infected area of the lower third of the thigh. Thus, one was able to save the limb of the patient, to prevent the development of arrosive bleeding and to improve the healing and recovery of the suppurative thigh lesion.

Keywords: surgical infection, critical limb ischemia, surgical site infection, vascular implant infection, vascular reintervention
p. 344 of the original issue
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Address for correspondence:
79000, Ukraine,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv National
Medical University,
Surgery Department ¹2.
Tel. +38 032 275-76-32,
e-mail: vykhtyuk@gmail.com,
Taras I. Vykhtyuk
Information about the authors:
Vykhtyuk Taras I., Assistant of Surgery Department ¹2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0001-5600-7760
Zhykovskiy Volodymyr S., PhD, Assistant of the Department of Disaster Medicine and Military Medicine, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-0594-5316

A.G. MAKEEV 1, 2, S.A. KUSHTUMOV 1, 2, E.V. SHINKEVICH 2, P.I. MURAVIEV 2, M.P. GRUZIN 2, V.G. KUTORKIN 2

CHRONIC POSTTRAUMATIC THORACOABDOMINAL AORTIC ANEURYSM COMPLICATED BY RUPTURE

Irkutsk State Medical University 1,
Irkutsk State Regional Clinical Hospital 2, Irkutsk,
The Russian Federation

The article reports a rare clinical follow-up of the patient with chronic posttraumatic thoracoabdominal aortic aneurysm of IV type according to Crawford E.S., complicated with a rupture into the posterior mediastinum and retroperitoneal space. The occurrence of chronic posttraumatic thoracoabdominal aortic aneurysm is suspected to be associated with a blunt trauma of the lumbar region (a fall from own growth height) and with the aortic damage by metal structures implanted four years earlier for transpedicular fixation with intrabody vertebral fusion of the thoracic spine. Aneurysm rupture into the posterior mediastinum and retroperitoneal space, which occurred during the planned in-hospital examination of the patient, indicates the difficulties in predicting the moment of its onset. Timely diagnosis and emergency reconstructive surgery aimed at restoring the continuity of the damaged thoracoabdominal aorta, determined a good result of treatment. There is still no convincing information about the frequency of such complications as the formation of post-traumatic aneurysm after transpedicular fixation with interbody vertebral fusion of the spine; only the descriptions of single observations are presented. This fact stimulated us to describe a rather rare clinical follow-up.

Keywords: spinal trauma, transpedicular fixation, thoracoabdominal aortic aneurysm, aneurysm rupture, aortal prosthetics
p. 348-353 of the original issue
References
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Address for correspondence:
664003, The Russian Federation,
Irkutsk, Krasnoye Vosstaniye Str., 1,
Irkutsk State Medical University,
Department of Human Anatomy,
Operative Surgery and Forensic Medicine.
Tel. +7 902 576-75-41,
e-mail: a.makeev@ismu.baikal.ru,
alexandermakeev@rambler.ru,
Alexander G. Makeev
Information about the authors:
Makeev Alexander G., PhD, Associate Professor of the Department of Human Anatomy, Operative Surgery and Forensic Medicine, Irkutsk State Medical University, Cardiovascular Surgeon of the Vascular Surgery Unit, Irkutsk State Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0002-4512-2656
Kushtumov Sergei A., PhD, Assistant of the Department of Hospital Surgery, Irkutsk State Medical University, Head of the Vascular Surgery Unit, Irkutsk State Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0003-4630-1274
Shinkevich Eduard V., PhD, Cardiovascular Surgeon, Vascular Surgery Unit, Irkutsk State Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0002-2729-4278
Muraviev Pavel I., Cardiovascular Surgeon, Vascular Surgery Unit, Irkutsk State Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0002-9061-0544
Gruzin Maxim P., Cardiovascular Surgeon, Vascular Surgery Unit, Irkutsk State Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0003-2801-4343
Kutorkin Victor G., Cardiovascular Surgeon, Vascular Surgery Unit, Irkutsk State Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0001-7891-7378

V.V. BOYKO 1, R.M. SMACHYLO 1, M.S. CHERNYAYEV 2, I.I. YAKOVTSOVA 3, S.V. DANYLIUK 3, O.M. TYSHCHENKO 1, A.L. VESELYI 1

MULTIFOCAL ANGIOMYOLIPOMA OF THE LIVER AND LUNG

V.T. Zaytsev Institute of General and Urgent Surgery 1 of the National Academy of Medical Sciences of Ukraine,
Kharkiv National Medical University 2,
Kharkiv Medical Academy of Post-graduate Education 3, Kharkiv,
Ukraine

The article presents a clinical case of surgical treatment of a patient with a rare oncological disease – multifocal angiomyolipoma of the liver and lungs. The patient had been hospitalized to the clinic, examined using spiral computed tomography of the abdominal organs and the chest. The following was revealed – bilateral multiple lung neoplasms, liver neoplasms: in Sg2 and Sg4 – 3 tumors up to 2 cm in diameter, in Sg1 – a large similar tumor 10x8cm adjacent to the inferior vena cava. Differential diagnostics with hepatocellular carcinoma was performed by using the determination of the blood tumor markers and trepan biopsy of the tumor of the caudate hepatic lobe, followed by histological examination. After confirming of probable benign nature of the tumor, the patient was operated on. Intraoperative findings were the following: in Sg2 and Sg4 of the liver – neoplasms up to 2 cm in diameter; in Sg1 of the liver – a neoplasm 9×8×10 cm, closely adjacent to the inferior vena cava, easily vulnerable with bleeding after contact. Resection of Sg1 of the liver with a tumor was performed by the left-sided method using afferent vascular exclusion of the liver, clamp crush technique, and electrosurgical welding. The postoperative period was stable, without complications, the patient was discharged from hospital on the 12th postoperative day. The immunohistochemical study of the removed tumor confirmed the diagnosis of liver angiomyolipoma.

Keywords: angiomyolipoma, caudate lobe of the liver, liver resection, computed tomography, immunohistochemistry, electrosurgical sealing
p. 354-359 of the original issue
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Address for correspondence:
61103, Ukraine,
Kharkiv, Balakirev Entry, 1,
V.T. Zaytsev Institute of General and Urgent Surgery
Of the National Academy of Medical
Sciences of Ukraine,
Surgery Department of the Liver and Bile Ducts.
Tel. mobile: +38 0506 15-45-55,
e-mail: dr.chernyayev@gmail.com,
Mykyta S. Chernyayev
Information about the authors:
Boyko Valeriy V., MD, Professor, Corresponding Member of the National Academy of Medical Sciences of Ukraine, Director of V.T. Zaytsev Institute of General and Urgent Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine.
https://orcid.org/0000-0003-4771-9699
Smachylo Rostyslav M., MD, Professor, Head of the Surgery Department of the Liver and Bile Ducts, V.T. Zaytsev Institute of General and Urgent Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine.
https://orcid.org/0000-0003-1237-0255
Chernyayev Mykyta S, PhD, Assistant of the Surgery Department ¹1, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-6543-311X
Yakovtsova Iryna I., MD, Professor, Head of the Pathologic Anatomy Department, Kharkiv Medical Academy of Post-graduate Education, Kharkiv, Ukraine.
https://orcid.org/0000-0002-1027-9215
Danyliuk Svitlana V., PhD, Associate Professor of the Pathologic Anatomy Department, Kharkiv Medical Academy of Post-graduate Education, Kharkiv, Ukraine.
https://orcid.org/0000-0002-9971-0410
Tishchenko Olexander M., MD, Professor of the Surgery Department of the Liver and Bile Ducts, V.T. Zaytsev Institute of General and Urgent Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine.
https://orcid.org/0000-0002-9151-778X
Veselyi Andrii L., Radiologist of the Computed Tomography Cabinet, V.T. Zaytsev Institute of General and Urgent Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine.
https://orcid.org/0000-0002-5350-4259
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