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Khirurgii

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Year 2022 Vol. 30 No 4

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

R.E. KALININ, I. A. SUCHKOV, E. A. KLIMENTOVA, A.S. PSHENNIKOV

COMPREHENSIVE ASSESSMENT OF ENDOTHELIAL AND PLATELET-DERIVED GROWTH FACTORS ON RESTENOSIS DEVELOPMENT OF THE RECONSTRUCTION ZONE IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASIS

Ryazan State Medical University, Ryazan,
Russian Federation

Objective. Comprehensive assessment of the influence of vasculoendothelial growth factor A 165 and platelet-derived growth factor (PDGF) on the risk of development of reconstruction zone restenosis being one of the main postoperative complications in the remote postoperative period in patients with peripheral arterial disease.
Methods. The study included patients (n=47) with peripheral arterial disease (stage IIB-III) underwent the open interventions. In the period immediately prior the operation, in the first hours, and then on the 1st, 7th and 30th days after the operation, the amount of vasculoendothelial growth factor (VEGF A 165) and platelet-derived growth factor (PDGF) in the blood serum has been determined. In cases of the restenosis development of the intervention zone, a vascular wall sample with restenosis was taken intraoperatively for the subsequent examination of the studied biomarkers by enzyme immunoassay.
Results. In the first hours and on the first day after surgery, the amount of VEGF A165 in patients with restenosis was 2.2 fold and 1.8 fold, respectively, reduced in comparison with its values in patients without this complication (p<0.01). By the end of the first week, the PDGF values (p<0.01) were 1.4 fold higher in patients with restenosis of the intervention zone than in patients without restenosis. The difference between the compared groups in the indicated period of time in terms of VEGF A 165 was 85% (p<0.01). By the end of the first month, in patients with restenosis an increased level of the PDGF marker (p<0.01) retained against the background of decreased VEGF A 165 values (p=0.02) compared with patients without this complication.
Conclusion. VEGF A 165 values for the first hours is considered to be used as a prognostic marker for the restenosis development of the reconstruction zone after open lower extremity vascular interventions.

Keywords: re-endothelialization, atherosclerosis, VEGF A165, PDGF, vascular wall homogenate
p. 331-339 of the original issue
References
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  14. Kalinin RE, Suchkov IA,. Schulkin AV, Klimentova EA, Egorov AA. Influence of various surgical interventions on vascular wall apoptosis indices in patients with atherosclerosis of peripheral arteries Novosti Khirurgii. 2021 Aug-Sep; Vol 29 (4):420-25 (In Russ.)
  15. Mukaihara K, Yamakuchi M, Kanda H, Shigehisa Y, Arata K, Matsumoto K, Takenouchi K, Oyama Y, Koriyama T, Hashiguchi T, Imoto Y. Evaluation of VEGF-A in platelet and microRNA-126 in serum after coronary artery bypass grafting. Heart Vessels. 2021;36(11):1635-45. doi: 10.1007/s00380-021-01855-6.
Address for correspondence:
390026, Russian Federation,
Ryazan, st. Vysokovoltnaya, 9,
Ryazan State Medical University,
Department of Cardiovascular,
X-ray Endovascular Surgery
and Radiation Diagnostics,
Tel. +7-4912-97-18-03
E-mail: Suchkov_med@mail.ru
Suchkov Igor A.
Information about the authors:
Kalinin R.E., MD, Professor, Rector of the Ryazan State Medical University, Head of the Department of Cardiovascular, X-ray Endovascular Surgery and Radiation Diagnostics Ryazan State Medical University named after Academician I.P. Pavlov of the Ministry of Health of Russia.
https://orcid.org/0000-0002-0817-9573
Suchkov I.A., MD, Professor, Vice-Rector for Research and Innovative Development, Professor of the Department of Cardiovascular, X-ray Endovascular Surgery and Radiation Diagnostics, Ryazan State Medical University named after Academician I.P. Pavlov, Ministry of Health of Russia.
https://orcid.org/0000-0002-1292-5452
Klimentova E.A., Junior Researcher, Scientific and Educational Center, Ryazan State Medical University named after Academician I.P. Pavlov, Ministry of Health of Russia.
https://orcid.org/0000-0003-4855-9068.
Pshennikov A.S., MD, Associate Professor, Professor of the Department of Cardiovascular, X-ray Endovascular Surgery and Radiation Diagnostics of Ryazan State Medical University named after Academician I.P. Pavlov of the Ministry of Health of Russia.
https://orcid.org/0000-0002-1687-332X.

T.N. TSERAKHAVA 1, I.O. POHODENKO-CHUDAKOVA 2, O.A. YUDINA 3, N. NIJIATI 1

EVALUATION OF THE EFFECTIVENESS OF THE STANDARD COMPLEX TREATMENT OF ACUTE PURULENT PERIOSTITIS OF THE MANDIBLE BASED ON MORPHOLOGICAL CHANGES IN EXPERIMENTAL CONDITIONS

Belarusian State Medical University, Minsk,
Republic of Belarus

Objective. The aim of the study is to determine the effectiveness of the standard complex treatment of acute purulent periostitis of the mandible on the basis of morphological changes in experimental conditions.
Methods. The study was performed on 47 rabbits (acute purulent periostitis of the lower jaw was simulated on 45). Series 1 – 12 animals that received only surgical treatment after the model was created. Series 2 – 7 animals that underwent surgery and received antibacterial therapy. Series 3 – 26 rabbits that were not treated. Series 4 served as a control and consisted of 2 animals without pathology. Micro-preparations were prepared according to the standard method. Morphological changes were evaluated in the analysis of periosteal pathology and expressed in points depending on their degree. The obtained data were processed statistically.
Results. The surgical method of treatment of periostitis in combination with antibiotic therapy made it possible to localize the inflammatory focus 2 days earlier than with isolated surgical treatment. An integrated approach contributed to optimization both in the focus of inflammation and in adjacent tissues. However, the prolonged persistence of inflammation was accompanied by reactive bone resorption and substitutive sclerosis which violated the anatomical relationship of structures in the area of examination.
Conclusion. Standard treatment of experimental acute purulent periostitis of the lower jaw does not give the desired result. It can lead to a chronic course of the disease and severe complications. This is the basis for the development of new complexes for its treatment.

Keywords: acute purulent periostitis, infectious and inflammatory process, morphological changes, standard treatment, experimental study
p. 340-350 of the original issue
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  3. Delbet-Dupas C, Devoize L, Mulliez A, Barthélémy I, Pham Dang N. Does anti-inflammatory drugs modify the severe odontogenic infection prognosis? A 10-year’s experience. Med. Oral Patol. Oral Cir. Bucal. 2021 Jan; 26(1): e28-e35. doi: 10.4317/medoral.23926
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  8. Gumenyuk S.E., Gaivoronskaya T.V., Gumenyuk A.S., Ushmarov D.I., Isyanova D.R. Simulation of wound process in experimental surgery. Kuban Scientific Medical Bulletin. 2019;26(2):18-25. doi: 10.25207/1608-6228-2019-26-2-18-25(In Russ.)
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Address for correspondence:
220116, Republic of Belarus,
Minsk, Dzerzhinsky Ave., 83,
Educational institution
«Belarusian State Medical University»,
Department of Surgical Dentistry,
tel. +375 29 644 07 20,
e-mail: ip-c@yandex.ru,
Pokhodenko-Chudakova Irina O.
Information about the authors:
Terekhova Tamara N., MD, Professor, Professor of the Department of Pediatric Dentistry of the Educational Institution «Belarusian State Medical University», Minsk, Republic of Belarus.
https://orcid.org/0000-0002-2647-5082
Pohodenko-Chudakova Irina O., MD, Head of the Department of Surgical Dentistry of the Educational Establishment “Belarusian State Medical University”, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-0353-0125
Yudina Olga A., PhD, Associate Professor, Associate Professor of the Department of Pathological Anatomy of the Educational Establishment “Belarusian State Medical University”, Minsk, Republic of Belarus. https://orcid.org/0000-0001-7623-0601
Nizyati Nilupar, Post-Graduate Student of the Department of Pediatric Dentistry of the Educational Establishment “Belarusian State Medical University”, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-4895-2281

A.J. NOYES, J.P. FELESHTYNSKY, V.Y. PIROGOVSKY

SURGICAL TREATMENT FOR ANAL FISSURE COMBINED WITH HEMORRHOIDS

National University of Health of Ukraine named after P.L. Shupyk, Kiev,
Ukraine

Objective. Simultaneous surgical treatment of patients with anal fissure and hemorrhoids improves the results of treatment of these patients.
Methods. 177 patients with anal fissure and hemorrhoids were studied. GI – fissure excision and hemorrhoidectomy, GII – anal fissure excision without intervention for hemorrhoids, GIII – proposed method used. Result assessment by following criteria: pain intensity, urinary retention, wound suppuration, recurrence, incontinence, hospital stay. For assessment of blood flow intensity in fissure area Laser Doppler flowmetry was performed.
Results. Pain intensity: GI – 8±1, GII – 6±2, GIII – 4±1. Urinary retention: GI – 19(31.6%), GII – 8(13%), GIII – 6 (10.5%). Wound suppuration: GI – 5 (8.3%), GII – 1 (1.7%), GIII – 1 (1.7%). Days of hospital stay: GI – 6±1.2, GII – 4±1.3, GIII – 3±1.1. Fissure recurrences: GI – 5 (8.3%), GII – 2 (3.3%), GIII – 1 (1.7%). Recurrence of hemorrhoids: GI – 6 (10%), GIII – 2 (3.5%). Iatrogenic incontinence: GI – 4 (6.7%), GII –
1 (1.7%), GIII – 0. We observed significant decrease in relative risk of complications (by 88%) in GIII compared with GI – OR=0.12 (0.04-0.29), p=0.0001, and a tendency to reduction of complication risk by 15% compared with GII – OR=0.85 (0.29-2.4), p=0.734. Blood flow intensity (flowmetry results) in GII and GIII was comparable.
Conclusion. Surgical treatment of patients with a combination of anal fissure and hemorrhoids by combining fissure excision with transanal hemorrhoidal deartherialization improves treatment outcomes. Surgical treatment of patients with anal fissure combined with hemorrhoids, by the proposed method can improve treatment results. This method does not impair blood flow in the area of anal fissure. Thus, the proposed method is both minimally invasive and radical. Therefore it can be easily implemented in surgical practice.

Keywords: hemorrhoids, anal fissure, laser Doppler flowmetry, hemorrhoidal dearterialization, anal sphincterotomy
p. 351-357 of the original issue
References
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  2. Salati SA. Anal Fissure – an extensive update. Pol Przegl Chir. 2021 Mar 12;93(4):46-56. doi: 10.5604/01.3001.0014.7879
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  7. Trenti L, Biondo S, Galvez A, Bravo A, Cabrera J, Kreisler E. Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes. Tech Coloproctol. 2017 May;21(5):337-44. doi: 10.1007/sl0151-017-1620-1
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  12. Trilling B, Pflieger H, Faucheron JL. Decreased blood flow to the posterior anal canal shown during Doppler-guided hemorrhoidal artery ligation explains anodermal ischemia in anal fissure. Tech Coloproctol. 2017 May;21(5):411-12. doi: 10.1007/sl0151-017- 1636-6
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Address for correspondence:
04112, Ukraine,
Kiev, st. Dorogozhitskaya, 9,
National University of Health
of Ukraine. P.L. Shupika,
Department of Surgery and Proctology
tel. +38 063 323 64 33,
e-mail: noyesdoc@gmail.com,
Noes Andrew Jimmy
Information about the authors:
Noes Andriy Jimmy, Graduate Student, PhD, Department of Surgery and Proctology, National University of Health of Ukraine named after P.L. Shupyk, Kiev, Ukraine.
https://orcid.org/0000-0003-4463-9044
Feleshtinsky Yaroslav P., MD, Professor, Head of the Department of Surgery and Proctology, National University of Health of Ukraine named after P.L. Shupyk, Kiev, Ukraine.
https://orcid.org/0000-0003-4376-4265
Sorokin Bogdan V. MD, Professor, Department of Oncology, National University of Health of Ukraine named after P.L. Shupyk, Kiev, Ukraine.
https://orcid.org/0000-0003-0511-7550
Pirogovsky Volodymyr Y., PhD, Assistant, Department of Surgery and Proctology, National University of Health of Ukraine Named after P.L. Shupyk, Kiev, Ukraine.
https://orcid.org/0000-0002-7453-991X

V.A. DUDKO 1, 2, T.I. KLEPCHA 1, A.L LIPNITSKI 1, 2, A.V. MAROCHKOV 1, 2, T.V. SERGIEVICH 1

DYNAMICS OF CORTISOL LEVEL DURING ANESTHESIA OF CARDIOSURGERY UNDER CARDIOPULMONARY BYPASS

Mogilev Regional Clinical Hospital 1, Mogilev,
Vitebsk State Order of Peoples’ Friendship Medical University 2, Mogilev, Republic of Belarus

Objective. The aim of our research was to define the dynamic of the cortisol level in patients in the perioperative period during cardiac surgery.
Methods. A prospective nonrandomized observational study was carried out, which included 30 cardiac surgery patients. The age of the patients ranged from 49 to 67 years (64.0 (59.56; 33.25) years), body mass index – 29.05 (25.56; 33.25) kg/m². All patients underwent cardiac surgery under cardiopulmonary bypass. All patients underwent blood sampling at the following stages: stage 1 – the patient was on an operation table, catheterization of the peripheral vein, intravenous blood sampling; stage 2 – the patient is on the operating table, before being connected to the cardiopulmonary bypass; stage 3 – the end of the operation, suturing skin; stage 4 – the patient is in the intensive care unit, 1-3 hours after the operation; stage 5 – 17-20 hours later after the operative intervention. The quantitative determination of cortisol in the blood serum was carried out by the immunochemical method using the apparatus Architect plus i10000sr (Abbott, USA).
Results. In stage 1, the cortisol level was 8.5 (6.3; 10.4) mcg/dl; at stage 2 – 11.0 (5.1; 14.3) mcg/dl; when suturing the skin – 28.4 (16.6; 36.5) mcg/dl; after 1-3 hours after the operation – 18.55 (14.6; 23.5) mcg/dl; on the next day – 13.2 (8.0; 19.9) mcg/dl. We also revealed a reliable difference in the level of cortisol in the serum at stages 3 and 5, depending almost on the inclusion of prednisolone in the composition of the primary solution.
Conclusion. Determination of the level of cortisol should be used as a component of anesthetic monitoring during cardiac surgery.

Keywords: cardiac surgery, anesthesia, cortisol, cardiopulmonary bypass, prednisolone
p. 358-365 of the original issue
References
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  3. Kornilov IA, Ponomarev DN, Shmyrev VA, Skopets AA, Sinelnikov YuS., Lomivorotov VV. Physiological parameters of artificial blood circulation from the position of the evidence based medicine. Part I. Messenger of anesthesiology and resuscitation. 2016;13(2):57-69. doi: 10.21292/2078-5658-2016-13-2-57-69 (In Russ.)
  4. Arora D, Mehta Y. Recent trends on hemodynamic monitoring in cardiac surgery. Ann Card Anaesth. 2016 Oct-Dec;19(4):580-83. doi: 10.4103/0971-9784.191557
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  6. Vogeser M, Felbinger TW, Kilger E, Roll W, Fraunberger P, Jacob K. Corticosteroid-binding globulin and free cortisol in the early postoperative period after cardiac surgery. Clin Biochem. 1999 Apr;32(3):213-6. doi: 10.1016/s0009-9120(99)00009-0
  7. Kaushal RP, Vatal A, Pathak R. Effect of etomidate and propofol induction on hemodynamic and endocrine response in patients undergoing coronary artery bypass grafting/mitral valve and aortic valve replacement surgery on cardiopulmonary bypass. Ann Card Anaesth. 2015 Apr-Jun;18(2):172-78. doi: 10.4103/0971-9784.154470
  8. Abbas Sedighinejad A, Imantalab V, Mirmansouri A, Naderi Nabi B, Tarbiat M, Sadeghi AM, Nassiri Sheikhani N, Haghighi M, Sayahe Varag Z. Comparing the effects of isoflurane-sufentanil anesthesia and propofol-sufentanil anesthesia on serum cortisol levels in open heart surgery with cardiopulmonary bypass. Anesth Pain Med. 2016 Nov 21;6(6):e42066. doi: 10.5812/aapm.42066. eCollection 2016 Dec.
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  10. Fillinger MP, Rassias AJ, Guyre PM, Sanders JH, Beach M, Pahl J, Watson RB, Whalen PK, Yeo KT, Yeager MP. Glucocorticoid effects on the inflammatory and clinical responses to cardiac surgery. J Cardiothorac Vasc Anesth. 2002 Apr;16(2):163-69. doi: 10.1053/jcan.2002.31057
  11. Ahmad M, Md Din NSB, Tharumalay RD, Che Din N, Ibrahim N, Amit N, Farah NM, Osman RA, Abdul Hamid MF, Ibrahim IA, Jamsari EA, Palil MR, Ahmad S. The effects of circadian rhythm disruption on mental health and physiological responses among shift workers and general population. Int J Environ Res Public Health. 2020 Sep 30;17(19):7156. doi: 10.3390/ijerph17197156
  12. Ronaldson A, Kidd T, Poole L, Leigh E, Jahangiri M, Steptoe A. Diurnal cortisol rhythm is associated with adverse cardiac events and mortality in coronary artery bypass patients. J Clin Endocrinol Metab. 2015 Oct;100(10):3676-82. doi: 10.1210/jc.2015-2617
Address for correspondence:
212016, Republic of Belarus,
Mogilev, st. Belynitsk-Biruli, 12,
Mogilev Regional Clinical Hospital,
Department of Anesthesiology and Resuscitation
of the Center for Cardiovascular Surgery,
tel.: +375 222 62-75-95,
e-mail: vladimirdudko@mail.ru,
Dudko Vladimir A.
Information about the authors:
Dudko Vladimir A., Anesthesiologist, Head of the Department of Anesthesiology and Intensive Care of the Ñenter of Cardiovascular Surgery, Mogilev Regional Clinical Hospital, the Branch of the Departments of Anesthesiology and Resuscitation with a course of the Faculty of the Advanced Training and Retraining and Surgery of the Faculty of the Advanced Training and Retraining of Vitebsk State Medical University, assistant, Mogilev, Republic of Belarus.
https://orcid.org/0000-0002-5959-5454
Klepcha Tatyana I., Anesthesiologist, Department of Anesthesiology and Intensive Care of the Ñenter of Cardiovascular Surgery, Mogilev Regional Clinical Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0002-4426-0213
Lipnitski Artur L., PhD, Anesthesiologist, Head of the Department Coordination for Organ and Tissue Transplantation Mogilev Regional Clinical Hospital, the Branch of the Departments of Anesthesiology and Resuscitation with a Course of the Faculty of the Advanced Training and Retraining and Surgery of the Faculty of the Advanced Training and Retraining of Vitebsk State Medical University, Mogilev, Republic of Belarus.
https://orcid.org/0000-0002-2556-4801
Marochkov Alexey V., MD, Professor, Anesthesiologist of Anesthesiology and Intensive Care Unit, Mogilev Regional Clinical Hospital, the Branch of the Departments of Anesthesiology and Resuscitation with a Course of the Faculty of the Advanced Training and Retraining and Surgery of the Faculty of the Advanced Training and Retraining of Vitebsk State Medical University, Professor, Mogilev, Republic of Belarus.
https://orcid.org/0000-0001-5092-8315
Sergievich Tatyana V., Physician of Clinical Laboratory Diagnostics, Head of the Department of Clinical Laboratory Diagnostics, Mogilev Regional Clinical Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0003-4981-5430

P.D. DZIAMESHKA

LONG-TERM RESULTS OF RADIOSURGICAL TREATMENT OF INTRACRANIAL METASTASIS OF RENAL CELL CANCER

N.N. Alexandrov National Cancer Centre of Belarus, Minsk,
The Republic of Belarus

Objective. To study the indicators and predictors of overall survival (OS) of patients with metastatic brain lesion in renal cell carcinoma after stereotactic radiosurgery (SRS).
Methods. The results of SRS of patients (n= 62) with 1 – 10 metastases in the brain with a diameter of no more than 3 cm were analyzed. A status on the Karnofsky scale was of at least 70%, withot extracranial progression, or there are reserves of systemic treatment. The OS parameters were studied and the prognostic factors after SRS were determined.
Results. The median OS was 18.0 months. Statistically significant differences in OS were revealed in patients with single and solitary metastases compared to the subgroup of patients with multiple foci (median OS were 20.0 months, 16.6 months, 10.6 months, respectively). The median OS with a single SRS session was 14.3 months, with 2 sessions – 19.8 months, and with 3 or more sessions it was not achieved. The factors influenced on OS indicators were the number of metastases and the fact of repeated sessions of SRS with intracranial progression.
Conclusion. SRS for metastases of kidney cancer in the brain provides satisfactory OS values in patients with good functional status and a controlled extracranial process.

Keywords: renal cell carcinoma, brain metastasis, radiosurgery, overall survival
p. 366-372 of the original issue
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  11. Yamamoto M, Serizawa T, Shuto T, Akabane A, Higuchi Y, Kawagishi J, Yamanaka K, Sato Y, Jokura H, Yomo S, Nagano O, Kenai H, Moriki A, Suzuki S, Kida Y, Iwai Y, Hayashi M, Onishi H, Gondo M, Sato M, Akimitsu T, Kubo K, Kikuchi Y, Shibasaki T, Goto T, Takanashi M, Mori Y, Takakura K, Saeki N, Kunieda E, Aoyama H, Momoshima S, Tsuchiya K. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol. 2014 Apr;15(4):387-95. doi: 10.1016/S1470-2045(14)70061-0
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Address for correspondence:
223040, Republic of Belarus,
Minsk region, ag. Lesnoy,
Republican Scientific and Practical Center
of Oncology and Medical Radiology
named after A.I. N.N. Alexandrov,
Llaboratory of Radiation Therapy,
tel. +375291234930,
e-mail: pdemeshko@icloud.com,
Demeshko Pavel D.
Information about the authors:
Dziameshka Pavel D., MD., Professor, Chief Researcher of the Laboratory of Radiation Therapy, Republican Scientific and Practical Center of Oncology and Medical Radiology named after N.N.. Aleksandrov, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-1324-3656

S.A. IVANOV 1, O.G. KHOROV 2, A.L. RANKOVICH 1

ANALYZE OF OUTCOMES OF EXTERNAL NOSE RECONSTRUCTION USING CARTILAGE TRANSPLANTS

Gomel State Medical University 1, Gomel,
Grodno State Medical University 2, Grodno,
Republic of Belarus

Objective. To analyze the nasal function in patients who underwent reconstruction of the external nose using cartilage allografts.
Methods. The outcomes of 73 nasal reconstructions using cartilage allografts have been studied. Functional parameters were evaluated using the 5-point NAFEQ scale (functional part). Patients were interviewed immediately before the operation and 6 months after it. The distribution of scores before and after reconstruction was assessed in the entire group and in patients with initially normal and impaired function separately. Demographic and clinical parameters in patients with initially normal and impaired function were compared.
Results. The distribution of scores after reconstruction significantly improved in parameters of «nasal air passage», «nasal bleeding», «crusting», «total nasal functioning». The lowest scores were obtained for the formation of mucinous crusts, nasal breathing and total nasal functioning. There was no statistically significant dynamics in the distribution of pre- and postoperative scores in patients with initially normal function. A statistically significant increase of higher scores was marked in parameters of «nasal air passage», «nasal bleeding», «crusting», «total nasal functioning» in patients with functional impairments due to the disease caused defect. The total number of acceptable outcomes for total nasal functioning in the entire group was 68 (93%), among patients with initially normal function – 42 out of 43 (98%), among patients with functional impairments – 26 out of 30 (87%).
Conclusion. The use of cartilage allografts provided an acceptable functional outcomes in most cases, both in patients with initially normal function, and with functional impairments.

Keywords: nasal reconstruction, nasal function, allogeneic cartilage, cartilage graft
p. 382-391 of the original issue
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Address for correspondence:
246050, Republic of Belarus,
Gomel, Lange Str., 5.
Educational Establishment
Gomel State Medical University”,
Department of Oncology.
Phone +375 29 616 73 98,
e-mail: srgivgm@gmail.com
Ivanov Sergey A.
Information about the authors:
Ivanov Sergey A., PhD, Associate Professor, Associate Professor of the Department of Oncology, Gomel State Medical University, Gomel, Republic of Belarus.
http://orcid.org/0000-0002-9256-2910
Khorov Oleg G. MD, Professor, Head of the Department of Otorhinolaryngology, Grodno State Medical University, Grodno, Republic of Belarus.
http://orcid.org/0000-0002-8191-5784
Rankovich Alexey L., 5th Year Student of the Faculty of Medicine, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-8564-079X

REVIEWS

M.N. MURAVYOV, V.A. PANFILOV, K.V. ROMANENKO, A.O. VIRGANSKY

ASPECTS OF ANTICOAGULANT AND ANTIPLATELET THERAPY IN PATIENTS WHO UNDERWENT PERIPHERAL ARTERY RECONSTRUCTION. HISTORY AND THE PRESENT

Pirogov Russian National Research Medical University, Moscow,
Russian Federation

The use of anticoagulants and disaggregant agents in patients with peripheral atherosclerosis has been an integral part of therapy for many years. . The role and their combination has undergone numerous changes with the development of understanding of their mechanisms of action and influence on peripheral hemodynamics. In addition, the use of anticoagulants and disaggregant agents plays a decisive role in patients with critical lower limb ischemia who underwent reconstruction of the peripheral arterial bed. In the postoperative period in many cases the precisely well-chosen tablet therapy can be the very “key link” in saving the limb. Besides, atherosclerosis is multi-organ disease that usually affects the coronary and cerebral pools. Pathological processes in these systems can significantly affect the health and quality of life, are often disabling nature, often threatening the patient’s life. Today the inconsistency of clinical and practical information about the effectiveness of various schemes of antiplatelet and anticoagulant therapy is beyond doubt. For example, the required duration of tablet therapy is not supported by reliable studies. A large number of outdated studies, their insufficient “scale” are consided to be a stumbling block for determining the current unified standard of perioperative therapy for patients with peripheral atherosclerosis. The identification of the “ideal” scheme will allow improving the immediate and remote results of surgical interventions, but also to carry out an effective prevention of formidable complications of the cardiovascular system as a whole.

Keywords: peripheral artery atherosclerosis, low limb ischemia, femoropopliteal bypass, low limb amputation, anticoagulants, disaggregants
p. 382-391 of the original issue
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Address for correspondence:
117997, Russian Federation,
Moscow, st. Ostrovityanov, house 1,
Russian National Research
Medical University N.I. Pirogov,
Department of Faculty Surgery No. 1
of the Faculty of Medicine,
tel: +7 916 824-07-31,
e-mail: muravyov.mn@gmail.com,
Muravyov Maxim N.
Information about the authors:
Virgansky Anatoly O., MD, Professor of the Department of Faculty Surgery No. 1 of the Medical Faculty of the Russian National Research Medical University Named after N.I. Pirogov, Moscow, Russian Federation.
https://orcid.org/0000-0002-0204-7991
Muravyov Maksim N., Post-Graduate Student of the Department of Faculty Surgery No. 1 of the Medical Faculty of the Russian National Research Medical University Named after N.I. Pirogov, Moscow, Russian Federation.
http://orcid.org/0000-0001-9742-4333
Panfilov Vladislav A., Cardiovascular Surgeon, CSH im. V.V. Vinogradova, Moscow, Russian Federation.
http://orcid.org/0000-0001-5186-5459
Romanenko Konstantin V., Cardiovascular Surgeon, Head of the Department of Vascular Surgery, CCH Named after V.V. Vinogradova, Moscow, Russian Federation.
http://orcid.org/0000-0002-0342-746X

B.G. ALIEV, A. ISMAEL, I.L. URAZOVSKAYA, D.S. MANSUROV, A.N. TKACHENKO, V.M. KHAYDAROV, A.A. SPICHKO

FREQUENCY AND STRUCTURE OF NEGATIVE CONSEQUENCES OF TOTAL HIP ARTHROPLASTY IN LONG TERMS

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg,
Russian Federation

Today, the total hip arthroplasty (THA) is consided to be the operation of choice for severe stages of osteoarthritis, femoral neck fracture, osteonecrosis of the femoral head and a number of other diseases. At the same time, THA does not always lead to a positive effect. Instability following total hip arthroplasty is an unfortunately frequent and serious problem that requires thorough evaluation and preoperative preparation. The negative consequences of this surgical operation, according to different authors, range from 2 to 35% of all cases of THA. Complications can be local and general and can be verified both in the immediate postoperative period and in the remote period after the operation. The review is designed to analyze literature data concerning the incidence and structure of complications of hip arthroplasty. In recent decades the widespread use of THA was the reason for the appearance of patient dissatisfaction in relation to treatment outcomes. At scientific forums and in current literature, the issues related to improving the functional results and quality of life of patients undergoing THA are actively discussed. However, information of the incidence and structure of complications, as well as the possibilities of their prevention, were not able to evaluate treatment satisfaction in a valid way and remain contradictory. Every year after THA performance, the number of excellent and good results reduces, and the number of unsatisfactory results increases. The joint’s function is limited, and the results of subsequent endoprosthetics are worse than during primary operations. There are more and more publications about unjustified hip arthroplasty. This circumstance is a stimulus to search for precise criteria to identify the indication and contraindications for total hip arthroplasty and to develop a set of preventive measures for the negative consequences of THA. The purpose of this paper is to carry out a literature review – to gather and summarize publications related to THA studies that have analyzed the effects of process orientation in this problem.

Keywords: total hip arthroplasty, complications, indications and contraindications for surgery
p. 392-400 of the original issue
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Address for correspondence:
191036, Russian Federation,
St. Petersburg, st. Kirochnaya, 41,
North-Western State Medical University,
I.I. Mechnikova, Department
of Traumatology, Orthopedics and Military Surgery,
tel. +7 911 215-19-72,
e-mail: altkachenko@mail.ru
Tkachenko Alexander N.
Information about the authors:
Aliev Bakhtiyar G., Resident Physician, Department of Traumatology and Orthopedics, North-Western State Medical University Named after I.I. Mechnikova, St. Petersburg, Russian Federation.
https://orcid.org/0000-0003-0664-6198
Ismael Abbas, Resident Physician, Department of Traumatology and Orthopedics, North-Western State Medical University Named after I.I. Mechnikova, St. Petersburg, Russian Federation.
https://orcid.org/0000-0003-4652-6588
Urazovskaya Irina L., PhD, Assistant, Department of Hospital Therapy and Cardiology Named after M.S. Kushakovsky, North-Western State Medical University Named after I.I. Mechnikova, St. Petersburg, Russian Federation.
https://orcid.org/0000-0003-4165-4599
Mansurov Jalolidin S., PhD, Assistant, Department of Traumatology, Orthopedics and Military Surgery, North-Western State Medical University Named after I.I. Mechnikova, St. Petersburg, Russian Federation.
https://orcid.org/0000-0002-1799-641X
Tkachenko Alexander N., MD, Professor, Professor of the Department of Traumatology, Orthopedics and Military Surgery, North-Western State Medical University Named after I.I. Mechnikova, St. Petersburg, Russian Federation.
https://orcid.org/0000-0003-4585-5160
Khaidarov Valeriy M., PhD, Associate Professor of the Department of Traumatology, Orthopedics and Military Surgery, North-Western State Medical University Named after I.I. Mechnikova, St. Petersburg, Russian Federation.
https://orcid.org/0000-0002-0754-4348
Spichko Alexander A., Resident Physician, Department of Traumatology and Orthopedics, North-Western State Medical University Named after I.I. Mechnikova, St. Petersburg, Russian Federation.
https://orcid.org/0000-0002-9355-1068

I.M. EFREMOV, G.A. SHEVALAEV

VACUUM THERAPY IN THE TREATMENT OF A PATIENT WITH CHRONIC PERIPROSTHETIC INFECTION AFTER TOTAL HIP ARTHROPLASTY

Ulyanovsk State University, Ulyanovsk,
Russian Federation

A clinical observation of the treatment of a patient with chronic deep periprosthetic infection after total hip arthroplasty complicated by arrosive bleeding from the femoral artery and extensive purulent-necrotic lesions of paraarticular soft tissues is presented. The patient underwent complex treatment based on the rehabilitation of the focus of chronic infection with combined etiotropic antibiotic therapy and bacteriophage therapy. After debridement, the patient was started continuous vacuum therapy of the wound using the Suprasorb CNP 1® device (Lohmann & Rauscher, Austria). Change of dressings for 3, 5, 9, 14 days. Variable vacuum therapy was started on the 9th day. On the 15th day from the beginning of vacuum therapy, the wound of the left groin area was plasty with local tissues. Vacuum therapy of the wound was continued for another 7 days. As a result of the complex treatment, it was possible to arrest the infectious and inflammatory process, the wound defects healed, the endoprosthesis was preserved without replacing the modular components. The presented clinical observation demonstrated the effectiveness of an integrated approach with the inclusion of vacuum therapy for the treatment of chronic periprosthetic infection. Further study of the use of vacuum therapy in this category of patients is needed.

Keywords: hip joint, chronic periprosthetic infection, debridement, wound vacuum therapy, bacteriophage therapy
p. 401-407 of the original issue
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  16. Briko NI, Bozhkova SA, Brusina EB, Zhedaeva MV, Zubareva NA, Zueva LP, Ivanova EB, Kazachek IaV, Kvashnina DV, Kovalishena OV, Kuz’menko SA, Pavlov VV, Pasechnik IN, Popov DA, Tsigel’nik AM, Tsoi ER, Shmakova MA, Shubniakov II, Iakovlev SV. Profilaktika infektsii oblasti khirurgicheskogo vmeshatel’stva. Klinicheskie rekomendatsii. N. Novgorod, RF: Remedium Privolzh’e; 2018. 72 s. http://nasci.ru/?id=2260 (In Russ.)
Address for correspondence:
432017, Russian Federation,
Ulyanovsk, st. Lev Tolstoy, 42,
Ulyanovsk State University of the Ministry
of Education and Science of the Russian Federation, Department of Hospital Surgery,
Anesthesiology, Resuscitation,
Urology, Traumatology and Orthopedics,
tel.: +79176124177,
e-mail: efremov-im@rambler.ru,
Efremov Ivan M.
Information about the authors:
Efremov Ivan M., PhD, Associate Professor of the Department of Hospital Surgery, Anesthesiology, Resuscitation, Urology, Traumatology and Orthopedics, Ulyanovsk State University, Ulyanovsk, Russian Federation.
https://orcid.org/0000-0002-4625-8424
Shevalaev Gennady A., PhD, Associate Professor, Associate Professor of the Department of Hospital Surgery, Anesthesiology, Resuscitation, Urology, Traumatology and Orthopedics, Ulyanovsk State University, Ulyanovsk, Russian Federation.
https://orcid.org/0000-0002-4089-6994

À.V. POPKOV, N.A. KONONOVICH, D.A. POPKOV, À. À. CHERTISHCHEV

A CASE OF THE EFFECTIVE APPLICATION OF TWO ELASTIC NAILS WITH BIOACTIVE COATING FOR TREATMENT OF PSEUDOARTHROSIS OF THE LEG BONES

Federal State Budgetary Institution “Russian Ilizarov Scientific Center "Restorative Traumatology and Orthopaedics" of Ministry of Healthcare, the Russian Federation, Kurgan,
Russia Federation

A positive result of the use of bioactive-coated flexible nails to treat the pseudarthrosis of the shin bones in a 52-year-old patient suffered hematogenous osteomyelitis in childhood has been presented. Subsequently, a shortening of the left leg, as well as its deformation after an incorrect healed of a tibial shaft fracture have been formed. The formation of a pseudarthrosis was a consequence of unsuccessful distraction osteosynthesis to restore the segment length and eliminate deformity. The choice of treatment method was based on the results of an experimental study in vivo and the known literature data. The advantage of this technique was its low injury rate in comparison with the known methods of false joints treating and the possibility of providing conditions for the activation of osteogenesis at the junction of pathologically altered bone fragments. Intramedullary osteosynthesis by bioactive-coated flexible implants associated by external fixator provided supporting the stable rigid fixation throughout the entire treatment period. All these factors contributed to early consolidation (within 60 days) while maintaining the achieved state after the termination of hardware fixation. The technique used for the treatment of long bones pseudoarthrosis is considered to be easily implementable having the broad perspectives to eliminate such pathology.

Keywords: pseudoarthrosis, flexible implants, hydroxyapatite coating, bioactive implant
p. 408-414 of the original issue
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Address for correspondence:
640014, Russian Federation,
Kurgan, st. M. Ulyanova, 6,
National Medical Research Center
of Traumatology and Orthopedics
Named after Academician G. A. Ilizarov,
Experimental Laboratory,
tel. office: +7(3522) 41-52-27,
e-mail: n.a.kononovich@mail.ru,
Kononovich Natalya A.
Information about the authors:
Popkov Arnold V., MD, Professor, Chief Researcher of the Clinic of Neuroorthopedics, Systemic Diseases and Pathology of the Foot, National Medical Research Center for Traumatology and Orthopedics named after Acdemician G. A. Ilizarov, Ministry of Health of Russia, Kurgan, Russian Federation
https://orcid.org/0000-0001-5791-1989
Kononovich Natalia A. PhD, Leading Researcher, Experimental Laboratory, National Medical Research Center for Traumatology and Orthopedics Named after Academician G. A. Ilizarov, Ministry of Health of Russia, Kurgan, Russian Federation
https://orcid.org/0000-0002-5990-8908,
Popkov Dmitry A., MD, Head of the Clinic for Neuroorthopedics, Systemic Diseases and Pathology of the Foot, Academician G. A. Ilizarov National Medical Research Center for Traumatology and Orthopedics, Ministry of Health of Russia, Kurgan, Russian Federation
https://orcid.org/0000-0002-8996-867X
Chertishchev Alexander A., Orthopedist-Traumatologist, Physician of the Highest Category of Traumatology and Orthopedic Department No. 12, National Medical Research Center of Traumatology and Orthopedics Named After. Academician G.A. Ilizarov Ministry of Health of Russia, Kurgan, Russian Federation.
https://orcid.org/0000-0002-3796-2444
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