Novosti
Khirurgii
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Year 2014 Vol. 22 No 2

HISTORY SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.137   |  

E. MATEVOSSIAN 1, I. SNOPOK 2, J. NäHRIG 3, I. SINICINA 4, D. DOLL 5

HISTORICAL FACTS ABOUT FIRST IN THE WORLD CLINICAL POSTMORTEM EXPLANTATION AND CONSEQUENT ALLOGENIC HETEROTOPIC TRANSPLANTATION OF DONOR KIDNEY: LEGENDARY LIFE PAGES OF PROMINENT SURGEON Y. VORONOY

“Rechts der Isar” Hospital of Technical University of Munich 1, Munich,
St. Lukas Hospital, Solingen 2,
Institute of General Pathology and Pathologic Anatomy,
“Rechts der Isar” Hospital of Technical University of Munich 3, Munich,
Ludwig-Maximilian Institute of Forensic Medicine, Innenstadt Hospital and Technical University of Munich 4, Munich ,
St. Mary's Hospital, Academic Teaching Hospital Hannover University, Vechta 5,
Federal Republic of Germany

Kidney transplants are one of the most common transplant operations in the modern transplantology saving annually tens of thousands of lives worldwide. This technique has come a long way of development before reaching the current state. Such world famous scientists and surgeons as Carrel, Landsteiner, Hufnagel and Murray were pioneers of the kidney transplantation. The honorable place among them belongs also to the Ukrainian surgeon Yury Voronoy who performed the first human-to-human renal transplant using cadaver organ. Astonishing is that until recently this fact hasn’t been known to the world medical community.
In the present paper we aim to review the archival literature about Yury Voronoy and present a new independent view at the biography of this prominent surgeon and scientist. We have also tried to describe and analyze the first in the world clinical kidney explantation and allotransplatation to human carried out in 1933 by Voronoy. In addition we had the goal to perform a retrospective analysis of the results of all the kidney transplantations that he performed and evaluate them in respect on their importance for the development of the transplantology. We have also tried to review the researches of this scientist in the other branches of surgery.
Yury Voronoy was not an ordinary person, surgeon and scientist who, despite all the unfavorable political and social circumstances of his time by fate and thanks to the force of his own character, became a pioneer of the world kidney transplantation. The results of the clinical transplantations performed by Yury Voronoy were an important source of the primary knowledge that allowed developing this method for the surgeons of the western countries. Every patient with the transplanted kidney, as a matter of fact, to a certain extent is obliged by his life to Yury Voronoy.

Keywords: history of medicine, history of transplantology, kidney transplantation, Y.Y. Voronoy
p. 137 – 149 of the original issue
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Address for correspondence:
Priv.-Doz. Dr. med. habil. Edouard Matevossian, Department of Surgery, Transplantationszentrum München Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany,
e-mail: edouard.matevossian@tum.deñ
Information about the authors:
Matevossian E. MD, PhD, a head of the department of transplantation surgery and transplantation, an assistant professor, “Rechts der Isar” hospital of Technical University of Munich, Munich, Germany.
Snopok I. An assistant physician of the surgical unit, St. Lukas hospital, Solingen, Germany.
Nährig J. MD, PhD, Chief physician of the Pathological-anatomical Institute, pathologist, an associate professor, “Rechts der Isar” hospital of Technical University of Munich, Munich, Germany.
Sinicina I. MD, PhD, a head physician of the Institute of Forensic Medicine, an associate professor, Innenstadt Hospital, University of Ludwig-Maximillians and “Rechts der Isar” hospital of Technical University of Munich, Munich, Germany.
Doll D. MD, PhD, Chief physician of the surgery unit, surgeon, an associate professor, Catholic hospital of Oldenburg, St. Mary's Hospital, Vechta, Germany.

EXPERIMENTAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.150   |  

R.E. KALININ, I.A. SUCHKOV, A.N. NOVIKOV, A.S. PSHENNIKOV

MODELING AND CORRECTION OF EXPERIMENTAL VENOUS ENDOTHELIAL DYSFUNCTION

HBEE HPE “Ryazan State Medical University named after academician I.P. Pavlov”,
The Russian Federation

Objectives. To estimate the different ways of the venous endothelial dysfunction modeling in experiment and study its further correction using the micronized purified flavonoid fraction (MPFF).
Methods. The experiment was carried out on 105 Wistar rats divided into 3 groups: the 1st one – the model of deep venous thrombosis, the 2nd – the model of the postthrombotic syndrome and the 3rd group – the model of L-NAME-induced endothelial dysfunction. The micronized purified flavonoid fraction was administrated within 6 months in the dosage 100 mg/kg/day. At the scheduled time the blood sampling was performed in 7 animals with their further euthanasia. The following metabolites have been determined: super oxide dismutase (SOD), malone dialdehyde (MDA) and nitric oxide (II) (NO).
Results. In all groups a reliable reduction of metabolites of nitric oxide (II), increasing of MDA level and, as a consequence, compensatory activation of antioxidant system, manifested in the increase of SOD level have been revealed. The authentic decreasing of NO and SOD levels, and increasing of MDA level and as the result a compensatory activity of antioxidant system, manifesting in the increase in the SOD level have been found out in all groups. The administration of the micronized purified fraction of flavonoids has led to the reliable (ð<0,05) increasing of NO synthesis and decreasing of MDA and SOD levels in all groups during the experiment. All studied readings had reached their initial levels by the 1st month of the research and remained on these levels within whole period of the experiment. It is likely, that SOD activity on the background of the micronized purified fraction of flavonoids administration decreased due to lipid peroxidation products reduction being a prerequisite for positive effects of NO realization.
Conclusions. The performed research has proved that the reproduced models allow making all requisite conditions for studying different diseases of the venous system in experiment. The administration of the micronized purified fraction of flavonoids makes a positive influence on the endothelium functional state characterizing by the increase of nitric oxide (II) level and reduction of free-radical oxidation.

Keywords: endothelial dysfunction, micronized purified fraction of flavonoids, thrombosis, postthrombotic syndrome
p. 150 – 154 of the original issue
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Address for correspondence:
390026, Rossiiskaia Federatsiia, g. Riazan', ul. Vysokovol'tnaia, d. 9, kafedra angiologii, sosudistoi, operativnoi khirurgii i topograficheskoi anatomii GBOU VPO «Riazanskii gosudarstvennyi meditsinskii universitet im. akad. I.P. Pavlova»,
e-mail: anovikovn@rambler.ru,
Novikov Aleksei Nikolaevich
Information about the authors:
Kalinin R.E. MD, professor, a head of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE “Ryazan State Medical University named after academician I.P. Pavlov”.
Suchkov I.A. PhD, an associate professor of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE “Ryazan State Medical University named after academician I.P. Pavlov”.
Novikov A.N. An intramural post-graduate student of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE “Ryazan State Medical University named after academician I.P. Pavlov”.
Pshennikov A.S. PhD, an assistant of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE “Ryazan State Medical University named after academician I.P. Pavlov”.

GENERAL AND SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.155   |  

S.L. ZYBLEV, Z.A. DUNDAROV

APPLICATION OF ANTIOXIDANTS IN ACUTE GASTRODUODENAL ULCER BLEEDING

EE "Gomel State Medical University”
The Republic of Belarus

Objectives. To examine the effectiveness of using the drug "Citoflavin” in patients with the acute gastroduodenal ulcer bleeding.
Methods. The research enrolled 76 patients divided into two groups. In the first group the drug "Citoflavin" was included into the complex of intensive therapy. In the second group the traditional therapy of acute blood loss was carried out. The number of erythrocytes, hemoglobin concentration, blood biochemical values, acid-base balance, gases and blood electrolytes of patients were evaluated. The level of antioxidant activity (ÀÎÀ) of the blood serum was analyzed.
Results. On admission the significant depletion of the antioxidant properties of blood serum and a significant increase substances with prooxidant activity have been observed. Within 48 hours the blood serum of patients of the second group had prooxidant activity testifying to the development of oxidative stress. After 24 hours blood serum of the first group had antioxidant activity. After 48 hours AOA rate did not differ from the rate of healthy people. Hyperglycemia, hyperuremiya, hyperasotemia and hyperuricemia were observed in the blood biochemical analysis of all patients on admission. During the first day the blood biochemical parameters reached the normal values in the first group. High efficiency of the antioxidant complex "Citoflavin" for the correction of metabolic posthemorrhagic changes has been found out. Introduction of the antioxidant complex eliminates the prevalence of peroxidation processes and prevent the oxidative stress which has developed as a result of acute severe blood loss. In the first group the reduction of hospital stay length and mortality in comparison with the second group have been registered.
Conclusions. As a result of severe blood loss the oxidative stress with the depletion of the antioxidant defense system of the organism has developed that exponentiates the occurrence of the organ dysfunction. Standard treatment regimen does not allow to fill the antioxidant capacity of the body and reduce the peroxidation processes. The use of antioxidants at acute blood loss is known as the effective measure of oxidative stress cupping improves the treatment results of patients.

Keywords: gastroduodenal bleeding, severe blood loss, oxidative stress, antioxidantss
p. 155 – 163 of the original issue
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Address for correspondence:
246000, Respublika Belarus', g. Gomel', ul. Lange, d. 5, UO «Gomel'skii gosudarstvennyi meditsinskii universitet», kafedra khirurgicheskikh boleznei ¹2 s kursami detskoi khirurgii, anesteziologii i reanimatologii,
e-mail: S.zyblev@yandex.ru,
Zyblev Sergei Leonidovich
Information about the authors:
Zyblev S.L. An assistant of the surgical diseases chair ¹2 with the course of pediatric surgery, anesthesiology and reanimatology of EE “Gomel State Medical University”.
Dundarov Z.A. MD, professor, a head of the surgical diseases chair ¹2 with the course of pediatric surgery, anesthesiology and reanimatology of EE “Gomel State Medical University”.
DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.164   |  

O.A. BAULINA, A.S. IVACHEV, V.A. BAULIN, À.À. BAULIN

LAPAROSCOPIC FIXATION OF HIS ANGLE USING XENOPERICARDIAL BAND IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE

SBEE APE “Penza Institute of Physicians’ Advanced Training”,
The Russian Federation

Objectives. To carry out a comparative evaluation of the results of laparoscopic His angle fixation with the polypropylene mesh and xenopericardial band in patients with gastroesophageal reflux disease.
Methods. Depending on the fixation material type used for the laparoscopic His angle fixation the patients were divided into two groups. In the main group (32 patients) antireflux surgery was performed using biological implant – the calf pericardium. In the comparison group (162 patients) – surgery was performed using polypropylene mesh as a fixation material.
Results. Indications for antireflux surgery were: reflux esophagitis, extraesophageal manifestations of gastroesophageal reflux disease, failure of the cardia, hiatal hernia, ineffective conservative treatment, expressed clinic of gastroesophageal reflux disease, reduction quality of life, the impossibility of an adequate medical treatment due to economic factors, combined abdominal pathology, patient preference even with an effective treatment in the case of the reduced quality of life, lifelong need for conservative treatment and its high cost. In both groups, attention was paid primarily to the prosthesis-associated complications. In the main group there were no such complications and early postoperative complications were: dysphagia during 3 days (3,1%); hyperthermia during 2 days (34,4%). In the distant postoperative period, 95% of clinic, endoscopic and radiographic results may be regarded as good and excellent. In the comparison group prosthesis-related the following complications were observed: suppuration in the mesh area (1,9%); mesh eruption through the posterior wall into the lumen of the esophagus (5,6%); foreign body sensation (2,5%). In the distant period good and excellent results make up 89,5%.
Conclusions. The first positive short- and long-term results manifested good prospects of the new method, using the xenopericardial plate as a fixation material, and possibilities of its introduction in the antireflux surgery.

Keywords: gastroesophageal reflux disease, surgical treatment, laparoscopic fixation of His angle, xenopericard, polypropylene mesh
p. 164 – 170 of the original issue
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  8. Baulin AA, Baulin VA, Baulina EA, Starov AA. Pat. 2431448 Ros. Federatsiia, MKI6 A 61 V 17/00 Sposob khirurgicheskogo lecheniia gryzh pishchevodnogo otverstiia diafragmy [The method of surgical treatment of hiatal hernia]; zaiavitel' i patentoobladatel' Baulin A.A. 2009111933/14; zaiavl. 31.03.2009; opubl. 20.10.2011 Biul. ¹ 29. Data publikatsii: 20 Oktiabria, 2011
  9. Granderath F., Kamolz Ò., Pointner R. Gastroesophageal reflux disease. Wien: Springer-Verlag, 2006. p. 320.
  10. Kotiv BN, Priadko AS, Vasilevskii DI, Silant'ev DS. Lechenie gryzh pishchevodnogo otverstiia diafragmy s primeneniem setchatykh implantov [Treatment of hiatal hernias with mesh implants using]. Khirurgiia. Zhurn im NI Pirogova. 2012;(4):59–62.
  11. Stadlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ Jr, Michael Brunt L, Hunter JG, Demeester TR, Swanstrom LL, Daniel Smith C, Filipi CJ. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc. 2009 Jun;23(6):1219-26
  12. Starodubtsev VA, Kupriianov MP, Belousova IB, Baulin AA, Baulin VA. Blizhaishie i otdalennye endoskopicheskie rezul'taty khirurgicheskogo lecheniia gastroezofageal'noi refliuksnoi bolezni [The short- and long-term results of surgical endoscopic treatment of gastroesophageal reflux disease]. Eksperiment i Klin Gastroenterologiia. 2012;(4):39–42.
  13. Tytgat GN, McColl K, Tack J, Holtmann G, Hunt RH, Malfertheiner P, Hungin AP, Batchelor HK. New algorithm for the treatment of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2008 Feb 1;27(3):249-56.
  14. Burikov MA, Shul'gin OV. Modifitsirovannyi metod laparoskopicheskoi khirurgicheskoi korrektsii gryzhi pishchevodnogo otverstiia diafragmy [The modified method of laparoscopic surgical correction of hiatal hernia]. Al'manakh In-ta khirurgii im AV Vishnevskogo. 2012:7(10):111–12.
  15. Mitroshin AN, Sivakon' SV, Mozerov SA, Abdullaev AK, Mitroshin IA. Issledovanie biointegratsii ksenoperikarda pri plastike defektov sukhozhil'no-sviazochnykh struktur. Izvestiia vyssh ucheb zavedenii [Study biointegration xenopericardial in plastic tendon-ligamentous structures defects]. Povolzhsk region. Med nauki. Klin Med. 2010;3(15):35–43.
Address for correspondence:
440060, Rossiiskaia Federatsiia, g. Penza, ul. Stasova, d. 8 A, GBOU DPO «Penzenskii institut usovershenstvovaniia vrachei», kafedra khirurgii i endoskopii,
e-mail: olga.kosenko@mail.ru,
Baulina Ol'ga Aleksandrovna
Information about the authors:
Baulina O.A. A post-graduate student of the surgery and endoscopy chair of SBEE APE “Penza Institute for Advanced Training of Physicians”.
Ivachev A.S. MD, professor, a head of the surgery and endoscopy chair of SBEE APE “Penza Institute for Advanced Training of Physicians”.
Baulin V.A. PhD, an assistant of the surgery and endoscopy chair of SBEE APE “Penza Institute for Advanced Training of Physicians”.
Baulin A.A. MD, professor of the surgery and endoscopy chair of SBEE APE “Penza Institute for Advanced Training of Physicians”.
DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.171   |  

V.N. OCHKOLYAS 1, G.YU. SOKURENKO 2

THE EVALUATION OF EXPRESSION OF CEREBRAL ISCHEMIA AFTER SURGICAL TREATMENT OF THE INTERNAL CAROTID ARTERY PATHOLOGY BY DETERMINING THE AUTOANTIBODY LEVEL TO NR2A SUBUNIT OF NMDA GLUTAMATE RECEPTORS

FSEE HPE “First Saint-Petersburg I.P. Pavlov State Medical University” 1
FSBE “All-Russian Center of Emergency and Radiation Medicine named after A.M. Nikiforov” RMES 2 ,
Saint-Petersburg
The Russian Federation

Objectives. Study of the NMDA glutamate receptors reaction on the change of the cerebral blood flow in the internal carotid artery basin in patients with cerebral ischemic disease.
Methods. 92 patients with hemodynamically significant stenosis of the internal carotid artery have been examined. The patients were divided into 2 groups: patients with a sufficient structural and functional potential of the cerebral blood flow compensation and patients with a low structural and functional potential of the cerebral blood flow compensation. The determination of antibody level to NR2A was carried out before the operation (the 1st period of control), 30 minutes after ICA clamping (the 2nd period of control), 3 hours after the operation (the 3rd period of control), 3 days (the 4th period of control) and 14 days (the 5th period of control) and 4 weeks after the operation (the 6th period of control). The immunoassay method for the semiquantitative determination of the antibodies level to NR2A subunit of NMDA receptors of glutamate was applied.
Results. It has been established that the alteration of NMDA glutamate receptors prevailed in the group of patients with a low potential of structural and functional compensation of the cerebral blood flow. Deterioration of the cerebral blood flow during the period of carotid artery clamping is considered as a factor objectively aggravating the degree of hypoxia in the affected vascular pool and amplifying the degree of alteration of NMDA glutamate receptors. Wherein the longer the clamping of the ICA, the greater destructive effect on the NMDA glutamate receptors occurs via the implementation of excitotoxicity mechanisms.
Conclusions. Objective estimation of the cerebral ischemia degree as well as the evaluation of the adjuvant therapy efficacy is known as one of the primary conditions for the treatment of patients with ischemic brain. In this regard the level of AAT to NR2A subunit of NMDA glutamate receptors is considered as an objective criterion for the effectiveness of the cerebral blood flow and allows evaluating both the cerebral ischemic disease course and the effectiveness of the therapeutic measures.

Keywords: ischemic stroke, carotid endarterectomy, NMDA glutamate receptors
p. 171 – 178 of the original issue
References
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Address for correspondence:
197022, Rossiiskaia Federatsiia, g. Sankt-Peterburg, ul. L. Tolstogo, d. 6-8, FGOU VPO «Pervyi Sankt-Peterburgskii meditsinskii universitet imeni akademika I.P.Pavlova», kafedra nevrologii i neirokhirurgii,
e-mail: ovn@ihb.spb.ru; dumpo@rambler.ru
Ochkolias Vladislav Nikolaevich
Information about the authors:
Ochkolyas V.N. PhD, an associate professor of the neurology and neurosurgery chair with the clinic, FSEE HPE “The First I.P. Pavlov State Medical University of St. Peterburg”.
Sokurenko G.Yu. MD, professor, Chief physician of the clinic ¹ 2 of FSBE “All-Russian Center of Emergency and Radiation Medicine named after A.M. Nikiforov”, MES of Russia, St. Petersburg
DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.179   |  

A.N. POPOV 1, B.A.VESELOV 1, R.R. FASKHIEV1, E.P. BURLEVA2, A.V. NAZAROV1

BRACHIAL-SUBCLAVIAN FISTULA AS VASCULAR ACCESS CHOICE IN PROBLEMATIC PATIENTS ON CHRONIC HEMODIALYSIS

Municipal Autonomic Establishment “City Clinical Hospital ¹40” 1,
SBEE HPE “Ural State Medical University” 2,
Yekaterinburg,
The Russian Federation

Objectives. To determine the structure of complications and functioning time of the brachial - subclavian fistula (BSF).
Methods. During the period from September 2002 to June 2012 23 patients with the end-stage renal disease (ESRD) underwent 25 BSF with polytetrafluoroethylene (two patients twice). The age of patients ranged from 30 to 74 years (M=52 years), there were 15 women, 10 men. The stay duration on chronic hemodialysis before the formation of the fistula ranged from 1 to 132 months (M=44 months). Over the ten-year follow-up period, the complications were analyzed, and the calculation of the cumulative five-year BSF patency using the Kaplan-Meier method was performed.
Results. Totally, 37 complications were registered. The most frequent complication during the use of arteriovenous fistula (AVF) was thought to be thrombosis – in 28 cases. 27 patients underwent thrombectomy and 1 patient – systemic thrombolysis (with thrombolytic drug Actilyse). The maximal number of thrombosis was registered during the first two years – 21 cases (75%), at present 17 (81%) of AVF have been restored. Four aneurysmal resections were performed (n=4). 2 surgeries were performed in patients with infected prosthesis and 2 more operations – the excision of cutaneous fistulas in the projection of BSF without local infection. The BSF cumulative patency through 62 months of follow-up was 48.02% with a standard error – 14,13%.
Conclusions. Formation of the brachial-subclavian fistula from PTFE clarifies acceptable medical options for problematic patients on chronic hemodialysis.

Keywords: ñhronic hemodialysis, àrteriovenous fistula, brachial - subclavian fistula, complications, arteriovenous explant, polytetrafluoroethylene
p. 179 – 183 of the original issue
References
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Address for correspondence:
620102, g. Ekaterinburg, ul. Volgogradskaia, 189, MAU «Gorodskaia klinicheskaia bol'nitsa ¹40», otdelenie sosudistoi khirurgii,
e-mail: burleva@gkb40.ur.ru,
Burleva Elena Pavlovna
Information about the authors:
Popov A.N. A cardiovascular surgeon of the cardiovascular surgery unit of MAE “City Clinical Hospital ¹40”, Yekaterinburg.
Veselov B.A. A cardiovascular surgeon of the cardiovascular surgery unit of MAE “City Clinical Hospital ¹40”, Yekaterinburg.
Faskhiev R.R. A physician of functional and ultrasound diagnostics of the functional diagnostics unit of MAE “City Clinical Hospital ¹40”, Yekaterinburg.
Burleva E.P. MD, professor of the general surgery chair of SBEE HPE “Ural State Medical University”.
Nazarov A.V. MD, a head of the chronic dialysis and detoxification unit of MAE “City Clinical Hospital ¹40”, Yekaterinburg.
DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.184   |  

R.V. SABADOSH

THE ROLE OF SMALL SAPHENOUS VEIN IN THE DEEP VENOUS THROMBOSIS DEVELOPMENT AT ACUTE VARICOSE THROMBOPHLEBITIS OF THE LOWER LIMBS

SHEE “Ivano-Frankovsk National Medical University”,
The Ukraine

Objectives. To improve the treatment results of patients with acute varicose thrombophlebitis (AVTP) of the lower limbs by studying the role of a small saphenous vein (SSV) in the extension of a thrombotic process in the deep venous system.
Methods. 236 patients with AVTP were examined. After the color duplex scanning the limbs were referred to one of 3 groups: the 1st group with thrombosis of the superficial veins; the 2nd – the limbs with thrombotic process in the superficial and perforating veins; and the 3rd – the limbs with thrombotic process in the superficial and deep veins. The thrombosis frequency of SSV and great saphenous vein (GSV) were compared in each of 3 indicated groups as well as inside of the third one.
Results. Among all patients with AVTP, complicated with deep venous thrombosis (DVT), the frequency of GSV thrombosis made up 70.2% (95% CI 55,1-82,7%) and SSV – 34,0% (20,9-49,3%) (p=0,004). Among the same patients but with a pathological reflux in SSV and GSV simultaneously, the frequency of SSV thrombosis composed 88,9% (51,8-99,7%) and GSV – 44,4% (13,7-78,8%) (p=0,007). The frequency of SSV thrombosis in the 2nd group in contrast to the frequency of thrombosis of GSV was higher than in the 1st group, and the difference of thrombosis frequency in groups 3 and 1 was statistically higher than for GSV.
Conclusions. From the obtained results it can be concluded that thrombosis of SSV in case of AVTP plays more important role in the development of accompanying DVT than thrombosis of GSV. However, due to the considerably more frequent detection of pathological reflux in the GSV and its thrombosis among all patients with AVTP complicated DVT is more common.

Keywords: superficial vein thrombosis, varicose veins, small saphenous vein, deep venous thrombosis
p. 184 – 190 of the original issue
References
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  9. Savel'ev VS, Pokrovskii AV, Zatevakhin II, Kirienko AI. Rossiiskie klinicheskie rekomendatsii po diagnostike i lecheniiu khronicheskikh zabolevanii ven [Russian clinical guidelines for the diagnosis and treatment of chronic venous disease]. Flebologiia. 2013;7(2, vyp. 2):2-47.
  10. Decousus H, Quere I, Presles E, Becker F, Barrellier MT, Chanut M, Gillet JL, Guenneguez H, Leandri C, Mismetti P, Pichot O, Leizorovicz A. Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study. Ann Intern Med. 2010 Feb 16;152(4):218-24.
  11. Chernukha LM, Shchuk³n SP. Trombotichn³ uskladnennia vazhkikh form varikozno¿ khvorobi: d³agnostika, kh³rurg³chne l³kuvannia ta prof³laktika trombembol³¿ legenevo¿ arter³¿ [Thrombotic complications of severe varicose disease: diagnosis, surgical treatment and prevention of pulmonary embolism in patients with thromboembolism]. Nauk V³sn Uzhgor Un-t Cer Meditsina. 2012;3(45):128–32.
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Address for correspondence:
76000, Ukraina, g. Ivano-Frankovsk, ul. Galitskaia, d. 2, GVUZ «Ivano-Frankovskii natsional'nyi meditsinskii universitet», kafedra khirurgii stomatologicheskogo fakul'te-ta.
e-mail: r.sabadosh@gmail.com
Sabadosh Rostislav Vasil'evich
Information about the authors:
Sabadosh R.V. PhD, an associate professor of the surgery chair of the dental faculty of SHEE “Ivano-Frankovsk National Medical University”.
DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.191   |  

L.M. CHERNUKHA1, E.V. KASHYROVA1, E.V. LUGOVSKOY2, S.V. KOMISARENKO2, I.N. KOLESNIKOVA2, E.M. MAKOHONENKO2, T.N. PLATONOVA2, L.V. PIROGOVA2, O.V. GORNICKAYA2

CHARACTERISTICS OF HEMOSTATIC SYSTEM STATE AT ARTERIOVENOUS FORMS OF CONGENITAL VASCULAR MALFORMATIONS

SE “National Institute of Surgery and Transplantology named after O.O. Shalymov under NAMS of the Ukraine”,1
A.V. Palladin Institute of Biochemistry of the National Academy of Sciences of the Ukraine2
The Ukraine

Objectives. To study the hemostatic system state in patients with diffuse arteriovenous forms of congenital vascular malformations (AVF CVM) based on the assessment of immunodiagnostic tests informativeness for determination of plasma coagulation and fibrinolysis systems activation degree aimed to forecast hemostasiological disturbances in the perioperative period.
Methods. The study results of plasma hemostasis system (D-dimer, soluble fibrin, fibrinogen) and fibrinolysis system (protein C) using immunodiagnostic tests in the preoperative and in the early postoperative periods (up to 3 days) in the main group patients with AVF CVM (n=23) and in the control group patients with varicose vein disease (n=16, clinical class Ñ3-Ñ5, by CEAP) are presented in the article.
Results. In the preoperative period in 9 (43%) patients with AVF CVM, the imbalance manifested in a significant activation of coagulation capacity with normal activity of protein C was revealed. In 10 (62,5%) patients of the control group, a moderate activity of the coagulation capacity activation of hemostasis system at the normal activity of the fibrinolysis system (protein C) was established. The correlation between characteristics of coagulative and fibrinolytic potentials was observed in postoperative period in the main group, hypocoagulation – in 4 (57%) patients; imbalance between characteristics of coagulation and fibrinolytic system (hypercoagulability) – in 5 (45,5%) patients of the control group.
Conclusions. Diagnostic tests defining the state of coagulative and fibrinolytic systems are considered necessary to be done for timely correction of hemostasiological disturbances and for the prevention of fatal hemorrhagic complications in the perioperative period in patients with diffuse AVF CVM.

Keywords: congenital vascular malformations, arteriovenous forms, immunodiagnostic test-system, D-dimer, soluble fibrin, fibrinogen, protein C, balance, imbalance
p. 191 – 198 of the original issue
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  7. Lugovskoi EV, Kolesnikova IN, Lugovskaia NE, Gritsenko PG, Litvinova LM, Gogolinskaia GK, Liashko ED, Kostiuchenko EP, Golota VIa, Kurochka VV, Komisarenko SV. Rastvorimyi fibrin i D-dimer pri normal'no protekaiushchei beremennosti i pri ugroze ee preryvaniia [Soluble fibrin and D-dimer in normal pregnancy and the threat of abortion]. Ukr b³okh³m zhurn. 2006;78(4):120–29.
  8. Platonova TN, Gornitskaia OV. Vydelenie i svoistva aktivatora proteina C iz iada shchitomordnika obyknovennogo (Agkistrodon halys halis) [Isolation and properties of protein C activator from the venom of the copperhead snake (Agkistrodon halys halis)]. Biomed Khimiia: Nauchno-Prakt Zhurn. 2003;49(5):470–78.
  9. Rublenko AM, Urvant LP, Makogonenko ªM, Platonova TM, Tsap PIu, Chernishenko TM, Kolesnikova ²M, Fishchenko VO, Lugovskoi EV. Vliianie aktivatora proteina s na obshchii gemostaticheskii potentsial plazmy krovi pri endoprotezirovanii tazobedrennogo sustava [Effect of activator protein with the overall hemostatic potential of blood plasma in hip replacement]. Ukr B³okh³m Zhurn. 2011;83(5):32–39.
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  13. Vachev AN, Trukhanova IG, Gureev AD. Korrektsiia koagulopatii potrebleniia u patsientov pri otkrytykh operatsiiakh na briushnom otdele aorty [Correction of coagulopathy in patients with open operations on the abdominal aorta]. Angiologiia i Sosud Khirurgiia. 2013;19(3):117–21.
  14. Dolgov VV, Svirin PV. Laboratornaia diagnostika narushenii gemostaza [Laboratory diagnosis of hemostatic disorders]. Moscow -Tver': OOO Izdatel'stvo Triada; 2005. 227 p.
  15. Carr ME, Jr, Hermans J. Size and density of fibrin fibers from turbidity. Macromolecules. 1978 Jan–Feb;11(1):46–50.
Address for correspondence:
03680, Ukraina, g. Kiev, ul. Geroev Sevastopolia, d. 30, GU «Natsional'nyi institut khirurgii i transplantologii im. A.A. Shalimova NAMNU», otdel khirurgii magistral'nykh sosudov,
e-mail: aristosha@list.ru,
Kashirova Elena Vladimirovna
Information about the authors:
Chernukha L.M. MD, a leading researcher of the main vessels department of SE “National Institute of Surgery and Transplantology named after O.O. Shalymov under NAMS of the Ukraine”, Kiev, the Ukraine.
Kashyrova O.V. A junior researcher of the main vessels department of SE “National Institute of Surgery and Transplantology named after O.O. Shalymov under NAMS of the Ukraine”, Kiev, the Ukraine.
Lugovskoy E.V. A corresponding member of NAS of the Ukraine, Dr.Sci.(Biol), professor, a head of the structure and function of protein department of A.V. Palladin Institute of Biochemistry of NAS of the Ukraine.
Komisarenko S.V. An academician of NAS and NAMS of the Ukraine, Dr.Sci.(Biol), professor, Director of A.V. Palladin Institute of Biochemistry of NAS of the Ukraine.
Makohonenko E.M. Dr.Sci.(Biol), a chief researcher of the structure and function of protein department of A.V. Palladin Institute of Biochemistry of NAS of the Ukraine.
Platonova T.M. Dr.Sci.(Biol), a leading researcher of the protein structure and function of protein department of A.V. Palladin Institute of Biochemistry of NAS of the Ukraine.
Pirogova L.V. A junior researcher of A.V. Palladin Institute of Biochemistry of NAS of the Ukraine.
Gornickaya O.V. PhD, a senior researcher of A.V. Palladin Institute of Biochemistry of NAS of the Ukraine.
DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.199   |  

V.A. SAMARTSEV1, Y.A. ENCHEVA1, 2, M.V. KUZNETSOVA1, 3, T.I. KARPUNINA1

THE PECULIARITIES OF BURN WOUND CONTAMINATION

SBEE HPE “Perm State Medical Academy named after academician E.A. Vagner” 1,
SAME PR “City Clinical Hospital ¹21”, Perm2,
Institute of Ecology and Genetics of Microorganisms of Ural Branch or RAS3,2

Objectives. To reveal the peculiarities of burn wound contamination taking into account antibiotic sensitivity and genotypic characteristics of dominant pathogens.
Methods. The medical records from the burn unit of Perm multi-type hospital have been analyzed for the period 2011-2012 yrs. Microbiological monitoring included the detection of genetic determinants of antibiotic resistance and strain typing with rep-PCR and RAPD-PCR.
Results. It was shown that 270 bacterial cultures that were referred to 19 taxons were isolated from 190 patients within the period analyzed. Total proportion of Staphylococcus aureus and Pseudomonas aeruginosa comprised 40% of the bacteria isolated. Frequency of S. aureus and P. aeruginosa in mono- or mixed cultures did not significantly differ, whereas A. baumannii was more often detected in associations. Prevailing majority of associations including S. aureus was found with Enterococcus spp., while P. aeruginosa associations were observed with A. baumannii. Following the repeated inoculations from the wound S. aureus and P. aeruginosa strains were detected in 37,5% and 52,2%, respectively. The proportion of S. aureus strains being oxacillin-resistant comprised 32,6%, specific weight of ceftazidime-resistant P. aeruginosa strains – 33,3% and imipenem – 21,7%. Molecular typing confirmed the suggestion based on phenotypic characteristics of cultures about circulation of the closely related isolates in burn unit. Genome of non-fermenting bacterial strains of P. aeruginosa and A. baumannii contain neither intI-, nor blaVIM- sequences.
Conclusions. Characteristic features of infectious complications of burn wounds could be considered as follows: predominance of S. aureus and P. aeruginosa among etiopathogens; growing role of multi-resistant A. baumannii strains; delayed pathogen elimination from wounds and development of mixed and super infections.

Keywords: microbiota, burn wound, antibiotic resistance, genotyping
p. 199 – 206 of the original issue
References
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  5. Gordinskaia NA, Sabirova EV, Abramova NV, Dudareva EV, Skleenova EIu, Nekaeva ES. Fenotipicheskie i molekuliarno-geneticheskie osobennosti vozbuditelei ranevoi ozhogovoi infektsii [Phenotypic, molecular and genetic features of microbial infection of burn wound]. Klin Mikrobiol i Antimikrob Khimioterapiia. 2012;(4):342–46.
  6. Oncul O, Ulkur E, Acar A, Turhan V, Yeniz E, Karacaer Z, Yildiz F. Prospective analysis of nosocomial infections in a burn care unit, Turkey. Indian J Med Res. 2009 Dec;130(6):758–64.
  7. Krutikov MG. Kontrol' infektsii v ozhogovom statsionare Kombustiol [Infection control in the burn hospital Kombustiol]. 2003. 14; [Available from] http://combustiolog.ru/journal/kontrol-infektsii-v-ozhogovom-statsionare.
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  16. Shatalova EV, Bel'skii VV. Vzaimnoe vliianie vozbuditelei pri smeshannoi infektsii ozhogovoi travmy [Mutual influence of pathogens in a mixed infection of burn injury]. Zhurn Mikrobiol Epidemiol i Immunobiol. 1999;(4):3–7.
  17. Eidel'shtein MV, Skleenova EIu, Shevchenko OV, Tapal'skii DV, Azizov IS, Dsouza DV, Timokhova AV, Sukhorukova MV, Kozyreva VK, Safronova EV, Astakhova MV, Karpov IA, Shamaeva SKh, Abramova NV, Gordinskaia NA, Kozlov RS. Rasprostranennost' i molekuliarnaia epidemiologiia gramotritsatel'nykh bakterii, produtsiruiushchikh metall-beta-laktamazy, v Rossii, Belarusi i Kazakhstane [Prevalence and molecular epidemiology of Gram-negative bacteria producing metall-beta-lactamase in Russia, Belarus and Kazakhstan]. Klin Mikrobiol i Antimikrob Khimioterapiia. 2012;(2):132–52.
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Address for correspondence:
614107, Rossiiskaia Federatsiia, g. Perm', ul. Kim, d. 2, GBOU VPO «Permskaia gosudarstvennaia meditsinskaia akademiia im. ak. E.A. Vagnera», kafedra obshchei khirurgii ¹1,
e-mail: samarcev-v@mail.ru,
Samartsev Vladimir Arkad'evich
Information about the authors:
Samartsev V.A. MD, professor, a head of the general surgery chair ¹1 of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”.
Encheva Y.A. An extramural post-graduate student of the general surgery chair ¹1 of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”, surgeon of the burn unit of SAME PR “City Clinical Hospital ¹21”.
Kuznettsova M.V. PhD, a senior researcher of the molecular microbiology and biotechnology laboratory of Institute of ecology and genetics of microorganisms of Ural branch of RAS, an associate professor of the microbiology and virology chair of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”.
Karpunina T.I. MD, professor of the microbiology and virology chair of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”.

TRAUMATOLOGY AND ORTHOPEDICS

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.207   |  

V.P. DEYKALO 1, G.V. DIVOVICH 2

EPIDEMIOLOGY OF CONGENITAL CLUBFOOT AMONG CHILDREN’S POPULATION OF GOMEL REGION

EE “Vitebsk State Medical University” 1,
EE “Gomel State Medical University” 2,
The Republic of Belarus

Objectives. To study the prevalence and the structure of a congenital clubfoot among children of Gomel region of the Republic of Belarus.
Methods. We have analyzed medical records in the orthopedic and trauma consultative offices of Gomel regional policlinic, Gomel central city children's policlinic and in its branches No. 1 and No. 4 as well as the card files of clubfoot patients in Gomel branch of the Belarusian orthopedic regenerative center, documents of Gomel regional specialized orthopedic medico-rehabilitation commission of experts during the period from 2000 to 2012 yrs. The data on cases reports of a congenital clubfoot, a child’s sex, side of deformity localization have been included in the research base.
Results. The data statistical analysis concerning cases of a congenital clubfoot has shown the following: the number of children with a congenital clubfoot regarding to the relation of the total number of newborns in Gomel region on the average makes 0,06% (varying on years from 0,02% to 0,09%); 0,63 cases of a congenital clubfoot are the share of one thousand newborns; on every 1585 childbirth there is one case of a clubfoot. This defect does seem to have an increased incidence in boys than in girls (2,8:1). There is one case of a congenital clubfoot out of 1089 boys and there is one case of a congenital clubfoot out of 3054 girls. Club foot (unilateral and bilateral) is a condition which affects children, more often males than females, and generally at birth, bilateral forms of disease dominate among girls.
Conclusion. In Gomel region (the Republic of Belarus) the incidence of clubfoot children birth, the correlation of this pathology occurrence according to sex and the side of lesion are correlated with the information on the prevalence and structure presented in literature. The results of this study are considered to be representative and can be used for studying of the problem of a clubfoot in the other regions of Belarus.

Keywords: congenital clubfoot, equino-varus deformity of foot, congenital deformity of foot, prevalence of a congenital clubfoots
p. 207 – 212 of the original issue
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  13. Blandinskii VF i dr. Lechenie atipichnoi vrozhdennoi kosolaposti metodom Ponseti [Treatment of atypical clubfoot by the Ponseti method]. Travmatol i Ortoped Rossii. 2010;(1):75–79.
  14. Natsional'nyi statisticheskii komitet Respubliki Belarus' [National statistical committee of the Republic of Belarus]. (Elektronnyi resurs). belstat.gov.by/
  15. Vasil'kov NA. i dr Analiz mediko-demograficheskikh pokazatelei naseleniia Gomel'skoi oblasti [Analysis of medical and demographic values of the population of Gomel region]. Vopr Organizatsii i Informatizatsii Zdravookhraneniia. 2011;(3):4–11.
Address for correspondence:
246050, Respublika Belarus', g. Gomel', ul. Lange, d. 5, UO «Gomel'skii gosudarstvennyi meditsinskii universitet», kafedra travmatologii, ortopedii i VPKh,
e-mail: divovich_gol@mail.ru,
Divovich Gennadii Vladimirovich
Information about the authors:
Deykalo V.P. MD, professor, Rector of EE “Vitebsk State Medical University”.
Divovich G.V. An assistant of the traumatology, orthopedics and military field surgery chair of EE “Gomel State Medical University”.

ANESTHESIOLOGY-REANIMATOLOGY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.213   |  

K.V. NIKITINA, I.M. SAMSONOVA

CORRELATION OF INTRAABDOMINAL PRESSURE WITH INDICATORS OF BLOOD GASES, ACID-BASE BALANCE AND FREQUENCY OF MECHANICAL LUNG VENTILATION IN PATIENTS WITH ACUTE DESTRUCTIVE PANCREATITIS

EE “Vitebsk State Medical University”
The Republic of Belarus

Objectives. To study the correlation of different levels of intraabdominal pressure with indicators of the respiratory index (PaO2/FiO2), PaCO2, the acid-base balance and necessity for carrying out a mechanical ventilation of the lungs (MVL) in patients with the acute destructive pancreatitis at hospitalization to the intensive care unit.
Methods. 70 patients with the acute destructive pancreatitis after transferring to the intensive care unit of a hospital have been examined. The indicators of intraabdominal pressure, the acid-base balance, PaCO2, a respiratory index and number of the patients demanded the mechanical lung ventilation ñonduction have been determined. Depending on the intraabdominal pressure level the patients were distributed into 3 groups. The received results were compared between the groups and their correlation was analyzed.
Results. At intraabdominal pressure up to 12 mm Hg the respiratory index and PaCO2 didn’t change, thus 24% of patients demanded mechanical lung vantilation. Intraabdominal pressure over 12 mm Hg promoted the reduction of the respiratory index up to 236 mm Hg, thus 68 % of patients required MLV. Intraabdominal pressure over 20 mm Hg led to the reduction of the respiratory index up to 201 mm Hg and the increase ÐàÑÎ2, thus 100 % of patients required MLV. Indicators of the acid-base balance at different level of intraabdominal pressure (5-25 mm Hg) didn’t change.
Conclusions. Intraabdominal pressure increase over 20 mm Hg in patients with the acute destructive pancreatitis leads to the respiratory insufficiency development and increase the number of the patients with MLV up to 100 %.

Keywords: acute destructive pancreatitis, respiratory insufficiency, intraabdominal pressure, respiratory index, acid-base balances
p. 213 – 217 of the original issue
References
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Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, d. 27, UO «Vitebskii gosudarstvennyi meditsinskii universitet», kafedra anesteziologii i reanimatologii s kursom FPK i PK,
e-mail: katarinaanaest@gmail.com,
Nikitina Ekaterina Vladimirovna
Information about the authors:
Nikitina E.V. PhD, an assistant of the anesthesiology and reanimatology chair with the course of advanced training and retraining of EE “Vitebsk State Medical University”.
Samsonova I.M. An assistant of the anesthesiology and reanimatology chair with the course of advanced training and retraining of EE “Vitebsk State Medical University”.

NEW METHODS

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.218   |  

A.V. BRUKHNOU, V.G. PIACHERSKI, A.V. MAROCHKOV, Z.V. KOKHAN, A.N. BARDZILOUSKI

ANTERIOR TRANSSCALENE ACCESS TO BRACHIAL PLEXUS WHILE PERFORMING REGIONAL BLOCK

ME “Mogilev Regional Hospital”,
The Republic of Belarus

Objectives. This report focuses on an area of practice increases safety of a regional brachial plexus blockage performed according to anatomical landmarks with electrical stimulation of the peripheral nerves but without ultrasonograpy by means of development of a new anterior transscalene approach for brachial plexus block.
Methods. The advantages and disadvantages of different generally recognized accesses for transscalene brachial plexus block: the brachial plexus in the interscalene space: access according to Winnie, Meier and posterior access according to Pippa have been analyzed. Mutual arrangement of the brachial plexus trunks and other anatomical abnormalities in the neck area has been evaluated.
The access to the brachial plexus according to the anatomical landmarks (the sternal head of a sternocleidomastoid muscle, the clavicular head of the sternocleidomastoid muscle, the cricoid, the jugular notch, the interscalene groove) when the risk of large vessels damage as well as the dome of the pleura and the development of total spinal anesthesia will consider to be minimal.
Results. The main difference of proposed access to the brachial plexus from the widely known techniques of Winnie and Meier is the direction of the injection needle into the opposite side of the main vessels, the dome of the pleura, the spinal canal, which undoubtedly increases the block safety performance. The designed access was used to perform brachial plexus block with 1% lidocaine by the anatomical landmarks, using a peripheral nerve stimulator without the ultrasound visualization. Blocks were done for anesthesia maintenance of surgical interventions for the shoulder joint injuries, fractures of the clavicle and proximal shoulder sections in 20 patients. Regional anesthesia with the developed access use in all 20 cases was accompanied by a complete motor and sensory block. No complications were observed.
Conclusions. When using ultrasound imaging during regional block is impossible, the proposed access can be an alternative to the classical variants of the brachial plexus access. In the case of impossibility of performance of ultrasound visualization in regional block the proposed approach can be considered as the alternative classic variant of access to the brachial plexus.

Keywords: anterior transscalene access, brachial plexus block, electrical stimulation of peripheral nerves, anatomical landmarks
p. 218 – 223 of the original issue
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Address for correspondence:
212026, Respublika Belarus', g. Mogilev, ul. B.-Biruli, d. 12. UZ «Mogilevskaia oblastnaia bol'nitsa», otdelenie anesteziologii i reanimatsii,
e-mail: andreibruhnov@gmail.com,
Brukhnou Andrei Viktorovich
Information about the authors:
Brukhnou A.V. An anesthesiologist-reanimatologist, of the anesthesia and resuscitation department of ME “Mogilev regional hospital”.
Piacherski V.G. An anesthesiologist-reanimatologist, anesthesia and resuscitation department of ME “Mogilev regional hospital”.
Marochkov A.V. MD, professor, a head of anesthesia and resuscitation department of ME “Mogilev regional hospital”.
Kokhan Z.V. An anesthesiologist-reanimatologist, anesthesia and resuscitation department of ME “Mogilev regional hospital”.
Bardzilouski A.N. An anesthesiologist-reanimatologist, anesthesia and resuscitation department of ME “Mogilev regional hospital”.

INFORMATION TECHNOLOGIES IN SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.224   |  

P.M. KOSENKO1, S.A. VAVRINCHUK1, L.K. KULIKOV2, E.S. PODVALNYJ3, A.V. PLOTNIKOV4

MATHEMATICAL MODELING OF THE MOTOR-EVACUATION DISORDERS OF THE GASTROINTESTINAL TRACT IN PATIENTS WITH ULCEROUS PYLORIC DUODENAL STENOSIS

HBEE HPE “Far Eastern State Medical University”, Khabarovsk 1,
SBEE APE “Irkutsk State Medical Academy of Post-Graduate Education”2,
FSBEE HPE “Russian Academy of National Economy and Public Administration under the President of the Russian Federation” Voronezh Branch3,
FSBEE HPE “Voronezh State Technical University”4,
The Russian Federation

Objectives. To improve the diagnosis of ulcerative pyloric duodenal stenosis by creating a mathematical model of the motor-evacuation disorders and the automated computer system diagnosis.
Methods. 57 patients with ulcerative pyloric duodenal stenosis, divided according to the degree of stenosis severity into three groups have been examined. Control group consisted of 28 healthy persons. Evaluation of the gastrointestinal tract motor activity was performed using the peripheral electrogastroenterography method. Mathematical modeling of the motor-evacuation disorders was done on the basis of the discriminant analysis of the peripheral electrogastroenterography parameters.
Results. The group of patients with a subcompensated pyloric duodenal ulcerous stenosis is found out to be heterogeneous concerning the character of the disorders of gastrointestinal motility with the presence of transitional types from the motility compensation (hyperkinetic type) to decompensation (hypomotor type). The mathematical model of motor-evacuation disorders in patients with ulcerous pyloric duodenal stenosis was designed on the basis of the discriminant analysis parameters. To improve the prediction of patients’ distribution into the corresponding groups according to the stenosis degree severity, our earlier data concerning the age peculiarities of the peripheral electrogastroenterography readings have been used. 23 electrophysiological parameters were included in the designed mathematical model, 17 of them were considered to be statistically important for the differential diagnostics. It provided a high (96,2%) prediction accuracy of patients’ distribution in the corresponding groups permitted firstly to create a computer system diagnosis and definition of the compensation degree of the pyloric duodenal stenosis.
Conclusion. On the basis of the mathematical model of motor-evacuation disorders prediction, a computer decision support system for determining of compensation degree of pyloric duodenal stenosis was designed, allowing performing of the automated analysis of the peripheral electrogastroenterography data.

Keywords: gastrointestinal motility, peptic ulcer, duodenal stenosis, electrogastroenterography, mathematical modeling, discriminant analysis
p. 224 – 230 of the original issue
References
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Address for correspondence:
680000, Rossiiskaia Federatsiia, g. Khabarovsk, ul. Murav'eva-Amurskogo, d. 35, GBOU VPO «Dal'nevostochnyi gosudarstvennyi meditsinskii universitet», kafedra obshchei i fakul'tetskoi khirurgii,
e-mail: rec@mail.fesmu.ru,
Kosenko Pavel Mikhailovich
Information about the authors:
Kosenko P.M. PhD, an associate professor of the general and faculty surgery of SBEE HPE “Far Eastern State Medical University”, Khabarovsk.
Vavrinchuk S.A. MD, an associate professor of the surgery chair with the course of endoscopic and plastic surgery of the advanced training and retraining faculty of SBEE HPE “Far Eastern State Medical University”, Khabarovsk.
Kulikov L.K. MD, professor, a Head of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Post-graduate Education”.
Podvalnyj E.S. Dr.Sci.(Tech) , professor, Director of FSBEE HPE “Russian Academy of National Economy and Public Administration under the President of the Russian Federation” Voronezh branch.
Plotnikov A.V. A post-graduate student of the computer-aided and computing systems chair of SBEE HPE “Voronezh State Technical University”.

REVIEWS

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.231   |  

A.A. PECHENKIN, A.A. LYZIKOV

CAROTID ENDARTERECTOMY: OUTCOMES AND PROSPECTS

EE “Gomel State Medical University”
The Republic of Belarus

Today the atherosclerotic lesions of the brachiocephalic arteries occupy one of the leading places among vascular disease, second only to coronary vessels and lower extremities vessels. Despite the development of high technologies and minimally invasive treatment techniques, carotid endarterectomy remains a leading treatment method of the given pathology. By the present moment the methods of examination and indication for the surgery have been strictly determined; many kinds of surgeries have been worked out. However, the problem of further disease progression remains valid regardless of the method of intervention and the plastic material used in the operation. On the average restenosis is detected in 10-15% of earlier operated patients. Different operative techniques and their distant results have been analyzed in the review. Comparative analysis of plastic materials used for carotid endarterectomy has been carried out.
Literature analysis has permitted to determine the most significant and successful ways to reduce restenosis incidence in distant postoperative period. At the same time it has been established that there are no distinct data concerning restenosis development after various operative interventions. Significant variety of opinions concerning plastic materials has been found out, indicating the absence of a single point of view of their choice.
The carried out literature analysis proves the necessity for further studies of restenosis pathogenesis after surgical interventions as well as for search of the operative correction techniques and alternative tissue for the internal carotid artery reconstruction. To study the application of the femoral vein for reconstruction of the aortic arch branches seems to be perspective.

Keywords: atherosclerosis, brachiocephalic arteries, internal carotid artery, operative treatment, carotid endarterectomy
p. 231 – 238 of the original issue
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Address for correspondence:
246000, Respublika Belarus', g. Gomel', ul. Lange, d. 5, UO «Gomel'skii gosudarstvennyi meditsinskii universitet», kafedra khirurgicheskikh boleznei ¹ 3,
e-mail: peleka@tut.by,
Pechenkin Aleksei Aleksandrovich
Information about the authors:
Pechenkin A.A. An assistant of the surgical diseases chair¹ 3 of EE “Gomel State Medical University”.
Lyzikov A.A. An associate professor of the surgical diseases chair¹ 3 of EE “Gomel State Medical University”.

CASE REPORTS

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.239   |  

P.N. MYSHENTSEV, S.E. KATORKIN

TACTICS IN THE TREATMENT OF LOWER LIMB SECONDARY LYMPHEDEMA

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

Objectives. To evaluate the effectiveness of tactics of diagnosis and treatment in patients with the lower-limb secondary lymphedema.
Methods. During 5 years 58 patients with the lower-limb secondary lymphedema (IV stage) were being monitored. Ultrasound scanning, volumetry, computed tomography and clinical analysis of movements were applied during the examination combined with clinical and laboratory studies. The staged operative interventions were carried out in patient on the complex conservative treatment background. Life quality was estimated by means of the questionnaire “SF-36 Health Status Survey” (Russian version).
Results. The presented observation of the patient shows that on the first stage of treatment, the use of lymphotropic and prolonged intramuscular antibiotic therapy, the series of plasmapheresis and ultraviolet blood irradiation resulted in a stable remission in the recurrent erysipelas. Surgical intervention by creating lymphoveinous anastomosis to correct a lymphatic drainage proved to be ineffective. Volumetry and computed tomography performed at the next examination of the patient, permitted to specify a heavy, IV stage of the disease. In this regard, the patient underwent surgery of the modified tibia dermalipofascioectomy by Karavanov II. Five months later a reduction of functional failure of the affected limb and the increase of life quality have been approve. The reduction of the feeling of heaviness in the leg and quickly relieve symptoms have been registered. Volumetric measures of lower limbs made up 20477 cm3. Computed tomography showed a decrease in the soft tissue thickness of the left shin up to 26 mm, and the preservation of their density at the level of -26 HU.
Conclusions. Computer tomography plays a significant role in determining the disease stage and choice of a diagnostic optimal treatment tactics. At all stages of the disease a systematic complex treatment is indicated. A surgical correction such as the lymphoveinous shunting is considered to be possible in patients with the initial stages. Resection is recommended in the case of the 3rd, especially 4th stage of lymphedema.

Keywords: lymphedema of the lower limbs, computer tomography, surgical treatment
p. 239 – 243 of the original issue
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Address for correspondence:
443079, Rossiiskaia Federatsiia, g. Samara, pr. Karla Marksa, d. 165 «b», Kliniki Samarskogo gosudarstvennogo meditsinskogo universiteta, kafedra i klinika gospital'noi khirurgii,
e-mail: katorkinse@mail.ru, Katorkin Sergei Evgen'evich
Information about the authors:
Myshentsev P.N. PhD, an associate professor of the hospital surgery chair and clinic of SBEE HPE “Samara State medical University”.
Katorkin S.E. PhD, an associate professor of the hospital surgery chair and clinic of SBEE HPE “Samara State medical University”.

EXCHANGE OF EXPERIENCE

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.244   |  

V.I. RUSYN, Y.M. POPOVYCH, V.V. KORSAK, V.V. RUSYN

THE PLACE OF HYBRID SURGERY IN TREATMENT OF CRITICAL LOWER LIMB ISCHEMIA

SHEE “Uzhgorod National University”,
The Ukraine

Objectives. To optimize accesses to surgical treatment of patients with occlusive-stenotic arterial lesions in case of critical lower limb ischemia by applying hybrid technologies.
Methods. The results of examination and surgery treatment of 35 patients with the occlusive-stenotic arterial lesions of the lower limbs have been analysed in the paper. 21 patients has been a two-stage operative treatment with 3-7 days intervals an open reconstruction or endovascular intervention has been firstly performed depending on the type, extent and character of the occlusive-stenotic lesions. In 14 patients the reconstructive-restorative operations have been combined with the endovascular interventions, i.e. the hybrid operations have been performed. The hybrid interventions were primary performed at the occlusive-stenotic lesions of the talocrural segment with local occlusive stenotic lesion of it, i.e. the open reconstruction was carried out firstly and then the endovascular intervention on the shin arteries was done to improve the outflow ways. The endovascular percutaneous balloon angioplasty was combined with stenting in 12 patients.
Results. A satisfactory result during 1 year follow-up was observed in 28 (80%) patients; the passability of zone of the open and endovascular reconstruction was observed in 25 (71,4%) and 28 (80%) patients, respectively. In two patients due to reocclusion in the place of the balloon angioplasty the stenting was performed to restore the magistral main blood flow. The lack of conditions for performing repeated endovascular interventions which led to a high amputation of the lower limb have been observed in 5 (14,3%) patients after the percutaneous transluminal balloon angioplasty.
Conclusions. Thus, thanks to the application of hybrid technologies during one-year observation period one managed to save the limb in 30 (85,7%) patients.

Keywords: occlusive stenotic lesions, critical ischemia of the lower limbs, angiography, hybrid operations, endovascular interventions, reconstructive restorative surgeries
p. 244 – 251 of the original issue
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Address for correspondence:
88010, Ukraina, g. Uzhgorod, ul. Kapushanskaia, d. 22, GVUZ «Uzhgorodskii natsional'nyi universitet», Zakarpatskaia oblastnaia klinicheskaia bol'nitsa im. A. Novaka, kafedra khirurgicheskikh boleznei,
e-mail: angiosurgery@i.ua,
Popovich Iaroslav Mikhailovich
Information about the authors:
Rusin V.I. MD, professor, a head of the surgical diseases chair of SHEE “Uzhgorod National University”.
Popovich Y.M. PhD, an associate professor of the surgical diseases chair of SHEE “Uzhgorod National University”.
Korsak V.V. MD, professor of the surgical diseases chair of SHEE “Uzhgorod National University”.
Rusin V.V. PhD, an associate professor of the surgical diseases chair of SHEE “Uzhgorod National University”.
Contacts | ©Vitebsk State Medical University, 2007