Novosti
Khirurgii
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Year 2012 Vol. 20 No 6

HISTORY OF SURGERY

S.A. SUSHKOU, YU.S. NEBYLITSIN, E.N. REUTSKAYA, A.N. RAK

DIFFICULT PATIENT. WOUND OF PYOTR IVANOVICH BAGRATION. PART I

EE “Vitebsk State Medical University”
The Republic of Belarus

In 2012 it was a 200 years anniversary of the Patriotic war of 1812. It was the bloodiest war of the XIX century. The given paper makes an attempt to show comprehensively the problems of medical aid rendering to the wounded in the Russian army during battles, having studied them on one concrete case – the wounding of a legendary general Pyotr Ivanovich Bagration. The materials reflecting the circumstances of the general’s wounding are presented in the first part of the paper and the course of the pathological process and peculiarities of the conducted treatment are described in details on the basis of evidence of the witness.
During the War of 1812 the military doctors managed to return back to front tens of thousands of soldiers and officers of the Russian army. At the same time, despite the wound of P.I. Bagration wasn’t fatal initially and the best surgeons of that time were constantly beside him, he died of the developed gaseous gangrene.
The authors of many publications completely blame the doctors who rendered the medical aid for the unfavorable outcome. But such approach seems to be simplified as the most objective estimation can be done not using the results of the isolated analysis of the conducted treatment but studying comprehensively the problem taking into account all realities of that time: the level of the medical science at the beginning of the XIX century, the state of medical service of the Russian army, the military situation of that war period, etc.

Keywords: history of military-field surgery, gunshot wound, Pyotr Ivanovich Bagration, medical aid renderingc
p. 3 – 11 of the original issue
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  9. Larinskii N. «…Rana byla khorosha i obeshchala spasenie…» Istoriia raneniia PI Bagrationa [The wound was good and promised salvation ..." History of PI Bagration Wound]. Available from: http://webcache.googleusercontent.com.
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Address for correspondence:
210023, Respublika Belarus, g. Vitebsk, pr. Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra obschey khirurgii,
e-mail: nebylicin.uravgm@mail.ru,
Nebylitsin Yuriy Stanislavovich
Information about the authors:
Sushkov S.A. Candidate of medical sciences, associate professor, vice-rector on scientific research work of EE “Vitebsk StateMedical University
Nebylitsin Yu.S. Candidate of medical sciences, associate professor of the chair of general surgery of EE “Vitebsk State Medical University”
Reutskaya E.N., a 6-year student of the medical faculty of EE “Vitebsk State Medical University
Rak A.N., a 6-year student of the medical faculty of EE “Vitebsk State Medical University

EXPERIMENTAL SURGERY

I.V. MAIBORODIN, V.V. MOROZOV, JA.V. NOVIKOVA, V.A. MATVEEVA, L.V. ARTEMYEVA, A.L. MATVEEV, S.V. HOMENIUK, S.V. MARCHUKOV

ACCELERATION OF DEVELOPMENT OF POSTOPERATIVE GRANULATIONS AFTER ADMINISTRATION OF MESENCHYMAL STEM CELLS NEAR THE THROMBOSED VEIN IN EXPERIMENT

Center of Modern Medical Technology of the Institute of Chemical Biology and Fundamental Medicine of Siberian branch of RAS , Novosibirsk, The Russian Federation

Objectives. To estimate the possibility of paravasal application of the autologous multipotent mesenchymal stem cells of a bone marrow origin (AMMSCBMO) for the blood flow restoration in a thrombosed vein in experiment.
Methods. The morphological results of the AMMSCBMO introduction with GFP transfected gene and DAPI cellular nuclei additionally marked with a dye near the thrombosed vein were studied by means of the fluorescence microscopy.
Results. Many vessels consisting of the specifically fluorescent cells were found out in the place of a surgical intervention performed at thrombosis modeling. The restoration of the blood flow in the thrombosed main vein is always the result of thrombolysis. The signs of AMMSCBMO embedding into the wall of thrombosed vessels haven’t been found. The recanalization of the blood clot and formation of collaterals haven’t been detected as well. At thrombosis modeling in experiment? thrombosis of the small branches occurs by introduction of thrombin and ligation of the main vein. In them restoration of blood flow occurs by involving introduced AMMSCBMO or through a blood clot recanalization or through the obliteration of thrombosed vessels and formation of new ones. Thus the restoration of the blood flow in the tissue region of the affected vein is quicker probability of development of tissue hypoxemic necroses and other complications decreases. Gradually introduced AMMSCBMO and the structures generated with their participation, are extruded by own cells an organism-recipient.
Conclusions. At introduction of AMMSCBMO in paravasal cellulose of the main thrombosed vein, they take part in restoration of the tissue blood flow in the region of the thrombosed vein, and also in development of granulations in the place of the surgical intervention performed at thrombosis modeling.

Keywords: multipotent mesenchymal stem cells, venous thrombosis, recanalization of blood clot, angiogenesis, restoration of blood flow
p. 12 -19 of the original issue
References
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  13. Maiborodin IV, Iakimova NV, Matveeva VA, Pekarev OG, Maiborodina EI, Pekareva EO. Angiogenez v rubtse matki krys posle vvedeniia autologichnykh mezenkhimal'nykh stvolovykh kletok kostnomozgovogo proiskhozhdeniia [Angiogenesis in rat uterine scar after implantation of autologous bone marrow mesenchymal stem cells]. Biul Eksperim Biologii i Meditsiny. 2010;150(12):705–11.
  14. Maiborodin I, Yakimova N, Matveeva V, Shevela A, Maiborodina E, Pekareva, Tkachuk O. Angiogenesis in rat uterine scar after introduction of autological mesenchymal stem cells of bone marrow origin. J Biomedical Science and Engineering. 2011;4(3):164–72.
  15. Maiborodin IV, Kolesnikov IS, Sheplev BV, Ragimova TM, Shevela AI, Kovyntsev AN, Kolmakova IA, Pritchina IA, Kozlova EV, Voitovich AB, Kovyntsev DN. Granulematoznoe vospalenie posle primeneniia preparatov fibrina [Granulomatous inflammation after treatment of fibrin]. Morfol Vedomosti. 2007;1(3-4):116–18.
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Address for correspondence:
630090, Rossiyskaya Federatsiya, g. Novosibirsk, pr. akad. Lavrenteva, d 8, Institut himicheskoy biologii i fundamentalnoy meditsinyi SO RAN, Tsentr novyih meditsinskih tehnologiy, laboratoriya stvolovoy kletki,
e-mail: imai@mail.ru.
Maiborodin Igor Valentinovich
Information about the authors:
Maiborodin I.V. Doctor of medical sciences, professor, leading researcher of the stem cell laboratory of the Institute of Chemical Biology and Fundamental Medicine of RAS, Novosibirsk
Morozov V.V. Doctor of medical sciences, professor, leading researcher of the stem cell laboratory of the Institute of Chemical Biology and Fundamental Medicine of RAS, Novosibirsk
Novikova JA.V. Candidate of medical sciences, researcher of the invasive medical technologies laboratory of the Institute of Chemical Biology and Fundamental Medicine of RAS, Novosibirsk
Matveeva V.A. Candidate of biological sciences, senior researcher of the stem cell laboratory of the Institute of Chemical Biology and Fundamental Medicine of RAS, Novosibirsk
Artemyeva L.V. Leading engineer of the stem cell laboratory of the Institute of Chemical Biology and Fundamental Medicine of RAS, Novosibirsk
Matveev A.L. Post-graduate student of the molecular microbiology chair of the Institute of Chemical Biology and Fundamental Medicine of RAS, Novosibirsk
Homeniuk S.V. Researcher of the invasive medical technologies laboratory of the Institute of Chemical Biology and Fundamental Medicine of RAS, Novosibirsk
Marchukov S.V. Post-graduate student of the stem cell laboratory of the Institute of Chemical Biology and Fundamental Medicine of RAS, Novosibirsk

S.V. SHKODKIN 1,2, M.I. KOGAN 3, S.V. IVANOV4, J.B. IDASHKIN 2, O.I. STEPCHENKO2

ULTRASOUND ESTIMATION OF THE EXPERIMENTAL STENT EFFICACY IN COMPARISON WITH CONVENTIONALLY USED ONES

FSBEE HPE “Belgorod State National Research University” 1,
RSBME “Belgorod Regional Clinical Hospital Of Saint Joasaph” 2,
FSBEE HPE “Rostov State Medical University” 3,
FSBEE HPE “Kursk State Medical University”4,
The Russian Federation

Objectives. To estimate sonographic changes in the stented kidney depending on the type of stent used and the terms of the drainage in the experiment.
Methods. Ultrasound anatomy of the stented kidney was studied in male rabbits of Gray giant breed. In the main study group the unilateral experimental stent implantation with the external diameter of 3 Ch and length of 4 cm made of nickelide-titanium wire 100 mm in diameter and protected with the original nanostructured coat containing carbon-silver was carried out. The stents were manufactured by the laboratories of the Research institute “Belgorod State National Research University”. As a control (n=10 animals), the unilateral implantation of “White-star standart” stent of the company Urotech (Germany) of the same diameter was performed. In the pre- and postoperative period the ultrasound of the kidneys using the apparatus “Aloka 3500” with the use of linear sensor of 8 Mhz was done. The morphometric size and physiology of renal blood flow were registered.
Results. Ultrasound picture of the stented kidney in the control group of animals was characterized by the progression of retention changes in the upper urinary tract. The cause of retention changes of the upper urinary tract was vesico-ureteral reflux and the obstruction of the internal stent. Disturbance of the urine outflow from the upper urinary tract in the control group of animals was accompanied by sonographic signs of sclerotic changes in the stented kidney. In the main group no statistically significant differences in ultrasonic morphometric parameters and renal blood flow were registered in comparison with the initial data and the contralateral kidney (ð>0,05).
Conclusions. Segmental drainage of the upper urinary tract by experimental stent did not disturb physiology in the stented kidney and did not lead to the development of obstructive uropathy.

Keywords: ureteric stent, reflux, hydronephrosis, pyelonephritis
p. 20 – 26 of the original issue
References
  1. Doronchuk DN, Trapeznikova MF, Dutov VV. Vybor metoda drenirovaniia verkhnikh mochevykh putei pri mochekamennoi bolezni [Choice of an upper urinary tract drainage method in urolithiasis]. Urologiia. 2010;(3):7–10.
  2. 2. Aliaev IuG, Rapoport LM, Tsarichenko DG, Stoilov SV, Bushuev VO. Stentirovanie pochek pri ureterogidronefroze u bol'nykh giperplaziei prostaty bol'shikh razmerov [Kidney stenting of patients with large prostatic hyperplasia in ureterohydronephrosis]. Andrologiia i Genital Khir. 2008;(3):43–44.
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  5. 5. Chew BH, Knudsen BE, Nott L, Pautler SE, Razvi H, Amann J, Denstedt JD. Pilot study of ureteral movement in stented patients: first step in understanding dynamic ureteral anatomy to improve stent comfort. J Endourol. 2007 Sep;21(9):1069–75.
  6. 6. Guliev BG. Palliativnoe lechenie obstruktsii mochetochnikov u onkologicheskikh bol'nykh [Palliative treatment of ureteral obstruction in oncological patients]. Vestn Sankt-Peterb gos med akad im II Mechnikova. 2006;(3):102–104.
  7. 7. Novikova EG, Teplov AA, Smirnova SV, Onopko VF, Rusakov IG. Striktury mochetochnikov u bol'nykh rakom sheiki matki [Ureteral stricture in patients with cervical cancer]. Ros Onkol Zhurn. 2009;(30):28–34.
  8. 8. Doronchuk DN, Trapeznikova MF, Dutov VV. Otsenka kachestva zhizni bol'nykh mochekamennoi bolezn'iu v zavisimosti ot metoda drenirovaniia verkhnikh mochevyvodiashchikh putei [Quality of life of patients with urolithiasis, depending on the method of drainage of the upper urinary tract]. Urologiia. 2010;(2):14–17.
  9. 9. Chepurov AK, Zenkov SS, Mamaev IE. Vliianie dlitel'nogo drenirovaniia verkhnikh mochevykh putei mochetochnikovymi stentami na funktsional'nye sposobnosti pochki [Influence of prolonged ureteral stent drainage of the upper urinary tract on renal functional capacity]. Andrologiia i Genit Khirurgiia. 2009;(2):172
  10. 10. Chepurov AK, Zenkov SS, Mamaev IE. Rol' infitsirovaniia verkhnikh mochevykh putei u bol'nykh s dlitel'nym drenirovaniem mochetochnikovymi stentami [The role of the upper urinary tract infections in patients with long-term ureteral stents drainage]. Andrologiia i Genit Khirurgiia. 2009:173.
Address for correspondence:
308011, Rossiyskaya Federatsiya, g. Belgorod, ul. Nekrasova 8/9, korp. 8, FGFOU VPO «Belgorodskiy gosudarstvennyiy natsionalnyiy issledovatelskiy universitet», kafedra khirurgicheskih bolezney ¹2,
e-mail: shkodkin-s@mail.ru,
Shkodkin Sergey Valentinovich
Information about the authors:
Shkodkin S.V. Candidate of medical sciences, associate professor of the surgical diseases chair ¹2 of FSBEE HPE “Belgorod State National Research University”, urologist of the urological unit of RSBME “Belgorod Regional Clinical Hospital of Saint Joasaph”.
Kogan M.I. Doctor of medical sciences, professor, Honored worker of Science of RF, head of the urology and man’s reproductive health chair with the course of children urology-andrology of FSBEE HPE “Rostov State Medical University”.
Ivanov S.V. Doctor of medical sciences, professor, head of the surgical diseases chair ¹1 of FSBEE HPE “Kursk State Medical University”.
Idashkin J.B. Urologist of the urological unit of RSBME “Belgorod Regional Clinical Hospital of Saint Joasaph”.
Stepchenko O.I. Ultrasound diagnostics specialist of diagnostic center of RSBME “Belgorod Regional Clinical Hospital of Saint Joasaph”.

GENERAL AND SPECIAL SURGERY

A.A. ZIANKOU1,2, U. P. OSTROVSKIJ3,4, A.P. KUTSKO1

POSSIBILITY OF THE HYBRID MYOCARDIAL REVASCULARIZATION WITH FULL ARTERIAL BYPASS GRAFTING OF THE LEFT VENTRICLE CORONARY ARTERIES AT MULTIVASCULAR AFFECTION

ME “Vitebsk Regional clinical hospital” 1,
EE “Vitebsk State Medical University”2
SE RSPC “Cardiology” 3
SEE “Belarusian Medical Academy of post-graduate education”4
Minsk
The Republic of Belarus

Objectives. To estimate immediate results of the proposed method of the hybrid myocardial revascularization (HMR) with full arterial bypass grafting of the left ventricle coronary arteries at the multivascular affection.
Methods. 77 patients with the ischemic heart disease underwent the full minimally invasive coronary surgery (MICS) at multivascular affection from 2011 to 2012 in the cardiac surgery department of Vitebsk regional clinical hospital. The strategy of the MICS was focused on performing functionally adequate arterial revascularization of the left ventricle from the left-sided mini-thoracotomy as well as on avoidance the artificial blood circulation on the ascending aorta. In 7 (9,9%) cases hybrid approach with full arterial composite-sequential revascularization of the left ventricle was done as well as percutaneous transluminal coronary angioplasty of the right coronary artery (RCA) during the same hospitalization. Indications for the HMR were: inadequate visualization and positioning of the branches of the RCA with high risk of the cardiopulmonary bypass; high probability of the competitive blood flow in the RCA-system after revascularization from the left internal mammary artery. Mean age was 59,4 years, all patients were male. 3 (42,9%) patients had hemodynamically significant affection of the left coronary artery trunk.
Results. There were no lethal outcomes in the studied group as well as emergency conversions to the cardiopulmonary bypass and sternotomy. Intraoperative inotropic support was not used, 3 (42,9%) patients underwent vasopressor therapy. Immediate results of the HMR showed a low rate of the perioperative complications and are associated with short period of ICU – stay and reduced hospital length of stay.
Conclusions. Hybrid approach with full arterial revascularization of the left ventricle is feasible in patients with multivascular coronary artery affection. The proposed method broadens indications to hybrid myocardial revascularization. Its application is supposed to reduce the number of complications, to improve long-term results, to cut down cost of treatment. Further investigations are necessary to confirm these assumptions.

Keywords: hybrid myocardial revascularization, minimally invasive coronary surgery, full arterial revascularization
p. 27 – 34 of the original issue
References
  1. Davidavicius G, Van Praet F, Mansour S, Casselman F, Bartunek J, Degrieck I, Wellens F, De Geest R, Vanermen H, Wijns W, De Bruyne B. Hybrid revascularization strategy: a pilot study on the association of robotically enhanced minimally invasive direct coronary artery bypass surgery and fractional-flow-reserve-guided percutaneous coronary intervention. Circulation. 2005 Aug 30;112(9 Suppl):I317–22.
  2. Angelini GD, Wilde P, Salerno TA, Bosco G, Calafiore AM. Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularisation. Lancet. 1996 Mar 16;347(9003):757–58.
  3. Farhat F, Depuydt F, Praet FV, Coddens J, Vanermen H. Hybrid cardiac revascularization using a totally closed-chest robotic technology and a percutaneous transluminal coronary dilatation. The Heart Surgery Forum. 2000; 3(2):119–20. Available from: http://www.hsforum.com.
  4. Gilard M, Bezon E, Cornily JC, Mansourati J, Mondine P, Barra JA, Boschat J. Same-day combined percutaneous coronary intervention and coronary artery surgery. Cardiology. 2007;108(4):363–67.
  5. Kon ZN, Brown EN, Tran R, Joshi A, Reicher B, Grant MC, Kallam S, Burris N, Connerney I, Zimrin D, Poston RS. Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with results from conventional off-pump coronary artery bypass. J Thorac Cardiovasc Surg. 2008 Feb;135(2):367–75.
  6. Stahl KD, Boyd WD, Vassiliades TA, Karamanoukian HL. Hybrid robotic coronary artery surgery and angioplasty in multivessel coronary artery disease. Ann Thorac Surg. 2002 Oct;74(4):S1358–62.
  7. Us MH, Basaran M, Yilmaz M, Yaymaci B, Ulusoy E, Sanioglu S, Ozbek C, Arslan Y, Pocan S, Yilmaz AT. Hybrid coronary revascularization in high-risk patients. Tex Heart Inst J. 2006;33(4):458–62.
  8. Wittwer T, Cremer J, Boonstra P, Grandjean J, Mariani M, Mugge A, Drexler H, den Heijer P, Leitner ER, Hepp A, Wehr M, Haverich A. Myocardial "hybrid" revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty: preliminary results of a multicentre study. Heart. 2000 Jan;83(1):58–63.
  9. Riess FC, Bader R, Kremer P, Kuhn C, Kormann J, Mathey D, Moshar S, Tuebler T, Bleese N, Schofer J. Coronary hybrid revascularization from January 1997 to January 2001: a clinical follow-up. Ann Thorac Surg. 2002 Jun;73(6):1849–55.
Address for correspondence:
210037, Respublika Belarus, g. Vitebsk, ul. Voinov-internatsionalistov, d. 37, UZ «Vitebskaya oblastnaya klinicheskaya bolnitsa», otdelenie kardiohirurgii,
e-mail: Zenkov_Al@rambler.ru, Zenkov Aleksandr Aleksandrovich
Information about the authors:
Ziankou A.A. Candidate of medical sciences, head of the cardiac surgery department of EE “Vitebsk State Medical University”, associate professor of the surgery chair of the faculty of advanced training and retraining of specialists of EE “Vitebsk State Medical University”.
Ostrovskij U.P. Corresponding member of NAS of RB, doctor of medical sciences, professor, head of the cardiac surgery laboratory of SE RSPC “Cardiology”, head of the cardiac surgery chair of SEE “Belarusian Medical Academy of post-graduate education”.
Kutsko A.P. Head of the angiography and x-ray and endovascular surgery study of EE “Vitebsk regional clinical hospital”

A.A. LYZIKOV 1, J.W. NEILSON 2, A.A. PECHENKIN 1.

EFFICIENCY OF AUTOVENOUS RECONSTRUCTIONS OF AORTO-ILIAC SEGMENT OCCLUSIVE LESIONS IN PATIENTS WITH HIGH RISK OF PURULENT-NECROTIC COMPLICATIONS

EE “Gomel State medical university1”,
The Republic of Belarus
Baylor University2, Texas,
USA

Objectives. To analyze the efficiency of the aorto-iliac segment reconstructions using the femoral vein in patients with high risk of infectious complications.
Methods. During the period of 2010 to 2011 we performed 10 reconstructions of the femoral vein aorto-iliac segment at Gomel regional vascular surgery department. 4 patients were operated on for the late complications of vascular prosthesis, 1 patient – for the suppuration of the artificial prosthesis and presence of the enteric-prosthetic fistula, 5 patients underwent initial reconstructions for the critical ischemia with purulent-necrotic lesions.
Results. The adequate revascularization was obtained in all patients operated on for late complications. Symptoms of venous insufficiency were not observed in this group. The patient operated on for suppuration of the artificial prosthesis and presence of the enteric-prosthetic fistula died on the 8th day. We achieved the adequate revascularization in patients with critical ischemia with purulent-necrotic changes as well. In this group the postoperative period was accompanied by the marked disturbance of the lymphatic outflow during the nearest postoperative period. There were no signs of venous insufficiency in the distant period.
Conclusions. The adequate revascularization was obtained in all cases. In repeatedly operated patients the intervention didn’t cause the lymphatic outflow disturbances during the whole period of observation. In patients at the stage of the critical ischemia with purulent-necrotic lesions the postoperative wounds healed with the secondary tension with the signs of lymphatic-venous insufficiency in the nearest postoperative period. There were no disturbances of the lymphatic outflow in the distant period in all investigated groups and we may consider the use of the femoral vein to reconstruct the aorto-iliac segment in patients with high risk of purulent-necrotic complications to be effective and safe method of revascularization.

Keywords: femoral vein, aorto-iliac reconstructions, artificial vascular prosthesis, infection of prosthesis, purulent-septic complications
p. 35 – 40 of the original issue
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  5. Gordon LL, Hagino RT, Jackson MR, Modrall JG, Valentine RJ, Clagett GP.
  6. Complex aortofemoral prosthetic infections: the role of autogenous superficial femoropopliteal vein reconstruction. Arch Surg. 1999 Jun;134(6):615–20.
  7. Troitskii AV, Lysenko ER, Khabazov RI, Azarian AS, Griaznov OG, Solov'eva ED, Koziavkin VV, Kuleshova LG. Autovenoznye rekonstruktsii pri infektsii aortobedrennykh sinteticheskikh protezov [Autovenous reconstruction in infection of aortofemoral synthetic prostheses ]. Kardiologiia i Serdech-Sosud Khirurgiia. 2008;(4):46–51.
  8. Parsons RE, Sanchez LA, Marin ML, Holbrook KA, Faries PL, Suggs WD, Lyon RT, Lowy FD, Veith FJ. Comparison of endovascular and conventional vascular prostheses in an experimental infection model. J Vasc Surg. 1996 Dec;24(6):920–25.
  9. Lyzikov AA. Pozdnie oslozhneniia aorto-podvzdoshnykh rekonstruktsii [Late complications of aortoiliac reconstruction]. Novosti Khirurgii. 2010;18(5):63–68.
  10. Lyzikov AA, Pechenkin AA, Bontsevich DN. Gnoino-septicheskie oslozhneniia primeneniia tkanykh iskusstvennykh sosudistykh protezov pri rekonstruktsiiakh aorto-podvzdoshnogo segmenta u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei [Septic complications of woven synthetic vascular grafts for reconstruction of aortoiliac segment in patients with critical ischemia of the lower extremities]. Novosti Khirurgii. 2007;15(3):97–101.
  11. Lyzikov AA, Osipov VA. Mikrobnyi spektr pri gnoino-troficheskikh narusheniiakh u patsientov s patologiei sosudov [Microbial spectrum under purulent trophic disorders in patients with vascular pathology]. Vestn VGMU. 2011;10(2):76–82.
  12. Lyzikov AA, Voropaev EV, Osipov VA, Pechenkin AA. Modelirovanie uslovii vysokogo riska infektsionnykh oslozhnenii v eksperimente [Simulation of conditions with high risk of infectious complications in the experiment]. Novosti Khirurgii. 2011;19(3):16–20
Address for correspondence:
230006, Respublika Belarus, g. Gomel, ul. Lange, d. 5 UO «Gomelskiy gosudarstvennyiy meditsinskiy universitet», kafedra khirurgicheskih bolezney ¹3 s kursom serdechno-sosudistoy khirurgii,
e-mail: lyzikov@mail.ru,
Lyizikov Aleksey Anatolevich
Information about the authors:
Lyzikov A.A. Candidate of medical sciences, associate professor of the surgical diseases chair ¹3 with the course of the cardiovascular surgery of EE “Gomel State Medical University”
Neilson J.W. Professor of Baylor University, Texas, USA
Pechenkin A.A. Assistant of the surgical diseases chair ¹3 with the course of the cardiovascular surgery of EE “Gomel State Medical University”.

A.V. FEDOSEEV, S.Y. MURAVYEV, I.I. USPENSKIY

OPTIMIZATION OF HERNIOPLASTY CHOICE METHOD IN PATIENTS WITH INGUINAL HERNIA IN VIEW OF THE SPERMATIC CORD BLOOD FLOW

SBEE HPE “Ryazan State Medical University named after academician I.P. Pavlov”
The Russian Federation

Objectives. To improve treatment outcomes in patients with inguinal hernias by optimizing the choice of inguinal hernioplasty methods depending on the of blood flow in the spermatic cord.
Methods. The research was conducted in two groups of patients. The control group included 28 subjects who don’t have inguinal hernias. The main group numbered 62 patients with the inguinal hernias. Depending on the method of hernioplasty patients were divided into three groups. In the first group an open preperitoneal hernioplasty was performed, in the second – Lichtenstein hernioplasty? in the third – laparoscopic hernioplasty (TAPP). A color duplex scanning of the arteries and veins of the spermatic cord was performed using the ultrasonic scanner Toshiba Nemio 580 before the surgery and 30 days afterwards.
Results. Preoperative velocity parameters of the blood flow along the spermatic cord vessels in the main group were identical with the data of the control group. During the postoperative period 30 days ofterword, in the patients who underwent an open preperitoneal hernioplasty, better blood flow in the spermatic cord was registered and, consequently, a smaller residual deficit of blood flow – 8,06%. Slightly larger deficit, 9,69%, after surgery was recorded in the 3rd subgroup of patients who had undergone TAPP. After surgical treatment, resistance index decreased to the level of the control group in the patients of the 1st and 2nd subgroups. Subgroup II patients who had undergone Liechtenstein hernioplasty, had the highest residual blood flow deficit – 15,40%, and resistance index – 0,85.
Conclusions. Preperitoneal prosthesis using an open technique as well as TAPP method is optimal for the patients with hernias as after their use a registered residual blood deficit is lower if compared with Liechtenstein hernioplasty.
Preperitoneal positioning of the implant is preferable for patients of the reproductive age to save their fertility.

Keywords: inguinal hernia, hernioplasty, blood flow in the spermatic cord
p. 41 – 44 of the original issue
References
  1. Kirillov IuB, Aristarkhov VG, Zotov IV, i dr. Vliianie pakhovoi gryzhi na morfofunktsional'noe sostoianie iaichka [Influence of inguinal hernia on testicular morphology and function]. Riazan', RF: Rus slovo; 2006. 95 p
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  3. Siziakin DV. Sostoianie spermatogeneza u muzhchin pri pakhovykh gryzhakh [Status of spermatogenesis in men with inguinal hernias]. Khirurgiia.2007(8):66–68.
  4. Toskin KD, Zhebrovskii VV. Gryzhi briushnoi stenki [Hernia of the abdominal wall]. Moscow, RF: Meditsina; 1990. 272 p.
  5. Astrakhantsev AF, Zotov IV. Vliianie pakhovoi gryzhi na funktsional'noe sostoianie iaichka [Effect of an inguinal hernia on the testicular function]. Aktual'nye Vopr Klin Morfologii: sb nauch tr Riazan med un-ta. Ryazan, RF: RiazGMU; 2001;(Vyp 2):28–30.
  6. Emel'ianov SI, Protasov AV, Rutenberg GM. Endokhirurgiia pakhovykh i bedrennykh gryzh [Endosurgery inguinal and femoral hernias]. Saint-Petersburg: Mir meditsiny; 2001. 175 p.
  7. Zotov IV. Morfologiia iaichka pri kosykh i priamykh pakhovykh gryzhakh [Testicular morphology in oblique and direct inguinal hernias]. Voen-Med Zhurn. 2002;(4):79.
  8. Aydede H, Erhan Y, Sakarya A, Kara E, Ilkgul O, Can M. Effect of mesh and its localization on testicular flow and spermatogenesis in patients with groin hernia. Acta Chir Belg. 2003;103(6):607–10.
  9. Bailey M. Inguinal hernia – laparoscopic or open repair? The case of laparoscopic repair. Ann R Coll Surg Engl. 2005 2005 Jan;87(1):57–8.
  10. Fitzgibbons RJ Jr. Can we be sure polypropylene mesh causes infertility? Ann Surg. 2005 Apr;241(4):559–61.
Address for correspondence:
390013, Rossiyskaya Federatsiya, g. Ryazan, ul. Dzerzhinskogo, d. 11, MUZ GKB BSMP, kafedra obschey khirurgii,
e-mail: hirurgiarzn@gmail.com,
Muravyev Sergey Yurevich
Information about the authors:
Fedoseev A.V., Doctor of medical sciences, professor, head of the general surgery chair of SBEE HPE “Ryazan State Medical University named after Academician I.I. Pavlov”
Muravyev S.Y. Candidate of medical sciences, assistant of the general surgery chair of SBEE HPE “Ryazan State Medical University named after Academician I.I. Pavlov”
Uspenskiy I.I.. Assistant of the general surgery chair of SBEE HPE “Ryazan State Medical University named after Academician I.I. Pavlov”

A.E. SHCHERBA, L.V. KIRKOVSKY, A.M. DZYADZKO, E.L. AVDEY, A.F. MINOU, L.S. BOLONKIN, O.O. RUMO

LIVER RESECTION UNDER HYPOTHERMIC PERFUSION

ME “The 9th Minsk City Clinical Hosptal”,
Republican Scientific Research Center of Transplantation of Organs and Tissues,
The Republic of Belarus

Objectives. To demonstrate the experience of the liver resection applying methods of hypothermic perfusion in conditions of the total vascular exclusion at tumors and parasitic lesions localization in the hepatocaval confluence and/or inferior vena cava regions.
Methods. The treatment results of 155 patients who had undergone the liver resections (LR) were analyzed. Vascular occlusion techniques (Pringle maneuver, selective vascular isolation, total vascular exclusion (TVE)) were applied in 80 patients (51,6%). Pringle maneuver was used in 68 patients (43,8%), selective vascular isolation in 42 (27%), total vascular isolation (TVI) – in 4 (6%) and TVE with hypothermic perfusion in 5 (3,3%).
Results. The average time of LR was longer at TVI with hypothermic perfusion, 712±155 min, then at standard major LR, 280±154 min (Mann-Whitney, p=0,00001). The average blood loss at LR with TVI and hypothermic perfusion (n=9) was 2880±1948 ml and 588±478 ml at standard major LR (n=47; Mann-Whitney, p=0,00003). Hepatic failure developed in 1 of 5 LR at hypothermic perfusion (20%) and in 7 of 47 standard major LR (14,9%). Biliary complications developed in 3 of 9 (33,3%) LR with TVI and hypothermic perfusions and in 9 of 47 (19,1%) at standard major LR, but the difference was not statistically significant. There were no mortality cases after LR with TVI and LR with hypothermic perfusions. Mortality after standard major LR made up 6,3% (3 of 47; Fisher test, p=0,9).
Conclusions. Liver resection at the hypothermic conservation promotes the overcoming limitations of the thermal ischemia and brings an additional time for resection and reconstruction as well as expands the possibilities of the resection surgery and permits to avoid the liver transplantation at benign hardly accessible liver tumors.

Keywords: liver resection, hypothermic liver perfusion
p. 45 – 52 of the original issue
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  16. Lamesch P, Raygrotzki S, Kehrer G, Gubernatis G, Ringe B, Evers B, Yacoub EA, Pichlmayr R. In situ Protektion der Lebermit der HTK Lîsung nachBretschneider. Langenbecks Arch Chir. 1991;376(2):85–92.
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  24. Hoti E, Salloum C, Azoulay D. Hepatic resection with in situ hypothermic perfusion is superior to other resection techniques. Dig Surg. 2011;28(2):94–9.
Address for correspondence:
220116, Respublika Belarus, g. Minsk, ul. Semashko, d. 8, UZ «9-ya Gorodskaya klinicheskaya bolnitsa g. Minska», RNPTs Transplantatsii organov i tkaney, otdel transplantologii,
e-mail: aleina@tut.by,
Scherba Aleksey Evgenevich
Information about the authors:
Shcherba A.E. Candidate of medical sciences, head of the transplantation department of ME “The 9th Minsk City Clinical Hospital”
Kirkovsky L.V. Candidate of medical sciences, surgeon of the portal hypertension chair of ME “The 9th Minsk City Clinical Hospital”, RSRC of Transplantation of organs and tissues
Dzyadzko A.M. Candidate of medical sciences, head of the anesthesiology and resuscitation department of ME “The 9th Minsk City Clinical Hospital”
Avdey E.L., Candidate of medical sciences, head of the portal hypertension chair of ME “The 9th Minsk City Clinical Hospital”, RSRC of Transplantation of organs and tissues
Minou A.F., head of the anesthesiology department of ME “The 9th Minsk City Clinical Hospital”, RSRC of Transplantation of organs and tissues
Bolonkin L.S., anesthesiologist of the anesthesiology department of ME “The 9th Minsk City Clinical Hospital”, RSRC of Transplantation of organs and tissue.
Rumo O.O. Doctor of medical sciences, deputy head physician on surgery of ME “The 9th Minsk City Clinical Hospital”, head of RSRC of Transplantation of organs and tissues.

K.M. KUBRAKOV 1, I.A. KOVALEVA 1, A.V. PAVLENKO 2, E.A.KONOPELKO 2

ETIOLOGICAL STRUCTURE AND RESISTANCE OF THE MAJOR INFECTIOUS AGENT OF THE WOUND INFECTION IN PATIENTS WITH BURN DISEASE

EE “VITEBSK STATE MEDICAL UNIVERSITY” 1,
ME “VITEBSK REGIONAL CLINICAL HOSPITAL” 2,
THE REPUBLIC OF BELARUS

Objectives. To study the etiological structure of the wound infection in patients with burn disease, to carry out analysis of sensitivity of the isolated microflora to antibacterial drugs.
Methods. We analyzed the results of 868 bacterial platings of the wound discharge from the burn surface of the patients who were treated at the burn department of ME “Vitebsk regional clinical hospital” in 2010. The species composition of microflora isolated in patients with burn disease was studied; the leading pathogens of suppurative-inflammatory processes were determined. Resistance to antibiotics of 718 strains included into the group of the main pathogens was established. The identification and evaluation of sensitivity of microorganisms to antimicrobial drugs was carried out with the help of test-systems on the microbiological analyzer ATB Expression.
Results. Gram-positive microorganisms identified in 63,19% of the bacteriological research dominate in the structure of the wound infection in patients with burn disease. Gram-negative microorganisms are isolated in the composition of associations in 72,34% of cases. The main agent causing suppurative-inflammatory processes in the case of burns is the S. aureus (57,57% of cases). The dominant representative among gram-negative microflora is P. aeruginosa. (19,71%). A high level of resistance of S. aureus to the antibacterial drugs has been established in relation to oxacillin, gentamycin, ciprofloxacin; and of P. aeroginosa – to ciprofloxacin, gentamycin, ofloxacin.
Conclusions. A leading role of gram-positive microorganisms in the etiology of the wound infection in patients with burn disease has been certified. Clinically most significant strains have been proved to possess a high degree of resistance in relation to the frequently applied antibiotics used at the burn department. Isolated microorganisms are resistant to oxacillinum, gentamycinum, ciprofloxacinum and this should be taken into consideration when the empirical antimicrobial therapy is administered.

p. 53 – 59 of the original issue
References
  1. Tolstov AV. Diagnostika, klassifikatsiia, profilaktika i lechenie generalizovannoi infektsii u tiazhelo obozhzhennykh [Diagnosis, classification, prevention and treatment of generalized infection in severely burned patients ]. Aspirant Vestn Povolzh'ia. 2008;(3-4):124–27.
  2. Vorob'eva ON, Denisenko LI, Doshchitsina AS, Chelpanova LI, Dulepo SA. Dinamika antibiotikorezistentnosti vozbuditelei gnoino-septicheskikh protsessov u ozhogovykh bol'nykh [Dynamics of antimicrobial resistance of septic processes in burn patients ]. Biul Vostoch-Sibir Nauch Tsentra SO RAMN. 2005;(1):19–24.
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  11. Greenhalgh DG, Saffle JR, Holmes JH 4th, Gamelli RL, Palmieri TL, Horton JW, Tompkins RG, Traber DL, Mozingo DW, Deitch EA, Goodwin CW, Herndon DN, Gallagher JJ, Sanford AP, Jeng JC, Ahrenholz DH, Neely AN, O'Mara MS, Wolf SE, Purdue GF, Garner WL, Yowler CJ, Latenser BA. American Burn Association consensus conference to define sepsis and infection in burns. J Burn Care Res. 2007 Nov-Dec;28(6):776–90.
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Address for correspondence:
210023, Respublika Belarus, g. Vitebsk, pr. Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra nevrologii i neyrokhirurgii,
e-mail: k-kubrakov@yandex.ru,
Kubrakov Konstantin Mihaylovich
Information about the authors:
Kubrakov K.M. Candidate of medical sciences, associate professor of the neurology and neurosurgery chair of EE “Vitebsk State Medical University”
Kovaleva I.A. A 5-year student of the medical faculty of EE “Vitebsk State Medical University”
Pavlenko A.V. Head of the burn unit of ME “Vitebsk regional clinical hospital”
Konopelko E.A. Physician-bacteriologist of ME “Vitebsk regional clinical hospital”, Republican Scientific and Practical Center “Infection in surgery”.

S.V. SHAKHRAI, YU.M. GAIN, M.YU. GAIN

EXPERIMENTAL JUSTIFICATION AND FIRST CLINICAL EXPERIENCE OF TRANSPLANTATION OF CULTURE OF AUTOLOGICAL ADIPOSE TISSUE MESENCHYMAL STEM CELLS IN COMPLEX SURGICAL TREATMENT OF EXTRA- AND TRANS-SPHINCTER RECTUM FISTULAS

SEE “Belarusian Medical Academy of post-graduate education”, Minsk, The Republic of Belarus

Objectives. To develop the technology of minimally invasive treatment of trans- and extra-sphincter rectum fistulas with the use of semi-conductor laser radiation and transplantation of autological adipose tissue mesenchymal stem cells.
Methods. The way of chronic paraproctitis modeling has been developed in experiment. Morphological changes of pararectal tissue at complex use of the laser radiation with the length of a wave 1056 nanometers and autological adipose tissue mesenchymal stem cells to treat rectum fistulas have been studied. The worked out minimally invasive method of surgical treatment of high rectum fistulas has been applied in 10 patients.
Results. The designed technology includes the pretransplantation stage (biological material intake, extraction, cultivating, proliferation, differentiation of the autological adipose tissue mesenchymal stem cells in the fibroblast direction with the culture selection of stem cells up to 500 thousands units in 1 ml), and the surgical stage with decontamination of the fistulous channel by the laser radiation with wave length 1560 nm, with suturing the internal opening of rectum fistula and transplantation of mesenchymal stem cells culture from adipose tissue in the fistula channel and parafistula space.
In experiment the results have been obtained testifying to high efficacy of the suggested technology with quick fibrous replacement of the fistula lumen and reduction of the inflammatory process in this zone and in parafistula tissues caused by autological mesenchymal stem cells differentiation in the cellular elements of the connective-fibrous layer, their production of biologically active factors that induce regeneration and promote the accelerated organization of the extracellular matrix.
It has been established that technology application in patients with high rectum fistulas of autotransplantation of adipose tissue mesenchymal stem cells differentiated in the fibroblast direction is an effective complex method of their treatment
Conclusions. The first experience of clinical application of the developed technology allows saying that its practical use promotes efficacy increase of surgical treatment as well as expansion of the application sphere of cellular technologies in practical public health services.

Keywords: chronic paraproctitis, rectum fistulas, adipose tissue mesenchymal stem cells, cellular transplantation
p. 60 – 69 of the original issue
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  14. Christoforidis D, Pieh MC, Madoff RD, Mellgren AF. Treatment of transsphincteric anal fistulas by endorectal advancement flap or collagen fistula plug: a comparative study. Dis Colon Rectum. 2009 Jan;52(1):18–22.
  15. Johnson EK, Gaw JU, Armstrong DN. Efficacy of anal fistula plug vs. fibrin glue in closure of anorectal fistulas. Dis Colon Rectum. 2006 Mar;49(3):371–76.
  16. Ky AJ, Sylla P, Steinhagen R, Steinhagen E, Khaitov S, Ly EK. Collagen fistula plug for the treatment of anal fistulas. Dis Colon Rectum. 2008 Jun;51(6):838–43.
  17. Lenisa L, Espin-Basany E, Rusconi A, Mascheroni L, Escoll-Rufino J, Lozoya-Trujillo R, Vallribera-Valls F, Megevand J. Anal fistula plug is a valid alternative option for the treatment of complex anal fistula in the long term. Int J Colorectal Dis. 2010 Dec;25(12):1487–93.
  18. Safar B, Jobanputra S, Sands D, Weiss EG, Nogueras JJ, Wexner SD. Anal fistula plug: initial experience and outcomes. Dis Colon Rectum. 2009 Feb;52(2):248–52.
Address for correspondence:
220013, Respublika Belarus, G. Minsk, ul. P. Brovki, d. 3, korp. 3, GUO «Belorusskaya meditsinskaya akademiya poslediplomnogo obrazovaniya», kafedra neotlozhnoy khirurgii s kursom ambulatornoy khirurgii,
e-mail: s.shakhrai@mail.ru,
Shahray Sergey Vladimirovich
Information about the authors:
Shakhrai S.V. Candidate of medical sciences, associate professor of the emergency surgery chair of SEE “Belarusian Medical Academy of post-graduate education”.
Gain U.M. Doctor of medical sciences, professor, Vice-rector on scientific research work, professor of the emergency surgery chair of SEE “Belarusian Medical Academy of post-graduate education”.
Gain M.Y. Post-graduate student of the emergency surgery chair of SEE “Belarusian Medical Academy of post-graduate education”.

TRAUMATOLOGY AND ORTHOPEDICS

O.A. SOKOLOVSKY

ÑORRECTION OF THE COXOFEMORAL JOINT DEFORMITY AFTER AVASCULAR NECROSIS OF THE HIP PROXIMAL SECTION IN CHILDREN

SE “Republican Scientific-Practical Center of Traumatology and Orthopedics”, Minsk
The Republic of Belarus

Objectives. To establish regularities of the coxofemoral joint deformities development after the avascular necrosis of the hip bone head in children and to determine optimal ways of surgical correction for each type of deformity.
Methods. We studied X-ray patterns of 800 children with the congenital hip disjunction and subluxation in 1057 joints, which were made 12-16 years after the conservative treatment. Avascular necrosis was revealed in 148 cases (12,25%) in 106 patients.
Results. A number of regularities of the coxofemoral joint deformities development after the avascular necrosis (AN) have been established. The approaches based on the obtained data have been stated concerning the operative correction of deformity of the hip proximal section. Varus-detorsion osteotomy is an optimal intervention after the 1st and 2nd type of AN, and at the cavity dysplasia – the triple pelvis osteotomy. The posterior rotary osteotomy of the hip bone is the operation of choice at the three-plane hip proximal section deformity. One-stage correction of the pelvis and hip deviations is an optimal one after the 3rd and 4th types of AN. Triple pelvis osteotomy permits to normalize the position of the acetabulum and one of the hip bone osteotomy types – the position of the hip proximal section; in case of the three-plane deformity the operation should include the element of roration and in case of high stationary point of the greater trochanter – to normalize its position, and after the 4th type of AN – to correct varus deformity.
Conclusions. The presence of the AN particular type of the hip proximal section leads to a gradual development of similar coxofemoral joint deformities attributable only to this group. In childhood it is necessary to perform operations taking into account not only the present deviations but also those abnormalities which will unavoidably appear as the result of the continuing functioning of the damaged growth zones of the hip proximal section. Each type of deformity requires the correction of deviations typical for it including multiplane ones.

Keywords: avascular necrosis of the hip head, coxofemoral joint, deformity of the hip proximal section, surgical correction
p. 70 – 76 of the original issue
References
  1. Clarke NM, Jowett AJ, Parker L. The surgical treatment of established congenital dislocation of the hip: results of surgery after planned delayed intervention following the appearance of the capital femoral ossific nucleus. J Pediatr Orthop. 2005 Jul-Aug;25(4):434–39.
  2. Kim HW, Morcuende JA, Dolan LA, Weinstein SL. Acetabular development in developmental dysplasia of the hip complicated by lateral growth disturbance of the capital femoral epiphysis. J Bone Joint Surg Am. 2000 Dec;82-A(12):1692–700.
  3. Oh CW, Guille JT, Kumar SJ, Lipton GE, MacEwen GD. Operative treatment for type II avascular necrosis in developmental dysplasia of the hip. Clin Orthop Relat Res. 2005 May;(434):86–91.
  4. Pozdnikin IuA. Atsetabuloplastika-osteotomiia taza kak metod rekonstruktsii displasticheskoi vertluzhnoi vpadiny [Pelvic acetabuloplasty - osteotomy as a method of reconstruction of dysplastic acetabular cavity]. Ortopediia, Travmatol i Protezirovanie. 1983;(3):35–36.
  5. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. Bone Joint Surg Am. 1980 Sep;62(6):876–88.
  6. Heymann CH, Herndon CH. Legg-Perthes disease; a method for the measurement of the roentgenographic. J Bone Joint Surg Am. 1950 Oct;32(A:4):767–78.
  7. Tachdjian MO. Pediatric Orthopedics. 2nd ed. Philadelphia, PA: WB Saunders; 1990. 2405 p.
  8. Millis MB, Murphy SB, Poss R. Osteotomies about the hip for the prevention and treatment of osteoarthrosis. Instr Course Lect. 1996;45:209–26.
  9. Akhtiamov IF, Sokolovskii OA. Khirurgicheskoe lechenie displazii tazobedrennogo sustava [Surgical treatment of hip dysplasia]. Kazan', RF; 2008: Tsentr operativ pechati. 371 p.
  10. Maquet P. Biomechanics of hip dysplasia. Acta Orthop Belg. 1999 Sep; 65(3):302–14.
Address for correspondence:
210023, Respublika Belarus, g. Minsk, ul. Kizhevatova 60/4, GU «Respublikanskiy nauchno-prakticheskiy tsentr travmatologii i ortopedii», laboratoriya travmatologii i ortopedii detskogo i podrostkovogo vozrasta,
e-mail: sakalouski@yandex.ru,
Sokolovskiy Oleg Anatolevich
Information about the authors:
Sokolovsky O.A. Doctor of medical sciences, head of the laboratory of the childhood and adolescence traumatology and orthopedics of SE “Republican Scientific-Practical Center of Traumatology and Orthopedics”.

YU.V. OSIPAU

RATES OF REHABILITATION OF THE DISABLED AND AGGRAVATION OF DISABILITY AT VERTEBRAL AND SPINAL CORD TRAUMA IN THE REPUBLIC OF BELARUS

SE “Republican Scientific And Practical Center for Medical Assessment and Rehabilitation”,
The Republic of Belarus

Objectives. To study the rates of complete and partial rehabilitation and aggravation of disability among adults caused by the spinal column and spinal cord traumas in Belarus during the period from 2002 to 20012.
Methods. Monitoring of disability at the spinal column and spinal cord traumas was carried out using the automatic monitoring system “Disability”. The rates of the partial rehabilitation of disability, the complete rehabilitation of the disabled as well as the rates of the disability aggravation were investigated.
Results. The conducted monitoring has shown that on the average 260 adults are initially registered as disabled due to vertebral and spinal cord traumas annually, it makes up 0,30 per 10,000 of the population of the Republic of Belarus. The rate value of complete and partial rehabilitation and aggravation of disability at the spinal column and spinal cord traumas are in the linear correlation depending on the presence or absence of the spinal cord trauma and have regional peculiarities. In patients with vertebral column fractures without the spinal cord damage the average rate of partial rehabilitation made 42,2%, the average rate of complete rehabilitation made up 23%, and the rate of aggravation of disability made up 5,1%; at the spinal column fractures with the spine and spinal cord trauma the rate of partial rehabilitation was 16,3%, of complete rehabilitation it was 8%, however, the rate of aggravation of disability was as low as 3,9%.
Conclusions. The rate value of complete and partial rehabilitation at the spinal column and spinal cord traumas are in the linear correlation depending on the presence or absence of the spinal cord trauma: in patients with the spine and spinal cord trauma, the rates of complete rehabilitation of the disabled and the partial rehabilitation are 2,5 times lower than at traumas of the spine. Absence of significant positive dynamics of restoring of the restricted vital activity (per 1 FC and more) was registered in 71,8% of the newly certificated disabled with the spine and spinal cord trauma.

Keywords: traumas of the spine, spinal cord trauma, disability, rates of rehabilitation of the disabled, rates of disability aggravation
p. 77 – 82 of the original issue
References
  1. Ivanova GE, Krylova VV, Tsykunova MB, Poliaeva BA, red. Reabilitatsiia bol'nykh s travmaticheskoi bolezn'iu spinnogo mozga [Rehabilitation of patients with traumatic spinal cord disease]. Moscow, RF: Moskov uchebniki i Kartolitografiia; 2010. 640 p.
  2. Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma. 2004 Oct;21(10):1371–83.
  3. Mezhdunarodnaia statisticheskaia klassifikatsiia boleznei i problem, sviazannykh so zdorov'em [International statistical classification of diseases and problems related with health] (Desiatyi peresmotr (MKB-10): kratkii variant. Minsk: Asar; 2001. 400 p
Address for correspondence:
223027, Respublika Belarus, Minskaya obl., Minskiy r-n, p. Gorodische, GU «Respublikanskiy nauchno-prakticheskiy tsentr meditsinskoy ekspertizyi i reabilitatsii», laboratoriya meditsinskoy ekspertizyi i reabilitatsii pri ortopedo-travmatologicheskoy patologii,
e-mail: OsipovY@tut.by,
Osipov Yuriy Vitalevich
Information about the authors:
Osipau YU.V. Head of the laboratory of medical expertise and rehabilitation at orthopedic and trauma pathology, SE “Republican Scientific and Practical center for Medical Assessment and Rehabilitation”.

ANESTHESIOLOGY-REANIMATOLOGY

A.V. MAROCHKOV

COMPARATIVE ESTIMATION OF EFFICACY OF FEMORAL NERVE REGIONAL BLOCKAGE AND “THREE IN ONE” BLOCKAGE

ME “Mogilev Regional Hospital”
The Republic of Belarus

Objectives. To estimate application efficacy, safety and possibility of the femoral nerve blockage and blockage of the branches of the lumbar plexus by the inguinal access (“three in one” blockage).
Methods. Prospective randomized study of the blockage results at the lower limbs operations has been conducted. Depending on the blockage technique two groups of patients were singled out. 40 femoral nerve blockages were done in the 1st group. 40 blockages of the branches of the lumbar plexus by the inguinal access combined with the sciatic nerve blockage with electrostimulator of the peripheral nerves were carried out in the 2nd group.
Results. The amount of lidocaine used for one blockage comprised 4,5±0,3 mg/kg (37,5±5,5 ml of 1% lidocaine solution) in the 1st group; in the 2nd group – 4,5±0,4 mg/kg (38,0±4,85 ml of 1% lidocaine solution) (ð>0,05). In the 1st group skin sensitivity in the femoral nerve projection was absent in 29 cases out of 40 and was preserved in the form of touch sensation with the blunt object at the level of the thigh middle third and higher in 11 cases. Skin sensitivity in the projection of the obturator and lateral skin nerves was preserved in the form of touch sensation with the blunt object in 14 cases.
In the 2nd group skin sensitivity in the femoral nerve projection was absent in 38 out of 40 cases, in the projection of the obturator nerve – in 34 cases and in the in the projection of the lateral nerve – in 27 cases. Skin sensitivity was preserved in 2 cases out of 40, in the projection of the obturator nerve – in 4 cases and in the projection of the lateral nerve – in 11 cases. The blockage of the lumbar plexus by the inguinal access (“three in one”) was ineffective in 2 out of 40 cases according the skin sensitivity estimation.
Conclusions. Application of a simple technical procedure at “three in one” blockage increases anesthesia efficacy and expands the boundaries of the possible operation.

Keywords: regional anesthesia, electrostimulator of the peripheral nerves, femoral nerve blockage, “three in one” blocks
p. 83 – 87 of the original issue
References
  1. Rafmell DP, Nil DM, Viskoumi KM. Regionarnaia anesteziia: Samoe neobkhodimoe v anesteziologii [Regional anesthesia: essentials of anesthesiology]: per s angl. V: Zil'ber AP, Mal'tsev VV, red. Moscow, RF: MEDpress-inform; 2007. 272 p.
  2. Marochkov AV, Bordilovskii AN, Evseenko AI. Effektivnost' i bezopasnost' regionarnoi anestezii perifericheskikh nervov i spletenii [The efficacy and safety of regional anesthesia and peripheral nerve plexus]. Novosti Khirurgii. 2007;15(4):96–102.
  3. Malroi M, Emel'ianov SI, per s angl. Mestnaia anesteziia: il prakt ruk [Local anesthesia: Illustr practical guide]. Mossow, RF: BINOM. Laboratoriia znanii; 2003. 301 p.
  4. Kuzin MI, Kharnas SSh. Mestnoe obezbolivanie [Local anesthesia]: monografiia. 2-e izd., pererab. i dop. Moscow, RF: Meditsina; 1993. 224 p.
  5. Chelly JE. Peripheral Nerve Blocks: A Color Atlas. 3rd ed. Philadelphia, US: Lippincott Williams&Wilkins; 2008. 496 p.
  6. Van Geffen GJ. The value of ultrasonography for performing peripheral nerve blocks: Theory, practice and clinical experience in adults and children. Rotterdam, NL: Optima GrafischeCommunicatie; 2008. 234 p.
  7. Diuk Dzh. Sekrety anestezii [Secrets of anesthesia]: per. s angl. Moscow, RF: MEDpress-inform, 2005. 511 p.
  8. Capdevila X, Biboulet Ph, Bouregda M, Barthelet Y, Rubenovitch J, d’Athis F. Comparison of the three-in-One and fascia iliacacompartment blocks in adults: clinical andradiographic analysis. Anesth Analg. 1998 May;86(5):1039–44.
  9. Winnie AP, Ramamurthy S, Durrani Z. The inguinal paravascular technic of lumbar plexus anesthesia: the "3-in-1 block". Anesth Analg. 1973 Nov-Dec;52(6):989–96.
  10. Macalou D, Trueck S, Meuret P, Heck M, Vial F, Ouologuem S, Capdevila X, Virion JM, Bouaziz H. Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block. Anesth Analg. 2004 Jul;99(1):251–54.
Address for correspondence:
212026, Respublika Belarus, g. Mogilev, ul. B.-Biruli, d. 12, UZ «Mogilevskaya oblastnaya bolnitsa», reanimatsionno-anesteziologicheskoe otdelenie,
e-mail: marochkov@mail.ru,
Marochkov Aleksey Viktorovich
Information about the authors:
Marochkov A.V. Doctor of medical sciences, head of the anesthesiology-resuscitation department of ME “Mogilev Regional Hospital”.

MATTERS OF PERSONNEL TRAINING

A.P. TRUKHAN

ASSESSMENT OF KNOWLEDGE LEVEL OF PECULIARITIES OF BATTLE SURGICAL TRAUMA. PART II: SYNDROME OF PROLONGED COMPRESSION

EE “Belarusian State Medical University”
The Republic Of Belarus

Objectives. To evaluate the knowledge level of surgeons who work in the medical establishments of Ministry of Health of the Republic of Belarus concerning the problems of pathogenesis and treatment of the syndrome of the prolonged compression.
Methods. The data of testing results of 270 surgeons of the establishments of Ministry of Health are presented in the article. Surgeons from various regions of the country working in polyclinics, general surgical and specialized departments of hospitals were included in the investigation. The tests included 20 questions concerning the syndrome of the prolonged compression (SPC) (10 questions present the theme “Pathogenesis of SPC” and 10 – “Treatment of SPC” with 4-5 variants of answers to choose one correct answer).
Results. Surgeons demonstrated the satisfactory knowledge level of the syndrome of the prolonged compression (Me (25%-75%) – 11 (9-12)), however, the answers concerning the theme “Treatment of SPC” testify to the certain lack of knowledge. Lower level of knowledge (statistically significant differences) were shown by the surgeons of the so-called “restricted” specialization (Mann-Whitney U-test, U=3124, ð=0,0040). While evaluating the impact of work experience on the number of correct answers, statistically significant differences between the groups were absent (Kruskal-Wallis test, H=39,04, p=0,5580). Surgeons working in polyclinics demonstrated lower knowledge level of the syndrome of the prolonged compression (Kruskal-Wallis test, H=6,27, p=0,0440).
Conclusions. To improve the system of surgeons’ training to render medical aid in case of emergencies, its thorough analysis is required.

Keywords: surgery of catastrophe, syndrome of the prolonged compression, training of surgeonss
p. 88 – 92 of the original issue
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  1. Musatov KhA. Khirurgiia katastrof [Surgery of disasters]: uchebnik. Moscow, RF: Meditsina; 1998. – 592 p.
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  3. Zhidkov SA, Shnitko SN, red, Alekseev SA, Bogdan VG, Korik VE, Popchenko AL. Voenno-polevaia khirurgiia [Military field surgery]: uchebnik. Minsk, RB: BGMU, 2008. 350 p.
  4. Nechaev EA, Revskoi AK, Savitskii GG. Sindrom dlitel'nogo sdavleniia [Prolonged compression syndrome]: ruk dlia vrachei. Moscow, RF: Meditsina; 1993. 208 p.
  5. Garkavi AV. Sindrom dlitel'nogo sdavleniia miagkikh tkanei konechnostei [Syndrome prolonged compression of soft tissues of the extremities]. Med Pomoshch'. 2000;(2):23–25.
  6. Iarmagomedov AA, Kostomarova LG, Stazhadze LL. Otsenka stepeni podgotovki vrachei skoroi pomoshchi po probleme: Diagnostika i lechenie sindroma dlitel'nogo sdavleniia na dogospital'nom etape [Evaluation of ambulance physicians training on the problem: Diagnosis and treatment of the syndrome of prolonged compression at pre-hospital stage]. Meditsina Katastrof. 2000;(3):54–57.
  7. Galikian VO, Ovanesian RA, Sherdukalova LF. Klassifikatsiia i lechenie sindroma dlitel'nogo sdavleniia [Classification and treatment of prolonged compression syndrome]. Khirurgiia. 1999;(1):43–46.
Address for correspondence:
220034, Respublika Belarus, g. Minsk, ul. Azgura, d. 4, UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet», voenno-meditsinskiy fakultet, kafedra voenno-polevoy khirurgii,
e-mail: aleksdoc@yandex.ru,
Trukhan Aleksey Petrovich
Information about the authors:
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."

LECTURES, REVIEWS

A.G.SALMANOV1, A.K.TOLSTANOV 2, V.F.MARIEVSKI 3, V.V. BOYKO 4, I.A.TARABAN 5

EPIDEMIOLOGICAL SURVEILLANCE FOR RESISTANCE TO ANTIMICROBIAL PREPARATIONS

State sanitary-epidemiological department of the Ukraine 1 ,
Ministry of healthcare of the Ukraine 2 ,
SE “Institute of epidemiology and infectious diseases named after L.V.Gromashevsky of NAMS of the Ukraine” 3 ,
SE “Institute of general and urgent surgery of NAMS of the Ukraine” 4,
Kharkov National Medical University 5,
The Ukraine

Increasing concern about the emergence of resistance of the clinically important pathogens has led to the establishment of a number of surveillance programmes to monitor the actual extent of resistance at the local, regional and national levels. This review describes some of the major programs of surveillance initiatives and the ways to apply the obtained data in different settings. In the hospital, surveillance data are used to monitor local antibiograms resistance and to determine infection control strategies and antibiotic usage policies. The surveillance data are used to monitor public health threats such as infectious disease outbreaks involving resistant pathogens and the effects of bioterrorism countermeasures by following the effects of prophylactic use of different antibiotics on resistance. Initially, the pharmaceutical industry sponsored surveillance programmes to monitor the susceptibility of clinical isolates to marketed antibiotic products. However, at present, in the era of burgeoning resistance, many developers of antimicrobial agents find surveillance data useful for defining new drug discovery and development strategies, in that they assist with the identification of new medical needs, allow modelling of future resistance trends, and identify high-profile isolates for screening the activity of new agents. Surveillance data also represent an integral component of regulatory submissions for new agents and, together with clinical trial data, are used to determine breakpoints. It is clear that antibiotic resistance surveillance systems will continue to provide valuable data to health care providers, university researchers, pharmaceutical companies and the government.

Keywords: antibiotic resistance, epidemiological surveillance, nosocomial infectionss
p. 93 – 101 of the original issue
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  29. Tenover FC, Lancaster MV, Hill BC, Steward CD, Stocker SA, Hancock GA, O'Hara CM, McAllister SK, Clark NC, Hiramatsu K. Characterization of staphylococci with reduced susceptibilities to vancomycin and other glycopeptides. J Clin Microbiol. 1998 Apr;36(4):1020–27.
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Address for correspondence:
01601, Ukraina, g. Kiev, ul. Grushevskogo, d. 7, Gosudarstvennaya sanitarno- epidemiologicheskaya sluzhba Ukrainyi,
e-mail: moz.sag@bigmir.net,
Salmanov Aydyin Gurbanovich
Information about the authors:
Salmanov A.G. Candidate of medical sciences, chief specialist of the State sanitary-epidemiological department of the Ukraine
Tolstanov A.K. Doctor of medical sciences, deputy minister of the Ministry of Healthcare of the Ukraine
Marievski V.F. Doctor of medical sciences, professor, director of SE “Institute of epidemiology and infectious diseases named after L.V.Gromashevsky of NAMS of the Ukraine”
Boyko V.V. Doctor of medical sciences, professor, director of SE “Institute of General and Urgent Surgery of NAMS of the Ukraine”
Taraban I.A. Doctor of medical sciences, professor, professor of the surgery chair ¹1 of Kharkov National Medical University

A.N.BOGOMOLOV 1, I.I.KANUS2

ANESTHESIA PROVISION AND POSTOPERATIVE ANALGESIA AT TOTAL ENDOPROSTHESIS OF THE KNEE JOINT

SE “RSPC of Traumatology and Orthopedics” 1,
SEE “Belarusian Medical Academy of Post-graduate education” 2,
Minsk
The Republic of Belarus

The number of patients with the degenerative-dystrophic diseases of the knee joints is annually increasing throughout in the world. Conservative treatment methods provide only temporary relief and don’t restore the capacity of movements in the limbs. In recent years, the expansion of the indications for endoprosthesis of large joints has been registered as the most effective way to reduce pain, restore physical activity and improve the quality of life. Total knee endoprosthesis is one of the most traumatic interventions in surgery. The review provides detailed data on the peculiarities of anesthesia at the total knee replacement. Possible complications arising from this intervention are described. Modern aspects of anesthetic management and postoperative analgesia as well as their key role in providing early postoperative rehabilitation after the total knee replacement are shown.

Keywords: total knee joint endoprothesis, anesthesia provision, postoperative analgesia
p. 102 – 110 of the original issue
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Address for correspondence:
220024, Respublika Belarus, g. Minsk, ul. Kizhevatova, d. 60, kor. 4, GU «RNPTs travmatologii i ortopedii», otdelenie anesteziologii i reanimatsii,
e-mail: Reanimator.by@mail.ru,
Bogomolov Aleksandr Nikolaevich
Information about the authors:
Bogomolov A.N. Anesthesiologist-resuscitator, the anesthesiology-resuscitation department with intensive care wards of SE “RSPC of Traumatology and Orthopedics”, Minsk
Kanus I.I. Honored Worker of Science of the Republic of Belarus, doctor of medical sciences, professor of the anesthesiology-resuscitation chair of SEE “Belarusian Medical Academy of Post-graduate Education”

PRACTICAL CASES

D.A. IONKIN, K.V. SHISHIN, S.S. ANDREENKOV, A.B. SHURAKOVA, O.I. ZHAVORONKOVA, J.A. STEPANOVA

CONGENITAL CYST OF THE ACCESSORY SPLEEN WITH INTERNAL HEMORRHAGE AND RUPTURE THREAT

FSBE “A.V.Vishnevsky Institute of Surgery”, Moscow
The Russian Federation
Address for correspondence

The observation case of the complicated course of a cyst in the accessory spleen in 18-year old patient is presented in the article. The results and peculiarities of the preoperative clinical and instrumental examination are given. The technique of the performed laparoscopic removal of the accessory splenetic lobe is described.
The observation is interesting because of rarity of such affections and as a result difficulty in diagnostics. The application of modern diagnostics methods permitted to make diagnosis at the preoperative stage and to reveal the occurred hemorrhage and to prevent possible severe complication. Complicated course of the cyst of the accessory splenetic lobe determined the necessity of an adequate surgical treatment. Modern minimally invasive precise surgical technologies allow solving this problem rather quickly and simply, providing a good cosmetic effect.
There have been no presented observations in the literature up to present of cysts in the accessory splenetic lobe located in the organ port above the splenetic stem and pancreatic bottom with a complicated course.

Keywords: congenital cyst of the accessory spleen, complicated course, operative treatment, laparoscopic removal of the accessory spleens
p. 111 – 115 of the original issue
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Address for correspondence:
117997, Rossiyskaya Federatsiya, g. Moskva, ul. Bolshaya Serpuhovskaya, d. 27, FGBU «Institut hirurgii im. A.V. Vishnevskogo», otdeleniya khirurgicheskoy gepatologii i pankreatologii,
e-mail: ionkin@ixv.comcor.ru,
Ionkin Dmitriy Anatolevich
Information about the authors:
Ionkin D.A. Candidate of medical sciences, senior researcher of the surgical hepatology and pancreatology department of FSBE “A.V. Vishnevsky Institute of Surgery”
Shishin K.V. Doctor of medical sciences, senior researcher of the endoscopic surgery department of FSBE “A.V. Vishnevsky Institute of Surgery”
Andreenkov S.S. Post-graduate student of the surgical hepatology and pancreatology department of FSBE “A.V. Vishnevsky Institute of Surgery”
Shurakova A.B. Candidate of medical sciences, researcher of the radiology diagnostics department of FSBE “A.V. Vishnevsky Institute of Surgery”
Zhavoronkova O.I. Candidate of medical sciences, senior researcher of the radiology diagnostics department of FSBE “A.V. Vishnevsky Institute of Surgery”
Stepanova J.A. Doctor of medical sciences, senior researcher of the radiology diagnostics department of FSBE “A.V. Vishnevsky Institute of Surgery”.

EXCHANGE OF EXPERIENCE

J.G. SHAPKIN, E.V. EFIMOV, A.V. KHOROSHKEVICH, A.J. KHROMYKH

SURGICAL TREATMENT OF DIABETIC FOOT SYNDROME COMPLICATED BY PURULENT-NECROTIC PROCESSES

State Budgetary Educational Establishment of Higher Professional Education “Saratov State Medical University named after V.I..Razumovsky”,
The Russian Federation

Objectives. To summarize the experience of treating patients with diabetic foot syndrome complicated by purulent necrotic process.
Methods. This report is based on the results of examination and treatment of 160 patients with diabetic foot at the age from 45 to 80, who had developed the phenomena of purulent-necrotic process in the shin and foot. General clinical examination methods, assessment of blood coagulation, the qualitative determination of microflora (aerobic and anaerobic) by conventional methods were included in the examination complex. The patients were subjected to complex conservative and operative treatment. The analysis of the nearest treatment results was performed.
Results. 5 patients underwent finger removal with the resection of metatarsal bone heads, with a mandatory closure of wounds with soft tissue over the bone stump with the running drainage. Because of inability to save limbs in 77 patients, high amputations were done. In 27 patients, the resection of the foot according to Sharp was carried out, in 50 – at the hip level. Complications in the form of wound suppuration occurred after foot resections in 3 patients and after hip resections – in 6. Mortality rate in the operated patients with diabetic foot syndrome made up 7,8% (6 people), the overall mortality rate – 3,75%.
Conclusions. The basis of successful treatment of diabetic foot syndrome complicated by purulent-necrotic process is the correction of carbohydrate metabolism and accompanying pathology as well as additional intensive medical therapy supplemented with antibiotics of the bactericidal action. The terms of operative interventions in patients with diabetic foot depend on the severity and character of purulent-necrotic process, the degree of endotoxemia syndrome that in the number of cases demands preoperative correcting therapy.

Keywords: diabetic foot syndrome, purulent-necrotic complications, surgical treatments
p. 116 – 120 of the original issue
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Address for correspondence:
410012, Rossiyskaya Federatsiya, g. Saratov, ul. Bolshaya kazachya, d. 112, GBOU VPO «Saratovskiy gosudarstvennyiy meditsinskiy universitet», kafedra obschey khirurgii,
e-mail: khoroshkevich.av@yandex.ru,
Khoroshkevich Anna Vasilevn
Information about the authors:
Shapkin J.G. Doctor of medical sciences, professor, head of the general surgery chair of SBEE HPE “Saratov State Medical University named after V.I.Razumovsky”
Efimov E.V. Candidate of medical sciences, assistant of the general surgery chair of SBEE HPE “Saratov State Medical University named after V.I.Razumovsky”
Khoroshkevich A.V. Candidate of medical sciences, assistant of the general surgery chair of SBEE HPE “Saratov State Medical University named after V.I.Razumovsky”
Khromykh A.J. A 3-year student of the medical faculty of SBEE HPE “Saratov State Medical University named after V.I.Razumovsky”.
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