Novosti
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Year 2012 Vol. 20 No 4
EXPERIMENTAL SURGERY
I.S. IVANOV, S.V. IVANOV, G.N. GORYAINOVA, A.V. IVANOV, D.V. TARABRIN
EXPERIMENTAL USING OF CELLULAR TECHNOLOGIES TO IMPROVE THE PROPERTIES OF CONNECTIVE TISSUE
Federal Budgetary State Establishment “Kursk State Medical University”
The Russian Federation
Objectives. To study the impact of the site of the ectogenous embryonic fibroblasts introduction in regard to endoprosthesis on the collagen metabolism dynamics.
Methods. The experiment was conducted on 150 mice. The sterile polytetrafluoroethylene prosthesis was placed above the aponeurosis. The animals were divided into 3 groups numbering 50 animals: the 1 group – without fibroblasts introduction; the 2 – a single introduction of fibroblasts on the 7 day; the 3 group – the fibroblasts were injected twice on the 7 and 10 days. Cultivated fibroblasts were obtained from the embryos of white mice. Ectogenous fibroblasts were injected in the paratransplant zone only on the side of prosthesis inverted to the skin and subcutaneous tissue. Animals were derived from the experiment on the 10, 30 and 60 days. The sections were stained with Sirius Red.
Results. It has been revealed that at early terms the introduction of fibroblasts and repetition factor of the introduction don’t influence the collagen types correlation depending on the spatial orientation of the prosthesis. Further a reliable increase of the collagen type I is registered. Introduction of the ectogenous fibroblasts accelerates the increase of collagen correlation of I and III types more in the case of repeated introduction. On the 30 and 60days of the experiment reliable differences in the collagen correlation of I and III types have been registered and the increase of the collagen type I content has been observed on the side of prosthesis inverted to the skin. Deposition of the ectogenous fibroblasts due to the structure of the polytetrafluoroethylene prosthesis material and their further participation in the collagen metabolism is considered to be a critical factor in the process of connective tissue capsule formation and prevalence of the collagen type I at the late terms of the experiment.
Conclusions. The application of the ectogenous fibroblasts has a reliable modifying effect on the dynamics of the collagen type I formation on the introduction side.
1. Egiev VN. Sravnitel'naia otsenka stepeni fiksatsii fibroblastov na sinteticheskikh endoprotezakh, ispol'zuemykh dlia plastiki defektov perednei briushnoi stenki [The comparative estimation of fibroblasts fixation degree on the synthetic endoprothesis used for the plastic of anterior abdominal wall defects]. Gerniologiia. 2006;(2):37–41.
2. Timoshin AD, Iurasov AV, Shestakov AL. Kontseptsiia khirurgicheskogo lecheniia posleoperatsionnykh gryzh perednei briushnoi stenki [The concept of surgical treatment of postoperative abdominal wall hernias]. Gerniologiia. 2004;(1):5–10.
3. Iarosh AL. Issledovanie biosovmestimosti khirurgicheskikh implantatov novogo pokoleniia dlia plastiki perednei briushnoi stenki Fundamental'nye issledovaniia. [The study of biocompatibility of new generation surgical implants for plasty of anterior abdominal wall]. Fundamental Issledovaniia. 2011;(10 ×. 1):186–89.
4. Gananadha S, Samra JS, Smith GS, Smith RC, Leibman S, Hugh TJ. Hugh Laparoscopic ePTFE mesh repair of incisional and ventral hernias. ANZ Journal of Surgery. 2008 Oct;78(10):907–13.
5. Il'in DA. Model' vozdeistviia polimernogo materiala na kul'turu fibroblastov Estestvoznanie i gumanizm. [Impact model of polymeric material on fibroblasts culture]. Estestvoznanie i Gumanizm. 2006;3(3):91–97.
6. Nikitin VN. Vozrastnaia i evoliutsionnaia biokhimiia kollagenovykh struktur [Developmental and evolutionary biochemistry of collagen structures]. Kiev, SSSR: Naukova dumka, 1977. 297 p.
7. Junge K, Klinge U, Rosch R, Mertens PR., Kirch J, Klosterhalfen B, Lynen P, Schumpelick V. Decreased collagen type I/III ratio in patients with recurring hernia after implantation of alloplastic prostheses. Langenbecks Arch Surg. 2004 Feb;389(1):17–22.
8. Meyer AL, Berger E, Monteiro Jr O, Alonso PA, Stavale JN, Goncalves MP. Quantitative and qualitative analysis of collagen types in the fascia transversalis of inguinal hernia patients. Arq Gastroenterol. 2007 Jul-Sep;44(3):2303–34.
9. Rosch R, Klinge U, Si Z, Junge K, Klosterhalfen B, Schumpelick V. A role for the collagen I/III and MMP-1/-13 genes in primary inguinal hernia? BMC Med Genet. 2002;3:2.
10. Broderick G, McIntyre J, Noury M, Strom HM, Psoinos C, Christakas A, Billiar K, Hurwitz ZM, Lalikos JF, Ignotz RA, Dunn RM. Dermal collagen matrices for ventral hernia repair: comparative analysis in a rat model. Hernia. 2012 Jun;16(3):333–43.
11. Hebda PA, Dohar JE. Transplanted fetal fibroblasts: survival and distribution over time in normal adult dermis compared with autogenic, allogenic, and xenogenic adult fibroblasts. Otolaryngol Head Neck Surg. 1999;121(3):245–51
305000, Rossiyskaya FederatsiyaKursk, Ul. K. Marksa, d. 3,GBOU VPO «Kurskiy gosudarstvennyiy meditsinskiy universitet»,kafedra hirurgicheskih bolezney ¹1
e-mail: ivanov.is@mail.ru,
Ivanov Ilya Sergeevich
Ivanov I.S., Candidate of Medical Sciences, Associate Professor of the Surgical Diseases Chair ¹1 of Federal State Budgetary State Establishment “Kursk State Medical University”
Ivanov S.V., Doctor of Medical Sciences, Professor, Head Of The Surgical Diseases chair ¹1 of Federal State Budgetary State Establishment “Kursk State Medical University”
Goryainova G.N., Candidate of Medical Sciences, Associate Professor of the Pathologic Anatomy Chair of Federal State Budgetary State Establishment “Kursk State Medical University”
Ivanov A.V., Doctor of Medical Sciences, Professor, Head of Histology, Embryology and Cytology Chair of Federal State Budgetary State Establishment “Kursk State Medical University”
Tarabrin D.V., Resident of the Surgical Diseases Chair ¹1 of Federal State Budgetary State Establishment “Kursk State Medical University”.
Article in the .pdf formatYU.M. GAIN, E.P. KISSELEVA, S.V. SHACHRAI
SUBSTANTIATION OF COMPLEX TRANSPLANT APPLICATION ON THE BASIS OF AMNIOTIC MEMBRANE AND MESENCHYMAL STEM CELLS FROM THE ADIPOSE TISSUE TO RESTORE THE CUTANEOUS INTEGRITY
State Educational Establishment “Belarusian Medical Academy of Postgraduate Education”, Minsk
The Republic of Belarus
Objectives. To develop and substantiate the restoration technology of cutaneous integuments’ integrity by means of the complex transplant consisting of the amniotic membrane and the autologous mesenchymal stem cells from the adipose tissue.
Methods. From 27 laboratory animals two experimental groups (the group with application of amniotic membrane and the autologous mesenchymal stem cells from the adipose tissue, and also the control group with spontaneous regeneration of wound defect) have been formed. The area of the wound surfaces was defined on 0, 10 and 20 days after transplantation. The skin biopsy material of all animal experimental groups was examined on the 20 day after the procedure. The first result of the clinical application of the developed restoration technique of the integumentary tissues wound defect in the conditions of a chronic arterial tissue ischemia is presented.
Results. It has been found out that allogenic amniotic membrane is a universal matrix for generating a complex skin transplant with mesenchymal stem cells from the adipose tissue. It serves a universal cell frame and matrix to transfer mesenchymal stem cells from the adipose tissue providing good conditions for the growth, differentiation and implantation of the cells coated on it.
In the experiment a reliably higher rate of the wound surface regeneration was observed in the animals with the transplant application in comparison with the control group. The first experience of a clinical application of the developed technique has shown a high rate of restoration of integrity of integuments’ defects in the conditions of a chronic arterial ischemia of tissues.
Conclusions. The use of a complex transplant from amniotic membrane and mesenchymal stem cells from adipose tissue has shown the possibility of high-grade restoration of integrity of the integument both in the laboratory animals and in humans.
1. Mano JF, Silva GA, Azevedo HS, Malafaya PB, Sousa RA, Silva SS, Boesel LF, Oliveira JM, Santos TC, Marques AP, Neves NM, Reis RL. Natural origin biodegradable systems in tissue engineering and regenerative medicine: present status and some moving trends. J R Soc Interface. 2007 Dec 22;4(17):999–30.
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3. Kern S, Eichler H, Stoeve J, Kluter H, Bieback K. Comparative analysis of mesenchymal stem cells from bone marrow, umbilical cord blood, or adipose tissue. Stem Cells. 2006 May;24(5):1294–301.
4. Baglioni S, Francalanci M, Squecco R, Lombardi A, Cantini G, Angeli R, Gelmini S, Guasti D, Benvenuti S, Annunziato F, Bani D, Liotta F, Francini F, Perigli G, Serio M, Luconi M. Characterization of human adult stem-cell populations isolated from visceral and subcutaneous adipose tissue. FASEB J. 2009 Oct;23(10):3494–505.
5. Benson-Martin J, Zammaretti P, Bilic G, Schweizer T, Portmann-Lanz B, Burkhardt T, Zimmermann R, Ochsenbein-Kolble N. The Young's modulus of fetal preterm and term amniotic membranes. Eur J Obstet Gynecol Reprod Biol. 2006 Sep-Oct;128(1-2):103–7.
6. Davis JW. Skin transplantation with a review of 550 cases at the Johns Hopkins Hospital. Med J. 1910;15:307–96.
7. Fernandes M, Sridhar MS, Sangwan VS, Rao GN. Amniotic membrane transplantation for ocular surface reconstruction. Cornea. 2005 Aug;24(6):643–53.
8. Baguneid MS, Seifalian AM, Salacinski HJ, Murray D, Hamilton G, Walker MG. Tissue engineering of blood vessels. Br J Surg. 2006 Mar;93(3):282–90.
9. Szekeres-Bartho J. Immunological relationship between the mother and the fetus. Int Rev Immunol. 2002 Nov-Dec;21(6):471–95.
10. Petrova EA, Kiseleva EP, Karatai NV, Laznev KV, Zhavnerko GK, Gain IuM. Vital'naia markirovka MSK kvantovymi tochkami na osnove selenida kadmiia [Vital labeling of MSC by quantum dots on the basis of cadmium selenide]. Lab Diagnostic. 2012;(2):106–13.
210013, Respublika Belarus Minsk, ul. P. Brovki, d. 3, kor. 3,GUO «Belorusskaya meditsinskaya akademiya poslediplomnogo obrazovaniya»,
e-mail: nayka@belmapo.by,
Gain Yuriy Mihaylovich
Gain YU.M., Doctor of medical sciences, Professor, Vice-Rector on the Research Activity, Professor of the Emergency Surgery Chair of State Educational Establishment “Belarusian Medical Academy of Postgraduate Education”
Kiseleva E.P., Post-graduate Student of the Emergency Surgery Chair of State Educational Establishment “Belarusian Medical Academy of Postgraduate Education”
Shachrai S.V., Candidate of Medical Sciences, Associate Professor of the Emergency Surgery Chair of State Educational Establishment “Belarusian Medical Academy of Postgraduate Education”.
GENERAL AND SPECIAL SURGERY
V.I. BELOKONEV 1, A.A. STAROSTINA 2, Z.V. KOVALEVA2, E.V. SELEZNEVA2
SUBSTANTIATION OF APPROACHES TO THE SELECTION OF PATIENTS WITH THYROID DISEASES FOR THE OPERATION
State Budgetary Educational Establishment of Higher Professional Education “Samara State Medical University”, Ministry of Health and Social Development of Russia 1,
Municipal Medical Budgetary Establishment “N.I.Pirogov City Clinical Hospital ¹1, Samara 2,
The Russian Federation
Objectives. To substantiate approaches to the selection of patients with thyroid diseases for the operation.
Methods. 204 out of 289 patients (70,58%) with the thyroid diseases were operated on. Patients with a toxic goiter were selected for the operation according to severity of thyrotoxicosis and its complications, terms of non-surgical treatment and its efficiency; patients with nodular euthyroid goiter were selected for the operation according to the sizes of nodules and thyroid gland, development of compression syndrome. Maximum subtotal resection of the thyroid gland leaving a small amount of thyroid tissue up to 3 grams was performed in 62 patients (30,39%). 142 patients (69,61%) were subjected to thyroidectomy, in 37 patients (26,06%) there was no direct visualization of recurrent laryngeal nerves and inferior laryngeal nerves versus 105 (73,94%) patients with visualization.
Results. The temporary phonation changes have been reported in 8 patients (21,62%) who underwent thyroidectomy without visualization of recurrent laryngeal nerves and inferior laryngeal nerves and in 3 patients (2,85%) – with visualization.
At the given volumes of operations there wasn’t any recurrence of thyrotoxicosis in patients with a toxic goiter. However, only /3 of patients did not require a thyroid hormone replacement therapy following this procedure.
Conclusions. The substantiated selection of patients with the thyroid diseases for the operations for thyroid nodules on the basis of the accepted standards has improved the treatment results of this severe pathology. Thyroidectomy is an operation of choice in patients in multinodular goitres. Clinical results indicate to the advantages of thyroidectomy with visualization of recurrent laryngeal nerves and inferior laryngeal nerves while treating patients with thyroid pathology.
1. Dedov II, Mel'nichenko GA, Fadeev VV. Endokrinologiia [Endocrinology]. Moscow: GEOTRAR-Media, 2009. 432 p.
2. Petunina NA, Martirosian NS, Trukhina LV. Sindrom tireotoksikoza. Podkhody k diagnostike i lecheniiu [Symptoms of hyperthyroidism. Approaches to the diagnosis and treatment]. Trudnyi Patsient. 2012;10(1):20–24.
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10. Kotel'nikov GP, Shpigel' AS. Dokazatel'naia meditsina. Nauchno-obosnovannaia meditsinskaia praktika [Evidence-based medicine. Evidence-based medical practice]. Monografiia. Samara, 2000. 116 p.
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12. Starostina AA. K voprosu o tselesoobraznosti vypolneniia tireoidektomii u bol'nykh s toksicheskimi formami zoba [On the question of the appropriateness of thyroidectomy in patients with goiter toxic forms]. Samara: Aspirants Vestn Povolzh'ia, 2011; 5-6:169–71.
443099, Rossiyskaya Federatsiya , SAMARAul. Chapaevskaya, d. 89, GBOU VPO «Samarskiy gosudarstvennyiy meditsinskiy universitet»,kafedra hirurgicheskih bolezney ¹2
e-mail: nbelokoneva@yandex.ru,
Belokonev Vladimir Ivanovich
Belokonev V.I. Honored Doctor of the Russian Federation, Doctor Of Medical Sciences, Professor, Head of the Surgical Diseases Chair ¹2 of State Budgetary Educational Establishment of Higher Professional Education “Samara State Medical University”
Starostina A.A. Extramural Post-Graduate Student of State Budgetary Educational Establishment of Higher Professional Education “Samara State Medical University”
Kovaleva Z.V. Candidate of Medical Sciences, Surgeon of the Municipal Medical Budgetary Establishment “N.I.Pirogov City Clinical Hospital ¹1 Samara,
Selezneva E.V. Endocrinologist of the MUNICIPAL Medical Budgetary Establishment “N.I.Pirogov City Clinical Hospital ¹1”, Samara.
P.K. KHOLMATOV, U.A. KURBANOV, N.U. USMANOV
RESULTS OF PORTOSYSTEMIC SHUNTING AT PORTAL HYPERTENSION
Tajik Abu Ali Ibn Sino State Medical University ,
The Republic of Tajikistan
Objectives. To study the immediate results of portosystemic shunting in patients with the portal hypertension.
Methods. The treatment results of 41 patients with the portal hypertension (PH) were studied: 17 patients with A class, 24 patients with B class according to the classification of Child – Pugh. Splenorenal anastomosis was made side by side in 14 patients, the distal splenorenal shunting – in 11, the splenorenal anastomosis with the upper interlobar vein of the left kidney with splenectomy – in 2, the splenorenal anastomosis and splenectomy - in 10 cases and the mesocaval anastomosis – in 4 cases.
Results. Esophageal varicosity of the I grade was revealed in 6 (14,6%), of the II grade – in 14 (34,29%) and of the III grade – in 21 (51,2%) patients. Patients with the liver cirrhosis (functional class A) having an initial degree of esophageal varicosity revealed the expansion of the splenic vein (VESV) up to 0,86±0,21 cm and a moderate enlargement of the spleen up to 12,9±2,5 cm. The high-speed parameters in the portal system veins in this group is appeared to reduce. In patients with the liver cirrhosis (functional class B) and marked VESV one registered the following: a more pronounced expansion of the splenic vein 0,98±0,17 cm, splenomegaly, in 14 (58,3%) patients the blood flow was registered in the periomphalic vein. In the early postoperative period after the splenorenal anastomosis performance combined with splenectomy gastro-esophageal bleeding has developed in 3 patients. The portosystemic shunt was successful in 38 patients.
Conclusions. Surgical correction with the performance of various portosystemic anastomoses in A and B class patients according to the classification of Child – Pugh at esophageal varicosity of the II-III grades is considered to be an effective method of prevention and treatment of the gastro-esophageal bleeding.
1. Khazanov AI. Alkogol'nye i virusnye tsirrozy pecheni u statsionarnykh bol'nykh (1996–2005 gg.): rasprostranennost' i iskhody [Alcoholic and viral cirrhosis of the liver in outpatients (1996-2005 yrs.): Prevalence and outcomes]. Ros Zhurn Gastroenterol Gepatol Koloproktol.. 2007;(2):19–27.
2. Nazyrov FG, Akilov KhA, Deviatov AV. Khirurgiia portal'noi gipertenzii u bol'nykh tsirrozom pecheni v Tsentral'no Aziatskom regione [Surgery of portal hypertension in patients with liver cirrhosis in the Central Asian region]. Annaly Khirurg Gepatologii. 2003;8(1):19–28.
3. Zatevakhin II. Trans"iuguliarnoe vnutripechenochnoe portosistemnoe shuntirovanie - endovaskuliarnyi metod sozdaniia portokaval'nogo anastomoza [Transjugular intrahepatic portosystemic shunt - endovascular method of a portocaval anastomosis creation]. Flebologiia. 2008;(4):10–16.
4. Henderson JM. Role of distal splenorenal shunt for long-term management of variceal bleeding. World J Surg. 1994 Mar-Apr;18(2):205–10.
5. Hillert C, Fischer L, Broering DC, Rogiers X. Liver transplantation in patients with liver cirrhosis and esophageal bleeding. Langenbecks Arch Surg. 2003;388:150–54.
6. Qazi SA, Khalid K, Hameed AM, Al-Wahabi K, Galul R, Al-Salamah SM.Al-Salamah Transabdominal gastro-esophageal devascularization and esophageal transection for bleeding esophageal varices after failed injection sclerotherapy: long-term follow-up report. World J Surg. 2006 Jul;30:1329–37.
7. Wolff M, Hirner A. Current state of portosystemic shunt surgery. Langenbecks Arch Surg. 2003 Jul;388:141–49.
8. Rossle M. When endoscopic therapy or pharmacotherapy fails to control variceal bleeding: what should be done? Immediate control of bleeding by TIPS? Langenbecks Arch Surg. 2003 Jul;388(3):155–62.
9. Wright AS, Rikkers LF. Current management of portal hypertension. J Gastrointest Surg. 2005 Sep-Oct;9(7):992–1005.
10. Yamamoto S, Sato Y, Nakatsuka H, Oya H, Kobayashi T, Hatakeyama K. Bene?cial effect of partial portal decompression using the inferior mesenteric vein for intractable gastroesophageal variceal bleeding in patients with liver cirrhosis. World J Surg. 2007 Jun;31(6):1264–69.
11. Moon SB, Jung SE, Ha JW, Park KW, Seo JK, Kim WK. The usefulness of distal splenorenal shunt in children with portal hypertension for the treatment of severe thrombocytopenia and leucopenia. World J Surg. 2008 Mar;32(3):483–37.
12. Makuuchi M, Miller CM, Olthoff K, Schwartz M. Adult–adult living donor liver transplantation. J Gastrointest Surgery. 2004 Mar-Apr;8(3):303–12.
13. Nazyrov FG. Vybor khirurgicheskoi taktiki u bol'nykh s tsirrozom pecheni s izolirovannoi splenektomiei v anamneze [The choice of surgical treatment in patients with liver cirrhosis and isolated splenectomy in history]. Annaly Khirurgii. 2008(2):46–49.
14. Terblanche J. Portal hypertension: A surgical hepatologist's view of current management. J Gastrointest Surg. 1997 Jan-Feb;1(1):4–12.
15. Ferreira FG, Ribeiro MA, de Fatima Santos M, Assef JC, Szutan LA. Doppler ultrasound could predict varices progression and rebleeding after portal hypertension surgery: lessons from 146 EGDS and 10 years of follow-up. World J Surg. 2009 Oct;33(10):2136–43.
734003, Respublika Tadzhikistan,Dushanbe, prospekt Rudaki, d. 139,Tadzhikskiy gosudarstvennyiy meditsinskiyuniversitet im. Abuali ibni Sino,kafedra hirurgicheskih bolezney ¹1
e-mail: egan0428@mail.ru,
Holmatov Pulat Kadyirovich
Kholmatov P.K., Candidate of Medical Sciences, Associate Professor of the Surgical Diseases Chair ¹1 of Tajik Abu Ali Ibn Sino State Medical University
Kurbanov U.A., Doctor of Medical Sciences, Professor, Rector of Tajik Abu Ali Ibn Sino State Medical University
Usmanov N.U., Academician of the Academy of Sciences of Tajikistan, Professor of The Surgical Diseases Chair ¹2 of Tajik Abu Ali Ibn Sino State Medical University.
V.E. KORIK 1, S.A. ZHIDKOV 2, D.A. KLYUYKO 1
OXYGENATION CHANGE OF THE ABDOMINAL ORGANS AT LAPAROSCOPY SURGERIES IN VARIOUS GASEOUS MEDIA
EE “Belarusian State Medical University” 1 Minsk
Military Medical Administration of the Ministry of Defence of the Republic of Belarus2
The Republic of Belarus
Objectives. To study the impact of carbon dioxide and synthetic air insufflated to the abdominal cavity on the respiratory activity of the abdominal cavity organs of patients undergoing laparoscopic cholecystectomy.
Methods. Two groups of patients (62 patients in each group) with calculous cholecystitis were included in the investigation. To create a working space for the laparoscopic procedures in the first group carbon dioxide was used; in the second – synthetic air. Investigation of the influence of gases on the internal organs oxygenation (liver, peritoneum and small intestine) was studied by the direct oximetry at the beginning of the operation (after setting the ports), insufflation of gas at the end of surgery prior to the removal of the tools.
Results. On insufflation of carbon dioxide the oxygen utilization rate by the peritoneum increased from 198,5 to 264,9 mm Hg/min, at the same time the oxygen content in it 2 times decreased from 125,4 to 64,2 mm Hg. The tissue respiration rate in the intestinal wall increased from 347,3 to 549,5 mm Hg/min and oxygen partial pressure increased from 121,9 to 144,7 mm Hg. The tissue respiration rate in the liver decreased from 215,8 to 73,4 mm Hg/min, and oxygen partial pressure increased from 74,3 to 132,3 mm Hg. While using the air gaseous mixture, statistically significant differences between the findings obtained at the beginning and at the end of the operation were not revealed.
Conclusions. The obtained data suggest that the peritoneum is easily permeable both to carbon dioxide and oxygen; in consequence of this the use of carbon dioxide markedly inhibits the oxygenation of the border tissue and causes acidemia. The air gaseous mixture has no significant effect on the respiratory activity of the organs and tissues.
1. Beliaev AIu, Nikolaeva IP. Sravnitel'naia otsenka gazoobmena i kislorodno-shchelochnogo sostoianiia pri laparoskopicheskikh ginekologicheskikh operatsiiakh, vypolnennykh po «gazovoi» i «bezgazovoi» metodike [Comparative evaluation of gas exchange and oxygen-base status in laparoscopic gynecological operations performed in the accordance of the "gas" and "gasless" method]. Endoskop Khirurgiia. 2000;(2):10–12.
2. Korik VE. Karboksiperitoneum pri laparoskopicheskikh operatsiiakh – neobkhodimost' al'ternativy [Carboxyperitonium in laparoscopic operation - alternative]. Voen Meditsina. 2009;(4):73–75.
3. Volz J, Koster S, Spacek Z, Paweletz N. Characteristic alterations of the peritoneum after carbon dioxide pneumoperitoneum. Surg Endosc. 1999 Jun;13(6):611–14.
4. De Souza AM, Wang CC, Chu CY, Lam PM, Rogers MS. The effect of intra abdominal pressure on the generation of 8-iso prostaglandin F2? during laparoscopy in rabbits. Hum Reprod. 2003 Oct;18(10):2181–88.
5. Jacobs VR, Kiechle M, Morrison JE Jr. Carbon dioxide gas heating inside laparoscopic insufflators has no effect. JSLS. 2005 Apr-Jun;9(2):208–12.
6. Suginami R, Taniguchi F, Suginami H. Prevention of postlaparoscopic shoulder pain by forced evacuation of residual CO(2). JSLS. 2009 Jan-Mar;13(1):56–59.
7. Korik VE. Vliianie karboksiperitoneuma i pnevmoperitoneuma na kislotno-osnovnoe sostoianie krovi [Carboxyperitonium and pneuperitonium effect on blood acid-base status]. Novosti Khirurgii. 2011;(4):31–35.
8. Titovets EP. Akvaporiny cheloveka i zhivotnykh: fundamental'nye i klinicheskie aspekty [Aquaporins of man and animals: basic and clinical aspects]. Minsk, RB: Belnauka, 2007. 239 p.
9. Blank ME, Ehmke H. Aquaporin-1 and HCO3(-)-Cl- transporter-mediated transport of CO2 across the human erythrocyte membrane. J Physiol. 2003 Jul 15;550(Pt 2):419–29.
10. Ivanov II, Loktyushkin AV, Gus'kova RA, Vasil'ev NS, Fedorov GE, Rubin AB. Oxygen channels of erythrocyte membrane. Dokl Biochem Biophys. 2007 May-Jun;414:137–40.
11. Borgnia M, Nielsen S, Engel A., Agre P. Cellular and molecular biology of the aquaporin water channels. Annu Rev Biochem. 1999;68:425–58.
12. Musa-Aziz R, Chen LM, Pelletier MF, Boron WF. Relative CO2/NH3 selectivities of AQP1, AQP4, AQP5, AmtB, and RhAG. Proc Natl Acad Sci U S A. 2009 Mar 31;106(13):5406–11.
220034, Respublika BelarusMinsk, ul. Azgura, d. 4, UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet», voenno-meditsinskiy fakultetkafedra voenno-polevoy hirurgii
e-mail: kluiko@list.ru,
Klyuyko Dmitriy Aleksandrovich
Korik V.E., Candidate of Medical Sciences, Associate Professor, Colonel of Medical Service, Head of Military Field Surgery Chair of the Military Medicine Faculty of EE "Belarusian State Medical University."
Zhidkov S.A., Doctor of Medical Sciences, Professor, Colonel of Medical Service, the Chief of Military Medical Department of the Ministry of Defense of the Republic of Belarus
Klyuyko D.A., Major of Medical Service, Graduate Student of The Chair of Military–Field Surgery of the Military Medicine Faculty of EE "Belarusian State Medical University."
YU.S. VINNIK, S.S. DUNAEVSKAYA, D.A. ANTUFRIEVA
RISK OF COMPLICATIONS DEVELOPMENT AT ALCOHOL-RELATED ACUTE PANCREATITIS
State Budgetary Educational Establishment of Higher Professional Education “Krasnoyarsk State Medical University named after Professorv.F.Voyno-Yasenetsky”
The Russian Federation
Objectives. To work out a prognostic method of development of a severe alcohol-related acute pancreatitis on the basis of dynamics of the laboratory diagnostics parameters.
Methods. 75 patients with the diagnosed alcohol-related acute pancreatitis were under our observation. All patients were receiving a conventional therapy. The age of the majority of patients with acute pancreatitis was from 23 up to 76 years. On the basis of the detailed blood analysis the following parameters were calculated: reactive response of neutrophils (RRN), ratio index of the segmented neutrophils to lymphocytes (ISL); the level of the urine diastasis was also taken into account (LUD).
Results. Risk estimation of the complications development was carried out according to the parameters dynamics: reactive response of neutrophils (RRN), ratio index of the segmented neutrophils to lymphocytes (ISL); the level of the urine diastasis (LUD). In obtaining 2 out of 3 positive values of the above mentioned parameters one could make a conclusion about high probability of a severe course.
There were no lethal outcomes in the group with low risk of complications development; the average period of hospitalization made up 8,79±0,9 days. While predicting a severe course, destructive forms of acute pancreatitis developed in 94,12% cases; lethality made up 48%. The average term of hospitalization for the given group of patients made up 40,46±2,5. So, at revealing a high risk of severe acute pancreatitis development it is recommended to administer intensive starting therapy (concept of “abort of pancreatonecrosis”)
Conclusions. The correlation between the clinical course of the disease and dynamics of the changes in the laboratory diagnostics parameters has been proved. The suggested express-method to estimate the risk of the complications development in patients with acute pancreatitis of alcohol etiology is characterized by high specificity and negative prognostic significance.
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660022, Rossiyskaya FederatsiyaKrasnoyarsk, ul. Partizana Zheleznyaka, d. 1,GBOU VPO «Krasnoyarskiygosudarstvennyiy meditsinskiy universitetim. prof. V.F. Voyno-Yasenetskogo»,kafedra obschey hirurgii,
e-mail: Vikto-potapenk@yandex.ru,
Dunaevskaya Svetlana Sergeevna
Vinnik YU.S.Honored Scientist of Russia Doctor of medical sciences, Professor, Head of the general surgery chair of SBEE HPE «Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky".
Dunaevskaya S.S. Candidate of medical sciences, Associate Professor of the General Surgery Chair of of SBEE HPE «Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky "
Antyufrieva D.A. Clinical Resident of the General Surgery Chair of SBEE HPE «Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky".
S.N. VORONOV, D.A. MILLER, A.A. GOLUBEV
PROPHYLAXIS OF VENOUS THROMBOEMBOLISM AT SURGICAL TREATMENT OF PATIENTS WITH CHRONIC CALCULOUS CHOLECYSTITIS
State Budgetary Educational Establishment of Higher Professional Education “Tver State Medical Academy”, Ministry of Health and Social Development of Russia
The Russian Federation
Objectives. To work out the algorithm of prophylactic anticoagulant dose choice to prevent the venous thromboembolism (VTE) in patients with chronic calculous cholecystitis at surgical treatment.
Methods. On the basis of the hemostasis system studying, 58 patients of the main group were divided into 3 subgroups. In the first subgroup of patients (16 patients with hyperaggregation and hypercoagulation) were administered the standard prophylactic dose of fragmin 0,2 ml (5000 ME). In the second subgroup of patients (19 patients with hyporaggregation and hyporcoagulation) a half of the standard prophylactic dose of fragmin 0,1 ml (2500 ME) was administered. In the third subgroup of patients (23 patients with hyperaggregation and hyporaggregation of hypercoagulation of thrombocytes and hypercoagulation and hyporcoagulation) the dose of the low molecular weight heparin was administered without taking into consideration the performed analysis of the hemostasis system and all the patients got the standard prophylactic dose of fragmin 0,2 ml (5000 ME). The nearest results of the laparoscopic cholecystectomy in patients of the main group were compared with the results of the surgical treatment in 5468 patients of the control group.
Results. Reduction of the thrombocytes aggregation was registered in the patients of the first and second subgroups. In patients of the third subgroup with hyporaggregation of thrombocytes, significant depression of the blood platelet hypofunction was registered. Coagulation hemostasis changes were seen in the first and second subgroups, which were approximating to the readings of healthy subjects. At the same time the readings of the intravascular blood coagulation of SFMC was higher in the patients of the 3 group and the degree of hyporcoagulation was more marked in them. In more than half patients postoperative period was without complications. 2 cases of the intraoperative bleeding from the gallbladder bed were registered in patients of the 3rd group. Hematomas of the postoperative wounds were also revealed in these patients. None of the patients of three subgroups was noticed to develop VTE.
Conclusions. Administration of the low molecular weight heparin to prevent VTE after laparoscopic cholecystectomy in patients with hemostasis hypofunction should be half-dosed and with hyperfunction – a full standard dosed.
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170000, Rossiyskaya FederatsiyaTver, ul. Sovetskaya, d. 4, GBOU VPO «Tverskaya gosudarstvennaya meditsinskaya akademiya», kafedra gospitalnoy hirurgii s kursom urologii,
e-mail: voronov-sergej@mail.ru,
Voronov Sergey Nikolaevich
Voronov S.N., Candidate of Medical Sciences, Assistant of the Hospital Surgery Chair with the Course Of Urology of State Budgetary Educational Establishment of Higher Professional Education “Tver State Medical Academy”
Miller D.A., Doctor of Medical Sciences, Professor of the Faculty Therapy Chair of State Budgetary Educational Establishment of Higher Professional Education “Tver State Medical Academy”
Golubev A.A., Candidate of Medical Sciences, Associate Professor of the Hospital Surgery Chair with the Course of Urology of State Budgetary Educational Establishment of Higher Professional Education “Tver State Medical Academy”.
D.D. SULTANOV 1, A.D. GAIBOV 1, E.L. KALMYKOV 1, S.H. MALLAEV 2
RISK FACTORS OF VARICOSITY DEVELOPMENT IN RURAL RESIDENTS OF THE SOUTHERN REGION OF TAJIKISTAN
The Republican Scientific-Practical Center of the Cardiovascular Surgery 1,
Central Regional Hospital of Jilikul District 2
The Republic of Tajikistan
Objectives. To study the disease incidence of the lower limb veins in the rural residents of the southern region of Tajikistan.
Methods. The examination results of 1438 people of Jilikul district of Khatlon region of Tajikistan were analyzed. The research was conducted in rural health clinics and in the central regional hospital when these patients with various diseases or for prophylactic examinations addressed.
Results. Varicosity was detected in 697 (48,5%) of all 1438 examined subjects. Combination of various risk factors among the subjects with varicosity was the following: one risk factor was detected in 177 (25,4%), two factors – in 143 (20,5%), three factors – in 338 (48,5%) and in 39 (5,6%) patients with varicosity any risk factors were absent. Combinations of two or more factors were observed in 69,1% patients with varicosity, whereas, they were registered among the healthy subjects in 24.7%. The severity of chronic venous insufficiency (CVI) was assessed using the international classification of CEAP, the section “I. Clinical classification”. Thus, class 1 was observed in 332 (47,6%) patients, C2 – in 182 (26,1%), C3 – in 119 (17,1%), C4 – in 46 (6,6%) C5 – 9 patients (1,3%) and C6 –also in 9 patients (1,3%). The heredity factor was revealed in 47,9% patients.
Conclusions. According to the research results different forms of varicosity were detected in 48,5% of rural residents of the working age. Mild forms (telangiectasia and reticular varicosity) made up 46,7%. Risk factors and various variants of their combination in the group of patients with varicosity were twice as often as in healthy subjects. The obtained data testify to the fact of practically absence of serious diagnostic and preventive measures among rural residents.
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3. Bogdanets LI, Arakelian VS, Sapelkin SV, Kalinina EV. Lechenie khronicheskoi venoznoi nedostatochnosti preparatom Venza [Drug therapy of chronic venous insufficiency with Venza]. Angiologiia i Sosud Khirurgiia 2005;11(3):55–59.
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734003, Respublika Tadzhikistan, Dushanbe, ul. Sanoi, d. 33,Respublikanskiy nauchnyiy tsentr serdechno-sosudistoy hirurgii, Tadzhikskiy gosudarstvennyiy meditsinskiy universitet, kafedra hirurgicheskih bolezney ¹ 2,
e-mail: sultanov57@mail.ru,
Sultanov Dzhavli Davronovich
Sultanov D.D., Doctor of Medical Sciences, Professor of the Surgical Diseases Chair ¹1 of Tajik Abu Ali Ibn Sino State Medical University
Gaibov A.D., Doctor of Medical Sciences, Corresponding Member of Academy of Medical Sciences of the Republic of Tajikistan, Professor of the Surgical Diseases Chair ¹2 of Tajik Abu Ali Ibn Sino State Medical University
Kalmykov E.L. , Candidate of Medical Sciences, Assistant of the Surgical Diseases Chair ¹2 of Tajik Abu Ali Ibn Sino State Medical University
Mallaev S.H., Chief Physician of the Central Regional Hospital of Jilikul District of Halton Region
PEDIATRIC SURGERY
A. V. ZAPOLYANSKY 1, V. I. AVERIN 2, Å. M. KOLESNIKOV 2,O. YU. KOROSTELEV 1
CLINICAL PECULIARITIES OF THE EXTRAHEPATIC PORTAL HYPERTENSION IN CHILDREN
ME “The 1st City Clinical Hospital”, Children’s Surgical Centre 1,
EE “Belarusian State Medical University” 2, Minsk,
The Republic of Belarus
Objectives. To make the analysis of the clinical course of the extrahepatic portal hypertension in children of different ages to determine the optimal surgical treatment strategy.
Methods. The analysis of clinical observations and survey results of 168 patients (91 boys, 77 girls) with the portal hypertension, who underwent treatment at the Children’s Surgical Centre in Minsk (2000 – 2007 years). General clinical tests, ultrasound examination of the abdominal organs, esophagogastroduodenoscopy, splenoportography, hepatic biopsy have been used to diagnose the diseases and to evaluate severity of its course.
Results. Blood flow problems from portal vein through the liver into the inferior vena cava was considered as the main reason of child’s portal hypertension. Extrahepatic block of the portal blood flow was diagnosed in 86,3% of patients. The main trigger factors of extrahepatic portal hypertension development were the purulent-septic diseases in infancy and the umbilical vein catheterization revealed in 41,3% of the examined patients. These factors contribute to portal vein thrombosis development with the consequent partial recanalization and the formation of obstructive block portal blood.
Direct statistically significant correlation association between the portal hypertension course severity (stage) and the varicosity degree of the esophageal veins have been revealed. Esophageal-gastric bleeding occurred most frequently – 76,8% – over the age of 1 to 7 years and was considered to be the first clinical symptom in most patients (58,3%).
In the dynamic observation it is appeared the frequency of bleeding usually reduces with increasing age.
Conclusions. The high frequency of bleeding in early childhood requires the early surgical treatment of this patients’ group. Severe course of extrahepatic portal hypertension, a high degree of disability due to this disease and the risk of life-threatening complications development imperatively demand on the special medical care for these patients on the basis of major medical institutions.
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220116, Respublika Belarus, Minsk, pr-t. Dzerzhinskogo, d. 83, UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet», kafedra detskoy hirurgii,
e-mail: averinvi@mail.ru,
Averin Vasiliy Ivanovich
Averin V.I., Doctor of Medical Sciences, Professor, Head of the Pediatric Surgery Chair of EE “Belarusian State Medical University”
Zapolyansky A.V., Candidate of Medical Sciences, Pediatric Surgeon of the Surgical Department ¹2 of ME “The 1st City Clinical Hospital”, Children’s Surgical Centre.
Kolesnikov E.M., Candidate of Medical Sciences, Associate Professor of the Pediatric Surgery Chair of EE “Belarusian State Medical University”
Korostelev O.YU., Pediatric Surgeon of the Surgical Department ¹2 of ME “The 1st City Clinical Hospital”, Children’s Surgical Centre
ONCOLOGY
A.O. KHORAU, K.N. UGLANICA
EFFICACY ESTIMATION OF COMBINED USE OF NEOADJUVANT POLYCHEMOTHERAPY AND INTRAVENOUS LASER IRRADIATION OF THE BLOOD IN PATIENTS WITH LOCALLY ADVANCED BREAST CANCER
EE “Grodno State Medical University”
The Republic of Belarus
Objectives. To evaluate the immediate results of treatment at the combined use of the neoadjuvant polychemotherapy and intravenous laser irradiation of the blood in patients with locally advanced breast cancer.
Methods. 101 primary patients with locally advanced breast cancer were included in the research. In the main group (49 patients) – neoadjuvant polychemotherapy was used in combination with intravenous laser irradiation of the blood. In the comparison group (52 patients) – only neoadjuvant chemotherapy was carried out. The efficacy of treatment and side effects were evaluated.
Results. The objective effect in the comparison group made up 55,8%, while in the study group – 73,5%. There were 7 (13,5%) cases of complete clinical regression in the comparison group, in the study group– 12 (24,5%). The complete morphological regression in the comparison group was reported in 2 (4,3%) of observations; in the study one – in 9 (20,0%).
The side effects of treatment were more common in the comparison group. Post therapeutic changes of the III-IV degree in the study group were revealed in 64,4% cases, while in the comparison group – in 38,6% of cases. Leucopenia of the I-II degree in the study group was observed in 10 cases (20,4%), in the comparison group – in 25 (48,1%) of cases. Leucopenia (III degree) was registered in 2 (4,1%) of patients of the study group and in 7 (13,5%) patients of the comparison group. In 3 patients (5,8%) of the comparison group the cardiac dysfunction was observed. The cases of nausea and vomiting (I-II grade) have been reported significantly rare (42,7%) in the study group.
In the main group one observed neither nausea nor vomiting (III degree) versus 5 such cases in the comparison group.
Conclusions. The use of neoadjuvant polychemotherapy and intravenous laser irradiation of the blood in patients with locally advanced breast cancer is a reasonable and effective method of preoperative treatment.
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15. Ivanova FG, Nikolaeva TN, Gorbunova VA. Izuchenie effektivnosti i toksichnosti standartnoi skhemy khimioterapii pri rake molochnoi zhelezy [Efficacy and toxicity of standard chemotherapy regimens in breast cancer]. Sibirskii onkol. zhurn. 2009;35(5):56–59.
16. Slonimskaia EM, Tarabanovskaia NA, Doroshenko AV, Garbukov EIu, Kokorina IuL. Kseloda v neoad"iuvantnom lechenii operabel'nogo raka molochnoi zhelezy [Xeloda in neoadjuvant treatment of operable breast cancer]. Sibirskii onkol zhurn. 2009;(1):14–18.
230009, Respublika Belarus, Grodno, ul. Gorkogo, d. 80, UO «Grodnenskiy gosudarstvennyiy meditsinskiy universitet», kafedra onkologii,
e-mail: anti-11@yandex.ru,
Horov Anton Olegovich
Khorov A.O., Assistant of the Oncology Chair of EE “Grodno State Medical University”.
Uglyanitsa K.N., Doctor of Medical Sciences, Professor, Head of the Oncology Chair of EE “Grodno State Medical University”.
A.V. HIDRANOVICH
BREAST CANCER OUTCOME PROGNOSIS BASED ON BLOOD SERUM BIOCHEMICAL INDICES
EE “Vitebsk State Medical University”
The Republic of Belarus
Objectives. To evaluate the prognostic significance of the serum biochemical indices in patients with breast cancer.
Methods. To design the model 162 patients suffering from the breast cancer have been examined, 12 of them with the cured breast cancer for more than 5 years were under the dispensary supervision; 9 females with benign hyperplastic breast diseases and 18 healthy women of corresponding age. The results of the 5-year survival prognosis were verified in the group consisting of 44 patients.
Results. To refer the patient to one of the prognostic groups one suggests to use the interpretation of the mathematics analysis of the complex of the blood serum biochemical indices, including autocrine motility factor (AMF), concentration of high density lipoproteins cholesterol (HDL CHOL), relative concentration of arachidonic acid (C20:4), stearic acid (C18:0), concentration of general serum cholesterol (CHOL). For prognosis two discriminant functions (DF1 and DF2) were calculated with further reference of a patient to one of the risk groups. 5-year survival prognosis after diagnosis has been made for the patients of the 1st risk group composes 79,8±5,5%, for the patients of the 2 risk group – 50,8±7,4%, for the patients of the 3 risk group – 10,4±5,6%.
A simplified method includes stratification of risk of hematogenic metastasis based on interpretation of AMF activity.
Conclusions. The performed research let to propose a new method for prognosis of breast cancer outcome and to reveal heterogeneity in clinically homogenous groups as well as to suggest the method to prognosticate the breast cancer outcome.
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10. Van de Vijver MJ, He YD, van't Veer LJ, Dai H, Hart AA, Voskuil DW, Schreiber GJ, Peterse JL, Roberts C, Marton MJ, Parrish M, Atsma D, Witteveen A, Glas A, Delahaye L, van der Velde T, Bartelink H, Rodenhuis S, Rutgers ET, Friend SH, Bernards R. A gene-expression signature as a predictor of survival in breast cancer. N Engl J Med. 2002 Dec 19;347(25):1999–2009.
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15. Keyhani M. Nasizadeh S, Dehghannejad A. Serum Ca15-3 Measurement In Breast Cancer Patients Before And After Mastectomy. Arch Iranian Med. 2005; 8(4):263–66.
16. Catanzaro PJ. Evolution of sub-clinical metastases in breast cancer. J Clin Oncol. 2008;26(May 20 Suppl; abstr 12024).
17. Ahmad A, Aboukameel A, Kong D, Wang Z, Sethi S, Chen W, Sarkar FH, Raz A. Phosphoglucose isomerase/autocrine motility factor mediates epithelial-mesenchymal transition regulated by miR-200 in breast cancer cells. Cancer Res. 2011 May 1;71(9):3400–409.
210023, Respublika Belarus, Vitebsk, pr. Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra onkologii s kursami luchevoy diagnostiki, terapii, FPK i PK,
e-mail: hidranovich@mail.ru,
Gidranovich Anton Viktorovich
Gidranovich A.V., Assistant of the Oncology Chair with the Course of Radial Diagnostics, Therapy, Faculty of Training and Retraining of the Staff of EE “Vitebsk State Medical University”. The Republic of Belarus.
TRAUMATOLOGY AND ORTHOPEDICS
A.A. LERNER, M.V. FOMENKO
TEMPORARY ACUTE BONE SHORTENING AND ANGULAR DEFORMATION – MODULAR STRATEGY IN TREATMENT OF SEVERE COMBINED TRAUMA OF THE LIMBS
Medical Center “Ziv”, Safed,
Israel
Objectives. To study long-term results of patients treatment with severe combined trauma of the limbs using the method of external stabilization with temporary acute bone shortening and angular deformation of the damaged segments.
Methods. Treatment results were analyzed in 12 patients, who underwent temporary acute bone shortening and external stabilization of the injured limb. Gradual elongation of the bones by the G.A. Ilizarov method was further performed to restore the length of the injured limb. While treating four patients with significant one-sided defects of the soft tissues at the acute period, temporary angular deformation of the injured segments was performed in addition to shortening to cover the fracture place without excessive resection of bone fragments ends.
Results. Complete healing of the wounds and fractures’ adnation were achieved in all 12 patients. The superficial posttraumatic wound infection without bone tissue involvement was observed in 5 of them. There were no cases of deep and chronic infection. The applied technique permitted to reveal the given advantages. Demand for free and local transplants decreases thus additional trauma and possible complications from the donor wound are excluded. The time of the operative intervention is shortened that is particularly important for patients with multiple and combined traumas. A good possibility is proposed to restore defects in the severe combined cases of injuring bones and soft tissue during one and the same operative intervention. One may perform the primary surgical treatment of a wound maximally radical that further decreases the possibility of the necrotic and purulent-septic complications development. The application of the three-dimensional external fixer of G.A. Ilizarov provides a possibility of early functional load.
Conclusion. Temporary acute bone shortening of the limb using the external bone fixation technique accompanied by further gradual restoring of the length of the injured segment by the G.A. Ilizarov method is one of effective ways to treat compound fractures with severe tissue damages. It is advisable to use this method to restore the limbs after the extensive compound high-energy fractures with extensive injuries and defects of soft tissues.
1. Lowenberg DW, Feibel RJ, Louie KW, Eshima I. Combined muscle flap and Ilizarov reconstruction for bone and soft tissue defects. Clin Orthop. 1996;332:37–51.
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3. Bundgaard KG, Christensen KS. Tibial bone loss and soft-tissue defect treated simultaneously with Ilizarov-technique – a case report. Acta Orthop Scand. 2000; 71(5):534–36.
4. Lerner A, Fodor L, Soudry M, Peled IJ, Herer D, Ullmann Y. Acute shortening: modular treatment modality for severe combined bone and soft tissue loss of the extremities. J Trauma. 2004 Sep;57(3):603–608.
5. Lerner A, Fodor L, Stein H, Soudry M, Peled IJ, Ullmann Y. Extreme bone lengthening using distraction osteogenesis after trauma: a case report. J Orthop Trauma. 2005 Jul;19(6):420–24.
6. Meffert RH, Inoue N, Tis JE, Brug E, Chao EY. Distraction osteogenesis after acute limb-shortening for segmental tibial defects. Comparsion of a monofocal and a bifocal technique in rabbits. J Bone Joint Surg Am. 2000 Jun;82(6):799–808.
7. Nho SJ, Helfet DL, Rozbruch SR. Temporary intentional leg shortening and deformation to facilitate wound closure using the Ilizarov/Taylor spatial frame. J Orthop Trauma. 2006 Jul;20(6):419–24.
8. Simpson A, Andrews C, Giele H. Skin closure after acute shortening. J Bone Joint Surg (Br). 2001;83-B:668–71.
9. Ullmann Y, Fodor L, Ramon Y, Soudry M, Lerner A. The Revised "Reconstructive Ladder" and Its Applications for High-Energy Injuries to the Extremities. Ann Plast Surg. 2006 Apr;56(4):401–405.
10. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res. 1989 Jan;(238):249–81.
11. Ilizarov GA. The Tension-Stress Effect on the Genesis and Growth of Tissues: Part II. The Influence of the Rate and Frequency of Distraction. Clin Orthop Relat Res. 1989 Feb;(239):263–85.
12. Lindsey CA, Makarov MR, Shoemaker S, Birch JG, Buschang PH, Cherkashin AM, Welch RD, Samchukov ML. The effect of the amount of limb lengthening on skeletal muscle. Clin Orthop Relat Res. 2002 Sep;(402):278–87.
13. Makarov MR, Kochutina LN, Samchukov ML, Birch JG, Welch RD. Effect of rhythm and level of distraction on muscle structure: an animal study. Clin Orthop Relat Res. 2001 Mar;(384):250–64.
14. Nakamura K, Matsushita T, Okazaki H, Kurokawa T. Soft tissue responses to limb lengthening. Journal of Orthopaedic Science. 1997 May;2(3):191–97.
13100, ISRAEL, SAFED MEDICAL CENTER “ZIV”,Orthopedics department
å-mail: alex_lerner@yahoo.com
Lerner Aleksandr Aronovich
Lerner A.A., Senior Lecturer of the Medical Faculty of Bar-Ilan University, Director of the Orthopedics Department, Medical Center “ZIV”, SAFED
Fomenko M.V., Candidate of Medical Sciences, Physician of the Orthopedics Department, Medical Center “ZIV”, SAFED
UROLOGY
A.G. BEREZHNOY, E.V. DYABKIN, F.P. KAPSARGIN, A.A. ZALEVSKIY
TOPOGRAPHIC AND ANATOMIC BASIS OF A SURGICAL ACCESS TO KIDNEY
State Budgetary Educational Establishment of Higher Professional Education “Krasnoyarsk State Medical University named after Professor V.F.Voyno-Yasenetsky”
The Russian Federation
Objectives. To identify topographic and anatomical peculiarities of the XII rib structure in order to develop a new operational access to the kidney.
Methods. The investigation was carried out on 30 corpses referred to the second period of the adulthood. It included 18 males and 12 females. Refinement of the technique and studying the parameters of operational access to the kidney with a longitudinal incision of the XII rib was performed by the method of A.Yu. Sozon-Yarashevich supplemented by A.G. Mirzamuhamedov. To assess the approach one used the following parameters: the depth and width of the wound, the inclination angle of the operation action axis, the operating inclination angle along the wound length, the operating angle of the wound width.
Results. The average depth of the wound made up 6,49±0,11 cm. The minimum depth of the wound was 4,5 cm, and the highest – 7,8 cm The average width of the wounds was equal to 7,44±0,12 cm: the lowest – to 6,0 cm, and the highest – 9,0 cm. The average value of the inclination angle of the operation action axis made up 87°±0,4. In our studies the angles of the operational actions from 86,8° to 90° occurred in 77% and from 80° to 86,8° - in 23% of cases. The average value of the operating angle of the wound length was 95°±1,0 and these values were recorded in half of cases. The average angle of operation according to the width of the wounds was equal to 61°±1,2. The research results showed that the spatial relationships in the wound are characterized above all by the angle of the operating action determined both according to the length and the width of the wound.
Conclusions. The investigation of the parameters of the operational access to the kidney with a longitudinal incision of the XII rib confirms its topographic and anatomical appropriateness. This operational access should be used in patients with complicated forms of urolithiasis requiring the open surgery.
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[Atlas Topographic anatomy of cuts through the frozen body of a man - the top of the scientific achievement of NI Pirogov]. Vopr Rekonstruk i Plastich Khirurgii. 2009;(2):38–43.
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660022, Rossiyskaya Federatsiya, Krasnoyarsk, ul. Partizana Zheleznyaka, d. 1, GBOU VPO «Krasnoyarskiy gosudarstvennyiy meditsinskiy universitet imeni prof. V.F. Voyno-Yasenetskogo»,
e-mail: dyabkyn@mail.ru,
Dyabkin Evgeniy Vladimirovich
Berezhnoy A.G., Candidate of Medical Sciences, Assistant of Urology, Andrology and Sexology, the Chair of State Budgetary Educational Establishment of Higher Professional Education “Krasnoyarsk State Medical University named after professor V.F.Voyno-Yasenetsky”.
Dyabkin E.V., Candidate of Medical Sciences, Assistant of the General Surgery Chair of State Budgetary Educational Establishment of Higher Professional Education “Krasnoyarsk State Medical University named after professor V.F.Voyno-Yasenetsky”.
Kapsargin F.P., Doctor of Medical Sciences, Head of Urology, Andrology and Sexology Chair of State Budgetary Educational Establishment of Higher Professional Education “Krasnoyarsk State Medical University named after professor V.F.Voyno-Yasenetsky”
Zalevsky A.A., Doctor of Medical Sciences, Professor of the Operative Surgeryand Topographic Anatomy of STATE Budgetary Educational Establishment of Higher Professional Education “Krasnoyarsk State Medical University named after professor V.F.Voyno-Yasenetsky”.
A.K. USOVICH, V.A. KRASNOBAEV
PECULIARITIES OF STRUCTURAL ORGANIZATION OF MUSCULAR TISSUE AND CONCREMENT FORMATION IN HUMAN PROSTATE
EE “Vitebsk State Medical University”
The Republic Of Belarus
Objectives. To reveal age-specific periods of the prostatic concrements definition and establish the interrelation of lithogenesis with prostate muscular tissue peculiarities.
Methods. 303 prostates of corpses from twenty-week fetuses up to ninety-three year old men who have died accidentally and lethality was not connected with genitourinary apparatus and pelvic organs pathology made up the research material.
Results. It has been established that in the period of human prostate development (fetuses - teenagers) when intensity of the prostate glands secretion is not high the prostatic concrements have not been found. At young men as a result of intensive growth of prostate gland and increase of their secretory activity on the background of lagging of the glandular muscular cover formation the prostatic concrements are formed.
In the period of the highest organ functional activity (22-35 years) the structure of muscular tissue is formed in human prostate providing a full evacuation of a secret from actively functioning prostatic glands. In the period of age prostate involution which morphological manifestations are revealed in some men from the age of 38 the total thinning of myocyte bundles is observed as well as the density reduction of their location around the terminal segments of prostatic glands. As a consequence of it the internal secretion of the prostate gland accelerates growth and diameter of concrements.
At the senile age in comparison with elderly one the specific volumes of muscular and elastic tissues decrease significantly as well as the thickness and myocytes density location. The expressed bundles of the smooth muscular tissue have not observed. Prostatic corpuscles have been found in the lumens of all glandular segments.
Conclusions. Concrements in the prostate have been found in young and older than 38 years persons. Presence of concrements is revealed in such sites of the prostate where the structure of the muscular bundles cannot provide a full secret evacuation from the glands.
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210023, Respublika Belarus, Vitebsk, pr. Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra anatomii cheloveka,
e-mail: krasnobayev@bk.ru,
Krasnobaev Vladimir Alekseevich
Usovich A.K., Doctor of Medical Sciences, Head of the Human Anatomy Chair of EE “Vitebsk State Medical University”
Krasnobaev V.A., Assistant, Extramural Post-Graduate of the Human Anatomy Chair of EE “Vitebsk State Medical University”
ANESTHESIOLOGY-REANIMATOLOGY
S.A. TACHYLA
CHANGE OF ACID-BASE STATUS INDICATORS AND BLOOD GAS COMPOSITION AT CARRYING OUT BALANCED ENDOTRACHEAL ANESTHESIAIN THE ABDOMINAL SURGERY
ME “Mogilev Regional Hospital”
The Republic of Belarus
Objectives. To carry out a comparative assessment of the impact of a multi-component balanced endotracheal anesthesia with the use of isoflurane, sevoflurane and propofol on the parameters of acid-base status and gas composition of the venous blood in patients undergoing abdominal surgery.
Methods. 135 patients during anesthesia at abdominal surgeries were examined. Depending on the anesthetics used three groups were identified. In the first group (n=43) isoflurane was used to maintain a state of general anesthesia; in the second group (n=42) – sevoflurane, in the third group (n=50) – propofol. Venous blood samples obtained during anesthesia were collected for blood gas and of acid-base status analysis at six stages.
Results. Changes in acid-base status during anesthesia with different anesthetics are subjected to general regularities. During anesthesia a significant decrease in lactate levels and increase of pH to normal values were registered in comparison with the initial level. We have found out the partial pressure and oxygen saturation in the venous blood during anesthesia were significantly higher with inhaled anesthetics (isoflurane and sevoflurane in the mixture with nitrous oxide) use as compared with propofol.
Conclusions. We attribute the obtained changes in acid-base status to the appropriate carrying out of anesthesia and mechanical lung ventilation during the surgery. Significant increase of oxygen content in the venous blood during anesthesia maintenance is considered to repose in the organ protective effect basis of the inhaled anesthetics.
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4. Karagulle E, Turk E, Dogan R, Ekici Z, Sahin D, Moray G. Effects of the application of intra-abdominal low pressure on laparoscopic cholecystectomy on acid-base equilibrium. Int Surg. 2009 Jul-Sep;94(3):205–11.
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6. Ture H, Mercan A, Koner O, Aykac B, Ture U. The effects of propofol infusion on hepatic and pancreatic function and acid-base status in children undergoing craniotomy and receiving phenytoin. Anesth Analg. 2009 Aug;109(2):366–71.
7. Grachev S.S. Otsenka pokazatelei kislotno-osnovnogo sostoianiia i aktselerografii pri anesteziologicheskom obespechenii intraabdominal'nykh operativnykh vmeshatel'stv [Evaluation of acid-base status and accelerography for anesthetic management in intra-abdominal surgery]. Voennaia meditsina. 2010;(4):33–36.
8. Gorokhvatskii IuI, Azizova OA, Gudymovich VG. Mekhanizmy kardioprotektornogo deistviia sevoflurana [Mechanisms of cardioprotective effect of sevoflurane]. Vestnik Intensivnoi Terapii. 2007;(4):3-11
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10. De Ruijter W, Musters RJ, Boer C, Stienen GJ, Simonides WS, de Lange JJ. The cardioprotective effect of sevoflurane depends on protein kinase C activation, opening of mitochondrial K(+)(ATP) channels, and the production of reactive oxygen species. Anesth Analg. 2003 Nov;97(5):1370–76.
11. Zinchuk VV, Maksimovich NA., Kozlovskii VI. i dr. Disfunktsiia endoteliia: fundamental'nye i klinicheskie aspekty [Endothelial dysfunction: basic and clinical aspects.]. Grodno, RB: 2006. 183 p.
12. Kharasch ED, Frink JrEJ, Artru A, Michalowski P, Rooke GA, Nogami W. Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function. Anesth Analg. 2001 dec;93(6):1511–20.
212016, Respublika Belarus, Mogilev, ul. Belyinitskogo-Biruli, d. 12, UZ «Mogilevskaya oblastnaya bolnitsa», reanimatsionno-anesteziologicheskoe otdelenie,
å-mail: tsa80@inbox.ru,
Tochilo Sergey Anatolevich
Tochilo S.A., Anesthesiologist-Resuscitator of ME “Mogilev Regional Hospital”, Extramural post-graduate student oF the General and Clinical Pharmacology Chair with the Course of Anesthesiology and Resuscitation of EE “Gomel State Medical University”.
A.V. MAROCHKOV
APPLICATION OF VARIOUS SCHEMES OF ROCURONIUM BROMIDE DOSING IN PATIENTS WITH OBESITY
ME “Mogilev Regional Hospital”
The RepublicoOf Belarus
Objectives. To determine the optimal scheme of rocuronium bromide dosing in the composition of the multicomponent balanced endotracheal anesthesia with sevoflurane in case of the laparoscopic abdominal operations in patients with obesity.
Methods. 76 patients suffering from obesity were included in the study. The patients received rocuronium bromide in the dosage of 0,45 mg/kg. Dose of rocuronium was calculated either for the actual body weight (AW) (the 1 group) or for the ideal body weight by formulas of Lorentz, Brooke and Devine (the 2, 3 and 4 group, correspondently).
Results. Rocuronium's onset time of action was the shortest at the dose on FM – 80 s (52-127). In calculating of rocuronium dose using the formulas of Lorentz and Brooke onset time of complete neuromuscular block was longer (125 s (75-340) in the 2 group and 110 s (80-200) in the 3rd group). The greatest time of Rocuronium’s onset of action was in the 4 group – 270 s (130-340). Duration of rocuronium action was also the longest in the 1st group (39,5 min (35-51), and the shortest – in the 4 group (29 min (27-31).
Conclusions. In patients with obesity undergoing abdominal surgeries the use of rocuronium should be done taking into consideration the ideal body weight. The most controlled for rocuronium dosing as a component of the balanced endotracheal anesthesia is considered to be a scheme with the myorelaxant calculation for the ideal body weight by the formula of Lorentz.
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212016, Respublika Belarus, Mogilev, ul. Belyinitskogo-Biruli, d. 12, UZ «Mogilevskaya oblastnaya bolnitsa», reanimatsionno-anesteziologicheskoe otdelenie,
e-mail: marochkov@mail.ru,
Marochkov Aleksey Viktorovich
Marochkov A.V., Doctor of Medical Sciences, Head of the Anesthesiology-Resuscitation Department of ME “Mogilev Regional Hospital”.
LECTURES, REVIEWS
A.A. BAESHKO, S.N. TIKHON, E.V. KRYZHOVA, P.V. MARKAUTSAN, V.F. VARTANYAN, V.M. DECHKO, K.M. KOVALEVICH, N.G. SHESTAK
FOAM-FORM SCLEROTHERAPY: HISTORY OF THE DEVELOPMENT AND PRESENT-DAY FINDINGS
EE “Belarusian State Medical University”, Minsk
The Republic of Belarus
Sclerotherapy is a modern, safe and effective method of the chronic venous diseases treatment, which has gained a great popularity among phlebologists of all countries. During the past decade the qualitatively new technology, a foam scleraobliteration of veins, based on the injection of the preparation in the form of small dispersed foam has been introduced into the clinical practice. Ultrasound control of the procedure not only simplifies the stage of the dilated veins puncture, but also gives an opportunity to estimate immediate and long-term results of the treatment. The principles of the foam-form sclerotherapy, the history of its development, efficacy and possible side-effects are viewed in this article on the literature basis using electronic resources of PubMed, MEDLINE, EMBASE.
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20. Gillet JL, Guedes JM, Guex JJ, Hamel-Desnos C, Schadeck M, Lauseker M, Allaert FA. Side-effects and complications of foam sclerotherapy of the great and small saphenous veins: a controlled multicentre prospective study including 1,025 patients. Phlebology. 2009 Jun;24(3):131–38.
21. Coleridge SP. Chronic venous disease treated by ultrasound guided foam sclerotherapy. Eur J Vasc Endovasc Surg. 2006;32(5):577–83.
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23. Ceulen RPM. Sommer A, Vernooy K. Microembolism during foam sclerotherapy of varicose veins. N Engl J Med. 2008;358:1525–26.
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25. Neuhardt DL. Morrison N, Rogers C, Salles-Cunha S. Emboli detection in the middle cerebral artery concurrent with treatment of lower extremity superficial venous insufficiency with foam sclerotherapy (CO2/O2). Phlebology. 2009;24:88–89.
26. Neuhardt DL. Salles-Cunha SX, Morrison N. Emboli detection in the middle cerebral artery during and following foam sclerotherapy (room air) of lower extremity veins. Phlebology. 2008;23(Suppl. 1):8.
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28. Hill D. Hamilton R, Fung T. Assessment of techniques to reduce sclerosant foam migration during ultrasound-guided sclerotherapy of the great saphenous vein. J Vasc Surg. 2008 Oct;48(4):934–39.
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30. Jia X, Mowatt G, Burr JM, Cassar K, Cook J, Fraser C. Systematic review of foam sclerotherapy for varicose veins. Br J Surg. 2007 Aug;94(8):925–36. Review.
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32. Cavezzi A, Frullini A. The role of sclerosing foam in ultrasound guided sclerotherapy of the saphenous veins and of recurrent varicose veins. Austral NZ J Phlebol. 1999;3(2):49–50.
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36. Barret JM, Allen B, Ockelford A, Goldman M. Microfoam Ultrasound-Guided Sclerotherapy Treatment for Varicose Veins in a Subgroup with Diameters at the Junction of 10mm or Greater Compared with a Subgroup of Less Than 10mm. Dermatol Surg. 2004;30:1386–90.
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220116, Respublika Belarus, Minsk, pr-t. Dzerzhinskogo, d. 83, UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet», kafedra operativnoy hirurgii i topograficheskry anatomii,
e-mail: dr_shestak@gmail.com,
Shestak Nikita Gennadevich
Baeshko A.A., Doctor of Medical Sciences, Professor, Head of the Operative Surgery and Topographic Anatomy chair of EE “Belarusian State Medical University”
Tikhon S.N., Candidate of Medical Sciences Associate Professor of the Operative Surgery and Topographic Anatomy Chair of EE “Belarusian State Medical University”
Kryzhova E.V., Candidate of Medical Sciences Associate Professor of the Operative Surgery and Topographic Anatomy Chair of EE “Belarusian State Medical University”
Markautsan P.V., Candidate of Medical Sciences Associate Professor of the Operative Surgery and Topographic Anatomy Chair of EE “Belarusian State Medical University”
Vartanyan V.F., Candidate of medical sciences Associate Professor of the Operative Surgery and Topographic Anatomy Chair of EE “Belarusian State Medical University”
Dechko V.M., Candidate of Medical Sciences, Associate Professor of the Operative Surgery and Topographic Anatomy Chair of EE “Belarusian State Medical University”
Kovalevich K.M., Candidate of medical sciences, Associate Professor of the Operative Surgery and Topographic Anatomy Chair of EE “Belarusian State Medical University”
Shestak N.G., A 5-year Student of the Medical Faculty of EE “Belarusian State Medical University”
PRACTICAL CASES
S.I. TRETYAK1, S.M. RASHCHYNSKY1,2, O.A. YUDINA3, I.E. SHIMANSKY2, N.T. RASHCHYNSKAYA2, T.I. KOROTKAYA2
PLEXIFORM ANGIOMYXOID MYOFIBROBLASTIC TUMOR OF THE STOMACH: LITERATURE REVIEW AND OWN OBSERVATIONS
EE “Belorussian State Medical University” 1,
ME “City Clinical Emergency Hospital”2, MinsK
ME “Municipal Clinical Pathological- Anatomical Bureau” 3, Minsk
The Republic of Belarus
Objectives. To carry out the analysis of the first own clinical observation of the plexiform angiomyxoid myofibroblastic tumor (PAMT), which is a unique mesenchymal tumor firstly described in 2007.
Methods. The clinical picture of the disease, results of the diagnostics methods, principles of morphological research of own observation and accessible database of Pubmed have been analyzed.
Results. PAMT is a very rare mesenchymal tumor with unique morphological characteristics and it should be distinguished from Gastrointestinal stromal tumors (GISTs) and other mesenchymal tumors of the stomach. All cases described in the literature were considered as an accidental finding or diagnosed during the gastric bleeding. Our observation illustrates difficulties of the differential diagnostics and variety of clinical manifestations.
Conclusions. The presented case is the first description of PAMT in the Belarusian and the Russian literature. The case of observation for the initially-plural localization of PAMT is given firstly in the world.
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3. Miettinen M, Makhlouf HR, Sobin LH, Lasota J. Plexiform fibromyxoma: a distinctive benign gastric antral neoplasm not to be confused with a myxoid GIST. Am J Surg Pathol. 2009;33:1624–32.
4. Bamboat ZM. DeMatteo RP. Updates on the management of gastrointestinal stromal tumors. Surg Oncol Clin N Am. 2012;21:301–16.
5. Rau TT, Hartmann A, Dietmaier W, Schmitz J, Hohenberger W, Hofstaedter F, Katenkamp K. Plexiform angiomyxoid myofibroblastic tumor: differential diagnosis of gastrointestinal stromal tumor in the stomach. J Clin Pathol. 2008;61:1136–37.
6. Galant C, Rousseau E, Ho Minh Duc DK, Pauwels P. Plexiform angiomyxoid myofibroblastic tumor of the stomach. Am J Surg Pathol. 2008.;32:1910.
7. Yoshida A. Klimstra DS, Antonescu CR. Plexiform angiomyxoid tumor of the stomach. Am J Surg Pathol. 2008;32:1910–12.
8. Takahashi Y, Suzuki M., Fukusato T. Plexiform angiomyxoid myofibroblastic tumor of the stomach. World J Gastroenterol. 2010;16:2835–40.
9. Sing Y, Subayan S, Mqadi B, Ramdial PK, Reddy J, Moodley MS, Bux S. Gastric plexiform angiomyxoid myofibroblastic tumor. Pathol Int. 2010;60:621–25.
10. Tan CY, Santos LD, Biankin A. Plexiform angiomyxoid myofibroblastic tumor of the stomach: a case report. Pathology. 2010;42:581–83.
11. Kim A, Bae YK, Shin HC, Choi JH. Plexiform angiomyxoid myofibroblastic tumor of the stomach: a case report. J Korean Med Sci. 2011;26:1508–11.
12. D’Egidio A, Schein M. Pancreatic pseudocysts: a proposed classification and its management implications. Br J Surg. 1991;78:981–84.
13. Warshaw AL. Rattner DW. Timing of surgical drainage for pancreatic pseudocysts. Clinical and chemical criteria. Ann Surg. 1985;202:720–24.
14. Degen L, Wiesner W, Beglinger C. Cystic and solid lesions of the pancreas. Best Pract Res Clin Gastroenterol. 2008;22(1):91–103.
220116, Respublika Belarus, Minsk, pr. Dzerzhinskogo, d. 83, UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet», 2-ya kafedra hirurgicheskih bolezney,
e-mail: rashchyn@mail.ru,
Raschinskiy Sergey Markovich
Tretyak S.I., Doctor of Medical Sciences, Professor, Head of the 2nd Chair of Surgical Diseases of EE “Belorussian State Medical University”
Rashchynsky S.M., Candidate of Medical Sciences, Assistant of the 2nd Chair of Surgical Diseases of EE “Belorussian State Medical University”, Head of the 3rd Surgical (Hepatologic) Department of ME “City Clinical Emergency Hospital, Minsk.
Yudina O.A., Candidate of Medical Sciences, Head of the General Pathology Chair of ME “Municipal Clinical Pathological And Anatomical Bureau”.
Shimansky I.E., Candidate of Medical Sciences, Deputy of the Chief Physician on Surgery of ME “City Clinical Emergency Hospital”, Minsk.
Rashchynskaya N.T., Surgeon of the 3rd Surgical (Hepatologic) Department of ME “City Clinical Emergency Hospital, Minsk.
Korotkaya T.I., Physician of the MRT of ME “City Clinical Emergency Hospital, Minsk
TO HELP THE PRACTITIONER
A.P.TRUKHAN1, S.A.ZHIDKOV 2, V.E.KORYK 1, I.I.PIKIRENYA
CLINICAL DIAGNOSTICS COMPILING IN VICTIMS WITH EXPLOSIVE TRAUMA
EE “Belorussian State Medical University” 1,
Military Medical Directorate of the Ministry Of Defence2,
Ministry of Health of the Republic of Belarus 3,
The Republic of Belarus
The analysis results of clinical diagnoses of 195 victims of the explosion at the station, “Octyabrskaya” of Minsk subway in April 11, 2011 who sought for the medical help on the attack day are presented in the article. The aim of the study is to evaluate the compliance of diagnoses to the basic principles of construction and formulation of diagnosis in patients with the explosive trauma.
As a result of this analysis the most common errors in the construction of diagnoses have been revealed as well as in the description of the morphological characteristics of lesions. The most common problems in medical specialists have been found out to cause the discrimination of the terms “mixed” and “combined” trauma.
Particular attention is paid to the preservation of clinical characteristics of the state severity of the wounded in the final diagnosis. The necessity of knowledge of pathogenesis of the explosive injuries and basic principles of their classification for the correct formulation of the diagnosis has been shown.
1. Avtandilov, GG, Zairat'iants OV, Kakturskii LV. Oformlenie diagnoza: Uch posobie [Making the diagnosis: a textbook]. Moscow, RF: Meditsina, 2004. 304 p.
2. Ambalov IuM, Proidakov MA, Kuznetsov VP. Terminologiia diagnoza (Spravochnoe posobie) [Terminology of diagnosis (a handbook)]. Rostov-na-Donu, RF: Izdatel'stvo RGMU, 2001. 12 p.
3. Boiko IuG, Siliaeva NF. Teoreticheskie osnovy i printsipy postroeniia diagnoza [Theoretical foundations and principles of diagnosis]. Med Novosti. 1998;(8):30–33.
4. Bykov IIu, Efimenko NA, Gumanenko EK, red. Voenno-polevaia khirurgiia: Natsional'noe rukovodstvo [Military surgery: National guideline] . Moscow, RF: GEOTAR-Media, 2009. 816 p.
5. Musalatov KhA. Khirurgiia katastrof: Uchebnik [Surgery of disasters: a textbook]. Moscow, RF: Meditsina, 1998. 592 p.
6. Mustafin TI. Printsipy oformleniia i struktury diagnoza. Meditsinskoe svidetel'stvo o smerti: Uchebno-metodicheskoe posobie [Principles of forming and structure of the diagnosis. Medical certificate of death: a handbook]. Ufa, RF: Izdatel'stvo Bashgosmeduniversitta, 2003. 60 p.
220034, Respublika Belarus Minsk, ul. Azgura, d. 4, UO «Belorusskiy gosudarstvennyiymeditsinskiy universitet»,voenno-meditsinskiy fakultet,kafedra voenno-polevoy hirurgii,å-mail: aleksdoc@yandex.ru,
Truhan Aleksey Petrovich
Trukhan A.P., Candidate of Medical Sciences, Major of Medical Service, Assistant of Military –Field Surgery Chair of the Military Medicine Faculty of EE "Belarusian State Medical University."
Zhidkov S.A., Doctor of Medical Sciences, Professor, Colonel of Medical Service, the Chief of Military Medical Department of the Ministry of Defense of the Republic of Belarus
Koryk V.E., Candidate of Medical Sciences, Associate Professor, Colonel of Medical Service, Head of Militaryfield Surgery Chair of the Military Medicine Faculty of EE "Belarusian State Medical University."
Pikirenya I.I., Candidate of Medical Sciences, Associate Professor, Chief Surgeon of the Ministry of Public Health of the Republic of Belarus
