Novosti
Khirurgii

 This journal is
indexed in Scopus
journal cover
android icon Android Applicaion

Year 2022 Vol. 30 No 6

SCIENTIFIC PUBLICATIONS

JU.V. IVANOV 1, I.A. LOMAKIN 2, E.I. KOLBENEV 3, E.A. EPIFANCEV 1, A.I. ZLOBIN 1

THE SPECIFICITY OF PLANNING AND PERFORMING SURGICAL OPERATIONS FOR CERVICO-STERNAL LOCALIZATION IF NODULAR GOITER

Federal State Budgetary Institution "Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies" of the Federal Medical and Biological Agency of Russia 1, Moscow,
FSBEI 72 Central polyclinic of the Ministry of Emergencies of Russia 2, Moscow,
Remsi Diagnostics Rus LLC 3, St. Petersburg,
Russian Federation

To evaluate the results of surgical treatment of patients (n=87) with substernal goiter. The main emphasis was done on the application of multislice spiral three-dimensional computed tomography reconstruction
With the volume of the retrograde component of the thyroid gland up to 100 cm3, it is preferable to perform the operation through the cervical approach, even without crossing the prethyroid muscles, with the volume from 100 to 150 cm3 - cervical access with the intersection of the prethyroid muscles, and with the retrograde component more than 150 cm3 - combined access.
The main risk factor for the expansion of surgical access from cervical to combined is the volume of the retrograde component of the thyroid gland more than 150 cm3. The use of the ultracision «Harmonic» Scalpel «Neurosan-400» complex, the magnifying optics by an operating surgeon during surgery can improve the safety of surgery and significantly reduces the risk of intraoperative complications, primarily: bleeding, recurrent laryngeal nerve injury, identification of inadvertently removed parathyroid glands.
Preoperative (3-4 days) X-ray endovascular occlusion of the thyroid arteries allows significantly reducing the arterial blood flow to the gland, followed by a decrease of its volume, which leads to a reduction of intraoperative blood loss, facilitates the operation technique, to shorten the actual operating time.
For the safe and effective treatment of patients with substernal goiter, the clinic should have a multidisciplinary team of specialists for surgery.

Keywords: journal goiter, multispiral computed tomography, combined operative access, X-ray endovascular occlusion
p. 501-509 of the original issue
References
  1. Ivanov JuV, Solov’ev NA, Chudnyh S.M. Sovremennye aspekty diagnostiki zabolevanij shhitovidnoj zhelezy. Lechashhij Vrach. 2004;(6):26-28. (In Russ.)
  2. Welman K, Heyes R, Dalal P, Hough S, Bunalade M, Anikin V. Surgical Treatment of Retrosternal Goitre. Indian J Otolaryngol Head Neck Surg. 2017 Sep;69(3):345-50. doi: 10.1007/s12070-017-1151-0
  3. Gostimsky AV, Karpatsky IV, Matveeva ZS, Shudaev IR, Selikhanov BA. Diagnosis and Choice of Surgical Tactics in Cervical Abroad Zoba. Tauride Medical and Biological Bulletin. 2020;23(2):52-58. doi: 10.37279/2070-8092-2020-23-2-52-58. (In Russ.)
  4. Kacprzak G, Karas J, Rzechonek A, Blasiak P. Retrosternal goiter located in the mediastinum: surgical approach and operative difficulties. Interact Cardiovasc Thorac Surg. 2012 Nov;15(5):935-37. doi: 10.1093/icvts/ivs339
  5. Rolighed L, Rønning H, Christiansen P. Sternotomy for substernal goiter: retrospective study of 52 operations. Langenbecks Arch Surg. 2015 Apr;400(3):301-6. doi: 10.1007/s00423-015-1288-9
  6. Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, Jung HK, Choi JS, Kim BM, Kim EK. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011 Sep;260(3):892-99. doi: 10.1148/radiol.111102067.
  7. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2009 Nov;19(11):1159-65. doi: 10.1089/thy.2009.02748.
  8. Anakin V, Velman K, Asadi N, Dalal P, Reshetov I, Beddow E. Zagrudinny zob in thoracic surgical practice.Surgery. Journal named after NI Pirogov. 2021;(12):20-26. doi: 10.17116/hirurgia202112120 (In Russ.)
  9. McKenzie GA, Rook W. Is it possible to predict the need for sternotomy in patients undergoing thyroidectomy with retrosternal extension? Interact Cardiovasc Thorac Surg. 2014 Jul;19(1):139-43. doi: 10.1093/icvts/ivu094
  10. Chen X, Xu H, Ni Y, Sun K, Li W. Complete excision of a giant thyroid goiter in posterior mediastinum. J Cardiothorac Surg. 2013 Nov 7;8:207. doi: 10.1186/1749-8090-8-207
  11. Sakkary MA, Abdelrahman AM, Mostafa AM, Abbas AA, Zedan MH. Retrosternal goiter: the need for thoracic approach based on CT findings: surgeon’s view. J Egypt Natl Canc Inst. 2012 Jun;24(2):85-90. doi: 10.1016/j.jnci.2012.04.002
  12. Ivanov YuV, Istomin NP, Soloviev NA, Zlobin AI, Popov DV. Diagnosis and peculiarities of surgical treatment of girdle thyroid lesions. Surgeon. 2010;(4):69-73. (In Russ.)
Address for correspondence:
115682, Russian Federation,
Moscow, Orekhovy Blvd, 28
Federal Scientific and Clinical Center
for Specialized Types of
Medical Care and Medical Technologies
of the Federal Medical-Biological Agency of Russia,
tel.: +7 926 520 70 62,
e-mail: Sancho-83@inbox.ru,
Zlobin Alexander I.
Information about the authors:
Ivanov Yury V., MD, Professor, Honored Doctor of the Russian Federation, Head of the Department of Surgery, Federal State Budgetary Institution «Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies» FMBA of Russia, Moscow, Russian Federation,
https://orcid.org/0000-0001-6209-4194
Lomakin Ivan A., surgeon, Federal State Budgetary Educational Institution “72 Central Polyclinic” of the Ministry of Emergency Situations of the Russian Federation, Moscow, Russian Federation.
https://orsid.org/0000-0002-9734-7507
Kolbenev Evgeniy I., Department of Radiation Diagnostics, Ramsey Diagnostics Rus LLC, Radiologist. Moscow, Russian Federation.
https://orcid.org/0000-0002-6516-0529
Epifantsev Evgeniy A., Surgeon, Department of Surgery, Federal State Budgetary Institution «Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies», FMBA of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0001-9768-7440
Zlobin Aleksandr I., PhD, Surgeon, Department of Surgery, Federal State Budgetary Institution «Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies», FMBA of Russia, Moscow, Russian Federation
https://orcid.org/0000-0002-8241-659X

T.À. JARKENOV 1, S.Ê. SAKHANOVA 1, M.N. ZHUMABAEV 1, S.T. ZAIROVA 2, M.M. MUKUSHEV 1, K.Z. NURMANOV 1

INFLUENCE OF POLYMORPHISMS OF GENES OF TUMOR NECROSIS FACTOR ALPHA, INTERLEUKIN-1β, INTERLEUKIN-6 AND INTERLEUKIN-10 ON THE DEVELOPMENT OF ACUTE PANCREATITIS IN THE KAZAKH POPULATION

West Kazakhstan Marat Ospanov Medical University 1,
Military Institute of Air Defense named T.J. Begeldinov 2, Aktobe,
Republic of Kazakhstan

Objective. To study the relationship of polymorphisms (rs1800629) of the tumor necrosis factor alpha gene, (rs16944) of the interleukin-1 gene, (rs1800795) of the interleukin-6 gene, (rs1800896) of the interleukin-10 gene with the development of acute pancreatitis in the Kazakh population.
Methods. The material for the study was DNA samples isolated from the peripheral blood of 96 unrelated patients with acute pancreatitis (44 men and 52 women) of Kazakh nationality. The assessment of the severity of the disease was based on the analysis of clinical and laboratory criteria. The control group included 108 (64 men and 44 women) unrelated Kazakh volunteers. Genotyping of polymorphisms (rs1800629) of the TNF-α -308 G/A gene, (rs16944) of the IL-1β -511 C/T gene, (rs1800795) of the IL-6 -174 G/C gene, (rs1800896) of the IL-10 -1082 gene A/G was carried out by real-time PCR.
Results. The genotypes of the studied polymorphisms in the control group were in accordance with the Hardy–Weinberg distribution (p>0,05). An analysis of the association of the studied genotypes with the risk of developing the disease found that the homozygous genotype -308A/A TNF-α -308 was associated with an increased risk of developing acute pancreatitis (OR=10,557, 95% CI 0,561-198,681; p=0,033). There were no significant differences in the distribution of genotypes (rs16944) of the IL-1β gene, (rs1800795) of the IL-6 gene, (rs1800896) of the IL-10 gene between patients with acute pancreatitis and control subjects (p>0,05).
Conclusion. Subjects carrying the -308A/A TNF-α, genotype have an increased risk of developing acute pancreatitis in the Kazakh population.

Keywords: àcute pancreatitis, tumour necrosis factor, Interleukin-1b, Interleukin-6, Interleukin-10, genetic polymorphism
p. 510-518 of the original issue
References
  1. Chen Y, Xie CL, Hu R, Shen CY, Zeng M, Wu CQ, Chen TW, Chen C, Tang MY, Xue HD, Jin ZY & Zhang XM. Genetic Polymorphisms: A Novel Perspective on Acute Pancreatitis. Gastroenterol Res Pract. 2017;2017:5135172. doi: 10.1155/2017/5135172
  2. Rodriguez-Nicolas A, Jiménez P, Carmona FD, et al. Association between Genetic Polymorphisms of Inflammatory Response Genes and Acute Pancreatitis. Immunol Invest. 2019;48(6):585-96. doi: 10.1080/08820139.2019.1576729
  3. Park JW, Choi JS, Han KJ, Lee SH, Kim EJ, Cho JH. Association of a genetic polymorphism of IL1RN with risk of acute pancreatitis in a Korean ethnic group. Korean J Intern Med. 2018 Nov;33(6):1103-10. doi: 10.3904/kjim.2017.133
  4. Jarkenov TA, Skipenko OG, Zhumabaev MN,. Zairova ST, Akataev NA, Yessenbaev DB, Mukushev MM Nurmanov, KZh, Balshambaev ME. The Association of Tumor Necrosis Factor-α Gene Polymorphism with the Severity of Acute Pancreatitis: a Systematic Review. Novosti Khirurgii. 2020 May-Jun; 28(3):309-17. doi: 10.22416/1382-4376-2017-27-3-27-33 (In Russ.)
  5. Liu Y, Dan G, Wu L, Chen G, Wu A, Zeng P, Xu W. Functional effect of polymorphisms in the promoter of TNFAIP3 (A20) in acute pancreatitis in the Han Chinese population. PLoS One. 2014 Jul 22;9(7):e103104. doi: 10.1371/journal.pone.0103104. eCollection 2014.
  6. Bishehsari F, Sharma A, Stello K, Toth C, O’Connell MR, Evans AC, LaRusch J, Muddana V, Papachristou GI, Whitcomb DC. TNF-alpha gene (TNFA) variants increase risk for multi-organ dysfunction syndrome (MODS) in acute pancreatitis. Pancreatology. 2012 Mar- Apr;12(2):113-8. doi: 10.1016/j.pan.2012.02.014
  7. Samgina TA, Bushueva OIu, Ivanov VP, Solodilova MA, Nazarenko PM, Polonikov AV. Sviaz’ promotornogo polimorfizma -308G>A gena faktora nekroza opukholi s tiazhest’iu techeniia ostrogo pankreatita u russkoi populiatsii zhitelei Kurskoi oblasti. Eksperim i Klin Gastroenterologiia. 2014;(9):17-20. https://elibrary.ru/item.asp?id=22677286 (In Russ.)
  8. Özhan G, Yanar HT, Ertekin C, Alpertunga B. Polymorphisms in tumour necrosis factor alpha (TNFalpha) gene in patients with acute pancreatitis. Mediators Inflamm. 2010;2010:482950. doi: 10.1155/2010/482950
  9. Park JW, Choi JS, Han KJ, Lee SH, Kim EJ, Cho JH. Association of a genetic polymorphism of IL1RN with risk of acute pancreatitis in a Korean ethnic group. Korean J Intern Med. 2018 Nov;33(6):1103-10. doi: 10.3904/kjim.2017.133
  10. Chi DZ, Chen J, Huang DP. Influence of interleukin-1β and interleukin-6 gene polymorphisms on the development of acute pancreatitis. Genet Mol Res. 2015 Feb 3;14(1):975-80. doi: 10.4238/2015.February.3.5.
  11. Samgina T.A., Zhivotova G.A., Nazarenko P.M., Polonikov A.V. The role of cytokine genetic polymorphism in development of acute pancreatitis: analysis of intergenic and environmental interactions. Russian Journal of Gastroenterology. doi: 10.22416/1382-4376-2017-27-3-27-33
  12. Jiang BZ, Tang L, Xue H, Liu DP. Role of IL-10 gene polymorphisms in the development of acute pancreatitis. Genet Mol Res. 2016;15(2):10.4238/gmr.15027743. doi: 10.4238/gmr.15027743
  13. Jiang S, Ni M, Zhang Y, Wu Y, Lu X. Association of IL-10 polymorphisms with acute pancreatitis. Int J Clin Exp Med. 2016;9(12):23702-706. https://e-century.us/files/ijcem/9/12/ijcem0038845.pdf
  14. Li D, Li J, Wang L, Zhang Q. Association between IL-1β, IL-8, and IL-10 polymorphisms and risk of acute pancreatitis. Genet Mol Res. 2015;14(2):6635-6641. doi: 10.4238/2015.June.18.6
  15. Bao XB, Ma Z, Gu JB, Wang XQ, Li HG, Wang WY. IL-8 -251T/A polymorphism is associated with susceptibility to acute pancreatitis. Genet Mol Res. 2015;14(1):1508-1514. doi: 10.4238/2015.February.20.6
Address for correspondence:
030019, Republic of Kazakhstan,
Aktobe, Maresev st. 68,
West Kazakhstan Medical
University named after Marat Ospanov,
Department of Surgical Diseases No1,
grid.443411.7,
tel.: +7 7132 544297,
e-mail: timurjarkenov@zkmu.kz,
Dzharkenov Timur A.
Information about the authors:
Jarkenov Timur A., MD, Professor of the Department of Surgical Diseases No. 1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
https://orcid.org/0000-0003-4579-6412
Sakhanova Svetlana K., MD, Associate Professor, Head of the Scientific and Practical Center, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
https://orcid.org/0000-0001-9786-6326
Zhumabaev Marat N, Ph.D., Associate Professor, Head of the Department of Surgical Diseases No. 1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan. https://orcid.org/0000-0002-5092-6034
Zairova Saule T, PhD, Head of the Psychological Service security, Military Institute of Air Defense Named T.J. Begeldinov, Aktobe, Republic of Kazakhstan.
https://orcid.org/0000-0003-3734-6884
Mukushev Manas M , PhD, Associate Professor of the Department of Surgical Diseases No. 1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
https://orcid.org/0000-0003-1811-3276
Nurmanov Kairat Z, Assistant of the Department of Surgical Diseases No. 1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
https://orcid.org/0000-0003-1422-7524

À.I. ÊOUSHNEROU 2, I.A. HADJI-ISMAIL 1, A.V. VARABEI 2, S.I. RUDENKA 1

FEATURES OF ULTRASOUND DIAGNOSTICS IN ACUTE COMPLICATIONS OF DIVERTICULAR DISEASE OF THE COLON

Belarusian Medical Academy of Postgraduate Education 1,
Medical Centre «NeoMediñal» 2, Minsk,
Republic of Belarus

Objective. To analyze and systematize the results of ultrasound scan in patients with acute complications of diverticular disease of the colon.
Methods. The results of ultrasound scan of the intestine were analyzed in 57 patients who complained of acute abdominal pain, flatulence and stool abnormalities, who had diverticular disease of the colon. Of these, 31 (54,4%) were women and 26 (45,6%) were men. In 49 (86%) patients, diverticula were located in the left side of the colon, in 6 (10,5%) patients, diverticula were located in the right side of the colon and 2 (3,5%) patients, diverticula were found all over colon.
Result. A preliminary ultrasound classification of acute complications of diverticular disease of the colon according to the severity of the course (4 degrees) has been developed. The first degree indicates an inflamed diverticulum with/without pericolitis, with/without abscess ≤2 cm in diameter regardless of localisation in relation to the mesenteric and anti-mesenteric margins. The second degree indicates an inflamed diverticulum with an abscess >3 cm in diameter or with a diverticulum perforation along the mesenteric margin, as well as with an abscess >2cm and with a perforation along the anti-mesenteric margin. The third degree is characterized by focal or generalized purulent peritonitis. The fourth degree - development of faecal peritonitis.
Conclusion. Ultrasound is safe, non-invasive, easy and affordable, It allows at once visualize not only the entire gastrointestinal tract, but also other organs and systems, in parallel interpret both clinical and ultrasound data, classify patients into outpatient and inpatient depending on the severity of complications of diverticular disease of the colon.

Keywords: diverticular disease, colon, ultrasound, complication, classification
p. 518-527 of the original issue
References
  1. Ambrosetti P, Chautems R, Soravia C, Peiris-Waser N, Terrier F. Long-term outcome of mesocolic and pelvic diverticular abscesses of the left colon: a prospective study of 73 cases. Dis Colon Rectum. 2005 Apr;48(4):787-91. doi: 10.1007/s10350-004-0853-z
  2. Vorob’ev GI, Pancyrev JuM, Zhuchenko AP, Achkasov SI, Manvelidze AG, Moskalev AI, Bolihov KV. Ostryj divertikulit sigmovidnoj kishki: klinika, diagnostika i lechenie. Med Vestn Bashkortostana. 2008;3(3):12-19. (In Russ.)
  3. Baker ME. Imaging and interventional techniques in acute left-sided diverticulitis. J Gastrointest Surg. 2008 Aug;12(8):1314-17. doi: 10.1007/s11605-008-0490-2
  4. Sheiman L, Levine MS, Levin AA, Hogan J, Rubesin SE, Furth EE, Laufer I. Chronic diverticulitis: clinical, radiographic, and pathologic findings. AJR Am J Roentgenol. 2008 Aug;191(2):522-28. doi: 10.2214/AJR.07.3597
  5. Norsa AH, Tonolini M, Ippolito S, Bianco R. Water enema multidetector CT technique and imaging of diverticulitis and chronic inflammatory bowel diseases. Insights Imaging. 2013 Jun;4(3):309-20. doi: 10.1007/s13244-013-0239-7
  6. Rafferty J, Shellito P, Hyman NH, Buie WD; Standards Committee of American Society of Colon and Rectal Surgeons. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006 Jul;49(7):939-44. doi: 10.1007/s10350-006-0578-2
  7. Frush DP, Applegate K. Computed tomography and radiation: understanding the issues. J Am Coll Radiol. 2004 Feb;1(2):113-19. doi: 10.1016/j.jacr.2003.11.012
  8. Horuzhik SA, Mihajlov AN. Doza obluchenija pri komp’juterno-tomograficheskih issledovanijah: dozimetricheskie parametry, izmerenie, sposoby snizhenija, radiacionnyj risk. Vestn Rentgenologii i Radiologii. 2007;(6):53-62. https://elibrary.ru/item.asp?id=15183864 (In Russ.)
  9. Kaiser AM, Jiang JK, Lake JP, Ault G, Artinyan A, Gonzalez-Ruiz C, Essani R, Beart RW Jr. The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol. 2005 Apr;100(4):910-17. doi: 10.1111/j.1572-0241.2005.41154.x
  10. Laméris W, van Randen A, Bipat S, Bossuyt PM, Boermeester MA, Stoker J. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol. 2008 Nov;18(11):2498-511. doi: 10.1007/s00330-008-1018-6
  11. Laméris W, van Randen A, van Gulik TM, Busch OR, Winkelhagen J, Bossuyt PM, Stoker J, Boermeester MA. A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department. Dis Colon Rectum. 2010 Jun;53(6):896-904. doi: 10.1007/DCR.0b013e3181d98d86
  12. Êoushnerou AI, Hadzhi-Ismail IA, Vorobej AV, Rudenko SI. Ul’trazvukovaja diagnostika oslozhnennoj divertikuljarnoj bolezni obodochnoj kishki. Zdravoohranenie. 2021;(6):63-71. https://www.zdrav.by/hirurgiya/ultrazvukovaya-diagnostika-oslozhnennoj-divertikulyarnoj-bolezni-obodochnoj-kishki/ (n Russ.)
  13. Andeweg CS, Felt-Bersma R, Verbon A, Stoker J, Boermeester M, Bleichrodt R. Summary of the practice guideline on diverticulitis in the colon: diagnostics and treatment in specialty care. Ned Tijdschr Geneeskd. 2013;157(15):A6124. [Article in Dutch]
  14. Andeweg CS, Mulder IM, Felt-Bersma RJ, Verbon A, van der Wilt GJ, van Goor H, Lange JF, Stoker J, Boermeester MA, Bleichrodt RP; Netherlands Society of Surgery; Working group from Netherlands Societies of Internal Medicine, Gastroenterologists, Radiology, Health echnology Assessment and Dieticians. Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Dig Surg. 2013;30(4-6):278-92. doi: 10.1159/000354035
  15. Trubacheva JuL, Orlova LP, Moskalev AI, Skridlevskij SN, Belov DM, Shahmatov DG, Achkasov SI. Ultrasound diagnosis of chronic paracolic inflammatory mass in diverticular disease. Hirurgija. Zhurn im. N.I. Pirogova. 2020;9:14-19. doi: 10.17116/hirurgia202009114 (In Russ.)
  16. Êoushnerou AI, Hadzhi-Ismail IA, Vorobej AV, Rudenko SI. Comprehensive Ultrasound Diagnosis of Sigmoid Diverticulitis. Ros Zhurn Gastrojenterologii, Gepatologii, Koloproktologii. 2021;31(4):45-54. doi: 10.22416/1382-4376-2021-31-4-45-54 (In Russ.)
  17. Puylaert JB. Ultrasound of acute GI tract conditions. Eur Radiol. 2001;11(10):1867-77. doi: 10.1007/s003300101076
  18. Puylaert JB. Ultrasound of colon diverticulitis. Dig Dis. 2012;30(1):56-59. doi: 10.1159/000336620
  19. Shelygin YuA, Achkasov SI, Moskalev AI. Classification of diverticular disease. Koloproktologija. 2014;(4):5-13. https://elibrary.ru/item.asp?id=22616014 (In Russ.)
  20. Klarenbeek BR, de Korte N, van der Peet DL, Cuesta MA. Review of current classifications for diverticular disease and a translation into clinical practice. Int J Colorectal Dis. 2012 Feb;27(2):207-14. doi: 10.1007/s00384-011-1314-5
  21. Sher ME, Agachan F, Bortul M, Nogueras JJ, Weiss EG, Wexner SD. Laparoscopic surgery for diverticulitis. Surg Endosc. 1997 Mar;11(3):264-67. doi: 10.1007/s004649900340
  22. Kushnerov AI. Ul’trazvukovaja diagnostika novoobrazovanij tolstoj kishki. Prakticheskoe rukovodstvo. Moscow, RF: Med. lit.; 2014. 119 p. (In Russ.)
  23. Butorova LI. Divertikuljarnaja bolezn’ tolstoj kishki: klinicheskie formy, diagnostika i lechenie: posobie dlja vrachej. Mosñow, RF: 4TE Art; 2011. 48 s. http://www.mucofalk.ru/ data/download/butorova-divert.pdf (In Russ.)
  24. . Orlova LP. Trubacheva Yu.L., Markova E.V. Colonic diverticulitis: diagnostic value and appearance of inflamed diverticula – echographic evaluation. Ul’trazvukovaja i Funktion Diagnostika. 2008;(3):18-25. (In Russ).
Address for correspondence:
223041, Republic of Belarus,
Minsk region, Minsk district, a/g Lesnoy-1.
Belarusian Medical Academy of Postgraduate Education, Department of Surgery,
Tel. +375 44 7514263,
e-mail: docismailabbas@gmail.com,
Haji Ismail Ismail Abbas
Information about the authors:
Koushnerou Alexandr I., MD, Professor, Medical Center «NeoMedical», Minsk, Republic of Belarus.
https://orcid.org/0000-0002-1012-5101
Haji-Ismail Ismail Abbas, PhD, Associate Professor, Belarusian Medical Academy of Postgraduate Education, Department of Surgery, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-9588-7422
Varabei Aliaksandr V., MD, Professor, Corresponding Member of the National Academy of Sciences of the Republic of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-9765-2755
Rudenka Svetlana I., PhD, Ðhysician (ultrasound) at the NeoMedical Medical Center, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-6066-0153

V.I. SILVISTROVICH, A.A. LYZIKOV, M.L. KAPLAN

MODIFIED POLYVINYL ALCOHOL-BASED HYDROGEL COATINGS OF PROLONGET ACTION IN THE TREATMENT OF TROPHIC ULCERS OF DIABETIC GENESIS IN EXPERIMENT

EE "Gomel State Medical University", Gomel,
Republic of Belarus

Methods. The study was performed on 240 male laboratory rats after preliminary modeling of alloxan diabetes mellitus, paw ischemia by ligation of the femoral artery, formation of a trophic ulcer by intradermal injection of 0.6 ml of 10% calcium chloride. The developed wound dressings were used in all animals, which were divided into four groups. A clinical assessment of the wound was carried out, the sampling of granulation tissue was performed on the third, seventh and 14th days. Histological material was stained with hematoxylin-eosin and trichrome MSB according to the standard method. A semi-quantitative histological evaluation was used to assess reparative processes.
Results. When applying a wound dressing without an antibacterial agent (first group), there is abundant infiltration with neutrophils, coagulation necrosis during the entire observation period. The presence of immature granulation tissue by day 14 indicates the absence of regeneration in the ulcer. The addition of gentamicin to dressing reduces inflammatory responses. Granulation tissue matures by the 7th day. Signs of epithelialization in the edges of wounds with the absence of inflammation are noted by the 14th day. With the addition of gentamicin and methyluracil to dressing, the presence of granulations was noted by the 7th day, and complete epithelization of wounds by the 14th day.
Conclusion. The addition of gentamicin and methyluracil to the composition of wound dressings statistically significantly (p<0.0001) stimulates regeneration in ulcers compared to the control group and wound dressings without gentamicin and methyluracil, and also reduces inflammatory reactions in the defect zone, stimulates the growth of granulations and their transformation into collagen (p<0.0001), which is an objective criterion for early healing.

Keywords: trophic ulcer, diabetes mellitus, wound dressing, hydrogel
p. 528-539 of the original issue
References
  1. International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: International Diabetes Federation, 2021. http://www.diabetesatlas.org
  2. Armstrong D, Boulton A, Bus S. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367–75.
  3. Lazzarini P, Pacella R, Armstrong D, Netten J. Diabetes-related lower-extremity complications are a leading cause of the global burden of disability. Diabet Med. 2018;35(9):1297-99 doi: 10.1111/dme.13680.
  4. Zhang Y, Lazzarini P, McPhail S, Netten J, Armstrong D, Pacella R. Global Disability Burdens of Diabetes-Related Lower-Extremity Complications in 1990 and 2016. Diabetes Care. 2020;43(5):964-974. doi: 10.2337/dc19-1614.
  5. Jeyaraman K, Berhane T, Hamilton M, Chandra A, Falhammar H. Mortality in patients with diabetic foot ulcer: a retrospective study of 513 cases from a single Centre in the Northern Territory of Australia. BMC Endocr Disord. 2019;19(1):1-7. doi: 10.1186/s12902-018-0327-2.
  6. Grekova NM, Lebedeva YuV, Shishmencev NB, Dinerman GV. Puti snizheniya chastoty vysokih amputacij pri saharnom diabete i prognoz dlya operirovannoj diabeticheskoj stopy. Sovremennye Problemy Nauki i Obrazovaniya. 2017(5); https://science-education.ru/ru/article/view?id=26714 (data obrashcheniya: 11.09.2022 (In Russ.)
  7. Galstyan G, Vikulova OK, Isakov MA, ZHeleznyakova AV, Serkov AA, Egorova DN, Artemova EV, Shestakova MV, Dedov I.I. Epidemiologiya sindroma diabeticheskoj stopy i amputacij nizhnih konechnostej v Rossijskoj Federacii po dannym Federal’nogo registra bol’nyh saharnym diabetom (2013–2016 gg.). Saharnyj Diabet. 2018;21(3):170-77. doi: 10.14341/DM9688 (In Russ.)
  8. Aledzhanov NYu. Klinicheskie osobennosti i kompleksnyj podhod k lecheniyu troficheskih yazv. Nauchnoe Obozrenie. Medicinskie nauki. 2021;(2):35-39. DOI 10.17513/srms.1176. In Russ.)
  9. Bogdanec L.I. Kak mozhno predupredit’ obrazovanie i recidiv troficheskih yazv u bol’nyh s varikoznoj bolezn’yu. Stacionarozameshchayushchie Tekhnologii: Ambulatornaya Hirurgiya. 2015;(1-2):20-25. (In Russ.)
  10. Huang Z-H, Li S-Q, Kou Y, Huang L, Yu T, Hu A. Risk factors for the recurrence of diabetic foot ulcers among diabetic patients: a meta-analysis. Int Wound J. 2019;16(6):1373-1382. doi: 10.1111/iwj.13200.
  11. Komelyagina EYu, Anciferov MB. Osobennosti zazhivleniya ran u bol’nyh s sindromom diabeticheskoj stopy. Endokrinologiya. Novosti. Mneniya. Obuchenie. 2018;7(4):42-47. In Russ.)
  12. Supil’nikov AA, Devyatkin AA, Pavlova ON, Gulenko ON. Morfologicheskie i fiziologicheskie aspekty techeniya ranevogo processa. Vestnik Medicinskogo Instituta «REAVIZ». 2016;(3):144-151 (In Russ.)
  13. Morozov AM, Sergeev AN, Sergeev NA, Dubatolov GA, ZHukov SV, Gorodnichev KI, Muravlyanceva MM, Suhareva DD. Ispol’zovanie sovremennyh ranevyh pokrytij v mestnom lechenii ran razlichnoj etiologii. Sovremennye Problemy Nauki i Obrazovaniya. 2020;(2). doi: 10.17513/spno.29705 (In Russ.)
  14. Risman BV, Ivanov GG, Mustakimov DN. Rezul’taty lecheniya pacientov s gnojno-nekroticheskimi oslozhneniyami sindroma diabeticheskoj stopy s primeneniem sovremennyh ranevyh pokrytij na osnove al’ginatov, gidrokolloidov i gidrogelej (Ranevye pokrytiya i sindrom diabeticheskoj stopy). Rany i Ranevye Infekcii. Zhurnal im Prof BM Kostyuchyonka. 2017;4(2):18–23. DOI: 10.25199/2408-9613-2017-4-2-18-23 (In Russ.)
  15. Kashtanov AD, Vasil’ev YuL, Bajrashevskaya AV. Obzor sovremennyh materialov, primenyaemyh dlya pokrytiya ranevyh poverhnostej. Operativnaya Khirurgiya i Klinicheskaya Anatomiya. 2020;4(2):49-56.(In Russ.)
  16. Junker JP, Kamel RA, Caterson EJ, Eriksson E. Clinical Impact Upon Wound Healing and Inflammation in Moist, Wet, and Dry Environments. Adv Wound Care (New Rochelle). 2013;2(7):348-56. doi: 10.1089/wound.2012.0412
  17. Hinman CD. Maibach H. Effect of air exposure and occlusion on experimental human skin wounds. Nature. 1963 Oct 26;200:377-8. doi: 10.1038/20377a0
  18. Yakimcova LB, Popko E S. Vysvobozhdenie lekarstvennyh veshchestv iz gidro- gelevyh plenok na osnove sopolimerov akrilamida s 2-akrilamid-2-metil- propansul’fokislotoj i ee natrievoj sol’yu. Sviridovskie Chteniya: sb. St.2012;(8):243-52.
  19. Cvetkova EA, Gol’dade VA, Uharceva IYu, Zotov SV, Kadolich ZhV, Sil’vistrovich VI, Kikineva EG. Polimernye kompozicionnye materialy s magnitnymi napolnitelyami (obzor). Vestn Tekhnolog Un. 2020;23(12):27-37.
  20. Abramov Y, Golden B, Sullivan M, Botros SM, Miller JJ, Alshahrour A, Goldberg RP, Sand PK. Histologic characterization of vaginal vs. abdominal surgical wound healing in a rabbit model. Wound Repair Regen. 2007 Jan-Feb;15(1):80-86. doi: 10.1111/j.1524-475X.2006.00188.x.
Address for correspondence:
246000, Republic of Belarus,
Gomel, st. Lange, 5,
Gomel State Medical University,
Department of Surgical Diseases No. 1
with a Course of Cardiovascular Surgery,
tel. mob.: +375 29 6837629,
e-mail: trosko.viktoriya.89@inbox.ru,
Silvistrovich Victoria I.
Information about the authors:
Silvistrovich Victoria I., assistant of the Department of Surgical Diseases No. 1 with a course of cardiovascular surgery, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-9968-5614
Lyzikov Aleksey An., MD, Professor, Head of the Department of Surgical Diseases No. 1 with a Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0003-0639-121X
Kaplan Mark L., PhD Candidate of Medical Sciences, Associate Professor of the Department of Surgical Diseases No. 1 with a Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0001-7782-3281
Osipov Boris B., PhD, Associate Professor of the Department of Surgical Diseases No. 1 with a Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0001-9283-3680

A.M. MEREDZHI 1, 2, A.Y. ORLOV 1, A.S. NAZAROV1, Y.V. BELYAKOV 1, A.V. KUDZIEV1, T.V. LALAYAN 1, S.B. SINGAEVSKIY 1, P.V. SMIRNOV 2

PERCUTANEOUS FULL-ENDOSCOPIC TRANSFORAMINAL SUBANNULAR DISCECTOMY FOR LARGE MEDIAN «PROTRUSIVE» TYPE LUMBAR DISC HERNIATIONS

Polenov Neurosurgical Research Institute, branch of Federal State Budgetary Institution “Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation 1, Saint Petersburg,
Multidisciplinary Clinic Named after N.I. Pirogov 2, Saint Petersburg,
Russian Federation

Objective. Evaluation of clinical results and technical features of percutaneous full-endoscopic transforaminal subannular removal of large median hernias of the «protrusion» type of the lumbar spine.
Methods. The patients (n=27) with large median hernias of the lumbar spine have been operated (2016-2019 and the results of percutaneous full-endoscopic transforaminal discectomy for large median herniations have been analized. To evaluate the results of surgical treatment used the ODI questionnaire, VAS scale and McNab.
Results. The assessment was made before surgery, the next day, after 1, 6 12 and 24 months after surgery,The average severity of preoperative radicular axial and back pain according VAS after surgery decreased from 7,8±1,4 and 5,2±1,2 to 1,6±1,2 (in average 6,3, 95% CI (confidence interval) : from 5,6 to 7,0; t=19,00; p<2,2×1016) and 3,6±1,4 (in average 1,1, 95% CI: from 0,2 to 2,0; t=2,411; p=0,0233) the next day; to 1,8±1,4 (in average 5,9, 95% CI: from 5,1 to 6,8; t=15,12; p=2,2×10−14) and 3,6±1,4 (in average 1,2, 95% CI: from 0,5 to 1,8; t=3,677; p=0,0011) after 1 month; to 1,5±1,2 (in average 6,2, 95% CI: from 5,5 to 6,9; t=17,60; p=5,9×10−16) and 2,8±1,4 (in average 2,3, 95% CI: from 1,5 to 3,0; t=6,332; p=1,1×10−6) after 6 months; to 1,5±1,2 (in average 6,3, 95% CI: from 5,7 to 7,0; t=20,26; p<2,2×10−16) and 2,8±1,4 (in average 2,4, 95% CI: from 1,7 to 3,2; t=6,653; p=4,7×10−7) after 12 months and 1,6±1,2 (in average 5,7, 95% CI: from 5,0 to 6,5; t=15,87; p=6,9×10−15) and 2,0±1,2 (in average 3,3 áàëëà, 95% CI: from 2,6 to 4,0; t=9,991; p=2,2×10−10) 24 months after surgery, respectively, According to the McNab scale, 10 (37,0%) patients rated the treatment results “excellent”, 15 (55,6%) “good”, 2 (7,4%) satisfactory. The average ODI improved from 65,2±6,4 to 19,2±2,8 (in average 47,9, 95% CI: from 44,4 to 51,4; t=28,04; p<2,2×10−16) after 1 month; to 14,6±2,2 (in average 50,3, 95% CI: from 46,9 to 53,6; t=30,91; p<2,2×10−16) after 6 months; to 15,4±2,3 (in average 50,9, 95% CI: from 47,6 to 54,1; t=32,15; p<2,2×10−16) after 12 months and to 14,4±2,2 (in average 51,4, 95% CI: from 48,7 to 54,2; t=38,05; p<2,2×10−16) 24 months after surgery, respectively.
Conclusion. Percutaneous full-endoscopic transforaminal subannular removal of large median herniations of the “protrusive” type of the lumbar spine is consided to be a safe and effective method; avoiding excessive unnecessary resection of the bone structural elements of the spine and the risks of neurological complications associated with traction of dural sac and roots of the spinal cord; reducing the recurrence risk of such herniations and avoiding spinal fusion; facilitating early postoperative activation and recovery of the patient.

Keywords: endoscopic transforaminal discectomy for large median disc herniations
p. 540-551 of the original issue
References
  1. Akhaddar A, Belfquih H, Salami M, Boucetta M. Surgical management of giant lumbar disc herniation: analysis of 154 patients over a decade. Neurochirurgie. 2014 Oct;60(5):244-48. doi: 10.1016/j.neuchi.2014.02.012
  2. Barth M, Diepers M, Weiss C, Thomé C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine (Phila Pa 1976). 2008 Feb 1;33(3):273-79. doi: 10.1097/BRS.0b013e31816201a6
  3. Barth M, Weiss C, Thomé C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine (Phila Pa 1976). 2008 Feb 1;33(3):265-72.
  4. Black HA. Massive Herniation of the intervertebral disc producing compression of the cauda equina. Calif Med. 1948;69:271-74.
  5. Carragee EJ, Spinnickie AO, Alamin TF, Paragioudakis S. A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect. Spine (Phila Pa 1976). 2006 Mar 15;31(6):653-57. doi: 10.1097/01.brs.0000203714.76250.68
  6. Carragee EJ, Han MY, Suen PW, Kim D. Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am. 2003 Jan;85(1):102-8. doi: 10.2106/00004623-200301000-00016
  7. Choi KC, Lee JH, Kim JS, Sabal LA, Lee S, Kim H, Lee SH. Unsuccessful percutaneous endoscopic lumbar discectomy: a single-center experience of 10,228 cases. Neurosurgery. 2015 Apr;76(4):372-80; discussion 380-1; quiz 381. doi: 10.1227/NEU.0000000000000628
  8. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001 Sep 1;26(17):1873-78. doi: 10.1097/00007632-200109010-00011
  9. Cribb GL, Jaffray DC, Cassar-Pullicino VN. Observations on the natural history of massive lumbar disc herniation. J Bone Joint Surg Br. 2007 Jun;89(6):782-84. doi: 10.1302/0301-620X.89B6.18712
  10. Belykh E, Krutko AV, Baykov ES, Giers MB, Preul MC, Byvaltsev VA. Preoperative estimation of disc herniation recurrence after microdiscectomy: predictive value of a multivariate model based on radiographic parameters. Spine J. 2017 Mar;17(3):390-400. doi: 10.1016/j.spinee.2016.10.011
  11. Fardon DF, Milette PC; Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976). 2001 Mar 1;26(5):E93-E113. doi: 10.1097/00007632-200103010-00006
  12. Faulhauer K, Manicke C. Fragment excision versus conventional disc removal in the microsurgical treatment of herniated lumbar disc. Acta Neurochir (Wien). 1995;133(3-4):107-11. doi: 10.1007/BF01420059
  13. Goel VK, Nishiyama K, Weinstein JN, Liu YK. Mechanical properties of lumbar spinal motion segments as affected by partial disc removal. Spine (Phila Pa 1976). 1986 Dec;11(10):1008-12. doi: 10.1097/00007632-198612000-00007
  14. Choi G, Lee SH, Lokhande P, Kong BJ, Shim CS, Jung B, Kim JS. Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine (Phila Pa 1976). 2008 Jul 1;33(15):E508-15. doi: 10.1097/BRS.0b013e31817bfa1a
  15. Jeon CH, Chung NS, Son KH, Lee HS. Massive lumbar disc herniation with complete dural sac stenosis. Indian J Orthop. 2013 May;47(3):244-49. doi: 10.4103/0019-5413.111505
  16. Kim KT, Park SW, Kim YB. Disc height and segmental motion as risk factors for recurrent lumbar disc herniation. Spine (Phila Pa 1976). 2009 Nov 15;34(24):2674-78. doi: 10.1097/BRS.0b013e3181b4aaac
  17. Lee DY, Shim CS, Ahn Y, Choi YG, Kim HJ, Lee SH. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation. J Korean Neurosurg Soc. 2009 Dec;46(6):515-21. doi: 10.3340/jkns.2009.46.6.515
  18. Louison R, Barber JB. Massive herniation of lumbar discs with compression of the cauda equine – a surgical emergency; report of two cases. J Natl Med Assoc. 1968 May;60(3):188-90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2611474/
  19. McGirt MJ, Eustacchio S, Varga P, Vilendecic M, Trummer M, Gorensek M, Ledic D, Carragee EJ. A Prospective Cohort Study of Close Interval Computed Tomography and Magnetic Resonance Imaging After Primary Lumbar Discectomy: Factors Associated With Recurrent Disc Herniation and Disc Height Loss. Spine. 2009;34(19):2044-51. doi: 10.1097/brs.0b013e3181b34a9a
  20. Kondo M, Oshima Y, Inoue H, Takano Y, Inanami H, Koga H. Significance and pitfalls of percutaneous endoscopic lumbar discectomy for large central lumbar disc herniation. J Spine Surg. 2018 Mar;4(1):79-85. doi: 10.21037/jss.2018.03.06
  21. Mochida J, Nishimura K, Nomura T, Toh E, Chiba M. The importance of preserving disc structure in surgical approach to lumbar disc herniation. Spine. 1996 Jul 1;21(13):1556-63; discussion 1563-4. doi: 10.1097/00007632-199607010-00014
  22. Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008 Apr 20;33(9):931-39. doi: 10.1097/BRS.0b013e31816c8af7
  23. Lee SH, Choi KC, Baek OK, Kim HJ, Yoo SH. Percutaneous endoscopic intra-annular subligamentous herniotomy for large central disc herniation: a technical case report. Spine (Phila Pa 1976). 2014 Apr 1;39(7):E473-9. doi: 10.1097/BRS.0000000000000239
  24. Benson RT, Tavares SP, Robertson SC, Sharp R, Marshall RW. Conservatively treated massive prolapsed discs: a 7-year follow-up. Ann R Coll Surg Engl. 2010 Mar;92(2):147-53. doi: 10.1308/003588410X12518836438840
  25. Shen M, Razi A, Lurie JD, Hanscom B, Weinstein J. Retrolisthesis and lumbar disc herniation: a preoperative assessment of patient function. Spine J. 2007 Jul-Aug;7(4):406-13. doi: 10.1016/j.spinee.2006.08.011
  26. Meredzi AM, Gulyaev DA, Singaevskiy SB, Prishvin AP. Percutaneous transforaminal endoscopic discectomy for the upper lumbar disc herniation. Ros Neirokhirurg Zhurn im prof. AL Polenova. 2017;9(4):22-29. https://polenovjournal.ru/2017_4 (In Russ.)
  27. Merzhoev AM, Guliaev DA, Davydov EA. Perkutannaia endoskopicheskaia poiasnichnaia diskektomiia – interlaminarnyi dostup. Ros Neirokhirurg Zhurn im prof AL Polenova. 2017;9(1):49-56. https://polenovjournal.ru/2017_ (In Russ.)
Address for correspondence:
19101, Russian Federation, St. Petersburg,
«Russian Research Neurosurgical Institute Named after prof, A. L. Polenov» - a Branch of the Federal
State Budgetary Institution «NMRC» Named after V.A. Almazov Ministry of Health of the Russian Federation, Mayakovsky st., 12
E-mail: yv.belyakov@yahoo.com,
tel. +79967992946
Belyakov Yury V.
Information about the authors:
Mereji Amir M., Neurosurgeon, PhD, Senior Researcher, Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System, Russian Research Neurosurgical Institute Named after Proftssor A. L. Polenov a Branch of the Federal State Budgetary Institution «NMRC» named after V.A. Almazov Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation, Multidisciplinary Clinic Named after N.I. Pirogov, Saint Petersburg, Russian Federation.
https://orcid.org/0000-0003-3282-2992
Orlov Andrey Y., Neurosurgeon. MD, Head of the Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System Russian Research Neurosurgical Institute Named after Professor A. L. Polenov a Branch of the Federal State Budgetary Institution «NMRC» named after V.A. Almazov Ministry of Health of the Russian Federation, Russia, St. Petersburg, Russian Federation, Multidisciplinary Clinic Named after N.I. Pirogov, Russia, St. Petersburg, Russian Federation.
https://orcid.org/0000-0001-6597-3733
Nazarov Alexander S. Neurosurgeon, PhD, Senior Researcher at the Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System, Head of the Department of Neurosurgery of the Spine and Peripheral Nervous System, Russian Research Neurosurgical Institute Named after Professor A. L. Polenov a Branch of the Federal State Budgetary Institution «NMRC» Named after V.A. Almazov Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0002-5727-5991
Belyakov Yury V., Neurosurgeon, Researcher at the Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System, Russian Research Neurosurgical Institute Named after Professor, A. L. Polenov a Branch of the Federal State Budgetary Institution «NMRC» Named after V.A. Almazov Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0001-8772-5781
Kudziev Andrey V., Neurosurgeon, Researcher in the Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System, Russian Research Neurosurgical Institute Named after Professor A. L. Polenov a Branch of the Federal State Budgetary Institution «NMRC» Named after V.A. Almazov Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0001-9061-5014
Lalayan Tigran V., Neurologist, PhD, Associate Professor of the Department of Neurology and Manual Medicine, Faculty of Postgraduate Education of the First SSMU Named after Academician I.P. Pavlov, St. Petersburg, Russian Federation.
https://orcid.org/0000-0001-7946-0517
Singaevskiy Sergey B., Surgeon, MD, Chief Physician of the Multidisciplinary Clinic Named after N.I. Pirogov, St. Petersburg, Russian Federation.
https://orcid.org/0000-0003-3426-2431
Smirnov Pavel V., Neurologist of the Multidisciplinary Clinic Named after N.I.Pirogov. St. Petersburg, Russian Federation.
https://orcid.org/0000-0001-5225-5329

GENERAL & SPECIAL SURGERY

A.N. IHNATSIUK, A.S. KARPITSKI

TREATMENT OF PERFORATIONS OF THE THORACIC ESOPHAGUS

Healthcare Institution «Brest Regional Clinical Hospital», Brest,
Republic of Belarus

Objective. To improve the results of treatment of esophageal perforations by using the current minimally invasive video-assisted thoracoscopic technologies.
Methods. The patients (n=54) underwent the treatment: 41 (75.9%) men and 13 women (24.1%). The average age of patients was 52 years. The causes of perforations are as follows: spontaneous rupture of the esophagus − 21 (38.9%); foreign body of the esophagus - 9 (16.7%); cancer − 2 (3.7%); iatrogenic damage - 5 (9.3%); cardiodilatation with achalasia of the cardia - 2 (3.7%); bougie stricture of the esophagus with reflux esophagitis − 1 (1.9%); swelling of the scar-altered esophagus due to chemical burn of the esophagus - 14 (25.9%). The average time from the initial clinical manifestations to surgery was 24 hours. The discrepancy between the primary diagnosis and the final one was revealed in 23 (42.6%) patients. All patients (n=54) were operated on. 47 (87%) patients were discharged in satisfactory condition, 7 (13%) died.
Results. Pre-operative factors affecting the tactics of surgery: «coincidence of the primary diagnosis with the main one»; «diagnosis» and «distance from incisors to esophageal perforation» was determined. The best treatment results in the groups using the «controlled fistula» method were obtained. Thus, in the upper and middle thoracic regions, the optimal method was to fix the drainage at the site of esophageal perforation, in the lower thoracic region - the installation of a T-shaped drainage system.
Conclusion. The method of choosing surgical treatment depends on the correct primary diagnosis, the level of perforation and the main cause of esophageal perforation. In the absence of «compromised» esophagus in the treatment of its perforation, minimally invasive thoracoscopic intervention provides the best results by reducing the duration of rehabilitation, improving the quality of life and reducing mortality rate. The conducted clinical study made it possible to improve the treatment outcomes of patients with esophageal perforation in various pathologies.

Keywords: esophageal perforation, T-shaped drainage system, fixation of the transpleural tube, extirpation of the esophagus.
p. 552-561 of the original issue
References
  1. Axtell AL, Gaissert HA, Morse CR, Premkumar A, Schumacher L, Muniappan A, Ott H, Allan JS, Lanuti M, Mathisen DJ, Wright CD. Management and outcomes of esophageal perforation. Dis Esophagus. 2022 Jan 7;35(1):doab039. doi: 10.1093/dote/doab039
  2. Chirica M, Kelly MD, Siboni S, Aiolfi A, Riva CG, Asti E, Ferrari D, Leppäniemi A, Ten Broek RPG, Brichon PY, Kluger Y, Fraga GP, Frey G, Andreollo NA, Coccolini F, Frattini C, Moore EE, Chiara O, Di Saverio S, Sartelli M, Weber D, Ansaloni L, Biffl W, Corte H, Wani I, Baiocchi G, Cattan P, Catena F, Bonavina L. Esophageal emergencies: WSES guidelines. World J Emerg Surg. 2019 May 31;14:26. doi: 10.1186/s13017-019-0245-2. eCollection 2019.
  3. Zhu J, Zhu SB, Xi EP. Puncture of the anterior wall of the pericardium by a fish bone from an oesophageal perforation. Eur Heart J. 2022 Jul 7;43(26):2531. doi: 10.1093/eurheartj/ehac258
  4. DeVivo A, Sheng AY, Koyfman A, Long B. High risk and low prevalence diseases: Esophageal perforation. Am J Emerg Med. 2022 Mar;53:29-36. doi: 10.1016/j.ajem.2021.12.017
  5. Mure?an M, Mure?an S, Balmo? I, Sala D, Suciu B, Torok A. Sepsis in acute mediastinitis – a severe complication after oesophageal perforations. A review of the literature. J Crit Care Med (Targu Mures). 2019 May 13;5(2):49-55. doi: 10.2478/jccm-2019-0008. eCollection 2019
  6. Kassem MM, Wallen JM. Esophageal Perforation And Tears. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Jan 17]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK532298/
  7. Biancari F, D’Andrea V, Paone R, Di Marco C, Savino G, Koivukangas V, Saarnio J, Lucenteforte E. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg. 2013 May;37(5):1051-59. doi: 10.1007/s00268-013-1951-7
  8. Aiolfi A, Ferrari D, Riva CG, Toti F, Bonitta G, Bonavina L. Esophageal foreign bodies in adults: systematic review of the literature. Scand J Gastroenterol. 2018 Oct-Nov;53(10-11):1171-78. doi: 10.1080/00365521.2018.1526317
  9. Watkins JR, Farivar AS. Endoluminal Therapies for Esophageal Perforations and Leaks. Thorac Surg Clin. 2018 Nov;28(4):541-54. doi: 10.1016/j.thorsurg.2018.07.002
  10. García-Moreno V, Maiocchi K, Gómez-Quiles L, Villarin-Rodríguez A, Aliaga-Hilario E, Martínez-Hernández A, Abdelkader N, López E, Escrig-Sos J, Laguna-Sastre JM. Treatment of esophageal perforation: A review of our experience at a tertiary referral hospital spanning the past 19 years. Rev Gastroenterol Mex (Engl Ed). 2022 Oct-Dec;87(4):405-10. doi: 10.1016/j.rgmxen.2021.11.014
  11. Ostapenko GO, Lishov EV. Surgical treatment of intrathoracic esophageal perforations, complicated with diffusive purulent mediastinitis. Sib Med Zhurn Irkutsk [Internet]. 2008 [dostupno: 2022 Ianv 18];76(1):43-46. Rezhim dostupa: https://elibrary.ru/item.asp?id=17844846 (In Russ.)
  12. Wright CD, Mathisen DJ, Wain JC, Moncure AC, Hilgenberg AD, Grillo HC. Reinforced primary repair of thoracic esophageal perforation. Ann Thorac Surg. 1995 Aug;60(2):245-48; discussion 248-9. doi: 10.1016/0003-4975(95)00377-w
  13. El-Sourani N. Esophageal perforation: diagnosis, management and decision-making - a retrospective tertiary centre study. Turk J Surg. 2021 Dec 31;37(4):342-346. doi: 10.47717/turkjsurg.2021.5289. eCollection 2021 Dec.
  14. Loske G, Scharsack E, Gobrecht O. Emergency endoscopic negative pressure therapy of a long oesophageal perforation in eosinophilic esophagitis with a single-lumen nasogastric tube-like open-pore film drain. Endoscopy. 2022 May;54(5):E247-E248. doi: 10.1055/a-1493-1805
  15. Panneerselvam K, Samuel R, Sealock RJ. Esophageal Perforation Successfully Treated With EVT. ACG Case Rep J. 2022 Jan 12;9(1):e00711. doi: 10.14309/crj.0000000000000711. eCollection 2022 Jan
  16. Eroglu A, Aydin Y, Ulas AB. Minimally Invasive and Endoscopic Approach to Esophageal Perforation. Eurasian J Med. 2022 Feb;54(1):101-106. Published online 2022 Feb 1. doi: 10.5152/eurasianjmed.2022.21135
  17. Stathopoulos P, Zumblick M, Wächter S, Schiffmann L, Gress TM, Bartsch D, Seitz G, Denzer UW. Endoscopic vacuum therapy (EVT) for acute esophageal perforation: Could it replace surgery? Endosc Int Open. 2022 Feb 24;10(5):E686-E693. doi: 10.1055/a-1781-0827. eCollection 2022 May.
  18. Kumar A, Singla V, Pulle MV, Asaf BB, Puri HV, Bishnoi S. Multidisciplinary, minimally invasive approach for oesophageal perforations with delayed presentation. J Minim Access Surg. 2022 Jul-Sep;18(3):353-59. doi: 10.4103/jmas.JMAS_28_21
  19. Khaitan PG, Famiglietti A, Watson TJ. The Etiology, Diagnosis, and Management of Esophageal Perforation. J Gastrointest Surg. 2022 Dec;26(12):2606-15. doi: 10.1007/s11605-022-05454-2
  20. Tamatey MN, Sereboe LA, Tettey MM, Entsua-Mensah K, Gyan B. Boerhaave’s syndrome: diagnosis and successful primary repair one month after the oesophageal perforation. Ghana Med J. 2013 Mar;47(1):53-55. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645189/
Address for correspondence:
224027, Republic of Belarus,
Brest, 7 Meditsinskaya str.,
Brest Regional Clinical Hospital,
Department of Thoracic Surgery,
tel.: +375298054971,
e-mail: alexihnatsiuk@gmail.com,
Ignatsiuk Aliaksandr N.
Information about the authors:
Ignatyuk Alexander N., Applicant of the Department of General Surgery of the Educational Establishment «Grodno State Medical University», Surgeon of the Department of Thoracic Surgery of the Educational Institution «Brest Regional Clinical Hospital», Brest, Republic of Belarus.
https://orcid.org/0000-0002-8925-380X
Karpitsky Alexander S., MD, Professor, Chief Physician of the ME «Brest Regional Clinical Hospital», Brest, Republic of Belarus.
https://orcid.org/0000-0001-8205-8959

TRAUMATOLOGY AND ORTHOPEDICS

T.A. STUPINA, N.S. MIGALKIN, I.N. MEZENTSEV, A.S. SUDNITSYN

PATHOMORPHOLOGICAL STUDY OF THE COMPONENTS OF THE CHARCOT ANKLE COMPLICATED BY CHRONIC OSTEOMYELITIS AS A BASIS FOR DEVELOPING DIAGNOSTIC HISTOLOGICAL CRITERIA

Federal State Budgetary Institution National Ilizarov Medical Research Centre for Traumatology and Orthopaedics of the RF Ministry of Health, Kurgan,
Russian Federation

Objective. Purpose of this article – to study the charateristic features of the structural rearrangement of the main components of the ankle joint in diabetic neuroosteoarthropathy complicated by chronic osteomyelitis using histopathological semi-quantitative assessment of osteomyelitis.
Methods. Analysis of the data of pathohistological studies of the operating material (bone-and-cartilaginous fragments of the ankle with adjacent soft tissues) of 30 patients with the established diagnosis of diabetic neroosteoarthropathy complicated by chronic osteomyelitis. Light microscopy of paraffin-embedded sections using immunohistochemical evaluation of marker of neutrophilic granulocytes CD15 was performed.
Results. The pronounced destruction of the articular cartilage and subchondral bone was revealed in all the patients. The articular cartilage structure disturbance was noted both on the side of the articular surface (synovial pannus, active chondroclasts), and on the side of the subchondral zone (destruction of the basophilic section, the calcified cartilage zone). Fragments of cartilage and bone were distributed in the articular cavity and in the synovium. The synovium was hypertrophied, hypervascularized with inflammatory infiltration. The histopathological semi-quantitative assessment of osteomyelitis and the immunohistochemical detection of CD15-positive neutrophils made it possible to identify signs of the active stage of chronic osteomyelitis in 8 patients, those of subacute course – in 16 patients, weakened chronic osteomyelitis (remission) – in 6 patients. An increased number of osteoclasts, intense destruction of the subchondral bone plate and a pronounced inflammatory infiltrate with the content of 5 or more neutrophils were observed in patients with an active inflammatory stage of chronic osteomyelitis. A positive correlation was found between the inflammatory stage of chronic osteomyelitis and the severity of inflammatory infiltration and osteonecrosis.
Conclusion. The combination of signs – pronounced destruction of the articular cartilage, subchondral bone, hypertrophy of the synovial membrane, bone and cartilaginous fragments in the joint cavity and in the synovial membrane, fragments of bone tissue in the cartilage is a diagnostic histological criterion for the chronic stage of diabetic neroosteoarthropathy. The histopathological semi-quantitative assessment of osteomyelitis and the immunohistochemical determination of CD15 increase the accuracy of the pathological diagnostics of the inflammatory phases of chronic osteomyelitis in diabetic foot syndrome.

Keywords: histology, the ankle (joint), diabetic äèàáåòè÷åñêàÿ neroosteoarthropathy, osteomyelitis, diagnostics
p. 562-571 of the original issue
References
  1. Harris A, Violand M. Charcot Neuropathic Osteoarthropathy. [Updated 2021 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. https://www.ncbi.nlm.nih.gov/books/NBK470164/
  2. Sinacore DR, Bohnert KL, Smith KE, Hastings MK, Commean PK, Gutekunst DJ, Johnson JE, Prior FW. Persistent inflammation with pedal osteolysis 1year after Charcot neuropathic osteoarthropathy. J Diabetes Complications. 2017;31(6):1014-20. doi: 10.1016/j.jdiacomp.2017.02.005
  3. Sybenga AB, Jupiter DC, Speights VO, Rao A. Diagnosing Osteomyelitis: A Histology Guide for Pathologists. J Foot Ankle Surg. 2020;59(1):75-85. doi: 10.1053/j.jfas.2019.06.007.
  4. Faglia E, Clerici G, Caminiti M, Curci V, Somalvico F. Influence of osteomyelitis location in the foot of diabetic patients with transtibial amputation. Foot Ankle Int. 2013;34:222-27. doi: 10.1177/1071100712467436
  5. Tsvetkov VO, Kolovanova OV, Frolova OE, Gusarova TA, Ezhova LG. Informativnost’ bakteriologicheskogo issledovaniia kostnoi tkani v diagnostike osteomielita pri sindrome diabeticheskoi stopy. Sakharnyi diabet. 2019;22(5):428-435. doi: 10.14341/DM10048. (In Russ.)
  6. Tiemann A, Hofmann GO, Krukemeyer MG, Krenn V, Langwald S. Histopathological Osteomyelitis Evaluation Score (HOES) an innovative approach to histopathological diagnostics and scoring of osteomyelitis. GMS Interdiscip Plast Reconstr Surg DGPW. 2014;3:Doc08. doi: 10.3205/iprs000049.
  7. Dmitrienko AA, Anichkin VV, Kurek MF, Bugakov VA, Konovkov VV, Kushne AO. Differentiated surgical tactics at purulent complications of diabetic charcot osteoarthropathy. Novosti Khirurgii. 2013 Nov-Dec; Vol 21 (6): 47-56. doi: 10.18484/2305-0047.2013.6.47 (In Russ.)
  8. La Fontaine J, Shibuya N, Sampson HW, Valderrama P. Trabecular quality and cellular characteristics of normal, diabetic, and charcot bone. J Foot Ankle Surg. 2011;50(6):648-53. doi: 10.1053/j.jfas.2011.05.005.
  9. Dharmadas S, Kumar H, Pillay M, Jojo A, Pj T, Mangalanandan TS, Vivek L, Praveen VP, Bal A. Microscopic study of chronic charcot arthropathy foot bones contributes to understanding pathogenesis - A preliminary report. Histol Histopathol. 2020 May;35(5):443-48. doi: 10.14670/HH-18-162
  10. Berli MC, Higashigaito K, Götschi T, Pfirrmann CWA, Sutter R, Rosskopf AB. The «Balgrist Score» for evaluation of Charcot foot: a predictive value for duration of off-loading treatment. Skeletal Radiol. 2021;50(2):311-20. doi: 10.1007/s00256-020-03541-6.
  11. Donegan R, Sumpio B, Blume PA. Charcot foot and ankle with osteomyelitis. Diabet Foot Ankle. 2013;4:10. doi: 10.3402/dfa.v4i0.21361
  12. Alpert SW, Koval KJ, Zuckerman JD. Neuropathic Arthropathy: Review of Current Knowledge. J Am Acad Orthop Surg. 1996;4(2):100-108.
  13. Petrova NL, Petrov PK, Edmonds ME, Shanahan CM. Inhibition of TNF-α Reverses the Pathological Resorption Pit Profile of Osteoclasts from Patients with Acute Charcot Osteoarthropathy. Journal of Diabetes Research. 2015; . doi: 10.1155/2015/917945 (In Russ.)
  14. Diachkova GV, Diachkov KA, Kliushin NM, Larionova TA, Shastov AL. A multifaceted osteomyelitis: radiological diagnosis. Genii ortopedii. 2020;26(3):385-391. doi: 10.18019/1028-4427-2020-26-3-385-391 (In Russ.)
  15. Stupina TA, Migalkin NS, Sudnitsyn AS. Structural reorganization of the cartilage tissue in chronic osteomyelitis of the foot bones. Genii ortopedii. 2019;25(4):523-27. doi: 10.18019/1028-4427-2019-25-4-523-527 (In Russ.)
Address for correspondence:
640014, Russian Federation,
Kurgan, st. M. Ulyanova, 6,
National Medical Research Center
for Traumatology and Orthopedics
Named after Academician G.A. Ilizarov,
tel. +7 905 850-67-89,
e-mail: StupinaSTA@mail.ru,
Stupina Tatyana A.
Information about the authors:
Stupina Tatyana A., MD (Biol), Senior Researcher, Laboratory of Morphology, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
http://orcid.org/0000-0003-3434-0372
Migalkin Nikolai S., Researcher. Laboratory of Morphology, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
http://orcid.org/0000-0002-7502-5654
Mezentsev Igor N., Pathologist, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
http://orcid.org/0000-0002-7598-0707
Sudnitsyn Anatoly S., PhD, Orthopedic Surgion, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
http://orcid.org/0000-0002-2602-2457

REVIEWS

A.Y. GRIGORYAN, A.G. TEREKHOV

THE PLACE OF PHYSIOTHERAPY METHODS OF INFLUENCE IN THE TREATMENT OF VENOUS TROPHIC ULCERS (LITERATURE REVIEW)

Kursk State Medical University, Kursk,
Russian Federation

The main cause of the development of trophic ulcers is the insufficiency of the venous system of the lower extremities. Venous trophic ulcers (VTU) occupy up to 80% of the structure of trophic lesions of the skin and soft tissues. This pathology is more common in elderly and senile people, when the incidence of the lesion reaches 5% in the population. Without a doubt, in order to achieve complete and rapid healing, surgical treatment is necessary, which would eliminate the etiological factor of the development of VTU. However, in most cases, surgical correction of venous insufficiency is not feasible. Conservative treatment should be multidirectional, and recently more and more attention has been paid to physiotherapy methods of influence. The analysis of the literature data confirms the possibility of using various types of physiotherapeutic methods of exposure as additional therapy for patients suffering from trophic ulcers of mainly venous etiology. It was found that the combination of methods based on various physical factors of influence has the most favorable effect on the healing of VTU. It is not possible to talk about the preferential effectiveness of any one method of physiotherapy, since the studies of individual authors are not identical, which does not allow them to be compared. Thus, we consider further research in this direction to be promising, since these studies will optimize the treatment process and improve the quality of life of patients with VTU.

Keywords: venous trophic ulcer, phototherapy, electrotherapy, magnetotherapy, hyperbaric oxygen therapy, negative pressure therapy, ultrasound therapy.
p. 572-582 of the original issue
References
  1. Raffetto JD, Ligi D, Maniscalco R, Khalil RA, Mannello F. Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment. J Clin Med. 2020 Dec 24;10(1):29. doi: 10.3390/jcm10010029
  2. Geisler AN, Taylor N. Venous stasis ulcers: An update on diagnosis and management. Curr Geriatr Rep. Curr Geriatr Rep. 2020;9(4):219-28.doi: 10.1007/s13670-020-00344-4
  3. Carman TL, Al-Omari A. Evaluation and Management of Chronic Venous Disease Using the Foundation of CEAP. Curr Cardiol Rep. 2019 Aug 30;21(10):114. doi: 10.1007/s11886-019-1201-1
  4. Alkahtani SA, Kunwar PS, Jalilifar M, Rashidi S, Yadollahpour A. Ultrasound-based Techniques as Alternative Treatments for Chronic Wounds: A Comprehensive Review of Clinical Applications. Cureus. 2017 Dec 15;9(12):e1952. doi: 10.7759/cureus.1952
  5. Sztandera P, Zbyradowski J. Physical therapy treatment in chronic wounds – the high voltage stimulation and the magnetotherapy. J Educ Health Sport. 2018;8(9):346-52. doi: 10.5281/m9.figshare.6988748
  6. Chittoria RK, Kumar SH. Low-level laser therapy (LLLT) in wound healing. In: Shiffman MA, Low M, editors. Chronic Wounds, Wound Dressings and Wound Healing. Cham: Springer International Publishing; 2021. p. 21-26. https://link.springer.com/chapter/10.1007/15695_2017_89
  7. Krupka M, Bozek A, Bartusik-Aebisher D, Cieslar G, Kawczyk-Krupka A. Photodynamic therapy for the treatment of infected leg ulcers-a pilot study. Antibiotics (Basel). 2021 Apr 29;10(5):506. doi: 10.3390/antibiotics10050506
  8. Jamil MMA, Adon MN, Mamman HB, Rahman NAA, Ambar R, Choon CC. Wound healing and electrofusion application via pulse electric field exposure. In: Lecture Notes in Electrical Engineering.Singapore: Springer, Singapore; 2021. p. 775-84. https://link.springer.com/chapter/10.1007/978-981-15-5281-6_56
  9. Ntege EH, Sunami H, Shimizu Y. Advances in regenerative therapy: A review of the literature and future directions. Regen Ther. 2020 Feb 20;14:136-53. doi: 10.1016/j.reth.2020.01.004. eCollection 2020 Jun.
  10. Nair HKR. Microcurrent as an adjunct therapy to accelerate chronic wound healing and reduce patient pain. J Wound Care. 2018 May 2;27(5):296-306. doi: 10.12968/jowc.2018.27.5.296
  11. Rajendran SB, Challen K, Wright KL, Hardy JG. Electrical stimulation to enhance wound healing. J Funct Biomater. 2021;12(2):40. doi: 10.3390/jfb12020040
  12. Hunckler J, de Mel A. A current affair: electrotherapy in wound healing. J Multidiscip Healthc. 2017 Apr 20;10:179-94. doi: 10.2147/JMDH.S127207. eCollection 2017.
  13. Farber PL, Isoldi FC, Ferreira LM. Electric Factors in Wound Healing. Adv Wound Care (New Rochelle). 2021 Aug;10(8):461-76. doi: 10.1089/wound.2019.1114
  14. Jedrzejczak-Silicka M, Kordas M, Konopacki M, Rakoczy R. Modulation of Cellular Response to Different Parameters of the Rotating Magnetic Field (RMF)-An In Vitro Wound Healing Study. Int J Mol Sci. 2021 May 28;22(11):5785. doi: 10.3390/ijms22115785
  15. Onik G, Knapik K, Sieroń A, Sieroń-Stołtny K. Physical medicine modalities most frequently applied in the lower limbs chronic wounds treatment in Poland. Pol Ann Med. 2017;24(1):92-98. doi: 10.1016/j.poamed.2016.09.001
  16. Mansourian M, Shanei A. Evaluation of Pulsed Electromagnetic Field Effects: A Systematic Review and Meta-Analysis on Highlights of Two Decades of Research In Vitro Studies. Biomed Res Int. 2021 Jul 29;2021:6647497. doi: 10.1155/2021/6647497. eCollection 2021.
  17. Amareswari VH, Padma K, Dharmarajan P, Shivakumar S, Dhilip KS. Evaluation of efficacy of pulsed electromagnetic field therapy as an adjuvant therapy in healing of diabetic foot ulcers. Int J Physiol. 2020;8(2):6-12. doi: 10.37506/ijop.v8i2.1234
  18. Ferroni L, Gardin C, De Pieri A, Sambataro M, Seganfreddo E, Goretti C, Iacopi E, Zavan B, Piaggesi A. Treatment of diabetic foot ulcers with Therapeutic Magnetic Resonance (TMR®) improves the quality of granulation tissue. Eur J Histochem. 2017 Aug 7;61(3):2800. doi: 10.4081/ejh.2017.2800
  19. Thistlethwaite KR, Finlayson KJ, Cooper PD, Brown B, Bennett MH, Kay G, O’Reilly MT, Edwards HE. The effectiveness of hyperbaric oxygen therapy for healing chronic venous leg ulcers: A randomized, double-blind, placebo-controlled trial. Wound Repair Regen. 2018 Jul;26(4):324-31. doi: 10.1111/wrr.12657
  20. Moraru DC, Doru R-C, Marcovici I, Bejan V, Bozomitu LI, Tamas C. Ciuntu BM, Popa CL, Dobre C, Iosip B, Tecuceanu A, Atanasoae I, Munteanu I, Diaconu I. In: 2019 E-Health and Bioengineering Conference (EHB); 2019 Nov 21-23; IEEE; 2019. doi: 10.1109/EHB47216.2019.8969976
  21. Colenci R, Abbade LPF. Fundamental aspects of the local approach to cutaneous ulcers. An Bras Dermatol. 2018 Nov/Dec;93(6):859-70. doi: 10.1590/abd1806-4841.20187812
  22. Sridhar J, Arla Sai Varsha, Karthick S, Ravishankar P, Shailesh. Comparative study of negative pressure wound therapy with moist gauze dressings in the treatment of leg ulcer wounds. Int Surg J. 2020;7(12):4143-47. doi: 10.18203/2349-2902.isj20205016
  23. Walczak DA, Wojtyniak M, Jaguscik R, Porzezyńska JJ, Fałek W, Czerwińska M, Ptasińska K, Kozaczek L, Szymański B, Trzeciak PW. Management of large chronic venous leg ulcers with negative pressure wound therapy. Negat Press Wound Ther J. 2017;4(2):17. doi: 10.18487/npwtj.v4i2.26
  24. Uddin SMZ, Komatsu DE, Motyka T, Petterson S. Low-Intensity Continuous Ultrasound Therapies-A Systemic Review of Current State-of-the-Art and Future Perspectives. J Clin Med. 2021 Jun 18;10(12):2698. doi: 10.3390/jcm10122698
  25. de Lucas B, Pérez LM, Bernal A, Gálvez BG. Ultrasound Therapy: Experiences and Perspectives for Regenerative Medicine. Genes (Basel). 2020 Sep 17;11(9):1086. doi: 10.3390/genes11091086
  26. Alkahtani SA, Kunwar PS, Jalilifar M, Rashidi S, Yadollahpour A. Ultrasound-based Techniques as Alternative Treatments for Chronic Wounds: A Comprehensive Review of Clinical Applications. Cureus. 2017 Dec 15;9(12):e1952. doi: 10.7759/cureus.1952
  27. Wiegand C, Bittenger K, Galiano RD, Driver VR, Gibbons GW. Does noncontact low-frequency ultrasound therapy contribute to wound healing at the molecular level? Wound Repair Regen. 2017 Sep;25(5):871-82. doi: 10.1111/wrr.12595
  28. 28. Izosimov VV, Umerov EE, Grivenko SG. Clinical and biochemical aspects of complex therapy of complicated forms of chronic venous insufficiency of lower extremities. Kursk Scientific and Practical Bulletin “Man and His Health”. 2017;(4):52-56. doi: 10.21626/vestnik/2017-4/10 (In Russ.)
  29. 29. Kataoka Y, Kunimitsu M, Nakagami G, Koudounas S, Weller CD, Sanada H. Effectiveness of ultrasonic debridement on reduction of bacteria and biofilm in patients with chronic wounds: A scoping review. Int Wound J. 2021 Apr;18(2):176-86. doi: 10.1111/iwj.13509
  30. Sukovatykh BS, Sereditsky AV, Muradyan VF, Azarov AM, Sukovatykh MB, Lapinas AA, Khachatryan AR. Efficiency of endovascular methods in managing late proximal deep vein thrombosis. Kursk Scientific and Practical Bulletin “Man and His Health”. 2020;(1):13-20. doi: 10.21626/vestnik/2020-1/02 (In Russ.)
  31. Lyu W, Ma Y, Chen S, Li H, Wang P, Chen Y, Feng X. Flexible ultrasonic patch for accelerating chronic wound healing. Adv Healthc Mater. 2021;2100785. doi: 10.1002/adhm.202100785
  32. Omar MT, Gwada RF, Shaheen AA, Saggini R. Extracorporeal shockwave therapy for the treatment of chronic wound of lower extremity: current perspective and systematic review. Int Wound J. 2017 Dec;14(6):898-908. doi: 10.1111/iwj.12723
  33. Taheri P, Shahbandari M, Parvaresh M, Vahdatpour B. Extracorporeal shockwave therapy for chronic venous ulcers: A randomized controlled trial. Galen. 2021;10(0):1931. doi: 10.31661/gmj.v10i0.1931
  34. Zhang L, Fu XB, Chen S, Zhao ZB, Schmitz C, Weng CS. Efficacy and safety of extracorporeal shock wave therapy for acute and chronic soft tissue wounds: A systematic review and meta-analysis. Int Wound J. 2018 Aug;15(4):590-99. doi: 10.1111/iwj.12902
  35. Karakaya E, Akdur A, Ayvazoğlu Soy E, Araz C, Ok Atilgan A, Özturan Özer E, Şençelikel T, Haberal M. Effect of Subcutaneous Topical Ozone Therapy on Second-Degree Burn Wounds in Rats: An Experimental Study. J Burn Care Res. 2021 Jun 16:irab110. doi: 10.1093/jbcr/irab110. Online ahead of print.
  36. Sukovatykh BS, Sereditskiy AV, Azarov AM, Muradyan VF, Sukovatykh MB. One-year results of conservative and endovascular treatment of deep venous thrombosis followed by severe acute venous insufficiency. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im NI Pirogova. 2021;(2):67-72. doi: 10.17116/hirurgia202102167 (In Russ.)
  37. Fitzpatrick E, Holland OJ, Vanderlelie JJ. Ozone therapy for the treatment of chronic wounds: A systematic review. Int Wound J. 2018 Aug;15(4):633-44. doi: 10.1111/iwj.12907
  38. Rakhmetova KK, Dolgintsev ME, Bobyntsev II, Bezhin AI, Vorvul’ AO, Belykh AE. Effect of GHK-D-Ala peptide on innate immunity mechanisms and lipid peroxidation processes in infected wounds. Humans and Their Health. 2021;24(1):54-61. doi: 10.21626/vestnik/2021-1/07 (In Russ.)
  39. Pasek J, Szajkowski S, Cieslar G. Therapeutic efficacy of physical combined therapy in the treatment of venous crural ulcers. Phlebology. 2021 Jul;36(6):481-88. doi: 10.1177/0268355520982452
  40. Dolibog P, Dolibog PT, Franek A, Brzezińska-Wcisło L, Wróbel B, Arasiewicz H, Chmielewska D, Ziaja J, Błaszczak E. Comparison of ultrasound therapy and radial shock wave therapy in the treatment of venous leg ulcers – clinical, pilot study. Postepy Dermatol Alergol. 2018 Oct;35(5):454-61. doi: 10.5114/ada.2018.79191
  41. Pasek J, Szajkowski S, Pietrzak M, Cieslar G. Comparison of the efficacy of topical hyperbaric oxygen therapy alone vs a combination of physical methods including topical hyperbaric oxygen therapy, magnetotherapy, and low-energy light therapy in the treatment of venous leg ulcers. Dermatol Ther. 2020 Nov;33(6):e14474. doi: 10.1111/dth.14474
  42. Song BW, Hong H, Jung YJ, Lee JH, Kim BS, Lee HB. Combination Therapy Comprising a Static Magnetic Field with Contractility Improves Skin Wounds. Tissue Eng Part A. 2018 Sep;24(17-18):1354-63. doi: 10.1089/ten.TEA.2017.0470
  43. Coelho VHM, Alvares LD, Carbinatto FM, deAquino Junior AE, Ramirez Angarita DP, BagnatoVS. Photodynamic therapy, laser therapy and cellulose membrane for the healing of venous ulcers: results of a pilot study. J Nurs Care. 2017;6: 387. doi: 10.4172/2167-1168.1000387
Address for correspondence:
305041,
Kursk, st. Karl Marx, 3,
«Kursk State Medical University» of the Ministry
of Health of Russia, Department of Operative Surgery and Topographic Anatomy,
tel.: +7 951 072-32-02,
e-mail: alexter4646@yandex.ru,
Terekhov Alexey G.
Information about the authors:
Grigoryan Arsen Y., PhD, Associate Professor, Associate Professor of the Department of Operative Surgery and Topographic Anatomy, KSMU of the Ministry of Health of Russia, Kursk, Russian Federation.
http://orcid.org/0000-0002-5039-5384
Terekhov Aleksey G., Full-Time Postgraduate Student of the Department of Operative Surgery and Topographic Anatomy, Assistant of the Department of Surgical Diseases No. 1, KSMU of the Ministry of Health of Russia, Kursk, Russian Federation.
http://orcid.org/0000-0003-2073-7387

O.N. GANUSEVICH 1, T.N. NESTEROVICH 2, I.V. FEDORKEVICH 1

CURRENT APPROACHES TO SYSTEMIC TREATMENT OF SKIN MELANOMA

EÅ «Gomel Regional Clinical Oncological Dispensary» 1,
EE «Gomel State Medical University» 2, Gomel,
Republic of Belarus

Melanoma accounts for about 10% of all diagnosed skin cancers. However, its aggressive course, due to the high ability for regional and distant multiple metastasis, leading to high mortality rates and makes the issue of treatment relevant. Understanding of molecular biology and immunological characteristics of the tumor contributed to the emergence of targeted drugs (BRAF, MEK inhibitors) and immuno-oncological drugs (Checkpoint inhibitors as a type of f immunotherapy - blockers CTLA-4 (cytotoxic T-lymphocyteassociated protein 4), PD-1 (programmed death 1) and its ligands (PD-L1). They block proteins that stop the immune system from attacking the cancer cells and made it possible to enhance tumor response to treatment and significantly improve patient outcomes. Currently, the main approach in systemic treatment is not to stimulate the immune response, but to remove factors that inhibit its development, the so-called immune checkpoint inhibitors. The worst prognosis in patients with metastatic melanoma, the overall 5-year survival rate previously was 9-20%; at present, the use of current systemic therapy gives a chance of about 50% of patients to live for 5 or more years. The systemic treatment of metastatic melanoma has improved considerably with the introduction of new, targeted substances and immune checkpoint inhibitors.

Keywords: melanoma, metastases, systemic therapy, targeted therapy, immunotherapy
p. 583-591 of the original issue
References
  1. Michielin O, van Akkooi A, Lorigan P, Ascierto PA, Dummer R, Robert C, Arance A, Blank CU, Chiarion Sileni V, Donia M, Faries MB, Gaudy-Marqueste C, Gogas H, Grob JJ, Guckenberger M, Haanen J, Hayes AJ, Hoeller C, Lebbé C, Lugowska I, Mandalà M, Márquez-Rodas I, Nathan P, Neyns B, Olofsson Bagge R, Puig S, Rutkowski P, Schilling B, Sondak VK, Tawbi H, Testori A, Keilholz U. ESMO consensus conference recommendations on the management of locoregional melanoma: under the auspices of the ESMO Guidelines Committee. Ann Oncol. 2020;31(11):1449-1461. doi: 10.1016/j.annonc.2020.07.005
  2. Coricovac D, Dehelean C, Moaca E, Pinzaru I, Bratu T, Navolan D, Boruga O. Cutaneous Melanoma — a long road from experimental models to clinical outcome: a review. Int J Mol Sci. 2018;19:1566. doi: 10.3390/ijms19061566
  3. Arnold M, Singh D, Laversanne M, Vignat J, Vaccarella S, Meheus F, Cust AE, de Vries E, Whiteman DC, Bray F. Global Burden of Cutaneous Melanoma in 2020 and Projections to 2040. JAMA Dermatol. 2022;158(5):95-503. doi: 10.1001/jamadermatol.2022.0160
  4. Maverakis E, Cornelius LA, Bowen GM, Phan T, Falin B. Patel FB, Sarah Fitzmaurice S, He Y, Burrall B, Duong C, Kloxin AM, Sultani H, Wilken R, Martinez SR, Patel F. Metastatic melanoma - a review of current and future treatment options. Acta Derm Venereol. 2015;95:516-24. doi: 10.2340/00015555-2035
  5. Villani A, Potestio L, Fabbrocini G, Troncone G, Malapelle U, Scalvenzi M. The treatment of advanced melanoma: therapeutic update. Int J Mol Sci. 2022;23:6388. doi: 10.3390/ijms23126388
  6. Zhukova NV, Orlova RV, Antimonik NYu, Kutukova SI, Belyak NP, Popova NV, Erdniev S.P. Modern treatment of metastatic melanoma: from standards to an individualized approach in real clinical practice. Research’n Practical Medicine Journal. 2018;5(2):130-140] doi: 10.17709/2409-2231-2018-5-2-14 (In Russ.)
  7. Anokhina EM, Novik AV, Protsenko SA, Baldueva IA, Semiglazova TYu, Semenova AI, Latipova DKh, Teletaeva GM, Rubinchik VN, Oganesyan AP, Yaremenko EV. Ipilimumab in patients with disseminated melanoma: the N.N. Petrov National Medical Research Center of Oncology Expanded Access Program experience. Voprosy Oncologii. 2018;64(3):388-393 (In Russ.)
  8. Frinton E, Tong D, Tan J, Read G, Kumar V, Kennedy S, Lim C, Board RE. Metastatic melanoma: prognostic factors and survival in patients with brain metastases. J Neurooncol. 2017;135:507-512. doi: 10.1007/s11060-017-2591-9
  9. Mantia CM, Werner L, Stwalley B, Ritchings C, Tarhini AA, Atkins MB, McDermott DF, Regan MM. Sensitivity of treatment-free survival to subgroup analyses in patients with advanced melanoma treated with immune checkpoint inhibitors. Melanoma Res. 2022;32:35-44. doi: 10.1097/CMR.0000000000000793
  10. van Zeijl MCT, Ismail RK, de Wreede LC, van den Eertwegh AJM, de Boer A, van Dartel M, Hilarius DL, Aarts MJB, van den Berkmortel FWPJ, Boers-Sonderen MJ, de Groot JB, Hospers GAP, Kapiteijn E, Piersma D, van Rijn RS, Suijkerbuijk KPM, ten Tije AJ, van der Veldt AAM, Vreugdenhil G, Haanen JBAG, Wouters MWJM. Real-world outcomes of advanced melanoma patients not represented in phase III trials. Int J Cancer. 2020;147:3461-70. doi: 10.1002/ijc.33162
  11. Trojaniello C, Luke JJ, Ascierto PA. Therapeutic advancements across clinical stages in melanoma, with a focus on targeted immunotherapy. Front Oncol. 2021;11:670726. doi: 10.3389/fonc.2021.670726
  12. Testori AAE, Chiellino S, Akkooi ACJ. Adjuvant therapy for melanoma: past, current, and future developments. Cancers. 2020;12:1994. doi: 10.3390/cancers12071994
  13. Poklepovic AS, Luke JJ. Considering adjuvant therapy for Stage II melanoma. Cancer. 2020;126:1166-1174. doi: 10.1002/cncr.32585
  14. Luke JJ, Rutkowski P, Queirolo P, Del Vecchio M, Mackiewicz J, Chiarion Sileni V, de la CruzMerino L, Khattak MA, Schadendorf D, Long GV, Ascierto PA Mandala M, De Galitiis F, Sondak V, Scolyer RA, Kirkwood JM, Chen K, Ibrahim N, Ahsan S, Eggermont AMM . Pembrolizumab versus placebo after complete resection of high-risk stage II melanoma: Efficacy and safety results from the KEYNOTE-716 double-blind phase III trial. Ann Oncol. 2021;32(5):1314. doi: 10.1016/j.annonc.2021.08.2116
  15. Luke JJ, Ascierto PA, Carlino MS, Gershenwald JE, Grob JJ, Hauschild A, Kirkwood JM, Long GV, Mohr P, Robert C, Ross M, Scolyer RA, Yoon ChH, Poklepovic A, Rutkowski P, Anderson JR, Ahsan S, Ibrahim N, Eggermont AMM. KEYNOTE-716: Phase III study of adjuvant pembrolizumab versus placebo in resected high-risk stage II melanoma. Future Oncol. 2020;16(3): 4429-4438. doi: 10.2217/fon-2019-0666
  16. Dummer R, Hauschild A, Santinami M, Atkinson V, Mandalà M, Kirkwood JM, Chiarion Sileni V, Larkin J, Nyakas M, Dutriaux C, Haydon A, Robert C, Mortier L, Schachter J, Lesimple T, Plummer R, Dasgupta K, Gasal E, Tan M, Long GV, Schadendorf D. Five-year analysis of adjuvant dabrafenib plus trametinib in stage III melanoma. N Engl J Med. 2020;383:1139-48. doi: 10.1056/NEJMoa2005493
  17. Long GV, Hauschild A, Santinami M, Atkinson V, Mandalà M, Chiarion Sileni V, Larkin J, Nyakas M, Dutriaux C, Haydon A, Robert C, Mortier L, Schachter J, Schadendorf D, Lesimple T, Plummer R, Ji R, Zhang P, Mookerjee B, Legos J, Kefford R, Dummer R, Kirkwood JM. Adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma. N Engl J Med. 2017;377:1813-23. doi: 10.1056/NEJMoa1708539
  18. Bhave P, Pallan L, Long GV, Menzies AM, Atkinson V, Cohen JV, Sullivan RJ, Chiarion-Sileni V, Nyakas M, Kahler K, Hauschild A, Plummer R, Trojaniello C, Ascierto PA, Zimmer L, Schadendorf D, Allayous C, Lebbe C, Maurichi A, Santinami M, Roy S, Robert C, Lesimple T, Patel S, Versluis JM, Blank CU, Khattak A, Van der Westhuizen A, Carlino MS, Shackleton M, Haydon A. Melanoma recurrence patterns and management after adjuvant targeted therapy: a multicentre analysis. Br J Cancer. 2021;124:574-580. doi: 10.1038/s41416-020-01121-y
  19. Eggermont AMM, Blank CU, Mandala M, Long GV, Atkinson V, Dalle S, Haydon A, Lichinitser M, Khattak A, Carlino MS, Sandhu S, Larkin J, Susana Puig S, Ascierto PA, Rutkowski P, Schadendorf D, Koornstra R, Hernandez-Aya L, Maio M, van den Eertwegh AJM, Grob JJ, Gutzmer R, Jamal R, Lorigan P, Ibrahim N, Marreaud S, van Akkooi ACJ, Suciu S, Robert C. Adjuvant pembrolizumab versus placebo in resected stage III melanoma. N Engl J Med. 2018;378:1789-801. doi: 10.1056/NEJMoa1802357
  20. Jenkins RW, Fisher DE. Treatment of advanced melanoma in 2020 and beyond. J Invest Dermatol. 2021;141(1):23-31. doi: 10.1016/j.jid.2020.03.943.
  21. Weber J, Mandala M, Del Vecchio M, Gogas HJ, Arance AM, Cowey CL, Dalle S, Schenker M, Chiarion Sileni V, Marquez Rodas I, Grob JJ, Butler MO, Middleton MR, Maio M, Atkinson V, Queirolo P, Gonzalez R, Kudchadkar RR, Smylie M, Meyer N, Mortier L, Atkins MB, Long GV, Bhatia S, Lebbé C, Rutkowski P, Yokota K, Yamazaki N, Kim TM, de Pril V, Sabater J, Qureshi A, Larkin J, Ascierto PA. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med. 2017;377:1824-35. doi: 10.1056/NEJMoa1709030
  22. McKean MA, Amaria RN. Multidisciplinary treatment strategies in high-risk resectable melanoma: role of adjuvant and neoadjuvant therapy. Cancer Treat Rev. 2018;70:144-153. doi: 10.1016/j.ctrv.2018.08.011
  23. Ascierto PA, Borgognoni L, Botti G, Guida M, Marchetti P, Mocellin S, Muto P, Palmieri G, Patuzzo R, Quaglino P, Stanganelli I. New paradigm for stage III melanoma: from surgery to adjuvant treatment. J Transl Med. 2019;17:266. doi: 10.1186/s12967-019-2012-2
  24. Wright FC, Kellett S, Look Hong NJ, Sun AY, Hanna TP, Nessim C, Giacomantonio CA, Temple-Oberle CF, Song X, Petrella TM. Locoregional management of in-transit metastasis in melanoma: an Ontario Health (Cancer Care Ontario) clinical practice guideline. Curr Oncol. 2020;27(3):318-325. doi: 10.3747/co.27.6523
  25. Kwak M, Farrow N, Salama AKS, Mosca PJ, Hanks BA, Slingluff Jr. CL, Beasley GM. Updates in adjuvant systemic therapy for melanoma. J Surg Oncol. 2019;119(2):222-231. doi: 10.1002/jso.25298.
  26. Keilholz U, Ascierto PA, Dummer R, C. Robert C, Lorigan P, van Akkooi A, Arance A, Blank CU, Chiarion Sileni V, Donia M, Faries MB, Gaudy-Marqueste C, Gogas H, Grob JJ, Guckenberger M, Haanen J, Hayes AJ, Hoeller C, Lebbé C, Lugowska I, Mandalà M, Márquez-Rodas I, Nathan P, Neyns B, Olofsson Bagge R, Puig S, Rutkowski P, Schilling B, Sondak VK, Tawbi H, Testori A, Michielin O. ESMO consensus conference recommendations on the management of metastatic melanoma: under the auspices of the ESMO Guidelines Committee. Ann Oncol. 2020;31(11):1435-1448. doi: 10.1016/j.annonc.2020.07.004
  27. ranke V, Berger DMS, Klop WMC, van der Hiel B, van de Wiel BA, ter Meulen S, Wouters MWJM, van Houdt WJ, van Akkooi ACJ. High response rates for T-VEC in early metastatic melanoma (stage IIIB/C-IVM1a). Int J Cancer. 2019;145:974-978. doi: 10.1002/ijc.32172
  28. Ressler JM, Karasek M, Koch L, Silmbrod R, Mangana J, Latifyan S, Aedo-Lopez V, Kehrer H, Weihsengruber F, Koelblinger P, Posch C, Kofler J, Michielin O, Richtig E, Hafner C, Hoeller C. Real-life use of talimogene laherparepvec (T-VEC) in melanoma patients in centers in Austria, Switzerland and Germany. Journal for ImmunoTherapy of Cancer. 2021;9:e001701. doi: 10.1136/ jitc-2020-001701
  29. Sood S, Jayachandiran R, Pandey S. Current advancements and novel strategies in the treatment of metastatic melanoma. Integrative Cancer Therapies. 2021;20:1-20. doi: 10.1177/1534735421990078
  30. Steininger J, Gellrich FF, Schulz A, Westphal D, Beissert S, Meier F. Systemic therapy of metastatic melanoma: on the road to cure. Cancers. 2021;13:1430. doi: 10.3390/cancers13061430
  31. Michielin O, Atkins MB, Koon HB, Dummer R, Ascierto PA. Evolving impact of long-term survival results on metastatic melanoma treatment. Cancer Treat Rev. 2020;8:e000948. doi: 10.1136/jitc-2020-000948
  32. Terheyden P, Krackhardt A, Eigentler T. The systemic treatment of melanoma — the place of immune checkpoint inhibitors and the suppression of intracellular signal transduction. Dtsch Arztebl Int. 2019;116:497-504. DOI: 10.3238/arztebl.2019.0497
  33. Randic T, Kozar I, Margue C, Utikal J, Kreis S. NRAS mutant melanoma: towards better therapies. Cancer Treat Rev. 2021;99:102238. doi: 10.1016/j.ctrv.2021.102238
  34. Larkin J, Chiarion Sileni V, Gonzalez R, Grob JJ, Rutkowski P, Lao CD, Cowey CL, Schadendorf D, Wagstaff J, Dummer R, Ferrucci PF, Smylie M, Hogg D, Hill A, Márquez Rodas I, Haanen J, Guidoboni M, Maio M, Schöffski P, Carlino MS, Lebbé C, McArthur G, Ascierto PA, Daniels GA, Long GV, Bastholt L, Rizzo JI, Balogh A, Moshyk A, Hodi FS, Wolchok JD. Five-year survival with combined nivolumab and ipilimumab in advanced melanoma. N Engl J Med. 2019;381:1535-46. doi: 10.1056/NEJMoa1910836
  35. Ferrucci PF, Pala L, Conforti F, Cocorocchio E. Talimogene laherparepvec (T-VEC): an intralesional cancer immunotherapy for advanced melanoma. Cancers. 2021;13:1383. doi: 10.3390/cancers13061383
  36. Pavlick AC, Zhao R, Lee C, Ritchings C, Rao S. First-line immunotherapy versus targeted therapy in patients with BRAF-mutant advanced melanoma: a real-world analysis. Future Oncol. 2021;17(6):689-699. doi: 10.2217/fon-2020-0643
  37. Glitza Oliva IC, Schvartsman G, Tawbi H. Advances in the systemic treatment of melanoma brain metastases. Ann Oncol. 2018;29:1509-1520. doi: 10.1093/annonc/mdy185
  38. Hughesa T, Klairmonta M, Sharfmanb WH, Kaufman HL. Interleukin-2, ipilimumab, and anti-PD-1: clinical management and the evolving role of immunotherapy for the treatment of patients with metastatic melanoma. Cancer Biol Ther. 2021;22(10-12):513-526. doi: 10.1080/15384047.2015.1095401
  39. Cowey CL, Scherrer E, Boyd M, Aguilar KM, Beeks A, Krepler C. Pembrolizumab Utilization and Clinical Outcomes Among Patients With Advanced Melanoma in the US Community Oncology Setting: An Updated Analysis. J Immunother. 2021 Jul-Aug 01;44(6):224-33. doi: 10.1097/CJI.0000000000000363
  40. Oganesian AP, Protsenko SA, Baldueva IA, Semenova AI, Anokhina EM, Novik AV. Evaluation of the effectiveness of modern immunotherapy. Voprosy Încologii. 2020;66(3):211-217 (In Russ.)
  41. Stege H, Haist M, Schultheis M, Fleischer MI, Mohr P, Meier F, Schadendorf D, Ugurel S, Livingstone E, Zimmer L, Herbst R, Pföhler C, Kähler K, Weichenthal M, Terheyden P, Nashan D, Debus D, Kaatz M, Ziller F, Haferkamp S, Forschner A, Leiter U, Kreuter A, Ulrich J, Kleemann J, Bradfisch F, Grabbe S, Loquai C. Discontinuation of BRAF/MEK-Directed Targeted Therapy after Complete Remission of Metastatic Melanoma-A Retrospective Multicenter ADOReg Study. Cancers (Basel). 2021 May 12;13(10):2312. doi: 10.3390/cancers13102312
  42. Dummer R, Flaherty KT, Robert C, Arance A, de Groot JWB, Garbe C, Gogas HJ, Gutzmer R, Krajsova I, Liszkay G, Loquai C, Mario Mandala M, Schadendorf D, Yamazaki N, di Pietro A, Cantey-Kiser J, Edwards M, Ascierto PA. COLUMBUS 5-year update: a randomized, open-label, phase III trial of encorafenib plus binimetinib versus vemurafenib or encorafenib in patients with BRAF V600-mutant melanoma. J Clin Oncol. 2022;40:4178-4188. doi: 10.1200/JCO.21.02659
  43. Ferrucci PF, Di Giacomo AM, Del Vecchio M, Atkinson V, Schmidt H, Schachter J, Queirolo P, Long GV, Stephens R, Svane IM, Lotem M, Abu-Amna M, Gasal E, Ghori R, Diede SJ, Croydon ES, Ribas A, Ascierto PA. KEYNOTE-022 part 3: a randomized, double-blind, phase 2 study of pembrolizumab, dabrafenib, and trametinib in BRAF-mutant melanoma. J Immuno Ther Cancer. 2020;8:e001806. doi: 10.1136/jitc-2020-001806
  44. Diab A, Tykodi SS, Daniels GA, Maio M, Curti BD, Lewis KD, Jang S, Kalinka E, Puzanov I, Spira AI, Cho DC, Guan S, Puente E, Nguyen T, Hoch U, Currie SL, Lin W, Tagliaferri MA, Zalevsky J, Sznol M, Hurwitz ME. Bempegaldesleukin plus nivolumab in first-line metastatic melanoma. J Clin Oncol. 2021;39:2914-2925. doi: 10.1200/JCO.21.00675
  45. Mazurenko NN. Genetic heterogeneity of skin melanoma: new targets for selective exposure. Malignant tumors. 2015;4(2):3-8 doi: 10.18027/2224-5057-2015-4s2-3-8 (In Russ.)
  46. Rogala P, Czarnecka AM, Cybulska-Stopa B, Ostaszewski K, Piejko K, Zietek M, Dziura R, Rutkowska E, Galus L, Kempa-Kaminska N, Calik J, Sałek-Zan A, Zemełka T, Bal W, Kamycka A, Switaj T, Kaminska-Winciorek G, Suwinski R, Mackiewicz J, Rutkowski P. Long-term outcomes of targeted therapy after first-line immunotherapy in BRAF-mutated advanced cutaneous melanoma patients — real-world evidence. J Clin Med. 2022;11:2239. doi: 10.3390/jcm11082239
  47. Hawthorne S, Zhao L, Hanson M, Kanas G, Davis C, Robinson D, Turnure M, Clark O. Treatment of advanced/metastatic melanoma in the United States and Western Europe: results of the CancerMPact survey. Cancer Manag Res. 2020;12:5633-5639. doi: 10.2147/CMAR.S263468
  48. Samlowski W, Adajar C. Cautious addition of targeted therapy to PD-1 inhibitors after initial progression of BRAF mutant metastatic melanoma on checkpoint inhibitor therapy. BMC Cancer. 2021;21:1187. doi: 10.1186/s12885-021-08906-1
  49. Si L, Zhang X, Shu Y, Pan H, Wu D, Liu J, Mao L, Wang X, Wen X, Gu Y, Zhu L, Lan S, Cai X, Diede SJ, Dai H, Niu C, Li J, Guo J. Pembrolizumab in Chinese patients with advanced melanoma: 3-year follow-up of the KEYNOTE-151 study. Front Immunol. 2022;13:882471. doi: 10.3389/fimmu.2022.882471
  50. Amaral T, Seeber O, Mersi E, Sanchez S, Thomas I, Meiwes A, Forschner A, Leiter U, Eigentler T, Keim U, Garbe C. Primary resistance to PD-1-based immunotherapy — a study in 319 patients with stage IV melanoma. Cancers. 2020;12:1027. doi: 10.3390/cancers12041027
Address for correspondence:
246012, Republic of Belarus,
Gomel, Meditsinskaia st., 2,
Gomel State Medical University,
Department of Oncology,
tel. office: +375 232 491154,
mob.: +375 29 7309039,
e-mail: nesterovichtanya10@gmail.com,
Nesterovich Tatyana N.
Information about the authors:
Ganusevich Olga N., Oncologist-Surgeon of the Oncological Department of General Oncology and Rehabilitation of the Institution «Gomel Regional Clinical Oncological Dispensary», Gomel, Republic of Belarus.
http://orcid.org/0000-0003-2202-2254.
Nesterovich Tatyana N., Assistant of the Department of Oncology of the Educational Institution «Gomel State Medical University», Gomel, Republic of Belarus.
http://orcid.org/0000-0001-5692-1042.
Fedorkevich Igor V., Oncologist-Surgeon, Head of the Oncological Department of General Oncology and Rehabilitation of the Institution «Gomel Regional Clinical Oncological Dispensary», Gomel, Republic of Belarus.
http://orcid.org/0000-0002-7695-8042.

A.I. PANASYUK 1, E.G. GRIGORYEV 1, 2

RECURRENT GASTROINTESTINAL BLEEDING FROM DIEULAFOY’S LESIONS IN A PATIENT WITH VON WILLEBRAND DISEASE


Irkutsk State Medical University 1,
Irkutsk Scientific Centre of Surgery and Traumatology 2, Irkutsk,
Russian Federaration

The authors report the case of recurrent anematizing digestive bleeding in a 58-year-old woman who suffered from von Willebrand disease (VWD) and factor VIII deficiency. The hemorrhagic syndrome arose from a vascular malformation of the jejunum wall – Dieulafoy’s Lesions, a relatively rare pathology of the gastrointestinal tract, associated with high lethality. Convoluted arteries without signs of vasculitis were the contributor of hemorrhage. It is not improbable that Dieulafoy’s Lesions is a congenital malformation, since it develops in patients aged from 20 weeks to 94 years. Ulcers of the posterior wall of the upper third of the stomach was described. .. Such ulcers, located distal to the duodenojejunal junction, occur in no more than 1% of case reports. Intraluminal capsule and/or two-balloon jejunoscopy provides detection of the hemorrhage origin and localization. In the reported case, a bleeding vessel was found by means of selective contrasting of the upper mesenteric artery, which detected extravasation into the lumen of the first jejunum loop. Endovascular occlusion was technically impossible. After laparotomy esophagogastroduodenoscopy with manual intraabdominal assistance was performed. Two defects of the mucous membrane closed by a red blood clot appeared in 39-35 cm from the ligament of Treitz. Intestinal resection was performed in 2/3 according to A.V. Melnikov. Histological examination verified the diagnosis. In the presented case report, complex hematological pathology complicated the disease course. Intensive replacement therapy allowed bringing the VIII and von Willebrand factors to normal levels. In consequence, the surgical intervention without excessive bleeding.was performed.

Keywords: recurrent intestinal bleeding, Dielafua lesion, von Willebrand disease, mesenteriography, intestinal resection
p. 592-596 of the original issue
References
  1. Zagoven’ev IG, Zagoven’eva SN, Dubovko VR, Polfuntikov AA,Turusheva LS. Dieulafoy lesion in surgical practice of emergency care hospital. Endoscopic Surgery. 2013;19(1):36-38. (In Russ.)
  2. Iarustovskii MB, Volkova SS, Nazarov NS. Dieulafoy’s ulcer as one of the causes of gastrointestinal bleeding after cardiac surgery. Annals of Surgery. 2017;22(2):120-23. doi: 10.18821/1560-9502-2017-22-2-120-123 (In Russ.)
  3. Malik A, Inayat F, Goraya MHN, Almas T, Ishtiaq R, Malik S, Tarar Z. Jejunal Dieulafoy’s Lesion: A Systematic Review of Evaluation, Diagnosis, and Management J Investig Med High Impact Case Rep. 2021;9:2324709620987703. doi: 10.1177/2324709620987703.
  4. Shul’ga IP. Lazareva IN. Sluchai smerti pri klinicheski ne ustanovlennom diagnoze v rezul’tate bolezni D’elafua. Izbrannye Vopr. Sud.-Med. Ekspertizy. 2010;(11):101-104. https://www.forens-med.ru/book.php?id=1656 (In Russ.)
  5. Kosolapenkov AIu, Griashchenko OV, Kudba NN. K voprosu o bolezni D’elafua. V sb.: Khirurgiia na poroge XXI veka Astrakhan’, RF: Izd-vo AGMA; 2000. s. 73-76. (In Russ.)
  6. Zemlianoi VP, Sigua BV, Gurzhii DV, Melendin IA, Berest DG, Vinnichuk SA. Khirurgicheskaia taktika pri sindrome D’elafua redkoi lokalizatsii. Zhurn im NV Sklifosovskogo «Neotlozh Med Pomoshch’». 2018;7(1):65-67. doi: 10.23934/2223-9022-2018-7-1-65-67(In Russ.)
  7. Gadenstätter M, Wetscher G, Crookes PF, Mason RJ, Schwab G, Pointner R. Dieulafoy’s disease of the large and small bowel. J Clin Gastroenterol. 1998 Sep;27(2):169-72. doi: 10.1097/00004836-199809000-00018
  8. Juler GL, Labitzke HG, Lamb R, Allen R. The pathogenesis of Dieulafoy’s gastric erosion. Am J Gastroenterol. 1984;79(3):195-200. PMID: 6199971.
  9. Wegdam JA, Hofker HS, Dijkstra G, Stolk MF, Jacobs MA, Suurmeijer AJ. Occult gastrointestinal bleeding due to a Dieulafoy lesion in the terminal ileum. Ned Tijdschr Geneeskd. 2006;150:1776-79.
  10. Zheludochno-kishechnoe krovotechenie. Iazva D’elafua [Elektronnyi resurs]. Medical News. 30 marta 2017 [data obrashcheniia: 2021 sent 14] Available from: http://family-doctor.com.ua/zdorove-ot-a-do-a/gastroenterologiya/zheludochno -kishechnoe-krovotechenie-yazva-delafua (In Russ.)
  11. Nga ME, Buhari SA, Iau PT, Raju GC. Jejunal Dieulafoy lesion with massive lower intestinal bleeding. Int J Colorectal Dis. 2007 Nov;22(11):1417-18. doi: 10.1007/s00384-006-0227-1
Address for correspondence:
664003, Russian Federation,
Irkutsk, Krasnoe Vosstanie st., 1,
Irkutsk State Medical University,
Department of Hospital Surgery.
tel. +7 902 51 11 027,
e-mail: egg@iokb.ru
Grigoriev Evgeny G.
Information about the authors:
Panasyuk Alexandr I., Surgeon, Assistance of the Department of Hospital Surgery, Irkutsk Regional Hospital, Irkutsk State Medical University, Irkutsk, Russian Federaration
http://orcid.org/0000-0002-1710-2762
Grigoryev Eugene G., MD, Professor, Irkutsk Scientific Centre of Surgery and Traumatology, Scientific Coordinator, Irkutsk State Medical University, Head of the Department of Hospital Surgery. Irkutsk, Russian Federaration
http://orcid.org/0000-0002-5082-7028
Contacts | ©Vitebsk State Medical University, 2007-2023