Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2016 Vol. 24 No 6

HISTORY OF SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2016.6.533   |  

Y.S. NEBYLITSIN, N.A. SMOLYANETS

LOVE TO MEDICAL ART IS LOVE TO HUMANITY. TO 85TH ANNIVERSARY OF ALEXANDER NIKOLAYEVICH VEDENSKY

EE "Vitebsk State Medical University",
The Republic of Belarus

The article is devoted to life and work of the famous surgeon, Doctor of medical sciences, Professor Alexander Nikolayevich Vedensky. In 1958 year he graduated from the 1st Leningrad Medical Institute He was founder of the reconstructive vascular surgery and n author of many scientific works, inventions and innovations. Alexander Nikolayevich Vedensky wrote monographs to all main sections of phlebology, which were written in simple and accessible language letting using them as a teaching material. The monographs present the issues that are still relevant, despite the rapid development of phlebology in recent decades.
Under supervision of A.N. Vedensky 2 dissertations for Doctors degree and 10 dissertations for Candidates degree have been defended. He had more than 30 years of working experience from an assistant of Leningrad Scientific Research Institute of Blood Transfusion to Professor of the vascular surgery department of State Institute of Advanced Training for Physicians on the basis of Leningrad Research Institute of Traumatology and Orthopedics named after R.R. Vreden, A.N. Vedensky was a founder of Leningrad School of Phlebology, characterized by depth knowledge and particular attention to anatomy and pathophysiology. Innovative and original solutions of Alexander Nikolayevich Vedensky permitted him not only to develop, but to apply the whole set of original methods for the transplantation of venous valves into clinical practice. It is difficult to overestimate the role of Alexander Nikolayevich Vedensky in the development of the native phlebology. Alexander Nikolayevich throughout his life studied himself and helped others to study. There were always a lot of people near him, who inherited his invaluable experience. Alexander Nikolayevich Vedensky was an outstanding clinician and a splendid physician. He was able to perform the most complex operations and at the same time he was not inherent in academic and arrogance and was available for any ordinary man. A.N. Vedensky was characterized by simplicity and sincerity of communication, helpfulness, kindness and attention.

Keywords: Vedensky Alexander Nikolayevich, phlebology, Leningrad Institute of Blood Transfusion
p. 533-538 of the original issue
References
  1. Stoiko IM, Trikhina SI, Mazaishvili KV. Aleksandr Nikolaevich Vedenskii "dobryi genii" russkoi flebologii [Vedensky - "good genius" of Russian phlebology]. Moscow, RF: Lika; 2013. 149 p.
  2. Vedenskii AN, Korostovtseva NV. Gomo- i autoplastika vorotnoi veny [Homo- and autoplasty of portal vein]. Vestnik Khirurgii im II Grekova. 1963;(5):161-63.
  3. Klement AA, Vedenskii AN. Khirurgicheskoe lechenie zabolevanii ven konechnostei [Surgical treatment of vein diseases of the extremities]. Leningrad, USSR: Meditsina; 1976. 295 p.
  4. Vedenskii AN. Plasticheskie i rekonstruktivnye operatsii na magistral'nykh venakh [Plastic and reconstructive surgery on the main veins]. Leningrad, USSR: Meditsina; 1979. 224 p.
  5. Vedenskii AN. Varikoznaia bolezn' [Varicose veins]. Leningrad, USSR: Meditsina; 1983. 207 p.
  6. Vedenskii AN. Posttromboticheskaia bolezn' [Postthrombotic disease]. Leningrad, USSR: Meditsina; 1986. 240 p.
  7. Vedenskii AN, Belokonev EV. Ekstravazal'naia korrektsiia nedostatochnykh klapanov glubokikh ven karkasnymi spiraliami v kompleksnom lechenii varikoznoi bolezni nizhnikh konechnostei [Extravasal correction of insufficient valves, deep vein by wire frame spirals in the complex treatment of varicose veins of the lower extremities]. Vestn Khirurgii im II Grekova. 1981;(7):53-58.
  8. Vedenskii AN, Stoiko IuM. Distantsionnaia okkliuziia ust'ev perforantnykh ven [Remote occlusion of the mouth of perforating veins]. Vestn Khirurgii im II Grekova. 1990;(10):124-28.
  9. Vedenskii AN, Stoiko IuM, Shaidakov EV, Omarov MA, Filatova AV. Sovremennye metody diagnostiki i korrektsii klapannoi nedostatochnosti pri khronicheskikh zabolevaniiakh ven [Current methods of diagnosis and correction of valvular insufficiency in chronic diseases of the veins]. Vestn Khirurgii im II Grekova. 1993;(2):155.
  10. Vedenskii AN, Briusov PG, Stoiko IuM. Sovremennye metody diagnostiki i korrektsii klapannoi nedostatochnosti pri varikoznoi bolezni i ee retsidivakh [Current methods of diagnosis and correction of valve insufficiency with varicose disease and its relapses]. Voen-Med Zhurn. 1993;(10):17-20.
Address for correspondence:
210023, Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State
Medical University,
department of general surgery.
Tel: +375 212 37-80-82
E-mail: nebylicin.uravgm@mail.ru
Nebylitsin Yuri Stanislavovich
Information about the authors:
Nebylitsin Y.S. Ass. Professor of department of general surgery, EE "Vitebsk State Medical University".
Smolyanets N.A. A 5-year student, EE "Vitebsk State Medical University", medical faculty.

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2016.6.539   |  

A.S. GOROHOVA2, A.Y. GRIGORYAN1, A.I. BEZHIN1, T.A. PANKRUSHEVA1, L.V. ZHILYAEVA1, E.S. MISHINA1, E.V. KOBZAREVA1

EFFECTIVENESS OF IMMOBILIZED FORMS OF BENZALKONIUM CHLORIDE IN TREATMENT OF PURULENT WOUNDS

SBEE HPE "Kursk State Medical University"1,
RBME "Tim Central Regional Hospital"2,
Kursk,
The Russian Federation

Objectives. To substantiate the possibility of application of an immobilized form of benzalkonium chloride in the treatment of experimental purulent wounds.
Methods. The experiment was carried out on Vistar male rats (n=180). Animals were divided into three groups, 60 animals per each. In the control group the topical treatment of wounds was performed using the ointment "Levomekol", while in the test group using an immobilized form of benzalkonium chloride of the following composition: benzalkonium chloride 0,02; metronidazolum 1,0; polyethylene oxide M.w. 400 80,0; polyethylene oxide M.w. 1500 20,0. The dynamics of wound healing was studied by means of planimetric, bacteriological and histological methods.
Results. While studying the spectrum of antimicrobial action the designed immobilized form of benzalkonium chloride showed the best results against the test strains Staphylococcus aureus ATCC 6538-P, Bacillus cereus ATCC 10702 and Candida albicans ATCC 885-653 by comparing with the control. Planimetric study showed that the percentage reduction of wound area in the experimental group was greater than in control on the 5th, 8th and 15th day of observation, while the rate of healing in the experimental group was reliably 1,63 fold higher (p≤0,05) compared with the control. In the experimental group of animals the microbial contamination of wounds was 2,2 and 1,8 fold less than in the wounds of the control group on the 5th and the 8th day of treatment, respectively. After the histological study, it was noted that the regeneration rate was more and the reepithelialization of wound occured earlier in the experimental group than in the control, moreover by the 10th day in the experimental group the wounds had been covered by the newly formed epidermis .
Conclusion. Results of the planimetric, bacteriological and histological studies of purulent wounds in the experiment show a greater rate of recovery and expressed positive effect on wound treated with the ointment on the basis of an immobilized form of benzalkonium chloride.

Keywords: purulent wound, wound treatment, immobilized forms of benzalkonium chloride, polyethylene oxide, metronidazolum, ointment "Levomecol", healing
p. 539-545 of the original issue
References
  1. Kallstrom G. Are quantitative bacterial wound cultures useful? J Clin Microbiol. 2014 Aug;52(8):2753-6. doi: 10.1128/JCM.00522-14.
  2. Blatun LA. Mestnoe medikamentoznoe lechenie ran [Local medical treatment of wounds]. Khirurgiia Zhurn im NI Pirogova. 2011;(4):51-59.
  3. Tanaka K, Akita S, Yoshimoto H, Houbara S, Hirano A. Lipid-colloid dressing shows improved reepithelialization, pain relief, and corneal barrier function in split-thickness skin-graft donor wound healing. Int J Low Extrem Wounds. 2014 Sep;13(3):220-5. doi: 10.1177/1534734614541544.
  4. Chekmareva IA. Morfofunktsional'nye aspekty regeneratsii ran pri lechenii iod-soderzhashchimi maziami [Morphological and functional aspects of wound regeneration in the treatment of iodine-containing ointments]. Khirurgiia Zhurn im NI Pirogova. 2014;(1):54-58.
  5. Li X, Li B, Ma J, Wang X, Zhang S. Development of a silk fibroin/HTCC/PVA sponge for chronic wound dressing. J Bioact Compat Polym. 2014 Jul;29(4):398-11. doi: 10.1177/0883911514537731.
  6. Epstein SP, Chen D, Asbell PA. Evaluation of biomarkers of inflammation in response to benzalkonium chloride on corneal and conjunctival epithelial cells. J Ocul Pharmacol Ther. 2009 Oct;25(5):415-24. doi: 10.1089/jop.2008.0140.
  7. De Saint Jean M, Brignole F, Bringuier AF, Bauchet A, Feldmann G, Baudouin C. Effects of benzalkonium chloride on growth and survival of Chang conjunctival cells. Invest Ophthalmol Vis Sci. 1999 Mar;40(3):619-30.
  8. Plotnikov F.V. Kompleksnoe lechenie patsientov s gnoinymi ranami v zavisimosti ot sposobnosti mikroorganizmov-vozbuditelei formirovat' bioplenku [Complex treatment of patients with purulent wounds, depending on the ability of microorganisms- pathogens to form biofilms ]. Novosti Khirurgii. 2014;22(5):575-82.
Address for correspondence:
305041, The Russian Federation,
Kursk, Karl Marx st., 3,
Kursk State Medical University,
department of operative surgery
and topographic anatomy.
Tel.: 79202675197
E-mail: arsgrigorian@mail.ru
Grigoryan Arsen Yurevich
Information about the authors:
Gorohova A.S. Head of the surgical unit of RBME "Tim Central Regional Hospital".
Grigoryan A.Y. PhD, Ass. Professor of department of operative surgery and topographic anatomy, SBEE HPE "Kursk State Medical University".
Bezhin A.I. MD, Professor, Head of department of operative surgery and topographic anatomy, SBEE HPE "Kursk State Medical University".
Pankrusheva T.A. Dr.Sci. (Pharmacy), Professor, Head of the pharmaceutical technology department, SBEE HPE "Kursk State Medical University".
Zhilyaeva L.V. PhD, Assistant of department of microbiology, virology and immunology, SBEE HPE " Kursk State Medical University".
Mishina E.S. Assistant of department of histology, embryology and cytology, SBEE HPE "Kursk State Medical University".
Kobzareva E.V. PhD (Pharmacy), Assistant of department of disaster medicine, SBEE HPE "Kursk State Medical University".

GENERAL & SPECIAL SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2016.6.546   |  

O.V. SHULYARENKO

COMPARISON OF TOTAL EXTRAPERITONEAL AND TRANSABDOMINAL PREPERITONEAL INGUINAL HERNIAPLASTY

National Medical Academy of Post-graduate Education named after P.L. Shupyk, Ministry of Health, Kiev. Ukraine

Objectives. To compare the early results of total extraperitoneal and transabdominal preperitoneal primary herniaplasty.
Methods. Treatment results of patients (n=47) operated on in the clinic of the department of surgery and vascular surgery (2014-2016) due to the unilateral primary uncomplicated hernia have been analyzed. All patients (males) are divided into two groups: the 1st (n=25) group the total extraperitoneal inguinal hernia repair by the developed method has been performed, the 2nd (n=22) group the transabdominal preperitoneal herniaplasty has been made. The patients age varied from 20 to 61 years, the average age in the 1st group was 39,3 years, in the 2nd 38,1.
Results. In the 1st group an average operation time made up 36,4 minutes, in the 2nd 37,8. The level of pain syndrome according to the Visual Analogue Scale for Pain was 1,8 scores in the first group, 2,3 scores in the second one. The pain syndrome which requires non-narcotic analgesics lasted 2,3 days in the 1st group and 2,5 days in the 2nd one. There were no indications for narcotic analgesics. In the 1st group the good early results were observed in 21 (84%) patients, satisfactory in 4 (16%), in the 2nd group the good early results were registered in 11 (50%), satisfactory in 11 (50%) patients.
Conclusion. The proposed method of the total extraperitoneal inguinal herniaplasty is considered to be an operation of choice for inguinal hernias (2, 3A and 3B types) based on the Nyhus classification. The good early results were 34% higher in the total extraperitoneal inguinal herniaplasty group than in the transabdominal preperitoneal primary herniplasty group.

Keywords: inguinal hernia, herniaplasty, mesh, surgery, operation, early results, pain syndrome, Nyhus classification
p. 546-550 of the original issue
References
  1. Aver'ianov MIu, Gaar EV, Gorokhov VN. Sravnitel'nyi analiz primeneniia nenatiazhnykh i traditsionnykh sposobov gernioplastiki pri gryzhakh zhivota [Comparative analysis of the use of tension-free and the traditional methods of hernioplasty with abdominal hernias]. Sovrem Tekhnologii v Meditsine. 2011;(3):39-43.
  2. Vinnik IS, Petrushko SI, Gorbunov NS, Nazar'iants IuA. Operativnoe lechenie gryzh perednei briushnoi stenki [Surgical treatment of hernias of the anterior abdominal wall]. Krasnoiarsk, RF; 2011. 260 p.
  3. Saclarides TJ, Myers JA, Millican KA, eds. Common surgical diseases: an algorithmic approach to problem solving. 3-rd ed. New York, US: Springer; 2015. 363 p.
  4. Nikolaev NE, Alekseev SA. Klassifikatsiia, etiopatogenez i vybor sposobov khirurgicheskogo lecheniia pakhovoi gryzhi [Classification, etiopathogenesis and the choice of methods of surgical treatment of inguinal hernia]. Zdravookhranenie. 2014;(12):36-39.
  5. Vizgalov SA, Smotrin SM. Pakhovye gryzhi: sovremennye aspekty etiopatogeneza i lecheniia [Inguinal hernia: current aspects of pathogenesis and treatment]. Zhurn Grodn Gos Med Un-ta. 2010;(4):17-22.
  6. Pinevich DL, Sukonko OG, Poliakova SL, Smirnov VM, Minich AA. Printsipy khirurgii uskorennogo vyzdorovleniia [The principles of "accelerated surgery recovery"]. Zdravookhranenie. 2014;(5):34-48.
  7. Nichitailo ME, Bulik II. Sovremennye aspekty endovideokhirurgicheskogo lecheniia slozhnykh i retsidivnikh pakhovykh gryzh [Modern aspects endovideosurgical treatment of complex and recurrent inguinal hernias]. Klin Khirurgiia. 2010;(3):10-16.
  8. Zhebrovskii VV. Khirurgiia gryzh zhivota [Surgery of abdominal hernias]. Moscow, RF: Med Inform Agentstvo; 2005. 384 p.
  9. Tam KW, Liang HH, Chai CY. Outcomes of staple fixation of mesh versus nonfixation in laparoscopic total extraperitoneal inguinal repair: a meta-analysis of randomized controlled trials. World J Surg. 2010 Dec;34(12):3065-74. doi: 10.1007/s00268-010-0760-5.
  10. Petri A, Sebin K, red. Nagliadnaia statistika v meditsine [Visual statistics in medicine]. Leonov VP, per. s angl. Moscow, RF: GEOTAR-MED; 2003. 144 p.
  11. Palamarchuk VI, Shuliarenko VA, Siriachenko VG, Ignatov IN, Shuliarenko OV. Sposob total'noi ekstraperitoneal'noi gernioplastiki [A method of total extraperitoneal hernia repair]. Patent 102998 Ukraina. 25.11.2015.
  12. Lau H, Patil NG, Yuen WK, Lee F.Urinary retention following endoscopic totally extraperitoneal inguinal hernioplasty. Surg Endosc. 2002 Nov;16(11):1547-50.
  13. Bittner R, Schmedt CG, Leibl BJ. Transabdominal pre-peritoneal approach. In: LeBlanc KA. Laparoscopic hernia surgery. London, UK: Arnold Publisher; 2003. p. 54-64.
  14. Lau H, Loong F, Yuen WK, Patil NG. Management of herniated retroperitoneal adipose tissue during endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc. 2007 Sep;21(9):1612-16.
  15. Nasr AO, Tormey S, Walsh TN. Lipoma of the cord and round ligament: an overlooked diagnosis? Hernia. 2005 Oct;9(3):245-47.
Address for correspondence:
04112, Ukraine, Kiev, Dorogozhytskaya st., 9, department of surgery and vascular surgery.
Tel: +380 444 32-24-52
E-mail: oleg.v.shu@gmail.com
Shulyarenko Oleg Vladimirovich
Information about the authors:
Shulyarenko O.V. PhD, Ass. Professor, of National Medical Academy of Post-graduate Education named after P.L. Shupyk, department of surgery and vascular surgery.
DOI: https://dx.doi.org/10.18484/2305-0047.2016.6.551   |  

A.V. STAKANOV 1, 2,3, S.P. DASHEVSKII 1,2, T.S. MUSAYEVA 3, E.A. POTSELUEV 4, I.B. ZABOLOTSKIKH 3

RISK OF ACUTE KIDNEY INJURY DEVELOPMENT IN ACUTE COLONIC OBSTRUCTION

SBE RR "Rostov Regional Clinical Hospital" 1,
SBEE HPE "Rostov State Medical University" 2,
SBEE HPE "Kuban State Medical University" 3, Krasnodar,
MBME "City Hospital 7 of Rostov-on Don" 4,
Rostov-on Don ,
The Russian Federation

Objectives. To assess the risk of acute kidney injury (AKI) in patients with acute colonic obstruction (ACO), depending on the extent of intra-abdominal hypertension (IAH).
Methods. Clinical observations included patients with ACO (n=220). Four groups according to the initial grade of the AHI were identified, which was estimated on the basis of urinary bladder pressure: 1 0 grade IAH 0-11 mmHg (n = 64); 2 1 grade IAH 12-15 mmHg (n = 54); 3 2 grade IAH 16-20 mmHg (n = 78); 4 3 grade IAH 21-25 mmHg (n = 18); 4 grade IAH> 25 mmHg was not revealed. AKI was diagnosed when at least one of the criteria (KDIGO) was present. Stroke Index (SI, mL/m2) was determined hourly by the transmission time of the pulse wave (esCCO technology, Nihon Kohden). The criteria for the daily comparison in groups were the following: prevalent type of circulation, volemic and oxygen status, diuresis, blood biochemistry parameters.
Results. Hypovolemia was confirmed by low or borderline levels of a central venous pressure (CVP) in all four groups, the severity degree of volemic disorders is inversely proportional to the level of intra-abdominal pressure. Infusion in the 4th group was limited to a decreased myocardial contractility according to the results of increments in central venous pressure (CVP); hemodynamic profile had an initial tendency to decrease the cardiac output and compensatory vasoconstriction. Furthermore, the worsening of hypokinesia and transformation in vasoplegia on the background of epidural analgesia was observed. The dynamics of creatinine growth during the first three days after eliminating of acute colonic obstruction is proportional to the reduction of diuresis with increasing degree of intraabdominal hypertention in the groups.
Conclusion. Neoliguric form of acute kidney injury is specific for patients with acute colonic obstruction and a risk of its development directly proportional to the initial grade of intra-abdominal hypertension.

Keywords: abdominal surgery, acute colonic obstruction, intra-abdominal hypertension, postoperative period, epidural analgesia, dynamics of creatinine growth, acute kidney injury
p. 551-560 of the original issue
References
  1. Andrusev AM, Vatazin AV, Gurevich KIa, Zakharova EN, Zemchenkov AIu, Kotenko ON, i dr. Klinicheskie rekomendatsii po diagnostike i lecheniiu ostrogo pochechnogo povrezhdeniia [Clinical guidelines for the diagnosis and treatment of acute kidney injury] [Elektronnyi resurs]. Moscow, RF; 2014. Available from: http://nonr.ru/?page_id=3115
  2. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int. 2012;2(Suppl):1-138.
  3. Rimes-Stigare C, Frumento P, Bottai M, Martensson J, Martling CR, Bell M. Long-term mortality and risk factors for development of end-stage renal disease in critically ill patients with and without chronic kidney disease. Crit Care. 2015 Nov 3;19:383. doi: 10.1186/s13054-015-1101-8.
  4. Shramenko EK, Gur'ianov VG. Analiz faktorov, naibolee znachimo vliiaiushchikh na iskhod ostrogo povrezhdeniia pochek [Analysis of factors, the most significant impact on the outcome of acute renal injury]. Meditsina Neotlozhnykh Sostoianii. 2015;2:104-108.
  5. Smit M, Hofker HS, Leuvenink HG, Krikke C, Jongman RM, Zijlstra JG, et al. A human model of intra-abdominal hypertension: even slightly elevated pressures lead to increased acute systemic inflammation and signs of acute kidney injury. Crit Care. 2013;17(2):425. doi: 10.1186/cc12568.
  6. Waele JJ, Malbrain M, Kirkpatrick AW. The abdominal compartment syndrome: evolving concepts and future directions. Crit Care. 2015;19:211. doi: 10.1186/s13054-015-0879-8.
  7. Cannesson M, Ramsingh D, Rinehart J, Demirjian A, Vu T, Vakharia S, et al. Perioperative goal-directed therapy and postoperative outcomes in patients undergoing high-risk abdominal surgery: a historical-prospective, comparative effectiveness study. Crit Care. 2015;19:261. doi: 10.1186/s13054-015-0945-2.
  8. Moussa MD, Scolletta S, Fagnoul D, Pasquier P, Brasseur A, Taccone FS, et al. Effects of fluid administration on renal perfusion in critically ill patients. Crit Care. 2015;19:250. doi: 10.1186/s13054-015-0963-0.
  9. Zabolotskikh IB, Musaeva TS, Kulinich OV. Individual approach to perioperative fluid therapy based on the direct current potential levels in patients after major abdominal surgery. Eur J Anaesthesiol. 2015;32(S53):260.
  10. Vincent JL, Pelosi P, Pearse R, Payen D, Perel A, Hoeft A, et al. Perioperative cardiovascular monitoring of high-risk patients: a consensus of 12. Crit Care. 2015 May 8;19:224. doi: 10.1186/s13054-015-0932-7.
  11. Perel A. Perioperative Goal-Directed Therapy [Electronic Resource]. ICU. 2014/2015 Winter;14(Is 4). Available from: http://healthmanagement.org/c/icu/issuearticle/perioperative-goal-directed-therapy.
  12. Ronco C, Ricci Z, Backer D, Kellum JA, Taccone FS, Joannidis M, et al. Renal replacement therapy in acute kidney injury: controversy and consensus. Crit Care. 2015;19:146. doi: 10.1186/s13054-015-0850-8.
  13. Komissarov KS, Pilotovich VS, Iurkevich MIu, Dmitrieva MV, Zafranskaia MM. Tekhnicheskie osobennosti eksperimental'noi modeli ostrogo ishemicheski-reperfuzionnogo povrezhdeniia pochek [Technical characteristics of the experimental model of acute ischemia-reperfusion renal injury]. Novosti Khirurgii. 2015;23(3):262-67.
  14. Shano VP, Gumeniuk IV, Gusak EA, Gladkaia SV, Gaidash LL. Ostroe posleoperatsionnoe povrezhdenie pochek [Acute postoperative kidney damage]. MEDICUS. 2015;(4):20-25.
  15. Stakanov AV. Sistemnaia gemodinamika i splankhnicheskii krovotok v usloviiakh predoperatsionnoi analgezii na fone intraabdominal'noi gipertenzii pri ostroi tolstokishechnoi neprokhodimosti [Systemic hemodynamics and splanchnic blood flow in terms of preoperative analgesia against the background of intra-abdominal hypertension in acute colonic obstruction]. Obshch Reanimatologiia. 2013;IX(2):39-44.
  16. Brunner R, Drolz A, Scherzer TM, Staufer K, Fuhrmann V, Zauner C, et al. Renal tubular acidosis is highly prevalent in critically ill patients. Crit Care. 2015 Apr 6;19:148. doi: 10.1186/s13054-015-0890-0.
Address for correspondence:
344010, Russian Federation,
Rostov-on-Don, Nakhichevanskii pr., 29.
Rostov State Medical University,
department of anesthesiology and intensive care.
Tel.: +7 928 171-20-67
E-mail: stakanova1@mail.ru
Stakanov Andrey Vladimirovich
Information about the authors:
Stakanov A.V. PhD, Anesthesiologist of the Intensive Care Unit of 1, SBE RR "Rostov Regional Clinical Hospital", Assistant of the anesthesiology and reanimatology department, SBEE HPE "Rostov State Medical University", Applicant for Doctors degree of department of anesthesiology, reanimatology and transfusiology, faculty of advanced training and retraining of specialists, SBEE HPE "Kuban State Medical University".
Dashevskii S.P. Anesthesiologist, Deputy chief physician (medical work), SBE RR "Rostov Regional Clinical Hospital", Assistant of the anesthesiology and reanimatology department, SBEE HPE "Rostov State Medical University".
Musayeva T.S. PhD, Assistant of department of anesthesiology, reanimatology and transfusiology, faculty of advanced training and retraining of specialists, SBEE HPE" Kuban State Medical University".
Potseluev E.A. PhD, Head of the Intensive Care Unit, MBME "City Hospital 7 of Rostov-on Don".
Zabolotskikh I.B. MD, Professor, Head of department of anesthesiology, reanimatology and transfusiology, faculty of advanced training and retraining of specialists, SBEE HPE "Kuban State Medical University", Supervisor of the anesthesiology-reanimation service, SBME "Regional Clinical Hospital 2" of MH of Krasnodar Region, Vice-president of the Federation of Anesthesiologists and Reanimatologists of Russia.
DOI: https://dx.doi.org/10.18484/2305-0047.2016.6.561   |  

V.S. DERCKACHEV, S.A. ALEKSEJEV, Z.A. IBRAGIMOVA, M.P. POTAPNEV, V.N. BORDAKOV, A.V. HONCHARICK, S.E. SEMERICHINA, L.V. KARTUN

IMMUNOLOGICAL PREDICTORS OF EARLY POSTOPERATIVE PYO-INFLAMMATORY COMPLICATIONS IN PATIENTS WITH LONG BONE FRACTURES

EE "Belarusian State Medical University",
Minsk.
The Republic of Belarus

Objectives. To identify the predictors of early postoperative complications based on biochemical and immunological parameters of patient peripheral blood.
Methods. The patients (n=38) operated on due to fractures of long tubular bone were divided into two groups depending on the occurrence of pyo-inflammatory complications in the early incisional period (10 days). In the first group of patients (n=23) no complications was observed and in the second (n=15) pyo-inflammatory complications developed. Peripheral blood samples were collected prior and in 3, 5 and 10 days after the operation. Some biochemical (superoxiddismutase, catalase, malonic dialdehyde, calprotectin, procalcitonin, C-reactive protein/CRP) and immunological parameters (CD3+, CD4+, CD8+ lymphocytes; immunoglobulins IgA, IgE, IgG, IgM; interleukin-1β/IL-1β, IL-6, IL-4, IL-8, IL-10, tumor necrosis factor-α, interferon-γ) were evaluated.
Results. The pyo-inflammatory complications (n=15) have developed in the incisional period up to 10 days. Those patients in comparison the patients without any complications in the preoperative period demonstrated an blood level of CRP, IL-6, IL-10, procalcitonin, CD3+CD4+ T lymphocytes and decreased level of IgE. 3 days after the operation the reliably high values of IL-6, IL-10, CD3+CD4+T cells retained, increase of IgG and IgM in the blood serum and reduction of IgE level are considered to be an additional predictor of pyo-inflammatory complications.
Conclusion. Within the preoperative period predictors of infectious markers in patients after the operation of osteosynthesis are an elevated level of blood CRP, IL-6, IL-10, procalcitonin and reduced level of IL-6, in 3 days after the operation an elevated level IL-10, CD3+CD4+ T lymphocytes, serum IgG, IgM and decreased level of IgE were observed.

Keywords: fractures of long tubular bones, operation, pyo-inflammatory complications, peripheral blood, laboratory assessment, additional predictor, preoperative period
p. 561-567 of the original issue
References
  1. Gavrilova KP, Fedorov VE. Analiz prichin posleoperatsionnykh oslozhnenii v ekstrennoi khirurgicheskoi praktike [Analysis of the causes of postoperative complications in emergency surgical practice]. Biul Med Internet-Konf. 2013;3(3):810.
  2. Pligina EG, Rozinov VM, Produes AP. Immunologicheskie kriterii prognozirovaniia razvitiia gnoino-vospalitel'nykh oslozhnenii u detei s mnozhestvennymi i sochetannymi travmami oporno-dvigatel'nogo apparata [Immunological criteria for predicting of development of inflammatory complications in children with multiple and associated injuries of the musculoskeletal system]. Vestn Travmatologii i Ortopedii im NN Priorova. 2000;(2):49-54.
  3. Miromanov AM, Miromanova HA, Namokonov EV. Prognozirovanie gnoino-vospalitel'nykh oslozhnenii v rannem posleoperatsionnom periode u bol'nykh s perelomami dlinnykh trubchatykh kostei [Prediction of inflammatory complications in the early postoperative period in patients with long bone fractures]. Travmatologiia i Ortopediia Rossii. 2009;(4):88-90.
  4. Vershinina MG, Kukhtina NB. Laboratornaia diagnostika sepsisa v usloviiakh mnogoprofil'nogo statsionara [Laboratory diagnosis of sepsis in a general hospital ]. Khirurgiia Zhurn im NI Pirogova. 2014;(6):74-76.
  5. Agadzhanian VV, Pak VP. Profilaktika i lechenie gnoinoi ranevoi infektsii pri otkrytykh diafizarnykh perelomakh kostei goleni na rannem gospital'nom etape [Prevention and treatment of purulent wound infections with open diaphyseal fractures of the tibia at an early hospital stage. ]. Ortopediia Travmatologiia i Protezirovanie. 1984;(10):14-17.
  6. Horst K, Hildebrand F, Pfeifer R, Köppen K, Lichte P, Pape HC, et al. Plate osteosynthesis versus hemiarthroplasty in proximal humerus fractures - does routine screening of systemic inflammatory biomarkers makes sense? Eur J Med Res. 2015 Jan 14;20:5. doi: 10.1186/s40001-014-0079-z.
  7. Gumanenko EK, Ogarkov PI, Lebedev VF, Boiarintsev VV, Kuzin AA. Infektsionnye oslozhneniia politravm: mikrobiologicheskie i epidemiologicheskie aspekty [Infectious complications of polytrauma: microbiological and epidemiological aspects]. Vestnik Khirurgii im II Grekova. 2006;165 (5):56-62.
  8. Kochetkov AV, Gudilov MS. Kliniko-laboratornaia diagnostika i monitoring gnoino-septicheskikh oslozhnenii posle operatsii na organakh briushnoi polosti [Clinical and laboratory diagnosis and monitoring of septic complications after operations on the abdominal organs]. Novosti Khirurgii. 2015;23(1):105-11.
  9. Chumakov VN, Osinskaia LF. Kolichestvennyi metod opredeleniia aktivnosti tsink-med'zavisimoi superoksiddismutazy v biologicheskom materiale [A quantitative method for determining the activity of the zinc-superoxide dismutase medzavisimoy in biological material]. Vopr Med Khimii. 1977;23(5):712-16.
  10. Mamontova NS, Beloborodova EN, Tiukalova LN. Aktivnost' katalazy pri khronicheskom alkogolizme [Catalase activity in chronic alcoholism]. Klin Lab Diagnostika. 1994;(1):27-28.
  11. Asakawa T, Matsushita S. Coloring conditions of thiobarbituric acid test for detecting lipid hydroperoxides. Lipids. 1980 Mar;15(Is 3):137-40. doi: 10.1007/BF02540959.
  12. Konietschke F, Placzek M, Schaarschmidt S, Hothorn LA. nparcomp: An R Software Package for Nonparametric Multiple Comparisons and Simultaneous Confidence Intervals. J Stat Softw. 2015 Mar;64(Is 9):1-17.
  13. Gel'fand BR, Filimonov MI, Brazhnik TB, Sergeeva NA, Burnevich SZ. Prokal'tsitonin: novyi laboratornyi diagnosticheskii marker sepsisa i gnoino-septicheskikh oslozhnenii v khirurgii [Procalcitonin: a new laboratory diagnostic marker of sepsis and septic complications in surgery]. Vestn Intensiv Terapii. 2003;(1):12-16.
  14. Wolf HM, Fischer MB, Pühringer H, Samstag A, Vogel E, Eibl MM. Human serum IgA downregulates the release of inflammatory cytokines (tumor necrosis factor-alpha, interleukin-6) in human monocytes. Blood. 1994 Mar 1;83(5):1278-88.
  15. Dorofeev IuL, Ptashnikov DA, Tkachenko AN, Bakhtin MIu, Kalimullina AF. Prognoz glubokikh infektsionnykh oslozhnenii pri endoprotezirovanii tazobedrennykh sustavov [Prediction of deep infectious complications in hip arthroplasty]. Vestn Khirurgii im II Grekova. 2015;174(5):40-44.
Address for correspondence:
220116, Republic of Belarus, Minsk,
Dzerzhinsky pr. 83,
EE "Belarusian State Medical University",
department of general surgery.
Tel.: 375 172 20-24-70
E-mail: vsderkachev@mail.ru
Derkachev Viktor Sergeevich
Information about the authors:
Derkachev V.S. PhD, Ass. Professor of the department of the general surgery, EE
"Belarusian State Medical University",
Aleksejev S.A. MD, Professor, Head of the department of general surgery, EE
"Belarusian State Medical University".
Ibragimova Z.A. PhD (Biology), Head of the laboratory of biochemical research methods, EE "Belarusian State Medical University".
Potapnev M.P. MD, Professor, Chief researcher of the laboratory of biochemical methods of investigation, EE "Belarusian State Medical University".
Bordakov V.N. MD, Professor of the department of general surgery, EE "Belarusian State Medical University".
Honcharick A.V. Senior researcher of the laboratory of biochemical methods of investigation, EE "Belarusian State Medical University".
Semerichina S.E. PhD, Freelance researcher of the laboratory of biochemical methods of investigation, EE "Belarusian State Medical University".
Kartun L.V. Senior researcher of the laboratory laboratory of biochemical methods of investigation, EE "Belarusian State Medical University".
DOI: https://dx.doi.org/10.18484/2305-0047.2016.6.568   |  

V.K. OKULICH

ABZYME ACTIVITY OF IMMUNOGLOBULINS IN SURGICAL INFECTION

EE "Vitebsk State Medical University",
Vitebsk,
The Republic of Belarus

Objectives. To determine the role of proteolytic, DNAse, esculinase and urease activity of abzymes in clinical and laboratory picture and to assess the capacity to destroy exopolymeric matrix of biofilms in patients with surgical infection.
Methods. All the patients tested for abzyme activity were divided into the following groups: a group of persons with various chronic inflammatory processes; with spreading inflammatory processes; persons with local acute inflammatory processes, pyoinflammatory disease of the maxillofacial area, chronic osteomyelitis, cholecystitis, adenomatous goiter, gastroduodenitis and severe form of pneumonia. Control group consisted of donors of blood transfusion station and patients without pyoinflammatory processes. Proteolytic activity of immunoglobulin G in reactions with chromogenic substrates: benzoyl-arginine-p-nitroanilide (BAPNA), lysine-p-nitroanilide (LPA), arginine-proline-p-nitroanilide (APNA) and acetyl-aspartate-p-nitroanilide (AANA) was determined in patients with surgical infection and healthy donors.
Results. It was found out that the rate of BAPNA-amidase abzyme activity in patients with surgical infection was reliably higher, LPA- and APNA-amidase rate didnt differ and AANA-amidase rate was significantly lower than in donors. It was revealed that immunoglobulins derived from patients with surgical infection have the ability to destroy the exopolymeric matrix of the biofilm. Presence of reliably elevated levels of DNAse and esculinase activity of IgG in surgical patients with pyo-inflammatory processes in comparison with patients without suppurative complications was determined. Positive reliable correlation between type of causative agent and DNAse activity of IgG was revealed. The elevated levels of urease activity of IgG, derived from patients with gastroduodenitis, associated with H. pylori in comparison with patients without H. pylori infection was shown.
Conclusion. Obtained data concerning catalytic activity of IgG in patients with infectious process may be used for development of new diagnostic criteria and methods for prognosis of pyoinflammatory diseases.

Keywords: surgical infection, catalytic antibodies, abzymes, biofilm, proteolytic activity, diagnostic criteria, pyoinflammatory diseases
p. 568-578 of the original issue
References
  1. Kosinets AN, Kosinets VA, Struchkov IuV. Infektsiia v khirurgii [Infection in Surgery]: uchebnik. Minsk, RB: Bel Entsykl im P Bro?ki; 2012. 496 s.
  2. Generalov II. Abzimnaia aktivnost' immunoglobulinov [Abzyme activity immunoglobulin]. Vitebsk, RB: VGMU; 2000. 152 p.
  3. Leatnerbarrow RJ. Designer catalytic antibodies. Nature. 1989 Mar 16;338:206-207. doi: 10.1038/338206a0.
  4. Keinan E. Catalytic Antibodies. Germany: VCH-Wiley press; 2005. 586 .
  5. Odintsova ES, Parkhomenko TA, Kunder EV, Okulich VK, Zhil'tsov IV, Sen'kovich SA, i dr. DNK-gidrolizuiushchie IgG antitela iz krovi patsientov bakterial'nymi infektsionnymi zabolevaniiami [DNA-hydrolyzing antibody IgG from the blood of patients with bacterial infectious diseases]. Immunopatologiia Allergologiia Infektologiia. 2006;(2):23-31.
  6. Brown EL, Nishiyama Y, Dunkle JW, Aggarwal S, Planque S, Watanabe K, et al. Constitutive production of catalytic antibodies to a Staphylococcus aureus virulence factor and effect of infection. J Biol Chem. 2012 Mar 23;287(13):9940-51. doi: 10.1074/jbc.M111.330043.
  7. Paul S, Planque SA, Nishiyama Y, Hanson CV, Massey RJ. Nature and nurture of catalytic antibodies. Adv Exp Med Biol. 2012;750:56-75. doi: 10.1007/978-1-4614-3461-0_5.
  8. Jerne NK. Towards a network theory of the immune system. Ann Immunol (Paris). 1974 Jan;125C(1-2):373-89.
  9. Davey ME, O'toole GA. Microbial biofilms: from ecology to molecular genetics. Microbiol Mol Biol Rev. 2000 Dec;64(4):847-67.
  10. Dongari-Bagtzoglou A. Pathogenesis of mucosal biofilm infections: challenges and progress. Expert Rev Anti Infect Ther. 2008 Apr;6(2):201-8. doi: 10.1586/14787210.6.2.201.
  11. Chebotar' IV, Maianskii AN, Konchakova ED, Lazareva AV, Chistiakova VP. Antibiotikorezistentnost' bioplenochnykh bakterii [Antibiotic resistance of biofilm bacteria]. Klin Mikrobiologiia i Antimikrob Khimioterapiia. 2012;14(1):51-58.
  12. Mal'tsev SV, Mansurova GSh. Chto takoe bioplenka [What is biofilm]. Prirodnaia Meditsina: Klinicheskie Issledovaniia. 2013;1:86-89.
  13. Frimel G, red. Immunologicheskie metody [Immunological methods]: monografiia. Tarasova AP, per. s nem. Moscow, SSSR: Meditsina; 1987. 472 p.
  14. Okulich VK, Sen'kovich SA, Plotnikov FV, Kabanova AA, Matskevich EL. Rol' abzimnoi aktivnosti immunoglobulinov klassa G u patsientov s khirurgicheskoi infektsiei [Role of abzyme activity of immunoglobulin G in patients with surgical infection. Khirurgiia Vostochnaia Evropa. 2013;(2):6-14.
  15. Pollack SJ, Jacobs JW, Schultz PG. Selective chemical catalysis by an antibody. Science. 1986 Dec 19;234(4783):1570-73.
Address for correspondence:
210023, Republic of Belarus,
Vitebsk, pr. Frunze, 27, EE "Vitebsk
State Medical University",
department of clinical microbiology,
Tel.: +375 212 06.12.37
E-mail: vokul@mail.ru
Okulich Vitaly Konstantinovich
Information about the authors:
Okulich V.K. PhD, Ass. Professor of department of clinical microbiology, EE "Vitebsk State Medical University".

ONCOLOGY

DOI: https://dx.doi.org/10.18484/2305-0047.2016.6.579   |  

I.V. MAIBORODIN1, A.E. KOZJAKOV 2, E.V. BABAYANTS 2,
S.E. KRASILNIKOV 2

ANGIOGENESIS IN LYMPH NODES IN THE DEVELOPMENT OF CANCER IN THE REGION OF LYMPH COLLECTION

SBSE FSBSE "Institute of Chemical Biology and Fundamental Medicine", Russian Academy of Sciences, Siberian Branch, 1
SBEE HPE "Novosibirsk State Medical University" 2
Novosibirsk,
The Russia Federation

Objectives. To estimate the angiogenesis state in the axillary lymph nodes (ALN) in the breast cancer (BC) patients and to determine the correlation between a ALN vascularization and the stage of oncological process.
Methods. A numerical density of blood vessels in ALN structures of patients at different stages of BC was investigated by immunohistochemical method with the application of CD34 antibodies and use of morphometry at the level of light microscopy. The pair coefficients of correlation between the BC stage and an ALN vascularization have also been studied.
Results. A rapid and significant increase of a number of vessels in axillary lymph nodes as a whole and in all their zones has been occured with the development of breast cancer. It is noted that the changes occuring of vascularization in paracortex and medullary substance are especially expressed. In different axillary lymph nodes zones of patient suffering from breast cancer a strong or a very strong positive correlation between the stage of oncologic process and vascularization indicators take place. Probably, the duration of oncological disease in the region of lymph collection and tumor size influence the angiogenesis intensity in lymph nodes. The longer a tumor is occurred in a body, the longer the production of proangiogenic cytokines and their effect on a lymph node are registered. The larger the tumor, the more significantly pronounced expression of hypoxia and more greatly secretion of substances that stimulate angiogenesis, and the more pronounced effect of these releases on vascular growth in various structures of lymph node. At the same time, no reliable differences between women without breast cancer and patients suffereing from breast cancer (I stage) was revealed; differences is detected only from II stage.
Conclusion. A substantial manifestation of the vascular network of lymph nodes may be a symptom of a malignant tumor development in the region of lymph collection. By increasing the number of vessels in lymph nodes it seems presumable to judge indirectly about oncological process duration and size of the tumor itself.

Keywords: breast cancer, axillary lymph nodes, vascularization, angiogenesis, angiogenesis indicators, dependence between angiogenesis and cancer stages, size of tumor
p. 579-585 of the original issue
References
  1. Weidner N, Semple JP, Welch WR, Folkman J. Tumor angiogenesis and metastasiscorrelation in invasive breast carcinoma. N Engl J Med. 1991 Jan 3;324(1):1-8.
  2. Farnsworth RH, Lackmann M, Achen MG, Stacker SA. Vascular remodeling in cancer. Oncogene. 2014 Jul 3;33(27):3496-505. doi: 10.1038/onc.2013.304.
  3. Kaku T, Kamura T, Kinukawa N, Kobayashi H, Sakai K, Tsuruchi N, et al. Angiogenesis in endometrial carcinoma. Cancer. 1997 Aug 15;80(Is 4):741-47. doi: 10.1002/(SICI)1097-0142(19970815)80.
  4. Aki R, Amoh Y, Bouvet M, Katsuoka K, Hoffman RM. Color-coded fluorescence imaging of lymph-node metastasis, angiogenesis, and its drug-induced inhibition. J Cell Biochem. 2014 Mar;115(3):457-63. doi: 10.1002/jcb.24677.
  5. Chien MH, Lee LM, Hsiao M, Wei LH, Chen CH, Lai TC, et al. Inhibition of metastatic potential in breast carcinoma in vivo and in vitro through targeting VEGFRs and FGFRs. Evid Based Complement Alternat Med. 2013;2013:718380.
  6. Dębiński P, Dembowski J, Kowal P, Szydełko T, Kołodziej A, Małkiewicz B, et al. The clinical significance of lymphangiogenesis in renal cell carcinoma. Med Sci Monit. 2013 Jul 24;19:606-11. doi: 10.12659/MSM.883981.
  7. Haisan A, Rogojanu R, Croitoru C, Jitaru D, Tarniceriu C, Danciu M, et al. Digital microscopy assessment of angiogenesis in different breast cancer compartments. Biomed Res Int. 2013;2013:286902. doi: 10.1155/2013/286902.
  8. Orecchioni S, Gregato G, Martin-Padura I, Reggiani F, Braidotti P, Mancuso P, et al. Complementary populations of human adipose CD34+ progenitor cells promote growth, angiogenesis, and metastasis of breast cancer. Cancer Res. 2013 Oct 1;73(19):5880-91. doi: 10.1158/0008-5472.CAN-13-0821.
  9. Lee E, Pandey NB, Popel AS. Pre-treatment of mice with tumor-conditioned media accelerates metastasis to lymph nodes and lungs: a new spontaneous breast cancer metastasis model. Clin Exp Metastasis. 2014 Jan;31(1):67-79. doi: 10.1007/s10585-013-9610-9.
  10. Liao Y, Lu W, Che Q, Yang T, Qiu H, Zhang H, et al. SHARP1 suppresses angiogenesis of endometrial cancer by decreasing hypoxia-inducible factor-1α level. PLoS One. 2014 Jun 11;9(6):e99907. doi: 10.1371/journal.pone.0099907. eCollection 2014.
  11. Zhang J, Guo H, Zhu JS, Yang YC, Chen WX, Chen NW. Inhibition of phosphoinositide 3-kinase/Akt pathway decreases hypoxia inducible factor-1α expression and increases therapeutic efficacy of paclitaxel in human hypoxic gastric cancer cells. Oncol Lett. 2014 May;7(5):1401-8.
  12. Abbasi MM, Monfaredan A, Hamishehkar H, Seidi K, Jahanban- Esfahlan R. Novel DOX-MTX nanoparticles improve oral SCC clinical outcome by down regulation of lymph dissemination factor VEGF-C expression in vivo: oral and IV modalities. Asian Pac J Cancer Prev. 2014;15(15):6227-32.
  13. Yanase M, Kato K, Yoshizawa K, Noguchi N, Kitahara H, Nakamura H. Prognostic value of vascular endothelial growth factors A and C in oral squamous cell carcinoma. J Oral Pathol Med. 2014 Aug;43(7):514-20. doi: 10.1111/jop.12167.
  14. .Maiborodin IV, Maiborodina VI, Babaiants EV, Strunkin DN, Sisakian VG, Kolotova NM. Nekotorye osobennosti izmenenii podmyshechnykh limfaticheskikh uzlov bez metastazov posle khimioterapii pri rake molochnoi zhelezy [Some features of changes of lymphatic nodes free of metastasios after chemotherapy in breast cancer]. Antibiotiki i Khimioterapiia. 2009;54(9-10):42-47.
  15. Lykov AP, Nikonorova IuV, Bondarenko NA, Poveshchenko OV, Kim II, i dr. Izuchenie proliferatsii, migratsii i produktsii oksida azota kostnomozgovymi mul'tipotentnymi mezenkhimnymi stromal'nymi kletkami krys Vistar pri gipoksii i giperglikemii [Study of proliferation, migration and production of nitric oxide bone marrow multipotent mesenchymal stromal cells of Wistar rats during hypoxia and hyperglycemia]. Biul Eksperim Biologii i Meditsiny. 2015;159(4):432-34.
Address for correspondence:
630090, Russian Federation,
Novosibirsk, pr. Acad. Lavrentev, 8,
Institute of Chemical Biology and
Fundamental Medicine SB RAS,
Stem Cell Laboratory
Tel.: 8 913 753-07-67
E-mail: imai@mail.ru,
Maiborodin Igor Valentinovich
Information about the authors:
Maiborodin I.V. MD, Professor, Leading researcher of stem cell laboratory, SBSE FSBSE "Institute of Chemical Biology and Fundamental Medicine", the Russian Academy of Sciences, Siberian Branch.
Kozjakov A.E. Post-graduate student of oncology department, SBEE HPE "Novosibirsk State Medical University".
Babayants E.V. PhD, Applicant for Doctors degree of oncology department, SBEE HPE "Novosibirsk State Medical University".
Krasilnikov S.E. MD, Professor of oncology department, SBEE HPE "Novosibirsk State Medical University".

ANESTHESIOLOGY-REANIMATOLOGY

DOI: https://dx.doi.org/10.18484/2305-0047.2016.6.586   |  

V.G. PIACHERSKI, A.V. MARACHKOU

COMPARISON OF THE EFFICACY OF ULTRASOUND-GUIDED BLOCKADE OF THE SCIATIC NERVE PERFORMED THROUGH THREE APPROACHES: GLUTEAL, SUBGLUTEAL AND POPLITEAL

ME "Mogilev Regional Hospital",
Mogilev,
The Republic of Belarus

Objectives. Comparative assessment of the areas of sensory and motor block in blockade of the sciatic nerve, performed through three approaches: gluteal, subgluteal and popliteal.
Methods. In group A (n=31) the blockade was performed through the gluteal approach; in group B (n=193) through the subgluteal access; in group C (n=32) through the popliteal approach. All of the blockades of the sciatic nerve were performed with 30 ml of 1% lidocaine (epinephrine 1:200 000). Sensory block was evaluated in the foot, ankle joint, shin, popliteal fossa and posterior side of femur.
Results. In group A a complete motor block of the sciatic nerve occurred in all 31 patients. A complete sensor block was developed in all patients (100%) in the area of the foot, shin, popliteal fossa, posterior side of the thigh. Complete motor blockade of the sciatic nerve was obtained in all patients in the area of the foot, shin, popliteal fossa, posterior side of the thigh. In group B a complete sensor block in the area of the foot, shin occurred in all patients. In the popliteal fossa area a complete sensory block developed in no patient, a partial block occurred in 143 patients (74,8%) and in 50 patients (25,2%) the sensor block didnt developed at all. In group B a sensor block in the lower, middle and upper third of the thigh developed in no patient. In group C a complete sensory block in all 32 patients developed only in the area of the foot, ankle joint and lower third of the thigh. Complete motor block wasnt registered in any patient.
Conclusion. When the sciatic nerve is blocked by the subgluteal approach, the complete sensor block doesnt develop in the popliteal fossa and posterior side of the thigh. Using the popliteal approach, the sensor block occurs only in the area of the foot, ankle joint and lower third of the tibia. When the sciatic nerve is blocked through the gluteal approach, the sensor block develops in the area of the foot, shin, popliteal fossa and lower third of the tibia.

Keywords: sciatic nerve, peripheral block, US-control, gluteal approach, subgluteal approach, popliteal approach, incisional period
p. 586-591 of the original issue
References
  1. Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: part 1. Br J Anaesth. 2010 May;104(5):538-46. doi: 10.1093/bja/aeq069.
  2. Tran DQ, Bertini P, Zaouter C, Muñoz L, Finlayson RJ. A prospective, randomized comparison between single- and double-injection ultrasound-guided infraclavicular brachial plexus block. Reg Anesth Pain Med. 2010 Jan-Feb;35(1):16-21. doi: 10.1097/AAP.0b013e3181c7717c.
  3. Brull R, Macfarlane AJ, Parrington SJ, Koshkin A, Chan VW. Is circumferential injection advantageous for ultrasound-guided popliteal sciatic nerve block?: A proof-of-concept study. Reg Anesth Pain Med. 2011 May-Jun;36(3):266-70. doi: 10.1097/AAP.0b013e318217a6a1.
  4. Latzke D, Marhofer P, Zeitlinger M, Machata A, Neumann F, Lackner E, et al. Minimal local anaesthetic volumes for sciatic nerve block: evaluation of ED 99 in volunteers. Br J Anaesth. 2010 Feb;104(2):239-44. doi: 10.1093/bja/aep368.
  5. Brukhnov AV, Pecherskii VG, Marochkov AV, Kokhan ZV. Obosnovanie taktiki anesteziologicheskogo obespecheniia u patsientov pri khirurgicheskikh vmeshatel'stvakh na verkhnikh konechnostiakh [Substantiation of tactics of anesthesia in patients undergoing surgical procedures on upper extremities]. Khirurgiia Vostochnaia Evropa. 2014;(2):79-89.
  6. Rafmell DR, Nil DM, Viskoumi KM. Regionarnaia anesteziia. Samoe neobkhodimoe v anesteziologii [Regional anesthesia. The most important thing in anesthesiology]. Moscow, RF: MEDpress-inform; 2008. 272 p.
  7. Iliukevich GV, Oletskii VE. Regionarnaia anesteziia [Regional anesthesia]. Minsk, RB: Kovcheg; 2006. 164 p.
  8. Chelly JE. Peripherial nerve blocks: a color atlas. 3rd ed. Hardcover; 2009. 496 p.
  9. Dufour E, Quennesson P, Van Robais AL, Ledon F, Laloe PA, Liu N, et al. Combined ultrasound and neurostimulation guidance for popliteal sciatic nerve block: a prospective, randomized comparison with neurostimulation alone. Anesth Analg. 2008 May;106(5):1553-8, table of contents. doi: 10.1213/ane.0b013e3181684b42.
  10. Eldegwy MH, Ibrahim SM, Hanora S, Elkarta E, Elsily AS. Ultrasound-guided sciatic politeal nerve block: a comparison of separate tibial and common peroneal nerve injections versus injecting proximal to the bifurcation. Middle East J Anaesthesiol. 2015 Jun;23(2):171-76.
  11. Marhofer P, Harrop-Griffiths W, Willschke H, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: Part 2Recent developments in block techniques. BJA. 2010;104(Is 6):673-83.
  12. Piacherski V, Marochkov A. Features and principles the spread of local anesthetic blockade of the sciatic nerve at depends on the amount of anesthetic. OJAnes. 2014 Feb;14(2):31-35 doi: 10.4236/ojanes.2014.42004.
  13. Sinel'nikov RD. Atlas anatomii cheloveka. Tom 3: Uchenie o nervnoi sisteme, organakh chuvstv i organakh vnutrennei sekretsii [Atlas of Human Anatomy. Vol. 3: The doctrine of the nervous system, sensory organs and endocrine organs]. Moscow, RF: Meditsina; 1974. 399 p.
  14. Ostroverkhov GE, Bomash IuM, Lubotskii DN. Operativnaia khirurgiia i topograficheskaia anatomiia [Operative surgery and topographic anatomy]. 4-e izd dop. Kursk, RF: Kursk; 1995. 720 p.
  15. Kovanov VV. Operativnaia khirurgiia i topograficheskaia anatomiia [Operative surgery and topographic anatomy]. Moscow, RF: Meditsina; 1977. 416 p.
  16. Moayeri N, Groen GJ. Differences in quantitative architecture of sciatic nerve may explain differences in potential vulnerability to nerve injury, onset time, and minimum effective anesthetic volume. Anesthesiology. 2009 Nov;111(5):1128-34. doi: 10.1097/ALN.0b013e3181bbc72a.
Address for correspondence:
212026, Republic of Belarus,
Mogilev, Bolshaya-Birulya st.,
12, ME "Mogilev Regional Hospital",
Department of anesthesiology
and intensive care.
Tel.: + 375 212 37-80-82
E-mail: pechersky.v@yandex.by
Pecherskiy Valery Gennadevich
Information about the authors:
Piacherski V.G. PhD, Anesthesiologist of the department of anesthesiology and reanimation, ME "Mogilev Regional Hospital".
Marachkou A.V. MD, Professor, Head of the department of anesthesiology and reanimation, ME "Mogilev Regional Hospital".

NEUROSURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2016.6.592   |  

M.V. OLIZAROVICH 1,2, P.S. REMOV1,2

MICROSURGICAL INTERVENTION ON THE SPINE USING COMPUTER CALCULATION AND GRAPHIC VISUALIZATION

E "Gomel Regional Clinical Hospital"1,
EE "Gomel State Medical University"2
Gomel,
The Republic of Belarus

Objectives. Identification of the factors that determine the volume of resection of the posterior supportive complex bone structures, and evaluation of the effectiveness of microsurgical interventions on the lumbosacral part of spine conducted according to a pre-surgical computer calculation and graphical visualization.
Methods. Microsurgical interventions for dystrophic pathology of the spine had been performed in 43 patients.Resection of the bone and ligament structures was carried out according to the preoperative computer calculations. The type of bone resection in the dependence on the level of intervention and compressing factor, parameters of the interarch spaces have been analyzed. Quality-of-life considerations in patients undergoing surgical treatment was evaluated in the late postoperative period.
Results. The effect of compressing factor type and parameters of interarchspace on the resection volume of bone structures of the posterior supportive complex was established during the study. Interlaminectomy was performed reliably more often (p<0,05) at the level of LV-SI well as in cases of intervertebral disc hernias (IVD) without sequestration. Partial hemilaminectomy of both arches (above- and underlying vertebrum), supplemented by the medial facetectomy prevailed (p<0,05) at LIV-LV level, as well as in cases of the central segmental spinal canal stenosis. According to the calculations, the length of the bone window in cases of IVD hernias without sequestration was significantly less in comparison with the cases of sequestered hernias (p<0,01) and the central spinal canal stenosis (p<0,01). Analysis of the parameters of the interarch spaces has shown that in the segments of LIV-LV level, the interarch space on both sides is narrower (p<0,0001) and shorter (p<0,0001) compared to the segments of LV-SI level.
Conclusion. Technical aspects, laid down in the computer calculation algorithm, permitted to improve significantly the life quality of patients 6 months after the intervention (p <0,01). The developed methodology for the preoperative planning was carried out by means of the available software and didnt require bulky, expensive equipment.

Keywords: spine surgery, spine canal stenosis, intervertebral disc hernia, facetectomy, computer, algorithm, preoperative planning
p. 592-600 of the original issue
References
  1. Shchedrenok VV, Sebelev KI, Anikeev NV, Tiul'kin ON, Kaurova TA, Moguchaia OV. Izmeneniia dugootrostchatykh sustavov pri travme i degenerativno-distroficheskikh zabolevaniiakh poiasnichnogo otdela pozvonochnika [Changes facet joints in trauma and degenerative diseases of the lumbar spine.]. Travmatologiia i Ortopediia Rossii. 2011;(60):114-17.
  2. Chernorotov VA, Kradinov VA, Kradinova EA. Definition of forecast development of osteochondrosis of the cervical spine and its role in choosing the tactics of the sanatorium rehabilitation. Journal of Health Sciences. 2014;(1):171-78.
  3. Akshulakov SK, Kerimbaev TT, Aleinikov VG, Urunbaev EA, Kisaev EV, Sansyzbaev AB, i dr. Sovremennye problemy khirurgicheskogo lecheniia degenerativno-distroficheskikh zabolevanii pozvonochnika [Current problems in the surgical treatment of degenerative diseases of the spine]. Neirokhirurgiia i Nevrologiia Kazakhstana. 2013;(30):7-16.
  4. Khanaev AL. Predoperatsionnoe planirovanie protiazhennosti dorsal'nogo spondilodeza pri vrozhdennykh skolioticheskikh deformatsiiakh pozvonochnika [Preoperative planning the length of the dorsal spinal fusion for congenital scoliotic spine deformations]. Khirurgiia Pozvonochnika. 2004;(2):24-30.
  5. Shchadenko SV, Gorbacheva AS, Arslanova AR, Tolmachev IV. 3D-vizualizatsiia dlia planirovaniia operatsii i vypolneniia khirurgicheskogo vmeshatel'stva (CAS-tekhnologii) [3D-visualization for operational planning and execution of surgery (CASE-technology]. Biul Sib Meditsiny. 2011;13(4):165-72.
  6. Kariev MKh, Norov AU. Rol' komp'iuternoi tomografii v diagnostike gryzh mezhpozvonkovykh diskov i degenerativnogo stenoza pozvonochnogo kanala u bol'nykh poiasnichnym osteokhondrozom [The role of computed tomography in the diagnosis of herniated discs and degenerative spinal canal stenosis in patients with lumbar osteochondrosis]. Ukr Neirokhirurg Zhurn. 2001;(4):126-28.
  7. Paholpak P, Wang Z, Sakakibara T, Kasai Y. An increase in height of spinous process is associated with decreased heights of intervertebral disc and vertebral body in the degenerative process of lumbar spine. Eur Spine J. 2013 Sep;22(9):2030-34. doi: 10.1007/s00586-013-2764-y.
  8. Ogura H, Miyamoto K, Fukuta S, Naganawa T, Shimizu K. Comparison of magnetic resonance imaging and computed tomography-myelography for quantitative evaluation of lumbar intracanalar cross-section. Yonsei Med J. 2011 Jan;52(1):137-44. doi: 10.3349/ymj.2011.52.1.137.
  9. Holly LT, Foley KT. Intraoperative spinal navigation. Spine (Phila Pa 1976). 2003 Aug 1;28(15 Suppl):S54-61.
  10. Mezger U, Jendrewski C, Bartels M. Navigation in surgery. Langenbecks Arch Surg. 2013 Apr;398(4):501-14. doi: 10.1007/s00423-013-1059-4.
  11. Mannion AF, Denzler R, Dvorak J, Grob D. Five-year outcome of surgical decompression of the lumbar spine without fusion. Eur Spine J. 2010 Nov;19(11):1883-91. doi: 10.1007/s00586-010-1535-2.
  12. Polishchuk NE, Slyn'ko EI, Muravskii AV, Brinkach IS. Osobennosti tekhniki mikrodiskektomii nizhnepoiasnichnykh diskov v zavisimosti ot ikh topografo-anatomicheskikh variantov [Features of microdiscectomy technique of lower lumbar disc based on their topographic and anatomical variants]. Ukr Neirokhirurg Zhurn. 2011;(3):44-51.
Address for correspondence:
246000, Republic of Belarus,
Gomel, Lange st., 5,
UO "Gomel State
Medical University",
Department of neurology and neurosurgery.
Tel. mob: +375 44 748 43 72
Tel.: 8 0232 40-76-01
E-mail: olism@mail.ru
Olizarovich Mikhail Vladimirovich
Information about the authors:
Olizarovich M.V. PhD, Ass. Professor of the neurology and neurosurgery department, EE "Gomel State Medical University", neurosurgeon of the neurosurgical unit N1 of "Gomel Regional Clinical Hospital".
Remov P.S. Assistant of the neurology and neurosurgery department, EE "Gomel State Medical University", neurosurgeon of the neurosurgical unit N1, E "Gomel Regional Clinical Hospital".

REVIEWS

DOI: https://dx.doi.org/10.18484/2305-0047.2016.6.601   |  

V.S. KOZOPAS

CURRENT TECHNIQUES AND METHODS OF THE TREATMENT OF PELVIC FRACTURES

Danylo Halytsky Lviv National Medical University,
Lviv,
Ukraine

In recent decades, the problem of injuries in general and the pelvic damages in particular, including multiple and combined injuries, remains one of the most urgent not only in traumatology and orthopedics, but also in other fields of surgery, as well as reanimatology and health organization. Analyzing polytrauma structure the pelvic damages are observed in 17-39% of cases. Despite such frequent verification of pelvic injuries, conservative and surgical treatment of this disease does not always lead to positive results. In the case of combined pelvic injuries mortality may reach up to 80%, among the patients who have undergone pelvic injury the invalids became up to 50%.
The literature review on the diagnosis and treatment of pelvic fractures permits to inform the specialists, dealing with this issue, about current classification of pelvic fractures along with the standards of examination, treatment, principles of medical evacuation and optimization of medical aids orientated on patients with pelvic ring fractures. It is shown, that providing emergency care to the victims with pelvic injuries, especially with multiple and combined trauma at the prehospital and hospital stages, requires the development of techniques that are effective for pain control, the administration of anti-shock fluids at the accident site, creating unified facilities of immobilization, as well as the revision of organization of medical care providing in these cases.

Keywords: fractures of the pelvis, polytrauma, victims, immobilization, accident site, method of treatment, prehospital and hospital stages
p. 601-609 of the original issue
References
  1. Bitchuk DD, Kovalev SI, Istomin AG, Chaienko VP, Fadeev OP. Vneochagovyi osteosintez taza pri politravme [Extrafocal pelvis osteosynthesis in polytrauma]. Ortopediia Travmatologiia i Protezirovanie. 1996;(2):48-50.
  2. Ushakov SA, Lukin SIu, Istokskii KN, Nikol'skii AV, Mitreikin IuV. Lechenie travmy taza, oslozhnennoi povrezhdeniiami urogenital'nogo trakta [Treatment of pelvic trauma complicated by lesions of the urogenital tract]. Genii Ortopedii. 2011;(1):140-44.
  3. Batpenov ND. Baimagambetov ShA, Makhambetchin MM. Raneniia kishki oskolkom kosti pri nestabil'nykh perelomakh taza u bol'nykh s politravmoi [Wound gut bone splinter when the unstable pelvic fractures in patients with multiple injuries]. Travmatologiia i Ortopediia Rossii. 2011;62(4):100-104.
  4. Chemiris AI, Nerianov IuM, Kudievskii AV, i dr. Oshibki i nedostatki pri okazanii pervoi meditsinskoi pomoshchi postradavshim s politravmoi na dogospital'nom etape [Mistakes and shortcomings in the provision of first aid to victims with polytrauma at the prehospital stage]. Travma. 2003;4(5):587-90.
  5. Goncharov SF, Borisenko LV. Zadachi Vserosiiskoi sluzhby meditsiny katastrof po realizatsii tselevoi programmy po bezopasnosti dorozhnogo dvizheniia [Objectives of All-Russian disaster medicine service for the implementation of targeted road safety programs]. Meditsina Katastrof. 2006;(3):5-7.
  6. Shevchenko VS. Nadannia dopomogi postrazhdalim z poltravmoiu na etap gostrogo perodu travmatichno khvorobi [Assistance to the victims of polytrauma during the acute period of traumatic disease]. Travma. 2003;4(4):454-56.
  7. Bondarenko AV, Peleganchuk VA, Gerasimova OA. Gospital'naia letal'nost' pri sochetannoi travme i vozmozhnosti ee snizheniia [Hospital mortality in combined injury and the possibility of its reduction]. Vestn. Travmatologii i Ortopedii. 2004;(3):49-52.
  8. Bichkov VV. Osnovn napriamki optimzats nadannia medichno dopomogi postrazhdalim v dorozhn'o-transportnikh prigodakh [The main directions of optimization of medical care to victims of road accidents]. Travma. 2009;10(4):430-33.
  9. Wolinsky PR. Assessment and management of pelvic fracture in the hemodynamically unstable patient. Orthop Clin North Am. 1997 Jul;28(3):321-29.
  10. Fitzgerald CA, Morse BC, Dente CJ. Pelvic ring fractures: has mortality improved following the implementation of damage control resuscitation? Am J Surg. 2014 Dec;208(6):1083-90; discussion 1089-90. doi: 10.1016/j.amjsurg.2014.09.002.
  11. Abrassart S, Stern R, Peter R. Unstable pelvic ring injury with hemodynamic instability: What seems the best procedure choice and sequence in the initial management? Orthop Traumatol Surg Res. 2013;99(2):175-82 doi: 10.1016/j.otsr.2012.12.014.
  12. Hou Z, Smith WR, Strohecker KA. Morgan Steven J. Hemodynamicallyunstable pelvic fracture management by advanced trauma life support guidelines results in high mortality. Orthopedics. 2012 Mar;35(3):e319-24. doi: 10.3928/01477447-20120222-29.
  13. Müller ME, Schneider R, Willenegger H, Allgöwer M, ed. Manual of Internal fixation. Springer-Verlag Berlin Heidelberg; 1991. 410 . doi: 10.1007/978-3-662-02695-3.
  14. Vlasov AP, Shevalaev GA. Sistemnyi koaguliatsionno-liticheskii distress-sindrom pri travmaticheskoi bolezni [System coagulation-lytic distress syndrome in traumatic disease]. Travmatologiia i Ortopediia Rossii. 2014;(1):80-85.
  15. Babosha VA, Pasternak VN, Lobanov VN. Nestabil'nye povrezhdeniia taza-dogospital'nyi etap pomoshchi [Unstable pelvic damage, prehospital assistance]. Ortopediia Travmatologiia i Protezirovanie. 2002;(3):147-51.
  16. Lobanov GV. Zovnshnia fksatsia poshkodzhen' taza (morfologchne ta eksperimental'no-mekhanchne dosldzhennia [External fixation of pelvic injuries (morphological and experimental mechanical study]. Vsnik Ortoped Travmatolog ta Protezuvannia. 1999;25(1):141-42.
  17. Lobanov GV, Oksimets VM, Ostroverkhov OA, Borovoi IS. Vybor taktiki lecheniia postradavshikh s mnozhestvennymi povrezhdeniiami oblasti tazobedrennogo sustava v ostrom periode travmy [The choice of tactics of treatment of patients with multiple injuries of the hip region during the acute phase of injury]. Ltopis Travmatolog ta Ortoped. 2003;(1,2):48-50.
  18. Kolesnikov VV, Onishchenko NS, Dushkin OF. Ispol'zovanie protivoshokovogo kostiuma Kashtan v lechenii tiazheloi sochetannoi travmy [Using antishock suit "chestnut" in the treatment of severe combined trauma]. Vestn Travmatologii Ortopedii im NN Priorova. 2002;(2):9-13.
  19. Schildhauer TA, Wilber JH, Patterson BM. Posterior locked lateral compression injury of the pelvis: report of three cases. J Orthop Trauma. 2000 Feb;14(2):107-11.
  20. Sokolov VA, Didenko AA, Makarov SA. Ispol'zovanie kostiuma "Kashtan" dlia neinfuzionnoi korrektsii ostroi krovopoteri i shoka pri travmakh [Using Costume "Chestnut" for a correction fluid of acute blood loss and shock with injuries]. Vestn Intensiv Terapii. 1993;(2-3):23-26.
  21. Diatlov MM. Povrezhdeniia krovenosnykh sosudov taza pri ego nestabil'nykh perelomakh i vyvikhakh u bol'nykh s sochetannoi travmoi [Damage to the blood vessels of the pelvis in its unstable fractures and dislocations in patients with combined trauma]. Vestn Travmatologii Ortopedii im NN Priorova. 1999;(2): 27-33.
  22. Failinger MS, McGanity PL. Unstable fractures of the pelvic ring. J Bone Joint Surg Am. 1992 Jun;74(5):781-91.
  23. Shirley PJ. Transportation of the critically ill and injured patient. Hosp Med. 2000;61(6):406-10. doi: 10.12968/hosp.2000.61.6.1356.
  24. Gumanenko EK, Shapovalov VM, Dulaev AK, Dydykin A V. Sovremennye podkhody k lecheniiu postradavshikh s nestabil'nymi povrezhdeniiami tazovogo kol'tsa [Current approaches to the treatment of patients with unstable pelvic ring injuries]. Voen-Med Zhurn. 2003;(4):17-24.
  25. Ankin L.N. Problemy uluchsheniia lecheniia povrezhdenii taza [Problems of improving the treatment of injuries of the pelvis]. Ortopediia Travmatologiia i Protezirovanie. 2009;(2):96-101.
  26. Tile M, Helfet DL, Kellam JF, eds. Fractures of the Pelvis and Acetabulum. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2003. 830 .
  27. Kukuruz IS, Burlaka VV, Bondarenko VV. Khrurgchne lkuvannia pri poЄdnani travm taza tazovikh organv [Surgical treatment of concomitant injury of the pelvis and pelvic organs]. Vsnik Ortoped Travmatolog ta Protezuvannia. 2003;(2):39-44.
  28. Rosseman R. A brief history of MAST. Pag: Wise Inc., 2001.
  29. Pasternak VN, Babosha VA, Lobanov GV. Nestabil'nye povrezhdeniia taza - pomoshch' na etape ostrogo perioda travmy s pozitsii meditsiny ekstremal'nykh sostoianii [Unstable pelvic injuries - assistance at the stage of the acute period of injury from the standpoint of medicine of extreme conditions]. Ukr zhurn ekstremal'no meditsini m GO MozhaЄva. 2004;(4):59-63
  30. Mardanpour K1, Rahbar M. The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation. J Inj Violence Res. 2013 Jul;5(2):77-83. doi: 10.5249/jivr.v5i2.138.
  31. Bassam D, Cephas GA, Ferguson KA, Beard LN, Young JS. A protocol for the initial management of unstable pelvic fractures. Am Surg. 1998 Sep;64(9):862-67.
  32. Pape HC, Giannoudis P, Krettek C. The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery. Am J Surg. 2002 Jun;183(6):622-29.
  33. Beidik OV, Levchenko KK, Liubitskii AP, Gabatkin AI, Afanas'ev DV, Shevchenko KV, i dr. Sravnitel'naia otsenka zhestkosti fiksatsii kostnykh otlomkov spitsevymi, sterzhnevymi i spitse-sterzhnevymi sposobami naruzhnogo chreskostnogo osteosinteza [Comparative evaluation of stiffness fixation of bone fragments spoke, and spoke rod-rod outer ways chreskostnogo osteosynthesis]. Genii Ortopedii. 2003;(1):109-14.
  34. Simonian PT, Routt ML Jr, Harrington RM, Tencer AF. Anterior versus posterior provisional fixation in the unstable pelvis. A biomechanical comparison. Clin Orthop Relat Res. 1995 Jan;(310):245-51.
  35. Cherkes-Zade DI, Lapshin VB, Nozhin NP, Kamenev AF. Lechenie povrezhdenii taza s ispol'zovaniem apparatov naruzhnoi fiksatsii [Treatment of injuries of the pelvis using an external fixator]. Ortopediia Travmatologiia i Protezirovanie. 1993;(3):44-47.
  36. Ankin LN, Ankin NL. Povrezhdeniia taza i perelomy vertluzhnoi vpadiny [Damage to the pelvic and acetabular fractures]. Kiev, Ukraina: Kniga plius; 2007. 216 p.
  37. Klmovits'kii VG, Pasternak VP, Poliachenko IuV. Poltravma patogenetichne obgruntuvannia lkuval'nogo kompleksu gostrogo perodu travmatichno khvorobi [Polytrauma - pathogenetic substantiation of a medical complex of the acute period of traumatic disease]. Ukrans'kii Zhurnal Ekstremal'no Meditsini m GO MozhaЄva. 2002;3(1):11-16.
  38. Peitzman AB, Rhodes M, Schwab CW, Yealy DM, Fabian TC. The trauma manual. 2nd ed. Lippincott: Williams and Wilkins; 2003. 310 p.
  39. Džupa V, Pavelka T, Taller S. Pelvic ring injury as part of multiple trauma. Rozhl Chir. 2014;93(5):292-96.
  40. Shapovalov VM, Dulaev AK, Dydykin A.V. Eksperemental'naia razrabotka i klinicheskoe priminenie minimal'no invazivnoi vnutrennei sterzhnevoi fiksatsii tazovogo kol'tsa [Experimental and clinical development of application of minimally invasive internal fixation of pelvic ring core]. Vestn Travmatologii i Ortopedii im NN Priorova. 2001;(4):33-37.
  41. Pohlemann T. Prymary treatment of politrauma patients with pelvis traum as leading injury. Eur J Trauma. 2002;(1):41-42.
  42. Balbachevsky D, Belloti JC, Doca DG, Jannarelli B, Junior JA, Fernandes HJ, et al. Treatment of pelvic fractures - a national survey. Injury. 2014 Nov;45(Suppl 5):S46-51. doi: 10.1016/S0020-1383(14)70021-X.
  43. Bialik EI, Fain AM. Etapnoe lechenie povrezhdenii v oblasti lonnogo sochleneniia s primeneniem original'nogo fiksatora u postradavshikh s sochetannoi travmoi taza [Staged treatment of lesions in the symphysis pubis with the original lock in victims with concomitant injury of the pelvis]. Politravma. 2013;(4):30-34.
  44. Hiesterman TG, Hill BW, Cole PA. Surgical technique: a percutaneous method of subcutaneous fixation for the anterior pelvic ring: the pelvic bridge. Clin Orthop Relat Res. 2012 Aug;470(8):2116-23. doi: 10.1007/s11999-012-2341-4.
  45. Chen HW, Liu GD, Ou S, Zhao GS, Pan J. Treatment of unstable sacral fractures with percutaneous reconstruction plate internal fixation. Acta Cir Bras. 2012 May;27(5):338-42. doi: 10.1590/S0102-86502012000500010.
  46. Li C. L. Clinical comparative analysis on unstable pelvic fractures in the treatment with percutaneous sacroiliac screws and sacroiliac joint anterior plate fixation. Eur Rev Med Pharmacol Sci. 2014;18(18):2704-8.
  47. Khanin MIu, Minasov BSh, Minasov TB, Iakupov PP, Zagitov BG. Ortopedicheskii damage-control pri povrezhdeniiakh taza u patsientov s politravmoi [Orthopedic damage-control with pelvic lesions in patients with multiple injuries]. Prakt Meditsina. 2011;(6):122-25.
  48. Smirnov AA. Operativnoe lechenie vertikal'no-nestabil'nykh povrezhdenii taza (tip S po klassifikatsii AO) [Surgical treatment of vertically unstable pelvic injuries (type C by AO classification)]. Travmatologiia i Ortopediia Rossii. 2012;(1):73-76.
  49. Donchenko SV, Dubrov VE, Sliniakov LIu, Cherniaev AV, Lebedev AF, i dr. Algoritm khirurgicheskogo lecheniia nestabil'nykh povrezhdenii tazovogo kol'tsa [The algorithm of surgical treatment of unstable pelvic ring injuries]. Vestn Travmatologii i Ortopedii im NN Priorova. 2013;(4):9-16.
Address for correspondence:
79010, Ukraine,
Lviv. Pekarskaya st., 69,
Lviv National Medical University
named after Danila Galitsky,
Department of disaster medicine
and military medicine.
Tel.: 38 (032) 260-08-28
E-mail: kozopas@ukr.net
Kozopas Viktor Stepanovich
Information about the authors:
Kozopas V.S. PhD, Assistant of department of disaster medicine and military medicine of Danylo Halytsky Lviv National Medical University.

CASE REPORTS

DOI: https://dx.doi.org/10.18484/2305-0047.2016.6.610   |  

E.L. KALMYKOV 1, A.D. GAIBOV 2, O.N. SADRIEV 2, A.N. SAFAROVA 2

PRIMARY MUSCLE HYDATIDOSIS OF THE LUMBAR REGION

Tajik National Research Center for Transplantation of Organs and Human Tissue2 of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan,
Republican Scientific Center of the Cardiovascular Surgery of the Ministry of Health and
Social Protection of the Population, the Republic of Tajikistan,
Dushanbe,
The Republic of Tajikistan

Human echinococcosis is a severe parasitic disease affecting almost all organs and tissues of the human body. The frequency of muscle echinococcosis is not more than 0,7-0,9% of cases and reports about the primary muscular lesion by the parasite is casuistic. The patient (21-years-old) complained of the occurrence of a dense, painless tumor formation in the left lumbar region. Within two recent years the patient noticed the presence of tumor formation and its gradual growth. Tumor biopsy was performed in one of the clinics. Single hooks of echinococcus were obtained according to the histological findings. Radiography of the chest and ultrasonography of the liver, spleen, abdominal cavity, retroperitoneal space, and heart revealed no hydatid cysts. Computer tomography of the brain also detected no pathological changes. According to general and biochemical analysis all parameters are normal. By means of ultrasound examination of tumors, a multi-chamber liquid formation was found, its content is homogeneous, and size of the cyst is 13×7 cm. The patient was operated on. The hydatid cyst was removed; fibrous capsule cavity was treated thrice with 90% ethanol and with 100% glycerol solution additionally. During the residual cavity revision it was found out that the cyst wall tightly adhered to the surrounding spinal cord tissue. The wound was closed and drained only after hemostasis is secure. The patient received postoperative albendazole therapy. The observation period of this patient made up 5 years. Within control surveys, no disease recurrence was detected as well as the localization of hydatid cysts in other organs.

Keywords: echinococcosis, primary hydatid cyst, muscles, hemostasis, hydatidectomy, hydatidosis, observation period
p. 610-616 of the original issue
References
  1. Tekin R, Avci A, Tekin RC, Gem M, Cevik R. Hydatid cysts in muscles: clinical manifestations, diagnosis, and management of this atypical presentation. Rev Soc Bras Med Trop. 2015 Sep-Oct;48(5):594-8. doi: 10.1590/0037-8682-0197-2015.
  2. Madhar M, Aitsoultana A, Chafik R, Elhaoury H, Saidi H, Fikry T. Primary hydatid cyst of the thigh: on seven cases. Musculoskelet Surg. 2013 Apr; 97(1):77-9. doi: 10.1007/s12306-011-0157-0.
  3. Das DK, El-Sharawy M, Ayyash EH, Al-Enezi NA, Iqbal JR, Madda JP. Primary hydatid cyst of the supraspinatus muscle: complete removal of the germinal layer and cytodiagnosis by fine-needle aspiration. Diagn Cytopathol. 2014 Mar; 42(3):268-72. doi: 10.1002/dc.22925.
  4. Jellad A, Boudokhane S, Ezzine S, Ben Salah Z, Golli M. Femoral neuropathy caused by compressive iliopsoas hydatid cyst: a case report and review of the literature. Joint Bone Spine. 2010 Jul;77(4):371-72. doi: 10.1016/j.jbspin.2010.03.016.
  5. Gluncić I, Roje Z, Bradarić N, Petricević A, Pisac VP, Gluncić V. Primary echinococcosis of the sternocleidomastoid muscle. Croat Med J. 2001 Apr; 42(2):196-98.
  6. Motie MR, Rezapanah A, Pezeshki Rad M, Razavian H, Azadmand A, Khajeh M. Primary localization of a hydatid cyst in the latissimus dorsi muscle: an unusual location. Surg Infect (Larchmt). 2011 Oct;12(5):401-3. doi: 10.1089/sur.2010.077.
  7. Arazi M, Erikoglu M, Odev K, Memik R, Ozdemir M. Primary echinococcus infestation of the bone and muscles. Clin Orthop Relat Res. 2005 Mar; (432):234-41.
  8. Bilanović D, Zdravković D, Randjelović T, Tosković B, Gacić J. Lesion of the femoral nerve caused by a hydatid cyst of the right psoas muscle. Srp Arh Celok Lek. 2010 Jul-Aug;138(7-8):502-5.
  9. Alimehmeti R, Seferi A, Rroji A, Alimehmeti M. Saphenous neuropathy due to large hydatid cyst within long adductor muscle: case report and literature review. J Infect Dev Ctries. 2012 Jun 15; 6(6):531-35.
  10. Yildiz S, Komur E, Akti Z, Karabag H. Infected primary paraspinal hydatidosis with water lily sign. Emerg Med. 2012 Dec;43(6):989-91. doi: 10.1016/j.jemermed.2010.11.057.
  11. Aydin BK, Acar MA, Sumer S, Demir NA, Erkocak OF, Ural O. Primary hydatid disease of brachialis and biceps brachii muscles: a case report. Trop Doct. 2014 Jan; 44(1):53-5. doi: 10.1177/0049475513512636.
  12. Mahmood Nouriyan S, Mokhtari M, Abbasi Fard S, Nouriyan N. Primary solitary hydatid cyst in paraspinal cervical muscles: a case report and review of the literature. Neurol Neurochir Pol. 2011 Jul-Aug;45(4):387-90.
  13. Gougoulias NE, Varitimidis SE, Bargiotas KA, Dovas TN, Karydakis G, Dailiana ZH. Skeletal muscle hydatid cysts presenting as soft tissue masses. Hippokratia. 2010 Apr; 14(2):126-30.
  14. Sogüt O, Ozgönül A, Bitiren M, Köse R, Cece H. Primary hydatid cyst in the deltoid muscle: an unusual localization. Int J Infect Dis. 2010 Sep;14(Suppl 3):e347-8. doi: 10.1016/j.ijid.2009.07.009.
  15. Gaibov AD, Kamolov AN, Mirzoev SA, Kalmykov EL, Aminov RS. Emboliia bifurkatsii aorty, vyzvannaia razorvavsheisia ekhinokokkovoi kistoi serdtsa [Embolism of bifurcation of the aorta caused by a ruptured hydatid cyst of the heart]. Kardiologiia i Serdech-Sosud khirurgiia. 2009;2(5):89-92
  16. Acar A, Rodop O, Yenilmez E, Baylan O, Oncül O. Case report: primary localization of a hydatid cyst in the adductor brevis muscle. Turkiye Parazitol Derg. 2009;33(2):174-76.
  17. Calò PG, Tatti A, Tuveri M, Farris S, Nicolosi A. Hydatid cyst of trapezius muscle: an unusual localisation. Report of a case and review of the literature. Chir Ital. 2007 Nov-Dec;59(6):873-76.
  18. Kazakos CJ, Galanis VG, Verettas DA, Polychronidis A, Simopoulos C. Primary hydatid disease in femoral muscles. J Int Med Res. 2005 Nov-Dec;33(6):703-6.
  19. Zulfikaroglu B, Koc M, Ozalp N, Ozmen MM. A rare primary location of echinococcal disease: report of a case. Ups J Med Sci. 2005;110(2):167-71.
  20. Keskin D, Ezirmik N, Karsan O, Gürsan N. Primary hydatidosis of the gracilis muscle in a girl. J Int Med Res. 2002 Jul-Aug; 30(4):449-51.
  21. Cankorkmaz L, Ozturk H, Koyluoglu G, Atalar MH, Arslan MS. Intermuscular hydatid cyst in a 4-year-old child: a case report. J Pediatr Surg. 2007 Nov;42(11):1946-48.
  22. Gupta R, Mathur SR, Agarwala S, Kaushal S, Srivastav A. Primary soft tissue hydatidosis: aspiration cytological diagnosis in two cases. Diagn Cytopathol. 2008 Dec;36(12):884-86. doi: 10.1002/dc.20936.
  23. Nell M, Burgkart RH, Gradl G, von Eisenhart-Rothe R, Schaeffeler C, Trappe D et al. Primary extrahepatic alveolar echinococcosis of the lumbar spine and the psoas muscle. Ann Clin Microbiol Antimicrob. 2011 Apr 15;10:13. doi: 10.1186/1476-0711-10-13.
  24. Ormeci N, Idilman R, Akyar S, Palabiyikoğlu M, Coban S, Erdem H, et al. Hydatid cysts in muscle: a modified percutaneous treatment approach. Int J Infect Dis. 2007 May;11(3):204-8.
  25. Carpintero P, Kindelan J, Montero R, Carpintero A. Primary hydatidosis of the peripheral muscles: treatment with albendazole. Clin Infect Dis. 1997 Jan;24(1):85-6.
Address for correspondence:
734000, Republic of Tajikistan,
Dushanbe, Mayakovsky st., 2,
National Research Center
for transplantation of organs and human tissues.
E-mail: egan0428@mail.ru
Kalmykov Egan Leonidovich
Information about the authors:
Kalmykov E.L. PhD, Deputy Director (Science) of National Research Center for transplantation of organs and human tissues of the Ministry of Health and Social Protection of the Population, the Republic of Tajikistan
Gaibov A.D. MD, Professor, Corresponding Member of the Academy of Medical Sciences of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan, Professor of department 2 of the surgical diseases, Avicenna Tajik State Medical University.
Sadriev O.N. Leading Researcher of the Republican Scientific Center of the Cardiovascular Surgery of the Ministry of Health and Social Protection of the Population, the Republic of Tajikistan.
Safarova A.N. PhD, Vascular Surgeon of Republican Scientific Center of the Cardiovascular Surgery of the Ministry of Health and Social Protection of the Population, the Republic of Tajikistan.
DOI: https://dx.doi.org/10.18484/2305-0047.2016.6.617   |  

V.I. BELOKONEV 1, S.M. PIKALOV 2, S.Y. PUSHKIN 2, A.N. ZHDANOVA 1

GIANT SLIDING INGUINAL SCROTAL HERNIA OF THE BLADDER

FSBEE HE "Samara State Medical University" 1,
SBME "Samara Regional Clinical Hospital named after V.D. Seredavin" 2,
Samara,
The Russian Federation

A clinical observation of 64-year-old patient with giant sliding inguinal scrotal hernia, suffering from third-degree obesity is presented in this article. On admission the patient complained that the scrotum gradually increased in size to the extent of impairing free movement and urinary tract disorders. He has been ill since 1991, when a tumor-like formation developed in the right groin after lifting a heavy object and gradually began to increase in size. The patient appealed to a physician only in 2015 due to his inability to urinate otherwise than in the in lying position by pressure on the scrotum. The patient was operated on and during the operation a combined right-sided huge oblique congenital hernia, complicated by hydrocele, which couldnt be reset and and direct sliding inguinal hernia containing the ureter and bladder had been revealed. With some technical difficulties the fibro-changed huge hernia sac with a testicle was initially isolated. After isolation and treatment, the neck of the spermatic cord was tied off, the hernia sac with the right testicle were removed. Its stump after the closure with the internal purse-string suture was loaded in the preperitoneal space. When this stage was completed medially in relation to the removed hernia sac a tumor-like large formation remained in the scrotum. The right ureter and most part of the bladder were found in division of tumor-like formation. The bed was prepared via the suprapubic access in the preperitoneal space, in which via the window in the transverse fascia in the projection of the medial inguinal fossa the bladder and right ureter were displaced and the epicystostomy was imposed. In the inguinal canal the stitching of the transverse fascia was carried out, after that its posterior wall was reinforced with synthetic prosthesis, covering both inguinal fossae.Operation was completed by scrotal excision and reconstruction with skin grafts plasty. The incisional period was uneventful. The point of this observation is the rarity of this disease and the difficulty of preoperative diagnosis established clinically only. An exact diagnosis was established only during the operation. Inguinal-scrotal chronic hernia is a complex surgical pathology. Prevention of the formation of these hernias is considered to be as an early surgical treatment. One peculiarity is worthy of notice: the performance of scrotal plasty is an attempt to avoid complications and to improve the outcome of treatment.

Keywords: sliding inguinal hernia of the bladder, herniotomy, hydrocele, combined method of plasty, epicystostomy, incisional period, outcome of treatment
p. 617-622 of the original issue
References
  1. Kukudzhanov NI. Pakhovye gryzhi [Inguinal hernias]. Moscow, RF: Meditsina; 1969. 440 p.
  2. Belokonev VI, Pushkin SIu, Kovaleva ZV, Melent'eva ON, Ponomareva IuV. Gryzhi zhivota [Hernias of the abdomen]: ucheb posobie. Moscow, RF: Forum. Infa-M; 2015. 184 p.
  3. Zhebrovskii VV, El'bashir MT. Khirurgiia gryzh zhivota i eventratsii [Surgery of abdominal hernias and eventrations]. Moscow, RF: MIA; 2009. 440 p.
  4. Ivanov SV, Gorbacheva OS, Ivanov IS, Goriainova GN, Ob"edkov EG, i dr. Gigantskaia pakhovo-moshonochnaia gryzha [Giant inguinal-scrotal hernia]. Novosti Khirurgii. 2015;23(2):226-30.
  5. Aboev SA. Rekonstruktsiia briushnoi stenki pri gryzhakh pakhovoi oblasti [Reconstruction of the abdominal wall in the groin hernia]. Vladikavkaz, RF; 2011. 156 p.
  6. Schumpelick V, Fitzgibbons RJ, eds. Recurrent hernia prevention and treatment. Springer-Verlag Berlin Heidelberg; 2007. 427 .
  7. Jenkins JT, ODwyer PJ. Inguinal hernias. BMJ. 2008 Feb 2; 336(7638): 269-72. doi: 10.1136/bmj.39450.428275.
  8. Fedoseev AV, Murav'ev SIu, Chekushin AA. Iniutin AA. Vzgliad na etiologiiu i patogenez gryzheobrazovaniia v I veke [A view at the etiology and pathogenesis of herniation in the twenty-first century]. Gerniologiia. 2009;(2):8-13.
Address for correspondence:
443095, Russian Federation, Samara,
Tashkent st., 159,
GBUZ "Samara Regional
Clinical Hospital named after V.D. Seredavin".
Tel.: (846) 956-32-47
E-mail: zh.antoninauro@gmail.com
Zhdanova Antonina Nikolaevna
Information about the authors:
Belokonev V.I. Honored Physician of RF, MD, professor, Head of department of the surgical diseases N2, FSBE HE "Samara State Medical University".
Pikalov S.M. Chief freelance urologist of the Ministry of Health of Samara region, Head of the urology unit, physician of the highest category of SBME "Samara Regional Clinical Hospital named after V.D.Seredavin".
Pushkin S.Y. MD, Deputy Chief (Surgery), SBME "Samara Regional Clinical Hospital named after V.D.Seredavin".
Zhdanova A.N. Clinical intern of the urology department, FSBE HE "Samara State Medical University".

EXXHANGE OF EXPERIENCE

DOI: https://dx.doi.org/10.18484/2305-0047.2016.6.623   |  

N. TORMA 1, I. KOPOLOVETS 2, M. FRANKOVIČOVÁ 3,4, Z. TORMOVÁ 3,4, V. LACKOVÁ 1, G. KOPOLOVETS 1, A. OLOS 2

MINIMALLY INVASIVE TREATMENT OF LOWER LIMB VARICOSITY OF C5-C6 CLASSES (CEAP)

Vascular Center "IMEA " 1, Kosice,
The Slovak Republic,
DSME "Uzhgorod National University" 2, Uzhgorod,
Ukraine,
East Slovak Institute of Cardiovascular Diseases VUSCH 3, Kosice
P.I.Safarik University 4, Kosice,
The Slovak Republic

Objectives. To evaluate the results of minimally invasive methods for treatment of chronic venous insufficiency in patients with trophic ulcers.
Methods. In 2015 79 patients with chronic venous insufficiency (CVI) stages C5-C6 according to the CEAP classification had been treated. All the patients were divided into 2 groups. Group I included 45 (60.7%) patients with CVI according to CEAP class C5 (healed venous ulcer). Group II included 34 (39.3%) patients with CVI according to CEAP clinical stage C6 (active venous ulcer). Two types of thermal obliteration procedures: radiofrequency obliteration (VNUS ClosureFast) and endovenous laser obliteration (ELVES 1470 nm) were used. In general, thermal obliteration of the venous trunks was performed in 69.6% of studied patients. Recrossectomy for recurrent varicose veins was performed in 6.3% of patients; mini-phlebectomy was carried out in 25.3% of cases. 16.5% of patients with incompetent perforating veins underwent sclerotherapy; surgical ligation of incompetent perforating veins was performed in 11.4% of patients.
Results. In the postoperative period within 4-6 months the complete healing of trophic ulcer was observed in 26 (76.5%) patients of group II (CEAP stage C6). In 3-4 months after surgery the reduction of the trophic ulcer area by more than 50% was observed in 3 patients with a large circular defect. Transfascial sclerotherapy of tibial perforating veins due to recurrent ulcer 5 and 7 months after radiofrequency obliteration was performed in 4 patients.
Conclusion. Endovenous methods of treatment of lower extremity varicose vein in patients with trophic ulcers allow to achieve good postoperative results. Complete healing of trophic ulcer was observed in 76.5% of patients. The performance of the local treatment of wounds and adequate compression therapy allowing to achieve the positive results and to eliminate the venous reflux for patients with active ulcer.

Keywords: chronic venous insufficiency, varicose vein disease, venous reflux, radiofrequency obliteration, trophic ulcers, compression therapy, complete healing
p. 623-626 of the original issue
References
  1. Venger K, Bedeniuk AD, Romaniuk TV. Trofchn virazki venoznogo enezu taktika khrurgchnogo lkuvannia [Trophic venous ulcers genesis surgical tactic]. Shpital'na Khrurgia. 2011;(1):57-60.
  2. Chernukha LM. Khronicheskie zabolivaniia ven problema, trebuiushchaia resheniia [Chronic venous disease - a problem to solve]. Zdorovia Ukrani. 2011;259(6):18-19.
  3. Mazzaccaro DP, Stegher S, Occhiuto MT. Varicose veins: new trends in treatment in a Vascular Surgery Unit. Ann Ital Chir. 2016;87:166-71.
  4. Rusin V, Korsak VV, Boldzhar PO, Borsenko M, Mitrovka BA Lkuvannia venoznikh trofchnikh virazok shliakhom ekhosklerooblterats proniznikh ven [Treatment of venous trophic veins by means of echoscleroobliteration]. Klnchna Khrurgia. 2014;2:5-7.
  5. Smirnov AA, Kulikov LK, Privalov IA, Sobotovich VF. Retsidiv varikoznogo rasshireniia ven nizhnikh konechnostei [Recurrence of varicose veins]. Novosti Khirurgii. 2015; 23(4):447-50. doi: 10.18484/2305-0047.2015.4.447.
  6. King JT, O'Byrne M, Vasquez M, Wright D. Treatment of truncal incompetence and varicose veins with a single administration of a new polidocanol endovenous microfoam preparation improves symptoms and appearance. Eur J Vasc Endovasc Surg. 2015 Dec;50(6):784-93. doi: 10.1016/j.ejvs.2015.06.111.
  7. Van der Velden SK, De Maeseneer MG, Pichot O, Nijsten T, van den Bos RR. Postural diameter change of the saphenous trunk in chronic venous disease. Eur J Vasc Endovasc Surg. 2016 Jun;51(6):831-7. doi: 10.1016/j.ejvs.2016.02.019.
  8. Hudson AJ, Whittaker DR, Szpisjak DF, Lenart MJ, Bailey MM. Tumescent technique without epinephrine for endovenous laser therapy and serum lidocaine concentration. J Vasc Surg Venous Lymphat Disord. 2015 Jan;3(1):48-53. doi: 10.1016/j.jvsv.2014.07.006.
Address for correspondence:
88000, Ukraine, Uzhgorod,
Universitetskaya st., 10,
VGUZ "Uzhhorod National University".
Tel.: +380 50 558-82-11
E-mail: i.kopolovets@gmail.com
Kopolovets Ivan Ivanovich
Information about the authors:
Torma N. PhD, Vascular Surgeon, "IMEA ", Kosice, the Slovak Republic.
Kopolovets I. PhD, Researcher of DSME "Uzhgorod National University", Uzhgorod, Ukraine.
Frankovičová M. PhD, Professor, Head of Vascular Surgery Clinic, East Slovak Institute of Cardiovascular Diseases "VUSCH", P.I.Safarik University, medical faculty, Kosice, the Slovak Republic.
Tormová Z. Angiologist, East Slovak Institute of Cardiovascular Disease "VUSCH", Kosice, the Slovak Republic.
Lacková V. Angiologist, Vascular Center "IMEA ", Kosice, the Slovak Republic.
Kopolovets G. Angiologist, Vascular Center "IMEA ", Kosice, the Slovak Republic.
Olos A. Surgeon, DSME "Uzhgorod National University", Uzhgorod, Ukraine.
Contacts | ©Vitebsk State Medical University, 2007