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Year 2017 Vol. 25 No 5

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

I.Y. TSYMBALYUK, A.M. MANUILOV, K.A. POPOV, A.A. BASOV

METABOLIC CORRECTION OF THE ISCHEMIA-REPERFUSIVE INJURY WITH SODIUM DICHLOROACETATE IN VASCULAR ISOLATION OF THE LIVER IN EXPERIMENT

FSBEE HE “Kuban State Medical University” of the Ministry of Health of the Russian Federation, Krasnodar,
The Russian Federation

Objectives. To study the effect of sodium dichloroacetate on the ischemia course and the development of the reperfusive syndrome as a result of the vascular liver isolation in rats.
Methods. The experimental study was performed on 110 non-linear male rats divided into 7 groups. Under the general anesthesia the laparotomy was carried out, sodium dichloroacetate has been injected intraperitoneally in the dosage of 300 mg/kg, the hepatoduodenal ligament was exposed and clamped within 10, 15 and 20 minutes. The comparison groups were composed of rats that had undergone the same manipulations except the sodium dichloroacetate injections. The control group included rats that had undergone only laparotomy. On the 15th reperfusion minute the animals were subjected to the blood and liver sampling for further laboratory studies. In the blood plasma the activity of the LDH, the AST and the ALT was determined. In erythrocytes and the liver homogenate, the activity of the glutathione peroxidase, the glutathione reductase and the content of the reduced glutathione were determined.
Results. Sodium dichloroacetate considerably improves the liver ischemia tolerance which has been confirmed by the lowering of the hepatocyte cytolysis. Thus the LDH activity in the blood plasma was 2-3.2 times lower than the indices of the control groups. The research of the glutathione metabolism against the background of correction by means of sodium dichloroacetate has also revealed the enhancement of this link in the non-specific resistance system. Besides the activity of the glutathione reductase and the glutathione concentration in erythrocytes have not decreased even during the 20-minute ischemia. In the liver homogenate the increase in the glutathione peroxidase by 1.7-2.8 times has been revealed. The concentration of the restored glutathione has decreased by the 10-minute ischemia by 30% and further has maintained on that level. Such changes can be caused by the intensive system functioning of the glutathione metabolism by local injuries which is accompanied by the more active resistance to the injuring factor.
Conclusions. The presented data demonstrate the cytoprotective effect of sodium dichloroacetate on the models of the ischemic-reperfusive liver injury as a result of its vascular isolation.

Keywords: Pringle maneuver, hepatic ischemia reperfusion injury, metabolic cytoprotection, sodium dichloroacetate, glutathione system
p. 447-453 of the original issue
References
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  15. Kulinskii VI, Kolesnichenko LS. Sistema glutationa I. Sintez, transport, glutationtransferazy, glutationperoksidazy [Synthesis, transport, glutathione transferase, glutathione peroxidase]. Biomed Khimiia. 2009;55(3):255-77.
Address for correspondence:
350063, Russian Federation,
Krasnodar, Sedina str., 4,
FSBEE HE “Kuban State Medical University”,
Department of Surgery ¹2
of the Faculty of the Advanced Training
and Retraining of Specialists,
tel. mob.: 7 928 430-07-69,
e-mail: igor_ts@inbox.ru,
Igor Y. Tsymbalyuk
Information about the authors:
Tsymbalyuk I.Y., Post-Graduate Student, Senior Laboratory Assistant of the Surgery Department ¹2 of the Faculty of the Advanced Training and Retraining of Specialists of FSBEE HE “Kuban State Medical University”.
Manuilov A.M., MD, Professor, Head of the Surgery Department ¹2 of the Faculty of the Advanced Training and Retraining of Specialists of FSBEE HE “Kuban State Medical University”.
Popov K.A., Post-Graduate Student, Assistant of the Fundamental and Clinical Biochemistry Department of FSBEE HE “Kuban State Medical University”.
Basov A.A., MD, Professor of the Fundamental and Clinical Biochemistry Department of FSBEE HE “Kuban State Medical University”.

O.Y. POPADYUK

ASSESSMENT OF DEGRADABLE AND MECHANICAL PROPERTIES OF NANO-CONTAINING WOUND HEALING POLYMER MATERIALS

SHEI “Ivano-Frankivsk National Medical University”, Ivano-Frankivsk,
Ukraine

Objectives. To evaluate the mechanical and degrading properties of nano-containing wound-healing polymer materials in the study in vitro.
Methods. The bio-polymer bases in the form of films were used in the research in which nano-oxides zinc (ZnO), magnesium nano-oxides (MgO) and pyrogenic silica (SiO2) in various concentrations were introduced. The degradation, relative elongation at break, tensile strength in tensile testing machine, density and Shore hardness, and their swelling properties of the studied bio-polymers were investigated in vitro.
Results. The study has shown that the introduction into the polymeric base of 1% solution of silicon oxide slightly increases the film strength, while an increase in its content up to 5% slightly reduces it. The same pattern is observed in the case of the introduction of zinc and magnesium into the film. After 1 day of the film exposure in water, tensile strength could not be determined as the films degraded and was destroyed while fixing the studied materials in the tensile machine. This demonstrates the ability of the film to degrade being in contact with the liquid. Conducted at 36°C study shows that the strength of all films is sharply reduced and is within the error of the tensile machine. Investigation of the density of synthesized films has shown that films with 1% content of zinc nanooxides and silicon oxide have a high density, which correlates with the breaking strength. Determining the degree of film swelling has shown a high capacity for swelling in the films without nanooxides of zinc and somewhat decreased degree of swelling in case of its presence.
Conclusions. Our study has shown that the properties of bio-degradable polymeric materials depend on concentration of active drugs that are introduced and their degradation properties can provide drug delivery of the medication to the affected region.

Keywords: wounds, treatment of wounds, wound coverings, nano-containing materials, degradable polymer materials
p. 454-458 of the original issue
References
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  8. Grigoreva MV Polimernyie sistemyi s kontroliruemyim vyisvobozhdeniem biologicheski aktivnyih soedineniy. [Polymeric systems with controlled release of biologically active compounds]. Biotekhnolohiya. 2011;4(2):9-23.
  9. Bajpai AK, Shukla SK, Bhanu S, Kankane S Responsiv epolymers incontrolled drug delivery. Progr. Polym. Sci. 2008;33:1088–118.
  10. Popadyuk O.Ya., Melnyk M.V., Melnyk D.O. Biodegradujucha polimerna osnova “Biodep” [Biodegradable polymer base “Biodep”]. Patent for utility model, UA 112145; ÌÏÊ A61K 31/21, A61K 9/40. 12.12.2016.
  11. Ilina A.V., Zubareva A.A., Kurek D.V., Levov A.N., Varlamov V.P. Nanochastitsyi na osnove suktsinilirovannogo hitozana s doksorubitsinom: formirovanie i svoystva. [Nanoparticles based on succinylated chitosan with doxorubicin: formation and properties]. Ross Nanotehnologii. 2012;7(1-2):84-89.
  12. Yusova A.A., Gusev I.V., Lipatova I.M. Svoystva gidrogeley na osnove smesey alginata natriya s drugimi polisaharidami prirodnogo proishozhdeniya [Properties of hydrogels based on mixtures of sodium alginate with other polysaccharides of natural origin] Chemistry of Plant Raw Materials. 2014;4:59-66.
Address for correspondence:
76018, Ukraine,
Ivano-Frankivsk, Galitskaya str., 2,
SHEI “Ivano-Frankivsk National Medical University”,
Department of General Surgery,
tel.: +380 34 252-82-32, E-mail: popadyukoleg@ukr.net Oleg Y. Popadyuk
Information about the authors:
Popadyuk O.Y., PhD, Associate Professor of the General Surgery Department of SHEE “Ivano-Frankivsk National Medical University”.

GENERAL & SPECIAL SURGERY

I.A. KRYVORUCHKO 1, L.A. PERERVA 2, N.N. GONCHAROVA 1, I.A. TARABAN 1

CURRENT APPROACHES TO THE TREATMENT OF COMPLICATED PANCREATIC PSEUDOCYSTS II TYPE

Kharkiv National Medical University 1, Kharkiv,
SE “National Institute of Surgery and Transplantology named after O.O. Shalimov” 2, National Academy of Medical Sciences of Ukraine, Kiev,
Ukraine

Objectives. Improving the results of surgical treatment of complicated pancreatic pseudocysts (type II), using minimally invasive techniques.
Methods. Treatment outcomes of patients (n=247) with complicated pancreatic pseudocysts (type II) according to classification system offered by A. D’Egidio and M. Schein in 1991 have been analyzed. All patients underwent general clinical blood and urine tests, biochemical blood tests, ultrasound examination, multislice computed tomography, endoscopic fibrogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, magnetic resonance imaging, endoscopic ultrasonography and morphological studies. To choose the operative treatment method it is necessary to take into account the patient’s age, the type and location of pseudocysts, kind of complications, the state of other organs and systems, severity of organ dysfunction according to SOFA Score. The outcomes of surgical treatment of patients were evaluated according to the classification of Clavien-Dindo (2004).
Results. 119 (48.2%) patients underwent the minimally invasive “step-up surgical approach” technique, in 97 cases (81.5%) surgery was performed in a single stage and in 22 (18.5%) cases – it was a stage before the open surgery. Primary open surgical procedures were performed in 128 (51.8%) patients. Complications occurred in 40 (16.2%) of 247 patients, 1 (0.4%) patient died.
Conclusion. A minimally invasive “step-up surgical approach” technique is preferable in treatment the patients with complicated pancreatic pseudocysts which serves as a basis consisting of a puncture, puncture-drainage percutaneous interventions, transmural anastomosis and transgastric or transduodenal stenting of pseudocysts, X-ray endovascular occlusion of the arrosive blood vessels, with subsequent implementation of open surgical procedures (according to the indications), which together with the minimally invasive interventions should be considered as intercomplementary methods of treatment.
The choice of open interventions depends on disease severity, localization of pseudocysts, the state of the pancreatic ductal system, and the presence of adjacent organs complications.

Keywords: pancreas, chronic pancreatitis, complicated pseudocyst, minimally invasive intervention, open surgeries, external drainage, internal drainage
p. 459-466 of the original issue
References
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  13. Khaled YS, Ammori MB, Ammori BJ. Laparoscopic lateral pancreaticojejunostomy for chronic pancreatitis: a case report and review of the literature. Surg Laparosc Endosc Percutan Tech. 2011 Feb;21(1):e36-40. doi: 10.1097/SLE.0b013e3182075111.
  14. Abidov EA. Primenenie rentgenokhirurgicheskikh metodov v lechenii patsientov po povodu kist podzheludochnoi zhelezy, oslozhnennykh vnutribriushnym krovotecheniem [The use of X-ray surgical methods in the treatment of patients with pancreatic cysts complicated by intra-abdominal hemorrhage]. Kl³n³chna Kh³rurg³ia. 2013;(11):31-33.
  15. Ferris H, Buckley M. Pancreatico pleural fistula: an unusual complication of chronic pancreatitis. Ir Med J. 2012 Jul-Aug;105(7):246-47.
Address for correspondence:
61022, Ukraine, Kharkov,
Science Ave., 4,
Kharkov National Medical University,
Department of Surgery ¹ 2,
Tel.: +38 050 301-90-90,
E-mail: ikryvoruchko@mail.ru,
Igor A. Kryvoruchko
Information about the authors:
Kryvoruchko I.A., MD, Professor, Head of the Surgery Department ¹ 2 of Kharkov National Medical University.
Pererva L.A., PhD, Researcher of SE “National Institute of Surgery and Transplantology named after O.O. Shalimov”, National Academy of Medical Sciences of Ukraine.
Goncharova N.N., MD, Associate Professor of the Surgery Department ¹ 2 of Kharkov National Medical University.
Taraban I.A., MD, Professor of the Surgery Department ¹ 2 of Kharkov National Medical University.

À.V. VARABEI 1, Y.N. ARLOUSKI 1, N.A. LAGODICH 2, V.F. AREHAY 3

X-RAY ENDOBILIARY AND ENDOSCOPIC INTERVENTIONS IN COMPLEX TREATMENT OF INTRAHEPATIC CHOLANGIOLITHIASIS IN HEPATICOJEJUNOSTOMY STRICTURES

SBE “Belarusian Medical Academy of Postgraduate Education” 1,
ME “Minsk Regional Clinical Hospital 2,
SE “Republican Scientific and Practical Center of Oncology and Medical
Radiology named after N.N. Alexandrov” 3, Minsk
The Republic of Belarus

Objectives. To improve the treatment results of patients with the intrahepatic cholangiolithiasis in hepaticojejunostomy strictures using minimally invasive methods.
Methods. During the period from 2009 till 2016 25 patients with hepaticojejunostomy strictures were being treated in our center. 6 of these patients had coexistent intrahepatic cholangiolithiasis. The final diagnosis of hepaticojejunostomy stricture and cholangiolithiasis above the anastomosis was established according to MRI-cholangiography, double balloon enteroscopy and percutaneous transhepatic cholangiography. Rehepaticojejunostomy was performed in 13 (52%) patients. 12 (48%) patients were subject to minimally invasive intervention such as laser vaporization of anastomosis using double balloon enteroscopy (7 patients) and lithoextraction with double balloon enteroscopy (1), transhepatic cholangioscopy (2 patients) with laser lithotripsy (1), balloon dilatation of the stricture of rehepaticojejunoanastomosis (4), lithoextraction (4), including with double balloon enteroscopy («randezvous» procedure) (1), stenting (2). Combined minimally invasive procedures was reduced to performing simultaneous variants of percutaneous transhepatic endobiliary interventions (balloon dilatation, laser vaporization of bile duct concrements through the cholangioscope, stenting of the lobar ducts and the hepaticojejunoanastomoses zone) and endoscopic interventions using a double balloon enteroscope (lithoextraction, sanation).
Results. There were no lethal outcomes after minimally invasive interventions. Among early complications were the following: cholangitis aggravation (5 patients); incrustation of stents with bile concrements - in 1 patient (within 1 year after the procedure), requiring a reoperation; recurrences of HJA strictures (2), for the elimination of which in the period from 6 months till 2 years rehepaticojejunostomy was performed. In the long-term period, in 5 (10.9%) of the operated patients in the period from 6 months up to 3 years the recurrence of HJA stricture was observed. All these patients were subject to rehepaticojejunostomy.
Conclusions. Combined endoscopic and endobiliary techniques of treatment and endobiliary minimally invasive correction of rehepaticojejunostomy strictures and cholangiolithiasis demonstrate good immediate and long-term results.

Keywords: bile ducts, stricture, hepaticojejunostomy, cholangiolithiasis, antegrade interventions, double balloon enteroscopy, lithotripsy
p. 467-475 of the original issue
References
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  2. Schmidt SC, Langrehr JM, Hintze RE, Neuhaus P. Long-term results and risk factors influencing outcome of major bile duct injuries following cholecystectomy. Br J Surg. 2005 Jan;92(1):76-82. doi: 10.1002/bjs.4775.
  3. Bonnel DH, Fingerhut AL. Percutaneous transhepatic balloon dilatation of benign bilioenteric strictures: long-term results in 110 patients. Am J Surg. 2012 Jun;203(6):675-83. doi: 10.1016/j.amjsurg.2012.02.001.
  4. Gastaca M. Biliary complications after orthotopic liver transplantation: a review of incidence and risk factors. Transplant Proc. 2012 Jul-Aug;44(6):1545-49. doi: 10.1016/j.transproceed.2012.05.008.
  5. Jung JY, Lee SK, Oh HC, Lee TY, Kwon SH, Lee SS, et al. The role of percutaneous transhepatic cholangioscopy in patients with hilar strictures. Gut Liver. 2007 Jun;1(1):56-62. doi: 10.5009/gnl.2007.1.1.56.
  6. Yang DH, Lee SK, Moon SH, Park DH, Lee SS, Seo DW, et al. Percutaneous transhepatic cholangioscopic intervention in the management of complete membranous occlusion of bilioenteric anastomosis: report of two cases. Gut Liver. 2009 Dec;3(4):352-55. doi: 10.5009/gnl.2009.3.4.352.
  7. Negi SS, Sakhuja P, Malhotra V, Chaudhary A. Factors predicting advanced hepatic fibrosis in patients with postcholecystectomy bile duct strictures. Arch Surg. 2004 Mar;139(3):299-303. doi: 10.1001/archsurg.139.3.299.
  8. Quintero GA, Patiño JF. Surgical management of benign strictures of the biliary tract. World J Surg. 2001 Oct;25(10):1245-50.
  9. Chapman WC, Halevy A, Blumgart LH, Benjamin IS. Postcholecystectomy bile duct strictures. Management and outcome in 130 patients. Arch Surg. 1995 Jun;130(6):597-602; discussion 602-4.
  10. Sicora SS. Management of post-cholecystectomy benign bile duct strictures: review. Indian J Surg. 2012 Feb; 74(1):22-28. doi: 10.1007/s12262-011-0375-6.
  11. Kapranov SA, Avaliani MV, Kuznetsova VF. Chrespechenochnye endobiliarnye vmeshatel’stva pri strikturakh zhelchnykh protokov [Transhepatic endobiliary interference with stricture of the bile duct]. Annaly Khirurg Gepatologii. 1997;2:123-31.
  12. Bagnenko SF, Savello VE, Kabanov MI, Korol’kov AI, Iakovleva DM. Primenenie smennykh transpechenochnykh karkasnykh stentov u bol’nykh s posttravmaticheskimi strikturami pechenochnogo i obshchego zhelchnogo protoka [The use of replaceable transhepatic skeletal stents in patients with posttraumatic strictures of the hepatic and common bile duct.]. Vestn Khirurgii im II Grekova. 2008;167(2):69-71.
  13. Oh CH. Percutaneous transhepatic cholangioscopy in bilioenteric anastomosis stricture. Clin Endosc. 2016 Nov;49(6):530-32. doi: 10.5946/ce.2016.125.
  14. Tulin AI, Shavlovskis Ia. Chreskozhnoe chrespechenochnoe drenirovanie Y-obraznoi sistemoi kateterov pri retsidiviruiushchikh rubtsovykh strikturakh zhelchnykh protokov [Percutaneous transhepatic drainage by the Y-shaped catheter system with recurrent scar cicles of the bile ducts]. Annaly Khirurg Gepatologii. 2016;21(4):47-54.
  15. Mueller PR, van Sonnenberg E, Ferrucci JT Jr, Weyman PJ, Butch RJ, Malt RA, et al. Biliary stricture dilatation: multicenter review of clinical management in 73 patients. Radiology. 1986 Jul;160(1):17-22. doi: 10.1148/radiology.160.1.3715030.
  16. Lee AY, Gregorius J, Kerlan RK, Gordon RL, Fiderman N. Percutaneous transhepatic balloon dilatation of biliary-enteric anastomotic strictures after surgical repair of jatrogenic bile duct injuries. PLoS One. 2012;7(10):e46478. doi: 10.1371/journal.pone.0046478.
Address for correspondence:
223041, Republic of Belarus,
Minsk region, Lesnoy, 1,
ME «Minsk Regional Clinical Hospital»,
Tel.: 375 17 265-22-13,
e-mail: varabeiproct@tut.by,
Alexander V. Varabei
Information about the authors:
Varabei A.V., Corresponding Member of the National Academy of Sciences of Belarus, MD, Professor, Head of the Surgery Department of SBE “Belarusian Medical Academy of Postgraduate Education”.
Arlouski Y.N., PhD, Associate Professor of the Surgery Department of SBE “Belarusian Medical Academy of Postgraduate Education”.
Lagodich N.A., Endoscopist of the Endoscopy Unit of ME “Minsk Regional Clinical Hospital”2.
Arehay V.F., X-ray-Endovascular Surgeon of SE ““Republican Scientific and Practical Center of Oncology and Medical Radiology named after N.N. Alexandrov”.

Y.S. VINNIK, A.B. SALMINA, S.S. DUNAEVSKAYA, N.A. MALINOVSKAYA, D.A. ANTUFRIEVA

PLASMA MEMBRANE BLEBBING OF LYMPHOCYTES AS A MARKER OF ENDOTHELIAL DYSFUNCTION IN PROGRESSIVE PERIPHERAL ARTERY DISEASE OF THE LOWER EXTRIMITIES

FSBEF HE “Krasnoyarsk State Medical University named after prof. V.F. Voyno- Yasenetsky”, Krasnoyarsk,
The Russian Federation

Objectives. To determine the role of membrane blebbing of the lymphocytes as a marker of the endothelial dysfunction in the progressive clinical course of the peripheral artery disease of the legs.
Methods. The cohort prospective study was conducted enrolling 60 patients with the peripheral artery disease of the legs, with multilevel lesion of arteries, and ΙΙA stage of ischemia according to the classification of Fontaine-Pokrovsky. Based on the objective physical examination results all patients were divided into two groups; the 1st contained 30 patients with no progressive clinical course of the peripheral artery disease of the legs, the 2nd had 30 patients with a progressive clinical course. Membrane blebbing of the lymphocytes of the peripheral blood for all the patients was determined using the phase-contrast microscopy. For the objectification of the pathological process progression, Doppler ultrasound imaging of the lower limbs arteries was made to evaluate the residual vascular lumen during the first hospitalization and 6 months afterwards.
Results. Membrane blebbing of the lymphocytes of the peripheral blood is an indicator which objectively reflects the violations in the endothelium functional state. At progressive clinical course the large number of lymphocytes was revealed at the terminal blebbing state 14.9 [13.8; 19.7]%, which reflects the intensity of the pathological process. During Doppler ultrasound imaging of patients with progressive clinical course, more pronounced narrowing of the superficial femoral artery lumen is registered, which makes up -14.3 [-11.2; -17.9]%. In case of a progressive clinical course the residual vascular lumen for the posterior tibial artery was 14.5 [5.4; 21.3]% and for the anterior tibial artery it was 16.7 [11.2; 19.4]%.
Conclusions. The highest correlation coefficients with the progression of peripheral artery disease have initial (rS=0.87, p=0.001) and terminal membrane blebbing of the lymphocytes (rS=0.92, p=0.001). Complex diagnostics of the endothelium state, including membrane blebbing of the lymphocytes reflects the type of the pathological process course of the peripheral artery disease of the legs.

Keywords: peripheral artery disease of the legs, membrane blebbing, vascular surgical procedures, tibial arteries, superficial femoral artery
p. 476-480 of the original issue
References
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  3. Zou J, Xia Y, Yang H, Ma H, Zhang X. Hybrid endarterectomy and endovascular therapy in multilevel lower extremity arterial disease involving the femoral artery bifurcation. Int Surg. 2012 Jan-Mar;97(1):56-64. doi: 10.9738/0020-8868-97.1.56.
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  6. Koshkin VM, Sergeeva NA, Kuznetsov MR, Nastavsheva OD. Konservativnaia terapiia u bol’nykh khronicheskimi obliteriruiushchimi zabolevaniiami arterii nizhnikh konechnostei. Sovremennye predstavleniia [Conservative therapy in patients with chronic obliterating diseases of lower limb arteries. Contemporary representations]. Med Sovet. 2015;(8):6-9.
  7. Tadokoro R, Murai H, Sakai KI, Okui T, Yokota Y, Takahashi Y. Melanosome transfer to keratinocyte in the chicken embryonic skin is mediated by vesicle release associated with Rho-regulated membrane blebbing. Sci Rep. 2016 Dec 2;6:38277. doi: 10.1038/srep38277.
  8. Ioskevich NN, Zinchuk VV. Prooxidant-antioxidant balance in blood during the surgical treatment of obliterating arterial atherosclerosis in the lower extremities. Rocz Akad Med Bialymst. 2004;49:222-26.
Address for correspondence:
660077, Russian Federation,
Krasnoyarsk, Partizana Zheleznyaka str., 1,
FSBEF HE “Krasnoyarsk State Medical University
named after prof. V.F. Voyno-Yasenetsky”,
Department of General Surgery
named after M.I. Gulman,
tel. office: 963 191-29-70,
e-mail: Vikto-potapenk@yandex.ru,
Svetlana S. Dunaevskay
Information about the authors:
Vinnik Y.S., MD, Professor, Head of the General Surgery Department named after M.I. Gulman of FSBEF HE “Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky”.
Salmina A.B., MD, Professor, Head of the Department of the Biological Chemistry with the Course of Medical, Pharmaceutical and Toxicological Chemistry of FSBEF HE “Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky”.
Dunaevskaya S.S., MD, Associate Professor, Professor of the General Surgery Department named after
M.I. Gulman of FSBEF HE “Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky”.
Malinovskaya N.A., MD, Associate Professor, Professor of the Department of the Biological Chemistry with the Course of Medical, Pharmaceutical and Toxicological Chemistry of FSBEF HE “Krasnoyarsk State Medical University named after prof. V.F. Voyno- Yasenetsky”.
Antufrieva D.A., Assistant of the General Surgery Department named after M.I.Gulman of FSBEF HE “Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky”.

TRANSPLANTOLOGY

S.L. ZYBLEV 1, T.S. PETRENKO 1, S.V. ZYBLEVA 2, Z.A. DUNDAROV 1, A.V. VELICHKO 2

THE EARLY DIAGNOSIS OF RENAL GRAFT DYSFUNCTION

EE “Gomel State Medical University” 1,
SI “Republican Scientific and Practical Center for Radiation Medicine and Human Ecology” 2, Gomel,
The Republic of Belarus

Objectives. To develop diagnostic technology of the reperfusion injury due to imbalance of pro-/antioxidant state of recipient in the post-transplant period.
Methods. The examination results of 60 patients with the stage 5 chronic kidney disease (CKD) have been analyzed. Kidney transplantation has been performed in all patients. The balance of pro-/antioxidant state of the organism was assessed by the method of luminol-dependent chemiluminescence (LDCL) of the blood plasma before the surgery and 24 hours after it. To study the influence of anesthetic support and surgery treatment on the state of pro-/antioxidant balance, the group of patients (n=20) was examined who underwent the scheduled surgery treatment under general anesthesia.
Results. The kidney transplantation has been found out to cause a significant shift in the balance of pro-/antioxidants to pro-oxidants and a significant reduction of the potency of antiradical body system within the patients with the stage 5 CKD during the first 24 hours already. When analyzing the pro-/antioxidant balance level and the capacity of antioxidant organism system in the group of patients with the immediate graft function (IGF), the index of pro-/antioxidant balance in the first day after the surgery was 24.0 [11.9; 44.6]%, and the capacity of antioxidant system was 35.8 [12.7; 40.8]%. In the group of patients with the delayed graft function (DGF) in the first 24 hours in the postoperative period a more significant balance shift to pro-oxidant up to 10.7 [6.1; 19.2]% (p=0.011) was detected, the antioxidant organism system was exhausted up to 12.7 [6.1; 29.3]% (p=0.024). There were no significant changes identified in the indices of pro-/antioxidant balance level of the blood plasma within the group of patients who underwent the scheduled surgical treatment in the postoperative period.
Conclusions. The determination of the severity of reperfusion injury within the patients after kidney transplantation can be performed on the basis of detection of pro-/antioxidant state imbalance and the potency index of the organism antioxidant system that expands the diagnostic possibilities of early risk detection of the delayed graft function.

Keywords: kidney transplantation, postoperative period, reperfusion injury, delayed graft function, balance of pro-/antioxidant state, luminol-dependent chemiluminescence, chronic renal insufficiency
p. 481-487 of the original issue
References
  1. Pikirenia II, Pirov BS, Korotkov SV, Kalachik OV, Dziadz’ko AM, Rummo OO. Stanovlenie i razvitie transplantatsii organov v Respublike Belarus’ [Formation and development of organ transplantation in the Republic of Belarus]. Khirurgiia Vostochnaia Evropa. 2016;(2):258-66.
  2. Vatazin AV, Nesterenko IV, Zul’karnaev AV, Shakhov NL. Patogeneticheskie mekhanizmy razvitiia ishemicheski-reperfuzionnogo povrezhdeniia pochki kak perspektivnye misheni spetsificheskoi terapii [Pathogenetic mechanisms of development of ischemically-reperfusion damage of kidney as perspective targets of specific therapy]. Vestn Transplantologii i Iskusstv Organov. 2015;(1):147-56.
  3. Vatazin AV, Astakhov PV, Zul’karnaev AB, Vetchinnikova ON, Kantariia RO, Siniutin AA, i dr. Nespetsificheskie mekhanizmy ishemicheskogo i reperfuzionnogo povrezhdeniia pochechnogo allotransplantata i sposoby vozdeistviia na nikh [Nonspecific mechanisms of ischemic and reperfusion injury of renal allograft and ways of influencing them]. Nefrologiia. 2013;13(1):42-48.
  4. Cho YW, Terasaki PI, Cecka JM, Gjertson DW. Transplantation of kidneys from donors whose hearts have stopped beating. N Engl J Med. 1998; 338:221-25. doi: 10.1056/NEJM199801223380403.
  5. Minina MG, Khubutiia MSh, Gubarev KK, Guliaev VA, Pinchuk AV, Kaabak MM, i dr. Prakticheskoe ispol’zovanie ekstrakorporal’noi membrannoi oksigenatsii v donorstve organov dlia transplantatsii [Practical use of extracorporeal membrane oxygenation in the donation of organs for transplantation]. Vestn Transplantologii i Iskusstv Organov. 2012;14(1):27-35.
  6. Treska V, Kobr J, Hasman D, Racek J, Trefil L, Reischig T, et al. Ischemia-reperfusion injury in kidney transplantation from non-heart beating donor--do antioxidants or antiinflammatory drugs play any role? Rozhl Chir. 2009 Feb;88(2):65-68. [Article in Czech]
  7. Vostálová J, Galandáková A, Strebl P, Zadražil J. Oxidative stress in patients after kidney transplantation. Vnitr Lek. 2013 Apr;59(4):296-300. [Article in Czech]
  8. Kalachik OV, Ugolev II, Zabello TN, Sadovskii DN, Oganova EG, Muravskii VA. Otsenka funktsional’nykh kharakteristik al’bumina metodom elektronnogo paramagnitnogo rezonansa u patsientov posle transplantatsii pochki [Evaluation of functional characteristics of albumin by electron paramagnetic resonance in patients after kidney transplantation]. Vestsi Nats Akadi Navuk Belarusi. Ser Med Navuk. 2014;(4):72-77.
  9. Omotayo OE, Siti AS, Mohd SAbW. Potential applications of lipid peroxidation products in renal transplantation. Transplant Tech. 2013;1(1):1-3. doi: 10.7243/2053-6623-1-3.
  10. Beliakov NA, Semes’ko SG. Antioksidantnaia aktivnost’ biologicheskikh zhidkostei cheloveka: metodologiia i klinicheskoe znachenie [Antioxidant activity of human biological fluids: methodology and clinical significance]. Efferent Terapiia. 2005;11(1):5-21.
  11. Vladimirov IuA, Proskurina EV. Svobodnye radikaly i kletochnaia khemiliuminestsentsiia [Free radicals and cellular chemiluminescence]. Uspekhi Biol Khimii. 2009;49:341-88.
  12. Kolesnikov VA, Evseev AK, El’kov AN, Pinchuk AV, Kokov LS, Tsar’kova TG, i dr. Prognozirovanie razvitiia oslozhnenii posle transplantatsii pochki s pomoshch’iu monitoringa redoks-potentsiala plazmy krovi [Predicting the development of complications after kidney transplantation by monitoring the redox potential of blood plasma]. Sovrem Tekhnologii v Meditsine. 2015;7(4):84-90.
  13. Vladimirov IuA. Aktivirovannaia khemiliuminestsentsiia i bioliuminestsentsiia kak instrument v mediko-biologicheskikh issledovaniiakh [Activated chemiluminescence and bioluminescence as an instrument in biomedical research]. Soros Obrazovat Zhurn. 2001;7(1):16-23.
  14. Hosseini F, Naseri MK, Badavi M, Ghaffari MA, Shahbazian H, Rashidi I. Effect of beta carotene on lipid peroxidation and antioxidant status following renal ischemia/reperfusion injury in rat. Scand J Clin Lab Invest. 2010 Jul;70(4):259-63. doi: 10.3109/00365511003777810.
  15. Nagelschmidt M, Minor T, Gallinat A, Moers C, Jochmans I, Pirenne J, et al. Lipid peroxidation products in machine perfusion of older donor kidneys. J Surg Res. 2013 Apr;180(2):337-42. doi: 10.1016/j.jss.2012.04.071.
Address for correspondence:
246000, Republic of Belarus,
Gomel, Lange str., 5,
EE “Gomel State Medical University”
Department of Surgical Diseases ¹2,
tel. mob.: 375 029 109-21-09,
e-mail: S.zyblev@yandex.by,
Sergey L. Zyblev
Information about the authors:
Zyblev S.L. PhD, Ass. Professor of Department of Surgical Diseases N2, EE “Gomel State Medical University”.
Petrenko T.S. PhD, Ass. Professor of Department of Clinical Laboratory Diagnostics, Allergology and Immunology, EE “Gomel State Medical University”.
Zybleva S.V. PhD, Immunologist, Academic Secretary of SI “Republican Scientific and Practical Center for Radiation Medicine and Human Ecology”
Dundarov Z.A. MD, Professor, Head of Department of Surgical Diseases N2, EE “Gomel State Medical University”.
Velichko A.V. PhD, Ass. Professor, Head of Surgical Department (transplantation, reconstructive and endocrine surgery), SI “Republican Scientific and Practical Center for Radiation Medicine and Human Ecology”.

ONCOLOGY

F.SH. AKHMETZYANOV1,2,3, V.I. EGOROV 1,2

OPTIMIZATION OF SURGICAL TREATMENT OF PATIENTS UNDERGOING OBSTRUCTIVE COLONIC RESECTION

FSBEE HE ”Kazan State Medical University” 1,
SAME “Republican Clinical Oncology Center” 2,
Volga region branch of fsbe “N.N.Blokhin Russian Oncology Research Center” Ministry of Health of RF” 3, Kazan,
The Russian Federation

Objectives. The study of the short-term results of reconstructive operations in patients undergoing obstructive colonic resection in a specialized hospital.
Methods. The data of patients (n=128) with functioning intestinal stoma after obstructive colon resections being treated from January 2011 to December 2016 were analyzed. The reconstruction of the colon was failed in 7 patients. There were 57 males (47.1%) and 64 females (52.9%) from total of 121 patients. The average age of patients was 67.8±10.4 years. There were 55 patients (45,5%) older than 70 years.
The main cause for obstructive resections was large intestinal obstruction – in 103 patients (85.1%); the left-sided tumor of the colon was originated predominantly – in 103 patients (85.1%).
Results. Median time of reconstructive and restorative phase was 6 (1-31) months. In 7 out of 121 patients the disease recurrence was diagnosed intraoperatively (2 cases – single parietal peritoneal metastases, 4 cases – an intestine stump recurrence and mesenteric lymph node metastasis). The end-to-end anastomosis were performed in 107 patients (88.4%); in 10 of them (8.3%) anastomosis was performed by stapler technique. The median postoperative hospital stay was 14 (8-16) days and in patients without complications – 10 (8-12) days. Incisional complications developed in 21 cases (17.4%). Postoperative mortality was 2.5%.
Conclusion. The conducted study has confirmed the treatment efficacy of complicated forms of colorectal cancer as well as performing reconstructions of the colon in a specialized hospital. The optimal time of the reconstruction phase after the obstructive colon resection is considered to be 5-6 months.

Keywords: colorectal neoplasms, intestinal reconstruction, intestinal stoma, intestinal obstruction, abdominal adhesions, anastomosis, mortality
p. 488-493 of the original issue
References
  1. Chissov VI, Starinskii VV, Petrova GV. Sostoianie onkologicheskoi pomoshchi naseleniiu Rossii v 2015 godu [Oncological assistance to the population of Russia in 2015]. Moscow, RF; 2016. 236 p.
  2. Totikov ZV, Totikov VZ, Kalitsova MV, Medoev VV. Novyi sposob dekompressii pri tolstokishechnoi neprokhodimosti opukholevogo geneza [A new way of decompression in colonic obstruction of tumor origin]. Med Vestn Iuga Rossii. 2016;(3):86-91. doi: 10.21886/2219-8075-2016-3-86-91.
  3. Lin BQ, Wang RL, Li QX, Chen W, Huang ZY. Investigation of treatment methods in obstructive colorectal cancer. J BUON. 2015 May-Jun;20(3):756-61.
  4. Osian G. Emergency Surgery for Colorectal Cancer Complications: Obstruction, Perforation, Bleeding. Contemporary Issues in Colorectal Surgical Practice. 2012. ð. 75-87.
  5. Fujita F, Torashima Y, Kuroki T, Eguchi S. Risk factors and predictive factors for anastomotic leakage after resection for colorectal cancer: reappraisal of the literature. Surg Today. 2014 Sep;44(9):1595-602. doi: 10.1007/s00595-013-0685-3.
  6. Akhmetzianov FSh, Shaikhutdinov NG, Shaimardanov IV. Organizatsiia lecheniia v ekstrennykh i neotlozhnykh sostoianiiakh, palliativnaia terapiia bol’nykh onkologicheskogo profilia [Organization of treatment in emergency and urgent conditions, palliative therapy of cancer patients]. Povolozh Onkol Vestn. 2014;(1):9-14.
  7. Blinnikov OI, Dronov AF, Smirnov AN. Laparoskopicheskie operatsii pri ostroi spaechnoi kishechnoi neprokhodimosti u detei [Laparoscopic surgery for acute adhesive intestinal obstruction in children]. Laparoskop Khirurgiia.1993;(1):82-88.
  8. Luntovskii AM, Kecherukov AI, Chinarev IuB, Plotnikov VV, Spirev VV. Vosstanovlenie nepreryvnosti tolstoi kishki posle operatsii tipa Gartmana [Restoration of colon continuity after operations of the Hartmann type]. Med Nauka i Obrazovanie Urala. 2005;(1):73.
  9. Khalikov MM, Gataullin IG. Analiz neposredstvennykh i otdalennykh rezul’tatov rekonstruktivno-vosstanovitel’nogo etapa posle operatsii tipa Gartmana [Analysis of immediate and long-term results of the reconstructive-restorative stage after operations of the Hartmann type]. Povolzh Onkol Vestn. 2015;(4):43-46.
  10. Baek SJ, Kim SH, Lee CK, Roh KH, Keum B, Kim CH, et al. Relationship between the severity of diversion colitis and the composition of colonic bacteria: a prospective study. Gut Liver. 2014 Mar; 8(2):170-76. doi: 10.5009/gnl.2014.8.2.170.
  11. Zarnescu EC, Zarnescu NO, Costea R, Rahau L, Neagu S. Morbidity after reversal of Hartmann operation: retrospective analysis of 56 patients. J Med Life. 2015 Oct-Dec; 8(4):488-91.
  12. Son DN, Choi DJ, Woo SU, Kim J, Keom BR, Kim CH, et al. Relationship between diversion colitis and quality of life in rectal cancer. World J Gastroenterol. 2013 Jan 28; 19(4):542-49. doi: 10.3748/wjg.v19.i4.542.
  13. Groshilin VS, Sultanmuradov MI, Moskovchenko AN, Petrenko NA. Sovremennye aspekty profilaktiki oslozhnenii posle obstruktivnykh rezektsii distal’nykh otdelov tolstoi kishki [Modern aspects of preventing complications after obstructive resections of the distal colon]. Fundam Issledovaniia. 2013;(9-1):24-27.
  14. Malakhov YP, Lysenko MV. Rekonstruktivnye operatsii na levoi polovine obodochnoi kishki posle radikal’nykh vmeshatel’stv po povodu ee ostroi opukholevoi obstruktsii [Reconstructive surgery on the left side of the colon after radical interventions for her acute tumor obstruction]. Voen-Med Zhurn. 2006; 327(8):20-27.
  15. Tan WS, Lim JF, Tang CL, Eu KW. Reversal of Hartmann’s procedure: experience in an Asian population. Singapore Med J. 2012 Jan;53(1):46-51.
Address for correspondence:
420012, Russian Federation,
Republic of Tatarstan,
Kazan, Butlerova str., 49,
FSBEE HE “Kazan State Medical University”,
Department of Oncology, Radiation
Diagnosis and Radiation Therapy,
tel.: +927 429-96-71,
e-mail: drvasiliy21@gmail.com
Information about the authors:
Akhmetzyanov F.Sh. MD, Professor, Head of Department of Oncology, Radiation Diagnosis and Radiation Therapy, FSBEE HE “Kazan State Medical University”, Head of medical-diagnostic building N2 of the Republican Clinical Oncology Center of the Ministry of Health of the Republic of Tatarstan, an employee of department for the development of current and prospective methods of treatment of neoplastic diseases of Volga Federal Branch of N.N. Blokhin Russian Cancer Research Center of the Ministry of Health of RF.
Egorov V.I. PhD, Assistant of Department of Oncology, Radiation Diagnosis and Radiation Therapy of FSBEE HE “Kazan State Medical University”, oncologist of the Republican Clinical Oncology Center of the Ministry of Health of the Republic of Tatarstan.

ANESTESIOLOGY-REANIMATOLOGY

S.A. TACHYLA

PREDICTORS FOR THE DEVELOPMENT OF MULTIPLE ORGAN DYSFUNCTION SYNDROME IN PATIENTS AFTER ABDOMINAL SURGERY

ME «Mogilev Regional Hospital», Mogilev
The Republic of Belarus

Objectives. To determine the diagnostic value of clinical and laboratory findings in patients within the first 24 hours after the abdominal surgery as a predictive factor for prognosis of multiple organ dysfunction syndrome (MODS) development.
Methods. A prospective case-control study in patients (n=157) was carried out, which identified a number of clinical and laboratory findings within the first day after the abdominal surgery. Two groups were singled out: the first one (n=88) – without any symptoms of MODS, the second (n=69) – with the presence of MODS.
Results. It was revealed that the patients in the second group had a significant increase in heart rate variability (p=0.005), a reduction of mean arterial pressure (p=0.045), and oxygenation index (p=0.001). Diuresis in patients did not differ between the groups, but urea and creatinine levels were significantly increased in the second group (p<0.001). A reduction of total protein (p=0.007) and cholesterol (p=0.029) reflecting the change in metabolism was registered in the second group.
The analysis of the characteristic curves showed that SOFA scores (area under the curve [AUC]): 0.857; 95% confidence interval [CI]: 0.773-0.941; ð<0.001) and Apache III: (AUC 0.83; 95% CI 0.734-0.916; ð<0.001) seemed to have a better predictive value concerning MODS. A high predictive efficiency has been expressed in results of the comparative analysis: oxygenation index (AUC 0.717; 95% CI 0.621-0.813; ð=0.001) and cholesterol level (AUC 0.724; 95% CI 0.667-0.782; ð<0.001). Total protein level is an indicator of an average diagnostic efficacy (AUC 0.65; 95% CI 0.549-0.746; ð=002). Elevated C-reactive protein test has not been shown to be a marker for the development of MODS in the first 24 hours after the abdominal surgery.
Conclusion. The SOFA score is shown to have advantages in comparison with Apache III scale of MODS, because the total maximum SOFA score can be easily calculated. Patients after abdominal surgery on admission to the intensive care unit are needed to determine the value of oxygenation index. Due to the cheapness and technical simplicity of total cholesterol level it can be used as a screening of MODS.

Keywords: multiple organ dysfunction syndrome, predictors, oxygenation index, cholesterol, total protein, C-reactive protein, abdominal surgery
p. 494-502 of the original issue
References
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  15. Ho KM, Lee KY, Dobb GJ, Webb SA. C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a prospective cohort study. Intensive Care Med. 2008 Mar;34(3):481-87.
Address for correspondence:
212016, Republic of Belarus,
Mogilev, Belyinitskogo-Biruli str., 12,
ME «Mogilev Regional Hospital»,
Unit of Anesthesiology and Reanimation,
tel./fax: 375 222 50-08-81,
e-mail: tsa80@inbox.ru,
Sergey A. Tachyla
Information about the authors:
Tachyla S.A., PhD, Anesthetist-Resuscitator of ME «Mogilev Regional Hospital».

INFORMATION TECHNOLOGIES IN SURGERY

S.E. KATORKIN, A.V.KOLSANOV, S.A.BYSTROV, P.M.ZELTER, I.S.ANDREEV

VIRTUAL 3-D MODELING IN SURGICAL TREATMENT OF CHRONIC PANCREATITIS

FSBEE HE “Samara State Medical University”, Samara
The Russian Federation

Objectives. To study the effectiveness of color 3-D modeling on the basis of data analysis of multidetector computed tomography when performing the subtotal resection of the pancreas head in chronic pancreatitis.
Methods. In the study the patient was enrolled with a diagnosis of chronic pancreatitis with enlargement of the major pancreatic duct, cysts of the pancreas head, obstructive jaundice. The case-history had an alcohol abuse. For 5 years, he was suffering from constant shingles in the epigastrium. 10 days before hospitalization the patient began to note the yellowish discoloration of the skin. A multidetector computed tomography with bolus contrasting before and after the operation was performed. Based on the obtained data in the program “Autoplan”, which was created in the Center for Breakthrough Studies of the FSBEE HE “Samara State Medical University”, a preoperative color 3-D model of the surgical intervention area was created, which was tested intraoperatively.
Results. According to this 3-D model, the patient was identified three cysts in the head of the pancreas, unrelated, a significant expansion of the major pancreatic duct, marked bilious hypertension with the expansion of common bile duct and common hepatic duct. For the purpose of biliary decompression, the percutaneous transhepatic cholangiostoma was applied. The duodenum-preserving subtotal resection of the pancreas head with the longitudinal pancreatojejunostomy was performed, and hepaticojejunoanastomosis was formed on the Roux-en-Y. The data of the preoperative model were confirmed intraoperatively, and all three cysts were eliminated. The postoperative period proceeded without complications. The patient was discharged on the 14th day in a satisfactory condition. To assess the adequacy of the scope of the surgical intervention, a postoperative color 3-D model was also constructed. The postoperative 3-D model did not reveal any pathological formations in the pancreas.
Conclusions. 3-D modeling provides a surgeon with the reliable topographic and anatomical information about the organs of the hepatobiliopancreatoduodenal region. 3-D reconstruction improves the chances for success of the operation and reduces the risk of postoperative complications. Postoperative 3-D modeling allows estimating the adequacy of the volume of the performed surgical intervention.

Keywords: chronic pancreatitis, pancreatectomy, computed tomography, 3-D modeling, surgical planning
p. 503-509 of the original issue
References
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Address for correspondence:
443079, Russian Federation,
Samara, Karla Marksa Ave., 165«b»,
Clinic of FSBEE HE “Samara
State Medical University”,
Department and Clinic of Hospital Surgery,
tel. office: +7 846 276-77-89,
e-mail: katorkinse@mail.ru,
Sergey E. Katorkin
Information about the authors:
Katorkin S.E., PhD, Associate Professor, Head of the Department and Clinic of Hospital Surgery of FSBEE HE “Samara State Medical University”.
Kolsanov A.V., MD, Professor, Head of the Department of Operative Surgery and Clinical Anatomy with the Course of Innovative Technologies of FSBEE HE “Samara State Medical University”, Director of the Institute of Innovative Development of “Samara State Medical University”, Supervisor of the Center of Breakthrough Research “Information technology in medicine.”
Bystrov S.A., PhD, Associate Professor, Head of the Surgical Unit of the Clinic of Hospital Surgery of FSBEE HE “Samara State Medical University”.
Zelter P.M., PhD, Assistant of the Department of Radiation Diagnostics and Radiation Therapy with the Course of Medical Informatics of FSBEE HE “Samara State Medical University”.
Andreev I.S., PhD, Surgeon of the Surgical Unit of the Clinic of Hospital Surgery of FSBEE HE “Samara State Medical University”.

REVIEWS

Î.À. GOVORUKHINA

CURRENT DIAGNOSIS AND TREATMENT OF HIRSCHSPRUNG’S DISEASE IN CHILDREN

SE “Republican Scientific and Practical Center of Pediatric Surgery”, Minsk,
The Republic of Belarus

The paper reviews recent studies that evaluate the present-day concept concerning Hirschsprung’s disease in children as well as current diagnostic and treatment methods of this pathology.
Hirschsprung’s disease is a relatively common disease in the pediatric surgery. The literature analysis has shown that if the pathogenesis of the disease is no longer considered controversial entity, the application of new methods of examination and surgical treatment still remains complex and ambiguous. The use of one or another method of diagnosis and treatment is thought to be determined mainly by the possibilities and preferences of medical establishment. At the same time, the functional results of surgical treatment leave much to be desired due to the absence of clearly defined terms for surgical correction of the defect, as well as the unresolved issues of choice of operative treatment method appropriated for each specific child.
The analysis of the literature data has shown the possibility of solving these problems by developing a rational program of examination, taking into account all existing complications and determining the appropriate treatment tactics.
Radical one-stage surgical treatment of Hirschsprung’s disease with the use of minimally invasive methods is becoming more widespread. Current surgical methods for treating Hirschsprung’s disease in infant and young children are essential in reducing morbidity and mortality associated with this disease.

Keywords: Hirschsprung’s disease, agangliosis, colon, enterocolitis, transanal endorectal pull-through, postoperative complications, mortality
p. 510-517 of the original issue
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  18. Nasr A, Langer JC. Evolution of the technique in the transanal pull-through for Hirschsprung’s disease: effect on outcome. J Pediatr Surg. 2007 Jan;42(1):36-9; discussion 39-40.
  19. Georgeson KE, Robertson DJ. Laparoscopic-assisted approaches for the definitive surgery for Hirschsprung’s disease. Semin Pediatr Surg. 2004 Nov;13(4):256-62.
  20. Cobellis G, Noviello C, Cruccetti A, Romano M, Mastroianni L, Amici G, et al. Staged laparoscopic-assisted endorectal pull-through for long segment Hirschprung’s disease and total colonic aganglionosis. Minerva Pediatr. 2011 Jun;63(3):163-67.
  21. Bradnock TJ, Walker GM. Evolution in the management of Hirschsprung’s disease in the UK and Ireland: a national survey of practice revisited. Ann R Coll Surg Engl. 2011 Jan; 93(1): 34-38. doi: 10.1308/003588410X12771863936846.
  22. Huang EY, Tolley EA, Blakely ML, Langham MR. Changes in hospital utilization and management of Hirschsprung disease: analysis using the kids’ inpatient database. Ann Surg. 2013 Feb;257(2):371-7. doi: 10.1097/SLA.0b013e31827ee976.
  23. Niramis R, Watanatittan S, Anuntkosol M, Buranakijcharoen V, Rattanasuwan T, Tongsin A, et al. Quality of life of patients with Hirschsprung’s disease at 5 - 20 years post pull-through operations. Eur J Pediatr Surg. 2008 Feb;18(1):38-43. doi: 10.1055/s-2008-1038325.
Address for correspondence:
220013, Republic of Belarus,
Minsk, Nezavisimost Ave., 64,
SI «Republican Scientific
and Practical Center for Pediatric Surgery»,
Tel.: +375 29 1696581,
E-mail: govorukhina@mail.ru
Olga A. Govorukhina
Information about the authors:
Govorukhina O.A. PhD, Ass. Professor, Head of Department of Surgical Diseases N 2, SE “Republican Scientific and Practical Center of Pediatric Surgery”.

I.N. KLIMOVICH, S.S. MASKIN, P.V. ABPAMOV

DIAGNOSIS AND TREATMENT OF SYNDROME OF INTESTINAL INSUFFICIENCY IN ACUTE BLEEDING FROM UPPER GASTROINTESTINAL TRACT

FSBEE HE “Volgograd State Medical University”, Volgograd,
The Russian Federation

Acute massive bleeding from the gastroduodenal zone leads to the development of the syndrome of intestinal insufficiency (SII), due to ischemia/reperfusion injury of the intestinal wall. Violation of the barrier functions of the intestinal wall causes a massive inflow of the toxins from the intestine to the portal circulation and intestinal lymphatic collector that triggers multiple organ failure. As a result the issue of early diagnosis of the SII arises urgently, which currently represent a wide range of invasive biochemical studies, studying of myoelectric parameters and sonography data. However, taking into consideration the complicated, multilateral nature of the pathogenesis of intestinal insufficiency, it is extremely difficult to differentiate the most informative one. At a result, in the clinical practice there is no established strategy of SII treatment in the gastrointestinal bleeding (GIB). The main tendencies of SII therapy are limited by intraintestinal detoxification and correction of oxidative stress. This explains a large number of experimental studies in which using the modeling of hemorrhagic hypotension and intestinal ischemia/reperfusion lesions, the possibilities of supporting its secretory and kinetic functions, the correction of metabolic disorders and regenerating mechanisms, the enhancement of antioxidant and anti-inflammatory abilities are studied.
However, despite the large arsenal of experimental and clinical investigations, the issues of early detection and etiopathogenetic treatment of SII are far from being solved and require further study.

Keywords: syndrome of intestinal insufficiency, gastrointestinal bleeding, ischemia, diagnostics of intestinal insufficiency, treatment of intestinal insufficiency, intestinal wall
p. 518-524 of the original issue
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Address for correspondence:
400131, Russian Federation,
Volgograd, Fallen Fighters Sq., 1,
FGBOU VO «Volgograd State
Medical University»,
department of Hospital Surgery,
Tel.: + 905 336-23-69,
E-mail: klimovichigor1122@yandex.ru
Igor N. Klimovich
Information about the authors:
Klimovich I.N., MD, Associate Professor of the Hospital Surgery Department of FSBEE HE “Volgograd State Medical University”.
Maskin S.S., MD, Professor, Head of the Hospital Surgery Department of FSBEE HE “Volgograd State Medical University”.
Abramov P.V., Post-Graduate Student of the Hospital Surgery Department of FSBEE HE “Volgograd State Medical University”.

CASE REPORTS

S.N. YERMASHKEVICH1, M.M.KANDZERSKI2, V.I. PETUKHOV1, V.P.BULAUKIN1, M.I.KUHAYEU1, A.V.HARBUNOV2, S.G.BELAVUSAU2, M.O.RUSETSKAYA1, A.I.YANKOYSKI2, Y.S.PODOLINSKY2, M.V.KUNTSEVICH1

GASTRO-PULMONARY FISTULAS AT LEFT-SIDE TRAUMATIC DIAPHRAGMATIC HERNIA

EE “Vitebsk State Medical University” 1,
ME “Vitebsk Regional Clinical Hospital” 2, Vitebsk,
The Republic of Belarus

Gastro-pulmonary fistulas are extremely rare. The article describes a clinical case of the gastro-pulmonary fistulas complicating a left-side traumatic diaphragmatic hernia and resulted in the development the lower lobe gangrene of the left lung and sepsis.
41-year-old man 6 years after a penetrating stab injury to the left-side of the chest, cured by the tube thoracostomy, had pains in the left side of the lower part the chest and in the left hypochondrium, cough with expectoration of muco-purulent sputum streaked with blood, the body temperature increased up to 38°C. Chest X-ray, ultrasound and computed tomography of the abdomen showed subdiaphragmatic abscess and the destruction of the lower lobe of the left lung. After the puncture with the ultrasound-guided draining, the air vent was registered. The correct diagnosis was made 1,5 months after clinical onset of the disease as a result of a repeated magnetic resonance imaging. The patients underwent the anterolateral thoracotomy in the fifth intercostal space on the left-side with the resection of V ribs and the intersection of the left costal arch, uncoupling the gastro-pulmonary fistulas, the closure of the defect of the diaphragm, the lower lobectomy. The patient was discharged in a satisfactory condition 2 weeks after the surgery.
The analysis of the case and the literature review on the etiology, diagnosis and treatment of gastro-pulmonary fistulas are presented.

Keywords: diaphragm, stomach, lung, gastro-pulmonary fistula, traumatic diaphragmatic hernia, lung gangrene, sepsis
p. 525-534 of the original issue
References
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Address for correspondence:
210023, Republic of Belarus,
Vitebsk, Frunze Ave., 27,
EE “Vitebsk State Medical University”,
Department of Hospital Surgery
with Urology and Pediatric Surgery Courses,
tel. mob.: 375 29 731-55-16,
e-mail: ermashkevich_sn@tut.by,
Sergey N. Yrmashkevich
Information about the authors:
Yermashkevich S.N. PhD, Ass. Professor of Department of Hospital Surgery with Urology and Pediatric Surgery Courses, EE ‘’Vitebsk State Medical University’’.
Kandzerski N.M. Head of Thoracic Purulent Surgical Unit, ME ‘’Vitebsk Regional Clinical Hospital’’.
Petukhov V.I. MD, Head of Surgery Department of the Faculty of Advanced Training and Retraining, EE ‘’Vitebsk State Medical University’’.
Bulaukin V.P. PhD, Ass. Professor of the Surgery Department of the Faculty of Advanced Training and Retraining, EE ‘’Vitebsk State Medical University’’, Head of the Republican Scientific and Practical Center “Infection in Surgery”.
Kuhayeu M.I. PhD, Assistant of the Surgery Department of the Faculty of Advanced Training and Retraining, EE ‘’Vitebsk State Medical University’’.
Harbunov A.V. Deputy Chief Physician on Surgery, ME ‘’Vitebsk Regional Clinical Hospital’’.
Belavusau S.G. Surgeon of the Unit of Purulent Surgery, ME ‘’Vitebsk Regional Clinical Hospital’’.
Rusetskaya M.O. PhD, Ass. Professor of the Hospital Surgery Department with Urology and Pediatric Surgery Courses, EE ‘’Vitebsk State Medical University’’.
Yankoyski A.I. Surgeon of the Unit of Purulent Surgery of ME ‘’Vitebsk Regional Clinical Hospital’’.
Podolinsky Y.S. Surgeon of the Unit of Purulent Surgery, ME ‘’Vitebsk Regional Clinical Hospital’’.
Kuntsevich M.V. Post-Graduate Student of the Hospital Surgery Department with Urology and Pediatric Surgery Courses, EE ‘’Vitebsk State Medical University’’.

EXCHANGE OF EXPERIENCE

À.À. DMITRIENKO 1, V.V.ANICHKIN 2, À.À. TRETYAKOV 2, M.F.KUREK 2, À.Y. MAKANIN 1

SURGICAL CORRECTION OF FOOT DEFORMITY IN CHARCOT OSTEOARTHROPATHY

SME “Gomel City Clinical Hospital ¹3” 1,
EE “Gomel State Medical University” 2, Gomel
THE Republic of Belarus

Objectives. To analyze the first experience of the reconstructive surgery in patients with Charcot joint.
Methods. Treatment results of 4 patients with Charcot joint (diabetic neurogenic arthropathy) who were performed the reconstructive surgery aimed to correct osteoarticular foot deformities. Charcot joint diagnostics was based on the results of clinical and radiological studies (direct radiography, computed tomography). In the treatment of patients, the technique of arthrodesis of the destructed foot joints was used with the stabilization of by the external fixators or using the techniques of focal (osteal and transosseous) osteosynthesis (internal fracture fixation).
Results. It is established that when the destruction is located in the ankle joint area, the method of choice of the surgical correction of the foot deformation in the acute phase of diabetic neurogenic arthropathy is arthrodesis of the joint with the external fixation with the compression-distraction apparatus; in the chronic phase of neurogenic arthropathy – arthrodesis of the joint using internal fracture fixation with a metal plate with angular stability of screws. When the destruction zone is located in the middle part of the foot in the chronic phase of the disease, the method of choice of the surgical correction is arthrodesis of the tarsal joints with the internal fixation with the metal wires. In all 4 patients, the performed surgical interventions resulted in the improvement of the anatomical and functional characteristics of the foot and there was no need to use complex orthopedic footwear while resting on the limb and walking, and one managed to avoid recurrences of trophic ulcers on the foot during the entire period of the postoperative follow-up.
Conclusions. The issue of using various methods of orthopedic correction of the foot deformity is relevant in the surgery of the diabetic foot syndrome (DFS) and should be considered individually, taking into account such factors as: the stage of the disease, localization and prevalence of the bone-joint destruction zone, the severity of foot deformity, the presence of foci of purulent inflammation and trophic ulcers as well as the patient’s somatic status.

Keywords: diabetic foot syndrome, Charcot joint, neurogenic arthropathy, foot deformity, arthrodesis of the joints, foot trophic ulcer
p. 535-542 of the original issue
References
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  4. Pavliuchenko SV, Zhdanov AI, Orlova IV. Sovremennye podkhody k khirurgichekomu lecheniiu neiroosteoartropatii Sharko (obzor literatury) [Modern approaches to the surgical treatment of neuro-osteoarthropathy of Charcot (a review of the literature)]. Travmatologiia i Ortopediia Rossii. 2016;22(2):114-23.
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  12. Belczyk RJ, Rogers LC, Andros G, Wukich DK, Burns PR. External fixation techniques for plastic and reconstructive surgery of the diabetic foot. Clin Podiatr Med Surg. 2011 Aug;28(4):649-60. doi: 10.1016/j.cpm.2011.07.001.
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Address for correspondence:
246013, Republic of Belarus,
Gomel, Ilicha str., 286,
SME “Gomel City Clinical Hospital ¹3”,
Surgical Unit ¹3,
tel. 375 44 780-19-50,
e-mail: dmitrienko-83@mail.ru,
Anatoly A. Dmitrienko
Information about the authors:
Dmitrienko A.A. Deputy Chief Physician on Medical Affairs, SME ‘’Gomel City Clinical Hospital N3’’.
Anichkin V.V. MD, Professor of Department of Surgical Diseases N3, EE ‘’Gomel State Medical University’’.
Tretyakov A.A. Assistant of Department of Traumatology, Orthopedics, Military Field Surgery, EE ‘’Gomel State Medical University’’.
Kurek M.F. PhD, Ass. Professor of Department of Surgical Diseases N1, EE ‘’Gomel State Medical University’’.
Makanin A.Y. Head of Surgical Unit N3, SME ‘’Gomel City Clinical Hospital N3’’.

K.N.ZHANDAROV1, S.V.ZHDONETS1, K.S.BELYUK2, V.A.MITSKEVICH1, YU.F.PAKULNEVICH1

TRANSANAL ENDOSCOPIC MICROSURGERY OF RECTAL TUMORS

ME “Grodno Regional Clinical hospital” 1,
EE “Grodno State Medical University” 2, Grodno,
The Republic of Belarus

Objectives. To improve the methods of transanal endoscopic microsurgery (TEM) of the rectal neoplasms increasing the radicalism of surgical treatment and to reduce the incidence of complications and recurrences.
Methods. The analysis of the results of transanal surgeries (n=44) performed due to the large villous benign tumors and polyps with a wide base (39), rectal cancer (n=4; T1-T2NxMo) on the background of recurrent malignant polyp has been conducted. Transanal total mesorectumectomy (n=1) was performed in combination with laparoscopy and sigmorectal anastomosis.
Results. No intraoperative complications were registered. The postoperative bed-day was 6.8±1.2 days in the study group. In the early incisional period, after removing the neoplasms the defects in the rectal wall was closed with suture, the evidence of edema in 33 (76%) patients at the site of wall closure (which had gone down completely by the 7th-8th days) was detected during control rectoscopy. 4 patients who had been operated on villous tumors of low localization, the dehiscence of intestinal wall suture had been already registered by the 2nd-4th days afterward.
In the long-term postoperative period, complications requiring surgical correction appeared in 3 (6.8%) patients (cicatricial stenosis-1, tumor recurrence-2), who have been successfully performed the repeated interventions with the use of TEM. Within 2 years no signs of both local recurrent and metastatic disease spread to the lungs and to the liver were revealed in the patient after transanal mesorectumectomy with laparoscopy. In the remaining 31 (70.5%) patients, the outcomes of surgical treatment are regarded as good and satisfactory.
Conclusion. The transanal endoscopic microsurgery is accepted as an effective alternative method for large rectal adenomas of any type of growth. Minimally invasive surgeries with the SILS system are possible to perfom throughout the rectum; since they possess a number of advantages and there is minimal risk of complications and recurrences.

Keywords: transanal endoscopic microsurgery, SILS-port, rectal tumors, rectoscopy, complications, recurrences, mortality
p. 543-552 of the original issue
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  8. Zhandarov KN, Zhdonets SV, Beliuk KS, Mitskevich VA, Pakul’nevich IuF. TEM dobrokachestvennykh i zlokachestvennykh novoobrazovanii priamoi kishki [TEM of benign and malignant neoplasms of the rectum]. Novosti Khirurgii. 2017;25(1):78-86. doi:10.18484/2305-0047.2017.1.78.
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Address for correspondence:
230006, Republic of Belarus,
Grodno, Gorkogo str., 80,
EE «Grodno state medical university»,
Department of Surgical Diseases ¹1,
tel. mob.: 375 29 78-19-403,
e-mail: BelyukKS@yandex.ru,
Konstantin S. Belyuk
Information about the authors:
Zhandarov K.N. MD, Professor.
Zhdonets S.V. Physician, ME “Grodno Regional Clinical hospital”.
Belyuk K.S. PhD, Assistant of the Surgical Diseases Department N1, “Grodno State Medical University”.
Mitskevich V.A. Physician, ME “Grodno Regional Clinical hospital”.
Pakulnevich Y.F. Physician, Head of Proctology and Purulent Surgery Department, ME “Grodno Regional Clinical hospital”.
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