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Khirurgii

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Year 2014 Vol. 22 No 4

EXPERIMENTAL SURGERY

L.K. KULIKOV 1, S.S. KAZANKOV 2, Y.A. PRIVALOV 1, V.F. SOBOTOVICH 1, A.A. SMIRNOV 1, V.I. GARMASHOV3

DYNAMICS OF BIOCHEMICAL PARAMETERS OF GRANULATION TISSUE OF INFECTED WOUNDS APPLYING A BIOLOGICALLY ACTIVE AGENTS IN EXPERIMENTAL TREATMENT

SBEE APE “Irkutsk State Medical Academy of Post-graduate Education” 1,
NSME “Railway Clinical Hospital OF JSC RRW”, Irkutsk 2,
LLC “Scientific and Production Company “Lewes-A”, Institute of Labor Hygiene and Occupational Diseases of ESSC SB OF RAMS, Angarsk 3,
The Russian Federation

Objectives. To study some biochemical parameters of granulation tissue at treatment of the experimental infected wounds applying biologically active agents.
Methods. The experimental group of animals with infected wounds was divided into four subgroups. The first subgroup (control) consisted of rats without treatment, the second – treatment of infected wounds applying a medical preparation “Abisyl-1”. In the third subgroup the treatment was carried out using “Antiran”, in the fourth – “Antiran” plus ultrasonic cavitation (USC). To collect the granulation tissue the animals were withdrawn from the experiment on the 4th, 8th, 14th, 21st and 28th days. The most prominent biochemical parameters such as oxyproline, tyrosine, nucleic acids and malon dialdehyde have been determined in the granulation tissue.
Results. It was established that the terpene containing a medical preparation “Antiran” is significantly reduced the time of healing of experimental infected wounds, activates epithelialization and reconstruction of the epidermal derivatives, decreases the area of the infected wounds by 85,9% in 28 days after therapy onset and by 96,1% – in treatment of infected wounds in combination with USC. The concentration of malon dialdehyde (MDA) in the tissues of infected wounds reached a maximum in the exudative destructive period of inflammation and it was higher at spontaneous healing as well as at “Abisyl-1” application throughout the whole wound healing process. While applying the “Antiran” (both in combination with USC and without it), the concentration of MDA by the end of observation was reduced to the level of intact tissues. Furthermore, from the 14th day the content of collagen in experimental infected wounds reduced progressively in treatment of “Antiran” applying due to the scar maturation.
Conclusions. The necrotic tissue activity has been reduces in short terms, an increase of proteins of collagen and non-collagen origin occurs as well as reparative activity of tissues is stimulated in treatment of infected wounds applying “Antiran” in combination with the ultrasonic cavitation (USC).

Keywords: infected wounds, granulation tissue, biochemical changes, biologically active agents
p. 395 – 402 of the original issue
References
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Address for correspondence:
664079, Rossiyskaya Federatsiya, g. Irkutsk, m-n Yubileynyiy, d. 100, GBOU DPO «Irkutskaya gosudarstvennaya meditsinskaya akademiya poslediplomnogo obrazovaniya», kafedra khirurgii,
e-mail: giuv.surgery@ya.ru,
Kulikov Leonid Konstantinovich
Information about the authors:
Kulikov L.K. MD, a head of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Post-graduate Education”.
Kazankov S.S. PhD, a surgeon of the purulent surgery department of “Railway clinical hospital of JSC RRW.
Privalov Y.A. PhD, an associate professor of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Post-graduate Education”.
Sobotovich V.F. PhD, an associate professor of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Post-graduate Education”.
Smirnov A.A. PhD, an assistant of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Post-graduate Education”.
Garmashov V.I. PhD, a general director of LLC "Scientific and Production Company" Lewes-A, Institute of Labor Hygiene and Occupational Diseases of ESSC SB of RAMS, Angarsk, Irkutsk region.

GENERAL AND SPECIAL SURGERY

A.V. CHERNYH, E.N. LYUBYH, V.G. VITCHINKIN, E.I. ZAKURDAEV

ANATOMICAL JUSTIFICATION OF MODIFICATIONS OF MEDIATED PLASTIC REPAIR OF THE INGUINAL CANAL

SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”,
The Russian Federation

Objectives. To modify the method of the mediated plastic repair of the inguinal canal.
Methods. The study was carried out on 39 unfixed male corpses with the inguinal hernias, who died at the age of 34-87 years. The number of persons with the direct inguinal hernia was 26 (66,6%), with the indirect hernias – 8 (20,5%), with supravesicalis hernias – 2 (5,1%), with inguinal-scrotal hernias – 3 (7,8%). The shape of the inguinal gap has been determined, the height, length of the inguinal gap and the width of falciform aponeurosis measured.
Results. The triangular shape of the inguinal gap was revealed in 25 (64,1%) cases, the oval-transitional form in 9 (23,1%) and the slotted-oval shape – in 5 (12,8%). Depending on the specific shape of the inguinal gap the method of basic suture application was modified at the mediated plastic repair of the inguinal canal. In the triangular gap the pubic tubercle periosteal and lacunare ligament are firstly sewed, then the thread through the falciform aponeurosis, the lower edges of the internal oblique and transverse abdominal muscles is passed. The suture is completed with the thread conduction through the inguinal ligament. In cases with the oval-transitional form of inguinal gap, the pubic tubercle periosteal and lacunare ligament are firstly sewed, then the thread is passed through the lateral edge of the rectus sheath, falciform aponeurosis, the lower edge of the internal oblique and transverse abdominal muscles have been sewed. Hereinafter falciform aponeurosis is sewed again, the suture is completed with a thread passing through the inguinal ligament. In the slotted-oval shape of the inguinal gap the pubic tubercle periosteal and lacunare ligament are firstly sewed, then the thread is passed through the falciform aponeurosis. The bridge of suture must lie on the anterior surface of falciform aponeurosis. The suture is completed by the second stitching of falciform aponeurosis and inguinal ligament.
Conclusions. A choice of modifications of the main suture at the inguinal canal mediated plastic repair should be implemented taking into account the shape of the inguinal gap.

Keywords: inguinal hernia, hernioplasty, inguinal canal, variant anatomy
p. 403 – 407 of the original issue
References
  1. Vinnik IuS, Petrushko SI., Nazar'iants IuA, Chaikin AA, Klimov NIu, Pakhomova RA. Anatomicheskaia i klinicheskaia kharakteristika u bol'nykh s pakhovymi gryzhami [Anatomical and clinical characteristics of patients with inguinal hernias]. Kuban Nauch Med Vestn. 2013; (3):33–36.
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Address for correspondence:
394036, Rossiyskaya Federatsiya, g. Voronezh, ul. Studencheskaya, d. 10, GBOU VPO «Voronezhskaya gosudarstvennaya meditsinskaya akademiya imeni N.N. Burdenko», kafedra operativnoy hirurgii s topograficheskoy anatomiey,
e-mail: ezakurdaev@rambler.ru,
Zakurdaev Evgeniy Ivanovich
Information about the authors:
Chernyh A.V. MD, professor, the first Vice-rector, a head of the operative surgery chair with the topographic anatomy of SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”, the Ministry of Public Health of the Russian Federation.
Lyubyh E.N. MD, professor, director of scientific-research herniology center, professor of the faculty surgery chair of SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”, the Ministry of Public Health of the Russian Federation.
Vitchinkin V.G. PhD, an associate professor of the operative surgery chair with the topographic anatomy of SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”, the Ministry of Public Health of the Russian Federation.
Zakurdaev E.I. A post-graduate student of the operative surgery chair with the topographic anatomy of SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”, the Ministry of Public Health of the Russian Federation.

A.V. VARABEI 1,2, A.CH. SHULEIKA 1,2, Y.N. ARLOUSKI 1,2, Y.I. VIZHINIS 1,2, N.A. LAGODICH 2,3

BILIARY HYPERTENSION IN CHRONIC PANCREATITIS

SEE “Belarusian Medical Academy of Post-Graduate Education”1, Minsk,
Republican Center of Reconstructive Surgical Gastroenterology, Coloproctology and Laser Surgery 2,
ME “Minsk Regional Clinical Hospital”3,
The Republic of Belarus

Objectives. To carry out an analysis of the surgical treatment results and validate the choice of operation in patients with chronic pancreatitis complicated by biliary hypertension and evaluate the role of double balloon enteroscopy in diagnostics and treatment of postoperative complications after pancreatic surgeries.
Methods. The results of surgical treatment of 187 patients with chronic pancreatitis have been analyzed. Biliary hypertension occurred in 67 (35,8%) cases, different types of surgical correction have been performed. In the postoperative period 14 examinations of the pancreatico-jejuno anastomosis state by means of the double balloon enteroscopy have been performed.
Results. Biliary postoperative complications were registered in 5,9% cases, including strictures of biliodigestive anastomosis – 1,5% cases, leakage of the anastomosis – in 4,4%. Berne variant of Beger's operation was performed with intrapancreatic choledocholysis and biliary anastomosis creation in 50 (74,6%) cases, complications occurred in 2%. Extrapancreatic bypass surgery was performed in 17,1% cases, complications occurred in 15,3%. Double balloon enteroscopy during the examination of pancreato-jejunoanastomosis zone succeeded in 90% of cases, the later biliary complications were identified with their correction performance: laser recanalization of strictures and laser lithotripsy of residual concrements.
Conclusions. The choice of surgical correction of biliary hypertension should be individualized depending on the presence of jaundice, other complications of chronic pancreatitis, patient’s somatic state. The suggested surgical tactics on the basis of the biliary hypertension classification lets to optimize surgical approaches. Optimal surgical approach in patients with chronic pancreatitis and biliary hypertension is considered to be Berne variant of Beger's operation with intrapancreatic biliary anastomosis permitted to correct immediately all complications of chronic pancreatitis. Extrapancreatic shunt operation is considered to be recommended for performance in the absence of complications and inability to allocate intrapancreatic part of choledoch. The double balloon enteroscopy is preferable to use for diagnostics and treatment in the cases of late complications after biliodigestive anastomoses.

Keywords: chronic pancreatitis, biliary hypertension, surgical treatment, double balloon enteroscopy
p. 408 – 415 of the original issue
References
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  5. Dobrov SD, Poliakevich AS, Blagitko EM, Tolstykh GN. Zhelchnaia gipertenziia u bol'nykh khronicheskim pankreatitom [Biliary hypertension in patients with chronic pancreatitis]. Ann Khirurg Gepatol. 2012;17(4):36–41.
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  12. Cahen DL, Rauws EA, Gouma DJ, Fockens P, Bruno MJ.Removable fully covered self-expandable metal stents in the treatment of common bile duct strictures due to chronic pancreatitis: a case series. Endoscopy. 2008 Aug;40(8):697–700.
  13. Deviere JM, Reddy DN, Puspok A, Ponchon T, Bruno MJ, Bourke MJ, Neuhaus H, Roy A, Gonzalez-Huix F, Barkun AN, et al. 147 Preliminary Results From a 187 Patient Multicenter Prospective Trial Using Metal Stents for Treatment of Benign Biliary Strictures. Gastrointest Endosc. 2012;75:AB123.
  14. Traverso LW, Kozarek RA.Pancreatoduodenectomy for chronic pancreatitis: anatomic selection criteria and subsequent long-term outcome analysis. Ann Surg. 1997 Oct;226(4):429–35.
  15. Buchler MW, Warshaw AL.Resection versus drainage in treatment of chronic pancreatitis. Gastroenterology. 2008 May;134(5):1605–7.
  16. Vorobej AV, Grishin IN, Shulejko ACh, Lur'e VN, Orlovskij JuN, Vizhinys JuI, Butra JuV, Lagodin NA. Patogeneticheskoe obosnovanie pervichnyh i povtornyh operacij na podzheludochnoj zheleze pri hronicheskom pankreatite [Pathogenetic substantiation of primary and repeat operations on the pancreas in chronic pancreatitis]. Ann Hirurg Gepatol. 2012;17(3):80–88
Address for correspondence:
220013, Respublika Belarus, g. Minsk, ul. P. Brovki d.3, k.3, GUO «Belorusskaya akademiya poslediplomnogo obrazovaniya», kafedra khirurgii,
e-mail: varabeiproct@tut.by,
Vorobey Aleksandr Vladimirovich
Information about the authors:
Varabei A.V. MD, professor, a head of the surgery chair of SEE “Belarusian Medical Academy of Post-graduate Education”.
Shuleika A.Ch. PhD, an associate professor of the surgery chair of SEE “Belarusian Medical Academy of Post-graduate Education”.
Arlouski Y.N. PhD, an assistant of the surgery chair of SEE “Belarusian Medical Academy of Post-graduate Education”.
Vizhinis Y.I. An assistant of the surgery chair of SEE “Belarusian Medical Academy of Post-graduate Education”.
Lagodich N.A. An endoscopist of the endoscopic department of ME “Minsk Regional Clinical Hospital”.

O.A. KUDELICH1, G.G. KONDRATENKO1, O.A. YUDINA2, P.M. MOTOLYANETS3

MULTIVARIATE ANALYSIS OF FACTORS ASSOCIATED WITH IMMEDIATE CAUSES OF DEATH IN SEVERE ACUTE PANCREATITIS

EE “Belarusian State Medical University”1,
ME “Minsk City Clinical pathoanatomical Bureau” 2,
SE “Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus” 3,
The Republic of Belarus

Objectives. To reveal the most significant immediate causes of death at severe acute pancreatitis and determine the most important pathological changes in vital organs to develop the targeted method of protection.
Methods. A randomized analysis of pathoanatomical studies of deceased patients (n = 225) due to severe acute (and/or exacerbation of chronic) pancreatitis has been performed. Correlation analysis is used to determine the age and the period from the disease onset to lethal outcome.
Results. In the most cases the multiple organ dysfunction syndrome (MODS) in severe acute pancreatitis led to the immediate death in 165 cases (73,3%). Intoxication as the second most common cause of death was revealed in 27 cases (12%). In different age groups the immediate causes of death have been differed reliably (χ 2=22,8; ð=0,043) without any correlation between them (Spearmàn’s r =-0,017; ð=0,795). Analysis of vital organ structural changes has revealed that pathologically significant lung damage was reported most commonly at severe acute pancreatitis (83,1%) in both age groups; the second most common lesion was cerebral tissue (70,2%), hereafter renal parenchyma (69,3%), myocardium (67,1%) and liver (54,2%). The reliable differences and correlation dependence of frequency of injury of cardiovascular (χ 2=8,35; ð=0,004/ r = 0.193; ð=0,004) and hepatic (χ 2=7,1; ð=0,008/ r=-0,178; ð=0,009) systems of different age groups have been detected.
Conclusions. The multiple organ dysfunction syndrome (MODS) due to endogenous intoxication in patients with severe acute pancreatitis is considered to be the main immediate cause of death (73.3%) irrespective of age and disease onset. Generalized microcirculatory disturbances being a reason of tissue hypoxia manifest rationality of compensation of energy deficit of cells and MODS prevention applying the agents providing hypoxia appeared to be independent of complex II of the respiratory chain.

Keywords: severe acute pancreatitis, immediate causes of death, endogenous intoxication, multiple organ dysfunction syndrome
p. 416 – 427 of the original issue
References
  1. Yadav D, Lowenfels AB.The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013 Jun;144(6):1252-61.
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  3. Gomatos IP, Xiaodong X, Ghaneh P, Halloran C, Raraty M, Lane B, Sutton R, Neoptolemos JP.Prognostic markers in acute pancreatitis. Expert Rev Mol Diagn. 2014 Apr;14(3):333–46.
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  7. Saenko VF, Desiaterik VI, Pertseva TA, Shapovaliuk VV. Sepsis i poliorgannaia nedostatochnost' [Sepsis and multiple organ failure]. Krivoi Rog, RF: Mineral, 2005. 466 p.
  8. Wig JD, Bharathy KG, Kochhar R, Yadav TD, Kudari AK, Doley RP, Gupta V, Babu YR.Correlates of organ failure in severe acute pancreatitis. JOP. 2009 May 18;10(3):271–75.
  9. Nordback I, Paajanen H, Sand J. Prospective evaluation of a treatment protocol in patients with severe acute necrotising pancreatitis. Eur J Surg. 1997 May;163(5):357–64.
  10. Mole DJ, Olabi B, Robinson V, Garden OJ, Parks RW.Incidence of individual organ dysfunction in fatal acute pancreatitis: analysis of 1024 death records. HPB (Oxford). 2009 Mar;11(2):166–70. doi: 10.1111/j.1477-2574.2009.00038.x.
  11. Riabov GA. Gipoksiia kriticheskikh sostoianii [Hypoxia of critical states]. Moscow, RF: Meditsina; 1988. 288 p.
  12. Zaiko NN, Byts' IuV, red. Ataman AV. Patologicheskaia fiziologiia [Pathological physiology]. Moscow, RF: MEDpress-inform, 2006. 635 p.
  13. Zhidkov SA, Korik VE, Kliuiko DA, Titovets EP. Vozmozhnosti primeneniia priamoi oksimetrii dlia otsenki sostoianiia podzheludochnoi zhelezy pri ostrom pankreatite v eksperimente [Direct oximetry applying to assess the pancreas in acute pancreatitis in the experiment]. Novosti Khirurgii 2010; 3(18):9–16.
  14. Afanas'ev VV. Klinicheskaia farmakologiia reamberina [Clinical pharmacology of reamberin]. Saint-Petersburg, RF: 2005. 44 p.
  15. Kosinets VA. Vliianie preparata «Reamberin», soderzhashchego iantarnuiu kislotu, na funktsional'nuiu aktivnost' mitokhondrii myshechnogo sloia tonkoi kishki pri rasprostranennom gnoinom peritonite [Effect of the drug "Reamberin" containing succinic acid, on the mitochondrial functional activity of small intestine muscular layer in generalized purulent peritonitis]. Novosti Khirurgii 2007;4(15):8–15.
Address for correspondence:
220116, Respublika Belarus, g. Minsk, pr. Dzerzhinskogo d. 83, UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet», 1-ya kafedra khirurgicheskih bolezney,
e-mail: kudelichsurg@gmail.com,
Kudelich Oleg Arkadevich
Information about the authors:
Kudelich O.A. A post-graduate student of the 1st chair of surgical diseases of EE “Belarusian State Medical University”.
Kondratenko G.G. MD, professor, a head of the 1st chair of surgical diseases of EE “Belarusian State Medical University”.
Yudina O.A. PhD, a head of the general pathology department of ME “Minsk City Clinical Pathoanatomical Bureau”.
Motolyanets P.M. A physician-pathologist of SE “Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus”.

D.M. OVSIANIK

THE DIAGNOSIS OF INFECTED PANCREATIC NECROSIS BASED ON AN ASSESSMENT OF INDICATORS OF ENDOTHELIAL DYSFUNCTION

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

Objectives. To study the indicators of endothelial dysfunction in acute pancreatitis and assess their potential for differential diagnosis of infected and sterile pancreatic necrosis.
Methods. A prospective investigation of indicators of endothelial dysfunction - the number of circulating endothelial cells and concentration of stable degradation products of nitric oxide in the blood of patients (n=92) with various forms of acute pancreatitis has been carried out. The results of a study of healthy volunteers (n=15) were used as a control. For diagnostic test evaluation of sensitivity/specificity for forecast verification and diagnosis of infected pancreatic necrosis the Receiver Operating Characteristic (ROC) analysis has been applied.
Results. In case of the edematous form of acute pancreatitis a statistically significant increase of circulating endothelial cells number and the level of nitrate/nitrite in the blood by 1.5-folds compared to healthy persons (ð=0,0051; ð=0,0206) have been observed. An expressive clinical manifestation of endothelial dysfunction has been occurred in pancreatic necrosis, as for its sterile course the tendency to regress have been appeared. In the infected pancreatic necrosis the negative dynamics demonstrating this disease usually was found in increase of the number of circulating endothelial cells in the blood. Within the first week of hospitalization the level of nitrate/nitrite – >36 uM/L (sensitivity – 81,8%, specificity – 60,3%, AUC=0,7; ð=0,0323) may be used in prediction of infected pancreatic necrosis. The presence of 39 and more circulating endothelial cells in 100 ul. plasma (sensitivity – 84 %, specificity – 86%, AUC = 0,834; p <0,001) happen to be one of diagnostic signs of infection of pancreatic necrosis in the second phase of disease.
Conclusions. The received results testify to expediency of the research of endothelial dysfunction by determination of the number of circulating endothelial cells in the blood of patients with acute pancreatitis as a method should be applied for early detection of infection of pancreatic necrosis.

Keywords: acute pancreatitis, infected pancreatic necrosis, endothelial dysfunction, diagnostics
p. 428 – 435 of the original issue
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  1. Ermolov AS, Ivanov PA, Blagovestnov DA, Grishin AV, Andreev VG. Diagnostika i lechenie ostrogo pankreatita [Diagnosis and treatment of acute pancreatitis]. Mosñow, RF: Vidar. 2013. 384 p.
  2. Litvin AA. Infitsirovannyi pankreonekroz [Infected pancreatic necrosis]. Moscow, RF: Integratsiia; 2011. 240 p.
  3. Savel'ev VS, Filimonov MI, Gel'fand BR, Burnevich SZ. Infitsirovannyi pankreonekroz [Infected pancreatic necrosis]. Infektsii v Khirurgii. 2003;1(2):34–39.
  4. Forsmark CE. Pancreatitis and its complications. New Jersey: Humana Press Inc, 2005. 349 p.
  5. Petukhov VA. Endotelial'naia disfunktsiia: sovremennoe sostoianie voprosa (po materialam nauchnogo simpoziuma) [Endothelial dysfunction: current status of the issue (based on scientific symposium)]. Khirurgiia. Prilozhenie Consiliun medicum. 2008;(1):3–11.
  6. Sushkov SA, Nebylitsyn IuS, Samsonova IV, Miadelets OD, Kozlovskii VI. Strukturnye i funktsional'nye izmeneniia endoteliia pri eksperimental'nom venoznom tromboze [Structural and functional alterations of the endothelium in experimental venous thrombosis]. Kl³n³chna Flebolog³ia. 2013;6(1):126–35.
  7. Kolbasova EA, Kiseleva NI, Tikhonova LV. Issledovanie tsirkuliruiushchikh endotelial'nykh kletok u patsientok s khirurgicheskoi i estestvennoi menopauzoi [The study of circulating endothelial cells in patients with surgical and natural menopause]. Mat' i Ditia v Kuzbasse. 2013;(1):8–13.
  8. Savel'ev VS, Petukhov VA, An ES. Disfunktsiia endoteliia pri lipidnom distress-sindrome i dismetabolicheskikh posledstviiakh peritonita [Endothelial dysfunction in lipid distress syndrome and dismetabolic consequences of peritonitis]. Rus Med Zhurn. 2009;17(14):881–90.
  9. Semenova AS, Morrison VV, Dolishnii VN. Vozmozhnosti uluchsheniia rezul'tatov lecheniia patsientov s abdominal'nym sepsisom na osnove patogeneticheskikh printsipov [Opportunities to improve patient outcomes with abdominal sepsis based on pathogenetic principles]. Fundam Issledovaniia. 2008;(7):23–25.
  10. Savel'ev VS, Petukhov VA. Peritonit i endotoksinovaia agressiia [Peritonitis and endotoxin aggression]. Moscow, RF: 2012. 326 p.
  11. Bradley EL. A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis. Atlanta. September 11-13, 1992. 1993;128(5):586–90.
  12. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Acute Pancreatitis Classification Working Group. Gut. 2013 Jan;62(1):102–11.
  13. Hladovec J. Circulating endothelial cells as a sign of vessel wall lesions. Physiol Bohemoslov. 1978;27(2):140–44.
  14. Zan'ko SN, Kiseleva NI, Solodkov AP, Khotetovskaia ZhV. Opredelenie kolichestva tsirkuliruiushchikh endotelial'nykh kletok v plazme krovi: instruktsiia po primeneniiu [Determination of the number of circulating endothelial cells in blood plasma]. Viteb gos med un-t. ¹ 91-1004; utv. 21.06.2005. Sovrem metody diagnostiki, lecheniia i profilaktiki zabolevanii]. Minsk, RB; 2005;2(6):63–65.
  15. Veremei IS, Osochuk SS, Shcherbinin IIu, Deiun GV, Dubrovskaia AV, Solodkov AP. Fotometricheskii metod opredeleniia nitratov i nitritov v biologicheskikh zhidkostiakh [Photometric method for the determination of nitrate and nitrite in biological fluids] : instruktsiia po primeneniiu.Viteb gos med un-t. ¹ 91-0008; utv. 19.03.2001. Sovrem. metody diagnostiki, lecheniia i profilaktiki zabolevanii. Minsk, RB; 2003;2(3):5–12.
  16. Grinkhal'kh T. Osnovy dokazatel'noi meditsiny [Basics of evidence-based medicine]. Moscow, RF: GEOTAR-Media, 2006. 240 p.
Address for correspondence:
210023, Respublika Belarus, g. Vitebsk, pr. Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra fakultetskoy khirurgii,
e-mail: ovsyanik.dmitriy@yandex.ru,
Ovsianik Dmitriy Mechislavovich
Information about the authors:
Ovsianik D.M. A post-graduate student of the faculty surgery chair of EE “Vitebsk State Medical University”.

L.P. KOTELNIKOVA1,2, I.S. MUKHAMADEEV1,2, I.G. BURNISHEV2, R.A. STEPANOV1,2, N.N. FEDACHUK1,2

THE RESULTS OF SURGICAL TREATMENT FOR THE COMPLICATIONS OF PORTAL HYPERTENSION

SBEE HPE “Perm State Medical Academy named after E.A.Vagner”1,
SBME “Perm Regional Clinical Hospital” of Perm order “Badge of Honor” region 2,
The Russian Federation

Objectives. To evaluate the early postoperative period and long-term results in the patients with portal hypertension operated for ongoing bleeding from the varicose dilated esophageal veins (VDEV) as well as its primary and secondary prophylaxis.
Methods. The analysis of short- and long-term surgical treatment results of patients (n=69) with portal hypertension syndrome complicated by VDEV have been performed: shunt operations (n=18), modified Sugiura-Futagawa operation (n=51).
Results. Splenorenal anastomosis has been performed to the patients with Child-Pugh Class A and B hepatic dysfunction (n=18). Postoperative complications developed in 4 (22,2%) patients. Mortality rate made up 5,5% (n=1). The modified Sugiura-Futagawa operation has been carried out in 51 patients: Child-Pugh class A hepatic insufficiency was diagnosed in 4 (7,8%) cases, class B – in 17 (33,3%), class C – in 24 (47,1%), and extrahepatic portal hypertension – in 6 (11,8%) patients in the case of conservative treatment and endoscopic procedures have failed. Postoperative complications developed in 25 patients (49%), specific – in 18 (35,3%) cases. Mortality rate made up 31,4% (n=16). Within a year no recurrences of bleeding after both operations have been observed, survival rate has been 100% after shunt surgeries and 88% – after modified Sugiura-Futagawa operations.
Conclusions. Postoperative period and outcomes of both shunt and disconnection operations at portal hypertension complicated by gastrointestinal bleeding depend upon the class of initial hepatic impairment (Child-Pugh Classification). In the case of inability of shunting, shunt thrombosis and ongoing bleeding it seems to be advisable to perform azigoportal disconnection surgery (a modified Sugiura-Futagawa operation), available to provide the reliable hemostasis even in severe patients with satisfactory short- and long-term results.

Keywords: portal hypertension, bleeding from the esophageal dilated varicose veins, portosystemic shunt, Sugiura-Futagawa operations
p. 436 – 442 of the original issue
References
  1. Merli M, Nicolini G, Angeloni S, Rinaldi V, De Santis A, Merkel C, Attili AF, Riggio O.Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol. 2003 Mar;38(3):266–72
  2. Bargallo X, Gilabert R, Nicolau C, Garcia-Pagan JC, Bosch J, Bru C.Sonography of the caudate vein: value in diagnosing Budd-Chiari syndrome. AJR Am J Roentgenol. 2003 Dec;181(6):1641–45.
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  5. Zviagintsev TD, S.V.Glushchenko SV. Khronicheskie diffuznye zabolevaniia pecheni: patogeneticheskie podkhody k lecheniiu [Chronic diffuse liver diseases: pathogenetic approaches to treatment]. Zdorov,ia Ukraini. 2010;(1):46–47.
  6. Zapolianskii AV, Averin VI, Kolesnikov EM, Korostelev OIu. Klinicheskie osobennosti vnepechenochnoi portal'noi gipertenzii u detei [Clinical features of extrahepatic portal hypertension in children]. Novosti Khirurgii. 2012;20(4):52–56.
  7. Rusin VI, Rumiantsev KE, Kopolovets II, Kravchuk IB. Neposredstvennye rezul'taty lecheniia krovotechenii iz varikoznykh ven pishchevoda u patsientov s V-klassom tsirroza pecheni [The stort-term results of bleeding esophageal varices treatment in patients with B-class cirrhosis]. Novosti Khirurgii. 2013; 21(1):36–45.
  8. De Franchis R; Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010 Oct;53(4):762–68. 9. Sass DA, Chopra KB. Portal hypertension and variceal hemorrhage. Med Clin North Am. 2009 Jul;93(4):837–53.
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  12. Garelik PV, Mogilevets EV, Marmysh GG, Mileshko MI. Effektivnost' sochetannykh metodik v profilaktike epizodov krovotechenii iz varikozno rasshirennykh ven pishchevoda pri tsirroze pecheni s portal'noi gipertenziei [Effectiveness of combined methods in the prevention of of bleeding esophageal varices in cirrhosis with portal hypertension]. Al'manakh in-ta im AV Vishnevskogo. 2011;6(2):173–74.
  13. Rikkers LF. Surgical complications of cirrhosis and portal hypertension. In: Townsend CM, Beauchamp RD, Evers MB, Mattox KL eds. Textbook of Surgery: The biological basis of modern surgical practice. Philadelphia: WB Saunders, 2001:1060–75.
  14. Qazi SA, Khalid K, Hameed AM, Al-Wahabi K, Galul R, Al-Salamah SM. 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(7):1329–37.
Address for correspondence:
614000, Rossiyskaya Federatsiya, g. Perm, ul. Petropavlovskaya, d. 26, GBOU VPO «Permskaya gosudarstvennaya meditsinskaya akademiya im. ak. E.A. Vagnera», kafedra khirurgii FPK i PPS,
e-mail: rusl-stepanov@yandex.ru,
Stepanov Ruslan Alekseevich
Information about the authors:
Kotelnikova L.P. MD, professor, a head of the surgery chair of the advanced training faculty and retraining of the staff of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”, a surgeon of SBME “Perm Regional Clinical Hospital” of Perm order “Badge of Honor” region.
Mukhamadeev I.S. MD, an associate professor of the surgery chair of the advanced training faculty and retraining of the staff of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”, a head of the vascular surgery department of SBME “Perm Regional Clinical Hospital” of Perm order “Badge of Honor” region.
Burnishev I.G. PhD, a head of the 2nd surgical department of SBME “Perm Regional Clinical Hospital” of Perm order “Badge of Honor” region.
Stepanov P.A. PhD, an assistant of the surgery chair of the advanced training faculty and retraining of the staff of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”, a physician of the vascular surgery department of SBME of SBME “Perm Regional Clinical Hospital” of Perm order “Badge of Honor” region.
Fedachuk N.N. An extramural post-graduate student of the surgery chair of the advanced training faculty and retraining of the staff of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”, a surgeon of SBME of SBME “Perm Regional Clinical Hospital” of Perm order “Badge of Honor” region.

S.V. SPIRYDONAU1, A.P. SHKET1, Y.M. CHESNOV1, N.N. SHCHATSINKA1, V.A. ADZINTSOU1, V.V. SCUMAVETZ1, V.V. ANDRUSCHUK1, A.A. KOAROVSKY1, Y.P. OSTROVSKY1,2

THE IMMEDIATE RESULTS OF AORTIC VALVE REPLACEMENT WITH ALLOGRAFTS

SE “Republican Scientific Practical Center “Cardiology”1,
SEE “Belarusian Medical Academy of Post-Graduate Education” 2, Minsk,
The Republic of Belarus

Objectives. To evaluate the immediate clinical results of aortic valve replacement with allografts.
Methods. Aortic valve replacement with allografts has been performed in 40 patients. Cryopreserved allografts were used in 33 cases (82,5%); fresh sterilized allografts – in 5 (12,5%); homovital allografts – in 2 (5%).
Indications for allograft use were: infective endocarditis of aortic valve (11 patients, 27,5%), prosthetic valve endocarditis (15 patients, 37,5%), prosthetic dysfunction (3 patients, 7,5%), aortic valve defects of different etiology (11 patients, 27,5%). Dimensions of allografts varied from 21 mm to 27 mm. The prosthetics has been performed as full root replacement in 35 cases (87,5%), the technique of subcoronary allograft implantation – in 5 cases (12,5%).
Results. The 30-day postoperative mortality rate was 15,0% (6 patients). At discharge the peak gradient was 17,9±12,4 mm Hg for the 21-mm prosthesis, 16,0±8,3 mm Hg for 23-mm prosthesis, 10,8±3,1 mm Hg for 25-mm prosthesis, 8,7±3,8 mm Hg for 27-mm prosthesis.
Conclusions. Early postoperatively the allografts in aortic position show low transprosthetic gradient. regardless of the valve size implanted. Allograft implantation is considered to be an alternative to mechanical and biological prostheses in patients with infective and prosthetic endocarditis, as well as in elderly patients with a narrow aortic annulus diameter.

Keywords: aortic valve replacement, cryopreserved aortic allograft, infectious endocarditis
p. 443 – 448 of the original issue
References
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  9. Hoquel R, Rashid Z, Sarkar SK.Antibiotic sterilization of cadaveric homograft aortic valve for clinical use. Bangladesh Med Res Counc Bull. 2007 Aug;33(2):69–72.
  10. Spiridonov SV, Iudina OA, Shket AP, Chesnov IuM, Dryk SI, Odintsov VO, Shchetinko NN, Zuenok NN, Ostrovskii IP. Varianty predimplantatsionnoi podgotovki kriosokhranennykh allograftov [Variants of preimplantation preparation of cryopreserved allografts]. Novosti Khirurgii. 2013;21(2):76–81.
  11. Maselli D, Pizio R, Bruno LP, Di Bella I, De Gasperis C.Left ventricular mass reduction after aortic valve replacement: homografts, stentless and stented valves. Ann Thorac Surg. 1999 Apr;67(4):966–71.
  12. Bisdas T, Wilhelmi M, Haverich A, Teebken OE. Cryopreserved arterial homografts vs silver-coated Dacron grafts for abdominal aortic infections with intraoperative evidence of microorganisms. J Vasc Surg. 2011 May;53(5):1274-1281.e4.
Address for correspondence:
220036, Respublika Belarus, g. Minsk, ul. R. Lyuksemburg, d. 110, GU RNPTs «Kardiologiya», 2-e kardiokhirurgicheskoe otdelenie,
e-mail: spiridonov@telegraf.by,
Spiridonau Sergey Viktorovich
Information about the authors:
Spirydonau S.V. PhD, a cardiac surgeon of SE RSPC “Cardiology”.
Shket A.P. PhD, a cardiac surgeon, a head of the 2nd cardiac surgery unit of SE RSPC “Cardiology”.
Chesnov Y.M. MD, a cardiac surgeon of SE RSPC “Cardiology”.
Shchatsinka N.N. A cardiac surgeon of SE RSPC “Cardiology”.
Adzintsou V.O. A cardiac surgeon of SE RSPC “Cardiology”.
Shumavetz V.V. PhD, a cardiac surgeon of SE RSPC “Cardiology”.
Andruschuk V.V. PhD, a cardiac surgeon of SE RSPC “Cardiology”.
Komarovsky V.V. A cardiac surgeon of SE RSPC “Cardiology”.
Ostrovsky Y.P. MD, professor, a corresponding member oà NAS RB, a head of the laboratory of the heart surgery of SE RSPC “Cardiology”, a head of the cardiac surgery chair of SEE “Belarusian Medical Academy of Post-graduate Education”.

D.D. SULTANOV1,2, F.M. TUHTAEV 1, N.R. KURBANOV 2

TRANSAXILLARY FIRST RIB RESECTION AT COSTOCLAVICULAR SYNDROME

Republican Scientific Center of Cardiovascular Surgery of Ministry of Health and Social Protection of the Republic of Tajikistan1
Avicenna Tajik State Medical University2, Dushanbe
The Republic of Tajikistan

Objectives. To improve the method of transaxillary first rib resection at the costoclavicular syndrome (CCS).
Methods. The results of survey and surgical treatment of patients (n=77) with Falconer-Weddell costoclavicular syndrome have been analyzed.
The tests of Edson, Lange, Roos, Wright have been carried out to reveal the signs of compression of the neurovascular bundle (NVB) and differentiation of the compression level. Neurological tests have been defined for neurological disorders. In patients with the secondary Raynaud's syndrome to predict the outcome of operation the cold and nitroglycerine tests were done. Methods of investigations included Doppler ultrasound and X-ray examinations. In 58 (75,3%) of 77 patients with CCS the signs of Raynaud's syndrome were observed besides the enumerated symptoms. All patients were operated on under endotracheal anesthesia. Decompression operations have been conducted in all patients (n=77); selective cervico-thoracic sympathectomy – in 58 cases.
Results. The pleura damage during the operation was registered in 4 (5,2%) patients. Non-specific complications such as hemothorax (n=1) and wound bleeding after surgery with festering it further (n=1) have been occurred. In the postoperative period the brachial plexitis manifested by pain in the arm and neck regions which was stopped with anti-inflammatory, anesthetic agents was observed in 3 patients. All above-mentioned complications were transient in 9 (11,7%) patients. The gradual regression of the neurological symptoms and arterial disturbances was noticed. In the long-term period the positive results were registered in all operated patients, the certain symptoms were recurred in some of them in winter season.
Conclusions. Transaxillary first rib resection despite of some technical difficulties of performance is considered as a highly-effective and pathogenetically grounded method of costoclavicular syndrome treatment. The decompression effect has been achieved on all three anatomically “narrow” for compression areas.

Keywords: costoclavicular syndrome, thoracic outlet syndrome, surgical treatment
p. 449 – 456 of the original issue
References
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Address for correspondence:
34003, Respublika Tadzhikistan, g. Dushanbe, ul. Sanoi, d. 33, Tadzhikskiy gosudarstvennyiy meditsinskiy universitet im. Abuali ibni Sino, kafedra khirurgicheskih bolezney,
e-mail: sultanov57@mail.ru,
Sultanov Dzhavli Davronovich
Information about the authors:
Sultanov D.D. MD, professor of the chair of surgical diseases ¹2 of Avicenna Tajik State Medical University, a head of the Science department of Republican Scientific Center of Cardiovascular Surgery.
Tuhtaev F.M. A post-graduate student of Republican Scientific Center of Cardiovascular Surgery.
Kurbanov N.R. PhD, an assistant of the chair of surgical diseases ¹2 of Avicenna Tajik State Medical University.

A.M. KUPCHENKO, V.A. KOSINETS

IDENTIFICATION AND DETERMINATION OF ANTIBACTERIAL SENSITIVITY OF ANAEROBIC MICROFLORA IN TREATMENT OF GENERALIZED PURULENT PERITONITIS

EE “Vitebsk State Medical University”
The Republic of Belarus

Objectives. To study the structure and sensitivity of anaerobic microflora of peritoneal exudate to antibacterial preparations in patients with generalized purulent peritonitis.
Methods. By means of the test systems “ID-ANA“ and “AB-AN“, designed in Vitebsk State Medical University, the bacteriological study of peritoneal exudate in patients (n=92) with generalized purulent peritonitis have been performed and identification of pathogens and determination of their sensitivity to antibacterial preparations were carried.
Results. Bacteriological study of peritoneal exudate confirmed the polymicrobial character of microflora with a wide spectrum of anaerobic pathogens, often multiply resistant to antibacterial preparations. In 73% of cases the peritoneal inflammation was caused by the mixed aerobic-anaerobic microflora, in 14% – only anaerobes, in 13% – only aerobes. Among the selected 93 strains of anaerobic microorganisms of the genus Bacteroides spp. – 63,4%, Eubacterium spp. – 7,53%, Fusobacterium spp. – 6,45%, Peptococcus spp. – 5,63%, Peptostreptococcus spp. – 5,38%, Bifidobacterium spp. – 4,32%, Peptococcus spp. – 4,3%, Clostridium spp. – 3,23%, of undifferentiated gram (-) rods – 3,22%, of undifferentiated gram (+) and gram (-) coccuses – 3,22%. Anaerobic non-clostridial flora of peritoneal exudate is the most sensitive to meropenem (96,8%), imipenem (94,6%) and metronidazole (88,2%). Extremely low activity against drug-resistant anaerobes: penicillin (8,6% sensitive strains), amoxicillin (24,7%), ticarcillin (31,2%) and chloramphenicol (28%) has been registered.
Conclusions. Identification of anaerobic microflora and determination of sensitivity to antibacterial preparations applying the test- systems “ID-ANA” and “AB-AN” allow reducing time required to study the sensitivity for 4 strains of microorganisms to antibacterial preparations up to 17 minutes, records of the results – up to 5 minutes, providing the prescription and conduction of a targeted effective antibacterial therapy in generalized purulent peritonitis.

Keywords: generalized purulent peritonitis, antibacterial therapy, anaerobic microflora, test-system
p. 457 – 462 of the original issue
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  14. Montravers P, Gauzit R, Muller C, Marmuse JP, Fichelle A, Desmonts JM.Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy. Clin Infect Dis. 1996 Sep;23(3):486–94.
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Address for correspondence:
210023, Respublika Belarus, g. Vitebsk, pr. Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra operativnoy khirurgii i topograficheskoy anatomii,
e-mail: anna.annushka75@mail.ru,
Kupchenko Anna Mihaylovna
Information about the authors:
Kupchenko A.M. A senior lecturer of the operative surgery and topographic anatomy of EE “Vitebsk State Medical University”.
Kosinets V.A. MD, professor of the hospital surgery chair of EE “Vitebsk State Medical University”.

ONCOLOGY

V.T. MALKEVICH, I.A. ILYIN

THE COMPARATIVE ASSESSMENT OF VARIOUS METHODS OF RECONSTRUCTIVE ESOPHAGOCOLOPLASTY AT ESOPHAGEAL AND GASTROESOPHAGEAL CANCER

SE "N.N. Alexandrov Republican Scientific Practical Center of Oncology and Medical Radiology "
Ìinsk,
The Republic of Belarus

Objectives. To assess the efficacy of prevention complex of ischemic complications in esophageal reconstruction by esophagocoloplasty in patients with esophageal and gastroesophageal cancer.
Methods. In the Republican Scientific Practical Center of Oncology and Medical Radiology named by N.N. Alexandrov in the department of thoracic oncopathology the delayed esophagocoloplasty has been produced for 41 patients after radical surgeries due to the esophageal and gastroesophageal cancer (primary disconnection and induced disconnection surgeries due to the primary plastic complications) in the period from 2007 to 2013 yrs. This cohort was divided into 2 groups: control (n=21) group and the main (n=20) one.
In the control group the patients have been operated by performing a conventional plasty, in the main group – by applying the developed prevention complex of ischemic complications: graft vascularization by transposition of the mesenteric colon vessels to the internal thoracic vessels, formation of the modified end-to-end esophagus-colon anastomosis, the elimination of osseous (resection of the xiphoid process of the sternum) and muscular (left-sided wide dissection of the anterior straight muscles of the neck) compression factors to the graft in retrosternal tunnel formation.
Results. In analyzing the structure of post-operative surgical complications it was found out that the use of prevention complex of ischemic complications permits to reduce significantly the frequency of postoperative complications in 3,8-folds from 57,1% up to 15% (p=0,006). Thus, the frequency of ischemic complications reduced in 6,6-folds from 33,3% to 5% (p=0,024). Analysis of the logistic regression model shows that the developed prevention complex of ischemic complications reduces reliably (p=0,045) a proportional risk of specific ischemic complications (graft necrosis and/or esophageal-colon anastomotic leakage) in 9,5-folds.
Conclusions. Applying the prevention complex of ischemic complications in delayed esophagocoloplasty performing allows improving of the immediate results of treatment in patients undergoing radical operation for esophageal and gastroesophageal cancer.

Keywords: esophagoplasty, esophagocoloplasty, two-stage operation, esophageal cancer, gastroesophageal cancer
p. 463 – 469 of the original issue
References
  1. Shah SV, Chheda YP, Pillai SK, Shah SV.Total oesophagectomy for squamous cell carcinoma with or without standard two field node dissection - a prospective study. Indian J Surg Oncol. 2013 Dec;4(4):336–40.
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  4. Dunn DH, Johnson EM, Morphew JA, Dilworth HP, Krueger JL, Banerji N.Robot-assisted transhiatal esophagectomy: a 3-year single-center experience. Dis Esophagus. 2013 Feb-Mar;26(2):159–66.
  5. Gutschow CA, Holscher AH, Leers J, Fuchs H, Bludau M, Prenzel KL, Bollschweiler E, Schroder W. Health-related quality of life after Ivor Lewis esophagectomy. Langenbecks Arch Surg. 2013 Feb;398(2):231–37.
  6. Wright CD, Kucharczuk JC, O'Brien SM, Grab JD, Allen MS; Society of Thoracic Surgeons General Thoracic Surgery Database. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg. 2009 Mar;137(3):587–95.
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  8. Kassis ES, Kosinski AS, Ross P Jr, Koppes KE, Donahue JM, Daniel VC. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg. 2013 Dec;96(6):1919–26.
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  11. Vorobei AV, Chepik DA, Vizhinis EI., Lur'e VN. Klinicheskoe obosnovanie odnoetapnoi zagrudinnoi ezofagokoloplastiki v lechenii bol'nykh s posleozhegovoi rubtsovoi strikturoi pishchevoda [The clinical substantiation of single-stage substernal esophagocoloplasty in treating patients with after burn esophageal scar stricture]. Meditsina. 2009;(4):52–56.
  12. Uchiyama H, Morita M, Toh Y, Saeki H, Kakeji Y, Matsuura H, Maehara Y. Superdrainage of the ileocolic vein to the internal jugular vein interposed by an inferior mesenteric vein graft in replacing the esophagus with the right hemicolon. Surg Today. 2010 Jun;40(6):578–82.
  13. Awsakulsutthi S.Result of esophageal reconstruction using supercharged interposition colon in corrosive and Boehave's injury: Thammasat University Hospital experience. J Med Assoc Thai. 2010 Dec;93 Suppl 7:S303-6.
  14. Averin V, Podgaiskii VN, Nesteruk LN, Grinevich IuM, Ryliuk AF. Pervyi opyt revaskuliarizatsii transplantata pri plastike pishchevoda u detei v nestandartnykh situatsiiakh [The first experience of graft revascularization in esophagoplasty children in unusual situations]. Novosti Khirurgii. 2012;20(1):80–84.
  15. Kesler KA, Pillai ST, Birdas TJ, Rieger KM, Okereke IC, Ceppa D, Socas J, Starnes SL. "Supercharged" isoperistaltic colon interposition for long-segment esophageal reconstruction. Ann Thorac Surg. 2013 Apr;95(4):1162–68.
Address for correspondence:
223040, Respublika Belarus, Minskaya oblast, Minskiy rayon, agrogorodok Lesnoy 2, GU "RNPTs onkologii i meditsinskoy radiologii im. N.N. Aleksandrova", otdel torakalnoy onkopatologii s gruppoy anesteziologii,
e-mail: ileus@tut.by,
Ilin Ilya Anatolevich
Information about the authors:
Malkevich V.T. MD, a chief researcher of the thoracic oncopathology department with the anesthesiology group of SE “N.N. Alexandrov Republican Scientific Practical Center of Oncology and Medical Radiology”.
Ilyin I.A. A full-time post-graduate student, SE “N.N. Alexandrov Republican Scientific Practical Center of Oncology and Medical Radiology”.

E.I. SEMIONKIN, N.V. YAKOVLEVA, E.P. KULIKOV

PSYCHOLOGICAL PROFILE OF PATIENTS WITH COLON CANCER AT SURGICAL TREATMENT

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

Objectives. To study the psychological profile of patients with colon cancer (CC) at surgical treatment taking into consideration the gender peculiarities.
Methods. The patients (n=181) with colon cancer have been examined. All the patients have been operated on. The psycho-physiological state and psychodynamic personality traits have been assessed with the following methods: a test that could be used to diagnose the health, activity and mood (HAM test), test of self-esteem by Dembo-Rubinstein, Lüscher color test, à manifest anxiety scale (MAS), standardized diagnostic interview “Individual perception of health state” and heart rate variability test.
Results. Personality traits of patients are characterized by introversion, distortion of self-rated health, stigmatization of life course. A large number of introverts are characterized by a specific attitude towards to the disease. This type of reaction is associated with ”feelings inside”, the patients can not splash out all the accumulated emotions caused to a high neuro-mental stress. Psycho-emotional stress causes reconstruction of autonomic nervous system functioning towards sympathetic system activation. The suppression of basic necessities (rejected basic colors) was observed in the most patients prior and after operation. It characterizes a high anxiety level and less effective compensating behavior.
Some of the gender differences have been revealed which are as follows: women show a higher anxiety level, low spirits, as well as a negative attitude towards life. After the operation a probability of sexual neuroses, fits of anger, nervous exhaustion and cardiovascular disorders are observed in women.
Conclusions. The patients with colon cancer are considered to be in a state of psychological disadaptation with the following specific peculiarities: introversion, protective distortion of self-rated health, a heightened anxiety and a high level of stress, predominance of sympathetic autonomic regulation. Some gender differences have been detected: women are more prone to stress-related anxiety, mood disorders, depressive states, as well as self-assessment of various aspects of life are lower in women and they have more critical attitude toward themselves and more doubts about a favorable clinical outcome. The patients suffered from colon cancer should be provided with professional clinical, psychological and psychotherapeutic care.

Keywords: colon cancer, psychological stress, gender differences, autonomic nervous system, state of fear
p. 470 – 473 of the original issue
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Address for correspondence:
390039, Rossiyskaya Federatsiya, g. Ryazan, ul. Internatsionalnaya d. 3 A, GBOU VPO “Ryazanskiy meditsinskiy universitet”, kafedra fakultetskoy khirurgii s kursom anesteziologii i reanimatologii,
e-mail: semionkin@list.ru,
Semionkin Evgeniy Ivanovich
Information about the authors:
Semionkin E.I. PhD, an associate professor of the faculty surgery chair with the course of anesthesia and reanimation of SBEE HPE “Ryazan Medical University”.
Yakovleva N.V. PhD, an associate professor, a head of the general psychology chair with the course of pedagogy of SBEE HPE “Ryazan Medical University”.
Kulikov E.P. MD, professor, a head of the oncology chair with the course of radiation diagnostics of SBEE HPE “Ryazan Medical University”.

ANESTHESIOLOGY-REANIMATOLOGY

O.I. SVETLITSKAYA, I.I. KANUS

RESPIRATORY SUPPORT OF PATIENTS WITH ACUTE LUNG INJURY

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

Objectives. To improve the treatment results of an acute lung injury syndrome in patients with severe community-acquired pneumonia of viral and bacterial etiology by optimization of the respiratory support.
Methods. Complex examination of patients (n=216) with a severe community-acquired, viral and bacterial pneumonia who were treated in the intensive care unit (ICU) of Minsk City Emergency Hospital (2009-2013 yrs) has been conducted.
Results. It was established that 74,6% of patients with an acute lung injury of viral and bacterial etiology needed in respiratory support had excess body weight/obesity. The lowest parameters of the respiratory index: 114,3 mm Hg in patients with the 1st degree of obesity (3,25 points by LIS Scale) and 125,2 mm Hg in patients with the 3rd degree (2,25 points by LIS Scale) have been revealed in patients with the 1st and 3rd degree of obesity. In patients with body mass index (BMI) > 30 kg/m2 an early non-invasive lung ventilation (NILV) was applied, the early application of artificial lung ventilation (ALV) (if PaO2/FiO2 < 175 mm Hg one hour after NILV) with the compliance of principal postulates of “safe” ALV and performing “recruitment” maneuver immediately after intubation to prevent/eliminate atelectasis, that had a positive impact on the restoration of oxygenation and resulted in reduction of the artificial lung ventilation time and lethality rate in the intensive care unit.
Conclusions. The proposed concept of the respiratory support allowed making effective prosthesis of the respiratory organs function having lowered lethality in 3-folds. This method is characterized by the differentiated approach to the regimen choice of ventilation taking into the account severity of alveolar and capillary membrane injury and the accompanying diseases (excess body mass /obesity).

Keywords: acute lung injury, mechanical ventilation, community-acquired pneumonia, obesity
p. 474 – 480 of the original issue
References
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  13. Morgan OW, Bramley A, Fowlkes A, Freedman DS, Taylor TH, Gargiullo P, Belay B, Jain S, Cox C, Kamimoto L, Fiore A, Finelli L, Olsen SJ, Fry AM.Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1) disease. PLoS One. 2010 Mar 15;5(3):e9694.
  14. Iashina LA, Ishchuk SG. Izbytochnaia massa tela, ozhirenie i patologiia legkikh: vzgliad pul'monologa [Excess body weight, obesity and lung disease: a view of pulmonologist]. Zdorov'ia UkraIni. 2011;(4):14–15.
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Address for correspondence:
220013, Respublika Belarus, g. Minsk, ul. P. Brovki 3, korpus 3, GUO «Belorusskaya meditsinskaya akademiya poslediplomnogo obrazovaniya», kafedra anesteziologii i reanimatologii,
e-mail: goodlife@tut.by,
Svetlitskaya Olga Ivanovna
Information about the authors:
Svetlitskaya O.I. PhD, an associate professor of anesthesiology and reanimatology chair of Belarusian Medical Academy of Post-graduate Education”.
Canus I.I. An Honored scientist, MD, professor of anesthesiology and reanimatology chair of Belarusian Medical Academy of Post-graduate Education”.

REVIEWS

Å.À. SHLYAKHTUNOV, V.M. SEMENOV

MOLECULAR GENETIC DIAGNOSIS OF SOME MALIGNANT SOLID TUMORS

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

This article aims to review the recent literature on topic of the molecular genetic diagnosis of some malignant solid tumors. Possibilities of polymerase chain reaction (PCR) to identify the various tumor-associated genes have been determined. The characteristics, localization, functions of series genes, such as tyrosinase gene (TYR), survivin (BIRC5), epidermal growth factor (ErbB-2/HER2-Neu), as well as "housekeeping" genes (GAPDH, 18S rRNA) are presented. Their clinical importance, prognostic significance in different types of malignant tumors such as melanoma, breast cancer, lung cancer, ovarian cancer, colon cancer, etc have been determined. The study of these genes is considered to be one of diagnostic option of minimal residual disease in the case of opportunity to reveal the progression of neoplastic process at the stage of single tumor cells presence. The polymerase chain reaction (PCR) can be used to identify the specific genes directly in tumor tissue obtained at biopsy and in treated tumor cells. The tumor-associated genes disseminated in the peripheral blood is able to identify a number of tumors. The researches aimed at studying of the expression of tumor-associated genes are considered to be promising and relevant to customize treatment (surgery, neo- and adjuvant drug therapy) of patients suffering from malignant tumors.

Keywords: cancer, tumor marker, genetic diagnosis
p. 481 – 487 of the original issue
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Address for correspondence:
210023, Respublika Belarus, g. Vitebsk, pr. Frunze, d. 27, UO “Vitebskiy gosudarstvennyiy meditsinskiy universitet”, kafedra onkologii s kursami LD, LT, FPK i PK,
e-mail: Evgenij-shlyakhtunov@yandex.ru,
Shlyakhtunov Evgeniy
Information about the authors:
Shlyyakhtunov E.A. PhD, an associate professor of oncology chair with the courses of RD, RT, the retraining and advanced training faculty of EE “Vitebsk State Medical University”.
Semenov V.M. MD, professor, a dean of the medical faculty of EE “Vitebsk State Medical University”.

CASE REPORTS

S.A. DOGJANI 1, E.B. HASANAJ 1, E. MATEVOSSIAN2, D. DOLL 3

MANAGEMENT OF THE BLUNT PEDIATRIC CERVICAL TRAUMA – CHALLENGE FOR THE TRAUMA SURGEON AND THE OPTIONS OF SOLVING THEIR EMERGENCY CONDITIONS

University Hospital of Trauma,
National Trauma Center1, Tirana, Albania,
Hospital “Rechts der Isar“2, Munich, Germany
St. Mary's Hospital 3, Vechta, Germany

Blunt injuries to the chest are not rare but if present are usually associated with either a direct impact to chest and neck or acceleration-deceleration injuries. Such injuries are associated with concomitant injuries to the cervical structures. This particular type of injury thus presents a diagnostic and therapeutic challenge to emergency physicians, anesthetists and surgeons alike. We report a case of tracheal injury due to blunt upper thoracic trauma which surgeons have successfully coped.
A 12-year-old boy fell from bicycle and sustained blunt injury to his upper chest aperture. He was brought to the hospital (6 h later) with pain in the chest, difficulty in breathing and inability to speak. His heart rate (HF) was 120/min, systolic blood pressure (SBP) was 110/70 mm Hg, respiratory rate (RR) was 32/min and SaO2 was 90%. This case is interesting in subcutaneous emphysema extending from his upper chest to his head, covering neck and throat. Radiographs and CT scan revealed a right-sided pneumothorax, pneumomediastinum and tracheal deviation. The patient was emergently taken to the operating room and a right-chest tube was placed. The patient underwent fiber optic examination of the trachea, where a injury 2-3 cm below of longitudinal direction (1 cm) in the anterior membranous part of the trachea has been detected, thus formally the trachea was ruptured. During the procedure the child's condition deteriorated with diminishing SaO2 down to 86% and difficulty in breathing but the child was hemodynamically stable. Under these conditions emergency intervention tracheotomy has been performed. Immediately all respiratory parameters returned to normal. The next morning the symptoms and signs were normal with no further complications. The patient was discharged home after a few days. Tracheal injury is a rare complication of blunt chest trauma. The patients usually present with symptoms and signs of respiratory distress. Primary repair is the treatment of choice in case of large defects, while small tears can be managed conservatively. Immediate operation is recommended to improve deteriorating pulmonary function.

Keywords: blunt chest trauma, subcutaneous emphysema, trachea rupture, pediatric, neck trauma, bicycle
p. 488 – 491 of the original issue
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Address for correspondence:
Department of Surgery, St. Mary's Hospital Vechta, Marienstr. 6-8, D-49377 Vechta, Germany. Europe
e-mail: ddoll@gmx.de
PD Dr. Dietrich Doll, MD, PhD
Information about the authors:
Dogjani S.A. MD, PhD, General Surgeon at the University Hospital of Trauma, National Trauma Centre, Tirana, Albania
Hasanaj E.B. MD, General Surgeon at the University Hospital of Trauma, National Trauma Centre, Tirana, Albania
Matevossian E. MD, PhD, Hospital “Rechts der Isar”, Munich, Germany
Dietrich Doll, MD, PhD. Priv-Doz. Dr. Department os Surgery, St. Mary's Hospital 3, Vechta, Germany

K.Y. PASHCHENKO

THE POSSIBILITIES OF SURGICAL REHABILITATION IN CHILDREN WITH PROLONGED DISABLED INTESTINE SYNDROME

Kharkov National Medical University
The Ukraine

Objectives. To determine the possibilities of surgical rehabilitation of patients with prolonged disabled intestine syndrome due to the staged restoration of the intestinal passage.
Methods. The treatment results of two children with terminal ileostomy previously formed at early age are presented in the study. Restoration of natural intestinal passage was conducted in children at the age of 8,5 and 16,5 years, respectively. Surgical rehabilitation of patients was held in the pediatric surgery clinic of Kharkov National Medical University at Kharkov Regional Clinical Hospital N1. After surgery completion the short- and long-term results and the quality of life have been studied.
Results. Carrying out of medical measures was directed to the main pathogenic features of the morphofunctional violations, which develop due to the prolonged disabled intestine syndrome. Medicamentous stimulation, hydrotraining of non-functioning segments of small and large intestine, energy disorders correction, electrical stimulation have been carried out. Surgery included formation of direct T-shaped anastomosis with preserving stoma at the first stage. After anastomotic healing the training of fistula obturation with a gradual increase in duration have been conducted. After regular unaided defecation appearance the stoma is closed. Thus, the restoration of full natural intestinal passage in patients with terminal enterostomy after 8.5 and 16.5 years has been successfully performed with the achievement of regular unaided defecation in the long-term period. It testifies to the reversibility of morphofunctional changes developing due to the prolonged disabled intestine syndrome.
Conclusions. The developed complex technique of staged rehabilitation of non-functioning intestine segments allows achieving the complete rehabilitation of disabled intestine segments during the prolonged period of absence of chyme passage. The rarity of such observations is considered to be of great interest for a wide range of surgical community.

Keywords: children, surgical treatment, enterostomy, rehabilitation
p. 492 – 496 of the original issue
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Address for correspondence:
61051, Ukraina, g. Khar'kov, Ul. Klochkovskaia, d. 337 A, KUOZ Oblastnaia detskaia klinicheskaia Bol'nitsa ¹ 1, Khar'kovskii natsionvl'nyi Meditsinskii universitet, kafedra detskaia khirurgii i detskoi anesteziologii,
e-mail: pky84@mail.ru,
Pashchenko Konstantin Iur'evich
Information about the authors:
Pashchenko K.Y., a post- graduate student of the chair of pediatric surgery and pediatric anesthesiology of Kharkiv National Medical University
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