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Khirurgii

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Year 2017 Vol. 25 No 6

EXPERIMENTAL SURGERY

O.V. FALKO, N.A. SHEVCHENKO, V.Y. PROKOPYUK, A.A. ROENKO, O.S. PROKOPYUK

COMPARATIVE ANALYSIS OF LIMBS’ TROPHIC ULCERS MODELING METHODS IN MICE

Institute for Problems of Cryobiology and Cryomedicine of NAS of Ukraine, Kharkov, Ukraine

Objective. To compare the existing methods of modeling an ulcerative defect as well as hemodynamics and innervation disorders, and then to develop the model of the lower limbs trophic ulcer in mice.
Methods. Trophic ulcers were simulated in male Balb/Ñ mice. Vascular insufficiency was formed by either ligation (group 1) or electrocoagulation (group 2) of the neurovascular bundle at the site of bifurcation of the common iliac and femoral arteries and veins. The ulcerative defect was formed by intradermal injection of 0.1 ml 10% calcium chloride (groups 3, 5 and 7) and 9% acetic acid (groups 4, 6 and 8). The animals of the groups 5 and 6 were electrocoagulated prior to administration of chemical agents and the animals of the groups 7 and 8 after it. The term of ulceration, ulcer area, period of complete healing and functional status of the limb were determined.
Results. Ligation (group 1) resulted in a mummification of limb tissues and electrocoagulation (group 2) led to a temporary disruption of function without forming ulcerous surface. Dry ulcer had been revealed in the animals of the groups 3 and 5 by the 10th day; the ulcer had been completely healed by the 20th day and the 30th day, respectively. A weeping ulcer was revealed in mice of the groups 4 and 8 to day 3; its healing had been observed by the 15th and the 35th, respectively. No ulcerative defects were observed in the animals of the groups 6 and 7, there was observed necrotic injury of skin and under laying structures. Impaired functional activity of the injured limb was found in all experimental groups. In the animals of the 1st and 7th groups the limb function did not recover up to the end of the experiment.
Conclusions. Intradermal administration of acetic acid and subsequent electrocoagulation of neurovascular bundle allow forming a long-lasting non-healing weeping ulcer and limb dysfunction, which were typical for trophic ulcers. Other studied techniques can be applied when simulating various diseases, related to vascular, nervous and skin damages.

Keywords: trophic ulcer, modeling, mice, electrocoagulation, ligation, acetic acid, calcium chloride
p. 561-566 of the original issue
References
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Address for correspondence:
61016, Ukraine,
Kharkov, Pereyaslavskaya str., 23,
Institute for Problems of Cryobiology
and Cryomedicine of NAS of Ukraine,
Department of Cryobiology
of the Reproduction Systems,
tel. office.: +38 057 373-59-53,
e-mail: o.v.falko@gmail.com,
Oksana V. Falko
Information about the authors:
Falko O.V., PhD, Researcher of the Department of Cryobiology of the Reproduction Systems for the Institute of Problems of Cryobiology and Cryomedicine of NAS of Ukraine.
Shevchenko N.A., PhD, Senior Researcher of the Department of Cryobiology of the Reproduction Systems of the Institute for Problems of Cryobiology and Cryomedicine of NAS of Ukraine.
Prokopyuk V.Y., PhD, Senior Researcher of the Department of Cryopathophysiology of the Institute for Problems of Cryobiology and Cryomedicine of NAS of Ukraine.
Roenko A.A., Post-Graduate Student of the Department of Cryobiology of the Reproduction Systems of the Institute for Problems of Cryobiology and Cryomedicine of NAS of Ukraine.
Prokopyuk O.S., MD, Professor, Head of the Department of Cryobiology of the Reproduction Systems of the Institute for Problems of Cryobiology and Cryomedicine of NAS of Ukraine.

GENERAL & SPECIAL SURGERY

A.T. SHCHASTNY

CHRONIC PANCREATITIS: CORRELATION BETWEEN PAIN SYNDROME INTENSITY AND PANCREAS NERVE TISSUE CHANGES

Vitebsk State Medical University, Vitebsk
The Republic of Belarus

Objective. To study interrelation between pain syndrome intensity and nerve tissue marker neurofilament (NF) expression in pancreas at chronic pancreatitis.
Methods. The research included 45 patients with chronic pancreatitis who needed surgical intervention because of abdominal pain that could not be stopped by medications. For assessment of a pain syndrome a visual analogue scale (VAS) was used. Involvement of nervous tissue was estimated by a NF expression in the serial histological sections of resected pancreas head stained with Anti-Neurofilament Monoclonal Antibody. Control group for morphological research included 7 pancreas head samples without any pancreas pathology from age comparable people died by accidents.
Results. In patients with chronic pancreatitis the pain syndrome intensity index, estimated by VAS, varied from 2 to 10 points. A «mild pain» (from 1 to 3 points) was noted by 4 (9%), «moderate pain» (4-6 points) – 17 (38%), «severe pain» (7-10 points) – 24 (53%) patients.
Statistical assessment of a pain syndrome intensity and NF expression showed a moderate linear relationship (r=0,3, p=0,04). The research of a pain syndrome intensity and positively NF-expressing nervous elements percent also showed a moderate correlation (r=0,33; p=0,03).
Conclusions. Chronic pancreatitis is associated with a different intensity pain syndrome (from 2 to 10 points). At the same time the intensity of the pain syndrome estimated by visual analogue scale (VAS) was associated with nervous tissue qualitative characteristics changes that was confirmed by high rates of NF expression and percent of NF- positively expressing nervous elements at the severe pain syndrome.

Keywords: chronic pancreatitis, immunohistochemistry, nerve tissue, neurofilament, abdominal pain, visual analog scale
p. 567-573 of the original issue
References
  1. Teo K, Johnson MH, Truter S, Pandanaboyana S, Windsor JA. Pain assessment in chronic pancreatitis: A comparative review of methods. Pancreatology. 2016 Nov-Dec;16(6):931-39. doi: 10.1016/j.pan.2016.09.006.
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  8. Michalski CW, Shi X, Reiser C, Fachinger P, Zimmermann A, Büchler MW, Di Sebastiano P, Friess H. Neurokinin-2 receptor levels correlate with intensity, frequency, and duration of pain in chronic pancreatitis. Ann Surg. 2007 Nov;246(5):786-93.
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  11. Hutter MM, Wick EC, Day AL, Maa J, Zerega EC, Richmond AC, Jordan TH, Grady EF, Mulvihill SJ, Bunnett NW, Kirkwood KS. Transient receptor potential vanilloid (TRPV-1) promotes neurogenic inflammation in the pancreas via activation of the neurokinin-1 receptor (NK-1R). Pancreas. 2005 Apr;30(3):260-65.
  12. Liddle RA. The role of Transient Receptor Potential Vanilloid 1 (TRPV1) channels in pancreatitis. Biochim Biophys Acta. 2007 Aug;1772(8):869-78.
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  14. Yuan A, Rao MV, Sasaki T, Chen Y, Kumar A, Veeranna, Liem RKH, Eyer J, Peterson AC, Julien JP, Nixon RA. &alfa;-internexin is structurally and functionally associated with the neurofilament triplet proteins in the mature CNS. J Neurosci. 2006;26(39). doi: 10.1523/JNEUROSCI.2580-06.2006.
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Address for correspondence:
210023, The Republic of Belarus,
Vitebsk, Frunze ave., 27,
EE “Vitebsk State Medical University”,
Department of Surgery
of the Faculty of Advanced Training and Retraining,
Tel.: +375 29 654-45-99,
E-mail: anatol1961@bk.ru,
Anatoliy T. Shchastny
Information about the authors:
Shchastny A.T., MD., Ass. Professor, Rector of Vitebsk State Medical University

V.N. NIKITIN 1.2, S.G. KLIPACH2

«DIFFICULT» STUMP IN COMPLICATED GIANT PENETRATING PYLORODUODENAL ULCERS

SBEE HPE “Omsk State Medical University” 1,
BME OR “City Emergency Clinical Hospital ¹2” 2, Omsk
The Russian Federation

Objective. To develop a method for treating «difficult» stump of the duodenum during surgery for a complicated giant penetrating pyloroduodenal ulcer.
Methods. The studied group consisted of 18 patients who underwent surgical treatment for the complicated pyloroduodenal giant ulcers. Ulcerations larger than 2.5 cm were referred to pyloroduodenal giant ulcers. One proposed the method of treating «difficult» duodenal stump, implying a longitudinal incision of the anterior wall of the duodenal bulb, affected by a circular ulcerative process. It allows determining the extent of ulcerative stenosis, making exterritorialy ulcer craters with the excision of the remnants of the duodenal bulb mucosa and using stenotically changed postbulbar part as a frame in the formation of the stump. Using a two-level continuous seam permits to evenly distribute the load across the seam and thus to increases the mechanical strength of the place of suturing.
Results. The average duration of the operation amounted to 136,6 minutes (95% CI:125,2; 152,0); duration of hospital treatment: from 7 to 26 days, with an average of 15.7 (95% CI:13,1; 18,2). The complications in the early postoperative period were: a wound infection – 2 (11,1%), pneumonia – 3 cases (16.7%), acute myocardial infarction – 1 (5.5 %), failure of the stump of duodenum in one case (5.5%). Postoperative mortality amounted to 16.7%: two patients – the cause was bilateral lower lobe necrotizing pneumonia (11.2%). The failure of the duodenal stump and abundant serous-fibrinous peritonitis, identified on the 6th day after the operation, occurred in one patient (5,5%). After 1 year 12 patients were examined: during endoscopy in one patient the ulcer of the posterior lip of the gastrojejunal anastomosis was revealed, superficial gastritis of the stump of the stomach was detected in 3 (25%), erosive gastritis of the stomach stump was identified in 1 (8.3%).
Conclusions. The conducted study has confirmed the efficacy of the proposed method of treating of the duodenum stump in therapy of patients with a complicated giant circular pyloroduodenal ulcer by minimizing the probability of the failure.

Keywords: pyloroduodenal ulcer, perforation, bleeding, penetration, stomach resection, the stump of the duodenum
p. 574-582 of the original issue
References
  1. Kubyshkin VA, Petrov DI, Smirnov AV. Metody endoskopicheskogo gemostaza v lechenii iazvennykh gastroduodenal’nykh krovotechenii [Methods of endoscopic hemostasis in the treatment of ulcerative gastroduodenal hemorrhages]. Khirurgiia Zhurn im NI Pirogova. 2013;(9):67-72.
  2. Barkun AN, Bardou M, Kuipers EJ, Sung J, Hunt RH, Martel M, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152(2):101-13. doi: 10.7326/0003-4819-152-2-201001190-00009.
  3. National Institute for Health and Clinical Excellence (NICE). Acute upper gastrointestinal bleeding: management. London, UK: National Institute for Health and Clinical Excellence (NICE); 2012 Jun. 23 p. (Clinical guideline; no. 141).
  4. Kim JJ, Sheibani S, Park S, Buxbaum J, Laine L. Causes of bleeding and outcomes in patients hospitalized with upper gastrointestinal bleeding. J Clin Gastroenterol. 2014 Feb;48(2):113-18. doi: 10.1097/MCG.0b013e318297fb40.
  5. Sazhin VP, Bronshtein PG, Zaitsev OV, Kondrus’ IV, Krivtsov GA, Lobankov VM, i dr. Natsional’nye klinicheskie rekomendatsii «Probodnaia iazva» [National Clinical Recommendations «Perforated Ulcer»] [Elektronnyi resurs]. 37 p. Rezhim dostupa: http://obshchestvo-khirurgov.rf/upload/perforated_ulcer.pdf.
  6. Søreide K, Thorsen K, Søreide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg. 2014 Jan;101(1):e51-64. doi: 10.1002/bjs.9368.
  7. Cienfuegos JA, Rotellar F, Valentí V, Arredondo J, Baixauli J, Pedano N, et al. Giant duodenal ulcer perforation: a case of innovative repair with an antrum gastric patch. Rev Esp Enferm Dig. 2012 Aug;104(8):436-39. [Article in Spanish]
  8. Krylov NN, Mukhammed MKh. Sushchestvuet li optimal’nyi variant gastroenteroanastomoza posle distal’noi subtotal’noi rezektsii zheludka [Is there an optimal option for gastroenteroanastomosis after distal subtotal resection of the stomach?] Khirurgiia Zhurn im NI Pirogova. 2012;(8):83-86.
  9. Nikitin NA, Korshunova TP, Onuchin MA, Goloviznin AA. Khirurgicheskoe lechenie sochetannykh oslozhnenii iazvennoi bolezni pri piloroduodenal’noi lokalizatsii iazvy [Surgical treatment of combined complications of peptic ulcer with pyloroduodenal ulcer localization]. Med Al’m. 2010;(1):121-25.
  10. Nobori C, Kimura K, Ohira G, Amano R, Yamazoe S, Tanaka H, et al. Giant duodenal ulcers after neurosurgery for brainstem tumors that required reoperation for gastric disconnection: a report of two cases. BMC Surg. 2016 Nov 17;16(1):75.
  11. Buck DL, Vester-Andersen M, Moller MH. Prompt Surgery Is Critical for Survival in Patients With Perforated Peptic Ulcer. Br J Surg. 2013;100:1045-49.
  12. Mukhopadhyay M, Banerjee C, Sarkar S, Roy D, Rahman1 QM. Comparative study between omentopexy and omental plugging for giant duodenal ulcer perforation. Indian J Surg. 2011 Oct; 73(5): 341–45. doi: 10.1007/s12262-011-0320-8.
  13. Vavrinchuk SA, Kosenko PM, Chernyshov DS. Sovremennye aspekty khirurgicheskogo lecheniia perforativnoi iazvy dvenadtsatiperstnoi kishki: monogr [Modern aspects of surgical treatment of perforated duodenal ulcer]. Khabarovsk, RF: IPKSZ; 2013. 241 p.
  14. Tsukanov IT, Nikitin VN, Nikolaichuk AI. Sposob formirovaniia kul’ti dvenadtsatiperstnoi kishki pri gigantskoi tsirkuliarnoi oslozhnennoi iazve [The method of forming the stump of the duodenum with a giant circular complicated ulcer]. Patent RF¹ 2460474. 10.09.2012.
  15. Thorsen K, Søreide JA, Kvaløy JT, Glomsaker T, Søreide K. Epidemiology of perforated peptic ulcer: Age- and gender-adjusted analysis of incidence and mortality. World J Gastroenterol. 2013 Jan 21;19(3):347-54. doi: 10.3748/wjg.v19.i3.347.
  16. Møller MH, Engebjerg MC, Adamsen S, Bendix J, Thomsen RW. The Peptic Ulcer Perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study. Acta Anaesthesiol Scand. 2012 May;56(5):655-62. doi: 10.1111/j.1399-6576.2011.02609.x.
Address for correspondence:
644043, Russian Federation,
Omsk, Lenin str., 12,
SBEE HPE “Omsk State Medical University”,
Department of Faculty Surgery
with the Course of Urology,
Tel: +7 3812 35-91-30,
E-mail: nikitin-1966@inbox.ru,
Vyacheslav N. Nikitin
Information about the authors:
Nikitin V.N., PhD, Associate Professor of the Department of Faculty Surgery with the Course of Urology of SBEE HPE “Omsk State Medical University”.
Klipach S.G., Head of Surgery Unit of BME OR “City Emergency Clinical Hospital ¹2”.

V.A. YANUSHKO ², N.A. ROGOVOY ¹, D.V. TURLIUK ², I.P. KLIMCHUK ¹, S.S. KALININ ¹

ENDOVENOUS LASER ABLATION OF GIACOMINI VEIN IN SURGICAL TREATMENT OF VARICOSE VEINS OF LOWER EXTREMITIES

4th N.E. Savchenko City Clinical Hospital ¹,
Republican Scientific and Practical Centre «Cardiology» ², Minsk,
The Republic of Belarus

Objective. To assess the efficacy of endovenous laser ablation (EVLA) in the complex treatment of varicose veins with paradoxical reflux in Giacomini vein.
Methods. In 2014-2016 we have operated 25 patients with paradoxical reflux in Giacomini vein. All EVLA procedures were guided by ultrasound (US). The average energy delivered was 60±6,2 J/cm and power of 10 watts. Men were 8(32%), women – 17(68%).
Results. Evaluation of the treatment results was conducted based on clinical data and US control. Pain during surgical intervention and in the first 5 days after the operation was assessed by visual analogue score. The change in the quality of life was assessed using the CIVIQ-2 questionnaire. Improvement of the quality of life in the postoperative period by 7.0 points was noted. Also, a decrease in the severity of the disease assessed by the VCSS questionnaire was found to be 3 points. Occlusion of the ablated veins was confirmed during surgery and on the follow-up examination at 1, 7 day and 1, 3, 6, 12 months after EVLA.
Conclusions. Ultrasound (US) guided EVLA of Giacomini vein is an effective and safe method of treatment of incompetent Giacomini varicose veins which provides high clinical and cosmetic results. Proposed method enables to operate with Giacomini vein only preserving great and small saphenous veins, which can be used further as prosthesis in arterial bypass grafting.

Keywords: varicose veins, endovenous laser ablation, Giacomini vein, saphenous vein, questionnaires, quality of life
p. 583-588 of the original issue
References
  1. Kirienko AI, Stoiko YM, Bogachev VY. Rossiiskie klinicheskie rekomendatsii po diagnostike i lecheniiu khronicheskikh zabolevanii ven [Russian clinical guidelines for diagnosis and treatment of chronic venous diseases]. Flebologiia. 2013;7(2 vyp 2):6-47.
  2. Giacomini, C. Osservazioni anatomiche per servire allo studio della circolazione venosa delle estremita inferiori (Parte I: Delle vene superficiali dell’arto addominale e principalmente della saphena esterna). Giornale della Reale Accademia di Medicina di Torino. 1873;14:109-15.
  3. Delis KT, Knaggs AL, Khodabakhsh P. Prevalence, anatomic patterns, valvular competence, and clinical significance of the Giacomini vein. J Vasc Surg. 2004 Dec;40(6):1174-83. doi: 10.1016/j.jvs.2004.09.019.
  4. Kosinski C. Observations on the superficial venous system of the lower extremity. J Anat. 1926 Jan;60(Pt 2):131-42.
  5. Theivacumar NS, Dellagrammaticas D, Mavor AI, Gough MJ. Endovenous laser ablation (EVLA) of great saphenous vein to abolish “paradoxical reflux” in the Giacomini vein: a short report. Eur J Vasc Endovasc Surg. 2007 Aug;34(2):229-31.
  6. Oğuzkurt L. Ultrasonographic anatomy of the lower extremity superficial veins. Diagn Interv Radiol. 2012 Jul-Aug;18(4):423-30. doi: 10.4261/1305-3825.DIR.5321-11.1.
  7. Park SW, Lee SA, Hwang JJ, Yun IJ, Kim JS, Chang SH, Chee HK, Chang IS. Early results of endovenous ablation with a 980-nm diode laser for an incompetent vein of Giacomini. Korean J Radiol. 2011 Jul-Aug; 12(4):481-86. Published online 2011 Jul 22. doi: 10.3348/kjr.2011.12.4.481.
  8. Georgiev M, Myers KA, Belcaro G. The thigh extension of the lesser saphenous vein: from Giacomini’s observations to ultrasound scan imaging. J Vasc Surg. 2003 Mar;37(3):558-63. doi: 10.1067/mva.2003.77.
  9. Riabinskaia OS, Osmanov RR. Klassifikatsiia gemodinamicheskikh variantov varikoznoi bolezni maloi podkozhnoi veny (na osnovanii dupleksnykh kharakteristik) [Classification of hemodynamic variants of varicose veins of the small saphenous vein (based on duplex characteristics).] Promeneva D³iagnostika Promeneva Terap³ia. 2011;(3-4):39-42.
  10. Bush RG, Hammond K. Treatment of incompetent vein of Giacomini (thigh extension branch). Ann Vasc Surg. 2007 Mar;21(2):245-48.
  11. Kulikova AN, Gafurova DR. Evoliutsiia khirurgicheskikh i endovazal’nykh metodov korrektsii stvolovogo venoznogo refliuksa u bol’nykh s varikoznoi bolezn’iu nizhnikh konechnostei [Evolution of surgical and endovasal methods of correction of stem venous reflux in patients with varicose disease of lower extremities]. Klin Meditsina. 2013;(7):13-18.
  12. van den BOS RR, de Maeseneer MMG. Endovenousthermal ablation for varicose veins: strengths and weaknesses. Phlebolymphology. 2012;19(4):164-65.
  13. Escribano JM, Juan J, Bofill R, Rodríguez-Mori A, Maeso J, Fuentes JM, Matas M. Haemodynamic strategy for treatment of diastolic anterograde giacomini varicose veins. Eur J Vasc Endovasc Surg. 2005 Jul;30(1):96-101. doi: 10.1016/j.ejvs.2005.03.001.
  14. Atasoy MM, Gümüş B, Caymaz I, Oğuzkurt L. Targeted endovenous treatment of Giacomini vein insufficiency-associated varicose disease: considering the reflux patterns. Diagn Interv Radiol. 2014 Nov;20(6):481-6. doi: 10.5152/dir.2014.14148.
  15. Guzelmansur I, Oguzkurt L, Koca N, Andic C, Gedikoglu M, Ozkan U. Endovenous laser ablation and sclerotherapy for incompetent vein of Giacomini. Phlebology. 2014 Sep;29(8):511-16. doi: 10.1177/0268355513496552.
Address for correspondence:
220036, The Republic of Belarus,
Minsk, Rosa Luxemburg str., 110,
4th N.E. Savchenko City Clinical Hospital,
Department of Vascular Surgery,
Tel.: +375 (17) 286-19-52,
+375 (29) 3852753,
E-mail: kolia_med@mail.ru,
Nikolay A. Rogovoy
Information about the authors:
Yanushko V.A., MD, Professor, Head of the Laboratory of Vessels Surgery of the Republican Scientific and Practical Centre «Cardiology».
Rogovoy N.A., Vascular Surgeon of the Department of Vascular Surgery of the 4th N.E. Savchenko City Clinical Hospital.
Turliuk D.V., PhD, Associate Professor, Leading Researcher of the Laboratory of Vessels Surgery of the Republican Scientific and Practical Centre «Cardiology».
Klimchuk I.P., PhD., Headof the Department of Vascular Surgery of the 4th N.E. Savchenko City Clinical Hospital.
Kalinin S.S, Head of the Department of Vascular Surgery of the 4th N.E. Savchenko City Clinical Hospital.

A.M. KUPCHENKO, V.A. KOSINETS

ETIOLOGICAL STRUCTURE OF DIFFUSE PERITONITIS AT VARIOUS LEVELS OF THE GASTROINTESTINAL TRACT DAMAGE

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

Objective. To determine the main causative agents of diffuse peritonitis at various levels of the gastrointestinal tract damage.
Methods. The aerobic and anaerobic microorganisms were identified in the peritoneal exudate of 144 patients with diffuse peritonitis using test systems «ENTER-ID» and «AN-ID»; their sensitivity to antibacterial drugs was determined with the test systems «AB-ENTER», «AB-GRAM(-)», «AB-PSEV», «AB-AN», designed in EE “Vitebsk State Medical University”. Depending on the level of the gastrointestinal tract damage, the following variants of the pathological process were identified: peritonitis as a complication of the stomach and duodenum diseases (1st level – 59 patients); as a complication of the small intestine diseases (2nd level – 23 patients); as a complication of the large intestine diseases (3rd level – 62 patients).
Results. In case of perforation localization on the 3rd level bacterial microflora was determined in all inoculations, on the 1st level the inoculations proved to be sterile in 27,1% of the cases, on the 2nd level – in 8,7%. On the 1st level E. ñoli (34,04%) and gram-positive aerobic microflora were identified in the peritoneal exudate, B. fragilis – only in 20,3%. On the 2nd level in the inoculations gram-negative aerobic microflora prevailed, mainly represented by E.ñoli (65,21%), anaerobic microflora reached 69,6%. In the inoculations on the 3rd level gram-negative aerobic microflora was more often determined: E.ñoli (55,36%) and Klebsiella spp. (16,07%), with the dominance of anaerobic component which reached 88,7%. Imipenem (91,3% sensitive microorganisms), amikacin (88,1%), ciprofloxacin (88,1%), meropenem (84,2%) had maximum antibacterial effect on aerobic component. Anaerobic non-clostridial microflora of the peritoneal exudate was most sensitive to meropenem (98,1%), imipenem (96,1%) and metronidazole (91,3%).
Conclusions. Administration of antimicrobial therapy in the treatment of patients with diffuse peritonitis should be carried out taking into account the level of the gastrointestinal tract damage. The obtained data will contribute to the creation of the modern efficient schemes of empiric antimicrobial therapy in the treatment of this disease.

Keywords: diffuse peritonitis, identification of microorganisms, test systems, gastrointestinal microbiome, sensitivity determination, anti-bacterial agents
p. 589-599 of the original issue
References
  1. Savel’ev VS, Gel’fand BR, red. Abdominal’naia khirurgicheskaia infektsiia: klinika, diagnostika, antimikrobnaia terapiia [Abdominal surgical infection: clinic, diagnosis, antimicrobial therapy: A practical guide]: prakt. rukov. Moscow, RF: Literra; 2006. 168 p.
  2. Chow AW, Evans GA, Nathens AB, Ball CG, Hansen G, Harding G, et al. Canadian practice guidelines for surgical intra-abdominal infections. Can J Infect Dis Med Microbiol. 2010 Spring; 21(1):11-37.
  3. Lopez N, Kobayashi L, Coimbra R. A Comprehensive review of abdominal infections. World J Emerg Surg. 2011 Feb 23;6:7. doi: 10.1186/1749-7922-6-7.
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  5. Timsit JF, Perner A, Bakker J, Bassetti M, Benoit D, Cecconi M, et al. Year in review in Intensive Care Medicine 2014: III. Severe infections, septic shock, healthcare-associated infections, highly resistant bacteria, invasive fungal infections, severe viral infections, Ebola virus disease and paediatrics. Intensive Care Med. 2015; 41(4): 575-88. doi: 10.1007/s00134-015-3755-8.
  6. Sartelli M. A focus on intra-abdominal infections. World J Emerg Surg. 2010 Mar 19;5:9. doi: 10.1186/1749-7922-5-9.
  7. Rybachkov VV, Kostiuchenko KV, Maevskii SV. Peritonit [Peritonitis]. Iaroslavl’, RF: IarMediaGrup; 2010. 308 p.
  8. Paul JS, Ridolfi TJ. A case study in intra-abdominal sepsis. Surg Clin North Am. 2012 Dec;92(6):1661-77. doi: 10.1016/j.suc.2012.08.014.
  9. Boiko VV, Krivoruchko IA, Teslenko SN, Sivozhelezov AV. Rasprostranennyi gnoinyi peritonit [Genreralized purulent peritonitis]. Khar’kiv, Ukraina: Prapor; 2008. 280 p.
  10. Sukovatykh BS, Blinkov IuIu, Frolova OG. Mekhanizmy razvitiia rasprostranennogo peritonita [Mechanisms of development of generalized peritonitis]. Vestnik Eksperim i Klin Khirurgii. 2012;5(2):469-77
  11. Brook I, Wexler HM, Goldstein EJ. Antianaerobic antimicrobials: spectrum and susceptibility testing. Clin Microbiol Rev. 2013 Jul;26(3):526-46. doi: 10.1128/CMR.00086-12.
  12. Kosinets VA. Identifikatsiia i opredelenie chuvstvitel’nosti k antimikrobnym preparatam osnovnykh vozbuditelei rasprostranennogo gnoinogo peritonita [Identification and determination of susceptibility to antimicrobial agents of the main pathogens of generalized purulent peritonitis]. Novosti Khirurgii. 2012;20(5):62-69.
  13. Chapter 2-5-4. Anaerobic infections (individual fields): intraperitoneal infections (acute peritonitis, hepatobiliary infections, etc.). J Infect Chemother. 2011 Jul;17(Suppl 1):84-91. doi: 10.1007/s10156-010-0146-5.
Address for correspondence:
210023, Republic of Belarus,
Vitebsk, Frunze ave., 27,
EE “Vitebsk State Medical University”,
Department of Operative Surgery
and Topographic Anatomy,
Tel. +375 33 675-48-62,
E-mail: anna.annushka75@mail.ru,
Anna M. Kupchenko
Information about the authors:
Kupchenko A.M., Senior Lecturer of the Department of Operative Surgery and Topographic Anatomy of EE “Vitebsk State Medical University”.
Kosinets V.A., MD, Professor, Professor of the Department of Hospital Surgery with Urology and Pediatric Surgery Courses of EE “Vitebsk State Medical University”.

M.Y. GAIN, S.V. SHAKHRAY, Y.M. GAIN

PILONIDAL SINUS: IS RADICAL OPERATION ALWAYS INDICATED?

SEE “Belarusian Medical Academy of Post-Graduate Education”, Minsk,
The Republic of Belarus

Objective. To study the treatment results of an acute inflammation of the sacrococcygeal region cyst in the distant period.
Methods. The study involved 481 patients suffering from an acute pilonidal sinus in which the abscess opening and draining was performed in 2007-2010. In the group A (250 patients) after the primary operation the second stage of treatment was applied including the radical operation to excise the cyst with the wound suturing by Donati. The group B includes 231 patients in whom the radical excision wasn’t performed. The groups were gender and age comparable. Follow-up was carried out in 2017 – in terms from 7 to 10 years after the primary operation.
Results. The recurrence rate after the radical excision (group A) was 10,8% (27 patients). 234 patients (93.6%) were subject to removal of postoperative sutures in terms up to 10 days. An average term of complete wound healing in the group A was 42 [28 - 57] (Me [25%-75%]) days. In the group B the abscess recurrence and repeated operation (abscess incision) was required in 74 patients (32.03%). In 157 (67.97%) cases, 7-10 years after the primary operation, absence of complaints (asymptomatic sinus, remission) was observed. While comparing two groups by general terms of disability for the period of 7-10 years, the significant advantages of the group B have been revealed: median of 12 days (group B) against 38 (in group A) (p=0.000319). Comparing two groups by the remote recurrence frequency has revealed the following data – 10.8% (group A) against 32.03% (group B) (p = 0.00164).
Conclusions. The research result testifies to the necessity for further discussion concerning a rational surgical tactics, choice of indications for radical excision.

Keywords: pilonidal sinus, sacrococcygeal region, abscess, drainage, wound healing, cysts
p. 600-604 of the original issue
References
  1. Datsenko BM. Ostroe nagnoenie epitelial’nogo kopchikovogo khoda [Acute suppuration of epithelial coccygeal]. Khar’kiv, Ukraina: Prapor; 2006. 165 p.
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  3. Gecim IE, Goktug UU, Celasin H. Endoscopic pilonidal sinus treatment combined with crystalized phenol application may preven trecurrence. Dis Colon Rectum. 2017 Apr;60(4):405-407. doi: 10.1097/DCR.0000000000000778.
  4. Dessily M, Charara F, Ralea S, AlléJ JL. Pilonidal sinus destruction with a radial laser probe: technique and first Belgian experience. Acta Chir Belg. 2017 Jan 6:1-8.doi: 10.1080/00015458.2016.1272285.
  5. Isik A, Idiz O, Firat D. Novel approachesin pilonidalsinus treatment. Prague Med Rep. 2016;117(4):145-52. doi: 10.14712/23362936.2016.15.
  6. Harris C, Sibbald RG, Mufti A, Somayaji R. Pilonidal Sinus Disease: 10 Steps to Optimize Care. Adv Skin Wound Care. 2016 Oct;29(10):469-78. doi: 10.1097/01.ASW.0000491324.29246.96.
  7. Iesalnieks I, Ommer A, Petersen S, Doll D, Herold A. German national guideline on the management of pilonidal disease. Langenbecks Arch Surg. 2016 Aug;401(5):599-609. doi: 10.1007/s00423-016-1463-7.
Address for correspondence:
220013, Republic of Belarus,
Minsk, P. Brovki str., 3, b.3,
SEE “Belarusian Medical Academy
of Post-Graduate Education”,
Department of Emergency Surgery;
Tel.: 375-17-225-88-10,
E-mail: mishahain@tut.by,
Michail Y. Gain
Information about the authors:
Gain M.Y., PhD, Senior Lecturer of the Department of Emergency Surgery of SEE “Belarusian Medical Academy of Post-Graduate Education”.
Shakhray S.V., MD, Professor of the Department of Emergency Surgery of SEE “Belarusian Medical Academy of Post-Graduate Education”.
Gain Y.M., MD, Professor, Vice-rector for scientific work of SEE “Belarusian Medical Academy of Post-Graduate Education”.

TRAUMATOLOGY & ORTHOPEDICS

Z.S. NAUMENKO, M.V. CHEPELEVA, N.V. GODOVYKH

CYTOKINES AND MICROBIOCENOSIS IN PREDICTING THE POSTOPERATIVE PERIOD COURSE IN PATIENTS WITH PERIPROSTHETIC INFECTION OF THE HIP JOINT AFTER REMOVAL OF THE INFECTED IMPLANT

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

Objective. To study microbiocenosis and the dynamics of the main cytokines in order to predict the postoperative period course after the hip joint implant removing in patients with the periprosthetic infection.
Methods. All the patients underwent debridement of the hip joint with the infected implant removal. The patients were retrospectively divided into two groups: group I included 29 patients with uncomplicated postoperative period course, group II – 20 patients with the infection recurrence in the immediate postoperative period due to hematoma infection in the residual cavity of the femoral medullary canal after the removal of the implant stem. Study of the concentrations of IL-1β, IL-6, IL-10, IL-8, TNF&alfa;, IFNγ was carried out by the enzyme-linked immunosorbent method before the surgery, on the 3, 7, 21, 30 days after surgery. Microbiocenosis was analyzed before the surgery, intraoperatively and postoperatively.
Results. It was found out, that the pathogens represented by monocultures (mainly Staphylococcus aureus, S. epidermidis) prevailed in Group I patients, and mixed infections prevailed in Group II patients. Microbiocenosis of Group II patients was characterized by the increase in the proportion of Gram-negative bacterii (Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanii) postoperatively.
Dynamically, there was a tendency for Group I cytokines to decrease, and for those in Group II – to increase. In Group I statistically significant differences were observed 30 days after surgery, comparing with the preoperative period, for IL-1β, IL-8, IL-10 the concentrations of which decreased. In Group II, IL-1β, IL-6, IL-10 significantly increased at this time. In Group I the complex dynamics of serum cytokines evidenced in favor of infection process stopping, in Group II – in favor of pyoinflammatory complications.
Conclusions. The changes in microbiocenosis structure as well as the comprehensive investigation of cytokine concentrations can be used as additional predictive criteria of infection recurrences in patients with periprosthetic infection after the hip joint implant removal.

Keywords: the hip joint, arthroplasty, periprosthetic infection, Staphylococcus aureus, cytokines, microbiocenosis, recurrence
p. 605-612 of the original issue
References
  1. Slobodskoi AB, Osintsev EI, Lezhnev AG, Voronin IV, Badak IS, Dunaev AG. Faktory riska razvitiia periproteznoi infektsii posle endoprotezirovaniia krupnykh sustavov [Risk factors for periprosthetic infection after endoprosthetics of large joints]. Vestn Travmatologii i Ortopedii im NN Priorova. 2015;(2):13-18.
  2. Darwiche H, Barsoum WK, Klika A, Krebs VE, Molloy R. Retrospective analysis of infection rate after early reoperation in total hip arthroplasty. Clin Orthop Relat Res. 2010 Sep;468(9):2392-96. doi: 10.1007/s11999-010-1325-5.
  3. Petrova NV. Diagnostika implant-assotsiirovannykh infektsii v ortopedii s pozitsii dokazatel’noi meditsiny [Diagnosis of implant-associated infections in orthopedics from the perspective of evidence-based medicine]. Khirurgiia Pozvonochnika. 2012;(1):74-83.
  4. Simbirtsev A.S., Gromova AI. Funktsional’nyi polimorfizm genov reguliatornykh molekul vospaleniia [Functional polymorphism of the genes of regulatory molecules of inflammation]. Tsitokiny i Vospalenie. 2005;4(1):3-10.
  5. Markelova EV, Kostiushko AV, Krasnikov VE. Patogeneticheskaia rol’ narushenii v sisteme tsitokinov pri infektsionno-vospalitel’nykh zabolevaniiakh [Pathogenetic role of disorders in the cytokine system in infectious and inflammatory diseases]. Tikhookean Med Zhurn. 2008;(3):24-29.
  6. Romanova IM, Gintsburg AL. Tsitokiny – vozmozhnye aktivatory rosta patogennykh bakterii [Cytokines are possible activators of growth of pathogenic bacteria]. Vestn RAMN. 2000;(1):13-17.
  7. Berbari E, Mabry T, Tsaras G, Spangehl M, Erwin PJ, Murad MH, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2010 Sep 1;92(11):2102-9. doi: 10.2106/JBJS.I.01199.
  8. Buttaro MA, Tanoira I, Comba F, Piccaluga F. Combining C-reactive protein and interleukin-6 may be useful to detect periprosthetic hip infection. Clin Orthop Relat Res. 2010 Dec;468(12):3263-67. doi: 10.1007/s11999-010-1451-0.
  9. Elgeidi A, Elganainy AE, Abou Elkhier N, Rakha S. Interleukin-6 and other inflammatory markers in diagnosis of periprosthetic joint infection. Int Orthop. 2014 Dec;38(12):2591-95. doi: 10.1007/s00264-014-2475-y.
  10. Jacovides CL, Parvizi J, Adeli B, Jung KA. Molecular markers for diagnosis of periprosthetic joint infection. J Arthroplasty. 2011 Sep;26(6 Suppl):99-103.e1. doi: 10.1016/j.arth.2011.03.025.
  11. Chepeleva MV, Kliushin NM, Ermakov AM, Ababkov IV. Interleikin-6 v prognozirovanii techeniia posleoperatsionnogo perioda u patsientov s periproteznoi infektsiei tazobedrennogo sustava [Interleykin-6 in predicting the course of the postoperative period in patients with periprosthetic hip infection]. Sib Nauch Med Zhurn. 2015;35(4):45-48.
  12. Shipitsyna IV, Osipova EV, Naumenko ZS. Issledovanie faktorov persistentsii: bioplenkoobrazuiushchei sposobnosti i antilizotsimnoi aktivnosti etiologicheskikh agentov khronicheskogo osteomielita [Investigation of persistence factors: biofilm-forming ability and antilizimic activity of etiological agents of chronic osteomyelitis]. Infektsii v Khirurgii. 2014;12(2):40-42.
  13. Liu B, Tikhilov RM, Shubniakov II, Bozhkova SA, Artiukh VA, Denisov AO. Analiz effektivnosti saniruiushchikh operatsii pri paraendoproteznoi infektsii [Analysis of the effectiveness of sanitizing operations with paraendoprosthetic infection]. Travmatologiia i Ortopediia Rossii. 2014;(2):22-29.
  14. Frangiamore SJ, Siqueira MB, Saleh A, Daly T, Higuera CA, Barsoum WK. Erratum to: Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation. Clin Orthop Relat Res. 2016 Jul; 474(7):1740-41. doi: 10.1007/s11999-016-4824-1.
  15. Frangiamore SJ, Saleh A, Grosso MJ, Farias KM, Zhang X, Daly TM, et al. Neer Award 2015: Analysis of cytokine profiles in the diagnosis of periprosthetic joint infections of the shoulder. J Shoulder Elbow Surg. 2017 Feb;26(Is 2):186-96. doi: 10.1016/j.jse.2016.07.017.
Address for correspondence:
640014, Russian Federation,
Kurgan, M. Ulyanova str., 6,
FSBE “Russian Ilizarov Scientific
Center “Restorative Traumatology
and Orthopaedics”,
Clinical Laboratory of Microbiology
and Immunology,
tel. office: +7 352 2 45-16-54,
e-mail: zinaida_n@inbox.ru,
Zinaida S. Naumenko
Information about the authors:
Naumenko Z.S., PhD, Head of the Scientific and Clinical Laboratory of Microbiology and Immunology of FSBE “Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”.
Chepeleva M.V., PhD, Senior Researcherof the Scientific and Clinical Laboratory of Microbiology and Immunology of FSBE “Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”.
Godovykh N.V., Junior Researcher of the Scientific and Clinical Laboratory of Microbiology and Immunology of FSBE “Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”.

ONCOLOGY

Y.B. RADZISHEVSKA 1,2, L.Y. VASIL’EV 1, V.G. KNIGAVKO 2, N.I. LYKHOVITSKAYA 1

RELATIONSHIPS OF NOSOLOGICAL FORM OF THE PRIMARY AND SECOND NEOPLASMS IN ONCOLOGICAL PATIENTS

SE “Institute of Medical Radiology named after S.P. Grigoriev”
of the National Academy of Medical Sciences of Ukraine 1,
Kharkov National Medical University 2, Kharkov,
Ukraine

Objective. To investigate the relationship between nosological forms of the primary and second neoplasms in patients who have undergone special treatment for cancer, and who have developed second neoplasms three and more years after the end of treatment.
Methods. The study has compared the nosological structure of second neoplasms that developed in 203 patients undergoing treatment for oncological pathology with the official data on the specific weight of 10 major nosological forms of malignant neoplasms in Ukraine. The statistical significance of the obtained results has been estimated using confidence intervals normalized taking into account the specificity of the patients of the clinic where the study was conducted.
Results. In accordance with the specific weight of the nosological forms of the primary neoplasms, conditioned first by the specialization of the clinic, the study groups were divided into 5 nosological subgroups: patients with breast, thyroid, uterine, cervical, ovarian, and subgroup with other forms of cancer. For each of the subgroups, the nosological structure of the second neoplasms was investigated and compared with the overall structure of malignant neoplasms according to the official statistics. It is shown that the frequencies of five allocated nosological forms calculated for the clinic correspond fairly well to the population mean, while for two most representative nosological forms the correspondence is within the expected stochastic variability. Thus, it has been demonstrated that there are no statistically significant differences between the percentage composition of 10 major nosological forms of cancer in Ukraine and the structure of nosological forms of second neoplasms in the study group of patients.
Conclusions. The nosological form of second neoplasms is not a consequence of the primary cancer, but reproduces the overall nosological structure of the incidence of malignant neoplasms.

Keywords: primary neoplasms, second neoplasms, incidence structure of malignant neoplasms, etiology of second cancers
p. 613-620 of the original issue
References
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  15. Abe H, Hanasawa K, Naitoh H, Endo Y, Tani T, Kushima R. Invasive ductal carcinoma within a fibroadenoma of the breast. Int J Clin Oncol. 2004 Aug;9(4):334-38.
  16. Schaapveld M, Aleman BM, van Eggermond AM, Janus CP, Krol AD, van der Maazen RW, et al. Second cancer risk up to 40 years after treatment for Hodgkin’s Lymphoma. N Engl J Med. 2015 Dec 24;373(26):2499-511. doi: 10.1056/NEJMoa1505949.
  17. Grantzau T, Mellemkjær L, Overgaard J. Second primary cancers after adjuvant radiotherapy in early breast cancer patients: a national population based study under the Danish Breast Cancer Cooperative Group (DBCG). Radiother Oncol. 2013 Jan;106(1):42-49. doi: 10.1016/j.radonc.2013.01.002.
Address for correspondence:
61024, Ukraine,
Kharkov, Pushkinskaya str., 82,
SE «Institute of Medical Radiology
named after S.P. Grigoriev»,
Medical Informatics Group,
tel. office: +380 (67) 799-36-63,
e-mail: radzishevska@ukr.net,
Evgeniya B. Radzishevska
Information about the authors:
Radzishevska E.B., PhD, Head of the Medical Informatics Group of SE “Institute of Medical Radiology named after S.P. Grigoriev “of the National Academy of Medical Sciences of Ukraine, Associate Professor of the Department of Medical and Biological Physics and Medical Informatics of Kharkov National Medical University.
Vasil’ev L.Y., PhD, Head Physician of SE “Institute of Medical Radiology named after S.P. Grigoriev “of the National Academy of Medical Sciences of Ukraine.
Knigavko V.G., Doctor of Biological Sciences, Professor, Head of the Department of Medical and Biological Physics and Medical Informatics of Kharkov National Medical University.
Lykhovitskaya N.I., PhD, Researcher of the Nuclear Medicine Department of SE “Institute of Medical Radiology named after S.P. Grigoriev “of the National Academy of Medical Sciences of Ukraine.

REVIEWS

D.A. MOROZOV 1, O.L. MOROZOVA 1, S.A. KLYUEV 2, I.A. BUDNIK 1, L.D. MALTSEVA 1, K.D. MOROZOV 1

INTRA-ABDOMINAL HYPERTENSION SYNDROME IN CHILDREN

FSAEI HE I.M. Sechenov First Moscow State Medical University MOH Russian Federation (Sechenov University) 1,
FSAE National Scientific Center of Children's Health of the Ministry of Health of Russia2, Moscow,
The Russian Federation

Intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS) are diagnosed in every third critically ill child and lethality in the syndrome of intra-abdominal hypertension (SIAH) is observed in more than half of children. The World Society of the Abdominal Compartment Syndrome (WSACS) consensus definitions and practical guidelines for diagnosis and management of IAH/ACS do not account for age-dependent anatomical and physiological characteristics of pediatric patients and are often ignored by health care professionals. Intra-abdominal pressure measurement is performed in less than half of critically ill patients. When applied in children, currently standard approach to diagnosis and treatment of IAH/ACS delivers unsatisfactory results. Timely abdominal decompression is mandatory for effective prevention of multiple organ failure and poor outcome. This article reviews the most common causes and risk factors, associated with intra-abdominal hypertension in children of different age groups; it discusses the pathophysiology of ACS, summarizes different techniques for intra-abdominal pressure measurement, overviews recent advances in assessment of target organ damage using instrumental and molecular diagnostic techniques, and highlights new treatment options in this patient population.

Keywords: intra-abdominal hypertension, abdominal compartment syndrome, multiple organ failure, congenital malformations, biomarkers of renal damage, monitoring, child
p. 621-631 of the original issue
References
  1. Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al.Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013 Jul;39(7):1190-206. doi: 10.1007/s00134-013-2906-z.
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Address for correspondence:
119991, Russian Federation,
Moscow, Trubetskaya str., 8,
FSAEI HE I.M. Sechenov First Moscow State Medical University Ministry of Healthcare Russian Federation (Sechenov University),
Department of Pathophysiology,
tel. office: 8 (499) 622 96 47,
e-mail: morozova_ol@list.ru,
Olga L. Morozova
Information about the authors:
Morozov D.A., MD, Professor, Head of the Department of Pediatric Surgery, Urology and Andrology of FSAEI HE I.M. Sechenov First Moscow State Medical University MOH Russian Federation (Sechenov University).
Morozova O.L., MD, Professor of the Department of Pathophysiology of FSAEI HE I.M. Sechenov First Moscow State Medical University MOH Russian Federation (Sechenov University).
Klyuev S.A., Pediatric Surgeon, Post-Graduate Student of FSAE National Scientific Center of Children’s Health of the Ministry of Health of Russia.
Budnik I.A., PhD, Associate Professor of the Department of Pathophysiology of FSAEI HE I.M. Sechenov First Moscow State Medical University MOH Russian Federation (Sechenov University).
Maltseva L.D., PhD, Associate Professor of the Department of Pathophysiology of FSAEI HE I.M. Sechenov First Moscow State Medical University MOH Russian Federation (Sechenov University).
Morozov Ê.D., Student of FSAEI HE I.M. Sechenov First Moscow State Medical University MOH Russian Federation (Sechenov University).

V.N. ZASIMOVICH, N.N. IOSKEVICH

REPERFUSION (REOXYGENATION) INJURY AS A PROBLEM OF THE ARTERY RECONSTRUCTIVE SURGERY IN ATHEROSCLEROTIC GENESIS CHRONIC ISCHEMIA OF THE LOWER LIMBS

ME “Brest Regional Hospital”1, Brest
EE “Grodno State Medical University”2, Grodno
The Republic of Belarus

Objective. To perform the analysis of literature sources dedicated to the problem of reperfusion (reoxygenation) injury after revascularization of the lower limbs.
Methods. The native and foreign literature data have been analyzed concerning the investigation stages of the problem, pathogenesis, clinical manifestations of reperfusion (reoxygenation) injury and methods of its prediction, prevention and correction for recent 20 years.
Results. The steady increase in atherosclerosis incidence, quantitative rise of lower limbs revascularization determines an increase in the frequency of reperfusion injury, significantly reducing the effectiveness of surgical interventions, impeding the restoration of function and, often, and preservation of the limb. Post-reperfusion injuries of the organs and systems remote from the lower limbs result in an evident life quality decline and lethality increase. The generalization of data on the studies of various links in the pathogenesis of ischemia-reperfusion and the methods of its correction indicate their fragmentation. The relationship between the severity of reperfusion injuries and the initial degree of the limb ischemia has not been adequately investigated.
Conclusions. Necessity in improvement of the surgical treatment results of chronic lower limb ischemia requires systemic researches on the correlation of disturbances of prooxidant-antioxidant balance, oxygen transport function, electrolyte and energy balance, depending on the degree of ischemia. This will allow developing the criteria for the severity of reperfusion (reoxygenation) injury, algorithms of its prediction, diagnosis, and correction. There is an urgent need to create a practically meaningful classification of ischemia-reperfusion, to determine the laboratory criteria for the degree of its severity, and to develop schemes for its medicinal prevention and treatment.

Keywords: reperfusion injury, revascularization, peripheral artery disease, atherosclerosis, prooxidant-antioxidant balance, oxygen transport function
p. 632-642 of the original issue
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Address for correspondence:
224027, Republic of Belarus,
Brest, Meditsinskaya str., 7,
ME "Brest Regional Hospital",
Vascular Surgery Unit,
Tel.office: +375 162 27-23-64,
E-mail: zasimovich.v@gmail.com,
Vladimir N. Zasimovich
Information about the authors:
Zasimovich V.N., Head of the Vascular Surgery Unit of ME “Brest Regional Hospital”.
Ioskevich N.N., MD, Professor of the Department of Surgical Diseases ¹1 of EE “Grodno State Medical University”.

R.E. KALININ, I.A. SUCHKOV, N.D. MZHAVANADZE, E.A. KLIMENTOVA, S.A. ISAKOV, A.N. RYABKOV, R.M. VORONIN

IMPACT OF INTRINSIC COAGULATION PATHWAY FACTORS ACTIVITY AND HEMOSTATIC MARKERS OF ENDOTHELIAL DYSFUNCTION ON THROMBOTIC COMPLICATIONS IN PATIENTS WITH ATHEROSCLEROTIC PERIPHERAL ARTERIAL DISEASE

FSBEE HE “Ryazan State Medical University named after Academician I.P. Pavlov”, Ryazan
The Russian Federation

Modern vascular surgery has various options for performing open and percutaneous endovascular interventions aimed to treat patients with peripheral arterial disease. One of the most common complications of surgical interventions is thrombosis. According to different authors’ data, postoperative thrombosis develops in 60-90% of cases, especially when performing distal reconstructions. The coagulating blood system plays the main role in the development of thrombotic complications. The effect of the extrinsic pathway of the coagulation cascade on the process of thrombus formation in patients with peripheral atherosclerosis is widely covered and investigated, which facilitated the introduction of a variety of antithrombotic drugs. The intrinsic pathway has always been considered less important. Nowadays, the internal pathway is of considerable interest from the point of view of the development of thromboses and the pathogenesis of inflammatory processes. With a high level of XI, IX factors, the risk of thrombotic complications increases, their newest inhibitors have been developed. XII and VIII factors are not well understood. No less important role in the development of thrombosis belongs to haemostatic markers of endothelial dysfunction, such as von Willebrand factor (WF), plasminogenactivator inhibitor-1 (PAI-1), protein C (PRC) and its endothelial receptor. Changes in hemostatic markers of the endothelial dysfunction in the postoperative period, such as an increased PV and PAI-1 and deficiency of PRC, play a significant role in the development of thrombotic complications and may determine the patency of vascular reconstructions. Further study in this direction permits to establish the predictors of thrombotic complications and to develop algorithms for optimal antithrombotic therapy.

Keywords: atherosclerosis, intrinsic coagulation pathway, hemostatic markers of endothelial dysfunction, thrombotic complications, antithrombotic therapy
p. 643-654 of the original issue
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Address for correspondence:
390026, Russian Federation,
Ryazan, Vyisokovoltnaya str., 9,
FSBEE HE “Ryazan State Medical University
named after Academician I.P. Pavlov”
Department of Cardiovascular,
X-ray Endovascular, Operative Surgery
and Topographic Anatomy,
tel.: +7 4912 46-08-03,
e-mail: Suchkov_med@mail.ru
Igor A. Suchkov
Information about the authors:
Kalinin R.E., MD, Professor, Rector, Head of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Topographic Anatomy of FSBEE HE “Ryazan State Medical University named after Academician I.P. Pavlov”.
Suchkov I.A., MD, Associate Professor, Vice-rector for research and innovative development, Professor of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Topographic Anatomy of FSBEE HE “Ryazan State Medical University named after Academician I.P. Pavlov”.
Mzhavanadze N.D., PhD, Assistant of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Topographic Anatomy of FSBEE HE “Ryazan State Medical University named after Academician I.P. Pavlov”.
Klimentova E.A., Post-Graduate of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Topographic Anatomy of FSBEE HE “Ryazan State Medical University named after Academician I.P. Pavlov”.
Isakov S.A., MD, Professor of the Department of Dermato-Venerology of FSBEE HE “Ryazan State Medical University named after Academician I.P. Pavlov”.
Ryabkov A.N., MD, Associate Professor of the Department of Pharmacology with the Course of Pharmacy of FSBEE HE “Ryazan State Medical University named after Academician I.P. Pavlov”.
Voronin R.M., MD, Professor of the Department of Mobilization Training of Public Health and Disaster Medicine of FSBEE HE “Ryazan State Medical University named after Academician I.P. Pavlov”.

CASE REPORTS

V. SIHOTSKÝ 1,2, P. BEREK 1,2, I. KOPOLOVETS 1,4, M. KUBÍKOVÁ 1,2, M. TOMEČKO 1, M. STANČÁKOVÁ 2,3, I. DRAHOVSKÁ 2,3, M. FRANKOVIČOVÁ 1,2

AORTOBIFEMORAL GRAFT INFECTION: POSSIBILITIES OF TREATMENT

Clinic of Vascular Surgery VÚSCH a.s. 1,
Faculty of Medicine PJ Šafárik 2,
University Hospital of L. Pasteur 3, Košice,
Slovakia
DSME “Uzhgorod National University” 4, Uzhgorod,
Ukraine

Authors describe two case reports of patients with infected aortobifemoral graft. Both were treated by total graft excision. In the first case they decided for extra anatomical revascularization of lower extremities after total graft excision, because of virulent infection (Staphylococcus aureus and G+ bacteries) and graft enteral fistula. They performed axilobifemoral bypass grafting. In the second case, where infection was not so virulent (Staphylococcus epidermidis) they decided for in situ reconstruction with desobliterated native aorta, iliac arteries and femoral vein. Both patients are now without signs of infection and they can walk without claudication pain. Graft infection is one of the most serious complications of aortobifemoral bypass surgery therefore the prevention of infection is very important. It is important to keep all rules of asepsis and antisepsis during surgery. Treatment of graft infection is based on intravenously administered antibiotics and excision of infected graft. Limb revascularization after graft removal can be provided by extra anatomical bypass or in situ arterial reconstruction.

Keywords: infection, aortobifemoralgraft, revascularization, extra anatomical bypass
p. 655-661 of the original issue
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Address for correspondence:
88000, Ukraine, Uzhgorod,
Universitetskaya st., 10,
Uzhgorod National University
Tel.: +380 50 558 82 11
E-mail: i.kopolovets@gmail.com
Ivan I. Kopolovets
Information about the authors:
Sihotský V., PhD, Vascular Surgeon, Clinic of Vascular Surgery, East Slovakian Cardiovascular Institute and P.J. Šafýrik´s University, Košice, Slovakia. Deputy of the Head of the Department for Pedagogics.
Berek P., PhD, Vascular Surgeon, Deputy of the Head of the Department for Treatment Clinic of Vascular Surgery, East Slovakian Cardiovascular Institute and P.J. Šafýrik´s University, Košice, Slovakia.
Kopolovets I., PhD, Researcher of DSME "Uzhgorod National University", Uzhgorod, Ukraine. Vascular surgeon, Clinic of Vascular Surgery, East Slovakian Cardiovascular Institute, Košice, Slovakia.
Kubikový M., PhD, Vascular Surgeon, Clinic of Vascular Surgery, East Slovakian Cardiovascular Institute and P.J. Šafýrik´s University, Košice, Slovakia.
Tomečko M., PhD, Vascular Surgeon, Clinic of Vascular Surgery, East Slovakian Cardiovascular Institute and P.J. Šafýrik´s University, Košice, Slovakia.
Stančýkový M., General Surgeon, I. Surgical Clinic, University Hospital of J. Pasteur and P.J. Šafýrik´s University, Košice, Slovakia.
Drahovský I., PhD, Head of the Department, I. Clinic of Radiodiagnosics and Imagine Techniques, University Hospital of J. Pasteur and P.J. Šafýrik´s University, Košice, Slovakia
Frankovičový Ì., PhD, Professor, Head of the Department, Clinic of Vascular Surgery, East Slovakian Cardiovascular Institute and P.J. Šafýrik´s University, Košice, Slovakia.

EXCHANGE OF EXPERIENCE

O.I. OKHOTNIKOV, M.V. YAKOVLEVA, S.N. GRIGORIEV

PERCUTANEOUS TRANSHEPATIC EXTRACTION OF ENDOBILIARY FOREIGN BODIES

BME “Kursk Regional Clinical Hospital” 1,
FSBEE HE “Kursk State Medical University” 2, Kursk
The Russian Federation

Objective. To present the own experience of removing foreign bodies from the biliary tree while performing mini-invasive antegrade endobiliary interventions.
Methods. We observed 11 patients with endobiliary foreign bodies (fragments of a 0.035 «metal conductor, 5 Fr manipulation catheter, 10 Fr endobiliary drainage, 9 mm self-expanding stent, incorrectly installed self-expanding 10 mm stent, blocked uncoated self-expanding stent 8 mm), that were caught in the bile ducts during the antegrade transhepatic mini-invasive X-ray surgical interventions. Foreign bodies entered the biliary ducts directly during transhepatic cholangiostomy, as well as during manipulations performed after the initial drainage (drainage replacement, endobiliary stenting).
Foreign bodies were removed by antegrade access. Manipulations were carried out through the lumen of the vascular introducer 6-10Fr, established instead of the cholangiostomical drainage. Percutaneous transhepatic access with a diameter of 28 Fr was used to extract self-expanding stents; in one case a retrograde endoscopic access was used.
Results. Antegrade transhepatic access successfully removed 10 of 11 foreign bodies. Fragments of conductors and manipulative catheters were extracted with endoscopic forceps and an endoscopic basket through the lumen of the commensurate introducer. The drainage fragment was removed by antegrade asses by endoscopic forceps after fixing it to the end face of the introducer 10 Fr. An incorrectly installed self-expanding stent, as well as 2 irreversibly blocked stents, were removed by antegrade transhepatic access under visual control after telescopic dilatation of the puncture canal into the gall-tree to 28 Fr. One fragmented, self-expanding, covered stent was removed endoscopically. There were no complications related to the creation of access for the extraction of foreign bodies, as well as to the technique of their extraction.
Conclusions. Minimally invasive percutaneous transhepatic access seems to be an alternative to open surgical access to the gall-tree in case of extracting of large foreign bodies, in particular - irreversibly blocked endobiliary stents.

Keywords: biliary tract, foreign bodies, antegradecholangiostomy, endobiliary stent, endobiliary interventions
p. 662-668 of the original issue
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  13. Zurera LJ, Canis M, Espejo JJ, García-Revillo J, Delgado F, Benito A. Practical aspects in the percutaneous extraction of foreign bodies using a Goose-Neck Snar. Radiologia. 2007 Jul-Aug;49(4):247-54. [Article in Spanish]
  14. Okhotnikov OI, Grigor’ev SN, Iakovleva MV. Opyt 100 uspeshnykh antegradnykh transpechenochnykh kontaktnykh kholedokholitotripsii v lechenii endoskopicheski trudnogo kholedokholitiaza [Experience of 100 successful antegrade transhepatic contact choledocholithotripsies in the treatment of endoscopically difficult choledocholithiasis]. Diagnost i Intervents Radiologiia. 2011;5(1):67-72.
Address for correspondence:
305007, Russian Federation,
Kursk, Sumskaya str., 45-a,
BME “Kursk Regional Clinical Hospital”,
Unit of X-ray Surgical Methods
of Diagnosis and Treatment ¹2,
tel.: +7 4712 35-93-30
e-mail: oleg_okhotnikov@ mail.ru,
Oleg I. Okhotnikov
Information about the authors:
Okhotnikov O.I., MD, Professor, Head of the Unit of X-ray Surgical Methods of Diagnosis and Treatment ¹2 of BME “Kursk Regional Clinical Hospital”, Professor of the Department of Radiation Diagnostics and Therapy of FSBEE HE “Kursk State Medical University».
Yakovleva M.V., PhD, Associate Professor of the Department of Surgical Diseases of FSBEE HE “Kursk State Medical University», Physician of the Unit of X-ray Surgical Methods of Diagnosis and Treatment ¹2 of BME “Kursk Regional Clinical Hospital”.
Grigoriev S.N., PhD, Head of the Unit of Purulent Surgery, Physician of the Unit of X-ray Surgical Methods of Diagnosis and Treatment ¹2 of BME “Kursk Regional Clinical Hospital”.
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