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Year 2014 Vol. 22 No 6

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.643   |  

V.А. KOSINETS

THE EFFECTS OF INTERLEUKIN-2 ON THE SMALL INTESTINE STRUCTURAL STATE IN EXPERIMENTAL GENERALIZED PURULENT PERITONITIS

EE “Vitebsk State Medical University”
The Republic of Belarus

Objectives. To study the effects of recombinant interleukin-2 on structural changes in the small intestine wall in experimental generalized purulent peritonitis.
Methods. The experiment was carried out on 40 male rabbits divided into the following groups: intact (n=5); 6-hour peritonitis without surgical treatment (n=5); control (n=15) – surgical treatment of peritonitis; main (n=15) – surgical treatment of peritonitis with the use of the recombinant interleukin-2 – roncoleukin for postoperative peritonitis. In the postoperative period the main group of animals intravenously injected roncoleukin in a dose of 10 000 IU/kg twice daily within 5-days. Tissue samples of the small intestine were morphologically examined by light microscopy.
Results. The expressed inflammatory and destructive changes in the small intestine wall in 6 hours after induction of peritonitis have been revealed. Disturbances of blood and lymph circulation, destruction of villi of mucous coat, dystrophic and necrotic changes in muscular coat testified to the early terms of enteral insufficiency development in generalized purulent peritonitis. In the postoperative period after laparotomy, sanitation of the abdominal cavity and decompression of the small intestine the morphological picture of pathological disturbances of the structure of the small intestine coats had no accurate tendency to improvement.
Conclusion. Development of experimental generalized purulent peritonitis is accompanied by the expressed early changes of the structure of the small intestine wall leading to the colonization resistance disturbance caused the intestinal paresis and its transformation to the infection reservoir.
Traditional surgery doesn't stop the progressing of the pathological process in the small intestine continuing to expand in the postoperative period.
In case of peritonitis intravenous administration of recombinant interleukin-2 has direct effects on the inflammatory process course in the small intestine and prevents the development of destructive processes in its tissues. The data obtained allow considering this property when administering the drug in treatment of generalized purulent peritonitis.

Keywords: generalized purulent peritonitis, small intestine, structural changes, inflammation, immune system, interleukin-2, roncoleukin

p. 643-648 of the original issue

References

1. Gostishchev VK, Sazhin VP, Avdovenko AL. Peritonit [Peritonitis]. Moscow, RF: GEOTAR-Media; 2002. 238 p.
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3. Grishina TI. Klinicheskoe znachenie narusheniia immuniteta pri khirurgicheskikh vmeshatel'stvakh [The clinical significance of impaired immunity in surgical interventions]. Andrologiia i genital'naia khirurgiia. 2000;(2):35–38.
4. Efimenko NA, Rozanov VE, Bolotnikov AI. Immunopatogenez i kontseptsiia sovremennoi immunoterapii peritonita u postradavshikh s tiazheloi sochetannoi travmoi zhivota [Immunopathogenesis and modern concept of immunotherapy of peritonitis in patients with severe combined trauma of the abdomen]. Moscow. RF: OOO Avtograf, 2008. 302 p.
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6. Bozza FA, Salluh JI, Japiassu AM, Soares M, Assis EF, Gomes RN, Bozza MT, Castro-Faria-Neto HC, Bozza PT. Cytokine profiles as markers of disease severity in sepsis: a multiplex analysis. Crit Care. 2007;11(2):R49.
7. Fjell CD, Thair S, Hsu JL, Walley KR, Russell JA, Boyd J. Cytokines and signaling molecules predict clinical outcomes in sepsis. PLoS One. 2013 Nov 14;8(11):e79207
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9. Wilson PG, Manji M, Neoptolemos JP. Acute pancreatitis as a model of sepsis. J Antimicrob Chemother. 1998 Jan;41 Suppl A:51–63.
10. Bubnova NA. Egorova VN. Obobshchennyi opyt primeneniia Ronkoleikina (rekombinantnogo interleikina-2) v lechenii khirurgicheskikh zabolevanii [Generalized experience of Roncoleukin (recombinant interleukin-2) in the treatment of surgical diseases]: posobie dlia vrachei. Saint-Petersburg, RF: Al'ter Ego, 2010. 80 p.
11. Egorova VN, Popovich AM. Ronkoleikin®.Opyt primeneniia v khirurgii i reanimatologii [Ronkoleykin®. Experience in surgery and resuscitation]. Saint-Petersburg, RF: Al'ternativnaia Poligrafiia, 2004. 48 p.
12. Kozlov VK. Disfunktsiia immunnoi sistemy v patogeneze sepsisa: vozmozhnosti diagnostiki [Immune system dysfunction in sepsis: diagnostic potential. Cytokines and inflammation]. Tsitokiny i Vospalenie. 2006;5(2):15–29.
13. Kozlov VK. Immunopatogenez i tsitokinoterapiia khirurgicheskogo sepsisa [Immunopathogenesis and cytokine therapy of surgical sepsis]. Vestn Ross Voen Med Akademii. 2002;2(8):12–22.
14. Kozlov VK. Sepsis: etiologiia, immunopatogenez, kontseptsiia sovremennoi immunoterapii [Sepsis: etiology, immunopathogenesis, and concept of modern immunotherapy]. Saint-Petersburg, RF: Dialekt; 2006. 304 p.
15. Kosmaczewska A.Low-Dose Interleukin-2 Therapy: A Driver of an Imbalance between Immune Tolerance and Autoimmunity. Int J Mol Sci. 2014 Oct 15;15(10):18574–92.
16. Hoyer KK, Dooms H, Barron L, Abbas AK. Interleukin-2 in the development and control of inflammatory disease. Immunol Rev. 2008 Dec;226:19–28
17. Miae Jeon, Hyun Jung Kwon, Yong Hyun Kim, Kook-Il Han, Kung-Woo Nam, Yeongjun Baik, Sunghee Lee, Wan-Jong Kim, Man-Deuk Han. Pretreatment with recombinant human interleukin 2 (rhIL-2) Up-regulates PCNA-positive cells after partial hepatectomy in rat liver. Biotechnology and Bioprocess Engineering. Feb 2014;19(1):43–51.

Address for correspondence:
210023, Respublika Belarus, g. Vitebsk, pr-t Frunze, d. 27,
UO «Vitebskiy gosudarstvennyiy
meditsinskiy universitet», kafedra gospitalnoy khirurgii
s kursami urologii i detskoy khirurgii,
tel. mob.: 375 296 24 20 76,
e-mail: vkosinets@yandex.ru,
Kosinets Vladimir Aleksandrovich

Information about the authors:
Kosinets V.A. MD, professor of the hospital surgery chair with courses of urology and pediatric surgery of EE “Vitebsk State Medical University”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.649   |  

A.P. TRUKHAN

THE ASSESSMENT OF EFFICIENCY OF TOURNIQUET APPLICATION AS AN ELEMENT OF FIRST AID IN CRUSH SYNDROME. А REPORT 2: SOME MORPHOLOGICAL CHANGES

EE "Belarusian State Medical University"
The Republic of Belarus

Objectives. To assess the effectiveness of tourniquet application as a component of the first aid in crush syndrome on the basis of morphological changes in the tissues.
Methods. The work is based on the experimental modeling of crush syndrome of moderate severity in rabbits by the method developed by the author (compression 25 kg/cm² on the area of 6 cm² on the pelvic limb within 5 hours). In the main group, in contrast to the comparison group, after the elimination of compression a tourniquet was applied for 1,5 hours on the injured limb. To assess the influence of tourniquet application on local and system changes on the third day after the elimination of compression, corresponded to the end of the early postcompression period, the samples of tissues (muscles of the damaged limb, kidneys, and lungs) for morphological examination have been taken. The results were evaluated using specially developed indices of morphological changes.
Results. It has been established the tourniquet application as an element of the first aid in the crush syndrome leads to more severe muscular destructive changes of an affected limb (p=0,0357). This is due to the prolongation of the ischemic time of limbs, and additional traumatic effect of tourniquet application on tissues. Furthermore the tourniquet application leads to more significant kidney (p=0,0104) and lung (p=0,0341) damage, associated with greater severity of traumatic shock, as well as more severe syndrome of reperfusion-recirculation (the gradual entering of a large number of products of muscular destruction and changed by hypoxia metabolism, inflammatory mediators to the systemic circulation).
Conclusion. The application of the tourniquet as а part of the first aid for crush syndrome leads to more expressed local and visceral morphological changes.

Keywords: crush syndrome treatment, tourniquet, morphological changes, experimental surgery

p. 649-653 of the original issue

References

1. Trukhan AP. Otsenka effektivnosti primeneniia zhguta kak elementa pervoi pomoshchi pri sindrome dlitel'nogo sdavleniia. Soobshchenie 1: Izmeneniia biokhimicheskikh pokazatele [Evaluating the effectiveness of the tourniquet as a first aid for crush syndrome]. Novosti Khirurgii. 2014;22(3):280–85.
2. Tsybuliak GN. Obshchaia khirurgiia povrezhdeni [General surgery damage]. Rukovodstvo dlia vrachei Saint-Petersburg, RF: Gippokrat, 2005. 647 p.
3. Nechaev EA, Revskoi AK, Savitskii GG. Sindrom dlitel'nogo sdavleniia [Crush syndrome]: rukovodstvo dlia vrachei. Moscow, RF: Meditsina, 1993. 208 p.
4. Bordakov VN, Alekseev SA, Chumanevich OA, Patsai DI, Bordakov P . V. Sindrom dlitel'nogo sdavleniia [Crush syndrome ]. Voen Meditsina. 2013;(1):26–32.
5. Garkavi AV. Sindrom dlitel'nogo sdavleniia miagkikh tkanei konechnostei [Crush syndrome of soft tissues of the extremities]. Med Pomoshch'. 2000;(2):23–28.
6. Sherdukalova LF, Ovanesian RA, Galikian VO. Klassifikatsiia i lechenie sindroma dlitel'nogo sdavleniia [Classification and treatment of crush syndrome]. Khirurgiia. 1999;(1):43–46.
7. Murata I, Ooi K, Sasaki H, Kimura S, Ohtake K, Ueda H, Uchida H, Yasui N, Tsutsui Y, Yoshizawa N, Hirotsu I, Morimoto Y, Kobayashi J. Characterization of systemic and histologic injury after crush syndrome and intervals of reperfusion in a small animal model. J Trauma. 2011 Jun;70(6):1453–63.
8. Malinoski DJ, Slater MS, Mullins RJ. Crush injury and rhabdomyolysis.. Crit Care Clin. 2004 Jan;20(1):171–92.

Address for correspondence:
220034, Respublika Belarus,
g. Minsk, ul. Azgura, d. 4,
Voenno-meditsinskiy fakultet v
UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet»,
kafedra voenno-polevoy khirurgii,
tel. mob.: 8-044-7331058, aleksdoc@yandex.ru,
Trukhan Aleksey Petrovich

Information about the authors:
Trukhan A.P. PhD, an associate professor of the military field surgery chair of the military medical faculty of EE "Belarusian State Medical University", lieutenant colonel of medical service.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.654   |  

V.F. KULIKOVSKY ¹, S.V. SHKODKIN ¹, Y.R. KOLOBOV ¹, V.P. BONDAREV ²

EXPERIMENTAL STUDY OF BIOLOGICAL AND BIOMECHANICAL COMPATIBILITY OF NANOSTRUCTURED SPIRAL STENT

FSAEE HPE “Belgorod State National Research University”¹
RSME “Kursk Regional Pathologic-anatomic Office” ²
The Russian Fedreratin

Objectives. To study the effect of spiral mechanical properties of nanostructured spiral stent on indicators of biological and biomechanical compatibility and the possibility of its atraumatic removal through the wall of a hollow organ.
Methods. The mechanical properties of the intestinal tube (5 animals) and implantation of the esophageal stents (40 animals) were studied on Wistar rats. Wherein the titanium nickelide spiral stent was implanted in the esophagus in one half, a spiral prolene stent with the same geometrical parameters without spiral part to remove. On the 14^th and 30^th days after stent implantation the microcirculatory disorders in the wall of the stented abdominal esophagus have been studied using laser Doppler flowmetry as well as the peritoneal inflammatory response and the stomach impermeability after stent removal.
Results. The differences in the mechanical properties of the studied devices depended on the severity of the submucosal and circular muscle layer have been revealed. The quantitative values of Young’s elasticity modulus and tensile strength had stereotyped indices; the last was determined by a species of biological object. Cytology of the visceral peritoneum throughout the experiment was characterized by greater severity of inflammatory changes in the control group. The microcirculatory disturbances have been registered in all animals in the wall of the stented esophagus, but up to the 14^th day of the experiment in the control group the perfusion reduction significantly differed from the main group: 371,8±94,5 and 606,9±52,6 PU, respectively (p<0,05). Morphological study on both control intervals showed the greater severity of inflammatory infiltration, hypertrophic and sclerotic changes in the control.
Conclusion. Experimental study of the stented esophagus of the laboratory Wistar rats has revealed microcirculatory disorders, inflammatory changes and the incidence of perforation of the esophageal wall with identical geometric characteristics are considered to be associated with mechanical rigidity of stent spiral.

Keywords: medical implants, stent, biocompatibility

p. 654-664 of the original issue

References

1. Topol'skii AM, Zhane AK, Karuna IuV. Endoskopicheskie transpapilliarnye metody lecheniia pri patologii pankreatobiliarnoi zony [Transpapillary endoscopic treatments for pancreatobiliary zone pathology]. Kuban Nauchn Med Vestn. 2007;(4-5):205–208.
2. Kogan MI, Shkodkin SV, Idashkin IuB, Liubushkin AV, Miroshnichenko OV. Otsenka effektivnosti razlichnykh sposobov drenirovaniia pochki [The evaluation of the effectiveness of different methods of drainage kidney]. Med Vestn Bashkortostana. 2013;(2):82–85
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4. Fanelli F, Orgera G, Bezzi M, Rossi P, Allegritti M, Passariello R.Management of malignant biliary obstruction: technical and clinical results using an expanded polytetrafluoroethylene fluorinated ethylene propylene (ePTFE/FEP)-covered metallic stent after 6-year experience. Eur Radiol. 2008 May;18(5):911–19.
5. Plaksin SA, Artmeladze RA, Shchetkina IN, Sablin EE. Khirurgicheskaia taktika pri mestnorasprostranennom rake pishchevoda [Surgical tactics in locally widespread esophageal cancer]. Perm Med Zhurn. 2010; 4(27):1–22.
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7. Komiakov BK, Guliev AZh, Davranov BG. Palliativnoe drenirovanie verkhnikh mochevykh putei pri opukholevoi obstruktsii mochetochnikov [Palliative drainage of the upper urinary tract with tumor ureteral obstruction]. Ambulatornaia Khirurgiia. Statsionarozameshchaiushchie Tekhnologii. 2006;(2):17–19.
8. Martov AG, Maksimov VA, Ergakov DV, Davydova SS, Asfandiiarov FR, Kalashnikov ES. Primenenie tolterodina v lechenii simptomov, sviazannykh s nalichiem u patsientov vnutrennego stenta [Use of tolterodine in the treatment of symptoms associated with the presence of internal stent patients]. Ural Med Zhurn. 2012;(2):18–25.
9. Cauda F, Cauda V, Fiori C, Onida B, Garrone E.Heparin coating on ureteral Double J stents prevents encrustations: an in vivo case study. J Endourol. 2008 Mar;22(3):465–72.
10. Kolobov IuR. Tekhnologii formirovaniia struktury i svoistv titanovykh splavov dlia meditsinskikh implantatov s bioaktivnymi pokrytiiami [Technology of formation of structure and properties of titanium alloys for medical implants with bioactive coatings]. Ross Nanotekhnologii. 2009;4(1112):69–81.
11. Ivanov MB, Kolobov IuR, Golosov EV, Kuz'menko IN, Veinov VP, Nechaenko DA, Kungurtsev ES. Mekhanicheskie svoistva nanostrukturnogo titana seriinogo proizvodstva [Mechanical properties of nanostructured titanium of serial production]. Ross Nanotekhnologii. 2011;6( 5-6):108–14.

Address for correspondence:
308015, Rossiyskaya Federatsiya,
g. Belgorod, ul. Pobedyi, d. 85,
Kafedra gospitalnoy khirurgii
FGAOU VPO «Belgorodskiy gosudarstvennyiy
natsionalnyiy issledovatelskiy universitet», tel. 79103207071,
e-mail: shkodkin-s@mail.ru,
Shkodkin Sergey Valentinovich

Information about the authors:
Kulikovsky V.F. MD, professor, director of medical institute, a head of the hospital surgery chair of FSAEE HPE “Belgorod State National Research University”.
Shkodkin S.V. PhD, associate professor of the hospital surgery chair of FSAEE HPE “Belgorod State National Research University”.
Kolobov Y.R. Dr. Sci., professor, a head of the scientific, educational and innovation center "Nanostructured Materials and Nanotechnology" of FSAEE HPE “Belgorod State National Research University”.
Bondarev V.P. A head of the department of pediatric pathology and infectious pathology of RSME “Kursk regional pathologic and anatomic office”.

Article in the .pdf format

GENERAL AND SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.665   |  

V.I. BELOKONEV ¹, J.V. PONOMAREVA ¹, S.Y. PUSHKIN ², O.N. MELENTIEVA ¹, M.G. GULYAEV ¹

POTENTIAL PREDICTORS AND MORPHOLOGICAL ASPECTS OF SEROMA DEVELOPMENT AFTER PLASTIC SURGERY OF THE ANTERIOR ABDOMINAL WALL HERNIA

SBEE HPE “Samara State Medical University”¹,
SBME “Samara Regional Clinical Hospital named after M.I. Kalinin”²,
The Russian Federation

Objectives. To determine potential predictors of seroma formation on the basis of pathomorphological picture.
Methods. The analysis of indicators of the level of C-C motifligand 2 (CCL2) has been conducted by ELISA in the serum and exudates of 68 patients prior surgery and after it on the 4^th, 10^th-12^th day in case the surgical removal of ventral hernia W3, W4 the cutaneous and adipose flap was dissected with the plastic gates by polypropylene endoprosthesis. In patients with advanced seroma a morphological study of its walls, contents, and adjacent tissues was carried out.
Results. In patients with normal postoperative period after hernioplasty the elevation of CCL2 values in the serum and exudate was observed and their reduction has occured up to 10^th-12^th days. Similar changes were revealed in the group of patients with planned surgical pathology. Patients who subsequently seroma developed to the 4^th day the level of CCL2 was 3 folds higher regarding to the control groups without any tendency to reduce (p<0,05). Morphological analysis revealed signs of both acute and chronic inflammation in the tissues depending on the terms of seroma existence.
Conclusion. The injured cells of the adipose tissue and macrophages migrating to the inflammatory focus are considered to be the source of the chemokine CCL2, supporting an exudative inflammation. From this point of view the determination of CCL2 level in the blood serum and/or discharge from the drainage after hernioplasty accompanied by immobilization of subcutaneous and adipose flap over a large area can serve as factors predicting seroma formation.

Keywords: ventral hernia, surgical treatment, seroma, subcutaneous and adipose flap, chemokine CCL2, polypropylene endoprosthesis

p. 665-670 of the original issue

References

1. Stupin VA. Effektivnost' ul'trazvukovogo issledovaniia v diagnostike retentsionnykh oslozhnenii u patsientov s posleoperatsionnymi gryzhami [The effectiveness of ultrasound in the diagnosis of retention of complications in patients with postoperative hernias]. Gerniologiia. 2009;(1):40.
2. Belianskii LS, Todurov IM, Manoilo NV. Osobennosti khirurgicheskogo lecheniia defektov briushnoi stenki u bol'nykh s massivnym povrezhdeniem funktsional'nykh myshechnykh kompleksov [Features of surgical treatment of abdominal wall defects in patients with massive damage of functional muscle complexes]. Gerniologiia. 2007;(3):29–31.
3. Fedorov IV, Slavin LE, Kochnev AV, Voronin AV, Khasanov NF. Seroma kak oslozhnenie khirurgii gryzh zhivota [Seroma as a complication of surgery abdominal hernias]. Gerniologiia. 2007;(2):27–29.
4. Lopez-Cano M, Armengol-Carrasco M.Use of vacuum-assisted closure in open incisional hernia repair: a novel approach to prevent seroma formation. Hernia. 2013 Feb;17(1):129–31.
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6. Edwards C, Angstadt J, Whipple O, Grau R. Laparoscopic ventral hernia repair: postoperative antibiotics decrease incidence of seroma-related cellulitis. Am Surg. 2005 Nov;71(11):931–35;
7. Barton A, Blitz M, Callahan D, Yakimets W, Adams D, Dabbs K. Early removal of postmastectomy drains is not beneficial: results from a halted randomized controlled trial. AmJSurg. 2006 May;191(5):652–56.
8. Klink CD, Binnebosel M, Lucas AH, Schachtrupp A, Grommes J, Conze J, Klinge U, Neumann U, Junge K.Serum analyses for protein, albumin and IL-1-RA serve as reliable predictors for seroma formation after incisional hernia repair. Hernia. 2011 Feb;15(1):69–73.
9. Rosch R, Junge K, Schachtrupp A, Klinge U, Klosterhalfen B, Schumpelick V.Mesh implants in hernia repair. Inflammatory cell response in a rat model. EurSurgRes. 2003 May-Jun;35(3):161–66.
10. Anderson JM, Rodriguez A, Chang DT. Foreign body reaction to biomaterials. SeminImmunol. 2008 Apr;20(2):86–100.
11. Al-Gaithy ZK, Ayuob NN.Vascular and cellular events in post-mastectomy seroma: an immunohistochemical study. Cell Immunol. 2012;272(2):130–36.
12. Eser M, Gokceimam M, Eyvaz K, Tutal F, Gecer MO, Goktas S, Uzun H, Kaptanoglu L, Kurt N. Effect of local bleomycin sulfate application on seroma formation in a rat mastectomy and axillary lymph node dissection model. EurJPharmacol. 2014 Jan 15;723:375–80
13. Kocdor MA, KilicYildiz D, Kocdor H, Canda T, Yilmaz O, Oktay G, Harmancioglu O.Effects of locally applied 5-fluorouracil on the prevention of postmastectomyseromas in a rat model. EurSurgRes. 2008;40(3):256–62.

Address for correspondence:
443079, Rossiyskaya Federatsiya, g. Samara, ul. Gagarina, d. 20, Institut eksperimentalnoy meditsinyi i biotehnologiy (IEMB) GBOU VPO «Samarskiy gosudarstvennyiy meditsinskiy universitet»,
tel. office: 7 846 260-09-42,
e-mail: jvponomareva@mail.ru,
Ponomareva Juliya Vyacheslavovna

Information about the authors:
Belokonev V.I. MD, professor, Honored Doctor of Russia, a head of the surgical diseases chair №2 of SBEE HPE “Samara State Medical University”.
Ponomareva J.V. PhD, senior researcher of Institute of Experimental Medicine and Biotechnologies of SBEE HPE Samara State Medical University”.
Pushkin S.Y. MD, Deputy Chief on Surgery of SBME “Samara Regional Clinical Hospital named after M.I. Kalinin”.
Melentieva O.N. PhD, an associate professor of the surgical diseases chair №2 of SBEE HPE “Samara State Medical University”.
Gulyaev M.G. A post-graduate student of the surgical diseases chair №2 of SBEE HPE “Samara State Medical University”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.671   |  

S.A. YESKOV ¹, V.V. ZHARKOV ², Y.P. MARTYNOV¹, V.V. EROKHOV¹, О.A. YUDINA ³, R.V. KASHANSKI ³

EXPERIMENTAL JUSTIFICATION FOR A NEW METHOD OF LEFT ATRIUM RESECTION

ME “The 9^th City Clinical Hospital: ¹,
SE “Republican Scientific and Practical Center of Oncology and Medical Radiology named after N.N. Alexandrov” ²,
ME «City Clinical Pathologoanatomic Bureau” ³,
The Republic of Belarus

Objectives. To evaluate comparatively standard and original methods of the left atrium (LA) resection in pneumonectomy performed for the locally advanced lung cancer invading neighboring left atrium.
Methods. The study was performed in 32 adult cadavers. A comparison of LA wall areas excluded by vascular clamp in the application of traditional and developed ways of LA resection has been conducted.
Results. A new LA resection technique has been designed based on possibility of LA wall mobilization on the beating heart up to the mitral valve annulus by transection of fetal dorsal mesocardium remnant and dissection of the friable tissues between anterior wall of LA on the one side and pulmonary trunk and ascending aorta on the other. After the main stem bronchus and pulmonary artery transsection the vascular clamp should be applied to the approximated anterior and posterior walls of LA and located in transverse plane. One of the branches of the vascular clamp is placed along the vena cordis magna, the coronary sinus and the other is applied along the mobilization line limit of anterior wall. This technique has not accompanied by deformity of the orifice area of the opposite pulmonary veins. The worked out method permits to augment the exclusion area of the posterior wall of LA at the right sided pneumonectomy by 115,8% (on the average) and at the left sided - by 117,7% (on the average) in comparison with a standard method.
Conclusion. The developed technique of LA resection has the advantage of exclusion of a larger portion of the posterior LA wall compared to the conventional one that promotes security elevation and radicality of surgical intervention in cases of advanced lung carcinoma to the posterior wall of LA.
The designed method of the LA resection can be an alternative to its resection under conditions of the artificial blood circulation and thereby substantially reduce the cost of treatment.

Keywords: locally advanced lung cancer, left atrium, resection

p. 671-677 of the original issue

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10. Wiebe K, Baraki H, Macchiarini P, Haverich A. Extended pulmonary resections of advanced thoracic malignancies with support of cardiopulmonary bypass. Eur J Cardiothorac Surg. 2006 Apr;29(4):571–77.
11. Es'kov SA, Zharkov VV. Khirurgicheskaia tekhnika rezektsii levogo predserdiia pri rake legkogo [Surgical method of resection of the left atrium in lung cancer]. Onkol Zhurn. 2012;6(2):35–41.

Address for correspondence:
220116, Respublika Belarus,
g. Minsk, ul. Semashko, 8,
UO «9-ya gorodskaya klinicheskaya bolnitsa»,
torakalnoe otdelenie,
tel. office: 375 17 376-81-28,
e-mail: 445e@mail.ru,
Yeskov Sergey Aleksandrovich

Information about the authors:
Yeskov S.A. A head of the thoracic department of ME “The 9^th City Clinical Hospital”.
Zharkov V.V. MD, professor, a chief researcher of the thoracic oncopathology department with anesthesia group of SE “Republican Scientific and Practical Center of Oncology and Medical Radiology named after N.N.Alexandrov”.
Martynov Y.P. An intern of ME “The 9^th City Clinical Hospital”.
Erokhov V.V. A surgeon of ME “The 9^th City Clinical Hospital”.
Yudina O.A. PhD, an associate professor, a head of the general pathology department of ME “City Clinical Pathologoanatomic Bureau”.
Kashanski R.V. A pathologist of the general pathology department of ME “City Clinical Pathologoanatomic Bureau”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.678   |  

О.N. SADRIEV¹, А.D. GAIBOV^1,2

SIMULTANEOUS OPERATIONS IN SURGICAL ADRENAL DISEASES

Tajic State Medical University named after AbuAli Ibn Sino ¹,
Republican Scientific Center of Cardiovascular Surgery ²,
Dushanbe,
The Republic of Tajikistan

Objectives. To study the influence of simultaneously performed abdominal and retroperitoneal operations on the quality, duration and severity of adrenalectomy.
Methods. The results of diagnosis and treatment of 7 patients with the adrenal glands tumors have been analyzed; the patients had a variety of related surgical diseases requiring surgical treatment. Nine patients with adrenal tumors underwent only adrenalectomy were taken as the control group. Topical diagnosis of adrenal tumors and related pathologies was made using ultrasonography and computed tomography letting to establish accurate diagnosis.
Results. Arterial hypertension was considered to be the main clinical symptom of all forms of adrenal tumors. All patients had a statistically significant increase (p <0,05) levels of the blood hormones and their metabolites in the urine. Character and volume of the preoperative antihypertensive therapy depended on the severity of hypertension and related cardiovascular and surgical pathologies.
The wide open surgical approaches, such as lumbar-laparotomy or thoraco-phrenico-lumbar-laparotomy have been used in all cases. Despite the volume and severity of simultaneous operations in patients of the main group, postoperative complications and length of hospitalization were less than in the control group. Within five-year observation there were no any data for recurrence and mortality in these patients.
Conclusion. To patients with adrenal tumors and surgical comorbidity of other organs it is advisable to carry out the simultaneous surgical correction, as it does not lead to a significant increase of the number of complications and mortality. When planning simultaneous operations in patients with adrenal gland tumor it is important to determine the level of anesthetic risk and choose the surgical access. Such operations should be performed in clinical centers with modern equipment by skilled surgeons possessing by sufficient practice in treating patients with adrenal diseases.

Keywords: adrenal tumors, pheochromocytoma, adrenalectomy, simultaneous operations

p. 678-686 of the original issue

References

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2. Bogdanov IuV, Tkachuk EH, Bogdanov DIu, Tsoi AC. Opyt vypolneniia simul'tannykh operatsii [Experience performing of simultaneous operations]. Endoskop Khirurgiia. 2000;(2):10–14.
3. Sand M, Uecker S, Bechara F G, Gelos M, Sand D, Wiese T H, Mann B. Simultaneous ectopic adrenocorticotropic hormone syndrome and adrenal metastasis of a medullary thyroid carcinoma causing paraneoplastic Cushing's syndrome. International Seminars in Surgical Oncology. 2007;(4):15.
4. Nikonenko AS, Zavgorodnii SN, Podluzhnyi AA, Vil'khovoi SO, Gaidarzhi EI Opyt primeneniia simul'tannykh operatsii u bol'nykh s opukholiami nadpochechnikov [Experience of simultaneous operations performance in patients with adrenal tumors]. Zaporozh Meditsin Zhurnal. 2010;12(1):17–18.
5. Counselman FL, Brenner CJ, Brenner DW. Adrenal pheochromocytoma presenting with persistent abdominal and flank pain. J Emerg Med. 1991 Jul-Aug;9(4):241–46.
6. Fedorov AV, Kriger AG, Kolygin AV, Kochatkov AV. Odnomomentnye operatsii. Terminologiia (obzor literatury i sobstvennoe predlozhenie) [Simultaneous operations. Terminology (a review of literature and own proposal)]. Khirurgiia. Zhurnal im NI Pirogova. 2011;(7):72–76.
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10. Latypov VR, Popov OS, Vusik AN, Latypova VN, Geidarov R Ia.Osobennosti i rezul'taty khirurgicheskogo lecheniia patsientov s opukholiami nadpochechnikov [Features and results of surgical treatment of patients with tumors of the adrenal glands]. Sibir Onkolog Zhurnal. 2010;1(37):56–60.
11. Pelosi MA, Pelosi MA 3rd.Simultaneous laparoscopic surgical treatments. Surg Laparosc Endosc. 1998 Feb;8(1):81–82.
12. Kim HJ, Choi GS, Park JS, Park SY, Jun SH. Simultaneous laparoscopic multi-organ resection combined with colorectal cancer: comparison with non-combined surgery. World J Gastroenterol. 2012 Feb 28;18(8):806–13
13. Sarela AI, Murphy I, Coit DG, Conlon KC.Metastasis to the adrenal gland: the emerging role of laparoscopic surgery. Ann Surg Oncol. 2003 Dec;10(10):1191–96.
14. Fanmin M, Nianzeng X, XU Yingmin, Jingdong Z, Shengynan X, Qiangyuan QI Study on retroperitoneal laparoscopic simultaneous operation in the treatment of bilateral kidney and adrenal lesions. J Clin Urology (China) 2014; 29(4):330–33.

Address for correspondence:
734003, Respublika Tadzhikistan,
g. Dushanbe, prospekt Rudaki, d. 139.
Tadzhikskiy gosudarstvennyiy meditsinskiy universitet
imeni Abuali ibni Sino, kafedra khirurgicheskih bolezney №2,
tel.: 992 915 25 00 55
e-mail: sadriev_o_n@mail.ru
Sadriev Okildzhon Nemadzhonovich

Information about the authors:
Sadriev O.N. A postgraduate student of the surgical diseases chair №2 of Tajic State Medical University named after AbuAli Ibn Sino.
Gaibov A.D. Corresponding Member of Academy of Medical Sciences of the Ministry of Health and Social Protection of the Republic of Tajikistan, MD, professor of the surgical diseases chair №2 of Tajic State Medical University named after AbuAli Ibn Sino, curator of the vascular surgery department of Republican Scientific Center of Cardiovascular Surgery.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.687   |  

I.V. HAPONOV

PECULIARITIES OF DIAGNOSIS AND TREATMENT OF COLONIC ACUTE DIVERTICULITIS

SE “Dnepropetrovsk Medical Academy of the Ministry of Health of the Ukraine”
The Ukraine

Objectives. To study peculiarities of diagnosis and treatment outcomes of the colonic acute diverticulitis (AD) using contemporary methods.
Methods. Fifty-eight patients with colonic acute diverticulitis have been observed. Clinical manifestations of the disease, diagnosis and treatment peculiarities have been studied. On the 1^st and 4^th days after hospitalization content of faecal calprotectin (FC), cytokines (tumor necrosis factor (TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10)) have been determined in the blood serum using the method of quantitative immune enzyme test-system for analysis in accordance with the author’s instruction. To control the intoxication, the cell tests of reactivity and intoxication (CTRI) have been determined: leukocytic index according to Kalf-Kalif, Ostrovsky, Fischenko and Khymich, index of leukocyte correlation of Osin, nuclear index of intoxication of Dashtayants. The results of treatment have been analyzed.
Results. During the acute period of the disease the non-invasive methods of diagnosis (US, CT), X-ray and endoscopic methods were considered to be preferable after reduction of acute symptoms. Content of FC, TNF-α, IL-6, IL-10 and ratio TNF-α/IL-10 statistically reliable different from analogue indices of the control group and tended to normalization during the second examination, correlated with CTRI. Conservative treatment was effective in 81% of patients; operative interventions have been used in 11 cases. 5 resections of the sigmoid colon and 4 left-sided hemicolectomies with the application of anastomoses have been carried out; in 2 cases transverse colostomy has been applied after laparotomy.
Conclusion. The diagnosis of acute diverticulitis can usually be made on the basis of the study of clinical symptoms and results of non-invasive (ultrasound, X-ray, biochemical, laboratory) methods of research. At the same time indices of faecal calprotectin, pro- and anti-inflammatory cytokines of the blood significantly vary as well as their ratio, which is thought to be a marker of the disease. In 19% of cases acute diverticulitis requires the operative treatment with preference to carry out resection of the affected parts of colon with the application of anastomoses.

Keywords: colon inflammation, diverticula, clinical trials, treatment

p. 687-692 of the original issue

References

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Address for correspondence:
49044, Ukraina, g. Dnepropetrovsk,
GU «Dnepropetrovskaia meditsinskaia
akademiia MZ Ukrainy»,
kafedra obshchei khirurgii,
tel.mob.: +38050561-55-87, +380503614427,
e-mail: v_gaponov@ukr.net,
Gaponov Ivan Vladimirovich

Information about the authors:
Haponov I.V. A day-time postgraduate student of the general surgery chair of SE “Dnepropetrovsk Medical Academy of the Ministry of Health of the Ukraine”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.693   |  

G.A. SMIRNOV, V.V. PETROVA, T. GVAZAVA, A.V. REMEZOV, V.P. AKIMOV

THE ROLE OF THE VENOUS SYSTEM LESION IN PATHOGENESIS OF DIABETIC FOOT SYNDROME

SBEE HPE “North-West State Medical University named after I.I. Mechnikov”, Saint-Petersburg,
The Russian Federation

Objectives. To study the feature changes of the lower limbs veins in the diabetic foot syndrome.
Methods. The results of the macro- and microscopic investigations of the lower limb veins have been analyzed. The preparations obtained after the lower limb amputation or at the autopsy of 70 patients have been studied. The preparations were subdivided into 3 groups: 30 preparations were of the patients with the pyo-necrotic complications of diabetic foot syndrome (DFS), 20 preparations – of chronic venous diseases patients (CVD), 20 – without any lower limb venous pathology. Macroscopic research with venous state estimation has been carried out. Microscopic investigation on micropreparations obtained from macropreparations has been conducted. Immunohistochemical study with the assessment of collagen type IV deposition in the venous wall has been performed.
Results. The results in macroscopic research of the preparations of the lower limb vein have shown the reliable difference between samples of different groups by a number of parameters, such as paravasal tissue edema, vein wall thickness, presence of areas of veins expansion diameter, paravasal fibrosis and phlebotrombosis. Microscopic research has demonstrated high frequency of intramural and paravasal fibrosis, musculas layer disorganization, endothelial mis-proliferation and phlebotrombosis in the lower limb veins of patients with DFS. There was no incidence of chronic vein wall inflammation and venous valve destruction. During immunohistochemical studies in 19 out of 20 cases the collagen type IV hyperproduction in the subendothelial space has been found out in the lower limb venous preparations in case of DFS.
Conclusion. Changes of the venous system in diabetic foot syndrome differ from those in chronic venous insufficiency and manifest by primary lesions of deep veins, marked fibrosis, tendency towards phlebothrombosis without valve affection as well as chronic inflammations of the venous wall.

Keywords: diabetes mellitus, diabetic foot syndrome, chronic venous disease, venous insufficiency

p. 693-700 of the original issue

References

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16. Balabolkin MI. Endokrinologiia [Endocrinology]. Moscow. SSSR. Universum Pablishing. 1998, 599 p.

Address for correspondence:
191015, Rossiyskaya Federatsiya,
g. Sankt-Peterburg, ul. Kirochnaya,
d. 41, GBOU VPO «Severo-Zapadnyiy
gosudarstvennyiy meditsinskiy universitet
im. I.I.Mechnikova»,
kafedra khirurgii im. N.D. Monastyirskogo,
tel. mob. 7-911-919-01-82,
e-mail: akimov.spbmapo@ mail.ru,
Akimov Vladimir Pavlovich

Information about the authors:
Smirnov G.A. A post-graduate student of the surgery chair named after N.D.Monastyrsky of SBEE HPE “North-West State Medical University named after I.I. Mechnikov”.
Petrova V.V. PhD, associate professor of the surgery chair named after N.D.Monastyrsky of SBEE HPE “North-West State Medical University named after I.I. Mechnikov”.
Gvazava T. A post-graduate student of the surgery chair named after N.D.Monastyrsky of SBEE HPE “North-West State Medical University named after I.I. Mechnikov”.
Remezov A.V. A post-graduate student of the surgery chair named after N.D.Monastyrsky of SBEE HPE “North-West State Medical University named after I.I. Mechnikov”.
Akimov V.P. MD, professor, a head of the surgery chair named after N.D.Monastyrsky of SBEE HPE “North-West State Medical University named after I.I. Mechnikov”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.701   |  

S.E. KATORKIN, A.A. ZHUKOV, M.J. KUSHNARCHUK

COMBINED TREATMENT OF VASOTROPHIC ULCERS IN LOWER LIMBS CHRONIC VENOUS INSUFFICIENCY

SBEE HPE “Samara State Medical University”,
The Russian Federation

Objectives. To optimize approaches to treatment of the C6 class patients by combined application of surgical correction methods, autodermoplasty and combined impact of a low-intensity laser radiation and fine dispersion drug irrigation of the trophic ulcers.
Methods. The examination and treatment of 160 patients of C6 class were carried out. In 102 (63,7%) patients in the group I a combined impact of laser radiation and fine dispersion drug irrigation were applied. In the II group (n=58) patients were treated with standard methods.
Seventy (68,6%) patients of the 1^st and thirty-four (58,6%) of the 2^nd group were operated on. Phlebectomy was conducted together with the operations of Cokkett – 25 (24,5%), Linton – 20 (19,6%), SEPS – 32 (31,4%), SEPS and fasciotomy – 17 (16,7%), autodermoplasty – 94 (58,7%). Assessment of long-term results of combined treatment has been carried out (3 months – 3 years).
Results. In the 1^st group on the 5^th day a decrease of microbial contamination levels from 10⁷–10⁸ to 10⁴–10⁵ (р<0,05) was registered, and on the 20^th day – its absence was established. Dynamic parameters of epithelialization prevailed in the 1^st group more than in 2-folds (p<0,05). Clearing of the surface, appearance of granulation and epithelialization beginning made up 4,2±1,1 and 9,6±1,3, 5,9±0,8 and 13,1±2,1, 8,9±1,2 and 23,3±1,6 days, respectively. The complete epithelialization in patients of the 1^st and 2^nd groups was 29,1±0,7 and 46,2±0,8 days (p<0,05). 12 months after the conservative treatment, trophic ulcer recurrence in the 1^st group made 34,8%, and in the 2^nd group – in 66,7%. Preoperative preparation in the 1^st group reduced the preoperative period by 2,8 folds. Full engraftment of the autodermotransplant in the 1^st group was achieved in 75% of cases, in the 2^nd – in 32,3%.
Conclusion. The method of local application of the combined low intensity laser radiation and fine dispersion drug irrigation is on is desired to be a pathogenetically substantiated non-invasive method of conservative treatment and preoperative preparation of the trophic ulcers in the C6 class patients.

Keywords: venous trophic ulcer, chronic venous insufficiency, surgical treatment, autodermoplasty

p. 701-709 of the original issue

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Address for correspondence:
443079, Rossiyskaya Federatsiya,
g. Samara, pr. Karla Marksa, d. 165 «b»,
Kliniki Samarskogo gosudarstvennogo
meditsinskogo universiteta,
kafedra i klinika gospitalnoy khirurgii.
tel. office 8 107 846 276-77-89,
e-mail: katorkinse@mail.ru,
Katorkin Sergey Evgenevich

Information about the authors:
Katorkin S.E. PhD, an associate professor of the chair and clinic of hospital surgery of SBEE HPE “Samara State Medical University”.
Zhukov A.A. A day-time postgraduate student of the chair and clinic of hospital surgery of SBEE HPE “Samara State Medical University”.
Kushnarchuk M.J. A clinical resident of the chair and clinic of hospital surgery of SBEE HPE “Samara State Medical University”.

Article in the .pdf format

UROLOGY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.710   |  

F.P. KAPSARGIN, E.V. DYABKIN, A.I. KORMILKIN, E.A. ALEXEEVA

A COMPARATIVE ASSESSMENT OF SURGICAL TREATMENT OF KIDNEY STONES

SBEE HPE “Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky,
The Russian Federation

Objectives. To evaluate the clinical efficacy of various surgical treatment methods of nephrolithiasis.
Methods. The results of 267 nephrolithotomies within the period from 2007 to 2011 have been analyzed. The age of patients ranged from 21 to 75 years (48,2±3,5 years). For the purpose of representativeness 50% women and 50% men were included in the study.
All the patients depending on the method of surgical intervention were divided into 4 groups: 1) the traditional open surgery: pyelolithotomy or nephrolithotomy (63 patients), 2) percutaneous nephrolithoextraction – 83 patients, 3) extracorporeal shockwave lithotripsy (ESWL) (104 patients), and 4) combined minimally invasive interventions – 17 patients.
Results. It has been established the post-operative recovery period is usually much shorter by implementing minimally invasive intervention. Time of the retroperitoneal drainage in open surgeries made up 7,7±0,6 days, and in minilumbotomy – 6,2±0,34. After minimally invasive operations the reduction of leukocytes has been registered, whereas in patients after open nephrolithotomy an elevation of this indicator appeared to be on the third day. Duration of endoscopic intervention for kidney stones varied between 25 and 65 minutes (average 38,7±1,8 min). Blood loss was minimal (150,8±37,6) ml after percutaneous interventions and open surgery characterized by a significantly larger volume of blood loss (211,1±17,5 ml). Combined nephrolithotomy is indicated for large (more than 1,5-2,0 cm) and dense (1000 units HU or more) stones in intrarenal located pelvis.
Conclusion. As a result of our study it has been revealed that the use of a minimally invasive approach to treating and removing renal stones helps to reduce the average time of disability up 20 days. The percutaneous approach is commonly used in the case of certain contraindications to ESWL. The application of the proposed methods allows reducing recovery time.

Keywords: kidney stones, urolithiasis, lithotripsy, nephrolithotomy, surgical treatment

p. 710-714 of the original issue

References

1. Apolikhin OI, Kakorina EP, Sivkov AV, Beshliev DA, Solntseva TV, Komarova VA. Sostoianie urologicheskoi zabolevaemosti v Rossiiskoi Federatsii po dannym ofitsial'noi statistiki [The state of urologic diseases in the Russian Federation according to official statistics]. Urologiia. 2008;(3):3–9.
2. Kadyrov ZA, Istratov VG, Suleimanov SI. Nekotorye voprosy etiologii i patogeneza mochekamennoi bolezni [Some aspects of the etiology and pathogenesis of urolithiasis]. Urologiia. 2006;(5):98–101.
3. Popov SV, Novikov AI, Gorgotskii IA. Mesto transuretral'noi kontaktnoi nefrolitotripsii v lechenii bol'nykh s kamniami pochek [The role of transurethral contact nephrolithotripsy in the treatment of patients with kidney stones]. Urologiia. 2012;(5):81–85.
4. Turk С, Knoll Т, Petrik A, Sarica K, Skolarikos A, Straub M, Seitz С. Guidelines on urolithiasis. Eur Assoc Urol. 2014. 98 p.
5. Dasaeva LA, Shatokhina SI, Shilov EM. Diagnostika, medikamentoznoe lechenie i profilaktika mochekamennoi bolezni [Diagnosis, medical treatment and prevention of urolithiasis]. Klin Meditsina. 2004;(1):21–26
6. Kapsargin FP, Diabkin EV, Berezhnoi AG. Sovremennye podkhody khirurgicheskogo lecheniia mochekamennoi bolezni [Modern approaches of surgical treatment of urolithiasis]. Novosti Khirurgii. 2013;5(21):101–106.
7. Neimark AI, Nugumanov PM. Odnomomentnyi dopolnitel'nyi perkutannyi nefroskopicheskii dostup v lechenii korallovidnogo nefrolitiaza [A A momentary additional percutaneous nephroscopic access in treatment of staghorn nephrolithiasis]. Kazansk Med Zhurn. 2009;90(1):125–27.
8. Lopatkin NA /red. Natsional'noe rukovodstvo po urologii [National guidance in urology]. Moscow, RF: GEOTAR-Media, 2009. 1021 p.
9. Polienko AK, Sevost'ianova OA, Moseev VA. Vliianie nekotorykh prichin na rasprostranenie mochekamennoi bolezni [Influence of some reasons for the spread of urolithiasis].Urologiia. 2006;(1):74–78.
10. Desai MR, Jasani A.Percutaneous nephrolithotripsy in ectopic kidneys. J Endourol. 2000 Apr;14(3):289–92.

Address for correspondence:
660022, Rossiyskaya Federatsiya,
g. Krasnoyarsk, ul. Partizana Zheleznyaka,
d. 1, GBOU VPO «Krasnoyarskiy gosudarstvennyiy meditsinskiy
universitet imeni professora V.F. Voyno-Yasenetskogo»,
kafedra obschey khirurgii,
tel. office: 7 (391) 208-99-26,
e-mail: dyabkyn@mail.ru,
Dyabkin Evgeniy Vladimirovich

Information about the authors:
Kapsargin F.P. MD, a head of the urology, andrology and sexology chair of SBEE HPE “Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky”.
Dyabkin E.V. PhD, an assistant of the general surgery chair of SBEE HPE “Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky”.
Kormilkin A.I. An applicant for Candidate’s degree of the urology, andrology and sexology chair of SBEE HPE “Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky”.
Alexeeva E.A. PhD, associate professor of the urology, andrology and sexology chair of SBEE HPE “Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky”.

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ANESTHESIOLOGY-REANIMATOLOGY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.715   |  

A.V. BRUKHNOU, V.G. PIACHERSKI, A.V. MARACHKOU, Z.V. KOKHAN

REGIONAL INTERSCALENE BRACHIAL PLEXUS BLOCK ACCESS USING MINIMAL DOSES OF LOCAL ANESTHETIC

HI "Mogilev Regional Hospital"
The Republic of Belarus

Objectives. To work out an effective method of the ultrasound-assisted regional interscalene brachial plexus block access using minimal doses of local anesthetic.
Methods. Two groups of patients were formed. In group A 40 brachial plexus blocks using interscalene access with minimal doses of local anesthetic have been performed at the level of the ventral roots of spinal nerves C5, C6, C7, C8, Th1. Local anesthetic (ropivacaine 0,75%) was injected per one milliliter to each of five roots, the total volume of local anesthetic injected – 5 ml. In the control group B (27 cases) the block was done using interscalene access at the level of the brachial plexus trunks with 30 ml of 0,75% ropivacaine. In group A when the area of surgical intervention extended to the area of innervation by the branches of superficial cervical plexus (the operations on the clavicle), additionally, the block of the superficial cervical plexus branches has been performed. In group B the additional block of the superficial cervical plexus branches during surgical procedures on the clavicle was not required.
Results. According to the results of the blocks in all 67 patients the motor block was evaluated as «+» and «++»; the sensory block was evaluated in the areas of the intended surgery and, in all cases the patients reported the inability to differentiate the thermal stimulus and did not feel the needle injection. Anesthesia in both groups was found to be effective for a planned surgery; the transition to another type of anesthesia was not required.
Conclusion. The presented method for the selective block of the brachial plexus at the level of the ventral spinal nerve roots C5, C6, C7, C8, Th1 using minimal dose of local anesthetic (5 ml of 0,75% ropivacaine) is considered to be adequate to in terms of anesthesia to the brachial plexus block (30 ml of 0,75% ropivacaine) at the trunk level. Herewith the probability of systemic toxicity development of local anesthetic effect has reduced; this also applies to reduce financial costs of regional blockades.

Keywords: brachial plexus block, minimal volume, complications, ropivacaine

p. 715-720 of the original issue

References

1. Brukhnov AV, Pecherskii VG, Marochkov AV, Kokhan ZV, Bordilovskii AN. perednii chrezsestnichnyi dostup k plechevomu spleteniiu pri vypolnenii regionarnoi blokady [The anterior interscalene brachial plexus block access in the performance of regional blockade]. Novosti Khirurgii. 2014;22(2):218–23 .
2. Kuchin IuL. Blokada plechevogo spleteniia mezhlestnichnym dostupom u patsientov s perelomami kliuchitsy: randomizirovannoe sravnenie tekhnik s ul'trazvukovym kontrolem i neirostimuliatorom [Interscalene brachial plexus block access for patients with fractures of the clavicle: a randomized comparison of ultrasound techniques and neurostimulator]. Novosti Khirurgii. 2013; 21(6):105–108.
3. Williams SR, Chouinard P, Arcand G, Harris P, Ruel M, Boudreault D, Girard F.Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesth Analg. 2003 Nov;97(5):1518–23.
4. Maier G, Biuttner I. Kamchatnov PR, red./ Perifericheskaia regionarnaia anesteziia atlas: [Peripheral regional anesthesia: atlas]. Moscow, RF: BINOM. Laboratoriia Znanii. 2010. 260 p.
5. Malroi M. Emel'ianova SI. Red/. Mestnaia anesteziia [Local anesthesia]. Moscow, RF: Binom. Laboratoriia Znanii, 2003. 301 p.
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7. Kokhan ZV, Marochkov AV, Brukhnov AV, Pecherskii VG. O vozmozhnosti identifikatsii pravil'nogo polozheniia in"ektsionnoi igly pri blokade sedalishchnogo nerva [On the possibility of identifying of correct position of the injection needle in the blockade of sciatic nerve]. Novosti Khirurgii. 2013;21(5):80–85.
8. Riazi S, Carmichael N, Awad I, Holtby RM, McCartney CJ.Effect of local anaesthetic volume (20 vs 5 ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. Br J Anaesth. 2008 Oct;101(4):549–56.
9. Gautier P, Vandepitte C, Ramquet C, DeCoopman M, Xu D, Hadzic A. The Minimum Effective Anesthetic Volume of 0.75% Ropivacaine in Ultrasound-Guided Interscalene Brachial Plexus Block. Anesthesia & Analgesia. October 2011;113 (4):951–55.
10. Duggan E, El Beheiry H, Perlas A, Lupu M, Nuica A, Chan VW, Brull R.Minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2009 May-Jun;34(3):215–18.
11. Sinel'nikov RD. Atlas anatomii cheloveka. Tom 3. Uchenie o nervnoi sisteme, organakh chuvstv i organakh vnutrennei sekretsii [The doctrine of the nervous system, sensory organs and organs of internal secretion]. Moscow, SSSR: Izdatel'stvo Meditsina, 1974. 399 p.
12. Nizar Moayeri, Paul E Bigeleisen, Gerbrand J Groen. Quantitative architecture of the brachial plexus and surrounding compartments, and their possible significance for plexus blocks. Anesthesiology. 2008;108(2):299–304.
13. Kovanov VV. Operativnaia khirurgiia i topograficheskaia anatomiia [Operative surgery and topographic anatomy]. Moscow, SSSR: Izdatel'stvo Meditsina, 1977. 410 p.
14. Moayeri N, Bigeleisen PE , Groen GJ . Quantitative architecture of the brachial plexus and surrounding compartments, and their possible significance for plexus blocks. Anesthesiology. 2008;108(2):299–304.
15. Cuvillon P, Nouvellon E, Ripart J, Boyer JC, Dehour L, Mahamat A, L'hermite J, Boisson C, Vialles N, Lefrant JY, de La Coussaye JE. A comparison of the pharmacodynamics and pharmacokinetics of bupivacaine, ropivacaine (with epinephrine) and their equal volume mixtures with lidocaine used for femoral and sciatic nerve blocks: a double-blind randomized study. Anesth Analg. 2009 Feb;108(2):641–49.

Address for correspondence:
212026, Respublika Belarus',
g. Mogilev, ul. B.-Biruli, d. 12,
UZ «Mogilevskaia oblastnaia bol'nitsa»,
otdelenie anesteziologii i reanimatsii,
tel. mob.: +375 29 630-75-48,
e-mail: andreibruhnov@gmail.com,
Brukhnov Andrei Viktorovich

Information about the authors:
Bruhnov AV. An anesthesiologist of department of anesthesiology and Intensive care of “Mogilev Regional Hospital”.
Pechersky VG. An anesthesiologist of department of anesthesiology and intensive care of “Mogilev Regional Hospital”.
Marochkov AV. MD, professor, a head of the department of anesthesiology and intensive care "Mogilev Regional Hospital."
Kohan ZV. An anesthesiologist of department of anesthesiology and Intensive care of “Mogilev Regional Hospital”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.721   |  

N.L. GOMON ¹, I.P. SHLAPAK ²

MULTIMODAL COMBINED ANASTHESIA / ANALGESIA IN COMPLEX TREATMENT OF SURGICAL PATIENTS WITH ABDOMINAL PROFILE

Vinnitsa National Medical University named after N.I. Pirogov¹
National Medical Academy of Postgraduate Education named after P.P. Shupyk, Kiev ²
Ukraine

Objectives. To achieve a minimal impact on hemodynamics of multimodal anesthesia in combination with epidural analgesia with low concentration of bupivacaine as a technique of antinociceptive mechanism during surgery and in the postoperative period by using the hemodynamic index in surgical patients with abdominal profile.
Methods. Depending on the use of anesthesia and postoperative analgesia 45 patients with the operations on the abdominal organs (3-4 degree of risk according to ASA) were divided into two groups. In the first group a balanced general anesthesia with endotraheal mechanical ventilation of the lungs was used; in the second group – a prolonged epidural analgesia with bupivacaine (0,1-0,25%) additionally applied.
Results. It was found out that the use of antinociceptive mechanism due to additional application of low concentrations of bupivacaine (0,1% or 0,25%) for the epidural analgesia based on the dynamics of the integral hemodynamic indicator is accompanied by a stable hemodynamics without hypotension and periods of increase of the average arterial pressure as well as by stable indices of the heart rate, low intensity of postoperative pain syndrome, earlier terms of the intestinal motility restoring in comparison with the general multicomponent anesthesia and a pharmacological postoperative analgesia. The use of traditional pharmacological techniques is accompanied by the periods of the arterial pressure increase, expense of large quantities of drugs for anesthesia, analgesia and symptomatic support, longer terms of the intestinal passage restoring that increases the risk of postoperative early and delayed complications.
Conclusion. The conducted study gives an opprtunity to recommend the use of the multimodal anesthesia combined with the epidural analgesia with low concentration of bupivacaine for perioperative providing of surgical patients of the abdominal profile.

Keywords: multimodal anesthesia, epidural analgesia, abdominal surgery

p. 721-726 of the original issue

References

1. Potapov AL, Kobeliatskii IuIu. Obezbolivanie posle ob"emnykh otkrytykh abdominal'nykh operatsii - opiaty ili epidural'naia analgeziia [Analgesia after open voluminous abdominal surgery - opioids or epidural analgesia]? Bіl', Zneboliuvannia і Іntensivna Terapіia. 2011;(4):39–42.
2. Stakanov AV, Potseluev EA, Musaeva TS. Prognozirovanie riska razvitiia sindroma intraabdominal'noi gipertenzii u patsientov s ostroi tolstokishechnoi neprokhodimost'iu v usloviiakh epidural'noi anal'gezii [Predicting of the risk of intra-abdominal hypertension syndrome in patients with acute colonic obstruction under epidural analgesia]. Anesteziologiia i Reanimatologiia, 2013;(5):42–46.
3. Pilkington KB, Wagstaff MJ, Greenwood JE. Prevention of gastrointestinal bleeding due to stress ulceration: a review of current literature. 2012 Mar;40(2):253–59.
4. Dibrova IuA, Shchitov OV, Larchenko TF, Pol'ovik IF. Khirurpchna taktika pri vtorinnikh virazkakh shlunka [Surgical tactics in secondary ulcers of the stomach]. Klinichna Khirurgiia. 2012 kviten';4(829):13–14.
5. Naghibi K, Saryazdi H, Kashefi P, Rohani F.The comparison of spinal anesthesia with general anesthesia on the postoperative pain scores and analgesic requirements after elective lower abdominal surgery: A randomized, double-blinded study. J Res Med Sci. 2013 Jul;18(7):543–48.
6. Soliarik SO, Glumcher FS, Kuchin IuL. Vpliv kontrol'ovanoi patsiuntom epshchural'noi anal'gezp nazapal'nu reaktsiiu v pisliaoperats1inii periud [Effect of control epidural analgesia on inflammatory reaction in postoperation period]. Bil', Zneboliuvannia i Intensivna Terapiia. 2012;(2):76–79.
7. Shlapak IP, Nedashkivskii SM, Sidorenko AL. Opyt ispol'zovaniia gidroksietilkrokhmalu vtoroi generatsii v kompleksnoi terapii vo vremia operativnykh vmeshatel'stv v briushnoi polosti s ispol'zovaniem neiroaksial'noi anestezii [Experience of hydroxyethyl starch application of second generation in combined therapy during abdominal surgery with neuraxial anesthesia]. Meditsina Neotlozhnykh Sostoianii 2013;2(49):30–34.
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9. Kunovs'kii VV, Kvіt AD. Bol'ovii sindrom ta shliakhi iogo nіveliuvannia u kompleksnomu khіrurgіchnomu lіkuvannі khvorikh z nevіdkladnoiu abdomіnal'noiu patologієiu [Pain and ways of relieving in complex surgical treatment of patients with emergency abdominal pathology]. Meditsina Neotlozhnykh Sostoianii. 2013;(7):106–10.
10. Schricker T, Lattermann R. Strategies to attenuate the catabolic response to surgery and improve perioperative outcomes. Can J Anaesth. 2007 Jun;54(6):414–19. [Article in English, French]
11. Vinnik IuL, Oleksenko VV. Puti umen'sheniia chastoty vozniknoveniia i tiazhesti alimentarno-enterogennogo vegetativnogo sindroma poste gastrektomii [Ways of reduction of the frequency of occurrence and severity alimentary and enterogenous autonomic syndrome after gastroectomy]. Klinichna Khirurgiia. 2013;(1):69–63.
12. Zabolotskikh IB, Trembach NV. Vliianie anestezii na chastotu razvitiia deliriia posle obshirnykh abdominal'nykh operatsii u pozhilykh bol'nykh [Influence of anesthesia on the incidence of delirium after major abdominal surgery in elderly patients] Anesteziologiia i Reanimatologiia. 2013;(6):4–7.
13. Rawal N. Epidural technique for postoperative pain: gold standard no more? Reg Anesth Pain Med. 2012 May-Jun;37(3):310–17.
14. Kaur J, Bajwa SJ.Comparison of epidural butorphanol and fentanyl as adjuvants in the lower abdominal surgery: A randomized clinical study. Saudi J Anaesth. 2014 Apr;8(2):167–71.
15. Wuethrich PY1, Henning A, Schweizerhof M, Kessler TM, Burkhard FC. Postvoid residuals remain unchanged in patients with postoperative thoracic epidural analgesia after thoracotomy. Reg Anesth Pain Med. 2011 Jan-Feb;36(1):46–50.

Address for correspondence:
21018, Ukraina, g. Vinnitsa, ul Pirogova, d. 56,
Vinnitskiy natsionalnyiy meditsinskiy universitet
im.N.I.Pirogova, kurs
anesteziologii-reanimatologii
kafedryi khirurgii №1,
tel. 380 677 24-31-07,
e-mail: mgomon@meta.ua,
Gomon Nikolay Longinovich

Information about the authors:
Gomon N.L. PhD, an associate professor, a head of the course of anesthesiology- reanimatology of the surgery chair №1, Vinnitsa National Medical University named after N.I. Pirogov.
Shlapak I.P. MD, professor, a head of the anesthesiology chair, National Medical Academy of Postgraduate Education named after P.P. Shupyk.

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OTORHINOLARYNGOLOGY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.727   |  

A.L. MALETS ¹, S.N. RJABCEVA², J.G. ROMANOVA¹, V.P. SHORATS¹

CYCLOOXYGENASE-2 ROLE IN PATHOGENESIS OF THE LARYNGEAL PAPILLOMATOSIS IN ADULTS

EE "Belarusian Medical Academy of Post-Graduate Education"¹,
EE “Belarusian State Medical University” ²,
The Republic of Belarus

Objectives. On the basis of the immunohistochemical analysis to study the expression of cyclooxygenase-2 (COX-2) marker depending on the degree of dysplasia in the laryngeal papilloma tissue in adults.
Methods. The papilloma tissue fragments (62) obtained during the surgical treatment of the larynx with the tumor removal in adult patients with respiratory papillomatosis have been served as a research material. The evaluation of the dysplasia degree in the papilloma tissue was performed. The immunohistochemical assessment of expression of COX-2 monoclonal antibody in cells of the laryngeal papillomas has been conducted.
Results. The first studied group consisted of patients with laryngeal papilloma without epithelial dysplasia (7/11,3%), the second – with dysplasia of the first (mild) degree (12/19,4%), the third – with a second-degree dysplasia (moderate) (28/45,2%), the fourth – with severe dysplasia (9/14,5%), the fifth – with laryngeal cancer against a background of papillomatosis (6/9,7%). The reliable difference of the studied groups according to the weak expression intensity in the epithelial cells of laryngeal papillomas with the inverse correlation interrelation has been established. The moderate growth of expression COX-2 in the cells with dysplasia was revealed in comparison with papillomas without dysplasia. The highest figure of intensity of moderate expression and substantially equal value found in the groups of the first and second degree of epithelial dysplasia papillomas have been recorded. Reliable difference between the studied groups in severe expression intensity in cells of the laryngeal papillomas with the direct correlations has been established. The laryngeal cancer cells had the highest intensity value of severe COX-2 expression.
Conclusion. In the cells of laryngeal papillomas in adults the increase of the intensity of immunohistochemical COX-2 markers with increasing degree of dysplasia testifing the activity of this enzyme has been observed. COX-2 is considered to be an important factor in the pathogenesis of laryngeal papillomatosis in adults, and it plays one of the key roles in malignant transformation and progression of neoplasms.

Keywords: papilloma, larynx, cyclooxygenase-2, dysplasia

p. 727-734 of the original issue

References

1. Blumin JH, Handler EB, Simpson CB, Osipov V, Merati AL. Dysplasia in adults with recurrent respiratory papillomatosis: incidence and risk factors. Ann Otol Rhinol Laryngol. 2009 Jul;118(7):481–85.
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8. Jaeckel EC, Raja S, Tan J, Das SK, Dey SK, Girod DA, Tsue TT, Sanford TR.Correlation of expression of cyclooxygenase-2, vascular endothelial growth factor, and peroxisome proliferator-activated receptor delta with head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg. 2001 Oct;127(10):1253–59.
9. Wu R, Abramson AL, Shikowitz MJ, Dannenberg AJ, Steinberg BM.Epidermal growth factor-induced cyclooxygenase-2 expression is mediated through phosphatidylinositol-3 kinase, not mitogen-activated protein/extracellular signal-regulated kinase kinase, in recurrent respiratory papillomas. Clin Cancer Res. 2005 Sep 1;11(17):6155–61.
10. Lucs AV, Wu R, Mullooly V, Abramson AL, Steinberg BM. Constitutive overexpression of the oncogene Rac1 in the airway of recurrent respiratory papillomatosis patients is a targetable host-susceptibility factor. Mol Med. 2012 Mar 30;18:244–49.
11. Yoo HJ, Sepkovic DW, Bradlow HL, Yu GP, Sirilian HV, Schantz SP.Estrogen metabolism as a risk factor for head and neck cancer. Otolaryngol Head Neck Surg. 2001 Mar;124(3):241–47.
12. Salhab M, Singh-Ranger G, Mokbel R, Jouhra F, Jiang WG, Mokbel K.Cyclooxygenase-2 mRNA expression correlates with aromatase expression in human breast cancer. J Surg Oncol. 2007 Oct 1;96(5):424–28
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15. Zhang P, Steinberg BM.Overexpression of PTEN/MMAC1 and decreased activation of Akt in human papillomavirus-infected laryngeal papillomas. Cancer Res. 2000 Mar 1;60(5):1457–62.
16. Wu R, Coniglio SJ, Chan A, Symons MH, Steinberg BM. Up-regulation of Ras-1 by epidermal growth factor mediates COX-2 expression in recurrent respiratory papillomatosis. Mol Med. 2007 Mar-Apr; 13(3-4):143–50.

Address for correspondence:
220013, Respublika Belarus,
g. Minsk, ul. P. Brovki, d. 3, korp. 3,
GUO «Belorusskaya meditsinskaya akademiya
poslediplomnogo obrazovaniya»,
kafedra otorinolaringologii,
tel. mob.: 375 29 1020548,
e-mail: malets-al@yandex.ru,
Malets Elena Leonidovna

Information about the authors:
Malets E.L. A post-graduate student of the otorhinolaryngology chair of EE “Belarusian Medical Academy of Post-graduate Education”.
Rjabceva S.N. PhD, an assistant of the pathologic anatomy chair of EE “Belarusian State Medical University”.
Romanova J.G. PhD, associate professor of the otorhinolaryngology chair of EE “Belarusian Medical Academy of Post-graduate Education”.
Shorats O.P. An junior researcher of the research laboratory of EE “Belarusian Medical Academy of Post-graduate Education”.

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DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.735   |  

E.A. SHLYAKHTUNOV

MINIMAL RESIDUAL DISEASE AT SOLID TUMORS – A CONTEMPORARY STATE OF THE PROBLEM

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

The paper presents a review of the current literature concerning some aspects of on the diagnosis of minimal residual disease (MRD) at solid tumors. Distant metastases are considered to be the main cause of death in patients with malignant tumors. MRD is defined as the presence of tumor cells which can not be detected by current routine diagnostic methods used to determine the tumor stage. It is found that in 20–45% of oncological patients (category M0) the circulating tumor cells (CTCs) have been revealed in the peripheral blood, and in 25-60% of patients the disseminated tumor cells (MLC) are found in the bone marrow. Currently, CSC and MLC are proposed to be classified as MRD. A threshold number of CTCs is determined, which makes up 5 CTCs in 7.5 ml of blood. Availability of ≥5 tumor cells in 7.5 ml of peripheral blood is associated with poor prognosis.
Currently, CSC is used to search for a commercially available device approved by the FDA - CellSearch (Veridex LLC) for monitoring the treatment of patients suffering from breast cancer, colorectal cancer and prostate cancer. In addition, using various modifications of PCR analysis can identify tumor-associated genes such as the tyrosinase gene (TYR), gene survivin (BIRC5), gene of epidermal growth factor receptor (ErbB-2/HER2-Neu), as well as "household" genes (GAPDH, 18S rRNA). These genes are now being considered as markers of MRD.

Keywords: minimal residual disease, metastasis, malignant solid tumor, diagnostics

p. 735-742 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,
tel. office: 375 212 57-64-16,
e-mail: Evgenij-shlyakhtunov@yandex.ru,
Shlyakhtunov Evgeniy Aleksandrovich

Information about the authors:
Shlyakhtunov E.A. PhD, associate professor of the oncology chair with the courses of X-ray diagnostics and X-ray therapy of the advanced training and personnel retraining faculty of EE “Vitebsk State Medical University”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.743   |  

D.V. NAREZKIN, E.V. SERGEEV

PREVENTIVE METHODS OF PYO-INFLAMMATORY WOUND COMPLICATIONS IN HERNIOTOMY OF STRANGULATED POSTOPERATIVE VENTRAL HERNIAS

SBEE HPE “Smolensk State Medical Academy”,
The Russian Federation

All activities for the prevention of wound complications in the surgical treatment of strangulated postoperative ventral hernias of the anterior abdominal wall can be divided into three types: preoperative, intraoperative and postoperative. Historically the most common preoperative method to prevent wound complications is considered to be antibiotic prophylaxis. Intraoperative methods are the most used however, they are very controversial. At the present stage the mesh implants and suture material with antibacterial properties are actively commonly introduced.
Considerable importance is given to the application of low-temperature plasma or laser, as the methods of intraoperative prevention. Important preventive value within the surgical treatment is considerd to eliminate bacterial load in an infected wound and the drainage. In the postoperative period the majority of preventive measures are focused at reducing, early diagnosis and evacuation of pathological accumulations of fluid in the wound.
Today the methods of ultrasonographic diagnosis or computed tomography are considered to be fast, safe and effective in confirming the presence of pathological fluid.
Despite improved methods of prevention of wound postoperative complications of herniotomy of strangulated postoperative ventral hernias at present there is no clear algorithm of preventive measures application.

Keywords: postoperative ventral hernia, wound complications, hernioplasty

p. 743-749 of the original issue

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Address for correspondence:
214019, Rossiyskaya Federatsiya,
g. Smolensk, ul. Krupskoy, d. 28,
GBOU VPO «Smolenskaya gosudarstvennaya
meditsinskaya akademiya»,
kafedra gospitalnoy khirurgii,
tel. 7-980-310-10-10,
e-mail: br.rus32@gmail.com,
Sergeev Evgeniy Valerevich

Information about the authors:
Narezkin D.V. MD, professor, Vice-rector for dealing with practical public health and post-educational training, Head of the hospital surgery chair of SBEE HPE “Smolensk State Medical Academy”.
Sergeev E.V. A post-graduate student of the faculty surgery chair of SBEE HPE “Smolensk State Medical Academy”.

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EXCHANGE OF EXPERIENCE

DOI: http://dx.doi.org/10.18484/2305-0047.2014.6.750   |  

V.L. BELEVICH, E.Y. STRUKOV, A.O. BREDNEV, D.V. OVCHINNIKOV

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY – THE METHOD OF CHOICE FOR LONG-TERM ENTERAL NUTRITION

FSBMEE HPE “Military Medical Academy named after S.M. Kirov”, the Ministry of Defense Russian Federation, Saint-Petersburg
The Russian Federation

Objectives. To analyze the experience of the percutaneous endoscopic gastrostomy performance in patients with different clinical pathology, to determine the indications for its application in each case, to find out the «weakest» technical points of this procedure and to warn against failures during mastering the method.
Methods. Over the period of 2007-2014 the imposition of 395 gastrostomies in patients with various disorders of swallowing and dysphagia have been carried out. The main group of 366 patients (93%) was comprised of patients with neurological status, treated in the emergency departments and intensive care units. 19 (4,8%) patients were underwent the percutaneous endoscopic gastrostomy (PEG) due to disturbance related to the esophagus integrity as a result of cancer progression and tumor lysis – 11 patients and so as a result of its injury – 8. 10 (2,2%) patients with Parkinson’s disease underwent PEG to more effective delivery of drugs to the small intestine (gastroenterostomy).
Results. This technique has been used in the case of necessity of enteral tube feeding more than 3 weeks in the absence of real positive forecast of consciousness and swallowing function recovery. The average operative time is 10-15 min. The postoperative complications were observed in 10 (2,2%) cases: peritonitis – 1, suppuration of surgical wounds – 5, pneumomediastinum – 1, bleeding – 1. Uncontrolled removal of the tube was observed in 2 cases.
Conclusion. The results of study have manifested the widespread application of endoscopic gastrostomy in clinical practice provides more proficient and reliable nutritional support of patients, improves outcomes and quality of life, reducing the number of complications. It can be considered the method of choice for the long-term enteral nutrition (more than 3 weeks) in patients with dysphagia of various geneses.

Keywords: percutaneous endoscopic gastrostomy, gastrostomy, enteral nutrition, dysphagia, feeding tube

p. 750-754 of the original issue

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Address for correspondence:
194044, Rossiyskaya Federatsiya,
g. Sankt-Peterburg, ul. Akademika Lebedeva, d. 6, FGBVOU VPO «Voenno-meditsinskaya akademiya imeni S.M. Kirova» MO RF, kafedra obschey khirurgii,
tel. 8-911-213-62-53,
e-mail: antonbrednev@rambler.ru,
Brednev Anton Olegovich

Information about the authors:
Belevich V.L. PhD, a senior instructor of the general surgery chair of FSBMEE HPE “Military Medical Academy named after S.M. Kirov”, the Ministry of Defense, Russian Federation, colonel of the medical service.
Strukov E.Y. PhD, an applicant for Doctor’s degree of the of the anesthesiology and reanimatology chair of FSBMEE HPE “Military Medical Academy named after S.M. Kirov”, the Ministry of Defense, Russian Federation, lieutenant colonel of the medical service.
Brednev A.O. An adjunct of the general surgery chair of FSBMEE HPE “Military Medical Academy named after S.M. Kirov”, the Ministry of Defense, Russian Federation senior lieutenant of the medical service.
Ovchinnikov D.V. PhD, vice head of department of organization of scientific work and training of the teaching staff) (for the preparation of scientific and scientific-pedagogical personnel) of FSBMEE HPE “Military Medical Academy named after S.M. Kirov”, the Ministry of Defense, Russian Federation, major of the medical service.

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