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Khirurgii

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Year 2013 Vol. 21 No 6

EXPERIMENTAL SURGERY

I.A. SHVED, A.V. VOROBEY, T.E. VLADIMIRSKAYA, G.V. SHERSTYUK, O.P. SHORETS, S.V. ALEKSANDROV

THE PECULIARITIES OF LASER WOUNDS HEALING AFTER LIVER RESECTION BY HIGH-INTENSITY LASER RADIATION IN EXPERIMENT

SEE “Belarusian Medical Academy of Post-Graduate Education”,
The Republic of Belarus

Objectives. Studying the peculiarities of the laser wound healing after liver resection by high-intensity laser radiation (HILR) with different wavelength in experiment.
Methods. Experiments have been carried out on 64 rabbits. The resection of the portion of the liver was done by means of laser irradiation by a wavelength of 1064 nm, 1330 nm and 1440 nm. Samples of the blood and liver for hematologic and morphological studies were taken immediately and then on the 1st, 3rd, 7th, 14th, 30th days after operation.
Results. At all regimes the extensive zones of thermal liver injury and a secondary necrosis were formed, the zones of primary and secondary laser damages encapsulated, the remote damages developed perifocally. In an acute experiment more expressed macrophage reaction using the HILR regime at 1320 nm was registered. Inhibition of leukocyte reaction development was observed in animals using HILR at 1064 nm and 1440 nm. 14 days after the operation the output of purulent exudate on the surface of a fibrous capsule was observed in animals with the application of HILR at 1064 nm, substantial increase of segmented nuclei leukocytes number was revealed in the blood as well as the protein of a sharp phase and the erythrocyte sedimentation rate (ESR). By the 30th day of observation a full encapsulation with the constriction of the damage site and retention of non-resorbed necrosis areas of the liver tissue have been occurred in all animals.
Conclusions. It has been established that development of wound process, perifocal-distant changes and inflammatory reaction after liver resection with high-intensity laser irradiation depends on a used regime (1064 nm, 1320 nm and 1440 nm) in acute and chronic experiment. Healing of a liver wound occurs faster after radiation therapy by laser with the wavelength 1320 nm, causing more expressed macrophage reaction in a wound and increase of the total number of blood leukocytes in the early postoperative period.

Keywords: liver resection, high-intensity laser radiation, wound healing
p. 3 – 9 of the original issue
References
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  3. Theisen-Kunde D, Wolken H, V. Danicke; R. Brinkmann; H. Bruch; M. Kleemann. In vivo study of partial liver resection on pigs using a 1.9 μm thulium fiber laser. Medical Laser Applications and Laser-Tissue Interactions: Procedings SPIE, Munich, Germany, May 22, 2011yr. 2011Jun 02;8092.
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  6. Schmitz-Valckenberg S, Guo L, Maass A, Cheung W, Vugler A, Moss SE, Munro PM, Fitzke FW, Cordeiro MF Real-time in vivo imaging of retinal cell apoptosis after laser exposure. Invest Ophthalmol Vis Sci. 2008 Jun;49(6):2773–80.
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Address for correspondence:
220013, Respublika Belarus', g. Minsk, ul. P.Brovki, d.3, k.3, GUO «Belorusskaia meditsinskaia akademiia poslediplomnogo obrazovaniia», nauchno-issledovatel'skaia laboratoriia,
e-mail: galinasher@mail.ru
Sherstyuk Galina Valentinovna
Information about the authors:
Shved I.A. MD, professor, a senior researcher of SRL SEE “Belarusian Academy of Post-graduate Education”.
Vorobey A.V. MD, professor, a head of the surgery chair of SEE “Belarusian Academy of Post-graduate Education”.
Vladimirskaya T.E. PhD, a leading researcher of SRL SEE “Belarusian Academy of Post-graduate Education”.
Sherstyuk G.V. PhD, a leading researcher of SRL SEE “Belarusian Academy of Post-graduate Education”.
Shorets O.A. A junior researcher of SRL SEE “Belarusian Academy of Post-graduate Education”.
Aleksandrov S.V. A lecturer of the surgery chair of SEE “Belarusian Academy of Post-graduate Education”.

A.A. GLUKHOV, E.V. MIKULICH, N.T. ALEKSEEVA, A.P. OSTROUSHKO

INDICES OF OXIDATIVE STRESS AND ANTIOXIDANT DEFENSE AS QUALITY CRITERIA OF TREATMENT OF CHRONIC EXPERIMENTAL OSTEOMYELITIS

SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”,
The Russian Federation

Objectives. Assessment of the processes of oxidative stress and the antioxidant defense system (ADS) against the background of the stream sanitation and platelet enriched plasma (PRP) application in the treatment of chronic experimental osteomyelitis.
Methods. The study was performed on 112 albino outbred male rats. After the modeling of chronic osteomyelitis, the animals were divided into 2 control and 3 experimental groups. Treatment was not provided in the first control group. In the second control group the surgical sanitation was performed. In the experimental groups focus surgical sanitation was done. Then, in the first experimental group the stream sanitation of the damage site was performed, in the second experimental group PRP was used and in the third experimental group the combined treatment was carried out including the use of the jet sanitation and PRP. Lipid peroxidation (LPO) by the level of malondialdehyde (MDA), oxidative modification of proteins (OMP) by the content of carbonyl groups, enzymatic link of the antioxidant defense system (ADS) by the activity of superoxide dismutase (SOD) and non-enzymatic link of the ADS by the content of SH-groups were evaluated on 14th, 28th and 90th day.
Results. The dynamics of lipid peroxidation, oxidative modification of proteins as well as enzymatic and non-enzymatic units of the antioxidant defense system were studied. It has been registered that on the inflammatory process background in chronic osteomyelitis, the development of pathological activity of the free radical oxidation takes place leading to a decrease of has the tissues regenerative capacity of in the place of inflammation. Oxidative stress developed. When applying the jet sanitation and platelet rich plasma in the treatment of chronic osteomyelitis, the balanced functioning of the pro- and antioxidant defense systems is observed, preventing the development of the oxidative stress.
Conclusions. It is determined that in treatment of platelet rich plasma (PRP) and stream sanitation, a rapid cupping of oxidative stress has occurred, which contributes to the stabilization of the metabolic processes and a more favorable course of a wound healing.

Keywords: chronic osteomyelitis, lipid peroxidation, oxidative modification of proteins, antioxidant defense system
p. 10 – 16 of the original issue
References
  1. Glukhov AA, Alekseeva NT, Mikulich EV. Eksperimental'noe obosnovanie primeneniia struinoi sanatsii i trombotsitarnogo kontsentrata v lechenii khronicheskogo osteomielita dlinnykh trubchatykh kostei [Experimental justification for applying jet sanitation and platelet concentrate in the treatment of chronic osteomyelitis of long bones]. Vestn Eksperim i Klin Khirurgii. 2012;V(1):131–36.
  2. Nikitin GD, Rak AV, Linnik SA. Khirurgicheskoe lechenie osteomielita [Surgical treatment of osteomyelitis]. Saint -Petersburg, RF: 2000. 286 p.
  3. Amiraslanov IuA, Svetukhin AM, Borisov IV, Ushakov AA. Vybor khirurgicheskoi taktiki pri lechenii bol'nykh osteomielitom dlinnykh kostei v zavisimosti ot kharaktera porazheniia [The choice of surgical tactics in the treatment of patients with osteomyelitis of the long bones depending on the character of the lesion]. Khirurgiia. 2008;(9):46–50.
  4. Ishutov IV, Alekseev DG. Osnovnye printsipy ozonoterapii v lechenii patsientov s khronicheskim osteomielitom [The basic principles of ozone therapy in the treatment of patients with chronic osteomyelitis]. Vestn Eksperiment i Klin Khirurgii. 2011; IV (2):314–20.
  5. Zaitsev AB, Mitrofanov VN. Sistemnyi podkhod k rekonstruktivno-vosstanovitel'nomu lecheniiu khronicheskogo osteomielita goleni [System approach to reconstructive and regenerative treatment of chronic osteomyelitis of the tibia]. Travmatology i Ortopedia. 2010 Apr; 2:215–18.
  6. Khasanov AG, Nurtdinov MA, Nigmatzianov SS, Sakaev RSh. Rezul'taty primeneniia plazmennykh potokov v kompleksnom lechenii khronicheskogo osteomielita [The results of application of plasma flows in the treatment of chronic osteomyelitis]. Vestn Eksperim i Klin Khirurgii. 2010;III(3):207–09.
  7. Belokhvostikova TS, Kirdei LE, Gavrilova EIu, Promtov MV, Leonova SN, Kirdei EG. Korrektsiia vtorichnykh narushenii immunnoi sistemy pri khronicheskom posttravmaticheskom osteomielite [Correction of secondary disorders of the immune system in chronic post-traumatic osteomyelitis]. Med Immunolology. 2002;4(2):228–29.
  8. Dubinina EE. Rol' aktivnykh form kisloroda v kachestve signal'nykh molekul v metabolizme tkanei pri sostoianii okislitel'nogo stressa [Role of active oxygen species as signaling molecules in the tissue metabolism in the state of oxidative stress]. Vopr Med Khimii. 2001;47(6):561–81.
  9. Go YM, Halvey PJ, Hansen JM, Reed M, Pohl J, Jones DP. Reactive aldehyde modification of thioredoxin-1 activates early steps of inflammation and cell adhesion. Am J Pathol. 2007 Nov;171(5):1670–81.
  10. Jones DP, Carlson JL, Mody VC, Cai J, Lynn MJ, Sternberg P. Redox state of glutathione in human plasma. Free Radic Biol Med. 2000 Feb 15;28(4):625–35.
  11. Chesnokova NP, Ponukalina EV, Bizenkova MN, Afanas'eva GA. Vozmozhnosti effektivnogo ispol'zovaniia antioksidantov i antigipoksantov v eksperimental'noi i klinicheskoi meditsine [Opportunities of the effective application of antioxidants and antihypoxants in experimental and clinical medicine]. Uspekhi Sovr Estestvoznaniia. 2006;(8):18–25.
  12. Berndt C, Lillig CH, Holmgren A. Thiol-based mechanisms of the thioredoxin and glutaredoxin systems: implications for diseases in the cardiovascular system. Am J Physiol Heart Circ Physiol. 2007 Mar;292(3):H1227–36.
  13. Stal'naia ID, Garishchvili TG. Orekhovich VN, red. Metody opredeleniia malonovogo dial'degida s pomoshch'iu tiobarbiturovoi kisloty [Methods of determining malonic dialdehyde using thiobarbituric acid]. Sovrem Metod v Biokhimii. Moscow, RF: Meditsina. 1977. p. 66–68.
  14. Dubinina EE, Burmistrov SO, Khodov DA, Porotov IS. Okislitel'naia modifikatsiia belkov syvorotki krovi cheloveka, metodom ee opredeleniia [Oxidative modification of human serum proteins by the method of its determination]. Vopr Med Khimii. 1995;41(1):24–26.
  15. Sirota TV. Novyi podkhod v issledovanii protsessa autookisleniia adrenalina i ispol'zovanie ego dlia izmereniia aktivnosti superoksiddismutazy [A new approach to study the process of autooxidation of adrenaline to measure the activity of superoxide dismutase]. Vopr Med Khimii. 1999;45(3):263–72.
  16. Rubina KhM, Romanchuk LA. Kolichestvennoe opredelenie SH-grupp v tsel'noi i deproteinizirovannoi krovi spektrofotometricheskim metodom [Quantitative determination of SH-groups in the intact and deproteinizated blood spectrophotometrically]. Vopr Med Khimii. 1961;VII(vyp 1):652–55.
Address for correspondence:
394000, Rossiiskaia Federatsiia, g. Voronezh, ul. Studencheskaia, d. 10, GBOU VPO «Voronezhskaia gosudarstvennaia meditsinskaia akademiia im. N.N. Burdenko», kafedra obshchei khirurgii,
e-mail: alenkamik@yandex.ru,
Glukhov Aleksandr Anatol'evich
Information about the authors:
Glukhov A.A. MD, professor, a head of the chair of general surgery of SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”.
Mikulich E.V. PhD, an assistant of the chair of general surgery of SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”.
Alekseeva N.T. PhD, an associate professor, a head of the chair of normal human anatomy of SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”.
Ostroushko A.P. An assistant of the chair of general surgery of SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”.

I.V. MAIBORODIN, E.A. BEREGOVOY, I.V. KUZNETSOVA, A.I. SHEVELA, M.I. BARANNICK, V.I. MAIBORODINA

INTRAOSTEAL COLLOST IMPLANTATION IN EXPERIMENT

Center of New Medical Technologies of the Institute of Chemical Biology and Fundamental Medicine of Nb RAS,
Novosibirsk,
The Russian Federation

Objectives. Assessment of the processes of oxidative stress and the antioxidant defense system (ADS) against the background of the stream sanitation and platelet enriched plasma (PRP) application in the treatment of chronic experimental osteomyelitis.
Methods. The study was performed on 112 albino outbred male rats. After the modeling of chronic osteomyelitis, the animals were divided into 2 control and 3 experimental groups. Treatment was not provided in the first control group. In the second control group the surgical sanitation was performed. In the experimental groups focus surgical sanitation was done. Then, in the first experimental group the stream sanitation of the damage site was performed, in the second experimental group PRP was used and in the third experimental group the combined treatment was carried out including the use of the jet sanitation and PRP. Lipid peroxidation (LPO) by the level of malondialdehyde (MDA), oxidative modification of proteins (OMP) by the content of carbonyl groups, enzymatic link of the antioxidant defense system (ADS) by the activity of superoxide dismutase (SOD) and non-enzymatic link of the ADS by the content of SH-groups were evaluated on 14th, 28th and 90th day.
Results. The dynamics of lipid peroxidation, oxidative modification of proteins as well as enzymatic and non-enzymatic units of the antioxidant defense system were studied. It has been registered that on the inflammatory process background in chronic osteomyelitis, the development of pathological activity of the free radical oxidation takes place leading to a decrease of has the tissues regenerative capacity of in the place of inflammation. Oxidative stress developed. When applying the jet sanitation and platelet rich plasma in the treatment of chronic osteomyelitis, the balanced functioning of the pro- and antioxidant defense systems is observed, preventing the development of the oxidative stress.
Conclusions. It is determined that in treatment of platelet rich plasma (PRP) and stream sanitation, a rapid cupping of oxidative stress has occurred, which contributes to the stabilization of the metabolic processes and a more favorable course of a wound healing.

Keywords: chronic osteomyelitis, lipid peroxidation, oxidative modification of proteins, antioxidant defense system
p. 17 – 23 of the original issue
References
  1. Dunn MG, Avasarala PN, Zawadsky JP. Optimization of extruded collagen fibers for ACL reconstruction. J Biomed Mater Res. 1993 Dec;27(12):1545–52.
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  3. Sirak SV, Sletov AA, Alimov ASh, Tskhovrebov ACh, Fedurchenko AV, Afanas'eva OV. Kliniko-eksperimental'noe obosnovanie primeneniia preparata Kollost i biorezorbiruemykh membran Diplen-Gam i Parodonkol pri udalenii retenirovannykh i distopirovannykh nizhnikh tret'ikh moliarov [Clinical and experimental validation of the Collost drug and bioresorbable membrane Dinplen-Cum and Parodonkol in removing of impacted and dystopic lower third molars]. Stomatologiia. 2010; 87(2):10–14 .
  4. Vozmozhnosti primeneniia Kollosta – revoliutsionnogo bioplasticheskogo materiala novogo pokoleniia [The possibility of applications Collost - the revolutionary bioplastic material of new generation]. Zdorov'ia Ukraini. 2008(22):50–51.
  5. Maiborodin IV, Kolesnikov IS, Sheplev BV, Ragimova TM, Kovyntsev AN, Kovyntsev DN, Shevela AI. Morfologiia podlezhashchikh tkanei desny posle dental'noi implantatsii s primeneniem preparatov fibrina [The morphology of the underlying gingival tissues after dental implantation with fibrin]. Stomatologiia. 2009;88(1):9–13.
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  7. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, Gogly B. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part III: leucocyte activation: a new feature for platelet concentrates? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Mar;101(3):e51–5.
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  12. Fredriksson MI, Gustafsson AK, Bergstrom KG, Asman BE. Constitutionally hyperreactive neutrophils in periodontitis. J Periodontol. 2003 Feb;74(2):219–24.
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  14. Kellouche S, Mourah S, Bonnefoy A, Schoevaert D, Podgorniak MP, Calvo F, Hoylaerts MF, Legrand C, Dosquet C. Platelets, thrombospondin-1 and human dermal fibroblasts cooperate for stimulation of endothelial cell tubulogenesis through VEGF and PAI-1 regulation. Exp Cell Res. 2007 Feb 1;313(3):486–99.
Address for correspondence:
630090, Rossiiskaia Federatsiia, g. Novosibirsk, pr. akad. Lavrent'eva, d. 8, Institut khimicheskoi biologii i fundamental'noi meditsiny SO RAN, Tsentr novykh meditsinskikh tekhnologii, laboratoriia stvolovoi kletki
e-mail: imai@mail.ru,
Maiborodin Igor' Valentinovich
Information about the authors:
Maiborodin I.V. MD, professor, a leading researcher of the stem cell laboratory of the Institute of chemical biology and fundamental medicine of NB RAS.
Beregovoy E.A. PhD, an applicant for Doctor’s degree of the regenerative surgery laboratory of the Institute of chemical biology and fundamental medicine of NB RAS.
Kuznetsova I.V. PhD, a researcher of the stem cell laboratory of the Institute of chemical biology and fundamental medicine of NB RAS.
Shevela A.I. MD, professor, Honored physician of RF, deputy director on research of the Institute of chemical biology and fundamental medicine of NB RAS.
Barannick M.I. PhD, an applicant for Doctor’s degree of the stem cell laboratory of the Institute of chemical biology and fundamental medicine of NB RAS.
Maiborodina V.I. MD, a senior researcher of the stem cell laboratory of the Institute of chemical biology and fundamental medicine of NB RAS.

GENERAL AND SPECIAL SURGERY

V.L. BELEVICH, D.V. OVCHINNIKOV, A.O. BREDNEV

ENDOSCOPIC METHODS OF ELIMINATION OF DYSPHAGIA SYNDROME IN STENOSING DISEASES OF THE ESOPHAGUS AND RELATED-COMPLICATIONS

FSOMEE HPE “Military Medical Academy named after S.M. Kirov”, MD RF
Saint-Petersburg,
The Russian Federation

Objectives. To assess the experience of stents application, formulate the main indications and contraindications for the esophageal stenting, prove that the esophageal stenting with self-expandable metal stents is considered as the treatment of choice in incurable patients.
Methods. Within the period from 2007 to 2012 yrs. 68 patients have treated for the cancer of esophagus and gastric cardia, 2 patients with benign esophageal strictures were subjected to stenting at the general surgery department of the Military Medical Academy named after S.M. Kirov. The group of patients included 53 men and 17 women. 60 patients with dysphagia grade III-IV have been examined, 6 of them – with trachea-esophageal, 2 – esophageal-pleural fistulas formed during the tumor disintegration, 2 patients were treated for burn strictures of the esophagus. M.I. Tech's esophageal stents of Korean firm were used. Insertion was carried out by short endoscopic delivery systems of a small diameter.
Results. Satisfactory evaluation of the stent state and adequate stent expansion, absence of any misplacement were considered as an indication for starting oral food intake. Patients may be allowed to go home shortly after an esophageal stent procedure (the same day). The first day the patient could use water and foods need to be liquid, moist and soft, in the following days it was possible to increase the density of products.
Conclusions. The study found that stenting of the esophagus is a current method of endoscopic surgery, aimed at the expanding and maintaining of the lumen of the esophagus by means of the inserted self-expandable stents. Esophageal stenting possesses by fewer complications unlike other techniques. The role of palliative treatment (for example, stenting) is considered to reduce dysphagia, improve the quality of life and increase life expectancy.

Keywords: esophageal stricture, stenting, esophageal cancer, tracheoesophageal fistula
p. 24 – 28 of the original issue
References
  1. Korolev MP, Fedotov LE, Smirnov AA. Endoprotezirovanie samoraspravliaiushchimisia metallicheskimi stentami pri stenoziruiushchikh zabolevaniiakh pishchevoda [Endoprosthesis of self-expanding metal stents in esophageal stenosis]. Vestn Khirurgii im II Grekova. 2010;169(1):58–64.
  2. Lazarev AF, Fokeev SD. Sravnitel'nyi analiz radikal'nogo lecheniia raka pishchevoda [Comparative analysis of radical treatment of esophageal cancer]. Ros Onkol Zhurn. 2006;(2):35–38.
  3. Roman LD, Kotiv BN, Bisenkov LN, Shostka KG, Kostiuk IP. Palliativnye vmeshatel'stva v khirurgicheskom lechenii raka grudnogo otdela pishchevoda [Palliative interventions in the surgical treatment of cancer of the thoracic portion of esophagus]. Vopr Onkology. 2009;55(1):56–59.
  4. Van Boeckel PG, Sijbring A, Vleggaar FP, Siersema PD. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther. 2011 Jun;33(12):1292-301.
  5. Gallinger IuI, Godzhello EA. Endoskopicheskoe lechenie striktur pishchevodnykh anastomozov [Endoscopic treatment of esophageal anastomotic strictures]. Moscow, RF: PROFIL, 2006. 152 p.
  6. Skvortsov MB. Rak pishchevoda: khirurgicheskoe lechenie [Esophageal cancer: surgical treatment]. Sib Med Zhurn. 2011;(4):21–30.
  7. Khairuddinov RV. Sovremennye printsipy diagnostiki i khirurgicheskogo lecheniia raka pishchevoda [The current principles of diagnosis and surgical treatment of esophageal cancer]. Vestn Khirurgii. 2006;165(3):48–51.
  8. Cook MB, Wild CP, Everett SM, Hardie LJ, Bani-Hani KE, Martin IG, Forman D. Risk of mortality and cancer incidence in Barrett's esophagus. Cancer Epidemiol Biomarkers Prev. 2007 Oct;16(10):2090-6.
  9. Ott C, Ratiu N, Endlicher E, Rath HC, Gelbmann CM, Scholmerich J, Kullmann F. Self-expanding Polyflex plastic stents in esophageal disease: various indications, complications, and outcomes. Surg Endosc. 2007 Jun;21(6):889–96.
  10. Saito Y, Tanaka T, Andoh A, Minematsu H, Hata K, Tsujikawa T, Nitta N, Murata K, Fujiyama Y. Novel biodegradable stents for benign esophageal strictures following endoscopic submucosal dissection. Dig Dis Sci. 2008 Feb;53(2):330–33.
  11. Ishchenko AA, Belonogov AV, Baryshnikov ES, Dimov AA. Endokhirurgicheskie sposoby vosstanovleniia enteral'nogo pitaniia pri neoperabel'nom rake pishchevoda [Endosurgical methods to restore enteral nutrition in inoperable cancer of the esophagus]. Sib Onkol Zhurn. 2008;(pril):62–63.
  12. Klimashevich AV. Vozmozhnost' lecheniia nepreryvno retsidiviruiushchikh striktur pishchevoda metodom stentirovaniia [The treatment of constantly recurrent stricture of the esophagus by stenting]. Izv Vyssh Ucheb Zavedenii Povolzh Region Med Nauki. 2011(3):81–88.
  13. Klimashevich AV, Nikol'skii VI, Bogonina OV, Antonov VV. Profilaktika i lechenie rubtsovykh striktur pishchevoda [Prevention and treatment of scar stricture of the esophagus]. Fund Issledovaniia. 2012;(4–1):63–68.
  14. Eloubeidi MA, Talreja JP, Lopes TL, Al-Awabdy BS, Shami VM, Kahaleh M. Success and complications associated with placement of fully covered removable self-expandable metal stents for benign esophageal diseases (with videos). Gastrointest Endosc. 2011 Apr;73(4):673-81.
  15. Mosca F, Consoli A, Stracqualursi A, Persi A, Portale TR. Comparative retrospective study on the use of plastic prostheses and self-expanding metal stents in the palliative treatment of malignant strictures of the esophagus and cardia. Dis Esophagus. 2003;16(2):119–25.
Address for correspondence:
194044, Rossiiskaia Federatsiia, g. Sankt-Peterburg, ul. Akademika Lebe-deva, d. 6, FGKVOU VPO «Voenno-meditsinskaia akademiia imeni S.M. Kirova» MO RF, kafedra obshchei khirurgii,
e-mail: val-belevich@yandex.ru,
Belevich Valerii Leont'evich
Information about the authors:
Belevich V.L. PhD., a senior lecturer of the chair of general surgery of FSOMEE HPE “Military Medical Academy named after S.M. Kirov”, colonel of medical service.
Ovchinnikov D.V. PhD., a senior assistant of a head of the department (preparing of scientific-project complex and organization of the research work), FSOMEE HPE “Military Medical Academy named after S.M. Kirov”, major of medical service.
Brednev A.O. An adjunct of the chair of general surgery of FSOMEE HPE “Military-Medical Academy named after S.M. Kirov”, senior lieutenant of medical service.

A.B. LARICHEV1, S.V. FAVSTOV1, V.L. BAKHILINA2

SOME SURGICAL ASPECTS OF ULCEROUS GASTRODUODENAL BLEEDING

SBEE HPE “Yaroslavl State Medical Academy”1,
SBCME YR “N.A. Semashko City
Hospital” 2, Yaroslavl,
The Russian Federation

Objectives. To carry out the comparative assessment of surgical tactics’ options during the treatment of ulcerous gastroduodenal bleeding depending on activity of its source.
Methods. The prospective analysis of treatment results of 719 patients with ulcerous gastroduodenal bleeding is presented. The study enrolls the patients with the defect (0,5-3 cm) of gastric or duodenal mucosa with the lesion to muscular and more deeply lying layers, having the roll-like, dense and straight edges disrupted in the proximal and flat in the distant direction with a smooth fundus. The patients were subdivided into 2 groups: the 1st one consisted of 285 patients in whom medical and diagnostic algorithm included active surgical actions. While treating 434 patients the restrained tactics with a priority of an endoscopic guide and complex medical treatment of the gastric ulcer with the reached primary hemostasis had been performed in 252 patients.
Results. Among patients of the first group in a case of inability to stop bleeding by the endoscopic method and at high risk of its recurrence, in 104 patients the urgent surgical operations were performed, more often the stomach resections (58%). The postoperative lethality made up 10,6%. In 181 patients the conservative treatment was applied with a lethal outcome in 5,5% of all patients. Among patients of the second group after primary endoscopic hemostasis the recurrence of bleeding developed in 45 cases. In 40 from them endoscopic hemostasis was recurrented and completed successfully in 32 patients. In general during conservative treatment the inefficiency of endoscopic hemostasis was in 17 observations (3,9%), 15 patients (3,5%) died. From 35 operated patients the lethal outcome developed in 9 cases (postoperative lethality – 25,7%) in patients of advanced and senile age with the serious accompanying pathology.
Conclusions. In case of ulcerous gastroduodenal bleeding the priority of an endoscopic hemostasis (numerous performance of this procedure) reduces operative activity from 36,6% to 8,1%. The tendency to reduce the general mortality from 7,4% to 5,3% is observed.

Keywords: gastroduodenal ulcer, bleeding, endoscopic hemostasis, operative treatment
p. 29 – 37 of the original issue
References
  1. Gostishchev VK, Evseev MA. Gastroduodenal'nye krovotecheniia iazvennoi etiologii (patogenez, diagnostika, lechenie) [ Gastroduodenal bleeding of ulcer etiology (pathogenesis, diagnosis and treatment)]: Ruk dlia vrachei. Moscow, RF: GEOTAR-Media, 2008. 384 p.
  2. Korolev MP. Gastroduodenal'nye krovotecheniia kak problema ekstrennoi khirurgii [Gastroduodenal bleeding as a problem of emergency surgery]. Vestn Khirurgii. 2011; 170(2):52–54.
  3. Stupin VA, Baglaenko MV, Kan VI, Siluianov SV, Tronin RIu, Ardabatskii LA, Sokolova RS, Martirosov AV. Struktura letal'nosti pri iazvennykh gastroduodenal'nykh krovotecheniiakh [The structure of mortality in gastroduodenal ulcer bleeding]. Khirurgiia. Zhurn im NI Pirogova. 2013;(5):31–35.
  4. Uteshev NS, Tveritneva LF, Ermolov AS, Pakhomova GV. Analiz rezul'tatov lecheniia patsientov s iazvennoi bolezn'iu zheludka i dvenadtsatiperstnoi kishki, oslozhnennoi krovotecheniem [Analysis of the results of treatment of patients with gastric and duodenal ulcers complicated by bleeding]. Zhurn im NV Sklifosovskogo Neotlozh Med Pomoshch'. 2012;(3):56–59.
  5. Cheung FK, Lau JY. Management of massive peptic ulcer bleeding. Gastroenterol Clin North Am. 2009 Jun;38(2):231–43.
  6. Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G. An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium. Gastrointest Endosc. 2008 Mar;67(3):422–29.
  7. Tsoi KK, Chan HC, Chiu PW, Pau CY, Lau JY, Sung JJ. Second-look endoscopy with thermal coagulation or injections for peptic ulcer bleeding: a meta-analysis. J Gastroenterol Hepatol. 2010 Jan;25(1):8–13.
  8. Laursen SB, Jorgensen HS, Schaffalitzky de Muckadell OB. Management of bleeding gastroduodenal ulcers. Dan Med J. 2012 Jul;59(7):C4473.
  9. Wong TC, Wong KT, Chiu PW, Teoh AY, Yu SC, Au KW, Lau JY. A comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers. Gastrointest Endosc. 2011 May;73(5):900–8.
  10. Marzhatka Z. Terminologiia, opredelenie terminov i diagnosticheskie kriterii v endoskopii pishchevaritel'nogo trakta: Endoskopiia pishchevaritel'nogo trakta [Terminology, definitions of terms and diagnostic criteria in endoscopy of digestive tract; endoscopy of the digestive tract]: Nomenklatura OMED. Normed Verlag, 1996. 141 p.
  11. Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet. 1974 Aug 17;2(7877):394–97.
  12. Vilianskii MP, Kruzhilina VI, Khorev AN. Gastroduodenal'nye krovotecheniia [Gastroduodenal bleedings]. Iaroslavl', RF: Iarosl Gos Med In-t. 1984. 117 p.
  13. Wang CH, Ma MH, Chou HC, Yen ZS, Yang CW, Fang CC, Chen SC. High-dose vs non-high-dose proton pump inhibitors after endoscopic treatment in patients with bleeding peptic ulcer: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2010 May 10;170(9):751–58.
Address for correspondence:
150000, Rossiiskaia Federatsiia, g. Iaroslavl', ul. Revoliutsionnaia, d. 5, GBOU VPO «Iaroslavskaia gosudarstvennaia meditsinskaia akademiia»;
e-mail: larich-ab@mail.ru,
Larichev Andrei Borisovich
Information about the authors:
Larichev A.B. MD, professor, a head of a chair of the general surgery of SBEE HPE “Yaroslavl State Medical Academy”
Favstov S.V. A post-graduate student of a chair of the general surgery of SBEE HPE “Yaroslavl State Medical Academy”
Bakhilina V.L. A physician of the endoscopy unit of SBCME YR “N.A. Semashko City Hospital”, Yaroslavl.

V.A. SAMARTSEV 1, V.A. GAVRILOV 1, A.G. KUCHUMOV2

DIFFERENTIATED APPLICATION OF SINGLE-ROW SUTURE FOR PREVENTION OF SURGICAL INFECTION IN ABDOMINAL SURGERY

SBEE HPE “Perm State Medical Academy named after academician E.A. Wagner” 1,
FSBEE HPE “Perm National Research Polytechnic University” 2,
The Russian Federation

Objectives. To improve surgical treatment results of the abdominal diseases by means of the differentiated use of a single-row continuous suture and modern synthetic antibacterial-coated suture materials and specified terms of absorption.
Methods. Biomechanical model has been designed and the characteristic parameters of simple interrupted and continuous sutures of the anterior abdominal wall aponeurosis have been calculated. The suture parameters have been experimentally proved on the laboratory animals and in clinical practice. Depending on the conducted treatment the surgical patients were subdivided into two groups. In the main group the continuous sutures for forming interorgan anastomoses and sewing of the abdominal wall hermetically according to algorhythm of prevention of surgical site infection have been applied. In the comparison group the laparotomic wounds and interorgan anastomoses were sewed with traditional interrupted suture by non-absorbable suture materials.
Results. The biomechanical modeling of the anterior abdominal wall aponeurosis sutures taking into consideration experimentally gained parameters of elasticity of aponeurosis and surgical thread have permitted to calculated the optimal characteristics of a single-row continuous suture as well as make a differentiated choice of surgical suture material. In the experiment on animals more rapid healing of surgical wounds by soft-fibrous scar using the modern absorbable surgical threads compared with the traditional sewing by capron have been shown. The advanced conception of prophylaxis of surgical infection site has been clinically applied that has permitted to reduce the number of postoperative complications from 14,2% to 3,6%.
Conclusions. The conducted study has confirmed the efficacy of single-row continuous suture application with absorbable suture materials in the complex prophylaxis of surgical site infection.

Keywords: suture materials, surgical site infections, biomechanical modeling of abdominal wall closure techniques
p. 38 – 46 of the original issue
References
  1. Buianov VM, Egiev VN, Udotov OA. Khirurgicheskii shov [A surgical suture]. Moscow, RF: Dimitreid Grafik Grup, 2000. p. 93.
  2. Gostishchev VK, Evseev MA. Nit' plius igla. Shovnyi material v obshchekhirurgicheskoi praktike: rukovodstvo dlia vrachei [A thread plus the needle. Suture material in general surgical practice: a guide for physicians]. Moscow, RF: AMA-Press, 2012. 188 p.
  3. Sahoo S, Greeson CB, McCarron JA, Milks RA, Aurora A, Walker E, Iannotti JP, Derwin KA. Effect of pretension and suture needle type on mechanical properties of acellular human dermis patches for rotator cuff repair. J Shoulder Elbow Surg. 2012 Oct;21(10):1413–21.
  4. Gostishchev VK, Dibirov MD, Khachatrian NN, Evseev MA, Omel'ianovskii VV. Novye vozmozhnosti profilaktiki posleoperatsionnykh oslozhnenii v abdominal'noi khirurgii [New features of the prevention of postoperative complications in abdominal surgery]. Khirurgiia. Zhurn im NI Pirogova. 2011;5(56):56–60.
  5. Egiev VN. Onoriadnyi nepreryvnyi shov anastomozov v abdominal'noi khirurgii [A single-row continuous suture of anastomosis in abdominal surgery]. Moscow, RF: Medpraktika, 2002. 100 p.
  6. Israelsson LA, Wimo A. Cost minimisation analysis of change in closure technique of midline incisions. Eur J Surg. 2000 Aug;166(8):642–6.
  7. Ceydeli A, Rucinski J, Wise L. Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg. 2005 Mar-Apr;62(2):220–5.
  8. Justinger C, Schilling MK. Closing the abdominal wall - challenges and possible solutions. Zentralbl Chir. 2011 Dec;136(6):564–7.
  9. Ming X, Nichols M, Rothenburger S. In vivo antibacterial efficacy of MONOCRYL plus antibacterial suture (Poliglecaprone 25 with triclosan). Surg Infect (Larchmt). 2007 Apr;8(2):209–14.
  10. Rodricks JV, Swenberg JA, Borzelleca JF, Maronpot RR, Shipp AM. Triclosan: a critical review of the experimental data and development of margins of safety for consumer products. Crit Rev Toxicol. 2010 May;40(5):422–84.
  11. Leaper DJ. Surgical-site infection. Br J Surg. 2010 Nov;97(11):1601–2.
  12. Nilsson T. Mechanical properties of Prolene and Ethilon sutures after three weeks in vivo. Scand J Plast Reconstr Surg. 1982;16(1):11–5.
  13. Kuchumov AG, Samartsev VA, Chaikina ES, Gavrilov VA. Biomekhanika shovnykh materialov v abdominal'noi khirurgii [Biomechanics of suture materials in abdominal surgery]. Sovr Probl Nauki i Obrazovania. 2012;(2):431.
  14. Fedorov AE, Samartsev VA, Gavrilov VA, Vil'deman VE, Slovikov SV. Eksperimental'noe issledovanie mekhanicheskikh svoistv sovremennykh khirurgicheskikh shovnykh materialov [Experimental study of the mechanical properties of current surgical materials]. Ros Zhurn Biomekhanik. 2009;13(4):78–84.
  15. Azizi E, Halenda GM, Roberts TJ. Mechanical properties of the gastrocnemius aponeurosis in wild turkeys. Integr Comp Biol. 2009 Jul;49(1):51–8.
Address for correspondence:
614107, Rossiiskaia Federatsiia, g. Perm', ul. Kim, d. 2, GBOU VPO «Permskaia gosudarstvennaia meditsinskaia akademiia im. ak. E.A. Vagnera», kafedra obshchei khirurgii lechebnogo fakul'teta,
e-mail: samarcev-v@mail.ru,
Samartsev Vladimir Arkad'evich
Information about the authors:
Samartsev V.A. MD, professor, a head of a chair of general surgery of medical faculty SEI HPE "Perm State Medical Academy named after academician E.A. Wagner". Gavrilov V.A. assistant of a chair of general surgery of medical faculty SEI HPE "Perm State Medical Academy named after academician E.A. Wagner". Kuchumov A.G. PhD, associate professor of theoretical mechanics SEI HPE "Perm National Research Polytechnic University."

A.A. DMITRIENKO 1, V.V. ANICHKIN 2, M.F. KUREK 2, V.A. BUGAKOV 1, V.V. KONOVKOV 1, A.O. KUSHNER 1

DIFFERENTIATED SURGICAL TACTICS AT PURULENT COMPLICATIONS OF DIABETIC CHARCOT OSTEOARTHROPATHY

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

Objectives. To work out the tactical approaches to the differentiated diagnostics and treatment of purulent complications of diabetic Charcot osteoarthropathy.
Methods. During the period of 2011-2013 yrs. 16 patients with Charcot foot were being treated at the center “Diabetic foot”, Gomel. Osteoarthropathy course was complicated by a purulent process in 9 (56%) patients when it was impossible to exclude the development of the secondary osteomyelitis according the clinical and X-ray data. Complex assessment including foot X-ray, microbiological study of the wound secretions, computer tomography (CT), magnetic-resonance imaging (MRT), histological and bacteriological study of the bone tissue samples has been conducted.
Results. Patients with purulent complications of diabetic Charcot osteoarthropathy were subdivided into 3 groups. 3 out of 9 patients in whom the bone destruction in the purulent inflammation region was determined by X-ray made up the 1st group, though there were no signs of osteomyelitis according to the histological and microbiological investigation data. In the 2nd group 3 patients were included, microbiological study of the bone tissue samples was positive in all cases, although histological study didn’t reveal osteomyelitis signs. Treatment in both groups was limited by dissection and drainage of the soft tissue abscesses. The outcome was recovery. 3 patients were in the 3rd group in whom the secondary osteomyelitis was verified by all previously mentioned study methods. Osteosequestrectomy was performed in 2 of them, one was subjected to amputation on the shin level due to the presence of the expanded purulent-necrotic limb lesion.
Conclusions. Solving the problem of purulent complications of the diabetic osteoarthropathy, including diagnostics and treatment of the secondary osteomyelitis demands on the complex of investigations. Correlation of clinical, instrumental methods with the results of microbiological and histological study permits to choose the correct treatment strategy and strictly substantiated and maximally sparing operative interventions allow achieving the best results.

Keywords: diabetic osteoarthropathy, purulent-necrotic complications, osteomyelitis, surgical treatment
p. 47 – 56 of the original issue
References
  1. Myerson MS. Salvage of diabetic neuropathy arthropathy with arthrodesis. In: Helal B, Rowley D, Cracchiolo A, Myerson M, eds. Surgery of disorders of the foot and ankle. Martin Dunitz, London, 1996:513-22.
  2. Frykberg RG, Mendeszoon E. Management of the diabetic Charcot foot. Diabetes Metab Res Rev. 2000 Sep-Oct;16 Suppl 1:S59–65.
  3. Armstrong DG, Peters EJ. Charcot's arthropathy of the foot. J Am Podiatr Med Assoc. 2002 Jul-Aug;92(7):390–94.
  4. Poll LW, Weber P, Bohm HJ, Ghassem-Zadeh N, Chantelau EA.Sudeck's disease stage 1, or diabetic Charcot's foot stage 0? Case report and assessment of the diagnostic value of MRI. Diabetol Metab Syndr. 2010 Oct 5;(2):60.
  5. Cofield RH, Morrison MJ, Beabout JW. Diabetic neuroarthropathy in the foot: patient characteristics and patterns of radiographic change. Foot Ankle. 1983 Jul-Aug;4(1):15–22.
  6. Ledermann HP, Morrison WB, Schweitzer ME. Pedal abscesses in patients suspected of having pedal osteomyelitis: analysis with MR imaging. Radiology. 2002 Sep;224(3):649–55.
  7. Fabbi M. Diagnosis of osteomyelitis in the diabetic foot patient .Diabetic Foot Journal [Electronic resourse]. 2011 Feb;11. Mode of access : www.diaheliclooljournal.net.
  8. Aragon-Sanchez J, Lipsky BA, Lazaro-Martinez JL. Diagnosing diabetic foot osteomyelitis: is the combination of probe-to-bone test and plain radiography sufficient for high-risk inpatients? Diabet Med. 2011 Feb;28(2):191–14.
  9. Berendt AR, Peters EJ, Bakker K, Embil JM, Eneroth M, Hinchliffe RJ, Jeffcoate WJ, Lipsky BA, Senneville E, Teh J, Valk GD. Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. Diabetes Metab Res Rev. 2008 May-Jun;24 Suppl 1:S145–61.
Address for correspondence:
246000, Respublika Belarus', g. Gomel', ul. Il'icha, d. 286, GUZ «Gomel'skaia gorodskaia klinicheskaia bol'nitsa ¹3», khirurgicheskoe otdelenie ¹3,
e-mail: dmitrienko-83@mail.ru,
Dmitrienko Anatolii Anatol'evich
Information about the authors:
Dmitrienko A.A. A surgeon of the surgical department ¹3 of SME “Gomel City Clinical Hospital ¹3”.
Anichkin V.V. MD, professor of the chair ¹3 of surgical diseases of EE “Gomel State Medical University”.
Kurek M.F. PhD, an assistant of the chair ¹3 of surgical diseases of EE “Gomel State Medical University”.
Bugakov V.A. A chief physician of SME “Gomel City Clinical Hospital ¹3”.
Konovkov V.V. A head of the surgical department ¹3 of SME “Gomel City Clinical Hospital ¹3”.
Kushner A.O. A surgeon of the surgical departmen ¹3 of SME “Gomel City Clinical Hospital ¹3”.

V.I. RUSIN, V.V. KORSAK, P.A. BOLDIZHAR, A.A. NOSENKO

TREATMENT OF PATIENTS WITH DIABETIC FOOT SYNDROME BY LUCILIA SERICATA LARVAE

SHEE “Uzhgorod National University”,
The Ukraine

Objectives. To improve treatment results of patients with the diabetic foot syndrome (DFS) by introducing method of wound healing by flies larvae (Lucilia sericata) for the debridement of wounds in the clinical practice.
Methods. 50 patients with infected foot wounds were selected for the study: 35 patients with a neuropathic form of DFS and 15 – with a neuroischemic form. The depth of lesions was II-III grade according to Wagner classification. Larvae therapy involves applying bandage with maggots to a wound according the appropriate method to help it heal.
Results. The medical use of live maggots (fly larvae) for treating non-healing wounds showed a complete cleaning of a wound after one course of introduction of maggots to a wound removed dead tissue from it in 8 (16%) cases, after two courses – in 23 (46%), after three courses – in 14 (28%), after four and further courses – in 5 (10%) cases. For local therapy the special medical bandage and hydrogel were used after complete washing out of the wound by larvae to promote the formation of granulation tissue in a clean healthy wound in 35 (70%) patients. Various terms of complete wound healing by the secondary tension were registered. To close the large smooth wound surface the autodermoplasty was performed in 15 (30%) patients. Good engraftment rates of the graft was marked in all the cases. Three primary actions of medical grade maggots on wounds: the cleaning the wound by dissolving dead and infected tissue, disinfection of wounds by killing bacteria and promotion of the wound healing. Maggot debridement therapy (MDT) is characterized by high effectiveness marked by the reduction of wound cleaning time and treatment cost.
Conclusions. Wound healing by larvae Lucilia Sericata is considered as an effective and safe method than conventional treatment. The larvae remove the dead tissue leaving viable tissue unharmed and stimulate the complete healing of the wound in 68,6% cases during three months. Maggot wound cleaning should be used as a preparatory step before performances of autodermoplasty.

Keywords: diabetic foot syndrome, infected foot wounds, maggot debridement therapy
p. 57 – 67 of the original issue
References
  1. Udovichenko OV, Grekova NM. Diabeticheskaia stopa [Diabetic foot]. Moscow, RF: Prakt meditsina, 2010. 272 p.
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  3. Sherman RA. Maggot therapy takes us back to the future of wound care: new and improved maggot therapy for the 21st century. J Diabetes Sci Technol. 2009 Mar 1;3(2):336–44.
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  6. Fleischmann W, Grassberger M, Sherman R. Maggot therapy: a handbook of maggot-assisted wound healing complementary medicine. Stuttgart Germany: George Thieme Verlag; 2004. p. 93.
  7. Sherman RA, Wyle F, Vulpe M. Maggot therapy for treating pressure ulcers in spinal cord injury patients. J Spinal Cord Med. 1995 Apr;18(2):71–4.
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  9. Blaizot X, Mourgeon B, Chene Y, Creveuil C, Combemale P, Laplaud AL, Sohyer-Lebreuilly I, Dompmartin A. Maggot therapy for wound debridement: a randomized multicenter trial. Arch Dermatol. 2012 Apr;148(4):432–38.
  10. Rusin V², Korsak VV, Nosenko OA. Zas³b for l³kuvannya hron³chnih wounds [The treatment for chronic wounds]. The patent of Ukraine N 78978; ¹ u2012, 10440, zaiavl 04.09.2012; opubl 10.04.2013. Bull (7).
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  13. Armstrong DG, Salas P, Short B, Martin BR, Kimbriel HR, Nixon BP, Boulton AJ. Maggot therapy in "lower-extremity hospice" wound care: fewer amputations and more antibiotic-free days. J Am Podiatr Med Assoc. 2005 May-Jun;95(3):254-57.
  14. Wang SY, Wang JN, Lv DC, Diao YP, Zhang Z. Clinical research on the bio-debridement effect of maggot therapy for treatment of chronically infected lesions. Orthop Surg. 2010 Aug;2(3):201-6.
Address for correspondence:
88010, Ukraina, g. Uzhgorod, ul. Kapushanskaia, d. 22, GVUZ «Uzhgorodskii natsional'nyi uni-versitet», Zakarpatskaia oblastnaia klinicheskaia bol'nitsa im. A. Novaka», kafedra khirurgicheskikh boleznei,
e-mail: vyacheslav_korsak@ukr.net,
Korsak Viacheslav Vasil'evich
Information about the authors:
Rusin V.I. MD, professor, a head of a chair of surgical diseases of SHEE "Uzhgorod National University."
Korsak V.V. MD, professor of a chair of surgical diseases of SHEE "Uzhgorod National University."
Boldizhar P.O. MD, professor of a chair of surgical diseases of SHEE "Uzhgorod National University."
Nosenko A.A. A graduate student of a chair of surgical diseases of SHEE "Uzhgorod National University."

TRANSPLANTOLOGY

V.JA. KHRYSHCHANOVICH1, S.I. TRETYAK1, A.N. KHARLAMOVA1, V.A. KONDRATOVICH2, A.M. PISARENKO2, E.I. KUZMENKOVA3, A.V. ROMANOVICH4, A.V. BOLSHOV1

RESULTS OF PARATHYROID ALLOTRANSPLANTATION

EE “Belarusian State Medical University” 1,
ME “Minsk City Clinical Oncologic Dispensary”2,
SE “Republican Center of Medical Rehabilitation and Balneotherapy”3,
ME “The 4th Municipal Clinical Hospital named after N.E. Savchenko”4, Minsk
The Republic of Belarus

Objectives. To evaluate the effectiveness of macroencapsulated parathyroid cells allotransplantation into the arterial bed of patients with postoperative hypoparathyroidism and without immunosupression application.
Methods. From December 2010 to November 2011 7 patients underwent to 7 allotransplantations of cultured macroencapsulated parathyroid cells it was indicated by the iatrogenic hypoparathyroidism after the thyroid surgery in all cases. An average recipient age was 52 [39-59] years. Donors were selected from patients undergoing parathyroidectomy for primary (adenoma) and secondary (due to chronic renal failure) hyperparathyroidism.
Results. The cultivated cells with high concentration of parathormone in the cultured liquid (2927,5 [1400,5-4847] pg/ml) and the degree of viability (99%) were selected for the transplantation. The median cellular allograft survival was 3 [1-9] months. In 4 patients (57,1%) the allografts retained their endocrine function for more than 2 months. None of the patients showed clinical symptoms of hyperparathyroidism in the posttransplantation follow-up period.
Conclusions. In some patients with hypoparathyroidism developed after the thyroid surgery, parathyroid cell allotransplantation is considered to be an effective therapeutic alternative vs the standard methods. Donors’ and recipients’ age, the duration of hypoparathyroidism didn’t influence significantly on the terms of the graft functioning. The problems concerning porosity, biocompatibility, long-term stability of the microporous membranes demand on the further investigation as well as the necessity of ABO- and HLA-matching of donor-recipient pairs and requirement for immunosuppression application.

Keywords: parathyroid culture, endocrine cells allotransplantation, immunosuppression free, surgical hypoparathyroidism, cell therapy
p. 68 – 77 of the original issue
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  1. Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, Racadot A, Proye C. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg. 1998 Jul;22(7):718–24.
  2. Wells SA Jr, Burdick JF, Hattler BG, Christiansen C, Pettigrew HM, Abe M, Sherwood LM. The allografted parathyroid gland: evaluation of function in the immunosuppressed host. Ann Surg. 1974 Dec;180(6):805–13.
  3. Nawrot I, Wozniewicz B, Tolloczko T, Sawicki A, Gorski A, Chudzinski W, Wojtaszek M, Grzesiuk W, Sladowski D, Karwacki J, Zawitkowska T, Szmidt J.Allotransplantation of cultured parathyroid progenitor cells without immunosuppression: Clinical results. Transplantation. 2007 Mar 27;83(6):734–40.
  4. Chapelle T, Meuris K, Roeyen G, De Greef K, Van Beeumen G, Bosmans JL, Ysebaert D. Simultaneous kidney-parathyroid allotransplantation from a single donor after 20 years of tetany: a case report. Transplant Proc. 2009 Mar;41(2):599–600.
  5. Guerrero MA, Evans DB, Lee JE, Bao R, Bereket A, Gantela S, Griffin GD, Perrier ND.Viability of cryopreserved parathyroid tissue: when is continued storage versus disposal indicated? World J Surg. 2008 May;32(5):836–39.
  6. Tsuji K, Fuchinoue S, Kai K, Kawase T, Kitajima K, Sawada T, Nakajima I, Agishi T. Culture of human parathyroid cells for transplantation. Transplant Proc. 1999 Nov;31(7):2697.
  7. Tretyak S, Prochorov A, Khryshchanovich V, Nedzvedz M, Romanovich A. Long-term preservation of vitality of xenogenic thyrocytes in the recipient after their transplantation into the blood stream. Adv Med Sci 2008; 53(1): 76?79.
  8. Kuji T, Kitamura H, Yasuda G, Umemura S, Kimura T, Shimizu S, Ikeda Y. Different pathological findings in each of four parathyroid glands in a long-standing hemodialysis patient. Clin Nephrol. 2000 Nov; 54(5):413–17.
  9. Wozniewicz B, Migaj M, Giera B, Prokurat A, Tolloczko T, Sawicki A, Nawrot I, Gorski A, Zabitkowska T, Kossakowska AE. Cell culture preparation of human parathyroid cells for allotransplantation without immunosupression. Transplant Proc. 1996 Dec; 28(6):3542–44.
  10. Murray HE, Paget MB, Downing R. Preservation of glucose responsiveness in human islets maintained in a rotational cell culture system. Mol Cell Endocrinol. 2005 Jun 30;238(1-2):39–49.
  11. Walker GM, Zeringue HC, Beebe DJ. Microenvironment design considerations for cellular scale studies. Lab Chip. 2004 Apr;4(2):91–97.
  12. Lo CY, Tam SC. Parathyroid autotransplantation during thyroidectomy: Documentation of graft function. Arch Surg. 2001 Dec;136(12):1381–85.
  13. Tibell A, Rafael E, Wennberg L, Nordenstrom J, Bergstrom M, Geller RL, Loudovaris T, Johnson RC, Brauker JH, Neuenfeldt S, Wernerson A. Survival of macroencapsulated allogeneic parathyroid tissue one year after transplantation in nonimmunosuppressed humans. Cell Transplant. 2001;10(7):591–99.
  14. Lee MK, Bae YH. Cell transplantation for endocrine disorders. Adv Drug Deliv Rev. 2000 Aug 20;42(1-2):103–20.
  15. Niimi M, Takashina M, Takami H, Shirasugi N, Hamano K, Esato K, Matsumoto K, Ikeda Y, Shatari T, Kodaira S, Kameyama K. Experimental parathyroid transplantation: human parathyroid grafts survived and functioned in mice treated with anti-CD4 monoclonal antibody. Biomed Pharmacother. 2000 Jun;54 (Suppl 1):80s–82s.
Address for correspondence:
220116, Respublika Belarus', g. Minsk, pr-t Dzerzhinskogo, d. 83, UO «Belorusskii gosudarstvennyi meditsinskii universitet», 2-ia kafedra khirurgicheskikh boleznei,
e-mail: vladimirkh77@mail.ru,
Khryshchanovich Vladimir Ianovich
Information about the authors:
Khryshchanivich V.Ja. PhD, associate professor of the 2nd chair of surgical diseases of EE “Belarusian State Medical University”.
Tretyak S.I. MD, professor, a head of the 2nd chair of surgical diseases of EE “Belarusian State Medical University”.
Kharlamova A.N. A researcher of the scientific-practical department of EE “Belarusian State Medical University”.
Kondratovich V.A. Deputy chief physician of ME “Minsk City Clinical Oncologic Dispensary”.
Pisarenko A.M. A head of the department of head and neck tumors of ME “Minsk City Clinical Oncologic Dispensary”.
Kuzmenkova E.I. PhD, a head of the endocrinology department of SE “Republican Center of Medical Rehabilitation and Balneotherapy”.
Romanovich A.V. An angiosurgeon of ME “The 4th City Clinical Hospital named after N.E. Savchenko”.
Bolshov A.V. PhD, assistant of the 2nd chair of surgical diseases of EE “Belarusian State Medical University”.

NEUROSURGERY

K.M. KUBRAKOV, V.M. SEMENOV, I.A. KOVALEVA, S.K. ZIANKOVA, V.V. SKVORTSOVA

ANTIBIOTIC RESISTANCE OF THE MAIN CAUSATIVE PATHOGENS OF BACTERIAL MENINGITIS IN NEUROSURGICAL PATIENTS

EE “Vitebsk State Medical University”,
The Republic of Belarus

Objectives. To study the etiological structure of the bacterial meningoencephalitis in neurosurgical patients in the late postoperative period, determine the resistance of the main causative agents to antibacterial drugs.
Methods. Bacteriological analysis of liquor was performed in 98 patients in the late postoperative period due to the development of bacterial meningoencephalitis clinical signs. The average age of patients was 48 (40-56) years, males dominated – 84,69% (n = 83). The identification and assessment of the sensitivity of microorganisms towards antimicrobial agents was carried out with the help of the test-system on the microbiological analyzer ATB Expression and by the method of standard paper discs (Becton Dickinson (USA).
Results. In 29 persons (29,59%) 53 pathogens were identified. Gram-negative microorganisms were identified in 81,17% of cases (n=43), gram-positive microorganisms (n=10) were obtained in 18,87%. Gram-positive strains included S. aureus – 9,43% (n=5), S. haemolyticus (n=2), S. pneumoniae (n=2), and one isolate E. faecalis. The group was represented by gram-negative bacteria K. pneumonia 9,43% (n=5) and non-fermenting gram-negative rods – 38 isolates (71,70%), which included 35 isolates of A. baumannii (66,04%) and 3 isolate of P. aeruginosa (5,66%). A. baumannii strain is highly resistant to commonly used antibiotics in hospital (cephalosporins III-IV-generation, aminoglycosides). The high resistance of S. aureus to broad-spectrum antibiotics particular to oxacillin, cefazolin, ceftriaxone has been determined.
Conclusions. In the late postoperative period the dominant causative agent of pyogenic meningoencephalitis in neurosurgical patients is A. baumannii. High resistance and polyresistance of the main causative agents of bacterial meningoencephalitis towards antibiotics requires the conduction of permanent bacteriological monitoring and timely correction of antibacterial therapy protocols.

Keywords: meningoencephalitis, neurosurgical operations, postoperative period, causative pathogens, antibiotic resistance
p. 78 – 83 of the original issue
References
  1. Grinberg MS. Neirokhirurgiia [Neurosurgery], per. s angl. Moscow, RF: MEDpress-inform; 2010. 1008 p.
  2. Ondrusova A, Mutuku JM, Rudinsky B, Sabo I, Kovac M. Etiology, risks factors, therapy of nosocomial cerebrovascular infections. Neuro Endocrinol Lett. 2007 Jun; 28 (Suppl 2):7–10.
  3. Tkachik IP. Ratsional'naia antibiotikoterapiia gospital'nykh infektsii v neirokhirurgii [Rational antibiotic therapy of nosocomial infections in neurosurgery]. Biul. UAN. 1998;(4):110–14.
  4. Anne J. Moore, David W. Newell. Neurosurgery: Principles and Practice Springer, 2005. 687 ñ.
  5. Bartlett Dzh. Ananich VA, red. Antimikrobnaia terapiia. Karmannyi spravochnik [Antimicrobial therapy. A pocket reference], per. s angl. Moscow, RF: Praktika, 2007. 440 p.
  6. Starchenko AA. Klinicheskaia neiroreanimatologiia: rukovodstvo dlia vrachei [Clinical neuroreanimatology: a guide for physicians]. Moscow, RF: MEDpress-inform, 2007. 944 p.
  7. De Bels D, Korinek AM, Bismuth R, Trystram D, Coriat P, Puybasset L. Empirical treatment of adult postsurgical nosocomial meningitis. Acta Neurochir (Wien). 2002 Oct;144(10):989–95.
  8. Suchkov SV, Blagoveshchenskii SV, Vinnitskii LI, Kachkov IA, Biktimirov RG, Pinegin BV, Gorozhanin AV. Sovremennye aspekty immunopatogeneza i immunokorrektsii u bol'nykh s vnutricherepnymi infektsionno-vospalitel'nymi oslozhneniiami [The current aspects of the immunopathogenesis and immune correction in patients with intracranial infectious and inflammatory complications]. Allergologiia i immunologiia. 2004;(2):323–29.
  9. Quagliarello V, Scheld WM. Bacterial meningitis: pathogenesis, pathophysiology, and progress. N Engl J Med. 1992 Sep 17;327(12):864–72.
  10. Lebedev VV, Krylov VV. Profilaktika i lechenie gnoinogo meningita [Prevention and treatment of purulent meningitis]. Neirokhirurgiia. 1998;(1):51–57.
  11. Kubrakov KM. Diagnostika i lechenie meningoentsefalitov u neirokhirurgicheskikh bol'nykh [Diagnosis and treatment of meningoencephalitis in neurosurgical patients]. Novosti Khirurgii. 2008;16(3):106–13.
  12. Paramythiotou E, Karakitsos D, Aggelopoulou H, Sioutos P, Samonis G, Karabinis A. Post-surgical meningitis due to multiresistant Acinetobacter baumannii. Effective treatment with intravenous and/or intraventricular colistin and therapeutic dilemmas. Med Mal Infect. 2007 Feb;37(2):124–25.
  13. Pintado V, Pazos R, Jimenez-Mejias ME, Rodriguez-Guardado A, Gil A, Garcia-Lechuz JM, Cabellos C, Chaves F, Domingo P, Ramos A, Perez-Cecilia E, Domingo D. Methicillin-resistant Staphylococcus aureus meningitis in adults: a multicenter study of 86 cases. Medicine (Baltimore). 2012 Jan;91(1):10–17.
  14. Briggs S, Ellis-Pegler R, Raymond N, Thomas M, Wilkinson L. Gram-negative bacillary meningitis after cranial surgery or trauma in adults. Scand J Infect Dis. 2004;36(3):165–73.
  15. Yang M, Hu Z, Hu F. Nosocomial meningitis caused by Acinetobacter baumannii: risk factors and their impact on patient outcomes and treatments. Future Microbiol. 2012 Jun;7(6):787–93.
Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, d. 27, UO «Vitebskii gosudarstvennyi meditsinskii universitet», kafedra nevrologii i neirokhirurgii,
e-mail: k-kubrakov@yandex.ru,
Kubrakov Konstantin Mikhailovich
Information about the authors:
Kubrakov K.M. PhD, an associate professor of the chair of neurology and neurosurgery of EE “Vitebsk State Medical University”.
Semenov V.M. MD, professor, a dean of the medical faculty of EE “Vitebsk State Medical University”.
Kovaleva I.A. A 5-year medical student of EE “Vitebsk State Medical University”.
Ziankova S.K. PhD, an associate professor of the chair of infectious diseases of EE “Vitebsk State Medical University”.
Skvortsova V.V. PhD, an associate professor of the chair of infectious diseases of EE “Vitebsk State Medical University”.

ONCOLOGY

V.T. KOKHNYUK

TUMORS OF THE VERMIFORM APPENDIX

SE “Republican Scientific and Practical Center of Oncology and Medical Radiology named after N.N. Alexandrov”,
The Republic of Belarus

Objectives. To study the long-term treatment results of patients with malignant tumors of the vermiform appendix.
Methods. The treatment results of malignant tumors of the vermiform appendix have been analyzed in 74 patients being supervised during the period from 1993 to June, 2012.
Results. 23 of 31 patients with carcinoid of the vermiform appendix were subjected to appendectomy at the specialized oncological departments. All the patients were suggested to undergo the right-sided hemicolectomy. The operation was performed in 21 patients. 7 patients were examined at the oncology hospitals and after making a diagnosis the right-sided hemicolectomy was carried out.
The vermiform appendix cancer was diagnosed in 43 patients. 15 surgeries for cancer of the appendix were carried out in specialized oncological facilities. The right-sided hemicolectomy was done in 13 patients, in 4 cases the operation had a palliative character due to the tumor dissemination. Palliative appendectomy of the tumor was carried out in 1 patient and in another one the operation was completed by the exploratory laparotomy. 28 patients underwent appendectomy at the surgical departments. Dissemination of the abdominal cavity was revealed during appendectomy in 3 of them, in another three patients the right-sided hemicolectomy was performed during laparotomy. Radical right-sided hemicolectomy was carried out in 22 patients, metastasis to the regional lymph nodes was detected in one of them. No local-regional recurrence was revealed in any case in patients with carcinoid of the vermiform appendix after the right-sided hemicolectomy during further observation. 5-year survival rate made up 86,6±7,2%. Dissemination of the abdominal cavity was found out in 1 patient with the vermiform appendix adenocarcinoma during the first year after the right-sided hemicolectomy; all the rest patients are alive without any signs of the tumor process progressing after the right-sided hemicolectomy. Patients with dissemination of the tumor process of the abdominal cavity died in terms up to 6 months. 5-year survival rate made up 81,8±6,3%.
Conclusions. The right-sided hemicolectomy is indicated to the patients with malignant tumors of the vermiform appendix.

Keywords: vermiform appendix, carcinoid, cancer, treatment outcomes
p. 84 – 88 of the original issue
References
  1. Zagorski K, Prokopowicz D, Panasiuk A. Appendicitis and its atypical causes. Wiad Lek. 1992 Jul;45(13-14):486–89.
  2. Machado NO, Chopra P, Pande G. Appendiceal tumour--retrospective clinicopathological analysis. Trop Gastroenterol. 2004 Jan-Mar; 25(1):36–9.
  3. Kaliteevskii PF. Bolezni cherveobraznogo otrostka [Diseases of the appendix]. Moscow, RF: Meditsina, 1970. 202 p.
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  6. Burgess P, Done HJ. Primary adenocarcinoma of the appendix. J R Coll Surg Edinb. 1990 Aug; 35(4):270.
  7. Druart ML, Crener K, Absil B, Rahier I, Engelholm L, Limbosch JM. Mucinous cystadenocarcinoma of the appendix. A rare tumour of the right iliac. Acta Chir Belg. 1999 Dec; 99(6):303–5.
  8. Timmermans L, Dewulf E, Vielle G. Appendicular mucocele. Report of 2 cases. Acta Chir Belg. 1991 Mar-Apr;91(2):59–62.
  9. Mishin IV, Danch AV. Mukotsele cherveobraznogo otrostka [Mucocele of the appendix]. Novosti Khirurgii. 2012;20(3):125–29.
  10. Jagdish S, Ninan S, Pai D, Ratnakar C. Spontaneous appendicocutaneous fistula. Indian J Gastroenterol. 1996 Jan;15(1):31.
Address for correspondence:
223040, Respublika Belarus', Minskii raion, agrogorodok Lesnoi, GU «Respublikanskii nauchno- prakticheskii tsentr onkologii i meditsinskoi radiologii im. N.N. Aleksandrova»,
e-mail: KVT53@yandex.ru,
Kokhnyuk Viktor Tikhonovich
Information about the authors:
Kokhnyuk V.T. MD, deputy director (Surgery) of SE “Republican scientific and practical center of oncology and medical radiology named after N.N. Alexandrov”.

E.V. RYABCHENKO

CENTRAL LYMPHADENECTOMY AT THYROID CANCER IN COMBINATION WITH AUTOIMMUNE THYROIDITIS

SBME "Krasnodar Regional Clinical Hospital ¹ 2"
"Interregional Center of the Endocrine Surgery"
The Russian Federation

Objectives. To determine the incidence of metastasis to the central group of the neck lymph nodes in a case of the thyroid cancer in combination with autoimmune thyroiditis (AIT) and find out the need to remove the cellulaz from the affected area.
Methods. The patients were divided into four groups. The first group consisted of the patients in whom metastasis to the regional lymph nodes was excluded based on the ultrasound investigation. Extrafascial thyroidectomy with a prophylactic central lymphadenectomy (CLA) has been performed. The second group included those in whom hemistrumectomy was expanded to a thyroidectomy with a prophylactic CLA after urgent histological investigation verifying cancer during the operation. The third group was made up of the patients with the diagnosed cancer after receiving the final histology data. In these cases a total thyroidectomy with a prophylactic CLA was performed as a second treatment stage. The fourth group was composed of the patients with regional lymph node metastasis of the II-V level (stage pTl-4aNlb) cytologically verified prior the surgery and the extrafascial thyroidectomy in the combination with therapeutic CLA (VI level) and fascial-covering lymphadenectomy (II-V level) have been performed.
Results. Metastasis incidence to the neck regional lymph nodes in a case of well-differentiated thyroid cancer reaches 36,1% at the papillary carcinoma and 12,2% at the follicular carcinoma without dependence on the tumor size. Metastasis incidence to the inner organs makes up 14,4% and 26,8%, correspondently. Modern ultrasound and cytological diagnostic methods don’t allow revealing intra-organ and regional metastasis to the main lymphatic collector – the VI zone of the neck cellulaz tissue at the preoperative period. It requires radical surgical tactics application with an obligatory total removal of the thyroid tissue and the central lymph collector of the neck.
Conclusions. Total thyroidectomy should be considered as the method of choice for surgical treatment of well-differentiated thyroid cancer in the combination with AIT, regardless of size and cytological characteristics of the tumor; it should be combined with the central (bilateral) neck lymphadenectomy.

Keywords: thyroid cancer, autoimmune thyroiditis, thyroidectomy central lymphadenectomy
p. 89 – 93 of the original issue
References
  1. Rumiantsev PO, Il'in AA, Rumiantseva UV, Saenko VA. Rak shchitovidnoi zhelezy: Sovremennye podkhody k diagnostike i lecheniiu [Thyroid cancer: the current approaches to diagnosis and treatment]. Moscow, RF: GEOTAR-Media, 2009. 476 p.
  2. Kennedi L, Basu A, Fadeev VV, red. Per s angl. Diagnostika i lechenie v endokrinologii. Problemnyi podkhod: rukovodstvo [Diagnosis and treatment of endocrinology. Problematic approach: a guide].Moscow, RF: GEOTAR-Media». 2010. 304 p.
  3. Frederick L Greene, David L Page, Irvin D Fleming, April G. Fritz, C.T.R., R.H.I.T. Charles M Balch, Daniel G Haller, Monica Morrow, Ed. AJCC Cancer Staging Manual. American Joint Committee of Cancer. – 6th ed. Springer, 2002.
  4. Comparison Guide: Cancer Staging Manual [Electronic resource]. – 6th ed. AJCC, 2002. Mode of access : www.cancerstaging.org.
  5. Kharnas SS, red, Ippolitov LI, Vasil'ev IA, Vetshev SP; Kharnas, S. S. Endokrinnaia khirurgiia : ruk. dlia vrachei [Endocrine Surgery: a guide for physicians]. Moscow, RF: GEOTAR-Media, 2010. 490 p.
  6. Adamian RT, Bel'tsevich DG, Butrova SA, Vanushko VE, Gazizova DO. In: Dedov II, Kuznetsov NS, Mel'nichenko GA, red. Endokrinn Khirurgiia [Endocrine Surgery]. Moscow, RF: Litterra, 2011. 352 p.
  7. Costanzo M, Caruso LA, Testa R, Marziani A, Cannizzaro MA. Hashimoto thyroiditis. Possible cause or consequence of a malignant thyroid tumor. Ann Ital Chir. 2006 Nov-Dec;77(6):469–71.
  8. Lucioni Marco. Practical Guide to Neck Dissection. Berlin Heidelberg New York: Springer-Verlag, 2007.
  9. Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M, eds. AJCC Cancer Staging Manual, 6th ed. Berlin: Springer-Verlag; 2002. 435 p.
  10. Deshler DG, Day Ò. Pocket guide to neck dissection classification and tnm staging of head and neck cancer. American Academy of Otolaryngology Head & Nee [Electronic resource]. 2008. Available: http://www.cancerstaging.org.
  11. Thyroid Carcinoma. NCCN Clinical Practice Guidelines in Oncology Thyroid Carcinoma V2.2007. Available: www.nccn.org
Address for correspondence:
350901, Rossiiskaia Federatsiia, g. Krasnodar, ul. Krasnykh Partizan, d. 6/2, GBUZ «Krasnodarskaia kraevaia klinicheskaia bol'nitsa ¹2», khirurgicheskoe otdelenie ¹2,
e-mail: rev7512@mail.ru, Ryabchenko Evgenii Viktorovich
Information about the authors:
Ryabchenko E.V. PhD, a surgeon of the surgical department ¹2 of "Interregional center of the endocrine surgery" of SBME "Krasnodar Regional Clinical Hospital ¹ 2".

MAXILLOFACIAL SURGERY

I.O. POHODENKO-ÑHUDAKOVA, E.A. AVDEEVA, K.V. VILKITSKAYA

THE CURRENT CLASSIFICATION OF TRAUMATIC INJURIES OF THE TRIGEMINAL NERVE SYSTEM

EE “Belarusian State Medical University”,
Minsk
The Republic of Belarus

Objectives. To develop a new classification of traumatic injuries of the trigeminal nerve on the basis of systematization of literature review and our own research.
Results. Trigeminal nerve injuries occupies one of leading places among the total number of facial pain syndromes. Neuritis n. trigeminus most often develops as iatrogenic injury caused by dental procedures. At the present stage none of the existing classifications presents the systematized data on traumatic injuries of the system of n. trigeminus completely and comprehensively taking into consideration the peculiarities of the etiology, pathogenesis and clinical manifestations which makes difficult the choice of the adequate treatment, rehabilitation methods and prevention of possible complications. New classification of traumatic injury of n. trigeminus system is based on the following principles: anatomical and topographical location of the damaged site of a nerve; the nature of the traumatic factor; location of paresthesia as one of the most significant clinical symptoms and the severity of damage which were determined by their objective impact on the clinical manifestations of pathology, diagnosis, differential diagnosis as well as the identification of effective treatment regimen and prevention of complications.
Conclusions. The classification allows evaluating objectively the volume of damage and the level of pathological process expansion in the trigeminal nerve system, most accurately determine the treatment methods and prophylaxis of complications which has affected positively on the treatment results proving the social and economic value.

Keywords: trigeminal nerve, traumatic injury, classification
p. 94 – 97 of the original issue
References
  1. Smirnov VA. Zabolevaniia nervnoi sistemy litsa [Diseases of the orofacial nervous system]. Moscow, RF: Meditsina, 1976. 239 p.
  2. Gekht BM, Il'ina NA. Nervno-myshechnye bolezni [Neuromuscular diseases]. Moscow, RF: Meditsina, 1982. 352 p.
  3. Iavorskaia ES. Bolevye i paresteticheskie sindromy cheliustno-litsevoi oblasti [Paresthetic and pain syndromes of maxillo-facial region]. Kiev, Ukraina: Medkniga, 2007. 56 p.
  4. Broggi G. Neurosurgery. Pain and psycho-affective disorders. 2008 Jun;62(6 Suppl 3):901-19.
  5. Okubo M, Castro A, Guo W, Zou S, Ren K, Wei F, Keller A, Dubner R.Transition to persistent orofacial pain after nerve injury involves supraspinal serotonin mechanisms. J Neurosci. 2013 Mar 20;33(12):5152–61.
  6. Obermann M, Rodriguez-Raecke R, Naegel S, Holle D, Mueller D, Yoon MS, Theysohn N, Blex S, Diener HC, Katsarava Z. Gray matter volume reduction reflects chronic pain in trigeminal neuralgia. Neuroimage. 2013 Jul 1;74:352–58.
  7. Grechko VE, Puzin MN, Stepanchenko AV. Odontogennye porazheniia sistemy troinichnogo nerva [Odontogenic lesions of the trigeminal nerve]. Moscow, RF: 1988. 105 p.
  8. Wolford LM, Stevao EL. Considerations in nerve repair. Proc (Bayl Univ Med Cent). 2003 Apr; 16(2):152–56.
  9. Grechko VE. Neotlozhnaia pomoshch' v neirostomatologii [Emergency care in neurostomatology]. Moscow, RF: Meditsina, 1990. 256 p.
  10. Pogrel MA. J Calif. Permanent nerve damage from inferior alveolar nerve blocks: a current update. Dent Assoc. 2012 Oct;40(10):795–97.
  11. Libersa P, Savignat M, Tonnel A. Neurosensory disturbances of the inferior alveolar nerve: a retrospective study of complaints in a 10-year period. J Oral Maxillofac Surg. 2007 Aug;65(8):1486–89.
  12. Fedotov SN. Reabilitatsiia bol'nykh s povrezhdeniiami III vetvi troinichnogo nerva pri perelomakh i shchadiashchii osteosintez nizhnei cheliusti metallicheskimi spitsami [Rehabilitation of patients with lesion of 3rd branch of the trigeminal nerve in fractures and sparing osteosynthesis of the mandible by metal spokes]. Arkhangel'sk, RF: AGMA, 1997. 321 p.
  13. Shargorodskii AG, red. Travmy miagkikh tkanei i kostei litsa [The injuries of soft tissue and facial bones]: ruk. dlia vrachei. Moscow, RF: GEOSTAR-MED, 2004. 383 p.
  14. Pokhoden'ko-Chudakova IO, Chudakov OP. Klassifikatsiia zabolevanii sistemy troinichnogo nerva [Classification of the trigeminal nerve diseases]. Problemy Zdorov'ia i Ekologii. 2006;(3):85–90.
Address for correspondence:
220116, Respublika Belarus', g. Minsk, pr-t. Dzerzhinskogo, d. 83, UO «Belorusskii gosudarstvennyi meditsinskii universitet», kafedra khirurgicheskoi stomatologii,
e-mail: ip-c@yandex.ru,
Pokhoden'ko-Chudakova Irina Olegovna
Information about the authors:
Pohodenko-Chudakova I.Î. MD, professor, a head of the surgical dentistry chair of EE “Belarusian State Medical University”.
Avdeeva E.A. PhD, an associate professor of the surgical dentistry chair of EE “Belarusian State Medical University”.
Vilkitskaya Ê.V. A post-graduate student of the surgical dentistry chair of EE “Belarusian State Medical University”.

ANESTHESIOLOGY-REANIMATOLOGY

A.V. MARACHKOU, A.L. LIPNITSKI

THE USE OF MAGNESIUM SULFATE TO POTENTIATE EFFECT OF LOW DOSES OF ROCURONIUM: A RANDOMIZED STUDY

ME “Mogilev Regional Hospital”,
The Republic of Belarus

Objectives. To investigate the effect of magnesium sulfate during the onset time of rocuronium action, making conditions for the trachea intubation and find out the effect duration of rocuronium (low doses).
Methods. Thirty patients (aged of 18-70 yrs.) underwent the laparoscopic cholecystectomy were enrolled in the study. All patients received rocuronium 0,3 mg/kg. Rocuronium dosage in all patients was calculated for the ideal body weight according to Lorentz formula. Control of neuromuscular transmission was measured according to Stockholm criteria for the pharmacodynamic studies of myorelaxants action. The patients were injected 45 mg/kg of MgSO4 (the 1st group) or the same volume of physiological solution (the 2nd group). The indicated drugs were given intravenously through syringe dispenser within 5 minutes and 1 minute after finishing the injections the induction in anesthesia was began.
Results. Onset time of rocuronium action was significantly less when magnesium sulfate was used and made up 90 seconds (80-140) (Me (25%-75%)) in the 1st group and 240 seconds (120-300) in the 2nd group (p<0,05, Mann-Whitney Test). Tracheal intubation was performed in all patients during 90-120 seconds from the first attempt. Five patients in the 2nd group had poor intubating conditions versus none in the magnesium group (p<0,05, χ2-test). Duration of rocuronium action didn’t differ between the groups and composed 25 min (22-30) in the 1st group and 27,5 min (22,5-33) in 2nd group (p>0,05).
Conclusions. Magnesium sulfate in the dose of 45mg/kg accelerates onset of rocuronium (low doses) action as well as improves the conditions for trachea intubation but does not prolong the action duration.

Keywords: muscle relaxants, rocuronium, magnesium sulfate, neuromuscular block, general anesthesia
p. 98 – 104 of the original issue
References
  1. Sparr HJ. Choice of the muscle relaxant for rapid-sequence induction. Eur J Anaesthesiol Suppl. 2001;23:71–6.
  2. Marochkov AV, Lipnitskii AL, Riabinina I0A, Lipnitskaia VV, Moisak IG. Primenenie rokuroniia (Esmerona®) u patsientov s ozhireniem vo vremia mnogokomponentnoi endotrakheal'noi anestezii sevofluranom [The use of rocuronium (esmerone ®) in patients with obesity in many component endotracheal anesthesia with sevoflurane]. Med Novosti. 2012;(7):80–83.
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  9. Lamp E, Dandoy M. Priming of atracunum with magnesium. British Journal of Anaesthesia. 1993; 70:A139.
  10. Fuchs-Buder T, Claudius C, Skovgaard LT, Eriksson LI, Mirakhur RK, Viby-Mogensen J. 8th International Neuromuscular Meeting. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand. 2007 Aug;51(7):789–08.
  11. Czarnetzki C, Lysakowski C, Elia N, Tramer MR. Time course of rocuronium-induced neuromuscular block after pre-treatment with magnesium sulphate: a randomised study. Acta Anaesthesiol Scand. 2010 Mar;54(3):299–306.
  12. Kim MH, Oh AY, Jeon YT, Hwang JW, Do SH. A randomised controlled trial comparing rocuronium priming, magnesium pre-treatment and a combination of the two methods. Anaesthesia. 2012 Jul;67(7):748–54.
  13. Aissaoui Y, Qamous Y, Serghini I, Zoubir M, Salim JL, Boughalem M. Magnesium sulphate: an adjuvant to tracheal intubation without muscle relaxation--a randomised study. Eur J Anaesthesiol. 2012 Aug;29(8):391–97.
  14. Adamus M, Hrabalek L, Wanek T, Gabrhelik T, Zapletalova J. Influence of age and gender on the pharmacodynamic parameters of rocuronium during total intravenous anesthesia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2011 Dec;155(4):347–53.
  15. Vickovic S, Pap D, Pjevic M, Uvelin A. Magnesium sulphate as an adjuvant to anaesthesia in patients with arterial hypertension: 1AP7-4. Eur. J. Anaesth. 2013;(30):25–25.
  16. Dube L, Granry JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anaesth. 2003 Aug-Sep;50(7):732–46.
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Address for correspondence:
212002, Respublika Belarus', g. Mogilev, ul. B. Biruli d. 12, UZ «Mogilevskaia oblastnaia bol'nitsa», otdelenie transplant-koordinatsii,
e-mail: Lipnitski.al@gmail.com,
Lipnitski Artur Leonidovich
Information about the authors:
Marachkou A.V. MD, professor, a head of the intensive care unit of ME “Mogilev Regional Hospital”.
Lipnitski A.L. A head of the transplant and coordination department of ME “Mogilev Regional Hospital”.

IU.L. KUCHYN

INTERSCALENE BRACHIAL PLEXUS BLOCK IN PATIENTS WITH CLAVICLE FRACTURES: RANDOMIZED COMPARISON OF TECHNIQUES WITH ULTRASOUND GUIDANCE AND NEUROSTIMULATOR

National Medical University named after O.O. Bogomolets, Kiev,
The Ukraine

Objectives. To investigate the effectiveness of the interscalene brachial plexus block controlled by the ultrasound in comparison with the technique controlled by means of the neurostimulator in patients with clavicle fractures.
Methods. 60 patients with the clavicle fractures were accidentally randomized into 2 study groups, each numbering 30 patients depending on the applied technique of the interscalene brachial plexus block. Patients in both groups were similar for the gender, age and local changes difficult to determine the site of puncture needle. In the first group the brachial plexus was identified by means of neurostimulator according to a standard motor response. In the second group the brachial plexus identification and introduction of the local anesthetic was controlled by means of the ultrasound. The rate of successful block, expended time and the number of needle punctures for performing manipulation have been compared.
Results. It is established that the use of ultrasound guidance at the interscalene brachial plexus block leads to the increase of successful regional anesthesia frequency (100% vs. 80%). The relative chances on the unsuccessful block at the electrolocation application concerning the ultrasound control made up 13,16. Ultrasound guidance permits to reduce the manipulation time 215 [180-300] sec vs. 600 [350-750] sec) and the number of the needle punctures (1 [1-2] vs. 3 [2-4]) during searching the plexus, which reduces patient’s discomfort during anesthesia as well as decreases the risks of complications.
Conclusions. In patients with the clavicle fractures interscalene brachial plexus block performance with the use of neurostimulator is complicated by anatomical landmarks changes and pain syndrome at their detection. Application of the ultrasound guidance technique can improve the results of regional anesthesia in these patients.

Keywords: regional anesthesia, brachial plexus, interscalene access, ultrasound guidance, neurostimulator, clavicle fracture
p. 105 – 108 of the original issue
References
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  3. Sauter AR, Dodgson MS, Stubhaug A, Halstensen AM, Klaastad O. Electrical nerve stimulation or ultrasound guidance for lateral sagittal infraclavicular blocks: a randomized, controlled, observer-blinded, comparative study. Anesth Analg. 2008 Jun;106(6):1910–15.
  4. Gurkan Y, Acar S, Solak M, Toker K. Comparison of nerve stimulation vs. ultrasound-guided lateral sagittal infraclavicular block. Acta Anaesthesiol Scand. 2008 Jul;52(6):851–55.
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Address for correspondence:
01133, Ukraina, g. Kiev, Laboratornyi pereulok 14-20, Kievskaia gorodskaia klinicheskaia bol'nitsa ¹17, otdelenie anesteziologii i intensivnoi terapii,
e-mail: kuchyn2@gmail.com,
Kuchyn Iuri Leonidovich
Information about the authors:
Kuchyn Iu.L. PhD, associate professor of the anesthesiology and intensive therapy chair of the National Medical University named after O.O. Bogomolets.

CASE REPORTS

C. HOENEMANN 1, M. NICOLAY 1, S. JüRGENS 1, C. BERSCH 1, E. MATEVOSSIAN 2, D. DOLL 1

AN ABDOMINAL WALL TUMOR IS A SPIEGHELIAN HERNIA CONTAINING ADENOCARCINOMA OF UNKNOWN PRIMARY ORIGIN

St. Mary's Hospital, Academic Teaching Hospital of the University of Hannover, Vechta 1,
Hospital rechts der Isar, Technical University of Munich 2,
Germany

The 84 year old lady presented with nausea, but without vomiting showing a fixed left sided abdominal mass that could be palpated 15 cm lateral to the umbilical. She had a history for bilateral inguinal hernia, umbilical hernia and epigastric hernia surgery. Contrast CT revealed a Spieghelian hernia containing contrasted large bowel as the reason for the left side abdominal mass. On operation the Spieghelian hernia contained metastatic greater omental cake adhering to the left colon. The site of the primary adenocarcinoma could not be located intra- and postoperatively. Reasons for ventral abdominal mass and this unusual left side abdominal mass – a Spieghelian hernia containing in fact metastatic tumor – are discussed.

Keywords: Spieghelian hernia, cancer of unknown primary origin (CUP), colorectal cancer tumor, colonic carcinoma, adenocarcinoma
p. 109 -112 of the original issue
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Address for correspondence:
PD Dr. Dietrich Doll, MD, PhD,
Department of Surgery, St.-Marien Hospital Vechta, Academic Teaching Hospital of The Hannover University, Marienstr. 6-8, D - 49377 Vechta, Germany,
e-mail: dolld@gmx.de
Information about the authors:
Hoenemann C. MD, PhD, Intensive Care unit, St. Mary's Hospital, Academic Teaching Hospital of the University of Hannover.
Nicolay M. MD, Surgery unit of St. Mary's Hospital, Academic Teaching Hospital of the University of Hannover.
Jürgens S. MD, a senior radiologist, practice on radiology and radiological interventions, St. Mary's Hospital, Academic Teaching Hospital of the University of Hannover.
Bersch C. MD, a senior autopsist, St. Mary's Hospital, Academic Teaching Hospital of the University of Hannover.
Matevossian E. MD, PhD, Surgery unit, Hospital rechts der Isar, Technical University of Munich.
Doll D. MD, PhD, Surgery unit of St. Mary's Hospital, Academic Teaching Hospital of the University of Hannover.

EXCHANGE OF EXPERIENCE

F.I. MAKHMADOV, K.M. KURBANOV, Z.H. NUROV, A.D. GULAHMADOV, A.J. SOBIROV

THE CURRENT ASPECTS OF DIAGNOSTICS AND TREATMENT OF MECHANICAL JAUNDICE

Avicenna Tajik State Medical University, Dushanbe
The Republic of Tajikistan

Objectives. Improvement of immediate treatment results of patients with mechanical jaundice of various etiologies by means of complex usage of minimally invasive diagnostic and treatment methods.
Methods. The given research is based on the results analysis of diagnostics and gradual decompressions of the biliary ducts using minimally invasive technologies in 226 patients with mechanical jaundice (MJ) of different genesis within the period of 2004-2012 yrs. Patients’ age varied from 19 to 89 yrs. Females composed 117 (51,8%), males – 109 (48,2%). Only 192 (84,6%) patients were at once to the surgical in-patient department, the rest 34 (15,4%) were transported from the therapeutic and infectious units. For differentiated diagnostics of MJ non-invasive methods were applied: sonography, fibrogastroduodenoscopy (FGDS), magnetic resonance cholangiopancreatography (MRCP), multislice computer tomography (MSCT) as well as invasive ones: endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTHC).
Results. The research results analysis showed that criteria of informativeness determination of the applied methods were detectability of concretions, strictures of the biliary ducts, mass lesions, dilation of the intrahepatic bile ducts, common hepatic and bile ducts. Different types of endoscopic decompression (n=57) and percutaneous transhepatic cholangiography (n=31) carried out in combination with ERCP and PTHC were considered to be an effective methods of the biliary hypertension elimination. Possibility to perform these types of biliary ducts decompression was subjected to the comparative estimation. The efficacy in the treatment of jaundice made up 93,3%.
Conclusions. Application of the current investigation methods (US, ERCP, PTHC, CT) permits to certify reliably the mechanical character of jaundice, reveal the cause and level of block, tumor lesion in the major duodenal papilla region and to assess the process prevalence. The choice of intervention type and volume at MJ depends primarily on MJ severity, patient’s general state, disease etiology as well as the level of obstruction zone and its expansion.

Keywords: mechanical jaundice, bilary ducts decompression, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography
p. 113 – 122 of the original issue
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Address for correspondence:
734003, Respublika Tadzhikistan, g. Dushanbe, pr. Rudaki d. 139, Tadzhikskii gosudarstvennyi meditsin-skii universitet im. Abulai ibni Sino, kafedra khirurgicheskikh boleznei ¹1,
e-mail: fmahmadov@mail.ru,
Makhmadov Farrukh Isroilovich
Information about the authors:
Makhmadov F.I. MD, an associate professor of the chair ¹1 of surgical diseases of Avicenna Tajik State Medical University, Dushanbe.
Kurbanov K.M. Academician of AMS of the Republic of Tajikistan, MD, professor, a head of the chair ¹1 of surgical diseases of Avicenna Tajik State Medical University, Dushanbe.
Nurov Z.H., a post-graduate student of the surgical diseases chair ¹1 of Avicenna Tajik State Medical University, Dushanbe.
Sobirov A.J. A post-graduate student of the chair ¹1 of surgical diseases of Avicenna Tajik State Medical University, Dushanbe.
Gulahmadov A.D. A post-graduate student of the chair ¹1 of surgical diseases of Avicenna Tajik State Medical University, Dushanbe.
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