This journal is
indexed in Scopus
Year 2018 Vol. 26 No 1
N.N. YAROTSKAYA 1, V.K. GOSTISHEV 2, V.A. KOSINETS 1, I.V. SAMSONOVA 1
ULTRASTRUCTURAL AND MORPHOFUNCTIONAL CHANGES IN THE MITOCHONDRIAL APPARATUS OF HEPATOCYTES IN EXPERIMENTAL DIFFUSE PURULENT PERITONITIS
Vitebsk State Medical University 1, Vitebsk,
The Republic of Belarus
I.M. Sechenov First Moscow State Medical University (Sechenov University) 2, Moscow,
The Russian Federation
Objective. To study the ultrastructural changes in the liver mitochondria in experimental diffuse purulent peritonitis against the background of the metabolic support.
Methods. The morphometric evaluation of the rabbit liver mitochondria electron microscopic images (n=55) was performed in experimental diffuse purulent peritonitis. The obtained electron diffraction patterns were estimated using the ImageJ 1.45s program, in which the number of mitochondria sections, the number of intermithochondrial contacts and the number of damaged and intact mitochondria were counted. The average area, perimeter, and specific volume (measured in %) were calculated for the undamaged mitochondrial profiles. Metabolic agents with energotropic properties, phosphocreatine preparations containing creatine phosphate and preparations containing the succinic acid, niacinamide, inosine diphosphate and riboflavin were used.
Results. Electron microscopic analysis of mitochondria of hepatocytes made it possible to reveal significant changes in their structure, caused by the development of purulent peritonitis. Morphometric evaluation of electron diffraction patterns showed changes in the quantitative and qualitative characteristics of mitochondria: the ratio of the damaged and intact mitochondria, their size, perimeter and specific volume of all groups. The use of metabolic support permitted to reduce the negative effect of purulent peritonitis in the postoperative period, which is exerted on the liver mitochondria, in comparison with the control group of animals that did not receive any metabolic support. Conducting a comparative analysis revealed a higher efficacy of the metabolic agent containing the succinic acid, niacinamide, inosine diphosphate and riboflavin, which resulted in more intensive restoration of the mitochondrial membrane structure.
Conclusions. The development of purulent peritonitis is accompanied by a violation of the ultrastructural organization of the liver mitochondria in all studied groups. Metabolic correction allows restoring the membrane structure of mitochondria, and as the result improving the energy supply of cells to combat the negative consequences of endotoxicosis in peritonitis.
- Vlasov AP, Tarasova TV, Kozlov IG, Loginova OV, Leshankina NY, Visaitov DA. The ways rising of detoxication natural mechanisms during peritonitis. Kuban Nauch Med Vestn. 2010;(2):17-22. (in Russ.)
- Chernov VN. Foci of introduction of infection and hepatic failure-accuracy in common abdominal infections. Kuban Nauch Med Vestn. 2013;(3):135-38. (in Russ.)
- Mittal M, Siddiqui MR, Tran K, Reddy SP, Malik AB. Reactive oxygen species in inflammation and tissue injury. Antioxid Redox Signal. 2014 Mar 1; 20(7):1126-67. doi: 10.1089/ars.2012.5149.
- Burnstock G, Vaughn B, Robson SC. Purinergic signalling in the liver in health and disease. Purinergic Signal. 2014 Mar;10(1):51-70. doi: 10.1007/s11302-013-9398-8.
- Camara AK, Lesnefsky EJ, Stowe DF. Potential therapeutic benefits of strategies directed to mitochondria. Antioxid Redox Signal. 2010 Aug 1;13(3):279-47. doi: 10.1089/ars.2009.2788.
- Jain MV, Paczulla AM, Klonisch T, Dimgba FN, Rao SB, Roberg K, Schweizer F, Lengerke C, Davoodpour P, Palicharla VR, Maddika S, łos M. Interconnections between apoptotic, autophagic and necrotic pathways: implications for cancer therapy development. J Cell Mol Med. 2013 Jan;17(1):12-29. doi: 10.1111/jcmm.12001.
- Reynolds ES. The use of lead citrate at high pH as an electron-opaque stain in electron microscopy. J Cell Biol. 1963 Apr;17:208-12.
- Bagnenko SF, Gorbachev NB, Amagyrov VP, Batotsyrenov BV, Miroshnichenko VN. Farmakologicheskaia korrektsiia metabolicheskikh narushenii pri razlitom peritonite: posobie dlia vrachei. S-Petersburg; 2007. 20 p. (in Russ.)
- Yakubouski SV, Lapsha VI, Emelianovà ÀÀ, Chaika LD. Alterations of liver microcirculation in experimental abdominal surgical infection and their pharmacological correction. Novosti Med-Biol Nauk. 2010;2(4):189-95. (in Russ.)
- Rumiantseva SA, Stupin VA, Afanas’ev VV, Oganov RG, Silina EV. Ratsional’naia farmakoterapiia pri sosudistoi patologii, ili chto takoe khorosho i chto takoe plokho: Klin praktikum po lekarstv terapii. Moscow - S-Petersburg, RF: Med kn; 2014. 339 p. (in Russ.)
- Vlasov PA, Suslov AV, Shibitov VA, Timoshkin SP, Loginov MA. Metabolicheskaia terapiia v korrektsii enteral’noi nedostatochnosti. Vestn Mordov Un-ta. 2013;(1-2):142-45. (in Russ.)
- Okovityi SV, Shulenin SN, Smirnov AV. Klinicheskaia farmakologiia antigipoksantov i antioksidantov. S-Petersburg, RF: FARMindeks; 2005. 72 p. (in Russ.)
- Perepech NB. Neoton (mekhanizmy deistviia i klinicheskoe primenenie. 2-e izd. S-Petersburg: Progress-Pogoda; 1997. 88 p. (in Russ.)
210022, The Republic of Belarus,
Vitebsk, Frunze Avenue, 27, b. 3
Vitebsk State Medical University,
Tel. mobile: +375 29 714-18-76,
Yarotskaya Natalia N.
Yarotskaya Natalia N., Researcher of the Research Laboratory, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
Gostishev Victor K., MD, Professor, Academician of RAMS, Head of the General Surgery Department of the Medical Faculty, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
Kosinets Vladimir A., MD, Professor of the Hospital Surgery Department with the Courses of Urology and Pediatric Surgery of Vitebsk State Medical University, Vitebsk, Republic of Belarus.
Samsonova Inna V., PhD, Associate Professor, Head of the Pathologic Anatomy Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
A.A. NAZARCHUK, S.V. VERNYGORODSKYI, V.G. PALII, G.G. NAZARCHUK
EXPERIMENTAL RESEACH OF EFFECTIVENESS OF ANTIMICROBIAL SURGICAL MATHERIALS CONTAINING DECAMETHOXINUM
National Pirogov Memorial Medical University, Vinnytsya, Ukraine
Objective. To study the properties of antimicrobial surgical materials containing decamethoxinum.
Methods. In the experimental model of the wound primary infected by Staphylococcus (60 white mongrel male rats), the antimicrobial effectiveness of dressings (medical coarse calico) and suture (silk) materials, impregnated with antiseptic decamethoxinum (with 1,10-Decamethylene-bis-(N,N-dimethylmethoxycarbonylmethyl) ammonium dichloride), in comparison with topical wound management with chlorhexidine was researched. The effectiveness of wound healing was studied experimentally by standard microbiological and morphological methods (3rd, 7th, 14th days).
Results. The decrease of S. aureus colonization in wounds (6.47±0.11 CFU/ml) was registered on the 3rd day after administration of antimicrobial silk and medical coarse calico with decamethoxinum. The use of materials, impregnated with decamethoxinum was proved to have advantages in reduction of S. aureus colonization (in 1.3-1.4 times) after 7 days. Complete reduction of S. aureus from wounds was registered on the 14th day. But at the same time, in the comparison group microbial colonization was higher than 106 CFU/ml (p<0.01).
In comparison group the pathomorphological changes of skin were noted such as a significant inflammation response, purulent inflammation extension in the derma (3rd day). While using antimicrobial silk and dressings with decamethoxinum, the depression of inflammatory reaction more than in 1.5 times was registered (p<0.05); exudation and purulent character of the inflammatory process was specified in the form of the expressed activation of leucocytes and macrophages in the first 7 days. In comparison group a long-lasting purulent inflammation was observed as well as progression of necrotic and dystrophic disorders (7th day). After using of surgical material, impregnated with decamethoxinum, the acceleration of reparation, more active wound healing were registered (7th, 14th day), than in comparison group (ð<0.05).
Conclusions. The use of antimicrobial surgical materials, impregnated with decamethoxinum provides effective antimicrobial, anti-inflammatory and anti-edematous action; synchronizes cell interaction in healing of purulent wounds; creates the balance between maturation and resorption of granulations and scar tissue.
- Sood A, Granick MS, Tomaselli NL. Wound dressings and comparative effectiveness data. Adv Wound Care (New Rochelle). 2014 Aug 1;3(8):511-29. doi: 10.1089/wound.2012.0401.
- Kong M, Chen XG, Xing K, Park HJ. Antimicrobial properties of chitosan and mode of action: a state of the art review. Int J Food Microbiol. 2010 Nov 15;144(1):51-63. doi: 10.1016/j.ijfoodmicro.2010.09.012.
- Maksimenia GG. The kliniko-farmakologichesky characteristic of preparations for processing of wounds. Voen Meditsina. 2014;(2):105-14. (in Russ.)
- Percival SL, Finnegan S, Donelli G, Vuotto C, Rimmer S, Lipsky BA. Antiseptics for treating infected wounds: Efficacy on biofilms and effect of pH. Crit Rev Microbiol. 2016;42(2):293-309. doi: 10.3109/1040841X.2014.940495.
- Afinogenov GE, Lebedeva IK, Darovskaya EN, Afinogenova AG, Zaitseva MIu, Moldaver BL, Balaev TA, Bogdanova TIa. A new natural antiseptic «Galenophyllipt» for the treatment of staphylococcal skinmuscle wound infection in white mice. Klin Mikrobiologiia Antimikrob Khimioterapiia. 2010;12(2):170-76. (in Russ.)
- Avtandilov GG. Osnovy patologoanatomicheskoi praktiki: ruk. 3 izd, dop. Moscow, RF: RosMAPO; 2007. 480 p. (in Russ.)
- Obermeier A, Schneider J, Wehner S, Matl FD, Schieker M, von Eisenhart-Rothe R, Stemberger A, Burgkart R. Novel high efficient coatings for anti-microbial surgical sutures using chlorhexidine in fatty acid slow-release carrier systems. PLoS One. 2014 Jul 1;9(7):e101426. doi: 10.1371/journal.pone.0101426. eCollection 2014.
- Popov VA, red. Ranevoi protsess: nanobiotekhnologii optimizatsii. S-Petersburg, RF: SpetsLit, 2013. 199 p. (in Russ.)
- Menke NB, Ward KR, Witten TM, Bonchev DG, Diegelmann RF. Impaired wound healing. Clin Dermatol. 2007 Jan-Feb;25(1):19-25. doi: 10.1016/j.clindermatol.2006.12.005.
Vinnytsya, Pirogov str., 56,
Vinnytsya National Pirogov
Memorial Medical University,
Department of Microbiology
Nazarchuk Alexander A.
Nazarchuk Aleksandr A., PhD, Senior Lecturer of the Department of Microbiology, Vinnytsya National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
Vernygorodskyi Sergii V., MD, Professor, Professor of the Department of Pathological Anatomy, Forensic Medicine and Law, Vinnytsya National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
Palii Viktor G., MD, Professor, Professor of the General Surgery Department, Vinnytsya National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
Nazarchuk Galina G., PhD, Assistant of the Eye Diseases Department, Vinnytsya National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
GENERAL & SPECIAL SURGERY
V.A. SHVARTZ 1, A.R. KISELEV 1,2, A.S. KARAVAEV 3, K.A. VULF 1, E.I. BOROVKOVA 4, A.D. PETROSYAN 1, O.L. BOCKERIA 1
MUTUAL DYNAMICS OF SYNCHRONIZATION OF LOW-FREQUENCY OSCILLATIONS IN CIRCULATION VEGETATIVE REGULATION AND INDICATORS OF VARIABILITY OF THE HEART RHYTHM IN PATIENTS AFTER OPERATIONS WITH ARTIFICIAL CIRCULATION IN THE EARLY POSTOPERATIVE PERIOD
A.N. Bakulev Scientific and Practical Center for Cardiovascular Surgery 1,
Saratov State Medical University named after V.I. Razumovsky 2,
Saratov Branch of the Institute of Radio Engineering and Electronics named after V.A. Kotelnikov of RAS 3,
Saratov National Research State University named after N.G. Chernyshevsky 4 , Saratov,
The Russian Federation
Objective. To investigate peculiarity of co-operative dynamics of autonomic circulatory control indices, including synchronization of low frequency oscillations in heart rate variability (HRV) and photoplethysmogram (PPG), in patients after surgery with cardiopulmonary bypass (CPB) in the early postoperative period.
Methods. 62 patients, who had survived surgery with CPB, were included in the study (40 men, 22 women, aged 57,9±7,6 years). The synchronous registration of cardiointervalogram and PPG during 15 minutes was performed in all patients before surgery and 5-7 days after surgery in the morning. We calculated the total percentage of phase synchronization of low frequency rhythms in HRV and PPG (index S), heart rate (HR) and some assessments of HRV (SDNN, TP, HF% è LF%). We calculated the dynamics of these indices after surgery: ΔS, ΔHR, ΔSDNN, ΔHF%, ΔLF%.
Results. After surgery, index S decreased (ΔS<-5%) in 26 patients, has not changed (ΔS -5% to +5%) in 18 patients and increased (ΔS>+5%) in 18 patients. Patients with ΔS<-5% had the highest value of the index S and the lowest of TR, relatively to other patients (ð<0.05). In all study phases, the strong correlation was shown for SDNN and TP (R=0.86 and 0.90, ð<0.05), and the medium correlation was shown for index S è TP (R=-0.41 and -0.53, ð<0.05). The multiple regression correlation was identified between ΔS and following indices: S, HF%, blood glucose, cardioplegia, ΔTP, ΔHF%.
Conclusions. We revealed the heterogeneity of patients with coronary artery disease, requiring surgery with CPB, using source autonomic status and its dynamics in the early postoperative period. We showed multiple dependent postoperative dynamics of the index S with some indices, which characterize the initial status of the patient, peculiarities of the operation and dynamics of autonomic status in the early postoperative period.
- Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996 Mar 1;93(5):1043-65. [No authors listed]
- Buccelletti F, Bocci MG, Gilardi E, Fiore V, Calcinaro S, Fragnoli C, Maviglia R, Franceschi F. Linear and nonlinear heart rate variability indexes in clinical practice. Comp Math Methods Med. 2012;2012:Article ID 219080. 5 p. doi: 10.1155/2012/219080.
- Zhang Q, Patwardhan AR, Knapp CF, Evans JM. Cardiovascular and cardiorespiratory phase synchronization in normovolemic and hypovolemic humans. Eur J Appl Physiol. 2015 Feb;115(2):417-27. doi: 10.1007/s00421-014-3017-4.
- Kiselev AR, Karavaev AS, Gridnev VI, Prokhorov MD, Ponomarenko VI, Borovkova EI, Shvartz VA, Ishbulatov YuM, Posnenkova OM, Bezruchko BP. Method of estimation of synchronization strength between low-frequency oscillations in heart rate variability and photoplethysmographic waveform variability. RusOMJ. 2016;5(1):e0101. doi: 10.15275/rusomj.2016.0101.(in Russ.)
- Soares PP, Moreno AM, Cravo SL, Nóbrega AC. Coronary artery bypass surgery and longitudinal evaluation of the autonomic cardiovascular function. Crit Care. 2005;9(2):R124-R131. doi: 10.1186/cc3042.
- Bakari S, Koca B, Oztunç F, Abuhandan M. Heart rate variability in patients with atrial septal defect and healthy children. J Cardiol. 2013 Jun;61(6):436-39. doi: 10.1016/j.jjcc.2013.01.014.
- Pantoni CB, Mendes RG, Di Thommazo-Luporini L, Simoes RP, Amaral-Neto O, Arena R, Guizilini S, Gomes WJ, Catai AM, Borghi-Silva A. Recovery of linear and nonlinear heart rate dynamics after coronary artery bypass grafting surgery. Clin Physiol Funct Imaging. 2014 Nov;34(6):449-56. doi: 10.1111/cpf.12115.
- Taylor R. Interpretation of the correlation coefficient: a basic review. J Diagn Med Sonogr. 1990;6(Is):35-39. doi: 10.1177/875647939000600106.
- Chello M, Mastroroberto P, De Amicis V, Pantaleo D, Ascione R, Spampinato N. Intermittent warm blood cardioplegia preserves myocardial beta-adrenergic receptor function. Ann Thorac Surg. 1997 Mar;63(3):683-88. doi: 10.1016/S0003-4975(96)01367-7.
- Lakusic N, Mahovic D, Sonicki Z, Slivnjak V, Baborski F. Outcome of patients with normal and decreased heart rate variability after coronary artery bypass grafting surgery. Int J Cardiol. 2013 Jun 20;166(2):516-18. doi: 10.1016/j.ijcard.2012.04.040.
- Jelinek HF, Huang ZQ, Khandoker AH, Chang D, Kiat H. Cardiac rehabilitation outcomes following a 6-week program of PCI and CABG patients. Front Physiol. 2013;4:302. Front Physiol. 2013;4:302. doi: 10.3389/fphys.2013.00302.
- Badra LJ, Cooke WH, Hoag JB, Crossman AA, Kuusela TA, Tahvanainen KU, Eckberg DL. Respiratory modulation of human autonomic rhythms. Am J Physiol Heart Circ Physiol. 2001 Jun;280(6):H2674-88.
- Nolan J, Batin PD, Andrews R, Lindsay SJ, Brooksby P, Mullen M, Baig W, Flapan AD, Cowley A, Prescott RJ, Neilson JM, Fox KA. Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Circulation. 1998 Oct 13;98(15):1510-16. doi: 10.1161/01.CIR.98.15.1510.
- Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987 Feb 1;59(4):256-62. doi: 10.1016/0002-9149(87)90795-8.
- Arslan ü, Memetoğlu ME, Kutlu R, Erbasan O, Tort M, çal?k ES, Y?ld?z Z, Kayg?n MAli, Erdem O, Tekin AI. Preoperative Hba1c level in prediction of short-term morbidity and mortality outcomes following coronary artery bypass grafting surgery. RusOMJ. 2015;4(Is 2):e0204. doi: 10.15275/rusomj.2015.0204.
121552, The Russian Federation,
Moscow, Rublevskoe Highway, 135,
A.N. Bakulev Scientific and Practical
Center for Cardiovascular Surgery,
Department of Surgical Treatment
of Interactive Pathology,
Tel. mobile: +79032619292,
Shvartz Vladimir A.
Shvartz Vladimir A., PhD, Researcher, Department of Surgical Treatment of Interactive Pathology, A.N. Bakulev Scientific and Practical Center for Cardiovascular Surgery, Moscow, Russian Federation.
Kiselev Anton R., MD, Researcher, Department of Surgical Treatment of Interactive Pathology, A.N. Bakulev Scientific and Practical Center for Cardiovascular Surgery, Moscow, Leading Researcher, Institute of Cardiology, Department of Promotion of New Cardiological Information Technologies, Saratov State Medical University named after V.I. Razumovsky, Saratov, Russian Federation.
Karavaev Anatoly S., PhD, Senior Researcher, Saratov Branch of the Institute of Radio Engineering and Electronics named after V.A. Kotelnikov of RAS, Saratov, Russian Federation.
Vulf Kristina A., Post-Graduate Student, Department of Surgical Treatment of Interactive Pathology, A.N. Bakulev Scientific and Practical Center for Cardiovascular Surgery, Moscow, Russian Federation.
Borovkova Ekaterina I., Post-Graduate Student, Assistant of the Department of Dynamic Modeling and Biomedical Engineering, Saratov National Research State University named after N.G. Chernyshevsky , Saratov, Russian Federation.
Petrosyan Andrey D., Cardiovascular Surgeon, Department of Surgical Treatment of Interactive Pathology, A.N. Bakulev Scientific and Practical Center for Cardiovascular Surgery, Moscow, Russian Federation.
Bockeria Olga L., Corresponding Member of the Russian Academy of Sciences, Chief Researcher, Department of Surgical Treatment of Interactive Pathology, A.N. Bakulev Scientific and Practical Center for Cardiovascular Surgery, Moscow, Russian Federation.
V.N. BELORUSETS 1, A.S. KARPITSKIJ 1, N.N. GOLUBEVA 2
MORPHOLOGICAL CHANGES IN THE RETROPERITONEAL FAT TISSUE IN THE EARLY PHASE OF ACUTE NECROTIZING PANCREATITIS
Brest Regional Hospital 1,
Brest Region Directorate of the State Forensic Examination Committee of the Republic of Belarus 2, Brest,
The Republic of Belarus
Objective. To study the nature of pathomorphological changes in the retroperitoneal tissue in the early phase of acute necrotizing pancreatitis.
Methods. The article presents the results of the histological examination of biopsy specimens of the retroperitoneal tissue of 22 patients with acute necrotizing pancreatitis, who were treated with early laparoscopic drainage of the retroperitoneal tissue performed in the first 5 days after the disease onset. The use of biopsy material allowed studying the morphological changes in the retroperitoneal tissue at the earliest stages of the disease.
Results. The analysis of the obtained results revealed a number of features of the inflammatory reaction in the retroperitoneal tissue in acute pancreatitis. First of all, it is a delayed exudative inflammatory reaction when an immediate increase of the vascular wall permeability for the blood cells did not occur. Microvascular reactions were delayed confirmed by the late (after 48 hours) occurrence of small-focal hemorrhages and fibrin deposits. There were practically no thromboses at the microcirculatory level. The peculiarity of cellular reactions in the first 2 days was the dominance of lymphocytes. The leukocyte round cell infiltration was detected, which indicates a serous nature of the inflammatory reaction. Starting with the second day, there were single polynucleous leukocyte infiltrates, being a morphological sign of a suppurative inflammation. Their amount progressively increased with the prolongation of the disease terms. Fat necrosis was detected 48 hours after the disease onset.
Conclusions. The lesion of the retroperitoneal tissue occurred much later than the manifestation of acute necrotizing pancreatitis. Pathomorphological changes in the retroperitoneal tissue in the early phase of acute pancreatitis are subject to evolution and have staging, determined by the duration of the impact of disturbing factors. The nature of the inflammatory reaction reflects a consistent transition from serous inflammation to purulent one. The obtained data show a pathogenetic foundation to apply early draining operations using minimally invasive technologies in the first 48 hours in the stage of serous inflammation, when pathological changes in the retroperitoneal tissue are potentially reversible.
- Kondratenko PG, Konkova MV, Vasiliev AA, Yepifantsev AA, Djansiz IN, Shirshov IV, Yudin AA. Surgical Tactics in Acute Necrotizing Pancreatitis. Ukr Zhurn Khirurgii. 2013;(3):150-55.(in Russ.)
- Shoroh GP, Shoroh SG. Ostryj destruktivnyj pankreatit. Minsk, RB: Paradoks; 2013. 208 p. (in Russ.)
- Lyzikov AN, Mayorov VM, Dundarov ZA, Avizhets YuN. Morphological features of extrapancreatic lesion of internal organs in acute enzymatic parapancreatitis. Problemy Zdorov’ja I Jekologii. 2014;(2):61-66. (in Russ.)
- Mayorov VM, Dundarov ZA, Avizhets ÍuN. Some morphological regularities of damage and spreading of the destructive process in the retroperitoneal area in severe acute necrotizing pancreatitis according to autopsy data. Novosti Khirurgii. 2015;23(4):385-90. doi: 10.18484/2305-0047.2015.4.385.(in Russ.)
- Tenner S, Baillie J, DeWitt J, Swaroop Vege S. Management of Acute Pancreatitis. Am J Gastroenterol. 2013;108:1400-15. doi: 10.1038/ajg.2013.218.
- IAP/APA evidence-based guidelines for the management of acute pancreatitis. Working Group IAP/APA Acute Pancreatitis Guidelines. Pancreatology. 2013 Jul-Aug;13(4 Suppl 2):e1-15. doi: 10.1016/j.pan.2013.07.063.
- Wada K, Takada T, Hirata K, Mayumi T, Yoshida M, Yokoe M, Kiriyama S, Hirota M, Kimura Y, Takeda K, Arata S, Hirota M, Sekimoto M, Isaji S, Takeyama Y, Gabata T, Kitamura N, Amano H. Treatment strategy for acute pancreatitis. J Hepatobiliary Pancreat Sci. 2010 Jan;17(1):79-86. doi: 10.1007/s00534-009-0218-z.
- Zerem E. Treatment of severe acute pancreatitis and its complications. World J Gastroenterol. 2014 Oct 14;20(38):13879-92. doi: 10.3748/wjg.v20.i38.13879.
- Kokosis G, Perez A, Pappas TN . Surgical management of necrotizing pancreatitis: An overview. World J Gastroenterol. 2014 Nov 21; 20(43): 16106–12. Published online 2014 Nov 21. doi: 10.3748/wjg.v20.i43.16106.
- Kudelich OA, Kondratenko GG, Yudina OA , Motolyanets PM. Multivariate analysis of factors associated with immediate causes of death in severe acute pancreatitis. Novosti Khirurgii. 2014;22(4):416-27. doi: 10.18484/2305-0047.2014.4.416.
- Kaliev AA. Clinical and morphologic comparison of pancreatic damage in acute destructive pancreatitis. Kazan Med Zhurn. 2013;94(4):464-68.(in Russ.)
- Wan MH, Huang W, Latawiec D, Jiang K, Booth D M, Elliott V, Mukherjee R, Xia Q. Review of experimental animal models of biliary acute pancreatitis and recent advances in basic research. HPB (Oxford). 2012 Feb; 14(2):73-81. doi: 10.1111/j.1477-2574.2011.00408.x.
- Vinnik YuS, Shestakova LÀ, Teplyakova OV, Cedrick NI, Peryanova OV, Gitlina AG, Yakimov SV, Plahotnikova AM. Experimental model of primary infected pancreatic necrosis. Novosti Khirurgii. 2013;21(3):3-8. doi: 10.18484/2305-0047.2013.3.3.(in Russ.)
- Ushkevich AL, Zhandarov KN, Prokopchik NI. Modelirovanie ostrogo destruktivnogo pankreatita, parapankreatita v eksperimente. Novosti Khirurgii. 2010;18(2):12-19. (in Russ.)
- Tolstoi AD, Panov VP, Krasnogorov VB, Vashetko RV, Skorodumov AV. Parapankreatit. Etiologiia, patogenez, diagnostika, lechenie. S-Petersburg, RF: Iasnyi Svet; 2003. 256 p.
224027, The Republic of Belarus,
Brest, Meditsinskaya Str.,7,
Brest Regional Hospital,
Purulent Surgery Unit,
Tel. office: +375 162 27-21-91,
Belorusets Victor N.
Belorusets Victor N., Applicant of the General Surgery Department, Grodno State Medical University, Surgeon of the Purulent Surgery Unit, Brest Regional Hospital, Brest, Republic of Belarus.
Karpitskij Aliaksandr S., MD, Professor, Head Physician, Brest Regional Hospital, Brest, Republic of Belarus.
Golubeva Natalja N., State Medical Forensic Expert of the Department îf Forensic Histological Examinations of the Laboratory Examination of Physical Evidence of a Biological Nature of the Brest Region Directorate of the State Forensic Examination Committee of the Republic of Belarus, Brest, Republic of Belarus.
Y.S. VINNIK1, R.A. PAKHOMOVA1, L.V. KOCHETOVA1, V.V. KOZLOV2
CHEMILUMINESCENT ACTIVITY AND CYTOARCHITECTONICS OF NEUTROPHILIC GRANULOCYTES IN PATIENTS WITH MECHANICAL JAUNDICE
Krasnoyarsk State Medical University named after Professor V. F. Voino-Yasenetsky1 ,Krasnoyarsk
I.M. Sechenov First Moscow State Medical University (Sechenov University) 2, Moscow,
The Russian Federation
Objective. To study the functional activity and cytoarchitectonics of neutrophilic granulocytes by the atomic force microscopy technique in the patients with mechanical jaundice of benign genesis of varying severity.
Methods. The subject of the study were 92 patients aged from 47 to 69 years undergoing the in-patient treatment in the surgical departments of medical institutions in Krasnoyarsk with the diagnosis of mechanical jaundice of benign genesis. The control group consisted of 60 donors, comparable in sex and age with the main group. Depending on the severity of mechanical jaundice, luminol-dependent chemiluminescence of neutrophils was investigated and atomic-force microscopy of neurophilic granulocytes was performed to determine the shape, membrane state, geometric dimensions and adhesion forces of the blood neutrophils.
Results. In patients with mechanical jaundice, the intensity of spontaneous chemiluminescence depends on the severity of mechanical jaundice. The kinetics of the chemiluminescent response of the peripheral blood neutrophils indicates an increase in the compensatory functional capacity of this cell population in case of mild degree of mechanical jaundice severity with their depletion in parallel with the increase in the severity of mechanical jaundice.
Atomic force microscopy revealed violations of the structural organization of the neutrophil granulocyte. With increasing severity of mechanical jaundice, neutrophil became convex in shape, the number of segments of the nucleus increased, the cell membrane became irregular, the neutrophil volume reached 62.20 + 5.94 μm3. The magnitude of the adhesion forces of neutrophils decreased by 25% in patients with class B severity of mechanical jaundice and by 31% with class C severity of mechanical jaundice.
Conclusions. Based on the analysis of the chemiluminescent activity of neutrophilic granulocytes and their cytoarchitectonics, we concluded that the functional capabilities of neutrophilic granulocytes in mechanical jaundice are depleted in parallel with the increase in the severity of mechanical jaundice. Dysfunctions of neutrophils in mechanical jaundice are caused by the change in its cytoarchitectonics and by the decrease in adhesion forces.
- Gal’perin EI. Klassifikatsiia tiazhesti mekhanicheskoi zheltukhi. Annaly Khirurg Gepatologii. 2012;17(2):26-33. (in Russ.)
- Welniak LA, Sun R, Murphy WJ. The role of growth hormone in T-cell development and reconstitution. J Leukoc Biol. 2002 Mar;71(3):381-87.
- Datsenko BM, Borisenko VB. Mechanical jaundice, acute cholangitis, biliary sepsis: pathogenic relationship and principles of differential diagnostics. Novosti Khirurgii. 2013;21;(5):31-39. doi: 10.18484/2305-0047.2013.5.31. (in Russ.)
- Smirnova ÎV, Titova NM, Manchuk VT, Elmanova NG, Kochetova LV, Pakhomova RÀ. Cellular immunity features in patients with benign origin obstructive jaundice depending on bilirubin. Fundam Issledovaniia. 2015;(2-10):2174-79. (in Russ.)
- Liu G, Yang H, Chen X, Wang X, Chu Y. Modulation of neutrophil development and homeostasis. Curr Mol Med. 2013 Sep;13(8):1270-83.
- Strydom N, Rankin SM. Regulation of circulating neutrophil numbers under homeostasis and in disease. J Innate Immun. 2013;5(4):304-14. doi: 10.1159/000350282.
- Stupin VA, Laptev VV, Tskaev AYu, Givirovskaya NE. Immune System in Benign Obstructive Jaundice Patients. Annaly Khirurg Gepatologii. 2008;13(2):69-75. (in Russ.)
- Kurtasova LM, Semenov EV, Zukov RA, Shkapova EA. Changes in parameters of luminol-dependent and lucigenin-dependent chemiluminescence of peripheral blood neutrophils in patients with bladder cancer in the disease dynamics. Med Immunologiia. 2015;17(2):173-78. (in Russ.)
- Savchenko AA, Dresvjankina LV, Grinshtejn YuI, Aristov AI. Features of chemiluminescent activity of blood neutrophils and sputum of patients with community-acquired pneumonia during the treatment. Sib Med Obozrenie. 2014;(5):52-56. (in Russ.)
660022, The Russian Federation,
Krasnoyarsk, P.Zheleznyak Str., 1,
Krasnoyarsk State Medical University
named after Professor
V. F. Voino-Yasenetsky,
General Surgery Department,
Tel. mobile +79029423912,
Pakhomova Regina A.
Vinnik Yurij S., MD, Professor, Head of the General Surgery Department named after Professor M.I. Gulman, Krasnoyarsk State Medical University named after Professor V. F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation.
Pakhomova Regina A., PhD, Assistant of the General Surgery Department named after Professor M.I. Gulman, Krasnoyarsk State Medical University named after Professor V. F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation.
Kochetova Lyudmila V., PhD, Associate Professor of the General Surgery Department named after Professor M.I. Gulman, Krasnoyarsk State Medical University named after Professor V. F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation.
Kozlov Vasiliy V., PhD, Associate Professor of the Department of Public Health and Health Care, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
R.E. KALININ, I.A. SUCHKOV, A.S. PSHENNIKOV, A.A. KAMAEV, S.A. ISAKOV, A.N. RYABKOV
APPLICATION OF MAGNESIUM DRUGS AND THEIR INFLUENCE ON THE INDICATORS OF CONNECTIVE TISSUE DYSPLASIA IN PATIENTS WITH VARICOSE VEINS
Ryazan State Medical University
named after Academician I.P. Pavlov, Ryazan,
The Russian Federation
Objective. To study the effect of magnesium drugs on the concentration of matrix metalloproteinases and magnesium ions in patients with varicose veins of the lower extremities.
Methods. The study included 124 patients with varicose veins of the lower extremities, C2-C6, which were divided into 4 groups. In the 1st group, surgical treatment followed with the administering the standard conservative treatment (32 patient); in the 2nd group after the operation in addition to conservative treatment, magnesium drugs (32 patient) were prescribed; in the 3rd group, conservative treatment without surgery (30 patient) was performed; in the 4th group patients received standard conservative treatment and magnesium drugs (30 patient). The 5th control group consisted of 20 healthy volunteers who did not suffer from varicose veins disease. Patients of groups 2 and 4 were given magnesium orotate 500 mg 2 tablets 3 times a day for 3 months. The content of serum matrix metalloproteinase-1 (MMP-1), matrix metalloproteinase-9 (MMP-9), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) was determined by quantitative solid-phase enzyme immunoassay. The magnesium ion concentration was determined by colorimetric method.
Results. In patients with varicose veins of lower extremities a significantly lower level of magnesium was registered compared to healthy volunteers not suffering from varicose veins: 35.5% of those with varicose veins had a magnesium deficiency, while only 15% had a decrease in this indicator among healthy volunteers. Against the background of additional therapy with magnesium drugs, there was a decrease in the number of patients with magnesium deficiency in groups with varicose veins of lower extremities, a decrease in MMP-9 concentration and an increase in TIMP-1 activity was also established.
Conclusions. This study has confirmed the efficacy of magnesium drugs which have a pronounced effect on collagen degradation processes and extracellular matrix, reduce the activity of MMP-9, increase the concentration of TIMP-1, thereby affecting the MMP/TIMP balance in patients with varicose veins of lower extremities.
- Pokrovskii AV, Gradusov EG, Bredikhin RA. Diagnostika i lechenie varikoznoi bolezni. Moscow, RF: RMAPO; 2013. 125 p. (in Russ.)
- Staffa R. Chronic venous insufficiency–epidemiology. Bratisl Lek Listy. 2002;103(4-5):166-68.
- Nebylitsyn IuS, Kondrat’eva VI. Experience of managing patients with primary varicosity. Nauka molodykh – Eruditio Juvenium. 2016;(3):52-66. (in Russ.)
- Kirienko AI, Bogachev VIu, Gavrilov SG, Zolotukhin IA, Golovanova OV, Zhuravleva OV, Briushkov AIu. Chronic diseases of lower extremity veins in industrial workers of Moscow (Results of the epidemiological survey). Angiologiia i Sosud Khirurgiia. 2004;10(1):77-85. (in Russ.)
- Seliverstov EI, Avak’iants IP, Nikishkov AS, Zolotukhin IA. Epidemiology of chronic venous disease. Flebologiia. 2016;10(1):35-43. doi: 10.17116/flebo201610135-42. (in Russ.)
- Fomina NV, Fomina MA. Assessment of communication activity of lysosomal cystein proteases in plasma and indicators of endothelial dysfunction in patients with diseases of lower limbs veins. Nauka molodykh –Eruditio Juvenium. 2014;(1):60-67. (in Russ.)
- Amălinei C, Căruntu ID, Giuşcă SE, Bălan RA. Matrix metalloproteinases involvement in pathologic conditions. Rom J Morphol Embryol. 2010;51(2):215-28.
- Gromova OA. Magnii i piridoksin: osnovy znanii. Moscow, RF: ProtoTip; 2006. 234 p. (in Russ.)
- Gromova OA, Kalacheva AG, Torshin IIu, Rudakov KV, Grustlivaia UE, Iudina NV, Egorova EIu, Limanova OA, Fedotova LE, Gracheva ON, Nikiforova NV, Satarina TE, Gogoleva IV, Grishina TR, Kuramshina DB, Novikova LB, Lisitsyna EIu, Kerimkulova NV, Vladimirova IS, Chekmareva MN, Lialiakina EV, Shalaeva LA, Taleporovskaia SIu, Siling TB, Prozorova NV, Semenov VA, Semenova OV, Nazarova NA, Galustian AN, Sardarian IS. Nedostatochnost’ magniia – dostovernyi faktor riska komorbidnykh sostoianii: rezul’taty krupnomasshtabnogo skrininga magnievogo statusa v regionakh Rossii. Farmateka. 2013;(6):115-29. (in Russ.)
- Pagès N, Gogly B, Godeau G, Igondjo-Tchen S, Maurois P, Durlach J, Bac P. Structural alterations of the vascular wall in magnesium-deficient mice. A possible role of gelatinases A (MMP-2) and B (MMP-9). Magnes Res. 2003 Mar;16(1):43-48.
390026, The Russian Federation,
Ryazan, Vyisokovoltnaya str., 9,
Ryazan State Medical University
named after Academician I.P. Pavlov,
Department of Cardiovascular,
Operative Surgery and Topographic Anatomy,
Tel. 7 951 101-21-23,
Kamaev Aleksey Andreevich
Kalinin Roman E., MD, Professor, Head of the Department of Cardiovascular, X-Ray Endovascular, Operative Surgery and Topographic Anatomy of Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
Suchkov Igor A., MD, Associate Professor, Professor of the Department of Cardiovascular, X-Ray Endovascular, Operative Surgery and Topographic Anatomy of Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
Pshennikov Alexander S., PhD, Associate Professor of the Department of Cardiovascular, X-Ray Endovascular, Operative Surgery and Topographic Anatomy of Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
Kamaev Aleksey À., Post-Graduate Student of the Department of Cardiovascular, X-Ray Endovascular, Operative Surgery and Topographic Anatomy of Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
Isakov Sergey À., MD, Professor of the Dermatovenereology Department of Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
Ryabkov Alexander N., MD, Associate Professor of the Department of Pharmacology with the Course of Pharmacy of the Faculty of Additional Professional Education of Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
A.N. VORONETSKY 1, A.E. DANOVICH 2
NEODYMIUM LASER IN TREATMENT OF CONGENITAL TRACHEOESOPHAGEAL FISTULA IN CHILDREN
Belarusian State Medical University 1,
6th Municipal Clinical Hospital 2, Minsk
The Republic of Belarus
Objective. To evaluate the efficiency of neodymium laser with an endoscopic support in the treatment of tracheoesophageal fistula in children.
Methods. Laser technology has been used in the treatment of 8 children with tracheoesophageal fistula (TEF) at the age of 1 month and 26 days to 7 years. One has used the medical multifunctional laser complex Multiline (Belarus), gastroscope «Olympus GIF-XP190N», bronchoscope «Olympus MAF TYPE GM». When performing esophagoscopy and bronchoscopy, the distal segment of the light guide was introduced in the fistula and at the contact impact of the neodymium laser with a wavelength of 1340 nm to the mucous membrane of the fistula with the exposure of 2-3 seconds at a radiation power of 15 watts, the tissues with obliteration of the fistulous duct were coagulated and evaporated.
Results. 8 children had the congenital TÅF; one child had the isolated TÅF, in 7 children it combined with the esophageal atresia. In all children with esophageal atresia, esophageo-esophageal anastomosis was applied with TEF uncoupling in the first or second day after birth. The cause for the TEF laser ablation was fistula recurrence in all of these 8 children. The therapeutic effect with closing the fistula entrance was achieved in 6 children with fistula entrance diameter no more than 3 mm. One child after laser TÅF ablation with fistula entrance diameter of 5 mm had recurrence and re-ablation was required. TÅF was not closed after five sessions of laser therapy in a child with a 4 mm fistula entrance.
Conclusions. Laser ablation of tracheoesophageal fistula can be applied in children when fistula entrance diameter is no more than 3.0 mm. The method is not traumatic and allows providing the physiological function of respiration without surgical intervention.
- Chepurnoy GI, Katsupeev VB, Chepurnoy MG, Leiga AV, Nosachev EA, Rozin BG, Vinnikov VV. Peculiarities of surgical treatment of tracheoesophageal fistula. Det Khirurgiia. 2014;18(4):54-55. (in Russ.)
- Prityko D. K voprosu o vnedrenii lazernoi terapii v pediatricheskuiu praktiku. Vrach. 2013;(8):83-84. (in Russ.)
- Tatur AA. Nonmalignant tracheoesophageal fistula:diagnosis, classification, treatment and prophylacxis. Med Novosti. 2016;(11) :16-20. (in Russ.)
- Roberts K, Karpelowsky J, Fitzgerald DA, Soundappan SS. Outcomes of oesophageal atresia and tracheo-oesophageal fistula repair. J Paediatr Child Health. 2016 Jul;52(7):694-98. doi: 10.1111/jpc.13211.
- Ashkraft KU, Kholder TM. Det Khirurgiia. S-Petersburg, RF: Pit-Tal; 1996. 384 p. (in Russ.)
- Zani A, Jamal L, Cobellis G, Wolinska JM, Fung S, Propst EJ, Chiu PP, Pierro A. Long-term outcomes following H-type tracheoesophageal fistula repair in infants. Pediatr Surg Int. 2017 Feb;33(2):187-90. doi: 10.1007/s00383-016-4012-0.
- Kavalchuk VI. Surgical treatment of esophageal atresia, prevention of postoperative complications. Khirurgiia Vostoch Evropa. 2015;(1):50-57. (in Russ.)
- Tröbs RB, Finke W, Bahr M, Roll C, Nissen M, Vahdad MR, Cernaianu G. Isolated tracheoesophageal fistula versus esophageal atresia – Early morbidity and short-term outcome. A single institution series. Int J Pediatr Otorhinolaryngol. 2017 Mar;94:104-11. doi: 10.1016/j.ijporl.2017.01.022. (in Russ.)
- Shah PS, Gera P, Gollow IJ, Rao SC. Does continuous positive airway pressure for extubation in congenital tracheoesophageal fistula increase the risk of anastomotic leak? A retrospective cohort study. J Paediatr Child Health. 2016 Jul;52(7):710-14. doi: 10.1111/jpc.13206.
220116, The Republic of Belarus,
Minsk, Dzerzhinsky Ave., 83,
Belarusian State Medical University,
Pediatric Surgery Department,
Tel. mobile: +375 029 32-902-32,
Voronetsky Alexandr N.
Voronetsky Alexandr N., PhD, Associate Professor of the Pediatric Surgery Department, Belarusian State Medical University, Minsk, Republic of Belarus.
Danovich Aleksandr E., Head of the Endoscopy Unit, 6th Municipal Clinical Hospital, Minsk, Republic of Belarus.
D.A. SHKURUPII, M.Î. HARKAVENKO, D.A. KHOLOD
OPHTHALMOLOGICAL COMPLICATIONS OF GENERAL ANESTHESIA
Ukrainian Medical Stomatological Academy, Poltava,
Objective. To determine the frequency and nature of ophthalmic disorders, depending on the use of general anesthesia means.
Methods. A prospective cohort non-interventional study was organized, in which 100 patients were included. A comparison was made of the nature of the disturbances of the visual organ, depending on the type of general anesthesia performed. Clinical examinations included standard perioperative monitoring, determination of the type and nature of pharmacological support for anesthesia, perioperative assessment of saturation, noninvasive blood pressure with determination of its systolic, diastolic and perfusion components, ophthalmologic examination, ocular tonometry, quality assessment of tear film, volume of basal secretion of tear, visual acuity, color sensation, peripheral and binocular vision.
Results. The incidence of disturbances of the visual organ and the visual analyzer after general anesthesia was 19% (n=19). Of them, 84.2% (n=16) of patients had several ophthalmic disorders. The relationship between changes in the arterial pressure figures and the frequency of ophthalmic disorders was established. At the same time, the development of ophthalmic disorders was mainly associated with a change in perfusion blood pressure (p = 0.02). The character of these changes depended on the use of a certain anesthetic. Thus, the drugs of the hypnotic group (thiopental sodium, propofol) reduced the ophthalmotonus, tear secretion, tear film resistance, visual acuity. These effects were more pronounced in thiopental sodium. Also, the ability of ketamine to increase the ophthalmotonus, to cause lacrimation and to disturb visual perception due to disorder of peripheral and binocular vision was proved. Ophthalmic disorders resulted from the use of sedatives (diazepam) and narcotic analgesics (fentanyl) were not proven.
Conclusions. Disturbances of the visual organ and visual analyzer after general anesthesia are transient and account for 19%, of which 84.2% of cases are combined ophthalmic disorders. Their occurrence depends on the arterial pressure figures and the pharmacological effect of the anesthetics used.
- Berg KT, Harrison AR, Lee MS. Perioperative visual loss in ocular and nonocular surgery. Clin Ophthalmol. 2010 Jun 24;4:531-46.
- Marcucci C, Cohen NA, Metro DG, Kirsch JR, editors. Avoiding Common Anesthesia Errors. Philadelphia PA, USA: Lippincott Williams & Wilkins; 2008. 1030 p.
- Anson J. Perioperative Corneal Abrasions: Etiology, Prevention, and Management [Electronic resource]. Available from: http://www.psanes.org/Anesthesiologists/ClinicalResources/ClinicalUpdates/tabid/94/anid/29/Default.aspx.
- Kocatürk ö, Kocatürk T, Kaan N, Dayanir V. The comparison of four different methods of perioperative eye protection under general anesthesia in prone position. J Clin Anal Med. 2012;3(2):163-65. doi: 10.4328/JCAM.607.
- Nair PN, White E. Care of the eye during anaesthesia and intensive care. Anaesth Intens Care. 2014 Jan;15(Is1):40-43. doi: 10.1016/j.mpaic.2013.11.008.
- Zheng K, Guta CG, Kulkarni V, Brock-Utne J. Prevention of corneal abrasions in patients with autoimmune dry eyes. Anesth Analg. 2009 Jan;108(1):385-86. doi: 10.1213/ane.0b013e31818c8fd7.
- Grixti A, Sadri M, Watts MT. Corneal protection during general anesthesia for nonocular surgery. Ocul Surf. 2013 Apr;11(2):109-18. doi: 10.1016/j.jtos.2012.10.003.
- White L. Section 5: Damage to the eye during general anaesthesia. Risks associated with your anaesthetic [Electronic resource]. London, UK: RCoA; 2017. 6 p. Available from: https://www.rcoa.ac.uk/system/files/05-DamageEye2017.pdf.
- Bansal S, Ansons A, Vishwanath M. Hypotension-induced blindness in haemodialysis patients. Clin Kidney J. 2014 Aug;7(4):387-90. doi: 10.1093/ckj/sfu036.
- Avetisov SE, Egorov EA, Moshetova LK, Neroev VV, Takhchidi KhP, red. Oftal’mologiia: nats ruk. Moscow, RF: GEOTAR-Media; 2013. 944 p. (in Russ.)
- Pontes KC de S, Borges APB, Eleotério RB, Ferreira PS, Duarte ÒS. Comparação da produção lacrimal em cães após indução anestésica com propofol e thiopental. Revista Ceres. 2010;57(6):757-61.
- Nair G, Kim M, Nagaoka T, Olson DE, Thulé PM, Pardue MT, Duong TQ. Effects of common anesthetics on eye movement and electroretinogram. Doc Ophthalmol. 2011 Jun;122(3):163-76. doi: 10.1007/s10633-011-9271-4.
- Schmechtig A, Lees J, Perkins A, Altavilla A, Craig KJ, Dawson GR, William Deakin JF, Dourish CT, Evans LH, Koychev I, Weaver K, Smallman R, Walters J, Wilkinson LS, Morris R, Williams SC, Ettinger U. The effects of ketamine and risperidone on eye movement control in healthy volunteers. Transl Psychiatry. 2013 Dec 10;3:e334. doi: 10.1038/tp.2013.109.
- Bunch TJ, Tian B, Seeman JL, Gabelt BT, Lin TL, Kaufman PL. Effect of daily prolonged ketamine anesthesia on intraocular pressure in monkeys. Curr Eye Res. 2008 Nov;33(11):946-53. doi: 10.1080/02713680802447121.
Poltava, Shevchenko Str., 23,
Ukrainian Medical Stomatological Academy,
Department of Anesthesiology
with Intensive Therapy
Tel: +380 532 60-95-81,
Shkurupii Dmytro A.
Shkurupii Dmytro A., MD, Associate Professor of the Department of Anesthesiology with Intensive Therapy, Ukrainian Medical Stomatological Academy, Poltava, Ukraine.
Harkavenko Maxim A., Applicant for Master’s Degree of the Department of Anesthesiology with Intensive Therapy, Ukrainian Medical Stomatological Academy, Poltava, Ukraine.
Kholod Dmytro A., Post-Graduate Student of the Department of Anesthesiology with Intensive Therapy, Ukrainian Medical Stomatological Academy, Poltava, Ukraine.
M.Y. GAIN, S.V. SHAKHRAI, Y.M. GAIN, D.V. KUDRYTSKI
LASER LIPOLYSIS: MECHANISMS, MODERN POSSIBILITIES AND USE PROSPECTS IN SURGERY
Belarusian Medical Academy of Post-Graduate Education, Minsk,
The Republic of Belarus
Objective. To estimate the prospects of surgical technologies of adipose tissue laser destruction by the analysis of literary data about the mechanisms, technical potential and areas of practical application.
Methods. Using the literature data, the comparative analysis of the main fields of application, mechanisms and efficiency of the modern laser lipolysis technologies was performed. The database of medical and biological publications PubMed (section «biotechnology» of National medical library of the USA) through NCBI-Entrez access was used. The analysis of more than 300 sources of medical literature was carried out.
Results. Laser lipolysis is the complex of surgical technologies aimed at thermal destruction of adipose tissue by laser radiation. Along the thermal destruction of adipocytes, use of the laser radiation of certain parameters effects collagen, promoting adipose cells destruction and skin lifting.
Diode laser lipolysis by the wavelength of 980 nanometers is characterized by less destructive action on the tissues and shorter rehabilitation period than traditional methods of liposuction. At present there are researches based on using the laser radiation of several sources of different power with various combinations of wavelength.
According to literature, the most widespread laser technologies of adipose tissue destruction are used for adipose tissue elimination by plastic and esthetic surgery, minimally-invasive excision of adipose tissue tumors (lipomas), and also for treatment of gynecomastia, hyperhidrosis, osmidrosis, cellulitis and some other conditions.
Conclusions. The literature analysis shows that numerous descriptions of laser lipolysis methods contain various, sometimes contradictory data on technology, efficiency, safety for a patient. Interest in this field is due to relevance of minimally-invasive technologies for correction of the most widespread surgical diseases in out-patient and short-term stays conditions.
- Apfelberg DB, Rosenthal S, Hunstad JP, Achauer B, Fodor PB. Progress report on multicenter study of laser-assisted liposuction. Aesthetic Plast Surg. 1994 Summer;18(3):259-64.
- Abdelaal MM, Aboelatta YA. Comparison of Blood Loss in Laser Lipolysis vs Traditional Liposuction. Aesthet Surg J. 2014 Aug;34(6):907-12. doi: 10.1177/1090820X14536904.
- Prado A, Andrades P, Danilla S, Leniz P, Castillo P, Gaete F. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg. 2006 Sep 15;118(4):1032-45. doi: 10.1097/01.prs.0000232428.37926.48.
- Leclère FM, Moreno-Moraga J, Mordon S, Servell P, Unglaub F, Kolb F, Rimareix F, Trelles MA. Laser-assisted lipolysis for cankle remodelling: a prospective study in 30 patients. Lasers Med Sci. 2014 Jan;29(1):131-36. doi: 10.1007/s10103-013-1279-4.
- Badin AZ, Gondek LB, Garcia MJ, Do Valle LCh, Flizikowski FB, De Noronha L. Analysis of laser lipolysis effects on human tissue samples obtained from liposuction. Aesthetic Plast Surg. 2005 Aug;29( Is 4):281-86. doi: 10.1007/s00266-004-0102-9.
- Goldman A, Wollina U, de Mundstock EC. Evaluation of Tissue Tightening by the Subdermal Nd: YAG Laser-Assisted Liposuction Versus Liposuction Alone. J Cutan Aesthet Surg. 2011 May;4(2):122-28. doi: 10.4103/0974-2077.85035.
- Goldman A, Schavelzon D, Blugerman G. Laser lipolysis:liposuction using Nd:YAG laser. Revista da Sociedade Brasileira de Cirurgia Plástica. 2002;17:17-26.
- Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol. 1990 Mar;16(3):248-63.
- Mordon SR, Wassmer B, Reynaud JP, Zemmouri J. Mathematical modeling of laser lipolysis. Biomed Eng Online. 2008 Feb 29;7:10. doi: 10.1186/1475-925X-7-10.
- Woodhall KE, Saluja R, Khoury J, Goldman MP. A comparison of three separate clinical studies evaluating the safety and efficacy of laser-assisted lipolysis using 1,064, 1,320 nm, and a combined 1,064/1,320 nm multiplex device. Lasers Surg Med. 2009 Dec;41(10):774-78. doi: 10.1002/lsm.20859.
- Lim SD, Youn JI, Kim WS, Kim IH, Hwang TS, Han HS, Yeo UC. Comprehensive histologic analysis of interstitial lipolysis with the 1444 nm wavelength during a 3-month follow-up. Histol Histopathol. 2011 Nov;26(11):1375-82. doi: 10.14670/HH-26.1375.
- Sadick NS, Diktaban T, Smoller BR. New clinical outcomes utilizing a 1064-nm Nd:YAG laser for lipolysis of the torso oblique region. J Cosmet Laser Ther. 2010 Aug;12(4):170-75. doi: 10.3109/14764172.2010.502457.
- DiBernardo BE, Reyes J, Chen B. Evaluation of tissue thermal effects from 1064/1320-nm laser-assisted lipolysis and its clinical implications. J Cosmet Laser Ther. 2009 Jun;11(2):62-69. doi: 10.1016/j.asj.2009.08.06.
- Badin AZ, Moraes LM, Gondek L, Chiaratti MG, Canta L. Laser lipolysis: flaccidity under control. Aesthetic Plast Surg. 2002 Sep-Oct;26(5):335-39. doi: 10.1007/s00266-002-1510-3.
- Kim KH, Geronemus RG. Laser lipolysis using a novel 1,064 nm Nd:YAG Laser. Dermatol Surg. 2006 Feb;32(2):241-48; discussion 247.
- Mordon S, Eymard-Maurin AF, Wassmer B, Ringot J. Histologic evaluation of laser lipolysis: pulsed 1064-nm Nd:YAG laser versus cw 980-nm diode laser. Aesthet Surg J. 2007 May-Jun;27(3):263-68. doi: 10.1016/j.asj.2007.03.005.
- McBean JC, Katz BE. A pilot study of the efficacy of a 1,064 and 1,320 nm sequentially firing Nd:YAG laser device for lipolysis and skin tightening. Lasers Surg Med. 2009 Dec;41(10):779-84. doi: 10.1002/lsm.20858.
- Leclere FM, Alcolea JM, Vogt P, Moreno-Moraga J, Mordon S, Casoli V, Trelles MA. Laser-assisted lipolysis for arm contouring in Teimourian grades III and IV: A prospective study involving 22 patients. Plast Surg (Oakv). 2016; 24(1): 35-40. doi: 10.1007/s10103-014-1705-2.
- Goldman A. Submental Nd:Yag laser-assisted liposuction. Lasers Surg Med. 2006 Mar;38(3):181-84. doi: 10.1002/lsm.20270.
- Youn JI, Holcomb JD. Ablation efficiency and relative thermal confinement measurements using wavelengths 1,064, 1,320, and 1,444 nm for laser-assisted lipolysis. Lasers Med Sci. 2013 Feb;28(2):519-27. doi: 10.1007/s10103-012-1100-9.
- Licata G, Agostini T, Fanelli G, Grassetti L, Marcianò A, Rovatti PP, Pantaloni M, Zhang YX, Lazzeri D. Lipolysis using a new 1540-nm diode laser: a retrospective analysis of 230 consecutive procedures. J Cosmet Laser Ther. 2013 Aug;15(4):184-92. doi: 10.3109/14764172.2012.758382.
- Parlette EC, Kaminer ME. Laser-assisted liposuction: here’s the skinny. Semin Cutan Med Surg. 2008 Dec;27(4):259-63. doi: 10.1016/j.sder.2008.09.002. Review.
- Khoury JG, Saluja R, Keel D, Detwiler S, Goldman MP. Histologic evaluation of interstitial lipolysis comparing a 1064, 1320 and 2100 nm laser in an ex vivo model. Lasers Surg Med. 2008 Aug;40(6):402-6. doi: 10.1002/lsm.20649.
- Levi JR, Veerappan A, Chen B, Mirkov M, Sierra R, Spiegel JH. Histologic evaluation of laser lipolysis comparing continuous wave vs pulsed lasers in an in vivo pig model. Arch Facial Plast Surg. 2011 Jan-Feb;13(1):41-50. doi: 10.1001/archfacial.2010.103.
- Leclère FM, Trelles M, Moreno-Moraga J, Servell P, Unglaub F, Mordon SR. 980-nm laser lipolysis (LAL): about 674 procedures in 359 patients. J Cosmet Laser Ther. 2012 Apr;14(2):67-73. doi: 10.3109/14764172.2012.670704.
- Seckel BR, Doherty ST, Childs JJ, Smirnov MZ, Cohen RH, Altshuler GB. The role of laser tunnels in laser-assisted lipolysis. Lasers Surg Med. 2009 Dec;41(Is 10):728-37. doi: 10.1002/lsm.20867.
- Valizadeh N, Jalaly NY, Zarghampour M, Barikbin B, Haghighatkhah HR. Evaluation of safety and efficacy of 980-nm diode laser-assisted lipolysis versus traditional liposuction for submental rejuvenation: a randomized clinical trial. J Cosmet Laser Ther. 2016;18(1):41-45. doi: org/10.3109/14764172.2015.1039041.
- Saluja R. Dual-wavelength laser lipolysis treatment of lipomas: a case report. J Drugs Dermatol. 2010 Apr;9(4):387-88.
- Stebbins WG, Hanke CW, Petersen J. Novel method of minimally invasive removal of large lipoma after laser lipolysis with 980 nm diode laser. Dermatol Ther. 2011 Jan-Feb;24(1):125-30. doi: 10.1111/j.1529-8019.2010.01385.x.
- Trelles MA, Mordon SR, Bonanad E, Moreno Moraga J, Heckmann A, Unglaub F, Betrouni N, Leclère FM. Laser-assisted lipolysis in the treatment of gynecomastia: a prospective study in 28 patients. Lasers Med Sci. 2013 Feb;28(2):375-82. doi: 10.1007/s10103-011-1043-6.
- Rho YK, Kim BJ, Kim MN, Kang KS, Han HJ. Laser lipolysis with pulsed 1064 nm Nd:YAG laser for the treatment of gynecomastia. Int J Dermatol. 2009 Dec;48(12):1353-59. doi: 10.1111/j.1365-4632.2009.04231.x.
- Lee SG, Ryu HJ, Kim IH. Minimally invasive surgery for axillary osmidrosis using a combination of subcutaneous tissue removal and a 1,444-nm Nd:YAG Laser. Ann Dermatol. 2014 Dec; 26(6): 755-57. Published online 2014 Nov 26. doi: 10.5021/ad.2014.26.6.755.
- Mordon SR, Trelles MA, Leclere FM, Betrouni N. New treatment techniques for axillary hyperhidrosis. J Cosmet Laser Ther. 2014 Oct;16(5):230-35. doi: 10.3109/14764172.2014.948883.
- Goldman A, Gotkin RH, Sarnoff DS, Prati C, Rossato F. Cellulite: a new treatment approach combining subdermal Nd:YAG laser lipolysis and autologous fat transplantation. Aesthet Surg J. 2008 Nov-Dec;28(6):656-62. doi: 10.1016/j.asj.2008.09.002.
220013, The Republic of Belarus,
Minsk, P.Brovka Str., 3,
Belarusian Medical Academy
of Post-Graduate Education,
Emergent Surgery Department,
Tel. office: +375 17-225-88-10,
Gain Mikhail Y.
Gain Mikhail Y., PhD, Senior Lecturer of the Emergent Surgery Department, Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus.
Shakhrai Siarhei V., MD, Associate Professor, Professor of the Emergent Surgery Department, Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus.
Gain Yuri M., MD, Professor, Vice-Rector for Scientific Work, Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus.
Kudrytski Dzmitry V., Post-Graduate Student of the Emergent Surgery Department, Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus.
V.A. LIPATOV 1, S.V. LAZARENKO 1, K.A. SOTNIKOV 2, D.A. SEVERINOV1, M.P. ERSHOV1
TO THE ISSUE OF METHODOLOGY OF COMPARATIVE STUDY OF THE DEGREE OF HEMOSTATIC ACTIVITY OF TOPICAL HEMOSTATIC AGENTS
Kursk State Medical University 1, Kursk,
City Clinical Hospital ¹1 2, Belgorod,
The Russian Federation
At present new drugs affecting the hemostasis system and locally affecting hemostatic agents are being intensively developed. New types of the developed substances require highly objective and precise comparative methods for efficiency measuring. However, despite the current situation, the choice of methods for assessing the hemostatic activity of drugs and hemostatic implants (both in clinical practice and in experiment) remains open. In this regard, the authors have analyzed most common modern methods, combinations of the evaluated hemostasis indicators and methods for studying hemostatic activity of drugs and implants (in vitro and in vivo); the advantages and disadvantages of these methods are described and their most effective combinations are proposed. The authors propose the algorithm for the selection of hemostatic agents developed for the purpose of their application in surgical interventions primarily on the parenchymal organs of the abdominal cavity. The algorithm is based on the phasing of using various techniques (I step - a screening study of physic-mechanical and hemostatic properties in vitro implant procedures, II step – the method of «acute» experience in vivo for determining bleeding time and blood loss volume, III step – the method of «chronic» experiment in vivo (investigation of expression of the animal tissue response to the implant after subcutaneous implantation and a simulated parenchymal injury of organs and so forth.), permitting to study comprehensively the hemostatic ability of the topical hemostatic implants and to avoid possible negative effects when they are used.
- Makhovsky VV. State of the problem and ways to optimize organ- preserving surgery tactics in spleen. Vopr Rekonstrukt i Plast Khirurgii. 2014;17(3):42-55. (in Russ.)
- Zhavoronok IS, Kondratenko GG, Gapanovich VN, Esepkin AV, Karman AD. The arrest of bleeding from the liver parenchyma by using an inorganic hemostatic agents. Novosti Khirurgii. 2016;24(4):361-67. doi: 10.18484/2305-0047.2016.4.361.(in Russ.)
- Kobelevskaia NV. Sovremennye aspekty lekarstvennoi gemostaticheskoi terapii. Vestn Poslediplom Med Obrazovaniia. 2014;(3):5-9. (in Russ.)
- Cherednikov EF, Kashurnikova MA, Romantsov MN, Barannikov SV, Bolkhovitinov AE, Gaponenkov DG, Liubimov P.Iu. Eksperimental’noe izuchenie novykh sredstv mestnogo gemostaza v lechenii iazvennykh krovotechenii. Nauch-Med Vestn Tsentral Chernozem’ia. 2016;(65):27-33. (in Russ.)
- Neshina EI, Skvortsova RG, Kuz’menko VV. Sistema gemostaza (voprosy i otvety). 2-e izd. Irkutsk, RF: RIO IGIUVa; 2011. 48 p..(in Russ.)
- Schick KS, Fertmann JM, Jauch KW, Hoffmann JN. Prothrombin complex concentrate in surgical patients: retrospective evaluation of vitamin K antagonist reversal and treatment of severe bleeding. Crit Care. 2009;13(6):R191. doi: 10.1186/cc8186.
- Samudrala S. Topical hemostatic agents in surgery: a surgeon’s perspective. AORN J. 2008 Sep;88(3):S2-11. doi: 10.1016/S0001-2092(08)00586-3.
- Bechstein WO, Strey C. Local and systemic hemostasis in surgery. Chirurg. 2007 Feb;78(2):95-6, 98-100. [Article in German]
- Masci E, Santoleri L, Belloni F, Bottero L, Stefanini P, Faillace G, Gianbattista B, Montinaro C, Mancini L, Longoni M. Topical hemostatic agents in surgical practice. Transfus Apher Sci. 2011 Dec;45( Is 3):305-11. doi: 10.1016/j.transci.2011.10.013
- Recinos G, Inaba K, Dubose J, Demetriades D, Rhee P. Local and systemic hemostatics in trauma: a review. Ulus Travma Acil Cerrahi Derg. 2008 Jul;14(3):175-81.
- Takács I, Wegmann J, Horváth S, Ferencz A, Ferencz S, Jávor S, Odermatt E, Roth E, Weber G. Efficacy of different hemostatic devices for severe liver bleeding: a randomized controlled animal study. Surg Innov. 2010 Dec;17(4):346-52. doi: 10.1177/1553350610384405.
- Lang H, Mouracade P, Gimel P, Bernhard JC, Pignot G, Zini L, Crepel M, Rigaud J, Salomon L, Bellec L, Vaessen C, Roupret M, Jung JL, Mourey E, Martin X, Bigot P, Bruyère F, Berger J, Ansieau JP, Salome F, Hubert J, Pfister C, Trifard F, Gigante M, Baumert H, Méjean A, Patard JJ. National prospective study on the use of local haemostatic agents during partial nephrectomy. BJU Int. 2014 May;113(5b):E56-61. doi: 10.1111/bju.12397.
- Darlington A, Ferreiro JL, Ueno M, Suzuki Y, Desai B, Capranzano P, Capodanno D, Tello-Montoliu A, Bass TA, Nahman NS, Angiolillo DJ. Haemostatic profiles assessed by thromboelastography in patients with end-stage renal disease. Thromb Haemost. 2011 Jul;106(1):67-74. doi: 10.1160/TH10-12-0785.
- Lawson JH, Michael PM. Challenges for providing effective hemostasis in surgery and trauma. Semin Hematol. 2004 Jan;41(1):55-64. doi: 10.1053/j.seminhematol.2003.11.012.
- Seegers WH, ed. Blood clotting enzymology. 1th ed. US: Academic Press; 2013. 628 p.
- Israelyan LA, Lubnin AYu, Gromova VV, Imayev AA, Shmigelsky AV, Stepanenko AYu. Thromboelastography as a method for preoperative screening for the hemostatic system in neurosurgical patients. Anesteziologiia i Reanimatologiia. 2009;(3):24-30. (in Russ.)
- Netiaga AA, Maistrenko AN, Bezhin AI, Lipatov VA, Chizhikov GM, Semenikhina LV, Gomon MS, Bobrovskaia EA. Sposob sravnitel’noi otsenki gemostaticheskikh svoistv khirurgicheskikh materialov. Patent Ros Federatsii ¹ 2373532. 20.11.09. (in Russ.)
- Chizhikov GM, Bezhin AI, Ivanov AV, Maystrenko AN, Lipatov VA, Netyaga AA, Zhukovsky VA. Experimental study of new drugs of local hemostasis in surgery of liver and spleen. Kursk Nauch-Prakt Vestn “Chelovek i ego Zdorov’e”. 2011;(1):19-25.(in Russ.)
- Tarkova AR, Chernyavskiy AM, Morozov SV, Grigor’ev IA, Tkacheva NI, Rodionov VI. Local hemostatic agent based on oxidized cellulose. Sib Nauch Med Zhurn. 2015;35(2):11-15. (in Russ.)
- Abzaeva KA, Zelenkov LE. Modern topical hemostatic agents and unique representatives of their new generation. Izv Akad Nauk. 2015;(6):1233-39. (in Russ.)
- Shi X, Fang Q, Ding M, Wu J, Ye F, Lv Z, Jin J. Microspheres of carboxymethyl chitosan, sodium alginate and collagen for a novel hemostatic in vitro study. J Biomater Appl. 2016 Feb; 30 (7):1092-102. doi: 10.1177/0885328215618354.
- Tiutrin II, Parshin AN, Pchelintsev OIu. Sposob otsenki funktsional’nogo sostoianiia sistemy gemostaza. Patent Ros Federatsii ¹ 5062553/14. 06.27.1996. (in Russ.)
- Grinevich TN, Naumov AV, Lelevich SV. Rotary thromboelastometry (ROTEM). Zhurn GrGMU. 2010;(1):7-9. (in Russ.)
- Grinevich TN. Rotation thromboelastometry Rotem as a new perspective method of the hemostasis system evaluation in patients of the traumatological profile. Novosti Khirurgii. 2010;18(2):115-22. (in Russ.)
- Vardanian AV, Roitman EV, Mumladze RB, Markov IN, Malishava NV. Diagnostika narushenii gemostaza dlia prognozirovaniia i profilaktiki venoznykh tromboembolicheskikh oslozhnenii. Biul Nauchn Tsentra Serdech-Sosud Khirurgii im AN Bakuleva RAMN. Serdech-Sosud Zabolevaniia. 2007;8(2):5-13. (in Russ.)
- Kheirabadi BS, Sieber J, Bukhari T, Rudnicka K, Murcin LA, Tuthill D. High-pressure fibrin sealant foam: an effective hemostatic agent for treating severe parenchymal hemorrhage. J Surg Res. 2008 Jan;144(1):145-50. doi: 10.1016/j.jss.2007.02.012.
- Mezhneva VV, Samsonova NN, Pliushch MG, Kostava VT. Eksperimental’nye issledovaniia gemostaticheskoi aktivnosti zhidkikh krovoostanavlivaiushchikh sredstv. Biul Nauchn Tsentra Serdech-Sosud Khirurgii im AN Bakuleva RAMN. Serdech-Sosud Zabolevaniia. 2007;8(2):71-75. (in Russ.)
- Adamian AA, Gliantsev SP, Kashperskii IuP, Makarov VA, Timin EN. Sposob vyiavleniia i sravnitel’noi otsenki gemostaticheskoi aktivnosti krovoostanavlivaiushchikh matrichnykh preparatov mestnogo deistviia. Patent Ros Federatsii ¹ 2127428. 03.10.1999. (in Russ.)
- Kim SH, Yoon HS, In CH, Kim KS. Efficacy evaluation of SurgiGuard® in partially hepatectomized pigs. Korean J Hepatobiliary Pancreat Surg. 2016 Aug;20(3):102-9. doi: 10.14701/kjhbps.2016.20.3.102.
- Baker-Groberg SM, Phillips KG, McCarty OJ. Quantification of volume, mass, and density of thrombus formation using brightfield and differential interference contrast microscopy. J Biomed Opt. 2013 Jan;18(1):16014. doi: 10.1117/1.JBO.18.1.016014.
- öllinger R, Mihaljevic AL, Schuhmacher C, Bektas H, Vondran F, Kleine M, Sainz-Barriga M, Weiss S, Knebel P, Pratschke J, Troisi RI. A multicentre, randomized clinical trial comparing the Veriset™ haemostatic patch with fibrin sealant for the management of bleeding during hepatic surgery. HPB (Oxford). 2013 Jul;15(7):548-58. doi: 10.1111/hpb.12009.
- Safronova EIu, Niushko KM, Alekseev BIa, Kalpinskii AS, Poliakov VA, Kaprin AD. Sposoby osushchestvleniia gemostaza pri vypolnenii rezektsii pochki. Research’n Practical Medicine Journal. 2016;3(1):58-65. doi: 10.17709/2409-2231-2016-3-1-8. (in Russ.)
- Gerasimov DA, Novikova NV, Lipatov VA, Tel’nov AN. Eksperimental’naia otsenka dinamiki i stepeni biodegradatsii novykh obraztsov krovoostanavlivaiushchikh implantatov na osnove karboksimetiltselliulozy. Zabaikal Med Vestn. 2016;(1):81-85. (in Russ.)
- Matonick JP, Hammond J. Hemostatic efficacy of EVARREST™, Fibrin Sealant Patch vs. TachoSil® in a heparinized swine spleen incision model. J Invest Surg. 2014 Dec; 27 (6):360-65. doi: 10.3109/08941939.2014.941444.
- Konstantinova YE, Abrosimova NV, Sotnikov KA, Lipatov VA. The indices of haemostatic activity of applicative hemostatic sponges made on the base of carboxymethylcellulose. Zdorov’e i Obrazovanie v XXI veke. 2016;18(1): 142-44. (in Russ.)
- Charlesworth TM, Agthe P, Moores A, Anderson DM. The use of haemostatic gelatin sponges in veterinary surgery. J Small Anim Pract. 2012 Jan; 53(1):51-56. doi: 10.1111/j.1748-5827.2011.01162.x.
- Gorskii VA, Faller AP, Ovanesian ER, Andreitsev IL, Belous GG, Sukhodulov AM. Gemostaticheskie vozmozhnosti preparata «TakhoKomb». Al’m Klin Meditsiny. 1999;(2):129-34. (in Russ.)
- Zacharoulis D, Lazoura O, Sioka E, Tzovaras G, Rountas C, Spiropoulos S, Zahari E, Chatzitheofilou C. Radiofrequency-assisted hemostasis in a trauma model: a new indication for a bipolar device. J Laparoendosc Adv Surg Tech A. 2010 Jun;20(5):421-6. doi: 10.1089/lap.2009.0324.
- Simo KA, Hanna EM, Imagawa DK, Iannitti DA. Hemostatic Agents in Hepatobiliary and Pancreas Surgery: A Review of the Literature and Critical Evaluation of a Novel Carrier-Bound Fibrin Sealant (TachoSil). ISRN Surg. 2012;2012: 729086. doi: 10.5402/2012/729086.
- Belozerskaya GG, Makarov VA, Aboyants RK, Malykhina LS. Applicator means hemostasis in capillary-parenchymalhemorrhage. Khirurgiia Zhurn im NI Pirogova. 2004;(9):55-59. (in Russ.)
- Polidoro DP, Kass PH. Evaluation of a gelatin matrix as a topical hemostatic agent for hepatic bleeding in the dog. J Am Anim Hosp Assoc. 2013 Sep-Oct;49(5):308-17. doi: 10.5326/JAAHA-MS-5927.
- Kudlo VV, Kiselevskii IuM. Izmeneniia pokazatelei biokhimicheskogo analiza krovi pri zakrytii rany pecheni sal’nikom, TakhoKombom i Ftoroplastom-4 v eksperimente. Zhurn GrGMU. 2016;(2):50-54. (in Russ.)
- Malkov IS, Korobkov VN, Filippov VA. Khirurgicheskaia taktika pri travmakh selezenki. Educatio. 2015;(6):127-30. (in Russ.)
- Petlakh VI. Rol’ mestnykh gemostatikov pri okazanii khirurgicheskoi pomoshchi bol’nym i porazhennym. Gl Vrach Iuga Rossii. 2014;(5):12-13. (in Russ.)
- Dutton RP. Haemostatic resuscitation. Br J Anaesth. 2012;109 (Suppl_1):i39-i46. doi: 10.1093/bja/aes389.
- Qiu Y, Zhu YY, Yan YJ, Chen N, Chen ZL. Study on preparation of fibrinogen-loaded poly (L-lactic) acid nano-fabrics and its haemostatic performance in swine traumatic haemorrhage models. Blood Coagul Fibrin. 2014 Jul;25(5):486-91. doi: 10.1097/MBC.0000000000000090.
- Pusateri AE, Modrow HE, Harris RA, Holcomb JB, Hess JR, Mosebar RH, Reid TJ, Nelson JH, Goodwin CW Jr, Fitzpatrick GM, McManus AT, Zolock DT, Sondeen JL, Cornum RL, Martinez RS. Advanced hemostatic dressing development program: animal model selection criteria and results of a study of nine hemostatic dressings in a model of severe large venous hemorrhage and hepatic injury in Swine. J Trauma. 2003 Sep;55(3):518-26.
- Siemer S, Lahme S, Altziebler S, Machtens S, Strohmaier W, Wechsel HW, Goebell P, Schmeller N, Oberneder R, Stolzenburg JU, Becker H, Lüftenegger W, Tetens V, Van Poppel H. Efficacy and safety of TachoSil as haemostatic treatment versus standard suturing in kidney tumour resection: a randomised prospective study. Eur Urol. 2007 Oct;52(4):1156-63.
- Andreev AI, Ibragimov RA, Kuznetsov MV, Fatykhov AM, Anisimov AYu. Clinical experience of using «Haemoblock» hemostatic solution in surgical practice. Kazan Med Zhurn. 2015;96(3):451-55. doi: 10.17750/KMJ2015-451. (in Russ.)
- Maslyakov VV, Yermilov PV, Polaykov AV. Kinds of operations on the spleen at its trauma. Uspekhi Sovrem Estestvoznaniia. 2012;(7):29-35. (in Russ.)
305004, The Russian Federation,
Kursk, Karl Marks Str., 3,
Kursk State Medical University,
Department of Operative Surgery
and Topographic Anatomy
Tel. mobile: +7 903 870-89-83,
Lipatov Viacheslav A.
Lipatov Viacheslav A., MD, Ass. Professor, Professor of the Department of Operative Surgery and Topographic Anatomy, Kursk State Medical University, Kursk, Russian Federation.
Lazarenko Sergej V., PhD, Assistant of the Oncology Department, Kursk State Medical University, Kursk, Russian Federation.
Sotnikov Konstantin A., Head of the Cabinet of Accounting and Medical Statistics, Radiologist, City Clinical Hospital ¹1, Kursk, Russian Federation.
Severinov Dmitriy A., Student, Kursk State Medical University, Kursk, Russian Federation.
Ershov Mixail P., Student, Kursk State Medical University, Kursk, Russian Federation.
E.N. DEGOVTSOV 1, P.V. KOLYADKO 2
SEROMAS AS A COMPLICATION OF SURGICAL TREATMENT OF INCISIONAL HERNIAS OF ANTERIOR ABDOMINAL WALL USING MESH IMPLANTS: CURRENT STATE OF THE PROBLEM
Omsk State Medical University of the Ministry of Health of Russia 1,
Nizhnevartovsk District Clinical Hospital, Nizhnevartovsk 2
The Russian Federation
The purpose of this review was to analyze the current literature about seromas after large incisional hernia repair with mesh implants. This complication may develop after different plasty methods of the anterior abdominal wall, but its incidence grows with the increase of volume of surgical intervention, which is typical for large and complex incisional hernias of the anterior abdominal wall. Their plasty is accompanied by the release of subcutaneous fat of the flap over a large area and installation of a mesh implant. The residual cavity resulting from the wide separation is formed, which is gradually filled with serous fluid, becoming seromas. The formation of seroma of postoperative wounds leads to the increased incidence of infectious complications, which in turn leads to the increase in the length of stay in hospital, and increases the economic burden of a hospital. This review considers terminological definitions, the main causes leading to the development of seromas, the specific pathogenetic and classification aspects of this complications and various current practical pre-, intra -, and postoperative methods of this complication prophylaxis.
- Janis JE, Khansa L, Khansa I. Strategies for postoperative seroma prevention: a systematic review. Plast Reconstr Surg. 2016 Jul;138(1):240-52. doi: 10.1097/PRS.0000000000002245.
- Golovin RV, Nikitin NA, Prokopev ES. Prognosis of development of complications of injuries after com-bined allohernia plastic interventions for postoperative ventral hernias of median localisation. Sovr Problemy Nauki i Obrazovaniia. 2014;(2):379. (in Russ.)
- Mikhin IV, Kukhtenko IuV, Panchishkin AS. Large and giant postoperative ventral hernias: possibilities of surgical treatment (literature review). Vestn Volgogr Gos Med Un-ta. 2014;(2):8-16. (in Russ.)
- Timerbulatov MV, Timerbulatov ShV, Gataullina EZ, Valitova ER. Postoperative ventral hernias: current state of the problem. Med Vestn Bashkortostana. 2013;8(5):101-7. (in Russ.)
- Plymale MA, Harris JW, Davenport DL, Smith N, Levy S, Scott Roth J. Abdominal Wall Reconstruction: the uncertainty of the impact of drain duration upon outcomes. Am Surg. 2016 Mar;82(3):207-11.
- Vlasov AV, Kukosh MV. Problema ranevykh oslozhnenii pri endoprotezirovanii briushnoi stenki po povodu ventral’nykh gryzh. Sovrem Tekhnologii v Meditsine. 2013;5(2):116-24. (in Russ.)
- Sforza M, Husein R, Andjelkov K, Rozental-Fernandes PC, Zaccheddu R, Jovanovic M. Use of quilting sutures during abdominoplasty to prevent seroma formation: are they really effective? Aesthet Surg J. 2015 Jul;35(5):574-80. doi: 10.1093/asj/sju103.
- Pilone V, Vitiello A, Borriello C, Gargiulo S, Forestieri P. The use of a fibrin glue with a low concentration of thrombin decreases seroma formation in postbariatric patients undergoing circular abdominoplasty. Obes Surg. 2015 Feb;25(2):354-59. doi: 10.1007/s11695-014-1467-8.
- Aidemirov AN, Vafin AZ, Chemianov GS, Mnatsakanian EG, Laipanov RM, Chumakov PI. Novye tekhnologii v diagnostike i lechenii bol’shikh i gigantskikh ventral’nykh gryzh. Med Vestn Sev Kavkaza. 2012;25(1):38-42. (in Russ.)
- Charyshkin AL, Frolov AA. Gernioplasty problems at patients with postoperative ventral hernias. Ul’ian Med-Biol Zhurn. 2015;(2):40-47. (in Russ.)
- Klink CD, Binnebösel M, Lucas AH, Schachtrupp A, Grommes J, Conze J, Klinge U, Neumann U, Junge K Serum analyses for protein, albumin and IL-1-RA serve as reliable predictors for seroma formation after incisional hernia repair. Hernia. 2011 Feb;15(1):69-73. doi: 10.1007/s10029-010-0746-0.
- Swanson E. Seroma prevention in abdominoplasty: eliminating the cause. Aesthet Surg J. 2016;36(1):NP23-NP24. doi: 10.1093/asj/sjv121.
- Di Martino M, Nahas FX, Kimura AK, Sallum N, Ferreira LM. Natural evolution of seroma in abdominoplasty. Plast Reconstr Surg. 2015 Apr;135(4):691e-98e. doi: 10.1097/PRS.0000000000001122.
- Shcherbatykh AV, Sokolova SV, Shevchenko KV. Sravnenie effektivnosti razlichnykh sposobov khirurgicheskogo lecheniia posleoperatsionnykh ventral’nykh gryzh. Vestn Ekperim i Klin Khirurgii. 2012;5(1):80-82. (in Russ.).
- Macias LH, Kwon E, Gould DJ, Spring MA, Stevens WG. Decrease in Seroma Rate After Adopting Progressive Tension Sutures Without Drains: A Single Surgery Center Experience of 451 Abdominoplasties Over 7 Years. Aesthet Surg J. 2016 Oct;36(9):1029-35. doi: 10.1093/asj/sjw040.
- Sanchez VM, Abi-Haidar YE, Itani KM. Mesh infection in ventral incisional hernia repair: incidence, contributing factors, and treatment. Surg Infect (Larchmt). 2011 Jun;12(3):205-10. doi: 10.1089/sur.2011.033.
- Belokonev VI, Ponomareva IuV, Pushkin SIu, Melent’eva ON, Guliaev MG. Potential predictors and morphological aspects of seroma development after plastic surgery of the anterior abdominal wall hernia. Novosti Khirurgii. 2014;22(6):665-70. doi: 10.18484/2305-0047.2014.6.665. (in Russ.)
- Postnikov DG, Pavlenko VV, Krasnov OA, Oorzhak OV, Egorova ON, Lesnikov SM. Problems of prophylaxis of wound complications at patients with postoperative ventral hernias. Meditsina i Obrazovanie v Sibiri. 2015;(3):73. (in Russ.)
- Westphalen AP, Araújo AC, Zacharias P, Rodrigues ES, Fracaro GB, Lopes Filho Gde J. Repair of large incisional hernias. To drain or not to drain. Randomized clinical trial. Acta Cir Bras. 2015 Dec;30(12):844-51. doi: 10.1590/S0102-865020150120000009.
- Morales-Conde S. A new classification for seroma after laparoscopic ventral hernia repair. Hernia. 2012 Jun;16(3):261-67. doi: 10.1007/s10029-012-0911-8.
- Sukovatykh BS, Ivanov AV, Valuiskaia NM, Gerasimchuk EV. The influence of late implantation fabric reaction on the choice of polypropylene endoprosthesis for preventive subaponeurotic plasty of the abdominal wall. Novosti Khirurgii. 2013;21(5):11-17. doi: 10.18484/2305-0047.2013.5.11(in Russ.).
- Bondarev RV, Chibisov AL, Orekhov AA, Chibisov LP. Profilaktika rannikh posleoperatsionnykh oslozhnenii pri gernioplastike posleoperatsionnykh ventral’nykh gryzh. Ukr Zhurn Khirurgii. 2012;(3):38-40. (in Russ.)
- Nockolds CL, Hodde JP, Rooney PS. Abdominal wall reconstruction with components separation and mesh reinforcement in complex hernia repair. BMC Surg. 2014 Apr 30;14:25. doi: 10.1186/1471-2482-14-25.
- Sonis AG, Grachev BD, Stolyarov EA, Ishutov IV. Prevention and treatment of infection wound complications at prosthetic hernia repair. Rany i Ranevaia Infektsiia. 2014;(2):16-22. (in Russ.)
- Vlasov AV. The prediction of the probability of seroma development in case of endoprosthesis replacement of ventral hernias. Sovrem Problemy Nauki i Obrazovaniia. 2013;(2):11. (in Russ.)
- Patti R, Caruso AM, Aiello P, Angelo GL, Buscemi S, Di Vita G. Acute inflammatory response in the subcutaneous versus periprosthethic space after incisional hernia repair: an original article. BMC Surg. 2014 Nov 15;14:91. doi: 10.1186/1471-2482-14-91.
- Kolpakov AA, Kazantsev AA. Sravnitel’nyi analiz rezul’tatov primeneniia protezov «titanovyi shelk» i polipropilena u bol’nykh s posleoperatsionnymi ventral’nymi gryzhami. RMZh. 2015;23(13):774-75. (in Russ.)
- Parshikov VV, Fedaev AA. Proteziruiushchaia plastika briushnoi stenki v lechenii ventral’nykh i posleoperatsionnykh gryzh: klassifikatsiia, terminologiia i tekhnicheskie aspekty (obzor). STM. 2015;7(2):138-52. doi: 10.17691/stm2015.7.2.19. (in Russ.)
- Plechev VV, Kornilaev PG, Feoktistov DV, Shavaleev RR, Khakamov TSh. Eksperimental’naia otsenka effektivnosti sposoba profilaktiki ranevykh oslozhnenii pri implantatsionnoi gernioplastike. Med Vestn Bashkortostana. 2013;8(6):171-73. (in Russ.)
- Lee YJ, Kim HY, Han HH, Moon SH, Byeon JH, Rhie JW, Ahn ST, Oh DY. Comparison of dissection with harmonic scalpel and conventional bipolar electrocautery in deep inferior epigastric perforator flap surgery: a consecutive cohort study. J Plast Reconstr Aesthetic Surg. 2017 Feb;70(2):222-28. doi: 10.1016/j.bjps.2016.11.005.
- Kukosh MV, Vlasov AV, Gomozov GI. Prevention of early postoperative complications at endoprosthesis of ventral hernias. Novosti Khirurgii. 2012;20(5):32-37. (in Russ.)
- Skillman JM, Venus MR, Nightingale P, Titley OG, Park A. Ligating perforators in abdominoplasty reduces the risk of seroma. Aesthetic Plast Surg. 2014 Apr;38(2):446-50. doi: 10.1007/s00266-013-0267-1.
- Nasr MW, Jabbour SF, Mhawej RI, Elkhoury JS, Sleilati FH. Effect of tissue adhesives on seroma incidence after abdominoplasty: a systematic review and meta-analysis. Aesthet Surg J. 2016 Apr;36(4):450-58. doi: 10.1093/asj/sjv276.
- Bercial ME, Sabino Neto M, Calil JA, Rossetto LA, Ferreira LM. Suction drains, quilting sutures, and fibrin sealant in the prevention of seroma formation in abdominoplasty: which is the best strategy? Aesthetic Plast Surg. 2012 Apr;36(2):370-73. doi: 10.1007/s00266-011-9807-8.
- Mukhtarov ZM, Malkov IS, Alishev OT. Prevention of wound postoperative complications in patients with postoperative ventral hernia. Prakt Meditsina. 2014;(5):106-9. (in Russ.)
- Postnikov DG, Pavlenko VV, Oorzhak OV, Lesnikov SM, Krasnov OA, Egorova ON, Salimov VR. Sravnitel’nyi analiz rezul’tatov profilaktiki ranevykh oslozhnenii pri gernioplastike posleoperatsionnykh gryzh. Meditsina i Obrazovanie v Sibiri. 2014;(6):55. (in Russ.)
- Dietz UA, Winkler MS, Härtel RW, Fleischhacker A, Wiegering A, Isbert C, Jurowich CH, Henschmann P, Germer CT. Importance of recurrence rating, morphology, hernial gap size, and risk factors in ventral and incisional hernia classification. Hernia. 2014 Feb;18(1):19-30. doi: 10.1007/s10029-012-0999-x.
- Kosins AM, Scholz T, Cetinkaya M, Evans GR. Evidence-based value of subcutaneous surgical wound drainage: the largest systematic review and meta-analysis. Plast Reconstr Surg. 2013 Aug;132(2):443-50. doi: 10.1097/PRS.0b013e3182958945.
- Gurusamy KS, Allen VB. Wound drains after incisional hernia repair. Cochrane Database Syst Rev. 2013 Dec 17;(12):CD005570. doi: 10.1002/14651858.CD005570.pub4.
644112, The Russian Federation,
Omsk, Perelet Str., 9,
Municipal Clinical Emergency Hospital N 1,
Department of Hospital Surgery,
Tel. office: +8 3812 75-32-72,
mobile.: +7 913 971-32-73;
Degovtsov Evgeny N.
Degovtsov Evgeny N., MD, Head of the Department of Hospital Surgery, Omsk State Medical University of the Ministry of Health of Russia, Omsk, Russian Federation.
Kolyadko Pavel V., Surgeon, Surgical Department N3, Nizhnevartovsk District Clinical Hospital, Nizhnevartovsk, Russian Federation.
M.D. ROMANOV 1, E.M. KIREEVA 1,2
PULMONARY ENDOMETRIOSIS: TREATMENT TACTICS
National Research N.P. Ogarev Mordovia State University 1,
Republican Clinical Hospital ¹ 4 2, Saransk
The Russian Federation
The article presents two clinical observations of a rare pathology, pulmonary endometriosis, complicated by hemoptysis. A 34-year-old female patient has had periodic hemoptysis during menses since 1969. At the age of 19 she underwent an emergency operation for pulmonary hemorrhage, which was stopped by the ligation of the intermediate bronchus root with the ligature due to ventricular fibrillation and unstable hemodynamics. Subsequently, periodic hemoptysis continued, but the patient refused to undergo bronchial examination and biopsy. 27.10.1983 a right-sided pneumonectomy was performed, during which the pneumocirrhosis of the lower and middle lobes and foci of the endometrioid tissue in the upper lobe of the right lung were observed. During the follow-up for 10 years, hemoptysis has not been observed, pathology from the side of the trachea bronchial tubes and left lung has not been detected.
The second observation demonstrates the effectiveness of a 6-month continuous course of treatment of pulmonary endometriosis in combination with adenomyosis with the use of dienogest in a 25-year-old patient, which was accompanied not only by the activity suppression of the endometriosis foci, but also by the disappearance of clinical and instrumental manifestations both in the uterus, and in the lung. In this observation, the duration of the disease before treatment was 3 months; both patients had an unfavorable gynecological anamnesis.
- Voskresenskii OV, Smoliar AN, Damirov MM, Galankina IE, Zhelev IG. Thoracic endometriosis and catamenial pneumothorax. Khirurgiia Zhurn im NI Pirogova. 2014;(10):4-9. (in Russ)
- Pichurov AA, Orzheshkovskiy OV, Dvorakovskaya IV, Romanova LA, Ivanishchak BE, Karelskaya EA, Petrunkin AM, Petrov AS, Atyukov MA, Yablonskiy PK. Thoracic endometriosis – the rare pathology in thoracic surgery. Vestn Khirurgii im II Grekova. 2014;173(1):26-29. (in Russ.)
- Chatra PS. Thoracic endometriosis: a case report. J Radiol Case Rep. 2012 Jan; 6(1):25-30. doi: 10.3941/jrcr.v6i1.614.
- Choi SY, Kim CK, Park CB. Successful treatment of catamenial hemoptysis by video-assisted thoracoscopic surgery. Thorac Cardiovasc Surg. 2013 Jan;61(1):94-96. doi: 10.1055/s-0032-1330227.
- Dvorakovskaya IV, Pechennikova VA, Ariel’ BM, Platonova IS, Novikova LN, Orzheshkovskiy OV, Pichurov AA,Yablonskiy PK. Pulmonary endometriosis as a form of endometrial disease. Pul’monologiia. 2016;26(4):459-65. doi: 10.18093/0869-0189-2016-26-4-459-465. (in Russ.)
- Adamian LV, Andreeva EN, Apolikhina IA, Bezhenar’ VF, Gevorkian MA, Gus AI, Demidov VN, Kalinina EA, Levakov SA, Marchenko LA, Popov AA, Sonova MM, Khashukoeva AZ, Chernukha GE, Iarotskaia EL. Endometrioz: diagnostika, lechenie i reabilitatsiia: federal’nye klinicheskie rekomendatsii po vedeniiu bol’nykh. Moscow, RF; 2013. 65 p. (in Russ.)
- Schweppe KW, Rabe T, Langhardt M, Kiesel L. Endometriosis-pathogenesis, diagnosis and therapeutic options for clinical and ambulatory care. J Reproduktionsmed Endokrinol. 2013;10(1):102-19.
- Romanov MD, Kuvakin VI, Kosarev IuI. Lechebnaia taktika pri legochnykh krovotecheniiakh. Klin Khirurgiia. 1986;10:29–31. (in Russ.)
- Sotnikova LS, Udut EV, Nasyrova RF, Tonkikh OS. Modern methods of endometriosis therapy – the experience of visanne use. Problemy Reproduktsii. 2012;(6):34-39. (in Russ.)
430032, The Russian Federation,
Saransk, Ulyanov Str., 32,
N.P. Ogarev Mordovia State University,
Department of Hospital Surgery,
Tel. mobile +79279710237,
Romanov Mikhail D.
Romanov Mikhail D., MD, Professor, Professor of the Hospital Surgery Department, National Research N.P. Ogarev Mordovia State University, Saransk, the Russian Federation.
Kireeva Ekaterina M., PhD, Associate Professor of the Hospital Surgery Department, Thoracic Surgeon, National Research N.P. Ogarev Mordovia State University, Republican Clinical Hospital ¹ 4, Saransk, the Russian Federation.
K.V. LIPATOV 1, E.A. KOMAROVA 1,2, A.V. BORODIN 1,2, Y.V. STRUCHKOV 1, V.V. FROLKOV 2, A.V. KIRILLIN 1,2 , M.A. KIRYUPINA 1
NECROTIZING INFECTION OF SOFT TISSUES AS THE COMPLICATION OF PERFORATING TUMOR OF SIGMOID COLON
I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 1,
City Clinical Hospital named after I.V. Davydovsky, Moscow 2,
The Russian Federation
This clinical case demonstrates the development of severe streptococcal (Streptococcus pyogenes) necrotizing soft tissue infection as a result of perforation of the sigmoid neoplasm. The rapidly progressive necrotic process in the soft tissues of the lumbar and gluteal region as well as necrotic process in the left thigh (with the predominant lesion of the superficial fascia, subcutaneous fat and skin) led to the formation of an extensive postnecrectomic wound defect with an area of more than 1000 square centimeters. In addition to the severity of illness, the patient’s belated treatment and the underestimation of the clinical situation by surgeons who provided emergency care contributed to such an extensive spread of the pathological process. The development of sepsis was accompanied by severe multiple organ failure. Because of the severity of the patient’s condition, the surgical removal of the sigmoid neoplasm extended in the abdomen wall became possible only after its stabilization as a result of surgical focal sanation and complex intensive therapy in the conditions of the ICU. The most important point of the stage-by-stage surgical treatment was the choice of methods for the plastic closure of an extensive postnecrectomic wound that involved the entire left gluteal region, part of the lumbar and antero-inner surface of the left thigh. Taking into account the size and localization of the defect, the plastic reserves of the surrounding skin, the wound was closed in three stages with the help of combined plastic surgery techniques: with local tissues by the method of tissue expansion and a split-thickness skin graft.
- Sadasivan J, Maroju NK, Balasubramaniam A. Necrotizing fasciitis. Indian J PlastSurg. 2013;46(3):472-78. doi: 10.4103/0970-0358.121978.
- Briko NI, Gluschkova EV, Dmitrieva NF, Klejmenov DA, Lipatov KV, Eschina AS, Timofeev UM, Mirskaja MA, Vvedenskaja OB. Invasive Streptococcal (Group A) Infection of Soft Tissues in a Moscow Surgical Hospital. Vestn RAMN. 2013;68(6):15-20. doi: 10.15690/vramn.v68i6.668. (in Russ.)
- Glass GE, Sheil F, Ruston JC, Butler PE. Necrotising soft tissue infection in a UK metropolitan population. Ann R Coll Surg Engl. 2015 Jan;97(1):46-51. doi: 10.1308/003588414X14055925058553.
- Privol’nev VV, Pleshkov VG, Kozlov RS, Savkin VA, Golub AV. Diagnostika i lechenie nekroticheskikh infektsii kozhi i miagkikh tkanei na primere gangreny Furn’e. Statsionarozameshchaiushchie Tekhnologii: Ambulator Khirurgiia. 2015;(3-4):50-57. (in Russ.)
- Wang JM, Lim HK. Necrotizing fasciitis: eight-year experience and literature review. Braz J Infect Dis. 2014 Mar-Apr;18(2):137-43. doi: 10.1016/j.bjid.2013.08.003.
119991,The Russian Federation,
Moscow, Bolshaya Pirogovskaya str., 2-4,
I.M. Sechenov First Moscow State Medical University (Sechenov University),
Department of General Surgery,
Tel. mobile: +7 (916) 635-89-88,
Lipatov Konstantin V.
Lipatov Konstantin V., MD, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
Komarova Elena A., PhD, Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University); Surgeon of the Purulent Surgery Unit, City Clinical Hospital named after I.V. Davydovsky, Moscow, Russian Federation.
Borodin Alexey V., PhD, Acting Head of the Purulent Surgery Unit, City Clinical Hospital named after I.V. Davydovsky; Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
Struchkov Yuri V., MD, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
Frolkov Valery V., PhD, Head of the Anaesthesiology, Reanimation and Intensive Care Unit, City Clinical Hospital named after I.V. Davydovsky, Moscow, Russian Federation.
Kirillin Alexey V., PhD, Deputy Chief Physician on Surgery, City Clinical Hospital named after I.V. Davydovsky; Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. http://orcid.org/0000-0003-0585-9941
Kiryupina Maria A., Student of the 4th course of General Medicine Faculty, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
EXCHANGE OF EXPERIENCE
K.M. KURBONOV, U.U. MANSUROV, K.R. NAZIRBOEV
SURGICAL TREATMENT TACTICS OF IATROGENIC LESIONS AND CICATRICIAL STRICTURES OF EXRTAHEPATIC BILE DUCTS
Avicenna Tajik State Medical University, Dushanbe,
The Republic of Tajikistan
Objective. To improve the results of surgical treatment of iatrogenic lesions and cicatricial strictures of extrahepatic bile ducts using timely two-stage treatment tactics.
Methods. The results of surgical treatment of 48 patients with iatrogenic lesions of extrahepatic bile ducts (EBD) in the period from 2004 to 2016 years were analyzed. New damages were observed in 17 (35.4%), scar strictures – in 31 (64.6%).
Results. In most cases the causes of lesions were: laparoscopic cholecystectomy – 39 (81.2%), traditional cholecystectomy – 3 (6.2%) and cholecystectomy from mini-access – 2 (4.2%). Overall, cholecystectomy accounted for 44 (91.6%) of the total number of interventions. In other cases, the causes of iatrogenic injuries of EBD were echinococcectomy from the liver in 2 cases, resection of the stomach – in 1 and pancreatic necroectomy in one patient. Iatrogenic injuries of EBD occurred in the clinic in 17 (35.4%), but the remaining patients were accordingly transferred from other institutions of the republic. When choosing a treatment strategy and the nature of surgical interventions one considered the time of diagnosis, severity of the patient’s state, the kind and nature of the iatrogenic lesion or strictures of EBD, as well as secondary complications. In 5 (10.4%) of 17 patients with new EBD injuries, the lesions were diagnosed intraoperatively. In 31 (64.6%) patients, postoperative cicatricial strictures were revealed. These patients were adhered to strictly two-stage therapeutic tactics. Various reconstructive surgeries were performed, including choledochojunoanastomosis on Roux - 9 patients and bihepaticojunoanastomosis on Roux - 15 cases. Of all 48 operated patients, postoperative complications were observed in 6 (12.5%) patients. Postoperative mortality made up 3 patients.
Conclusions. The main type of reconstructive treatment of iatrogenic lesions and cicatricial strictures of EBD are bi-, tri- and Roux hepaticojunoanastomosis on jejunum loop, depending on the localization level of injury or stricture.
- Barvanian GM, Glukhikh AA. Khirurgicheskoe lechenie iatrogennykh povrezhdenii vnepechenochnykh zhelchnykh protokov posle kholetsistektomii. Vestn Nats Med-Khirurg Tsentra im NN Pirogova. 2010;5(3):57-60. (in Russ.)
- Altyev BK, Khadzhiev AM, Shukurov BI. Khirurgicheskoe posobie pri iatrogennom bloke vnepechenochnykh zhelchnykh protokov. Annaly Khirurg Gepatologii. 2007;12(3):36. (in Russ.)
- Bystrov SA, Zhukov BN. The surgical tactics in case of bile flow after miniinvasive cholecystoectomy. Med Al’m. 2012;(1):90-93. (in Russ.)
- Vafin AZ, Delibatov KI. Lechenie striktury vnepechenochnykh zhelchnykh protokov iatrogennogo proiskhozhdeniia. Med Vestn Sever Kavkaza. 2010;17(1):23-28. (in Russ.)
- Krasil’nikov DM, Farrahov AZ, Kurbangaleev AI. Surgical tactics in iatrogenic injuries of bile ducts. Prakt Meditsina. 2010;(8):20-29. (in Russ.)
- Gal’perin EI, Vetshev PS. Rukovodstvo po khirurgii zhelchnykh putei. Moscow, RF: Vidar; 2009. 568 p. (in Russ.)
- Diamantis T, Tsigris C, Kiriakopoulos A, Papalambros E, Bramis J, Michail P, Felekouras E, Griniatsos J, Rosenberg T, Kalahanis N, Giannopoulos A, Bakoyiannis C, Bastounis E. Bile duct injuries associated with laparoscopic and open cholecystectomy: an 11-year experience in one institute. Surg Today. 2005;35(10):841-45.
- Costamagna G, Boskoski À. Current treatment of benign biliary structures. Ann Gastroenterol. 2013;26(1):37-40.
- Rystedt J, Lindell G, Montgomery A. Bile duct injuries associated with 55,134 cholecystectomies: treatment and outcome from a national perspective. World J Surg. 2016 Jan;40(1):73-80. doi: 10.1007/s00268-015-3281-4.
- Semenov DIu, Rebrov AA, Vasil’ev VV, Emel’ianova NP, Malakhova TV, Bubnova EV, Kamenskaia OV, Bykova AL. Antegradnye endobiliarnye vmeshatel’stva pod ul’trazvukovym i Rg-kontrolem pri lechenii bol’nykh so strikturami zhelchnykh protokov. Uchenye Zap SPb GMU im akad IP Pavlova. 2009;16(3):67-69. (in Russ.)
- Shalimov AA, Kopchak VM, Serdiuk VP, Khomiak IV, Dronov AI. Rubtsovye striktury zhelchnykh protokov: nash opyt khirurgicheskogo lecheniia. Annaly Khirurg Gepatologii. 2000;5(1):85-89. (in Russ.)
- Maliarchuk VI, Klimov AE, Rao Naresh. Striktury zhelchnykh protokov posle laparoskopicheskoi kholetsistektomii. Endoskop Khirurgiia. 2001;7(3):56. (in Russ.)
- Gal’perin EI, Chevokin AIu. Intraoperative injuries of bile ducts. Khirurgiia Zhurn im NI Pirogova. 2010;(10):4-10. (in Russ.)
- Marshall L. Use of retrograde intra-operative cholangiogram for detection and minimization of common bile duct injury. AMSJ. 2010;1:27-29.
734003, The Republic of Tajikistan,
Dushanbe, Rudaki Ave., 139,
Avicenna Tajik State Medical University,
Department of Surgical Diseases ¹ 1,
Tel. office: +992 98 555-78-88,
Mansurov Usmon U.
Kurbonov Karimhon M., MD, Professor, Academician of Academy of Medical Sciences of the Republic of Tajikistan, Honored Worker of Science and Technology of the Republic of Tajikistan, Head of the Department of Surgical Diseases ¹ 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
Mansurov Usmon U., Post-Graduate Student of the Department of Surgical Diseases ¹ 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
Nazirboev Kahramon R., PhD, Assistant of the Department of Surgical Diseases ¹ 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.