Novosti
Khirurgii
This journal is
indexed in Scopus









Year 2020 Vol. 28 No 3

SCIENTIFIC PUBLICATIONS
GENERAL & SPECIAL SURGE

DOI: https://dx.doi.org/10.18484/2305-0047.2020.3.249   |  

K.S. KOBELEV 1, D.D. DOLOTOVA 2, O.V. MIDLENKO 1, N.I. BELONOGOV 1, V.I. MIDLENKO 1

INVESTIGATION OF RISK FACTORS OF THE DERMAL BURN WOUND CONVERSION

Ulyanovsk State University 1 , Ulyanovsk,
"Gammamed-Soft", Ltd 2, Moscow,
The Russian Federation

Objective. The present study is focused on risk factors of burn wound conversion in the local treatment with DDBM (dressing, dressing, Breitman-Menzul) dressing material in comparison with routine treatment based on gauze bandages with iodophors.
Methods. During the research work, we used retrospective data of 281 patients with second-degree burn injuries. The group was divided into two: those who were treated with DDBM dressing (n=130), and those who were treated with gauze bandages with iodophors (n=151). Patients were included in this study if: 1) their age was over 18; 2) they had II degree burns without scab; 3) admission was not later than 3 days after trauma; 4) predominance of II degree burns in case of its combination with full-thickness skin burns (III degree). A predictive model of burn wound conversion was designed with logistic regression.
Results. The analysis showed that usage of DDBM dressing led to wound epithelialization on 15th [13; 17] day and to the reduction of burn conversion frequency by 28% in comparison with the treatment with gauze bandages with iodophors. Body mass index was found to be a highly significant predictor: risk of wound conversion tended to increase strongly for patients with body mass index over 29.5 kg/m2. A set of such variables as the location of burns on the back of the body and buttocks, body mass index, and treatment method allowed development of a binary regression model with high sensitivity and specificity (97.2% and 99.5%, respectively).
Conclusions. The study identified the advantages of local treatment with DDBM in comparison with iodophors gauze bandages. The developed predictive model allowed calculating the probability of burn wound conversion with high accuracy.

Keywords: burn wound conversion, dermal burns, moist wound healing, film dressing, predictive model
p. 249-257 of the original issue
References
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Address for correspondence:
432071, Russian Federation,
Ulyanovsk, Ryleev str., 30/30,
Ulyanovsk State University,
Institute of Medicine, Ecology and Physical Culture, the Department of Hospital Surgery,
Anesthesiology, Resuscitation, Urology,
Traumatology and Orthopedics,
tel. mobile: +79603686624,
e-mail: kskobelev78@mail.ru,
Kobelev Konstantin S.
Information about the authors:
Kobelev Konstantin S., Post-Graduate Student of the Department of Hospital Surgery, Anesthesiology, Resuscitation, Urology, Traumatology and Orthopedics, Institute of Medicine, Ecology and Physical Culture, Ulyanovsk State University, Traumatologist-Orthopedist of the Highest Category, Burn Department Employee, Central City Clinical Hospital, Ulyanovsk, Russian Federation.
http://orcid.org/0000-0002-0817-8175
Dolotova Daria D., PhD, Leading Researcher, Gammamed-Soft, Ltd, Moscow, Russian Federation.
https://orcid.org/0000-0002-5538-1109
Midlenko Oleg V., MD, Professor of the Department of Hospital Surgery, Anesthesiology, Resuscitation, Urology, Traumatology and Orthopedics, Institute of Medicine, Ecology and Physical Culture, Ulyanovsk State University, Ulyanovsk, Russian Federation.
https://orcid.org/0000-0001-8076-7145
Belonogov Nikolaj I., MD, Professor of the Department of Hospital Surgery, Anesthesiology, Resuscitation, Urology, Traumatology and Orthopedics, Institute Of Medicine, Ecology and Physical Culture, Ulyanovsk State University, Ulyanovsk, Russian Federation.
https://orcid.org/0000-0002-6064-9384
Midlenko Vladimir I., MD, Professor, Head of the Department of Hospital Surgery, Anesthesiology, Resuscitation, Urology, Traumatology and Orthopedics, Institute of Medicine, Ecology and Physical Culture, Ulyanovsk State University, Ulyanovsk, Russian Federation.
http://orcid.org/0000-0003-4358-8484
DOI: https://dx.doi.org/10.18484/2305-0047.2020.3.258   |  

A.B. SANNIKOV 1, 2, E.V. SHAJDAKOV 3, V.M. EMELYNENKO 2, I.V. DROZDOVA 1, Y.A. DEMIDENKO 1

ON THE POSSIBILITY OF USING THE ADHESIVE COMPOSITION SULFACRYLATE FOR OBLITERATION OF VARICOSE VEINS OF THE LOWER EXTREMITIES

Medical Center Palitra 1, Vladimir,
N.I.Pirogov Russian National Research Medical University of the Ministry of Health 2, Moscow,
N.P. Bekhterev Institute of the Human Brain, RAS 3, St. Petersburg,
The Russian Federation

Objective. To conduct clinical experimental studies on the use of cyancrylate glue Sulfacrylate (produced in Russia) for obliteration the lower extremities varicose veins in humans.
Methods. Endovascular catheter obliteration of the tributaries and main trunks of the great saphenous vein on the tibia was performed in 15 patients with varicose disease (C2 to CEAR) in order to substantiate the possibility of using the adhesive compound Sulfacrylate. Pain severity was clinically evaluated as well as presence or absence of phlebitis and thrombophlebitis, hyper pigmentation, neurological disorders, allergic reaction. Ultrasound control was carried out at various terms, starting from the 3rd day up to 6 months. Histological study of morphological changes was carried out selectively.
Results. All patients after the introduction of the glue Sulfacrylate had a clinic of moderate phlebitis, without the formation of blood clots in the lumen of the vein. No local or general allergic reaction was observed. Starting from the 7th day occluded venous segments were palpated in the form of moderate density bands without any infiltration of the surrounding tissues. In the absence of blood flow ultrasound examination showed gradual biodegradation of the adhesive strip inside the vein with the development of complete obliteration of the lumen starting from the 4th month. Starting from the 7th day aseptic inflammation in the wall of the vein was observed on histological examination which gradually stopped. Monocytic infiltration of the venous wall with the formation of multinucleated cells of foreign bodies was present until the complete biodegradation of the glue. The process of diffuse growth of connective tissue with the presence of fibroblasts from the subendothelium and in the middle shell was most actively observed in histological material from 90 to 120 days after occlusion. Within 180 days, the lumen of the veins occluded by "Sulfacrylate" was completely obliterated by mature connective tissue, in the absence of glue particles, which indicated its complete biodegradation.
Conclusions. The experimental studies conducted with the assessment of clinical symptoms, ultrasound examination and histological study of morphogenesis in the lumen of blood vessels in different periods up to 6 months allow us to conclude the potential use of the adhesive compound Sulfacrylate for endovasal obliteration of varicose veins in humans.

Keywords: cyanoacrylate embolization, non-thermal obliteration, non-tumescent obliteration, endovenous cyanoacrylate obliteration, varicose veins, cyanoacrylate medical glue "Sulfacrylate"
p. 258-267 of the original issue
References
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Address for correspondence:
600031, Russian Federation.,
Vladimir, Dobroselskaya str., 36b,
Medical Center Palitra,
tel.: 8(999) 776-47-73,
-mail: aliplast@mail.ru,
Sannikov Alexander B.
Information about the authors:
Sannikov Alexander B., PhD, Head of the Surgical Department of the Medical Center Palitra, Vladimir, Associate Professor of the Department of Continuing Education of Health Professionals, N.I.Pirogov Russian National Research Medical University of the Ministry of Health, Moscow, Russian Federation.
https://orcid.org/0000-0003-1792-2434
Drozdova Irina V., Functional Diagnostics Physician of the Medical Center Palitra, Vladimir, Russian Federation.
https://orcid.org/0000-0002-2430-053X
Demidenko Yaroslav A., PhD, Head Physician of the Medical Center Palitra, Vladimir, Russian Federation.
https://orcid.rg/0000-0002-7944-1516
Shajdakov Evgeny V., MD, Professor, N.P. Bekhterev Institute of the Human Brain, RAS, St. Petersburg, Russian Federation
https://orcid.org/0000-0002-7260-4968
Emelynenko Vladimir M., MD, Professor, Head of the Professor of the Department of Continuing Education of health Professionals, N.I. Pirogov Russian National Research Medical University of the Ministry of Health, Moscow, Russian Federation.
https://orcid.org/0000-0003-0909-1693

TRANSPLANTOLOGY

DOI: https://dx.doi.org/10.18484/2305-0047.2020.3.268   |  

A.V. VATAZIN, A.B. ZULKARNAEV, V.A. STEPANOV

A PERSPECTIVE APPROACH TO THE TISSUE COMPATIBILITY ASSESSMENT OF A DONOR AND A RECIPIENT DURING CADAVERIC KIDNEY TRANSPLANTATION

Moscow Regional Research Clinical Institute named after M.F. Vladimirskiy, Moscow,
The Russian Federation

Objective. To perform a multiple factor analysis of the impact of the epitope mismatche number on the renal transplant survival.
Methods. An observational retrospective cohort study including 824 adult kidney graft recipients was performed.
Results. All recipient donor pairs had human leukocyte antigen mismatches. Significant risk factors for graft loss in the preassigned multivariate model were as follows: HLA MM (1 HR 1; 2 HR 1.24 [95% confidence interval 95% CI 0.7; 2.15], p=0.344; 3 HR 1 , 48 [95% CI 0.86; 2.33], p=0.251; 4 HR 1.88 [95% CI 1.32; 2.52], p<0.001; 5 HR 2.41 [95 % CI 2; 2.93], p<0.001; 6 HR 2.98 [95% CI 2.59; 3.46], p<0.001) p<0.001; duration of HR conservation 1.08 per hour [95% CI 1.02; 1.16], p=0.01; panel-reactive antibodies value (PRA) HR 1.24 per every 10% [95% CI 1.06; 1.58], p=0.01; but not the type of donor, age and gender of the recipient.
When including the epitope mismatches (EpMM) in the model, significant risk factors were: EpMM (<10 HR 1; 10-19 HR 1.71 [95% CI 1.09; 2.49], p=0.021; 20-29 HR 2,11 [95% CI 1.59; 2.68], p<0.001; 30-39 HR 2.4 [95% CI 1.96; 2.86], p<0.001; 40-49 HR 2 , 59 [95% CI 2.17; 3.04], p<0.001; ≥50 HR 2.71 [95% CI 2.31; 3.15], p<0.001) p<0.001; PRA HR 1.18 for every 10% [95% CI 1.09; 1.5], p=0.007; but not the duration of conservation, donor type, age and gender of the recipient. However, HLA MM was no longer a significant risk factor for HR graft loss 1.19 [95% CI 0.88; 1.55], p=0.451
Conclusions. The number of epitope mismatches between donor phenotype and recipient phenotype remains an important factor in long-term graft survival, even in despite of some corrections of the number of HLA mismatches, the donor type and the level of pre-sensitization of the recipient.

Keywords: kidney transplantation, HLA, epitope, eplet, tissue compatibility, recipient selection
p. 268-275 of the original issue
References
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  4. Shi X, Lv J, Han W, Zhong X, Xie X, Su B, Ding J. What is the impact of human leukocyte antigen mismatching on graft survival and mortality in renal transplantation? A meta-analysis of 23 cohort studies involving 486,608 recipients. BMC Nephrol. 2018 May 18;19(1):116. doi: 10.1186/s12882-018-0908-3
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  14. Campos A, Malheiro J, Tafulo S, Santos S, Dias L, Martins S, Almeida M, Pedroso S, Henriques AC, Cabrita A. Increase of allosensitization after a kidney graft failure: Predictors and effect on retransplantation outcomes. Nefrologia. 2017 Jul-Aug;37(4):397-405. doi: 10.1016/j.nefro.2016.11.020 [Article in English, Spanish]
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  17. Dankers MK, Witvliet MD, Roelen DL, de Lange P, Korfage N, Persijn GG, Duquesnoy R, Doxiadis II, Claas FH. The number of amino acid triplet differences between patient and donor is predictive for the antibody reactivity against mismatched human leukocyte antigens. Transplantation. 2004 Apr 27;77(8):1236-39. doi: 10.1097/01.tp.0000120385.03278.28
  18. Duquesnoy RJ, Takemoto S, de Lange P, Doxiadis II, Schreuder GM, Persijn GG, Claas FH. HLAmatchmaker: a molecularly based algorithm for histocompatibility determination. III. Effect of matching at the HLA-A,B amino acid triplet level on kidney transplant survival. Transplantation. 2003 Mar 27;75(6):884-89. doi: 10.1097/01.TP.0000055101.20821.AC
Address for correspondence:
129110, Russian Federation,
Moscow, Schepkin str., 61/2, 6,
Moscow Regional Research Clinical Institute
Named after M.F. Vladimirskiy,
the Surgical Department of Kidney Transplantation,
tel. mobile +7-916-705-98-99,
e-mail:7059899@gmail.com,
Zulkarnaev Alexey B.
Information about the authors:
Vatazin Andrey V., MD, Professor, Chief Researcher of the Surgical Department of Kidney Transplantation, Moscow Regional Research Clinical Institute Named after M.F. Vladimirskiy, Moscow, the Russian Federation.
http://orcid.org/0000-0001-8497-0693
Zulkarnaev Alexey B., MD, Associate Professor, Leading Researcher of the Surgical Department of Kidney Transplantation, Moscow Regional Research Clinical Institute Named after M.F. Vladimirskiy, Moscow, Russian Federation.
http://orcid.org/0000-0001-5405-7887
Stepanov Vadim A., PhD, Senior Researcher of the Surgical Department of Kidney Transplantation, Moscow Regional Research Clinical Institute Named after M.F. Vladimirskiy, Moscow, Russian Federation.
http://orcid.org/0000-0002-0881-0599

TRAUMATOLOGY

DOI: https://dx.doi.org/10.18484/2305-0047.2020.3.276   |  

M.V. CHEPELEVA, N.M. KLIUSHIN, A.M. ERMAKOV, E.I. KUZNECOVA

LYMPHOCYTE POPULATIONS IN PATIENTS WITH PERIPROSTHETIC INFECTION OF THE HIP JOINT

National Medical Research Center of Traumatology and Orthopedics Named after Academician G.A. Ilizarov of the Ministry of Health of Russia, Kurgan,
The Russian Federation

Objective. To study the peculiarities of cell-mediated immunity in patients with periprosthetic hip joint infection depending on disease severity and according to the method of surgical intervention, subsequently used.
Methods. The values of cell-mediated immunity were studied at the preoperative stage in patients (n=66) with periprosthetic hip joint infection who were divided into three groups: group I (n=13) debridement of the infected joint with the replacement of the implant modular components; group II (n=36) articulating spacer installation; group III (n=17) resection arthroplasty. Lymphocyte subpopulations were studied by laser flow cytofluorimetry method.
Results. In comparison of the cell immunity values in groups I, II, III with those of the control group there was observed the absence of subpopulation alterations in group I, as well as the elevation of relative content of D3+D8+ for normal content of D3+D4+ in group II; the elevation of both relative and absolute values of D3+D8+ while reduction of the values of D3+D4+ in group III. The content of activated T-lymphocytes was elevated in all three groups. A Kruskal-Wallis test to analyze 3 groups revealed significant difference between the groups (I, II, III) regarding the immunoregulatory index (CD4/CD3); (H-6,67; =0,035). There was statistically significant difference between groups I-III (p=0,012) and between groups II-III (p=0,011). Intergroup difference was also identified regarding D3+D4+ (%); (H-22,57; =0,0003). Statistically significant difference was determined between groups I-III (p=0,0002) and between groups II-III (p=0,0003).
Conclusions. The alterations in lymphocyte population composition can be considered as an informative marker of severe infection. The study of T-lymphocyte subpopulations -helpers (D3+D4+) and cytotoxic T-lymphocytes (D3+D8+)) can be used to reveal immuno-compromised patients. These values can be regarded as additional diagnostic tests to select the optimal surgical treatment of periprosthetic infection.

Keywords: periprosthetic infection, hip joint, cell-mediated immunity, -helpers (D3+D4+), cytotoxic T-lymphocytes (D3+D8+)
p. 276-283 of the original issue
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  1. Kurtz SM, Lau EC, Son MS, Chang ET, Zimmerli W, Parvizi J. Are We winning or losing the battle with periprosthetic joint infection: trends in periprosthetic joint infection and mortality risk for the medicare population. J Arthroplasty. 2018 Oct;33(10):3238-45. doi: 10.1016/j.arth.2018.05.042
  2. Gomes LSM. Early Diagnosis of periprosthetic joint infection of the hip-current status, advances, and perspectives. Rev Bras Ortop (Sao Paulo). 2019 Jul;54(4):368-76. Published online 2019 Aug 20. doi: 10.1055/s-0039-1693138
  3. Izakovicova P, Borens O, Trampuz A. Periprosthetic joint infection: current concepts and outlook. EFORT Open Rev. 2019 Jul;4(7):482-94. Published online 2019 Jul 29. doi: 10.1302/2058-5241.4.180092
  4. Abblitt WP, Chan EW, Shinar AA. Risk of Periprosthetic joint infection in patients with multiple arthroplasties. J Arthroplasty. 2018 Mar;33(3):840-43. doi: 10.1016/j.arth.2017.10.024
  5. Winkler T, Trampuz A, Renz N, Perka C, Bozhkova SA. Classification and algorithm for diagnosis and treatment of hip prosthetic joint infection. Traumatology and Orthopedics of Russia. 2016;(1):33-45. doi: 10.21823/2311-2905-2016-0-1-33-45 (In Russ.)
  6. Saleh A, George J, Sultan AA, Samuel LT, Mont MA, Higuera-Rueda CA. The quality of diagnostic studies in periprosthetic joint infections: can we do better? J Arthroplasty. 2019 Nov;34(11):2737-43. doi: 10.1016/j.arth.2019.06.044
  7. Carli AV, Abdelbary H, Ahmadzai N, Cheng W, Shea B, Hutton B, Sniderman J, Philip Sanders BS, Esmaeilisaraji L, Skidmore B, Gauthier-Kwan OY, Bunting AC, Gauthier P, Crnic A, Logishetty K, Moher D, Fergusson D, Beaulé PE. Diagnostic accuracy of serum, synovial, and tissue testing for chronic periprosthetic joint infection after hip and knee replacements: a systematic review. J Bone Joint Surg Am. 2019 Apr 3;101(7):635-49. doi: 10.2106/JBJS.18.00632
  8. Saleh A, George J, Faour M, Klika AK, Higuera CA. Serum biomarkers in periprosthetic joint infections. Bone Joint Res. 2018 Jan;7(1):85-93. doi: 10.1302/2046-3758.71.BJR-2017-0323
  9. Gómez-García F, Espinoza-Mendoza RL. Whats new for the diagnosis of periprosthetic infections after the Philadelphia consensus? Acta Ortop Mex. 2019 Mar-Apr;33(2):127-35. [Article in Spanish; Abstract available in Spanish from the publisher]
  10. Chepeleva MV, Klyushin NM, Ermakov AM, Ababkov YuV. Interleukin-6 in predicting the course of postoperative period in patients with periprosthetic infection of the hip. Sib Nauch Med Zhurn. 2015;35(4):45-48. http://sibmed.net/article/360/8-4-2015.pdf (In Russ.)
  11. Heim CE, Vidlak D, Odvody J, Hartman CW, Garvin KL, Kielian T. Human prosthetic joint infections are associated with myeloid-derived suppressor cells (MDSCs): Implications for infection persistence. J Orthop Res. 2018 Jun;36(6):1605-13. doi: 10.1002/jor.23806
  12. Seebach E, Kubatzky KF. Chronic implant-related bone infections-can immune modulation be a therapeutic strategy? Front Immunol. 2019;10:1724. Published online 2019 Jul 23. doi: 10.3389/fimmu.2019.01724
  13. Preobrazhenskii PM, Kazemirskii AV, Goncharov MIu. Current views on diagnosing and treatment of patients with infection after the knee arthroplasty. Genii Ortopedii. 2016;(3):94-104. doi: 10.18019/1028-4427-2016-3-94-104 (In Russ)
  14. Lazarides AL, Vovos TJ, Reddy GB, Kildow BJ, Wellman SS, Jiranek WA, Seyler TM. Traditional laboratory markers hold low diagnostic utility for immunosuppressed patients with periprosthetic joint infections. J Arthroplasty. 2019 Jul;34(7):1441-45. doi: 10.1016/j.arth.2019.03.013
  15. Chuksina JuJu, Moscaletc OV, Jazdovskij VV, Eremin AV, Oshkukov SA. Clinical and immunological parallels in periprosthetic infection after total large joints arthroplasty. Kazan Med Zhurn. 2016;97(4):514-18. doi: 10.17750/KMJ2016-514 (In Russ.)
Address for correspondence:
640014, Russian Federation,
Kurgan, M. Ulyanova str., 6,
National Medical Research Center
of Traumatology and Orthopedics Named
after Academician G.A. Ilizarov of the Ministry
of Health of the Russian Federation,
tel. mobile: +7 912 838-42-49,
-mail: citoz@mail.ru,
Kuznecova Elena I.
Information about the authors:
Chepeleva Marina V., PhD, Senior Researcher, Scientific Clinical Laboratory of Microbiology and Immunology, National Medical Research Center of Traumatology and Orthopedics Named after Academician G.A. Ilizarov of the Ministry of Health of the Russian Federation, Kurgan, Russian Federation.
https://orcid.org/0000-0002-9731-115X
Kliushin Nicolay M., MD, professor, Head of the Clinic of Purulent osteology, National Medical Research Center of Traumatology and Orthopedics Named after Academician G.A. Ilizarov of the Ministry of Health the Russian Federation, Kurgan, Russian Federation.
https://orcid.org/0000-0002-1601- 9713
Ermakov Artem M., PhD, Traumatologist-Orthopedist, the Clinic of Purulent osteology, National Medical Research Center of Traumatology and Orthopedics Named after Academician G.A. Ilizarov of the Ministry of Health of the Russian Federation, Kurgan, Russian Federation.
https://orcid.org/0000-0002-5420-4637
Kuznecova Elena I., Junior Researcher, Scientific Clinical Laboratory of Microbiology and Immunology, National Medical Research Center of Traumatology and Orthopedics Named after Academician G.A. Ilizarov of the Ministry of Health of the Russian Federation, Kurgan, Russian Federation.
https://orcid.org/0000-0001-8022-5696

ONCOLOGY

DOI: https://dx.doi.org/10.18484/2305-0047.2020.3.284   |  

S.A. LUKYANOV 1, S.V. SERGIYKO 1, S.E. TITOV 2, 3, YU.. VERYASKINA 2

PROSPECTS OF MOLECULAR GENETIC PANELS USE IN THE PREOPERATIVE DIFFERENTIAL DIAGNOSIS OF NODULAR LESIONS OF THE THYROID GLAND

South Ural State Medical University 1, Chelyabinsk,
Institute of Molecular and Cellular Biology of Siberian Branch of RAS 2, Novosibirsk,
JSC ''Vector-Best'' 3, Novosibirsk,
The Russian Federation

Objective. To assess the possibility of a molecular genetic classifier in the preoperative thyroid cancer diagnosis using colored cytological preparations obtained during fine needle aspiration biopsy of thyroid nodes.
Methods. The results of cytological, histological and molecular genetic studies of patients (n=138) were compared. To conduct a molecular genetic study, colored glasses with cytological material from the thyroid nodes of patients were selected, the preoperative cytological conclusions corresponding to the classification of Bethesda (2017) group IV, V, and VI. All patients were operated on at the Regional Center of the Endocrine Surgery or the Regional Oncology and Nuclear Medicine Clinical Center in Chelyabinsk, where a final histological diagnosis was made. To determine agreement of preoperative cytological and postoperative histological conclusions the specimens were divided into 4 groups: a benign node; a follicular tumor without malignancy markers; papillary cancer; and a follicular tumor with malignancy markers.
Results. In thyroid cancer, the coincidence of the results of the preoperative molecular genetic and postoperative histological studies was found in 53 (94.6%) cases (a true positive result), and a discrepancy in 10 (7.2%) (a false positive result). In 72 (52.2%) cases in benign tumors, no molecular genetic markers of malignancy were detected (a true negative result), in 3 (2.2%) cases the cancer was missed (a false negative result).
The prognostic value of a positive result of a molecular genetic study was 84.1%, and the prognostic value of a negative result 96%.
Conclusions. Molecular genetic testing using commonly prepared colored smears can determine accurately the malignant and benign thyroid nodules, thereby it lets improving the quality of pre-operative differential diagnosis of the thyroid nodules and reduce the number of unreasonable operations.

Keywords: thyroid cancer, fine needle aspiration biopsy, molecular genetic study, micro-RNA, Bethesda classification
p. 284-289 of the original issue
References
  1. Beltsevich DG, Vanushko VE, Rumiantsev PO, Melnichenko GA, Kuznetsov NS, Abrosimov AYu, Polyakov VG, Mudunov AM, Podvyaznikov SO, Romanov IS, Polyakov AP, Sleptsov IV, Chernikov RA, Vorobyov SL. Fadeyev VV. 2017. Russian clinical practice guidelines for differentiated thyroid cancer diagnosis and treatment. Endokrin Khirurgiia. 2017;11(1):6-27. http://vidar.ru/Article.asp?fid=ESR_2017_1_6 (In Russ.)
  2. Ali S, Cibas E, eds. The Bethesda System for Reporting Thyroid Cytopathology: Definitions, Criteria, and Explanatory Notes. 2nd ed. New York: Springer; 2018.
  3. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer. 2007 Oct 25;111(5):306-15. doi: 10.1002/cncr.22955
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  6. Vargas-Salas S, Martínez JR, Urra S, Domínguez JM, Mena N, Uslar T, Lagos M, Henríquez M, González HE. Genetic testing for indeterminate thyroid cytology: review and meta-analysis. Endocr Relat Cancer. 2018 Mar;25(3):R163-R77. doi: 10.1530/ERC-17-0405
  7. Duick DS, Klopper JP, Diggans JC, Friedman L, Kennedy GC, Lanman RB, McIver B. The impact of benign gene expression classifier test results on the endocrinologist-patient decision to operate on patients with thyroid nodules with indeterminate fine-needle aspiration cytopathology. Thyroid. 2012 Oct;22(10):996-1001. doi: 10.1089/thy.2012.0180
  8. Titov SE, Ivanov MK, Karpinskaya EV, Tsivlikova EV, Shevchenko SP, Veryaskina YA, Akhmerova LG, Poloz TL, Klimova OA, Gulyaeva LF, Zhimulev IF, Kolesnikov NN. miRNA profiling, detection of BRAF V600E mutation and RET-PTC1 translocation in patients from Novosibirsk oblast (Russia) with different types of thyroid tumors. BMC Cancer. 2016 Mar 9;16:201. doi: 10.1186/s12885-016-2240-2
  9. Titov S, Demenkov PS, Lukyanov SA, Sergiyko SV, Katanyan GA, Veryaskina YA, Ivanov MK. Preoperative detection of malignancy in fine-needle aspiration cytology (FNAC) smears with indeterminate cytology (Bethesda III, IV) by a combined molecular classifier.J Clin Pathol. 2020 Mar 25:jclinpath-2020-206445. doi: 10.1136/jclinpath-2020-206445
  10. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2009 Nov;19(11):1159-65. doi: 10.1089/thy.2009.0274
Address for correspondence:
454092, Russian Federation,
Chelyabinsk, Vorovskii str., 64,
South Ural State Medical University,
the Department of General
and Pediatric Surgery,
tel. +7 950 744-45-95,
e-mail: 111lll@mail.ru,
Lukyanov Sergey A.
Information about the authors:
Lukyanov Sergey A., PhD, Assistant, the Department of General and Pediatric Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation.
http://orcid.org/0000-0001-5559-9872
Sergiyko Sergey V., MD, Associate Professor, Head of the Department of General and Pediatric Surgery, South Ural State Medical University, Chelyabinsk, the Russian Federation.
http://orcid.org/0000-0001-6694-9030
Titov Sergei E., PhD, Senior Researcher of the Laboratory of the Molecular Genetics, Institute of Molecular and Cellular Biologyof Siberian Branch of RAS, JSC Vector-Best, Novosibirsk, Russian Federation.
http://orcid.org/0000-0001-9401-5737
Veryaskina Yuliya A., PhD, Researcher of the Laboratory of the Molecular Genetics, Institute of Molecular and Cellular Biology of Siberian Branch of RAS Novosibirsk, Russian Federation.
http://orcid.org/0000-0002-3799-9407

ANESTESIOLOGY-REANIMATOLOGY

DOI: https://dx.doi.org/10.18484/2305-0047.2020.3.290   |  

D.P. MARKEVICH 1, A.V. MAROCHKOV 2

ANESTHESIA AND CORTISOL LEVEL IN PATIENTS WITH TRAUMATIC BRAIN INJURY DURING CRANIOTOMY

Mogilev City Emergency Hospital 1,
Mogilev Regional Hospital 2, Mogilev,
The Republic of Belarus

Objective. To analyze the serum cortisol level during the operation and in the early postoperative period in patients with traumatic brain injury to assess the effectiveness of anesthetic management methods for craniotomy.
Methods. The study included patients (n=111) with the traumatic brain injury. The patients of the 1st group (n=57) underwent to a combination of general anesthesia and cranial soft tissue nerve blockade with low-volumes of local anesthetics during craniotomy.
The patients of the 2nd group (n=58) underwent to general anesthesia. The serum cortisol was examined during the operation and within 10-12 hours after the intervention in 22 (38.6%) patients of the 1st group and 20 (37%) of patients in the 2nd group.
Results. During craniotomy in patients with cranial soft tissue nerve blockade the level of serum cortisol at the main stage of the operation and at the end of the intervention was lower than in patients of the 2nd group. In the 1st group cortisol level at the main stage of the operation was 136.4 (75; 325.4) ng/ml, and in the 2nd group 258.8 (161.7; 543.5) ng/ml, p=0.024. At the initial stage of the operation in the 1st group cortisol level was 119.6 (47.6; 327.2) ng/ml, and in the 2nd group it was 323.1 (156.9; 673.1) ng/ml, p=0.027. Difference of cortisol levels in patients of both groups 10-12 hours postoperatively have not been detected.
Conclusions. The concentration of blood cortisol was lower in patients with traumatic brain injury who received a combination of general anesthesia and cranial soft tissue nerve blockades than in patients who underwent only general anesthesia. Cranial soft tissue nerve blockades with small volumes of local anesthetics in patients with traumatic brain injury during surgery demonstrated high pain relief.

Keywords: traumatic brain injury, craniotomy, cotrisol, general anesthesia, nerve blockades
p. 290-298 of the original issue
References
  1. Shanko YG, Sidarovich RR, Tanin AL, Naledzka AN, Zurauleu UA. Epidemiology of traumatic brain injury in the Republic of Belarus. Mezhdunar Nevrol Zhurn. 2017;5(91):33-37. http://dx.doi.org/10.22141/2224-0713.5.91.2017.110854 (in Russ.)
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  5. Dzyadzko AM, Bolonkin LS, Minov AF, Piskun AB, Chugunova OA, Katin ML, Brukhatsky AA, Fedoruk AM, Shcherba AE. Evaluation of sympathetic blockade under thoracic epidural versus bilateral paravertebral anesthesias during high-traumaticity operations on the upper abdominal organs. Messenger of Anesthesiology and Resuscitation. 2015;12(1):34-40. doi: 10.21292/2078-5658-2015-12-1-34-40 (In Russ.)
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  13. Can BO, Bilgin H. Effects of scalp block with bupivacaine versus levobupivacaine on haemodynamic response to head pinning and comparative efficacies in postoperative analgesia: A randomized controlled trial. J Int Med Res. 2017 Apr;45(2):439-50. doi: 10.1177/0300060516665752
  14. Ayoub C, Girard F, Boudreault D, Chouinard P, Ruel M, Moumdjian R. A comparison between scalp nerve block and morphine for transitional analgesia after remifentanil-based anesthesia in neurosurgery. Anesth Analg. 2006 Nov;103(5):1237-40. doi: 10.1213/01.ane.0000244319.51957.9f
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Address for correspondence:
212030, Republic of Belarus,
Mogilev, Botkin str., 2,
Mogilev City Emergency Hospital,
Anesthesiology and Intensive Care Unit,
tel./fax: +375(222) 22-16-26,
e-mail: snyter1977@gmail.com,
Markevich Denis P.
Information about the authors:
Markevich Denis P., Head of Anesthesiology and Intensive Care Unit, Mogilev Emergency City Hospital, Mogilev, Republic of Belarus.
http://orcid.org/0000-0002-1117-3877
Marochkov Alexey V., MD, Professor, Anesthesiologist-Resuscitator, Mogilev Regional Hospital, Mogilev, Republic of Belarus.
http://orcid.org/0000-0001-5092-8315

NEUROSURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2020.3.299   |  

IA.V. TSYMBALIUK 1, V.I. TSYMBALIUK 1, 2, I.B. TRETYAK 1, V.V. MEDVEDIEV 2, V.G. GURIANOV 2, A.A. GATSKIY 1, T.I. PETRIV 1

COMPARATIVE ANALYSIS OF VARIOUS TYPES OF NEUROTIZATION AS A METHOD OF SURGICAL TREATMENT OF PERIPHERAL FACIAL PARESIS

Institute of Neurosurgery Named after A.P. Romodanov NAMS of Ukraine 1
National Medical University Named after A.A. Bogomolets 2, iev,
Ukraine

Objective. Determination of the optimal type of facial nerve neurotization in patients with the consequences of its traumatic injury.
Methods. The treatment results of patient (n=172) with the facial nerve injury who underwent neurotization using different donor nerves was analized.
Women (n=97) made up 56.4%, men (n=75) 43.6%. The median age was 38 years; the interquartile range was 29 50 years. The most common cause of the facial nerve damage was the removal of posterior fossa tumor 123 patients (71.5%). Various types of reconstructive interventions were performed: facial nerve neurotization by the branches of the accessory nerve to the sternocleidomastoid muscle 87 patients, facial nerve neurotization by branch of the accessory nerve to the sternocleidomastoid muscle and the descending branch of the hypoglossal nerve 62 patients, by the accessory nerve 10 patients, by the descending branch of the hypoglossal nerve 10 patients, anterior motor branches C2-C3 3 patients.
The immediate and long-term results of treatment were studied. Patients underwent a follow-up examination and an ENMG study no earlier than 4 months after the surgery. Long-term results were studied no earlier than 12 months and up to 24 months after the surgery by means of repeated neurological examinations and additional electrophysiological techniques.
Results. In all cases, a positive result has been achieved. In 147 (85.4%) out of 172 patients, the recovery of facial nerve function according to the House Brackmann scale to II III level was observed. The best results were achieved in the cases of neurotization by the branches of the accessory nerve and the simultaneous use of several donor nerves (p<0.001).
Conclusion. The use of the accessory nerve branches as donors ensures restoration of the facial nerve function to level II-III on the House Brackmann scale in 89.7% of patients and in terms of effectiveness, it does not differ from the technically more complex and prognostically less favorable facial nerve neurotization by the descending branch of the hypoglossal nerve and the branch of accessory nerve.

Keywords: neurotization, facial nerve, donor nerve, electroneuromyography, surgical treatment
p. 299-308 of the original issue
References
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Address for correspondence:
04050, Ukraine,
iev, Platon Mayboroda str., 32,
Institute of Neurosurgery Named
after A.P. Romodanov NAMS of Ukraine,
Department of Restorative Neurosurgery,
tel.: +38 (044) 483-12-53,
e-mail: yaroslav.neuro@gmail.com,
Tsymbaliuk Iaroslav V.
Information about the authors:
Tsymbaliuk Iaroslav V., Postgraduate Student of the Department of Neurosurgery, National Medical University Named after. A.A. Bogomolets, Neurosurgeon of the Restorative Neurosurgery Department, Institute of Neurosurgery Named after A.P. Romodanov NAMS of Ukraine, iev, Ukraine.
http://orcid.org/0000-0002-8746-0944
Tsymbaliuk Vitalii I., Academician of NAMS of Ukraine, Corresponding Member of NAS of Ukraine, MD, Professor, President of NAMS of Ukraine, Head of the Department of Neurosurgery, National Medical University Named after A.A. Bogomolets, Scientific Supervisor of Restorative Neurosurgery Department, Institute of Neurosurgery Named after A.P. Romodanov NAMS of Ukraine, iev, Ukraine.
http://orcid.org/0000-0003-3608-9679
Tretyak Igor B., MD, Head of Restorative Neurosurgery Department, Institute of Neurosurgery Named after A.P. Romodanov NAMS of Ukraine, iev, Ukraine.
http://orcid.org/0000-0003-0977-7062
Medvediev Vladimir V., MD, Associate Professor of the Department of Neurosurgery, National Medical University Named after. A.A. Bogomolets, iev, Ukraine.
http://orcid.org/0000-0001-7236-3191
Gurianov Vitaly G., PhD, Associate Professor of the Department of Public Health Service Management, National Medical University Named after A.A. Bogomolets, iev, Ukraine.
https://orcid.org/0000-0001-8509-6301
Gatskiy Alexander A., PhD, Neurosurgeon of the Restorative Neurosurgery Department, Institute of Neurosurgery Named after A.P. Romodanov NAMS of Ukraine, iev, Ukraine.
http://orcid.org/0000-0002-2212-2143
Petriv Taras I., PhD, Neurosurgeon of the Restorative Neurosurgery Department, Institute of Neurosurgery Named after A.P. Romodanov NAMS of Ukraine, iev, Ukraine.
http://orcid.org/0000-0001-9160-8908

REVIEWS

DOI: https://dx.doi.org/10.18484/2305-0047.2020.3.309   |  

T.A. JARKENOV 1, O.G. SKIPENKO 2, M.N. ZHUMABAEV 1, S.T. ZAIROVA 3, N.A. AKATAEV 1, D.B. YESSENBAEV 1, M.M. MUKUSHEV 1, K.ZH. NURMANOV 1, M.E. BALSHAMBAEV 1

THE ASSOCIATION OF TUMOR NECROSIS FACTOR-α GENE POLYMORPHISM WITH THE SEVERITY OF ACUTE PANCREATITIS: A SYSTEMATIC REVIEW

West Kazakhstan Marat Ospanov State Medical University 1, Aktobe,
The Republic of Kazakhstan
Hepato-Pancreato-Biliary Association of Commonwealth of Independent States 2, Moscow,
The Russian Federation,
Military Institute of Air Defense Named after T.J. Begeldinov 3, Aktobe,
The Republic of Kazakhstan

Objective. The performance of a systematic review of the current literature and meta-analysis to provide the more precise estimations of the association between TNF-α gene polymorphism with the development and severity of acute pancreatitis (AP).
Methods. A systematic review, searching the Medline and Web of Science databases revealed the relevant researches. The analysis based on ten molecular genetic case-control studies of the TNF-α promoter in patients with acute pancreatitis (n=1660) and healthy volunteers (n=1618).
Results. A systematic review showed discrepant results. In three studies the association of functionally significant polymorphism -308G> A in the TNF gene promoter with a severe form of AP, development SIRS and MODS have been established. The association of -308 G / A polymorphism of the TNF gene with the risk of a developing of moderate form of acute non-biliary pancreatitis was identified in one study. In other studies the association of TNF gene polymorphism with the severity of AP was not confirmed.
Conclusions. The presented genetic studies of the TNF-α promoter at acute pancreatitis manifested the controversal results.

Keywords: acute pancreatitis, clinical course, molecular genetic studies, tumor necrosis factorα, genetic polymorphism
p. 309-317 of the original issue
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Address for correspondence:
030019, Republic of Kazakhstan,
Aktobe, Maresyev str., 68,
West Kazakhstan Marat Ospanov Medical University, Surgical Diseases In the absenc No 1,
tel. +7 7132 544297,
e-mail: timurjarkenov@gmail.com,
Timur A. Jarkenov
Information about the authors:
Jarkenov Timur A.,MD, Professor of the Surgical Diseases Department No 1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
https://orcid.org/0000-0003-4579-6412
Skipenko Oleg G., MD, Professor, Member of Board of Hepato-Pancreato-Biliary Association of Commonwealth of Independent States, Moscow, Russian Federation.
https://orcid.org/0000-0002-4192-9620
Zhumabaev Marat N., PhD, Associate Professor, Head of the Surgical Diseases Department No1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
https://orcid.org/0000-0002-5092-6034
Zairova SauleT., PhD, Military Institute of Air Defense Named after T.J. Begeldinov, Aktobe, Republic of Kazakhstan.
https://orcid.org/0000-0003-3734-6884
Akataev Nagashybai A., PhD, Professor of the Surgical Diseases Department No1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
https://orcid.org/0000-0001-8964-5152
Yessenbaev Daulet B., Assistant of the Surgical Diseases Department No1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
https://orcid.org/0000-0001-9777-0594
Mukushev Manas M., PhD, Associate Professor of the Surgical Diseases Department No1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan
https://orcid.org/0000-0003-1811-3276
Nurmanov Kairat Zh., Assistant of the Surgical Diseases Department No1, West Kazakhstan Marat Ospanov Medical University), Aktobe, Republic of Kazakhstan.
https://orcid.org/0000-0003-1422-7524
Balshambayev Madi E., Assistant of the Surgical Diseases Department No1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
https://orcid.org/0000-0002-0206-1769
DOI: https://dx.doi.org/10.18484/2305-0047.2020.3.318   |  

YU.V. BELOV 1, I.A. GUBAREV 1, 2, A.Z. SALEKH 2, K.B. FROLOV 2, K.N. RYBAKOV 2

MINI-ACCESS IN THE ABDOMINAL AORTA SURGERY

Russian Research Surgery Center named after Academician B.V.Petrovsky 1,
N.I. Pirogov Municipal Clinical Hospital 1 2, Moscow
The Russian Federation

Minimally invasive surgery is an area of general surgery that allows surgical interventions to be performed with less damage to normal tissues and organs. Recently, a growth of operations on the aorto-iliac segment with the use of mini-laparotomy incisions is increasingly observed. Minimally invasive technologies are implemented through classical techniques of the reconstructive surgery of the abdominal aorta. According to most authors, the technique of mini-laparotomy access to the aorta has already been sufficiently studied and introduced into the standard clinical practice of many hospitals in our country. However, up to the present, many issues relating to abdominal aorta surgery from mini-access remain not covered: postoperative complications, features of surgical technique, causes of failures and conversion to laparotomy to complete the procedure, are not sufficiently described. Most surgeons dont have yet clear information about the spatial structure for the reproduction of manual techniques in the delimited wound volume. In addition, at present, despite a large number of scientific information in the native and foreign literature, there are no reliable data on modeling access to the working section of the abdominal aorta during operations for Leriche syndrome and abdominal aortic aneurysms by applying mini-laparatomic access.

Keywords: Leriche syndrome, abdominal aortic aneurysm, mini-access, mini-laparotomy, aorta surgery
p. 318-328 of the original issue
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Address for correspondence:
119049, Russian Federation,
Moscow, Leninsky pr., 8,
N.I. Pirogov Municipal Clinical Hospital No1,
Center for Vascular, X-ray Endovascular
Surgery and Minimally Invasive Phlebology,
tel. mobile:+7 985 353 51 90,
e-mail: angiodoc@mail.ru,
Gubarev Igor A.
Information about the authors:
Belov Yurii V., MD, Professor, Academician of RAS, Head of the Cardio-Aortic Surgery, Russian Research Surgery Center Named after Academician B.V.Petrovsky, Moscow, Russian Federation.
http://orcid.org/0000-0002-9280-8845
Gubarev Igor A., Aspirant, Russian Research Surgery Center Named after Academician B.V.Petrovsky, Cardiovascular Surgeon, No1. Pirogov Municipal Clinical Hospital No1, Moscow, Russian Federation.
http://orcid.org/0000-0003-3961-5670
Salekh Amro Z., Cardiovascular Surgeon, N.I. Pirogov Municipal Clinical Hospital No1, Moscow, Russian Federation.
http://orcid.org/0000-0001-6479-1743
Frolov Konstantin B., PhD, Head of the Center of Vascular, Endovascular Surgery and Minimally Invasive Phlebology of N.I. Pirogov Municipal Clinical Hospital No1, Moscow, the Russian Federation.
https://orcid.org/0000-0001-6310-3590
Rybakov Kirill N., Cardiovascular Surgeon, N.I. Pirogov Municipal Clinical Hospital No1, Moscow, Russian Federation.
https://orcid.org/0000-0002-6530-3382
DOI: https://dx.doi.org/10.18484/2305-0047.2020.3.329   |  

V.YA. KHRYSHCHANOVICH

MANAGEMENT PRINCIPLES OF PATIENTS WITH VENOUS THROMBOEMBOLISM DURING THE COVID-19 PANDEMIC

Belarusian State Medical University, Minsk,
The Republic of Belarus

The spread of the new SARS-CoV-2 infection, now classified as COVID-19, has become global. The physician who treats patients with COVID-19 face daily new serious problems. One of them is a high prevalence of venous thromboembolic complications, especially in the group of patients with a severe course of the infectious process. Current recommendations allow an empirical approach to prescribing anticoagulation in the case of a reasonable suspicion on the pulmonary embolism/deep vein thrombosis, if the assumed waiting period for visualization is >4/24 hours, respectively. The use of prophylactic doses of low-molecular-weight or unfractionated heparin or fondaparinux is mandatory for all COVID-19-positive inpatients throughout the entire period of hospitalization. If there are the absolute contraindications to anticoagulation, it is recommended to use compression therapy or to perform vena cava filter implantation . Most patients with the confirmed COVID-19-associated venous thromboembolism (VTE) or those with its reasonable suspicion should be prescribed a full treatment dose of anticoagulant. In ambulatory conditions for secondary long-term thromboprophylaxis the preference should be given to direct oral anticoagulants. Patients who had a ≥3-fold elevation of D-dimer level upon admission should continue the therapeutic anticoagulation after discharge. This literature review summarizes the latest recommendations on prevention, diagnosis, and treatment of COVID-19-associated VTE. Further research should focus on developing optimal management strategies for both inpatients and outpatients with COVID-19-associated venous thromboembolism (VTE ).

Keywords: venous thromboembolism, COVID-19, thromboprophylaxis, diagnosis, treatment
p. 329-338 of the original issue
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Address for correspondence:
220116, Republic of Belarus,
Minsk, pr. Dzerzhinskii, 83,
Belarusian State Medical University,
tel. +375 17277-11-55,
e-mail: scienceprorektor@bsmu.by,
Khryshchanovich Vladimir Ya.
Information about the authors:
Khryshchanovich Vladimir Ya., MD, Professor, Vice-Rector for Scientific Work, Professor of the 2nd Department of Surgical Diseases, Belarusian State Medical University, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-5353-205X

CASE REPORTS

DOI: https://dx.doi.org/10.18484/2305-0047.2020.3.339   |  

S.A. MARKOSYAN

TESTICULAR DERMOID CYST IN A 14-YEAR-OLD CHILD

National Research Ogarev Mordovia State University, Institute of Medicine, Saransk,
The Russian Federation

The paper presents a clinical case of a 14-year-old child with a dermoid cyst of the right testicle. The formation was first detected during a routine check-up in the polyclinic. Then the external genitalia ultrasound examination was repeatedly performed to the patient, which revealed an inhomogeneous echostructure with dimensions of 14 mm, 13.7 mm and 12 mm with a clear, even contour in the upper pole of the right testicle.
The enzyme-linked immunosorbent assay (ELISA) did not show an increase in the main tumour markers. The biochemical blood test revealed an insignificant rise in conjugated bilirubin and serum iron.
To clarify the diagnosis, magnetic resonance tomography of the pelvic organs with intravenous contrast was recommended. After examination, the cystic lesion of the right testicle was diagnosed.
After carrying out the necessary additional diagnostic measures (ultrasound examination of the peripheral lymphatic nodes, the abdominal cavity exploration with intravenous contrast enhancement), the child underwent an operation consisting in revising the right half of the scrotum and removing the formation of the right testicle. Intraoperatively, according to the express biopsy test, the dermoid cyst of the right testicle was diagnosed, which was confirmed by the subsequent histological examination. The postoperative period was uneventful. The patient was discharged in satisfactory state.
Thus, the presented clinical observation emphasizes the need to optimize the preventive work of primary care medical personnel for timely diagnosis of tumor processes in the external genital organs, especially in children of puberty.

Keywords: dermoid cyst, testicle, ultrasound, magnetic resonance tomography, child
p. 339-343 of the original issue
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Address for correspondence:
430032, Russian Federation,
Saransk, Ulyanov str., 26 a,
National Research Ogarev
Mordovia State University,
Institute of Medicine,
the Department of the Faculty Surgery
with Courses of Topographic Anatomy
and Operative Surgery, Urology
and Pediatric Surgery,
tel.mobile: +7 917 699 06 04,
e-mail: markosyansa@mail.ru,
Markosyan Sergey A.
Information about the authors:
Markosyan Sergey A., MD, Associate Professor, Professor, the Department of the Faculty Surgery with Courses of Topographic Anatomy and Operative Surgery, Urology and Pediatric Surgery, National Research Ogarev Mordovia State University, Institute of Medicine, Saransk, Russian Federation.
http://orcid.org/0000-0002-9876-4433
DOI: https://dx.doi.org/10.18484/2305-0047.2020.3.344   |  

V.A. BELOBORODOV, A.P. FROLOV

EMPHYSEMATOUS OSTEOMYELITIS COMPLICATED BY NECROTISING FASCIITIS AND MYOSITIS

Irkutsk State Medical University, Irkutsk,
The Russian Federation

Emphysematous osteomyelitis is an extremely rare, potentially fatal bacterial disease characterized by the presence of gas within bone and adjacent soft tissues.
The disease is often complicated by anaerobic necrotizing fasciitis. The article presents a clinical observation of successfully treated emphysematous osteomyelitis of the right femur complicated by necrotizing fasciitis and myositis in the 55-year-old man. The disease manifested 20 years later after a closed fracture of the right femur and osteosynthesis. Emphysematous osteomyelitis was characterized by severe pain in the right thigh, serious intoxication syndrome and the presence of gas bubbles in the medullary cavity of the right femur which was observed in the computed tomography scans.
The feature of emphysematous osteomyelitis management was a three-step approach. The first step was the opening of the purulent-necrotic focus with a wide longitudinal incision of the skin and fascia, excision of necrotic soft tissues. The second step was guillotine amputation of the right lower limb on the level of the upper third of the thigh. The third step was the formation of the thigh stump in the early stages with flow-washing drainage of a wound. This tactic helped to reduce the risk of primary amputation, saved more soft tissue to form the thigh stump more suitable for prosthetics and to shorten the treatment terms.

Keywords: emphysematous osteomyelitis, intraosseous gas, necrotizing fasciitis, necrotizing myositis
p. 344-349 of the original issue
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Address for correspondence:
664003, Russian Federation
Irkutsk, Krasnoe Vosstaniye str., 1,
Irkutsk State Medical University,
the Department of General Surgery
and Anesthesiology,
tel. mobile: +7 914 884-50-96,
e-mail: frolovphd@mail.ru,
Frolov Aleksandr P.
Information about the authors:
Beloborodov Vladimir A., MD, Professor, Head of the Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-3299-1924
Frolov Aleksandr P., PhD, Associate Professor of the Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-3453-548X
Contacts | ©Vitebsk State Medical University, 2007