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Year 2009 Vol. 17 No 1

HISTORY OF SURGERY

ZUBAREV P.N.

«LET’S COMRADE REMEMBER AFGHANISTAN...»

In the article the initial period of surgical support organization of the forces limited contingent in the Democratic Republic of Afghanistan is described. The problems and troubles, which military surgeons ran into, are shown. Despite poor material provision of the medical elements and lack for qualified personnel in the majority of them, the leading specialists managed to organize training of the staff to the principles and methods of the wound treatment in short terms and to provide timely qualified aid rendering to the Soviet soldiers.

Keywords: limited contingent of the Soviet forces, the Democratic Republic of Afghanistan, field surgery, surgical service organization.
p. 2 - 9 of the original issue

LOGVINENKO S.M.

A SURGEON IN THE WAR IS MORE THEN JUST A SURGEON

On the 15th of February twenty years have passed since the withdrawal of the Soviet forces from the Republic of Afghanistan. Medical service in general and surgeons in particular took an active part in saving lives and returning to the service of thousands of soldiers, having various wounds. The article is dedicated to the military physician, an outstanding surgeon Valentin Ivanovich Meshkov.

Keywords: military surgeons, Afghanistan, withdrawal of the Soviet forces.
p. 10 - 12 of the original issue

GENERAL AND SPECIAL SURGERY

SCHERBA A.E., SLOBODIN YU.V., AVDEY E.L., KOROTKOV S.V., KIRKOVSKY L.V., FEDORUK A.M., DZYADZKO A.M., RUMMO O.O.

EXPERIENCE OF THE LIVER TRANSPLANTATION IN THE REPUBLIC OF BELARUS

At present liver transplantation is a precious standard in treatment of the patients with the liver terminal affections of various etiologies. From April, 2008 to January, 2009 eleven orthotropic liver transplantations (OLT) were performed at the medical establishment “The 9th city clinical hospital” in Minsk. The average duration of OLT made up 10,8±0,39 hours (8–11,8). The average volume of the blood apparatus reinfusion, lost at OLT made up 2615±628 ml (750–7500). Survival rate after OLT composed 90,9%. Observation duration made up from 1 to 10 months. Complications during post-operative period developed in 6 patients. The average term of hospitalization made up 35,8±4,7 days(18–65).

Keywords: liver transplantation, terminal affections of the liver.
p. 13 – 19 of the original issue
References
  1. Homotransplantation of the liver in humans / T. E. Starzl [et al.] // Surgery Gynecology Obstetrics. – 1963. – Vol. 117. – P. 659-676.
  2. European liver transplantation registry [Electronic resourse]. – Mode of access: http://www.eitr.org/publi/.
  3. Bussutil, R. W. Transplantation of the liver / R. W. Bussutil, G. K. Klintmalm. – Elsevier, 2005. – 80 p.
  4. Lucey Michael R. Liver Transplantation / Michael R. Lucey, James Neuberger, Abraham Shaked. – Landes Bioscience, 2003. – P. 1-4.
  5. Sharma, S. Biliary strictures following liver transplantation: past, present and preventive strategies / S. Sharma, A. Gurakar, N. Jabbour // Liver Transplantation. – 2008. – Vol. 14, N 6. – P. 759-770.
  6. Killenberg, Paul G. Liver transplant patient / G. Paul Killenberg, Pierre-Alain Clavien. – Blackwell publishing, 2006. – P. 323-339.
  7. Winston, D. J. Infection in liver transplant recipients / D. J. Winston, C. Emmanouilides, R. W. Bussutil // Clinical Infectious Diseases. – 1995. – Vol. 21. – P. 2077-2091.
  8. Fishman, J. A. Infection in organ-transplant recipients / J. A. Fishman, R. H. Rubin // New England Journal of Medicine. – 1998. – Vol. 338. – P. 1741-1751.

EGOROV V.I., VISHNEVSKY V.A., KARMAZANOVSKY G.G., SCHYOGOLEV A.I., YASHINA N.I., SOLODININA E.N., SHEVCHENKO T.V., IZMAYLOVA N.S., DUBOVA E.A., PETROV P.V.

DIAGNOSTICS AND TREATMENT OF DUODENAL DYSTROPHY

In the article the literature data are presented concerning duodenal dystrophy, a disease resulting from a chronic pancreas tissue inflammation shifted in the duodenal wall. The analysis of own observations of the patients with cystic duodenal dystrophy who underwent pancreatoduodenal resection was carried out. The fragments revelation of the unaltered or altered ectopic pancreas isolated from the orthotropic gland during the histological test was the main criterion confirmed the disease nature. The methods of diagnostics and treatment of the given pathology are described. It is shown that while examining the patients with duodenal and pancreas head diseases one should take into consideration the existence of not such a rare anomaly as ectopic pancreas in the duodenal wall.

Keywords: duodenum, pancreas ectopy, duodenal dystrophy, pancreatoduodenal resection.
p. 20 - 28 of the original issue
References
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LITVIN A.A., ALI ABDULAZIZ A.M., RAGOLEVICH G.S.

INDIRECT ENDOLYMPHATIC ANTIBACTERIAL PROPHYLAXIS OF INFECTIOUS COMPLICATIONS OF SEVERE ACUTE PANCREATITIS

Hospital mortality among the patients with severe acute pancreatitis remains rather high. The research objective was efficiency evaluation of indirect endolymphatic antibacterial prophylaxis of infectious complications in the patients with severe acute pancreatitis. In the work the results of treatment of 224 patients with pancreatic necrosis are studied. Endolymphatic antibacterial prophylaxis was used in the treatment of 116 patients with severe acute pancreatitis.
Indirect endolymphatic antibacterial therapy of severe acute pancreatitis is an effective method of pathogenesis prevention of infectious complications and can be recommended as a component of the complex treatment of pancreatic necrosis. Due to the complex prophylaxis of infectious complications of severe acute pancreatitis (indirect endolymphatic antibacterial therapy, interstitial electrophonophoresis, selective intestines decontamination, a puncture and drainage of acute liquid formations under the ultrasound, etc.) the frequency of infected pancreatic necrosis has decreased from 50 % to 39 %. Endolymphatic therapy reduces requirement for expensive antibiotics, facilitates the change of tactical modes of antibacterial therapy in the patients with severe acute pancreatitis.

Keywords: severe acute pancreatitis, indirect endolymphatic antibacterial prevention.
p. 29 - 37 of the original issue
References
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  2. Mazaki, T. Meta–analysis of prophylactic antibiotic use in acute necrotizing pancreatitis / T. Mazaki, Y. Ishii, T. Takayama // Br. J. Surg. – 2006. – Vol. 93, N 6. – P. 674-684.
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KHUBULAVA G.G., SHAYDAKOV E.V., SHISHKEVICH A.N.

IMMEDIATE AND REMOTE RESULTS OF THE ENDOVASCULAR PROPHYLAXIS OF THE VENOUS THROMBOEMBOLISM (VTE)

The results analysis of the venous thromboembolism (VTE) in 256 patients, treated in the 1st surgical clinic of physicians advanced training of the Russian military-medical academy named after S.M. Kirov during the period from 2003 to 2006 is presented in the article.
48 patients were undergoing conservative therapy, aimed to prevent VTE and to treat the main disease; at 208 patients implantation of the permanent or removable cava filter was performed. All patients were examined in the immediate or remote terms after the performed treatment. The immediate results were evaluated during the stay of a patient at the in-patient department, the nearest - 3-6 months after the discharge. The remote results were analyzed in terms up to 3 years after a patient’s discharge and his state stabilization.
During the research it was found out that cava filter implantation regarding the indication as well as timely actions concerning acute clogging elimination in the lower limbs and small pelvis main veins serve as a reliable prophylaxis method of severe complications of the lower limbs deep veins thrombosis, including VTE and post-thrombosis disease.

Keywords: deep veins thrombosis, venous thromboembolism, endovascular prophylaxis, cava filter.
p. 38 - 46 of the original issue
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SMOTRIN S.M., KUZNETSOV A.G., NAUMOV I.A., ZHUK S.A.

PRE-OPERATIVE MEDICAMENT CORRECTION OF THE OPERATIVE TRAUMA ORGANISM SYSTEMIC REACTION IN PATIENTS WITH THE LOWER LIMBS CHRONIC ARTERIAL FAILURE

The article presents the data concerning the types of cell emigration to the traumatic injury locus both in healthy subjects and in patients with peripheral arterial disease which allow estimating and prognosticating the course of the first phase of a wound process. Three reaction types of cells emigration have been determined: normoergic, hypoergic, hyperergic. In chronic arterial failure of the lower limbs normoergic type of cells emigration was revealed in 16,7% patients. It is shown, that thymalinum and pyrogenalum stimulate emigration of leucocytes to the locus of tissues damage and can be applied to correct the system reaction of an organism to the operational trauma.

Keywords: types of cell emigration, medicament correction, chronic arterial failure, pyrogenalum, thymalinum.
p. 47 - 54 of the original issue
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  11. Kenney, R. T. Skin blister immunocytology. A new method to quantify cellular kinetics in vivo / R. T. Kenney, S. Rangdaeng, D. M. Scollard // J. Immunological Methods. – 1987. – Vol. 97. – P. 101-110.
  12. Борисова, А. М. Клинико-биохимические и иммунологические показатели у больных сахарным диабетом / А. М. Борисова, Н. Б. Анфицеров // Терапевтический архив. – 1993. – № 10.– С. 17-20.
  13. Neutrophil delivery to wounds of the upper ahd lower extremities / W. Lineaweaver [et al.] // Arch. Surg. – 1985. – Vol. 120, N 4. – P. 430-431.
  14. Кузин, М. И. Раны и раневая инфекция / М. И. Кузин, Б. М. Костюченок. – М.: Медицина, 1990. – 592 с.
  15. Смотрин, С. М. Хирургическая рана: прогнозирование и оптимизация заживления / С. М. Смотрин. – Гродно: ГрГМУ, 2005. – 180 с.

KUZNETSOV YA.O., KHULUP G.YA.

IMPROVEMENT OF THE TREATMENT METHODS OF PURULENT WOUND SURFACES

In this article the treatment data of 164 patients with acute and chronic wound surfaces of a various etiology of localization and of various sizes are summarized and presented. Three groups were formed: a control one (54 patients who underwent traditional treatment), the first basic group (56 patients who received such preparations as AKTIVTEX with chlorhexidine and furagin; AKTIVTEX with furagin and the sea-buckthorn oil) and the second basic group (54 patients who additionally obtained magneto therapy by the apparatus “Unispok”). The applied wound coverings didn’t appear to demand systemic antibiotic therapy. These wound coverings influencing actively regeneration and epithelization and reducing the treatment terms for 2–3 days can be effectively used for autograft preparation on the big wounds and ulcers.

Keywords: wound, trophic ulcer, regeneration, epithelization, wound coverings, magneto therapy.
p. 55 - 61 of the original issue
References
  1. Нечаев, Э. А. Хирургическая инфекция – клиника, диагностика, лечение: руководство для военных врачей / Э. А. Нечаев. – М.: Медицина. – 1993. – 296 с.
  2. Виткова, О. А. Эпидемиологический контроль за внутрибольничными инфкекциями / О. А. Виткова, А. Г. Шаташвили // Тезизы докл. II Рос. науч.-практич. конф. с междунар. участием. – М., 1999. – С. 54-55.
  3. Estimated costs of postoperative wound infections. A case control study of marginal hospital and several security costs / K. B. Poulsen [et al.] // Epidemiol. Infect. – 1994. – № 113. – P. 285-295.
  4. Девятов, В. А. Оценка динамики раневого процесса / В. А. Девятов // Хирургия. – 1998. – № 11. – С. 46-48.
  5. Критерии течения раневого процесса / С. В. Сандер [и др.] // Клин. хирургия. – 1996. – № 1. – С. 14-16.
  6. Раны и раневая инфекция: руководство для врачей / под ред. М. И. Кузина, Б. М. Костюченок. – 2-е изд., перераб. и доп. – М.: Медицина, 1990. – 592 с.
  7. Шандала, М. Г. Асептика и антисептика: проблемы и решения / М. Г. Шандала // Вестн. Рос. АМН. – 2000. – № 12. – С. 6-11.
  8. Применение сорбентов для местного лечения гнойных ран / М. М. Мамакеев [и др.] // Клин. хирургия. – 1994. – № 1. – С. 52-55.
  9. Влияние антисептиков на процесс раневого заживления / Ю. К. Абаев [и др.] // Актуальные вопросы хирургии: материалы XXV Пленума Правления Ассоциации белорус. хирургов и Респ. науч.-практич. конф., Борисов, 25-26 сент. 2008 г. – Борисов, 2008. – С. 136-137.

ONCOLOGY

MIKHAYLOVA E.I., TIMASHOVA V.P.

IMMUNOCHEMICAL TEST IN NON-INVASIVE DIAGNOSTICS OF THE COLON POLYPS

The main aim of the research was the study of the diagnostic value of the immunochemical test for the occult blood in the feces while detecting the colon polyps. 69 patients with the colon polyps, 25 healthy volunteers, 91 patients with the irritable colon syndrome and 20 patients with the large intestine diverticulum were included in the research group. The colon polyps’ diagnostics in all cases was done by means of colonoscopy with biopsy. The research result have shown that immunochemical test sensitivity in the detection of the colon polyps made up 37,68 (95% CI: 26,3 – 50,2), specificity – 80,17 (95% CI: 71,7 – 87,0). Immunochemical test (AUC,0,71, 95% CI:0,629 – 0,777) surpasses in the diagnostic value the hemoccult test (AUC,0,56, 95%CI:0,475 – 0,635; P=0,03) while detecting the colon polyps. Immunochemical test sensitivity in the detection of the colon polyps of large sizes ( 1 cm) made up 57,1% (95% CI: 37,20 – 75,50), specificity - 95,56% (95% CI: 90,60 – 98,30). While revealing large colon polyps diagnostic value of the immunochemical test didn’t show any statistic differences in comparison with the hemoccult test (AUC,0,66, 95% CI: 0,57 – 0,74; р=0,16) and ESR (AUC,0,73, 95% CI:0,65 – 0,80; р=0,63).

Keywords: colon polyps, non-invasive diagnostics, immunochemical test.
p. 62 - 69 of the original issue
References
  1. Вахрушева, С. С. 20-летний опыт амбулаторного удаления полипов дистальных отделов кишечника / С. С. Вахрушева, М. Н. Климентов, В. К. Шумихина // Актуальные проблемы проктологии: тез. докл. – СПб., 1993. – С. 28-29.
  2. Гуленков, С. И. Эндоскопическое удаление полипов желудочно-кишечного тракта в условиях дневного стационара поликлиники / С. И. Гуленков, Л. К. Соколов, А. И. Данько // Рос. журн. гастроэнтерологии, гепатологии и колопроктологии. – 1995. – № 3. – С. 85-87.
  3. Колоректальные новообразования / под ред. М. В. Стирнса; пер. с англ. Б. М. Газетова. – М.: Медицина, 1983. – 253 с.
  4. Малиновский, Н. Н. Диспансеризация больных хирургического профиля / Н. Н. Малиновский, Е. А. Решетников. – М.: Медицина, 1990. – 256 с.
  5. Мельников, Р. А. Полипы и рак толстой кишки / Р. А. Мельников, В. К. Ковалёв, И. В. Правосудов // Хирургия. – 1989. – № 5. – С. 101-102.
  6. Организация выявления и динамического наблюдения проктологических больных в системе диспансеризации населения: метод. рекомендации. – М., 1989. – 26 с.
  7. Результаты профилактической колоноскопии в условиях многопрофильной больницы / Г. А. Рыбинский [и др.] // Хирургия. – 1986. – № 4. – С. 63-67.
  8. Фёдоров, В. Д. Диффузный полипоз толстой кишки / В. Д. Фёдоров, А. М. Никитин. – М.: Медицина, 1985 – 192 с.
  9. О лечебной тактике при полипах толстой кишки (по поводу статьи Н. Н. Малиновского и соавт. «Нужно ли удалять полипы толстой кишки») / В. Д. Федоров [и др.] // Хирургия. – 1987. – № 1. – С. 82-86.
  10. Can Hemoccult II replace colonoscopy surveillance after radical surgery for colorectal cancer and after polipectomy / Henrik Jahn [et al.] / Springer New York 0012-3706 (Print) 1530-0 // [Electronic resource]. – 2005. – Mode of access: http://www.springerlink.com/content/w21612p736181071/. – Date of access: 03.08.2006.
  11. Screening of First Degree Relatives of Patients Operated for Colorectal Cancer: Evaluation of Fecal Calprotectin vs. Hemoccult II / J. Kristinsson [et al.] // Digestion. – 2001. – N 64. – Р. 104-110.
  12. Comparison of a brush-sampling fecal immunochemical test for hemoglobin with a sensitive guaiac-based occult blood test in detection of colorectal neoplasia / А. Smith [et al.] // Cancer. – 2006. – Vol. 107, N 9. – Р. 2152-2159.
  13. Allison, J. E. The Fecal Occult Blood Test Option Has Become a Better FIT / J. E. Allison // Gastroenterology. – Vol. 129. – Iss. 2. – P. 745-748.

TRAUMATOLOGY AND ORTHOPEDICS

NIKOLSKY M.A.

THE EXPERIENCE IN THE TREATMENT OF PATIENTS WITH POSTTRAUMATIC OSSIFYING MYOSITIS

The experience acquired in treatment of 19 patients with different localization posttraumatic ossifying myositis of extremities was made. Two patients were operated on, seventeen patients underwent conservative treatment.
The conclusion has been drawn that the success of treatment is predetermined by the individual approach to the choice of method and scheme of rehabilitation therapy. The conservative method is preferable. Surgical treatment is contraindicated at the stage of immature ossification, being inexpedient at the stage of mature ossification due to possible relapse on a still larger scale.

Keywords: posttraumatic ossifying myositis.
p. 70 - 76 of the original issue
References
  1. Некоторые клинические аспекты лечения больных с травматическими оссифицирующими миозитами / К. М. Белозор [и др.] // Ортопедия, травматология и протезирование. – 1989. – № 1. – С. 56-57.
  2. Сочетанная травма позвоночника / О. И. Дулуб [и др.] // Организация нейротравматологической помощи при спинальной травме: материалы респ. науч.-практич. конф., посвящ. 20-летию центра спинальной травмы / ГУ БелНИИТО. – Минск, 2007. – С. 54.
  3. Дятлов, М. М. Сложные повреждения таза. Что делать? / М. М. Дятлов // Руководство для врачей и студентов. – Гомель: ГГМУ, 2006. – С. 153-493.
  4. Каплан, А. В. Гетеротопическая травматическая оссификация / А. В. Каплан // Повреждения костей и суставов. – М.: Медицина, 1979. – С. 240-241.
  5. Рейнберг, С. А. Оссифицирующий миозит / С. А. Рейнберг // Рентгенодиагностика заболеваний костей и суставов. – М.: Медицина, 1964. – С. 81-87.
  6. Уотсон-Джонс, Р. Оссифицирующий миозит и травматическая субпериостальная оссификация / Р. Уотсон-Джонс // Переломы костей и повреждения суставов. – М.: Медицина, 1972. – С. 45-49.

ОTORHINOLARINGOLOGY

KUNITSKY V.S., KULIKOV A.V., SEMENOV S.A.

DIAGNOSTICS AND TREATMENT OF DUPUYTREN’S PHLEGMON

At the otorhinolaryngological department for adults in Vitebsk regional clinical hospital, 71 patients were treated for Dupuytren’s phlegmon during the period between 2003 to 2007. Etiological causes of the disease are hemolytic streptococcus, different types of staphylococcus, mixed flora and anaerobes. Together with the clinical methods of examination, computer tomography (CT) and magneto-resonant tomography (MRT) have been successfully used recently. All the patients were operated on during the first 24 hours after their admission. An important factor required for the phlegmon treatment is quick surgical interference – wide dissection, drainage of deep cellular spaces of the neck with aqueous antiseptic solutions and adequate antibiotic therapy.

Keywords: Dupuytren’s phlegmon, resection, drainage, deep cellular spaces of the neck.
p. 77 - 81 of the original issue
References
  1. Хоров, О. Г. Проблемы лечения нагноительных процессов челюстно-лицевой области и шеи / О. Г. Хоров, В. И. Колесник, Л. А. Кравцевич // Респ. науч.-практич. конф. оториноларингологов: матер. конф. – Минск, БГМУ, 2006. – С. 36-38.
  2. Соловьев, М. М. Абсцессы, флегмоны головы и шеи / М. М. Соловьев, О. П. Большаков. – М., МЕДпресс, 2001. – 230 с.
  3. Казимирекин, В. А. Клиническая значимость иммунограммы для прогнозирования течения флегмон лица и шеи: дис. … канд. мед. наук / В. А. Казимирекин. – М., 1990.
  4. Логосов, В. С. Флегмоны шеи / В. С. Логосов, Н. А. Мирошниченко, М. В. Гунчиков // Вестник оториноларингологии. – 1996. – № 5. – С. 43-45.
  5. Король, И. М. О лечении глубоких флегмон шеи и медиастенитов / И. М. Король, Е. И. Корженевич // Материалы 2 междунар. белорус.-польск. конф. по оториноларингологии. – Гродно, 2003. – С. 156-157.
  6. Флегмоны шеи / Б. С. Лопатин [и др.] // Новости оториноларингологии и логопатологии. – 2001. – № 2. – С. 37-39.

ANESTHESIOLOGY-REANIMATOLOGY

PRASMYTSKY O.T., SIVETS N.F., KOSTROVA E.M.

USE OF THE PHARYNGEAL CATHETER FOR ARTIFICIAL PULMONARY VENTILATION DURING LAPAROSCOPIC CHOLECYSTECTOMY

The research concerning the possibility of the pharyngeal catheter I-gel use during laparoscopic cholecystectomy is performed. Depending on the air-conducting device use, 2 groups of patients were singled out: the 1st one (the main) (n=15) – anesthesia aid through the pharyngeal catheter; the 2nd – through the endotracheal tube.
Demographic indexes, evaluation of the operative-anesthetic risk degree were analyzed including the physical state evaluation according to ASA and AAA anesthetic risk as well as indexes of hemodynamics, biochemical blood investigation, and acid basic state. At the stage of anesthesia hemodynamics indexes at artificial pulmonary ventilation remained stable, there were no reliable differences in their value which reflected their adequate ventilation.
The pharyngeal catheter is an alternative air-conducting device for general anesthesia. With application of the pharyngeal catheter the time for consciousness gaining is reduced, the discomfort after air-conducting device removal is absent.

Keywords: anesthesia, pharyngeal catheter, laparoscopic operation, cholecystitis.
p. 82 - 87 of the original issue
References
  1. Мельник, О. Б. Сравнительная оценка трех видов анестезиологического обеспечения лапароскопической холецистэктомии / О. Б. Мельник, М. А. Шляпкина, М. А. Ломова // Вестник интенсивной терапии. – 2005. – № 1. – С. 45-48.
  2. Использование ларингеальных масок для общей анестезии / С. И. Савицкий [и др.] // Здравоохранение. – 1997. – № 3. – С. 33.
  3. Судьин, В. И. Итоги пятилетнего опыта применения ларингеальной маски при анестезиологическом обеспечении операций / В. И. Судьин, В. Д. Яхьяев // Вестник интенсивной терапии. – 2005. – № 1. – С. 42-44.
  4. Bremner, W. G. M. Fixing the laryngeal mask airway during eye surgery / W. G. M. Bremner // Anaesth. Corresp. – 1993. – Vol. 48, N 6. – P. 542.
  5. Марченко, А. В. Ларингеальная маска. Преимущества использования и методические трудности / А. В Марченко, С. Л. Эпштейн, А. С. Бердикян // Вестник интенсивной терапии. – 2002. – № 3. – С. 38-43.
  6. Ригер, А. Ларингеальная маска: минимальная инвазивная техника в анестезиологии / А. Ригер, А. Броцман, К. Айрих // Вестник интенсивной терапии. – 1998. – № 3. – С. 9-14.
  7. Долбнева, Е. Л. Установка ларингеальной маски: варианты гемодинамического ответа при различных методиках анестезии / Е.Л. Долбнева // Анестезиология и реаниматология. – 2000. – № 5. – С. 80-84.
  8. Русинович, В. М. Перспективы применения ларингеально-масочной анестезии в хирургии // Материалы XXI Пленума Правления общества белорусских хирургов: сб. тр. – Минск, 1997. – С. 322-323.

DISCUSSION

PIMANOV S.I., MAKARENKO E.V.

GASTRODUODENAL ULCER TREATMENT REGARDING THERAPEUTIST POSITION

There are two tendencies in the conservative therapy of the gastroduodenal ulcers. The first one is an anti-secretory therapy which permits to achieve ulcer reparation or to prevent ulcer formation while taking antacid preparations. During the period of ulcer treatment a patient has to take inhibitor of the protonic pump in the standard dosage. The second tendency in the treatment of gastroduodenal ulcers implies eradication of Helicobacter pylori strictly according to the definite rules. In case of successful eradication one may observe decrease in frequency of ulcer recurrence as well as of ulcerous bleedings and perforations. Also positive changes of the functional and morphological characteristics of the stomach mucous membrane are registered: the level of serumal gastrin-17 decreases, inflammatory and atrophic changes in the stomach mucous membrane also reduce.
One more actual cause for ulcer forming is intake of aspirin and of non-steroid anti-inflammatory preparations. In case of ulcer anamnesis or presence of risk factors a patient should receive the inhibitor of the protonic pump in the standard dosage during the whole period of aspirin or non-steroid anti-inflammatory preparations intake (days or years).

Keywords: gastric ulcer, duodenal ulcer, ulcerous bleeding, ulcer perforation, Helicobacter pylori, eradication therapy, anti-secretory therapy, aspirin, non-steroid anti-inflammatory preparations.
p. 88 - 96 of the original issue
References
  1. Current concepts in the management of Helicobacter pylori infection – The Maastricht 2-2000 Consensus Report / P. Malfertheiner [et al.] // Aliment. Pharmacol. Ther. – 2002. – Vol. 16. – P. 167-180.
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  3. Gisbert, J. P. Systematic review and meta-analysis: levofloxacin-based rescue regimens after Helicobacter pylori treatment failure / J. P. Gisbert, F. De La Morena // Aliment. Pharmacol. Ther. – 2006. – Vol. 23. – P. 35-44.
  4. Пиманов, С. И. Что происходит после эрадикации Helicobacter pylori: ожидаемые, доказанные и спорные эффекты / С. И. Пиманов, Е. В. Макаренко, Ю. И. Королева // Рос. журн. гастроэнтерологии, гепатологии, колопроктологии. – 2007. – Т. 17, № 1. – С. 48-55.
  5. Alteration of histological gastritis after cure of Helicobacter pylori Infection / M. Hojo [et al.] // Aliment. Pharmacol. Ther. – 2002. – Vol. 16. – P. 1923-1932.
  6. Helicobacter pylori eradication improves gastric histology and decreases serum gastrin, pepsinogen I and pepsinogen II levels in patients with duodenal ulcer / S. Pimanov [et al.] // J. Gastroenterol. Hepatol. –2008. – Vol. 23. – P. 1666-1671.
  7. Asia Pacific consensus guideline on gastric cancer prevention / K. M. Fock [et al.] // J. Gastroenterol. Hepatol. – 2008. – Vol. 23. – P. 351-365.

LOBANKOV V.M.

TO THE QUESTION CONCERNING THERAPY TACTICS AND STRATEGY IN CASE OF PEPTIC ULCER IN PRESENT-DAY CONDITIONS

The problem of peptic ulcer has been studied both from the point of view of the individual tactics of patient’s treatment and treatment strategy in the patients’ population. Based on the personal investigations and literature data, methodological incorrectness of the “universal” anti-helicobacter conservative tactics in case of peptic ulcer is shown. The author proves expediency of the treatment strategy and tactics variation with the use of different types of conservative therapy and planned mainly organ-saving surgery. The concept of peptic ulcer population severity is presented as well as its criteria, gradation, determining factors. Treatment strategy should be formed based on the regional epidemiological indexes; its aim is to decrease the population severity. The choice of treatment tactics should be based on the disease severity, complications risk factors, medical activity of the patient; the aim is to minimize the risk of complications and urgent surgeries. In case of uncontrolled severe course of peptic ulcer, planned surgery in the specialized clinic is advisable.

Keywords: peptic ulcer, population severity of peptic ulcer, strategy and tactic of treatment.
p. 97 - 107 of the original issue
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  14. Шапошников, А. В. Ваготомия в лечении пилородуоденальных язв / А. В. Шапошников, А. И. Неделько, Л. А. Пантелеева. – Ростов-н/Д., 1989. –189 с.
  15. Анохин, Л. В. Общие закономерности развития суицидной ситуации в стране / Л. В. Анохин, И. Б. Бойко // Здравоохр. РФ. – 2000. – № 3. – С. 20-22.
  16. Комаров, Ф. И. Хронобиология и хрономедицина / Ф. И. Комаров, С. И. Рапопорт. – Триада-Х, 2000. – 488 с.
  17. Лобанков, В. М. Влияние солнечной активности на популяционную тяжесть язвенной болезни / В. М. Лобанков, М. Н. Камбалов // Пробл. здор. экол. – 2008. – № 2. – С. 142-146.
  18. Ведение больных язвенной болезнью в амбулаторно-поликлинических условиях: результаты многоцентрового российского фармако-эпидемиологического исследования / Л. С. Страчунский [и др.] // Рос. журн. гастроэнтерол. гепатол. колопроктол. – 2005. – № 6. – С. 16-21.

LECTIONS, REVIEWS

SHLYAKHTUNOV E.A.

THE UPPER LIMB HEMODYNAMICS AND MICROCIRCULATION PECULIARITIES IN THE BREAST CANCER PATIENTS

In the review the opinions of both the native and foreign scientists concerning the disturbances pathogenesis of the venous, arterial hemodynamics and microcirculation in the upper limbs in the breast cancer patients during the post-operative period as well as the muscular syndromes role and innervation disturbances in the lymphedema development are presented. Various operative and conservative correction methods of the developing disturbances are described, their efficiency is shown. As the performed literature analysis shows, the foundations of the complex treatment and prophylaxis of the post-mastectomy syndrome and lymphedema as its main manifestation have been worked out, although this problem hasn’t been completely solved.

Keywords: breast cancer, post-mastectomy syndrome, lymphatic edema, hemodynamics.
p. 108 - 118 of the original issue
References
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  4. Бураков, И. И. Результаты долгосрочного наблюдения за больными язвенной болезнью, ассоциированной НР, после эрадикации микроорганизма // Экспер. клин. гастроэнтерол. – 2002. – № 3. – С. 45-48.
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  6. Лобанков, В. М. «Хирургическая эпидемиология» язвенной болезни в Беларуси в период с 1990 по 2004 год // Вестн. хир. гастроэнтерол. – 2007. – № 1. – С. 50-55.
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  8. Svanes, C. Trends in perforated peptic ulcer: incidence, etiology, treatment, and prognosis / C. Svanes // Wld. J. Surg. – 2000. – Vol. 24. – P. 277-283.
  9. Пиманов, С. И. Эзофагит, гастрит и язвенная болезнь / С. И. Пиманов. – М: Мед. книга, Н. Новгород: Изд. НГМА, 2000. – 378 с.
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  11. Популяция больных язвенной болезнью двенадцатиперстной кишки гетерогенна по интегральному показателю качества жизни / А. А. Новик [и др.] // Гастроэнтеролoгия. – 2004. – № 2-3. – С. 103.
  12. Черносвитов, Е. В. Социальная медицина / Е. В. Черносвитов. – М.: Академ. Проект, Екатеринбург: Деловая книга, 2003. – 624 с.
  13. Sipponen, P. Peptic ulcer disease / Gastrointestinal and oesophageal pathology / P. Sipponen; ed. R. Whitehead. – 2-nd ed. – London: Churchill Livingstone, 1995. – P. 512-523.
  14. Шапошников, А. В. Ваготомия в лечении пилородуоденальных язв / А. В. Шапошников, А. И. Неделько, Л. А. Пантелеева. – Ростов-н/Д., 1989. –189 с.
  15. Анохин, Л. В. Общие закономерности развития суицидной ситуации в стране / Л. В. Анохин, И. Б. Бойко // Здравоохр. РФ. – 2000. – № 3. – С. 20-22.
  16. Комаров, Ф. И. Хронобиология и хрономедицина / Ф. И. Комаров, С. И. Рапопорт. – Триада-Х, 2000. – 488 с.
  17. Лобанков, В. М. Влияние солнечной активности на популяционную тяжесть язвенной болезни / В. М. Лобанков, М. Н. Камбалов // Пробл. здор. экол. – 2008. – № 2. – С. 142-146.
  18. Ведение больных язвенной болезнью в амбулаторно-поликлинических условиях: результаты многоцентрового российского фармако-эпидемиологического исследования / Л. С. Страчунский [и др.] // Рос. журн. гастроэнтерол. гепатол. колопроктол. – 2005. – № 6. – С. 16-21.

YAKUBTSEVICH R.E., SPAS V.V., PROTASEVICH P.P.

ANTICOAGULANT THERAPY AT THE EXTRACORPOREAL DETOXICATION CARRYING OUT IN THE INTENSIVE THERAPY

The important technics of critical conditions treatment in the intensive therapy are the methods of extracorporeal detoxication (hemosorption, hemodialysis, plasmapheresis, hemofiltration and others). It is known that it is necessary to use these or other anticoagulants to prevent extracorporeal contour thrombosis while performing these procedures. Today the diversity of means, methods and ways of anticoagulant therapy makes specialists carrying out the given kinds of treatment choose the most effective and safe one. In the given literature overview the authors have analyzed the data of the modern investigations including multi-central randomized ones.

Keywords: hemosorption, hemodialysis, plasmapheresis, hemofiltration, low-molecular heparins, heparin.
p. 119 - 125 of the original issue
References
  1. Воинов, В. А. Мембранный плазмаферез: рекомендации для врачей / В. А. Воинов. – Москва, 2004.
  2. Davies, H. Anticoagulation in CRRT: agents and strategies in Australian ICUs / H. Davies, G. Leslie // Aust. Crit. Care. – 2007. – Vol. 20, N 1. – P. 15-26.
  3. Continuous veno-venous hemodiafiltration in children after cardiac surgery / A. Jander [et al.] // Eur. J. Cardiothorac. Surg. – 2007. – Vol. 31, N 6. – P. 1022-1028.
  4. Influence of different heparin concentrations on the results of in vitro investigations in plasmaseparation technology using capillary membrane filters / J. K. Unger [et al.] // Artif. Organs. – 2003. – Vol. 27, N 7. – P. 649-657.
  5. Hosokawa, S. Optimization of heparinization in clinical double filtration plasmapheresis / S. Hosokawa, A. Oyamaguchi, O. Yoshida // Int. J. Artif. Organs. – 1989. – Vol. 12, N 8. – P. 544-548.
  6. Amanzadeh, J. Anticoagulation and continuous renal replacement therapy / J. Amanzadeh, R. F. Jr. Reilly // Semin. Dial. – 2006. – Vol. 19, N 4. – P. 311-316.
  7. Tejedor, Alonso M. A Thrombocytopenia and anaphylaxis secondary to heparin in a hemodialysis patient / Alonso M. A. Tejedor // Clin. Nephrol. – 2005. – Vol. 63, N 3. – P. 236-240.
  8. Sulodexide for hemodialysis anticoagulation in heparin-induced thrombocytopenia type II / J. Borawski [et al.] // J. Nephrol. – 2007. – Vol. 20, N 3. – P. 370-372.
  9. Optimal anticoagulation strategy in haemodialysis with heparin-coated polyacrylonitrile membrane / S. Lavaud [et al.] // Nephrol. Dial. Transplant. – 2003. – Vol. 18, N 10. – P. 2097-2104.
  10. Berbece, A. N. Sustained low-efficiency dialysis in the ICU: cost, anticoagulation, and solute removal / A. N. Berbece, R. M. Richardson // Kidney Int. – 2006. – Vol. 70, N 5. – P. 963-968.
  11. Iloprost for additional anticoagulation in continuous renal replacement therapy - a pilot study / J. Birnbaum [et al.] // Ren. Fail. – 2007. – Vol. 29, N 3. – P. 271-277.
  12. Antithrombin supplementation for anticoagulation during continuous hemofiltration in critically ill patients with septic shock: a case-control study / D. du Cheyron [et al.] // Crit. Care. – 2006. – Vol. 10, N 2. – P. R45.
  13. Role of prostacyclin (epoprostenol) as anticoagulant in continuous renal replacement therapies: efficacy, security and cost analysis / F. J. Gainza [et al.] // J. Nephrol. – 2006. – Vol. 19, N 5. – P. 648-655.
  14. Hosokawa, S. Clinical evaluation of nafamstat mesilate (FUT 175). A new anticoagulant for plasmapheresis / S. Hosokawa, A. Oyamaguchi, O. Yoshida // ASAIO J. – 1992. – Vol. 38, N 1. – P. 59-60.
  15. Effect of anticoagulant on biocompatibility in membrane plasmapheresis / S. Omokawa [et al.] // Int. J. Artif. Organs. – 1990. – Vol. 13, N 11. – P. 768-777.
  16. Is regional citrate superior to systemic heparin anticoagulation for continuous renal replacement therapy? A prospective observational study in an adult regional critical care system / S. M. Bagshaw [et al.] // J. Crit. Care. – 2005. – Vol. 20, N 2. – P. 155-161.
  17. Citrate anticoagulation during CVVH in high risk bleeding patients / L. Cubattoli [et al.] // Int. J. Artif. Organs. – 2007. – Vol. 30, N 3. – P. 244-252.
  18. A practical citrate anticoagulation continuous venovenous hemodiafiltration protocol for metabolic control and high solute clearance / A. J. Tolwani [et al.] // Clin. J. Am. Soc. Nephrol. – 2006. – Vol. 1, N 1. – P. 79-87.
  19. Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT) / P. D. Brophy [et al.] // Nephrol. Dial. Transplant. – 2005. – Vol. 20, N 7. – P. 1416-1421.
  20. Improving the delivery of continuous renal replacement therapy using regional citrate anticoagulation / R. Swartz [et al.] // Clin. Nephrol. – 2004. – Vol. 61, N 2. – P. 134-143.
  21. Comparative analysis of procoagulatory activity of haemodialysis, haemofiltration and haemodiafiltration with a polysulfone membrane (APS) and with different modes of enoxaparin anticoagulation / R. Klingel [et al.] // Nephrol. Dial. Transplant. – 2004. – Vol. 19, N 1. – P. 164-170.
  22. Al-Arrayed, S. Use of low molecular weight heparin for hemodialysis: a short-term study / S. Al-Arrayed, R. Seshadri // Saudi J. Kidney Dis. Transpl. – 2002. – Vol. 13, N 2. – P. 146-150.
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  24. Naumnik, B. Unfractionated Heparin but Not Enoxaparin Causes Delayed Plasma PAI-1 Depletion in Hemodialysis Patients: A Prospective Study / B. Naumnik, K. Pawlak, M. Mysliwiec // Clin. Appl. Thromb. Hemost. – 2007. – Sept. 25.
  25. Enoxaparin but not unfractionated heparin causes a dose-dependent increase in plasma TGF-beta 1 during haemodialysis: a cross-over study / B. Naumnik [et al.] // Nephrol. Dial. Transplant. – 2007. – Vol. 22, N 6. – P. 1690-1696.
  26. The pharmacokinetics of enoxaparin do not correlate with its pharmacodynamic effect in patients receiving dialysis therapies / D. F. Brophy [et al.] // J. Clin. Pharmacol. – 2006. – Vol. 46, N 8. – P. 887-894.
  27. The initial experience of using fraxiparin in extracorporeal detoxication in clinical cardiology / Iu. N. Sirenko [et al.] // Klin. Khir. – 1994. – N 12. – P. 23-25.
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  29. Pharmacokinetics of the low molecular weight heparin enoxaparin during 48 h after bolus administration as an anticoagulant in haemodialysis / B. Guillet [et al.] // Nephrol. Dial. Transplant. – 2003. – Vol. 18, N 11. – P. 2348-2353.
  30. Schneiter, S. Bleeding complication due to accumulation of low-molecular-weight heparin in a patient with renal insufficiency / S. Schneiter, U. Huynh-Do, M. Heizmann // Schweiz. Rundsch. Med. Prax. – 2007. – Vol. 96, N 18. – P. 733-737.
  31. Comparison of effects of different heparins on thrombin activatable fibrinolysis inhibitor in hemodialyzed patients / J. MaByszko [et al.] // Am. J. Nephrol. – 2004. – Vol. 24, N 6. – P. 624-629.
  32. Comparison of low-molecular-weight heparin (enoxaparin sodium) and standard unfractionated heparin for haemodialysis anticoagulation / D. Saltissi [et al.] // Nephrol. Dial. Transplant. – 1999. – Vol. 14, N 11. – P. 2698-2703.
  33. Sabloff, M. The effect of plasmapheresis on the serum activity level of dalteparin: a case report / M. Sabloff, P. S. Wells // Blood Coagul. Fibrinolysis. – 2000. – Vol. 11, N 4. – P. 395-400.
  34. In vitro and in vivo evaluation of enoxaparin removal by continuous renal replacement therapies with acrylonitrile and polysulfone membranes / A. Isla [et al.] // Clin. Ther. – 2005. – Vol. 27, N 9. – P. 1444-1451.

HANDS-ON WORKSHOPS

DENISENKO V.L.

OPERATIVE TREATMENT OF EPITHELIAL COCCYGEAL FISTULAS

The treatment tactics of epithelial coccygeal fistulas is presented in the article; the most effective ways of the operative treatment are described. It is recommended to use the one-phase method of treatment – to excise fistulas and to carry out plasty at once in case when fistulas are without the signs of inflammation. In case of abscess formation the two-stage method should be used – at the 1st stage the abscess is dissected, at the 2nd stage a radical surgery is carried out. The technique of 3 stages of radical surgeries is described, indications which permit to choose an optimal variant are determined. The suggested differential operative tactics allows reducing the complications number up to 0,1%, the recurrences – up to 0,5%.

Keywords: epithelial coccygeal fistula, operative treatment.
p. 126 - 132 of the original issue
References
  1. Дульцев, Ю. В. Эпителиальный копчиковый ход / Ю. В. Дульцев, В. Л. Ривкин. – М: Медицина, 1988. – 125 с.
  2. Агавелян, А. М. Тактика лечения острых неопухолевых проктологических заболеваний / А. М. Агавелян, А. К. Энфенджян // Вестн. хир. Армении. – 2001. – № 3. – С. 193-197.
  3. Il trattamento radicale della cisti pilonidale sacrococcigea / L. Rosato [et al.] // Minerva-Chir. – 1997. – Vol. 52, N 10. – Р. 1277-1279.
  4. Kadaka, M. Surgical treatment for pilonidal sinus: a forteen year experience / M. Kadaka // Ceneral Surgery. – Tokyo, Japan. – 1999. – Р. 1-6.
  5. Varabei, A. Treatment of pilonidal sinus abcess by rhomboid flap: is successful procedure / A. Varabei, M. Rimshza, V. Denisenko // Dis. Colon. Rectum. – 2004. – Vol. 47 – N 6. – P. 13.

EXPERIENCE EXCHANGE

FROLOV L.A.

SURGICAL TACTICS AT TREATMENT OF ACUTE PANCREATITIS PATIENTS

In the paper the treatment experience of acute pancreatitis patients is analyzed. The performed analysis has revealed that while treating acute pancreatitis one should follow active waiting tactics and give preference to complex conservative therapy.
At the early stage of the disease the only justified method of treatment is endoscopic interventions, which are compelled and they are regarded not only as a method of surgical detoxication, intra-abdominal hypertension removal, but also as a prophylactic method in the development of severe purulent-septic complications. Mini-invasive methods under visual control can be used in case of limited, local abscesses and suppurations of the post-necrotic cysts. The rest operations should be applied only when purulent-septic complications develop.
The presented data testify that the given approach to the treatment of acute pancreatitis patients decreases significantly postoperative lethality.

Keywords: acute pancreatitis, pancreatonecrosis, conservative therapy, early, delayed and late operations.
p. 133 - 139 of the original issue
References
  1. Острый панкреатит и травмы поджелудочной железы / Р. В. Вашетко [и др.]. – СПб.: Издательство «Питер», 2000. – 320 с.
  2. Ветшев, П. С. Холецистокардинальный синдром – миф или реальность / П. С. Ветшев, П. В. Ногтев // Хирургия. – 2005. – № 3. – С. 59-64.
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  4. Гостищев, В. К. Панкреонекроз и его осложнения, основные принципы хирургической тактики / В. К. Гостищев, В. А. Глушко // Хирургия. – 2003. – № 3. – С. 50-54.
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  8. Решетников, Е. А. Диагностика и дифференцированное лечение острого панкреатита билиарной этиологии / Е. А. Решетников, А. С. Миронов, Ю. Я. Малов // Хирургия. – 2005. – № 11. – С. 25-27
  9. Fernandez-Cruz, L. Minimally invasive surgery of the pancreas in progress / L. Fernandez-Cruz, G. Cesar-Borges // Surg. – 2005. – Vol. 4. – P. 342-354.
  10. Pitchumoni, C. Factors Influencing Mortality in Acute Pancreatitis: Can We Alter Them? / C. Pitchumoni, N. Patel, P. J. Shah // Clin. Gastroenterol. – 2006. – Vol. 39, N 9. – Р. 798-814.
  11. Recent advances in the surgical management of necrotizing pancreatitis / A. Leppaniemi, E. Kemppainen // Curr. Opin. Crit. Care. – 2005. – Vol. 11, N 4. – P. 349-352.

PRACTICAL CASES

VOROBYOV O.V., GAVRICHENKO V.I., BORDUKHAEV A.K.

LEIOMYOSARCOMA OF THE GREATER OMENTUM COMPLICATED BY INTRA-ABDOMINAL HEMORRHAGE

The description of a rare pathology – leiomyosarcoma of the greater omentum which has caused intra-abdominal hemorrhage is presented in the brief article. The patient was operated on; the tumor together with the greater omentum and the part of the gastro-colonic ligament was removed. In two years time data on the tumor recurrence and distant metastasis presence were not revealed during the examination.

Keywords: greater omentum, leiomyosarcoma, intra-abdominal hemorrhage.
p. 140 - 142 of the original issue
References
    1. Петерсон, Б. Е. Онкология / Б. Е. Петерсон. – М.: Медицина, 1980. – 447 с.
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    IN ASSISTANCE TO PRACTICIONER

    SCHASTNY A.T.

    PSEUDOCYSTS OF PANCREAS: DIAGNOSTICS, TREATMENT

    The questions of epidemiology, etiology, diagnostics and treatment of pseudocysts of the pancreas are illustrated; applied classifications of the disease are presented. It has been found out that diagnostic program in case of this pathology should provide the use of modern instrumental methods of investigation (ultrasound investigation, computer tomography, magneto resonant tomography, cholangiopancreatography, endoscopic retrograde papillocholangiography as well as biochemical and cytological analysis of the cyst content. Considerable attention has been paid to the operative methods of treatment, especially to mini-invasive technologies. Basing on the literature data and own experience of 300 patients operative treatment, advantages and disadvantages of various interventions in case of this pathology are determined; indications for operative treatment are formulated. Laparoscopies have been shown to be a perspective course in the treatment of patients with chronic pancreatitis accompanied by pseudocysts.

    Keywords: pancreas, pancreatitis, pseudocyst, treatment of pseudocysts, endoscopic surgery.
    p. 143- 156 of the original issue
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    BUSHMA K.M., SPAS V.V., SHAPEL I.A., GERASIMCHIK P.A., GRIGORUK A.V.

    TO THE QUESTION OF AMINOGLYCOSIDES NEPHROTOXICITY

    Aminoglycoside antibiotics play an important role in the antibacterial therapy of sepsis. Their administration is considerably limited by the risk of nephrotoxicity development (up to 25% cases). Science has several approaches concerning nephrotoxicity prevention based on the external factors management: single average daily dose administration, shortening of the therapy courses (not longer than 7 days), adequate hydratation, refusal to use other nephrotoxic agents during aminoglycoside course, kidney function control. However it has been cleared up that external factors stipulate for only 50% of nephrotoxicity. There are also internal, genetically grounded factors for aminoglycoside nephrotoxicity. They are: small diameter of proximal tubules and epithelial cells covering their lumen; high activity of lactatedehydrogenase, succinatdehydrogenase and acid phosphatase ensymopathias, small amount of ribonucleoproteins; reduced mitochondrial respiration capacity; active lipid peroxidation system; weak antioxidant potential. A low level of restored glutathione contributes considerably to nephrotoxicity realisation. At present some investigations are being carried on to develop the method of prevention of aminoglycoside nephrotoxicity influencing the internal risk factors.

    Keywords: sepsis, antibiotics, aminoglycosides, nephrotoxicity.
    p. 157 - 162 of the original issue
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    JUBILEIS

    DEYKALO V.P., ASKERKO E.A., KRYLOV A.I., BOLOBOSHKO K.B., PAVLOV S.A., TOLSTIK A.N., KHMELCHENKO V.P., ZHELEZNYAK A.V.

    TO THE 50TH ANNIVERSARY OF THE TRAUMATOLOGICAL SERVICE FOUNDATION IN VITEBSK REGION

    In the article the periods of traumatological and orthopedic service development in Vitebsk region are presented. Their characteristic is given. Medical professionals who have played a vital role in initiation and further development of orthopedic-traumatological aid to the population of Vitebsk region are mentioned. The achievements of both the clinic of traumatology and orthopedy and the chair for recent years are shown.

    Keywords: Vitebsk, traumatology, orthopedy, anniversary.
    p. 187 - 192 of the original issue
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