New medical technologies

TREATMENT OF HEEL BONE FRACTURES IN ISOLATED INJURES IN POLYTRAUMA

Podsonny A.A., Bondarenko A.V.

Podsonny A.A., Bondarenko A.V.

Altay State Medical University, Barnaul, Russia

Generally, the results of the treatment of heel bone fractures in patients with polytrauma are worse compared to isolated injures. It is determined by general serious condition of patients, more severe fractures and difficulty in use of traditional methods of treatment.

Objective - to study the results of treatment of heel bone fractures in isolated injures and polytrauma.

Materials and methods. 530 patients with 626 heel bone fractures have been treated in Barnaul city hospital #1 from 2000 till 2012. Isolated fractures of the heel bones occurred in 199 (37.5 %) patients, in combination with polytrauma - in 331 ones (62.5 %) including 102 (19.2 %) patients with concomitant injury, and in combination with multiple locomotorium injuries - in 229 (43.2 %) patients. Plaster immobilization was used in undisplaced fractures. Skeletal extension, external fixation, external osteosynthesis with plate and screws and percutaneous osteosynthesis with cannulated screws were used in displaced fractures.

Results. The usage of plaster immobilization contributed to better results of treatment and proved to be useful in extraarticular and articular undisplaced fractures of the heel bones. As for surgical methods of treatment, the best results were obtained when using cannulated screws.

Conclusions. Isolated heel bone fractures occur 2.2 times less frequent than in polytrauma. Severe open articular displaced fractures comprise the highest percentage of the heel bone fractures in polytrauma. It is advisable to use plaster immobilization to treat undisplaced heel bone fractures. In case of articular displaced fractures of the heel bones the usage of percutaneous osteosynthesis with cannulated screws is more effective.

Key words: polytrauma; heel bone fractures; osteosynthesis; cannulated screws.

Information about authors:

Bondarenko A.V., MD, PhD, professor, chair of traumatology and orthopedics, Altay State Medical University, Barnaul, Russia.

Podsonny A.A., postgraduate, chair of traumatology and orthopedics, Altay State Medical University, Barnaul, Russia.

Address for correspondence:

Podsonny A.A., Komsomolsky prospect,73, Barnaul, Russia, 656038

Tel: +7 (3852) 24-56-04, +7 (913) 089-15-26

E-mail: pmedic@rambler.ru

References:

1.      Koryshkov NA. Foot trauma. Yaroslavl ; Rybinsk, 2006. 208 p. Russian

2.      Tikhilov RM, Fomin NF, Koryshkov NA.  Modern aspects of treatment of consequences of hindfoot fractures. Traumatology and orthopedics of Russia. 2009; (2): 144-149. Russian

3.      Sokolov VA. Multiple and associated injuries. Moscow : GEOTAR-Media Publ., 2006. 512 p. Russian

4.      Kupitman ME, Atmansky IA, Chernikov MK, Maminov DV, Gashev AA, Zubkov MA, et al. Results and prospects of development surgical techniques for calcaneal bone fractures. Genius of orthopedics. 2013; (2): 22-26. Russian

5.      Frawley PA, Hart JA, Young DA. Treatment outcome of major fractures of the talus Text. Foot Ankle Int. 1995; l6: 339-345.

6.      Baker SP, O'Neill B, Haddon W Jr, Long WB. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J. Trauma. 1974; 14: 187–196.

7.      Bondarenko AV, Podsonny AA. Way of treatment of changes of calcaneal bone. Russian Federation patent RU 2440046. 2010 February 17. Russian

8.      Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle hind-foot, mid-foot, hallux and lesser toes. Foot and Ankle Int. 1994; 15: 349–353.

9.      Glants S. Biomedical Statistics : translated from english. Moscow : Praktika Publ., 1998. 459 p. Russian

Anesthesiology and critical care medicine

Influence of tranexamic acid on blood loss volume and risk of thromboembolic complications in knee joint endoprosthetics 

Vlasov S.V., Galyatina T.A., Vlasova I.V., Safronov N.F.

Vlasov S.V., Galyatina T.A., Vlasova I.V., Safronov N.F.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

In knee joint endoprosthetics the total blood loss during the 24 hours rarely exceeds 20-25 % of the circulating blood volume, resulting in development of different complications. One of the main reasons of postsurgical bleeding is activation of fibrinolysis. Fibrinolysis inhibitors can be used for decrease in blood loss degree. However, changes in hemostasis can increase already high risk of thromboembolic complications.

Objective – to study efficiency and safety of intrasurgical administration of tranexam in patients with expected surgical blood loss and high risk of venous thrombosis.

Materials and methods. The study included 107 patients with total knee joint endoprosthetics. During surgery the patients of the studied group (n = 55) received intravenous infusion of tranexam, 10 mg/kg. The studied hemostasis values included APPT, INR, SFC, D-dimer and lysis index (LI) before surgery and in postsurgical period. Ultrasound scanning of lower extremity veins was performed before surgery and in 4-5 days after intervention.

Results. There were no differences in blood loss volume in the groups. In postsurgical period the studied group with administration of tranexam showed more than two-fold decrease in draining losses (p = 0.037). At the same time one could observe statistically significant increase in SFC and D-dimer in the patients of both groups. Administration of tranexamic acid resulted in the proved decrease in products of fibrin lysis. Examination of lower extremity veins in postsurgical period using tranexam did not allowed any thrombotic changes in distal veins of operated extremities. The control group demonstrated thrombosis in distal veins in two patients.

Conclusion. During knee joint endoprosthetics administration of tranexamic acid infusion, 10 mg/kg, reliably decreases postsurgical blood loss. At that, risk of venous thrombosis does not increase.

Key words: venous thrombosis; blood loss; fibrinolysis inhibitors.    

Information about authors:

Vlasov S.V., candidate of medical sciences, anesthesiologist-resuscitator, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Galyatina T.A., physician of clinical laboratory diagnostics, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Vlasova I.V., candidate of medical sciences, head of department of functional diagnostics, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Safronov N.F., candidate of medical sciences, head of department of anesthesiology and resuscitation, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence: 

Vlasov S.V., 7^th district, 9, Leninsk-Kuznetsky, Russia, 652509

Tel: + 7 (384-56) 2-34-70, + 7 (384-56) 9-54-68

E-mail: svlasof@rambler.ru

References:

1.      Shevchenko YL, Stoyko YM, Zamyatin MN, Teplykh BA, Karpov IA, Smolkin  DA. Tranexamic acid blood-saving effect in knee joint endoprosthetics. General critical care medicine. 2008; 4 (6): 21-25. Russian

2.      Ellis MH, Fredman B, Zohar E, Ifrach N, Jedeikin R. The effect of tourniquet application, tranexamic acid, and desmopressin on the procoagulant and fibrinolytic systems during total knee replacement. J. Clin. Anesth. 2001; 13: 509-513.

3.      Mahdy M, Webster NR. Perioperative systemic haemostatic agents. Br. J. Anaesth. 2004; 93 (6): 842-858.

4.      Gunaydin B, Ozkose Z, Pezek S. Recombinant activated factor VII and epsilon aminocaproic acid treatment of a patient with Glanzmann's thrombasthenia for nasal polipectomy. J. Anesth. 2007; 21 (1): 106-107.

5.      Kopenkin SS, Moiseev SV. Prevention of venous thromboembolic complications in joint endoprosthetics. Surgery. 2006; (1): 36-39. Russian

6.      Vlasov SV, Safronov NF, Vlasova IV, Tleubaeva NV. Factors of risk of thrombohemorrhagic complications in knee joint endoprosthetics. Polytrauma. 2009; (2): 36-41. Russian

7.      Tengborn L. Fibrinolytic inhibitors in the management of bleeding disorders. World Federation of Hemophilia, 2007. 15 p. (Treatment of Hemophilia; vol. 42).

8.      Pan Y Z, Wu ВМ, Hong ХS. The clinical significance of platelet activation during exercise-induced myocardial ischema. Chung Hua Nei Ко Tsa Chih. 1994; 33 (2): 106-108.

9.      Zufferey P, Merquiol F, Laporte S, Decousus H, Mismetti P, Auboyer C, et al. Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery? Anesthesiology. 2006; 105 (5): 1034-1046.

10.  Bessonov SV, Orletskiy AK, Kassil VL. Features of anesthesiology provision in endoprosthetics of gross joints of lower extremities. Bulletin of traumatology by the name of N.I. Priorov. 2005; (1): 85-90. Russian

New Approaches to using Kashtan anti-shock suit during interhospital transportation of patients with polytrauma

Skopintsev D.A., Kravtsov S.A., Shatalin A.V.

Skopintsev D.A., Kravtsov S.A., Shatalin A.V.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Objective – to optimize pneumocompression modes of Kashtan anti-shock suit for transport immobilization in patients with polytrauma during interhospital transport.

Materials and methods. The study included 35 patients with polytrauma. All patients were transported from non-specialized medical facilities of Kuzbass region to Scientific Clinical Center of Miners’ Health Protection in Leninsk-Kuznetsky. The transport was performed on days 4-5 after trauma. During transportation Kashtan anti-shock suit was used only for providing reliable immobilization for lower extremities and pelvis bones using pneumocompression mode 30, 40 and 50 mm Hg over injured body regions and 15-20 mm Hg for other regions.

Results. For patients with polytrauma interhospital using compression of 30 mm Hg did not provide reliable immobilization and it resulted in additional displacement of bone fragments and pain syndrome increase. The compression with 40 and 50 mm Hg provides reliable immobilization of bone fragments. However, 50 mm Hg compression causes more expressed pain senses. The compression with 15-20 mm Hg over uninjured body regions allowed to perform more comfortable interhospital transportation for patients.

Conclusion. During interhospital transportation use of Kashtan anti-shock suit with the offered pneumocompression mode allows to provide reliable immobilization of fractures in patients with polytrauma and to reduce risk of development of compression complications.

Key words: polytrauma; interhospital transport; transport immobilization.

Information about authors:

Skopintsev D.A., anesthesiologist-resuscitator, department of resuscitation and intensive care, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Kravtsov S.A., MD, PhD, head of center of resuscitation, intensive care and anesthesiology, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Shatalin A.V., MD, PhD, head of center of resuscitation and intensive care, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Skopintsev D.A., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Federal Scientific Clinical Center of Miners’ Health Protection

Tel: + 7 (384-56) 2-40-11

E-mail: info@gnkc.kuzbass.net

References:

1.     Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AK, Kravtsov SA, Krylov YM et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. 492 p. Russian

2.     Agadzhanyan VV, Kravtsov SA, Shatalin AV, Skopintsev DA. Criteria for evaluation of severity of state in patients with polytrauma during interhospital transportation. Polytrauma; 2011. (1): 5-11. Russian

3.     Didenko AA. Development of Kashtan anti-shock suit ant its efficiency evaluation in laboratory tests and clinical practice. Abstracts diss. cand. med. sci. Moscow, 1996. 19 p. Russian

4.     Ivanov VI, Tatyanchenko VK, Elfimov AL, et al. Evaluation of severity degree of course of acute intratissual hypertensive syndrome (AIHS). In: Human and his health : the materials of X Russian national congress. St. Petersburg, 2005. p. 44-45. Russian

5.     Kolesnikov VV, Onishchenko NS, Dushkin OF. Use of Kashtan anti-shock suit in treatment of severe concomitant injury. Bulletin of traumatology and orthopedics by the name of N.N. Priorov. 2002; (2): 9–13. Russian

6.     Kravtsov SA, Skopintsev DA, Shatalin AV. Influence of infusion therapy on hemodynamics in patients with polytrauma during interhospital transportation. Polytrauma. 2011; (2): 36-41. Russian

7.     Pikovsky VY, Storozhenko IN, Sud’in VI, Artamoshina MP, Petrov AV. The study of antihypotensive action mechanisms of the anti-shock suit in patients with traumatic shock. Anesthesiology and critical care medicine. 1995. (1): 22–25. Russian

8.     Singaevsky AB, Malykh IY. Treatment of severe trauma. In: Actual problems of modern severe trauma : the abstracts from the All-Russian scientific practical conference. St. Petersburg, 2001. p. 106-107. Russian

9.     Sokolov VA, Makarov SA. Experience of using Kashtan anti-shock suit in conditions of military actions. Military medical journal. 1995; 316 (10): 72–74. Russian

10. Shatalin AV, Kravtsov SA, Agadzhanyan VV. The main factors influencing on mortality in patients with polytrauma transported to specialized traumatology center. Polytrauma. 2012; (3): 17-22. Russian

11. Shatalin AV, Agadzhanyan VV, Kravtsov SA, Skopintsev DA. Prevention of stress factors during interhospital transport of patients with polytrauma. In: New technologies in military field surgery and surgery of injuries in peace time. St. Petersburg, 2006. p. 347. Russian

12. Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK, et al. Assessment of pain. Br. J. Anaesth. 2008; 101 (1): 17-24.

13. McSwain NE, White RD, Paturas JL, Metcalf WR. The basic EMT: Comprehensive prehospital patient care. St. Louis, 1997. 824 p.

Clinical aspects of surgery

TACTICS OF SURGICAL TREATMENT OF

CHRONIC LARYNGITIS IN MINERS

Lopatin D. G.

Lopatin D. G.

Regional Clinical Hospital for War Veterans,

Kemerovo, Russia

Surgical treatment of 249 patients with chronic laryngitis was performed. 167 (67.1 ± 3.1 %) patients of the first subgroup received endolaryngeal surgery with indirect laryngoscopy. 82 (32.9 ± 3.1 %) patients of the second subgroup received endolaryngeal intervention under direct microlaryngoscopy. In case of indeterminate borders of a lesion the staining of altered larynx mucosa sections was performed using the special device developed by us.  The comparison of treatment outcomes in two groups was conducted with Chi-square test (χ² = 4.05 with 1 degree of freedom: p = 0.05).

Objective - to determine the tactics of effective surgical treatment of chronic laryngitis in miners.

Materials and methods. The present study included 249 miners with chronic laryngitis for which endolaryngeal operations were carried out. All patients were divided into two groups with statistical significance (p = 0.445, p = 0.574) and without differences according to age and sex. The process of distribution of patients into groups was conducted using computer randomized codes (simple randomization). The study was open, cohort, prospective, extended, randomized and controlled. The type of randomization was simple (odd, even). Patient selection was conducted according to the inclusion and exclusion criteria.

Conclusion. The number of patients with chronic laryngitis in Kuzbass, particularly among miners, is great and includes 6.7 % of all patients in otorhinolaryngological departments. When conducting operations under local anesthesia with guttural corneoscleral punch like “Cordes” one can achieve full recovery in 63.3 ± 1.3 %. The application of the proposed method of surgical treatment of chronic laryngitis can significantly increase the number of patients with recovery, achieve full recovery in 81.7 ± 0.7 % of patients and reduce the percentage of patients with further malignant process in the larynx.

Key words: chronic laryngitis; surgical treatment; microsurgical technique.

Information about author:

Lopatin D.G., otorhinolaryngologist, department of otorhinolaryngology, Regional Clinical Hospital for War Veterans, Kemerovo, Russia.

Address for correspondence:

Lopatin D.G., Sobornaya St., 5-38, Kemerovo, Russia, 650004

Tel: +7 (905) 949-57-67.

E-mail: endo_lor@mail.ru

References:

1. Inflammatory diseases of larynx and their complications : manual. Palchun VT, Lapchenko AS, Muratov DL, editors. Moscow : GEOTAR-Media Publ., 2010. 176 p. Russian

2. Fedina IN, Sineva EL. Features of development of upper respiratory tract pathology in miners of polar regions. Bulletinе of otorhinolaryngology. 2009; (6): 54. Russian

3. Eckley CA, Costa HO. Comparative study of salivary pH and volume in adults with chronic laryngopharyngitis by gastroesophageal reflux disease before and after treatment. Braz. J. Otorhinolaryngol. 2010; 72 (1): 55-60.

4. Ryabova MA, Nemykh OV. Chronic laryngitis: principles of pathogenetic treatment. St. Petersburg : Dialog Publ., 2010. p. 116-131. Russian

5. Vdovina EV. Dental health in patients with malignant tumors of larynx and   oropharyngeal region at the stages of combined treatment. Abstracts diss. cand. med. sci. Barnaul, 2012. p. 7-8. Russian

6. Yanov YK, Stepanova YE, Yurkov AY, Pevtsov DI, Shustova TI. Autofluorestsent diagnostics of larynx diseases. Russian otorhinolaryngology. 2010; (4): 95-96. Russian

Analysis of results of clinical treatment of ventral hernias with mesh implant

Rotkin E.A., Drugov A.S., Kuznetsov A.D.

Rotkin E.A., Drugov A.S., Kuznetsov A.D.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

During the last years one can observe wide spreading of prosthetic techniques for anterior abdominal hernia plastics. The approaches to treatment of ventral hernias were discussed and revised many times. However, there is no uniform opinion about choosing method of prosthetic surgery.

Objective – to analyze the results of herniotomies with mesh implants in patients with ventral hernias.

Materials and methods. 271 patients with ventral hernias were treated from 2005 till 2012. For these patients planned hernioplasty was performed with prosthesis installation according to the standard alloplastic techniques (onlay, sublay, inlay). There were 98 men (36 %), mean age of 48.5 ± 8.36 and 173 women (64 %), mean age of 54.2 ± 11.63. 176 patients were operated with onlay technique, 73 – with sublay, 22 – with inlay.

Results. Immediate causes of incisional hernia development were disorders in wound healing processes in 38.9 % and associated diseases in 24.5 %. The number of surgeries with onlay technique was 65 % of all operations, sublay – 27 %, inlay – 8 %. In 15.3 % of the patients in onlay group the wound complications were found as well as in 10.9 % in the sublay group and in 9.1 % in the inlay group. In the group of supraaponeurotic prosthesis fixation (onlay) the recurrence was in 7 (6.6 %) patients. In the group of subgaleal prosthesis location (sublay) the recurrence was noted in 2 (5.4 %) patients. 3 patients (21 %) with inlay surgery had the highest recurrence rate.

Conclusion. Hernioplasty with prosthesis installation into supraaponeurotic space (onlay) is considered as the most demanded and rational alloplasty. The wound complications after alloplasty of this type were noted in 15.3 %, but their characteristics and location did not require serious treatment.

Key words: ventral hernia; mesh implant; wound complications.

Information about authors:

Rotkin E.A., surgeon, surgery department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Drugov A.S., surgeon, surgery department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Kuznetsov A.D., surgeon, surgery department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Rotkin E.A., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Federal Scientific Clinical Center of Miners’ Health Protection

Tel: + 7 (384-56) 9-55-23

E-mail: Rotkin@inbox.ru

References:

1.      Belokonev VI, Pushkin SY, Kovaleva ZV, Vostretsov YA, Nagapetyan SV, Melentyeva ON, et al. Technique of variants of combined method of plastics for postoperative hernia. In: Bulletin of Herniology : collection of scientific papers. Мoscow, 2004. p. 13-19.) Russian

2.      Vasilyev SA. Classification of plastic materials. Annals of plastic, reconstructive and aesthetic surgery. 2001; (4): 51-56. Russian

3.      Gostevskoy AA. Unsolved issues of prosthetics of anterior abdominal wall in hernias. Bulletin of Surgery by the name of I.I. Grekov. 2007; 166 (4): 114-117. Russian

4.      Egiev VN, Chizhov DV, Filatkina NV.  Interaction of polypropylene endoprosthesis and tissues of anterior abdominal wall. Herniology. 2005; (2): 41-49. Russаin

5.      Zhebrovsky VV. Abdominal hernia surgery. Мoscow : Medical Information Agency Publ., 2005. 381 p. Russian

6.      Mariev AI, Ushakov ND, Shornikov VA, Ivanova AM. Postsurgical ventral hernias. Petrozavodsk : Petrozavodsk State University Publ., 2003. 124 p. Russian

7.      Non-tension hernioplasty. Egiev VN, editor. Мoscow, 2002. p. 148. Russian

8.      Sinichenko GI, Gayvoronsky IV, Kurygin AA, Romashkin-Timanov MV, Zhukovsky VA. Choice of method of anterior abdominal wall plastics in patients with postsurgical ventral hernias. Bulletin of Surgery by the name of I.I. Grekov. 2005; (6): 29-32. Russian

9.      Yagudin MK, Shaymardanov RS, Zaynutdinov AM. Risk of postsurgical complications in combined treatment of postsurgical ventral hernias. Annals of Surgery. 2004; (4): 167. Russian

10.  Bellón JM, Rodríguez M, Serrano N, García-Honduvilla N, Gómez V, Buján J. Polypropylene and polydioxanone show similar biomechanical efficacy in midline closure. Cir. Esp. 2005; 78 (6): 377-381.

11.  Cobb WS, Kercher KW, Heniford BT. The argument for lightweight polypropylene mesh in hernia repair. Surg. Innov. 2005; 12 (1): 63-69.

12.  Fischer T, Ladurner R, Gangkofer A, Mussack T, Reiser M, Lienemann A. Functional cine MRI of the abdomen for the assessment of implanted synthetic mesh in patients after incisional hernia repair: initial results. Eur. Radiol. 2007; 17 (12): 3123-3129.

13.  Heartsill L, Richards ML, Arfai N, Lee A, Bingener-Casey J, Schwesinger WH, et al. Open Rives-Stoppa ventral hernia repair made simple and successful but not for everyone. Hernia. 2005; 9 (2): 162-166.

14.  Korenkov M, Sauerland S, Arndt M, Bograd L, Neugebauer EA, Troidl H. Randomised clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia. Br. J. Surg. 2002; 89 (1): 50-56.

EFFECTIVENESS OF PANCREATIC RUPTURES TREATMENT USING ELECTRO-WELDING IN PATIENTS WITH POLYTRAUMA

Gorbenko K.V.

Gorbenko K.V.

Kharkov National Medical University,

Kharkov, Ukraine

Objective - to determine the effectiveness of the electro-welding method in the treatment of pancreatic ruptures in patients with polytrauma.

Materials and methods. The study was performed on the base of polytrauma department in Kharkov municipal clinical hospital of emergency care by the name of A.I. Meshchaninov. 27 cases of pancreatic ruptures were analyzed for the period from 2002 till 2012. For estimation of injury severity ISS was used.    The control group consisted of 15 patients treated with the standard techniques. The main group included 12 patients with using the new surgical technique.  

Results. The main problems of pancreatic trauma surgical treatment were analyzed. The effectiveness of the new method of electro-welding in patients with pancreatic ruptures was defined. Using EK 300M1 in treatment of pancreatic ruptures in patients from the main group showed the significant reduction of posttraumatic pancreatitis compared to the control group (25 % vs. 66.6 %).

Conclusions. It is determined that using the proposed method can restore the anatomical integrity of the gland, provide hemostasis while reducing the time of surgery and reduce occurrence of pancreatogenic postoperative complications, such as posttraumatic pancreatitis.

Key words: pancreas; trauma; pancreatitis; electro-welding; coagulation.

Information about author:

Gorbenko K.V., postgraduate of surgery chair #1, Kharkov National Medical University, Kharkov, Ukraine.

Address for correspondence:

Gorbenko K.V., Otara Yarosha St., 15-84, Kharkov, Ukraine, 61045

Tel: +380 (50) 643-95-01

Е-mail: gorbenkokostya@mail.ru

References:

1.             Ahmed N, Vernick JJ. Pancreatic injury. South Med. J. 2009; 102 (12): 53-56.

2.             Baker SP, O'Neill B, Haddon W Jr, Long WB. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J. Trauma. 1974; 14 (3): 187-196.

3.             Beloglyadov IA, Ivanov YV, Vorobyev VN. Using the universal welding complex EK-300M1 in laparoscopic cholecystectomy. In: Organization of high tech medical assistance in multi-profile hospital : the collection of scientific works dedicated to 40^th anniversary of Central Military Clinical Hospital by the name of A.A. Vishnevsky. Krasnogorsk, 2008. p. 54. Russian

4.             Debi U, Kaur R, Prasad KK, Sinha SK, Sinha A, Singh K. Pancreatic trauma: A concise review. World J. Gastroenterol. 2013; 19 (47): 9003-9011.

5.             Degiannis E, Glapa M, Loukogeorgakis SP, Smith MD. Management of pancreatic trauma. Injury. 2008; 39: 21-29.

6.             Glants S. Biomedical Statistics : translated from english. Moscow : Practice Publ., 1999. 459 p. Russian

7.             Gupta A, Stuhlfaut JW, Fleming KW, Lucey BC, Soto JA. Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radiographics. 2004; 24: 1381-1395.

8.             Ivanov YV, Shablovsky OR, Beloglyadov IA, Solovyev NA. Possibilities of using welding techniques in surgery. In: Actual issues of surgery : the materials from IX scientific practical conference of surgeons of Federal Medical and Biological Agency of Russia. Severodvinsk, 2008. p. 103-104. Russian

9.             Ivanova ON, Kunkin DD. Fifth International seminar "New directions of research in the field of welding living soft tissue". Automatic welding. 2011; (1): 63-64. Russian

10.         Al-Ahmadi K, Ahmed N. Outcomes after pancreatic trauma: experience at a single institution. Can. J. Surg. 2008; 51 (2): 118-124.

11.         Rickard MJ, Brohi K, Bautz PC. Pancreatic and duodenal injuries: keep it simple. ANZ J. Surg. 2005; 75: 581-586.

12.         Teslenko SN. Closed injuries to the pancreas. Kharkov surgical school. 2009; (4.1): 295-298. Russian

Functional, instrumental and laboratory diagnostics

OXIDATIVE STRESS MARKERS AS EARLY ASSESSMENT CRITERIA FOR PATIENTS WITH SEVERE CONCOMITANT THORACIC INJURY

Stupnitsky M.A.

Stupnitsky M.A.

Kharkov National Medical University,

Kharkov, Ukraine

Objective – to search the evaluation criteria for severity of state of patients in shock period of severe concomitant thoracic injury among the markers of oxidative injury to lipids and proteins, which could predict outcome.

Materials and methods. The blood plasma of 73 male patients aged from 20 to 68 was evaluated for the levels of protein carbonyl groups and malondialdehyde at the 1-2 days after trauma, with conversion into relative concentrations by means of division by total protein level for correction for infusion therapy.

Results. The patient population was divided into 5 clusters with cluster analysis taking into account the mortality level. The clusters were united into 3 groups with 20 %, 50 % and 100 % mortality. Valid cut off values between groups were determined according to ROC-analysis. According to these cut off values the oxidative stress severity criteria during shock period of severe concomitant thoracic injury were determined.

Conclusion. These criteria can make valid prediction of mortality and are independent of patient age, severity of injuries to individual anatomic regions and prehospital period duration. Favorable outcome (expected mortality - 20 %) in patients with the malondialdehyde level from 0.1004 to 0.1423 mcMl/g of protein can be expected in combination with the concentrations of the protein carbonyl groups from 14 to 17.29 mcM/g of protein, and doubtful outcome (expected mortality - 50 %) - from 10.78 to 14 mcM/g of protein. Very high and very low concentrations of proteins (less than 10.78 and more than 17.29 mcM/g of protein) and lipids (less than 0.1004 and more than 0.1423 mcM/g of protein) oxidative damage markers predict poor outcome of traumatic disease.

Key words: concomitant thoracic injury; lipid peroxidation; protein peroxidation; patient status evaluative criteria; survival prediction.

Information about author:

Stupnitsky M.A., applicant for candidate of medical science, Kharkov National Medical University, biochemistry chair, Kharkov, Ukraine.

Address for correspondence:

Stupnitsky M.A., Lypneva Sq., 10/8, Lviv, Ukraine, 79018

Tel: +380 (97) 128-63-73

E-mail: stupnytskyima@gmail.com

References:

1.       Gumanenko EK, Boyarintsev VV, Suprun TY, Lyashedko PP. Objective evaluation of the trauma severity : the manual. St. Petersburg, 1999. 111 p. Russian

2.       Dubinina EE, Burmistrov SO, Khodov DA, Porotov IG. Oxidative modification of human blood serum proteins: a method for its estimation. Questions of medical chemistry. 1995; 41 (1): 24–26. Russian

3.       Ermolov AS. Main principles of the combined trauma diagnostics and treatmant. In: 50 lectures about surgery : coll. Savel'ev VS, editor. Moscow: Media Medica Publ., 2010. p. 292–295. Russian

4.       Regeda MS, Kresyun VY, Frayt VM, Gayduchok ІG, Trutyak IR, Kimakovich VY, et al. Emergency states. Lvov : Magnoliya Publ., 2008. 835 p. Ukrainian

5.       Ulovitsina TI. Methods of the individual proteins estimation. Krasnoyarsk, 1991. 384 p. Russian

6.       Shcherban' NG, Gorbatch TV, Guseva NR, Mishura AI, Denisenko SA, Gilum LI, et al. Laboratory methods for study of the body antioxidant system status and the lipoperoxidation level : methodical reccomendations for doctors, graduate students, masters, scientific reserchers. Kharkov : KhSMU Publ., 2004. 36 p. Russian

7.       Chavko M, Adeeb S, Ahlers ST, McCarron RM. Attenuation of pulmonary inflammation after exposure to blast overpressure by n-acetylcysteine amide. Shock. 2009; 32 (3): 325–331.

8.       Duvigneau JC, Kozlov AV, Zifko C, Postl A, Hartl RT, Miller I, et al. Reperfusion does not induce oxidative stress but sustained endoplasmic reticulum stress in livers of rats subjected to traumatic-hemorrhagic shock. Shock. 2010; 33 (3): 289–298.

9.       Frink M, Zeckey C, Mommsen P, Haasoer C, Krettek C, Hildebrand F. Polytrauma management - a single centre experience. Injury. 2009; 40 (Suppl. 4): S5–S11.

10.     Miller DL, Mansour KA. Blunt Traumatic Lung Injuries. Thorac. Surg. Clin. 2007; 17 (1): 57–61.

11.     Smolle J, Prause G, Smolle-Jüttner F-M. Emergency treatment of chest trauma - an e-learning simulation model for undergraduate medical students. Eur. J. Cardio-Thoracic Surg. 2007; 32 (4): 644–647.

12.     Zheng W, Huang L-Z, Zhao L, Wang B, Xu HB, Wang GY, et al. Superoxide dismutase activity and malondialdehyde level in plasma and morphological evaluation of acute severe hemorrhagic shock in rats. Am. J. Emerg. Med. 2008; 26 (1): 54–58.

Researches of young scientists

MODIFIABLE RISK FACTORS OF OSTEOPOROSIS ON BACKGROUND OF RITUXIMAB THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS

Raskina T.A., Koroleva M.V.

Raskina T.A., Koroleva M.V.

Kemerovo State Medical Academy,

Kemerovo, Russia

Objective - to assess the influence of rituximab therapy on modifiable risk factors (RF) of osteoporosis in patients with rheumatoid arthritis (RA).

Materials and methods. We observed 56 patients with documented diagnosis of RA. All patients were divided into two groups according to the level of bone mineral density (BMD): group 1 - patients with osteopenia (n = 34), and group 2 - patients with osteoporosis (n = 22). To assess the risk factors the thematic case of RA patients was used developed by Rheumatology Research Institute of Russian Academy of Medical Sciences with the program "Osteoporosis in rheumatoid arthritis: diagnosis, risk factors, fractures, treatment." BMD was measured with dual-energy x-ray absorptiometry. Osteoporosis risk factors and BMD were assessed in   therapy with rituximab over the time.

Results. During treatment with rituximab positive trend was observed in both groups of patients related to two risk factors. Thus, 6 (27.3 %) patients with osteoporosis had a statistically significant increase in BMD and T-criterion, and levels of physical activity increased in 7 patients (31.8 %). In the group of patients with osteopenia the number of patients with low body weight decreased (1 patient, 2.9 %), and low levels of physical activity reduced (2 patients, 5.9 %). Osteoporotic fractures occurring with minimal trauma were registered in 3 patients with osteoporosis (13.6 %).

Conclusion. In patients with rheumatoid arthritis the therapy with rituximab has positive influence on bone mineral density and level of physical activity.   

Key words: rheumatoid arthritis; osteoporosis; rituximab; risk factors; bone mineral density.

Information about authors:

Raskina T.A., MD, PhD, professor, head of chair of propaedeutics of internal diseases, Kemerovo State Medical Academy, Kemerovo, Russia.

Koroleva M.V., postgraduate, chair of propaedeutics of internal diseases, Kemerovo State Medical Academy, Kemerovo, Russia.

Address for correspondence:

Koroleva M.V., Voroshilova St., 22A, Kemerovo, Russia, 650090

Kemerovo State Medical Academy

Tel: +7 (951) 187-55-28

E-mail: 576078@mail.ru

References:

1.             Shostak NA, Muradyants AA. Rheumatoid arthritis and osteoporosis. Russian Medical Journal. 2004; (4): 287. Russian

2.             Nasonov EL, Skripnikova IA, Nasonova VA. The problem of osteoporosis in rheumatology. Moscow : Stin Publ., 1997. 429 p. Russian

3.             Nasonov EL. Glucocorticoid osteoporosis: current recommendations. Consilium medicum. 2012; (4): 8. Russian

4.             Rozhinskaya LY. Systemic osteoporosis. Moscow, 2000. 196 p. Russian

5.             Karateev DE, Radenska-Lopovok SG, Nasonova VA. Synovium in the early stages of rheumatoid arthritis: clinical and morphological comparisons. Therapeutic archive. 2003; (5): 12-20. Russian

6.             Raskina TA, Letaeva MV. Bone mineral density in men with different clinical variants of rheumatoid arthritis. Scientific and practical rheumatology. 2011; (2): 21-24. Russia

7.             Clinical recommendations. Osteoporosis. Diagnosis, prevention and treatment. Benevolenskaya LI, Lesnyak OM, editors. Moscow: GEOTAR-Media Publ., 2010. 270 p. Russian

8.             Dydykina IS, Alekseeva LI. Osteoporosis in rheumatoid arthritis: diagnosis, risk factors, fractures, treatment. Scientific and practical rheumatology. 2011; (5): 13-17. Russian

9.             Nasonov EL. Anti-B-cell therapy in rheumatology: Focus on rituximab. Moscow, 2012. 344 p. Russian

10.          Grigoreva NV. Methotrexate and bone. News of medicine and pharmacy. 2009; (19): 293. Russian

11.         Cohen SB. Rituximab for rheumatoid arthritis refractory to anti–tumor necrosis factor therapy: Results of a multicenter, randomized, double–blind, placebo–controlled, phase III trial evaluating primary effectiveness and safety at twenty–four weeks. Arthritis Rheum. 2006; 54 (9): 2793-2806.

12.         Tak PP, Rigby WF, Rubbert-Roth A, Peterfy CG, van Vollenhoven RF, Stohl W et al. Inhibition of joint damage and improved clinical outcomes with rituximab plus methotrexate in early active rheumatoid arthritis: the IMAGE trial. . Ann. Rheum. Dis. 2011; 70: 39-46.

13.         Boumans MJ, Thurlings RM, Yeo L, Scheel-Toellner D, Vos K, Gerlag DM, et al. Rituximab abrogates joint destruction in rheumatoid arthritis by inhibiting osteoclastogenesis. Ann. Rheum. Dis. 2012; 71 (1): 108-113.

14.         Sinigaglia L, Nervetti A, Mela Q, Bianchi G, Del Puente A, Di Munno O, et al. A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. J Rheumatology. 2000; 27: 2582-2589.

15.         Lane NE, Pressman AR, Star VL, Cummings SR, Nevitt MC. Rheumatoid arthritis and bone mineral density in elderly women. The study of Osteoporotic fractures Research Group. Journal on Bone Mineral Research. 1995; 10 (2): 257-263.

FEATURES OF HEARING ORGAN INJURY IN MINE EXPLOSIVE TRAUMA

Pavlov V.V., Kichkina M. М.

Pavlov V.V., Kichkina M. М.

 Novokuznetsk State Institute of Postgraduate Medicine,

City Clinical Hospital #1, Novokuznetsk, Russia

Objective - to reveal the peculiarities of hearing organ injury after mine explosive trauma, and to evaluate the effectiveness of the complex of the procedures during a long period of time.

Materials and methods. The study is based on the clinical observations of hearing in 141 miners who were injured after the methane-air mixture explosion in 2010. Observations and treatment were performed both in acute period after trauma and within subsequent 3 years. The control group included 107 miners.

Results. During the primary investigation the hearing organ pathologies were detected in 106 patients (75 ± 3.6 %), of whom 63 persons (45 ± 4.1 %) had sensorineural hearing loss, 9 (6.4 ± 2.0 %) - post-traumatic otitis with rupture of the eardrum, 2 (1.6 ± 1.0 %) - unilateral deafness, 32 (22 ± 3.5 %) – ear thermal burns. In the result of the treatment, recovery occurred in 53 (42 ± 4.4 %) of the patients. Sensorineural hearing loss persisted in 61 (48 ± 4.4 %), in 8 of them (6 ± 2.1 %) sharp deterioration of hearing after 1.5-2 years appeared which led to the loss of specialty. In the control group the hearing pathologies were in 23 miners (21.3 ± 3.9 %) with experience of work in harmful conditions for more than 20 years. There were no cases of sudden hearing loss leading to the loss of specialty.

Conclusion. Traumatic injuries to hearing organ in miners after explosive mine trauma are 75 ± 3.6 %. Early audiological examination reveals acute posttraumatic sensorineural hearing loss, which should be treated as soon as possible. Hearing organ injury in miners not being a life-threatening injury at the time of trauma becomes one of the major causes of reduced quality of life, with a possible loss of specialty and costly rehabilitation in the form of regress payments and hearing aid.

Key words: features of hearing organ injury; mine explosive trauma.

Information about authors:

Pavlov V.V., MD, PhD, professor, chair of otorhinolaryngology by the name of A. N. Zimin, Novokuznetsk State Institute of Postgraduate Medicine, Novokuznetsk, Russia.

Kichkina M.M., audiologist, advisory policlinic of City Clinical Hospital #1, Novokuznetsk, Russia. 

Address for correspondence:

Pavlov V.V., Kirova St., 100-8, Novokuznetsk, 654066

Tel: + 7 (384-3) 79-66-28; +7 (903) 945-60-96

E-mail: ven-pavlov@ya.ru

References:

1. Antipyev VN, Lushnikova YV, Skakov IA. To the question about the explosions of methane in coal mines. Labour Safety in industry. 2011; (1): 59-61. Russian

2. Khoroshilova LS, Tarakanov AV, Horoshilov AV. Reasons of explosions of methane and coal dust in mines of Kuzbass. Newsletter of Scientific Center of Labor Safety in Coal Industry. 2012; (2): 187-191. Russian

3. Professional diseases of the upper respiratory tract and ear : a guide for physicians. Babiyak VI, Nakatis YA, editors. St. Petersburg : Hippocrates Publ., 2009. 696 р. Russian

4. Egorov SV. Perilymfoid fistulas of labyrinth as the reason of cochleovestibular frustration in the remote period of mine-explosive defeats. Russian otorhinolaryngology. 2010; (1): 31-35. Russian

5. Skritsky VA, Oparin VN. Causes and prevention of explosions of methane and endogenous fires in coal mines of Kuzbass. Mining Industry scientific and technical journal. 2010; (3): 50-56. Russian

6. Khoroshilova LS, Zabolotskaya KA. Condition of the coal industry of Kuzbass and security of labor of miners in the conditions of economic and political transformation in Russia. Labour Safety in industry. 2012; (1): 68-87. Russian

Rehabilitation

IS PLATYPODIA ALWAYS AN ANATOMIC AND FUNCTIONAL DEFECT OF THE FOOT?

Konovalova N.G.,  Maslennikova V.G.

Konovalova N.G.,  Maslennikova V.G.

Novokuznetsk Scientific Practical Center of Medical Social Expertise and Rehabilitation of Disabled Persons,

Novokuznetsk Prosthetic Orthopedic Enterprise,

Novokuznetsk, Russia

Platypodia is the most common defect of the foot. It is commonly thought that the loss of foot function corresponds to the degree of platypodia. Clinical experience shows that it is not always the case.

Objective - to analyze the relationship between the decrease in the height of foot arches and the loss of its function.

Materials and methods. Sixty people with degree of platypodia of the third degree were examined. The patients underwent clinical examination, plantopodography, and testing with the DiaSled complex.

Results. Seventy-five per cent of the subjects were found to have specific complaints, displacement of the overall center of pressure, diagonal skew, inter-extremity asymmetry, and abnormal regional load distribution. These patients demonstrated abnormal load distribution when walking between the two feet as well as in some areas of the foot. Twenty-five per cent of the subjects did not have any complaints and the load distribution between their feet appeared to be normal both when standing and walking.

Conclusion. The decrease in the height of the arches and the deformation of the foot may not lead immediately to impaired foot function. It is necessary to assess not only the shape of the feet, but also their function when determining medical restrictions to physical activity.

Key words: foot; platypodia; plantopodogram; DiaSled.

Information about authors:

Konovalova N.G., MD, PhD, senior researcher of department of medical and social professional rehabilitation, Novokuznetsk Scientific Practical Center of Medical Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.

Maslennikova V.G., orthopedist, computer diagnostic unit, Novokuznetsk Prosthetic Orthopedic Enterprise, Novokuznetsk, Russia.    

Address for correspondence:

Konovalova N. G., Malaya St., 7, Novokuznetsk, Kemerovo Region, 654055

Novokuznetsk Scientific Practical Center of Medical Social Expertise and Rehabilitation of Disabled Persons

Теl: + 7 (903) 908-18-61

E-mail: root@reabil-nk.ru; konovalovang@yandex.ru

References:

1.             Dzhumok AA. Diagnosis of the flatfoot and problem of its correction in children aged 9-10 engaged in playing tennis. The proceedings of the university by the name of P.F. Lesgaft. 2012; (11): 24-28. Russian

2.             Kurgansky AM. The prevalence of foot deformities among elementary school students in the city. In: Actual problems of pediatrics : Х congress of pediatricians of Russia. Moscow, 2006. p. 313-314. Russian

3.             Rykalina EB, Lukina GA. Extent of teenagers’ flatfoot. Bulletin of medical Internet conferences [Electronic resources]. 2013; 3 (2): 259-262. Available at: http://medconfer.com/node/2368. Russian

4.             Sergienko KN. About diagnosis of foot deformities. Physical education of students of creative specialties. 2002; (7): 26-31. Russian

5.             Sokov LP, Sokov EL, Sokov SL. Guidance for neuroorthopedics. Moscow : Kameron Publ., 2004. 541 p. Russian

6.             Lashkovsky VV, Marmysh AG. Pediatric and adolescent podiatry - Modern approaches to the diagnosis and treatment of diseases of the feet. Novosti hirurgii. 2011; 19 (2): 94-100. Russian

Case history

SURGICAL RESTORATION OF CHEST STRUCTURE IN PATIENT WITH CLOSED CHEST INJURY WITH POLYTRAUMA

Pronskikh Al. A., Kravtsov S.A., Pronskikh A.A.

Pronskikh Al. A., Kravtsov S.A., Pronskikh A.A.

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Closed chest injury in patients with polytrauma has great clinical significance in context of high mortality (76-85.7 %) and high rate of complications (45.6-75 %). In 90 % of cases it is accompanied by injuries to the lungs and mediastinal organs and severe respiratory complications: adult respiratory distress syndrome, congestive pneumonia, severe respiratory insufficiency. One of the key moments of treatment is a problem of injured chest structure restoration.

Objective – by means of a clinical example to demonstrate the possibilities of surgical restoration of chest structure with the original fixator in the patient with polytrauma with severe closed chest injury as the leading one.

Materials and methods. The case of treatment is presented with the patient with polytrauma and severe thoracic trauma. During the first day after admission to Clinical Center of Miners’ Health Protection the patient received surgical restoration of chest structure by means of open reduction, rib osteosynthesis with the original fixator – angle stability plate under endovideothoracoscopy.

Results. For the presented patient it was possible to reduce terms of stay in ICU and  artificial lung ventilation. The patient was discharged for out-patient treatment in satisfactory condition. There were no purulent septic complications and migrations of metal constructions.

Conclusion. Early restoration of chest structure using the original fixator under endovideothoracoscopy allowed maximal rapid mobilization of the patient, prevention of severe respiratory complications and reduction of ALV time.

Key words: polytrauma; closed chest injury; chest structure; endovideothoracoscopy.

Information about authors:

Pronskikh Al. A., traumatologist-orthopedist, department of traumatology and orthopedics #1, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Kravtsov S.A., MD, PhD, head of anesthesiology and resuscitation center, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Pronskikh A.A., MD, PhD, head of traumatology and orthopedics center, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Pronskikh A.A., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Tel: + 7 (384-56) 9-52-87; + 7 (904) 576-99-70

E-mail: Proal_88@mail.ru

References:

1.      Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AK, Kravtsov SA, Krylov YM et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. p. 13-14. Russian

2.      Vagner EA. Surgery of chest injuries. Moscow : Meditsina, 1981. 288 p. Russian

3.      Zhestkov KG, Barskiy BV, Voskresenskiy OV. Low invasive surgery in treatment of floating fractures of ribs. Pacific medical journal. 2006; (1): 62-65. Russian

4.      Klingunenko EN, Novikov PP, Maystroskiy AI, et al. Algorithm of intensive care in severe chest injury. Anesthesiology. 2003; (1): 34-43.) Russian

5.      Sigal EI, Zhestkov KG, Burmistrov MV, Pikin OV. Thoracoscopic surgery. Moscow, 2012. Russian

6.      Surgical diseases : manual. Fedorov VD, Emelyanov SI, editors. Moscow : MIA Publ., 2005. 475 p. Russian

7.      Sharipov IA. Chest injury. Problems and solutions. Moscow : Graal, 2003. 326 p. Russian

8.      Ahmed Z., Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J. Thorac. Cardiovasc. Surg. 1995; 110 (6): 1676-1680.

9.      Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest injury due to blunt trauma. Eur. J. Cardiothorac. Surg. 2003; 23 (3): 374-378.

10.  Nirula R, Diaz JJ, Trunkey DD, Mayberry JC. Rib fracture repair: indications, technical issues, and future directions. World J. Surg. 2009; 33: 14-22.

11.  Damage Control Management in the Polytrauma Patient. Pape H-C, Peitzman AB, Giannoudis PV, Schwab CW, editors. Springer, 2009. 463 p.

12.  Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, et al. Surgical Stabilization of Internal Pneumatic Stabilization? A Prospective Randomized Study of Management of Severe Flail Chest Patients. J. Trauma. 2002. 52 (4): 727-732.

13.  Zeigler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994; 37: 975–979.

Discussions

TERMINOLOGY AND CLASSIFICATION OF OPERATIONS IN PLASTIC SURGERY, TRAUMATOLOGY AND ORTHOPEDY

Torgunakov А. P. 

Torgunakov А. P. 

Kemerovo State Medical Academy,

Kemerovo, Russia

Scientific and technical progress of last decades promoted introduction of set of new terms, definitions and turns of speech. Also it has influenced on medical terminology, in particular, concerning surgical operation. The part of definitions and classifications do not correspond to present realities. There is an unsuccessful application of foreign terms.

Objective - to survey some terms, definitions and classifications with reference to surgical operation and to state author’s position.

Materials and methods. The study is based on 50 year experience of surgical activity of the author as general surgeon, the traumatologist, vascular surgeon and transplantologist, 43 year teaching of surgery, the analysis of the literature and case histories in Kemerovo city hospital #2 in relation with application of terms, assessment of patient severity state and degree of operational risk.

Results. In surgical activity and surgery teaching out-of-date definitions and classifications are used. Unreasonable use of foreign terms is noted.

Conclusion. The problem of terminology and definitions in surgical practice is more extensive and significant. The author has attracted reader’s attention to its small part to show necessity of the approach to this question with higher responsibility.

Key words: surgical operation; terminology; definitions.

Information about author:

Torgunakov A.P., MD, PhD, professor, had of general surgery chair, Kemerovo State Medical Academy, Kemerovo, Russia.

Address for correspondence:

Torgunakov A.P., Oktyabrsky prospect, 82-402, Kemerovo, Russia, 650065

Tel: + 7 (384-2) 53-15-96

E-mail: aptorgunakov@rambler.ru

References:

1.             Beburishvili AG, Panin SI, Pirozhenko PA. The technological classification of low invasive operations. Surgery. 2009; (7): 29-32. Russian

2.             Gostishchev VK. General surgery : the textbook for medical schools. 4^th edition. Мoscow : GEOTAR-Media Publ., 2006. p. 222. Russian

3.             Kovalenko PP. The bases of transplantology. Rostov-on-Don : The publishing office of Rostov university Publ., 1975. 179 p. Russian

4.             Torgunakov AP. The classification of surgery in acute cholecystitis. Surgery. 1985; (11): 101–102. Russian

5.             Multivolume surgery manual. Moscow : Medgiz Publ., 1962. Vol. 1. p. 211–248. Russian

Reviews

INTRACRANIAL PRESSURE MONITORING: PRESENT AND PROSPECTS (report 3)

Gorbachev V.I., Likholetova N.V., Gorbachev S.V.

Gorbachev V.I., Likholetova N.V., Gorbachev S.V.

Irkutsk State Medical Academy of Postgraduate Education,

Irkutsk, Russia

Objective – to review the non-invasive methods of measurement of intracranial pressure (ICP), based on morphological and functional features of extracranial organs.

The third part of the review presents otoacoustic and ophtalmoretinal measurements, ophtalmodynamometry, near-infrared spectroscopy (NIRS), heart rate variability, and also the combined methods. The advantages and disadvantages of non-invasive techniques and possibility of their use in clinical practice are reviewed. Non-invasive methods have a lot of advantages, but they are less exact in comparison with direct measurement of ICP. None of modern non-invasive technologies is suitable for carrying out continuous control.

Conclusion. Non-invasive techniques can provide reliable measurement of ICP and can be essential in case of contraindications to invasive monitoring.

Key words: intracranial pressure; non-invasive monitoring; otoacoustic and ophtalmoretinal methods; near-infrared spectroscopy (NIRS); heart rate variability.

Information about authors:

Gorbachev V.I., MD, PhD, professor, head of chair of anesthesiology and critical care medicine, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.   

Likholetova N.V., postgraduate, chair of anesthesiology and critical care medicine, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.   

Gorbachev S.V., resident, chair of anesthesiology and critical care medicine, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.

Address for correspondence:

Gorbachev V.I., Yubileyny district, 100, Irkutsk, Russia, 664049

Irkutsk State Medical Academy of Postgraduate Education

Tel: +7 (902) 566-63-89

Е-mail: gorbachevvi@yandex.ru

References:

1.        Allocca JA. Method and apparatus for noninvasive monitoring of intracranial pressure. United States patent US 4204547. 1980 May 27.

2.        Baurmann M. Über die Entstehung und klinische Bedeutung des Netzhautvenenpulses. Ber. Zusammenkunft Dtsch. Ophthalmol. Ges. 1925; 45: 53-59.

3.        Baevsky PM, Kirillov OI, Kletskin SZ. The mathematical analysis of changes of heart rhythm during stress. Moscow : Science Publ., 1984. 220 p. Russian

4.        Borchert MS, Lambert JL. Non-invasive measurement of intracranial pressure. World patent WO 98034536. 1998 February 11.

5.        Budohoski KP, Schmidt B, Smielewski P, Kasprowicz M, Plontke R, Pickard JD, et al. Non-Invasively Estimated ICP Pulse Amplitude Strongly Correlates with Outcome After TBI. Acta Neurochir Suppl. 2012; 114: 121-125.

6.        Cennamo G, Gangemi M, Stella L. The correlation between endocranial pressure and optic nerve diameter: an ultrasonographic study. Ophthalm. Echography. 1987; 7: 603-606.

7.        Denninghoff KR. Oximetric tonometer with intracranial pressure monitoring capability. United States patent US 6390989. 2002 May 21.

8.        Dobrynina YV, Kovalev VV, Gorbachev VI, Petrov SI, Khmelnitsky IV. Changes of vegetative tone in intracranial hypertension syndrome. Pathology of blood circulation and heart surgery. 2010; (3): 67-71. Russian

9.        Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. J. Intensive Care Med. 2011; 37 (7): 1059-1068.

10.    Efimov AP. New biomechanical methods of the non-invasive estimation of intracranial pressure and its verification. Bulletin of the Russian Academy of Natural Sciences. 2011; (3): 119-124. Russian

11.    Ewing DJ. Noninvasive evaluation of heart rate: the time domain. In: Low PA, editor. Clinical autonomic disorders. Boston : Little Brown and Co, 1993. p. 297-315.

12.    Firsching R, Müller C, Pauli SU, Voellger B, Röhl FW, Behrens-Baumann W. Noninvasive assessment of intracranial pressure with venous ophthalmodynamometry. Clinical article. J. Neurosurg. 2011; 115 (2): 371-374.

13.    Firsching R, Schutze R, Motschmann M, Behrens-Baumann W. Venous opthalmodynamometry: A noninvasive method for assessment of intracranial pressure. J. Neurosurg. 2000; 93 (1): 33-36.

14.    Frank AM, Alexiou C, Hulin P, Janssen T, Arnold W, Trappe AE. Non-invasive measurement of intracranial pressure changes by otoacoustic emission (OAE) – a report on preliminary data. Zentralbl Neurochir. 2006; 61 (4): 177-180.

15.    Geeraerts T, Launey Y, Martin L, Pottecher J, Vigué B, Duranteau J, et al. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. J. Intensive Care Med. 2007; 33 (10): 1704–1711.

16.    Geeraerts T, Merceron S, Benhamou D, Vigué B, Duranteau J. Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. J. Intensive Care Med. 2008; 34 (11): 2062-2067.

17.    Goel RS, Goyal NK, Dharap SB, Kumar M, Gore MA. Utility of optic nerve ultrasonography in head injury. J. Injury. 2008; 39 (5): 519-524.

18.    Golovin IA. Optimization of methods of intensive therapy of severe brain injury. Cand. med. sci. abstracts. dis. Voronezh, 2004. 22 p. Russian

19.    Gorbachev VI, Dobrynina YV, Khmelnytsky IV, Likholetova NV. Role of variational cardiointervalometry in monitoring of intracranial pressure in traumatic brain injury. Polytrauma. 2011; (4): 67-73. Russian

20.    Gorbachev VI., Dobrynina YV, Kovalev VV, Khmelnytsky IV, Mankov AV, Chichkan II. Method of diagnostic of intracranial hypertension. Russian Federation patent RU 242892. 2011 September 20. Russian.

21.    Gujjar AR, Sathyaprabha TN, Nagaraja D, Thennarasu K, Pradhan N. Heart rate variability and outcome in acute severe stroke. Role of power spectral analysis. Neurocrit Саrе. 2004; 1 (3): 347-353.

22.    Hansen HC, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: Ultrasound findings during intrathecal infusion test. J. Neurosurg. 1997; 87 (1): 34-40.

23.    Helmke K, Burdelski M, Hansen HC. Detection and monitoring of intracranial pressure dysregulation in liver failure by ultrasound. Transplantation. 2000; 70 (2): 392- 395.

24.    Hon ЕН, Lee ST. Electronic evaluations of the fetal heart rate patterns preceding fetal death, further observations. Аm. J. Obstetr. Gynecol. 1965; 87: 814-826.

25.    Katz-Leurеr М, Shochina М. Heart Rate Variability (HRV) parameters correlate with motor impairment and aerobic capacity in stroke patients. NeuroRehabilitation. 2005; 20 (2): 91-95.

26.    Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Academic Emerg. Med. 2008; 15 (2): 201-204.

27.    Kirk T, Jones K, Miller S, Corbett J. Measurement of intraocular and intracranial pressure: Is there a relationship? Ann. Neurol. 2011; 70 (2): 323-326.

28.    Lakusic N, Mahovic D, Ваbic Т. Gradual recovery of impaired cardiac autonomic balance within first six months after ischemic cerebral stroke. Acta Neurol. Belg. 2005; 105 (1): 39-42.

29.    Lang EW, Lagopoulos J, Griffith J [et al.] Noninvasive ceberovascular autoregulation assessment in traumatic brain injury: validation and utility. J Neurotrauma. 2003; 20 (1): 69-75.

30.    Lopes-Magana JA, Richards HK, Radolovich DK, Kim DJ, Smielewski P, Kirkpatrick PJ, et al. Critical closing pressure: comparison of three methods. J. Cereb. Blood Flow Metab. 2009; 29 (5): 987-993.

31.    Makikаlliо AM, Маkikаlliо TH, Коrреlаinеn JT, Sotaniemi KA, Huikuri HV, Myllylä VV. Heart rate dynamics predict poststroke mortality. J. Neurology. 2004; 62 (10): 1822-1826.

32.    Marchbanks RJ. Method and apparatus for measuring intracranial fluid pressure. United States patent US 4841986. 1989 June 27.

33.    Meyerson SC, Avan PA, Buki B. Non-invasive method and apparatus for monitoring intracranial pressure. United States patent US 6589189. 2003 July 8.

34.    Newman WD, Hollman AS, Dutton GN, Carachi R. Measurement of optic nerve sheath diameter by ultrasound: A means of detecting acute raised intracranial pressure in hydrocephalus. Br. J. Ophthalmol. 2002; 86 (10): 1109-1113.

35.    Panerai RB. The critical closing pressure of the cerebral circulation. Med. Eng. Phys. 2003; 25 (8): 621-632.

36.    Phillips AJ, Marchbanks RJ. Effects of posture and age on tympanic membrane displacement measurements. Br. J. Audiol. 1989; 23 (4): 279-284.

37.    Pine K. Portable MRI debuts at UCI Medical Center [Electronic resource]. UCI Healthcare News Releases 2001. Available at: http://www.healthcare.uci.edu/news_releases.asp?filename=MagneVu.htm

38.    Popovic D, Khoo M, Lee S. Noninvasive monitoring of intracranial pressure. Recent Patents on Biomed. Engin. 2009; 2: 165-179.

39.    Querfurth HW. Methods of and systems and devices for assessing intracranial pressure non-invasively. United States patent US 20067122007. 2006 October 17.

40.    Ragauskas A, Matijosaitis V, Zakelis R, Petrikonis K, Rastenyte D, Piper I, et al. Clinical assessment of noninvasive intracranial pressure absolute value measurement method. J. Neurology. 2012; 78 (21): 1684-1691.

41.    Ragauskas A. Method and apparatus for noninvasive determination of the absolute value of intracranial pressure. United States patent US 7147605. 2006 December 12.

42.    Rajajee V, Fletcher JJ, Rochlen LR, Jacobs TL. Comparison of accuracy of optic nerve ultrasound for the detection of intracranial hypertension in the setting of acutely fluctuating vs stable intracranial pressure: post-hoc analysis of data from a prospective, blinded single center study. Critical Care. 2012; 16: 79.

43.    Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic Nerve Ultrasound for the Detection of Raised Intracranial Pressure. Acta Neurochir. Suppl. 2011; 15 (3): 506-515.

44.    Rosenberg JB, Ariel LS, Richard HS, Lewis AE. Non-invasive Methods of Estimating Intracranial Pressure. J. Neurocrit. Care. 2011; 15 (3): 599-608.

45.    Samuel M, Burge DM, Marchbanks RJ. Quantitative assessment of intracranial pressure by the tympanic membrane displacement audiometric technique in children with shunted hydrocephalus. Eur. J. Pediatr. Surg. 1998; 8 (4): 200-207.

46.    Sayers В. Analysis of heart rate variability. Ergonomics. 1973; 16: 17-32.

47.    Schmidt B, Czosnyka M, Klingelhöfer J. Clinical applications of a non-invasive ICP monitoring method. Eur. J. Ultrasound. 2002; 16 (1-2): 37-45.

48.    Shimbles S, Dodd C, Banister K, Mendelow AD, Chambers IR. Clinical comparison of tympanic membrane displacement with invasive ICP measurements. Acta Neurochir. Suppl. 2005; 95: 197-199.

49.    Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, Gouliamos A, Karabinis A. Optic nerve sonography in the diagnostic evaluation of adult brain injury. J. Critical Care. 2008; 12: 67.

50.    Sutherland AI, Morris DS, Owen CG, Bron AJ, Roach RC. Optic nerve sheath diameter, intracranial pressure and acute mountain sickness on Mount Everest: A longitudinal cohort study. Br. J. Sports Med. 2008; 42 (3): 183-188.

51.    The Brain Trauma Foundation. The american association of neurological surgeons. The joint section on neurotrauma and critical care. Indications for intracranial pressure monitoring. J. Neurotrauma. 2007; 24: 37-44.

52.    Thees C, Scholz M, Schaller MDC, Gass A, Pavlidis C, Weyland A, et al. Relationship between intracranial pressure and critical closing pressure in patients with neurotrauma. Anesthesiology. 2002; 96 (3): 595-599.

53.    Wagner N, Walsted A. Postural-induced changes in intracranial pressure evaluated non-invasively using the MMS-10 tympanic displacement analyzer in healthy volunteers. Acta Otolaryngol. Suppl. 2000; 543: 44-47.

54.    Watanabe A, Kinouchi H, Horikoshi T, Uchida M, Ishigame K. Effect of intracranial pressure on the diameter of the optic nerve sheath. J. Neurosurg. 2008; 109 (2): 255-258.

55.    Weerakkody RA, Czosnyka M, Zweifel C, Castellani G, Smielewski P, Brady K, et al. Near infrared spectroscopy as possible non-invasive monitor of slow vasogenic ICP waves. Acta Neurochir. Suppl. 2012; 114: 181-185.

56.    Xu P, Kasprowicz M, Bergsneider M, Hu X. Improved noninvasive intracranial pressure assessment with nonlinear kernel regression. Eng. Medicine and Biology Society. 2010; 14 (4): 971-978.

57.    Yost WT, Cantrell JH. Non-invasive method of determining absolute intracranial pressure. United States patent US 6773407. 2004 August 10.

58.    Zabolotsky NV, Zabolotsky IB, Yukhnov VA. Method of non-invasive determination of intracranial pressure. Russian Federation patent RU 2185091, 2002 July 20. Russian

59.    Zweife C, Castellani G, Czosnyka M, Helmy A, Manktelow A, Carrera E, et al. Noninvasive Monitoring of Cerebrovascular Reactivity with Near Infrared Spectroscopy in Head-Injured Patients. J. Neurotrauma. 2010; 27 (11): 1951-1958.