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Khirurgii

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Year 2022 Vol. 30 No 5

SCIENTIFIC PUBLICATIONS

SUCHKOV S.G., ALEXANDROV D.A., NIKOLAEVTSEV V.A., SUCHKOV D.S., TOLSTOKOROV A.S. TOPCHIEV P.M., SKOROKHOD A.A.

THE ESTIMATION OF THE BLOOD SUPPLY AND VIABILITY OF BIOLOGICAL TISSUES USING A POTABLE CAPACITIVE SENSOR

Saratov State Medical University named after V.I. Razumovsky Ministry of Health of Russian Federation,
Saratov National Research State University named after N.G. Chernyshevsky,
Saratov, Russian Federation

Objective. The search for optimal time intervals for the use of a capacitive sensor and obtaining with its help universal normalized indicators of blood filling and tissue viability in the interests of disaster medicine and emergency surgery.
Methods. The fact of a significant difference in the dielectric permittivity of tissues not filled with blood and the dielectric permittivity of blood is used. Therefore, the level of blood filling of the tissue can be characterized by the value of the measured capacitance CT(t) of the electrode structure applied to the tissue. To study the effect of blood filling and the viability of biological tissues on the readings of a capacitive sensor, experiments were conducted on 20 male white laboratory rats weighing 200-250 g. In the first group of 10 animals, CT(t) indicators were examined on the thigh skin for 10 seconds with the results recorded every 5 seconds before the introduction of adrenaline and 5 minutes after its introduction. In the second group of 10 animals, CT(t) measurements were carried out on the thigh skin for 1 minute with the fixation of capacity values every 10 seconds to determine the universal normalized indicators of blood filling and viability of CN(t). The significance of the differences in paired measurements of absolute values of CT(t) was evaluated according to the Wilcoxon criterion. To determine the significance of the differences between the proposed normalized values of CN(t) in living and dead animals, the Student’s criterion was used.
Results. The device showed sufficient sensitivity to changes in blood filling of the skin in response to the introduction of adrenaline. The indicators of the capacitive sensor in live animals grow rapidly and statistically significantly within one minute of continuous measurement, unlike dead tissues, where the indicators do not change. It is established that the necessary and sufficient information is provided by the capacitance values at the tenth and twentieth seconds of measurement. The measurement results showed a significant variation in the absolute values of the sensor capacity in different animals, but a similar dynamics of the increase of these indicators under the same experimental conditions. These data made it possible to calculate universal normalized indicators for the practical use of a capacitive sensor.
Conclusion. The proposed compact autonomous capacitive sensor has prospects of application in emergency and vascular surgery for emergency assessment of blood filling and viability of tissues and organs of patients. Optimal time intervals and normalized indicators of performed measurements are established.

Keywords: biological tissue, blood supply, capacitive sensor, permittivity
p. 425-433 of the original issue
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Address for correspondence:
410012, Russian Federation,
Volga Federal District, Saratov Region, Saratov,
st. Bolshaya Kazachya 112,
Saratov State Medical University Named
after V.I. Razumovsky Ministry of Health of Russian Federation, Department of Surgery and Oncology,
tel. +7-987-823-06-09,
e-mail: denirov@bk.ru,
Aleksandrov Denis A.
Information about the authors:
Suchkov Sergei G., D (Phys & Math), Senior Researcher, Director of the Scientific and Technological Center «Micro- and Nanoelectronics» Saratov National Research State University named after N.G. Chernyshevsky, Saratov National Research State University, Saratov, Russian Federation.
http://orcid.org/0000-0001-9159-3515
Alexandrov Denis A., MD (Phys & Math), Professor, Professor of the Department of Surgery and Oncology, Saratov State Medical University named after V.I. Razumovsky Ministry of Health of Russian Federation, Saratov, Russian Federation.
http://orcid.org/0000-0001-5503-8354
Nikolaevtsev Victor A., PhD (Phys & Math), Associate Professor, Associate Professor of the Department of Micro- and Nanoelectronics on the basis of JSC «SPE «Contact», Leading Engineer of the STC «Micro- and Nanoelectronics» Saratov National Research State University named after N.G. Chernyshevsky, Saratov, Russian Federation.
http://orcid.org/0000-0002-1233-3983
Suchkov Dmitry S., PhD (Phys & Math), Deputy Director of the Research Institute of Mechanics and Physics, Saratov National Research State University named after N.G. Chernyshevsky, Saratov, Russian Federation.
http://orcid.org/0000-0003-4527-7874
Tolstokorov Alexander S., MD, Professor, Head of the Department of Surgery and Oncology, Saratov State Medical University Named after V.I. Razumovsky Ministry of Health of Russian Federation, Saratov, Russian Federation.
http://orcid.org/0000-0002-8541-5330
Topchiev Pavel M., Resident of the Department of Surgery and Oncology, Saratov State Medical University Named after V.I. Razumovsky Ministry of Health of Russian Federation, Saratov, Russian Federation.
http://orcid.org/0000-0002-7189-5396
Skorokhod Anatoly A., 3rd year Student of Saratov State Medical University Named after V.I. Razumovsky Ministry of Health of Russian Federation, Saratov, Russian Federation.
http://orcid.org/0000-0001-9071-6579

A.T. SHCHASTNY, A.S. OSOCHUK, A.F. MARTSINKEVICH, S.S. OSOCHUK

THE EFFECT OF TACROLIMUS ON THE DYNAMICS OF CHANGES IN THE PARAMETERS OF CELLULAR IMMUNITY IN THE EARLY STAGES AFTER KIDNEY TRANSPLANTATION

Vitebsk State Medical University, Vitebsk,
Republic of Belarus

Objective. To study the effect of tacrolimus on the dynamics of changes in some paramerters of cellular immunity after kidney transplantation in men and women.
Methods. The study included people (n=28) of both sexes (15 men and 13 women of the second period of adulthood (36-60 years – men and 36-55 years – women)) with kidney transplantation due to chronic renal failure. Venous blood was taken at admission (before surgery), after surgery (before the first appointment of tacrolimus), 24 hours and 7 days after kidney transplantation. For flow cytometer analysis, samples were processed in the first 4 hours after the collection.
Results. In women with chronic renal failure in the preoperative period, the number of dendritic cells is lower than in men. After kidney transplantation, a decrease of the number of myeloid and lymphoid dendritic cells, a decrease of the number of total T-lymphocytes due to T-helpers, and an increase of the number of natural killers have been revealed. The application of tacrolimus returned the number of total T-lymphocytes to preoperative values due to T-helpers and reduced the number of natural killers, increased the number of pre-B and B-lymphocytes.
Conclusion. The observed dynamic changes in cellular immunity parameters after kidney transplantation may be favorable for graft survival. However, the increase of the number of CD3 + CD4 + after the appointment of tacrolimus, as well as the increase of the content of CD19, requires further research to classify the identified effects as positive or negative.

Keywords: tacrolimus, kidney transplantation, dendritic cells, natural killers, T-lymphocytes, B-lymphocytes
p. 434-439 of the original issue
References
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Address for correspondence:
210009, Republic of Belarus,
Vitebsk, ave. Frunze, 27,
Vitebsk State Medical University,
Department of Hospital Surgery
with the Course of Advanced Training,
tel. +375-29-595-04-03,
e-mail: aos19950207@gmail.com,
Osochuk Alexander S.
Information about the authors:
Shchastny Anatoly Tadeushevich, MD, Professor, Rector of the Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0003-2796-4240
Osochuk Aleksandr Sergeevich, Post-Graduate Student of the Department of Hospital Surgery with the Course of Advanced Training, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-5942-3601
Martsinkevich Alexander Frantsevich, PhD, Associate Professor of the Department of General and Clinical Biochemistry with the Course of Advanced Training, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0003-3655-4489
Osochuk Sergey Stefanovich, MD, Professor, Head of the Research Laboratory of VSMU, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0003-2074-3832

GENERAL & SPECIAL SURGERY

D.S. SEMIN, V.P. ZEMLYANOY, B.V. SIGUA, E.G. TIMOFEEVA, A.I. ANDREEVA

DIFFERENTIATED ALGORITHM FOR THE CHOICE OF THE METHOD OF LOW-TRAUMATIC SURGERY FOR UMBILICAL HERNIAS

North-Western State Medical University Named after I.I. Mechnikov of the Ministry of Health of Russian Federation, St. Petersburg, Russian Federation

Objective. Optimization of the algorithm for choosing low-traumatic surgical treatment of patients with umbilical hernias.
Methods. From 2011 to 2018 214 patients with umbilical hernias were treated. The effectiveness of treatment was assessed by the recurrence criterion (found in 42 (19.6%) patients). When analyzing the results of treatment of patients in this group, the results were assessed using the GAIS scale. The patients (n=56 (26.2%)) aged 25 to 44 years were selected. The results obtained were assessed as unsatisfactory. This prompted the development and implementation in clinical practice of a differentiated algorithm for the choice of the method of minimally traumatic surgery for umbilical hernias. The main group consisted of 54 patients operated on according to the developed algorithm. Contraindications regarding the application of an endoprosthesis include: planned pregnancy and/or individual intolerance to synthetic materials. The essence of the algorithm is to select a suitable low-traumatic surgery and achieve a good cosmetic effect. To prevent the formation of deformities after surgical treatment in this area, it is recommended to perform operations through the upper intraumbilical approach. The final stage of the operation is to perform umbilicoplasty, reconstructing the normal anatomy of the navel by forming the superficial and three internal circular sutures with an absorbable atraumatic monofilament suture.
Results. Patients who underwent umbilicoplasty were assessed for the cosmetic effect according to the international GAIS scale. 12 patients with umbilical reconstruction were women, and the deformity was associated with the previous delivery. When evaluated on the GAIS scale, 83% (10) of the respondents were completely satisfied with the result, and in 2 (17%) observations it was noted that the patients were partially satisfied with the result. Long-term results were assessed in all cases. Patients were followed up for 6 to 12 months. No relapses were found.
Conclusion. A differentiated algorithm for the choice of the method of minimally traumatic surgery for umbilical hernias allows choosing an effective type of surgical intervention with the achievement of the maximum possible cosmetic effect.

Keywords: umbilical hernia, anterior abdominal wall, umbilical ring, surgical procedure
p. 440-446 of the original issue
References
  1. Zhebrovskii VV. Khirurgiia gryzh zhivota. Moscow, RF: Med inform agentstvo; 2005. 384 p.
  2. Grigorev GS, Krivoshchekov EP, Grigor’eva TS, Kostin AIu. Specificity of intra-abdominal endoprosthesis of umbilical and postoperative ventral hernias. Sarat Nauch-Med Zhurn. 2012;8(1):141-45. http://ssmj.ru/system/files/201201_141-145_.pdf
  3. Voskresenskii PV. Khirurgiia gryzh briushnoi stenki [Internet]. Moscow: Meditsina; 1965. 326 p. https://royallib.com/book/voskresenskiy_nikolay/hirurgiya_grig_bryushnoy_stenki
  4. Diaspro A, Cavallini M, Piersini P, Sito G. Gummy Smile Treatment: Proposal for a Novel Corrective Technique and a Review of the Literature. Aesthet Surg J. 2018 Nov 12;38(12):1330-38. doi: 10.1093/asj/sjy174
  5. Schwarz J, Reinpold W, Bittner R. Endoscopic mini/less open sublay technique (EMILOS)-a new technique for ventral hernia repair. Langenbecks Arch Surg. 2017 Feb;402(1):173-80. doi: 10.1007/s00423-016-1522-0
Address for correspondence:
195067, Russian Federation,
St. Petersburg, Piskarevsky prospect, 47,
Northwestern State
Medical University
Named after I.I. Mechnikov,
Department of Faculty
Surgery Named after I.I. Grekov
Tel.+7 921 748 08 58,
e-mail: cosmo@list.ru,
Semin Dmitry S.
Information about the authors:
Semin Dmitrii S., Surgeon of the Surgical Department No. 2, North-Western State Medical University Named after I.I. Mechnikov of the Ministry of Health of Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0002-5630-4914
Zemlyanoy Vyacheslav P., MD, Professor, Head of the Department of Faculty Surgery named after I.I. Grekov FGBOU VO North-Western State Medical University named after I.I. Mechnikov of the Ministry of Health of Russian Federation, Dean of the Faculty of Surgery Northwestern State Medical University named after I.I. Mechnikov of the Ministry of Health of Russian Federation, Honored Doctor of the Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0002-2329-0023
Sigua Badri V., MD, Head of the Center for Clinical Oncology, North-Western State Medical University I.I. Mechnikov Deputy Chief Physician for Oncology, Professor of the Department of Faculty Surgery named after I.I. Grekov FGBOU VO SZGMU named I.I. Mechnikov of the Ministry of Health of Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0002-4556-4913
Timofeeva Elena G., Clinical Resident, Department of Faculty Surgery named after I.I. Grekov, FGBOU VO North-Western State Medical University named after I.I. Mechnikov of the Ministry of Health of Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0003-4989-5362
Andreeva Arina I., Student of the Faculty of Medicine, North-Western State Medical University named after I.I. Mechnikov of the Ministry of Health of Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0003-4365-5210

M.D. LEVIN 1, 2, V. I. AVERIN 1, 3, Y. G. DEGTYAREV 1, 3, T.M. BOLBAS 1

METHOD FOR DETERMINING THE VOLUME OF THE RIGHT LUNG AND ITS ROLE IN THE DIAGNOSIS OF SOME LUNG DISEASES

Radiologist, Republican Scientific and Practical Center for Pediatric Surgery 1, Minsk,
Republic of Belarus,
State Geriatric Center (Dorot) 2, Netanya,
Israel,
Belarusian State Medical University 3, Minsk,
Republic of Belarus

Objectives. To improve the accuracy of diagnostics of diseases accompanied by changes in lung volume in children and adults.
Method. A horizontal line (isoline) through the lower edge of the 10th thoracic vertebra was draw. On the right, along the midclavicular line, we determine the height of the dome in centimeters. It is perpendicular, lowered (with a + sign), or erected (with a – sign) from the dome to the isoline. We also define the depth of the sinus as the distance from the intersection of the isoline with the right edge of the chest to the extreme point of the sinus. If this line is above the isoline, then it has a (+) sign if it is below - (-) was determined. The integral characteristic of the lung volume, i.e., the diaphragm index (ID) is the sum of the dome height and sinus depth in centimeters.
Results. In children of the control group, ID (3.04 ± 0.15) did not differ significantly from ID in adults (3.12 ± 0.07). With atelectasis of the lung or with hydrothorax, ID increased by more than 5 in 93% of patients. The ID was significantly lower in acute respiratory viral infection, aspiration, COPD, and asthma.
Conclusion. The proposed method is applicable in children, and in adult patients. It allows you to more accurately diagnose diseases accompanied by lung volume changes and assess the dynamics of the process. With ID 5 or more, the probability of atelectasis approaches 93%.

Keywords: atelectasis, aspiration, chronic obstructive pulmonary disease, lung volume, X-ray of the lungs
p. 447-452 of the original issue
References
  1. Goodman LR, ed. Felson’s Principles of Chest Roentgenology, A Programmed Text. Fifth ed. Philadelphia, United States; 2020.
  2. Levin MD. Method for determining lung volume and its role in the diagnosis of certain diseases in children. Zdravoochranenie Belorussii. 1988(11): 51-55. (In Russ.)
  3. Elsallabi O, Smer A, DeVrieze B, Sirineni G. Scimitar Syndrome. J Gen Intern Med. 2016 Feb;31(2):253-54. doi: 10.1007/s11606-015-3358-7
  4. Butler JP, Malhotra A, Loring SH. Revisiting atelectasis in lung units with low ventilation/perfusion ratios. J Appl Physiol (1985). 2019 Mar 1;126(3):782-86. doi: 10.1152/japplphysiol.00354.2018
Address for correspondence:
220116, Republic of Belarus,
Minsk, Dzerzhinsky Ave., 83,
Belarusian State Medical University,
Department of Pediatric Surgery,
tel. office: +375 017 290-49-23,
e-mail: averinvi@mail.ru
Averin Vasily Ivanovich
Information about the authors:
Levin Mikhail D., MD, Radiologist, State Geriatric Center (Dorot), Netanya, Israel.
https://orcid.org/0000-0001-7830-1944
Averin Vasily I., MD, Professor, Head of the Department of Pediatric Surgery, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-3343-8810
Degtyarev Yury G., MD, Professor of the Department of Pediatric Surgery, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-2696-4989
Bolbas Tamara M., Radiologist, Republican Scientific and Practical Center for Pediatric Surgery, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-5291-9356

P.S. ANDREEV, O.E. DAVYDOVA, S.E. KATORKIN, M.M. NIKOLAEV

COMPREHENSIVE TREATMENT OF PATIENTS WITH SEVERE FORMS OF ULCERATIVE COLITIS

Samara State Medical University, Ministry of Health of the Russian Federation

Objective. To improve the results of treatment of patients with ulcerative colitis (UC) by means of personalized antibacterial therapy selected on the basis of microbiological examination of biopsies of the colon mucosa.
Methods. The work is based on data from 80 patients who were diagnosed with a severe UC attack. In the main group of patients (n=40), complex treatment was supplemented with the appointment of antibacterial therapy, taking into account the sensitivity to it of microorganisms obtained from biopsies of the colon wall. In the control group of patients (n=40), conventional treatment has been prescribed. The immediate results of treatment in patients of the comparison groups were tracked for 30 and 90 days. Long-term results were analyzed after 6 and 12 months.
Results. After 2 weeks in all patients of the main group, the stool returned to normal, in patients of the comparison group, normalization of the stool was noted only 1 month after the start of treatment. In 24 (60 %) patients of the main group on the 7th day of treatment, the blood leukocyte level was within the normal range, whereas in the comparison group, this indicator normalized only in 4 (10 %) patients. Patients in the control group underwent surgical treatment 7,5% more often. In the control group, 6 (15 %) out of 7 operated patients had complications in the hospital.
In the main group, only 1 (2,5 %) patient had a relapse of the disease 6 months after the treatment, whereas in the control group the relapse occurred 4 times more often.
Conclusion. The use of personalized antibacterial therapy selected on the basis of the results of microbiological examination of biopsies of the colon mucosa improves the results of treatment of patients with severe forms of ulcerative colitis, allowing achieving rapid remission of the disease with an increase in its duration, and during surgical treatment of patients to reduce the number of perioperative complications.

Keywords: ulcerative colitis, microbiological examination, antibacterial therapy, colectomy
p. 453-461 of the original issue
References
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  4. Belousova EA, Abdulganieva DI, Alexeeva OP, Alexeenko SA, Baranovsky AYu, Valuyskikh EYu, Golovenko AO, Golovenko OV, Zhigalova TN, Knjazev OV, Kuljapin AV, Lahin AV, Livzan MA, Lubjanskaja TG, Nikolaeva NN, Nikitina NV, Nikulina IV, Osipenko MF, Pavlenko VV, Parfenov AI, Rogachikov JuE, Svetlova IO, Tkachev AV, Tkachenko EI, Halif IL, Chashkova EJu, Shhukina OB. Social and demographic characteristics, features of disease course and treatment options of inflammatory bowel disease in Russia: results of two multicenter studies. Almanac of Clinical Medicine. 2018; 46(5): 445-463. doi: 10.18786/2072-0505-2018-46-5-445-463. (In Russ.).
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  6. Alipour M, Zaidi D, Valcheva R. Mucosal Barrier Depletion and Loss of Bacterial Diversity are Primary Abnormalities in Paediatric Ulcerative Colitis. J. Crohns Colitis. 2016; Apr., Vol. 10(4):462–471. doi: 10.1093/ecco-jcc/jjv223.
  7. Karpukhin OYu, Khasanov ER, Bikbov BSh. Fecal microbiota transplantation in modern clinical practice. Practical medicine. 2017;6(107):7-12 (In Russ.).
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Address for correspondence:
443099, Russian Federation,
Samara, Chapaevskaya st. , 89,
Samara State Medical University,
Department of Hospital Surgery.
tel. +7 927 206-71-02,
e-mail: katorkinse@mail.ru
Katorkin Sergei E.
Information about the authors:
Andreev Pavel S., PhD, Associate Professor of the Department of Hospital Surgery, Head of the Coloproctological Department of the Hospital Surgery Clinic of the Samara State Medical University of the Ministry of Health of the Russian Federation.
http://orcid.org/0000-0002-0264-7305
Davydova Olga E., PhD, Coloproctologist, Clinic of Hospital Surgery, Assistant of the Department of Hospital Surgery, Samara State Medical University, Ministry of Health of the Russian Federation.
http://orcid.org/0000-0002-2403-1990
Katorkin Sergei E., MD., Professor, Head of the Department and Clinic of Hospital Surgery, Samara State Medical University of the Ministry of Health of the Russian Federation.
http://orcid.org/0000-0001-7473-6692
Nikolaev Mikhail M., Coloproctologist, Clinic of Hospital Surgery, Senior Laboratory Assistant, Department of Hospital Surgery, Samara State Medical University, Ministry of Health of the Russian Federation.
http://orcid.org/0000-0001-7438-5212

V.L. DENISENKO

COMPARATIVE EVALUATION OF THE IMMEDIATE RESULTS OF TREATMENT AND QUALITY OF LIFE OF PATIENTS AFTER VARIOUS TYPES OF SURGICAL INTERVENTIONS IN CHRONIC HEMORRHOIDS

Vitebsk State Medical University,
Vitebsk Regional Clinical Specialized Center, Vitebsk,
Republic of Belarus

Objective . To conduct a comparative quality of life assessment of patients after surgical treatment of chronic hemorrhoid in the early postoperative and rehabilitation periods.
Methods. The object of the study were patients (n=90) with chronic hemorrhoids (stage III-IV). The control group patients (n=30) underwent closed hemorrhoidectomy (standard technique). The second group (n=30) included patients underwent the effect vacuum ligator tool for the treatment of hemorrhoids by latex rings for internal hemorrhoids. (Manufacturer: Karl Storz (Germany). The third group (n=15) included patients who underwent desarterization of hemorrhoids, submucosal lifting and mucopexy. The operation was performed using the apparatus of the company A.M.I. (Austria) with a special nozzle RAR-2013 for performing mucopexy and mucosal lifting, as well as a modified Moricorn-RAR-2011 anoscope. Group 4 involved patients (n=15) who were underwent with the LigaSure device. Since the usage of the Ligasure technique results in significantly less immediate postoperative pain after hemoroidectomy, this technique is superior in terms of patient tolerance.
Results. The use of minimally invasive technique for the treatment of hemorrhoidal disease. Stage III-IV (latex ligation of hemorrhoids, Doppler-guided hemorrhoidal artery ligation, treatment of chronic hemorrhoids and the application of the LigaSure device) let minimizing excess opioid prescriptions in the postoperative period, diminishing postoperative morbidity, reducing the length of hospital stay and a short-term disability in order to return a patient back to the fullest life within the out-patient care.
Conclusion. In the first group of patients the average length of stay for a hospitalization was restored in 10.3±0.4 days (M±σ), in the second group - 1.8±0.3 days (M±σ), in the third one - 1, 3±0.3 days (M±σ), in the fourth group - 7.8±1.8 days (M±σ). The use of current techniques such as trans-anal disarterization of internal hemorrhoids under Doppler control with mucopexy and lifting, haemorrhoidectomy using a ligature device, latex ligation of hemorrhoids has significant advantages over classical methods (Milligan-Morgan hemorrhoidectomy).

Keywords: chronic hemorrhoids, surgical treatment of hemorrhoids, ligation of hemorrhoidal arteries using HAL-RAR technology, Ligasure device in the treatment of chronic hemorrhoids, latex ligation of hemorrhoids
p. 462-468 of the original issue
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Address for correspondence:
210001, Republic of Belarus,
Vitebsk, Nekrasov st., 10,
ME «Vitebsk Regional Clinical Specialized Center»,
tel. +375 212 33 22 47,
e-mail: vl_denisenko@mail.ru,
Denisenko Valery L.
Information about the authors:
Denisenko Valery Larionovich, MD, Associate Professor of the Department of General Surgery of Vitebsk State Medical University, Chief Physician of Vitebsk Regional Clinical Specialized Center, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0003-2394-340X

TRAUMATOLOGY AND ORTHOPEDICS

SH.M. MUMINOV, T.R. MINAEV, O.N. NIZOV, D.A. KHUDAYNAZAROV, A.B. KHàêIMOV, ZH.KH. DAVLATOV, KH.R. SUVONOV

EMERGENCY RECONSTRUCTIVE INTERVENTIONS FOR TRAUMATIC DEFECTS OF THE TENDONS OF THE UPPER LIMB

Republican Scientific Center for Emergency Medical Care, Tashkent City,
Republic of Uzbekistan

The article analyzes the experience of treating 15 patients with open concomitant injuries of the upper extremities with extensive defects of the flexor or extensor tendons over a considerable length, urgently reconstructed. In 11 (73.3%) patients, muscle-tendon transposition was performed, in 4 (26.7%) autotendinoplasty, with the use of the fascia lata of the thigh – in 3 (20%) and free fragments of waste tendons – in 1 (6.7 %). Skin defects in 10 (66.7%) cases were closed with local displaced flaps. A radial flap was used in 4 (25.7%) cases, and a pedicle flap from the anterior abdominal wall was used in 1 (6.7%) case. Intramedullary osteosynthesis was performed in 7 (46.7%) patients. In the next period, 2 (13.3%) cases of complications in the form of marginal skin necrosis of displaced flaps were noted, which did not require additional interventions. The main finding is that emergency repairs versus routine tendon repairs can shorten the period of disability by at least 3 months.

Keywords: traumatic tendon defect, muscle-tendon transposition, auto-tendon plasty
p. 469-474 of the original issue
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Address for correspondence:
100060, Tashkent, Republic of Uzbekistan,
Yakkasaray district, St. Yakkasarayskaya 2/5
e-mail mshm22@rambler.ru
Tel. +998911344524
Muminov Shukhrat Manapovich
Information about the authors:
Muminov Shukhrat M., MD, Professor , Head of Branch, Republican Scientific Center for Emergency Medical Care, Tashkent City, Republic of Uzbekistan.
https://orcid.org/0000-0001-5845-0432
Minaev Timur R., PhD, Intern, Republican Scientific Center for Emergency Medical Care, Tashkent, Republic of Uzbekistan.
https://orcid.org/0000-0002-7780-9305
Nizov Oleg N., PhD, Intern. Republican Scientific Center for Emergency Medical Care, Tashkent City, Republic of Uzbekistan.
https://orcid.org/0000-0002-5159-4326
Hudaynazarov Dilshod A., Intern, Republican Scientific Center for Emergency Medical Care, Tashkent City, Republic of Uzbekistan.
https://orcid.org/0000-0001-5675-5830
Khakimov Anvar B., Intern, Republican Scientific Center for Emergency Medical Care, Tashkent City, Republic of Uzbekistan.
https://orcid.org/0000-0003-4876-474X
Davlatov Jahongir K. Ugly, Intern, Republican Scientific Center for Emergency Medical Care, Tashkent City, Republic of Uzbekistan.
Suvanov Khusniddin R., Intern, Republican Scientific Center for Emergency Medical Care, Tashkent City, Republic of Uzbekistan.

REVIEWS

S.U. YAKUBOUSKI 1, H.H. KANDRATSENKA 1, V.A. LEMESH 2, V.N. KIPEN 2

NEOPLASMS OF THE THYROID GLAND: ROLE OF MOLECULAR MARKERS IN DIFFERENTIAL DIAGNOSIS AND MANAGEMENT

Belarusian State Medical University 1,
“Institute of Genetics and Cytology of the National Academy of Sciences of Belarus” 2,
Minsk, Republic of Belarus

Nodular goiter is a widespread pathology of the thyroid gland. Establishing the morphological nature of these nodular formations is based on a complex examination, including a fine-needle aspiration biopsy, being the final method of verification the diagnosis on the preoperative stage. However, up to 20-30% of fine-needle aspiration biopsy findings may be uncertain, which makes it difficult to choose an adequate treatment strategy. Studies conducted in recent decades have made it possible to get closer for understanding the genetic mechanisms of the occurrence and development of thyroid cancer. These data led to attempts to use molecular genetic testing for the differential diagnosis of thyroid nodules. The article presents an overview of the most common molecular genetic panels, describes the factors affecting their diagnostic efficiency. The indications and conditions for the use of molecular testing in clinical practice have been discussed.

Keywords: thyroid, thyroid nodule, thyroid cancer, molecular genetic testing, fine-needle aspiration biopsy
p. 475-486 of the original issue
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    • Address for correspondence:
    220116, Republic of Belarus,
    Minsk, Dzerzhinsky Ave., 83,
    Belarusian State Medical University,
    Department of Surgery and Transplantology,
    tel. office: +375 017 3400252,
    e-mail: yakub-2003@yandex.ru,
    Yakubouski Siarhei V.
    Information about the authors:
    Yakubouski Siarhei V., MD, PhD, Associate Professor of the 1st Department of Surgical Diseases of the Belarusian State Medical University, Minsk, Republic of Belarus.
    https://orcid.org/0000-0003-3759-7050
    Kondratenko Jennadij G., MD, Professor, Head of the 1st Department of Surgical Diseases of the Belarusian State Medical University, Minsk, Republic of Belarus.
    https://orcid.org/0000-0001-5295-1068
    Lemesh Valentina A., PhD., Associate Professor, Head of the Laboratory of Genetic and Cell Engineering of the State Scientific Institution “Institute of Genetics and Cytology of the National Academy of Sciences of Belarus”, Minsk, Republic of Belarus.
    https://orcid.org/0000-0003-1348-8642
    Kipen Viachaslau N., PhD., Leading Researcher of the Laboratory of Genetic and Cellular Engineering of the State Scientific Institution “Institute of Genetics and Cytology of the National Academy of Sciences of Belarus”, Minsk, Republic of Belarus
    https://orcid.org/0000-0002-7822-0746

    CASE REPORTS

    .N. BELYAEV 1, S.P. GRACHEV 2

    A CASE OF AORTO-ESOPHAGEAL FISTULA MASKED WITH MALLORY-WEISS SYNDROME

    National Research Mordovian State University named after N.P. Ogareva 1,
    Mordovian Republican Central Clinical Hospital 2, Saransk,
    Russian Federation

    A clinical case of aorto-esophageal fistula in a 55-year-old patient, who was repeatedly operated due to massive gastrointestinal bleeding with intra-operative finding of cardiac mucosal lacerations and massive thrombus has been described. The last episode of massive bleeding was complicated by severe hemorrhagic shock, intraoperative cardiac arrest and fatal outcome. Autopsy identified an aorto-esophageal fistula due to perforation of the esophagus by a fish bone. In this case, the typical anamnesis with intraoperative identification of cardiac esophageal mucosal ruptures did not arouse any doubt about the Mallory-Weiss syndrome diagnosis. However, the discrepancy between the severity of bleeding and detected small lacerations of esophageal and gastric mucosa, episodes of repeated massive bleeding, scarlet blood leakage from the cardiac area of the stomach and esophagus should be suggested a possibility of other source of bleeding. Fishbone and esophageal perforation were not detected during gastroesophageal endoscopy, most likely due to massive blood clots. Esophageal perforation with formation of aorto-esophageal fistula is extremely rare and is accompanied by high mortality due to profuse bleeding. The treatment of aorto-esophageal fistulas is very complex and there are no clear recommendations. In most cases, it requires interdisciplinary collaboration of cardiothoracic and general surgeons for hybrid procedures to repair esophageal and aortic lesions.

    Keywords: aorto-esophageal fistula, Mallory-Weiss syndrome, hemorrhage, fishbone
    p. 487-491 of the original issue
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    Address for correspondence:
    430013, Republic of Mordovia,
    Saransk, Pobeda st., 14/5, 1,
    Department of General Surgery
    named after Professor N.I. Atyasov,
    tel.: +79876933217,
    e-mail: belyaevan@mail.ru,
    Belyaev Alexander N.
    Information about the authors:
    Belyaev Alexandr N., MD, Professor, Head of the Department of Department of General Surgery named after Professor N.I. Atyasov National Research Mordovia State University.
    https://orcid.org/0000-0002-0698-3007
    Grachev Sergey P., PhD, Head of the Department of Clean Surgery, Mordovian Republican Central Clinical Hospital, Saransk, Russian Federation.
    https://orcid.org/0000-0002-2397-5885
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