Novosti
Khirurgii
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XV congress of surgeons of the Republic of Belarus

Year 2012 Vol. 20 No 1

HISTORY OF SURGERY

YU.S. NEBYLITSIN, N.V. RASENOK

THE DUEL OF ALEXANDER SERGEYEVICH PUSHKIN. MEDICAL ASPECTS

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

Clinical manifestations, course and treatment of the wound of a famous Russian poet Alexander Sergeyevich Pushkin which was the result of his duel with Zh.Sh. Dantes are viewed in the article. Absence of a doctor in the place of this duel can be explained not only by the haste in which the duel was being prepared but also by unwillingness to increase the number of people who would have been involved in these malpractices. Despite the fact that the most prominent physicians of the time were at the bedside of the wounded poet, they didn’t give any hope for his recovery as the wound was fatal. Besides, Alexander Sergeyevich Pushkin lived in quite different time and it was practically impossible to save the life of this genius poet taking into account the level of medicine development which was in the 30-s years of the XIX century.

Keywords: Alexander Sergeyevich Pushkin, duel, aid rendering, death of the poet
p. 3 – 9 of the original issue
References

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10.Davidov MI. Ranenie na dueli genial'nogo russkogo poeta A.S. Pushkina [Wound in a duel of the great Russian poet A. S. Pushkin]. Khirurgiia. 2000;(5):64–69.
11.Gumanenko EK. Ognestrel'nye raneniia mirnogo vremeni [Gunshot wounds in peacetime]. Vestn Khirurgii. 1998;157(5):62–67.
12.Zhukovskii VA. Konspektivnye zametki o gibeli Pushkina [Conspectus about the death of Pushkin] Elektron resurs. 2010. Rezhim dostupa: http://pushkin.niv.ru/pushkin/vospominaniya/vospominaniya.
13.Anikin ID. Ranenie i smert' Pushkina po svedeniiam sovremennikov [Wound and death of Pushkin according to the contemporaries]. Vestn Khirurgii. 1967;(1):131–37.

Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, d. 27, UO “Vitebskii gosudarstvennyi meditsinskii universitet”, kafedra obshchei khirurgii,
e-mail: nebylicin.uravgm@mail.ru,
Nebylitsin Yurii Stanislavovic
Information about the authors:
Nebylitsin Yu.S., Candidate of medical sciences, associate professor of the chair of general surgery of EE “Vitebsk State Medical University”
Rasenok N.V., the 5th year student of the medical faculty of EE “Vitebsk State Medical University”.

EXPERIMENTAL SURGERY

V.À. KOSINETS 1, S.S. OSOCHUK 2, N.N. YAROTSKAYA 2

INFLUENCE OF THE PREPARATION “OMEGAVEN” ON THE STATE OF LIVER MITOCHONDRION MEMBRANES AT EXPERIMENTAL WIDESPREAD PURULENT PERITONITIS

SEE HPE “I.M.Sechenov First Moscow Medical University” 1,
The Russian Federation
EE “Vitebsk State Medical University”2,
the Republic of Belarus

Objectives. To study the influence of the preparation of omega-3 fatty acids «Omegaven» on protein-lipid parities and phospholipid spectrum of mitochondrion membranes of the liver at the experimental widespread purulent peritonitis.
Methods. The research has been performed on 40 rabbits-males of chinchilla breed. Influence of the preparation of omega-3 fatty acids «Omegaven» on protein-lipid parities and phospholipid spectrum of mitochondrion membranes of the liver at the experimental widespread purulent peritonitis has been studied for the first time.
Results. The development of the widespread purulent peritonitis is characterized by the expressed imbalance of protein-lipid parities and phospholipid spectrum of mitochondrion membranes of the liver which is revealed through the percentage growth of lisophosphatides, possessing damaging action, and compensative activation of the systems restoring damages of mitochondrial membranes, at the expense of cardiolipin content increase.
Conclusions. It has been established that in the postoperative period «Omegaven» influences effectively phospholipid structure of mitochondrion by percentage decrease of lisophosphatides, level increase of polyglycerophosphatide and cardiolipin. The preparation prevents decrease in the amount of total phospholipids in mitochondrion membranes that together with stimulation of protein amount growth testifies to high protective properties of the preparation.

Keywords: widespread purulent peritonitis, «Omegaven», mitochondria, phospholipids, cardiolipin, cholesterol
p. 10 -15 of the original issue
References

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Address for correspondence:
119991, Rossiiskaia Federatsiia, g. Moskva, ul. Iauzskaia, d. 11, GOU VPO “Pervyi Moskovskii gosudarstvennyi meditsinskii universitet im. I.M. Sechenova”, kafedra obshchei khirurgii,
e-mail: vkosinets@yandex.ru,
Kosinets Vladimir Aleksandrovich
Information about the authors:
Kosinets V.A. Candidate of medical sciences, applicant for Doctor’s degree of the chair of general surgery of I.M. Sechenov First Moscow State Medical University.
Osochuk S.S. Doctor of medical sciences, Associate Professor, head of the central scientific research laboratory of EE “Vitebsk State Medical University”.
Yarotskaya N.N. junior scientific researcher of the central scientific research laboratory of EE “Vitebsk State Medical University”.

I.O. POKHODENKO-CHUDAKOVA 1, E.V. MAKSIMICH 1, S.F. KURALENYA 2

COMPARATIVE EVALUATION OF MORPHOLOGICAL CHANGES AT DIFFERENT VARIANTS OF INJECTION OF 2% SOLUTION OF LYDOKAIN HYDROCHLORIDE IN EXPERIMENT

EE “Belarusian State Medical University” 1,
ME “Minsk consultational -diagnostics center” 2,
the Republic of Belarus

Objectives. To study the morphological changes of the parenchymatous organs of the laboratory animals at various variants of the local anesthetic 2% lidocaine hydrochloride solution in the experiment at its frequent repeated injections.
Methods. The research was carried out on 27 white mouse males. All animals were divided into two series (16 and 11 animals) in which the anesthetic was injected 5 times a day in every 3-4 days (in the dose 50 mg/kg of the animal weight). Anesthetic injection was made in the maxillofacial area in the animals of the first series (the variant of the conducting mandibular anesthesia outside the mouth); intraperitoneal introduction of the drugs was made in the second series animals.
Results. Lethality after 2% lidocaine hydrochloride solution injection made up 37,5%. There were no lethal outcomes in the second series. Significant incidence of toxic manifestation from the central nervous system was established in the experimental animals of the first series; it can be explained by peculiarity of the head and neck vascularization and innervation. The most evident morphological changes of the parenchymatous organs were noted in the animals of the first series.
Conclusions. Morphological changes of the parenchymatous organs of the laboratory animals depend on the region of 2% lidocaine hydrochloride solution injection; it should be taken into consideration when conducting preclinical studies of drugs, used in the dental practice.

Keywords: morphological changes, toxicity, lidocaine
p. 16 – 19 of the original issue
References

1.Krzhechkovskaia VV, Vakhtangishvili RSh. Lekarstvennye sredstva v anesteziologii. Mestnye anestetiki. [Drugs in anesthesiology. Local anesthetics]. Rostov-na-Donu, RF: Feniks; 2006. 192 p.
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3.Violin BV, Ignatova ID, Ignatova AD. Izuchenie toksichnosti lekarstvennoi formy florfenikola dlia peroral'nogo primeneniia v opytakh na laboratornykh zhivotnykh [The study of the florfenikol toxic dosage for oral administration in experiments on laboratory animals] . Sb nauch tr VGNKI. 2006;67. p. 175–81.
4.Bircher AJ, Messmer SL, Surber C, Rufli T. Delayed-type hypersensitivity to subcutaneous lidocaine with tolerance to articaine: confirmation by in vivo and in vitro tests. Contact Dermatitis. 1996;34(6):387–89.
5.Astakshin EA. Rukovodstvo po laboratornym zhivotnym i al'ternativnym modeliam v biomeditsinskikh tekhnologiiakh [Guidance on laboratory animals and alternative models in biomedical technology]. Karkishchenko NN, Gracheva SV, editors. Moscow, ÐÔ: Standartinform; 2010. 344 p.
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7.Khibriev RU. Rukovodstvo po eksperimental'nomu (doklinicheskomu) izucheniiu novykh farmakologicheskikh veshchestv [Guidelines for experimental (preclinical) studies of new pharmacological agents]. Moscow, RF: Meditsina; 2005. 832 p.
8.Vorob'ev AL. Klinicheskaia anatomiia i operativnaia khirurgiia golovy i shei [Clinical anatomy and operative surgery of the head and neck]. Saint-Petersburg, ÐÔ: Elbi-SPb; 2008. 256 p.
9.Stoliarenko PIu. Istoriia sozdaniia lidokaina [History of the lidocaine]. Samara, RF: SamGMU; 2001. 36 p.
10.Denisov SD, Morozkina TS. Trebovanija k nauchnomu jeksperimentu s ispol'zovaniem zhivotnyh [Requirements for scientific experiment with animals]. Zdravoohranenie. 2001;(4):40–42.
11.Belousov JuB, Gurevich KG. Klinicheskaja farmakokinetika. Praktika dozirovanija lekarstv: spec. vypusk serii Racional'na farmakoterapija [Clinical pharmacokinetics. The practice of dispensing drugs: spec. produce a series of Rational pharmacotherapy]. Moscow, RF: Litterra; 2005. 288 p.
12.Malamed SF. Allergicheskie i toksicheskie reakcii na mestnye anestetiki [Allergic and toxic reactions to local anesthetics]. Klin Stomatologija. 2004;(4):26–30.
13.Gazhva SI, Pichugin VV, Sokolov VV. Metody obezbolivanija v stomatologii pri serdechno-sosudistyh zabolevanijah [Methods of anesthesia in dentistry in patients with cardiovascular diseases]. Nizhny Novgorod, RF: NGMA; 2008. 124 p.

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,
Pokhodenko-Chudakova Irina Olegovna
Information about the authors:
Pokhodenko-Chudakova I.O. Doctor of medical sciences, professor, head of the surgical dentistry chair of EE “Belarusian State Medical University”.
Maksimovich E.V. Assistant of the surgical dentistry chair of EE “Belarusian State Medical University”.
Kuralenya S.F. head of the laboratory of clinical pathologic histology of ME “Minsk Consultational -Diagnostics Center”.

V.A. NOVOSELETSKY 1, O.G. KHOROV 1, V.A. STRUK 2

INFLUENCE ANALYSIS OF ULTRA-HIGH MOLECULAR WEIGHT POLYETHYLENE OF HIGH DENSITY ON SOME BIOCHEMICAL BLOOD PARAMETERS IN EXPERIMENT

EE “Grodno State Medical University” 1,
EE “Grodno State University named after Yanka Kupala” 2,
The Republic of Belarus

Objectives. To evaluate the influence of the material from the modified ultra-high molecular weight polyethylene of high density (UHMWPE) at its implantation in the ear bulla of a rabbit on some biochemical blood parameters in comparison with titanium, which is widely applied in otosurgery.
Methods. 35 rabbits were used to carry out the experiment; they were divided into 3 groups. The 1st as well as the 2nd group included 15 animals which were excluded from the experiment 15, 60 and 90 days afterwards (5 animals in each term); the 3rd group was a control one (5 rabbits). In the 1st group implants from the modified ultra-high molecular weight polyethylene were used; in the 2nd group – from titanium; the 3rd group wasn’t operated on at all.
Results. While comparing two experimental groups of animals with the control group reliable differences in the blood content of bilirubin, AST, glucose, creatinine, total protein in different terms after operation were not revealed.
Conclusions. UHMWPE can be regarded as a material suitable for further investigations aimed to work out the original domestic construction of prosthesis of the ossicular chain.

Keywords: ultra-high molecular weight polyethylene of high density, ossiculoplasty, prosthesis
p. 20 – 24 of the original issue
References

1.Pluzhnikov MS, Diskalenko VV, Kurmashova LM. Sovremennoe sostojanie problemy hirurgicheskoj reabilitacii bol'nyh s hronicheskimi vospalitel'nymi zabolevanijami srednego uha [Current state of surgical rehabilitation of patients with chronic inflammatory diseases of the middle ear]. Vestn Otorinolaringol. 2006;(5):31–4.
2.Khorov OG, Melan'in VD. Izbrannye voprosy otologii: uchebnoe posobie [Selected problems of otology: a tutorial]. Grodno, RB: GrGMU; 2007. 160 p.
3.Khorov OG, Melan'in VD. Khirurgicheskoe lechenie bol'nyh destruktivnymi srednimi otitami [Surgical treatment of patients with destructive otitis media]. Grodno, RB: GrGMU; 2001. 150 p.
4.Weerda H. History of auricular reconstruction. Adv Otorhinolaryngol. 2010;68:1–24.
5.Semenov FV, Volik AK. Kliniko-audiologicheskie metody ocenki jeffektivnosti ossikuloplastiki s ispol'zovaniem titanovyh protezov pri hirurgicheskom lechenii bol'nyh hronicheskim srednim otitom [Clinical and audiological methods for evaluating the effectiveness of ossikuloplasty using titanium prosthesis in the surgical treatment of patients with chronic otitis media]. Ros Otorinolaringol. 2004;(4):145–48.
6.Melan'in VD, Khorov OG. Variant pervichnoj timpanomastoidoplastiki. Metodicheskie rekomendacii [Variant of the primary tympanomastoidoplasty. A guidelines]. Grodno, RB: GrGMU; 1999. 15 p.
7.Chernushevich II., Aleksandrov IN. Sravnitel'naja kharakteristika protezov, ispol'zuemyh pri ossikuloplastike [Comparative characteristics of prostheses used in ossikuloplastike]. Ros Otorinolaringol. 2004;(1):113–15.
8.Struk VA. Materialovedenie [Material Science]. Minsk, RB: IVC Minfina; 2008. 519 p.
9.Avdejchik SV, Struk VA. Nanokompozicionnye mashinostroitel'nye materialy: opyt razrabotki i primenenija [Nanocomposite engineering materials: the experience of the development and application]. Grodno, RB: GrGU; 2006. 403 p.
10.Andreev IN. Sverhvysokomolekuljarnyj polijetilen vysokoj plotnosti [Ultra- high-density polyethylene]. Leningrad, RF: Khimija; 1982. 80 p.
11.Vasilenko IP, Nikolaev MP, Nikolaev PM. Polimernye i metallokeramicheskie materialy v rekonstruktivno-plasticheskoj khirurgii posttravmaticheskih kraniofacial'nyh povrezhdenij [Plastic and metal-ceramic materials in reconstructive plastic surgery of post-traumatic craniofacial injuries]. Ros Otorinolaringol. 2003;(4):86–90.
12.Pinchuk LS, Nikolaev VI, Cvetkova EA. Jendoprotezirovanie sustavov: tehnicheskie i mediko-biologicheskie aspekty [Endoprosthesis replacement: technical, medical and biological aspects]. Gomel', RB: IMMS NANB; 2003. 308 p.
13.Dong HY, Joon HN. Readjustable Sling Procedure for the Treatment of Female Stress Urinary Incontinence with Intrinsic Sphincter Deficiency: Preliminary Report Korean J Urol.. 2010;51(6):420–25.
14.Kamyshnikov VS. Spravochnik po kliniko-biokhimicheskoj laboratornoj diagnostike. [Handbook of clinical and biochemical laboratory diagnosis]. Minsk, RB: Belarus'; 2002(Ch. 1). 496 p.
15.Kamyshnikov VS. Spravochnik po kliniko-biohimicheskoj laboratornoj diagnostike. [Handbook of clinical and biochemical laboratory diagnosis]. Minsk, RB: Belarus'; 2002(Ch. 2). 496 p.

Address for correspondence:
230009, Respublika Belarus', g. Grodno, ul. Gor'kogo, d. 80, UO “Grodnenskii gosudarstvennyi meditsinskii universitet”, kafedra otorinolaringologii i stomatologii,
e-mail: novasialetski@rambler.ru,
Novoseletskii Vladimir Aleksandrovich
Information about the authors:
Novoseletsky V.A. Lecturer of the military chair of EE “Grodno State Medical University”.
Khorov O.G. Doctor of medical sciences, professor, head of otolaryngology, dentistry chair of EE “Grodno State Medical University.
Struk V.A. Doctor of technical sciences, professor, dean of the faculty of the innovative technologies of the machine-building of EE “Grodno State University named after Yanka Kupala”.
Novoseletsky V.A. Lecturer of the military chair of EE “Grodno State Medical University”.
Khorov O.G. Doctor of medical sciences, professor, head of otolaryngology, dentistry chair of EE “Grodno State Medical University.
Struk V.A. Doctor of technical sciences, professor, dean of the faculty of the innovative technologies of the machine-building of EE “Grodno State University named after Yanka Kupala”.

GENERAL AND SPECIAL SURGERY

B.D. BOBOEV

SINGLE-STAGE LAPAROSCOPIC OPERATIONS AT CHOLECYSTOCHOLEDOCHOLITHIASIS

SBEE HPE “Saint-Petersburg State Medical University named after academician I.P. Pavlov”,
the Russian Federation

Objectives. To evaluate the possibilities of laparoscopic technologies in treatment of patients with cholecystocholedocholithiasis.
Methods. The treatment results of 94 patients with cholecystocholedocholithiasis were analyzed in the article. Laparoscopic surgeries were carried out in 94 patients and had successful outcomes in 92 patients (97,8%); the other 2 patients (2,1%) underwent the conversion (laparotomy, choledocholithotomy, Ker’s choledoch drainage).
Results. In 30 cases (32%) laparoscopic cholecystectomy (LCE) was done, extraction of concretions through the cystic duct, Halsted-Pikovsky choledoch drainage; in 21 cases (22,3%) – LCE, choledocholithotomy, Halsted-Pikovsky choledoch drainage; in 38 (40,4%) – LCE, LCE, choledocholithotomy, Ker’s common bile duct drainage; in 3 cases (3,2%) – LCE combined with supraduodenal choledochoduodenostomy; in 2 cases (2,1%) – conversion to the laparoscopic access was performed because of the laparoscopic choledocholithotomy failure.
Conclusions. Single-stage laparoscopic methods of cholecystocholedocholithiasis treatment are less traumatic and more physiologic ones and permit to save sphincter apparatus of the major duodenal papilla.

Keywords: cholecystocholedocholithiasis, single-stage laparoscopic operations, laparoscopic cholecystectomy, laparoscopic choledocholithotomy
p. 25 – 29 of the original issue
References

1.Nichitajlo ME. Laparoskopicheskaja jeksploracija obwego zhelchnogo protoka pri kholedoholitiaze [Laparoscopic exploration of common bile duct for choledocholithiasis]. Annaly Khirurg Gepatologii. 2004;9(1):125–28.
2.Hanif F, Ahmed Z, Samie MA, Nassar AH. Laparoscopic transcystic bile duct exploration: the treatment of first chouce for common bile duct stones. Surg Endosc. 2010;24(7):1552–56.
3.Savita KS, Bhartia VK. Laparoscopic common bile duct exploration. Indian J Surg. 2010;72(5):395–99.
4. Revjakin VI, Grinev SV, Prokushev VS. Taktika rentgenologicheskogo lechenija kholedoholitiaza [The tactics of X-ray treatment of choledocholithiasis] Endoskop Khirurgija. 2008;(2):3–9.
5.Stromberg C, Nilsson M, Leijonmark CE. Stone clearance and risk factors for failure in laparoscopic transcystic exploration of common bile duct. Surg Endosc. 2008;22:1194–99.
6.Gallinger JuM, Karpenkova VI, Amelina MA. Rezul'taty laparoskopicheskoj kholecistjektomii [Results of laparoscopic cholecystectomy]. Endoskop Khirurgija. 2002;(2):25–26.
7.Chandio A, Timmons S, Majeed A, Twomey A, Aftab F. Factors influencing the completion of laparoscopic cholecystectomy. Journal of the Society of Laparoendoscopic Surgeons. 2009;13(4):581–86.

Address for correspondence:
197089, Rossiiskaia Federatsiia, g. Sankt-Peterburg, ul. L'va Tolstogo, d. 6/8, korp. 37, GBOU VPO “Sankt-Peterburgskii gosudarstvennyi meditsinskii universitet imeni akad. I.P. Pavlova”, kafedra fakul'tetskoi khirurgii,
e-mail: boda75@mail.ru,
Boboev Bakhodur Dzhamshedovich
Information about the authors:
Boboev B.D. Candidate of medical sciences, applicant for Doctor’s degree of the chair of faculty surgery of State Medical University named after acad. I.P. Pavlov.

E.V. DYABKIN, YU.S. VINNIK, S.S. DUNAYEVSKAYA

DEVELOPMENTAL PECULIARITIES OF IMMUNODEFICIENCY CONDITION IN PATIENTS WITH MECHANICAL JAUNDICE OF NON-TUMOR GENESIS

SBEE HPE “Krasnoyarsk State Medical University named after professor V.F.Voyno-Yasenetsky”,
the Russian Federation

Objectives. To carry out analysis of the immune status changes in patients with the mechanical jaundice of non-tumor genesis.
Methods. 90 patients with the mechanical jaundice of non-tumor genesis were examined. The main causes of the disease were choledocholithiasis and strictures of the common bile duct. Control group included 20 practically healthy people at the age of 21-50 (10 females and 10 males).
Immune status estimation in patients with the mechanical jaundice and in those from the control group was done on hospitalization in the 1st, 5th days and on discharge from the hospital. The parameters of leukograms of the cellular, humoral elements of immunity, circulating immune complexes and phagocytosis activity were used to estimate the immune status.
Results. Changes in the immune status of patients with the mechanical jaundice of non-tumor genesis were revealed characterized by the marked lymphopenia and T-cell component suppression. The severity of immunodeficiency state is proved to correlate directly with the degree of patient’s severity.
Conclusions. The immunity state in patients with the mechanical jaundice of non-tumor genesis is connected with the secondary immunodeficiency revealed through reduction in number of the immunocompetent cells of the cellular link, their functional unbalance and insufficient decrease of the immunity humoral link function. Severity of these disturbances depends on the severity degree of the mechanical jaundice.

Keywords: mechanical jaundice of non-tumor genesis, severity of state, immunity, immunodeficiency
p. 30 – 35 of the original issue
References

1.Bashirov AB, Alibekov AE. Immunokorrekcija pri khirurgicheskom lechenii mehanicheskoj zheltuh: sb tez dokladov III kongr assoc hirurgov im NI Pirogova [Immunotherapy in the surgical treatment of obstructive jaundice. Collected papers. III Ñongr of Surg Assoc named after NI Pirogov]. Moscow, RF; 2006:181–82.
2.Beloborodov VA, Pahomova RA, Beloborodov AA. Zhelchnokamennaja bolezn' i ejo oslozhnenija [Gallstone disease and its complications]. Krasnoyarsk, RF: Centr Pechati; 2008. 180 p.
3.Belova JaV, Altuf'ev JuV. Mehanizmy razvitija patologicheskih processov v pecheni [Mechanisms of development of pathological processes in the liver]. Estestvennye Nauki. 2009;(3):114–120.
4.Ivanov JuV, Chudnyh SM. Mehanicheskaja zheltuha: diagnosticheskij algoritm i lechenie [Mechanical jaundice: diagnostic algorithm and treatment]. Lechawij vrach. 2002;(7–8):76–78.
5.Boyer JL. New perspectives for the treatment of cholestasis. J Hepatology. 2007;46(3):365–71.
6.Bueverov AO. Immunologicheskie mehanizmy povrezhdenija pecheni [Immunological mechanisms of liver damage]. Ros Zhurn Gastrojenterol, Gepatolog i Koloproktol. 1998;(5):18–21.
7.Briskin BS, Hachatrjan NN, Savchenko ZI. Immunnye narushenija i immunokorrekcija pri intraabdominal'noj infekcii [Immune disorders and immunotherapy in intra-abdominal infections]. Consilium Medicum. Khirurgija. 2004;(2):56–60.
8.Kuznecov VA, Rahmatullin IM, Haritonov GI. Ob immunologicheskih kriterijah otcenki tjazhesti sostojanija bol'nyh mehanicheskoj zheltukhoj [On the criteria to assess the severity of the immunological status of patients with obstructive jaundice]. Vestn Khirurgii im II Grekova. 1987;(9):105–107.
9.Kopejkin AA, Peskov OD, Sokolova SN. Biokhimicheskaja ocenka stepeni tjazhesti sostojanija bol'nyh s mehanicheskoj zheltuhoj [Biochemical assessment of the severity of the patients with obstructive jaundice]. Ros Med Biol Vestn im Àkad IP Pavlova. 2001;(3–4):50–54.
10.Vinnik JuS, Dunaevskaja SS, Kochetova LV, Djabkin EV. Sposob opredelenija stepeni tjazhesti mehanicheskoj zheltuhi neopuholevogo geneza [The method for determining the severity of nonneoplastic origin jaundice]: pat RF, G01N33.49; zajavitel' Krasnoyar gos med un-t ¹ 2364867; opubl 20.08.2009. BIPM. 2009;(23):11.

Address for correspondence:
660022, Rossiiskaia Federatsiia, g. Krasnoiarsk, ul. Partizana Zhelezniaka, d. 1, ÃÁÎÓ ÂÏÎ “Krasnoiarskii gosudarstvennyi meditsinskii universitet”, kafedra obshchei khirurgii,
e-mail: dyabkyn@mail.ru,
Dyabkin Evgenii Vladimirovich
Information about the authors:
Dyabkin E.V. Candidate of medical sciences, Assistant of the general surgery chair of state budgetary educational establishment of higher professional education “Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky”.
Vinnik YU.S. Doctor of medical sciences, professor, head of the general surgery chair of state budgetary educational establishment of higher professional education “Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky”.
Dunayevskaya S.S. Candidate of medical sciences, Associate Professor of the general surgery chair of state budgetary educational establishment of higher professional education “Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky”.

K.M. KURBONOV, F.I. MAKHMADOV, N.M. DAMINOVA

PROSPECTS OF MINIMALLY INVASIVE TECHNOLOGIES APPLICATION IN DIAGNOSTICS AND TREATMENT OF POSTOPERATIVE BILE PERITONITIS

Tajik State Medical University named after Abu Ali ibn Sino

Objectives. Improvement of diagnostics and treatment results of patients with the postoperative bile peritonitis by applying contemporary minimally invasive technologies.
Methods. The given investigation is based on results analysis of complex diagnostics and operative treatment of 60 patients with the postoperative bile peritonitis (PBP) developed after surgical interventions because of the liver diseases and cholelithiasis during the period 1993 to 2010. The age of patients varied from 29 to 64 years. In all cases endosurgical and minimally invasive technologies (n=49) to treat PBP were effectively used as well as combined endoscopic interventions (n=11). PBP developed after traditional (n=39) and video laparoscopic cholecystectomy (n=5) and also after hydatidectomy and atypical liver resection (n=16).
Results. Results analysis has shown that PBP develops due to various causes among which the central place belongs to the morphofunctional liver state as well as to the volume and character of surgical interventions, tactical and technical mistakes made during the postoperative period and during the operation. Application of a new technology including video laparoscopy permits not only to diagnose timely the postoperative bile peritonitis development, but in the number of cases it makes it possible to eliminate effectively the source of peritonitis and to carry out an adequate sanitation and drainage of the abdominal cavity.
Conclusions. Combined minimally invasive interventions at early stages of PBP development allows determining the localization as well as eliminating and correcting the cause of the complication development and thus saving patients from repeated complicated reconstructive-restoration surgeries.

Keywords: postoperative bile peritonitis, procalcitonin level of the blood serum, C-reactive protein content, video laparoscopy, combined endoscopic interventions
p. 36 – 41 of the original issue
References

1.Shapovaljanc SG, Orlov SJu, Mel'nikov AG. Jendoskopicheskie vozmozhnosti v lechenii «svezhih» povrezhdenij zhelchnyh protokov [Endoscopic features in the treatment of "fresh" damage of the bile ducts]. Annaly Khirurg Gepatol. 2005;(3):50–54.
2.Fedorov NV, Slavin LB, Chugunov AV. Povrezhdenie zhelchnyh protokov pri laparokospicheskoj kholecistjektomii [Damage of the bile ducts during laparoscopic cholecystectomy]. Moscow, RF: Triada–H; 2003. 79 p.
3.Bagnenko SF, Savello VE, Kabanov MIu. Primenenie smennykh transpechenochnykh karkasnykh stentov u bol'nykh s posttravmaticheskimi strikturami pechenochnogo i obshchego zhelchnogo protoka [The application of exchangeable transhepatic frame stents in patients with posttraumatic strictures of the hepatic and common bile duct]. Vestn Khirurgii. 2008;(2):69–71.
4.Borisov AE, Borisova NA, Verkhovskii VS. Endobiliarnye vmeshatel'stva v lechenii mekhanicheskoi zheltukhi [Endobiliary intervention in the treatment of obstructive jaundice]. Saint-Petersburg, RF: Eskulap; 1997. 147 p.
5.Daminova NM, Kurbonov KM. Endovideolaparoskopicheskie metody v diagnostike i lechenii otkrytykh povrezhdenii pecheni [Endovideolaparoscopic methods in diagnosis and treatment of open liver injuries]. Annaly Khirurg Gepatol. 2007;(3):153–54.
6.Kurbonov KM, Daminova NM. Sovremennye podkhody v diagnostike i lechenii posleoperatsionnogo zhelchnogo peritonita [Current approaches to diagnosis and treatment of postoperative biliary peritonitis]. Izv Àkad Nauk Resp Tadzhikistan. 2007;(4):71–78.
7.Grishin IN. Povrezhdeniia zhelchevyvodiashchikh putei [Damage of the biliary tract]. Minsk, RB: Kharvest; 2002. 142 p.

Address for correspondence:
734003, Respublika Tadzhikistan, g. Dushanbe, pr. Rudaki, d. 139, Tadzhikskii gosudarstvennyi meditsinskii universitet, kafedra khirurgicheskikh boleznei ¹ 1,
e-mail: fmahmadov@mail.ru,
Makhmadov Farrukh Isroilovich
Information about the authors:
Kurbonov K.M., Academician of AMS of the Republic of Tajikistan, Doctor of medical sciences, Professor, head of the chair of surgical diseases ¹ 1 of Tajik State Medical University named after Abu Àli Ibn Sino.
Makhmadov F.I. Doctor of medical sciences, Assistant of the chair of surgical diseases ¹ 1 of Tajik State Medical University named after Abu Àli Ibn Sino.
Daminova N.M. Candidate of medical sciences, Assistant of the chair of general surgery ¹ 1 of Tajik State Medical University named after Abu Ali Ibn Sino.

R.E. KALININ 1, I.A. SUCHKOV 2, A.S. PSHENNIKOV 1, A.A. NIKIFOROV 1

GENETIC STATUS OF PATIENTS WITH THE LOWER LIMBS ARTERIES OBLITERATING ATHEROSCLEROSIS

SBEE HPE “Ryazan State Medical University”1,
SME “Ryazan regional clinical cardiology dispensary” 2,
the Russian Federation

Objectives. To identify the incidence of certain genes mutations in patients with obliterating atherosclerosis of the lower limbs arteries.
Methods. 42 patients were examined in terms of grant of the President of Russian Federation ¹ MD-2536.2011.7. The first group (23 patients) included patients with stage II à disease who underwent a conservative therapy. The second group (19 patients) included patients with stage II b-III disease who underwent a reconstructive surgery. Control group included 6 healthy volunteers.
Results. It was found out that the concentration of NO metabolites comparing to the NTZ is 20-25% lower in heterezygotes and MTZ regardless of the study group. The tests showed that the number of ÌÒHFR HTZ subjects is higher in the study groups rather than in the control group. Heterozygosity of MTHFR is a risk factor for hyperhomocysteinemia and subsequently unfavorable course of the disease. It was noticed that heterozygosity of AGTR1 might cause favorable conditions for the development of intimal hyperplasia. Such feature might be especially observed within AGTR1 and JAK II polymorphism.
Conclusions. Polymorphsim of the studied genes plays an important role in progression of atherosclerosis, development of intimal hyperplasia, and restenosis of reconstruction area.

Keywords: atherosclerosis, gene polymorphism, endothelial dysfunction, NO-synthase
p. 42 – 45 of the original issue
References

1.Minushkina LO. Disfunktsiia endoteliia: sviaz' s polimorfizmom gena retseptora (tip 1) angiotenzina II u bol'nykh ishemicheskoi bolezn'iu serdtsa [Endothelial dysfunction: association with receptor gene polymorphism (type 1) angiotensin II in patients with coronary heart disease]. Moscow, RB: ROO Mir Nauki i Kul'tury, Elektron resurs. Rezhim dostupa: http://narure.web.ru/db/search.html.
2.Wang XL, Sim AS, Badenhop RF, McCredie RM, Wilcken DE. A smoking-dependent risk of coronary artery disease associated with a polymorphism of the endothelial nitric oxide synthase gene. Nat Med. 1996;2(l):41–45.
3.Ichihara S, Yamada Y, Fujimura T, Nakashima N, Yokota M. Association of a polymorphism of the endothelial constitutive nitric oxide synthase gene with myocardial infarction in the Japanese population. Am J Cardiol. 1998 Jan 1;81(1):83–86.
4.Colombo MG, Paradossi U, Andreassi MG, Botto N, Manfredi S, Masetti S, Biagini A, Clerico A. Endothelial nitric oxide synthase gene polymorphisms and risk of coronary artery disease. Clin Chem. 2003 Mar;49(3):389–95.
5.Wang XL, Mahaney MC, Sim AS, Wang J, Wang J, Blangero J, Almasy L, Badenhop RB, Wilcken DE. Genetic contribution of the endothelial constitutive nitric oxide synthase gene to plasma nitric oxide levels. Arterioscler Thromb Vasc Biol. 1997 Nov;17(11):3147–53.
6.Gardemann A, Weidemann H, Philipp M, Katz N, Tillmanns H, Hehrlein FW, Haberbosch W. TT genotype of the methylenetetrahydrofolatereductase C677T gene polymorphism is associated with the extent of coronary atherosclerosis in patients at high risk for coronary artery disease. Eur Heart J. 1999 Apr;20(8):584–92.
7.Welch G, Loscolzo J. Homocysteine and atherosclerosis. N Engl J Med. 1998;338,(15):1042–50.
8.Tseluiko VI. Polimorfizm gena angiotenzin prevrashchaiushchego ferment pri serdechno-sosudistoi patologii [Polymorphism of angiotensin-converting enzyme gene in cardiovascular pathology]. Tsitologiia i genetika. 2002;36(5):30–33.
9.Ferrario CM, Chappell MC. A new myocardial conversion of angiotensin. Curr Opin Cardiol. 1994;9(5):520–26.
10.Li Y, Kishimoto I, Saito Y, Harada M, Kuwahara K, Izumi T, Takahashi N, Kawakami R, Tanimoto K, Nakagawa Y, Nakanishi M, Adachi Y, Garbers DL, Fukamizu A, Nakao K. GuanylylcyclaseÀ inhibits angiotensin II type 1A receptor mediatedcardiac remodeling, an endogenous protective mechanismin the heart. Circulation. 2002 Sep 24;106(13):1722–28.
11.Tsai JC, Wang H, Perrella MA, Yoshizumi M, Sibinga NE, Tan LC, Haber E, Chang TH, Schlegel R. Induction of cyclin. A gem expression by homocysteine in vascular smooth muscle cells. J Clin Invest. 1996 Jan 1;97(1):146–53.
12.Voetsch B, Loscalzo J. Genetic determinants of arterialthrombosis. Arterioscler Thromb Vasc Biol. 2004;24:216–29.

Address for correspondence:
390026, Rossiiskaia Federatsiia, g. Riazan', ul. Stroikova, d. 96, Riazanskii oblastnoi klinicheskii kardiologicheskii dispanser, otdelenie sosudistoi khirurgii,
e-mail: suchkov_med@mail.ru,
Suchkov Igor' Aleksandrovich
Information about the authors:
Kalinin R.E. Doctor of medical sciences, àssociate professor, professor of the chair of angiology, vascular surgery, surgical and topographic anatomy of SBEE of HPO "Ryazan State Medical University" of Ministry of health and social development of Russia.
Suchkov I.A, Candidate of medical sciences, cardiovascular surgeon of SME “Ryazan Regional Clinical Cardiology Hospital."
Pshennikov A., Assistant of the chair of angiology, vascular surgery, surgical and topographic anatomy of SBEE of HPO "Ryazan State Medical University" of Ministry of health and social development of Russia.
Nikiforov A.S., Candidate of medical sciences, Head of Central Research Laboratory of SBEE of HPO "Ryazan State Medical University" of Ministry of health and social development of Russia.

S.E. KATORKIN, G.V. YAROVENKO, P.N. MYSHENTSEV, A.A. ZHUKOV, E.S. ISAEVA, D. MOCHAMMAD

EVALUATION OF VARIOUS METHODS OF OPERATIVE CORRECTION OF CHRONIC VENOUS INSUFFICIENCY FROM THE POINT OF EVIDENCE-BASED MEDICINE

SBEE HPE “Samara State Medical University”,
the Russian Federation

Objectives. To evaluate the results of surgical treatment of patients with chronic venous insufficiency when different types of surgical interventions on the perforating veins are carried out from the standpoint of evidence-based medicine.
Methods. The results of 401 surgical interventions in patients with C3-C6 classes of chronic venous insufficiency are analyzed. To assess effectiveness and objectification of treatment results the method of clinical analysis of motion was used on the hardware-software complex “MBN-Biomechanics”, including podometry, electromyography, goniometry in the process of walking before and after the surgery. Registration of support reactions, position and motion of general pressure center to the support surface in orthostasis was carried out using dynamometer and stabilometry. Ultrasonic dopplerography was performed on the apparatuses “Aloka 4” and “Logic 7”. The examination was conducted in the nearest (3 months) and distant (up to 3 years) postoperative periods.
Results. Cockett’s operation doesn’t eliminate the pathological shin muscular-venous pump overloading. Linton’s operation disturbs the function of the shin muscular-venous pump in the early postoperative period. Endoscopic dissection of the shin perforating veins is rather radical one and does not disturb the function of the shin muscular-venous pump. Accompanying pathology of the locomotive system worsens the results of operative interventions.
Conclusions. Using the methods of evidence-based medicine permits to evaluate objectively the results and make recommendations when choosing a surgical option in patients with chronic venous insufficiency of the lower limbs.

Keywords: chronic venous insufficiency, surgical correction, evidence-based medicine
p. 46 – 53 of the original issue
References

1.Kosinets AN, Sushkov SA. Varikoznaia bolezn': ruk dlia vrachei [Varicose veins: a guide for physicians].Vitebsk, RB: VGMU; 2009. 415 p.
2.Uhl J, Gillot C. The foot venous pump: anatomy and physiology. XV² World Congress of the Union Internationale de Phlebologie: e-abstract book. Monaco; 2009. 142 p.
3.Simka M. Calf muscle pump impairment and delayed healing of venous leg ulcers: air plethysmographic findings. J Dermatol. 2007;34(8):537–544.
4.Partsch H. Varicose veins and chronic venous insufficiency. Vasa. 2009;38(4):293–301.
5.Sushkov SA. Osnovnye printsipy operativnogo lecheniia varikoznoi bolezni nizhnikh konechnostei [The main principles of surgical treatment of varicose veins of lower extremities]. Novosti Khirurgii. 2010;(4):123–34.
6.Kirienko AI, et al. Otdalennye rezul'taty endoskopicheskoi dissektsii perforantnykh ven goleni pri khronicheskoi venoznoi nedostatochnosti [Long-term results of endoscopic dissection of perforating veins of legs with chronic venous insufficiency]. Angiol i Sosud Khirurg. 2007;(2):68–71.
7.Katorkin SE Biomekhanicheskie aspekty khronicheskoi venoznoi nedostatochnosti nizhnikh konechnostei [Biomechanical aspects of chronic venous insufficiency of lower extremities]. Saarbrucken, Germany: LAP LAMBERT Academic Publishing; 2011. 414 p.
8.Zhukov BN, Katorkin SE. Innovatsionnye tekhnologii v diagnostike, lechenii i meditsinskoi reabilitatsii bol'nykh khronicheskoi venoznoi nedostatochnost'iu nizhnikh konechnostei [Innovative technologies in the diagnosis, treatment and medical rehabilitation of patients with chronic venous insufficiency of lower extremities]. Samara, RF: Samar otd-nie Litfonda; 2010. 383 p.
9.Kotel'nikov GP, Shpigel' AS. Dokazatel'naia meditsina. Nauchno-obosnovannaia meditsinskaia praktika [Evidence-based medicine. Evidence-based medical practice]. Samara, RF; 2000. 126 p.
10.Glants S. Mediko-biologicheskaia statistika. Per s angl. [Medical and biological statistics]. Moscow, RF: Praktika; 1999. 459 p.

Address for correspondence:
443079, Rossiiskaia Federatsiia, g. Samara, pr. Karla Marksa, 165 «b», Kliniki Samarskogo gosudarstvennogo meditsinskogo universiteta klinika i kafedra gospital'noi khirurgii,
e-mail: yarovenko_galina@mail.ru,
Yarovenko Galina Viktorovna
Information about the authors:
Katorkin S.E. Candidate of medical sciences, associate professor of the chair and clinic of hospital surgery of Samara State Medical University”.
Yarovenko G.V. Doctor of medical sciences, physician of the cardiac-vascular department of the clinic of the hospital surgery of Samara State Medical University”.
Myshentsev P.N. Candidate of medical sciences, associate professor of the chair and clinic of hospital surgery of Samara State Medical University”.
Zhukov A.A. Post-graduate student of the hospital surgery chair of Samara State Medical University”.
Isaeva E.S. Physician, surgeon of the hospital surgery chair.
Mochammad D. Post-graduate student of the hospital surgery chair of Samara State Medical University”.

B.S. SUKOVATYKH, M.B. SYKOVATYKH

PATHOGENTIC JUSTIFICATION OF THE MINIMALLY INVASIVE TREATMENT OF THE PELVIC VARICOSE VEINS

SBEE HPE “Kursk State Medical University”,
the Russian Federation

Objectives. To clarify the mechanisms of development and on this ground to present pathogenetic justification of minimally invasive treatment of pelvic varicose veins.
Methods. Analysis of complex clinical, ultrasound, phlebography and phlebotonometry examinations of 60 female patients with pelvic varicose veins was carried out.
Results. It was found out that pelvic varicose veins developed because of hemodynamics disturbances in the system of the inferior vena cava, iliac and left renal veins. Combined action of the caval and reno-ovarian blood refluxes causes development of the pelvic venous congestion syndrome and formation of varicose veins of the vulva, pubis, perineum and gluteal area.
Conclusions. The designed methods of pelvic varicose veins sclerotherapy as well as differentiated approach to the pelvic venous congestion syndrome depending on the intensity of the blood refluxes along the gonadal veins are pathogenetically grounded and effective.

Keywords: chronic venous insufficiency, varicosity, pelvis, minimally invasive treatment
p. 54 – 61 of the original issue
References

1.Mozes VG, Ushakova GA. Varikoznoe rasshirenie ven malogo taza u zhenshchin v osnovnye vozrastno-biologicheskie periody zhizni: klinika, diagnostika, profilaktika [Pelvic varicose veins in women in the main age and biological periods of life: clinical picture, diagnosis, prevention]. Moscow, RF: EliksKom; 2006. 104 p.
2.Iushchenko AN. Varikoznaia bolezn' malogo taza: kazuistika ili rasprostranennaia bolezn' [Pelvic varicose veins: casuistry or widespread disease]. Novosti Meditsiny i Farmatsii. 2005;(9):14–16.
3.Maiorov MV. Sindrom khronicheskikh tazovykh bolei v ginekologicheskoi praktike [Chronic pelvic pain syndrome in gynecological practice]. Provizor. 2003;(23):17–19.
4.Gavrilov SG, Butenko OI, Cherkashina MA. Varikoznaia bolezn' ven malogo taza: sovremennoe sostoianie problemy [Pelvic varicose veins pain: current state]. Annaly Khirurgii. 2003;(1):7–12.
5.Bogachev Viu. Varikoznaia bolezn' ven malogo taza [Pelvic varicose veins]. Consilium Medicum. 2006;(1):20–23.
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8.Tarazov PG, Verdiev ND, Prozorovskii KV. Chreskateral'naia embolizatsiia varikoznorasshirennykh ovarial'nykh ven [Ttranscatheter embolization of ovarian varicose veins]. Vestn Khirurgii. 2002;(1):90–94.
9.Capasso P, Simons C, Trotteur G. Treatment of symptomatic pelvic varices by ovarian vein embolization. Cardiovasc Intervent Radiol. 1997;(20):107–11.
10.Tsukanov IuT, Vasilevich VV, Tsukanov AIu. Analiz otdalennykh rezul'tatov khirurgicheskogo lecheniia iz minidostupov i sklerozirovaniia pri poverkhnostnoi forme bolezni ven malogo taza [Analysis of long-term results of minimal access surgery and sclerosing in superficial form of the pelvic veins disease]. Endoskop Khirurgiia. 2006;(4):18–22.
11.Alekperova TV. Ul'trazvukovaia flebografiia. Opyt primeneniia v sovremennoi flebologicheskoi praktike [Ultrasonic phlebography. Experience of application in current phlebological practice]. Angiologiia Segodnia. 2000;(5): 2–9.
12.Belikov LN, Sukovatykh BS, Rodionov OA, Sukovatykh MB, Shcherbakov AN, Zaits VI. Sposob skleroterapii varikoznykh ven nizhnikh konechnostei [The method of sclerotherapy for varicose veins of the lower extrimities]: patent RF ¹ 2179457; zaiavitel' Kurskii gosudarstvennyi meditsinskii universitet. Otkrytiia Izobret. 2002;(5):32.
13.Sukovatykh BS, Gazazian MG, Rodionova IG, Belikov LN, Gorbachev IuI, Rodionov OA, Sukovatykh MB. Sposob kateternoi skleroterapii varikozno rasshirennoi iaichnikovoi veny [The method of catheter-assisted ovarian vein sclerotherapy]: pat RF ¹ 2183472; zaiavitel' Kurskii gosudarstvennyi meditsinskii universitet. Otkrytiia Izobret. 2002;(12):41.

Address for correspondence:
305041, Rossiiskaia Federatsiia, g. Kursk, ul. K. Marksa, d. 3, GBOU VPO “Kurskii gosudarstvennyi meditsinskii universitet”, kafedra obshchei khirurgii,
e-mail: kaf.obsh_hir@kurskmed.com,
Sukovatykh Boris Semenovich
Information about the authors:
Sukovatykh B.S. Doctor of medical sciences, professor, head of the general surgery chair of state budgetary educational establishment of higher professional education “Kursk State Medical University”.
Sykovatykh M.B. Candidate of medical sciences, associate professor of the general surgery chair of state budgetary educational establishment of higher professional education “Kursk State Medical University”.

M.G. SACHEK 1, V.P. BULAVKIN 1, S.N. EROSHKIN 1, L.M. PEDCHENETS 2, G.B. ANTONYCHEVA 2

LOWER LIMBS AMPUTATION RATE IN PATIENTS WITH DIABETIC FOOT SYNDROME IN VITEBSK REGION

EE “Vitebsk State Medical University” 1,
Me “Vitebsk regional endocrinology clinic” 2,
the Republic of Belarus

Objectives. To carry out rate analysis of particular types of the lower limbs amputations in patients with diabetic foot syndrome.
Methods. Ambulatory cards of patients with diabetic foot syndrome were analyzed, in whom the lower limbs amputations during the period of 2006-2010 were done.
Results. The number of patients in whom “diabetic foot syndrome” was diagnosed in Vitebsk region for the given period of time was steadily increasing; the same dynamics was marked while analyzing parameters throughout the Republic. The number of the performed lower limbs amputations because of the ulcerous-necrotic and purulent-necrotic forms of diabetic foot in the years 2006-2010 both in Vitebsk region and in the Republic of Belarus has in general remained stable, though rate decrease of the lower limbs high amputations has been registered.
Conclusions. The performed analysis shows that, despite number increase of patients with diabetic foot syndrome, there has been no increase in the lower limbs amputations. The reliable rate decrease of the high amputations of the lower limbs has been established; it is the result of the advancing development of diabetology, improvement of dressings as well as with development of shunting surgeries techniques on the lower limbs vessels and endovascular surgery advance.

Keywords: diabetes mellitus, diabetic foot syndrome, operative treatment, amputation
p. 62 – 66 of the original issue
References

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6.Dedov II, Udovichenko OV, Galstian GR. Diabeticheskaia stopa [Diabetic foot]. Moscow, ÐÔ: Prakticheskaia meditsina; 2005. 175 p.
7.Jeffcoate W, van Houtum W. Amputation as a marker of the quality of the foot care in diabetes. Diabetologia. 2004;47:2051–58.
8.Edmonds M.The diabetic foot–2003. Diabet Metab Res Rev. 2004;20 (Suppl. 1):9–12.
9.Kirienko AI, Koshkina VM, Bogacheva VIu. Ambulatornaia angiologiia: Ruk dlia vrachei [Ambulatory angiology: A guide for physicians]. Moscow, RF: Litterra; 2007. 325 p.
10.Rebrova OIu. Statisticheskii analiz meditsinskikh dannykh. Primenenie paketa prikladnykh programm Statistica [Statistical analysis of medical data. Application software package Statistica]. Moscow, RF: Mediasfera; 2002. 312 p.
11.Salko OB, Koryt'ko SS, Shepel'kevich AP. Sostoianie endokrinologicheskoi sluzhby Respubliki Belarus' na sovremennom etape, problemy i puti ikh resheniia [State of endocrinology service of the Republic of Belarus at the present stage, the problems and their solutions]. Vopr Organizatsii i Informatizatsii Zdravookhraneniia 2010;(3):57–62.
12.Bulavkin VP, Kut'ko AP, Tret'iakov AA. Revaskuliarizatsiia v kompleksnom lechenii gnoino-nekroticheskikh form diabeticheskoi stopy [Revascularization in complex treatment of purulent-necrotic forms of diabetic foot]. Dostizheniia Fundam Klin Meditsiny i Farmatsii. Mat 65 nauch sessii sotrudnikov un-ta. Vitebsk, RB: VGMU; 2010. p. 15–17.

Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, d. 27, UO “Vitebskii gosudarstvennyi meditsinskii universitet”, kafedra gospital'noi khirurgii,
e-mail: eroshki@rambler.ru,
Eroshkin Sergei Nikolaevich
Information about the authors:
Sachek M.G. Doctor of medical sciences, head of the hospital surgery chair of EE “Vitebsk State Medical University”.
Bulavkin V.P. Candidate of medical sciences, associate professor of the surgical diseases chair of the advanced training faculty of EE “Vitebsk State Medical University”.
Eroshkin S.N. Assistant of the surgical diseases chair of EE “Vitebsk State Medical University”.
Pedchenets L.M. Head physician of ME “Vitebsk Regional Endocrinology Clinic”.
Antonycheva G.B. Head of the department of ME “Vitebsk regional endocrinology clinic”.

S.V. SUSHKOV 1, M.YA. NASIROV 2, N.DZH. HADJIYEV 2

FERROPROTEINS AS BIOMARKERS AT WIDESPREAD PERITONITIS

SE “Institute of General and Emergency Surgery of AMSU” 1, Kharkov,
the Ukraine
Azerbaijan Medical University2, Baku,
the Republic of Azerbaijan

Objectives. To study the ferroproteins level in the blood plasma and peritoneal exudate in patients with the widespread peritonitis and possibility of their application as clinical-diagnostic and prognostic marker of acute inflammation.
Methods. 60 patients with the widespread peritonitis were investigated. LF and FR content in the blood plasma and peritoneal exudates was determined by ELISA in dynamics – before the operation and 1, 3, 5, 7 days after the operation. Severity of patients’ state was determined by means of Manheim peritoneal index: in 17 patients it was MPI I, in 23 patients - MPI II, in 20 patients - MPI III. Complex conventional treatment was carried out in all patients including surgical sanitation and drainage of the abdominal cavity, decompression of the gastrointestinal tract and conservative therapy. 15 practically healthy subjects were included into the control group.
Results. Distinct dependence of LF and FR concentration in the blood plasma and exudate was established depending on the severity degree of the patients with the widespread peritonitis according to MPI. Complete level correlation of both ferroproteins in the plasma with their level in the separated exudate along the drainages was revealed.
Conclusions. Determination of lactoferrin and ferritin in biological media in patients with the widespread peritonitis can be used as biomarkers of inflammatory process intensiveness as well as to evaluate severity of one’s state and adequacy of treatment.

Keywords: peritonitis,ferroproteins, lactoferrin, ferritin
p. 67 – 70 of the original issue
References

1.Nazarov PG. Reaktanty ostroi fazy vospaleniia [Acute phase reactants of inflammation]. Saint-Petersburg, RF: Nauka; 2001. 423 p.
2.Al-Delaimy WK, Jansen EH. Reliability of biomarkers of iron status, blood lipids, oxidative stress, vitamin D, C – reactive protein and fructosamine in two Dutch cohorts. Biomarkers. 2006;11(4):370–82.
3.Kondo K, Noguchi M, Mukai K, Matsuno Y, Sato Y, Shimosato Y, Monden Y. Transferrin receptor expression in adenocarcinoma of the lung as a histopathologic indicator of prognosis. Chest. 1990 Jun;97(6):1367–71.
4.Belaia OL. Vliianie bioflavonoida dikvertina na antioksidantnuiu sistemu tseruloplazmin/transferritin i perekisnoe okislenie lipidov u bol'nykh stabil'nymi formami ishemicheskoi bolezni serdtsa s dislipidemiei [Effect of bioflavonoid diquertin on antioxidant system ceruloplasmin / transferritin and lipid peroxidation in patients with stable coronary heart disease with dyslipidemia]. Klin Med. 2006;(7):46–50.
5.Orino K, Tsuji Y, Torti F, Torti S. Adenovirus E1A blocks oxidant-dependent ferritin induction and sensitizes cells to pro-oxidant cytotoxicity. FEBS Lett. 1999;461:334–38.
6.Bokeriia LA, Golukhova EZ, Chichkova MA. Ostrofazovye markery patologicheskogo protsessa v prognozirovanii kharaktera klinicheskogo techeniia ekssudativnogo perikardita posle kardiokhirurgicheskikh vmeshatel'stv [Acute-phase markers of the pathological process in the prediction of clinical course of exudative pericarditis after cardiac surgery]. Sovrem Meditsina: Teoriia i Praktika. 2004;(4):2–8.
7.Iliukevich GV, Smirnova LA. Ferroproteiny kak markery sistemnogo vospalitel'nogo otveta pri ostrom rasprostranennom peritonite [Ferroproteins as markers of systemic inflammatory response in acute generalized peritonitis]. Vestsi NAN Belarusi Ser Med -Biol Navuk. 2002;(2):23–25.
8.Lakin G.F. Biometriia [Biometrics]. Moscow, RF: Vysh shk; 1990. 352 p.

Address for correspondence:
AZ 1022, Azerbaidzhanskaia Respublika, g. Baku, ul. Bakikhanova, d. 23, Azerbaidzhanskii meditsinskii universitet, kafedra khirurgicheskikh boleznei pediatricheskogo fakul'teta,
e-mail: novruz.gadjiyev@rambler.ru,
Hadjiyev Novruz Dzhabbar ogly
Information about the authors:
Sushkov S.V. Doctor of medical sciences, professor, vice-rector on scientific work of SE “Institute of general and urgent surgery of AMS of the Ukraine”.
Nasirov M.YA. Doctor of medical sciences, Honored scientist, professor of the chair of surgical diseases, vice-rector of Azerbaijan Medical University.
HadjiyeV H.J.Candidate of medical sciences, senior laboratory assistant of the chair of surgical diseases of Azerbaijan Medical University, applicant for Doctor’s degree of SE “Institute of general and urgent surgery of AMS of the Ukraine”.

V.I. PETUKHOV, V.P. BULAVKIN, V.K. OKULICH, F.V. PLOTNIKOV

RATIONAL USE OF ANTIBIOTICS IN POSTTRAUMATIC OSTEOMYELITIS TREATMENT CONSIDERING DYNAMICS OF RESISTANCE CHANGE

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

Objectives. To evaluate antibiotics sensitivity of pathogens obtained from the patients with the posttraumatic osteomyelitis and to work out recommendations concerning rational antibiotics therapy.
Methods. 191 patients with the posttraumatic osteomyelitis were examined using the biological method. Microorganisms’ identification was carried out by means of the test-systems on the biochemical analyzer ATB Expression. Evaluation of the microorganisms sensitivity to the antibacterial preparation was carried out on the biochemical analyzer ATB Expression as well as using original test-systems «AB-STAPH», «AB-PSEU», «AB-GRAM(-)» and «AB-ENTER».
Results. Equal ratio of gram-positive and gram-negative floras during the whole period of patients’ hospitalization was determined. Pseudomonas aeruginosa was reliably more frequently observed in the quaternary inoculations compared with the primary ones. Reliable growth of microorganisms’ resistance to antibacterial preparations is registered.
Conclusions. Use of the developed scheme of the rational empirical antibiotics therapy in the complex treatment of posttraumatic osteomyelitis permitted to shorten hospitalization terms from 38±2,7 to 21,1±2,3 days (p<0,05).

Keywords: osteomyelitis, antibiotic, antibiotics resistance
p. 71 – 79 of the original issue
References

1.Amiraslanov IuA, Mitishin VA, Svetukhin AM. Khirurgicheskoe lechenie osteomielita dlinnykh trubchatykh kostei [Surgical treatment of long bones osteomyelitis]. I Belorus Mezhdunarod Kongr Khirurgov. Vitebsk, RB; 1996. p. 5–7.
2.Nikitin GD, i dr. Khronicheskii osteomielit (Plasticheskaia Khirurgiia) [Chronic osteomyelitis (Plastic Surgery). Leningrad, RF; 1990. 197 p.
3.Struchkov VI, Gostishchev VK, Struchkov IuV. Khirurgicheskie infektsii [Surgical infection. A guide for physicians]. Ðóê äëÿ âðà÷åé. Ìoscow, RF: Ìåäèöèíà; 1991. 560 p.
4.Iakovlev VP. Primenenie tsiprofloksatsina pri lechenii i profilaktike khirurgicheskoi infektsii [Ciprofloxacin in the treatment and prevention of surgical infection]. Antibiotiki i Khimioterapiia. 1999;44(7):38–44.
5.Eriukhin IA. Infektsiia v khirurgii. Staraia problema nakanune novogo tysiacheletiia. [Infection in surgery. The old problem on the eve of the new millennium]. Vestn Khirurg im II Grekova. 1998;(1)(Ñh. 1):85–91.
6.Zelenko AV. Mikroflora i ee chuvstvitel'nost' k antibiotikam u bol'nykh khronicheskim osteomielitom [Microflora and its sensitivity to antibiotics in patients with chronic osteomyelitis]. I Belorus Mezhdunarod Kongr Khirurgov. Vitebsk, RB; 1996. p. 38–39.
7.Vittver V, Ketterl' R. Khronicheskii ostit – sovremennaia terapiia [Chronic osteitis – a current therapy]. Antibiotiki i Khimioterapiia. 1996;41(9):57–59.
8.Tajima Y. Polyoxotungstates reduce the beta-lactam resistance of methicillin-resistant Staphylococcus aureus. Mini Rev Med Chem. 2005;5(3):255–68.
9.Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J Bone Joint Surg Am. 2004 Oct;86-A(10):2305–18.
10.Tambic Andrasevic A. Antibiotic resistance-bacteria fight back. Acta Med Croatica. 2004;58(4):245–50.
11.Kosinets AN, Okulich VK, Bulavkin VP. Antibakterial'naia terapiia v gnoinoi khirurgii: ruk [Antibacterial therapy in purulent surgery: A guide]. Vitebsk, RB: VGMU; 2002. 600 p.
12.Mareiko AM, Serookaia TI. Metody opredeleniia chuvstvitel'nosti mikroorganizmov k antibakterial'nym preparatam [Method for determining susceptibility of microorganisms to antibiotics]. Instruktsiia po primeneniiu. MZ RB; 2008. 83 p.
13.Okulich VK, Fedianin SD, Konopel'ko EA. Razrabotka test-sistem dlia opredeleniia chuvstvitel'nosti mikroorganizmov k antibiotikam [Development of test systems for determining susceptibility of microorganisms to antibiotics]. Rol' Antropogennykh i Prirodnykh Patogenov v Formirovanii Infektsionnykh i Neinfektsionnykh Boleznei Cheloveka: mat. Mezhdunar Konf 8–9 okt 2002 g Minsk, RB; 2002. 453 p.
14.Krasil'nikov AP. Spravochnik po antiseptike [A handbook on antiseptics]. Minsk, RB; 1995. 367 p.

Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, d. 27, UO “Vitebskii gosudarstvennyi meditsinskii universitet”, kafedra khirurgii FPK i PK.
e-mail: dr.plotnikov@mail.ru,
Plotnikov Filipp Viktorovich
Information about the authors:
Petukhov V.I. Doctor of medical sciences, Associate Professor, head of the chair of surgery of the faculty of advanced training and retraining of specialists of EE “Vitebsk State Medical University”.
Bulavkin V.P. Candidate of medical sciences, associate professor of the chair of surgery of the faculty of advanced training and retraining of specialists of EE “Vitebsk State Medical University”.
Okulich V.K. Candidate of medical sciences, associate professor of the chair of clinical microbiology of EE “Vitebsk State Medical University”.
Plotnikov F.V. Master of medical sciences, post-graduate student of the chair of surgery of the faculty of advanced training and retraining of specialists of EE “Vitebsk State Medical University”.

PEDIATRIC SURGERY

V.I. AVERIN 1, V.N. PODGAYSKY 2, L.N. NESTERUK 3, YU.M. GRINEVICH 1, A.F. RYLYUK 2

FIRST EXPERIENCE OF GRAFT REVASCULARIZATION AT ESOPHAGOPLASTY IN CHILDREN IN NON-STANDARD CASES

EE “Belarusian State Medical University” ¹,
SEE “Belarusian Academy of Post-Graduate Education” ²,
ME “The First city clinical hospital”, Children’s surgical center ³, Minsk
The Republic of Belarus

Objectives. To analyze the first experience of graft revascularization at esophagoplasty in children in non-standard cases.
Methods. In children’s surgical center (CSC) 5 children with the congenital and acquired esophagus pathologies were operated on. The technique of the additional graft vascularization was applied in 3 patients; free autotransplantation of the bowel segment with revascularization was carried out in 2 patients. The estimation of the operation as well as of early and late complications was done. There were no lethal outcomes.
Results. Nearest and distant results (from 3 to 10 months) were studied in all the patients. It was found out that the operations aiming to form the artificial esophagus with revascularization and additional vascularization of the bowel graft using microsurgical equipment permitted to complete successfully esophagoplasty in all children.
Conclusions. Operations when the artificial esophagus is formed with the bowel graft revascularization using microsurgical equipment may be successfully used both for the primary reconstruction of the upper sections of the alimentary tract and for the secondary reconstruction – “anaboly” forming to finish unsuccessful sub- and total esophagoplasty.

Keywords: esophagoplasty, revascularization, graft, children
p. 80 – 84 of the original issue
References

1.Isakov IuF, Stepanov EA, Razumovskii AIu, Bataev SK, Romanov AV, Kuleshov BV, Beliaeva ID. Iskusstvennyi pishchevod u detei [Artificial esophagus in children]. Khirurgiia. 2003;(7):6–16.
2.Smirnov AK. Koloezofagoplastika u detei [Coloesophagoplasty in children]. Det Khirurgiia. 2009;(3):17–19.
3.Ergun O, Celik A, Mutaf O. Two-stage coloesophagoplasty in children with caustic burns of the esophagus: hemodynamic basis of delayed cervical anastomosis – theory or fact. J Ped Surg. 2004;39(4):545–48.
4.Bassiouny IE, Al-Ramadan SA, Al-Nady A. Long-term functional results of transhiatal oesophagestomy and colonic interposition for caustic oesophageal stricture. Eur J Pediatr Surg. 2002;12(4):243–47.
5.Chepurnoi GI, Miasnikov AG, Rozin BG. Sheinyi ezofagokoloanastomoz pri total'noi plastike pishchevoda u detei [Cervical esophagocoloanastomosis with total plastic of esophagus in children]. Det Khirurg. 2004;(3):4–5.
6.Appignani A, Lauro V, Prestipino M, Centonze N, Domini R. Intesninal bypass of the oesophagus: 117 patients in 28 years. Pediatr Surg Int. 2000;16(5-6):326–28.
7.Page RD, Shackcloth MJ, Russell GN, Pennefather SH. Surgical treatment of anastomotic leaks after oesophagectomy. Eur J Cardiothorac Surg. 2005;(27):337–43.
8.Tabira Y, Sakaguchi T, Kuhara H, Teshima K, Tanaka M, Kawasuji M.The width of a gastric tube has no impact on outcome after esophagectomy. Am J Surg. 2005;189(3):417–21.
9.Cherniavskii AA, Ryzhov MK. Vybor sposoba zaversheniia izoperistal'ticheskoi trubchatoi ezofagoplastiki na osnovanii intraoperatsionnoi otsenki krovosnabzheniia zheludochnogo transplantata [Choice of the method of isoperistaltic tubular esophagogastroplasty on the basis of intraoperative assessment of gastric graft blood supply]. Khirurgiia. 2008;(2):26–32.
10.Belousov EV, Baitinger BF. Prichiny nesostoiatel'nosti pishchevodno-kishechnykh anastomozov na shee [Causes of incompetence of esophago-intestinal anastomoses in the neck]. Khirurgiia. 1984;(10):76–79.
11.Chepurnoi GI. Pishchevodno-tolstokishechnyi anastomoz na shee pri ezofagoplastike u detei [Cervical esophageal-colon anastomosis in children with esophagoplasty]. Det Khirurgiia. 2006;(5):17–21.
12.Hadidi AT. A technique to improve vascularity in colon replacement of the esophagus. Eu J Pediatr Surg. 2006;16(1):39–44.
13.Abakumov MM, Pogodina AN, Khaliullin AI. Profilaktika nekrozov tolstokishechnogo transplantata pri ezofagoplastike [Prevention of necrosis of the colonic graft in esophagoplasty]. Khirurgiia Legkikh i Pishchevoda: tez. dokl. rasshiren plenuma problemnoi komissii Grudnaia Khirurgiia. Vitebsk, RB; 1988. p. 4–5.
14.Hirschl RB, Yardeni D, Oldham K, Sherman N, Siplovich L, Gross E, Udassin R, Cohen Z, Nagar H, Geiger JD, Coran AG. Gastric transposition for esophageal replacement in children: experience with 41 consecutive cases with special emphasis on esophageal atresia. Ann Surg. 2002;236(4):531–41. discussion 539–41.
15.Drobiazgin EA. Lechenie striktur pishchevodnykh anastomozov [Treatment of esophageal anastomotic strictures]. MKhZh. 2009;(5):23–25.
16.Sakuraba M, Kimata Y, Hishinuma S, Nishimura M, Gotohda N, Ebihara S. Importance of additional microvascular anastomosis in esophageal reconstruction after salvage esophagectomy. Plast Reconstr Surg. 2004;113(7):1934–39.
17.Zonta A, Visconti FE, Dionigi P, Vai L, Avanzi MS, Mourad Z, Perosin D, Fraipont G, Guizzetti M, Aluffi A, Ciccone R, Perego M, Alvisi C, Passera R. Internal mammary blood supply for ileo-colon interposition in esophagogastroplasty: a case report. Microsurgery. 1998;18(8):472–75.
18.Chepik DA. Sovremennye napravleniia plastiki pishchevoda u bol'nykh s posleozhogovymi rubtsovymi strikturami pishchevoda [The current trends of esophagus plastic in patients with post-burn cicatricial strictures of the esophagus]. Novosti Khirurgii. 2009;17(3):154–67.
19.Ryliuk AF. Topograficheskaia anatomiia i khirurgiia organov briushnoi polosti [Topographic anatomy and surgery of the abdominal cavity]. Minsk, RB: Vysh shk; 1997. 319 p.

Address for correspondence:
220116, Respublika Belarus', g. Minsk, pr-t. Dzerzhinskogo, d. 83, UO “Belorusskii gosudarstvennyi meditsinskii universitet”, kafedra detskoi khirurgii,
e-mail: averinvi@mail.ru,
Averin Vasilii Ivanovich
Information about the authors:
Averin V.I. Doctor of medical sciences, professor, head of the pediatric surgery chair of EE “Belarusian State Medical University”.
Podgaysky V.N. Doctor of medical sciences, professor of surgery chair of SEE “Belarusian Academy of Post-Graduate Education”.
Nesteruk I.N. Surgeon of the ME “The First City Clinical Hospital”, Children’s Surgical Center
Grinevich Yu.M. Candidate of medical sciences, associate professor of the pediatric surgery chair of EE “Belarusian State Medical University”.
Rylyuk A.F. Doctor of medical sciences, professor of surgery chair of SEE “Belarusian Academy of Post-Graduate Education”.

TRAUMATOLOGY AND ORTHOPEDICS

V.P. DEYKALO, A.N. TOLSTIK

REHABILITATION OF PATIENTS WITH PROGRESSING SCAPOLUNATE COLLAPSE OF THE WRIST

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

Objectives. To improve the results of rehabilitation of patients with the progressing scapolunate collapse of the wrist.
Methods. Comparison of rehabilitation results in 3 groups of patients with the progressing scapolunate collapse of the wrist (PSLCW) has been carried out. The 1st group included 3 patients in whom the complete arthrodesis of the carpal joint was done. The 2nd group included 5 patients in whom PSLCW was the result of long-term existing false joint of the navicular. In the given group only capitate-lunate arthrodesis was done. The 3rd group included 6 patients operated on because of the same indications. They underwent the intervention aimed to reconstruct changes caused by the progressing scapolunate collapse of the wrist.
Results. The designed and introduced in practice technique of the surgical rehabilitation of patients at late stages of PSLCW including resection of the navicular proximal pole, the fragment of the styloid process of the radius, arthrodesis of the capitate-lunate joint and joints between the navicular distal pole, the bone of trapezium and trapezoid bone permitted to obtain satisfactory functional results of treatment in all patients of the research group.
Conclusions. Rehabilitation of patients with PSLCW based on arthrodesis of the capitate-lunate joint and triscaphoid joint (articulation of the navicular distal pole, the bone of trapezium and trapezoid bone) with the resection of the navicular proximal pole and the fragment of the styloid process of the radius permitted to reduce intensiveness of the pain syndrome with saving of acceptable capacity of movements in the wrist, letting patients return to performing their professional duties.

Keywords: wrist, navicular, false joint, wrist instability, arthrosis, rehabilitation
p. 85 – 88 of the original issue
References

1.Siegel JM, Ruby LK. A critical look at intercarpal arthrodesis: review of the literature. J Hand Surg (Am). 1996;(21):717–23.
2.Watson HK, Vender MI. Wrist and intercarpal arthrodesis. In: Chapman MV, editor. Operative orthopaedics. 2th ed. 1993;2(Chap. 91):1363–77.
3.Ashmead D, Watson HK, Damon C, Herber S, Paly W. SLAC wrist salvage. J Hand Surg. 1994;19(5):741–50.
4.Cohen MS, Kozin SH. Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis. J Hand Surg Am. 2001;26(1):94–104.
5.Viegas SF, Patterson RM, Hokanson JA, Davis J. Wrist anatomy: incidence, distribution, and correlation of anatomic variations, tears, and arthrosis. J Hand Surg Am. 1993;18(3):463–75.
6.Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am. 1984;9(3):358–65.

Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, d. 27, UO “Vitebskii gosudarstvennyi meditsinskii universitet”, kafedra travmatologii, ortopedii i VPKh,
e-mail: kaftravmvgmu@yandex.ru,
Tolstik Aleksandr Nikolaevich
Information about the authors:
Deykalo V.P. Doctor of medical sciences, professor, Rector of EE “Vitebsk State Medical University”.
Tolstik A.N. Candidate of medical sciences, Associate Professor of the chair of traumatology, orthopedics and military field surgery of EE “Vitebsk State Medical University”.

ONCOLOGY

A.V. PROKHOROV, M.N. SHEPETKO, I.N. LABUNETS

TREATMENT RESULTS OF PATIENTS WITH THYMUS TUMORS

EE “Belarusian State Medical University”,
the Republic of Belarus

Objectives. Analysis of the nearest and distant treatment results of patients with thymomas; carrying out of pathomorphological estimation of the tumors and determination of dependence between the histological structure of the thymus tumors and general survival rate of patients.
Methods. 113 patients with the mediastinum tumors including 17 patients with the thymus tumors were included in the research.
Results. 7 patients (41,2%) died of the disease progressing. 3 patients in whom thymoma invasiveness was doubtful died of locoregional recurrence or the disease progressing in the form of separate metastases in different terms after treatment had been completed.
Conclusions. Benign process in the thymus which hasn’t been proved at the intraoperative revision and an urgent morphological investigation should be regarded as malignant tumors when the radical volume of the surgical operation with the mediastinum lymphodissection should be performed.

Keywords: mediastinum tumors, thymus, thymomas
p. 89 – 92 of the original issue
References

1.Kaschiato D. Onkologiia [Oncology]. Brusov PG, editor (Ìîiseev ÀÀ, per s angl). Moscow, RF; 2008. 541 p.
2.Kharchenko VP. Bolezni vilochkovoi zhelezy [Diseases of thymus gland]. Moscow, RF; 1998. 129 p.
3.Ganul AV. Optimizatsiia diagnostiki i lecheniia patsientov so zlokachestvennymi opukholiami sredosteniia [Optimizing the diagnosis and treatment of patients with malignant tumors of the mediastinum]. Onkologiia. 2009;(2):131–35.
4.Marino M, Muller-Hermelink HK. Thymoma and thymic carcinoma. Relation of thymoma epithelial cells to the cortical and medullary differentiation of the thymus. Virchows Arch A Pathol Anat Histopathol. 1985;407(2):119–49.
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6.Blumberg D, Port JL, Weksler B, Delgado R, Rosai J, Bains MS, Ginsberg RJ, Martini N, McCormack PM, Rusch V, et al. Thymoma: a multivariate analysis of factors predicting survival. Ann Thorac Surg. 1995 Oct;60(4):908–13; discussion 914.
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8.Maggi G, Casadio C, Cavallo A, Cianci R, Molinatti M, Ruffini E. Thymoma: results of 241 operated cases. Ann Thorac Surg. 1991 Jan;51(1):152–56.
9.Nakahara K, Ohno K, Hashimoto J, Maeda H, Miyoshi S, Sakurai M, Monden Y, Kawashima Y. Thymoma: results with complete resection and adjuvant postoperative irradiation in 141 consecutive patients. J Thorac Cardiovasc Surg. 1988 Jun;95(6):1041–47.
10.Mornex F, Resbeut M, Richaud P, et al. Radiotherapy and chemotherapy for invasive thymomas: a multicentric retrospective review of 90 cases. The FNCLCC trialists. Federation Nationale des Centres de Lutte Contre le Cancer. Int J Radiat Oncol Biol Phys. 1995;32(3):651–59.
11.Ciernik IF, Meier U, Lutolf UM. Prognostic factors and outcome of incompletely resected invasive thymoma following radiation therapy. J Clin Oncol. 1994;12(7):1484–90.
12.Kubota K, Yamada S, Kondo T, Yamada K, Fukuda H, Fujiwara T, Ito M, Ido T. PET imaging of primary mediastinal tumours. Br J Cancer. 1996 Apr;73(7):882–86.
13.Liu RS, Yeh SH, Huang MH, Wang LS, Chu LS, Chang CP, Chu YK, Wu LC. Use of fluorine-18 fluorodeoxyglucose positron emission tomography in the detection of thymoma: a preliminary report. Eur J Nucl Med. 1995 Dec;22(12):1402–407.
14.Sasaki M, Kuwabara Y, Ichiya Y, Akashi Y, Yoshida T, Nakagawa M, Murayama S, Masuda K. Differential diagnosis of thymic tumors using a combination of 11C-methionine PET and FDG PET. J Nucl Med. 1999 Oct;40(10):1595–601.

Address for correspondence:
220116, Respublika Belarus', g. Minsk, pr-t. Dzerzhinskogo, d. 83, ÓÎ “Belorusskii gosudarstvennyi meditsinskii universitet”, kafedra onkologi,
e-mail: shepetjko@gmail.com,
Shepetko Mikhail Nikolaevich
Information about the authors:
Prokhorov A.V. Doctor of medical sciences, professor, head of the oncology chair of EE “Belarusian State Medical University”.
Shepetko M.N. Candidate of medical sciences, associate professor of the oncology chair of EE “Belarusian State Medical University”.
Labunets I.N. Candidate of medical sciences, assistant of the oncology chair of EE “Belarusian State Medical University”.

OTORHINOLORYNGOLOGY

D.M. PLAVSKY, O.G. KHOROV

ENHANCEMENT OF SIMULTANEOUS TYMPANOPLASTY AFTER SANITATION EAR SURGERIES

EE “Grodno State Medical University”,
the Republic of Belarus

Objectives. To determine the optimal thickness of the cartilage graft to improve the efficiency of surgical treatment of chronic suppurative otitis media and to estimate the clinical and morphological results of the performed treatment.
Methods. Experimental research aimed to study amplitude-frequency characteristics of the cartilage graft used at the reconstructive stage during operations on the middle ear permitting to determine its optimal thickness was carried out. 57 patients with chronic suppurative otitis media were operated on, in whom different operative interventions with the application of the methods suggested by the authors were used.
Results. The optimum thickness of the cartilage transplant was determined and it made up 0.2-0.3 mm as well as appropriateness of making incisures on it according to the suggested technique was proved. High and stable clinical and morphological results during all periods of observation in the operated patients were obtained.
Conclusions. Application of the suggested operation technique is substantiated and effective.

Keywords: tympanoplasty, atticotomy, tragus perichondrium, fascia of the temporal muscle, cartilage plate
p. 93 – 99 of the original issue
References

1.Skarzhinski G, Baryliak R, Lorens A. Novaia era v otokhirurgii [A new era in otosurgery]. Zhurn Ushn Nos i Gorlov Boleznei. 2008;( 2):35–43.
2.Stacke L. Die operative Freilegung der Mittelohrraume. Berlin Klin. Wochenschr; Germany; 1890. 96 p.
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5.Pluzhnikov MS, Diskalenko VV, Kurmashova LM. Sovremennoe sostoianie problemy khirurgicheskoi reabilitatsii bol'nykh s khronicheskimi vospalitel'nymi zabolevaniiami srednego ukha [Current state of surgical rehabilitation of patients with chronic inflammatory diseases of the middle ear]. Vestn Otorinolaringol. 2006;(5):63–66.
6. Skarzhinskii Kh. Funktsional'nye rezul'taty rekonstruktivnykh vmeshatel'stv posle modifitsirovannoi (konservativno – shchadiashchei) radikal'noi operatsii ukha [Functional results of reconstructive interventions after modified (conservative-sparing) radical surgery on the ear]. Ros Otorinolaringol. 2004; ¹ 2(9):105–107.
7.El'-Rafai Khusam, Sitnikov VP, Kunitskii VS. Effektivnost' khirurgicheskogo lecheniia bol'nykh khronicheskim gnoinym chasto retsidiviruiushchim tubotimpanal'nym otitom [The effectiveness of surgical treatment of chronic suppurative often recurrent tubotimpanal otitis media]. Zhurn ARS Medica. 2009;(2):124–25.
8.Borisenko ON. Zakrytyi variant etapnoi timpanoplastiki s mastoidektomiei u bol'nykh khronicheskim gnoinym srednim otitom [The closed version of staged tympanoplasty with mastoidectomy in chronic suppurative otitis media]. Vestn Otorinolaringol. 2001;(2):23–27.
9.Mikhasev GI, Firsov MA, Sitnikov VP. Modelirovanie svobodnykh kolebanii zvukoprovodiashchei sistemy rekonstruirovannogo srednego ukha [Model of free oscillations of the reconstructed sound-conducting system of the middle ear]. Rosi Zhurn Biomekhaniki. 2005;(1):52–62.
10.Khorov OG, Plavskii DM. Sposob plastiki barabannoi pereponki [Method of drum plastic]: pat. ¹13296 Resp. Belarus', zaiavitel' UO GrGMU ¹ 20080341; Ofitsial'nyi Biul Nats Tsentr Intellektual'noi Sobstvennosti. 2010;(3):58.
11.Kunitskii VS, Krishtopova MA. Ustroistvo dlia posloinogo polucheniia srezov khriashchevykh tkanei [A device for obtaining layered slices of cartilage tissue]: pat. 1472 Resp. Belarus', zaiavitel' VGMU ¹ u 20060102; Ofitsial'nyi Biul Nats Tsentr Intellektual Sobstvennosti. 2006;(6):164.
12.Fisch U. Tympanoplastyka, mastoidoplastyka i chirurgia strzemiaczka. Wroslaw, Poland; 2004. 284 p.

Address for correspondence:
230009, Respublika Belarus', g. Grodno, ul. Gor'kogo, d. 80, UO “Grodnenskii gosudarstvennyi meditsinskii universitet”, kafedra otorinolaringologii, stomatologii,
e-mail: plavskij_1982@mail.ru,
Plavsky Dmitrii Mikhailovich
Information about the authors:
Plavsky D.M. Assistant of otolaryngology, dentistry chair of EE “Grodno State Medical University”.
Khorov O.G. Doctor of medical sciences, professor, head of otolaryngology, dentistry chair of EE “Grodno State Medical University”.

NEW METHODS

E.A. ASKERKO, V.P.DEYKALO, V.V. TSUSHKO

ESTIMATION INDEX SCALE OF THE SHOULDER JOINT

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

On the basis of the objective clinical and radiological signs using metric indexes, the estimation scale of the shoulder joint function was designed. The scale was clinically tested taking into account perennial experience of the operative interventions and further rehabilitation of 419 patients with various pathologies of the shoulder joint. The scale was designed taking into account modern literature and includes 8 indexes of clinical and instrumental estimation, professional and everyday life activity. The average clinical index used for integrate estimation of the patient’s state before and after treatment.

Keywords: scale, shoulder joint, estimation, function
p. 100 – 104 of the original issue
References

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9.Riabchikov IV, Pankov IO, Riabchikova EN. Oprosnik MOS-36ITEM FORM HEALTH SURVEY (MOS SF-36) kak indikativnyi pokazatel' kachestva vosstanovitel'nogo lecheniia patsientov s perelomami oblasti kolennogo sustava. Mnogoprofil'naia klinika XXI veka. [The questionnaire MOS-36ITEM FORM HEALTH SURVEY (MOS SF-36) as a quality indicator of restorative treatment of patients with fractures of the knee joint. Multidisciplinary Clinic of XXI century]. Peredov Med Tekhnol: mat mezhdunar nauch prakt konf, Saint-Petersburg, 14–16 sent Saint-Petersburg, RF; 2011. p.180–81.
10.Pankov IO. Oprosnik «EQ-5D» kak indikativnyi pokazatel' kachestva vosstanovitel'nogo lecheniia patsientov s perelomami oblasti kolennogo sustava Mnogoprofil'naia klinika XXI veka [Questionnaire «EQ-5D» as a quality indicator of of restorative treatment of patients with fractures of the knee joint. Multidisciplinary Clinic of XXI century]. Peredov Med Tekhnol: mat mezhdunar nauch prakt konf, Saint-Petersburg: 14-16 sent. Saint-Petersburg, RF; 2011. p.180–82.

Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, d. 27, UO “Vitebskii gosudarstvennyi meditsinskii universitet”, kafedra travmatologii, ortopedii i voenno-polevoi khirurgii,
e-mail: kaftravmvgmu@yandex.ru,
Askerko Eduard Anatol'evich
Information about the authors:
Deykalo V.P. Doctor of medical sciences, professor, Rector of EE “Vitebsk State Medical University”.
Askerko E.A.Candidate of medical sciences, head of the chair of traumatology, orthopedics and military field surgery of EE “Vitebsk State Medical University”.
Tsushko V.V.Post-graduate student of the chair of traumatology, orthopedics and military field surgery of EE “Vitebsk State Medical University”.

LECTURES, REVIEWS

E.A. MATVEEVA

DIAGNOSTICS AND TREATMENT OF MALLORY-WEISS SYNDROME

SEE “Belarusian Medical Academy of Postgraduate Education”, Minsk
The Republic of Belarus

In the review the data concerning modern methods of diagnostics and treatment of Mallory-Weiss syndrome are presented. The chronology of historical views at the given problem, experimental data and modern classification of the disease are presented in details. The analysis of the domestic and foreign literature with the efficacy estimation of various techniques of minimally invasive and operative treatment used in the clinic is carried out. Despite a variety of ways of Mallory-Weiss syndrome diagnostics and treatments suggested by the authors, still there are no proved, from the point of evidence-based medicine, and comprehensive data concerning efficiency and safety of various methods of endoscopic hemostasis and their influence on the mucous epithelization in the hemostasis zone. There are no data on vascular anatomy of the cardio-esophageal conversion according to duplex scanning data at the endoscopic ultra-sound examination and cadaveric angiography as well as their link with various clinical manifestations of Mallory-Weiss syndrome. The given problems demand further solution.

Keywords: Mallory-Weiss syndrome, diagnostic, treatment, endosñopic hemostasis
p. 105 – 114 of the original issue
References

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39.Kiriakidi SF, Botov AV. Laparoskopicheskoe vnutrizheludochnoe ushivanie razryva pri sindrome Mallory-Weiss [Laparoscopic intragastric suturing the gap with Mallory-Weiss syndrome]. Endoskop Khirurgiia. 1999;(5):53–54.

Address for correspondence:
220013, Respublika Belarus', G. Minsk, ul. P.Brovki, 3, korp.3, GUO “Belorusskaia meditsinskaia akademiia poslediplomnogo obrazovaniia”, kafedra khirurgii,
e-mail: katy.matveeva@mail.ru,
Matveeva Ekaterina Aleksandrovna
Information about the authors:
Matveeva E.A. Post-graduate student of surgery chair of SEE “Belarusian Academy Of Post-Graduate Education”.

E. MATEVOSYAN 1, M. MAAK 1, G.V. SAPKO 2, H. FRISS 3, D. DOLL 3

BLUNT ABDOMINAL TRAUMA WITH LIVER DAMAGE – FROM TRYING SELECTIVE CONSERVATIVE THERAPY TO LIVER TRANSPLANTATION

Technical University of Munich 1, Munich,
Germany,
ME “Vitebsk regional clinical hospital” 2,
The Republic of Belarus,
Philipps-University of Marburg 3, Marburg,
Germany

Actual problems of medical aid rendering to the patients with the abdominal trauma accompanied by the liver parenchema damage at the prehospital and hospital stages are studied in the article. Abdominal trauma at the isolated and accompanying liver damage depending on the severity stage of parenchema damage demands differentiated treatment; it includes not only a conservative therapy but also surgical actions such as surface bleeding stopping, compression techniques(«packing» and «mesh-wrapping») up to the atypical and anatomical liver resection. Total hepatectomy with subsequent liver transplantation is the reasonable method of treatment at massive irreversible liver parenchema damage. This method should be applied only in specialized centers in case the indications are present.

Keywords: abdominal trauma, liver damages, aid rendering, liver transplantation
p. 115 – 119 of the original issue
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25.Veroux M, Madia C, Cillo U, Brolese A, Zanus G, Fiamingo P, Veroux P, D'Amico DF. Long-term follow-up after liver transplantation for blunt hepatic trauma. Transplant Proc. 2002 Jun;34(4):1226–28.
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27. Veroux M, Cillo U, Brolese A, Veroux P, Madia C, Fiamingo P, Zanus G, Buffone A, Gringeri E, D'Amico DF. Blunt liver injury: from non-operative management to liver transplantation. Injury. 2003 Mar;34(3):181–86.
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Address for correspondence:
Dr. Edouard Matevossian, MD,
Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany,
e-mail: matevossian@chir.med.tu-muenchen.de
Information about the authors:
Matevosyan E. Privatdozent, MD, Department of surgery and transplantation of Clinic, "Rehts der Isar” of Technical University of Munich.
Maak M. Doctor of medicine, Department of surgery of Clinic, "Rehts der Isar” of Technical University of Munich.
Sapko G.V. Surgeon, ME “Vitebsk regional clinical hospital”.
Friss H. Professor, Doctor of medicine, Department of surgery of Clinic, "Rehts der Isar” of Technical University of Munich.
Doll D.Privatdozent, MD, Department of visceral, vascular and thoracic surgery, Philipps-University of Marburg.

A.A. LYZIKOV

SURGICAL TACTICS AT ARTIFICIAL VASCULAR PROSTHESES INFECTION

EE “Gomel State Medical University”,
the Republic of Belarus

Different variants of surgical tactics at suppuration of the vascular prosthesis are described in the review. Basic variants of surgical tactics such as extraanatomic bypass, vascular prosthesis regrafting, appliance of allograft and femoral vein are proposed. Pros and cons of each method are shown. Comparative analysis of the performed techniques was performed. Indications and contraindications for each method are determined. Situations suitable for attempt of conservative treatment of infected prosthesis and regrafting by vascular prosthesis are described. Possible ways of prevention of the vascular prosthesis contamination are described in details. Different approaches to the antibiotics prevention of the infectious complications are listed. Step-by-step development of the prevention methods of the infectious complications is carried out.

Keywords: prosthesis infection, extraanatomic bypass, femoral vein, allograft, artificial prosthesis
p. 120 – 126 of the original issue
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Address for correspondence:
246050, Respublika Belarus', g. Gomel', ul. Lange, d.5, UO “Gomel'skii gosudarstvennyi meditsinskii universitet”, kafedra khirurgicheskikh boleznei ¹3 s kursom serdechno-sosudistoi khirurgii,
e-mail: Lyzikov@mail.ru,
Lyzikov Aleksei Anatol'evich
Information about the authors:
Lyzikov A.A. Candidate of medical sciences, associate professor of the surgical diseases chair ¹ 3 with the course of the cardiovascular surgery of EE “Gomel State Medical University”

EXCHANGE BY EXPERIENCE

S.A. KABANOVA, T.N. CHERNINA, A.A. KABANOVA

LOWER JAW RESECTION WITH SIMULTANEOUS RIB AUTOGRAFT PLASTIC WITH DOUBLE VASCULARISATION

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

The case of carrying out the operation using vascularized bone grafts for plastic of the lower jaw postoperative defects is described. Partial resection of the lower jaw with the formation of the vascular microanastomosis was performed in the patient with the diagnosis of the mandibular osteoblastoclastoma. At the same time the method of double revascularization of autograft from the basin of a.facialis was applied. There were no postoperative complications; this fact testifies to efficacy of the given operation and possibility of its introduction to practice.

Keywords: osteoblastoclastoma, lower jaw resection, autograft, double revascularization
p. 127 - 129 of the original issue
References

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Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, d. 27, UO “Vitebskii gosudarstvennyi meditsinskii universitet”, kafedra stomatologii detskogo vozrasta i cheliustno-litsevoi khirurgii,
e-mail: arinakabanova@mail.ru,
Kabanova Arina Aleksandrovna
Information about the authors:
Kabanova S.A. Candidate of medical sciences, associate professor of the chair of pediatric dentistry and maxillofacial surgery of EE “Vitebsk State Medical University”.
Chernina T.N. Senior lecturer of the chair of pediatric dentistry and maxillofacial surgery of EE “Vitebsk State Medical University”.
Kabanova A.A. Senior lecturer of the chair of pediatric dentistry. and maxillofacial surgery of EE “Vitebsk State Medical University”.
Contacts | ©Vitebsk State Medical University, 2007