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Year 2014 Vol. 22 No 5

HISTORY

A.Y. LADZEYEU, A.V. MAROCHKOV, V.N. DZMITRRYIEVA, O.V. SHUMSKAIA

HISTORY OF ELECTRICAL DEFIBRILLATION FROM ANCIENT TIMES UP TO PRESENT DAYS

ME “Mogilev regional hospital”,
The Republic of Belarus

Electrical defibrillation is considered to be an integral part of modern resuscitation. Despite the electrical defibrillators have appeared comparatively recently, their development was preceded by centuries of knowledge accumulation concerning electricity and its impact on a living organism. Even at the dawn of electrical phenomena study, many scientists had the idea of reviving the dead individual by the help of electricity. Thanks to the discovery of defibrillation this utopian idea was to some extent feasible. The widespread application of defibrillators in medical practice since the late 1950s has allowed the mankind to move a step closer to its eternal goal of victory over death.
The aim of the work is to highlight the key events on the thorny path of defibrillation development. Collecting the material it was found out that in the literature outstanding contributions of many Soviet scientists in the creation of a modern defibrillator were hushed up, therefore an important objective of this article was to restore historical justice in this matter.

Keywords: history of medicine, defibrillation, Gurvich N.L., defibrillator
p. 513-525 of the original issue
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Address for correspondence:
212022, Respublika Belarus,
g. Mogilev, ul. B. Biruli, d. 20,
UZ «Mogilevskaya oblastnaya bolnitsa»,
otdelenie po koordinatsii zabora organov i tkaney
dlya transplantatsii,
tel. office: 375 222 27-87-39,
e-mail: fedya102@yahoo.com,
Ladzeyeu Andrei Yurevich
Information about the authors:
Ladzeyeu A.Y. An anesthesiologist-resuscitator of the department on coordination of sampling of organs and tissues for transplantation of ME “Mogilev Regional Hospital”. Marochkov A.V. MD, professor, a head of the anesthesia and resuscitation department of ME “Mogilev Regional Hospital”.
Dzmitryieva V.N. An anesthesiologist-resuscitator of the department on coordination of sampling of organs and tissues for transplantation of ME “Mogilev Regional Hospital”. Shumskaia O.V. A nurse-anesthesiologist of the anesthesia and resuscitation department of ME “Mogilev Regional Hospital”.

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

I.V. MAIBORODIN1, V.A. MATVEEVA1, R.V.MASLOV 2, N.V. ONOPRIENKO3, I.V. KUZNETSOVA1, G.A. CHASTIKIN1

FLUORESCENT MACROPHAGES IN THE LYMPH NODES AFTER APPLICATION OF MULTIPOTENT MESENCHYMAL STROMAL CELLS WITH TRANSFECTED GFP GENE

SBEE HPE “Institute of chemical biology and fundamental medicine” SB RAS 1, Novosibirsk,
SBEE HPE “Moscow State Medical-Stomatological University named after A.I. Evdokimov” 2,
SBEE HPE “Novosibirsk State Medical University” 3,
The Russian Federation

Objectives. To determine the reactions of the regional lymph nodes, caused by implantation of the autologous multipotent mesenchymal stromal cells of the bone marrow origin (AMMSCMO) for acceleration of mandible bone defect regeneration in experiment.
Methods. The reactions of rat regional lymph nodes, caused by implantation of AMMSCBM for acceleration of bone defect regeneration of the mandible bone have been studied by the methods of fluorescent light microscopy in experiment.
Results. One week after the introduction in an injury site of the mandible bone of polyhydroxyalkanoate with adsorbed AMMSCBM with a transfected GFP gene the numerous large macrophages with a set of oval fluorescent inclusions up to 20 micrometers in diameter have been detected in the regional (submandibular) lymph nodes. In the fluorescent cells not the whole cytoplasm was glowing, but oval granules, different of sizes which reached 10 micrometers. Clusters of fluorescent cells differed in density and background color from the surrounding tissue and had a clear boundary. It gives the possibility to assume the concentration of cells with the fluorescent cytoplasm in the lymphoid nodules. On the basis of the large-sized cells of irregular shape and with the presence of inclusions and location of the lymph nodes, it was concluded that these objects are considered to macrophages, where the lysosomes with the absorbed fluorescent material are glowing. Dimensions of clusters of fluorescent cells and the number of the objects with a glow in them has increased up to 2 weeks after implantation, followed by a progressive decline in sizes and number.
Conclusion. AMMSCBM introduced by this method is partially absorbed by macrophages. At destruction of the structures created from AMMSCBM, detritus is also phagocytized by macrophages. In any case these macrophages appear in the lymphoid regional nodules, where initiation of immunity reactions against DNA and GFP protein isn't excluded.

Keywords: multipotent mesenchymal stromal cells, lymph nodes, macrophages, macrophage fluorescence
p. 526-532 of the original issue
References
  1. Chanda D, Kumar S, Ponnazhagan S.Therapeutic potential of adult bone marrow-derived mesenchymal stem cells in diseases of the skeleton. J Cell Biochem. 2010 Oct 1;111(2):249–57.
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  3. Volozhin AI, Vasil'ev AIu, Mal'ginov NN, Bulanova IM, Grigor'ian AS, Kiseleva EV, Cherniaev SE, Tarasenko IV. Ispol'zovanie mezenkhimal'nykh stvolovykh kletok dlia aktivizatsii reparativnykh protsessov kostnoi tkani cheliusti v eksperimente [The use of mesenchymal stem cells to enhance the reparative processes of the jawbone in the experiment]. Stomatologiia. 2010;89(1):10–14.
  4. Maiborodin I.V., Matveeva V.A., Kolesnikov I.S., Drovosekov M.N., Toder M.S., Shevela A.I. Regeneratsiia povrezhdennoi kosti nizhnei cheliusti krys posle ispol'zovaniia autologichnykh stromal'nykh stvolovykh kletok kostnomozgovogo proiskhozhdeniia, adsorbirovannykh na fibrinovom sgustke [Regeneration of damaged bone of rat mandible after using autologous bone marrow stromal stem cell origin, adsorbed on the fibrin clot]. Morfologiia. 2011;(6}:79–85.
  5. Campo JJ, Aponte JJ, Nhabomba AJ, Sacarlal J, Angulo-Barturen I, Jimenez-Diaz MB, Alonso PL, Dobano C.Feasibility of flow cytometry for measurements of Plasmodium falciparum parasite burden in studies in areas of malaria endemicity by use of bidimensional assessment of YOYO-1 and autofluorescence. J Clin Microbiol. 2011 Mar;49(3):968–74.
  6. Watson J. Suppressing autofluorescence of erythrocytes. Biotech. Histochem. Biotech Histochem. 2011 Jun;86(3):207
  7. Duan M, Li WC, Vlahos R, Maxwell MJ, Anderson GP, Hibbs ML.Distinct macrophage subpopulations characterize acute infection and chronic inflammatory lung disease. J Immunol. 2012 Jul 15;189(2):946–55.
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  10. Luhmann UF, Robbie S, Munro PM, Barker SE, Duran Y, Luong V, Fitzke FW, Bainbridge JW, Ali RR, MacLaren RE.The drusenlike phenotype in aging Ccl2-knockout mice is caused by an accelerated accumulation of swollen autofluorescent subretinal macrophages. Invest Ophthalmol Vis Sci. 2009 Dec;50(12):5934–43.
  11. Potter KA, Simon JS, Velagapudi B, Capadona JR.Reduction of autofluorescence at the microelectrode-cortical tissue interface improves antibody detection. J Neurosci Methods. 2012 Jan 15;203(1):96–105.
Address for correspondence:
630090, Rossiyskaya Federatsii,
g. Novosibirsk,
pr. akad. Lavrenteva, d. 8,
Institut himicheskoy biologii
i fundamentalnoy meditsinyi SO RAN,
tel.mob.: 7-913-753-07-67,
e-mail: imai@mail.ru.
Maiborodin Igor Valentinovich
Information about the authors:
Maiborodin I.V. MD, professor, leading researcher of the stem cell laboratory of SBEE HPE “Institute of chemical biology and fundamental medicine” SB RAS.
Matveeva V.A. PhD, senior researcher of the stem cell laboratory of SBEE HPE “Institute of chemical biology and fundamental medicine” SB RAS.
Maslov R.V. A post-graduate student of the hospital periodontics chair of the stomatological faculty of SBEE HPE “Moscow State Medical-Stomatological University named after A.I. Evdokimov”.
Onoprienko N.V. PhD, a senior lecturer of the obstetrics and gynecology chair of SBEE HPE “Novosibirsk State Medical University”
Kuznetsova I.V. PhD, a researcher of the stem cell laboratory of SBEE “Institute of chemical biology and fundamental medicine” SB RAS.
Chastikin G.A. PhD, applicant for Doctor’s degree of the stem cell laboratory of SBEE “Institute of chemical biology and fundamental medicine” SB RAS.

GENERAL AND SPECIAL SURGERY

I.S. IVANOV, V.A. LAZARENKO, S.V. IVANOV, G.M. SUKHOV, A.V. TCUKANOV, G.N. GORYANOVA, E.G. OBEDKOV, G.N. GAFAROV

DISORDERS OF THE CONNECTIVE TISSUE STRUCTURE COMPOSITION OF THE ANTERIOR ABDOMINAL WALL IN PATIENTS WITH VENTRAL HERNIA

SBEE HPE “Kursk State Medical University”,
The Russian Federation

Objectives. To find out the differences in the structure of collagen fibers in the skin and aponeurosis in patients with ventral hernias and without them.
Methods. 46 patients suffering from the anterior abdominal wall hernias composed the main group, 49 patients without signs of hernia disease or the signs of connective tissue dysplasia made up the control group.
The specimens of the skin and aponeurosis were taken during the planned surgical operations. The specimens were stained with Sirius Red dye and investigated by use of a polarization microscope Altami Polar 2, at magnification ×250 and ×400. Architectonics of the skin and fascia were studied as well as the quality composition of the connective tissue collagen fibers by use of the polarization microscopy.
Results. The study of the structure of collagen fibers in the aponeurosis has been revealed that the bundles are seems to be heterogeneous, and each bundle is determined by the longitudinal pulpings. The obtained results of the study of architectonics aponeurosis in patients of the main group has been demonstrated the evidence the collagen fibers are arranged in the different directions and planes (42% of cases), branched out into individual thin fibers (53%), the interfiber spaces (67%) were significantly higher compared with the control group of architectonics aponeurosis.
Conclusion. Study of the collagen fibers structure in the skin and aponeurosis revealed heterogenous individual segments in patients with ventral hernias. At the same time the longitudinal pulping was found out in each separate bundle that testifies to more porous structure of the aponeurosis in patients with ventral hernias caused by the weakness of the anterior abdominal wall and promoted the development of hernia defects. Application of polarization microscopy method for the preoperative study of collagen fibers in the skin and aponeurosis enables to predict and carry out the additional prevention of hernias formation.

Keywords: ventral hernia, polarization light microscopy, collagen, skin, aponeurosis
p. 533-537 of the original issue
References
  1. Andreev SD, Adamian AA. Plastika obshirnykh defektov briushnoi stenki biosinteticheskimi protezami [Plasty by biosynthetic prostheses of large defects of the abdominal wall]. Khirurgiia. 1993;(9):30–35.
  2. Darvin VV, Shpichka AV, Onishchenko SV. Alloplastika v lechenii obshirnykh i gigantskikh posleoperatsionnykh gryzh [Alloplasty in the treatment of large and giant postoperative hernias]. Gerniologiia. 2008;1(17):10–11.
  3. Neliubin PS, Galota EA, Timoshin AD. Khirurgicheskoe lechenie bol'nykh s posleoperatsionnymi i retsidivnymi ventral'nymi gryzhami [Surgical treatment of patients with postoperative and recurrent ventral hernias]. Khirurgiia. Zhurn im NI Pirogova 2007;(7):69–74.
  4. Zhebrovskii VV. Khirurgiia gryzh zhivota i eventratsii [Abdominal surgery of hernia and eventrations]. Moscow, RF: MIA; 2009. 440 p.
  5. Kharitonov SV, Kuznetsov NA, Nemov ID, Ziniakova MV. Zakonomernosti neoslozhnennogo ranevogo protsessa u bol'nykh so sredinnoi ventral'noi gryzhei posle razlichnykh vidov plastiki perednei briushnoi stenki [Regularities of uncomplicated wound healing process in patients with mid-ventral hernia after different types of plasty of anterior abdominal wall]. Khirurgiia. Zhurn im NI Pirogova. 2013;(1):47–52.
  6. Veligotskii NN, Komarchuk VV, Komarchuk EV. Khirurgicheskoe lechenie gryzh na fone displazii soedinitel'noi tkani [Surgical treatment of hernia on background of connective tissue dysplasia].Ukrain Khirurg Zhurn. 2011;3 (12):236–39.
  7. Bogdanov DIu, Rutenburg GM, Naurbaev MS, Alishikhov ShA, Grigorov DP, Kireev AA. Sravnitel'nye kharakteristiki gernioplastik pri posleoperatsionnykh gryzhakh zhivota [Comparative characteristics of hernioplasty in postoperative abdominal hernias]. Endoskop Khirurgiia. 2008;(6):3–13.
  8. Henriksen NA, Yadete DH, Sorensen LT. Connective tissue alteration in abdominal wall hernia. Br J Surg.2011;98(2):210–19.
  9. Junge K, Klinge U, Rosch R. Decreased collagen type I/III ratio in patients with recurring hernia after implantation of alloplastic prostheses. Langenbecks Arch Surg. 2004;389(1):17–22.
Address for correspondence:
305041, Rossiyskaya Federatsiya,
g. Kursk, ul. K.Marksa, d.3,
GBOU VPO «Kurskiy gosudarstvennyiy meditsinskiy universitet»,
kafedra khirurgicheskih bolezney ¹1,tel.: 7 4712 35-36-90,
e-mail: ivanov.is@mail.ru,
Ivanov Ilya Sergeevich
Information about the authors:
Ivanov I.S., PhD, associate professor of the surgical diseases chair ¹1 of SBEE HPE “Kursk State Medical University”.
Lazarenko V.A., MD, professor of the surgical diseases chair of PTF of SBEE HPE “Kursk State Medical University”.
Ivanov S.V., MD, associate professor of the surgical diseases chair ¹1 of SBEE HPE “Kursk State Medical University”.
Sukhov G.M., assistant of the surgical diseases chair ¹1 of SBEE HPE “Kursk State Medical University”. Tcukanov A.V., assistant of the surgical diseases chair ¹1 of SBEE HPE “Kursk State Medical University”.
Goryanova G.N., PhD, associate professor of pathologic anatomy chair of SBEE HPE “Kursk State Medical University”.
Obedkov E.G., assistant of the surgical diseases chair ¹1 of SBEE HPE “Kursk State Medical University”.
Gafarov G.N., post-graduate student of the surgical diseases chair ¹1 of SBEE HPE “Kursk State Medical University”.

G.R. ASKERKHANOV1,2, F.M. AJTEKOVA1,3

IMPACT OF VARIOUS TYPES OF HERNIOPLASTY ON PATIENTS’ LIFE QUALITY AND FERTILITY

SBEE HPE “Dagestan State Medical Academy” 1,
OJSC “Medical Centre named after R.P Askerkhanov” 2,
SBE RD “ Republican Clinical Hospital of Makhachkala” 3
The Russian Federation

Objectives. To study life quality and fertility of patients after various types of inguinal hernioplasty.
Methods. According to the hernioplasty method the patients were divided into three groups: the 1st group – tension hernioplasty (n=116); the 2nd – tension-free hernioplasty according to Lichtenstein method (n=288); the 3rd – laparoscopic hernioplasty (n=44). To evaluate the effect of the inguinal hernioplasty on patients’ fertility parameters, 135 males aged 18-40 were randomly selected from the main group. Testing and examination were conducted preoperatively, 4 months and 1 year, postoperatively. The results of the study have been assessed prior surgery, after a median follow-up of 4 months and 1 year, postoperatively.
Results. Improvement of life quality parameters in the patients of the 3rd group reaches its maximum by the end of the 4th month postoperatively. The 2nd and 3rd patient groups achieve the same parameters by the end of the 12th month. The carried out research revealed that in the 1st group patients the reduction of sperm concentration up to 41,0±12,3 mln/mL can be observed, which is 2-folds less than the initial parameter. The relative number of mobile forms is also reduced by 10% of the original ratio. Negative changes in the 2nd group are less expressed than in the 1st group. The average concentration of sperm in a unit volume of ejaculate is reduced by 7,8±10,9 mln/ml, which is 9% from the baseline. By the end of the year of postoperative period, the reduction according this parameter continues approximately on 15,3±20,9 mln/mL, that is 15% of the initial parameter. Quality and quantity characteristics of ejaculate stay without negative dynamics in the 3rd group. On the contrary, the increase of the relative number of mobile spermatozoons has been registered by the end of the year.
Conclusions. Life quality after laparoscopic hernioplasty reaches its maximum by the end of the 4th month in comparison with the other methods. Laparoscopic hernioplasty has not worsened spermatogenesis parameters unlike the tension and tension-free hernioplasty.

Keywords: inguinal hernia, hernioplasty, quality of life, questionnaire MOS SF-36, spermogram, fertility
p. 538-546 of the original issue
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  1. Novik AA, Ionova TI. Issledovanie kachestva zhizni v meditsine [The study of life quality in medicine]: uchebn. pos. Moscow, RF: GEOTAR-MED, 2004. 304 p.
  2. Novik AA, Ionova TI, red. Shevchenko IuL. Rukovodstvo po issledovaniiu kachestva zhizni v meditsine [A guide of the study of life quality in medicine]. 2e izdanie Moscow, RF: Olma Media Grupp, 2007. 320 p.
  3. Beltran MA, Cruces KS.Outcomes of Lichtenstein hernioplasty for primary and recurrent inguinal hernia. World J Surg. 2006 Dec;30(12):2281–87.
  4. Belokonev VI, Vavilov AV, Kovaleva ZV. Organizatsionnye printsipy raboty samarskogo gerniologicheskogo tsentra i ego problemy [Organizational principles of Samara herniological center and its problems]. Vestn Gerniologii. 2008. p.15–17.
  5. Hallen M, Sandblom G, Nordin P, Gunnarsson U, Kvist U, Westerdahl J. Male infertility after mesh hernia repair: A prospective study. Surgery. 2011 Feb;149(2):179–84.
  6. Skawran S. Obstructive azoospermia after bilateral endoscopic total extraperitoneal inguinal hernia repair - the role of surgeon.Hernia. 2009;1(13). 25 p.
  7. Miliukov VE, Kislenko AM. Profilaktika nekotorykh posleoperatsionnykh oslozhnenii pri pakhovoi gernioplastike traditsionnymi sposobami metodom intraoperatsionnoi verifikatsii i sokhraneniia nervnogo apparata pakhovoi oblasti [Prevention of some postoperative complications of inguinal hernioplasty by conventional methods of intraoperative verification and saving of nervous apparatus of inguinal area]. Annaly Khirurgii. 2005;(4):66–71.
  8. Protasov AV, A.V. Krivtsov LM, Mikhaleva AV, Tabuika NIu. Shukhtin NIu. Vliianie setchatogo implantata na reproduktivnuiu funktsiiu pri pakhovoi gernioplastike [Influence of the mesh implant on reproductive function in inguinal hernioplasty] Khirurgiia im NI Pirogova. 2010;(8):28–32.
  9. Gafarov UO, Povarikhina OA, Kuznetsov NA, Kharitonov SV. Vybor sposoba plastiki pri posleoperatsionnykh ventral'nykh gryzhakh [Choose the choice of plastics in postoperative ventral hernias]. Khirurg. 2008;(10):3–10.
Address for correspondence:
67000, Rossiyskaya Federatsiya, Respublika Dagestan,
g. Mahachkala, pl. Lenina d. 1,
GBOU VPO «Dagestanskaya gosudarstvennaya meditsinskaya akademiya»,
kafedra khirurgicheskih bolezney ¹1
mob. tel.: 8928 987-17-12,
e-mail: letom100@rambler.ru,
Ajtekova Fatima Mahmud-Pashaevna
Information about the authors:
Askerkhanov G.R. MD, professor, a head of the surgical diseases chair of SBEE HPE “Dagestan State Medical Academy”, general director of OJSC “Medical Centre named after Askerkhanov R.P”.
Ajtekova F.M. A lecturer of the surgical diseases chair of SBEE HPE “Dagestan State Medical Academy”, post-graduate student, clinical intern of the department of surgery of the abdominal cavity organs of SBE RD “ Republican Clinical Hospital of Makhachkala” .

S.G. SOVA1, E.O. LEBEDEVA2

CARDIOMYOPATHY CAUSED BY COMBINED ACTION OF LOCAL PULSE VIBRATION AND INDUSTRIAL NOISE

National Medical University named after A.A. Bogomolets, Kiev1,
SE “National Institute of Cardiovascular Surgery named AFTER N.M. Amosov NAMS of the Ukraine” 2

Objectives. To reveal signs of noncoronary dystrophic process in the myocardium of workers of aircraft enterprises exposed to a long combined impact of local impulse vibration and industrial noise.
Methods. In the hospital of occupational diseases of National Medical University named after A.A. Bogomolets and the department of urgent endovascular surgery with X-ray operation room of National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of the Ukraine during the period from 2008 to 2013, 34 workers of vibro-noise professions of the aircraft enterprises (the main group) and 27 persons of the control group underwent a profound cardiologic examination. Besides routine methods all workers were subjected to the coronaroventriculography (CVG) and a vectorechocardiography (VECG) at rest and in the dobutamine stress test.
Results. Among the inspected workers with the cardiac syndrome, in 86,7% persons of the main and 40,7% persons of the control group according VECG data, the signs of dystrophic process in the myocardium were revealed. At rest a mean value of the longitudinal myocardial deformation index of the left ventricle (LDMLV) in patients of the main group was lower than value of this index in the control group, not reaching statistically significant difference. Dobutamine stress-test revealed more substantial decline of index of LDMLV in the main group (17,2±2,2) as compared to control (13,4±1,4), making these differences reliable (ð<0,01).
Coronaroventriculography together with the conservative methods of cardiologic research allowed eliminating the influence on development of trophic disturbances in the myocardium of the basic modified cardiovascular risk factors and also primary cardiologic pathology in workers of both groups.
Conclusion. In workers of aircraft enterprises exposed to the long professional impact of local impulse vibration and industrial noise, the cardiomyopathy syndrome has been diagnosed. The exclusion of possible etiopathogenic role in development of this syndrome of primary cardiovascular pathology allows assuming presence of other development mechanisms of trophic violations in the cardiac muscle in this group of workers and demands carrying out further scientific search.

Keywords: cardiomyopathy, vibration, noise, myocardium, dystrophic process, coronaroventriculography, vectorechocardiography
p. 547-552 of the original issue
References
  1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2224–60.
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  4. Iavorovskii OP, Vertelenko MV, Shidlovskaia TV. Gigienichna otsenka shumu na robochikh mistsiakh i kharakteristika pochatkovikh porushen' v slukhovomu analizatori u pratsivnikiv «shumovikh» professh aviatsshnogo mashinobuduvannia [Hygienic assessment of noise in the workplaces and characteristics of primary disturbances in the auditory analyzer in "noise professions" workers of aeronautical engineering]. Ukr Zhurn Z Problem Meditsini Prashch. 2008;3(5):63–70.
  5. Gorbatovskii IaA, Epifantseva NN, Gracheva LV, Filimonov SN, Stankevich NG, Danilevskaia LA. Vliianie lokal'noi vibratsii na razvitie ishemicheskoi bolezni serdtsa u shakhterov iuga Kuzbassa [Influence of local vibration on the development of coronary heart disease in the the miners of Kuzbas south]. Klin Med. 2002;80(11):134–37.
  6. Vein AM. Vegetativnye rasstroistva: Klinika, diagnostika, lechenie [Autonomic dysfunction: clinical picture, diagnosis, treatment]. Moscow, RF: Med Inform Agenstvo, 1998. 752 p.
  7. Iavorovskii AP, Shevtsova VM, Sova SG. Kharakteristika i napriazhennost' truda pri vypolnenii sborochno-klepal'nykh rabot na aviatsionnykh predpriiatiiakh [Characteristics and intensity of labor in performing assembly and riveting works in aviation enterprises]. Ukr Zhurn Z Probl Med Prats³. 2013;3(36):25–33.
  8. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP Jr, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease. J Am Coll Cardiol. 2008 Dec 2;52(23):e143–263.
  9. Conti CR. Coronary arteriography. Circulation, 1977;55(2):227–37.
  10. Travin MI, Wexler JP. Pharmacological Stress Testing. Semin Nucl Med 24(4): 298-318, 1999.
  11. Madler CF, Payne N, Wilkenshoff U, Cohen A, Derumeaux GA, Pierard LA, Engvall J, Brodin LA, Sutherland GR, Fraser AG; Non-invasive diagnosis of coronary artery disease by quantitative stress echocardiography: optimal diagnostic models using off-line tissue Doppler in the MYDISE study. Myocardial Doppler in Stress Echocardiography (MYDISE) Study Investigators. Eur Heart J. 2003 Sep;24(17):1584–94.
Address for correspondence:
01601, Ukraina, g. Kiev,
bulvar T. Shevchenko, d. 13,
Natsionalnyiy meditsinskiy universitet im. A.A. Bogomoltsa,
kafedra gigienyi truda i professionalnyih bolezney,
tel. office: 380 44 424 34 42,
e-mail: owls@ukr.net,
Sova Sergey Gennadievich
Information about the authors:
Sova S.G., PhD, associate professor of the occupational hygiene and occupational diseases chair of National Medical University named after A.A. Bogomolts.
Lebedeva E.O., a surgeon of the department of urgent endovascular surgery with X-ray operation room of SE “National Institute of Cardiovascular Surgery named after N.M. Amosov of NAMS of the Ukraine”.

B.S. SUKOVATUKH, M.B. SUKOVATUKH

THE APPROACH TO THE TREATMENT OF INCOMPETENT PERFORATING VEINS IN PATIENTS WIH THE LOWER LIMB VARICOSE VEINS

SBEE HPE “Kursk State Medical University”,
The Russian Federation

Objectives. To study the correlation of the blood refluxes and on its basis to substantiate the approaches in treatment of incompetent perforating veins in patients with the lower limb varicose disease.
Methods. The analysis of the integrated examination and treatment of 181 patients suffering from varicose veins (CEAP class C3-C6) has been conducted. All patients were divided into two groups. 106 (58,6%) patients with class C3 were enrolled into the first group. The second group included 75 (41,4%) patients with class C4-C6. Duplex ultrasound is being performed to determine localization, intensity and extension of blood refluxes in the venous system of the affected limb.
Results. In 75,5% of patients with class C3 (the 1st group) the moderate intensive superficial blood reflux along the great saphenous vein in the thigh and upper third of the leg resulted to the incompetence of solitary perforating veins has been revealed. In 88% of patients with class C4-C6 (the 2nd group) a superficial blood reflux of high intensity extended from the groin until the malleolus. The reflux was considered to be responsible for the multiple perforating incompetence. Deep venous reflux in the 1st group of patients was noticed only in 10,4%.
It was of low intensity without any negative impact on perforating veins. Incompetence of deep vein valves in the 2nd group was detected in 36% of patients. It was clear that in 22,7% of patients a deep reflux was of high intensity caused the multiple incompetence of perforating veins.
Conclusion. The incidence of the venous reflux in perforating veins is considered to be directly depended on the intensity of blood reflux in superficial and deep veins. The higher occurrence of reflux expression, the more incidences of incompetent perforating veins has revealed.

Keywords: varicose veins, blood refluxes, perforating incompetence, surgical treatment
p. 553-559 of the original issue
References
  1. Launois R, Le Moine JG, Lozano FS, Mansilha A.Construction and international validation of CIVIQ-14 (a short form of CIVIQ-20), a new questionnaire with a stable factorial structure. Qual Life Res. 2012 Aug;21(6):1051–8.
  2. Savel'ev VS, Gologorskii VA, Kirienko AI. Flebologiia [Phlebology]. Moscow, RF: Meditsina, 2001. 664 p.
  3. Ignat'ev IM, Bredikhin RA. Varikoznaia bolezn'. Sovremennye aspekty problemy [Varicose veins. Current aspects of the problem]. Vestn Khirurgii im Grekova. 2004;163(4):105–109.
  4. Zolotukhin IA, Bogachev VIu, Kuznetsov AN, Kirienko AI. Nedostatochnost' perforantnykh ven goleni: kriterii i chastota vyiavleniia [Insufficiency of the perforating veins tibia: criteria and incidence of detection rate]. Flebologiia 2008;(1):21–26.
  5. Vincent JR, Jones GT, Hill GB, van Rij AM.Failure of microvenous valves in small superficial veins is a key to the skin changes of venous insufficiency. J Vasc Surg. 2011 Dec;54(6 Suppl):62S–9S.e1-3.
  6. Kirienko AI, Zolotukhin IA, Bogachev VIu, Andriiashkin AV, Kuznetsov AN. Otdalennye rezul'taty endoskopicheskoi disektsii perforantnykh ven goleni pri khronicheskoi venoznoi nedostatochnosti [Long-term results of endoscopic dissection of perforating leg veins in chronic venous insufficiency]. Angiologiia i Sosud Khirurgiia.2007;13(2):68–72.
  7. Sukovatykh BS, Sukovatykh MB, Belikov LN, Rodionov OA. Vybor sposoba miniinvazivnogo lecheniia vysokogo veno-venoznogo refliuksa krovi po bol'shoi podkozhnoi vene u bol'nykh s varikoznoi bolezn'iu ven nizhnikh konechnostei [Option of minimally invasive treatment method of high veno-venous blood reflux in the great saphenous vein in patients with varicose disease of the lower extremities]. Vestn Khirurgii. 2012;171(2):29–33.
  8. Iarich AN, Briushkov AIu, Karalkin AV, Zolotukhin IA. Nedostatochnost' perforantnykh ven pri varikoznoi bolezni: patogeneticheskoe znachenie i metody korrektsii [Insufficiency of the perforating varicose veins: pathogenetic role and methods of correction]. Flebologiia. 2010;(4):29–36.
  9. Zolotukhin IA, Karalkin AV, Iarich AN, Seliverstov II, Kirienko AI. Otkaz ot dissektsii perforantnykh ven ne vliiaet na rezul'tat flebektomii u patsientov varikoznoi bolezn'iu [Refusal of dissection of perforating veins not affect the result of phlebectomy in patients with varicose disease]. Flebologiia. 2012;(3):16–19.
  10. Al-Mulhim AS, El-Hoseiny H, Al-Mulhim FM, Bayameen O, Sami MM, Abdulaziz K, Raslan M, Al-Shewy A, Al-Malt M.Surgical correction of main stem reflux in the superficial venous system: does it improve the blood flow of incompetent perforating veins? World J Surg. 2003 Jul;27(7):793–96.
  11. Mendes RR, Marston WA, Farber MA, Keagy BA.Treatment of superficial and perforator venous incompetence without deep venous insufficiency: is routine perforator ligation necessary? J Vasc Surg. 2003 Nov;38(5):891–95.
  12. Zolotukhin IA, Karalkin AV, Iarich AN, Kirienko AI. Otsenka funktsii perforantnykh ven goleni pri varikoznoi bolezni s pomoshch'iu metodiki radionuklidnoi flebografii [The estimation of the leg perforating veinsfunction with varicose disease using the of radionuclide venography]. Flebologiia. 2011;(2):14–17.
  13. Sukovatykh BS, Sukovatykh MB, Belikov LN, Rodionov OA. Miniinvazivnoe lechenie vysokogo venovenoznogo refliuksa krovi po bol'shoi podkozhnoi vene u bol'nykh varikoznoi bolezn'iu ven nizhnikh konechnostei [Minimally invasive treatment of high blood of veno-venous reflux of the great saphenous vein in patients with varicose disease of the lower extremities]. Annaly Khirurgii. 2010;(4):60–65.
  14. Rossiiskie klinicheskie rekomendatsiipo diagnostike i lecheniiu khronicheskikh zabolevanii ven [Russian clinical guidelines for the diagnosis and treatment of chronic venous disease]. Flebologiia. 2013;(2):6–47.
  15. Pokrovskii AV, Gradusov EG, Ignat'ev IM, Akhmetzianov RV. Vosstanovlenie klapannoi funktsii glubokikh ven pri varikoznoi bolezni nizhnikh konechnostei [Restoration of valve function of deep veins with varicose disease of the lower extremities]. Angiologiia i Sosud Khirurgiia. 2014;20(2):80–89.
Address for correspondence:
305041, Rossiyskaya Federatsiya,
g. Kursk ul. K. Marksa 3,
GBOU VPO «Kurskiy gosudarstvennyiy meditsinskiy universitet»,
kafedra obschey khirurgii,
tel.: (4712) 52-98-62,
e-mail: SukovatykhBS@kursksmu.net,
Sukovatykh Boris Semenovich
Information about the authors:
Sukovatykh B.S. MD, professor, a head of the general surgery chair of SBEE HPE “Kursk State Medical University”.
Sukovatykh B.S. PhD, an associate professor of the general surgery chair of SBEE HPE “Kursk State Medical University”.

E.V. SHAIDAKOV 1, V.L. BULATOV 1,2, E.I. CHUMASOV1,3, E.S. PETROVA 1, I.N. SONKIN 4, K.P. CHERNIH 5

STRUCTURAL FEATURES OF GREAT SAPHENOUS VARICOSE VEIN IN PATIENTS OF DIFFERENT AGE GROUPS

FSBE “Scientific and Research Institute of Experimental Medicine” North-West Branch of the Russian Academy of Medical Sciences 1,
Saint-Petersburg Institute of Bioregulation and Gerontology 2,
FSBE HPE “Saint-Petersburg State Medical Academy of Veterinary Medicine” 3
NME “Railway Clinical Hospital of JSC "Russian Railways", Saint-Petersburg 4,
Saint-Petersburg SBME “Alexandrov City Hospital5
The Russian Federation

Objectives. To study the features of venous wall varicose transformation in patients of different age groups.
Methods. 32 estuarine fragments of the great saphenous vein (GSV) taken in a crossectomy and stripping of varicose veins have been investigated. Group A included 18 patients aged 60 years or less, group B – 14 patients older than 60. The smooth muscle, elastic elements, vasa vasorom (v.v.), nervi vasorum (n.v.) have been assessed. Statistical analysis has been done on the basis of semi-quantitative data according to the 10-point rating scale using a Spearman’s rank correlation coefficient and Mann-Whitney test.
Result. The marked hypertrophy of the inner circular layer of smooth muscle bundles (SMB) and hypotrophy of the external layer of longitudinal smooth muscle bundles of the median membrane have been found in group B. There is a significant difference between two groups according to the given features these groups (p<0,05). The signs of dystrophy, degeneration, decomposition and fragmentation of elastic fibers in the grains and lumps were considered to be the features of long-existing varicose veins. Some cases of severe degeneration of the internal and external elastic membranes up to its complete destruction have been registered. No statistically significant difference in the density of elastic fibers (p=0,23) war observed between groups. A tendency towards increase the number and diameter of v.v., due to the predominance of varicose venules has been observed in group B. Intergroup difference in density v.v. wear not detected (p=0,19). Degenerative and dystrophic changes of n.v. war revealed in all cases. No statistically significant between-group difference in density of n.v. were detected (p=0,22).
Conclusion. Varicose transformation of the venous wall is a negative progressive process, its dynamics of morphological changes s directly related to the duration of the morbility and age. The most significant signs of varicose transformation are observed in the muscular and connective tissue component of the venous wall.

Keywords: morphology, varicose disease, walls of great saphenous vein, elderly and senile age
p. 560-567 of the original issue
References
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  3. Rossiiskie klinicheskie rekomendatsii po diagnostike i lecheniiu khronicheskikh zabolevanii ven [Russian clinical guidelines for the diagnosis and treatment of chronic venous disease]. Flebologiia. 2013;2(2):6–47.
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  6. Gloviczki P, ed. Handbook of venous disorders: guidelines of the American Venous Forum. 3-rd. Hodder Arnold Publishers; 2009. 101 p.
  7. Jurukova Z, Milenkov C. Ulnastructural evidence for collagen degradation in the walls of varicose veins. Exp Mol Pathol 1982;37:37–47
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  9. Wali MA1, Eid RA.Intimal changes in varicose veins: an ultrastructural study. J Smooth Muscle Res. 2002 Jun;38(3):63–74.
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  11. Kachlik D, Stingl J, Sosna B, Straka Z, Lametschwandtner A, Minnich B, Fara P.Morphological features of vasa vasorum in pathologically changed human great saphenous vein and its tributaries. Vasa. 2008 May;37(2):127–36.
  12. Bouissou H, Julian M, Picraggi M-T, Maurcl b, Thiers J-C, Lougc L, Structure of healthy and varicose veins. In: Vanhoutle PM, editor. Return circulation and norepinephrine: an update. Paris: John Libbey Eurotcxt, 1991:139–50.
  13. Michael R. Berthold, Nicolas Cebron, Fabian Dill, Thomas R. Gabriel, Tobias Kotter, Thorsten Meinl, Peter Ohl, Christoph Sieb, Kilian Thiel, Bernd Wiswedel. KNIME.: The Konstanz Information Miner. Data Analysis, Machine Learning and Applications. Studies in Classification, Data Analysis, and Knowledge Organization Berlin, Springer: 2008, p. 319–326.
Address for correspondence:
197376, Rossiiskaia Federatsiia,
g. Sankt-Peterburg, ul. akad. Pavlova, d. 12,
Klinika NII Eksperimental'noi
Meditsiny SZO RAMN,
tel mob: +79218857201,
e-mail: bulatovvas@gmail.com,
Bulatov Vasilii Leonidovich
Information about the authors:
Shaidakov EV, MD, professor, deputy director of the State Organization "Institute of Experimental Medicine" RAMS, Saint-Petersburg.
Bulatov VL, A vascular surgeon FGBI "Institute of Experimental Medicine" RAMS, researcher at the Institute of Bioregulation and Gerontology, Saint- Petersburg.
Chumasov EI, Ph.D., professor of the chair of histology and general biology of FGBU VPO "St. Petersburg State Academy of Veterinary Medicine", a senior researcher at the Department of General and private morphology FGBI "Scientific Research Institute of Experimental Medicine," North West Branch of the Russian Academy of Medical Sciences, Saint-Petersburg.
Petrova ES, PhD, a senior researcher at the Department of general and private morphology. FGBI "Scientific Research Institute of Experimental Medicine," North-West Branch of the Russian Academy of Medical Sciences.
Sonkin IN, MD, a head of the department of vascular surgery. MSH Road Clinical Hospital of JSC "Russian Railways", Saint-Petersburg.
Chernykh KP, a vascular surgeon Petersburg GBUZ "Municipal Alexander Hospital," Saint Petersburg.

A.M. KUPCHENKO

THE AEROBIC MICROFLORA IN THE ETIOLOGICAL STRUCTURE OF GENERALIZED PURULENT PERITONITIS

EE “Vitebsk State Medical University”,
The Republic of Belarus

Objectives. To study the etiological structure and sensitivity of aerobic microorganisms of peritoneal exudate to antibacterial preparations in patients with generalized purulent peritonitis in regards to the current condition.
Methods. At Vitebsk Emergency Hospital the peritoneal exudate in 92 patients with generalized purulent peritonitis has been studied by the developed test systems «ID - ENT», «AB - ENTER», «AB - GRAM (-)», «AB - STAF», «AB - PSEUD». Pathogenetic significance of enterobacteria and Gram Negative Aerobic microorganisms as well as their specious composition and sensitivity to antibacterial preparations has been defined.
Results. In the majority (73%) cases the conducted microbiological examination has manifested the generalized purulent peritonitis caused by mixed aerobic and anaerobic flora (only by anaerobes – in 14%, only aerobes – in 13%). The representatives of the genus Enterobacteriaceae have dominated among the isolated 80 strains of aerobic and facultative - anaerobic microorganisms. The aerobic microflora of peritoneal exudate components was represented by E. ñoli – 53,75%, Enterococcus spp.– 10%, Streptococcus spp. – 8,75%, Klebsiella spp. – 10%, Proteus spp. – 5%, Staphylococcus spp. – 6,25%, Pseudomonas aeruginosa – 6,25%. In studying the sensitivity of main aerobic pathogens of generalized purulent peritonitis to antimicrobial agents the existence in the vast majority of strains of multiple drug resistance has been established. Carbapenems (meropenem – 94,4% of the sensitive microorganisms, imipenem – 88,7%), the third-generation aminoglycosides (amikacin – 87,3%), fluoroquinolones (moxifloxacin – 87,3%, ciprofloxacin – 84,5%, norfloxacin – 83,1%), the fourth generation cephalosporins (cefepime – 80,3%) exhibit maximal antibacterial effect on the aerobic component.
Conclusion. The obtained data concerning the etiological structure of aerobic microflora of peritoneal exudate in patients with generalized purulent peritonitis will assist in creating of new effective antibiotic therapy schemes available to reduce mortality rate and improve pharmacoeconomic treatment results of given morbility.

Keywords: generalized purulent peritonitis, antibacterial therapy, aerobic microflora, test-systems
p. 568-574 of the original issue
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  10. Kosinets VA. Identifikatsiia i opredelenie chuvstvitel'nosti k antimikrobnym preparatam osnovnykh vozbuditelei rasprostranennogo gnoinogo peritonita [Identification and deterrmination of susceptibility to antimicrobial agents of major pathogens of generalized purulent peritonitis]. Novosti Khirurgii. 2012;20(5):62–69.
  11. Montravers P, Dupont H, Gauzit R, Veber B, Auboyer C, Blin P, Hennequin C, Martin C. Candida as a risk factor for mortality in peritonitis. Crit Care Med. 2006 Mar;34(3):646–52.
  12. Strachunskii LS, Belousov IuB, Kozlova SN, red. Prakticheskoe rukovodstvo po antiinfektsionnoi khimioterapii [Practical guidance on anti-infective chemotherapy]. Smolensk, RF: MAKMAKh. 2007. 464 p.
  13. Montravers P, Gauzit R, Muller C, Marmuse JP, Fichelle A, Desmonts JM. Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy. Clin Infect Dis. 1996 Sep;23(3):486–94.
  14. Sazhin VP, Bodrova NG Klimov DE, Iurishchev VA, Avdovenko AL, Sazhin IV. Antibiotikoterapiia pri gnoinykh khirurgicheskikh zabolevaniiakh organov briushnoi polosti i miagkikh tkanei [Antibiotic treatment of purulent surgical diseases of the abdominal organs and soft tissues]. Khirurgiia. Zhurnal im NI Pirogova. 2010;(6):4–9.
  15. Kosinets AN, Konopel'ko AE, Fedianin SD, Okulich VK. Test-sistemy «AB-STAF», «AB-PSEV», «AB-ENTER» dlia ekspress-otsenki chuvstvitel'nosti mikroorganizmov k antibiotikam [Test systems "AB-STAF", " AB-PSEV", "AB-ENTER" for express - assessment of microorganisms sensitivity to antibiotics]. Novosti Khirurgii. 2006;14(1):2–8.
  16. Kosinets AN, Fedianin SD, Okulich VK, Konopel'ko EA, Kosinets VA, Shilin VE. Matskevich EL. Test-sistema «AB-Gram(-)» dlia otsenki chuvstvitel'nosti gramotritsatel'nykh bakterii k antibiotikam [Test System "AB- Gram (-)" for evaluation of sensitivity of gram negative bacteria to antibiotics]. Novosti Khirurgii. 2007;15(3):57–64.
Address for correspondence:
210023, Respublika Belarus,
g. Vitebsk, pr. Frunze, d. 27,
UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra operativnoy khirurgii i topograficheskoy anatomii,
tel. 375 33 675-48-62, e-mail: anna.annushka75@mail.ru,
Kupchenko Anna Mihaylovna.
Information about the authors:
Kupchenko A.N. A senior lecturer of the operative surgery and topographic anatomy chair of EE “Vitebsk State Medical University”.

P.V. PLOTNIKOV

INTEGRATED TREATMENT OF PATIENTS WITH PYOGENIC WOUNDS DEPENDING ON THE ABILITY OF MICROBIAL AGENTS TO FORM BIOFILM

EE “Vitebsk State Medical University”,
The Republic of Belarus

Objectives. To determine the effectiveness of the miltimodal treatment of pyogenic wounds depending on the ability of the isolated pathogen to form biofilm.
Methods. During the research, the comprehensive examination and treatment of 48 patients with pyogenic-inflammatory processes of soft tissues have been conducted in the Republican Scientific and Practical Center “Infection in Surgery” on the basis of the pyogenic surgery department of ME “Vitebsk Regional Clinical Hospital” during the period of 2012-2014. The control group patients (n=31) were subjected to a standard treatment, the main group patients (n=17) received the suggested integrated treatment of the pyogenic wounds taking into account the ability of pathogens to form biofilm based on the application of the vacuum-instillation therapy with the dimeksid solution as a rinsing liquid. There were no reliable differences in age, sex as well as in nosologic forms of diseases in the investigated groups.
Results. Antiseptics widely used in clinical practice have been studied. Dimeksid, inol, isopropyl alcohol destroied the biofilm most intensively. These antiseptics are considered to be recommended for treatment of wounds, associated with pathogens capable to form biofilm. Statistically significant reduction term of the clearance wound, the appearance of granulation tissue, the marginal epithelialization beginning and the length of treatment in the patients underwent the miltimodal treatment of the pyogenic wounds according to the worked out method have been revealed.
Conclusion. The performed research has proved the efficacy of the suggested method of pyogenic wounds treatment taking into account the ability of some pathogens to form biofilm. The application of proposed method can reduce treatment terms of patients with pyogenic wounds by 6 days (p=0,03).

Keywords: surgical infection, chronic and acute wounds, biofilm
p. 575-581 of the original issue
References
  1. Fedianin SD, Okulich VK, Konopel'ko EA, Kovalenko AA, Krishtopov LE, Sachek MG, Sokolovskii VO. Sravnitel'nyi analiz etiologicheskoi struktury i chuvstvitel'nosti k antibiotikam osnovnykh vozbuditelei khirurgicheskikh infektsii v statsionarakh goroda Vitebska [Comparative analysis of the etiological structure and sensitivity main pathogens of surgical infections to antibiotics in hospitals of Vitebsk]. Vestnik VGMU. 2012;11(3):73–79.
  2. Khanin MIu, Valeev MM, Chistichenko SA, Minasov TB, Iakupov RR, et al. Khirurgicheskoe lechenie bol'nykh s posttravmaticheskimi defektami miagkikh tkanei goleni pri mnozhestvennykh i sochetannykh povrezhdeniiakh [Surgical treatment of patients with post-traumatic tibia soft tissue defects with multiple and combined injuries]. Prakt Meditsina. 2011;(6):115–21.
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  4. Kirby JP, Mazuski JE.Prevention of surgical site infection. Surg Clin North Am. 2009 Apr;89(2):365–89, viii.
  5. Zhao G, Usui ML, Lippman SI, James GA, Stewart PS, Fleckman P, Olerud JE. Biofilms and Inflammation in Chronic Wounds. Adv Wound Care (New Rochelle). 2013 Sep;2(7):389–99.
  6. Percival SL, Thomas J,  Linton S,  Okel T,  Corum L,  Slone W. Percival SL. The antimicrobial efficacy of silver on antibiotic-resistant bacteria isolated from burnwounds. Int Wound J. 2012 Oct;9(5):488–93.
  7. Lawson MC, Hoth CA, Deforest CN, Bowman KS. Anseth Inhibition of Staphylococcus epidermidis biofilms using polymerizable vancomycin derivatives. Clin Orthop Relat Res. 2010 Aug;468(8):2081–91.
  8. Orgill DP, Bayer LR. Negative pressure wound therapy: past, present and future. Int Wound J. 2013 Dec;10 Suppl 1:15–9.
  9. Borrero Esteban MP, Begines Begines R,, Rodriguez Llamas S,, Diaz Campos T [Managing complications in severe traumatic injury with VAC therapy with instillation]. Rev Enferm. 2013 Nov;36(11):42–7. [Article in Spanish]
  10. Kabanova AA, Plotnikov FV. Metod opredeleniia sposobnosti mikroorganizmov – vozbuditelei gnoino-vospalitel'nykh protsessov cheliustno-litsevoi oblasti formirovat' bioplenki [Method for determination of the ability of microorganisms - causative agents of inflammatory processes of the maxillofacial region to form biofilms]. Sovremen Stomatologiia. 2013;(1):82–84.
  11. Blednov AV. Rezul'taty primeneniia pereviazochnykh sredstv «Kombiksin» i «Diosept» v klinike (klinicheskie ispytaniia pereviazochnykh sredstv) [Results of application of "Kombiksin" and "Diosept" dressings in the hospitals (clinical trials of dressings)]. Novosti Khirurgii. 2007;15(2):90–97.
  12. Murray CK, Obremskey WT, Hsu JR, Andersen RC, Calhoun JH, Clasper JC, Whitman TJ, Curry TK, Fleming ME, Wenke JC, Ficke JR. Prevention of infections associated with combatrelated extremity injuries. J Trauma 2011; 71:S235–57.
Address for correspondence:
210023 Respublika Belarus,
g. Vitebsk, pr.Frunze, d.
27, UO «Vitebskiy
gosudarstvennyiy
meditsinskiy universitet»,
kafedra khirurgii FPK i PK.
tel. mob.: 375 29-591-21-70,
e-mail: dr.plotnikov@mail.ru,
Plotnikov Filipp Viktorovich
Information about the authors:
Plotnikov F.V., post-graduate student of the surgery chair of the advanced training faculty and retraining of the personnel of EE “Vitebsk State Medical University”.

TRANSPLANTOLOGY

A.M. PISARENKO1,2, Y.E. DEMIDCHIK1, O.V. ILYINCHYK1,3, V.Y.KHRYSHCHANOVICH4, A.N. KOZLOVSKAYA2,4, D.G. BALASHOVA4, O.I. KENDENKOV4

SURGICAL TREATMENT RESULTS OF SECONDARY HYPERPARATHYROIDISM WITH PARATHYROID AUTOTRANSPLANTATION APPLICATION

SEE “Belarusian Medical Academy of Post-graduate Education” 1,
ME “Minsk City Clinical Ontological Dispensary” 2,
ME “The 1st City Clinical Hospital”3, Minsk,
EE “Belarusian State Medical University”4, Minsk,
The Republic of Belarus

Objectives. To study the effectiveness of surgical treatment of the secondary hyperparathyroidism with parathyroid autotransplantation application.
Methods. A retrospective data analysis of 39 patients receiving the renal replacement therapy in hemodialysis department of ME “The 1st Clinical Hospital” and suffering from the secondary hyperparathyroidism; they were subjected to parathyroidectomy (PTE) with autotransplantation of the parathyroid tissue on the basis of the head and neck tumors department of ME “Minsk City Clinical Oncologic Dispensary”. Patients’ average age was 50 [44-55] years. Parathyroid autograft was stored in sterile cold NaCl solution, grinded and implanted into brachioradialis muscle of the forearm. Serum levels of calcium, phosphate, parathyroid hormone (PTH), alkaline phosphatase have been evaluated in the postoperative period.
Results. Postoperative follow-up period made up 21 [12-24] months. Transient hypocalcaemia has developed in 5 patients. The recurrence of hyperparathyroidism was observed in two cases and reoperation was carried out. During follow-up period we observed the stable and statistically significant (P≤0,01) reduction of serum PTH, calcium and phosphate in comparison with initial levels, wherein differences in the level of PTH in 1 month and 24 months after PTE was unreliable (p<0,8). Sensitivity of US and scintigraphy of the parathyroid glands with Tc-99m-MIB I in regard to the nature of parathyroid pathology was 79.9%.
Conclusion. Total PTE with autologous parathyroid tissue transplantation in the forearm muscles is considered to be a highly effective and pathogenetic reasonable method of treatment of severe secondary renal hyperparathyroidism in dialysis patients. Along with safety, a small number of complications and the lack of lethality, the developed technology allowed reducing the recurrence rate of hyperparathyroidism, preventing the development of postoperative hypoparathyroidism, achieving a good cosmetic effect, shortening the time of hospitalization.

Keywords: chronic renal insufficiency, secondary hyperparathyroidism, surgical treatment, autotransplantation
p. 582-588 of the original issue
References
  1. Cohen EP, Moulder JE.Parathyroidectomy in chronic renal failure: has medical care reduced the need for surgery? Nephron. 2001 Nov;89(3):271–73.
  2. Albright F, Baird PC, Cope O, Bloomberg E. Studies on the physiology of parathyroid glands. IV. Renal complications of hyperparathyroidism. Am. J. Med. Sci. 1934;187(1):49–64.
  3. Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK.Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001 Oct;12(10):2131–38.
  4. Raggi P, Boulay A, Chasan-Taber S, Amin N, Dillon M, Burke SK, Chertow GM.Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol. 2002 Feb 20;39(4):695–701.
  5. Llach F.Secondary hyperparathyroidism in renal failure: the trade-off hypothesis revisited. Am J Kidney Dis. 1995 May;25(5):663–79.
  6. Fournier A, Moriniere PH, Oprisiu R, Yverneau-Hardy P, Westeel PF, Mazouz H, el Esper N, Ghazali A, Boudailliez B.1-alpha-Hydroxyvitamin D3 derivatives in the treatment of renal bone diseases: justification and optimal modalities of administration. Nephron. 1995;71(3):254–83.
  7. Gourgiotis S, Moustafellos P, Stratopoulos C, Vougas V, Drakopoulos S, Hadjiyannakis E.Total parathyroidectomy with autotransplantation in patients with renal hyperparathyroidism: indications and surgical approach. Hormones (Athens). 2006 Oct-Dec;5(4):270–75.
  8. Salem MM.Hyperparathyroidism in the hemodialysis population: a survey of 612 patients. Am J Kidney Dis. 1997 Jun;29(6):862–65.
  9. Chang CW, Tsue TT, Hermreck AS, Baxter KG, Hoover LA.Efficacy of preoperative dual-phase sestamibi scanning in hyperparathyroidism. Am J Otolaryngol. 2000 Nov-Dec;21(6):355–59.
  10. Takagi H, Tominaga Y, Uchida K, Yamada N, Morimoto T, Yasue M.Image diagnosis of parathyroid glands in chronic renal failure. Ann Surg. 1983 Jul;198(1):74–79.
  11. Takagi H, Tominaga Y, Uchida K, Yamada N, Kawai M, Kano T, Funahashi H, Mizuno S.Evaluation of image-diagnosing methods of enlarged parathyroid glands in chronic renal failure. World J Surg. 1986 Aug;10(4):605–11.
  12. Numano M, Tominaga Y, Uchida K, Orihara A, Tanaka Y, Takagi H. Surgical significance of supernumerary parathyroid glands in renal hyperparathyroidism. World J Surg. 1998 Oct;22(10):1098–102; discussion 1103.
  13. Yueming Sun, Huihua Cai, Jianfeng Bai, Hanlin Zhao, and Yi Miao Endoscopic Total Parathyroidectomy and Partial Parathyroid Tissue Autotransplantation for Patients with Secondary Hyperparathyroidism: A New Surgical Approach. World J Surg. Aug 2009; 33(8): 1674–1679.
  14. Chou F-F, Chi S-Y, Hsieh K-C. Hypoparathyroidism after total parathyroidectomy plus subcutaneous autotransplantation for secondary hyperparathyroidism – any side effects? World J. Surg. 2010:34(10):2350–54.
  15. Sohal AS, Gangji AS, Crowther MA, Treleaven D.Uremic bleeding: pathophysiology and clinical risk factors. Thromb Res. 2006;118(3):417–22.
  16. Chapelle T, Meuris K, Roeyen G, De Greef K, Van Beeumen G, Bosmans JL, Ysebaert D.Simultaneous kidney-parathyroid allotransplantation from a single donor after 20 years of tetany: a case report. Transplant Proc. 2009 Mar;41(2):599–600.
  17. Tonelli M, Klarenbach S, Rose C, Wiebe N, Gill J.Access to kidney transplantation among remote- and rural-dwelling patients with kidney failure in the United States. JAMA. 2009 Apr 22;301(16):1681–90.
Address for correspondence:
220116 Respublika Belarus,
g. Minsk, prospekt Dzerzhinskogo, d. 83,
UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet»,
2-ya kafedra hirurgicheskih bolezney,
tel. office: 375 17 287-86-52,
e-mail: vladimirkh77@mail.ru,
Khryshchanovich Vladimir Yanovich
Information about the authors:
Pisarenko A.M. Head of the head and neck tumors unit of ME “Minsk City Clinical Oncologic Dispensary”.
Demidchik Y.E. MD, professor, corresponding member of NAS RB, Rector of SEE “Belarusian Medical Academy of Post-graduate Training”.
Ilyinchyk O.V. A nephrologists, head of the hemodialysis department with the unit of peritoneal dialysis of ME “The 1st City Clinical Hospital”.
Khryshchanovich V.Y. PhD, associate professor of the 2nd surgical diseases chair of EE “Belarusian State Medical University”.
Kozlovskaya A.N. PhD, an assistant of the oncology chair of EE “Belarusian State Medical University”.
Kendenkov O.I. A 6-year student of EE “Belarusian State Medical University”.
Balashova D.G. A 6-year student of EE “Belarusian State Medical University”.

ONCOLOGY

U.U. ANDRUSHCHUK 1, Y.P. OSTROVSKY 1, V.V. ZHARKOV 2, S.A. KURGANOVICH 1, T.T. GEVORKYAN 1, V.E. PONOMAREVA 2, M.M. SHASHURO 2, N.M. NOVITSKAJA 1

THE COMPARATIVE ANALYSIS OF SURGICAL TREATMENT OF PATIENTS WITH TUMORS OF THE MAIN LOCATIONS AND COMPETITIVE CORONARY HEART DISEASE WITH DRUG THERAPY AND AFTER THE PRELIMINARY MYOCARDIAL REVASCULARIZATION

SE “Republican Scientific Practical Center “Cardiology”, 1 Minsk,
SE “N.N. Alexandrov Republican Scientific Practical Center of Oncology and Medical Radiology” 2, Minsk,
The Republic of Belarus

Objectives. To assess a comparative analysis of the immediate results of radical surgical treatment of patients with tumors of the main locations and competing coronary heart disease (CHD) with drug therapy and after the preliminary myocardial revascularization on the basis of the designed algorithm.
Methods. The patients (n=238) have been radically operated on for tumors of the main locations accompanied by cardiotropic therapy (1st group) and 13 patients – after myocardial revascularization surgery (2nd group). Patients of the first group were reliably older, but with a less pronounced cardiac pathology. The average functional class of heart failure and angina pectoris in patients of the second group was found to be significantly higher. There was no difference in the groups by gender, body mass index, type of oncological surgery.
Results. The duration of the operations amounted to 150,8±4,63 min. vs 331,3±35,6 min. for the first and second groups, respectively (p<0,005). The incidence of major cardiac complications was 10,1% and 0%, respectively (p=0,37), non-cardiac – 7,6% and 15,4% (p=0,65), all major postoperative complications – 16,8% and 15,4% (p=0,72), in-hospital mortality – 3,4% and 7,7% (p=0,50), average length of a hospital stay – 21,5±0,61 and 24,3±1,90 (p=0,19). Cardiac pathology itself was not considered to be as the main reason of the 9 (3,6%) deaths within the hospital period in both groups, but in 2 cases of the first group (0,8%) it exacerbated the complicated course of early postoperative period.
Conclusion. There were no significant differences in the proportion of major cardiac, non-cardiac, major postoperative complications, hospital mortality, duration of hospitalization of patients after radical surgery for tumor of the main locations with competitive CHD operated with drug therapy or after preliminary myocardial revascularization according to the worked out algorithm.

Keywords: cancer, coronary heart disease, aortic coronary shunting
p. 589-595 of the original issue
References
  1. Van der Pijl LL, Birim O, van Gameren M, Kappetein AP, Maat AP, Steyerberg EW, Bogers AJ. Validation of a prognostic model to predict survival after non-small-cell lung cancer surgery. Eur J Cardiothorac Surg. 2010 Nov;38(5):615–9.
  2. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology. J Am Coll Cardiol. 2007;50(17):e159-e242.
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  4. Ostrovskii IuP, Zharkov VV, Andrushchuk VV, Shestakova ShG, Mal'kevich VT, Iasko PG, Baranov AIu. Simul'tannoe khirurgicheskoe lechenie zlokachestvennykh novoobrazovanii razlichnykh lokalizatsii i konkuriruiushchei ishemicheskoi bolezni serdtsa - novyi podkhod [Simultaneous surgical treatment of malignant tumors of different localization and competing coronary heart disease - a new approach]. Belorus Med Zhurn. 2006;(2):70–71.
  5. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK; ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction - executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation. 2004 Aug 3;110(5):588–36.
  6. Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F, Daly C, De Backer G, Hjemdahl P, Lopez-Sendon J, Marco J, Morais J, Pepper J, Sechtem U, Simoons M, Thygesen K, Priori SG, Blanc JJ, Budaj A, Camm J, Dean V, Deckers J, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo J, Zamorano JL. Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J. 2006 Jun;27(11):1341–81
  7. Bassand JP, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernandez-Aviles F, Fox KA, Hasdai D, Ohman EM, Wallentin L, Wijns W. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2007 Jul;28(13):1598–660.
  8. Silber S, Albertsson P, Aviles FF, Camici PG, Colombo A, Hamm C, Jorgensen E, Marco J, Nordrehaug JE, Ruzyllo W, Urban P, Stone GW, Wijns W. Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J. 2005 Apr;26(8):804–47.
  9. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K, Kastrati A, Rosengren A, Steg PG, Tubaro M, Verheugt F, Weidinger F, Weis M. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J. 2008 Dec;29(23):2909–45.
  10. Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM, Grunwald MA, Levy D, Lytle BW, O'Rourke RA, Schafer WP, Williams SV, Ritchie JL, Cheitlin MD, Eagle KA, Gardner TJ, Garson A Jr, Russell RO, Ryan TJ, Smith SC Jr. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology. J Am Coll Cardiol. 1999 Jun;33(7):2092–197.
  11. Hunt SA. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology. J Am Coll Cardiol. 2005 Sep 20;46(6):e1–82.
Address for correspondence:
220036, Respublika Belarus',
g. Minsk, ul. R.Liuksemburg,
d. 110, GU «Respublikanskii
nauchno-prakticheskii tsentr «Kardiologiia»,
laboratoriia khirurgii serdtsa, tel.
rab. +375 17 2088605,
e-mail: heartslight@mail.ru,
Andrushchuk Vladimir Vladimirovich
Information about the authors:
Andruschuk VV, MD, a cardiac surgeon of the 2nd cardiac surgery department of the State Institution "Republican Scientific and Practical Centre Cardiology", the Laboratory of Cardiac Surgery.
Zharkov VV, MD, professor, a csenior researcher of the Department of Thoracic Anesthesiology oncopathology with a group of anestesiology of SE "Republican Scientific and Practical Centre of Oncology and Medical Radiology named by N.N. Aleksandrov. "
Ostrovsky YP, MD, professor, a corresponding member of the National Academy of Sciences, a head of the chair of Cardiac Surgery GUO "Belarusian Medical Academy of Postgraduate Education," the chief cardiac surgeon freelance of Ministry of Health of the Republic of Belarus.
Mounds SA, a specialist-physician of ultrasonic diagnostics SI "Republican Scientific and Practical Centre Cardiology", of the laboratory of cardiac surgery.
Gevorgyan TT, a specialist department of functional diagnostics SI "Republican Scientific and Practical Centre Cardiology".
Ponomareva VE, a physician of SI "Republican Scientific and Practical Centre of Oncology and Medical Radiology named by N.N. Aleksandrov" .
Shashuro MM, an assistant of department of thoracic cancer pathology with a group of anesthesiology GU "Republican Scientific and Practical Center of Oncology and Medical Radiology named by N.N. Aleksandrov".
Nowicka NM, an assistant of heart surgery laboratory SI "Republican Scientific and Practical Centre Cardiology ".

A.M. KURCHANKOU, V.P. KURCHIN

THE MULTIMODALITY TREATMENT OF PATIENTS WITH NON-SMALL CELL LUNG CANCER AND UNILATERAL DISSEMINATION COVERING THE PARIETAL PLEURA

SE “Republican Scientific and Practical Center of Oncology and Medical Radiology named after N.N. Alexandrov”, Minsk,
The Republic of Belarus

Objectives. To increase the treatment efficiency of non-small cell lung cancer patients with pleural dissemination.
Methods. Twenty one non-small cell lung cancer patients (morphologically confirmed diagnosis) with pleural dissemination on the tumor side have been included in the study. All patients were divided into two groups: a control group – 10 patients subjected to chemotherapy; a study group – 11 patients treated by multimodality therapy application: pleuropneumonectomy, intrapleural perfusion thermochemotherapy (IPT) and adjuvant chemotherapy.
Results. 4 patients were performed thermochemotherapy prior surgery; the operation was performed 2-4 weeks after it since the pleural dissemination was confirmed thoracoscopically. To the rest of patients, thermochemotherapy was performed simultaneously with the surgery since the pleural dissemination appeared to be an intraoperative finding and confirmed thoracoscopically. Lymph node affection was detected in 8 (72,7%) patients, wherein in 7 (63,6%) – mediastinal lymph nodes N2 have been also impressed. Tumor process was located on the right side in 4 (36,4%) patients, and in 7 (63,6%) – on the left side. Among them, adenocarcinomas are the dominating tumor type – in 9 (81,8%) patients. One patient (9,1%) had histologically squamous cell lung cancer, and one (9,1%) – sarcomatoid lung cancer. The postoperative complications were registered in 4 (36,4%) patients from 11 received the multimodality treatment with IPT. Mortality rate made up 18,2%. All patients of the control group died within 24 months (0%), while the overall 3-year survival rate for patients receiving the multimodality treatment was 61,4 ± 15,3% (p <0,05).
Conclusion. The carrying out of the multimodality treatment, including radical surgery, intrapleural perfusion thermochemotherapy and adjuvant chemotherapy, as well as the patients with non-small cell lung cancer, allows increasing the overall level of 3-years survival for non-small cell lung cancer patients with pleural dissemination from 0,0% up to 61,4±15,3% (p<0,05) in comparison with chemotherapeutic method.

Keywords: non-small cell lung cancer (NSCLC), radical treatment, multimodality treatment, intrapleural thermochemotherapy
p. 596-600 of the original issue
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  5. Friedberg JS, Mick R, Stevenson JP, Zhu T, Busch TM, Shin D, Smith D, Culligan M, Dimofte A, Glatstein E, Hahn SM.Phase II trial of pleural photodynamic therapy and surgery for patients with non-small-cell lung cancer with pleural spread. J Clin Oncol. 2004 Jun 1;22(11):2192–201.
  6. Kimura M, Tojo T, Naito H, Nagata Y, Kawai N, Taniguchi S.Effects of a simple intraoperative intrathoracic hyperthermotherapy for lung cancer with malignant pleural effusion or dissemination. Interact Cardiovasc Thorac Surg. 2010 Apr;10(4):568–71.
  7. Combined surgery of intrapleural perfusion hyperthermic chemotherapy and panpleuropneumonectomy for lung cancer with advanced pleural spread: a pilot study. Shigemura N, Akashi A, Ohta M, Matsuda H. Interact CardioVasc Thorac Surg. 2003;2(4):671–75.
Address for correspondence:
223040, Respublika Belarus,
Minskiy rayon, pos. Lesnoy,
GU «Respublikanskiy nauchno-prakticheskiy tsentr
onkologii i meditsinskoy radiologii im. N.N. Aleksandrova»,
otdel torakalnoy onkopatologii s gruppoy anesteziologii,
tel.mob.: 375 29 336-96-83,
e-mail: AKurchenkov@mail.ru
Information about the authors:
Kurchankou A.N. A researcher of the department of thoracic oncopathology with anesthesia group of SE “Republican Scientific and Practical Center of Oncology and Medical Radiology named after N.N. Alexandrov”.
Kurchin V.P. MD, a head of the department of thoracic oncopathology with anesthesia group of SE “Republican Scientific and Practical Center of Oncology and Medical Radiology named after N.N. Alexandrov”.

REVIEWS

G.A. POPEL

THE DIAGNOSTIC AND SURGICAL TREATMENT OF ANGIODYSPLASIA OF EXTERNAL LOCALIZATION

SBE “Belarusian Medical Academy of Postgraduate Education”, Minsk,
The Republic of Belarus

Today angiodysplasia of the external localization is considered to be rather difficult field of clinical angiology as it is relatively rare and insufficiently familiar pathology for practitioners. The magnitude of the problem is determined by the real risk of complications: venous ulcers, thrombosis, major bleeding from the transformed tissues, and disorders of the central hemodynamics due to abnormal arteriovenous reset. Furthermore, for angiodysplasias is characterized by the significant functional and anatomical disorders, cosmetic defects, and progressive course, that in aggregate are know to cause disability and disability in relatively young age. To treat angiodysplasia the staged surgeries are carried out in some cases, which are traumatic and invalidity in a great number of complications such as bleeding, trophic ulcers, hypertrophic and keloid scars in 7,4-20% of patients. The frequency of postoperative recurrence reaches 30-48% due to the objective (prevalence of the process) and subjective (underestimation of lesion) causes.
The review provides historical information about congenital vascular malformations; the characteristic of the classification systems is presented; different methods of diagnosis and treatment of angiodysplasia are analyzed as well as complications. Despite significant progress in this area, associated with the introduction of the modern instrumental methods in the diagnostics algorythm of current instrumental methods, literature data are of contradictory nature and there is no consensus concerning the choice of the most optimal methods and term of surgical treatment. The conducted analysis indicates need for further research of this pathology. Introduction of minimally invasive surgical techniques for angiodysplasia surgical treatment seems to be promising.

Keywords: hemangioma, angiodysplasia, àrteriovenous malformation, arteriovenous fistula, vascular malformation, venous malformation, vascular abnomalties, classification, sclerotherapy, diode lasers
p. 601-610 of the original issue
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Address for correspondence:
220013, Respublika Belarus,
g. Minsk, ul. P. Brovki d. 3, k. 3,
GUO «Belorusskaya akademiya poslediplomnogo obrazovaniya»,
kafedra khirurgii,
tel. office: 375 29 175-93-36,
e-mail: hpopel@mail.ru,
Popel Gennadiy Adolfovich
Information about the authors:
Popel G.A., assistant of the surgery chair of SBE “Belarusian Medical Academy of Postgraduate Education”.

CASE REPORTS

S.Y. PUSHKIN1, E.A. KORYMASOV 2, A.S. BENYAN 1, I.R. KAMEEV 1

THE FIRST EXPERIENCE OF “MATRIXRIB” PLATES APPLICATION AT TRAUMATIC CHEST DEFORMITY

GBUZ "Samara Regional Hospital im.M.I. Kalinin"1,
Medical University "Samara State Medical University"2,
The Russian Federation

Traumatic chest deformity is considered to be one of pathogenesis elements of the severe respiratory insufficiency in patients with multiple rib fractures.
Reduction of pleural cavity volume, pain syndrome due to the ribs fractures, disorders of the respiratory biomechanics are responsible for the necessity to apply special treatment methods aimed to restore both forms and volume of the musculoskeletal carcass of the chest. In the article the observation from the practice concerning the fixation of multiple rib fractures in the treatment of the patient with a clinically expressed hemithorax deformity has been described. The technology of plate rib osteosynthesis by means of the anatomic plates “MatrixRib” has been used. During the operation the osteosynthesis of four ribs was performed and simultaneous thoracoscopy was conducted to decompress pneumomediastinum. The rib cage integrity restoration has been achieved that contributes to normalization of breathing biomechanics, lung expansion and regress of respiratory insufficiency. Observation periods of up to 3 months after injury has demonstrated the effectiveness of the technique of the treatment, which is expressed in a satisfactory condition of the patient, the absence of complications, rehabilitation.
Hereby, application of rib osteosynthesis in the treatment of chest deformity in the early period of traumatic disease is considered to be the perspective way of treatment and a good precondition for further rehabilitation.

Keywords: rib fracture, traumatic chest deformity, fixation, osteosynthesis
p. 611-614 of the original issue
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Address for correspondence:
Pushkin SJ, MD, deputy chief medical officer for surgery GBUZ "Samara Regional Clinical Hospital named after MI Kalinin, a chief freelance specialist on thoracic surgery of the Ministry of Health of Samara region.
Korymasov EA, MD, professor, a head of department of surgery IPO Medical University "Samara State Medical University" Ministry of Health of Russia.
Benny Alexander, MD, a head of the surgical department of thoracic GBUZ "Samara Regional Clinical Hospital named after MI Kalinin ".
Cameo IR, thoracic surgeon thoracic surgery department GBUZ "Samara Regional Clinical Hospital named after M.I. Kalinin."
Information about the authors:
443095, Rossiiskaia Federatsiia,
g. Samara, ul. Tashkentskaia d. 159,
GBUZ "Samarskaia oblastnaia klinicheskaia
bol'nitsa im. M.I. Kalinina",
rab. tel.: +7 846 321-15-03,
mob. tel.: +7 927 720-29-88,
e-mail: serpuschkin@mail.ru,
Pushkin Sergei Iur'evich

EXCHANGE OF EXPERIENCE

S.S. AMONOV1, M.I. PRUDKOV 2, M.A. KACADZE 1, O.G.ORLOV 3

MINIMALLY INVASIVE INTRAOPERATIVE DIAGNOSIS AND TREATMENT OF INTERNAL BILIARY FISTULAS IN PATIENTS WITH HEPATIC ECHINOCOCCOSIS

Republican Scientific Center of Cardiovascular Surgery 1, Dushanbe,
The Republic of Tadzhikistan,
SBEE HPE “Ural State Medical University”, 2
SME “Sverdlovsk Regional Clinical Hospital ¹1”, Yekaterinburg 3,
The Russian Federation

Objectives. To study the possibilities of minimal access surgery, including echinococcectomy and treatment of parasitic cavity with perhydrol for intraoperative diagnostics and treatment of the internal biliary fistulas.
Methods. During the period of 2002-2011 36 patients with liver echinococcosis aggravated by the bile ducts lesions have been operated on. In 21 (58,3%) patients hydatid cysts were located in the right lobe of the liver, in 15 (41,7%) – in the left lobe. While analyzing the results, accessibility and quickness of performance as well as safety, quality changes of the fibrous capsule internal surface coloration, rate of postoperative complications have been evaluated. After patients’ discharge from the in-patient department, they were subject to the US liver in terms of 6-12-36-48 months.
Results. The presence of the biliary fistula could be predicted preoperatively in 7 (19,4%) patients. These patients were subjected to laparotomy, echinococcectomy with the fibrous capsule excision, closure of the biliary fistula, cholecystectomy, drainage of choledochotomy of the residual cavity and common bile duct. The presence of the biliary fistula was intraoperatively diagnosed in 4 (11,1%) patients after the fibrous capsule dissection of the hydatid cysts before treatment of the residual cavity with the perhydrol solution. The presence of the biliary fistula has not been revealed preoperatively in 25 (69,5%) patients according to US and CT data as well as laboratory tests before the surgery the presence of biliary fistula failed to detect. The presence of the internal fistula was detected only intraoperatively after treating the fibrous capsule with the perhydrol solution.
Postoperative complications were registered in 3 (8,3%) patients: bile leakage up to 80 ml per day in 1 (2,8%), pleural effusion in 1 (2,8%), postoperative wound abscess in 1 (2,8%) patient. All complications were eliminated conservatively. In long-term period the diseases relapse wasn’t revealed in any case.
Conclusions. The designed method of the fibrous capsule destruction of the hydatid cyst with perhydrol can be used to treat the residual cavity of hydatid cysts and for intraoperative diagnosis of the biliary fistula during echinococcectomy.

Keywords: hydatid cyst of the liver, biliary fistula, minimal access, minimally invasive echinococcectomy, destruction of the fibrous capsule with perhydrol
p. 615-620 of the original issue
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  16. Zhang JM, Yu SA, Shen W, Zheng ZD. Pathogenesis and treatment to postoperative bile leakage: report of 38 cases. Hepatobiliary Pancreat Dis Int. 2005 Aug;4(3):441–44.
  17. Krokhina NB, Orlov OG, Prudkov MI. Khirurgicheskoe lechenie prostykh kist pecheni [Surgical treatment of simple hepatic cysts]. Vestn Ural Med Akad. 2009;3(26):12–16.
Address for correspondence:
734003, Respublika Tadzhikistan,
g. Dushanbe, ul. Sanoi d. 33,
Respublikanskiy nauchnyiy tsentr
serdechno sosudistoy khirurgii,
endohirurgicheskot otdelenie
tel. mob.: 992-918-76-10-13,
e-mail: shuhrat.amonov@yandex.ru,
Amonov Shuhrat Shodievich
Information about the authors:
Amonov S.S. PhD, a surgeon of the endosurgical department of the Republican Scientific Center of Cardiovascular Surgery, Dushanbe.
Prudkov M.I. MD, professor, a head of the surgical diseases chair of the faculty of the advanced training and retraining of SBEE HPE “Ural State Medical University”, Yekaterinburg.
Kacadze M.A. MD of medical sciences, professor of the Republican Scientific Center of Cardiovascular Surgery, Dushanbe.
Orlov O.G. A surgeon of the 1st surgical department of SME “Sverdlovsk Regional Clinical Hospital ¹1”, Yekaterinburg.
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