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Year 2011 Vol. 19 No 3

GALLERY OF THE NATIVE SURGEONS

KHUBULAVA G.G., SHAYDAKOV E.V., SаZONOV A.B.

OPERATION OF TROYANOV-TRENDELENBURG.
DEDICATED TO ALEXEY ALEXEEVICH TROYANOV

The article is devoted to a talented Russian surgeon, public figure and remarkable person Alexey Alexeevich Troyanov. In 1888 A.A. Troyanov performed the first ligation of the greater saphenous vein, and we have every right to assume that A.A. Troyanov is the founder of phlebology in Russia, and Obukhov Hospital is a homeland of the native phlebology.
The methods of the plastic closure of an urethral fistula and congenital ectopias of the bladder belong to A.A. Troyanov. Besides operative techniques he suggested a number of original instruments. A spit-like needle holder of Troyanov and the bed to stretch the spine at spongilitis are widely known.
Great diligence, compassion, unselfishness, active citizenship – these traits have earned the enormous prestige to Alexey Alexeevich among his colleagues. The things, done by A.A. Troyanov, permit to say for sure that he has contributed significantly to the development of surgery. His name deservedly is among the prominent representatives of domestic medicine.

Keywords: Alexey Alexeevich Troyanov, Frederick Trendelenburg, the history of surgery
p. 3 - 8 of the original issue
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  12. Правдолюбов, В. В. К вопросу об оперативном лечении варикозного расширения вен нижних конечностей: дис. … д-ра медицины / В. В. Правдолюбов. – СПб.; МХА, 1892. – 247 с.
  13. Хольцов, Б. Н. Об остановке кровотечения при ранении больших вен и о перевязке общей бедренной вены в частности: дис. … д-ра медицины / Б. Н. Хольцов. – СПб.; МХА, 1892.
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EXPERIMENTAL SURGERY

ALEXANDROV S.V., VLADIMIRSKAYA T.Z.

EXPERIMENTAL INVESTIGATION RESULTS OF COAGULATION PROPERTIES OF HIGH-ENERGY PULSED LASER RADIATION AT THE LIVER TISSUE EXPOSURE

Objectives. To compare the depth of coagulation of the laser radiation of 1064nm, 1320nm, 1440nm when exposed to liver tissue and to monitor morphological changes within 14 days.
Methods. The depth of the damage zones was measured after exposure to laser radiation three wavelengths with an average power of 20 W at the liver tissue of experimental animals after 1 hour after exposure and after 3,7,14 hours. Morphological changes of liver tissue in the place of laser radiation were studied.
Results. The depth of coagulation and vaporization was for a wavelength of 1064 nm 446,90±12,389, for 1320 nm - 1018,8±21,983, for 1440 nm - 753,20±17,077 (data are given in microns). The depth of the perifocal zone for a wavelength of 1064 nm - 1724,9±22,673, for 1320nm - 1724,8±23,679, for 1440 nm - 1379,1±19,259 (mean±error of the mean, these are given in microns). By the 14th day after exposure of the laser pulse radiation with an average power of 20 W the liver tissue was restored.
Conclusions. The wavelength of 1320 nm has the most profound coagulation effects on liver tissue in the used modes.

Keywords: laser radiation, coagulation of the liver, laser hemostasis
p. 9 – 15 of the original issue
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LYZIKOV A.A., VOROPAEV E.V., OSIPOV V.A., PECHENKIN A.A.

MODELING HIGH RISK CONDITIONS OF INFECTIOUS COMPLICATIONS IN EXPERIMENT

Objectives. To create the experimental model of the subcultural bacteremia to study biological reactions of the vascular conduits on the presence of pathogenic microorganisms in the dose insufficient for sepsis development.
Methods. Experimental investigations were carried out on 30 out bred dogs with an average weight 15,3±3,7 kg. Aorto-femoral bypass with a combined conduit was performed in all of them. Modeling of high-risk conditions of postoperative septic complications by a single intravenous injection of S.aureus was performed in 20 dogs before the operation. 10 other animals were used for control and were not infected.
Results. The leucocytes level and clinical parameters in the experimental group didnt reliably differ from ones in the control group. For 3–5 days 14 out of 20 animals of the experimental group died because of the massive hemorrhage from the anastomoses. PCR analysis was carried out: in some animals together with the control strain of Staphylococcus a normal micro flora was identified as well as other types of Staphylococcus.
Conclusions. The presence of subcultural bacteriemia doesn t cause clinical and laboratory manifestations of sepsis but result in complications of conduit survival similar to the septic ones. Development of infectious complications doesnt depend on the dosage of pathogenic agent.

Keywords: prosthesis infection, experiment, modeling, subcultural bacteriemia, septic complications
p. 16 – 20 of the original issue
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GENERAL AND SPECIAL SURGERY

BELYUK K.S., ZHANDAROV K.N.

CLINICAL ESTIMATION OF DIFFERENT VARIANTS OF CHOLEDOCHOTOMY INCISION CLOSURE

Objectives. To study treatment results of different variants of choledochotomy incision closure and to estimate efficacy of new proposed methods.
Methods. Operations at 200 patients in whom open surgeries were carried out with different variants of choledochotomy closure. According to the choledochotomy closure patients were divided into three groups: the 1st one – 158 patients with external drainage of common bile duct; the 2nd – 22 patients with the precision suture of choledochtomy opening and drainage on Halsted; the 3rd – 20 patients with “deaf” precision suture of choledochtomy opening and in 12 of them drainage of common bile duct with hidden self-deleted drainage worked out in the clinic was done
Results. Adequate correction of the biliary hypertension was revealed in three groups of patients both with the external drainage of the common duct and with hidden self-deleted drainage. Application of the later in the patients of the 3rd group permitted to impose “deaf” precision suture of the choledochtomy opening without the risk of its failure and thus to reduce the number of complications as well as the duration of the postoperative treatment in comparison with the 1st and 2nd groups with the external drainage of the common bile duct.
Conclusion. Using “deaf” precision suture with hidden self-deleted drainage of the common bile duct improves treatment results of complicated gallstone disease.

Keywords: gallstone disease, choledocholithiasis, obstructive jaundice, precision suture of choledochotomy incision
p. 21 – 29 of the original issue
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SHCHASTNY A.T.

POSTOPERATIVE COMPLICATIONS OF THE PROXIMAL PANCREAS RESECTIONS IN PATIENTS WITH CHRONIC PANCREATITIS

Objectives. To work out tactical and technical recommendations concerning complication prevention of proximal resection of the pancreas.
Methods. Retrospective investigation of the results of 22 pancreas proximal resection was carried out. 102 (45,7%) duodenum-saving proximal resections the pancreas head on Beger were done. Berns modification of Beger operation was done in 46 (20,6%) patients. Frey operation was done in 13 (5,8%) patients. Pancreatoduodenal resection was performedin 62 (27,8%) patients, from them in 41 patients a pylori-saving variant was used.
Results. Postoperative lethality composed 3,1%; postoperative complications incidence composed 3, 8%. The greatest share of early postoperative complications was in the postoperative pancreatitis – 15 (21,1%) patients; insufficiency of various forms of anastomoses - in 14 (20%) and pancreatic fistulas – in 14 (20) cases. Bile outflow was diagnosed in 8,5% cases. Intra-abdominal hemorrhages and bleedings in the intestinal lumen composed 8,5%
Conclusions. Duodenum-saving techniques permit to obtain low parameters of the postoperative complications and lethality. Mini-invasive interventions allow eliminating adequately the postoperative complications without repeated operations in the majority of operated patients. It is necessary to concentrate patients with chronic pancreatitis in large medical institutions, employing surgeons-pancreatologists.

Keywords: chronic pancreatitis, proximal resection, postoperative complications, pancreato-digestive anastomosis
p. 30 – 43 of the original issue
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REVEL-MUROZ J.A., SOVTSOV S.A.

LOW-INVASIVE LASER TECHNOLOGIES IN TREATMENT OF PATIENTS WITH CHRONIC PANCREATITIS

Objectives. To improve the effectiveness of chronic fibrosing pancreatitis treatment by means of low-invasive technologies with the application of high-intensity laser radiation.
Methods. 20 patients with parenchymal and fibro-sclerotic chronic pancreatitis were operated on. Nine of them were men and eleven were women. The age of patients ranged from 27 to 71 years. All the patients had persistent pain and dyspeptic syndromes, with negligible effect on antispasmodics. Medical history of the disease was from 6 months to 15 years, the frequency of severe attacks requiring hospitalization was from 2 to 6 per year. The laparoscopic technique and mini laparotomic access using the O-ring retractor were performed. The diode laser device “LS-0, 97 - IRE-Polus” (wavelength 970 nm) was used as a source of laser radiation.
Results. All the patients noted the disappearance of pain, improvement of general condition, quality of life. No complications were observed in the immediate and distant period after laser tunnelization.
Conclusions. The results of clinical studiestestify to the possibility of safe and effective use of laser tunnelization of pancreas in the patients with chronic pancreatitis. One of the highlights of the surgical treatment in these patients is the relief of pain and improvement of life quality.

Keywords: chronic pancreatitis, laser radiation
p. 44 – 50 of the original issue
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SUKOVATYKH B.S., BLINKOV YU.YU., IVANOV P.A.

NEW APPROACH TO THE CHOICE OF TREATMENT METHOD AT DIFFUSE PURULENT PERITONITIS

Objectives. To improve the treatment results in patients with diffuse purulent peritonitis by means of objectification of the indications for the choice of surgical treatment.
Methods. The analysis of the complex diagnostics and the following treatment of 380 patients with diffuse purulent peritonitis was performed. According to the choice of treatment method the patients were divided into two groups. Control group included 245 patients; the choice of treatment method for them was made without quantitative characteristics of risk factors for progressing peritonitis. The basic group included 135 patients; the choice of treatment method for them was made on the base of the scale developed by the authors using quantitative assessment of risk factors for progressing peritonitis.
Results. On determining the indications for the choice of the treatment method of diffuse peritonitis it is necessary to perform quantitative assessment of 6 risk factors directly influencing the outcome of the disease: severity of the abdominal sepsis, degrees of intra-abdominal hypertension, the source of peritonitis, types of exudates, amount and properties of fibrin on peritoneum, severity of paralysis of the intestines. Depending on the score, if the number of points varies from 1 to 7, the choice is made in favor of traditional (semi-closed) method of treatment, the range from 8 to 14 means that combined method should be applied, if the score is 15 points and above - semi-opened method of treatment is preferred.
Conclusions. In the basic group the number of patients with post-operative complications decreased by 10% and lethality decreased by 8,2%.

Keywords: diffuse purulent peritonitis, choice of the treatment method
p. 51 – 56 of the original issue
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HUDAYBERGENOV SH.N., PAKHOMOV G.L., HAYALIEV R.YA., IRISOV O.T., ESHONKHODZHAYEV O.D.

SURGICAL TACTICS IN PATIENTS WITH BRONсHOPLEURAL FISTULAS AFTER PNEUMONECTOMY

Objectives. To improve the treatment tactics of patients with bronchial fistulas after pneumonectomy.
Methods. The analysis of treatment results in 109 patients with bronchopleural fistulas after pneumonectomy was performed. Primary operations were carried out because of the ontological diseases in 79 (72,5%) cases; in the rest 30 cases (27,5%) - because of the purulent pulmonary diseases.
Results. The patients were divided into 3 groups. 35 patients composed the 1st group, to whom an active tactics of the surgical treatment was applied, that is after state stabilization of patients with purulent complications (thoracoscopy with the drainage) on average after 6,1±1,2 days, they underwent the surgical treatment of fistulas. In 31 patients a delaying surgical tactics was used; in 43 patients endoscopic techniques were used at bronchopleural fistulas (BPF) closure. Use of the active surgical tactics appeared to be the most justified, in 31 (88,6%) patients, good results were registered. Complications were registered in 4 (11,4%) patients, lethality – in 3 (8,6%) cases. Delaying tactics determined satisfactory results only in 21 (67,7%) patients and complicated course – in 10 (32,3%) with lethality in 5 (16,1%) cases. Efficacy of BPF bronchoscopic elimination composed 62, 8% only; lethality outcomes were registered in 5 (11%) cases.
Conclusions. The active surgical tactics is the most justified at the bronchial stump failure after pneumonectomy regardless of the character and the side of the lesion.

Keywords: pneumonectomy, bronchial stump failure, treatment tactics, omenoplastics, lethality
p. 57 – 62 of the original issue
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CHERNUKHA L.M., NIKULNIKOV P.I., KASHIROVA O.V., VLAYKOV G.G., ALTMAN I.V., GUCH A.A., MATYASHCHUK A.S.

POSSTRAUMATIC ARTERIOVENOUS FISTULAS: TREATMENT EXPERIENCE

Objectives. To improve the outcomes of surgical treatment in patients with chronic posttraumatic arteriovenous vascular lesions (PAVL) on the basis of etiology and pathogenesis of the condition studying.
Methods. 18 patients with PAVL were examined for the period from 2005 to 2009; 16 of them were males, 2 females; aged 25-59 years, 50% of the subjects were aged 25-40 years. The systemic hemodynamic changes according to echocardiography data before and after surgery were analyzed in 2 patients with PAVL of the femoral, posterior tibial vessels.
Results. Mainly the damage of the lower extremities arteries (in 10 patients) were observed; 8 of them (66, 7%) needed reoperation, the duration of disease ranged from 3 months to 36 years. In this group ligation of the arteriovenous fistula was conducted in 2 patients, end-to-end arterial anastomosis in 1, lateral suture of artery in 1 patient, artery replacement with explants in 3; endovascular embolization in 1, stent-grafting of arteriovenous arteriovenous fistula with following surgical removal of pseudoaneurysm - 1.
Conclusions. The outcome of surgical treatment depends on the timeliness of special surgery done. Radical reconstructive surgery in patients with PAVL contributes to normalization of the general hemodynamic in early postoperative period. Combined use of surgical and endovascular methods allow decreasing considerably the intraoperative hemorrhage risk and surgical trauma in patients with chronic PAVL.

Keywords: chronic posttraumatic arteriovenous lesions, systemic hemodynamic disturbances, echocardiography, radical reconstructive surgery, endovascular, combined treatment
p. 63 – 69 of the original issue
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IGNATOVICH I.N.

PECULIARITIES OF ARTERIES LESIONS AND WAYS OF REVASCULARIZATION IN PATIENTS WITH NEUROISCHEMIC FORM OF DIABETIC FOOT

Objectives. To study the peculiarities of occlusive-stenotic arterial lesions influencing the character of revascularization in the patients with neuroischemic form of diabetic foot.
Methods. 106 patients with neuroischemic form of diabetic foot, who were treated in Minsk city center of diabetic foot, were investigated. For the arteries visualization contrast angiography was used in 82 cases (77,4%), CT- angiography was applied in 16 cases (15,1%), the combination of both methods was used in 8 cases (7,5%) .
Results. The vast majority of patients had distal occlusion with the lesions of three and two tibial arteries. When significant lesions of superficial femoral artery are absent, transluminal endovascular procedures can be performed. At critical stenosis of the superficial femoral artery one also has conditions for the endovascular plastics of at least one tibial artery to improve blood flow to the tissues of the foot. At the occlusion of the superficial femoral artery only in rare cases, there is at least one traversed tibia artery, which can provide a “flight path, this limits the number of shunt operations. In the research group of patients revascularization was performed in 46 (43,9%) patients.
Conclusion. The prospect of improving care to the patients with neuroischemic form of diabetic foot, the decrease of number of high amputations implicates further working out and introduction of the hybrid technologies of the limb revascularization as well as the adequate material-technical support of such interventions.

Keywords: diabetic foot, revascularization, artery
p. 70 – 76 of the original issue
References
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  6. Гавриленко, А. В. Хирургическое лечение больных с критической ишемией конечностей / А. В. Гавриленко, С. И. Скрылев. – М., 2005. – 176 с.
  7. Гавриленко, А. С. Хирургическое лечение больных с критической ишемией нижних конечностей, обусловленной поражениями артерий инфраингвинальной локализации / А. С. Гавриленко, С. И. Скрылев // Ангиология и сосудистая хирургия. – 2008. – № 4. – С. 111-118.
  8. Исмаилов, Н. Б. Лечебная и диагностическая тактика при атеросклеротическом окклюзионно-стенотическом поражении артерий нижних конечностей у геронтологических больных / Н. Б. Исмаилов, А. В. Веснин // Ангиология и сосудистая хирургия. – 2008. – № 3. – С. 27-31.
  9. Малахов, Ю. С. Анализ результатов хирургического лечения больных с гнойно-некротическими поражениями нижних конечностей ишемического генеза / Ю. С. Малахов, Д. А. Аверьянов, А. В. Иванов // Ангиология и сосудистая хирургия. – 2009. – № 1. – С. 133-138.
  10. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome / E. B. Jude [et al.] // Diabetes Care. – 2001. – Vol. 24. – P. 1433-1437.
  11. Гибридные операции у больных атеросклерозом нижних конечностей при развившейся критической ишемии / А. Н. Вачев [и др.] // Ангиология и сосудистая хирургия. – 2010. – Т. 16. – Прил. № 4: Нерешенные вопросы сосудистой хирургии: материалы 22 Междунар. конф., 22–24 нояб. 2010 г. – С. 61-62.
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SHVALB P.G., KALININ P.E., PSHENNIKOV A.S., SUCHKOV I.A.

EFFECT OF INTERMITTENT PNEUMOCOMPRESSION ON THE NITRIC OXIDE PRODUCTION AS THE MAIN MARKER OF ENOTHELIAL DYSFUNCTION IN PATIENTS WITH PERIPHERAL OCCLUSSIVE ARTERIAL DISEASE

Objectives. To evaluate the efficacy of intermittent pneumocompression (IPC) in the complex treatment of the peripheral occlusive arterial disease (POAD).
Methods. In the investigation 2 groups of patients were included: the first study group included 64 patients, who underwent the pneumocompression course) and the second one (60 patients) and they included patients with POAD at the stage IIА - IIB according to the classification of Fontaine in modification of Pokrovsky. We used a special program to register the levels of metabolites of nitric oxide, ankle-brachial pressure index, “reactive hyperemia” test (RH - test), pain-free walking distance which were monitored before IPC and after 1-month follow-up.
Results. It was found out that the use of IPC in treatment of patients with POAD is pathogenetically based upon the normalization of functional state of endothelium and has some advantages compared to the classical methods of conservative treatment. We observed the elevation of nitric oxide level which is the key mechanism of clinical improvement such as the increase of pain-free walking distance, ankle-brachial pressure index as well as improved RH-test.
Conclusion. A short-course intermittent pneumocompression is one of the methods of endotheliotropic treatment and is an aspect to be considered in combination therapy in patients with peripheral occlusive arterial disease.

Keywords: Intermittent pneumocompression, endothelial dysfunction, nitric oxide
p. 77 – 81 of the original issue
References
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  8. Skala- Rosenbaum, J. Is distal locking with IMHN necessary in every pertrochanteric fractures? / J. Skala- Rosenbaum, J. Bartonicek, R. Bartoska // International Orthopaedics. – 2010. – Vol. 34, N 7. – P. 1041-1047.
  9. Baumgaetner, M. R. The pertrochanteric external fixator reduced pain, hospital stay, and mechanical complications in comparison with the sliding hip screw / M. R. Baumgaetner // J. Bone Joint Surg. – 2002. – Vol. 84-A. – P. 1988.
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  12. Badras, L. The use of external fixation in the treatment of trochanteric fractures / L. Badras, E. Skretas, E. D. Vayanos // Rev. Chir. Orthop. – 1997. – Vol. 83. – P. 461-465.
  13. Джанбахышов, Г. С. Оперативное лечение переломов проксимального конца бедренной кости аппаратами внешней фиксации / Г. С. Джанбахышов // Азербайдж. журн. ортопедии и травматологии. – 2008. – № 2. – С. 51-53.

TRAUMATOLOGY AND ORTHOPEDICS

TALYSHINSKY R.R., GADZHIEV SH.SH.

OSTEOSYNTHESIS OF FEMUR PERTROCHANTERIC AND INTERTROCHANTERIC FRACTURES IN ELDERLY PATIENTS TREATED BY EXTERNAL FIXATION PIN APPARATUS

Objectives. To estimate effectiveness of pin apparatus use at osteosynthesis of the pertrochanteric and intertrochanteric fractures of the femur in elderly patients.
Methods. 116 patients with AO/ASIF type 31A1, 31A2 and 31A3 fractures who had been treated at the acute trauma department of Scientific Research Traumatology and Orthopaedics Institute of Ministry of Health of Azerbaijan Republic from 2006 to 2011 were included into the research.
Results. It has been established, that pin apparatus use at osteosynthesis of pertrochanteric and intertrochanteric fractures of the femur in elderly patients has a number of advantages in comparison with other methods such as mini invasive and short-term of surgery procedure, a little blood loss during surgery, possibility to obtain and maintain stable fixation of fragments during all treatment period up to fracture jointing, as well as early activation of patients along with functional treatment.
Conclusion. The use of pin apparatus at osteosynthesis of pertrochanteric and intertrochanteric fractures of the femur in elderly patients is an effective and mini invasive method of functional treatment. The method is simple and especially useful to treat elderly patients with aggravated general condition.

Keywords: osteosynthesis, pin apparatus, pertrochanteric and intertrochanteric fractures
p. 82 – 85 of the original issue
References
  1. Применение ритмической пневмокомпрессии для лечения больных хроническими облитерирующими заболеваниями артерий нижних конечностей / Е. М. Липницкий [и др.] // Ангиология и сосудистая хирургия. – 2007. – Т. 13, № 3. – С. 22-26.
  2. Intermittent pneumatic compression in stable claudicants: effect on hemostasis and endothelial function / E. Sutkowska [et al.] // International Angiology. – 2009. – Vol. 28, N 5. – P. 373-379.
  3. Intermittent compression pump for non-healing wounds in patients with limb ischemia. The Mayo Clinic experience (1998-2000) / V. M. Montori [et al.] // International Angiology. – 2002. – Vol. 21. – Р. 360-369.
  4. A prospective randomized controlled study with intermittent mechanical compression of the calf in patiants with claudication / J. De Haro [et al.] // Journal of Vascular and Endovascular Surgery. – 2010. – Vol. 51, N 4. – P. 857-862.
  5. Randomized study on the effects of different strategies of intermittent pneumatic compression for lower limb claudication / A. Berni [et al.] // Giornale di Chirurgia. – 2009. – Vol. 30, N 6-7. – Р. 269-273.
  6. Киричук, В. Ф. Дисфункция эндотелия / В. Ф. Киричук, П. В. Глыбочко, А. И. Пономарева. – Саратов: Изд-во Сарат. мед.ун-та, 2008. – 129 с.
  7. Пшенников, А. С. Одноэтапный метод определения уровня метаболитов оксида азота в сыворотке крови / А. С. Пшенников // Актуальные вопросы современной медицины: взгляд молодого специалиста: материалы науч.-практ. конф. – Рязань: РИО РязГМУ, 2010. – С. 183-185.
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UROLOGY

KOCHOYAN T.M., KOMOV D.V., MATVEEV V.B., KOMAROV I.G., KERIMOV R.A., LOGACHEV A.V.

SURGICAL TREATMENT OF KIDNEY TUMORS WITH ENDOSCOPIC TECHNIQUES

Objectives. To carry out the comparative analysis of the distant survival of patients with the kidney tumor depending on the access: the open or the endoscopic methods.
Methods: 214 patients with the kidney cancer were included into the investigation (90 males and 124 females) in whom nephrectomy was performed. All the patients were divided into two groups. 164 patients with the clinical diagnosis of the kidney cancer Т1-3N0M0 who underwent laparoscopic nephrectomy composed the main group. In the control group 50 patients were retrospectively selected in whom radical nephrectomy by the laparotomy access because of the localized kidney cancer was carried out.
Results. General survival of the patients with the renal-cell cancer after the laparoscopic nephrectomy made up 100%. 4-year survival without recurrences of the radically operated patients composed 94, 4%. General 1-year and 4-year survival of the patients who underwent the open nephrectomy composed 98, 9% and 96, 45, without recurrences 100% and 96,2% respectively.
Conclusions. Laparoscopic access for nephrectomy performing in patients with early kidney cancer stages is an acceptable one from the oncologic positions as well as less traumatic and safe in comparison with open surgeries.

Keywords: kidney tumors, kidney cancer, laparoscopic nephrectomy
p. 86 – 90 of the original issue
References
  1. Аксель, Е. М. Злокачественные новообразования в России и странах СНГ в 2002 г. / Е. М. Аксель, М. И. Давыдов. – М., 2004. – 281 с.
  2. Renal cell carcinoma: prognostic significance of incidentally detected tumors / K. H. Tsui [et al.] // J. Urol. – 2000. – Vol. 162, N 2. – P. 436-441.
  3. Матвеев, В. Б. Лапароскопическая хирургия в онкоурологии / В. Б. Матвеев, И. Г. Комаров, М. И. Волкова // Материалы Х Рос. онколог. конгр. – М., 2006. – С. 42-46.
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  5. Tan, A. V. Transperitoneal Radical Nephrectomy / A. V. Tan, A. D. Joice // Laparoscopic Urologic. Surgery in Malignances / Eds. J. Rosette, I. Gill. – Berlin: Springer, New York: Hiedelberg, 2005. – P. 19-28.
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  7. Long-term follow-up after laparoscopic radical nephrectomy / J. A. Portis [et al.] // J. Urol. – 2002. – Vol. 167, N 3. – P. 1257-1262.

ANESTHESIOLOGY-REANIMATOLOGY

PECHERSKY V.G., MAROCHKOV A.V.

PECULIARITIES OF THE LOCAL ANESTHETIC DISTRIBUTION AT THE SCIATIC NERVE BLOCKADE

Objectives. To investigate the peculiarities of distribution of the local anesthetic solution at the sciatic nerve blockade depending on the preparation volume and anatomical constitution peculiarities.
Methods. 166 sciatic nerve blockades were analyzed which were performed under ultrasound visualization control. The blockade of the sciatic nerve was done with lidocaine in the volume of 30 ml; 25 ml; 20 ml; 15 ml; 12,5 ml; 10 ml; 7,5 ml; 6,5 ml; 5 ml; 4,5 ml. The cross-sectional area corresponding to the local anesthetic was determined; the length of anesthetic distribution along the sciatic nerve was calculated.
Results. The anesthetic is spreading along the sciatic nerve in the proximal and distal directions, forming a kind of a cylinder. Minimal volume of the local anesthetic which is able to obduce the sciatic nerve completely is 5ml. A rare variant of the sciatic nerve structure is described where one of the branches of the sacral plexus was immediately formed by the tibial and by the common peroneal nerves.
Conclusions. At the preparation volume decreasing the reducing of the length of anesthetic distribution as well as the cross-sectional area, occupied by it around the nerve can be observed. Ultrasound visualization allows taking into account anatomical peculiarities of the sciatic nerve which can influence the quality of the carried out blockade.

Keywords: sciatic nerve blockade, ultrasound visualization, local anesthetic distribution
p. 91 – 95 of the original issue
References
  1. Кузин, М. И. Местное обезболивание / М. И. Кузин, С. Ш. Харнас. – М.: Медицина, 1993. – 224 с.
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ОTORHINOLARINGOLOGY

SITNIKOV V.P., HUSAM EL-REFAI, KOLESNIK T.I.

SIMULTANEOUS BILATERAL STAPEDOPLASTY IN PATIENTS WITH OTOSCLEROSIS

Objectives. Improvement of the surgical treatment effectiveness in patients suffering from otosclerosis by means of the simultaneous obtaining of binaural hearing.
Methods. During the period 2008-2010 on the basis of the ENT clinic of Gomel Regional Specialized Hospital a one-time (simultaneous) bilateral stapedoplasty was carried out in 12 patients suffering from the tympanum and tympano-cochlear forms of deafness. Before surgery, all patients underwent a full range of clinical-audiological examination.
Results. Evaluating the effectiveness of simultaneous bilateral stapedoplasty results was estimated by the closure of airbone interval (ABI) and by the postoperative level of auditory function according to the conventional tone threshold audiometry. Almost in all patients ABI was closed. Excellent functional results were achieved in 91,6%, good - in 8,4% of patients in the distant terms of the observation.
Conclusions. Simultaneous bilateral stapedoplasty is a highly-effective hearing improving surgery in patients suffering from otosclerosis with the presence of symmetrical conductive hearing loss and can be introduced into the arsenal of microsurgical interventions of highly qualified otosurgeon.

Keywords: otosclerosis, simultaneous bilateral stapedoplasty, audiometry
p. 96 – 100 of the original issue
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LECTURES, REVIEWS

VINNIK YU.S., SALMINA A.B., DROBUSHEVSKAYA A.I., TEPLYAKOVA O.V., POGILENKOVA E.A., KOTIKOV A.R.

PATHOGENESIS PECULIARITIES OF LONG-HEALING WOUNDS

This review shows modern views on the molecular mechanisms of the main phases of normal and complicated wound healing process. Significance of functional capabilities of fibroblasts and keratinocytes has been shown as well as the properties of the extra cellular matrix, microbial contamination, cytokine and protease activation in the pathogenesis of chronic wound healing. Data concerning the role of the protein expression connexin in providing the processes of direct intercellular interaction at wound healing are presented.

Keywords: chronic wounds, fibroblasts, keratinocytes, connexins, cell growth factors
p. 101 – 110 of the original issue
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MAGDIEV D.A., EGIZARYAN K.A.

TREATMENT OF DISTAL RADIOULNAR JOINT INJURIES

On the basis of both native and foreign literature studying, the data concerning the urgency of the problem of the ligament apparatus of the distal radioulnar joint (DRUJ) are presented in the review. In 51-65% of cases the fractures of the distal epimetafis of the radius with displacement of the bone fragments are the reasons of the DRUJ ligament apparatus injuries. The main mechanism of the isolated DRUI injury is falling down on the outstretched hand or forearm bones injury caused by the excessive rotation.
The fractures of the radius penetrating into DRUI remand a thorough reposition. Insignificant displacement left is known to result in deforming arthritis within 5 years in 100% of patients.
Up to present the indications to the conservative or operative treatment havent been completely determined. The operative techniques, used at the given injuries, are described in details in the review as well as the operation technology; the advantages and disadvantages of each method are studied.

Keywords: distal radioulnar joint, triangular fibro-cartilage complex, treatment
p. 111 – 117 of the original issue
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MALINOVSKAYA I.I.

INHIBITORS OF THE VASCULAR ENDOTHELIAL GROWTH FACTOR IN TREATMENT OF DIABETIC MACULAR EDEMA

Diabetic retinopathy and its manifestation, diabetic macular edema, are one of the leading causes of blindness worldwide. In the last decade many papers have appeared proving the key role of the vascular endothelial growth factor (VEGF) in the etiopathogenesis of these diseases, its effect on the development of the retinal neovascularization and increased vascular permeability. This article focuses on the results of a new direction in the treatment of diabetic macular edema - intravitreal inhibitors of VEGF.

Keywords: vascular endothelial growth factor, diabetic macular edema, inhibitors of vascular endothelial growth factor
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PRACTICAL CASES

ERMASHKEVICH S.N.

PARTIAL NECROSIS OF THE CECUM

The article describes a case of partial cecal necrosis, developed without visible reasons in the 20-aged patient. Its clinical picture simulated an acute appendicitis and was characterized by the pain in the right iliac region, fever and hyperleukocytosis. The patient underwent right hemicolectomy resulted in a favorable outcome. According to the literature cecal necrosis development analysis, a clinical picture, diagnostic and treatment tactics are presented.

Keywords: cecum, partial necrosis of the wall, acute appendicitis
p. 126 – 128 of the original issue
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