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Year 2013 Vol. 21 No 4

EXPERIMENTAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.3   |  

A.N. MASTYKAU, V.P. DEYKALO, I.V. SAMSONOVA, K.B. BALABOSHKA

EFFICACY OF PLATELET-RICH PLASMA APPLICATION IN TREATMENT OF TRAUMATIC ARTICULAR CARTILAGE DEFECTS

EE “Vitebsk State Medical University”
The Republic of Belarus

Objectives. To access the efficacy of platelet-rich plasma (PRP) application in treatment of knee hyaline cartilage defects in a rabbit model.
Methods. Chinchilla rabbits (n=10) were subdivided into two groups. The full-thickness cartilage defect of the load-bearing surface of the patello-femoral joint of left femur was created in the first group of animals (n=5). Partial-thickness cartilage defect was created at the same area in the second group of animals (n=5). 0.5 mL of PRP was injected in a joint cavity after wound closure. In order to form a control group the same cartilage defect was created at the contralateral knee joint and intra-articular injections of 0.5 ml of normal saline (0.9%) were injected. In 11 weeks after the operation the macroscopic and microscopic examination of cartilage defect area has been performed with the evaluation of characteristics of repair tissue by the O’Driscoll scale.
Results. Group of animals underwent the treatment of full-thickness cartilage defect with PRP characterized by significantly higher values of categories “Morphology of tissue”, “Matrix staining”, “Integrity of structure”, “Thickness of neo-formed cartilage”, “Clustering of chondrocytes”, “Inflammation” (p<0.05) and final value of the O’Driscoll Score (p<0.05) in comparison with the control group. In the group of animals with partial-thickness cartilage defect treated with PRP the values were significantly higher than in the categories “Inflammation” and “Hypocellularity” (p<0.05) and final value of the O’Driscoll Score (p<0.05) compared with the control one. There were no any complications associated with intra-articular PRP injections.
Conclusions. Intra-articular PRP injections improve cartilage regeneration in both full-thickness and partial-thickness cartilage defects of the knee. It is a safe and effective method which can be used for the treatment of knee cartilage injuries.

Keywords: knee joint, cartilage defect, platelet-rich plasma

p. 3 – 9 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 travmatologii, ortopedii i VPKh,
e-mail: barrett@tut.by,
Mastykov Anton Nikolaevich

Information about the authors:
Mastykau A.N. A post-graduate student of the traumatology, orthopedics and military-field medicine of EE “Vitebsk State Medical University”.
Deykalo V.P. MD, professor, Rector of EE “Vitebsk State Medical University”.
Samsonova I.V. PhD, associate professor, a head of the pathologic anatomy chair of EE “Vitebsk State Medical University”.
Balaboshka K.B. PhD, associate professor of the traumatology, orthopedics and military-field medicine of EE “Vitebsk State Medical University”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.10   |  

V.D. LUTSENKO, A.A. MIGUNOV, T.N. TATYANENKO, E.B. SUCHALKIN, S.N. GONTAREV

APPLICATION OF BIOPOLYMERIC MATERIALS AT HOLLOW ORGAN PERFORATION IN EXPERIMENT

National Research University “Belgorod State Research University”

Objective. To study the effectiveness of biopolymer materials application in hollow organs perforation in the experiment.
Materials. Experiment is performed on 63 white mature rats. Simulation of gastric ulcers was carried out by a modified method of Okabe, to simulate the perforation a perforating puncture of gastric wall (D 0.1 cm) was made. Animals were divided into 3 groups (23, 25 and 15 animals). In the 1^st group of animals the plasty of perforation is carried out by a membrane “Kollost”, in the 2^nd group of animals a mesh endoprosthesis “Prolene” with coverage of omentum has been used. Animals of the 3^d group are operated with application of traditional method – sutured by double-row stitches. Animals are disaffiliated with experiment on 7^th, 14^th, 21^st, 30^th, 60^th, 90^th and 120^th days.
Results. On the 7^th day it has been revealed that a connective tissue capsule of collagen fibers begins to form around the mesh. Epithelialization of ulcers is completed by the 30^th day, a mess is fully encapsulated to the 60^th day. Thus, in the area of perforation a positive reaction of connective tissue elements to the foreign synthetic material and minimization of adhesive process at cover of omentum have been revealed. On the 30^th day the membrane “Kollost” in closing of ulcer defects promoted to the restoration of the organ wall and stimulated the scarring processes at the expense of specific protein-collagen. The density of protein structure allowed to delimit the lumen of the hollow organ from the abdominal cavity tightly. On the 60^th day in suturing by double-row stitches the changes analogous to the healing of ulcers with biopolymer materials application have been revealed. In the long-term period the marked deformity and stricture formation are noted in the area of operations.
Conclusion. Application of biopolymeric materials accelerates the regenerative process of tissues in the operation zone, the tissues deformation and luminal constriction of organ are not occurred.

Keywords: perforation of a hollow organ, operative treatment, biopolymeric materials, morphological changes

p. 10 – 15 of the original issue

References

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Address for correspondence:
308036, Rossiiskaia Federatsiia, g. Belgorod, ul. Gubkina, 46, FGAOU VPO « Belgorodskii issledovatel'skii universitet», kafedra obshchei khirurgii meditsinskogo fakul'teta,
e-mail: Lutsenko@gb2bel.ru,
Lutsenko Vladimir Dmitrievich

Information about the authors:
Lutsenko V.D. MD, professor, a head of the general surgery chair with the course of topographic anatomy and operative surgery of the medical faculty of FSAEE HPE "Belgorod State National Research University".
Migunov A.A. PhD, senior lecturer of the general surgery chair with the course of topographic anatomy and operative surgery of the medical faculty of FSAEE HPE "Belgorod State National Research University ".
Tatyanenko T.N.PhD, associate professor of the general surgery chair with the course of topographic anatomy and operative surgery of the medical faculty of FSAEE HPE "Belgorod State National Research University ".
Suchalkin E.B. assistant of the general surgery chair with the course of topographic anatomy and operative surgery of the medical faculty of FSAEE HPE "Belgorod State National Research University ".
Gontarev S.N. MD, professor of the general surgery chair with the course of topographic anatomy and operative surgery of the medical faculty of FSAEE HPE "Belgorod State National Research University ".  

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.16   |  

A.V. HLUTKIN

OXYGEN-TRANSPORT FUNCTION OF BLOOD AND FREE RADICAL PROCESSES AT EXPERIMENTAL MODELING OF THE THERMAL BURN

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

Objectives. To evaluate oxygen-transport function of the blood and free radical processes after thermal skin injury in an infant rat model.
Methods. The study was conducted on outbred albino infant rats (55-65 g weight, 30 days age, n=54). Thermal injury of the skin was modeled by hot liquid (water) impact at temperature of 99-100°C using a specially designed device within 10 seconds (the zone of injury was about 8-9% of the body surface). The blood gas parameters as well as hemoglobin affinity for oxygen were determined according to p50 (pO₂ at 50% saturation of hemoglobin by oxygen). The sampling of tissues (lung, liver, kidney and heart) was performed to study lipid peroxidation (conjugated dienes, malondialdehyde) and antioxidant protection (α-tocopherol, catalase) in the tissues too. Determination of nitrate/nitrite concentration in the blood plasma was carried out using Griess reagent.
Results. Thermal injury in rats (30 days) leads to hypoxia based on the symptoms of metabolic acidosis and reduction of the pO₂ and SO₂ values as well as elevation of hemoglobin affinity for oxygen within the first 14 days and then return them to the primary values. In this case the oxidative stress has developed and its manifestation reduced to the 21^st days. Also one observes an increase of nitrate/nitrite concentration, reflecting the dysfunction of L-arginine-NO system, causing changes of blood oxygen binding properties and forming prooxidant-antioxidant imbalance.
Conclusions. The conducted studies testify to an important role of the oxygen-dependent processes in the thermal injury pathogenesis which is necessary to take into consideration in developing of appropriate measures to eliminate this pathology.

Keywords: thermal burn, oxygen, blood, radical, antioxidant, nitric oxide

p. 16 – 24 of the original issue

References

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9. Kamyshnikov VS. Spravochnik po kliniko-biokhimicheskoi laboratornoi diagnostike [A handbook of clinical and biochemical laboratory diagnostics]: v 2 t. 2-e izd. Minsk, RB: Belarus'; 2002;1. 465 p.
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12. Bryan NS, Grisham MB. Methods to detect nitric oxide and its metabolites in biological samples. Free Radic Biol Med. 2007 Sep 1;43(5):645–57.
13. Tarasov AE. Vliianie «tinrostima» na perekisnoe okislenie lipidov i antioksidantnuiu sistemu pri ozhogovoi bolezni v eksperimente [The influence of tinrostim on lipid peroxidation and antioxidant system in experimental burn]. Sovrem Naukoemkie Tekhnologii. 2005;(8):72.
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15. Zinchuk VV. Kislorodsviazyvaiushchie svoistva krovi [Blood oxygen binding properties]. Lap Lambert Academic Publishing; 2012. 167 p.
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Address for correspondence:
210009, Respublika Belarus', g. Grodno, ul. Gor'kogo, d. 80, UO «Grodnenskii gosudarstvennyi meditsinskii universitet», kafedra detskoi khirurgii,
e-mail: glutkinalex@mail.ru,
Glutkin Aleksandr Viktorovich

Information about the authors:
Hlutkin A.V. A post-graduate student of the pediatric surgery chair of EE “Grodno State Medical University”.

Article in the .pdf format

GENERAL AND SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.25   |  

A.A. ZIANKOU^1,2

APPLICATION OF THE EXTRACORPORеAL BLOOD CIRCULATION IN THE MINIMALLY INVASIVE MYOCARDIAL REVASCULARIZATION

ME “Vitebsk Regional clinical hospital” ¹,
EE “Vitebsk State Medical University”²
The Republic of Belarus

Objectives. To analyze the causes of the conversion to the extracorporeal circulation (ECC) during the full minimally invasive coronary surgery (MICS) for optimization of the surgical treatment results of the coronary heart disease (CHD).
Methods. From 2011 up to 2012 yrs at the cardiac surgery department of ME “Vitebsk regional clinical hospital” 104 patients with the CHD underwent full minimally invasive coronary surgery. MICS strategy is to perform a functionally complete myocardial revascularization from the left-sided minithoracotomy without application of artificial blood circulation (ABC) and manipulation on the ascending aorta. In 8 (7,7%) patients the ECC was employed during the main operation stage.
Results. Myocardial ischemia with hypotension (12,5%), ventricle fibrillation (37,5%), hemodynamic disturbances during the heart enucleation (12,5%), impediment of the heart enucleation and coronary artery positioning due to cardiomegaly (37,5%) were considered to be the causes of the conversion to the ECC during the full MICS. The postoperative period in patients after MICS with emergency connection of ECC was accompanied by a large loss of blood, a slow recovery of the functions of the respiratory and cardiovascular systems. In the case of a planned conversion to the ECC the more stable postoperative course was observed compared with the emergency conversion.
Conclusions. Predictors of the conversion to the ECC were the left coronary artery body stenosis, enlarged left ventricle volumes, apparent hypertrophy of the left ventricle and increased local index of contractility (LIC). The emergency conversion to the ECC during the complete MICS promotes increasing of perioperative complications, extension of the operation time, period of ICU – stay and hospital length of stay in comparison with patients without conversion to the ECC. The planned application of ECC to achieve the necessary completeness of revascularization is considered to be justified in high risk patients. In case of the conversion need to the ECC the femoral cannulation can be successfully used without sternotomy.

Keywords: minimally invasive myocardial revascularization, extracorporeal circulation, conversion

p. 25 – 32 of the original issue

References

1. Calafiore AM, Angelini GD, Bergsland J, Salerno TA. Minimally invasive coronary artery bypass grafting. Ann Thorac Surg. 1996 Nov;62(5):1545–48.
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3. Al-Ruzzeh S, George S, Bustami M, Wray J, Ilsley C, Athanasiou T, Amrani M. Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial. BMJ. 2006 Jun 10;332(7554):1365.
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5. AKSh bez IK: mif, logika i nauka [Coronary artery bypass grafting without applying the artificial bypass blood circulation: the myth, logics and science]. [Elektronnyi resurs] / Cheliabinsk, RF: Cheliab. tsentr khirurgii serdtsa; 2011. Rezhim dostupa: http://cardiosur.ru.
6. Hussain R, Soomro ТI. Сonversions in off-pump coronary artery Bypass grafting: analysis and outcome. Pakistan Heart Journal. 2008 Jan-Jun;41(1-2):5–9.
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8. Iaco AL, Contini M, Teodori G, Di Mauro M, Di Giammarco G, Vitolla G, Iovino T, Calafiore AM. Off or on bypass: what is the safety threshold? Ann Thorac Surg. 1999 Oct;68(4):1486–89.
9. Chowdhury R, White D, Kilgo P, Puskas JD, Thourani VH, Chen EP, Lattouf OM, Cooper WA, Myung RJ, Guyton RA, Halkos ME. Risk factors for conversion to cardiopulmonary bypass during off-pump coronary artery bypass surgery. Ann Thorac Surg. 2012 Jun;93(6):1936–41.
10. Hovakimyan A, Manukyan V, Ghazaryan S, Saghatelyan M, Abrahamyan L, Hovaguimian H Predictors of emergency conversion to on-pump during off-pump coronary surgery. Asian Cardiovasc Thorac Ann. 2008 Jun;16(3):226–30.
11. Reeves BC, Ascione R, Caputo M, Angelini GD. Morbidity and mortality following acute conversion from off-pump to on-pump coronary surgery. Eur J Cardiothorac Surg. 2006 Jun;29(6):941–47.
12. Chowdhury R, White D, Kilgo P, Puskas JD, Thourani VH, Chen EP, Lattouf OM, Cooper WA, Myung RJ, Guyton RA, Halkos ME. Risk factors for conversion to cardiopulmonary bypass during off-pump coronary artery bypass surgery. Ann Thorac Surg. 2012 Jun;93(6):1936–41.
13. Edgerton JR, Dewey TM, Magee MJ, Herbert MA, Prince SL, Jones KK, Mack MJ. Conversion in off-pump coronary artery bypass grafting: an analysis of predictors and outcomes. Ann Thorac Surg. 2003 Oct;76(4):1138–42.
14. 14. Emergency conversion in planned off-pump coronary artery bypass grafting: Outcome of semi-elective and delayed conversions. Ind J of Thorac Cardiovasc Surg. 2007;23(Issue):3184–87.

Address for correspondence:
210037, Respublika Belarus', g. Vitebsk, ul. Voinov-internatsionalistov, d. 37, UZ «Vitebskaia oblastnaia klinicheskaia bol'nitsa», otdelenie kardiokhirurgii,
e-mail: Zenkov_Al@rambler.ru,
Ziankou Aleksandr Aleksandrovich

Information about the authors:
Ziankou A.A. PhD, a head of cardiac surgery chair of ME ”Vitebsk regional clinical hospital”, associate professor of the surgery chair of the faculty of training and retraining of the staff of EE “Vitebsk State Medical University”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.33   |  

V.I. BELOKONEV ^1,2, A.B. NASIBYAN ^1,3, J.V. PONOMAREVA¹

OPTIONS OF OPERATIONS IN PATIENTS WITH RECCURENT INGUINAL HERNIA AFTER PROSTHETIC HERNIOPLASTY

SBEE HPE “Samara State Medical University” ¹,
MMBE “City Clinical Hospital №1 named after N.I. Pirogov” ², Samara
SBME ND “Kinel central city and regional hospital” ³,
The Russian Federation

Objective. To improve the treatment results of patients with inguinal hernia recurrence after prosthetic hernioplasty through the development of operation methods, allowing to minimize damage to the elements of the inguinal canal and close the defect in the zone of the inguinal canal with a view of destroyed tissue elements in it.
Methods. The analysis of the treatment of 24 patients with recurrent inguinal hernia by Lichtenstein hernioplasty (with synthetic materials application) – in 16 (66,7%), the combined method – in 3 (12,5%), laparoscopic hernioplasty – in 5 (20,8%) has been conducted. In re-plasty a combined method (modification of Lichtenstein hernioplasty) is used with the new developed technique of operation combined with the methods of restoration of the destroyed inguinal ligament partially or completely in which the allocation of the hernial sac, the closing of the newly formed hernial gate have been conducted with the exception of direct contact with spermatic cord.
Results. During performance of repeated operations it was found that after prosthetic hernioplasty, recurrences can be caused by displacement of the prosthesis along the upper and lower contours without and combined with the destruction of the inguinal ligament. To prevent the complications of repeated operations in patients with the recurrent inguinal hernia the separation of prosthesis from spermatic cord technically should be excluded that achieved by localization of the access above the zone of incision of aponeurosis made during the previous operation. Out of 9 patients operated by a combined method, the complications occurred in 4 patients, only 1 case out of 15 underwent a new method of the operation. Intraoperative orchiectomy not connected with the spermatic cord damage was required in 1 case. Hernia recurrences were not noted in the observed period (1-5 years).
Conclusions. The use of a new method of the operation in which the intervention carried out outside of the contact zone of spermatic cord with a synthetic graft confirmed the effectiveness of this approach.

Keywords: prosthetic hernioplasty, recurrent inguinal hernia, options of operations

p. 33 – 39 of the original issue

References

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2. Bereznitskii IaS, Astakhov GV, Kutovoi MA, Kuryliak SN. Opyt lecheniia pakhovykh gryzh s primeneniem maloinvazivnykh tekhnologii [Treatment of inguinal hernia using the mini-invasive techniques: our experience]. Ukr Zhurn Khirurgii. 2009;(4):11–13.
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4. Brough V, Deans G, Sedman H, Royston Ch. The first 1000 laparoscopic hernia repairs. Minimally Invasive Therapy. 1995;4(l):29.
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16. Bringman S, Conze J, Cuccurullo D, Deprest J, Junge K, Klosterhalfen B, Parra-Davila E, Ramshaw B, Schumpelick V. Hernia repair: the search for ideal meshes. Hernia. 2010 Feb;14(1):81–87.
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Address for correspondence:
443099, Rossiiskaia Federatsiia, g. Samara, ul. Chapaevskaia, d. 89, GBOU VPO «Samarskii gosudarstvennyi meditsinskii universitet», kafedra khirurgicheskikh boleznei №2,
e-mail: nbelokoneva@yandex.ru,
Belokonev Vladimir Ivanovich

Information about the authors:
Belokonev V.I. Honored physician of Russian Federation, MD, professor, a head of the surgical diseases chair №2 of SBEE HPE “Samara State Medical University”.
Nasibyan A.B. A surgeon of SBME ND “Kinel central city and regional hospital”, extramural post-graduate student of the surgical diseases chair №2 of SBEE HPE “Samara State Medical University”.
Ponomareva J.V. PhD, a senior researcher of the Institute of experimental medicine and biotechnologies of SBEE HPE “Samara State Medical University”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.40   |  

Y.S. VINNIK, S.S. DUNAEVSKAYAY.S. VINNIK, S.S. DUNAEVSKAYA

ESTIMATION OF SEVERITY OF PANCREATIC IMMUNODEFICIENCY

SBEE HPE “Krasnoyarsk State Medical University
named after prof. V.F. Voyno-Yasenetsky”
The Russian Federation

Objectives. To study the disturbances of the immune status in patients with severe acute pancreatitis.
Methods. 40 patients with the diagnosis of severe acute pancreatitis have been examined. The patients of 23-76 years old were included in the study. Phenotype of lymphocytes was evaluated by the indirect fluorescence method with monoclonal antibodies and the determination of receptors: CD3, CD4, CD8. The concentration of serum immunoglobulins A, M, G was determined by immunoprecipitation method on the agar gel. Peripheral blood’s functional activity of phagocyte was studied by means of flow cytometry. The percentage of phagocytic cells – phagocytosis index and an average number of phagocyted particles have been calculated by means of “Latex-test”. The reduction of laboratory index of the immune status was taken into consideration. The decreasing of index (from 15% up to 30%) from the lower limit of norm was considered as the first degree of immune insufficiency, within 31-60% – as the second degree of insufficiency, lower than 61% – as the third, the heaviest degree of immunity disturbances.
Results. It has been established that considerable deviations of immunogram indices were registered in case of severe acute pancreatitis. It was expressed in the reduction of the number of T helper cells to the third degree (T_h-3) and insignificant reduction of the suppressor T cells to the first degree (T_s-1). The reduction of the cellular component deficiency – T_h-1 T_s-1 occurred in dynamics. The indices of a phagocytal link had decreased by the 7^th day. Increase was registered at admission of IgA, the other changes in a humoral link were not revealed.
Conclusions. In the patients who had a severe acute pancreatitis, immune deficiency has been detected and cardinal changes were observed in the cellular components of the immune system. Deviations of immunogram indices have already been registered at the moment of hospital admission which could be probably connected with the secondary immunodeficiency developed earlier.

Keywords: acute pancreatitis, immunodeficiency, severe course

p. 40 – 44 of the original issue

References

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11. Mancini С, Vacrman JP, Carbonara АО, Hcrcmans JF. A single radial diffusion method for ihe immunological quantitation of proteins. Peeters H, ed. Protides of biological fluids. Amsterdam; NY: Elsevier; 1964. p. 370–73.

Address for correspondence:
660022, Rossiiskaia Federatsiia, g. Krasnoiarsk, ul. Partizana Zhelezniaka, d. 1, GBOU VPO «Krasnoiarskii gosudarstvennyi meditsinskii universitet im. prof. V.F. Voino-Iasenetskogo», kafedra obshchei khirurgii,
e-mail: Vikto-potapenk@yandex.ru,
Dunaevskaia Svetlana Sergeevna

Information about the authors:
Vinnik Y.S. Honored Scientist of the Russian Federation, MD, professor, a head of the general surgery chair of SBEE HPE “Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky”.
Dunaevskaya S.S. PhD, an associate professor of the general surgery chair of SBEE HPE “Krasnoyarsk State Medical University named after prof. V.F. Voyno- Yasenetsky”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.45   |  

F.G. NAZYROV, A.V. DEVYATOV, A.H. BABADZANOV, S.A. RAIMOV

PECULIARITIES OF DEVELOPMENT AND COURSE OF LIVER CIRRHOSIS COMPLICATIONS DEPENDING ON THE ETIOLOGICAL FACTOR

Republican Specialized Center of Surgery named after academician V.Vahidov
The Republic of Uzbekistan

Objectives. To study the peculiarities of the complications of liver cirrhosis (LC) depending on the etiological factors and to analyze the results of portosystemic shunting (PSSh) in these groups of patients.
Methods. The analysis covered the results of the PSSh in 309 cirrhotic patients with LC and portal hypertension (PH). All patients were divided into 4 groups: hepatitis “B”, “C”, HBV + HDV and chronic alcoholism.
Results. The performed analysis showed that for HBV-cirrhosis and especially for its combination with HDV-infection, a high incidence of clinically diagnosed hepatic encephalopathy and ascitic syndrome are considered to be the most typical. In turn, in case of HCV-cirrhosis and negative viral markers the risk of bleeding from the esophageal and gastric varices (EGV) predominates.
Conclusions. For HBV-cirrhosis and particularly for its combination with HDV-infection, high frequency of clinically diagnosed hepatic encephalopathy (24,7% and 33,3%) and ascitic syndrome (65,9% and 71,8%) are considered to be the most typical, while the incidence of bleeding from EGV is 53,8% and 56,4%, respectively. In turn, if HCV-cirrhosis and negative viral markers, clinical stages of hepatic encephalopathy detected in 18,9% and 20%, ascites in 47,2% and 45,7%, but the risk of bleeding reaches 71,7% and 51,4%, respectively. In cirrhotic patients HBV and HBV+HDV-etiology after PSSh the highest risk of developing liver failure (9,9-15,4%) and encephalopathy (63,4-84,2%) has been registered and the mortality rate reaches 3,3-5,1%. In case of HCV etiology cirrhosis surgery also contributes to poor functional status of hepatocytes, but the development of liver failure and encephalopathy is observed 1,5-2 folds rarely than in case of HBV and HBV + HDV-cirrhosis.

Keywords: viral hepatitis, liver cirrhosis, portal hypertension, bleeding from esophageal and gastric varices, portosystemic shunting

p. 45 – 50 of the original issue

References

1. Sadovnikova II. Tsirrozy pecheni. Voprosy etiologii, patogeneza, kliniki, diagnostiki, lecheniia [Cirrhosis of the liver. The etiology, pathogenesis, clinical manifestations, diagnosis, treatment]. RMZh. Pril: Bolezni Organov Pishchevareniia. 2003;5(2):37–42.
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Address for correspondence:
100115, Respublika Uzbekistan, g. Tashkent, ul. Farkhadskaia, d. 10, Respublikanskii spetsializirovannyi tsentr khirurgii im. akad. V. Vakhidova, otdelenie khirurgii portal'noi gipertenzii i pankreatoduodenal'noi zony,
e-mail: azam746@mail.ru,
Babadzhanov Azam Khasanovich

Information about the authors:
Raimov S.A. An applicant for Doctor’s degree of the department of portal hypertension and pancreatoduodenal zone, Republican Specialized Center of Surgery named after academician V. Vahidov.
Babadzanov A.H. PhD, a senior researcher of the department of portal hypertension and pancreatoduodenal zone, Republican Specialized Center of Surgery named after academician V. Vahidov.
Devyatov A.V. MD, professor, a chief researcher of the department of portal hypertension and pancreatoduodenal zone, Republican Specialized Center of Surgery named after academician V. Vahidov.
Nazyrov F. G. Honored Worker of Public health care of the Republic of Uzbekistan, MD, professor, Academician of the Russian Academy of Natural Sciences, director of Republican Specialized Center of Surgery named after academician V. Vahidov, a head of the department of surgery of liver, biliary ducts, pancreatoduodenal zone and portal hypertension, vice-president of the Association of surgeons- hepatologists of CIS.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.51   |  

V.JA. KHRYSHCHANOVICH¹, S.I. TRETYAK¹, I.P. KLIMCHUK², A.D. AVDIEVICH², A.V. ROMANOVICH², E.R. SHAGISULTANOV², G.A. POPEL³, A.V. BOLSHOV¹, G.V. GERASIMOVICH¹

RUPTURE OF ABDOMINAL AORTIC ANEURISM: PROGNOSTIC FACTORS OF MORTALITY

EE “Belarusian State Medical University” ¹,
ME “The 4th city clinical hospital named after N.E. Savchenko”², Minsk,
SEE “Belarusian Medical Academy of Postgraduate Education” ³,
The Republic of Belarus

Objectives. To analyze the prognostic factors influencing the postoperative mortality in patients with the ruptured of abdominal aortic aneurysm (AAA).
Methods. Thirty-nine patients operated for the rupture of AAA in Minsk city center of the vascular surgery within the period between 2007 up to January, 31, 2012 were included in the research. The retrospective analysis of the potential predictors of mortality was carried out: age, anamnesis, aneurysm diameter, creatinine and hemoglobin levels, systolic blood pressure, postoperative diuresis, transfusion volume, aortic clamping and surgery duration, type of reconstruction.
Results. General mortality rate made up 48%. An average age of all patients made up 70,7±6,8 years, the patients who died – 73±6,5 years. Previous history of the abdominal aortic aneurysm was present in 15 patients (42%) and the abdominal pain and pulsatile abdominal mass – in 100% of cases. Concentration of creatinine and hemoglobin levels, systolic blood pressure findings, postoperative daily volume of diuresis, intraoperative transfusion volume, type of surgery and its duration; hemoglobin level didn’t influence reliably the mortality rate data (p>0,05). The patient’s age > 80 years, aortic clamping duration > 80 min, aneurysm diameter > 9 cm, anuria before operation, anamnesis were the reliable prognostic factors of mortality in patients operated for AAA rupture.
Conclusions. Early diagnostics, timeous planned surgery of AAA are considered to be the most effective approaches in reduction of the mortality rate. Patients with the clinical triad: the abdominal pain and/or back pain, pulsatile mass in the abdomen and hypotension are indicated the immediate surgery.

Keywords: abdominal aortic aneurysm, ruptured aneurysm, mortality, prognosis of mortality, factors of mortality

p. 51 – 56 of the original issue

References

1. Wakefield TW, Whitehouse WM Jr, Wu SC, Zelenock GB, Cronenwett JL, Erlandson EE, Kraft RO, Lindenauer SM, Stanley JC. Abdominal aortic aneurysm rupture: statistical analysis of factors affecting outcome of surgical treatment. Surgery. 1982 May;91(5):586–96.
2. Ashton HA, Buxton MJ, Day NE, Kim LG, Marteau TM, Scott RA, Thompson SG, Walker NM. The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet. 2002 Nov 16;360(9345):1531–39.
3. Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, van Herwaarden JA, Holt PJ, van Keulen JW, Rantner B, Schlosser FJ, Setacci F, Ricco JB. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. 2011 Jan;41(Suppl 1):S1–S58.
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10. Boyle JR, Gibbs PJ, King D, Shearman CP, Raptis S, Phillips MJ. Predicting outcome in ruptured abdominal aortic aneurysm: a prospective study of 100 consecutive cases. Eur J Vasc Endovasc Surg. 2003 Dec;26(6):607–11.
11. Hatori N, Yoshizu H, Shimizu M, Hinokiyama K, Takeshima S, Kimura T, Iizuka Y, Tanaka S. Prognostic factors in the surgical treatment of ruptured abdominal aortic aneurysms. Surg Today. 2000;30(9):785–90.
12. Crawford ES, Saleh SA, Babb JW 3rd, Glaeser DH, Vaccaro PS, Silvers A. Infrarenal abdominal aortic aneurysm: factors influencing survival after operation performed over a 25-year period. Ann Surg. 1981 Jun;193(6):699–09.
13. Johansson G, Swedenborg J. Ruptured abdominal aortic aneurysms: a study of incidence and mortality. Br J Surg. 1986 Feb;73(2):101–03.
14. Bauer EP, Redaelli C, von Segesser LK, Turina MI. Ruptured abdominal aortic aneurysms: predictors for early complications and death. Surgery. 1993 Jul;114(1):31–35.
15. Hechelhammer L, Lachat ML, Wildermuth S, Bettex D, Mayer D, Pfammatter T. Midterm outcome of endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg. 2005 May;41(5):752–57.

Address for correspondence:
220116 Respublika Belarus', g. Minsk, prospekt Dzerzhinskogo, 83, UO «Belorusskii gosudarstvennyi meditsinskii universitet» 2-ia kafedra khirurgicheskikh boleznei,
e–mail: vladimirkh77@mail.ru
Khryshchanovich Vladimir Yanovich

Information about the authors:
Khryshchanovich V.Ja. PhD, an associate professor of the 2nd chair of surgical diseases of EE “Belarusian State Medical University”.
Tretyak S.I. MD, professor, Head of the 2nd chair of surgical diseases of EE “Belarusian State Medical University”.
Klimchuk I.P. PhD, a Head of the phlebology and vascular surgery department of ME “The 4th city clinical hospital named after N.E. Savchenko”.
Avdievich A.D. An angiosurgeon of ME “The 4th city clinical hospital named after N.E. Savchenko”.
Romanovich A.V. An angiosurgeon of ME “The 4th city clinical hospital named after N.E. Savchenko”.
Shagisultanov E.R. An angiosurgeon of ME “The 4th city clinical hospital named after N.E. Savchenko”.
Popel G.A. An assistant of the surgery chair of SEE “Belarusian Medical Academy of Postgraduate Education”.
Bolshov A.V. PhD, an assistant of the 2nd chair of surgical diseases of EE “Belarusian State Medical University”.
Gerasimovich G.V. A 6-year student of EE “Belarusian State Medical University”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.57   |  

A.A. SHLYAKOVA, K.G. KORNEVA, M.N. KUDYKIN, L.G. STRONGIN

PECULIARITIES OF CHRONIC VENOUS INSUFFICIENCY COURSE IN PATIENTS WITH DIABETES MELLITUS TYPE 2

SBEE HPE "Nizhny Novgorod State Medical Academy"
The Russian Federation

Objectives. To determine the peculiarities of course of the lower limbs chronic venous insufficiency (CVI) in patients with type 2 diabetes mellitus (DM).
Methods. 45 patients with CVI of the lower limbs have been examined, 19 patients with type 2 DM compose the main group, and 26 patients without type 2 DM – the control group. The leading clinical syndrome of CVI (edema, leg pain, varicose and trophic changes) has been assessed according to the 10-point visual analog scale (VAS). Presence and intensity of the diabetic polyneuropathy (DPN) was evaluated with the following scales: “Neuropathic Dysfunctional Account” (NDA), “Neuropathic Symptomatic Score” (NSS). All patients underwent ultrasound triplex scanning (USTS) of the veins and arteries of the lower extremities.
Results. In patients with type 2 DM the severe degree of CVI was revealed. In assessing diabetic polyneuropathy (DPN) reliable differences according to the NDA and NSS scales have been detected that testify to the presence of DPN in the patients with type 2DM. The leading clinical signs in patients with type 2 DM was edematous changes (52,6%), pain syndrome – in the control group (50%). In evaluation with a visual analog scale (VAS) the edematous syndrome (5,1±1,5) and trophic changes (4,8±3,6) prevailed in the main group. In USTS of the lower limb vessels in the patients with type 2 DM inconsistency of the saphenofemoral junction and perforating veins of various locations as well as the signs of atherosclerosis of the lower limbs were found. Positive correlation between the duration of type 2 DM and the severity of CVI in patients with macroangiopathy of lower limbs has been revealed.
Conclusions. Type 2 diabetes mellitus was found out to aggravate the course of chronic venous insufficiency of the lower extremities. Clinical and ultrasound features of the CVI course in patients with type 2 diabetes have been determined.

Keywords: chronic venous insufficiency, type 2 diabetes mellitus, diabetic macroangiopathy, diabetic polyneuropathy

p. 57 – 61 of the original issue

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6. Florea I, Loredana ES, Tolea I. Chronic Venous Insufficiency – Clinical-Evolutional Aspects. Current Health Sci J. 2011;37(1):21–25.
7. Stuard S, Cesarone MR, Belcaro G, Dugall M, Ledda A, Cacchio M, Ricci A, Ippolito E, Di Renzo A, Grossi MG. Five-year treatment of chronic venous insufficiency with O-(?-hydroxyethyl)-rutosides: safety aspects. Int J Angiol. 2008 Fall;17(3):143–48.
8. Eklof B. Revision of the CEAP classification. Medicographia. 2006;28(2):175–80.
9. Eklof B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, Meissner MH, Moneta GL, Myers K, Padberg FT, Perrin M, Ruckley CV, Smith PC, Wakefield TW. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004 Dec;40(6):1248–52.
10. Young MJ, Boulton AJ, MacLeod AF, Williams DR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993 Feb;36(2):150–54.
11. Ziegler D, Hanefeld M, Ruhnau KJ, Hasche H, Lobisch M, Schutte K, Kerum G, Malessa R. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study). ALADIN III Study Group. Alpha-Lipoic Acid in Diabetic Neuropathy. Diabetes Care. 1999 Aug;22(8):1296–01.
12. Ziegler D, Ametov A, Barinov A, Dyck PJ, Gurieva I, Low PA, Munzel U, Yakhno N, Raz I, Novosadova M, Maus J, Samigullin R. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care. 2006 Nov;29(11):2365–70.

Address for correspondence:
603005, Rossiiskaia Federatsiia, g. Nizhnii Novgorod, pl. Minina i Pozharskogo, d. 10/1, GBOU VPO «Nizhegorodskaia gosudarstvennaia meditsinskaia akademiia», kafedra endokrinologii i vnutrennikh boleznei,
e-mail: anna.shlyakova@mail.ru,
Shliakova Anna Andreevna

Information about the authors:
Shlyakova A.A. A post-graduate student of endocrinology and internal diseases chair of SBEE HPE “Nizhny Novgorod State Medical Academy”.
Korneva K.G. PhD, associate professor of endocrinology and internal diseases chair of SBEE HPE “Nizhny Novgorod State Medical Academy”.
Kudykin M.N. MD, professor of the extreme surgery chair of SBEE HPE “Nizhny Novgorod State Medical Academy”.
Strongin L.G. MD, professor, a head of endocrinology and internal diseases chair of SBEE HPE “Nizhny Novgorod State Medical Academy”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.62   |  

S.N. EROSHKIN

THE LONG-TERM TREATMENT RESULTS OF PYONECROTIC FORMS OF DIABETIC FOOT SYNDROME DEPENDING ON THE USED METHODS OF REVASCULARIZATION

EE “Vitebsk State Medical University”
The Republic of Belarus

Objectives. To compare the long-term treatment results of patients with pyonecrotic forms of diabetic foot syndrome (DFS) at applying of various methods of improving the peripheral blood flow in the lower extremities (medical, direct and indirect revascularization).
Methods. The results of treatment of 100 patients with pyonecrotic forms of DFS have been analyzed; various methods of revascularization have been applied: medical one (n=47); percutaneous balloon angioplasty (PBA) (n=35); revascularizing osteotrepanation (ROT) of the tibia in the manner of F.N. Zusmanovich (n=18). Critical ischemia of the lower limb was confirmed by the results of duplex ultrasound angioscanning and angiography. The main clinical efficacy criterion was considered to be the number of the lower limb amputations performed above the knee joint.
Results. 12 months after the beginning of observation the application of χ² criterion showed a significant increase of the frequency of high amputations of the lower limb in the group of patients treated with a conservative method in comparison with patients undergoing angioplasty (p=0,011) while in relation to the group of patients undergoing ROT the increase of the frequency of amputations turned out to be unreliable (p=0,067). During the inspection 24 months after the start of observation there was a reliable increase of the frequency of high limb amputation in patients receiving only conservative treatment with the respect as to the second group (p=0,023) and the third one (p=0,043).
Conclusions. Conservative treatment efficacy aimed to improve the lower limb blood flow at DFS remains rather low in the long-term period. The optimal method of limb revascularization at the pyonecrotic forms of DFS is percutaneous balloon angioplasty (PBA). However, 2 years after the beginning of observation the number of high amputations in the endovascular angioplasty and revascularizing osteotrepanation (ROT) become comparable. The frequency of amputations in the long-term period after ROT was significantly lower than after the conservative treatment. In cases of impossibility of percutaneous balloon angioplasty performance the revascularizing osteotrepanation is justified for the limb revascularization.

Keywords: diabetic foot syndrome, revascularizing osteotrepanation, high amputations, operations of the foot, percutaneous balloon angioplasty

p. 62 – 70 of the original issue

References

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13. Sumpio BE, Armstrong DG, Lavery LA, Andros G. The role of interdisciplinary team approach in the management of the diabetic foot: a joint statement from the Society for Vascular Surgery and the American Podiatric Medical Association. J Vasc Surg. 2010 Jun;51(6):1504–06.
14. Krivoshchekov EP, Tsimbalist DA, Nemchenko IA, Dmitrieva IA. Rezul'taty lecheniia bol'nykh s distal'nymi formami ateroskleroza nizhnikh konechnostei. Fundam Issledovaniia [The results of treatment of patients with distal forms of atherosclerosis of the lower extremities]. Med Nauki. 2011;(11):519–21.

Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr-t. Frunze, d. 27, UO «Vitebskii gosudarstvennyi meditsinskii universitet», kafedra gospital'noi khirurgii s kursami urologii i detskoi khirurgii,
e-mail: eroshki@rambler.ru,
Eroshkin Sergei Nikolaevich

Information about the authors:
Eroshkin S.N. An assistant of the hospital surgery chair with the course of urology and pediatric surgery of EE “Vitebsk State Medical University”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.71   |  

B.S. SUKOVATIH¹, YU.YU. BLINKOV¹, P.A. IVANOV²

THE COMBINED SURGICAL AND LAPAROSCOPIC TREATMENT OF THE GENERALIZED PERITONITIS

SBEE HPE “Kursk State Medical University” ¹,
Regional Budgetary Medical Establishment "Municipal Clinical Emergency Hospital" ², Kursk, The Russian Federation

Objectives. To improve the treatment results of patients with the generalized purulent peritonitis by optimizing video-laparoscopic technology of the abdominal cavity sanitation.
Methods. The results of the complex diagnostic examination and treatment of 90 patients with the generalized peritonitis have been analyzed. The first group included 49 patients who underwent the two-staged surgical treatment during the period of 2001-2006 years. At the first stage the patients were subjected to the surgical intervention, at the second stage in 24-48 hours after surgery the programmed video-laparoscopic sanitations of the abdominal cavity by the traditional technique have been performed. The aqueous sodium hypochlorite solution (0,03%) was used for the sanitation. The second group included 41 patients who were treated during the period of 2007-2012 years. The abdominal cavity was treated with the pulsating stream of antiseptic with addition of 200 ml of the immobilized form of sodium hypochlorite in 5% sodium carboxymethyl-cellulose gel during the endoscopic sanitation which is a distinctive feature of treatment method in the first group. The efficacy of treatment was evaluated according to the dynamics of the systemic endotoxicosis parameters, the degree of bacterial contamination of the abdominal cavity, the severity of violations of the bowel motor-evacuation function, the number of postoperative complications and mortality rate.
Results. At hospitalization the abdominal sepsis without the signs of multiple organ failure has been detected in all patients. The use of the original technique of the abdominal cavity sanitation lets to reduce the indicators of endotoxemia in 1,5 folds in the recent post-operative period, improve bowel evacuation function in 2 folds. The number of the recent postoperative complications has decreased by 16,8% and the mortality rate decreased by 9,4%.
Conclusion. The combined surgical and endoscopic method of treatment of peritonitis is pathogenetically substantiated and effective.

Keywords: generalized purulent peritonitis, laparoscopic sanitation, pulsating stream, immobilized form of sodium hypochlorite

p. 71 – 77 of the original issue

References

1. Eriukhin IA, Gel'fand BR, Shliapnikov SA. Khirurgicheskie infektsii [Surgical infections]: ruk. Saint-Petersburg, RF: Piter; 2003. 864 p.
2. Savel'ev BC, Gel'fand BR, Filimonov MI. Peritonit [Peritonitis]. Moscow, RF: Litera; 2006. 206 p.
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4. Sazhin VP, Avdovenko AP, Iurishchev VA. Sovremennye tendentsii khirurgicheskogo lecheniia peritonita [Modern trends in the surgical treatment of peritonitis]. Khirurgiia Zhurn im NI Pirogova. 2007;(11):36–39.
5. Zubarev PN, Vrublevskii NM, Danilin VI. Sposoby zaversheniia operatsii pri peritonite [Methods of completing the operation for peritonitis]. Vestn Khirurgii im II Grekova. 2008;167(6):110–13.
6. Sukovatykh BS, Blinkov IuIu, Bukreeva AE, Eshtokin SA, Ivanov PA. Lechenie rasprostranennogo peritonita [Treatment of generalized peritonitis]. Khirurgiia Zhurn im NI Pirogova. 2012;(9):42–47.
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11. Kosul'nikov SO, Karpenko SI, Tarnapol'skii SA, Kravchenko KV. Vybor saniruiushchikh rastvorov i metodov ushivaniia briushnoi stenki pri razlitom gnoinom peritonite [Selection of sanitizing solutions and methods for of the abdominal wall closure in generalized acute peritonitis]. Ukr Zhurn Khirurgii. 2009;(3):95–98.
12. Iakovlev SV, Kozlov RS, Gel'fand EB, Sidorenko SV, Popov TV. Antimikrobnaia terapiia peritonita [Antimicrobial treatment of peritonitis]. Infektsii v Khirurgii. 2007; 5(4):10–14.
13. Sukovatykh BS, Ivanov PA, Blinkov IuIu. Sposob lecheniia rasprostranennogo fibrinozno-gnoinogo peritonita [The method of treatment for generalized fibrinopurulent peritonitis]: patent RF, A61M 1/28; zaiavitel' Kursk. gos. un-t; №2438716; zaiavl. 15.07.2012; opubl. 10.01.2012. Ofits Biul. Izobreteniia Poleznye modeli. 2012;(1). 5 p.
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15. Sigel B, Golub RM, Loiacono LA, Parsons RE, Kodama I, Machi J, Justin J, Sachdeva AK, Zaren HA. Technique of ultrasonic detection and mapping of abdominal wall adhesions. Surg Endosc. 1991; 5(4):161–65.

Address for correspondence:
305041, Rossiiskaia Federatsiia, g. Kursk, ul. K. Marksa, d. 3, GBOU VPO «Kurskii gosudarstvennyi meditsinskii universitet», kafedra obshchei khirurgii,
e-mail: SukovatykhBS@kursksmu.net,
Sukovatykh Boris Semenovich

Information about the authors:
Sukovatih B.S. MD., professor, a head of the general surgery chair of SBEE HPE “Kursk State Medical University”.
Blinkov Yu.Yu. PhD, An associate professor of the general surgery chair of SBEE HPE “Kursk State Medical University”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.78   |  

A.G. SALMANOV ¹, V.F. MARIEVSKY²

ANTIBIOTIC RESISTANCE OF NOSOCOMIAL STRAINS OF STAPHYLOCOCCUS AUREUS IN THE UKRAINE: THE RESULTS OF MULTICENTER STUDY

State Sanitary and Epidemiological Department of the Ukraine¹
SE «Institute of Epidemiology and Infectious Diseases named after L.V.Gromashevsky of National Academy of Medical Siences of the Ukraine²», Kiev,
The Ukraine

Objectives. To study the activity of antimicrobials against clinical strains of S.aureus isolated in the surgical hospitals of different regions of the Ukraine.
Methods. The clinical strains of S.aureus (119041) isolated in 2008-2012 yrs in 97 surgical hospitals of 27 regions of the Ukraine have been studied. Clinical isolates were allocated and identified in 83 microbiological laboratories included in the research of medical establishments. The material for the epidemiological study was the data of the laboratory journals of the examined surgical hospitals of the Ukraine. S.aureus susceptibility to 37 antibiotics was investigated by the disc-diffusion test in accordance with the recommendations of the National Committee for Clinical laboratory Standards (NCCLS).
Results. The highest activity to S.aureus had linezolid, imipenem, vancomycin, meropenem, ceftriaxone, ciprofloxacin, netilmicin, gatifloxacin, and cefotaximum. The high rates of resistance were registered for penicillin (48,3%), ampicillin (41,2%), tetracycline (40,1%), ampicillin/sulbactam (35,2%), and to lincomycin (34,5%). The frequency of isolation of MRSA among tested strains was 33,8% varying from 20,7% to 55,8% in surgical hospitals of different regions.
Conclusions. Antibiotic resistance to S.aureus in surgical hospitals, being a subject of the research is considered to be a serious therapeutic and epidemiologic problem. Taking into account the constant changes and significant differences of the S.aureus resistance levels observed in various regions, the constant monitoring of antibiotic resistance to antimicrobials in every in-patient medical institution is required and on the base of the local obtained results to elaborate the hospital record sheets. Antibiotics application tactics should be determined in accordance with the local data of resistance to them in each surgical in-patient institution. The system of epidemiologic surveillance over microbial resistance should be established on the local, regional, and national levels.

Keywords: Staphylococcus aureus, antimicrobial resistance, surgery, nosocomial infections, MRSA

p. 78 – 83 of the original issue

References

1. Suggested citation: European Centre for Disease Prevention and Control. Surveillance of surgical site infections in Europe, 2008–2009. Stockholm: ECDC; 2012. Available from: http://www.ecdc.europa.eu.
2. The evolving threat of antimicrobial resistance – Options for action. Geneva, SW: World Health Organization; 2012. Available from: http://www.who.int.
3. European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2011. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2012. Available from: http://ecdc.europa.eu.
4. Salmanov A. Surgical site infections and antibiotic resistance of causal agents in the hospitals of Kiev, Ukraine. EpiNorth. 2009;10(3):120–27.
5. Fry DE. The continued challenge of Staphylococcus aureus in the surgical patient. Am Surg. 2013 Jan;79(1):1–10.
6. Takesue Y, Watanabe A, Hanaki H, Kusachi S, Matsumoto T, Iwamoto A, Totsuka K, Sunakawa K, Yagisawa M, Sato J, Oguri T, Nakanishi K, Sumiyama Y, Kitagawa Y, Wakabayashi G, Koyama I, Yanaga K, Konishi T, Fukushima R, Seki S, Imai S, Shintani T, Tsukada H, Tsukada K, Omura K, Mikamo H, Takeyama H, Kusunoki M, Kubo S, Shimizu J, Hirai T, Ohge H, Kadowaki A, Okamoto K, Yanagihara K. Nationwide surveillance of antimicrobial susceptibility patterns of pathogens isolated from surgical site infections (SSI) in Japan. J Infect Chemother. 2012 Dec;18(6):816–26.
7. Li H, Yu DL, Ren L, Zhong L, Peng ZH, Teng MJ. Analysis of Gram-positive bacterial infection in patients following liver transplantation. Chin Med J (Engl). 2012 Jul;125(14):2417–21.
8. Cheong CS, Tan LM, Ngo RY. Clinical audit of the microbiology of otorrhoea referred to a tertiary hospital in Singapore. Singapore Med J. 2012 Apr;53(4):244–48.
9. Gagliotti C, Balode A, Baquero F, Degener J, Grundmann H, Gur D, Jarlier V, Kahlmeter G, Monen J, Monnet DL, Rossolini GM, Suetens C, Weist K, Heuer O. Escherichia coli and Staphylococcus aureus: bad news and good news from the European Antimicrobial Resistance Surveillance Network (EARS-Net, formerly EARSS), 2002 to 2009. Euro Surveill. 2011 Mar 17;16(11). pii: 19819.
10. Salmanov AG, Lazorishchinets' VV, Marієvs'kii VF. Antibіotikorezistentnіst' klіnіchnikh shtamіv Staphylococcus aureus v khіrurgіchnikh statsіonarakh Ukraїnі v 2010 r [Antibiotic resistance of Staphylococcus aureus strains in surgical hospitals in Ukraine in 2010]. Khіrurgіia Ukraїnі. 2011;(3):26–31.
11. Marієvs'kii VF, Poliachenko IuV, Salmanov AG, Shpak ІV, Doan SІ. Antibіotikorezistentnіst' nozokomіal'nikh shtamіv Staphylococcus aureus v khіrurgіchnikh statsіonarakh Ukraїni v 2009 r [Antibiotic resistance of nosocomial Staphylococcus aureus strains in surgical hospitals in Ukraine in 2009 ]. Klіnіchna khіrurgіia. 2010;(9):31–35.
12. National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing; Twelfth informational supplement. NCCLS. Document M100 S4. 2002;22(1).

Address for correspondence:
01601, Ukraina, g. Kiev, ul. Grushevskogo, d. 7, Gosudarstvennaia sanitarno-epidemiologicheskaia sluzhba Ukrainy,
e-mail: moz.sag@bigmir.net,
Salmanov Aidyn Gurbanovich

Information about the authors:
Salmanov A.G. PhD, a chief specialist of State Sanitary and Epidemiological Department of the Ukraine.
Marievsky V.F. MD, professor, a head of laboratory of disinfectology of SE “Institute of Epidemiology and Infectious Diseases named after L.V.Gromashevsky of NAMS of the Ukraine”.

Article in the .pdf format

ONCOLOGY

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.84   |  

A.V. RUSYN, A.V. IGNAT, V.I. RUSYN, S.M. CHOBEY, K.Y. RUMYANTSEV, O.T. DEVINYAK

RECTAL CANCER – ESTIMATION OF THE QUALITY LIFE IN PATIENTS AFTER RADICAL SURGERY

SHEE "Uzhhorod National University",
The Ukraine

Objectives. To estimate the quality of life after sphincter-preserving operations (SPO) and after the extirpation of the rectum (RE).
Methods. The quality of life was estimated using the American Society of Colorectal Surgeons questionnaire (ASCRS) with the Cleveland Clinic scale of incontinence included. Questionnaires were sent out consequentially – 6 months and 1 year after the surgery. The questionnaires of patients who responded both to the first and the second request have been taken into consideration: after SPO – 47 questionnaires, after RE – 30.
Results. In the period up to 6 months after the SPO the patients with significant or full fecal incontinence dominated (72,4%). Up to 1 year the number of them decreased up to 29,8%, and a good continence was observed in 48,9% of patients after SPO. The proportion of such patients increased up to 4,6 folds, compared to 6 months period. Up to 6 months after the SPO the patients with severe and very severe violations of life quality dominated (70,3%). During the same period after the RE the patients with mild and moderate violations of the quality of life were dominated (73,4%). However, up to the 1^st year after SPO the quality of life has improved the patients with mild and moderate degree of disturbance has dominated (80,9%).
Conclusion. The quality of continence after SPO improves with increasing time after the intervention: up to 6 months a significant and full fecal incontinence prevails, but up to 1 year almost 50% of patients have a good result. After extirpation of the rectum the quality of life improves faster than after sphincter-preserving operations, but over time after SPO the number of patients with mild violations of the quality of life is reliably 3 folds higher. The conducted studies demonstrated the advantage of the SPO in rectal cancer to improve the quality of life.

Keywords: colorectal cancer, surgical treatment, sphincter preserving operations, extirpation of the rectum, continence, quality of life

p. 84 – 89 of the original issue

References

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4. Gezen C, Altuntas YE, Kement M, Aksakal N, Okkabaz N, Vural S, Oncel M. Laparoscopic and conventional resections for low rectal cancers: a retrospective analysis on perioperative outcomes, sphincter preservation, and oncological results. J Laparoendosc Adv Surg Tech. 2012 Sep; 22(7):625–30.
5. Warschkow R, Steffen T, Thierbach J, Bruckner T, Lange J, Tarantino I. Risk factors for anastomotic leakage after rectal cancer resection and reconstruction with colorectostomy. A retrospective study with bootstrap analysis. Ann Surg Oncol. 2011 Oct;18(10):2772–82.
6. Nishioka M, Shimada M, Kurita N, Iwata T, Morimoto S, Yoshikawa K, Higashijima J, Miyatani T. Clinicopathological analysis of distal margin for rectal cancer after preoperative chemoradiation therapy. Hepatogastroenterology. 2012 Oct;59(119):2142–46.
7. Moreno-Sanz C, Manzanera-Dнaz M, Clerveus M, Cortina-Oliva FJ, de Pedro-Conal J, Picazo-Yeste J. Pelvic reconstruction after abdominoperineal resection of the rectum. Cir Esp. 2011 Feb;89(2):77–81.
8. Kim JC, Kim CW, Yoon YS, Lee HO, Park IJ. Levator-sphincter reinforcement after ultralow anterior resection in patients with low rectal cancer: the surgical method and evaluation of anorectal physiology. Surg Today. 2012 Jun;42(6):547–53.
9. Bryant CL, Lunniss PJ, Knowles CH, Thaha MA, Chan CL. Anterior resection syndrome. Lancet Oncol. 2012;13(9):e403–8.
10. Sunesen KG, Norgaard M, Lundby L, Havsteen H, Buntzen S, Thorlacius-Ussing O, Laurberg S. Cause-specific colostomy rates after radiotherapy for anal cancer: a Danish multicentre cohort study. J Clin Oncol. 2011 Sep 10;29(26):3535–40.
11. Rockwood TH, Church JM, Fleshman JW, Kane RI, Mavrantonis C, Thorson AG, Wexner SD, Bliss МD, Lowry AС. Fecal Incontinence Quality of Life Scale. Quality of Life Instrument for Patients with Fecal Incontinence; American Society of Colon and Rectal Surgeons. Available from: http://www.fascrs. org.
12. Cleveland Clinic Incontinence Score. Available from: www.uhs.nhs.uk.

Address for correspondence:
88018, Ukraina, g. Uzhgorod, ul. Pobedy, d. 22, Zakarpatskaia oblastnaia klinicheskaia bol'nitsa im. A. Novaka, kafedra khirurgicheskikh boleznei meditsinskogo fakul'teta GVUZ «Uzhgorodskii natsional'nyi universitet»,
e-mail: rusinkafedra@gmail.com,
Rusin Vasilii Ivanovich

Information about the authors:
Rusyн A.V. MD, professor, a head of oncology chair of the medical faculty of SHEE "Uzhhorod National University".
Ignat A.V. A post-graduate student of oncology chair of the medical faculty of SHEE "Uzhhorod National University".
Rusyn V.I. MD, professor, a head of the surgical diseases chair of the medical faculty of SHEE "Uzhhorod National University".
Chobey S.M. MD, professor of the surgical diseases chair of the medical faculty of SHEE "Uzhhorod National University".
Rumyantsev K.E. PhD, an associate professor of the surgical diseases chair of the medical faculty of SHEE "Uzhhorod National University".
Devinyak O.T. An assistant of the pharmaceutical disciplines chair of the medical faculty of SHEE "Uzhhorod National University".

Article in the .pdf format

NEW METHODS

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.90   |  

M.D. LEVIN ¹, J.G. DEGTYAROV ², V.I. AVERIN ², I.F. ABU-VARDA ³ , T.M.BOLBAS ⁴

STANDARDIZATION OF RADIOLOGICAL EXAMINATION OF THE COLON AND ANORECTAL AREA

Geriatric center, NETANYA, ISRAEL,
EE “Belarusian State Medical University” ²,
SBE “Belarusian Medical Academy of Postgraduate Education” ³,
ME "The 1^st Municipal Clinical Hospital", Minsk ⁴, The Republic of Belarus

Objectives. To modify the irrigoscopy method and using it to determine the normal parameters of the colon and rectum as well as the anal cannel in different age groups. To determine the changes of these parameters at anorectal anomalies and chronic constipations.
Methods. The proposed method was performed in 501 patients, including 65 children without abnormalities of the colon and rectum, but with abdominal pain or volume formation in the abdominal cavity. A chronic constipation is considered to be a reason for the examination in 436 patients (356 children and 80 patients older than 65 years). Modification of irrigoscopy differs from the usual barium enema by placing of radiopaque marker near the anus; it permitted to measure the length of the anal canal. Contrast medium was introduced prior to the reflux start into the ileum; it allowed measuring the colon volume.
Results. The maximal widths of the rectum and various segments of the colon, length of the anal canal and volume of the colon have been measured in 65 children of different age without any pathology of the anorectal zone. The obtained parameters have been taken as an age-specific norm. The shortening of the roentgen-negative distance between the rectum and the marker near the anus was found in the patients with abnormal puborectal function.
Conclusions. Standardization of irrigoscopy has allowed to calculate the normal parameters of the rectum, all segments of the colon and the volume of the colon in different age groups. Up to present the obtained data are considered to be the exclusive criteria in the world literature. The use of radiopaque marker near the anus permits to determine the length of the anal canal in norm and to assess the puborectal function in various pathological states. The proposed method can dramatically increase the accuracy of the diagnosis without increasing the radiation dose in comparison with conventional irrigoscopy. This technique is equally applicable in both children and adult patients.

Keywords: irrigoscopy, rectal width, puborectalis, constipation, anorectal anomalies

p. 90 – 98 of the original issue

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Address for correspondence:
Amnon ve-Tanar, 1/2, 42202, Netanya, Israel Geriatricheskii tsentr,
e-mail: nivel70@hotmail.com,
Levin Mikhail Davydovich

Information about the authors:
Levin M.D. MD, a radiologist of the state geriatric center, Netanya, Israel.
Degtyarov J.G. PhD, an associate professor of the pediatric surgery chair of SEE “Belarusian Medical Academy of Postgraduate Education”.
Averin V.I. MD, professor, a head of the pediatric surgery chair of SEE “Belarusian Medical Academy of Postgraduate Education”.
Abu-Varda I.F. PhD, an associate professor of the pediatric surgery chair of SEE “Belarusian Medical Academy of Postgraduate Education”.
Bolbas T.M. A radiologist of ME “The 1st city clinical hospital”, Minsk.

Article in the .pdf format

INFORMATION TECHNOLOGIES IN SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.99   |  

L.K. KULIKOV¹, N.M. BYKOVA², U.A. PRIVALOV¹, V.F. SOBOTOVICH¹, A.A. SMIRNOV¹

DIFFERENTIAL DIAGNOSTICS OF SYMPTOMATIC ARTERIAL HYPERTENSION AT ADRENAL TUMORS

SBEE APE “Irkutsk State Medical Academy of Post-Graduate Education” ¹,
MAME “City Clinical Hospital №10”, Irkutsk²,
The Russian Federation

Objectives. To study efficiency of differential diagnostics of the secondary arterial hypertension in patients with the revealed adrenal tumors by means of the mathematical device of artificial neural networks (ANN).
Methods. 174 patients’ cards (56 males and 118 females, the age of 16-74 yrs.) with adrenal incidentalomas combined with arterial hypertension have been investigated. 57 patients out of 174 were operated on. In 26 patients (45,6%) the primary aldosteronism was diagnosed, in 14 (24,6%) – corticosteromas, in 13 (22,8%) – catecholamine-secreting tumors, and only in 4 (7%) – hormonally inactive tumors. Out of 117 patients who were subjected to the dynamic observation within a period of 1 to 15 years, 14 – were operated on after an additional examinations of clinical, laboratory signs of hormonal activity as well as the worked out method of the differential diagnostics of the symptomatic arterial hypertension.
Results. To diagnose the symptomatic arterial hypertension in patients with accidentally revealed adrenal tumors (incidentalomas) 35 signs have been singled out and divided into 2 groups. The first group included the signs characterized by the quantitative parameters. The second group included the information about a patient expressed in medical terms and concepts coded in figures. The established diagnoses in patients with symptomatic arterial hypertension of adrenal genesis were coded as the figures too. For forecasting the artificial neural networks (ANN) was created for each patient with the symptomatic arterial hypertension. For current forecasting the card of a definite patient was filled in with the coded information. The result of the forecast was seen on the monitor as a figure which was compared with the presumable results. The difference of obtained results less than 0,5 indicated that diagnosis of the symptomatic arterial hypertension in patients with incidentalomas is considered to be probable.
Conclusions. The accuracy of the worked out method is 92,9%, sensitivity – 79,1%, specificity – 96,2%. The received result of the decision of an “artificial intellect” can be considered to be as additional criteria to determine the treatment tactics of this category of patients.

Keywords: adrenal tumors, incidentaloma, symptomatic arterial hypertension, diagnostics, artificial neural networks

p. 99 – 106 of the original issue

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Address for correspondence:
664079, Rossiiskaia Federatsiia, g. Irkutsk, m-n. Iubileinyi, d.100, GBOU DPO «Irkutskaia gosudarstvennaia meditsinskaia akademiia poslediplomnogo obrazovaniia», kafedra khirurgii,
e-mail: giuv.surgery@ya.ru,
Kulikov Leonid Konstantinovich

Information about the authors:
Kulikov L.K. MD, professor, a head of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Post-graduate Education”.
Bykova N.M. PhD, a head of the endocrinology department of MAME “City Clinical Hospital № 10”, Irkutsk.
Privalov U.A. PhD, an associate professor of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Post-graduate Education”.
Sobotovich V.F. PhD, an associate professor of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Post-graduate Education”.
Smirnov A.A. PhD, an assistant of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Post-graduate Education”.  

Article in the .pdf format

REVIEWS

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.107   |  

D.B. BORISOV ¹, M.Y. KIROV ²

THE USE OF TRANEXAMIC ACID IN MAJOR JOINT REPLACEMENT

Northern Medical Clinical Centre named N. A. Semashko ¹,
Northern State Medical University ²,
Arkhangelsk,
Russian Federation

The literature review of researches devoted to the use of fibrinolysis inhibitors to reduce perioperative blood loss, particularly tranexamic acid in endoprothesis of large joints is presented in this paper. Analysis of the literature showed that sufficient number of evidences of tranexamic acid effectiveness in reducing of blood loss and the frequency of allogeneic blood transfusion in orthopedics is received. There is currently no information about the increase of the number of postoperative complications in tranexamic acid application in planned surgery. To determine the optimal regime of systemic administration of tranexamic acid the further research is needed. Intra-articular injection of the tranexamic acid in endoprothesis of joints effectively reduced the postoperative blood loss. Compared to intravenous administration the local intra-articular administration of the tranexamic acid seems to be more safe and effective in blood loss reduction. Major prospective studies are required to confirm this assumption.

Keywords: tranexamic acid, blood loss, joint replacement

p. 107 – 112 of the original issue

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Address for correspondence:
163000, Rossiiskaia Federatsiia, g. Arkhangel'sk, pr. Troitskii, d. 115, FGBUZ «Severnyi meditsinskii klinicheskii tsentr imeni N.A. Semashko», otdelenie anesteziologii, reanimatsii i intensivnoi terapii,
e-mail: bor_d@mail.ru,
Borisov Dmitrii Borisovich

Information about the authors:
Borisov D.B. PhD, a head of anesthesiology, resuscitation and intensive therapy unit of FSBEE “Northern medical clinical centre named after N.A. Semashko”.
Kirov M.Y. MD, professor, a head of anesthesiology and resuscitation chair of SBEE HPE “Northern State Medical University”.

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CASE REPORTS

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.113   |  

I.N. SONKIN¹, E.V. SHAIDAKOV², V.V. MIHAILOV³, A.S. REMIZOV¹, D.V. KRYLOV¹, K.P. CHERNYKH¹

THE FIRST EXPERIENCE OF TREATMENT OF FACIAL VENOUS DYSPLASIA

NSME “Railway Clinical Hospital” JSС “Russian Raiways”¹,
FSBE “NRI of Experimental Medicine” of NWD of RAMS,
SBEE HPE “North-Western State University named after I.I. Mechnikov” ³,
Saint-Petersburg
The Russian Federation

In recent years a surgical method and scleroobliteration by ethanol solution (70% and 96%) have been most frequently used in treatment of angiodysplasia.
A serious disadvantage of sclerosing by alcohols is considered to be the inability of dosing of necrosis both in depth and in the area as well as entering alcohol solution in the blood bed or a tissue burn near the tumor. That is why specialists more frequently use polidocanol or sodium tetradecyl as safer sclerosis agents. Combining of several methods (endovasal laser obliteration, phleboscleroobliteration, surgery) has permitted to advance treatment efficacy and improve a cosmetic result.The result of a successful combined treatment of the venous facial dysplasia in young female patient is presented in the research. Phleboscleroobliteration, endovenous laser and surgical treatment with good functional and cosmetic effect have been carried out step by step.

Keywords: venous dysplasia, phleboscleroobliteration, endovasal laser obliteration, surgical treatment

p. 113 – 117 of the original issue

References

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Address for correspondence:
195271, Rossiiskaia Federatsiia, g. Sankt-Peterburg, pr. Mechnikova, d. 27, Negosudarstvennoe uchrezhdenie zdravookhraneniia Dorozhnaia klinicheskaia bol'nitsa Otkrytogo aktsionernogo obshchestva «Rossiiskie zheleznye dorogi», otdelenie sosudistoi khirurgii,
e-mail sonkini@yandex.ru,
Son'kin Igor' Nikolaevich

Information about the authors:
Sonkin I.N. PhD, a head of the department of vascular surgery of NSME “Railway clinical hospital” of JSC “Russian railways”, Saint-Petersburg.
Shaidakov E.V. MD, professor, deputy director for research and clinical work of FSBE “NRI of Experimental Medicine” of Northwestern division of the Russian Academy of Medical Sciences, Saint-Petersburg.
Mihailov V.V. PhD, associate professor of maxillofacial surgery chair of SBEE HPE “Northwestern State University named after I.I. Mechnikov”.
Remizov A.S. PhD, vice–chief physician for surgery of NSME “Railway clinical hospital” of JSC “Russian railways”, Saint-Petersburg.
Krylov D.V. A surgeon of the department of vascular surgery of NSME “Railway clinical hospital” of JSC “Russian railways”, Saint-Petersburg.
Chernykh K.P. A surgeon of the department of vascular surgery of NSME “Railway clinical hospital” of JSC “Russian railways”, Saint-Petersburg.

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EXCHANGE OF EXPERIENCE

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.118   |  

V.I. RUSYN¹, Y.M. POPOVYCH¹, V.V. KORSAK¹, P.O. BOLDIZHAR¹, YU.S. NEBYLITSIN²

SURGICAL PREVENTION OF PULMONARY EMBOLISM AT THE DEEP VENOUS THROMBOSIS OF TIBIOPOPLITEAL SEGMENT

SHEE “Uzhgorod National University” ¹
The Ukraine
EE “Vitebsk State Medical University” ²,
The Republic of Belarus

Objectives. To evaluate short- and long-term results of the operative treatment at the deep venous thrombosis of the femoral-popliteal segment.
Methods. The analysis of the examination results of 25 patients with the deep venous thrombosis located in the femoral-popliteal segment and the presence of floating thrombus in the general and superficial femoral veins has been carried out in the paper. The complex of clinical and instrumental examination of patients included duplex ultrasonography, Doppler, radiopaque venography and radioisotope phleboscintigraphy. It allowed evaluating the functional status of the collateral blood flow and justifying the indications for surgical treatment of deep venous thrombosis of the lower extremities. The volume of the operative treatment included the open thrombectomy in the femoral veins, followed by the ligation of the superficial femoral veins below the confluence of the deep vein of the thigh. In the distant period the quantitative evaluation of the surgical treatment results was performed according to the current guidelines on the evaluation of patients with chronic venous disease of the lower limbs (VCSS clinical scale and the scale of work-capacity reduction VDS).
Results. The results have showed the high efficiency and appropriateness of surgical treatment – thrombectomy of the femoral-popliteal segment with the ligation of the superficial femoral vein. The given type of surgery in patients with thrombosis of the femoral -popliteal segment permitted to reduce the clinical manifestations of post-thrombotic syndrome and chronic venous insufficiency in the postoperative period.
Conclusions. Early thrombectomy is considered as an effective and pathogenetically justified method of surgical treatment. The widespread application of the open surgical treatment of deep venous thrombosis of the lower extremities allows preventing the pulmonary embolism and minimizing the effects of chronic venous insufficiency.

Keywords: deep venous thrombosis, thrombectomy, prevention of pulmonary embolism, post-trombophlebitic syndrome, radioisotope phleboscintigraphy

p. 118 - 123 of the original issue

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Address for correspondence:
88010, Ukraina, g. Uzhgorod, ul. Kapushanskaia, d. 22, GVUZ «Uzhgorodskii natsional'nyi universitet», Zakarpatskaia oblastnaia klinicheskaia bol'nitsa im. A. Novaka, kafedra khirurgicheskikh boleznei,
e-mail: angiosurgery@i.ua,
Popovich Iaroslav Mikhailovich

Information about the authors:
Rusin V.I. MD, professor, a head of the surgical diseases chair of SHEE “Uzhgorod National University”.
Popovich Y.M. PhD, An assistant of the surgical diseases chair of SHEE “Uzhgorod National University”.
Korsak V.V. MD, professor of the surgical diseases chair of SHEE “Uzhgorod National University”.
Boldizhar P.O. MD, professor of the surgical diseases chair of SHEE “Uzhgorod National University”.
Nebylitsin Yu.S. PhD, an associate professor of the chair of general surgery of EE “Vitebsk State Medical University”.

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