Year 2020 Vol. 28 No 6




City Clinical Hospital No16 1, Dnepr, Ukraine
D.F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine2, Kiev, Ukraine
M.I. Sitenko Institute of Spine and Joint Pathologyof theNationalAcademy of Medical Sciences of Ukraine3, Kharkiv, Ukraine
Kharkov Institute of Physics andTechnology4, Kharkiv,

Objective. To study in vitro the integration of the metal stainless steel implants with diamond-like carbon (DLC) coating within living bone of rats.
Methods. The experiment was carried out on albino male rats (n=48; 6 months of age). The steel implants and steel implants with DLC-coating were implanted in the metaphyseal defects of the femur (diameter 2 mm and depth 3 mm)) of the animals in the control and experimental groups (n=24 per group). DLC film was deposited using a filtered vacuum arc plasma flows to the steel implant surface. The coating material was free of metal and hydrogen impurities. The nanohardness of the coating deposited on the sample was from 30 to 40 GPa. The thickness of DLC coating was at least 1 μm. Euthanasia of rats was performed on the 7th, 14th, 30th, and 90th days after surgery by administering a lethal dose of sodium thiopental (90 mg/kg intramuscularly). Bone remodeling around implants was investigated histologically with morphometric assessment of osseointegration (percentage of bone-implant contact).
Results. Diamond-like carbon coating on the surface of steel implants has high adhesive qualities, as evidenced by the attachment of cells to the surface within 7 days after implantation and the formation of bone tissue around them in 14 days.
The formation of a connective tissue with the areas of bone tissue around the steel implants was registered. It was found that for the entire period of the study the osseointegration percentage around the implants made of steel with DLC coating was higher compared to the uncoated implants: by 14 days 2.6 folds, by 30 days 2.1 folds, by 90 days 1.5 folds.
Conclusion. Diamond-like carbon coatings on steel implants are a promising material for use in orthopedics and traumatology due to biocompatibility, osseointegration and the absence of negative remodeling of adjacent bone tissue.

Keywords: diamond-like carbon coating (DLC), bone, osseointegration, light microscopy
p. 617-624 of the original issue
  1. Alanazi AS. Medical Application of Diamond-like Carbon (DLC) Coating A review. Int J Clin Med Info [Electronic resource].2018;1(2):74-82. [cited 2019 Dec 7]. Available from:
  2. Balaji S, Rajan ST, Martin PJ, Vaithilingam V, Bean PA, Evans MDM, Bendavid A. Biomineralization of osteoblasts on DLC coated surfaces for bone implants. Biointerphases. 2018 May 22;13(4):041002. doi: 10.1116/1.5007805
  3. Ishige H, Akaike S, Hayakawa T, Hiratsuka M, Nakamura Y. Evaluation of protein adsorption to diamond-like carbon (DLC) and fluorinedoped DLC films using the quartz crystal microbalance method. Dent Mater J. 2019 Jun 1;38(3):424-29. doi: 10.4012/dmj.2018-060
  4. Rahmati M, Mozafari M. Biological Response to Carbon-Family Nanomaterials: Interactions at the Nano-Bio Interface. Front Bioeng Biotechnol. 2019 Jan 23;7:4. doi: 10.3389/fbioe.2019.00004. eCollection 2019.
  5. Muguruma T, Iijima M, Kawaguchi M, Mizoguchi I. Effects of sp2/sp3 ratio and hydrogen content on in vitro bending and frictional performance of DLC-coated orthodontic stainless steels. Coatings. 2018 May;8(6):199. doi: 10.3390/coatings8060199
  6. Liao TT, Zhang TF, Li SS, Deng QY, Wu BJ, Zhang YZ, Zhou YJ, Guo YB, Leng YX, Huang N. Biological responses of diamond-like carbon (DLC) films with different structures in biomedical application. Mater Sci Eng C Mater Biol Appl. 2016 Dec 1;69:751-59. doi: 10.1016/j.msec.2016.07.064
  7. Trindade R, Albrektsson T, Tengvall P, Wennerberg A. Foreign body reaction to biomaterials: on mechanisms for buildup and breakdown of osseointegration. Clin Implant Dent Relat Res. 2016 Feb;18(1):192-203. doi: 10.1111/cid.12274
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  10. Liu X, Zhang Y, Li S, Wang Y, Sun T, Li Z, Cai L, Wang X, Zhou L, Lai R. Study of a new bone-targeting titanium implant-bone interface. Int J Nanomedicine. 2016 Nov 25;11:6307-24. eCollection 2016. doi: 10.2147/IJN.S119520
  11. Bondarenko S, Dedukh N, Filipenko V, Akonjom M, Badnaoui AA, Schwarzkopf R. Comparative analysis of osseointegration in various types of acetabular implant materials. Hip Int. 2018 Nov;28(6):622-628. doi: 10.1177/1120700018759314
  12. Farkasdi S, Pammer D, Rácz R, Hriczó-Koperdák G, Szabó BT, Dobó-Nagy C, Kerémi B, Blazsek J, Cuisinier F, Wu G, Varga G. Development of a quantitative preclinical screening model for implant osseointegration in rat tail vertebra. Clin Oral Investig. 2019 Jul;23(7):2959-73. doi: 10.1007/s00784-018-2661-1
  13. Shah FA, Thomsen P, Palmquist A. Osseointegration and current interpretations of the bone-implant interface. Acta Biomater. 2019 Jan 15;84:1-15. doi: 10.1016/j.actbio.2018.11.018
  14. Vien BS, Chiu WK, Russ M, Fitzgerald M. A quantitative approach for the bone-implant osseointegration assessment based on ultrasonic elastic guided waves. Sensors (Basel). 2019 Jan 22;19(3). pii: E454. doi: 10.3390/s19030454
  15. De Maeztu MA, Braceras I, Alava JI, Sánchez-Garcés MA, Gay-Escoda C. Histomorphometric study of ion implantation and diamond-like carbon as dental implant surface treatments in beagle dogs. Int J Oral Maxillofac Implants [Electronic resource]. 2007 Mar-Apr;22(2):273-79. [cited 2019 Dec 7]. Available from:
Address for correspondence:
49000, Ukraine, Dnepr,
Bohdan Khmelnytsky Ave, 19,
City Clinical Hospital No16,
the Combined Trauma Unit,
tel. +3 8099 773-78-38,
Makarov Vasyl .
Information about the authors:
Makarov Vasyl ., PhD, Orthopedic Surgeon, the Combined Trauma Unit, City Clinical Hospital No16, Dnepr, Ukraine.
Dedukh Ninel V., DSBiol, Professor, the Department of Clinical Physiology and Pathology of the Musculoskeletal System, D.F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.
Nikolchenko Olga ., PhD, Senior Researcher, the Department of the Transplantology and Experimental Modeling with an Experimental Biological Clinic, M.I. Sitenko Institute of Spine and Joint Pathologyof the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine.
Strelnitskij Vladimir Ye., DScPhysic.-Math., Head of the Laboratory of Superhard Amorphous Diamond-Like and Polycrystalline Diamond Coatings, Kharkiv Institute of Physics and Technology, Kharkiv, Ukraine.
Vasilyev Vladimir V., PhDTech Sciences, Senior Researcher of the Laboratory of Superhard Amorphous Diamond-Like and Polycrystalline Diamond Coatings, Kharkiv Institute of Physics and Technology, Kharkiv, Ukraine.




Republican Specialized Center of Surgery named after academician V. Vakhidov

Objective. To identify the risk factors for the development of acute renal failure in patients with septic endocarditis.
Methods. A single-center prospective non-randomized and retrospective study was conducted in patients (n=107) with septic endocarditis. There were 60 men (56%) and 47 women (44%) with an average age of 42.411.3 years (Mϭ). Patients were divided into two groups: in group 1 (n=23) blood ultrafiltration (UF) during cardiopulmonary bypass (CPB) was performed; in group 2 (n=84) blood ultrafiltration was not used. 125 factors were included (age, sex, body surface area and clinical and biochemical parameters) for the prognosis of acute kidney injury (AKI). Factors showing a statistically significant association with AKI were included in the analysis to construct a multiple linear regression equation. The construction of the mathematical model was carried out by the method of least squares, with the calculation of Pearson correlation paired coefficients.
Results. There was no reliable difference in the duration of CPB and the duration of myocardial ischemia in the groups (p=0.326, p=0.464). In group 1 a linear relationship was found between the parameters of AKI and with the number of leukocytes according to Nechiporenko (r=0.95), the amount of cryoprecipitate (r=0.69), fresh frozen plasma (r=0.58), the volume of ultrafiltration (r=0.68), proteinuria (r=0.66) nd blood creatinine (r=0.67). Group 2 showed a linear relationship between AKI and the left ventricular end-diastolic volume (r=0.69), glomerular filtration rate (r=0.51), blood creatinine (r=0.52), CPB temperature (r=0.42) and CPB time (r=0.59). One patient in the group 2 developed AKI after surgery.
Conclusion. Hyperthermia during CPB and an elevation in CPB time increase the risk of AKI in patients with septic endocarditis

Keywords: septic endocarditis, cardiopulmonary bypass, acute kidney injury, risk factors, postoperative complication, ultrafiltration
p. 625-635 of the original issue
  1. Picichè M, Ranocchi F, Fiorani B, Bergonzini M, Feccia M, Montalto A, D Alessandro C, Cottini M, Gherli R, Mariani B, Paris G, Casali G, Luzi G, Pergolini A, Ferretti E, Giacopin F, Cattolica SL, Madaro L, Musumeci F. Surgical Treatment of Valvular Infective Endocarditis Complicated by An Abscess: A Single Centers Experience. Interv Cardiol J. 2017;3:1. doi: 10.21767/2471-8157.100045
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  5. Gatti G, Benussi B, Gripshi F, Della Mattia A, Proclemer A, Cannatà A, Dreas L, Luzzati R, Sinagra G, Pappalardo A. A risk factor analysis for in-hospital mortality after surgery for infective endocarditis and a proposal of a new predictive scoring system. Infection. 2017 Aug;45(4):413-23. doi: 10.1007/s15010-016-0977-9
  6. Yi Q, Li K, Jian Z, Xiao YB, Chen L, Zhang Y, Ma RY. Risk factors for acute kidney injury after cardiovascular surgery: evidence from 2,157 cases and 49,777 controls a meta-analysis. Cardiorenal Med. 2016 May;6(3):237-50. doi: 10.1159/000444094
  7. Mongero L, Stammers A, Tesdahl E, Stasko A, Weinstein S. The effect of ultrafiltration on end-cardiopulmonary bypass hematocrit during cardiac surgery. Perfusion. 2018 Jul;33(5):367-74. doi: 10.1177/0267659117747046
  8. Matata BM, Scawn N, Morgan M, Shirley S, Kemp I, Richards S, Lane S, Wilson K, Stables R, Jackson M, Haycox A, Mediratta N. A Single-Center Randomized Trial of Intraoperative Zero-Balanced Ultrafiltration During Cardiopulmonary Bypass for Patients With Impaired Kidney Function Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth. 2015 Oct;29(5):1236-47. doi: 10.1053/j.jvca.2015.02.020
  9. Kumar AB, Suneja M, Bayman EO, Weide GD, Tarasi M. Association between postoperative acute kidney injury and duration of cardiopulmonary bypass: a meta-analysis. J Cardiothorac Vasc Anesth. 2012 Feb;26(1):64-9. doi: 10.1053/j.jvca.2011.07.007
  10. Karkouti K, Rao V, Chan CT, Wijeysundera DN; TACS Investigators. Early rise in postoperative creatinine for identification of acute kidney injury after cardiac surgery. Can J Anaesth. 2017 Aug;64(8):801-809. doi: 10.1007/s12630-017-0899-8
  11. Benedetto U, Luciani R, Goracci M, Capuano F, Refice S, Angeloni E, Roscitano A, Sinatra R. Miniaturized cardiopulmonary bypass and acute kidney injury in coronary artery bypass graft surgery. Ann Thorac Surg. 2009 Aug;88(2):529-35. doi: 10.1016/j.athoracsur.2009.03.072
  12. Damman K, Masson S, Hillege HL, Voors AA, van Veldhuisen DJ, Rossignol P, Proietti G, Barbuzzi S, Nicolosi GL, Tavazzi L, Maggioni AP, Latini R. Tubular damage and worsening renal function in chronic heart failure. JACC Heart Fail. 2013 Oct;1(5):417-24. doi: 10.1016/j.jchf.2013.05.007
  13. Sigitova ON, Bogdanova AR. Predicton of risk acute kidney injury in coronary heart disease patients. Vestn Sovrem Klin Mediciny. 2013;6(5):18-23. (In Russ.)
  14. Iskenderov BG, Sysina ON, Budagovskaja ZM. The risk of acute renal lesions and its prognostic significance in patients with chronic renal disease undergoing surgical intervention. Klin Medicina. 2015;93(2):52-57. (In Russ.)
  15. Newland RF, Baker RA, Mazzone AL, Quinn SS, Chew DP, Newland RF, Baker RA, Mazzone AL, Quinn SS, Chew DP. Rewarming temperature during cardiopulmonary bypass and acute kidney injury: a multicenter analysis. Ann Thorac Surg. 2016 May;101(5):1655-62. doi: 10.1016/j.athoracsur.2016.01.086
  16. Schopka S, Diez C, Camboni D, Floerchinger B, Schmid C, Hilker M. Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: a matched pair analysis. J Cardiothorac Surg. 2014 Jan 18;9:20. doi: 10.1186/1749-8090-9-20
Address for correspondence:
100115, Republic of Uzbekistan,
Tashkent, Chilanzarsky district,
Kichik Khalkayuli str., 10,
Republican Specialized Research Medical Center
of Surgery Named after Academician V. Vakhidov, the Department Cardiopulmonary Bypass, +99893 5147235,
Islambekova Shakhida A.
Information about the authors:
Aliev Sherzod M., MD, Chief Cardiac Surgeon of the Republic of Uzbekistan, Head of the Department of Combined Heart Disease, Republican Specialized Research Medical Center of Surgery Named after Academician V. Vakhidov, Tashkent, Republic of Uzbekistan.
Nazirova Lyudmila A., PhD., Head of the Department of Anesthesiology, Republican Specialized Center of Surgery Named after Academician V. Vakhidov
Islambekova Shakhida A., Perfusionist, the Department of Cardiopulmonary Bypass, Republican Specialized Research Medical Center of Surgery Named after Academician V. Vakhidov, Tashkent, Republic of Uzbekistan.
Pahomov Georgy L., PhD, Thoracic Surgeon, Associate Professor of the Hospital Surgery Department, Tashkent Medical Academy, Tashkent, Republic of Uzbekistan.



Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow 1,
Federal Research Center "Institute of Management" RAS 2,
Central State Medical Academy of the Administrative Department of the President of the Russian Federation 3,
Center for Expertise and Quality Control of Medical Care 4
Pirogov Russian National Research Medical University 5,
City Clinical Hospital named after S.P. Botkin.
Department of Health of Moscow 6, Moscow,
The Russian Federation

Objective. To evaluate the possibilities of the developed method for the automatic liver density measurements according to the data of native ultra-low-dose and standard chest computed tomograms in the case when an upper segment of the abdomen is in the scanned zone.
Methods. Retrospective analysis of clinical data associated with patients (n=10,000) underwent ultra-low-dose computed tomography has been performed. The patients (n=100) were selected and additionally underwent standard computed tomography. The average age of patients was 62.512 years (Mσ). Manual measurement of the liver density was carried out in II, IV, VII-VIII segments. In addition the splenic density was measured. In the case of the liver density was <40 HU, liver-to-spleen ratio (L/S) <0.8-1.0, and the density difference was <10 HU hepatic steatosis was considered to be reliable. For automatic procedure a program for measurement of liver density including segmentation and the segmented density area was developed.
Results. A little difference was revealed in comparison of the automated and manual liver density measurement for standard computed tomography (51.43 vs. 50,37 HU, p=0.0192). For ultra-low-dose computed tomography the difference is slightly larger (54.90 and 55.60 HU, p=0.310). When assessing the difference between the compared methods for standard and ultra-low-dose computed tomography, no significant difference was found (p=0.0035). In comparison of manual and automated methods a larger number of the low liver density cases both for standard (10 vs. 6 cases, P(McNemar)=0.125) and ultra-low-dose tomograms (11 vs. 5 cases, P(McNemar)=0.0313) was detected. The agreement between two methods is considered to be satisfactory for both scanning protocols (kappa 0.726 vs. 0.593).
Conclusion. A good correlation between manual and automated methods for standard and ultra-low-dose computed tomography allows using the automatic method for analyzing a large amount of data and revealing the hepatic steatosis.

Keywords: X-ray liver density, computed tomography, ultra low-dose computed tomography, hepatic steatosis, nonalcoholic fatty liver disease
p. 636-647 of the original issue
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  6. Ratziu V, Charlotte F, Heurtier A, Gombert S, Giral P, Bruckert E, Grimaldi A, Capron F, Poynard T. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005 Jun;128(7):1898-906. doi: 10.1053/j.gastro.2005.03.084
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  8. Chen X, Li K, Yip R, Perumalswami P, Branch AD, Lewis S, Del Bello D, Becker BJ, Yankelevitz DF, Henschke C. Hepatic steatosis in participants in a program of low-dose CT screening for lung cancer. Eur J Radiol. 2017 Sep;94:174-179. doi: 10.1016/j.ejrad.2017.06.024
  9. Okhrimenko SE, Ilin LA, Korenkov IP, Morozov SP, Biriukov AP, Gombolevskii VA, Prokhorov NI, Lantukh ZA, Ryzhov SA, Soldatov IV, Fomin AA. Optimization of radiation doses to patients in x-ray diagnostics. Gigiena i Sanitariia. 2019;98(12):1331-37. doi: 10.18821/0016-9900-2019-98-12-1331-1337 ((In Russ.)
  10. Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Agmon IN, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M; European Society of Radiology (ESR) and the European Respiratory Society (ERS). ESR/ERS statement paper on lung cancer screening. Eur Radiol. 2020 Jun;30(6):3277-94. doi: 10.1007/s00330-020-06727-7
  11. Kulberg NS, Elizarov AB, Kovbas VS. Programma segmentacii izobrazhenija pecheni i opredelenija rentgenovskoj plotnosti pecheni CTLiverExam: svidetelstvo o gos registracii programmy dlja JeVM; RU 2019660983 2019 Avg 15 (In Russ.)
  12. Liao M, Zhao Y, Liu X, Zeng Y, Zou B, Wang X, Shih FY. Automatic liver segmentation from abdominal CT volumes using graph cuts and border marching. Comput Meth Prog Bio. 2017 May;143:1-12. doi: 10.1016/j.cmpb.2017.02.015
  13. Wu W, Zhou Z, Wu S, Zhang Y. Automatic Liver Segmentation on Volumetric CT Images Using Supervoxel-Based Graph Cuts. Comput Math Methods Med. 2016;2016:9093721. doi: 10.1155/2016/9093721
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  15. Jirapatnakul A, Reeves AP, Lewis S, Chen X, Ma T, Yip R, Chin X, Liu S, Perumalswami PV, Yankelevitz DF, Crane M, Branch AD, Henschke CI. Automated measurement of liver attenuation to identify moderateto-severe hepatic steatosis from chest CT scans. Eur J Rdiol. 2020 Jan;122:108723. doi: 10.1016/j.ejrad.2019.108723
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Address for correspondence:
125124, Russian Federation,
Moscow, Raskova Str., 16/26, 1,
Research and Practical Clinical Center
of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow,
the Department of Radiology Quality Development
tel. +7 962 967-50-71,
Gonchar Anna P.
Information about the authors:
Gonchar Anna P., Senior Researcher of the Department of Radiology Quality Development, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russian Federation.
Elizarov Alexey B., PhD, Senior Researcher of the Department of the Development of Medical Imaging Tools, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russian Federation.
Kulberg Nicholay S., PhD, Head of the Department of the Development of Medical Imaging Tools, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russian Federation.
Suleymanova Maria M., Clinical Intern, Central State Medical Academy of the Management Department of the Presidential Administration of the Russian Federation, Moscow, Russian Federation.
Alekseeva Tatiana I., Specialist of the Department of Medical Security Standardization, Center for Healthcare Quality Assessment and Control, Moscow, Russian Federation.
Chernyshev Dmitry A., Clinical Intern, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
Titov Mikhail Yu., Radiologist, City Clinical Hospital Named after S.P. Botkin, Department of Health of Moscow, Moscow, Russian Federation.
Bosin Victor Yu., MD, Professor, Chief Researcher of the Department of Radiology Quality Development, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russian Federation.
Morozov Sergey P., MD, Professor, Head of the Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russian Federation.
Gombolevsky Victor A., PhD, Head of the Department of Radiology Quality Development, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russian Federation.



Avicenna Tajik State Medical University, Dushanbe,
The Republic of Tajikistan

Objective. To evaluate the results of providing care to patients with pancreatogenic bleeding.
Methods. The treatment results of patients (n=84) with pancreatogenic bleedings were analyzed. In 73 (86.9%) cases bleedings occurred after direct interventions on the pancreas (n=12) and purulent-septic complications of acute pancreatitis (AP) (n = 61). In 11 (13.1%) cases, bleedings occurred in chronic pancreatitis (CP) complicated by pseudocysts (PC) of the pancreas. Type A bleeding occurred in 42 (50%) cases, type B in 26 (31%) , and type C in 16 (19%). The results of the medical care quality were assessed depending on the type and severity of bleeding.
Results. Conservative therapy in 31 out of 42 cases with type A bleeding allowed achieving stable hemostasis. In 12 cases in pancreatogenic bleedings caused by gastric and duodenal ulcers penetrating into the pancreas, the method of the combined endoscopic hemostasis with antisecretory therapy was considered to be effective to achieve hemostasis. In the presence of intraperitoneal postoperative profuse bleedings of type B and C owing to pancreatonecrosis, relaparotomy was performed in 38 cases; the stitching of a bleeding vessel with the pancreas tamponade, sanation and drainage of the abdominal cavity was carried out in 7 cases. 18 lethal outcomes were registered. Resection of the tail pancreas with splenectomy was performed in 4 cases, in 9 cases to achieve hemostasis in bleedings from the pancreatic, the bleeding vessel was sutured with the external drainage and tamponing of the pancreatic pseuodocyst in 6 cases and longitudinal pancreatic jejunal anastomosis in 3. Lethal outcomes were registered in 2 cases. In 2 cases, X-ray endovascular embolization of the gastroduodenal artery was performed. No morbidity and mortality were registered.
Conclusion. Bleeding accompanied by severe hemodynamic disturbances requires open surgical interventions. X-ray endovascular methods are considered to be effective in the case of bleeding due to acute and chronic pancreatitis and in the postlesional period.

Keywords: complication of pancreatitis, bleeding, pancreatitis, pseudoaneurysm, hemostasis, arrosive bleeding
p. 648-654 of the original issue
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  3. Wei AL,Guo Q, Wang MJ, Hu WM, Zhang ZD. Early complications after interventions in patients with acute pancreatitis.World J Gastroenterol. 2016 Mar 7;22(9):2828-36. doi: 10.3748/wjg.v22.i9.2828
  4. Kokhanenko NYu, Artemyeva NN, Zelenin VV, Kashintsev AA, Petrik SV, Glebova AV, Ivanov AL, Vavilova OG, Aletdinov YuV. Treatment of chronic pancreatitis complicated by bleeding. Annaly Khirurgicheskoy Gepatologii = Annals of HPB Surgery. 2017;22(2):20-29. doi: 10.16931/1995-5464.2017220-29 (In Russ.)
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  7. Bykova YF, Solovev MM, Merzlikin NV, Dambaev GT, Patkachakova KA. Surgical treatment of pancreatic pseudocysts. Annaly Hirurg Gepatologii. 2016;(4):100-107. doi: 10.16931/1995-5464.20164100-107 (In Russ.)
  8. DiMaio CJ. Management of complications of acute pancreatitis. Curr Opin Gastroenterol. 2018 Sep;34(5):336-42. doi: 10.1097/MOG.0000000000000462
  9. Zerem E, Hauser G, Loga-Zec S, Kunosić S, Jovanović P, Crnkić D. Minimally invasive treatment of pancreatic pseudocysts. World J Gastroenterol.2015 Jun 14;21(22):6850-60. doi: 10.3748/wjg.v21.i22.6850
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  11. Aranda-Narváez JM, González-Sánchez AJ, Montiel-Casado MC, Titos-García A, Santoyo-Santoyo J. Acute necrotizing pancreatitis: Surgical indications and technical procedures. World J Clin Cases. 2014 Dec 16;2(12):840-45. doi: 10.12998/wjcc.v2.i12.840.
  12. Neledova LA, Mizgiriov DV, Duberman BL. Hemorrhagic complications of pancreatitis in surgical practice. Grekovs Bulletin of Surgery. 2019;178(1):55-58. doi: 10.24884/0042-4625-2019-178-1-55-58 (n Russ.)
  13. Wu X, Chen G, Wu W, Zhang T, Liao Q, Dai M, Zhao Y. Management of late hemorrhage after pancreatic surgery: treatment strategy and prognosis. J Int Med Res. 2020 Jun;48(6):0300060520929127. Published online 2020 Jun 5. doi: 10.1177/0300060520929127
  14. Kriger AG, Gorin DS, Goev AA, Varava AB, Berelavichus SV, Akhtanin EA. Post-pancreatectomy hemorrhage. Annaly Khirurg Gepatologii = Annals of HPB Surgery. 2017;22(2):36-44. doi: 10.16931/1995-5464.2017236-44 (n Russ.)
  15. Goltsov V.R., Savello V.E., Demko A.E., Kulagin V.I., Platonov S.A., Kiselev M.A. Treatment of pancreatic pseudocyst complicated by bleeding. Annaly Khirurg Gepatologii = Annals of HPB Surgery. 2017;22(2):12-19. doi: 10.16931/1995-5464.2017212-19 (n Russ.)
  16. Wang BH, Xie LT, Zhao QY, Ying HJ, Jiang TA. Balloon dilator controls massive bleeding during endoscopic ultrasound-guided drainage for pancreatic pseudocyst: A case report and review of literature. World J Clin Cases. 2018 Oct 6;6(11):459-65. Published online 2018 Oct 6. doi: 10.12998/wjcc.v6.i11.459
  17. Tyberg A, Karia K, Gabr M, Desai A, Doshi R, Gaidhane M, Sharaiha RZ, Kahaleh M. Management of pancreatic fluid collections: A comprehensive review of the literature. World J Gastroenterol. 2016 Feb 21;22(7):2256-70. doi: 10.3748/wjg.v22.i7.2256
  18. Varadarajulu S, Bang JY, Sutton BS, Trevino JM, Christein JD, Wilcox CM. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology. 2013 Sep;145(3):583-90.e1. doi: 10.1053/j.gastro.2013.05.046
Address for correspondence:
734003, Republic of Tajikistan,
Dushanbe, Rudaki Av.,139.
Avicenna Tajik State Medical University,
the Department of Surgical Diseases No1,
tel.: +992 934054404
Ruziboyzoda Kahramon R.
Information about the authors:
Kurbonov Karimhon M., Academician of the Academy of Medical Sciences of the Republic of Tajikistan, Honored Worker of Science and Technology of the Republic of Tatarstan, Doctor of Medical Sciences (MD), Professor of the Department of Surgical Diseases No1 of Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
Ruziboyzoda Kahramon R., PhD, Assistant of the Department of Surgical Diseases No1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
Ali-Zade Sukhrob G, PhD, Associate Professor of the Department of Surgical Diseases No1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.



Kharkiv National Medical University MH of Ukraine 1,
Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine 2, Kharkiv

Objective. To evaluate the results of surgical treatment of patients operated on for isolated and multiple and duodenal injuries.
Methods. A retrospective two-center study was conducted in patients (n=60) with isolated and multiple duodenal injuries ≥ II degree according to the criteria of the American Association for the Surgery of Trauma (AAST) who underwent to operations in 2006-2018.
Results. 16 (26.7%) patients were with the closed injuries, 44 (73.3%) with the penetrating injuries, 35 (79.5%) with stab wounds, 5 (11.4%) with gunshot traumas, 4 (9.1%) with mine-explosive damages. Men composed 70%, women 30%, the average age was 36 [18-73] years. On admission the RTS, ISS, and APACHE II scores were 6 [4-8], 14 [4-25], and 14 [8-32], respectively; 22 victims (36.7%) were in shock. Duodenum damage of the II degree was in 31 (51.7%) victims, III in 24 (40%), IV in 3 (5%) and V in 2 (3.3%). Multiple intra-abdominal injuries occurred in 52 (86.7%) patients (1.81 associated injuries per patient). The primary suture was the most accepted surgical procedure in the majority of patients (76.4%); the duodenum was removed from the passage in 13.3%, duodenojejunostomy was performed in 6.7%, and pancreatoduodenal resection in 3.3%. Postoperative mortality was 18.3%.
Conclusion. Duodenal injuries with early diagnosis and timely surgical intervention can be effectively treated using simple surgical methods (primary suture). Complex injuries of the duodenum and those associated with the damage to neighboring organs and structures require a more thoughtful strategy, which includes careful consideration of the physiological stability of a patient, severity of injuries, severity of changes in the abdominal cavity, retroperitoneal space, and also the experience of a surgeon.

Keywords: injuries of the duodenum, severity of injuries, surgical treatment, complications, mortality
p. 655-663 of the original issue
  1. Coccolini F, Kobayashi L, Kluger Y, Moore EE, Ansaloni L, Biffl W, Leppaniemi A, Augustin G, Reva V, Wani I, Kirkpatrick A, Abu-Zidan F, Cicuttin E, Fraga GP, Ordonez C, Pikoulis E, Sibilla MG, Maier R, Matsumura Y, Masiakos PT, Khokha V, Mefire AC, Ivatury R, Favi F, Manchev V, Sartelli M,Machado F, Matsumoto J, Chiarugi M, Arvieux C, Catena F, Coimbra R; WSES-AAST Expert Panel. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines. World J Emerg Surg. 2019 Dec 11;14:56. doi: 10.1186/s13017-019-0278-6. eCollection 20192.
  2. OReilly DA, Bouamra O, Kausar A, Dickson EJ, Lecky F. The Epidemiology of and Outcome from Pancreatoduodenal Trauma in the UK, 19892013. Ann R Coll Surg Engl. 2015;97(2):125-30. doi: 10.1308/003588414X14055925060712
  3. OReilly D, Mahendran K, West A, Shirley P, Walsh M, Tai N. Opportunities for improvement in the management of patients who die from haemorrhage after trauma. Br J Surg. 2013;100(6):749-55. doi: 10.1002/bjs.9096
  4. García Santos E, Soto Sánchez A, Verde JM, Marini CP, Asensio JA, Petrone P. Duodenal injuries due to trauma: Review of the literature. Cir Esp. 2015 Feb;93(2):68-74. doi: 10.1016/j.ciresp.2014.08.004 [Article in English, Spanish]
  5. Moore EE, Cogbill TH, Malangoni MA, Jurkovich GJ, Champion HR, Gennarelli TA, McAninch JW, Pachter HL, Shackford SR, Trafton PG. Organ injury scaling, II: Pancreas, duodenum, small bowel, colon, and rectum. J Trauma. 1990 Nov;30(11):1427-29.
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  10. Nolan GJ, Bendinelli C, Gani J. Laparoscopic drainage of an intramural duodenal haematoma: a novel technique and review of the literature. World J Emerg Surg. 2011;6:42. Published online 2011 Dec 20. doi: 10.1186/1749-7922-6-42
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  14. Stone HH, Fabian TC. Management of duodenal wounds. J Trauma. 1979 May;19(5):334-39. doi: 10.1097/00005373-197905000-00006
  15. Malhotra A, Biffl WL, Moore EE, Schreiber M, Albrecht RA, Cohen M, Croce M, Karmy-Jones R, Namias N, Rowell S, Shatz DV, Brasel KJ. Western Trauma Association Critical Decisions in Trauma: Diagnosis and management of duodenal injuries. J Trauma Acute Care Surg. 2015 Dec;79(6):1096-101. doi: 10.1097/TA.0000000000000870
  16. Roberts DJ, Ball CG, Feliciano DV, Moore EE, Ivatury RR, Lucas CE, Fabian TC, Zygun DA, Kirkpatrick AW, Stelfox HT. History of the innovation of damage control for management of trauma patients: 1902-2016. Ann Surg. 2017 May;265(5):1034-44. doi: 10.1097/SLA.0000000000001803
  17. Cannon JW, Khan MA, Raja AS, Cohen MJ, Como JJ, Cotton BA, Dubose JJ, Fox EE, Inaba K, Rodriguez CJ, Holcomb JB, Duchesne JC. Damage control resuscitation in patients with severe traumatic hemorrhage: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017 Mar;82(3):605-617. doi: 10.1097/TA.0000000000001333
Address for correspondence:
61022, Ukraine,
Kharkiv, Nauka Av., 4,
Kharkiv National Medical University,
the Surgery Department No2,
tel.: +38-050-301-90-90,
Kryvoruchko Igor A.
Information about the authors:
Boyko Valeriy V., Corresponding Member of NAMS of Ukraine, MD, Professor, Director of Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine, Head of the Surgery Department No1, Kharkiv National Medical University, Kharkiv, Ukraine.
Kryvoruchko Igor A., MD, Professor, Head of the Surgery Department No2, Kharkiv National Medical University, Kharkiv, Ukraine.
Riabtsev Roman S., the Post-Graduate Student, Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine, Kharkiv, Ukraine.
Dotsenko Yevhen G., PhD, Deputy Chief Physician, Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine, Kharkiv, Ukraine.
Smachylo Rostyslav M., MD, Head of the Department of the Liver and Bile Ducts Surgery, Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine, Professor of the Surgery Department No1, Kharkiv National Medical University, Kharkiv, Ukraine.
Honcharova Natalya N., MD, Professor of the Surgery Department No2, Kharkiv National Medical University, Kharkiv, Ukraine.




Kirov State Medical University 1,
Kirov Research Institute of Hematology and Blood Transfusion of the Federal Medical-biological agency 2,
Kirov Regional Pediatric Hospital 3, Kirov,
The Russian Federation

Objective. To assess the hypercoagulable state of hemostasis in children with the destructive forms of appendicitis in the early postoperative period.
Methods. The study included children (n=30) with the destructive forms of acute appendicitis at the age of 7-14 years. The control group (n=50) consisted of healthy children. The severity of the intoxication-inflammatory syndrome was assessed according to the hemogram and biochemical blood analysis, the state of the coagulation link of hemostasis on the basis of screening, local tests and the integral test Thrombodynamics.
Results. There was a significant increase in the number of leukocytes, stab and segmented neutrophils, ESR in patients with the destructive forms of appendicitis in the early postoperative period. Leukocyte index of intoxication corresponded to moderate and severe patients 5.73; 3.6-7.4 (Me; Q1-Q3), C-reactive protein in the study group exceeded the norm 32 folds 163.8; 132.8-224.9 mg/l (Me; Q1-Q3). We established a statistically significant increase in the concentration of fibrinogen (5.91.0 g/l), soluble fibrin monomer complexes (204.059.1 μg/ml), factor VIII (301.396.6%), von Willebrand factor (226.062.5%) and its activity (161.536.2%), a significant increase in the indices of the integral test Thrombodynamics initial clot growth rate Vi (60.53.9 μm/min), stationary clot growth rate Vst (41.13.9 μm/min), CS clot size (1444.2192.9 μm) and clot density D (31157.62599.3 c.u.). The results of all patients in the study group showed inhibition of plasma fibrinolytic activity.
Conclusion. Destructive forms of appendicitis are accompanied by a pronounced intoxication-inflammatory syndrome in combination with hypercoagulation disorders of the hemostatic system, which causes a state of increased thrombotic readiness, which, in the presence of additional factors, can result in thrombosis. This is the basis for additional studies and a more scrupulous diagnostic search for thromboembolic complications in children.

Keywords: appendicitis, peritonitis, surgical treatment, coagulation disorders, hypercoagulation, prothrombotic condition, thrombosis
p. 664-670 of the original issue
  1. Levi M, Schultz M, van der Poll T. Sepsis and thrombosis. Semin Thromb Hemost. 2013 Jul;39(5):559-66. doi: 10.1055/s-0033-1343894
  2. Branchford BR, Carpenter SL. The role of inflammation in venous thromboembolism. Front Pediatr. 2018 May 23;6:142. doi: 10.3389/fped.2018.00142. eCollection 2018.
  3. Svirin PV., Larina LE., Zharkov PA., Kazankova AA., Petrov VYu., Lavrentyeva IN. Pediatric thrombosis: application of dalteparin for treatment and prevention. Russian Journal of Pediatric Hematology and Oncology. 2015;2(1):61-65. doi: 10.17650/2311-1267-2015-1-61-65 (In Russ.)
  4. van Ommen CH, Heijboer H, Büller HR, Hirasing RA, Heijmans HS, Peters M. Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands. J Pediatr. 2001 Nov;139(5):676-81. doi: 10.1067/mpd.2001.118192
  5. Lobastov KV, Barinov VE, Schastlivcev IV, Laberko LA. Caprini score as individual risk assessment model of postoperative venous thromboembolism in patients with high surgical risk. Khirurgiia Zhurn im NI Pirogova. 2014;(12):16-23. (In Russ.)
  6. Raffini L, Huang YS, Witmer C, Feudtner C. Dramatic increase in venous thromboembolism in childrens hospitals in the United States from 2001 to 2007. Pediatrics. 2009 Oct;124(4):1001-8. doi: 10.1542/peds.2009-0768
  7. Nurmeyev IN, Mirolyubov LM, Grebnev PN. Diagnostics and treatment of ileofemoral thrombosis in children. Det Khirurgiia. 2008;(1):29-30. ( In Russ.)
  8. Balandina AN, Koltsova EM, Shibeko AM, H A.D. Kuprash. Atauttakhanm FI. Thrombodynamics: a new method to the diagnosis of hemostasis system disorders. Vopr Gematologii/Onkologii i Immunopatologii v Pediatrii. 2018;17(4):114-26. doi: 10.24287/1726-1708-2018-17-4-114-126 (In Russ.)
  9. Ataullakhanov FI, Balandina AN, Vardanian DM, Verkholomova FIu, Vuimo TA, Karamzin SS, Krylov AIu, Momot AP, Parunov LA, Poletaev AV, Polokhov DM, Serebriiskii II, Sinauridze IA, Stupin VA, Taranenko IA, Cherniakov AV, Shulutko EM. Primenenie testa trombodinamiki dlia otsenki sostoianiia sistemy gemostaza: ucheb-metod rekomendatsii. Moscow, RF; 2015. 72 p. (In Russ.)
  10. Ostrovsky VK, Makarov SV, Yangolenko DV, Rodionov PN, Kochetkov L.N, Asanov BM. The some blood parameters and leukocytic index of intoxication in the evaluation of the severity and in the determination of their prognosis of inflammatory, purulent and pyodestructive diseases of the abdomen and of the lungs Ulian Med-Biol Zhurn. 2011;(1):73-78. (In Russ.)
  11. Shamsiev AM, Iusupov ShA, Razin MP, Shamsiev ZhA. Rasprostranennyi appendikuliarnyi peritonit u detei. Moscow, RF: GEOTAR-Media; 2020. 208 p. (In Russ.)
  12. Minaev SV, Isaeva AV, Obedin AN, Bolotov IuN, Bochniuk EA, Chintaeva LA, Gudiev ChG. S-reaktivnyi belok glavnyi marker dinamiki techeniia ostrykh vospalitelnykh protsessov v klinicheskikh usloviiakh. Med Vestn Sever Kavkaza. 2011;(2):95-99. (In Russ.)
  13. Momot AP. The problem of thrombophilia in clinical practice. Russian Journal of Pediatric Hematology and Oncology. 2015;2(1):36-48doi: 10.17650/2311-1267-2015-1-36-48. (In Russ.)
  14. Calabrò P, Gragnano F, Golia E, Grove EL. von Willebrand factor and venous thromboembolism: pathogenic link and therapeutic implications. Semin Thromb Hemost. 2018;44(03):249-60. doi: 10.1055/s-0037-1605564
  15. Roitman EV, Pechennikov VM. On the pathogenesis of catheter-associated thromboses. Tromboz Gemostaz i Reologiia. 2018;(4): 75-82. doi: 10.25555/THR.2018.4.0866(In Russ.)
Address for correspondence:
610027, Russian Federation,
Kirov, Karl Marx Str., 112,
Kirov State Medical University
of the Ministry of Health
of the Russian Federation
tel. +7 912 828-15-27,,
Razin Maxim Petrovich
Information about the authors:
Razin Maxim P., MD, Professor, Head of the Pediatric Surgery Departmentr, Kirov State Medical University, Kirov, Russian Federation.
Ignatyev Sergey V., PhD, Senior Researcher of the Scientific and Clinical Department of Hematology, Chemotherapy and Bone Marrow Transplantation, Kirov Research Institute of Hematology and Blood Transfusion of the Federal Medical-biological Agency, Kirov, Russian Federation.
Semakin Alexander S., Pediatric Surgeon, Kirov Regional Pediatric Hospital, Kirov, Russian Federation.




Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology 1
Minsk Municipal Clinical Pathology Bureau 2, Minsk,
The Republic of Belarus

Objective. To determine the diagnostic value of donors bile as a marker allowing to give an additional assessment, objectify the state of the liver graft, assess the need for dynamic air conditioning, and predict the course of the early postlesional period.
Methods. From July 2017 to November 2019 the bile intake from choledoch and biopsy from liver parenchyma were performed during the explantation operation. All grafts were divided into 2 groups. The first group consisted of organs intented for further transplantation and the organs of the second group were considered unfit for transplantation. Bile ABS (acid-based state) and morphological analysis of transplants were carried out in both groups.
Results. A reliable relationship between the level of bile lactate of both groups and the level of hepatocellular ballooning (R=0.50, p=0.001) was determined. In those cases where severe hepatocyte ballooning was observed the higher levels of lactate in the bile of donors 1.9 [1.2; 2.55] were reliably determined in comparison with those specimens where it was not expressed 0.6 [0.3; 1.7] (p=0.006). The performed ROC analysis allowed determining the level of bile lactate at 1 mmol/ L as a cut-off point at which the probability of liver hepatocyte ballooning is maximal (AUC=0.830). In group 1, a reliable association was obtained between the level of donor bile lactate and ALT at the peak value (R=0.56, p=0.004) and on the 7th postoperative day (R=0.53, p=0.01), as well as with the INR level at the peak value (R=0.63, p=0.001).
Conclusion. Bile lactate reliably reflects the degree of hepatocyte ballooning and objectifies the state of donor liver, as well as predicts the course of the early postoperative period. Bile lactate level greater than 1 mmol/L is a potential criterion for oxygenated machine perfusion.

Keywords: bile lactate, ballooning, transplantation, preservation, machine perfusion
p. 671-679 of the original issue
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  17. Brüggenwirth IMA, Porte RJ, Martins PN. Bile composition as a diagnostic and prognostic tool in liver transplantation. Liver Transpl. 2020 Apr 4. doi: 10.1002/lt.25771. Online ahead of print.
  18. Schlegel A, Muller X, Dutkowski P. Machine perfusion strategies in liver transplantation. Hepatobiliary Surg Nutr. 2019 Oct;8(5):490-501. doi: 10.21037/hbsn.2019.04.04
  19. Schlegel A, Muller X, Dutkowski P. Hypothermic Machine Preservation of the Liver: State of the Art. Curr Transplant Rep. 2018;5(1):93-102. doi: 10.1007/s40472-018-0183-z
Address for correspondence:
220045, Republic of Belarus,
Minsk, Semashko Str., 8,
Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology,
the Trasplantology Department,
Tel..: +375 29 604 88 10
Fedaruk Dzmitry A.
Information about the authors:
Fedaruk Dzmitry A., Surgeon, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
Petrenko Kristina I., Head of the Clinical-Diagnostic Laboratory, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
Kirkovsky Leanid V., PhD, Deputy Director for Medical Affairs for Civil Defense and Mobilization Work, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
Sadouski Dzianis N., PhD, Surgeon, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
Lebedz Volha A., Pathologist, Minsk Municipal Clinical Pathology Bureau, Minsk, Republic of Belarus.
Chichva Artur F., Pathologist, Minsk Municipal Clinical Pathology Bureau, Minsk, Republic of Belarus.
Filipenka Ekatserina V., Pathologist, Minsk Municipal Clinical Pathology Bureau, Minsk, Republic of Belarus.
Sharipov Shohrat Z., Head of the Thoracic Department, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
Fedaruk Aliaksei M., MD, Head of the Department of Hepatology and Minimally Invasive Surgery, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
Rummo Oleg O., MD, Professor, Corresponding Member of NAS of Belarus, Head of Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.




Republican Research and Practical Center of Traumatology and Orthopedics 1, Minsk,
Gomel State Medical University 2,
Francisk Skorina Gomel State University 3, Gomel,
The Republic of Belarus

Objective. The prospective study was performed to evaluate the efficacy and safety of osteosynthesis by closed intramedullary nailing with antibacterial coating in infected fractures and nonunions of the lower extremity long tubular bones.
Methods. The study included patients (n=8) with infected fractures and nonunions of the tibia and femur. Solid titanium nails (with holes for blocking ) were used as implants. Plasma spray coating method (from the active gas phase) was used for the required thickness coating. The technique of surgical intervention included two main components: debridement of the infection site and the insertion of the nail into the medullary canal. After surgery, all patients received antibiotics based on the microbiological study. Follow-up visits to assess the activity of the infectious process and the degree of consolidation were scheduled in 6, 12, 24 and 52 weeks.
Results. By the time of preparing this article, the mean follow-up for patients after surgery had been 4.4 1.0 months. None of the patients showed any signs of infection recurrence after surgery and completion of the course of antibiotic therapy, which indicates the effectiveness and safety of this technique. Not later than 2.5 months after the surgery, all 8 (100%) patients started full weight-bearing on the operated limb. Radiography confirmed the bone healing in 5 patients; in 3 patients X-ray shows the initial signs of fracture consolidation.
Conclusion. Intramedullary osteosynthesis with new three-component antibacterial coating allowed eradicating the infection and achieving bone healing in patients with infected fractures and non-unions of the tibia and femur. This technique is effective and its application is not associated with difficulties typical for the intraoperative preparation of antibacterial coatings.

Keywords: osteomyelitis, osteosynthesis, intramedullary nailing, antibacterial coating, infection
p. 680-687 of the original issue
  1. Metsemakers WJ, Reul M, Nijs S. The use of gentamicin-coated nails in complex open tibia fracture and revision cases: A retrospective analysis of a single centre case series and review of the literature. Injury. 2015 Dec;46(12):2433-37. doi: 10.1016/j.injury.2015.09.028
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  5. Moghaddam A, Zietzschmann S, Bruckner T, Schmidmaier G. Treatment of atrophic tibia non-unions according to diamond concept: Results of one- and two-step treatment. Injury. 2015 Oct;46(Suppl 4):S39-50. doi: 10.1016/S0020-1383(15)30017-6
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  14. Fuchs T, Stange R, Schmidmaier G, Raschke MJ. The use of gentamicin-coated nails in the tibia: preliminary results of a prospective study. Arch Orthop Trauma Surg. 2011 Oct;131(10):1419-25. doi: 10.1007/s00402-011-1321-6
  15. Raschke M, Vordemvenne T, Fuchs T. Limb salvage or amputation? The use of a gentamicin coated nail in a severe, grade IIIc tibia fracture. Eur J Trauma Emerg Surg. 2010 Dec;36(6):605-8. doi: 10.1007/s00068-010-0017-x
Address for correspondence:
220024, Republic of Belarus,
Minsk, Leytenant Kizhevatov Str., 60-4,
Republican Research and Practical Center
of Traumatology and Orthopedics
tel. +375 17 373-59-93,
Volotovski Pavel A.
Information about the authors:
Volotovski Pavel A., PhD, Academic Secretary, Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
Sitnik Alexander A., PhD, Associate Professor, Head of the Laboratory of Adult Traumatology, Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
Tapalski Dzmitry V., PhD, Associate Professor, Head of the Department of Microbiology, Virology and Immunology, Gomel State Medical University, Gomel, Republic of Belarus
Yarmolenko Maxim A., DSTech, Associate Professor, the Department of Radiophysics and Electronics, Francisk Skorina Gomel State University, Gomel, Republic of Belarus
Korzun Oleg A., PhD, Leading Researcher, Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
Bondarev Oleg N., PhD, Researcher, Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
Gerasimenko Mikhail A., MD, Professor, Head of the Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus




Sumy State University 1
Sumy Regional Centre for Emergency Medical Care and Disaster Medicine 2

Objective. To estimate the efficiency of different methods of temporary external hemostasis at the pre-hospital stage of emergency medical care, taking into account the localization of injuries.
Material and Methods. The cases (n=86) of prehospital emergency medical care for patients with external bleeding were studied. The data on the victims (age, gender), clinical status (type and location of injuries, type of bleeding), the volume of emergency care, the hemostasis methods used to control bleeding, their efficiency, side effects, difficulty of use were collected, and the duration of the pre-hospital stage were also taken into account.
Results. The study found out that the most common cause of external bleeding is domestic accident (45.35%) of cases. By the nature of tissue damage, the cut wounds prevailed. Multiple or combined injuries occurred in 13.95% of cases. A tourniquet was the main method of hemostasis. Contact hemostatic agents were used only in 2.32% of cases at the pre-hospital stage. In some cases, when attempting to control the external bleeding, several hemostatic agents were sequentially used due to the lack of their efficacy. In 17.4% of cases, the victims with multiple or combined injuries received intravenous administration of the systemic hemostatic agents. In the complex anti-shock measures in patients with severe trauma 77.91% of the prehospital patients underwent infusion therapy. Isotonic crystalloid solutions were used. A reliable increase in the duration of the prehospital stage of victims who underwent to a combination of hemostasis methods and intravenous infusion has been registered. The increase in the length of the prehospital stay occurs at the expense of the time required for creation of venous access and initiate infusion. The authors propose the algorithm for temporal control of external bleeding during emergency medical care at the pre-hospital stage.
Conclusion. The main principles that need to be guided in the choice of any methods for stopping of bleeding are the speed and reliability of hemostasis for entire time of evacuation and the minimum damaging effect on the tissues.

Keywords: emergency medical care, pre-hospital stage, external bleeding, tourniquet, contact hemostatic agent
p. 688-693 of the original issue
  1. Pereira BM, Dorigatti AE, Calderon LGM, Negrao M, Meirelles G, Duchesne JC. Pre-hospital environment bleeding: from history to future prospects. Anaesthesiol Intensive Ther. 2019 Jan;51(3):240-248. doi: 10.5114/ait.2019.86059
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  3. Posternak GI, Lesnoy VV. Mesto krovoostanavlivayuschego zhguta v sovremennom algoritme vremennoy ostanovki krovotecheniya na dogospitalnom etape. Meditsina neotlozhnyih sostoyaniy. 2017;4(83):57-60. doi: 10.22141/2224-0586.4.83.2017.107426 (In Russ.)
  4. Kauvar DS, Dubick MA, Walters TJ, Kragh JrJF. Systematic review of prehospital tourniquet use in civilian limb trauma. J Trauma Acute Care Surg. 2018 May;84(5):819-825. doi: 10.1097/TA.0000000000001826
  5. Blackbourne LH, Butler FK. Damage Control: Prehospital Care of the Patient With Vascular Injury. In: Rasmussen TE, Tai NR, editors. Richs Vascular Trauma. 3nd ed. Philadelphia, PA: Elsevier; 2016. p. 183-197. doi: 10.1016/B978-1-4557-1261-8.00016-3
  6. Samohvalov IM, Reva VA, Pronchenko AA, Yudin AB, Denisov AV. Mestnyie gemostaticheskie sredstva: novaya era v okazanii dogospitalnoy pomoschi. Politravma. 2013;1:80-86. (In Russ.)
  7. Peng HT. Hemostatic agents for prehospital hemorrhage control: a narrative review. Military Med Res. 2020 Mar;7(1):1-18. doi: 10.1186/s40779-020-00241-z
  8. Travers S, Lefort H, Ramdani E, Lemoine S, Jost D, Bignand M, Tourtier JP. Hemostatic dressings in civil prehospital practice: 30 uses of QuikClot Combat Gauze. Eur J Emerg Med. 2016 Oct;23(5):391-394. doi: 10.1097/MEJ.0000000000000318
  9. Tompeck AJ, Gajdhar AUR, Dowling M, Johnson SB, Barie PS, Winchell RJ, King D, Scalea TM, Britt LD, Narayan M. A comprehensive review of topical hemostatic agents: The good, the bad, and the novel. J Trauma Acute Care Surg. 2020 Jan;88(1):1-21. doi: 10.1097/TA.0000000000002508
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    Likert R. A technique for the measurement of attitudes. Arch Psychol. 1932;22(140):55.
Address for correspondence:
40022, Ukraine,
Sumy, Troitskaya Str., 39,
Medical Institute of Sumy State University,
the Department of Emergency Medicine
and Disaster Medicine
tel. +38 099 548 61 71,
Shkatula Yurii V.
Information about the authors:
Shkatula Yurii V., MD, Professor, Head of the Department of Emergency Medicine and Disaster Medicine Medical Institute of Sumy State University, Sumy, Ukraine.
Badion Yurii A., PhD, Assistant of the Department of Emergency Medicine and Disaster Medicine Medical Institute of Sumy State University, Sumy, Ukraine.
Novikov Maksym V., Deputy Director of Sumy Regional Centre for Emergency Medical Care and Disaster Medicine, Sumy, Ukraine.



Center for Advanced Training of Medical Specialists 1, Novosibirsk,
Belarusian State Medical University 2, Minsk,
The Republic of Belarus;
Dental Clinic "Dentaliya-Blesk 3, Novosibirsk,
The Russian Federation

Objective. To evaluate the effectiveness of the trigger points injections in the treatment of myofascial pain syndrome in the maxillofacial area.
Methods. During the period of 2014-2017 the patients (n=124) with the myofascial pain syndrome (76 women and 48 men, aged 19 to 62 yrs.) have been treated. In addition to clinical and radiological diagnostic methods, all patients underwent electromyography; the pain intensity assessed according to the Visual Analogue Pain Scale (VAS). In order to relieve myofascial pain syndrome, the methods of traditional therapy such as splint therapy, occlusion correction, drug and physiotherapy were used. In the case if traditional methods were ineffective the injections of Lymphomyosot and Traumel S solutions into trigger points were performed according to the method of J. Kersschot (2010). Control examinations were carried out 1, 3, 6, 12 and 18 and 24 months after the manipulation. During the follow-up examinations, attention was paid to the complaints of patients; the pain intensity was assessed by VAS. The criteria for the positive results of treatment were considered to be the absence of pain in resting-state and during functioning.
Results. In case of conventional treatment, positive results were obtained in 86 out of 124 patients (69.4%). Trigger point injections performed due to insufficient treatment efficacy in 38 patients resulted in pain relief in 32 (84.2%). As shown by our observations, a long painless period (within two years) was observed in 12 (37.6%) patients. A long-term effect for a period up to one and a half years was fixed in 8 patients (25%), up to 1 year - in 7 patients (21.8%), up to 6 months in 5 (15.6%).
Conclusion. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points, provide prompt relief of symptoms and a long period of remission.

Keywords: myofascial pain syndrome; temporomandibular joint; trigger points; trigger point injections; electromyography; bruxism, psychoemotional stress
p. 694-701 of the original issue
  1. Fokina NM Litsevaia bol. Chastnye aspekty. Lechenie. Consilium Medicum. 2017;19(9):44-48. (In Russ.)
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  11. Nouged E, Dajani J, Ku B, Al-Eryani K, Padilla M, Enciso R. Local anesthetic injections for the short-term treatment of head and neck myofascial pain syndrome: a systematic review with meta-analysis. J Oral Facial Pain Headache. 2019;33(2):183-98. doi: 10.11607/ofph.2277
  12. Fedotov SN, Gerasimova MA., Shorokhov SD, Tischenko AI. Botulinus toxin in complex treatment of myofacial pain syndrome. Stomatologiia. 2017;96(4):23-27. doi: 10.17116/stomat201796423-27 (In Russ.)
  13. Ilyin AA, Fazylova TA, Demchinsky EA., Olesova VN., Olesov EE. A complex treatment of irreducible displacement of the temporomandibular joint disc and myofascial pain disorders with the use of botulinum toxin. Klin Praktika. 2019;10(2):14-20. doi: 10.17816/clinpract10214-20 (In Russ.)
  14. Aksu Ö, Pekin Doğan Y, Say?ner Çağlar N, Şener BM. Comparison of the efficacy of dry needling and trigger point injections with exercise in temporomandibular myofascial pain treatment. Turk J Phys Med Rehabil. 2019 Sep;65(3):228-35. doi: 10.5606/tftrd.2019.1802
  15. Okada-Ogawa A, Sekine N, Watanabe K, Kohashi R, Asano S, Iwata K, Imamura Y. Change in muscle hardness after trigger point injection and physiotherapy for myofascial painsyndrome. J Oral Sci. 2019 Mar 28;61(1):36-44. doi: 10.2334/josnusd.17-0453
  16. Ahmed S, Subramaniam S, Sidhu K, Khattab S, Singh D, Babineau J, Kumbhare DA. Effect of local anesthetic versus botulinum toxin-A injections for myofascial pain disorders : a systematic review and meta-analysis. Clin J Pain. 2019 Apr;35(4):353-67. doi: 10.1097/AJP.0000000000000681
Address for correspondence:
220116, Republic of Belarus,
Minsk, Dzerzhinskii Av., 83,
Belarusian State Medical University,
the Surgical Dentistry Department
tel. +375296440720,
Pohodenko-Chudakova Irina Olegovna
Information about the authors:
Arsenova Irina A., MD, Professor, Director of LLC Center for Advanced Training of Medical Specialists, Novosibirsk, Russian Federation.
Pohodenko-Chudakova Irina O., MD, Professor, Head of the Surgical Dentistry Department, Belarusian State Medical University, Minsk, Republic of Belarus.
Larkina Maria A., Director of LLC, Dental Clinic Dentaliya-Blesk, Novosibirsk, Russian Federation




N.I. Pirogov Russian National Research Medical University, Moscow,
Russian Federation

For a long time, the complete removal of the saphenous vein trunk has been considered to be the only effective surgical treatment of varicose veins. Over time, in addition to modifications to the removal of veins with the help of probes, endovenous thermal methods of obliteration also appeared, however, complete excision / obliteration of the incompetent segment of the trunk still remained common in all these techniques. This concept began to undergo changes only after the appearance and the development of duplex ultrasound scanning of blood vessels, which made it possible to investigate deeply the venous system hemodynamics and, as a result, to determine the further necessary treatment technique for each patient individually. Due to a detailed study of the venous hemodynamics, in 1988 French angiologist Claude Franceschi proposed the method of the ambulatory conservative hemodynamic correction of venous insufficiency (Conservatrice et Hémodynamique de lInsuffisanceVeineuse en Ambulatoire), which became known in the world as the CHIVA. This method implies the elimination of the hydrostatic pressure column in the vein, removal of blood recirculation mechanism, maintaince re-entry mechanism and elimination of tributaries which are not connected with re-entry point. As a result of CHIVA performance the normal physiological blood flow is restored by eliminating reflux from the deep vein to the superficial vein and maintaining drainage from superficial to the deep veins. In the presented review, the advantages and disadvantages of the CHIVA method are examined in details, as well as a comparative analysis of the technique with other currently existing methods of treatment of varicose vein disease.

Keywords: varicose veins, phlebectomy, vein saving surgery, hemodynamic correction, CHIVA
p. 702-713 of the original issue
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Address for correspondence:
117997, Russian Federation,
Moscow, Ostrovityanov str., 1,
N.I. Pirogov Russian National
Research Medical University,
the Faculty Surgery Department No1.
tel. +7 977 605-17-08,
Golovina Veronika I.
Information about the authors:
Golovina Veronika I., Post-Graduate Student, the Faculty Surgery Department No1, N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation.
Seliverstov Evgeny I., PhD, Assistant of the Faculty Surgery Department No1, N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation.
Efremova Oksana I., PhD, Assistant of the Faculty Surgery Department No1, N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation.
Zolotukhin Igor A., MD, Professor of the Faculty Surgery Department No1, Head of the Department of Basic and Applied Research in Surgery of RI of Clinical Surgery, N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation.



Pirogov Russian National Research Medical University, Moscow,
The Russian Federation

Herniology is one of the most ancient branches of surgery and, it continues to develop quickly. New technology adds to arsenal of surgeons constantly recently, which have found their place also in hernia surgery. Despite the rapid development of herniology the optimal method for surgical repair of ventral hernia still remains to be determined. The role of preoperative examination methods in the algorithm for choosing a treatment option has not been defined. There is no single opinion concerning different spaces in which the mesh is placed, and expediency of the minimally invasive techniques application. In addition, there is no consensus on the terminology used in current herniology. This article touches upon the epidemiological and historical aspects of surgery for ventral hernias, discusses the anatomy of the anterior abdominal wall, analyzed current terminology and classifications, describes the methods of preoperative patient evaluation and indications for surgical treatment, so as consideres the current diagnostic and therapeutic surgical options. Since several controversial issues still remain in the management of patients with ventral hernia today is relevant to search the most physiological and functional methods of of treatment that ensure the minimum risk of recurrence and complications and improving patient quality of life.

Keywords: ventral hernia, hernia repair, anterior abdominal wall, surgical mesh, minimally invasive hernia repair, component separation
p. 714-729 of the original issue
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Address for correspondence:
117997, Russian Federation,
Moscow, Ostrovityanov Str., 1,
Pirogov Russian National Research
Medical University of MH of RF,
the Department of the Faculty Surgery
No1 of the Medical Faculty,
tel.: +7 916 292 6268,
Loban Konstantin M.
Information about the authors:
Sazhin ALexandr.V., Corresponding Member of RAS, MD, Professor, Head of the Department of the Faculty Surgery No1 of the Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
Loban Konstantin M., Post-Graduate Student, Laboratory Assistant of the Department of the Faculty Surgery No1 of the Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
Ivakhov Georgy B., PhD, Associate Professor, the Department of the Faculty Surgery No1 of the Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
Petukhov Vitaly A., MD, Professor, the Department of the Faculty Surgery No1 of the Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
Glagolev Nikolay S., PHD, Assistant of the Department of the Faculty Surgery No1 of the Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
Andriyashkin Andrey V., PhD, Associate Professor, the Department of the Faculty Surgery No1 of the Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
Akhmedov Ramil R., Clinical Intern of the Department of the Faculty Surgery 1 of the Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation.



B.V.Petrovsky National Research Centre of Surgery 1, Moscow,
Smolensk State Medical University 2, Smolensk,
I.M. Sechenov First Moscow State Medical University (Sechenov University) 3, Moscow,
The Russian Federation

An analytical review of the literature on minimally invasive video-assisted endoscopic surgery for benign esophageal diseases is presented. A brief historical information of thoracoscopic esophageal surgery is given. It is noted that the advantages of video-assisted endoscopic technologies make possible to shorten the duration of treatment, reduce the rate of morbidity and mortality, which is the basis for the widespread implementation into surgical practice. The relevance of this problem was emphasized, in particular it was found that the use of thoracoscopic access for true diverticula of the thoracic esophagus is associated with minimal tissue trauma, however, with the high risk of developing specific complications. Technical aspects of surgical interventions for these diseases require the careful study. A comparative study of thoracoscopic and laparoscopic approaches during Gellers operation for cardiac achalasia showed the advantages of the latter. Furthermore the indications for minimally invasive resection of benign esophageal tumors performed from a thoracoscopic approach should have an absolute character with assessment of risk/benefit ratios. The authors conclude that the use of minimally invasive surgical technologies in the treatment of benign esophageal diseases is promising, but the safety, clinical effectiveness and economic feasibility require further analysis.

Keywords: thoracoscopy, esophageal diverticulum, achalasia, esophagectomy
p. 730-738 of the original issue
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Address for correspondence:
241019, Russian Federation,
Smolensk, Krupskaja Str., 28,
Smolensk State Medical University,
the Hospital Surgery Departmentr,
tel. +7 915 645-15-04,
Bezaltynnykh Alexander A.
Information about the authors:
Shestakov Alexey L., MD, Head of the Department of Thoracoabdominal Surgery and Oncology, Russian Scientific Center for Surgery named after acad. B.V. Petrovsky,Moscow, Russian Federation, Moscow, Russian Federation.
Bezaltynnykh Alexander A., PhD, Associate Professor, the Hospital Surgery Department, Smolensk State Medical University, Smolensk, Russian Federation.
Narezkin Dmitry V., MD, Professor, Head of the Hospital Surgery Department , Smolensk State Medical University, Smolensk, Russian Federation.
Sergeev Alexey V., PhD, Associate Professor, the Hospital Surgery Department, Smolensk State Medical University, Smolensk, Russian Federation.
Shakhbanov Magomed E., Post-Graduate Student, the Department of Thoracic-Abdominal Surgery and Oncolody, Russian Scientific Center for Surgery named after acad. B.V. Petrovsky, Moscow, Russian Federation, Moscow, Russian Federation.
Tadzhibova Ireykhan M., Post-Graduate Student, the Department of Thoracic-Abdominal Surgery and Oncolody, B.V.Petrovsky National Research Centre of Surgery, Moscow, Russian Federation.
Petrosyan Tatyana V., Post-Graduate Student, the Department of Thoracic-Abdominal Surgery and Oncolody, Russian Scientific Center for Surgery named after acad. B.V. Petrovsky, Moscow, Russian Federation, Moscow, Russian Federation.
Abdullaev Abdulla G., MD, Professor of the Hospital Surgery Department, Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
Tarasova Irina A., PhD, Assistant of the Hospital Surgery Department, Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
Babich Andrey V., Student, Smolensk State Medical University, Smolensk, Russian Federation.



Irkutsk Regional Clinical Hospital 1,
Irkutsk State Medical University 2,
Irkutsk Scientific Centre of Surgery and Traumatology 3, Irkutsk
The Russian Federation

A rare case of a young woman with a single giant metastasis of spindle-cell choroidal melanoma to the liver is described. A 32 year-old woman underwent left ocular enucleation for choroidial melanoma 8 years ago. Ultrasound examination has been diagnosed the liver pathology when she was in the 8th month of pregnancy. Later, the pathology was confirmed during a caesarean section. After delivery, the patient was referred to the oncological dispensary, where metastatic melanoma was confirmed histologically based on a transcutaneous needle biopsy. Five courses of chemotherapy have been proved to be ineffective. The woman was hospitalized to the portal hypertension department of the regional hospital. A scrupulous oncological examination revealed a solitary nature of metastasis. Its volume reached 2338 cm3, unchanged parenchyma 951 cm3. Angioarchitecture of the liver was thoroughly studied based on MSCT-angiography findings and invasive selective celiacography. The peripheral hepatic arterial branches were deformed and fragmented with pronounced recalibration which specified a malignant process. Arterial vessels of the left lobe were unchanged. The parietal branching was traced along the whole length. The right and median veins were involved in the pathological process; the left hepatic vein was intact. In view of ineffective adjuvant therapy and disease progression, the patient underwent right lateral hemihepatectomy. The early postoperative period was uneventful. One year and ten months later during the examination the patient reported about her good life quality. She is now being followed up by oncologist.

Keywords: choroidea, melanoma, liver metastasis, chemotherapy, right-lateral hemihepatectomy
p. 739-744 of the original issue
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Address for correspondence:
664003, Russian Federation,
Irkutsk, Krasnoe Vosstanie Str., 1,
Irkutsk State Medical University,
the Hospital Surgery Department,
mobile tel. +7 9025 111 027,
Grigoryev Eugene G.
Information about the authors:
Novozhilov Alexandr V., PhD, Associate Professor of the Hospital Surgery Department, Irkutsk State Medical University, Head of the Portal Hypertension Department, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
Movsisyan Mikael O., Surgeon, the Portal Hypertension Department, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
Grigorev Sergey E., PhD, Associate Professor of the Hospital Surgery Department, Irkutsk State Medical University, Surgeon, the Portal Hypertension Department, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
Grigoryev Eugene G., MD, Professor, Corresponding Member of RAS, Supervisor, Irkutsk Scientific Centre of Surgery and Traumatology, Head of the Hospital Surgery Department, Irkutsk State Medical University, Irkutsk, Russian Federation.
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