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Year 2010 Vol. 18 No 5

HISTORY OF SURGERY

MYLANTYEVA YU.A., NEBYLITSIN YU.S., PILIPAYT M.T.

IN THE NAME OF GOD AND SURGERY

The article describes the life of V. F. Voyno-Yasenetsky, an outstanding surgeon and the hierarch of the Russian Orthodox Church. Possessing the qualities of a scientist as well as an excellent medical education, analytical and rational mind, Valentin Feliksovich worked not only in general surgery. Neurosurgery and oncology, orthopedics and dentistry, ophthalmology, otorhinolaryngology, gynecology and urology made up the sphere of his professional intrests. Following the innovative trends in surgery and high moral principles of the cleric, which he observed in professional activity, Valentin Feliksovich Voyno-Yasenetsky took the honorable place in the history of surgery and the Russian Orthodox Church.

Keywords: Valentin Feliksovich Voyno-Yasenetsky, history of surgery
p. 3 – 11 of the original issue
References
  1. Пузин, Н. П. Несколько писем В. Ф. Войно-Ясенецкого / Н.П. Пузин // Слово. – 1991. – № 3. – С. 47.
  2. Войно-Ясенецкий, В. Ф. Моя жизнь во Христе / В. Ф. Войно-Ясенецкий. – СПб.: Образование, 1996. – 76 с.
  3. Поповский, М. А. Жизнь и житие Святителя Луки Войно-Ясенецкого, архиепископа и хирурга / М. А. Поповский. – СПб.: Сатисъ, Держава, 2002. – 525 с.
  4. Шевченко, Ю. Л. Приветствует вас святитель Лука, врач возлюбленный / Ю. Л. Шевченко. – СПб.: Наука, 2009. – 623 с.
  5. Святой апостол и евангелист Лука // Энциклопедия православной святости. – М., 1997. – Т. 1.– С.341.
  6. Блохина, Н. Н. Врачеватель тела, души и духа / Н Н. Блохина, А.Н. Калягин // Сибирский медицинский журнал. – 1997. – № 1. – С. 53-55.
  7. Кассирский, И. А. Воспоминания о профессоре В. Ф. Войно-Ясенецком / И.А. Кассирский // Наука и жизнь. – 1989. – № 5. – С. 76-89.
  8. Косачёв, И. Д. Профессор Валентин Феликсович Войно-Ясенецкий – хирург и архиепископ / И. Д. Косачёв, П. Ф. Гладких, А. Е. Яковлев // Вестник хирургии им. И. И. Грекова. – 2007. – № 4. – С. 98-101.
  9. Котельников, В. П. В.Ф. Войно-Ясенецкий – выдающийся хирург нашего времени / В. П. Котельников // Клиническая медицина. – 1987. – Т. 65,
  10. № 10. – С. 152-155.
  11. Войно-Ясенецкий В.Ф. Очерки гнойной хирургии / М.: Бином, 2006. – 704 с.
  12. Епископ Лука. Я полюбил страдание... / Епископ Лука. – М.: Изд-во имени Святителя Игнатия Ставропольского, 1998. – 208 с.

MYLANTYEVA YU.A., NEBYLITSIN YU.S., PILIPAYT M.T.

IN THE NAME OF GOD AND SURGERY

The article describes the life of V. F. Voyno-Yasenetsky, an outstanding surgeon and the hierarch of the Russian Orthodox Church. Possessing the qualities of a scientist as well as an excellent medical education, analytical and rational mind, Valentin Feliksovich worked not only in general surgery. Neurosurgery and oncology, orthopedics and dentistry, ophthalmology, otorhinolaryngology, gynecology and urology made up the sphere of his professional intrests. Following the innovative trends in surgery and high moral principles of the cleric, which he observed in professional activity, Valentin Feliksovich Voyno-Yasenetsky took the honorable place in the history of surgery and the Russian Orthodox Church.

Keywords: Valentin Feliksovich Voyno-Yasenetsky, history of surgery
p. 3 – 11 of the original issue
References
  1. Пузин, Н. П. Несколько писем В. Ф. Войно-Ясенецкого / Н.П. Пузин // Слово. – 1991. – № 3. – С. 47.
  2. Войно-Ясенецкий, В. Ф. Моя жизнь во Христе / В. Ф. Войно-Ясенецкий. – СПб.: Образование, 1996. – 76 с.
  3. Поповский, М. А. Жизнь и житие Святителя Луки Войно-Ясенецкого, архиепископа и хирурга / М. А. Поповский. – СПб.: Сатисъ, Держава, 2002. – 525 с.
  4. Шевченко, Ю. Л. Приветствует вас святитель Лука, врач возлюбленный / Ю. Л. Шевченко. – СПб.: Наука, 2009. – 623 с.
  5. Святой апостол и евангелист Лука // Энциклопедия православной святости. – М., 1997. – Т. 1.– С.341.
  6. Блохина, Н. Н. Врачеватель тела, души и духа / Н Н. Блохина, А.Н. Калягин // Сибирский медицинский журнал. – 1997. – № 1. – С. 53-55.
  7. Кассирский, И. А. Воспоминания о профессоре В. Ф. Войно-Ясенецком / И.А. Кассирский // Наука и жизнь. – 1989. – № 5. – С. 76-89.
  8. Косачёв, И. Д. Профессор Валентин Феликсович Войно-Ясенецкий – хирург и архиепископ / И. Д. Косачёв, П. Ф. Гладких, А. Е. Яковлев // Вестник хирургии им. И. И. Грекова. – 2007. – № 4. – С. 98-101.
  9. Котельников, В. П. В.Ф. Войно-Ясенецкий – выдающийся хирург нашего времени / В. П. Котельников // Клиническая медицина. – 1987. – Т. 65,
  10. № 10. – С. 152-155.
  11. Войно-Ясенецкий В.Ф. Очерки гнойной хирургии / М.: Бином, 2006. – 704 с.
  12. Епископ Лука. Я полюбил страдание... / Епископ Лука. – М.: Изд-во имени Святителя Игнатия Ставропольского, 1998. – 208 с.

EXPERIMENTAL SURGERY

USHKEVICH A.L., ZHANDAROV K.N., PROKOPCHIK N.I.

PHOTODYNAMIC THERAPY IN TREATMENT OF ACUTE DESTRUCTIVE PANCREATITIS, PARAPANCREATITIS IN EXPERIMENT

Objectives. To estimate in the experiment the efficacy of the acute destructive pancreatitis and parapancreatitis treatment with application of photodynamic therapy.
Methods. Destructive pancreatitis, parapancreatitis were modeled in 20 laboratory animals (rabbits). Two groups were determined. In the 1st (control one, 10 animals) purulent pancreatitis was modeled; treatment wasn’t applied. In the 2nd group (experimental one, 10 animals) the day after destructive pancreatitis modeling the preparation Photolon was used locally in the foci of destruction, an hour later low-intensity laser radiation was applied. Clinical course was estimated, general and biochemical blood tests indexes were studied. Morphological investigations were performed in case of the death of an animal in the control group and in case of excluding from the experiment in the experimental group.
Results. In the experimental animals, destructive pancreatitis, parapancreatitis developed causing the death of animals after ADPP modeling in the control group. In the experimental group one noted the positive dynamics after photodynamic therapy in general state of animals. In the laboratory data one noted stabilization of general and biochemical blood tests. Macro- and microscopically limitation of the inflammatory reaction took place and not spreading of it.
Conclusions. Application of photodynamic therapy at acute destructive experimental pancreatitis, parapancreatitis leads to the reduction and limitation of inflammation in the pancreas and retroperitoneal fat.

Keywords: acute destructive pancreatitis, parapancreatitis, experiment, photodynamic therapy, Photolon, local administration of photosensitizer
p. 12 – 19 of the original issue
References
  1. Малоивазивное лечение деструктивного панкреатита / А. Н. Лищенко [и др.] // Эндоскоп. хирургия. – 2005. – № 1. – С. 74-75.
  2. Surgical treatment of severe acute pancreatitis: timing of operation is crucial for survival / P. Gotzinger [et al.] // Surg. Infect. – 2003. – Vol. 4, N 2. – P. 205-211.
  3. Photodynamic therapy for the treatment of microbial infections / G. Jori [et al.] // Photodynamic News. – 1999. – Vol. 2, N 1. – P. 2-3.
  4. Фотодинамическая терапия при гнойных заболеваниях мягких тканей / Е. Ф. Странадко [и др.] // Хирургия. – 2000. – № 9. – С. 67-70.
  5. Wilson, M. Lethal photosensitisation of Staphylococcus aureus in vitro: effect of growth phase, serum, and pre-irradiation time / M. Wilson // Laser Surg. Med. – 1995. – N 16. – P. 272-276.
  6. Bactericidal effects of photo activated porphyrins. An alternative approach to antimicrobial drugs / Z. Malik [et al.] // J. Photochem Photobiol B. Biol. – 1990. – N 5. – P. 281-293.
  7. Улащик, В. С. Фотодинамическая терапия и её применение в медицине / В. С. Улащик // Здравоохранение. – 2006. – № 6. – С. 24-28.
  8. Современный взгляд на антимикробную фотодинамическую терапию / В. Т. Пальчун [и др.] // Вестн. отоларингологии. – 2007. – № 3. – С. 4-6.
  9. Использование фотодинамической терапии лазерным аппаратом «Родник-1» с фотосенсибилизатором «Хлорфилипт» в лечении гнойных ран и трофических язв / А. В. Ищук [и др.] // Новости хирургии. – 2008. – Т. 16, № 1. – С. 44-52.
  10. Острый деструктивный панкреатит. Диагностика, тактика, лечение: метод. рекомендации / В. П. Гарелик [и др.]. – Гродно, 2008. – 32 с.
  11. Фотодинамическая терапия в лечении заболеваний периодонта / С. А. Наумович [и др.] // Медицинский журн. – 2007. – № 1. – С. 71-75.
  12. Моделирование острого деструктивного панкреатита, парапанкреатита в эксперименте / А. Л. Ушкевич [и др.] // Новости хирургии. – 2010. – Т. 18, № 2. – С. 8-14.

GENERAL AND SPECIAL SURGERY

SHESTIUK A.M., KARPITSKY A.S., PANKO S.V. , BOYFALIK R.I.

THE ROLE OF INSTRUMENTAL METHODS OF DIAGNOSTICS AT DETECTION OF ESOPHAGUS THORACIC REGION DAMAGES

Objectives. To evaluate the role of instrumental methods of diagnostics at detection of the esophagus thoracic regions damages.
Methods. The experience of medical aid rendering to 103 patients with the esophagus thoracic region trauma is analyzed in the article; these patients underwent in-patient treatment at hospitals of the Republic of Belarus.
Results. The interpretation of the examination results is found out to result in unnecessary mistakes in these patients. Among the instrumental methods of diagnostics of penetrating trauma of the esophagus thoracic region, only application of X-ray computer tomography of the thorax permits to detect the damage in 100%. Application of X-ray of the esophagus in 18,5%, X-ray of the thorax in 30,7%, fibroesophagoscopy in 31,7% of cases leads to false negative result.
Conclusions. X-ray computer tomography of the thorax especially with preliminary contrasting of the esophagus gives the possibility to reveal the perforation signs in the absolute number of examinations.

Keywords: esophagus, perforation, diagnosis
p. 20 – 27 of the original issue
References
  1. Алиев, М. А. Диагностика и лечение повреждений пищевода / М. А. Алиев, Ш. Жураев, В. А. Потапов. – Алма-Ата, 1991. – 158 c.
  2. Повреждения пищевода: диагностика и тактика лечения / Б. А. Янгиев [и др.] // Вестн. хирургии. – 2003. – № 5. – С. 54-56.
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  4. Авилова, О. М. Диагностика и лечение спонтанных разрывов пищевода / О. М. Авилова, В. Г. Гетьман // Вестн. хирургии. – 1986. – № 3. – С. 56-60.
  5. Комаров, Б. Д. Повреждения пищевода / Б. Д. Комаров, Н. Н. Каншин, М. М. Абакумов. – М.: Медицина, 1981. – 176 с.
  6. Spontaneous rupture of the esophagus / E. Maggiore [et al.] // Minerva Chir. – 1991. – Vol. 15. – P. 617-622.
  7. Погодина, А. Н. Механические проникающие повреждения пищевода / А. Н. Погодина, М. М. Абакумов // Хирургия. – 1998. – № 10. – С. 20-24.

MAYOROV V.M., DUNDAROV Z.A., PODOLSKY A.L.

MORPHOLOGICAL CHANGES OF THE INTERNAL ORGANS AT ACUTE NECROTIZING PANCREATITIS ACCORDING TO AUTOPSY DATA

Objectives. To analyze the causes of lethality outcomes, to reveal the regularities of the pathological changes in the internal organs and to determine the peculiarities of multi-organ failure development at acute destructive pancreatitis ADP).
Methods. The continuum retrospective analysis of 132 autopsied patients died of ADP was carried out during the investigation. Vivo diagnosis of the disease was based on the analysis of clinical and laboratory data and the results of the complex instrumental examination. Verification of the infection in the pancreatic necrosis zones and fluid accumulation was based on the bacteriological examination of the materials obtained by the puncture under the sonographic control or intraoperatively.
Results. The chief cause of the lethal outcome was a complicated ADP, which was diagnosed in 98, 64 % of the dead. Early lethal outcomes are caused by the development of a severe enzymatic uncorrected endotoxemia resistant to the applied methods of detoxification.
Conclusions. Lethal outcomes in the early phase of pancreatic necrosis development are linked with the massive intoxication of the enzymatic origin. Late complications manifest at the stage of melting of the destructively changed pancreas and the surrounding parapancreatic fiber.

Keywords: acute necrotizing pancreatitis, parapancreatitis, morphological changes, autopsy
p. 28 – 36 of the original issue
References
  1. Шотт, А. В. Выбор метода лечения острого панкреатита / А. В. Шотт, С. И. Леонович, Г. Г. Кондратенко // Проблемы хирургии в современных условиях: материалы XIII съезда хирургов Республики Беларусь. – Гомель, 2006. – Т. 2. – С. 226-228.
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DZIDZAVA I.I., KOTIV B.N., KASHKIN D.P., SMORODSKI A.V., SLOBODYANIK A.V.

THE CLEARANCE-TEST WITH INDOCIAN GREEN AS A PROGNOSTIC RISK FACTOR FOR SURVIVING IN PATIENTS WITH CIRRHOSES AND PORTAL HYPERTENSION

Objectives. To study the possibility and informational content of clearance-test with indocian green as a prognostic risk factor for surviving in the patients with cirrhoses and portal hypertension.
Methods. 189 patients with cirrhoses complicated by the portal hypertension syndrome and 30 patients without sings of liver diseases were included in the research.
Results. Plasma of disappearance rate (PDRICG) was reliably lower in the patients with cirrhoses (8,2±4,6%/min and 24,9±4,2%/min, p=0,001) and its retention rate on the 15th minute (RR15) significantly increased (34,1±16,5% and 6,8±2,3%, p=0,001). Highly reliable correlation between parameters of clearance-test and histology activity (r=-0,579, p=0,006) index, levels of bilirubin (r=-0,540, p=0,001) and albumin (r=0,447, p=0,001), protrombine time (r=0,449, p=0,001) and volume flow of the portal vein (r=0,482, p=0,001) was revealed. Indexes of test with indocianin green got worse in progress with increasing of heaviness of hepatocellular dysfunction, concordantly to the score of Child-Pugh and MELD. PDRICG had more prognostic ability if compared with these scales as in predicting one-year or five-year surviving (c- statistic 0,813±0,043 and 0,810±0,041). PDRICG less than 8,0%/min and RR15 more than 30,5%, with sensitivity 95% and specific character 80% were the risk factors for surviving after selective and partial portocaval shunting.
Conclusions. The definition of clearance of indocianin green is high informative and specific dynamical test, allowing to estimate the liver functional reserves and to predict survival rate in patients with cirrhoses.

Keywords: clearance-test, indocian green, liver cirrhoses, portocaval shunting
p. 37 – 48 of the original issue
References
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  4. Hashimoto, M. Hepatic parenchymal cell volume and the indocyanine green tolerance test / M. Hashimoto, G. Watanabe // J. Surg. Res. – 2000. – Vol. 92. – P. 222-227.
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  11. The lidocaine (MEGX) test as an index of hepatic function: its clinical usefulness in liver surgery / G. Ercolani [et al.] // Surgery. – 2000. – Vol. 127. – P. 464-471.
  12. Mukherjee, S. Comparison of indocyanine green clearance with Child’s-Pugh score and hepatic histology: a multivariate analysis / S. Mukherjee, M. A. Rogers, B. Buniak // Hepatogastroenterology. – 2006. – Vol. 53. – P. 120-123.
  13. Paquet, K. J. Sclerotherapy for the prevention of bleeding esophageal varices / K. J. Paquet // Internist (Berl.). – 1983. – Vol. 24. – Р. 81-84.
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  15. Подымова, С. Д. Болезни печени: руководство / С. Д. Подымова. – М.: ОАО «Изд-во «Медицина», 2005. – 768 с.
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  17. Hyperendothelinemia and ICG clearance in alcoholic and nonalcoholic cirrhosis / S. Maruyama [et al.] // Dig. Dis. Sci. – 2002. – Vol. 47. – P. 773-777.
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ZUBAREV P.N., KOCHETKOV A.V., BOYARINOV D.YU., KHOKHLOV A.V.

TREATMENT TACTICS OF REFLUX-ASSOCIATED INFLAMMATORY DISEASES OF THE ESOPHAGUS AND THEIR COMPLICATED FORMS

Objectives. To improve the diagnostics algorithm of the reflux-associated inflammatory diseases of the esophagus and its complicated forms as well as to improve the results of treatment.
Methods. Treatment analysis of 112 patients with reflux-associated inflammatory diseases of esophagus was performed, including cases complicated with peptic stricture, esophageal bleeding, Barrett esophagus. The optimal algorithm of examination of these patients was worked out using modern methods such as zoom-endoscopy, chromoscopy (including NBI-regimen), examination of motor function using impedometry, twenty-four-hour pH-metry. Surgical treatment in case of a complicated course included mini-invasive endoscopic supplies used to eliminate complications as the first step; the second step was correction of gastric sphincter complex using endovideosurgical methods.
Results. The suggested algorithm permitted to individualize treatment tactics depending on the pathogenetic mechanism of the disease progressing. At the evaluation of the distant treatment results in the group of patients with the worked out algorithm, excellent and good results were noted in 86,4% of cases. While using conventional diagnostics methods to determine surgical tactics this parameter was twice as low; in the nearest postoperative period excellent and good results were compared in both groups and they were 92,8% and 88,4% correspondently.
Conclusions. The suggested algorithm of examination and worked out treatment tactics permitted to improve results in patients with reflux-associated inflammatory diseases of the esophagus in the nearest and distant periods

Keywords: gastroesophageal reflux, reflux-esophagitis, ulcerous esophageal bleeding, peptic stricture of esophagus, esophageal mucous tunic metaplasia
p. 49 – 53 of the original issue
References
  1. Черноусов, А. Ф. Результаты фундопликаций при лечении рефлюкс-эзофагита / А. Ф. Черноусов, А. Л. Шестаков, Л. К. Егорова // Вестн. хирург. гастроэнтерологии. – 2009. – № 4. – С. 64-67.
  2. Richardson, W. S. Laparascopic antireflux surgery / W. S. Richardson, T. L. Trus, J. G. Hunter // Surg. Clin. N. Am. – 1996. – Vol. 76. – P. 437-458.
  3. Romagnullo, J. Medical or surgical therapy for erosive reflux esophagitis: cost utility analysis using a Markov model / J. Romagnullo, M. A. Meier, D. C. Sadowski // Ann. Surg. – 2002. – Vol. 236. – P. 191-202.
  4. Опыт клинического применения новой лапароскопической технологии при гастроэзофагеальной рефлюксной болезни / Г. К. Жерлов [и др.] // Эндоскоп. хирургия. – 2007. – № 5. – С. 11-16.
  5. Черноусов, А. Ф. Рефлюкс-эзофагит у больных с коротким пищеводом / А. Ф. Черноусов, Т. В. Хоробрых, Ф. П. Ветшев // Хирургия. – 2008. – № 8. – С. 24-30.
  6. Long-term results after reoperation for failed antireflux procedures / C. Deschamps [et al.] // J. Thorac. Cardiovasc. Surg. – 1997. – Vol. 113. – P. 545-550.
  7. Surgical Reintervention After Antireflux Surgery for Gastroesophageal Reflux disease. A Prospective Cohort Study in 130 Patients / E. J. B. Furnee [et al.] // Arch. Surg. – 2008. – Vol. 143, N 3. – P. 267-274.
  8. Clinical effectiveness of laparoscopic fundoplication in U.S. community / N. Vakil, M. Shaw, R. Kirby // Am. J. Med. – 2003. – Vol. 114, N 1. – P. 71-73.

SARAP P.V., VINNIK YU.S., OSTANIN A.A.

DYNAMIC SYSTEM-FORMING INDEXES OF PATIENTS’ STATE WITH URGENT SURGICAL PATHOLOGY RECEIVING IMMUNOACTIVE MEDICINES

Objectives. To investigate informative content of dynamic condition indicators in the patients with urgent abdominal surgical pathology receiving complex treatment with application of immunoactive medicines (IAM).
Methods. 276 patients receiving IAM as a part of complex treatment and control group of 166 persons are examined. Using the factorial analysis the main components are calculated and the system-forming dynamic condition indicators of patients are defined.
Results. Application of IAM has changed number of the factors defining the structure of dynamic condition indicators of patients’ state. Indicators of the immune system are more significant than indicators of intoxication and severity scales. Indicators of severity scales in the patients receiving IAM are more significant. Indicators of intoxication are more significant in patients of control group. Indicators of the vegetative regulation and intensity of adaptable reactions significantly present dynamics of a condition in the patients receiving IAM and present low significance in the patients of control group.
Conclusions. Use of the factorial analysis allows choosing the most informative, system-forming indicators for monitoring of patients’ condition depending on the complex treatment methods.

Keywords: urgent surgery, immunity, immunocorrection, factorial analysis
p. 54 – 62 of the original issue
References
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LYZIKOV A.A.

LATE COMPLICATIONS AT THE RECONSTRUCTIVE SURGICAL TREATMENT OF THE AORTA-ILIAC SEGMENT

Objectives. To reveal the factors influencing the development of late complications of aorta-iliac reconstructive surgery to determine high risk groups of the patients.
Methods. Case histories of 33 patients who were operated on from 2005 to 2009 at Gomel regional vascular surgery department for late complications of aorta-iliac surgeries were analyzed.
Results. It was revealed that maximal number of cases (90,7%) of late complications was noted in patients who had been initially operated on for sub- and decompensated blood supply deterioration. Clinical manifestations of prosthesis thrombosis are more severe than ones in case of false aneurism. False aneurisms were developed later (7,1±4,5 yrs vs. 4,6±4,7 yrs in case of the thrombosis) but required multiple surgery more often (40% and 22% correspondingly).
Conclusions. Patients with trophic leisure at different stages of expressions are more vulnerable to late complications. Therefore the use of the prosthetic grafts at that situation is unsafe and application of autogenous conduits seems to be reasonable.

Keywords: vascular prosthesis, prosthesis thrombosis, false aneurism, late complications, aorta-iliac reconstructive surgery
p. 63 – 68 of the original issue
References
  1. NUNN, D. B. POSTOPERATIVE ALTERATIONS IN SIZE OF DACRON AORTIC GRAFTS / D. B. NUNN, M. H. FREEMAN, P. C. HUDGINS // ANN. SURG. – 1979. – VOL. 189. – P. 741-746.
  2. Smoking and the patency of lower extremity bypass grafts: a meta-analysis / E. M. Willigendael [et al.] // J. Vasc. Surg. – 2005. – Vol. 42, N 1. – P. 67-74.
  3. Pressure distention compared with pharmacologic relaxation in vein grafting upregulates matrix metalloproteinase-2 and -9 / A. W. Chung [et al.] // J. Vasc. Surg. – 2005. – Vol. 42, N 4. – P. 747-756.
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  5. Neoaortic reconstruction for aortic graft infection: need for endovascular adjunctive therapies? / J. Faulk [et al.] // Ann. Vasc. Surg. – 2005. – Vol. 19, N 6. – P. 774-781.
  6. Therapeutical options in partial infected aorto-bifemoral prosthetic grafts / C. Burcoveanu [et al.] // Rev. Med. Chir. Soc. Med. Nat. Iasi. – 2003. – Vol. 107, N 2. – P. 459-462.

PAVLOV A.G., SUSHKOV S.A.

DIAGNOSTICS OF HEMODYNAMIC DISTURBANCES IN THE VEINS OF THE SHIN ANTERIOR MYOFASCIAL BED AT VARICOSITY

Objectives. To study hemodynamic disturbances in the veins of the shin anterior myofascial bed at varicosity.
Methods. Clinical, ultrasound and X-ray investigation of 353 patients with varicosity who were admitted for the operative treatment to the clinic of general surgery of Vitebsk state medical university and of 20 people without signs of the lower limbs venous system diseases was carried out. The data of the instrumental methods were compared with clinical manifestations and results of examination in the control group.
Results. It has been established that in 25,2% of patients with valvular insufficiency of the popliteal vein at phlebography the reflux in the system of anterior tibial veins is observed. The diameter of the anterior tibial veins at varicosity reliably differs from the norm on 16% on the average; and in the patients with trophic disturbances the difference in the diameter of the anterior tibial veins increases up to 29%. Incompetent perforating veins of the anterior myofascial bed are more frequently revealed in patients with a large “bottle-like” form of the lower leg. In case of trophic disturbances on the anterior-lateral surface of the tibia incompetent perforating veins of the anterior myofascial bed are revealed in 42,5% of cases; that is reliably more frequent than in patients with trophic disturbances of other localization or at varicosity without trophic disturbances.
Conclusions. Hemodynamic disturbances in the deep and perforating veins of the shin anterior myofascial bed contribute to the development of trophic disturbances; it should be taken into consideration while examining and planning of surgical treatment.

Keywords: varicosity, anterior tibial veins, perforating veins, shin anterior myofascial bed, trophic disturbances, ultrasound angioscanning, phlebography
p. 69 – 81 of the original issue
References
  1. Думпе, Э. П. Физиология и патология венозного кровообращения нижних конечностей / Э. П. Думпе, Ю. И. Ухов, П. Г. Швальб. – М.: Медицина, 1982. – 168 с.
  2. Флебология: руководство для врачей / В. С. Савельев [и др.]; под ред. В. С. Савельева. – М.: Медицина, 2001. – 664 с.
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  4. Клинико-рентгенологическая диагностика вертикального рефлюкса крови в мышечно-венозной помпе нижних конечностей и таза при варикозной болезни / Е.Ф. Фирсов [и др.] // Вестн. рентгенологии и радиологии. – 1998. – № 1. – С. 30-35.
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KUZMENKO A.V., USOVICH A.K.

SURGICAL ANATOMY OF THE MAIN TRUNK AND ANASTOMOSES OF THE INFERIOR GLUTEAL ARTERY

Objectives. Revealing of variations of the main trunk anatomy and anastomoses of the inferior gluteal artery.
Methods. The investigations were performed on 7 unfixed and 46 fixed dead bodies. Methods of dead bodies’ preparation and morphometry were used in the research.
Results. The data concerning variant anatomy of the main trunk of the inferior gluteal artery were obtained. It was determined that the inferior gluteal artery forms intra-pelvic anastomoses over the distance of 21,0±3,0 mm from the place of its beginning. The left inferior artery was established to form anastomoses more often than the right one with the main vessels of the pelvic cavity and adjoining regions.
Conclusions. The obtained data can be used in urgent surgery to stop bleeding from the damaged main trunk of the inferior gluteal artery.

Keywords: inferior gluteal artery, pelvic arteries, anastomoses
p. 82 – 87 of the original issue
References
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  2. Волчкевич, Д. А. Топографо-анатомические особенности строения ягодичных артерий / Д. А. Волчкевич // Журн. Гродн. гос. мед. ун-та. – 2004. – № 2. – C. 31-34.
  3. Silberzweig, J. E. Transcatheter arterial embolization for pelvic fractures may potentially cause a trial of sequela: gluteal necrosis, rectal necrosis, and lower limb paresis / J. E. Silberzweig // J. Trauma. – 2009. – Vol. 67, N 2. – P. 416-417.
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  5. Минеев, К. П. Клинико-морфологические аспекты перевязки сосудов таза / К. П. Минеев. – Свердловск: Изд. Урал. ун-та, 1990. – 180 с.

ONCOLOGY

SHISHLO I.F., NARKEVICH V.S.

EFFICACY OF DIAGNOSTIC METHODS OF THE HOLLOW ORGAN DEFECT AT POSTOPERATIVE PERITONITIS FOR CANCER PATIENTS

Objectives. To compare the efficacy of the main techniques of express-diagnostics of the hollow organ defect in cancer patients when the postoperative peritonitis is suspected.
Methods. Comparison of the indexes of diagnostic efficacy of clinical technique, X-ray contrast, colour contrast and X-ray colour contrast investigations to reveal the hollow organ defect in 130 cancer patients with the postoperative peritonitis was performed. The percentage of truly positive results as well as sensitivity, specificity and accuracy of the applied technique were calculated.
Results. Sensitivity of X-ray contrast imaging was inferior to clinical examination (p<0,05) and colour contrast imaging (p<0,05), and was not superior to X-ray colour contrast (p>0,05). Specificity of contrast techniques was maximal (100,0%), and the clinical examination didn’t exclude cases of hyperdiagnostics (60,0%, p>0,05). Diagnostic precision of all the techniques did not differ (p>0,05) and ranged from 67,4% to 92,3%.
Conclusions. Definite character of the separated liquid from drainages had high diagnostic sensitivity. X-ray contrast imaging was a conclusive method of perforation revealing in the absence of the drainage function of the abdominal cavity.

Keywords: cancer patients, postoperative peritonitis, diagnostic of the hollow organ defect, diagnostic efficacy
p. 88 – 93 of the original issue
References
  1. Послеоперационные осложнения у больных перитонитом / Б. К. Шуркалин [и др.] // Хирургия. – 2003. – № 4. – С. 32-35.
  2. Conservative surgical treatment of diffuse peritonitis / C. A. Seiler [et al.] // Surgery. – 2000. – Vol. 127, N 2. – P. 178-184.
  3. Wittmann, D. H. Management of secondary peritonitis / D. H. Wittmann, M. Schein, R. E. Condon // Ann. Surg. – 1996. – Vol. 224, N 1. – P. 10-18.
  4. Шишло, И. Ф. Возможности ранней диагностики послеоперационного перитонита у онкологических больных / И. Ф. Шишло // Мед. панорама. – 2010. – № 4. – С. 58-60.

UROLOGY

PRANOVICH A.A., VOSCHULA V.I., SCHAVELEVA M.V.

SICKNESS RATE DYNAMICS AND ANALYSIS OF THE MAIN TREATMENT METHODS OF BENIGN PROSTATIC HYPERPLASIA IN THE REPUBLIC OF BELARUS

Objectives. To study occurrence frequency of the benign prostatic hyperplasia (BPH) in the Republic of Belarus and to perform the analysis of the main methods of treatment application to treat the given pathology during the period of 1997-2008 years.
Methods. Analysis of BPH occurrence frequency in the Republic of Belarus was carried out. A special protocol was worked out in which patient’s age, diagnosis, kind of operative intervention were taken into consideration.
Results. At present BPH is one of the most distributed diseases among elderly and old age men. The amount of patients with the pathology mentioned above is increasing progressively in every region in particular and in the Republic in general. The quantity of BPH operations at in-hospital departments in the Republic has increased by 24% since 1997. 3574 patients have been operated on in 1997, whereas this number has increased up to 4708 in 2008. The situation of a considerable (more than twice) increase during the analyzed period of the performed cystostomies must be regarded as a problematic one. 784 and 1582 cystostomies were done in 1997 and 2008 correspondingly at the hospitals of the country. Their part has increased from 22% (1997) to 33.6 (2008) in general operations number.
Conclusions. At present on the background of a considerable increase of frequency occurrence of BPH among the population the problem of searching for new optimal ways of BPH patients treatment still remains unsolved.

Keywords: Benign prostatic hyperplasia, symptoms of the lower urinary tracts, symptomatic BPH, transurethral resection of the prostate, BPH-ectomy, cystostomy
p. 94 – 100 of the original issue
References
  1. Римашевская, Н. М. Население и глобализация / Н. М. Римашевская, В. Ф. Галецкий, А. А. Овсянников. – М.: Наука. – 2002. – 24 с.
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  4. Emberton, M. BPH. A progressive disease of the ageing male / M. Emberton [et al.] // Urology. – 2003. – N 13. – P. 267-273.
  5. (BPH) Benign prostatic hyperplasia. A progressive disease of the ageing male / P. Boyle [et al.] // Urology. – 2003. – N 61. – P. 267-273.
  6. Пушкарь, Д. Ю. Современный алгоритм обследования и лечения больных аденомой предстательной железы / Д. Ю. Пушкарь, П. И. Раснер // Урология. – 2007. – № 3. – С. 87-94.
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  9. The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic followup of transurethral resection of prostate for bladder outlet obstruction / A. W. Thomas [et al.] // J. Urol. – 2005. – N 6. – P. 91.

MAXILLOFACIAL SURGERY

KRAVTSEVICH L.A.

APPLICATION OF THE LOW LEVEL LASER THERAPY IN TREATMENT OF PHLEGMON OF MAXILLOFACIAL AREA AND NECK

Objectives. The aim of the research was to study the impact of local Low Level Light Therapy (LLLT) in treating patients with phlegmons of the maxillofacial area and the neck as well as to evaluate the efficiency of the treatment.
Methods. 52 patients with phlegmons of the maxillofacial area and the neck were under the observation, in 22 of them conservative treatment was applied and in 30 patients local Low Level Light Therapy was used.
Results. A comparative estimation of the treatment methods and their results in the patients with phlegmons of the maxillofacial area and the neck was performed. Based on the received clinical, cytological and microbiological results one can conclude that local application of LLLT exerts anti-inflammatory effect and stimulates reparative processes in the wound.
Conclusions. The given data of LLLT application in treating phlegmons of the maxillofacial area and the neck allow evaluating the advantage of this method in comparison with the traditional treatment.

Keywords: phlegmons of the maxillofacial area and the neck, low level laser therapy (LLLT), treatment
p. 101 – 106 of the original issue
References
  1. Состояние системы нейтрофильных гранулоцитов при иммуноориентированной терапии флегмон челюстно-лицевой области / О. В. Цымбалов [и др.] // Мед. акад. журн. – 2005. – Т. 5, № 1. – С. 99-105.
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  6. Робустова, Т. Г. Современная клиника, диагностика и лечение одонтогенных воспалительных заболеваний / Т. Г. Робустова // Рос. стоматол. журн. – 2003. – № 4. – С. 11-16.
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OPHTHALMOLOGY

MORKHAT V.I., VOLKOVICH T.K.

FEATURES OF PRIMARY AND SECONDARY FORMS OF BACTERIAL KERATITIS COURSE

Objectives. To study the features of primary and secondary forms of bacterial keratitis (BK).
Methods. The investigation was performed on 106 patients with bacterial keratitis. The first group was composed by 43 patients with the primary form of the disease, the second – by 63 patients with the secondary form. Microbiological investigation with sensitivity definition to antibacterial preparations was done in 58 cases. The analysis of reparative abilities with calculation of corneal epithelialization factor was carried out in 44 patients.
Results. Secondary form of bacterial keratitis developed more often (р=0,04) in persons older those at able-bodied age. Primary form of bacterial keratitis developed more often in males of able-bodied age. The conditional-pathogenic microflora prevailed in both groups.
Conclusions. St. Epidermidis prevails in etiology of primary and secondary forms of bacterial keratitis development which sensitivity is most marked to an antibacterial preparation tobramycin.
The primary form of bacterial keratitis is characterized by the marked reparative processes in the regress and scarring stage, secondary – by low intensity of reparative processes in all stages of inflammatory process resulting in prolongation of the ulcer-inflammatory defect epithelialization.

Keywords: bacterial keratitis, primary form, secondary form, microflora
p. 107 - 111 of the original issue
References
  1. Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases / T. Bourcier [et al.] // Br. J. Ophthalmol. – 2003. – Vol. 87. – P. 834-838.
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  5. Severe infective keratitis leading to hospital admission in New Zealand / T. Wong [et al.] // Br. J. Ophthalmol. – 2003. – Vol. 87. – P. 1103-1108.
  6. Trends in resistance to ciprofloxacin, cefazolin, and gentamicin in the treatment of bacterial keratitis / N. A. Afshari [et al.] // Journal of ocular pharmacology and therapeutics. – 2008. – Vol. 24. – P. 217-223.
  7. Шаимова, В. А. Клинико-этиологические особенности различных типов течения гнойной язвы роговицы / В. А. Шаимова // Вестн. офтальмологии. – 2002. – № 1. – С. 39-41.
  8. Волкович, Т. К. Импрессионная цитология в диагностике бактериального кератита / Т. К. Волкович, Т. А. Имшенецкая, И. В. Самсонова // ARS MEDICA. Новое в офтальмологии. – 2009. – № 9. – С. 32-37.

MORKHAT M.V., MORKHAT V.I., MARCHENKO L.N.

DIAPHANOOPHTHALMOSCOPIC DIAGNOSTICS OF DYSTROPHIC CHANGES AT AGE-RELATED MACULAR DEGENERATION AND DEGENERATIVE MYOPIA

Objectives. To study the diagnostic value of diaphanoophthalmoscopy (DO) at atraumatic transillumination for the detection of macular changes in dry and wet age-related macular degeneration (AMD) and the degenerative myopia (DM) with determination of typical DO pictures of various manifestations of AMD and DM.
Methods. The study included 119 eyes with AMD from 61 patients and 93 eyes with the degenerative myopia from 48 patients. Retrobulbar transillumination was performed using a non-invasive transpalpebral technique. Fundus was examined by indirect diaphanoophthalmoscopy (DO) using condensing lenses +20D. The DO findings were compared with ophthalmoscopy findings and in some cases with optical coherence tomography (OCT) and fluorescein angiography (FA) findings. Typical transillumination appearance was captured with fundus camera RetCam II without flash.
Results. The fundus view in DO and ophthalmoscopy differed significantly. DO illustrated high efficacy even in cases with media opacifications and poor dilatation, providing clearly defined margins of lesions. DO helped to reveal pathology lesions, that were invisible with ophthalmoscopy. FA and OCT also revealed the presence of changes revealed at DO, thus confirming diagnostic efficacy of DO.
Conclusions. The given method can be widely used for additional visualization at AMD and DM because it is rather effective, simple, non-invasive one.

Keywords: diaphanoophthalmoscopy, retina, age-related macular degeneration, myopia
p. 112 – 124 of the original issue
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VOLKOVICH T.K.

AUTOSERUM APPLICATION ACTIVATED BY ZYMOZAN IN TREATMENT OF THE SECONDARY FORM OF BACTERIAL KERATITIS

Objectives. To determine the efficiency of zymozan activated by autoserum application in the complex treatment of the secondary form of bacterial keratitis.
Methods. 63 patients with the secondary form of bacterial keratitis were included in the investigation. The 1st group includes 47 patients (traditional treatment), the 2nd group - 16 patients (traditional treatment + autoserum, activated by zymozan (АSАZ)). Efficiency of treatment was estimated by the method of the cornea impression cytology.
Results. Application of ASAZ in the complex treatment of the bacterial keratitis secondary form promoted the development of the early beginning (Ме=3,0, р=0,002) and reduction of the epithelialization duration of the ulcer-inflammatory defect for 4 days (р=0,033).
Conclusions. Application of zymozan activated autoserum is effective due to the activation of phagocytosis, proliferative and reparative processes at treatment of the secondary form of bacterial keratitis.

Keywords: bacterial keratitis, autoserum, zymozan, macrophages, epithelialization
p. 125 - 132 of the original issue
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LECTURES, REVIEWS

GAIN YU.M., KISELYOVA E.P.

PROSPECTS AND POSSIBILITIES OF CELL TRANSPLANTATION AT RESTORING OF EXTENSIVE SOFT TISSUE DEFECTS OF TRAUMATIC ORIGIN

Objectives. To estimate the efficacy of modern treatment techniques of cell transplantation, used to restore the extensive defects of soft tissues at a trauma of various etiology and to determine the most perspective directions for the development of the given technologies in the Republic of Belarus.
Methods. Modern native and foreign literature was analyzed dealing with theoretical aspects as well as clinical experience of application of cell technologies of the regenerative medicine in restoring soft tissues extensive defects of the traumatic origin.
Results. The comparative analysis of native and foreign literature was carried out with the efficacy estimation of the applied cell transplantation techniques in the experiment and in a clinic with the therapeutic aim. One should accept the therapeutic technologies based on the application of mesenchymal stem cells which permit to avoid the main disadvantages linked with the procedure of autologous tissues transplantation as the most perspective direction of substitution of the extensive tissue defects of the traumatic and other origins. The advantages of the given technique are the following: 1) small amount of aspirate containing mesenchymal stem cells obtained from the bone marrow, adipose tissue and other sources can be increased up to necessary amount in the vitro and then used to treat a number of diseases including the substitution of the extensive tissue defects forming as the result of trauma and other pathologies; 2) mesenchymal stem cells can be differentiated in several cell generations, thus giving the possibility to use total cell resource for restoring different tissues in contrast to the principle of healthy tissue intake for restoring their own kind at autologous tissues transplantation; 3) mesenchymal stem cells can be introduced in the biocompatible grafts, transplanted to the places of anatomical defects for further reconstruction of the damaged organ or tissue; 4) treatment of different diseases and traumas with application of mesenchymal stem cells can be autologous and at the same time solve the problems dealing with the immune reaction, vector-borne transmission of pathogens, wear and tear of synthetic materials, allergic reaction to the artificial implants.
Conclusions. Prospects of the regenerative medicine development based on the cellular technologies were and are rather impressive and they continue to attract attention of scientists all over the world. One may suppose that in the nearest future cell transplantation will take its rightful place in the arsenal of treatment for wounds, burns and for restoring a wide range of tissues in the human body.

Keywords: regeneration, stem cells, tissue engineering, burns, transplantation
p. 133 – 143 of the original issue
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ORLOVSKY YU.N.

DIAGNOSTICS AND TREATMENT OF BILE DUCT INJURIES AND COMPLICATIONS OF THEIR PRIMARY CORRECTION

In the review the data about modern methods of diagnostics and treatment of iatrogenic bile duct injuries, and also complications after primary reconstructive operations are presented. Historic information on the given problem is presented. The characteristic of classification systems of strictures and injuries of the bile ducts are presented. Versions of the reconstructive operations and the choice of the most optimal techniques are illustrated. Conclusions about the further prospects of the developed theme are formulated.

Keywords: bile duct, injury, diagnostics, operative treatment, Roux-en-Y anastomosis
p. 144 – 159 of the original issue
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EXPERIENCE EXCHANGE

KUDYKIN M.N., IZMAYLOV S.G., KLETSKIN A.E., MUKHIN A.S., PUGIN V.A., BESCHASTNOV V.V., RYABKOV M.G.

NEW POSSIBILITIES IN TREATMENT OF THE LOWER LIMBS CHRONIC ARTERIAL INSUFFICIENCY

Materials. Non-comparative prospective investigation of 43 patients with IIА and IIB degrees of limb ischemia was performed; in these patients the reconstructive intervention didn’t seem possible and conventional therapy was ineffective. Efficacy of the suggested treatment method of chronic limb ischemia with the phlebotrophic preparation «Antistax», regeneration stimulator «Ximedon» was studied as well as the application of the apparatus pneumomassage of the limb.
Results. Using the suggested complex method of treatment was found out to increase statistically the distance of pain-free walking by 30% and to increase the threshold of tolerance of the ischemic pains.
Conclusions. The worked out method of correction improves significantly the treatment results of patients with the lower limbs obliterating diseases.

Keywords: arterial ischemia of the limbs, chronic arterial insufficiency, lymphatic-venous insufficiency, conservative treatment, antistax, ximedon, pneumomassage
p. 160 – 165 of the original issue
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IN ASSISTANCE TO PRACTICIONER

VAVILOVA T.V.

LABORATORY INVESTIGATIONS IN DIAGNOSTICS OF DIC SYNDROME

Disseminated intravascular coagulation is a clinical-pathogenetic syndrome which complicates many diseases. DIC syndrome can be accompanied by thromboses and hemorrhage or both together leading to complex chain of events, multi-organ failure and death of a patient.
DIC syndrome isn’t an independent disorder; it’s always secondary one and develops on the background of different clinical situations. Such understanding of DIC syndrome resulted in the most significant practical conclusion – basis of its therapy is treatment of a disease and reasons caused coagulation disturbance. At the same time diagnostic programs for timely revealing of coagulating processes disturbances which can be regarded as laboratory signs of DIC were suggested. These programs include investigations available to every laboratory. The given publication is aimed to systematize knowledge concerning this question and provide clinicians laboratory instrument for timely diagnostics of DIC syndrome and targeted therapy monitoring at already developed condition.

Keywords: DIC syndrome, coagulation, diagnostics, treatment, monitoring
p. 166 – 174 of the original issue
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