Novosti
Khirurgii

DOI: https://dx.doi.org/10.18484/2305-0047.2019.1.5   |  

I.V. MAIBORODIN ¹, N.F. FIGURENKO ¹, A.A. ELOVSKIY ², T.V. MIKHEEVA ¹, R.V. MASLOV ¹, V.I. MAIBORODINA ³, A.I. SHEVELA ¹

POSSIBILITY OF INFLAMMATORY INJURES DEVELOPMENT IN INTACT LIVER AFTER THE MULTIPOTENT STROMAL CELL INJECTION IN EXPERIMENT

Institute of Chemical Biology and Fundamental Medicine¹,
Medical Center “Avicenna” ²,
Institute of Molecular Pathology and Pathomorphology, Federal Research Center for Fundamental and Translational Medicine³,
Novosibirsk,
The Russian Federation

Objective. To study the possibility of complications development after the injection of the autologous multipotent mesenchymal stromal cells of the bone marrow origin (MMSC) directly in the intact liver of rats.
Methods. The changes of the rat liver after the direct injection of MMSC with a transfected GFP-gene and additionally stained cellular membranes by Vybrant® CM-Dil were investigated by the methods of light microscopy with luminescence application.
Results. After the MMSC injections, the extensive congestions, depot of the injected cells in the liver were absent in all animals even after a week. In some cases, up to 1/3 observations, the aseptic inflammation manifested by the dilation and hyperemia of sinusoids, an increase of neutrophil number in the sinusoids, necroses of parenchyma and lympho-histiocytic infiltrates were developed in the organ. Long thin layers of the connective tissue extending in the vessel region and containing a large number of siderophages appeared in the liver during the 3rd week. By the 4th week the specified liver morphological changes have normalized. Throughout the experiment there was no any differentiation of injected MMSC to the liver cells.
Conclusions. The main causes of the revealed changes are the damage of the liver parenchyma at the cell suspension injection under pressure and also direct presence of MMSC and their detritus. At the syringe under pressure the MMSC suspension moves apart and lacerates the liver parenchyma along the vessels. Injected MMSC, some of which quickly perishes due to a dramatic change in living conditions, and also the detritus which is present together with them, immediately cause migration of macrophages to the site of injection and actually are the reason of aseptic inflammatory process. MMSC are quickly eliminated from the injection site in the liver by macrophages and also by means of vascular and lymphatic beds whereas the proceeding inflammatory reaction damages the liver cells and serves as the cause of the revealed changes.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2019.1.16   |  

O.YA. POPADYUK ¹, O.S. MALYSHEVSKA ¹, L.YA. ROPYAK ², V.S. VYTVYTSKYI ², M.М. DRONIAK ¹

STUDY OF NANO-CONTAINING BIOPOLYMER FILMS THERAPEUTIC AND PHYSICAL-MECHANICAL PROPERTIES

Ivano-Frankivsk National Medical University¹,
Ivano-Frankivsk National Technical University of Oil and Gas²,
Ivano-Frankivsk,
Ukraine

Objective. To investigate the influence of component composition and technological parameters of the formation of nano-containing biopolymer films on their therapeutic and physico-mechanical properties.
Methods. The authors studied nano-containing biopolymer films for wound treatment, which had contained gelatin, polyvinyl alcohol, glycerol, lactic acid, distilled water and zinc nano oxide with various technological mode manufactured. The studied options were as follows: elasticity, degradation time, vapor permeability of biopolymer films. Therapeutic properties of biopolymer films were evaluated based on the results of measuring the protective action diameter.
Results. The biopolymer film treatment properties are directly related to the diameter of the protective action. It has been defined that protective effect diameter of films containing zinc nanooxide increases both with an increase in the ratio of the concentrations of the components of the mixture and with an increase in the content of zinc nanooxide, reaching a maximum protective action diameter of 20.5 mm with its content of 197 mg.
Thermostat exposition period increasing leads to protective action diameter decreasing reaching a minimum, and in the future slightly increases. The increase in the heating temperature adversely affects the therapeutic properties of the film, which is due to the compaction of its structure. The film degradation time increases with increase of component concentration ratio, the zinc nanooxide concentration and the mixture heating temperature. Component composition and biopolymer film obtaining regimes and their influence on elasticity, degradation time and vapor permeability were studied. Introduction of zinc nanooxide into the composition of the film increases firstly its vapor permeability, which, after reaching the maximum, decreases. Biopolymer film is environmentally safe, water and carbon dioxide are released in its destruction. Nano-oxide of zinc is a weakly toxic, non-aggressive component, present in the products of destruction of the film in the bound state and insignificant amount.
Conclusions. Carried out studies have shown that the treatment properties of biodegradable polymeric materials depend on zinc nanooxide concentration, and their degradation properties provide metered delivery of the medicament to the lesion area.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2019.1.26   |  

A.R. KHASANOV ¹, M.S. KORZHUK ¹, K.G. BEZMOZGIN ², O.O. ZHUKOVA ¹, A.A. KINZERSKIY ¹

PLEURAL MANOMETRY IN THERAPEUTIC THORACENTESIS TO DETERMINE THE PREDICTORS OF UNWANTED OUTCOMES IN PATIENTS WITH PLEURAL EFFUSION

Omsk State Medical University ¹,
A.N. Kabanov Omsk City Clinical Hospital №1 ², Omsk,
The Russian Federation

Objective. To determine the prognostic value of the fluctuations of the intrapleural pressure associated with the act of breathing during thoracocentesis and draining of fluid from the pleural cavity.
Methods. The study included 36 patients who suffered from pleural effusion and underwent thoracentesis. The continuous intrapleural manometry during the procedure was performed. Then control examinations included repeated examination, chest X-ray and ultrasound examination of the pleural cavities. According to their results, patients were divided into 3 groups: group 1 – patients with straightened lungs and without complications (n=18), group 2 – patients with unexpandable lung (n=18), subgroup 2-1 – patients, which thoracocentesis, complicated by pneumothorax (n=6). The comparison criteria were the volume of the removed liquid (ml), the mean intrapleural pressure (cm H2O), the amplitude of the pressure fluctuations associated with the act of breathing, between the inspiration and expiration peaks in quiet breathing before and after the removal of the liquid (cm H₂O), the pleural elasticity and change of amplitude of the pressure fluctuations after the draining.
Results. It was found that association among the pleural elasticity and the amplitude change and unexpandable lung were statistically significant (p=0.00283). It was also found out that, with the development of pneumothorax, an increase in pleural elasticity is associated with a decrease in intrapleural pressure fluctuations (p=0.00199). There were no significant associations of development of unwanted outcomes with other comparison criteria.
Conclusions. Association with outcomes is confirmed for pleural elasticity and change of the amplitude of the fluctuations of intrapleural pressure associated with the act of breathing. An objective predictor of unexpandable lung, as well as the occurrence of pneumothorax after thoracocentesis, along with an elevation of pleural elasticity, is a decrease in the amplitude of oscillations of pleural pressure associated with the act of breathing.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2019.1.35   |  

V.N. ZASIMOVICH, A.S. KARPITSKI, A.M. NAZARUK, YA.A. MALASHCHYTSKI, M.N. BARYSENKA, A.S. ZHYMAILA, A.I. ARLAVETS

RETROGRADE LOOP ENDARTERECTOMY IN ATHEROSCLEROTIC OCCLUSION OF THE FEMORAL ARTERY

Brest Regional Hospital, Brest,
The Republic of Belarus

Objective. To compare the immediate and long-term surgical treatment results of the superficial femoral artery occlusion by the retrograde loop endarterectomy and femoral-popliteal bypass grafting above the knee joint space with a synthetic prosthesis.
Methods. From 2011 to 2015, 192 revascularizations of the limb were performed in the atherosclerotic superficial femoral artery occlusion. Patients were divided into groups two depending on the revascularization technique: the 1st group (n=133) – patients who underwent the retrograde loop endarterectomy, the 2^nd group (n=59) – patients who underwent femoral-popliteal bypass grafting above the knee joint space.
Results. Technical success was obtained in 100% of observations. After revascularization, the increase in the mean value of the ankle-brachial index was 0.43±0.03 in the group I, 0.41±0.04 in the group II (M±σ). Thrombosis of the desublimated segment developed in 6 patients (4.5%) of the Group I, thrombosis of the shunt – in 3 patients (5.1%) of the Group II. Long-term results were studied in the terms of 1-3 years. Survival rate after 1 year and 3 years in the group I was 97.7% и 92.5% respectively, in the group II – 98.3% и 91.5%.
Primary patency in the group I after 1 and 3 years made up 89.5% and 64.7% respectively, in the group II – 74.6% and 49.2%.
The primary level of limb preservation in the group I after 1 and 3 years was 94.0% and 85.0%, respectively. And in the group II, the same indicator was noticeably lower, and in 1 and 3 years was 84.7% and 62.7%, respectively.
Conclusions. The retrograde loop endarterectomy shows better results in the postoperative and distant periods compared to femoral-popliteal bypass grafting above the knee joint with a synthetic prosthesis. Retrograde looped endarterectomy can be the operation of choice in case of primary surgical intervention on isolated atherosclerotic occlusion of superficial femoral artery.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2019.1.42   |  

K.V. LIPATOV, E.A. KOMAROVA, V.I. KHRUPKIN, M.A. KIRYUPINA

SIGNIFICANCE OF DISTANT PEDICLED FLAPS GRAFTING IN CLOSING TRAUMATIC DEFECTS

I.M. Sechenov First Moscow State Medical University,
Moscow,
The Russian Federation

Objective. Comprehensive analysis of opportunities, technical features and disadvantages of wound plasty with distant pedicled flap closing wound defects of the limbs was performed.
Methods. The study included 14 patients with limb wounds of different origin, who were treated using distant pedicled flaps grafting. Wounds were of different origin (deep frostbites, chronic osteomyelitis, neurotrophic disorders), diverse localization and perimeter. The indication for this type of full-layer plastics was the need to treat the wound in a functionally significant zone and the impossibility of using other, less complex methods of skin grafting.
Results. A positive immediate result of treatment was obtained in all 14 cases of distant flaps grafting. The development of complications (critical bend of the pedicle of the flap, sub-flap hematoma, the flap’s edge necrosis) was registered in 3 cases in the early postoperative period, those complications did not significantly affect the immediate outcome of the operation. Long-term outcomes of treatment were evaluated in 8 patients in terms from 1 to 22 years after the operation. The key point determining the long-term treatment outcome was the patient’s compliance in the conditions of denervation of the flap and closure of wounds in functionally important areas. A flap necrosis in the plantar area occurred in two cases in patients, who did not follow the recommendations. In the remaining observations a stable positive result was obtained.
Conclusions. The distant pedicled flaps grafting is an effective method of reconstruction in functionally important areas under the conditions of limited plastic reserves of the surrounding skin. Denervation of such flaps exposes additional requirements to patients in terms of compliance with recommendations. The success of the operation in the long term period is largely determined by the patient’s compliance.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2019.1.49   |  

M.A. CHERKASOV, A.G. CHERNYI, I.I. SHUBNYAKOV, A.A. IRZHANSKI, K.K. IDRISOV, R.K. DZAMIKHOV

INTEGRATED QUALITY ASSESMENT OF MEDICAL CARE FROM PATIENT’S STANDPOINT

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden,
St. Petersburg,
The Russian Federation

Objective. To assess the quality of medical care and patient satisfaction in a specialized hospital.
Methods. Prospective study of the group consisting of 210 patients hospitalized with different orthopedic pathologies during the period from October to December 2017 was carried out. Before discharge from the hospital, patients were asked to complete the PPE-15 questionnaire (Picker Patient Experience Questionnaire). Beforehand, the PPE-15 questionnaire was translated and adapted for use in Russian-speaking medical practice.
Results. The average age of patients was 49.4 years (CI 95% 46.2-52.6), Male patients were 87 (42%), female patients – 120 (58%). The average value of pain by the visual analogue scale was 27.4 points (CI 95% 24.2-30.5), satisfaction with medical support averaged 93 points (CI 95% 90.8-95.2). 91% of patients were ready to recommend treatment at our clinic to their relatives and friends, 6% abstained and left the question unanswered, 3% answered negatively. The connection between patient’s satisfaction and the 1, 3, 4 and 7 domains of the PPE-15, p<0.001 questionnaire was the strongest. There was no correlation between satisfaction and other factors.
Conclusions. The presented assessment results of patients’ satisfaction and their readiness to recommend the hospital to their relatives or acquaintances allow us making optimistic forecasts. However, a detailed study of certain aspects of patients’ experiences on the PPE-15 questionnaire will be useful for monitoring the work of different hospitals or hospital departments and may indicate ways of improving health care. Satisfaction with the process of medical care is indeed one of the goals of the Ministry of Health, and since the patient is the most interested party in assessing its quality, taking into account his opinion on the assistance provided is key to achieving maximum satisfaction with the treatment process.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2019.1.59   |  

K.M. KUBRAKOV, V.I. PETUKHOV, A.V. KORNILOV

VACUUM THERAPY APPLICATION IN SURGICAL TREATMENT OF SPINAL EPIDURAL ABSCESSES

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

Objective. To improve the surgical treatment results in patients with spinal epidural abscesses.
Methods. Surgical removal of spinal epidural abscesses, including interlaminectomy using a vacuum-draining system, was performed in 5 patients. The median age of patients was 58 [52; 64] years, 3 patients were males, 2 -females. On admission, the neurological status was studied, laboratory, bacteriological and instrumental methods of examination (computed and magnetic resonance imaging, bone scintigraphy) were carried out. The intensity of the pain syndrome was determined by the visual analogue scale (VAS). Sepsis was confirmed in 3 patients.
Results. A positive clinical outcome was achieved in 5 patients. The severity of pain before treatment and 2-3 days after surgery significantly decreased from 8.0 [8.0; 9.0] points to 5.0 [4.0; 5.0] on the VAS scale. On discharge, pain in 4 patients had almost completely regressed, but 1 patient still had a mild pain (4 points on the VAS scale) in the postoperative wound area. All patients had a regression of neurological deficit – an increase in the strength and volume of active movements in the lower limbs up to 4 points, the normalization of the functions of the pelvic organs. There was no postoperative kyphotic spinal deformity in any patient. Recurrence of inflammatory process, requiring re-operations was not observed. Despite the positive neurological symptoms, regression of pain and an increase in the volume of active movements in the analyzed group, there was one death due to the extremely severe septic condition of the patient which had been already on admission.
Conclusions. The developed method of the spinal epidural abscesses surgical treatment, including interlaminectomy throughout the purulent focus and the installation of a vacuum-draining system, provides adequate sanitizing effect, rapid elimination of edema of the adjacent soft tissues, neural structures and high-quality tissue repair.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2019.1.66   |  

L.P. KOTELNIKOVA ¹, A.N. FEDACHUK ²

ASSESSMENT OF ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH ADRENAL TUMORS DURING SKIN THERMOMETRY WITH LOCAL HEATING

Perm State Medical University named after E.A. Wagner ¹,
Perm Regional Clinical Hospital ², Perm,
The Russian Federation

Objective. To investigate the endothelial dysfunction in patients with adrenal tumors during skin thermometry before and after surgery.
Methods. «Microtest», a device for skin thermometry, was used to detect endothelial dysfunction in 19 patients with the adrenal tumors. The index of thermal vasodilation K was calculated for the endothelial, neurogenic and myogenic ranges. The patients were divided into two groups: patients with pheochromocytoma (n=8) and with hormonal inactive adrenal tumors and arterial hypertension (n=11). The comparison group consisted of 27 healthy adults.
Results. The patients with pheochromocytoma had lower thermal vasodilatation indices in all ranges in comparison to healthy adults; this difference was significant only in the myogenic and neurogenic ranges. A significant decrease of all indices of thermal vasodilation for patients of the second group was observed. A significant increase in indices of thermal vasodilatation in the endothelial and myogenic ranges was registered in patients with pheochromocytoma as well as the trend to rise in the neurogenic range during the early postoperative period. There was a strong positive association between the normalization of blood pressure in the postoperative period, the preoperative treatment with doxazosin, and the value of the index of thermal vasodilation in the endothelial range after the surgery.
Conclusions. All patients with pheochromocytomas, hormone-inactive adrenal tumors and arterial hypertension had the signs of impaired microvascular bed endothelial function. Preoperative treatment and adrenalectomy significantly improve the reaction of the microvascular endothelium in response to external heat stimuli in patients with pheochromocytoma.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2019.1.72   |  

А.V. OREHVA ¹, ², Е.А. SHLIAKHTUNOU ¹, V.М. SEMENOV ¹

CLINICAL SIGNIFICANCE OF INHIBITOR OF APOPTOSIS PROTEIN SURVIVIN EXPRESSION IN COLORECTAL CANCER

Vitebsk State Medical University ¹
Vitebsk Regional Clinical Oncology Center ², Vitebsk,
The Republic of Belarus

All over the world, colorectal cancer occupies the third place in terms of incidence and is the leading cause of death from malignant neoplasms. The incidence of colon cancer is expected to have 60 % increased by 2030 and will make up 2.2 million new cases per year. But despite modern diagnostics, the disease is mainly detected in the 3-4 stages. Even with the treatment of early tumor forms, progression occurs in 40-50% of patients. Tumor markers are used to monitor the development of the tumor process, but not all of them are highly sensitive and specific. In recent years, there has been an active search for new diagnostic markers that could not only predict the development of the disease but would also be the markers of a response to chemo-radiotherapy. The expression of inhibitor of apoptosis proteins (IAP) is known to increase the viability of tumor cells, and their overexpression leads to chemo-radio-resistance and is always associated with poor clinical prognosis of the disease. Due to this, inhibitor of apoptosis proteins are considered as a promising target in gene therapy for cancer. One of the most studied members of the IAP protein family is the survivin protein. In this literature review, the issue of clinical use of inhibitor of apoptosis protein survivin in colorectal cancer will be considered.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2019.1.81   |  

E.M. SHARAFANOVICH ^{1, 2}, N.E. KONOPLYA ¹, V.I. AVERIN ³

CONTEMPORARY OPTIONS FOR MEDICAL TREATMENT OF PEDIATRIC VASCULAR LESIONS

Belarusian Medical Academy of Post-Graduate Education ¹,
Republican Scientific and Practical Center for Pediatric Surgery ²,
Belarusian Medical State University ³, Minsk
The Republic of Belarus

Vascular lesions constitute a considerable part (about 25%) of pediatric benign tumors and tumor-like masses. According to up-to-date understanding of vascular lesions (anomalies) they are divided into two main groups: vascular tumors (characterized by growth through cell proliferation) and vascular malformations (structural abnormalities of vessels development).
The mechanism of action of drugs for vascular lesions systemic medication aims at proliferation and angiogenesis, therefore that kind of management has implement mostly to vascular tumors.
The most significant pediatric benign vascular tumor is infantile hemangioma (IH). The distinctive features of IH, as a separate nosology, are its typical clinical course with phases of proliferation and subsequent involution, GLUT1 expression at immune-histochemical staining, and also positive response to beta-blockers treatment, in particular, to non-selective beta-blocker propranolol that, at present, has got a main place in the management of this kind of vascular tumors.
In certain vascular malformations molecular-genetic researches of recent years have demonstrated alterations relating to cell cycle regulation and vasculature development. For clinical course improvement of some vascular malformations, a medical treatment can be also applied.
The article presents an up-to-date vascular lesions classification and terminology, describes options of medical management for vascular tumors and tumor-like masses, provides some of their pathogenetic aspects that determine the prospects of new pharmaco-therapeutic approaches to vascular anomalies management.

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.1.91   |  

R.E. KALININ, I.A. SUCHKOV, A.S. PSHENNIKOV, S.A. VINOGRADOV

MARKERS OF ARTERIOVENOUS DIFFERENTIATION OF ENDOTHELIAL CELLS AND THEIR INFLUENCE ON ADAPTATION OF AUTOVENOUS CONDUITS IN MAIN ARTERIES RECONSTRUCTIVE SURGERY

Ryazan State Medical University, Ryazan,
The Russian Federation

Revascularization of the occluded arterial segments is currently the main treatment method in patients with critical limb ischemia. Discussions regarding the choice of the best conduit for the reconstructive procedures on the femoro-popliteal-tibial segments have been continuing over the last five decades. Autovenous conduits using the great saphenous vein remain the golden standard in vascular reconstructive surgery. However, up to 50% of autovenous transplants lose patency within 5 years. Reaction of venous conduit to arterial circulation and its morphofunctional changes are not fully described in present-day medical literature. Markers of embryonic arteriovenous differentiation of endothelial cells determining the faith of both arteries and veins have gained popularity within past years. Ephrin-B2 is specifically expressed in arterial endothelium while Eph-B4 is expressed in venous endothelial cells. Arterialization of the autovenous conduit is characterized by the loss of the venous marker Eph-B4 without obtaining the arterial marker Ephrin-B2, which is accompanied by the negative morphological remodeling of the venous wall, i.e. its thickening. Eph-B4 in venous endothelium interacts with a number of molecules including eNOS, caveolin and others, thus regulating the process of adaptation. Further studies of the adaptation of venous conduits to arterial circulation may help improve our understanding of this process and results of the autovenous reconstructive procedures.

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.1.101   |  

L.A. BOCKERIA, D.K. GUSCHIN, M.M. ZELENIKIN, L.A. YURPOLSKAYA

RARE CASE: FIBROMA OF THE INTERVENTRICULAR SEPTUM IN 17-MONTH-OLD CHILD

A.N. Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow,
The Russian Federation

Frequency of primary heart tumors in children is relatively rare and according to the literature data does not exceed 0.32%, while heart fibroma is registered in 13-18%. Cardiac fibroma is a benign tumor that occurs mainly in childhood. It can be manifested by heart rhythm disturbances, heart failure, sudden death, while large number of patients remain asymptomatic and tumor is revealed accidentally. Electrocardiography and echocardiography help to diagnose this heart neoplasm, but an accurate diagnosis can be made using additional methods such as computer or magnetic resonance imaging and histological examination. Nevertheless, in some situations, nature of tumor can be established only after its resection. This case report describes the stages of diagnosis and subsequent successful resection of a large fibroma of the interventricular septum, which has created the obstruction of right ventricular outflow tract, in a baby patient. It should be noticed that the course of the disease was almost asymptomatic. The tumor was first detected at the age of 1 month when performing routine echocardiography and subsequently the child was observed for several months by cardiologist; there was a tendency to the tumor increase, but there were no specific complaints from the child.

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.1.108   |  

R.V. KARPOVA, A.F. CHERNOUSOV, Т.V. KHOROBRYH, D.A. KAZAKOVA, YU.M. POLUEKTOV

LIVER REGENERATION AFTER INTRAHEPATIC INJECTION OF CRYOPRECIPITATE IN A PATIENT WITH CIRRHOSIS

I.M. Sechenov First Moscow State Medical University, Moscow,
The Russian Federation

Nowadays the mortality rate due to the liver cirrhosis has been steadily increasing. Conservative methods of treatment have a positive effect at an early stage of the disease in some patients. The amount of five-year survival rate is 62% in the compensation stage of cirrhosis whereas it decreases to 19% at the decompensation stage. At the present time, the most effective treatment of cirrhosis is liver transplantation because a five-year survival rate is 70-75%. However, this method is followed by the number of limitations. In this aspect, we give preference to minimally invasive techniques with the use of agents influencing an inflammation process and liver regeneration. This case report describes the clinical experience of seven-year observation of the patient with viral liver cirrhosis (HbsAg+, DNA HBV+, HDV+) in the decompensation stage (C-class by Child-Pugh) treated by the minimally invasive method: intrahepatic injection of cryoprecipitate. This contributed to the improvement of the general state and clinical and laboratory parameters for a long time. The cryoprecipitate is a highly concentrated solution of fibrinogen derived from donor plasma by cryoprecipitation, containing growth factors to decrease macrophage activity and cirrhosis progress. On admission, the patient had the unfavorable prognosis for the disease. However, the usage of cryoprecipitate showed significant improvement of the laboratory and hemodynamic tests. The effectiveness and availability of this method make it perspective for the treatment of the patients with liver cirrhosis in the stage of decompensation.

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.1.114   |  

YU.V. LARTSEV, S.Е. KATORKIN

SAMARA SCIENTIFIC-PEDAGOGICAL SCHOOL OF TRAUMATOLOGISTS-ORTHOPEDISTS (TO THE 70TH ANNIVERSARY OF ACADEMICIAN OF RAS G.P. KOTELNIKOV)

The article is devoted to an outstanding traumatologist-orthopedist, talented scientist, remarkable teacher, public figure, MD, professor, academician of the Russian Academy of Sciences, Rector of Samara State Medical University G.P. Kotelnikov. Adhering to a strictly scientific direction in traumatology and orthopedics, high moral values, he educated a whole pleiad of students, created a scientific and pedagogical school and made a great contribution to the development of Russian Health Care.
The main scientific directions of the research and pedagogical school of Academician G.P. Kotelnikov are the following: development of the problem of tendon-muscular plastics in traumatology and orthopedics, improvement of methods in diagnosis and treatment of destructive-dystrophic and oncological diseases of the musculoskeletal system, optimization of diagnostic and therapeutic measures for post-traumatic instability of the joints, studies on the use of gravitational therapy, the study of osteoporosis, development of the concept of traumatic disease, cellular technologies in orthopedics, development of systemic analysis, mathematics modeling and evidence in medicine. The field of his activity also includes transplantology, clinical biomechanics, phlebology, urology, maxillofacial surgery and military field surgery, gerontology. He is interested in nutrition, balneology, history of medicine. In the field of healthcare organization, the main scientific direction is the improvement of methodological approaches in the training of medical personnel.

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