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Year 2016 Vol. 24 No 4

HISTORY

A.Y. LADZEYEU, A.V. MAROCHKOV, V.N. DZMITRYIEVA

THE HISTORY OF CREATION AND DEVELOPMENT OF IMPLANTABLE CARDIOVERTER DEFIBRILLATORS

ME "Mogilev Regional Hospital"
Mogilev
The Republic of Belarus

The implantable cardioverter defibrillators (ICDs) currently play, along with drug therapy, one of the leading roles in the prevention of sudden cardiac death. Efficacy and safety of ICD in different groups of patients have been proven in a number of large randomized trials. Taking into account the high proportion of sudden cardiac death in the structure of total mortality, ICDs allow saving thousands of lives annually. Rapid scientific and technical progress, currently observed in all spheres of human activity, allows assuming with high probability a significant increase of reliability and therapeutic opportunities of ICDs in the nearest future. Due to the ever growing number of ICD implantations across the world, we consider important objective to increase interest in implantable antiarrhythmic devices among physicians of different specialties.
This paper briefly describes the history of the ICD from the formation of the concept in the late 60-ies of XX century, to current multifunctional implantable antiarrhythmic devices. The ICD example shows the impact of the development of microelectronics and computer technology at the end of XX - the beginning of XI century on the current medicine.

Keywords: sudden death, antiarrhythmic devices, implantable defibrillator, history of medicine, Mirowski, resynchronization therapy, microelectronics and computer technology
p. 317-327 of the original issue
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Address for correspondence:
212026, Republic of Belarus, Mogilev, B. Biruli str., 12,
ME "Mogilev Regional Hospital" department of anesthesiology and intensive care. Tel: +375 222 27-87-39
E-mail: fedya101@tut.by
Ladzeyeu Andrey Yurevich
Information about the authors:
Ladzeyeu A.Y. Anesthesiologist, ME "Mogilev Regional Hospital", department of anesthesiology and reanimation.
Marochkov A.V. MD, professor, Head, ME "Mogilev Regional Hospital", department of anesthesiology and reanimation.
Dzmitryieva V.N. Anesthesiologist, ME "Mogilev Regional Hospital", department of anesthesiology and reanimation.

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

V.V. KUDLA 1, I.G. ZHUK 2, R.I. KRAVCHUK 1, M.A. KURBAT 1, R.R. ZHMAILIK 3

ULTRAMICROSCOPIC COMPARATIVE EVALUATION OF THE LIVER TISSUE REACTION TO THE CLOSURE OF ITS WOUND SURFACE BY THE OMENTUM AND FLUOROPLASTIC

EE "Grodno State Medical University"1,
Grodno Regional Council of Deputies2,
ME "City Clinical Emergency Hospital"3
Grodno
The Republic of Belarus

Objectives. To carry out a comparative evaluation of the liver tissue reaction at the ultrastructural level to closure of its wound surface by the omentum and fluoroplastic.
Methods. In the experiment on white rats the marginal resection of the left liver lobe was performed. In the 1st group the wound was peritonized by the strand on the vascular pedicle of omentum fixed to the capsule with koralen 7/0 single interrupted sutures. In the 2nd group the wound defect was closed by a fibrous-porous fluoroplastic flap (2 mm thickness). On the 21st day 5 animals from each group were withdrawn from the experiment. At a distance of 5 mm in depth from the wound surface the samples of material were taken to produce the electron-microscopic preparations. The complex of digital camera Olympus Mega View III and the program for image processing iTEM were used. The morphometric evaluation of quantitative and qualitative parameters of hepatocyte mitochondria with further statistical analysis of the obtained material was performed.
Results. It has been found out that in closure of the liver wound by the omentum and fluoroplastic the similar reversible changes including activation of reparative processes in response to injury after surgery are developed at the ultrastructural level. However, the use of polymer fluoroplastic for plastic closure also causes increased secretory processes with moderate cellular response of the mononuclear phagocyte system. In addition, in the second group the number of lipid inclusions in hepatocytes being an additional source of energy production is increased. At the same time, the signs of active collagen production and therefore fibrosis at the subcellular level are not determined.
Conclusion. The use of the fluoroplastic for the plastic closure of the liver wounds in the experiment is justified due to evoking the same ultrastructural changes in the liver tissue so as using the greater omentum for this purpose.

Keywords: liver wound, resection, omentum, fluoroplastic, peritonization, lipid inclusions in hepatocytes, sealing
p. 328-335 of the original issue
References
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    Ãàçèçîâ ÈÌ, Êàëèãèí ÌÑ, Àíäðååâà ÄÈ, Éûëìàç ÒÑ, Ãóìåðîâà ÀÀ, Êèÿñîâ ÀÏ. Èçìåíåíèÿ ìèêðîñòðóêòóðû ïå÷åíè ïîñëå ÷àñòè÷íîé ãåïàòýêòîìèè ó êðûñ. Ãåíû è Êëåòêè. 2013;(3):101-105.
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Address for correspondence:
230025, Republic of Belarus, Grodno, Sverdlov st, 3,
EE "Grodno State Medical University", chair of operative surgery and topographic anatomy.
Tel: + 375 152 72-11-72 E-mail: kudloviktor@gmail.com
Kudla Viktor Valentinovich
Information about the authors:
Kudla V.V. Senior lecturer, EE "Grodno State Medical University", chair of operative surgery and topographic anatomy.
Zhuk I.G. MD, Professor, Chairman, Grodno Regional Council of Deputies.
Kravchuk R.I. PhD (B), Senior researcher, "Grodno State Medical University", research department.
Kurbat M.A. PhD, Ass. Professor, Head, EE "Grodno State Medical University", research department.
Zhmailik R.R. Surgeon-intern, ME "Grodno Clinical Emergency Hospital".

A.O. BAIYRKHANOVA1, T.K. BOTABEKOVA2, Y.M. SEMENOVA1

THE STUDY OF ANTI-PROLIFERATIVE EFFECT OF INTRAVITREAL IMPLANT IN SURGICAL TREATMENT OF PROLIFERATIVE VITREORETINOPATHY

Semey State Medical University1, Semey
JSC "Scientific Research Institute of Eye Diseases of the Badge of Honor Order"2 of Kazakhstan, Almaty
The Republic of Kazakhstan

Objectives. To study the anti-proliferative effect of chitosan film (ChF) in surgical treatment of experimental proliferative vitreoretinopathy (PVR) by the ultrasound method (US).
Methods. This study has been conducted on 10 adult rabbits (20 eyes) of “chinchilla” breed weighing 2,5 – 4,0 kg. To develop an experimental PVR the autohemotherapy (0,4 ml) is used. The eyes of animals were divided into 4 groups: the 1st and 2nd – the main groups – 10 right eyes (5 eyes – the implantation of ChF saturated with 5-fluorouracil (5-FU) and 5 eyes – ChF without 5-FU), the 1st and 2nd control groups – 10 left eyes (without implanting the film). On the 10th and 31st days after operation the anti-proliferative effect has been com­pared.
Results. On the 10th day the partial hemophthalmos in 4 eyes of the 1st and 2nd main groups and in all eyes of control groups has been noted. There was a vitreoretinal cord in the posterior part in 4 eyes of the 1st and 2nd control groups. On the 31st day in 2 eyes of the 1st main group tur­bid­ity of a vitreous body was observed. In 1 eye of the Ist main group and 3 eyes of the 2nd main group the partial hemophthalmos was noted. A vitreoretinal cord was visualized in 3 eyes of the 2nd main group. In all eyes of the control groups a hemophthalmos in the forming stage was observed, and the posterior covers were thickened. There was a vitreoretinal cord in 4 eyes of the 1st control and in 5 eyes of the 2nd control groups, the whole vitreous body was filled with accurate contours shadows; the exudate – in the posterior part.
Conclusion. Using the chitosan film with 5-fluorouracil enhances the anti-proliferative effect to a great extent. The chitosan film without 5-fluorouracil also blocks the proliferation process, but to a lesser extent. After the morphological studies the given implant can be clinically applied during vitreous surgery to prevent recurrence in the incisional period.

Keywords: vitreous body, proliferative vitreoretinopathy, chitosan, 5-fluorouracil, morphological studies, vitreous surgery, incisional period
p. 336-341 of the original issue
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  13. Baiyrkhanova A, Ismailova A, Botabekova T, Enin E, Semenova Y. Crosslinked Chitosan/PVA film, suturated with 5- Fluorouracil for the prevention of proliferative vitreoretinopathy. Int J Drug Deliv Tech. 2016 Apr-Jun;6(2):47-51.
  14. Nassar K, Lüke J, Lüke M, Kamal M, Soliman MM, Grisanti S, et al. Effect of different fixative solutions on eyes with experimental proliferative vitreoretinopathy. Int J Exp Pathol. 2015 Apr;96(2):103-10. doi: 10.1111/iep.12119.
  15. Berger AS, Cheng CK, Pearson PA, Ashton P, Crooks PA, Cynkowski T, et al. Intravitreal sustained release corticosteroid-5-fluoruracil conjugate in the treatment of experimental proliferative vitreoretinopathy. Invest Ophthalmol Vis Sci. 1996 Oct;37(11):2318-25.
  16. Hou H, Nieto A, Ma F, Freeman WR, Sailor MJ, Cheng L. Tunable sustained intravitreal drug delivery system for daunorubicin using oxidized porous silicon. J Control Release. 2014 Mar 28;178:46-54. doi: 10.1016/j.jconrel.2014.01.003.
Address for correspondence:
071400, Republic of Kazakhstan, Semey, Abay str.,103, office 141,
State Medical University.
Tel: 8701720 30 42
E-mail: alma23021984@gmail.com
Information about the authors:
Baiyrkhanova A.O. Applicant for Doctor’s degree, Semey State Medical University.
Botabekova T.K. Corresponding member, NAS of the Republic of Kazakhstan, MD, Professor, JSC "Scientific Research Institute of Eye Diseases of the Badge of Honor Order"2 of Kazakhstan, Chairman of the Board, Almaty.
Semenova Y.M. PhD, Head teacher, chair of ophthalmology, Ass. Professor, chair of general surgery, Semey State Medical University.

GENERAL & SPECIAL SURGERY

D.V. OSIPENKO, A.G. KHRISTIN

ASSESSEMENT OF PROTAMINE EFFECT ON THROMBOELASTOMETRY PARAMETERS IN CARDIAC SURGERY PATIENTS IN VITRO

ME "Gomel Regional Clinical Cardiologic Center",
Gomel
The Republic of Belarus

Objectives. To study the effects of protamine overdose on hemostatic parameters in vitro and to work out the criteria of protamine overdose using thromboelastometer ROTEM®.
Methods. Three groups of patients were formed randomly. The 10 µl of protamine solution (8,5 U) were added to the blood samples of the first group of patients. The concentration of protamine in the blood of the test sample was 1,57 U/ml. 10µl of sodium chloride solution were administrated to the blood samples of the second group. The third group (the control one) – no any additional drugs were introduced into the blood samples.
Results. In the first group of patients by Extem test the increase of the CT (104,5 s) was observed, which was higher by 37% (65,5 s) in the second group of patients and by 26% (77,0 s) in the third group. In the first group of patients by Intem test the increase of the CT values and CFT and also α angle change was determined compared with the second and third groups. The values of CT, CFT in the first group were higher than in the second group by 42% (210,0 s) and by 41% (71,5 s); the α angle in the first group (67,0º) was lower by 12% compared to the second group (75,5º). The values of CT, CFT in the first group were higher than in the third group by 50% (182,5 s) and by 23% (94,0 s); the α angle in the first group was lower by 7% compared to the third group (72,0º).
Conclusion. Protamine at a concentration of 1.57 U/ml has a strong hypocoagulation effect in vitro, which is manifested by specific changes in thromboelastometry ROTEM®

Keywords: blood, anticoagulants, heparin, protamine, measurement techniques, thromboelastometr, Rotem®
p. 342-347 of the original issue
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Address for correspondence:
246046, Republic of Belarus, Gomel, Medical st., 4, ME "Gomel Regional Clinical Cardiology Center", department of anesthesiology and intensive care. Tel / fax: (0232) 43-48-01
E-mail: Osipenko081081@mail.ru
Osipenko Dmitriy Vasilevich
Information about the authors:
Osipenko D.V. PhD, anesthesiologist, ME "Gomel Regional Clinical Cardiologic Center", department of anesthesiology and reanimation with intensive care.
Khristin A.G. Anesthesiologist, ME "Gomel Regional Clinical Cardiologic Center", department of anesthesiology and reanimation with intensive care.

N.A. PRONIN, S.V. TARASENKO, A.V. PAVLOV, I.A. SUCHKOV

OPERATIVE TREATMENT OF CHRONIC PANCREATITIS WITH REGARD TO ANATOMICAL FEATURES OF ARTERIAL NETWORK IN THE PANCREATIC HEAD

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

Objectives. Optimization of the surgical treatment of chronic pancreatitis with the regard to variants of the blood supply of the pancreatic head.
Methods. The study was conducted in two stages. At the 1st stages extraorgan arteries of the pancreas and duodenum were studied by the preparation method of 42 organ complex of the upper level of the abdominal cavity. At the 2nd, clinical stage, the patients were divided into 2 subgroups depending on the operative intervention. In the patients of A group (32 cases) the resection of the pancreatic head with the longitudinal pancreatojejunoanastomosis was performed by modified technique (2003) over standard Frey procedures taking into consideration the changes according to the obtained anatomical findings. The patients of B group (44 cases) were operated on by the Frey classical method (modification of 2003). The comparative retrospective and prospective assessment of treatment outcomes among the patients has been conducted.
Results. The anterior pancreatoduodenal arc has been found out to have several variants of localization in relation to the pancreatoduodenal complex. However, the sources of the arteries, forming the arc, and the sites of their offshoot are characterized by relatively constancy permiting ligation the elements of the anterior arc beyond the pancreatic altered tissues up to the stage of the parenchyma resection. Intraoperative blood loss was less than 400 ml (ð<0,01) in 24 patients in the group A and in 22 patients in the group B (ð<0,01). The early postoperative complications were observed in 18,75% patients in the group A and in 22,7% patients in the group B. In the late postoperative period (6 months after the surgery) the abdominal pain syndrome according to Visual Analogue Scale in 29 patients of the group A was assessed on the level 1-2 (ð<0,01), and in 31 patienrs of the group B the same parameters were registered (ð<0,01).
Conclusion. Combination of the preliminary ligation of the elements of the anterior pancreatoduodenal arterial arc with more radical excision of the scar-altered pancreatic parenchyma allows optimizing the surgical treatment of chronic pancreatitis.

Keywords: chronic pancreatitis, complications, pancreatic arteries, the Frey surgery, abdominal pain syndrome, Visual Analogue Scale, life quality
p. 348-354 of the original issue
References
  1. Egorov VI, Vishnevskij VA, Shastnyj AT, Shevchenko TV, Zhavoronkova OI, Petrov RV, i dr. Rezekcija golovki podzheludochnoj zhelezy pri hronicheskom pankreatite [Resection of the head of the pancreas in chronic pancreatitis]. Khirurgija Zhurn im NI Pirogova. 2009;(8):57-66.
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Address for correspondence:
390026, Russian Federation,
Ryazan, Vyisokovoltnaya str. 9,
Medical University RyazGMU Russian Ministry of Health,
chair of cardiovascular, endovascular, operative surgery and topographic anatomy. Tel: 8 9056 91-34-56
E-mail: proninnikolay@mail.ru
Pronin Nikolay Alekseevich
Information about the authors:
Pronin N.A. Assistant, SBEE HPE “Ryazan State Medical University named after Academician I.P.Pavlov”, chair of anatomy.
Tarasenko S.V. MD, Professor, Head, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", chair of hospital surgery, chief physician, SBE RR "City Clinical Emergency Hospital", Ryazan, Director, Center "Surgery of the liver, biliary tracts and pancreas".
Pavlov A.V. MD, Ass. Professor, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", chair of cardiovascular, endovascular, operative surgery and topographic anatomy.
Suchkov I.A. MD, Ass. Professor, Professor, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", chair of cardiovascular, endovascular, operative surgery and topographic anatomy.

V.I. RUSIN, E.S. SIRCHAK, S.S. FILIP, P.F. SERVETNIK

THE ROLE OF α1-ANTITRYPSIN IN THE ETIOLOGY OF CHRONIC PANCREATITIS AND ITS COMPLICATIONS

SHEE "Uzhgorod National University",
Uzhgorod
Ukraine

Objectives. To investigate the dynamics of α1-antitrypsin (α1-AT) indices in the blood and feces of patients with complicated forms of chronic pancreatitis (CP).
Methods. The patients (n=158) with the pseudocystic forms chronic pancreatitis (PCP) were examined. They were distributed into 2 groups: group I (n=76) – the patients with pancreatic pseudocysts without CP complications; group II (n=82) – patients with CP, in whom was complicated with the pre-liver portal hypertension (PH), infectioning of the PCP, hemorrhage from the upper parts of the digestive tract, duodenal obstruction and obstructive jaundice. The levels of α1-AT (“Immundiagnostic AG”, Germany) were determined in the blood serum and feces of patients and its clearance were calculated. The study was conducted before treatment and on the 5th day after the surgery.
Results. In patients of group I the indices of α1-AT in the blood plasma were slightly higher than the indices of the control group, but the level in the feces and its clearance did not differ from those in healthy people. In patients of group II the overall level of α1-AT in the blood plasma was 6,6 fold higher than the indices of the control group. High concentration of α1-AT in the blood in the given patients before treatment was accompanied by its increased level in feces as well as its fecal clearance.
Conclusion. In patients with complicated forms of PCP pancreatitis an increase of α1-AT level in the blood plasma and feces is observed as well as its fecal clearance. The highest indices of α1-AT in the blood plasma and feces are determined in infecting of PCP, pre-liver PH and duodenal obstruction in patients with CP. Surgical interventions on the pancreas lead to reduction of α1-AT level in the blood plasma and feces as well as its fecal clearance.

Keywords: chronic pancreatitis, pancreas, α1-antitrypsin, blood plasma, duodenal obstruction, surgical intervention, fecal clearance
p. 355-360 of the original issue
References
  1. Gubergrits NB. Osnovnye napravleniia v reabilitatsii bol'nykh khronicheskim pankreatitom [The main directions in rehabilitation of patients with chronic pancreatitis]. Zdorov'ia Ukra¿ni. 2008;19(1):60-61.
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  6. Shevchenko BF, Babii AM, Makarchuk VA, Oshmianskaia NIu, Petishko OP. Morfofunktsional'noe sostoianie podzheludochnoi zhelezy na etapakh ee fibroznoi transformatsii pri khronicheskom pankreatite [Morphofunctional state of the pancreas at stages of its fibrous transformation in chronic pancreatitis]. Vestn Problem Biologii i Meditsiny. 2014;1(4):305-13.
  7. Jupp J, Fine D, Johnson PD. The epidemiology and socioeconomic impact of chronic pancreatitis. Best Pract Res Clin Gastroenterol. 2010 Jun;24(3):219-31. doi: 10.1016/j.bpg.2010.03.005.
  8. Kavutharapu S, Nagalla B, Abbagani V, Porika SK, Akka J, Nallari P, et al. Role of proteases and antiprotease in the etiology of chronic pancreatitis. Saudi J Gastroenterol. 2012 Nov-Dec;18(6):364-8. doi: 10.4103/1319-3767.103427.
  9. Stoller JK, Aboussouan LS. A review of α1-antitrypsin deficiency. Am J Respir Crit Care Med. 2012 Feb 1;185(3):246-59. doi: 10.1164/rccm.201108-1428CI.
  10. Wang Q, Du J, Yu P, Bai B, Zhao Z, Wang S, et al. Hepatic steatosis depresses alpha-1-antitrypsin levels in human and rat acute pancreatitis. Sci Rep. 2015 Dec 4;5:17833. doi: 10.1038/srep17833.
Address for correspondence:
88000, Ukraine, Transcarpathian region, Uzhgorod, People sq., 1, SHEE "Uzhhorod National University", faculty of medicine, chair of propedeutics of internal deseases. Tel: + 38050-976-17-94
E-mail: szircsak_heni@bigmir.net
Sirchak Elizaveta Stepanovna
Information about the authors:
Rusin V.I. MD, Professor, SHEE "Uzhgorod National University", chair of surgical diseases, medical faculty.
Sirchak E.S. MD, Professor, SHEE "Uzhgorod National University", chair of propaedeutics of internal diseases, medical faculty.
Filip S.S. MD, Professor, SHEE "Uzhgorod National University", chair of general surgery, medical faculty.
Servetnik P.F. Post-graduate student, SHEE "Uzhgorod National University", chair of general surgery , medical faculty.

I.S. ZHAVORONOK 1, G.G. KONDRATENKO 1, V.N. GAPANOVICH2, A.V. ESEPKIN 3, A.D. KARMAN 1

THE ARREST OF BLEEDING FROM THE LIVER PARENCHYMA BY USING AN INORGANIC HEMOSTATIC AGENTS

EE "Belarusian State Medical University"1,
UE "Lotios"2,
ME "Minsk 10th City Clinical Hospital"3
Minsk The Republic of Belarus

Objectives. To study an application opportunity of a new local haemostatic agent “Gamastat” in the combination with a selective electrocoagulation of particular bleeding vessels of the gall bladder bed during cholecystectomy.
Methods. The comparative study of treatment results of patients (n=77), divided into two groups has been conducted. In the main group (n=45) of patients to stop bleeding from the gallbladder bed a haemostatic agent “Gamastat” and a selective coagulation only of particular bleeding vessels have been applied during surgery versus a standard technique of a continuous electrocoagulation of the gall bladder bed in cholecystectomy, used in the control group (n=32). A bleeding arrest after treating of the liver wound surface with local haemostatic agents or electrocoagulation was registered; dynamics of changes of the blood cytological and biochemical indicators and plasma haemostasis parameters were studied preoperatively and on the 3rd postoperative day.
Results. The complete haemostasis at “Gamastat” application and a selective coagulation of particular bleeding vessels have been achieved in a greater number of cases (88,9%), than at the application of a continuous electrocoagulation of the gall bladder bed (75% of cases).
If haemostasis by the abovementioned methods was not achieved, gall bladder bed bleeding was stopped by the use of more extensive electrocoagulation of the gall bladder bed and the plate “Tachoñomb”. The combination of “Gamastat” application and a selective electrocoagulation of bleeding vessels in the area of the gall bladder bed provides less hepatic parenchyma coagulation injury as evidenced by a reduced manifestation of hepatocyte cytolysis versus a continuous electrocoagulation.
Conclusion. In the main group the expressed local haemostatic activity of “Gamastat” has been established as well as reliably insignificant manifestation of electrocoagulative injury of the liver accompanied by less marked growth of indicators of cytolisis AlAt and AsAt in comparison with those in patients of the control group. Negative effects of “Gamastat” application were not observed.

Keywords: local haemostatic agent, Gamastat, selective electrocoagulation, bleeding arrest, hepatic bleeding, cholecystectomy, haemostasis
p. 361-367 of the original issue
References
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Address for correspondence:
220116, Republic of Belarus, Minsk, Dzerzhinskiyi pr., d. 83, Belarusian State Medical University, chair of surgical diseases N1. Tel: + 375 29 624-98-37
E-mail: zhavoronok_irina@rambler.ru
Zhavoronok Irina Sergeevna
Information about the authors:
Zhavoronok I.S. Post-graduate student, EE "Belarusian State Medical University", chair of surgical diseases N1.
Kondratenko G.G. MD, Professor, Head, EE "Belarusian State Medical University", chair of surgical diseases N1.
Gapanovich V.N. MD, Director, UE "Lotios".
Esepkin A.V. Head, ME "Minsk 10th city clinical hospital", surgical department N1.
Karman A.D. PhD, Ass. Professor, EE "Belarusian State Medical University", chair of surgical diseases N1.

Y.S. VINNIK, S.S. DUNAEVSKAYA, D.A. ANTUFRIEVA

LIFE QUALITY STUDY OF PATIENTS WITH OBLITERATING ATHEROSCLEROSIS OF THE VESSELS IN THE LOWER EXTREMITIES

SBEE HPE "Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky",
Krasnoyarsk
The Russian Federation

Objectives. To estimate life quality of patients with obliterating atherosclerosis of the vessels in the lower extremities against the background of a combined application of lyophilisate alprostadil and a systemic ozone therapy.
Methods. The patients were distributed among four groups depending on the conducted therapy. The standard treatment regimen was applied in the control group. The lyophilisate alprostadil was included in the complex therapy for patients of the first group. The systemic ozone therapy together with a basic therapy was applied in the second group. The lyophilisate alprostadil and ozone therapy were included in the complex treatment regimen for patients of the third group. To study the life quality of patients the questionnaire SF-36 was used before and after a therapy (6 months afterwards).
Results. Low rates of physical functioning and role-physical functioning as well as pain intensiveness were found out to be present in patients with atherosclerosis on admission. Low rates in all groups testified the pain considerably limits the activity of the studied patients. General health, vitality level, social and role-physical functioning were evaluated as average ones. Thus, the indices in all groups had no significant differences and were comparable. Six months afterwards, the indices of "physical functioning" for patients treated with lyophilisate alprostadil and ozone therapy together with the complex treatment regimen were higher than in the control, first and second groups. In 6 months the reduction of "a health psychological component" caused by progression of the main disease was noted in the control group.
Conclusion. The conducted study has verified that a combined application of lyophilisate alprostadil and a systemic ozone therapy reliably reduces pain during walking, thus improving physical and emotional health of patients.

Keywords: obliterating atherosclerosis of lower limbs vessels, physical functioning, role-physical functioning, complex therapy, life quality, lyophilisate alprostadil, ozone therapy
p. 368-372 of the original issue
References
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Address for correspondence:
660077, Russian Federation, Krasnoyarsk, Partizan Zheleznyak, 1, Medical University "Krasnoyarsk State Medical University named by Professor VF Voyno-Yasenetsky ", chair of general surgery named by Professor MI Gulman.
Tel: 963-191-29-70
E-mail: Vikto-potapenk@yandex.ru
Information about the authors:
Vinnik Y.S. MD, Professor, Head, SBEE HPE "Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky", chair of general surgery named after Professor M.I. Gulman.
Dunaevskaya S.S. MD, Ass. Professor, SBEE HPE "Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky", Professor, chair of general surgery named after Professor M.I. Gulman.
Antufrieva D.A. Post-graduate student, SBEE HPE "Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky", chair of general surgery named after Professor M.I. Gulman.

TRAUMATOLOGY & ORTHOPEDICS

D.A. POPKOV, A.V. POPKOV, V.A. SHCHUROV, N.A. KONONOVICH

FUNCTIONAL RECOVERY AFTER OPERATIVE LOWER LIMB LENGTHENING AT HIGH-DIVISION REGIME IN CHILDREN

FSBE " Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics", of the RF Ministry of Health,
Kurgan
The Russian Federation

Objectives. To study the features of the functional rehabilitation of children with congenital and acquired shortenings of the lower limbs after surgical lengthening using different regimes of distraction osteosynthesis.
Methods. Treatment results of children (n=95) with congenital and acquired lower limb shortening by the Ilizarov method for distraction osteosynthesis been analyzed. The distraction regime: group 1 (n=27, mean age 9,9±4,1 yrs) – 1mm a day (n=4); group 2 (n=30, mean age 10,1±1,9 yrs) 1mm a day (n=60) in the automated regime; group 3 (n=38, mean age 11,5±2,3 yrs) – a distraction regime 1 mm a day (n=60) in an automated regime combined with intramedullary reinforcement by elastic wires with hydroxyapatite coating. After removing the Ilizarov device the restoration of normal knee and ankle joint function, the dynamics of the antagonist muscles forces and onset time walking without additional support have been assessed.
Results. It was shown that at femoral lengthening by using a robotic high-division distractor with using intramedullary reinforcement with bioactive coating, the earlier restoration of active and passive amplitude of motions in the adjacent joints, segment muscle force and complete limb axial load had occured. Such effects could be associated with both the favorable conditions for regeneration of bone and muscle tissues at high-division rate as well as with the possibility of the earlier full functional load after the removal of the Ilizarov apparatus and leaving intramedullary implants in site.
Conclusion. Thus, the combination of robotic high-division distraction (24 h) and intramedullary bioactive reinforcement creates favorable conditions for a rehabilitation process and a faster functional recovery.

Keywords: robotic automated distractor, limb lengthening, bioactive implants, intramedullary implants, regeneration, muscular system, functional rehabilitation
p. 373-378 of the original issue
References
  1. Sokolovskii OA, Serdiuchenko SN, Brodko GA, Ur'ev GA. Uravnivanie dliny nizhnikh konechnostei – istoricheskie rakursy i sovremennye tendentsii [Equalization of the length of the lower extremities - historical perspectives and current trends]. Med Novosti. 2011;(7):11-19.
  2. Sabharwal S, Green S, McCarthy J, Hamdy RC. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am. 2011;93:213-221. doi: 10.2106/JBJS.J.01420.
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  5. Sun XT, Easwar TR, Manesh S, Ryu JH, Song SH, Kim SJ, et al. Complications and outcome of tibial lengthening using the Ilizarov method with or without a supplementary intramedullary nail: a case-matched comparative study. J Bone Joint Surg Br. 2011 Jun;93(6):782-87. doi: 10.1302/0301-620X.93B6.25521.
  6. Kim SJ, Balce GC, Agashe MV, Song SH, Song HR. Is bilateral lower limb lengthening appropriate for achondroplasia? Midterm analysis of the complications and quality of life. Clin Orthop Relat Res. 2012 Feb;470(2):616-21. doi: 10.1007/s11999-011-1983-y.
  7. Ur'ev GA, Il'iasevich IA, Zarovskaia AV, Sokolovskii OA, Iuzefovich AI. Izmenenie funktsional'nogo sostoianiia nervno-myshechnoi i sosudistoi sistem ukorochennykh konechnostei v usloviiakh distraktsionnogo osteosinteza [Changing of the functional state of neuromuscular and cardiovascular systems of shortened limbs in conditions of distraction osteosynthesis]. Med Zhurn. 2008;(2):97-100.
  8. Alzahrani MM, Anam EA, Makhdom AM, Villemure I, Hamdy RC. The effect of altering the mechanical loading environment on the expression of bone regenerating molecules in cases of distraction osteogenesis. Front Endocrinol (Lausanne). 2014 Dec 10;5:214. doi: 10.3389/fendo.2014.00214.
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  12. Prince DE, Herzenberg JE, Standard SC, Paley D. Lengthening with external fixation is effective in congenital femoral deficiency. Clin Orthop Relat Res. 2015 Oct;473(10):3261-71. doi: 10.1007/s11999-015-4461-0.
  13. Radler C, Antonietti G, Ganger R, Grill F. Recurrence of axial malalignment after surgical correction in congenital femoral deficiency and fibular hemimelia. Int Orthop. 2011 Nov;35(11):1683-8. doi: 10.1007/s00264-011-1266-y.
  14. Dal Monte A, Donzelli O. Tibial lengthening according to Ilizarov in congenital hypoplasia of the leg. J Pediatr Orthop. 1987 Mar-Apr;7(2):135-38.
  15. Popkov AV, Popkov DA. Osobennosti funktsional'nogo vosstanovleniia posle operativnogo lecheniia detei s vrozhdennym ukorocheniem nizhnikh konechnostei [Features of functional recovery after surgical treatment of children with congenital shortening of the lower limb]. Genii Ortopedii. 2008;(1):19-26.
Address for correspondence:
640014, Russian Federation, Kurgan, M. Ulyanova st., 6,
FGBI "Russian Scientific Center" Restorative Traumatology and Orthopaedics" named by Academician GA Ilizarov", laboratory of limb lengthening and correction of deformity in the lower limbs.
Tel: 7 (3522) 41-52-27
E-mail: n.a.kononovich@mail.ru
Kononovich Natalya Andreevna
Information about the authors:
Popkov D.A. MD, Head, FSBE "Russian Ilizarov Center for Restorative Traumatology and Orthopedics", laboratory of limb lengthening and correction of deformity in the lower limbs.
Popkov A.V. MD, Professor, Chief researcher,
FSBE "Russian Ilizarov Center for Restorative Traumatology and Orthopedics", laboratory of limb lengthening and correction of deformity in the lower limbs.
Shchurov V.A. MD, Professor, Chief researcher,
FSBE "Russian Ilizarov Center for Restorative Traumatology and Orthopedics", laboratory of limb lengthening and correction of deformity in the lower limbs.
Kononovich N.A. PhD, Leading researcher,
FSBE "Russian Ilizarov Center for Restorative Traumatology and Orthopedics",laboratory of limb lengthening and correction of deformity in the lower limbs.

MILITARY FIELD & SURGERY

V.V. MASLYAKOV, V.G. BARSUKOV, K.G. KURKIN

DIRECT TREATMENT RESULTS OF CHEST GUNSHOT WOUNDS IN CIVILIAN TRAUMA PATIENTS UNDER CONDITIONS OF LOCAL MILITARY CONFLICTS

The branch of PIEE HE "Medical University "Reaviz",
Saratov
The Russian Federation

Objectives. To analyze the treatment results of the chest gunshot wounds among the civilian trauma patients under the local military conflict.
Methods. The results of medical aid rendering to 106 patients were analyzed. The victims were divided into two groups: group A – 62 (58,5%) of wounded patients evacuated to hospitals within 1 hour after the chest injured, group B – 44 (41.5%) – admitted within more than 1 hour after chest injury.
Results. Penetrating wounds in the group A were diagnosed in 38 (61,3%) patients; non-penetrating – in 24 (38,7%). Visceral injuries were revealed in 39 (62,9%) cases. Penetrating wounds in the group B occured in 21 patients (44,7%), non-penetrating – in 23 (52,3%) cases. Injuries of the internal organs were detected in 21 (44,7%) cases.
The patients (group A) were subjected to the following operative interventions: the primary surgical procedure (PSP) of wound of the chest in 50 (80,6%) victims, the emergency thoracotomy was carried out at once in 12 (19,4%) cases. Non-penetrating chest wound was diagnosed during PSP in 24 (38,7%) cases The rest 26 (41,9%) patients were performed thoracotomy after PST. The patients (group B) underwent the following interventions: PSP of the wound was performed in 39 (88,6%) cases; the emergency thoracotomy was carried out at once in 5 (11,4%) victims. The wound was found out to be non-penetrating during PSP in 23 (52,3%). Thoracotomy was carried out after PSP in the rest 16 (36,4%) patients.
In the immediate postoperative period, 30 complications were registered in the group A, 21 complications - in group B. Total mortality in the group A was 12 (19,4%), in the group B – 20 (45,5%).
Conclusion. The breast gunshot wounds of patients among the civilian population, resulting in a local military conflicts, characterized by high morbidity and mortality, the number of which depends on the time of delivery of the injured patients.

Keywords: chest gunshot wounds, victims, emergency thoracotomy, immediate postoperative period, civilian population, complications, lethal outcomes
p. 379-384 of the original issue
References
  1. Bedin VV, Radionov IA. Sovremennye podkhody k khirurgicheskomu lecheniiu travmaticheskikh povrezhdenii pecheni [Current approaches to surgical treatment of traumatic lesions of the liver]. Annaly Khirurg Gepatologii. 2007;12(3):248-49.
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  3. Kerimov AZ, Gromov MS. Khirurgicheskaia taktika pri ognestrel'nykh raneniiakh zhivota v usloviiakh regional'nogo konflikta [Surgical Management of gunshot wounds abdomen in a regional conflict]. Sarat Nauch-Med Zhurn. 2010;6(2):460-62.
  4. Borisov AE, Kuiuachev KE, Muskudinov ND, Turdyev MS. Diagnostika i khirurgicheskaia taktika pri izolirovannoi i sochetannoi travme pecheni [Diagnosis and surgical tactics in isolated and combined liver injury]. Annaly Khirurg Gepatologii. 2007;12(3):250.
  5. Briusov PG, Urazovskii NIu. Novye tekhnologii pri khirurgicheskom lechenii ognestrel'nykh pronikaiushchikh ranenii grudi [New technologies in the surgical treatment of gunshot wounds penetrating the chest]. Khirurgiia Zhurn im NI Pirogova. 2001;(3):46-51.
  6. Gumanenko EK, Samokhvalov IM, Trusov AA, Badalov VI. Organizatsiia i soderzhanie spetsializirovannoi khirurgicheskoi pomoshchi v mnogoprofil'nykh voennykh gospitaliakh 1-go eshelona vo vremia kontrterroristicheskikh operatsii na Severnom Kavkaze [Organization and maintenance of specialized surgical care in a multidisciplinary military hospitals of the 1st tier during counter-terrorist operations in the North Caucasus] (Soobshch 5). Voen- Med Zhurn. 2006;327(3):7-18.
  7. Masliakov VV, Voinovskii AE, Lysov NA, Gromov MS, Dadaev AIa, Kerimov A3, i dr. Rezul'taty lecheniia ranenii grudi sredi grazhdanskogo naseleniia v lokal'nom voennom konflikte [Results of treatment of chest injuries among the civilian population on a local military conflict]. Med Nauka i Obrazovanie Urala. 2014;(2):96-100.
Address for correspondence:
410012, Russian Federation, Saratov, Upper market, 10. Branch of PEE HE "Medical University" Reaviz "Saratov, chair of surgical diseases.

Tel: 8 (8452) 74-27-21
E-mail: maslyakov@inbox.ru
Maslyakov Vladimir Vladimirovich
Information about the authors:
Maslyakov V.V. MD, professor, Vice Rector (science work and public relations), PEE HE "Saratov Medical University "Reaviz".
Barsukov V.G. PhD, Associate professor, PEE HE "Saratov Medical University "Reaviz", chair of surgical diseases.
Kurkin K.G. Post-graduate student, PEE HE "Saratov Medical University "Reaviz", chair of surgical diseases.

ONCOLOGY

V.V. ZHARKOV 1, S.A. YESKOV 2, V.V. EROKHOV 2

SURGICAL TREATMENT RESULTS OF PATIENTS WITH LOCALLY ADVANCED (PT4) NON-SMALL CELL LUNG CANCER

SE "Republican Scientific-Practical Center of Oncology and Medical Radiology named after N.N. Alexandrov"1,
ME "The 9th City Clinical Hospital"2,
Minsk
The Republic of Belarus

Objectives. To evaluate the immediate and long-term results of surgical treatment of patients with locally advanced non-small cell lung cancer (NSCLC – stage IIIA-IIIB) accompanied by mediastinal invasion of the tumor.
Methods. 180 surgeries had been performed (1996-2012 yrs) to the patients with locally advanced pT4 NSCLC. The age varied from 21 up to 81, the median age – 58. The right-sided tumor was registered in 103 cases and left-sided – in 77. The pT4 descriptor was determined on the basis of the lung cancer invasion of different structures or mediastinal organs. Affection of two or more structures occurred in 77 cases. The disease was staged as pT4N0M0 in 23 cases, pT4N1M0 – in 54, pT4N2M0 – in 103. Surgical interventions such as combined lobectomy or bilobectomy were performed only in 5 patients, and combined pneumonectomy – in 175, including 34 cases – the carinal wedge resection of tracheal bifurcation and 42 – sleeve resection. Resection of the vena cava superior was performed in 36 patients. The aorta was resected in 27 cases, the left atrium – in 70, the esophagus – in 31, the vertebrae – in 8 patients; ribs were resected in 18 cases.
Results. The postoperative morbidity was 33,9%, mortality – 17,8%. Overall five-year survival rate of patients with stages IIIA-IIIB (pT4N0-2M0) was 19,8%, median survival – 14,9 months. In the group of IIIA (pT4N0-1M0) stage – 26,0%, 22,7 months, respectively. In the group of patients with metastatic mediastinal lymph nodes (pT4N2M0) – 14,7%, 13,6 months, respectively (p=0,038).
Conclusion. Combined surgery allows achieving satisfactory immediate and long-term results of treatment at the admissible indices of postoperative mortality. The best results can be obtained for patients with stage IIIA (pT4N0-1M0) NSCLC.

Keywords: non-small cell lung cancer, locally advanced lung cancer, combined surgeries, overall survival, morbidity, mortality, postoperative period
p. 385-393 of the original issue
References
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Address for correspondence:
220116, Republic of Belarus, Minsk, Semashko st., 8, ME "9th
City Clinical Hospital", thoracic department.
Tel: 375 29 115-77-36
E-mail: 445e@mail.ru
Yeskov Sergey Aleksandrovich
Information about the authors:
Zharkov V.V. MD, Professor, Head "Republican scientific-practical center of oncology and medical radiology named after N.N. Alexandrov", surgical department.
Yeskov S.A. Head, ME "The 9th city clinical hospital", thoracic department.
Erokhov V.V. Surgeon, ME "The 9th city clinical hospital", thoracic department.

REVIEWS

Y.V. PEROV, I.S. POPOVA, I.A. MIHAILOV

OBSTRUCTED DEFECATION SYNDROME: A REVIEW OF THE LITERATURE

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

An obstructed defecation is a widespread problem encountered by coloproctology and gastroenterology in the practice. These disorders socially and psychologically distress patients and greatly diminished quality of life at the other. Despite the terminological distinction in naming etiopathogenic causes of obstructive defecation syndrome (ODS), they all can be reduced to two principal points: functional - (dysfunction and dyssynergia of the pelvic fundus muscles) and mechanical - (rectocele, rectal intussusception) and their combinations. Problems of treatment of ODS are in the correct choice of conservative and operative treatment, and combinations thereof. The management of obstructed defecation syndrome (ODS) is mainly conservative and consists of diet, laxatives, hydrocolontherapy, biofeedback, transanal electrostimulation and psychotherapy. The goal of surgical treatment is to restore various pelvic organs to their appropriate anatomic positions. However, there is a poor correlation between anatomic and functional results. Until today there is not a surgical gold standard. Functional outcomes of stapled transanal rectal resection for obstructed defecation are still controversial.

Keywords: constipation, obstructed defecation, pelvic dyssynergy, rectocele, rectal prolapse, hydrocolontherapy, psychotherapy
p. 394-400 of the original issue
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Address for correspondence:
400131, Russian Federation, Volgograd, Fallen Fighters Sq., 1, Volgograd State Medical University, chair of surgical diseases and neurosurgery of advanced medical faculty. Tel: +7 (8442) 54-60-16
E-mail: yvperov@list.ru
Perov Yuriy Vadimovich
Information about the authors:
Perov Y.V. PhD, Coloproctologist, SME "Emergency City Clinical Hospital ¹25", laboratory assistant, SBEE HPE "Volgograd State Medical University", chair of surgical diseases and neurosurgery.
Popova I.S. MD, Professor, SBEE HPE "Volgograd State Medical University", chair of surgical diseases and neurosurgery.
Mihailov I.A. Post-graduate student, SBEE HPE "Volgograd State Medical University", chair of surgical diseases and neurosurgery.

CASE REPORTS

K.V. LIPATOV, Y.V. STRUCHKOV, E.A. KOMAROVA, B.S. NASIBOV

POST-IMPLANTATION POLYACRYLAMIDE MAMMARY SYNDROME: A TOPICAL PROBLEM OF GENERAL SURGICAL HOSPITALS

SPEE HPE "I.M. Sechenov First Moscow Sate Medical University",
Moscow
The Russian Federation

Objectives. To investigate various forms of late purulent complications of injection contour mammoplasty from the point of view of therapeutic and diagnostic tactics elaboration in regard of this patient category.
Methods. Regarding to therapy results of patients (n=8) who had previously undergone breast augmentation by polyacrylamide hydrogel injections complicated by the infection of implants, the causes, clinical presentation, optimal diagnostic and therapeutic measures referring to different forms of late postoperative purulent complications had been studied.
Results. The risk of post-implantation infection remains for many years after the augmentation mammoplasty. The features of surgical treatment of these complications include the necessity of radical removal of all tissues infiltrated by hydrogel that leads to a severe cosmetic defect. With a view to eliminate the cosmetic defect, the endoprosthetics of mammary glands using silicone breast implants could be performed (6 - 12 months after the inflammatory process). In this case another aesthetic surgery would be accompanied by an increased risk of postoperative purulent complications.
Conclusion. Augmentation mammoplasty by polyacrylamide hydrogel injections appears to be inaccurate and dangerous technique of breast augmentation and should be officially prohibited. Surgical treatment of late purulent complications of augmentation mammoplasty by polyacrylamide hydrogel injections has a range of significant characteristics. To improve the long-term results the principal diagnostic and therapeutic conception of treatment the postoperative purulent complications after augmentation mammoplasty has been formulated in this study.

Keywords: augmentation mammoplasty, cosmetic defect, silicone breast implants, polyacrylamide hydrogel, purulent complications, post-implantation polyacrylamide mammary syndrome, long-term results
p. 401-406 of the original issue
References
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Address for correspondence:
119991, Russian Federation, Moskow,
ul. Bolshaya Pirogovskaya, d. 2, str. 4,
GBOU VPO
"Pervyiy Moskovskiy meditsinskiy
universitet im. I.M. Sechenova",
kafedra obschey khirurgii,
tel. mob. 89166358988,
e-mail: k_lipatov@mail.ru,
Lipatov Konstantin Vladimirovich
Information about the authors:
Lipatov K.V. MD, professor of the general surgery chair of SBEE HPE "I.M.Sechenov First Moscow State Medical University".
Struchkov Y.V. MD, professor of the general surgery chair of SBEE HPE "I.M.Sechenov First Moscow State Medical University".
Komarova E.A. PhD, an assistant of the general surgery chair of SBEE HPE "I.M.Sechenov First Moscow State Medical University".
Nasibov B.Sh., applicant of the general surgery chair of SBEE HPE "I.M.Sechenov First Moscow State Medical University".

EXCHANGE OF EXPERIENCE

G.A. POPEL 1, A.V. VARABEI 1, I.A. DAVIDOVSKI 1, M.T. VOEVODA 1, A.I. ROGATEN 2, N.V. DERKACHEVA 2

DIAGNOSTICS OF CONGENITAL VASCULAR MAL FORMATIONS OF EXTERNAL LOCALIZATION

SBE "Belarusian Medical Academy of Post-Graduate Education"1,
Minsk,
ME "Minsk Regional Clinical Hospital"2,
Minsk
The Republic of Belarus

Objectives. To develop a differentiated algorithm of application of the most informative diagnostic methods for improving the treatment outcomes of patients with congenital vascular malformations (CVMs) of the external localization.
Methods. The study included 202 patients with ÑVM aged 1-78 years for the period 1990-2015. Depending on the blood flow velocity, all CVMs were divided into two types: low-velocity and high-velocity. The arteriovenous malformations (AVMs) were corresponded to high-velocity blood flow CVM; venous (VM), capillary (CM) and lymphatic malformations (LM) were corresponded to low-velocity blood flow. For the evaluation of patients with CVM the diagnostic algorithm was proposed. In addition to general clinical examination of patients the following diagnostic methods were used: a comprehensive ultrasound of the vessels, plain radiography of soft tissues and bones, tomographic methods of investigation, including computed tomography with dynamic contrast-enhanced image (CTI) and magnetic resonance angiography (MRA) as well as arteriography and phlebography.
Results. Analysis of demographic studies has shown that the detection of congenital vascular development occurs in the majority of cases in females at a young age (11-20 years), and indirectly indicates the clinical manifestation of the disease during the hormonal changes. Comprehensive ultrasound is leading in the evaluation of patients with CVM. Computed tomography (ÑT) and magnetic resonance imaging (MRI) are the most informative methods for accurate topical diagnosis of congenital vascular malformations, for estimation of the extension of the pathological process, for visualization of blood vessels. To reveal an intense blood flow at CVM the selective angiography should be prefered, as in some cases it can be a medical procedure to perform embolization of the arteriovenous reset.
Conclusion. The current examination of patients with CVM of the external localization should be based on a multidisciplinary approach, including ultrasound diagnostic methods, tomographic methods of investigation, as well as angiography.

Keywords: vascular malformations, arteriovenous malformation, venous malformation, ultrasound, computed tomography, magnetic resonance imaging, angiography
p. 407-416 of the original issue
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Address for correspondence:
223041, Republic of Belarus, Minsk region and district, Lesnoy setl.,1, ME "Minsk Regional Clinical Hospital", chair of surgery.
Tel: 37517 2652263
E-mail: hpopel@mail.ru
Popel Gennadiy Adolfovich
Information about the authors:
Popel G.A. Assistant, SEE "Belarusian Medical Academy of Post-Graduate Education", chair of surgery .
Varabei A.V. Corresponding Member of NAS of Belarus, MD, Head, SEE "Belarusian Medical Academy of Post-Graduate Education", chair of surgery, Head, Republican Center of the Reconstructive Surgical Gastroenterology and Coloproctology.
Davidovski I.A. Ass. Professor, SEE "Belarusian Medical Academy of Post-Graduate Education", chair of surgery.
Voevoda M.T. Ass. professor SEE "Belarusian Medical Academy of Post-graduate Education", chair of surgery.
Rogaten A.I. Physician, ME "Minsk Regional Clinical Hospital", ultrasound diagnostics unit.
Derkacheva N.V. Head ME "Minsk Regional Clinical Hospital", MRI room.
Contacts | ©Vitebsk State Medical University, 2007-2023