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Year 2020 Vol. 28 No 6

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

V.Â. MAKAROV 1, N.V. DEDUKH 2, O.À. NIKOLCHENKO 3, V.YE. STREL’NITSKIJ 4, V.V. VASILYEV 4

OSSEOINTEGRATION OF IMPLANTS WITH A DIAMOND-LIKE CARBON COATING IN THE EXPERIMENT

City Clinical Hospital No16 1, Dnepr, Ukraine
D.F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine2, Kiev, Ukraine
M.I. Sitenko Institute of Spine and Joint Pathologyof theNationalAcademy of Medical Sciences of Ukraine3, Kharkiv, Ukraine
Kharkov Institute of Physics andTechnology4, Kharkiv,
Ukraine

Objective. To study in vitro the integration of the metal stainless steel implants with diamond-like carbon (DLC) coating within living bone of rats.
Methods. The experiment was carried out on albino male rats (n=48; 6 months of age). The steel implants and steel implants with DLC-coating were implanted in the metaphyseal defects of the femur (diameter 2 mm and depth 3 mm)) of the animals in the control and experimental groups (n=24 per group). DLC film was deposited using a filtered vacuum arc plasma flows to the steel implant surface. The coating material was free of metal and hydrogen impurities. The nanohardness of the coating deposited on the sample was from 30 to 40 GPa. The thickness of DLC coating was at least 1 μm. Euthanasia of rats was performed on the 7th, 14th, 30th, and 90th days after surgery by administering a lethal dose of sodium thiopental (90 mg/kg intramuscularly). Bone remodeling around implants was investigated histologically with morphometric assessment of osseointegration (percentage of bone-implant contact).
Results. Diamond-like carbon coating on the surface of steel implants has high adhesive qualities, as evidenced by the attachment of cells to the surface within 7 days after implantation and the formation of bone tissue around them in 14 days.
The formation of a connective tissue with the areas of bone tissue around the steel implants was registered. It was found that for the entire period of the study the osseointegration percentage around the implants made of steel with DLC coating was higher compared to the uncoated implants: by 14 days – 2.6 folds, by 30 days – 2.1 folds, by 90 days – 1.5 folds.
Conclusion. Diamond-like carbon coatings on steel implants are a promising material for use in orthopedics and traumatology due to biocompatibility, osseointegration and the absence of negative remodeling of adjacent bone tissue.

Keywords: diamond-like carbon coating (DLC), bone, osseointegration, light microscopy
p. 617-624 of the original issue
References
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Address for correspondence:
49000, Ukraine, Dnepr,
Bohdan Khmelnytsky Ave, 19,
City Clinical Hospital No16,
the Combined Trauma Unit,
tel. +3 8099 773-78-38,
e-mail: vasylmakarov2010@gmail.com,
Makarov Vasyl Â.
Information about the authors:
Makarov Vasyl Â., PhD, Orthopedic Surgeon, the Combined Trauma Unit, City Clinical Hospital No16, Dnepr, Ukraine.
https://orcid.org/0000-0003-0936-7039
Dedukh Ninel V., DSBiol, Professor, the Department of Clinical Physiology and Pathology of the Musculoskeletal System, D.F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.
https://orcid.org/0000-0003-0307-2328
Nikolchenko Olga À., PhD, Senior Researcher, the Department of the Transplantology and Experimental Modeling with an Experimental Biological Clinic, M.I. Sitenko Institute of Spine and Joint Pathologyof the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine.
https://orcid.org/0000-0001-9808-9485
Strel’nitskij Vladimir Ye., DScPhysic.-Math., Head of the Laboratory of Superhard Amorphous Diamond-Like and Polycrystalline Diamond Coatings, Kharkiv Institute of Physics and Technology, Kharkiv, Ukraine.
https://orcid.org/0000-0001-6047-6981
Vasilyev Vladimir V., PhDTech Sciences, Senior Researcher of the Laboratory of Superhard Amorphous Diamond-Like and Polycrystalline Diamond Coatings, Kharkiv Institute of Physics and Technology, Kharkiv, Ukraine.
https://orcid.org/0000-0002-5705-606X

GENERAL & SPECIAL SURGERY

SH.M. ALIEV 1, L.A. NAZIROVA 1, SH.A. ISLAMBEKOVA 1, G.L. PAHOMOV 2

PREDICTING THE RISK OF COMPLICATIONS DEVELOPMENT DURING SURGICAL CORRECTION OF SEPTIC ENDOCARDITIS

Republican Specialized Center of Surgery named after academician V. Vakhidov

Objective. To identify the risk factors for the development of acute renal failure in patients with septic endocarditis.
Methods. A single-center prospective non-randomized and retrospective study was conducted in patients (n=107) with septic endocarditis. There were 60 men (56%) and 47 women (44%) with an average age of 42.4±11.3 years (M±ϭ). Patients were divided into two groups: in group 1 (n=23) blood ultrafiltration (UF) during cardiopulmonary bypass (CPB) was performed; in group 2 (n=84) blood ultrafiltration was not used. 125 factors were included (age, sex, body surface area and clinical and biochemical parameters) for the prognosis of acute kidney injury (AKI). Factors showing a statistically significant association with AKI were included in the analysis to construct a multiple linear regression equation. The construction of the mathematical model was carried out by the method of least squares, with the calculation of Pearson correlation paired coefficients.
Results. There was no reliable difference in the duration of CPB and the duration of myocardial ischemia in the groups (p=0.326, p=0.464). In group 1 a linear relationship was found between the parameters of AKI and with the number of leukocytes according to Nechiporenko (r=0.95), the amount of cryoprecipitate (r=0.69), fresh frozen plasma (r=0.58), the volume of ultrafiltration (r=0.68), proteinuria (r=0.66) ànd blood creatinine (r=0.67). Group 2 showed a linear relationship between AKI and the left ventricular end-diastolic volume (r=0.69), glomerular filtration rate (r=0.51), blood creatinine (r=0.52), CPB temperature (r=0.42) and CPB time (r=0.59). One patient in the group 2 developed AKI after surgery.
Conclusion. Hyperthermia during CPB and an elevation in CPB time increase the risk of AKI in patients with septic endocarditis

Keywords: septic endocarditis, cardiopulmonary bypass, acute kidney injury, risk factors, postoperative complication, ultrafiltration
p. 625-635 of the original issue
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Address for correspondence:
100115, Republic of Uzbekistan,
Tashkent, Chilanzarsky district,
Kichik Khalkayuli str., 10,
Republican Specialized Research Medical Center
of Surgery Named after Academician V. Vakhidov, the Department “Cardiopulmonary Bypass”,
tel.mobile: +99893 5147235,
å-mail: shakhida_cardio@list.ru,
Islambekova Shakhida A.
Information about the authors:
Aliev Sherzod M., MD, Chief Cardiac Surgeon of the Republic of Uzbekistan, Head of the Department of Combined Heart Disease, Republican Specialized Research Medical Center of Surgery Named after Academician V. Vakhidov, Tashkent, Republic of Uzbekistan.
https://orcid.org/0000-0002-4113-8095
Nazirova Lyudmila A., PhD., Head of the Department of Anesthesiology, Republican Specialized Center of Surgery Named after Academician V. Vakhidov https://orcid.org/0000-0003-0303-4110
Islambekova Shakhida A., Perfusionist, the Department of «Cardiopulmonary Bypass», Republican Specialized Research Medical Center of Surgery Named after Academician V. Vakhidov, Tashkent, Republic of Uzbekistan.
https://orcid.org/0000-0002-3788-7819
Pahomov Georgy L., PhD, Thoracic Surgeon, Associate Professor of the Hospital Surgery Department, Tashkent Medical Academy, Tashkent, Republic of Uzbekistan.
https://orcid.org/0000-0002-7150-1473

A.P. GONCHAR 1, A. B. ELIZAROV 1, N. S. KULBERG 1, 2, M.M. SULEYMANOVA 3, T.I. ALEKSEEVA 4, D.A. CHERNYSHEV 5, M.Y. TITOV 6, V.Y. BOSIN 1, S.P. MOROZOV 1, V.A. GOMBOLEVSKIJ 1

AUTOMATIC MEASUREMENT OF LIVER DENSITY BY COMPUTED TOMOGRAPHY AND ULTRA-LOW-DOSE COMPUTED TOMOGRAPHY

Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow 1,
Federal Research Center "Institute of Management" RAS 2,
Central State Medical Academy of the Administrative Department of the President of the Russian Federation 3,
Center for Expertise and Quality Control of Medical Care 4
Pirogov Russian National Research Medical University 5,
City Clinical Hospital named after S.P. Botkin.
Department of Health of Moscow 6, Moscow,
The Russian Federation

Objective. To evaluate the possibilities of the developed method for the automatic liver density measurements according to the data of native ultra-low-dose and standard chest computed tomograms in the case when an upper segment of the abdomen is in the scanned zone.
Methods. Retrospective analysis of clinical data associated with patients (n=10,000) underwent ultra-low-dose computed tomography has been performed. The patients (n=100) were selected and additionally underwent standard computed tomography. The average age of patients was 62.5±12 years (M±σ). Manual measurement of the liver density was carried out in II, IV, VII-VIII segments. In addition the splenic density was measured. In the case of the liver density was <40 HU, liver-to-spleen ratio (L/S) <0.8-1.0, and the density difference was <10 HU hepatic steatosis was considered to be reliable. For automatic procedure a program for measurement of liver density including segmentation and the segmented density area was developed.
Results. A little difference was revealed in comparison of the automated and manual liver density measurement for standard computed tomography (51.43 vs. 50,37 HU, p=0.0192). For ultra-low-dose computed tomography the difference is slightly larger (54.90 and 55.60 HU, p=0.310). When assessing the difference between the compared methods for standard and ultra-low-dose computed tomography, no significant difference was found (p=0.0035). In comparison of manual and automated methods a larger number of the low liver density cases both for standard (10 vs. 6 cases, P(McNemar)=0.125) and ultra-low-dose tomograms (11 vs. 5 cases, P(McNemar)=0.0313) was detected. The agreement between two methods is considered to be satisfactory for both scanning protocols (kappa 0.726 vs. 0.593).
Conclusion. A good correlation between manual and automated methods for standard and ultra-low-dose computed tomography allows using the automatic method for analyzing a large amount of data and revealing the hepatic steatosis.

Keywords: X-ray liver density, computed tomography, ultra low-dose computed tomography, hepatic steatosis, nonalcoholic fatty liver disease
p. 636-647 of the original issue
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Address for correspondence:
125124, Russian Federation,
Moscow, Raskova Str., 16/26, 1,
Research and Practical Clinical Center
of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow,
the Department of Radiology Quality Development
tel. +7 962 967-50-71,
e-mail: anne.gonchar@gmail.com,
Gonchar Anna P.
Information about the authors:
Gonchar Anna P., Senior Researcher of the Department of Radiology Quality Development, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russian Federation.
http://orcid.org/0000-0001-5161-6540
Elizarov Alexey B., PhD, Senior Researcher of the Department of the Development of Medical Imaging Tools, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russian Federation.
http://orcid.org/0000-0003-3786-4171
Kulberg Nicholay S., PhD, Head of the Department of the Development of Medical Imaging Tools, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russian Federation.
http://orcid.org/0000-0001-7046-7157
Suleymanova Maria M., Clinical Intern, Central State Medical Academy of the Management Department of the Presidential Administration of the Russian Federation, Moscow, Russian Federation.
https://orcid.org/0000-0002-5776-2693
Alekseeva Tatiana I., Specialist of the Department of Medical Security Standardization, Center for Healthcare Quality Assessment and Control, Moscow, Russian Federation.
http://orcid.org/0000-0003-3296-3250
Chernyshev Dmitry A., Clinical Intern, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-6734-0531
Titov Mikhail Yu., Radiologist, City Clinical Hospital Named after S.P. Botkin, Department of Health of Moscow, Moscow, Russian Federation.
https://orcid.org/0000-0002-4933-6125
Bosin Victor Yu., MD, Professor, Chief Researcher of the Department of Radiology Quality Development, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russian Federation.
http://orcid.org/0000-0002-4619-2744
Morozov Sergey P., MD, Professor, Head of the Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russian Federation.
http://orcid.org/0000-0001-6545-6170
Gombolevsky Victor A., PhD, Head of the Department of Radiology Quality Development, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russian Federation.

Ê.Ì. KURBONOV, K.R. RUZIBOYZODA, S.G. ALI-ZADE

DIAGNOSIS AND TREATMENT OF PANCREATOGENIC BLEEDINGS

Avicenna Tajik State Medical University, Dushanbe,
The Republic of Tajikistan

Objective. To evaluate the results of providing care to patients with pancreatogenic bleeding.
Methods. The treatment results of patients (n=84) with pancreatogenic bleedings were analyzed. In 73 (86.9%) cases bleedings occurred after direct interventions on the pancreas (n=12) and purulent-septic complications of acute pancreatitis (AP) (n = 61). In 11 (13.1%) cases, bleedings occurred in chronic pancreatitis (CP) complicated by pseudocysts (PC) of the pancreas. Type A bleeding occurred in 42 (50%) cases, type B – in 26 (31%) , and type C – in 16 (19%). The results of the medical care quality were assessed depending on the type and severity of bleeding.
Results. Conservative therapy in 31 out of 42 cases with type A bleeding allowed achieving stable hemostasis. In 12 cases in pancreatogenic bleedings caused by gastric and duodenal ulcers penetrating into the pancreas, the method of the combined endoscopic hemostasis with antisecretory therapy was considered to be effective to achieve hemostasis. In the presence of intraperitoneal postoperative profuse bleedings of type B and C owing to pancreatonecrosis, relaparotomy was performed in 38 cases; the stitching of a bleeding vessel with the pancreas tamponade, sanation and drainage of the abdominal cavity was carried out in 7 cases. 18 lethal outcomes were registered. Resection of the tail pancreas with splenectomy was performed in 4 cases, in 9 cases to achieve hemostasis in bleedings from the pancreatic, the bleeding vessel was sutured with the external drainage and tamponing of the pancreatic pseuodocyst in 6 cases and longitudinal pancreatic jejunal anastomosis – in 3. Lethal outcomes were registered in 2 cases. In 2 cases, X-ray endovascular embolization of the gastroduodenal artery was performed. No morbidity and mortality were registered.
Conclusion. Bleeding accompanied by severe hemodynamic disturbances requires open surgical interventions. X-ray endovascular methods are considered to be effective in the case of bleeding due to acute and chronic pancreatitis and in the postlesional period.

Keywords: complication of pancreatitis, bleeding, pancreatitis, pseudoaneurysm, hemostasis, arrosive bleeding
p. 648-654 of the original issue
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Address for correspondence:
734003, Republic of Tajikistan,
Dushanbe, Rudaki Av.,139.
Avicenna Tajik State Medical University,
the Department of Surgical Diseases No1,
tel.: +992 934054404
e-mail: dr.hero85@mail.ru
Ruziboyzoda Kahramon R.
Information about the authors:
Kurbonov Karimêhon M., Academician of the Academy of Medical Sciences of the Republic of Tajikistan, Honored Worker of Science and Technology of the Republic of Tatarstan, Doctor of Medical Sciences (MD), Professor of the Department of Surgical Diseases No1 of Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
http://orcid.org/0000-0002-8100-9722.
Ruziboyzoda Kahramon R., PhD, Assistant of the Department of Surgical Diseases No1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
http://orcid.org/0000-0001-8381-0364.
Ali-Zade Sukhrob G, PhD, Associate Professor of the Department of Surgical Diseases No1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
https://orcid.org/0000-0002-2456-7509

V.V. BOYKO 1, 2, I.A. KRYVORUCHKO 1, R.S. RIABTSEV 2, YE.G. DOTSENKO 2, Ð.Ì. SMACHYLO 1, 2, N.N. HONCHAROVA 1

SURGICAL TREATMENT OF ISOLATED AND MULTIPLE DUODENAL INJURIES

Kharkiv National Medical University MH of Ukraine 1,
Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine 2, Kharkiv
Ukraine

Objective. To evaluate the results of surgical treatment of patients operated on for isolated and multiple and duodenal injuries.
Methods. A retrospective two-center study was conducted in patients (n=60) with isolated and multiple duodenal injuries ≥ II degree according to the criteria of the American Association for the Surgery of Trauma (AAST) who underwent to operations in 2006-2018.
Results. 16 (26.7%) patients were with the closed injuries, 44 (73.3%) – with the penetrating injuries, 35 (79.5%) – with stab wounds, 5 (11.4%) – with gunshot traumas, 4 (9.1%) – with mine-explosive damages. Men composed 70%, women – 30%, the average age was 36 [18-73] years. On admission the RTS, ISS, and APACHE II scores were 6 [4-8], 14 [4-25], and 14 [8-32], respectively; 22 victims (36.7%) were in shock. Duodenum damage of the II degree was in 31 (51.7%) victims, III – in 24 (40%), IV – in 3 (5%) and V – in 2 (3.3%). Multiple intra-abdominal injuries occurred in 52 (86.7%) patients (1.81 associated injuries per patient). The primary suture was the most accepted surgical procedure in the majority of patients (76.4%); the duodenum was removed from the passage in 13.3%, duodenojejunostomy was performed in 6.7%, and pancreatoduodenal resection – in 3.3%. Postoperative mortality was 18.3%.
Conclusion. Duodenal injuries with early diagnosis and timely surgical intervention can be effectively treated using simple surgical methods (primary suture). Complex injuries of the duodenum and those associated with the damage to neighboring organs and structures require a more thoughtful strategy, which includes careful consideration of the physiological stability of a patient, severity of injuries, severity of changes in the abdominal cavity, retroperitoneal space, and also the experience of a surgeon.

Keywords: injuries of the duodenum, severity of injuries, surgical treatment, complications, mortality
p. 655-663 of the original issue
References
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Address for correspondence:
61022, Ukraine,
Kharkiv, Nauka Av., 4,
Kharkiv National Medical University,
the Surgery Department No2,
tel.: +38-050-301-90-90,
e-mail: ikryvoruchko60@gmail.com,
Kryvoruchko Igor A.
Information about the authors:
Boyko Valeriy V., Corresponding Member of NAMS of Ukraine, MD, Professor, Director of Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine, Head of the Surgery Department No1, Kharkiv National Medical University, Kharkiv, Ukraine.
http://orcid.org/0000-0002-3455-9705
Kryvoruchko Igor A., MD, Professor, Head of the Surgery Department No2, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-5525-701X
Riabtsev Roman S., the Post-Graduate Student, Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine, Kharkiv, Ukraine.
https://orcid.org/0000-0003-1233-1766
Dotsenko Yevhen G., PhD, Deputy Chief Physician, Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine, Kharkiv, Ukraine.
https://orcid.org/0000-0003-1546-0897
Smachylo Rostyslav M., MD, Head of the Department of the Liver and Bile Ducts Surgery, Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine, Professor of the Surgery Department No1, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0003-1237-0255
Honcharova Natalya N., MD, Professor of the Surgery Department No2, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0001-5031-7311

PEDIATRIC SURGERY

Ì.P. RAZIN 1, S.V. IGNATYEV 2, À.S. SEMAKIN 3

COAGULATION DISORDERS IN CHILDREN WITH DESTRUCTIVE FORMS OF APPENDICITIS

Kirov State Medical University 1,
Kirov Research Institute of Hematology and Blood Transfusion of the Federal Medical-biological agency 2,
Kirov Regional Pediatric Hospital 3, Kirov,
The Russian Federation

Objective. To assess the hypercoagulable state of hemostasis in children with the destructive forms of appendicitis in the early postoperative period.
Methods. The study included children (n=30) with the destructive forms of acute appendicitis at the age of 7-14 years. The control group (n=50) consisted of healthy children. The severity of the intoxication-inflammatory syndrome was assessed according to the hemogram and biochemical blood analysis, the state of the coagulation link of hemostasis – on the basis of screening, local tests and the integral test «Thrombodynamics».
Results. There was a significant increase in the number of leukocytes, stab and segmented neutrophils, ESR in patients with the destructive forms of appendicitis in the early postoperative period. Leukocyte index of intoxication corresponded to moderate and severe patients – 5.73; 3.6-7.4 (Me; Q1-Q3), C-reactive protein in the study group exceeded the norm 32 folds – 163.8; 132.8-224.9 mg/l (Me; Q1-Q3). We established a statistically significant increase in the concentration of fibrinogen (5.9±1.0 g/l), soluble fibrin monomer complexes (204.0±59.1 μg/ml), factor VIII (301.3±96.6%), von Willebrand factor (226.0±62.5%) and its activity (161.5±36.2%), a significant increase in the indices of the integral test «Thrombodynamics» – initial clot growth rate Vi (60.5±3.9 μm/min), stationary clot growth rate Vst (41.1±3.9 μm/min), CS clot size (1444.2±192.9 μm) and clot density D (31157.6±2599.3 c.u.). The results of all patients in the study group showed inhibition of plasma fibrinolytic activity.
Conclusion. Destructive forms of appendicitis are accompanied by a pronounced intoxication-inflammatory syndrome in combination with hypercoagulation disorders of the hemostatic system, which causes a state of increased thrombotic readiness, which, in the presence of additional factors, can result in thrombosis. This is the basis for additional studies and a more scrupulous diagnostic search for thromboembolic complications in children.

Keywords: appendicitis, peritonitis, surgical treatment, coagulation disorders, hypercoagulation, prothrombotic condition, thrombosis
p. 664-670 of the original issue
References
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  12. Minaev SV, Isaeva AV, Obedin AN, Bolotov IuN, Bochniuk EA, Chintaeva LA, Gudiev ChG. S-reaktivnyi belok – glavnyi marker dinamiki techeniia ostrykh vospalitel’nykh protsessov v klinicheskikh usloviiakh. Med Vestn Sever Kavkaza. 2011;(2):95-99. https://medvestnik.stgmu.ru/files/medvestnik_2011_2.pdf (In Russ.)
  13. Momot AP. The problem of thrombophilia in clinical practice. Russian Journal of Pediatric Hematology and Oncology. 2015;2(1):36-48doi: 10.17650/2311-1267-2015-1-36-48. (In Russ.)
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Address for correspondence:
610027, Russian Federation,
Kirov, Karl Marx Str., 112,
Kirov State Medical University
of the Ministry of Health
of the Russian Federation
tel. +7 912 828-15-27,
e-mail:mprazin@yandex.ru,
Razin Maxim Petrovich
Information about the authors:
Razin Maxim P., MD, Professor, Head of the Pediatric Surgery Departmentr, Kirov State Medical University, Kirov, Russian Federation.
https://orcid.org/0000-0003-3561-3256
Ignatyev Sergey V., PhD, Senior Researcher of the Scientific and Clinical Department of Hematology, Chemotherapy and Bone Marrow Transplantation, Kirov Research Institute of Hematology and Blood Transfusion of the Federal Medical-biological Agency, Kirov, Russian Federation.
http://orcid.org/0000-0002-8457-2967
Semakin Alexander S., Pediatric Surgeon, Kirov Regional Pediatric Hospital, Kirov, Russian Federation.
http://orcid.org/0000-0002-6889-0543

TRANSPLANTOLOGY

D.A. FEDARUK 1, K.I. PETRENKO 1, L.V. KIRKOVSKY 1, D.N. SADOUSKY 1, V.A. LEBEDZ 2, A.F. CHICHVA 2, YE.V. FILIPENKO 2, S.Z. SHARIPOV 1, A.M. FEDARUK 1, O.O. RUMMO 1

BILE LACTATE AS A MARKER OF BALLOONING DEGENERATION OF HEPATOCYTES AND A POTENTIAL CRITERION FOR CHOOSING A METHOD OF LIVER TRANSPLANT PRESERVATION

Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology 1
Minsk Municipal Clinical Pathology Bureau 2, Minsk,
The Republic of Belarus

Objective. To determine the diagnostic value of donor’s bile as a marker allowing to give an additional assessment, objectify the state of the liver graft, assess the need for dynamic air conditioning, and predict the course of the early postlesional period.
Methods. From July 2017 to November 2019 the bile intake from choledoch and biopsy from liver parenchyma were performed during the explantation operation. All grafts were divided into 2 groups. The first group consisted of organs intented for further transplantation and the organs of the second group were considered unfit for transplantation. Bile ABS (acid-based state) and morphological analysis of transplants were carried out in both groups.
Results. A reliable relationship between the level of bile lactate of both groups and the level of hepatocellular ballooning (R=0.50, p=0.001) was determined. In those cases where severe hepatocyte ballooning was observed the higher levels of lactate in the bile of donors 1.9 [1.2; 2.55] were reliably determined in comparison with those specimens where it was not expressed 0.6 [0.3; 1.7] (p=0.006). The performed ROC analysis allowed determining the level of bile lactate at 1 mmol/ L as a cut-off point at which the probability of liver hepatocyte ballooning is maximal (AUC=0.830). In group 1, a reliable association was obtained between the level of donor bile lactate and ALT at the peak value (R=0.56, p=0.004) and on the 7th postoperative day (R=0.53, p=0.01), as well as with the INR level at the peak value (R=0.63, p=0.001).
Conclusion. Bile lactate reliably reflects the degree of hepatocyte ballooning and objectifies the state of donor liver, as well as predicts the course of the early postoperative period. Bile lactate level greater than 1 mmol/L is a potential criterion for oxygenated machine perfusion.

Keywords: bile lactate, ballooning, transplantation, preservation, machine perfusion
p. 671-679 of the original issue
References
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Address for correspondence:
220045, Republic of Belarus,
Minsk, Semashko Str., 8,
Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology,
the Trasplantology Department,
Tel..: +375 29 604 88 10
e-mail: tetrafed@yandex.ru
Fedaruk Dzmitry A.
Information about the authors:
Fedaruk Dzmitry A., Surgeon, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-9686-1950
Petrenko Kristina I., Head of the Clinical-Diagnostic Laboratory, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-4127-3588
Kirkovsky Leanid V., PhD, Deputy Director for Medical Affairs for Civil Defense and Mobilization Work, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-7852-4555
Sadouski Dzianis N., PhD, Surgeon, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-6351-1006
Lebedz Volha A., Pathologist, Minsk Municipal Clinical Pathology Bureau, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-6972-9903
Chichva Artur F., Pathologist, Minsk Municipal Clinical Pathology Bureau, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-0130-5004
Filipenka Ekatserina V., Pathologist, Minsk Municipal Clinical Pathology Bureau, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-4899-5724
Sharipov Shohrat Z., Head of the Thoracic Department, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-2754-043X
Fedaruk Aliaksei M., MD, Head of the Department of Hepatology and Minimally Invasive Surgery, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-9211-8396
Rummo Oleg O., MD, Professor, Corresponding Member of NAS of Belarus, Head of Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-7023-4767

TRAUMATOLOGY AND ORTHOPEDICS

P.A. VOLOTOVSKI 1, À.À. SITNIK 1, D.V. TAPALSKI 2, Ì.À. YARMOLENKO 3, Î.À. KORZUN 1, O.N. BONDAREV 1, Ì.À. GERASIMENKO 1

CLINICAL APPLICATION OF IMMEDIATE RESULTS OF CLOSED INTRAMEDULLARY NAILING WITH THREE-COMPONENT ANTIBACTERIAL COATING IN INFECTED FRACTURES AND NONUNION OF LONG TUBULAR BONES

Republican Research and Practical Center of Traumatology and Orthopedics 1, Minsk,
Gomel State Medical University 2,
Francisk Skorina Gomel State University 3, Gomel,
The Republic of Belarus

Objective. The prospective study was performed to evaluate the efficacy and safety of osteosynthesis by closed intramedullary nailing with antibacterial coating in infected fractures and nonunions of the lower extremity long tubular bones.
Methods. The study included patients (n=8) with infected fractures and nonunions of the tibia and femur. Solid titanium nails (with holes for blocking ) were used as implants. Plasma spray coating method (from the active gas phase) was used for the required thickness coating. The technique of surgical intervention included two main components: debridement of the infection site and the insertion of the nail into the medullary canal. After surgery, all patients received antibiotics based on the microbiological study. Follow-up visits to assess the activity of the infectious process and the degree of consolidation were scheduled in 6, 12, 24 and 52 weeks.
Results. By the time of preparing this article, the mean follow-up for patients after surgery had been 4.4 ± 1.0 months. None of the patients showed any signs of infection recurrence after surgery and completion of the course of antibiotic therapy, which indicates the effectiveness and safety of this technique. Not later than 2.5 months after the surgery, all 8 (100%) patients started full weight-bearing on the operated limb. Radiography confirmed the bone healing in 5 patients; in 3 patients X-ray shows the initial signs of fracture consolidation.
Conclusion. Intramedullary osteosynthesis with new three-component antibacterial coating allowed eradicating the infection and achieving bone healing in patients with infected fractures and non-unions of the tibia and femur. This technique is effective and its application is not associated with difficulties typical for the intraoperative preparation of antibacterial coatings.

Keywords: osteomyelitis, osteosynthesis, intramedullary nailing, antibacterial coating, infection
p. 680-687 of the original issue
References
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Address for correspondence:
220024, Republic of Belarus,
Minsk, Leytenant Kizhevatov Str., 60-4,
Republican Research and Practical Center
of Traumatology and Orthopedics
tel. +375 17 373-59-93,
e-mail: volotovski@gmail.com,
Volotovski Pavel A.
Information about the authors:
Volotovski Pavel A., PhD, Academic Secretary, Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
https://orcid.org/0000-0002-4455-035X
Sitnik Alexander A., PhD, Associate Professor, Head of the Laboratory of Adult Traumatology, Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
https://orcid.org/0000-0001-8903-5899
Tapalski Dzmitry V., PhD, Associate Professor, Head of the Department of Microbiology, Virology and Immunology, Gomel State Medical University, Gomel, Republic of Belarus
https://orcid.org/0000-0002-9484-7848
Yarmolenko Maxim A., DSñTech, Associate Professor, the Department of Radiophysics and Electronics, Francisk Skorina Gomel State University, Gomel, Republic of Belarus
https://orcid.org/0000-0002-1283-8762
Korzun Oleg A., PhD, Leading Researcher, Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
https://orcid.org/0000-0001-7826-5269
Bondarev Oleg N., PhD, Researcher, Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
https://orcid.org/0000-0002-5998-6711
Gerasimenko Mikhail A., MD, Professor, Head of the Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
https://orcid.org/0000-0001-9151-0214

EXTREME MEDICINE

Y.V. SHKATULA 1, Y.O. BADION 1, M.V. NOVIKOV 2

EFFICIENCY OF DIFFERENT METHODS OF TEMPORARY EXTERNAL HEMOSTASIS AT THE PRE-HOSPITAL STAGE OF EMERGENCY MEDICAL CARE

Sumy State University 1
Sumy Regional Centre for Emergency Medical Care and Disaster Medicine 2
Ukraine

Objective. To estimate the efficiency of different methods of temporary external hemostasis at the pre-hospital stage of emergency medical care, taking into account the localization of injuries.
Material and Methods. The cases (n=86) of prehospital emergency medical care for patients with external bleeding were studied. The data on the victims (age, gender), clinical status (type and location of injuries, type of bleeding), the volume of emergency care, the hemostasis methods used to control bleeding, their efficiency, side effects, difficulty of use were collected, and the duration of the pre-hospital stage were also taken into account.
Results. The study found out that the most common cause of external bleeding is domestic accident (45.35%) of cases. By the nature of tissue damage, the cut wounds prevailed. Multiple or combined injuries occurred in 13.95% of cases. A tourniquet was the main method of hemostasis. Contact hemostatic agents were used only in 2.32% of cases at the pre-hospital stage. In some cases, when attempting to control the external bleeding, several hemostatic agents were sequentially used due to the lack of their efficacy. In 17.4% of cases, the victims with multiple or combined injuries received intravenous administration of the systemic hemostatic agents. In the complex anti-shock measures in patients with severe trauma 77.91% of the prehospital patients underwent infusion therapy. Isotonic crystalloid solutions were used. A reliable increase in the duration of the prehospital stage of victims who underwent to a combination of hemostasis methods and intravenous infusion has been registered. The increase in the length of the prehospital stay occurs at the expense of the time required for creation of venous access and initiate infusion. The authors propose the algorithm for temporal control of external bleeding during emergency medical care at the pre-hospital stage.
Conclusion. The main principles that need to be guided in the choice of any methods for stopping of bleeding are the speed and reliability of hemostasis for entire time of evacuation and the minimum damaging effect on the tissues.

Keywords: emergency medical care, pre-hospital stage, external bleeding, tourniquet, contact hemostatic agent
p. 688-693 of the original issue
References
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Address for correspondence:
40022, Ukraine,
Sumy, Troitskaya Str., 39,
Medical Institute of Sumy State University,
the Department of Emergency Medicine
and Disaster Medicine
tel. +38 099 548 61 71,
e-mail: y.shkatula@med.sumdu.edu.ua
Shkatula Yurii V.
Information about the authors:
Shkatula Yurii V., MD, Professor, Head of the Department of Emergency Medicine and Disaster Medicine Medical Institute of Sumy State University, Sumy, Ukraine.
https://orcid.org/0000-0001-5689-6318
Badion Yurii A., PhD, Assistant of the Department of Emergency Medicine and Disaster Medicine Medical Institute of Sumy State University, Sumy, Ukraine.
https://orcid.org/0000-0002-1646-282X
Novikov Maksym V., Deputy Director of Sumy Regional Centre for Emergency Medical Care and Disaster Medicine, Sumy, Ukraine.
https://orcid.org/0000-0002-0806-0521

I.A. ARSENOVA 1, I.O. POHODENKO-CHUDAKOVA 2, M.A. LAR’KINA 3

TRIGGER POINT INJECTION THERAPY IN THE MANAGEMENT OF MYOFASCIAL PAIN SYNDROME IN THE MAXILLOFACIAL AREA

Center for Advanced Training of Medical Specialists 1, Novosibirsk,
Belarusian State Medical University 2, Minsk,
The Republic of Belarus;
Dental Clinic "Dentaliya-Blesk 3, Novosibirsk,
The Russian Federation

Objective. To evaluate the effectiveness of the trigger points injections in the treatment of myofascial pain syndrome in the maxillofacial area.
Methods. During the period of 2014-2017 the patients (n=124) with the myofascial pain syndrome (76 women and 48 men, aged 19 to 62 yrs.) have been treated. In addition to clinical and radiological diagnostic methods, all patients underwent electromyography; the pain intensity assessed according to the Visual Analogue Pain Scale (VAS). In order to relieve myofascial pain syndrome, the methods of traditional therapy such as splint therapy, occlusion correction, drug and physiotherapy were used. In the case if traditional methods were ineffective the injections of «Lymphomyosot» and «Traumel S» solutions into trigger points were performed according to the method of J. Kersschot (2010). Control examinations were carried out 1, 3, 6, 12 and 18 and 24 months after the manipulation. During the follow-up examinations, attention was paid to the complaints of patients; the pain intensity was assessed by VAS. The criteria for the positive results of treatment were considered to be the absence of pain in resting-state and during functioning.
Results. In case of conventional treatment, positive results were obtained in 86 out of 124 patients (69.4%). Trigger point injections performed due to insufficient treatment efficacy in 38 patients resulted in pain relief in 32 (84.2%). As shown by our observations, a long painless period (within two years) was observed in 12 (37.6%) patients. A long-term effect for a period up to one and a half years was fixed in 8 patients (25%), up to 1 year - in 7 patients (21.8%), up to 6 months – in 5 (15.6%).
Conclusion. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points, provide prompt relief of symptoms and a long period of remission.

Keywords: myofascial pain syndrome; temporomandibular joint; trigger points; trigger point injections; electromyography; bruxism, psychoemotional stress
p. 694-701 of the original issue
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Address for correspondence:
220116, Republic of Belarus,
Minsk, Dzerzhinskii Av., 83,
Belarusian State Medical University,
the Surgical Dentistry Department
tel. +375296440720,
e-mail: ip-c@yandex.ru
Pohodenko-Chudakova Irina Olegovna
Information about the authors:
Arsenova Irina A., MD, Professor, Director of LLC “Center for Advanced Training of Medical Specialists”, Novosibirsk, Russian Federation.
http://orcid.org/0000-0002-7560-5050
Pohodenko-Chudakova Irina O., MD, Professor, Head of the Surgical Dentistry Department, Belarusian State Medical University, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-0353-0125
Lar’kina Maria A., Director of LLC, Dental Clinic «Dentaliya-Blesk», Novosibirsk, Russian Federation
http://orcid.org/0000-0002-1452-0221

REVIEWS

V.I. GOLOVINA, E.I. SELIVERSTOV, O.I. EFREMOVA, I.A. ZOLOTUKHIN

POSSIBILITIES AND PROSPECTS OF HEMODYNAMIC SURGERY OF VARICOSE VEINS IN THE ERA OF ENDOVASCULAR THERMAL OBLITERATION

N.I. Pirogov Russian National Research Medical University, Moscow,
Russian Federation

For a long time, the complete removal of the saphenous vein trunk has been considered to be the only effective surgical treatment of varicose veins. Over time, in addition to modifications to the removal of veins with the help of probes, endovenous thermal methods of obliteration also appeared, however, complete excision / obliteration of the incompetent segment of the trunk still remained common in all these techniques. This concept began to undergo changes only after the appearance and the development of duplex ultrasound scanning of blood vessels, which made it possible to investigate deeply the venous system hemodynamics and, as a result, to determine the further necessary treatment technique for each patient individually. Due to a detailed study of the venous hemodynamics, in 1988 French angiologist Claude Franceschi proposed the method of the ambulatory conservative hemodynamic correction of venous insufficiency (Conservatrice et Hémodynamique de l’InsuffisanceVeineuse en Ambulatoire), which became known in the world as the CHIVA. This method implies the elimination of the hydrostatic pressure column in the vein, removal of blood recirculation mechanism, maintaince re-entry mechanism and elimination of tributaries which are not connected with re-entry point. As a result of CHIVA performance the normal physiological blood flow is restored by eliminating reflux from the deep vein to the superficial vein and maintaining drainage from superficial to the deep veins. In the presented review, the advantages and disadvantages of the CHIVA method are examined in details, as well as a comparative analysis of the technique with other currently existing methods of treatment of varicose vein disease.

Keywords: varicose veins, phlebectomy, vein saving surgery, hemodynamic correction, CHIVA
p. 702-713 of the original issue
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Address for correspondence:
117997, Russian Federation,
Moscow, Ostrovityanov str., 1,
N.I. Pirogov Russian National
Research Medical University,
the Faculty Surgery Department No1.
tel. +7 977 605-17-08,
e-mail: nikuskin@inbox.ru,
Golovina Veronika I.
Information about the authors:
Golovina Veronika I., Post-Graduate Student, the Faculty Surgery Department No1, N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-8719-7154
Seliverstov Evgeny I., PhD, Assistant of the Faculty Surgery Department No1, N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-9726-4250
Efremova Oksana I., PhD, Assistant of the Faculty Surgery Department No1, N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-5906-8120
Zolotukhin Igor A., MD, Professor of the Faculty Surgery Department No1, Head of the Department of Basic and Applied Research in Surgery of RI of Clinical Surgery, N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-6563-0471

À.V. SAZHIN, Ê.M. LOBAN, G.B. IVAKHOV, V.A. PETUKHOV, N.S. GLAGOLEV, A.V. ANDRIYASHKIN, R.R. AKHMEDOV

CURRENT CONCEPTS OF VENTRAL HERNIA SURGERY

Pirogov Russian National Research Medical University, Moscow,
The Russian Federation

Herniology is one of the most ancient branches of surgery and, it continues to develop quickly. New technology adds to arsenal of surgeons constantly recently, which have found their place also in hernia surgery. Despite the rapid development of herniology the optimal method for surgical repair of ventral hernia still remains to be determined. The role of preoperative examination methods in the algorithm for choosing a treatment option has not been defined. There is no single opinion concerning different spaces in which the mesh is placed, and expediency of the minimally invasive techniques application. In addition, there is no consensus on the terminology used in current herniology. This article touches upon the epidemiological and historical aspects of surgery for ventral hernias, discusses the anatomy of the anterior abdominal wall, analyzed current terminology and classifications, describes the methods of preoperative patient evaluation and indications for surgical treatment, so as consideres the current diagnostic and therapeutic surgical options. Since several controversial issues still remain in the management of patients with ventral hernia today is relevant to search the most physiological and functional methods of of treatment that ensure the minimum risk of recurrence and complications and improving patient quality of life.

Keywords: ventral hernia, hernia repair, anterior abdominal wall, surgical mesh, minimally invasive hernia repair, component separation
p. 714-729 of the original issue
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Address for correspondence:
117997, Russian Federation,
Moscow, Ostrovityanov Str., 1,
Pirogov Russian National Research
Medical University of MH of RF,
the Department of the Faculty Surgery
No1 of the Medical Faculty,
tel.: +7 916 292 6268,
e-mail: doctor.loban@gmail.com
Loban Konstantin M.
Information about the authors:
Sazhin ALexandr.V., Corresponding Member of RAS, MD, Professor, Head of the Department of the Faculty Surgery No1 of the Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0001-6188-6093
Loban Konstantin M., Post-Graduate Student, Laboratory Assistant of the Department of the Faculty Surgery No1 of the Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-8333-2398
Ivakhov Georgy B., PhD, Associate Professor, the Department of the Faculty Surgery No1 of the Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-9773-4953
Petukhov Vitaly A., MD, Professor, the Department of the Faculty Surgery No1 of the Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-1807-9864
Glagolev Nikolay S., PHD, Assistant of the Department of the Faculty Surgery No1 of the Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-1057-705X
Andriyashkin Andrey V., PhD, Associate Professor, the Department of the Faculty Surgery No1 of the Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-4170-9521
Akhmedov Ramil R., Clinical Intern of the Department of the Faculty Surgery ¹1 of the Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-0846-1616

A.L. SHESTAKOV 1, A.A. BEZALTYNNYKH 2, D.V. NAREZKIN 2, A.V. SERGEEV 2, M.E. SHAKHBANOV 1, 3, I.M. TADZHIBOVA 1, T.V. PETROSYAN 1, A.G. ABDULLAEV 3, I.A. TARASOVA 1, 3, A.V. BABICH 2

CURRENT STATE OF THORACOSCOPIC SURGERY FOR BENIGN ESOPHAGEAL DISEASES

B.V.Petrovsky National Research Centre of Surgery 1, Moscow,
Smolensk State Medical University 2, Smolensk,
I.M. Sechenov First Moscow State Medical University (Sechenov University) 3, Moscow,
The Russian Federation

An analytical review of the literature on minimally invasive video-assisted endoscopic surgery for benign esophageal diseases is presented. A brief historical information of thoracoscopic esophageal surgery is given. It is noted that the advantages of video-assisted endoscopic technologies make possible to shorten the duration of treatment, reduce the rate of morbidity and mortality, which is the basis for the widespread implementation into surgical practice. The relevance of this problem was emphasized, in particular it was found that the use of thoracoscopic access for true diverticula of the thoracic esophagus is associated with minimal tissue trauma, however, with the high risk of developing specific complications. Technical aspects of surgical interventions for these diseases require the careful study. A comparative study of thoracoscopic and laparoscopic approaches during Geller’s operation for cardiac achalasia showed the advantages of the latter. Furthermore the indications for minimally invasive resection of benign esophageal tumors performed from a thoracoscopic approach should have an absolute character with assessment of risk/benefit ratios. The authors conclude that the use of minimally invasive surgical technologies in the treatment of benign esophageal diseases is promising, but the safety, clinical effectiveness and economic feasibility require further analysis.

Keywords: thoracoscopy, esophageal diverticulum, achalasia, esophagectomy
p. 730-738 of the original issue
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Address for correspondence:
241019, Russian Federation,
Smolensk, Krupskaja Str., 28,
Smolensk State Medical University,
the Hospital Surgery Departmentr,
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Bezaltynnykh Alexander A.
Information about the authors:
Shestakov Alexey L., MD, Head of the Department of Thoracoabdominal Surgery and Oncology, Russian Scientific Center for Surgery named after acad. B.V. Petrovsky,Moscow, Russian Federation, Moscow, Russian Federation.
http://orcid.org/0000-0003-3387-7442
Bezaltynnykh Alexander A., PhD, Associate Professor, the Hospital Surgery Department, Smolensk State Medical University, Smolensk, Russian Federation.
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Narezkin Dmitry V., MD, Professor, Head of the Hospital Surgery Department , Smolensk State Medical University, Smolensk, Russian Federation.
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Sergeev Alexey V., PhD, Associate Professor, the Hospital Surgery Department, Smolensk State Medical University, Smolensk, Russian Federation.
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Shakhbanov Magomed E., Post-Graduate Student, the Department of Thoracic-Abdominal Surgery and Oncolody, Russian Scientific Center for Surgery named after acad. B.V. Petrovsky, Moscow, Russian Federation, Moscow, Russian Federation.
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Tadzhibova Ireykhan M., Post-Graduate Student, the Department of Thoracic-Abdominal Surgery and Oncolody, B.V.Petrovsky National Research Centre of Surgery, Moscow, Russian Federation.
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Petrosyan Tatyana V., Post-Graduate Student, the Department of Thoracic-Abdominal Surgery and Oncolody, Russian Scientific Center for Surgery named after acad. B.V. Petrovsky, Moscow, Russian Federation, Moscow, Russian Federation.
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Abdullaev Abdulla G., MD, Professor of the Hospital Surgery Department, Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0002-4264-4483
Tarasova Irina A., PhD, Assistant of the Hospital Surgery Department, Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0001-9344-7351
Babich Andrey V., Student, Smolensk State Medical University, Smolensk, Russian Federation.
http://orcid.org/0000-0001-6269-6283

A.V. NOVOZHILOV 1, 2, M.O. MOVSISYAN 1, S.E. GRIGOREV 1, 2, E.G. GRIGORYEV 2, 3

GIANT CHOROIDAL MELANOMA METASTASIS TO THE LIVER IN YOUNG WOMAN

Irkutsk Regional Clinical Hospital 1,
Irkutsk State Medical University 2,
Irkutsk Scientific Centre of Surgery and Traumatology 3, Irkutsk
The Russian Federation

A rare case of a young woman with a single giant metastasis of spindle-cell choroidal melanoma to the liver is described. A 32 year-old woman underwent left ocular enucleation for choroidial melanoma 8 years ago. Ultrasound examination has been diagnosed the liver pathology when she was in the 8th month of pregnancy. Later, the pathology was confirmed during a caesarean section. After delivery, the patient was referred to the oncological dispensary, where metastatic melanoma was confirmed histologically based on a transcutaneous needle biopsy. Five courses of chemotherapy have been proved to be ineffective. The woman was hospitalized to the portal hypertension department of the regional hospital. A scrupulous oncological examination revealed a solitary nature of metastasis. Its volume reached 2338 cm3, unchanged parenchyma – 951 cm3. Angioarchitecture of the liver was thoroughly studied based on MSCT-angiography findings and invasive selective celiacography. The peripheral hepatic arterial branches were deformed and fragmented with pronounced recalibration which specified a malignant process. Arterial vessels of the left lobe were unchanged. The parietal branching was traced along the whole length. The right and median veins were involved in the pathological process; the left hepatic vein was intact. In view of ineffective adjuvant therapy and disease progression, the patient underwent right lateral hemihepatectomy. The early postoperative period was uneventful. One year and ten months later during the examination the patient reported about her good life quality. She is now being followed up by oncologist.

Keywords: choroidea, melanoma, liver metastasis, chemotherapy, right-lateral hemihepatectomy
p. 739-744 of the original issue
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Address for correspondence:
664003, Russian Federation,
Irkutsk, Krasnoe Vosstanie Str., 1,
Irkutsk State Medical University,
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mobile tel. +7 9025 111 027,
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Grigoryev Eugene G.
Information about the authors:
Novozhilov Alexandr V., PhD, Associate Professor of the Hospital Surgery Department, Irkutsk State Medical University, Head of the Portal Hypertension Department, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0003-1957-287X
Movsisyan Mikael O., Surgeon, the Portal Hypertension Department, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0003-2070-9263
Grigorev Sergey E., PhD, Associate Professor of the Hospital Surgery Department, Irkutsk State Medical University, Surgeon, the Portal Hypertension Department, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0003-0254-8240
Grigoryev Eugene G., MD, Professor, Corresponding Member of RAS, Supervisor, Irkutsk Scientific Centre of Surgery and Traumatology, Head of the Hospital Surgery Department, Irkutsk State Medical University, Irkutsk, Russian Federation.
http://orcid.org/0000-0002-5082-7028
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