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Khirurgii

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Year 2017 Vol. 25 No 1

HISTORY

E.V. NIKITINA, I.M. SAMSONOVA, A.N. KIZIMENKO

A HISTORY OF THE FIRST ANESTHESIA

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

In 2016 the world community celebrated the 170th anniversary of the first successful demonstration of ether anesthesia. Among the greatest achievements of medicine, control over a pain while carrying out surgical operations has affected almost each person in the world. From the end of the XVØ century for the purpose of anaesthesia, physician and chemists unsuccessfully experimented with various gases, such as: nitrous oxide, ether, chloroform and others. On October, 16, 1846, a dentist William Thomas Green Morton (1819-1868) performed a public demonstration of a painless tooth extraction after administering ether as an inhalation anesthetic and that permitted surgeon John Collins Warren to remove a vascular tumor in Edward Gilbert Abbot. This event took place in Massachusetts General Hospital now known as the Ether Dome. News about the first successful demonstration of anesthesia rather quickly spread worldwide. According to many historians of medicine it made medical history by using ether as a general anesthetic during a surgery for the first time and it was the beginning of modern anesthesiology. The knowledge of how anesthesia was introduced into medical practice has a great significance for correct understanding of anesthesiologist’s specialty and new achievements in the future. In honor of this historical event Monument commemorating Morton’s demonstration of ether’s anesthetic use was built in Boston (the USA).

Keywords: William Morton, ether, nitrous oxide, anesthesia, 16 October 1846
p. 5-13 of the original issue
References
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  2. Stoliarenko PIu. Istoriia obezbolivaniia v stomatologii (ot drevnosti do sovremennosti) [History of anesthesia in dentistry (from ancient times to the present day)]. Samara, RF: Ofort; SamGMU; 2010. 342 p.
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  9. Babaian EA, Gaevskii AV, Bardin EV. Pravovye aspekty oborota narkoticheskikh, psikhotropnykh, sil'nodeistvuiushchikh, iadovitykh veshchestv i prekursorov [Legal aspects of narcotic, psychotropic, strong poisonous substances and precursors]. Moscow, RF: MTsFER; 2000. 440 p.
  10. Gurvich IA. Spravochnik molodogo apparatchika-khimika [Guideline of young chemist]. Moscow, RF: Khimiia; 1991. 256 p.
  11. Gauptman Z, Grefe Iu, Remane Kh. Organicheskaia khimiia [Organic chemistry]: ucheb. posobie: per. s nem. Potapov VM, red. Moscow, RF: Khimiia; 1979. 832 p.
  12. Zil'ber AP. 150 let ery anesteziologii (1846 – 16 oktiabria 1996) [150 years of anesthesiology era (1846 - October 16, 1996)]: Kalendar' k Iubileinomu Seminaru Aktual'nye Problemy Meditsin Krit Sostoian i Anesteziol. Petrozavodsk, RF; 1996. 27 p.
  13. Ehrenfeld JM, Urman RD, Segal S, editors. Anesthesia Student Survival Guide: A Case-Based Approach. Springer Science+Business Media LLC, 2010; 519 p.
  14. Iudin SS. Voprosy obezbolivaniia v khirurgii [Issues of anesthesia in surgery]. Moscow, RF: Medgiz; 1960. 557 p.
  15. Ortega RA, Lewis KP, Hansen CJ. Other monuments to inhalation anesthesia. Anesthesiology. 2008 Oct;109(4):578-87. doi: 10.1097/ALN.0b013e318186318c.
Address for correspondence:
210023, the Republic of Belarus,
Vitebsk, Frunze ave. 27,
EE «Vitebsk State Medical University»,
Department of Anesthesiology
and reanimatology with
a course of AT and RT,
Tel.: +375 33 316-10-25,
E-mail: katarinaanaest@gmail.com,
Ekaterina V. Nikitina
Information about the authors:
Nikitina E.V. PhD, Head of anesthesiology and reanimatology department with the courses advanced training and retraining, EE "Vitebsk State Medical University".
Samsonova I.M. Assistant of anesthesiology and reanimatology department with the courses advanced training and retraining, EE "Vitebsk State Medical University".
Kizimenko A.N. PhD, Ass. Professor of anesthesiology and reanimatology department with the courses advanced training and retraining, EE "Vitebsk State Medical University".

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

I.A. SHURYGINA, N.I. AUSHINOVA, M.G. SHURYGIN

EVALUATION OF EFFICACY AND SAFETY OF ADEPT DRUG FOR PREVENTION OF ADHESIONS IN THE ABDOMINAL CAVITY IN EXPERIMENT

FSBRE "Irkutsk Scientific Center of Surgery and Traumatology",
Irkutsk,
The Russian Federation

Objectives. To assess the efficacy and safety of Adept drug for adhesion prevention in the abdominal cavity in the experiment.
Methods. A simulation method of adhesions in the abdominal cavity of experimental animals (male Wistar rats) was carried out by opening the serous-muscular layer of the caecum followed by closing the wound with Schmieden suture and scarification of the parietal peritoneum of the right lateral channel. On the 14th and 30th days 2 groups were studied: NaCl (3 ml) was injected into the peritoneal cavity of control group (n=10) and Adept drug (3 ml) was injected into the peritoneal cavity only once in the experimental group (n=10). Macroscopic scale for the adhesion process assessment was used as well as histological study of the adhesion area with haematoxylin and eosin staining and by Van Gieson’s stain.
Results. At the 14th day in the control group, the severity of adhesions 9 (6;9) (Me [Q25-Q75]) scores did not differ significantly comparing to experimental group – 6 (3;8) scores). At the 30th day the severity of adhesions was assessed by 12 (9;13) scores vs. 7 (3;10) scores in the experimental group. By the method of multiple comparisons (2-tailed method) it was revealed that the severity of adhesions did not differ significantly on the 30th day (p = 0,609). Furthermore, in the experimental group the side effects of the Adept drug were registered: eosinophilic infiltration of the subserous layer (80%), the formation of the granulomatous inflammation with the large number of Pirogov-Langhans cells (20%). In one case the encapsulated omental abscess was found and in another case – inflammatory infiltration of adhesion zone.
Conclusion. A single intraoperative application of Adept drug at a dose of 3 ml per rat is thought to be not enough effective for the prevention of adhesions in the experiment. It is noteworthy the application of Adept drug leads to side effects: severe eosinophilic infiltration of the adhesion area, granulomatous inflammation characterized by a large number of Pirogov-Langhans cells, the encapsulated omental abscess.

Keywords: postoperative peritoneal adhesions, omental abscess, Adept drug, Pirogov-Langhans cells, Icodextrin, inflammatory response, wound healing
p. 14-19 of the original issue
References
  1. Burlev VA, Dubinskaia ED, Gasparov AS. Peritoneal'nye spaiki: ot patogeneza do profilaktiki [Peritoneal adhesions: from pathogenesis to prevention]. Probl Reproduktsii. 2009; (3):36-44.
  2. Aiushinova NI, Shurygina IA, Shurygin MG, Grigor'ev EG. Gospital'naia epidemiologiia spaechnoi bolezni briushnoi polosti [Hospital epidemiology of adhesive abdominal disease]. Biul Vost Sib. Nauchn Tsentra. 2016;1(4):115-18.
  3. Baranov GA, Karbovskii MIu. Otdalennye rezul'taty operativnogo ustraneniia spaechnoi kishechnoi neprokhodimosti [Long-term results of surgical removal of adhesive intestinal obstruction]. Khirurgiia. 2006; (7):56-60.
  4. Tarasenko EI. Ostraia spaechnaia tonkokishechnaia neprokhodimost': diagnostika i lechenie [Acute adhesive small bowel obstruction: diagnosis and treatment]. Annaly Êhirurgii. 2007;(4):61-65
  5. Lai KN, Tang SC, Leung JC. Mediators of inflammation and fibrosis. Perit Dial Int. 2007 Jun;27 Suppl 2:S65-71.
  6. Mendel' NA. Profilaktika spaikoobrazovaniia i retsidivov ostroi neprokhodimosti kishechnika: dokazatel'nye issledovaniia [Prevention of adhesions and recurrence of acute intestinal obstruction: evidence-based research]. Khirurgiia Ukrainy. 2012;(3):085-091.
  7. Karakas DO, Yigitler C, Gulec B, Kucukodaci Z, Ipcioglu OM, Akin ML. Comparison of 4 % icodextrin and omega 3 Fatty acids in prevention of peritoneal adhesions. Indian J Surg. 2014 Jun;76(3):181-86. doi: 10.1007/s12262-012-0661-y.
  8. Adept® Summary of safety and effectiveness data. [cited 2016 Nov 5]. ADEPT® (4% icodextrin) adhesion reduction solution. Available from: http://www.accessdata.fda.gov/cdrh_docs/pdf5/p050011b.pdf
  9. Adept – predotvrashchenie obrazovaniia spaek [Preventing the formation of adhesions]. [Elektronnyi resurs]. [Data dostupa: 05.11.2016]. Rezhim dostupa: http://www.baxter.com.ru/downloads/healthcare_professionals/products/Adept%20_new.pdf
  10. Poehnert D1, Grethe L1, Maegel L2, Jonigk D2, Lippmann T2, Kaltenborn A3, Schrem H4, Klempnauer J1, Winny M1. Evaluation of the Effectiveness of Peritoneal Adhesion Prevention Devices in a Rat Model. Int J Med Sci. 2016 Jun 30;13(7):524-32. doi: 10.7150/ijms.15167. eCollection 2016.
  11. Rodgers KE, Verco SJ, diZerega GS. Effects of intraperitoneal 4% icodextrin solution on the healing of bowel anastomoses and laparotomy incisions in rabbits. Colorectal Dis. 2003 Jul;5(4):324-30.
  12. Klink CD1, Schickhaus P, Binnebösel M, Jockenhoevel S, Rosch R, Tolba R, Neumann UP, Klinge U. Influence of 4% icodextrin solution on peritoneal tissue response and adhesion formation. BMC Surg. 2013 Sep 10;13:34. doi: 10.1186/1471-2482-13-34.
Address for correspondence:
664003, the Russian Federation, Irkutsk,
Bortsov Revolutsi Str., 1,
Irkutsk Scientific Center of Surgery
and Traumatology,
Tel.: +7 395 229-03-69
E-mail: irinashurygina@gmail.com
Irina A. Shurygina
Information about the authors:
Shurygina I.A. MD, Professor of RAS, Deputy Director for Science, FSBRE "Irkutsk Scientific Center of Surgery and Traumatology".
Aushinova N.I. PhD, Senior Researcher of FSBRE "Irkutsk Scientific Center of Surgery and Traumatology".
Shurygin M.G. MD, Head of the scientific-laboratory department, FSBRE "Irkutsk Scientific Center of Surgery and Traumatology".

GENERAL & SPECIAL SURGERY

A.V. CHERNYH, E.I. ZAKURDAEV, E.F. CHEREDNIKOV, N.V. YAKUSHEVA, V.G. VITCHINKIN, M.P. ZAKURDAEVA, Y.V. MALEEV

A METHOD FOR PREVENTING OF INTRAOPERATIVE INTERCOSTAL NERVE TRAUMATIZATION AT HERNIOTOMY OF UMBILICAL HERNIAS

FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko",
Voronezh,
The Russian Federation

Objectives. To develop a method of prognostication of the number of intercostal nerves in the lateral edge of the aponeurotic sheath of the rectus abdominis muscle in the umbilical region of the anterior abdominal wall.
Methods. The unfixed corpses (n= 88) of both sexes without pathology of the anterior abdominal wall were studied: 45% of male corpses (average age – 53,8±11,9 years) and 55% – females (51,9±13,2 years). Linea bicostalis (the distance between the lower points of the costal arches) and linea bispinalis (the distance between the front upper iliac spines) were measured. The number of the intercostal nerves at the lateral edge of the aponeurotic sheath of rectus abdominis muscle in the umbilical region of the anterior abdominal wall was established.
Results. Linea bicostalis on the average composed 29,2±0,3 cm and the linea bispinalis - 28,2±0,2 cm. In the area of the lateral edge of the aponeurotic sheath of rectus abdominis muscle in the umbilical region of the anterior abdominal wall, 2 pairs of the intercostal nerves were more often observed (60% of cases), rarely – 1 pair of nerves (20%). In 11% of cases there were 3 pairs of intercostal nerves to the rectus abdominis muscle, and 4 pairs of nerves in 2% of cases. In 7% of cases the asymmetric number of the intercostal nerves was registered. Using the logistic regression technique, the method was proposed predicting the probability of finding 2 pairs of intercostal nerves in the area of the lateral edge of the aponeurotic sheath of rectus abdominis muscle in the umbilical region at anterior abdominal wall: P=100×(1/(1+e^(12,1+0,33×a1-0,76×a2))), where P is the probability of finding 2 pairs of intercostal nerves, a1 – linea bispinalis, a2– linea bicostalis.
Conclusion. The developed method allows predicting the quantity of the intercostal nerves in the area of the lateral edge of the aponeurotic sheath of the rectus abdominis muscle in the umbilical region of the anterior abdominal wall and can be recommended for use in clinical practice.

Keywords: anterior abdominal wall, aponeurotic sheath, rectus abdominis muscle, innervation, intercostal nerves, umbilical hernia, hernia repair
p. 20-25 of the original issue
References
  1. Parshikov VV, Khodak VA, Petrov VV, Dvornikov AV, Mironov AA, Samsonov AA, Romanov RV. Retromuskuliarnaia plastika briushnoi stenki setkoi [Retromuscular plasty of abdominal wall by mesh]. Fund Issledovaniia. 2012;(7):159-163.
  2. Gutarra F. Dicled myofascial oblique rectus abdominis flap technique F. Gutarra, J.R. Asensio. Plast. Reconstr. Aesthet. Surg. 2009;(62):1490-1496.
  3. Moore M, Bax T, MacFarlane M, McNevin MS. Outcomes of the fascial component separation technique with synthetic mesh reinforcement for repair of complex ventral incisional hernias in the morbidly obese. Am J Surg. 2008 May;195(5):575-9; discussion 579. doi: 10.1016/j.amjsurg.2008.01.010.
  4. Mori H, Akita K, Hata Y. Anatomical study of innervated transverse rectus abdominis musculocutaneous and deep inferior epigastric perforator flaps Surg Radiol Anat. 2007 Mar;29(2):149-54.
  5. Skipidarpikov AA, Bezhin AI, Netiaga AA, Skipidarnikova AN. Osobennosti innervatsii priamykh myshts zhivota u liudei s razlichnymi tipami teloslozheniia [Features of the innervation of the rectus muscle in people with different body types]. Kursk Nauchno-Prakt Vestn Chelovek i Ego Zdorov'e. 2013;(1):21-26.
  6. Jkiz Z.A., üçerler Hülya. Bilateral absence of the tendinous intersection of the rectus abdominis muscle. Anatomy.2009:(3): 69-71.
  7. Meenakshi S, Manjunath K. Y. The tendinous intersection of rectus abdomines muscle J MGIMS, March 2008, Vol 13, No (1), 34 - 39
  8. M Haque, A Gupta, A Nasar. Variation in Tendinous Intersections of Rectus Abdominis Muscle in North Indian Population with Clinical Implications. J Clin Diagn Res. 2015 Jun; 9(6): AC10–AC12. Published online 2015 Jun 1. doi: 10.7860/JCDR/2015/14027.6028 PMCID: PMC4525496
  9. Suh HS, Eom JS, Lee TJ. Anatomical Location of the Tendinous Intersections of the Rectus Abdominis Muscle in Korean Women. J Korean Soc Plast Reconstr Surg. 2006 Jul 33(4):469-473.
  10. Maleev IuV, Chernykh AV, Shevtsov A N, Golovanov DN, Stekol'nikov V V. Aktual'nye voprosy tipovoi anatomii perednei oblasti shei v aspekte zaprosov klinicheskoi praktiki [Topical issues of the typical anterior of the neck anatomy in the aspect of clinical practice inquiries]. Zhurn Anatom i Gistopatol. 2015;4(3):79-80
  11. Sushkou SA, Korobov GD, Miadelets OD. Metod vyiavleniia atrofii stenki zadnikh bol'shebertsovykh ven pri varikoznoi bolezni [Method for detection of atrophy of the wall of the posterior tibial veins in varicosity]. Novosti Khirurgii. 2013;21(3): 90-102.
  12. Red'kin AN, Banov SM, Popov SS, Novomlinskaia NI, Ostroushko AP, Sokolov AP, Sokolova MG, Glukhov AA. Novyi metod dooperatsionnogo prognoza effektivnosti limfodissektsii u bol'nykh rakom molochnoi zhelezy [A new method of preoperative prediction efficiency of l lymphodissection in patients with breast cancer] Vestn Eksperim i Klin Khirurgii. 2015;(8):1:100-110
  13. Sudakov DV, Korovin EN, Rodionov OV, Sudakov OV, Fursova EA. Vybor taktiki lecheniia oslozhnenii sakharnogo diabeta na osnove neirosetevogo modelirovaniia [Choice of treatment tactics of diabetes complications based on neural network modeling]. Sistemnyi Analiz i Upravlenie v Biomed Sistemakh. 2014;13(3):592-597.
  14. Chernykh AV, Zakurdaev EI, Zakurdaeva MP. K voprosu o profilaktike travmatizatsii mezhrebernykh nervov pri zadnei separatsionnoi gernioplastike pupochnykh gryzh [The issue of prevention of traumatic intercostal nerves at the posterior separation umbilical hernia repair]. Novosti Khirurgii. 2016;24(3):234-239. doi: 10.18484/2305-0047.2016.3.234
Address for correspondence:
394036, the Russian Federation, Voronezh,
Student str., 10,
FGBOU HE «Voronezh State
Medical University named after NN Burdenko»,
Department of operative surgery and
topographic anatomy.
Tel.: 8 951 566-43-61
E-mail: ezakurdaev@rambler.ru
Evgeny I. Zakurdaev
Information about the authors:
Chernyh A.V. MD, Professor, Head of the operative surgery department with topographic anatomy, FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko".
Zakudaev E.I. PhD, Assistant of the operative surgery department with topographic anatomy, FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko".
Cherednikov E.F. MD, Professor, Head of the faculty surgery department, FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko".
Yakusheva N.V. PhD, Ass. Professor of the operative surgery departmentr with topographic anatomy, FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko".
Vitchinkin V.G. PhD, Ass. Professor of the operative surgery department with topographic anatomy, FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko".
Zakudaeva M.P. Post-graduate student of the operative surgery departmentr with topographic anatomy, FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko".
Maleev Y.V. MD, Ass. Professor of the operative surgery department with topographic anatomy, FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko".

Y.S. VINNIK, S.S. DUNAEVSKAYA

APPLICATION OF CHEMILUMINESCENT ANALYSIS IN ACUTE PANCREATITIS DIAGNOSTICS

FSBEE HE "Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky",
Krasnoyarsk The Russian Federation

Objectives. To determine the type of chemiluminescent reaction depending on acute pancreatitis severity.
Methods. The patients (n=60, an average age made up 44 years) with an acute pancreatitis in the enzymatic phase were enrolled in the study. The diagnosis was made on the basis of clinical laboratory indices as well as on the data of instrumental investigations, using for estimation an integral disease severity scale and a patient’s general condition. Registering generation rate of active oxygen forms was carried out by means of the method of luminol-dependent chemiluminescence; the indices of spontaneous and induced reaction were estimated.
Results. Activation of the lipid peroxidation processes occurred at mild form of an acute pancreatitis has been established resulting in the elevation of generation of active metabolites, and in particular, of active oxygen forms. The increase of the maximal value of a chemiluminescence by 3,97 fold and the area under the curve by 2,56 fold has been registered against the background of reducing time-to-peak response. In case of moderate forms of acute pancreatitis the changes occurred in chemiluminescent reaction characterized it as hyperoxemic one. The elevation of the reaction intensity by 9,51 times was established against the background of the reducing time-to-peak response by 3,11 fold. A severe form of the disease was characterized by the generation reduction of active oxygen forms against the background of the expressed endointoxication and characterized the chemiluminescent reaction as hypoxemic one. Decrease in the maximal value of a chemiluminescence by 9,30 fold the curve symmetry and reducing time-to-peak response was registered against the background of the elevation area under the curve at a spontaneous reaction by 1,39 fold.
Conclusion. The conducted study confirmed that the changes of chemiluminescent reaction may serve as additional criteria for severity evaluation of an acute pancreatitis. At mild and moderate forms of an acute pancreatitis, the processes of hyperproduction of active oxygen forms predominated. Severe acute pancreatitis is characterized by the production reduction of active oxygen forms that is manifested by hypoxemic type of chemiluminescent reaction.

Keywords: acute pancreatitis, diagnostics, chemiluminescence, active oxygen forms, moderate forms, reaction intensity, hypoxemic type
p. 26-30 of the original issue
References
  1. Fomin AV, Gidranovich AV. Otsenka tiazhesti sostoianiia bol'nykh ostrym pankreatitom (obzor literatury) [Assessment of the severity of patients with acute pancreatitis (review). Vestn VGMU. 2004;3(1):41-50.
  2. Firsova VG, Parshikov VV, Gradusov VP. Ostryi pankreatit: sovremennye aspekty patogeneza i klassifikatsii [Acute pancreatitis: current aspects of pathogenesis and classification]. Sovrem Tekhnologii v Meditsine. 2011; (2):127-34.
  3. Baddeley RNB, Skipworth JRA, Pereira SP. Acute pancretitis. Medicine. 2011;39(2):108-15.
  4. Ivlev V.V., Varzin S.A., Shishkin A.N. Sovremennye podkhody k lecheniiu bol'nykh ostrym destruktivnym pankreatitom [Current approaches to the treatment of patients with acute destructive pancreatitis]. Vestn Sankt-Peterburskogo un-ta. 2013(11)1:122-126.
  5. Kochetova L.V., Dunaevskaia S.S. Metabolicheskaia korrektsiia v kompleksnom lechenii bol'nykh ostrym pankreatitom [Metabolic correction in complex treatment of patients with acute pancreatitis]. Kazan Meditsin Zhurn. 2011;92(3):315-18.
  6. Tarasenko A.V., Aleseev S.A. Ekspress-diagnostika sostoianiia T-kletochnogo zvena immuniteta i dinamicheskaia immunokorregiruiushchaia terapiia pri ostrom destruktivnom pankreatite [Express diagnostics of the state of T-cell immunity and dynamic immunocorrective therapy at acute destructive pancreatitis]. Novosti Khirurgii. 2010;18(3):47-57.
  7. Balakleets E.H., Slavinskii A.A., Lishchenko A.N. Aktivatsiia neitrofil'nykh leikotsitov sistemy verkhnei poloi i vorotnoi ven u bol'nykh ostrym pankreatitom [Activation of of neutrophil leukocytes of system of superior vena and portal vein in patients with acute pancreatitis]. Kuban Nauch Meditsin Vestn. 2010;(9):31-33
  8. Nagoev B.S., Iuanov A.A. Sostoianie funktsional'noi i metabolicheskoi aktivnosti leikotsitov u bol'nykh ostrym i khronicheskim pankreatitami [Status of functional and metabolic activity of leukocytes in patients with acute and chronic pancreatitis]. Vestn Novykh Med Tekhnologii. 2006;13(4):113-15.
  9. Weber H, Hühns S, Jonas L, Sparmann G, Bastian M, Schuff-Werner P.
    10. Hydrogen peroxide-induced activation of defense mechanisms against oxidative stress in rat pancreatic acinar AR42J cells. Free Radic Biol Med. 2007 Mar 15;42(6):830-41.
  10. García-Hernández V1, Sarmiento N1, Sánchez-Bernal C1, Matellán L1, Calvo JJ2, Sánchez-Yagüe J3. Modulation in the expression of SHP-1, SHP-2 and PTP1B due to the inhibition of MAPKs, cAMP and neutrophils early on in the development of cerulein-induced acute pancreatitis in rats. Biochim Biophys Acta. 2014 Feb;1842(2):192-201. doi: 10.1016/j.bbadis.2013.11.003. Epub 2013 Nov 10.
  11. Kurygin A.A., Bagnenko S.F., Grinev M.V., Tolstoi A.D., Lapshin V.N., Gol'tsov V.R., Krasnorogov V.B. Ostryi pankreatit (protokoly diagnostiki i lecheniia) [Acute pancreatitis (medical guideline)]. Khirurgiia. Zhurnal im NI Pirogova. 2005.-N 7.-S.19-23
  12. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974 Jul;139(1):69-81.
Address for correspondence:
660077, Russian Federation,
Krasnoyarsk, Partizan Zhelezniak str., 1,
FGBOU IN «Krasnoyarsk State
Medical University named after
Prof. VF Voyno-Yasenetsky»,
Department of general
surgery named after prof. MI Gulman.
Tel.: + 963-191-29-70
e-mail: Vikto-potapenk@yandex.ru
Svetlana S. Dunaevskaya
Information about the authors:
Vinnik Y.S. MD, Professor, Head of the general surgery department named after Professor M.I.Gulman, FSBEE HE "Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky".
Dunaevskaya S.S. MD, Ass. Professor of the general surgery dspartment named after Professor M.I.Gulman, FSBEE HE "Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky".

M.R. KUZNETSOV 1, S.V. SAPELKIN 1,2, A.O. VIRGANSKY 1, L.A. MAGNITSKY 1

RESTORATIVE METHOD OF THE MAIN ARTERIAL BLOOD FLOW OF THE LOWER LIMBS

FSBEE HE "Russian National Research Medical University Named After N.I.Pirogov"1 , Moscow,
FSBE "A.V.Vishnevsky Institute of Surgery"2,
Moscow,
The Russian Federation

Objectives. To develop a new restorative method of the main lower limb blood flow in the chronic arterial insufficiency provided an adequate blood flow in occlusion of the superficial femoral artery and the popliteal artery at the knee joint fissure.
Methods. A combined approach designed to restore the blood flow has been developed. The semi-closed endarterectomy is performed from the posterior access of popliteal artery in the patient’s pronepositio, and after turning a patient on his back the femoral-popliteal bypass above the knee joint fissure is carried out. According to the proposed method 34 patients have been operated on, mean an average age – 64,6±10,6 [42-85] years. The indications for surgery were the intermittent claudication (n=20), pain at rest (n=8) and trophic ulcers of the lower limbs (n=6). All patients had occlusive disease of the superficial femoral artery of TASC C or D with pathological process involving of P1, P2 or of all popliteal artery segments.
Results. The technical success of interventions was 100%. After the surgery 25 patients (73,5%) had no clinical symptoms of chronic arterial insufficiency, 8 (23,5%) transferred into the stage I – IIA. In the immediate postoperative period the primary patency of grafts was 91,2%, the secondary – 97,0%. No lethal outcomes were registered within 30 days after the operation. Thrombotic complications occurred in 3 patients, which in 2 cases were successfully eliminated by thrombectomy. Amputation at the middle third of the thigh was necessary in 1 patient.
Conclusion. The proposed method of the main arterial blood restoration in the lower limbs may be considered as a quite effective and physiological in a long-lasting popliteal artery disease. It should be noted that further studies of the results in the remote postoperative period are required.

Keywords: femoral-popliteal bypass, endarterectomy, popliteal artery, peripheral artery disease, posterior access, thrombotic complications, postoperative period
p. 31-37 of the original issue
References
  1. Sedov VM, Gusinskii AV, Shlomin VV, Shatravka AV, Kas'ianov IV, Vazhenin SO, Nikolaev DI, Kokh BB. Analiz rannikh posleoperatsionnykh oslozhnen posle rekonstruktivnykh operatsii na arteriiakh aorto-bedrennogo segmenta [Analysis of early postoperative complicated after reconstructive surgery on the arteries of aorto-femoral segment]. Vestn Saint-Petersburg U-ta. 2008;(11)1: 60-70.
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  4. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007 Jan;45 Suppl S:S5-67.
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  11. Veith FJ, Gupta SK, Ascer E, White-Flores S, Samson RH, Scher LA, Towne JB, Bernhard VM, Bonier P, Flinn WR, et al. Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions. J Vasc Surg. 1986 Jan;3(1):104-14.
  12. Losev RZ, Burov IuA, Mikul'skaia EG, Eliseev AA, Bogdanova NB, Skriabin VV. Mnogourovnevye revaskuliarizatsii nizhnikh konechnostei s ispol'zovaniem petlevoi trombendarterektomii [Lower extremity multilevel revascularization using a loop endarterectomy]. Vestn Khirurgii Im II Grekova. 2007;165(5):21-23.
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Address for correspondence:
117997, the Russian Federation,
Moscow, Ostrovityanov str., 1,
Pirogov Russian National
Research Medical University.
Department of faculty surgery N1.
E-mail: mrkuznetsov@mail.ru
Maksim R. Kuznetsov
Information about the authors:
Kuznetsov M.R. MD, Professor of the faculty surgery department N1, the medical faculty, FSBEE HE "Russian National Research Medical University Named After N.I.Pirogov".
Sapelkin S.V. MD, Leading researcher of FSBE "A.V.Vishnevsky Institute of Surgery", Professor of the faculty surgery department N1, the medical faculty, FSBEE HE "Russian National Research Medical University Named After N.I.Pirogov".
Virgansky A.O. MD, Professor of the faculty surgery department N1, the medical faculty, FSBEE HE "Russian National Research Medical University Named After N.I.Pirogov".
Magnitsky L.A. Post-graduate student of the faculty surgery department N1, the medical faculty, FSBEE HE "Russian National Research Medical University Named After N.I.Pirogov".

V.A. KHODOS

SIDE EFFECTS AND COMPLICATIONS OF MICROFOAM STEM SCLEROOBLITERATION IN VARICOSITY; MEASURES TO PREVENT AND TO ELIMINATE

National Medical Academy of Post-Graduate Education Named After P.L. Shupyk,
Kiev,
Ukraine

Objectives. To study side effects and complications of microfoam stem scleroobliteration and to determine measures of their prevention and elimination.
Methods. The results of microfoam stem scleroobliteration in 603 patients (658 lower limbs) including men and women with the lower limb varicosity (from 2009 to 2015) were analyzed. Reflux along the great saphenous vein (GSV) was found in 607 (92,25%) lower limbs, and along the small saphenous vein (SSV) – in 51 (7,75%) lower limbs. A specificity of microfoam sclerotherapy catheter stem scleroobliteration was its combination of hydrocompression around stem performance and phased application of microfoam. The generalized and local side effects and complications were analyzed during the assessment of medical treatment results. Based on the data received after ultrasonic duplex scanning (3-24 months) after the microfoam scleroobliteration, the presence of GSV/SSV recanalization was registered.
Results. Visual disturbances were registered in 8 (1,33%) out of 603 patients, the transient neurologic symptoms – in 6 (0,99%), a vasovagal reaction – in 1 (0,17%) patient. Among local complications, occurrence of GSV thrombophlebitis (femoral segment) was revealed in 4 (0,61%) cases (658 lower limbs), venous thrombosis – in 2 cases (0,30%). Re-canalization of different length was detected in 62 (9,42%) stem veins within 3-12 months. In 32 cases the repeated microfoam scleroobliteration was involved within those terms. During 12-24 months the repeated microfoam scleroobliteration was carried 19 cases and in 3 cases it was performed for the third time. Re-canalization had no hemodynamic significance in the remaining 11 cases.
Conclusion. The analysis of conducted studies showed that the application of the microfoam sclerotherapy catheter stem scleroobliteration in combination with the hydrocompression around stem and stepwise administration of the microfoam minimizes the occurrence frequency of generalized and local side effects and complications, and leads to reduction of recanalization amount, provides appropriate safety in application of this method.

Keywords: varicosity, thrombophlebitis, reflux, microfoam sclerotic obliteration, sclerotic therapy complications, recanalization, hydrocompression
p. 38-43 of the original issue
References
  1. Davies HO, Popplewell M, Darvall K, Bate G, Bradbury AW. A review of randomised controlled trials comparing ultrasound-guided foam sclerotherapy with endothermal ablation for the treatment of great saphenous varicose veins. Phlebology. 2016 May;31(4):234-40. doi: 10.1177/0268355515595194.
  2. Kurdal AT, Yildirim F, Ozbakkaloglu A, Iskesen I, Tetik O. Ultrasound-guided catheter-directed foam sclerotherapy for great saphenous vein. Minerva Chir. 2015 Feb;70(1):33-6.
  3. Williamsson C, Danielsson P, Smith. L. Catheter-directed foam sclerotherapy for chronic venous leg ulcers. Phlebology. 2014 Dec;29(10):688-93. doi: 10.1177/0268355513505506.
  4. Shadid N, Ceulen R, Nelemans P, Dirksen C, Veraart J, Schurink GW, van Neer P, vd Kley J, de Haan E, Sommer A. Randomized clinical trial of ultrasound-guided foam sclerotherapy versus surgery for the incompetent great saphenous vein. Br J Surg. 2012 Aug;99(8):1062-70. doi: 10.1002/bjs.8781.
  5. Baeshko AA, Shestak NG, Koryt'ko SS, Kovalevich KM, Vartanian V.F. Rezul'taty ul'trazvuk-kontroliruemoi pennoi skleroterapii bol'shoi podkozhnoi veny po usovershenstvovannoi metodike [The results of ultrasound-controlled foam sclerotherapy of the great saphenous vein according the improved method]. Angiologiia i Sosud Khirurgiia. 2015;21(4):127-133.
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  8. Sarvananthan T, Shepherd AC, Willenberg T, Davies AH. Neurological complications of sclerotherapy for varicose veins. J Vasc Surg. 2012 Jan;55(1):243-51. doi: 10.1016/j.jvs.2011.05.093.
  9. Hill DA. Neurological and chest symptoms following sclerotherapy: a single centre experience. Phlebology. 2014 Oct;29(9):619-27. doi: 10.1177/0268355513499017.
  10. Maurya AK, Singh S, Sachdeva V, Nath B, Verma SC, Gupta PK. Outcome of Ultrasound Guided Foam Sclerotherapy Treatment for Varicose Veins: Procedure is Standard and Need No Further Study. Indian J Vasc Endovasc Surg. 2015;2(3): 96-100.doi: 10.4103/0972-0820.166933.
  11. Bradbury AW, Bate G, Pang K, Darvall KA, Adam DJ. Ultrasound-guided foam sclerotherapy is a safe and clinically effective treatment for superficial venous reflux. J Vasc Surg. 2010 Oct;52(4):939-45. doi: 10.1016/j.jvs.2010.04.077.
  12. Gillet JL, Guedes JM, Guex JJ, Hamel-Desnos C, Schadeck M, Lauseker M, Allaert FA. Side-effects and complications of foam sclerotherapy of the great and small saphenous veins: a controlled multicentre prospective study including 1,025 patients. Phlebology. 2009 Jun;24(3):131-8. doi: 10.1258/phleb.2008.008063.
  13. Darvall KA, Bate GR, Bradbury AW. Patient-reported outcomes 5-8?years after ultrasound-guided foam sclerotherapy for varicose veins. Br J Surg. 2014 Aug;101(9):1098-104. doi: 10.1002/bjs.9581
  14. Chapman-Smith P, Browne A. Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux. Phlebology. 2009 Aug;24(4):183-8. doi: 10.1258/phleb.2009.008080.
  15. Frullini A, Felice F, Burchielli S, Di Stefano R. High production of endothelin after foam sclerotherapy: a new pathogenetic hypothesis for neurological and visual disturbances after sclerotherapy. Phlebology. 2011 Aug;26(5):203-8. doi: 10.1258/phleb.2010.010029.
Address for correspondence:
04112, Ukraine, Kiev,
Dorogozhytskaya str., 9,
National Medical Academy of Postgraduate Education named after PL Shupyk,
Department of surgery and vascular surgery.
Tel.: +38 050 469-56-15
E-mail: vkhodos@ukr.net
Valentin A. Hodos
Information about the authors:
Khodos V.A. MD, Ass. Professor of the surgery and vascular surgery department, National Medical Academy of Postgraduate Education Named After P.L. Shupyk.

TRANSPLANTOLOGY

V.Y. KHRYSHCHANOVICH1, P.Y. VERSHININ2,
A.V. BOLSHOV1, S.I. TRETYAK1, E.I. KUZMENKOVA3, A.M. PISARENKO4, E.V. KHODOSOVSKAYA, T.S. KOLESNIKOVA1, O.O. RUMMO2

ALLOTRANSPLANTATION OF CULTIVATED PARATHYROID CELLS OF A LIVING UNRELATED DONOR TO RECIPIENT WITH RENAL TRANSPLANT: THE FIRST CLINICAL OBSERVATION

EE "Belarusian State Medical University"1,
ME "The 9th City Clinical Hospital", Minsk 2,
SE "Republican Center of Medical Rehabilitation and Balneotherapy"3,
ME "Minsk City Clinical Oncologic Dispensary"4,
Minsk,
The Republic of Belarus

Objectives. To demonstrate the possibility of successful treatment of a severe postsurgical hypoparathyroidism by the cultured parathyrocyte allotransplantation to a kidney transplant recipient.
Methods. A 37-year-old female with the kidney transplant and a severe postsurgical hypoparathyroidism on the background of intensive replacement therapy was a recipient of parathyroid allograft. The indications for parathyroid autotransplantation include symptoms of tetany, high convulsive readiness (Chvostek’s and Trousseau’s signs), extremely low rates of total/ionized calcium (1,71/0,98 mmol/L) and parathyroid hormone (1,7 pg/ml) in the peripheral blood. Culture (21×106) of parathyroid cells obtained from a living unrelated donor (62-year-old female) with the secondary hyperparathyroidism was implanted into the recipients’ left brachioradialis muscle. Site selection for parathyroid allograft was conditioned by the absence of arteriovenous fistula on the side of the transplantation. Immunosuppressive therapy consisted of 150 mg/day of cyclosporine, 720 mg/day of mycophenolic acid, 6 mg/day of methylprednisolone.
Results. No postoperative complications of the intervention, local and general side effects on the parathyroid cell allograft were observed. Clinical and laboratory improvement of hypoparathyroidism occurred 1 month after the transplantation: parathyroid hormone concentration increased up to 14,7 pg/ml and reached a maximum value (61,7 pg/mL) after 3,5 months. No convulsions were observed over a 6-month follow-up, Chvostek’s and Trousseau’s signs were stopped, the amount of oral substitution therapy significantly reduced, and there was no more need for parenteral administration of calcium salt solutions. Six months after transplantation a patient led a very active life and took per os 0,5 g/day of calcium.
Conclusion. Combined allotransplantation of cadaveric kidneys and cultured parathyroid cells obtained from the hyperplastic parathyroid tissue of a living unrelated donor is considered to be an effective treatment of permanent severe hypoparathyroidism in patients who need the organ transplantation with subsequent immunosuppressive therapy.

Keywords: parathyroid cells allotransplantation, kidney transplant, intensive substitution therapy, surgical hypoparathyroidism, hyperplastic parathyroid tissue, immunosuppressive therapy, postoperative complications
p. 44-52 of the original issue
References
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  5. Watkins EJr, Haynes LL, Adams HD. Aortic-pedicle technic for obtaining immediate vascularization of fetal parathyroidgland transplants in man; application in three patients with hypoparathyroidism appearing after thyroidectomy. N Engl J Med. 1959 Jul 16;261(3):105-12.
  6. Carl G. Groth, William S. Hammond, Shunzaburo Iwatsuki, et al. Survival of a homologous parathyroid implant in an immunosuppressed patient. Lancet. 1973 May 19;1(7812):1082-85.
  7. Wells SA Jr, Burdick JF, Hattler BG, Christiansen C, Pettigrew HM, Abe M, et al. The allografted parathyroid gland: evaluation of function in the immunosuppressed host. Ann Surg. 1974 Dec;180(6):805-13.
  8. Duarte B, Mozes MF, John E, Aronson I, Pollak R, Jonasson O. Parathyroid allotransplantation in the treatment of complicated idiopathic primary hypoparathyroidism. Surgery. 1985 Dec;98(6):1072-6.
  9. Zeng Q. Allotransplantation of parathyroid glands to treat intractable hypoparathyroidism. Surgery. 1986 Jan; 99(Is 1):131-32.
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  11. Alfrey EJ1, Perloff LJ, Asplund MW, Dafoe DC, Grossman RA, Bromberg JS, Holland T, Naji A, Barker CF. Normocalcemia thirteen years after successful parathyroid allografting in a recipient of a renal transplant. Surgery. 1992 Feb;111(2):234-36.
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  13. Hasse C, Zielke A, Klöck G, Schlosser A, Zimmermann U, Rothmund M. Isotransplantation of microencapsulated parathyroid tissue in rats. Exp Clin Endocrinol Diabetes. 1997;105(1):53-6.
  14. Torregrosa NM, Rodríguez JM, Llorente S, Balsalobre MD, Rios A, Jimeno L, et al. Definitive treatment for persistent hypoparathyroidism in a kidney transplant patient: parathyroid allotransplantation. Thyroid. 2005 Nov;15(11):1299-302.
  15. Chapelle T, Meuris K, Roeyen G, De Greef K, Van Beeumen G, Bosmans JL, et al. Simultaneous kidney-parathyroid allotransplantation from a single donor after 20 years of tetany: a case report. Transplant Proc. 2009 Mar;41(2):599-600. doi: 10.1016/j.transproceed.2008.12.026.
  16. Cabané P1, Gac P, Amat J, Pineda P, Rossi R, Caviedes R, Caviedes P.
    Allotransplant of microencapsulated parathyroid tissue in severe postsurgical hypoparathyroidism: a case report. Transplant Proc. 2009 Nov;41(9):3879-83. doi: 10.1016/j.transproceed.2009.06.211.
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Address for correspondence:
220116, the Republic of Belarus,
Minsk, Dzerzhinski str., 83,
EE «Belarusian State Medical University»,
Department of surgical diseases N2.
Tel.: +375 17 287-86-52
Fax: + 375 17 201-91-60
E-mail: vladimirkh77@mail.ru
Vladimir Y. Khryshchanovich
Information about the authors:
Khryshchanovich V.Y. MD, Ass. Professor of department N2 of surgical diseases, EE "Belarusian State Medical University".
Vershinin P.Y. Head of the nephrology and hemodyalysis unit, ME "The 9th City Clinical Hospital".
Bolshov A.V. PhD, Ass. Professor of department N2 of surgical diseases, EE "Belarusian State Medical University".
Tretyak S.I. Honored Worker of Science of the Republic of Belarus, MD, Professor, Corresponding Member of NAS of Belarus, Head of department N2 of surgical diseases, EE "Belarusian State Medical University".
Kuzmenkova E.I. Head of the endocrinology unit of SE "Republican Center of Medical Rehabilitation and Balneotherapy".
Pisarenko A.M. Head of the department of head and neck tumors of ME "Minsk City Clinical Oncologic Dispensary".
Khodosovskaya E.V. Senior researcher of the laboratory of biochemical methods of investigation, EE "Belarusian State Medical University".
Kolesnikova T.S. Senior researcher of the laboratory of biochemical methods of investigation, EE "Belarusian State Medical University".
Rummo O.O. Honored Worker of Science of the Republic of Belarus, MD, professor, Deputy Chief of surgery, ME "The 9th City Clinical Hospital", Minsk, Chief Freelance transplantologist of the Ministry of Health of the Republic of Belarus.

UROLOGY

R.A. NAKONECHNYY

PROGNOSTIC MARKERS OF ENDOVESICAL TREATMENT OF VESICOURETERAL REFLUX IN CHILDREN

Lviv Danylo Halytsky National Medical University
Lviv,
Ukraine

Objectives. To determine cystoscopic prognostic markers of treatment effectiveness in children with different clinical forms of vesicoureteral reflux (VUR) for an adequate patients’ treatment and defect correction.
Methods. The patients (n=270) with various forms of VUR of II-IV grades at the age from 6 months up to 14 years the structure of the ureter ostium was analyzed during the endovesical treatment. Half a year after the endovesical treatment a cystoscopic picture was evaluated in 64 patients with VUR of I-IV grades in whom VUR of stage remained in the same condition or decreased. The position of the “volcano shape» protrusion, migration and extrusion of the implant and if the implant bulged – the hydrodilatation grade of the ureteral orifice sprawled on it were studied.
Results. Six months after a single implantation the effectiveness of the minimally invasive treatment of VUR (II grades) was 87,84%, of III – 83,45% and of IV – 39,22%. The effectiveness of endovesical VUR re-treatment of I-IV grades reached 57,81%, which in general made gain on recovery by 13,7%. Generally, minimally invasive intervention efficiency has risen up to 90%. The lack of “volcano shape» protrusion after the first endovesical procedure turned out to be an evident negative prognostic marker regarding the effectiveness of repeated implantation – OR=0,24 [0,07-0,9], RR=0,36 [0,12-1,05], and the migration of the implant in the lateral direction was less pronounced negative marker – ÎR=0,76 [0,31-1,85], RR=0,84 [0,46-1,51].
Reducing the «volcano shape» protrusion and its displacement to the medial direction are positive prognostic markers regarding the effective re-implantation. The association was more significant with implant volume loss: ÎR=2,08 [0,82-5,28], RR=1,54 [0,92-2,57] if compared with ÎR=1,71 [0,69-4,25] and RR=1,39 [0,82-2,34] in case of migration to the midline of the bladder.
Conclusion. While planning the endovesical re-treatment of VUR the personalized approach to a patient is necessary considering the prognostic cystoscopic markers.

Keywords: vesicoureteral reflux, endoscopó, cystoscopy, bladder, prognostic cystoscopic markers, treatment, final results
p. 53-59 of the original issue
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  15. Lee EK, Gatti JM, Demarco RT, Murphy JP. Long-term followup of dextranomer/hyaluronic acid injection for vesicoureteral reflux: late failure warrants continued followup. J Urol. 2009 Apr;181(4):1869-74; discussion 1874-5. doi: 10.1016/j.juro.2008.12.005.
Address for correspondence:
79010, Ukraine, Lviv,
Pecarskaya str., 69,
Lviv Danylo Halytsky National
Medical University,
Department of Pediatric Surgery,
Tel.: + 38-032-293-97-39
E-mail: nrostyslav@gmail.com
Rostyslav A. Nakonechnyy
Information about the authors:
Nakonechnyy R.A. Post-graduate student of the pediatric surgery department, Lviv Danylo Halytsky National Medical University

ONCOLOGY

U.U. ANDRUSHCHUK1, Y.P. OSTROVSKY1,2, V.V. ZHARKOV1, A.V. VALENTSIUKEVICH1, L.G. SHESTAKOVA1,2, O.A. YUDINA3, T.V. ILYINA1, S.G. OMELTSCHENKO1, S.A. KURGANOVICH1, A.Z. SMOLENSKY3

SURGICAL TREATMENT OF PATIENTS WITH PRIMARY MALIGNANT TUMORS OF THE HEART

SE "Republican Scientific Practical Centre Cardiology" 1,
SEE "Belarusian Medical Academy of Post-graduate Education" 2,
ME "City Clinical Pathology Bureau" 3,
Minsk,
The Republic of Belarus

Objectives. To evaluate the results of surgical treatment of patients with primary malignant tumors of the heart (PMTH).
Methods. Within the period from 2001 to 2015 11 patients (5 men, 6 women, mean age 50,7±18,1 years) had undergone surgical resection of primary malignant cardiac tumor in RSPC «Cardiology». PMTH was located in the left side of the heart in seven patients, in the right side – in three, in both right and left sides – in one patient.
Results. Three operations of the heart autotransplantation (HA), one orthotopic heart transplantation (OHT), three radical resections of the tumor «in situ» (RRT) and four cytoreductive interventions (CRI) had been performed. Average time of myocardial ischemia was 119,9±20,2 min, artificial circulation – 178,1±31,9 min., average blood loss – 1601,8±367,3 ml. Major hospital complications (MHC) occurred in six patients. Three patients died due to the non-cardiac causes in the hospital period. The observation period was 467,0±100,3 days. Seven patients (one withdrew) died due to disease progression or relapse. Recurrence-free survival was 456,8±103,0 days, the average duration up to the outcome – 357,6±121,6 days. The survival of patients after radical surgeries (RS) – 565,4±112,2 days, discharged from the center, was 2,5 fold higher than in CRI patients 221,0±28,0 days.
Conclusion. Primary malignant tumors of the heart is a rare pathology with almost fatal prognosis, late detectability and unsatisfactory results of treatment. Radical surgeries (RS) – RRT, HA, OHT as a part of a multimodal treatment are considered to be a current therapeutic strategy of PMTH (except lymphoma). MHC-rate and hospital mortality after RS are high. Relapse or disease progression was the cause of death in all patients within the period of observation. Radical operations and in the case of inability of their performance the cytoreductive operations comprising a multimodal therapy can reduce symptoms and prolong life.

Keywords: primary cardiac tumors, surgery, sarcoma, lymphoma, multimodal therapy, recurrence, mortality
p. 60-70 of the original issue
References
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Address for correspondence:
220036, the Republic of Belarus, Minsk,
Rosa Luxemburg str., 110,
The Republican Scientific and
Practical Center Cardiology, Laboratory
of heart surgery,
Tel: +375 17 2088605
E-mail: heartslight@mail.ru,
Vladimir V. Andruschuk
Information about the authors:
Andrushchuk U.U. PhD, Cardiac surgeon of cardiac surgery unit N2, SE "Republican Scientific Practical Centre Cardiology".
Ostrovsky Y.P. MD, Professor, Academician of NAS of Belarus, Head of department of cardiac surgery, SEE "Belarusian Medical Academy of Post-graduate Education", Chief Freelance cardiac surgeon Ministry of Health of the Republic of Belarus.
Zharkov V.V. MD, Professor, Head of surgical unit of thoracic oncopathology with the group of anesthesiology, SE "Republican Scientific and Practical Center of Oncology and Medical Radiology named after N.N.Alexandrov".
Valentsiukevich A.V. Head of anesthesiology and intensive care unit, SE "Republican Scientific Practical Centre Cardiology".
Shestakova L.G. MD, Head of extracorporeal circulation unit, SE "Republican Scientific Practical Centre Cardiology", lecturer of cardiac surgery department, SEE "Belarusian Medical Academy of Post-graduate Education".
Yudina O.A. PhD, Ass. Professor, Head of general pathology unit N1, ME "City Clinical Pathology Bureau", Ass. Professor of pathologic anatomy department, EE "Belarusian State Medical University".
Ilyina T.V. Head of X-ray unit, SE "Republican Scientific Practical Centre Cardiology".
Omeltschenko S.G. Clinical intern (cardiac surgery), SE "Republican Scientific Practical Centre Cardiology".
Kurganovich S.A. Physician (ultrasound diagnostics), SE "Republican Scientific Practical Centre Cardiology", fellow-worker of heart surgery laboratory.
Smolensky A.Z. Pathologist of general pathology unit N1, ME "City Clinical Pathology Bureau".

REVIEWS

I.N. KLIMOVICH, S.S. MASKIN, P.V. ABRAMOV

PATHOGENESIS OF INTESTINAL INSUFFICIENCY SYNDROME IN UPPER GASTROINTESTINAL TRACT BLEEDINGS

FSBEE HE "Volgograd State Medical University" of the Ministry of Health of Russia
Volgograd,
The Russia Federation

The intestinal insufficiency syndrome (IIS) is accompanied by severe gastrointestinal bleeding (GIB) from the upper gastrointestinal tract. Acute massive blood loss causes blood circulation centralization, as the main protective and compensatory reaction of the organism, which saves from immediate destruction the brain highly sensitive to hypoxia, but it damages internal organs and especially the intestines, as a shock body. Intestinal hypoxia leads to massive epithelial mucous destruction with exposing the submucosa. Due to the elevated permeability of the intestinal wall barriers, potentiation of the systemic endotoxicosis occurs by the hydrolysis products of the blood streamed into the intestinal lumen and effect of vital activity products of allochthonous microflora manifested the initial stage of multiple organ failure.
At present, some issues of pathogenesis violations of the «barrier» function of the intestinal wall in case of IIS still remain insufficiently studied, including features of microvascular circulation and its regulation in the intestinal wall caused the intestinal critical oxygen dependence even in minor hemorrhagic hypotension, against sufficient ensuring with oxygen of other organs; mechanisms of the ischemic and especially of the reperfusion injury of the intestinal wall. All this dictates the need for further experimental and clinical studies, the results of which will serve as a basis for the development of new treatment methods of intestinal insufficiency syndrome.

Keywords: intestinal insufficiency syndrome, gastrointestinal bleeding, ischemia-reperfusion, intestinal wall, «barrier» function, allochthonous microflora, hemorrhagic hypotension
p. 71-77 of the original issue
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Address for correspondence:
400131, the Russian Federation,
Volgograd, Pavshikh Bortsov sg 1,
FGBOU IN «Volgograd State
Medical University»
Department of Hospital Surgery.
Tel.: 8 905 336-23-69
E-mail: klimovichigor1122@yandex.ru
Igor N. Klimovich
Information about the authors:
Klimovich I.N. MD, Ass. Professor of hospital surgery department, FSBEE HE "Volgograd State Medical University".
Maskin S.S. MD, Professor, Head of hospital surgery department, FSBEE HE "Volgograd State Medical University".
Abramov P.V. Post-graduate student of hospital surgery department, FSBEE HE "Volgograd State Medical University".

K.N. ZHANDAROV.1, S.V. ZHDONETS.1, K.S. BELYUK.2, V.A. MITSKEVICH.1, Y.F. PAKULNEVICH.1

TRANSANAL ENDOSCOPIC MICROSURGERY OF BENIGN AND MALIGNANT RECTAL TUMORS

ME "Grodno Regional Clinical Hospital" 1,
EE "Grodno State Medical University".2,
Grodno,
The Republic of Belarus

The objective of a literature review is to determine the place of the transanal endoscopic microsurgery (TEM) in ñoloproctology, to identify disadvantages and to establish the main directions advancing this technique. An important challenge for colorectal surgeons and oncologists, is the reduction of morbidity, prevention of complications and functional disorders, faster recovery after extensive surgeries, which in the recent past were widely used in the colorectal surgery. At present for this reason preference is given to low-traumatic surgical techniques such as a loop endoscopic electrosurgical excision procedure, traditional transanal excision and method of transanal endomicrosurgery (TEM). It is clear that all methods have their advantages and disadvantages, so as the indications for each. Due to the high cost of the complete set of TEM, the given high-precision method of treating rectal tumors is still not widely used in ñoloproctology. Recently there have been reports about the first experience of using TEO, TAMIS, RTS. TEO (transanal endoscopic operation) – a modified TEM system, with original integrated optical system and the ability to use both established laparoscopic instruments, and original TAMIS (transanal minimal invasive surgery) – the use of SILS Port, Covidien in the anal canal. The conducted analysis has shown that methods of transanal endomicrosurgery are constantly being advanced and find new sites of application in the large intestine and rectum surgery. However some technical moments, such as improvement of straightening of rectum and visualization require further development and improvement.

Keywords: transanal surgery, SILS-port, rectum tumor, ñoloproctology, a loop endoscopic electrosurgical excision procedure, traditional transanal excision, removing rectal tumors
p. 78-86 of the original issue
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  3. Casadesus D. Surgical resection of rectal adenoma: a rapid review. World J Gastroenterol. 2009 Aug 21; 15(31): 3851-54. doi: 10.3748/wjg.15.3851.
  4. Gataulin IG, Petrov SV, Igumenov AV. Optimizatsiia diagnosticheskogo algoritma i vybor khirurgicheskoi taktiki u bol'nykh vorsinchatymi novoo/liazovaniiami tolstoi kishki [Optimization of diagnostic algorithm and the choice of surgical approach in patients with villous tumors of the colon]. Koloproktologiia. 2005;(1):39-44.
  5. Toyonaga T, Man-i M, Fujita T, East JE, Nishino E, Ono W, et al. Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum. Endoscopy. 2010 Sep;42(9):714-22. doi: 10.1055/s-0030-1255654.
  6. Vorob'ev GI, Tsar'kov PV, Podmarenkova LF, Sorokin EI. Otdalennye rezul'taty transanal'nogo endokhirurgicheskogo udaleniia do/liokachestvennykh i zlokachestvennykh novoo/liazovanii priamoi kishki [Long-term results of endosurgical transanal removal of benign and malignant tumors of the rectum]. Koloproktologiia. 2005;(1):32-39.
  7. Buess G, Kipfmüller K, Hack D, Grüssner R, Heintz A, Junginger T. Technique of transanal endoscopic microsurgery. Surg Endosc. 1988;2(2):71-5.
  8. Swanstrom LL, Smiley P, Zelko J, Cagle L. Video endoscopic transanal-rectal tumor excision. Am J Surg. 1997 May;173(5):383-85.
  9. Beets-Tan RG, Beets GL, Vliegen RF, Kessels AG, Van Boven H, De /liuine A, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet. 2001 Feb 17;357(9255):497-504.
  10. Buess G, Theiss R, Hutterer F, Pichlmaier H, Pelz C, Holfeld Th, et al. Die transanale endoskopische Rektumoperation – Erprobung einer neuen Methode im Tierversuch. Leber Magen Darm. 1983;13:73-77.
  11. de Graaf EJ, Burger JW, van Ijsseldijk AL, Tetteroo GW, Dawson I, Hop WC. Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Dis. 2011 Jul;13(7):762-7. doi: 10.1111/j.1463-1318.2010.02269.x.
  12. Huber PJ Jr, Reiss G. Rectal tumors: treatment with a posterior approach. Am J. Surg. 1993Dec;166(Is 6):760-63.
  13. Buess G, MentgesB, Manncke K. StarlingerM, Becker H.D. Minimal invasive surgery in the local treatment of rectal cancer. Int J Colorectal Dis. 1991 May;6( Is 2):77-81. doi: 10.1007/BF00300195.
  14. Denisenko VL. Transanal'nye endoskopicheskie operatsii v kompleksnom lechenii oslozhnennogo kolorektal'nogo raka. Khirurgiia [Transanal endoscopic surgery in the complex treatment of complicated colorectal cancer]. Zhurn Im NI Pirogova. 2013;(11):67-68.
  15. Slisow W, Kolbow C, Fischer J. Perioperative clinical pathomorphologic evaluation of pararectal lymph node status and its contribution to definitive decision for local excision of rectal cancer. Zentralbl Chir. 1993;118(4):197-202; discussion 202-4. [Article in German].
  16. Goncharov AL, Fedorchenko AA, Vinogradov IuA, Shalaeva TN. Transanal'naia endoskopicheskaia mikrokhirurgiia [Transanal endoscopic microsurgery]. Khirurgiia. Zhurn Im NI Pirogova. 2015;(8):41-45.
  17. Vorob'ev GI, Tsar'kov PV, Podmarenkova LF, Sorokin EI. Otdalennye rezul'taty transanal'nogo endokhirurgicheskogo udaleniia do/liokachestvennykh i zlokachestvennykh novoo/liazovanii priamoi kishki [Long-term results of endosurgical transanal removal of benign and malignant tumors of the rectum]. Koloproktologiia. 2005;(1):32-39.
  18. Gataulin IG, Petrov SV, Igumenov AB. Optimizatsiia diagnosticheskogo algoritma i vybor khirurgicheskoi taktiki u bol'nykh vorsinchatymi novoo/liazovaniiami tolstoi kishki [Optimization of diagnostic algorithm and a choice of surgical approach in patients with villous tumors of the colon]. Koloproktologiia. 2005;(1):39-44.
  19. Kit OI, Gevorkian IuA, Soldatkina NV. Sovremennye vozmozhnosti koloproktologii: transanal'naia endoskopicheskaia khirurgiia [Current possibilities of coloproctology: transanal endoscopic surgery]. Ros Zhurn Gastroenterol Gepatol Koloproktol. 2015;(4):86-91.
  20. Rimonda R, Arezzo A, Arolfo S, Salvai A, Morino M. transanal minimally invasive surgery (tamis) with sils™ port versus transanal endoscopic microsurgery (tem): a comparative experimental study. Surg Endosc. 2013 Oct;27(10):3762-68. doi: 10.1007/s00464-013-2962-z.
  21. Puchkov KV, Khubezov DA, Iudin IV. Primenenie rektal'nogo ekspandera dlia transanal'nogo udaleniia opukholei priamoi kishki [Application of rectal transanal expander for removal of rectal tumor]. Ros Med-Biol Vestn Im Akad IP Pavlova. 2006;(4):82-86.
  22. Caselli MG, Ocares UM, Caselli MB. Uso del dispositivo SILS en transanal minimamente invasiva para el manejo de lesiones benignas de recto. Revista Chilena De Cirugia. 2012;64(4):391-94.
  23. Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW. Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients. Dis Colon Rectum. 2013 Mar;56(3):301-7. doi: 10.1097/DCR.0b013e31827ca313.
  24. Anishchenko VV, Bass AA, Arkhipova AA. Pervyi opyt primeneniia tekhnologii odnogo dostupa v transanal'noi khirurgii [The first experience of one approach technology in transanal surgery]. Koloproktologiia. 2013;(1):35-38.
  25. Zhandarov K, Batayeu S. Transanal laparoscopic operations SILS port evaluation of rectal functions. Abstracts of the 9th Scientific and annual Meeting of the European Society of Coloproctology, 2014 Sep 24-26; Barcelona, Spain. Colorectal Diesease. 2014;16(Suppl 3):59.
  26. Denisenko VL. Pervyi opyt primeneniia transanal'noi endoskopicheskoi mikrokhirurgii pri lechenii opukholei priamoi kishki [The first experience with transanal endoscopic microsurgery in the treatment of colorectal tumors]. Novosti Khirurgii. 2011;19(2):128-31.
  27. Odariuk TS, Vorob'ev GI, Shelygin IuA. Khirurgiia raka priamoi kishki [Surgery for rectal cancer]. Moscow, RF: Dedalus; 2005. 21 p.
  28. Nakamura T, Mitomi H, Ihara A, Onozato W, Sato T, Ozawa H, et al. Risk factors for wound infection after surgery for colorectal cancer. World J Surg. 2008 Jun;32(6):1138-41. doi: 10.1007/s00268-008-9528-6.
  29. Shelygin IA, Chernyshov SV, Orlova LP, Rybakov EG. Vozmozhnosti transanal'noi endoskopicheskoi khirurgii pri rannem rake priamoi kishki [Transanal endoscopic surgery in early rectal cancer]. Ros Zhurn Gastroenterol Gepatol Koloproktol. 2014;(4)45-50.
  30. Baatrup G, /lieum B, Qvist N, Wille-Jørgensen P, El/liønd H, Møller P, et al. Transanal endoscopic microsurgery in 143 consecutive patients with rectal adenocarcinoma: results from a Danish multicenter study. Colorectal Dis. 2009 Mar;11(3):270-5. doi: 10.1111/j.1463-1318.2008.01600.x.
  31. De Graaf EJ, Doornebosch PG, Tollenaar RA, Meershoek-Klein Kranenbarg E, de Boer AC, Bekkering FC, et al. Transanal endoscopic microsurgery versus total mesorectal excision of T1 rectal adenocarcinomas with curative intention. Eur J Surg Oncol. 2009 Dec;35(12):1280-5. doi: 10.1016/j.ejso.2009.05.001.
  32. Lezoche E, Baldarelli M, De Sanctis A, Lezoche G, Guerrieri M. Early rectal cancer: definition and management. Dig Dis. 2007;25(1):76-9.
  33. Steele RJ, Hershman MJ, Mortensen NJ, Armitage NC, Scholefield JH. Transanal endoscopic microsurgery--initial experience from three centres in the United Kingdom. /li J Surg. 1996 Feb;83(2):207-10.
  34. Pirogovskii VIu, Sorokin BV, Zadorozhnii SI, Tashchiev RK, Taranenko AA, Zlobenets CA, i dr. Primenenie transanal'noi endoskopicheskoi mikrokhirurgii v lechenii bol'nykh opukholiami priamoi kishki. [Application of transanal endoscopic microsurgery in the treatment of patients with rectal tumors]. Onkologiia. 2011;13(3):239-42.
  35. Shelygin IuA, Achkasov SI, Veselov VV, Filon AF, Peresada IV. Sovremennye printsipy lecheniia krupnykh adenom priamoi kishki. [Current principles of treatment of large rectal adenoma]. Onkologiia. 2013;(2):32-37.
  36. Vorobiev GI, Tsarkov PV, Sorokin EV. Gasless transanal endoscopic surgery for rectal adenomas and early carcinomas. Tech Coloproctol. 2006 Dec;10(4):277-81.
  37. /lietagnol F, Merrie A, George B, Warren BF, Mortensen NJ. Local excision of rectal tumours by transanal endoscopic microsurgery. /li J Surg. 2007 May;94(5):627-33.
  38. Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M. Intersphincteric resection for low rectal tumours. /li J Surg. 1994Sep;81(Is 9): 1376-78 doi: 10.1002/bjs.1800810944.
  39. Lauscher JC, Grittner F, Stroux A, Zimmermann M, le Claire M, Buhr HJ, et al. Reduction of wound infections in laparoscopic-assisted colorectal resections by plastic wound ring drapes (REDWIL)?–A randomized controlled trial. Langenbecks Arch Surg. 2012 Oct;397(7):1079-85. doi: 10.1007/s00423-012-0954-4.
  40. Dobson MW, Geisler D, Fazio V, Remzi F, Hull T, Vogel J. Minimally invasive surgical wound infections: laparoscopic surgery decreases morbidity of surgical site infections and decreases the cost of wound care. Colorectal Dis. 2011 Jul;13(7):811-5. doi: 10.1111/j.1463-1318.2010.02302.x.
  41. Yamamoto S, Fujita S, Akasu T, Ishiguro S, Kobayashi Y, Moriya Y. Wound infection after elective laparoscopic surgery for colorectal carcinoma. Surg Endosc. 2007 Dec;21(12):2248-52. doi:10.1007/s00464-007-9358-x.
  42. DeSouza A, Domajnko B, Park J, Marecik S, Prasad L, Abcarian H. Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy? Surg Endosc. 2011 Apr;25(4):1031-6. doi: 10.1007/s00464-010-1309-2.
  43. Lee L, Mappin-Kasirer B, Sender Liberman A, Stein B, Charlebois P, Vassiliou M, et al. High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection. Surg Endosc. 2012 Nov;26(11):3180-5. doi: 10.1007/s00464-012-2311-7.
  44. Person B, Vivas DA, Wexner SD. Totally laparoscopic low anterior resection with transperineal handsewn colonic J-pouch anal anastomosis for low rectal cancer. Surg Endosc. 2006 Apr;20(4):700-2.
  45. D'Hoore A, Wolthuis AM. Laparoscopic low anterior resection and transanal pull-through for low rectal cancer: a Natural Orifice Specimen Extraction (NOSE) technique. Colorectal Dis. 2011 Nov;13(Suppl 7):28-31. doi: 10.1111/j.1463-1318.2011.02773.x.
  46. Rasulov AO, Mamedli ZZ, Kulushev VM, Gordeev SS, Dzhumabaev KhE. Miniinvazivnye tekhnologii v khirurgii raka priamoi kishki [Minimally invasive techniques in rectal cancer surgery]. Koloproktologiia. 2014;(1):28-36.
  47. Lim SB, Seo SI, Lee JL, Kwak JY, Jang TY, Kim CW, et al. Feasibility of transanal minimally invasive surgery for mid-rectal lesions. Surg Endosc. 2012 Nov;26(11):3127-32. doi: 10.1007/s00464-012-2303-7.
  48. Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW. Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients. Dis Colon Rectum. 2013 Mar;56(3):301-7. doi: 10.1097/DCR.0b013e31827ca313.
Address for correspondence:
230006, the Republic of Belarus,
Grodno, Gorky Str., 80,
EE «Grodno State Medical University».
Department of surgical diseases N1.
Tel.: + 375 29 78-19-403
E-mail: BelyukKS@yandex.ru
Konstantin S. Belyuk
Information about the authors:
Zhandarov K.N. MD, Professor, Head of surgical diseases department N1, EE "Grodno State Medical University".
Zhdonets S.V. Surgeon of ME "Grodno Regional Clinical Hospital".
Belyuk K.S. PhD, Surgeon, Assistant of the surgical diseases department N1, EE "Grodno State Medical University".
Mitskevich V.A. Proctologist of ME "Grodno Regional Clinical Hospital".
Pakulnevich Y.F. Head of proctology and purulent surgery department, ME "Grodno Regional Clinical Hospital".

CASE REPORTS

R.E. KALININ, I.A. SUCHKOV, A.A. EGOROV, O.V. MEDVEDEVA

EXAMPLES OF NON-STANDARD RECONSTRUCTIONS IN HEMODIALYSIS PATIENTS WITH PERMANENT VASCULAR ACCESS

SBEE HPE "Ryazan State Medical University Named After Academician I.P.Pavlov",
Ryazan,
The Russian Federation

A program hemodialysis is a leading treatment method for patients with terminal stage of a chronic kidney disease. A permednt vascular access is required for an adequate hemodialysis. There are many hemodialysis options available with both autologous and synthetic materials used for a vascular access. There is no perfect vascular access, thus such complications as thrombosis in the area of reconstruction has developed. Different types of reconstructive procedures are sometimes used to restore the function of permanent vascular access. This article presents non-standard reconstructive procedures in hemodialysis patients with permanent vascular access. Five clinical cases of rendering medical aid to patients with pathological tortuosity of the brachial artery, with a false arteriovenous fistula aneurysm of the proximal anastomosis, with dialysis recycling syndrome are described in details. On the basis of the reviewed data it is possible to state that the vascular access surgery can be interesting and creative, not conventional. Physician activities should be aimed at increasing of operating time of available permanent vascular access and if possible to use the patient’s own tissues for this purpose.

Keywords: chronic kidney disease, autologous and synthetic materials, arteriovenous fistula, permanent vascular access, reconstructive procedures, aneurysm of the proximal, hemodialysis
p. 87-92 of the original issue
References
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  6. Vorob'ev GI, Tsar'kov PV, Podmarenkova LF, Sorokin EI. Otdalennye rezul'taty transanal'nogo endokhirurgicheskogo udaleniia dobrokachestvennykh i zlokachestvennykh novoobrazovanii priamoi kishki [Long-term results of endosurgical transanal removal of benign and malignant tumors of the rectum]. Koloproktologiia. 2005;(1):32-39.
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  11. de Graaf EJ, Burger JW, van Ijsseldijk AL, Tetteroo GW, Dawson I, Hop WC. Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Dis. 2011 Jul;13(7):762-7. doi: 10.1111/j.1463-1318.2010.02269.x.
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  14. Denisenko VL. Transanal'nye endoskopicheskie operatsii v kompleksnom lechenii oslozhnennogo kolorektal'nogo raka. Khirurgiia [Transanal endoscopic surgery in the complex treatment of complicated colorectal cancer]. Zhurn Im NI Pirogova. 2013;(11):67-68.
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  16. Goncharov AL, Fedorchenko AA, Vinogradov IuA, Shalaeva TN. Transanal'naia endoskopicheskaia mikrokhirurgiia [Transanal endoscopic microsurgery]. Khirurgiia. Zhurn Im NI Pirogova. 2015;(8):41-45.
  17. Vorob'ev GI, Tsar'kov PV, Podmarenkova LF, Sorokin EI. Otdalennye rezul'taty transanal'nogo endokhirurgicheskogo udaleniia dobrokachestvennykh i zlokachestvennykh novoobrazovanii priamoi kishki [Long-term results of endosurgical transanal removal of benign and malignant tumors of the rectum]. Koloproktologiia. 2005;(1):32-39.
  18. Gataulin IG, Petrov SV, Igumenov AB. Optimizatsiia diagnosticheskogo algoritma i vybor khirurgicheskoi taktiki u bol'nykh vorsinchatymi novoobrazovaniiami tolstoi kishki [Optimization of diagnostic algorithm and a choice of surgical approach in patients with villous tumors of the colon]. Koloproktologiia. 2005;(1):39-44.
  19. Kit OI, Gevorkian IuA, Soldatkina NV. Sovremennye vozmozhnosti koloproktologii: transanal'naia endoskopicheskaia khirurgiia [Current possibilities of coloproctology: transanal endoscopic surgery]. Ros Zhurn Gastroenterol Gepatol Koloproktol. 2015;(4):86-91.
  20. Rimonda R, Arezzo A, Arolfo S, Salvai A, Morino M. transanal minimally invasive surgery (tamis) with sils™ port versus transanal endoscopic microsurgery (tem): a comparative experimental study. Surg Endosc. 2013 Oct;27(10):3762-68. doi: 10.1007/s00464-013-2962-z.
  21. Puchkov KV, Khubezov DA, Iudin IV. Primenenie rektal'nogo ekspandera dlia transanal'nogo udaleniia opukholei priamoi kishki [Application of rectal transanal expander for removal of rectal tumor]. Ros Med-Biol Vestn Im Akad IP Pavlova. 2006;(4):82-86.
  22. Caselli MG, Ocares UM, Caselli MB. Uso del dispositivo SILS en transanal minimamente invasiva para el manejo de lesiones benignas de recto. Revista Chilena De Cirugia. 2012;64(4):391-94.
  23. Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW. Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients. Dis Colon Rectum. 2013 Mar;56(3):301-7. doi: 10.1097/DCR.0b013e31827ca313.
  24. Anishchenko VV, Bass AA, Arkhipova AA. Pervyi opyt primeneniia tekhnologii odnogo dostupa v transanal'noi khirurgii [The first experience of one approach technology in transanal surgery]. Koloproktologiia. 2013;(1):35-38.
  25. Zhandarov K, Batayeu S. Transanal laparoscopic operations SILS port evaluation of rectal functions. Abstracts of the 9th Scientific and annual Meeting of the European Society of Coloproctology, 2014 Sep 24-26; Barcelona, Spain. Colorectal Diesease. 2014;16(Suppl 3):59.
  26. Denisenko VL. Pervyi opyt primeneniia transanal'noi endoskopicheskoi mikrokhirurgii pri lechenii opukholei priamoi kishki [The first experience with transanal endoscopic microsurgery in the treatment of colorectal tumors]. Novosti Khirurgii. 2011;19(2):128-31.
  27. Odariuk TS, Vorob'ev GI, Shelygin IuA. Khirurgiia raka priamoi kishki [Surgery for rectal cancer]. Moscow, RF: Dedalus; 2005. 21 p.
  28. Nakamura T, Mitomi H, Ihara A, Onozato W, Sato T, Ozawa H, et al. Risk factors for wound infection after surgery for colorectal cancer. World J Surg. 2008 Jun;32(6):1138-41. doi: 10.1007/s00268-008-9528-6.
  29. Shelygin IA, Chernyshov SV, Orlova LP, Rybakov EG. Vozmozhnosti transanal'noi endoskopicheskoi khirurgii pri rannem rake priamoi kishki [Transanal endoscopic surgery in early rectal cancer]. Ros Zhurn Gastroenterol Gepatol Koloproktol. 2014;(4)45-50.
  30. Baatrup G, Breum B, Qvist N, Wille-Jørgensen P, Elbrønd H, Møller P, et al. Transanal endoscopic microsurgery in 143 consecutive patients with rectal adenocarcinoma: results from a Danish multicenter study. Colorectal Dis. 2009 Mar;11(3):270-5. doi: 10.1111/j.1463-1318.2008.01600.x.
  31. De Graaf EJ, Doornebosch PG, Tollenaar RA, Meershoek-Klein Kranenbarg E, de Boer AC, Bekkering FC, et al. Transanal endoscopic microsurgery versus total mesorectal excision of T1 rectal adenocarcinomas with curative intention. Eur J Surg Oncol. 2009 Dec;35(12):1280-5. doi: 10.1016/j.ejso.2009.05.001.
  32. Lezoche E, Baldarelli M, De Sanctis A, Lezoche G, Guerrieri M. Early rectal cancer: definition and management. Dig Dis. 2007;25(1):76-9.
  33. Steele RJ, Hershman MJ, Mortensen NJ, Armitage NC, Scholefield JH. Transanal endoscopic microsurgery--initial experience from three centres in the United Kingdom. Br J Surg. 1996 Feb;83(2):207-10.
  34. Pirogovskii VIu, Sorokin BV, Zadorozhnii SI, Tashchiev RK, Taranenko AA, Zlobenets CA, i dr. Primenenie transanal'noi endoskopicheskoi mikrokhirurgii v lechenii bol'nykh opukholiami priamoi kishki. [Application of transanal endoscopic microsurgery in the treatment of patients with rectal tumors]. Onkologiia. 2011;13(3):239-42.
  35. Shelygin IuA, Achkasov SI, Veselov VV, Filon AF, Peresada IV. Sovremennye printsipy lecheniia krupnykh adenom priamoi kishki. [Current principles of treatment of large rectal adenoma]. Onkologiia. 2013;(2):32-37.
  36. Vorobiev GI, Tsarkov PV, Sorokin EV. Gasless transanal endoscopic surgery for rectal adenomas and early carcinomas. Tech Coloproctol. 2006 Dec;10(4):277-81.
  37. Bretagnol F, Merrie A, George B, Warren BF, Mortensen NJ. Local excision of rectal tumours by transanal endoscopic microsurgery. Br J Surg. 2007 May;94(5):627-33.
  38. Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M. Intersphincteric resection for low rectal tumours. Br J Surg. 1994Sep;81(Is 9): 1376-78 doi: 10.1002/bjs.1800810944.
  39. Lauscher JC, Grittner F, Stroux A, Zimmermann M, le Claire M, Buhr HJ, et al. Reduction of wound infections in laparoscopic-assisted colorectal resections by plastic wound ring drapes (REDWIL)?–A randomized controlled trial. Langenbecks Arch Surg. 2012 Oct;397(7):1079-85. doi: 10.1007/s00423-012-0954-4.
  40. Dobson MW, Geisler D, Fazio V, Remzi F, Hull T, Vogel J. Minimally invasive surgical wound infections: laparoscopic surgery decreases morbidity of surgical site infections and decreases the cost of wound care. Colorectal Dis. 2011 Jul;13(7):811-5. doi: 10.1111/j.1463-1318.2010.02302.x.
  41. Yamamoto S, Fujita S, Akasu T, Ishiguro S, Kobayashi Y, Moriya Y. Wound infection after elective laparoscopic surgery for colorectal carcinoma. Surg Endosc. 2007 Dec;21(12):2248-52. doi:10.1007/s00464-007-9358-x.
  42. DeSouza A, Domajnko B, Park J, Marecik S, Prasad L, Abcarian H. Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy? Surg Endosc. 2011 Apr;25(4):1031-6. doi: 10.1007/s00464-010-1309-2.
  43. Lee L, Mappin-Kasirer B, Sender Liberman A, Stein B, Charlebois P, Vassiliou M, et al. High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection. Surg Endosc. 2012 Nov;26(11):3180-5. doi: 10.1007/s00464-012-2311-7.
  44. Person B, Vivas DA, Wexner SD. Totally laparoscopic low anterior resection with transperineal handsewn colonic J-pouch anal anastomosis for low rectal cancer. Surg Endosc. 2006 Apr;20(4):700-2.
  45. D'Hoore A, Wolthuis AM. Laparoscopic low anterior resection and transanal pull-through for low rectal cancer: a Natural Orifice Specimen Extraction (NOSE) technique. Colorectal Dis. 2011 Nov;13(Suppl 7):28-31. doi: 10.1111/j.1463-1318.2011.02773.x.
  46. Rasulov AO, Mamedli ZZ, Kulushev VM, Gordeev SS, Dzhumabaev KhE. Miniinvazivnye tekhnologii v khirurgii raka priamoi kishki [Minimally invasive techniques in rectal cancer surgery]. Koloproktologiia. 2014;(1):28-36.
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Address for correspondence:
390026, the Russian Federation,
Ryazan, Vyisokovoltnaya, 9 str.,
"Ryazan State Medical University named after Academician I.P.Pavlov".
Tel.: 7 491 246-08-03
e-mail: Suchkov_med@mail.ru
Igor A. Suchkov
Information about the authors:
Kalinin R.E. MD, Professor, Rector of SBEE HPE "Ryazan State Medical University Named After Academician I.P.Pavlov" of the Ministry of Health of Russia, Head of cardiovascular, X-ray-endovascular, operative surgery and topographic anatomy department.
Suchkov I.A. MD, Ass. Professor, Professor of cardiovascular, X-ray-endovascular, operative surgery and topographic anatomy departtment.
Egorov A.A. PhD, Applicant for Doctor’s degree of cardiovascular, X-ray-endovascular, operative surgery and topographic anatomy department.
Medvedeva O.V. MD, Ass. Professor, Head of departmentr of public health and health care, the organization of nursing with the course of social hygiene and public health organization of advanced professional training faculty.

M.G. SACHEK 1, M.O. RUSETSKAYA 1, S.N. ERMASHKEVICH 1, N.M. KONDERSKIJ 2, A.I. YANKOVSKIJ 2, Y.S. PODOLINSKIJ 2, M.V. KUNTSEVICH 2, A.V. SLAVETSKAYA 2, I.N. IVANOVA 2, A.V. POLONIKOV 3

ACUTE ESOPHAGEAL NECROSIS

EE "Vitebsk State Medical University"1
EH "Vitebsk Region Clinical Hospital"2, EH "Vitebsk Regional Pathoanatomical Bureau"3, Vitebsk,
The Republic of Belarus

The article presents the description of such a rare pathology as an acute esophageal necrosis in the patient with acute disorders of cerebral circulation treated at the neurology department of Vitebsk regional hospital. The patient was repeatedly hospitalized with stroke (at first he had it in May, 2015). While being treated at the neurology department, the patient was diagnosed an acute esophageal necrosis present with upper gastrointestinal bleeding. The patient was examined by the brigade on duty and sent to the intensive care unit where the activities for examination, treatment and preparation for surgery were conducted. Abdominal ultrasound, fibroesophago-gastroduodenoscopy, chest computed tomography and drainage of the right and left pleural cavities were carried out. However, during the preoperative preparation on the background of progressive phenomena of multiple organ failure the patient died.
The autopsy established delimited necrosis of the middle and lower thirds of the esophageal mucosa, at the same time the mucous membranes of the pharynx, the upper third of the esophagus and the stomach were intact. The ulcerous-necrotic changes in the mucous and submucosal layers were revealed histologically. The causes of the acute esophageal necrosis are still unknown. It can be assumed effect of possible precipitating factors on esophageal mucosa. The represented observation testifies that even preventive appointment of proton pump blockers and drugs affecting the motility of the intestine unableto prevent the development of acute esophageal necrosis. The described case demonstrates the possibility of occurrence of such a situation when a patient needs emergency surgery.

Keywords: acute esophageal necrosis, rare pathology, acute stroke, gastrointestinal bleeding, mortality, black esophagus, emergency surgery
p. 93-98 of the original issue
References
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Address for correspondence:
210023, the Republic of Belarus,
Vitebsk, Frunze Ave., 27,
EE «Vitebsk State Medical University»,
department of hospital surgery with
courses of urology and pediatric surgery,
Tel.: +375 (29) 714-62-00
e-mail: marinarusetska@mail.ru
Marina O. Rusetskaya
Information about the authors:
Sachek M.G. MD, Professor, Head of the hospital surgery department with the courses of urology and pediatric surgery, EE "Vitebsk State Medical University".
Rusetskaya M.O. PhD, Ass. Professor of the hospital surgery department with the courses of urology and pediatric surgery, EE "Vitebsk State Medical University".
Ermashkevich S.N. PhD, Ass. Professor of the hospital surgery department with the courses of urology and pediatric surgery, EE "Vitebsk State Medical University".
Konderskij N.M. Head of the thoracic purulent surgical unit, ME "Vitebsk Regional Clinical Hospital".
Yankovskij A.I. Physician of the thoracic purulent surgical unit, ME "Vitebsk Regional Clinical Hospital".
Podolinskij Y.S. Physician of the thoracic purulent surgical unit, ME "Vitebsk Regional Clinical Hospital".
Kuntsevich M.V. Surgeon-intern of ME "Vitebsk Regional Clinical Hospital".
Slavetskaya A.V. Therapist of the thoracic purulent surgical unit, ME "Vitebsk Regional Clinical Hospital".
Ivanova I.N. Endoscopist of ME "Vitebsk Regional Clinical Hospital".
Polonikov A.V. Autopsist of "Vitebsk Regional Pathoanatomical Bureau".

EXCHANGE OF EXPERIENCE

A.N. VORONETSKY

ENTEROSCOPY IN CROHN'S DISEASE IN CHILDREN WITH CONSISTENT APPLICATION OF SOLUBLE AND ENDOVIDEO CAPSULES

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

Objectives. To demonstrate the effectiveness of endovideocapsule enteroscopy in children with Crohn’s disease by preliminary use of a soluble capsule to assess the intestinal patency and therapy monitoring.
Methods. The endoscopic method for diagnosing of the small intestine patency with using a soluble capsule «PillCam patency» and subsequent enteroscopy using endovideocapsule «PillCam» in children with Crohn’s disease had been applied. This article describes two clinical observations of patients with Crohn’s disease; a continuous migration of the capsule due to the presence of strictures of the small intestine took place in one of thîse patients.
Results. The two-stage endoscopic examination of children with Crohn’s disease is justified using clinical examples: at the first stage the intestinal patency is checked using a soluble capsule, if the intestine is passable, at the second stage enteroscopy using endovideocapsule is carried out.
The delay of endovideocapsule migration during the examination has been established to be possible. It does not require an active intervention if a patient has no signs of intestinal obstruction. However, in case of the capsule migration delay, the patient must be dynamically observed in the surgical hospital. In our observation the capsule remained in the small intestine over 7 months with subsequent spontaneous elimination. One of the effective diagnostic methods of capsule delay is the performance of a plain abdominal X-ray, since the capsule batteries are radiopaque.
Conclusion. One of Crohn’s disease complications in children can be a narrowing of the small intestine lumen and its patency, so prior the endovideocapsule enteroscopy the intestinal patency should be checked. The unimpeded migration of a soluble capsule is thought to be a basis for the subsequent capsule endoscopy. In case of endovideocapsule delay in the intestine and preservation passage of the intestinal contents it is necessary to ensure patient’s clinical dynamic observation until the elimination of the capsule.

Keywords: capsule enteroscopy, Crohn’s disease, soluble capsule, migration of a soluble capsule, passage, intestinal stricture, endoscopy
p. 99-105 of the original issue
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Address for correspondence:
220116, the Republic of Belarus,
Minsk, Dzerzhinsky Ave., 83,
Department of pediatric surgery.
Tel.: +375 029 32-902-32
E-mail: anvoron@mail.ru
Alexander N. Voronetsky
Information about the authors:
Voronetsky A.N. PhD, Ass. Professor of the pediatric surgery department, EE "Belarusian State Medical University".
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