Journal of Experimental and Clinical Surgery

Scientific and practical journal "Journal of Experimental and Clinical Surgery" is established by the Institute of Surgical Infection of N.N. Burdenko Voronezh State Medical Academy  in 2008.

The journal publishes original articles on clinical and experimental studies, literature reviews, brief reports on clinical observations, information on innovations, inventions and innovative projects, new methods of diagnosis and treatment, materials on the history of departments, clinics and surgical hospitals.

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Current Issue

Vol 15, No 4 (2022)

Original articles

Sanitation Effect of Gaseous Ozone in the Treatment of Experimental Infected Pancreatic Necrosis: Microbiological Evaluation
Vinnik Y.S., Teplyakova O.V., Peryanova O.V., Yakimov S.V., Erguleeva A.D., Ponedelnik D.N.
Abstract

Introduction. Search for new means and methods of sanitation of the abdominal cavity remains significant related to growing antibiotic resistance of bacterial pathogens in surgical infection. This challenge is of particular relevance in the development of purulent complications of acute pancreatitis due to the complexity of radical control of the inflammation source.
The aim of the study was to evaluate outcomes of microbiological examination of peritoneal exudate, biopsies of the pancreas, arterial blood in the topical application of gaseous ozone for the treatment of experimental infected pancreatic necrosis.
Methods. This prospective experimental study included 43 laboratory animals - Soviet Chinchilla rabbits. Group 1 consisted of 13 animals, groups 2 and 3 consisted of 12 animals each. All animals were infected with pancreatic necrosis simulated using a clinical strain of A. baumannii. Sanitation relaparotomies were performed in 24 hours and 60 hours under anesthesia: with 0.9% sodium chloride solution in animals of group 1, with 0.02% aqueous solution of chlorhexidine bigluconate in animals of group 2, with ozone-oxygen gas mixtures in animals of group 3. The control group included six sham-operated animals. Animals were withdrawn from the experiment in 96 hours with taking samples for microbiological investigations.
Results. Animals of group 1 showed an increased frequency (from 23.1 to 100.0%, p=0.003) and degree (from 3.5 (3.0; 4.5) to 7.0 (5.5; 7. 5) lg COE/ml, p<0.001) of bacterial contamination of peritoneal exudate within 24 to 96 hours. Most parameters in animals of group 2 were not significantly different from those achieved in animals of group 1. Notably, the bacterial count of A. baumannii in the peritoneal exudate in 60 hours (6.0 (5.7; 6.7) lg COE/ml), and the degree of secondary (enterogenic) contamination of the pancreas (5.5 (5 .0; 6.7) lg CFU/g) and peritoneal exudate in 96 hours (7.7 (7.0; 8.0) lg CFU/ml) in animals of group 2 significantly exceeded those in animals of group 1 (p≤ 0.010). Intraperitoneal application of a directed flow of gaseous ozone in 24 and 60 hours allowed achieving elimination of A. baumannii in 80.0% of pancreatic biopsy samples by the end of the fourth day (p=0.002 and p=0.007 when compared with results of groups 1 and 2, respectively), prevent its spread into the peritoneal exudate and systemic circulation. The treatment with gaseous ozone was also accompanied by the decreased bacterial count of A. baumannii and the degree of secondary (enterogenic) contamination by other opportunistic microorganisms in the analyzed samples.
Conclusion. Perspectives for translating the results obtained into clinical practice determine the relevance of studying modern molecular methods of bacteriological analysis. This should be combined with an adequate assessment of the safety of various targeted treatment options of the abdominal tissues and organs with an ozone-oxygen gas mixture.

Journal of Experimental and Clinical Surgery. 2022;15(4):290-299
pages 290-299 views
Study of Hematopoietic Stem Cells in Patients with Extensive Burns
Kozlova M.N., Zemskov V.M., Alekseev A.A., Demidova V.S., Shishkina N.S., Kulikova A.N., Zemskov A.M., Bobrovnikov A.E.
Abstract

Introduction. Assessment of tissue regeneration, including that at the cellular and subcellular levels, appears to be one of the important trends in the complex treatment of patients with extensive burns. It is known that hematopoietic stem cells (HSCs) contribute to tissue restoration and regeneration through paracrine effects or direct cell differentiation, being a central component of post-burn anemia recovery and capable of forming not only blood cells, but also other types of cells. Notably, the role of these cells in burn injury has not been studied yet.
The aim of the study was to investigate in dynamics the content of hematopoietic stem cells of different phenotypes in patients with extensive burns in the process of complex treatment.
Methods. Hematopoietic stem cells and their subpopulations in peripheral blood samples were analyzed on a FACSCalibur flow cytometer (Becton Dickinson, USA) using the CellQuest program and CD45/CD34/CD38 and CD45/CD34/CD133 monoclonal antibody panels (BD, USA). The results obtained were statistically processed using the GraphPad Prism 7.0 program (USA), results were considered statistically significant at p<0.05.
Results. Hematopoietic stem cells and their subpopulations were studied at different stages of the complex treatment in 25 patients with a large burn area, ​​more than 30% of the body surface. The comparison group consisted of 15 healthy volunteers. Upon admission to the Burn Center, a group of severely burned patients revealed a significant deep deficiency of both total HSCs CD45+34+ (p=0.0002) and their subpopulations CD45dim34+38+ (p=0.019), with predominantly early precursors of hematopoiesis CD45dim34+38- (p=0.0001) and CD45dim34+133+ (p=0.0002). In the course of the complex treatment, including surgical necrectomy and autodermoplasty of burn wounds, there was observed normalization of total HSCs CD45+34+ (0.05±0.012%, p=0.031) and a subpopulation of early HSCs CD45dim34+38- (0.039±0.009%, p=0.016) in 20 days of treatment in the group of burn patients. There was a significant increase of mature CD45dim34+133- HSCs (p=0.0380) as a result of treatment, while the deficit of the more differentiated population of CD45dim34+38+ HSCs did not fully recover (p=0.272).
Conclusion. The firstly detected modulations in the content of hematopoietic stem cells of different phenotypes in patients with extensive burns may reflect the state of compensatory-adaptive reactions of hematopoiesis in the course of the complex treatment. The data obtained may support the predictive use of HSC subcellular markers to assess the regenerative potential in burn wounds healing, including that during staged surgical treatment and autodermoplasty, and to predict the development of local and general complications of burn disease.

Journal of Experimental and Clinical Surgery. 2022;15(4):300-305
pages 300-305 views
Surgical Treatment of Bronchopleural Fistulas on the Background of Pleural Empyema
Nikulin A.V., Gallyamov E.A., Diduev G.I., Surkov A.I., Horobrikh T.V.
Abstract

Pleural empyema (EP) is one of the most complex nosologies of thoracic surgery. Mortality in this disease reaches 28% according to the literature. The causes of the development of nonspecific empyema of the pleura are various purulent-destructive lung diseases, as well as inflammatory diseases, surgical interventions and injuries. The presence or absence of bronchopleural fistula (BPS) is crucial in determining the prognosis of treatment of pleural empyema. This article is devoted to the study of the issues of surgical treatment of BPS against the background of various EP variants.
Objective. To evaluate the effectiveness of using fibrin glue as a regeneration stimulator in the treatment of patients with bronchopleural fistulas on the background of pleural empyema.
Materials and methods. In the I. V. Davydovsky State Clinical Hospital No. 23, for the treatment of patients with EP complicated by the development of bronchopleural fistula, an integrated approach is used using the concept of biological stimulation of tissue repair through the use of fibrin glue obtained by cryoprecipitation.
Results. Our experience based on the study of 136 patients with pleural empyema of various etiologies (post-pneumonic (n=76), post-resection (n=11), covid-associated (n=49)) shows encouraging results. The clinical efficacy of using fibrin glue as a stimulator of tissue repair was 91,89% in the group of post-pneumonic EP, 66,66% in the group of post-resection EP and 90,9% in the group of covid-associated EP. However, the results obtained require further analysis and study.
Conclusion. Despite the achievements of recent decades in antibiotic therapy, the improvement of surgical techniques and new minimally invasive methods of treatment, the problem of the development of bronchopleural fistulas remains relevant to this day. Knowledge of the issues of pathogenesis, risk factors, as well as the improvement of therapeutic tactics in the development of this formidable complication will increase the effectiveness of treatment and improve the prognosis of this category of patients. The use of biological stimulators of tissue repair based on own blood plasma may be a promising direction of treatment of this complex pathology.

Journal of Experimental and Clinical Surgery. 2022;15(4):306-313
pages 306-313 views
Diagnostic Options for Postoperative Complications in Surgery
Solomakh A.A., Gorbachenko V.I.
Abstract

Currently, scientific research is usually carried out in accordance with the postulates of evidence-based medicine in Russia and foreign countries. However, the implementation of these principles requires deep knowledge of surgery and mathematical modeling. Authors: a surgeon and a programmer developed mathematical models involved in the diagnosis of postoperative complications in surgery. In this paper, we investigated a deep, fully connected neural network for the diagnosis of postoperative complications on the clinical example of acute appendicitis. As a training set of parameters, we used a set developed by the authors on the basis of real clinical data, which has a state registration number in the form of a database, and includes a knowledge base. The interquantile range of the F1 measure is proposed for the selection of significant features. An approach to coding composite categorical features, characterized by a compact representation, is proposed. For pre-processing of training data, it is proposed to use a step-up autoencoder. The autoencoder converts the selected functions into a higher-dimensional space, which, according to Kover's theorem, facilitates the classification of features. The neural network is implemented using the Keras and TensorFlow libraries. To train the neural network, the Adam algorithm with adaptive learning speed is used. To reduce the effect of overfitting, a modern regularization method — dropout-was used. The analysis and selection of the classifier quality metrics are carried out. To evaluate the characteristics of the neural network, k-block cross-validation was used. The trained neural network showed high diagnostic performance on the test data set.

Journal of Experimental and Clinical Surgery. 2022;15(4):314-322
pages 314-322 views

Experience

Successful Treatment Of The Patient With Advanced Testic Cancer
Stepanova Y.A., Gritskevich A.A., Oganyan V.A., Kalinin D.V.
Abstract

Testicular cancer is a rare oncourological disease. Of great significance is the fact of the disease onset precisely at the age when men are planning their future life: education, family, etc. According to current clinical guidelines, the treatment of this disease should be complex, including surgical treatment, polychemotherapy and external beam radiation therapy, which leads to a cure in 90% of cases.
In the presented clinical case, a 25-year-old patient was diagnosed with right testicular cancer stage III, T2N3M1S0 [PUL]. However, despite the significant initial prevalence of the pathological process, as well as the detection of a single retroperitoneal metastasis in the pancreas two years after the last stage of surgical treatment, the applied multi-stage tactics of complex treatment of the patient allowed not only removing the tumor and metastases, but also rehabilitating the patient socially.

Journal of Experimental and Clinical Surgery. 2022;15(4):323-332
pages 323-332 views

New in surgery

Two-Stage Abdominal Wall Reconstruction in a Patient with a Complex Postoperative Hernia
Gogia B.S., Chertova A.D., Aljautdinov R.R., Karmazanovsky G.G.
Abstract

Surgical treatment of incisional hernia is an actual problem of abdominal surgery. Despite the improvement of surgical techniques, the results of surgical treatment cannot be considered satisfactory: the recurrence rate continues to be high and is due to failures in the reconstruction of complex ventral hernia. Although there are many works devoted to various aspects of the surgical treatment of patients with complex incisional hernias, the problem is not sufficiently resolved. The treatment of this category of patients is a difficult task for both surgeons and patients due to the high risk of general and local complications. A clinical case of surgical treatment of a patient with a complex incisional hernia is presented, in which it was possible to carry out a complete reconstruction of the anterior abdominal wall in two stages without "components separation" method.

Journal of Experimental and Clinical Surgery. 2022;15(4):333-341
pages 333-341 views

Review of literature

Alternative Options of Blood Vessels Anastomosis
Makaev A.G., Zhulkov M.O., Sirota D.A., Agaeva K.A., Grenaderov A.S., Makaev A.G., Sabetov A.K., Khvan D.S.
Abstract

For a number of centuries, the problem of bleeding arrest from damaged vessels remains the major issue of surgery (alongside with infectious complications and fight against the pain syndrome). The development of vascular surgery began exactly when bleeding from a damaged vessel was arrested by tying it, and the introduction of reconstructive vascular surgery, being one of the most outstanding achievements of the 20th century, was the peak of creation. With the advent and development of this relatively young branch of clinical surgery, it became possible to effectively help patients with various vascular pathologies, previously considered incurable and doomed to death. However, the development of each industry is necessarily associated with the development of technical support. The lack of high-quality suture material and instruments has restrained the development of reconstructive vascular surgery for a long time; this fact forced researchers and surgeons to develop techniques for the seamless connection of blood vessels. Despite the widespread use of manual surgical suture, it is not always possible to use this option due to altered vascular walls. Development of technology for manufacturing synthetic materials allowed for techniques providing fast and high-quality connection of blood vessels, significantly reducing the time required for reconstruction and, as a result, reducing the incidence of complications.

Journal of Experimental and Clinical Surgery. 2022;15(4):342-346
pages 342-346 views
Impact of Chronic Soft Tissue Wounds on Psycho-Emotional Background and Quality of Life of Patients: Social Context
Koloshein N.A., Tulupov A.A., Grehov A.V.
Abstract

Introduction. In recent years, there has been a growing interest of clinicians in assessing the quality of life associated with the health of patients with chronic wounds, which is due to the need for an objective dynamic assessment of the patient's psycho-emotional state and the effectiveness of the therapy; on its basis strategic decisions can be made aimed at improving not only the results of treatment but also the quality of life, social functioning of patients (social adaptation).
The aim of the study was to review research that investigates the impact of chronic soft tissue wounds on changes in the quality of life associated with the health of patients, in order to systematize a massive amount of information for use in everyday clinical practice, seeking to understand the personal needs of each patient in the context of his life.
Material and methods. The authors performed a search for relevant papers in the electronic databases PubMed, Cyberleninka; this was followed by an analysis of the data obtained regarding the impact of chronic wounds on the psycho-emotional background of patients.
Conclusions. The data obtained, their critical evaluation and analysis of scientific publications related to the subject of the study evidence that a dynamic assessment of the psycho-emotional state of patients with chronic soft tissue wounds is necessary in wide clinical practice in order to timely identify and prevent the development of psycho-emotional disorders, leading to a decline in health-related quality of life.

Journal of Experimental and Clinical Surgery. 2022;15(4):347-353
pages 347-353 views
Negative Effects of Knee Replacement
Mansurov J.S., Tkachenko A.N., Saiganov S.A., Khaidarov V.M., Urazovskaya I.L., Tsololo Y.B., Baranovskii A.A.
Abstract

Introduction Total knee arthroplasty is the treatment of choice in orthopedic practice for patients with late –stage knee osteoarthritis. However, arthroplasty has not only benefit results and the service life of the endoprothesis is limited. The use of modern conservative therapy and joint-preserving surgions allowed to delay or to avoid knee arthroplasty.

Purpose. The study purpose is the analysis of publications with negative results of knee arthroplasty in patients with knee osteoarthritis.

Materials and methods.  The electronic Pub-Med/MEDLINE and eLibrary databases were searched for reviews published between 2002 and 2022.  A keyword search was also done using the terms: knee joint osteoarthritis, total knee replacement/arthroplasty, complications, patient satisfaction, indications/contraindications for surgery; related definitions and descriptions were extracted.

Results. The negative consequences of total knee arthroplasty are heterogeneous. Complications can be local and systemic such as surgical site infection, periprosthetic fracture, aseptic loosening (aseptic instability) of the endoprosthesis and its wear and the implant failure. The researcher’s data indicate increasing the number of patients who are not satisfied with the results of arthroplasty both in the short term and in the long-term after the operation, due to the natural wear of the prosthesis. Patients are not satisfied with the results of the operation 8% -30%. In recent years, there have been more publications devoted to the limitation of indication for arthroplasty in pftients with knee osteoarthritis. The replacement of the knee joint with an implant was done unreasonably in great number of cases.A number of patients after total knee arthroplasty require revision surgery within the first 5 years. Currently, the risk of failure of knee arthroplasty with the revision surgery in 10 years after primary arthroplasty is 5-6.8%. The main reasons for revision surgery after primary knee arthroplasty are periprosthetic infection and instability of the implant components, while the results of revision surgery are worse than   the primary arthroplasty.

Journal of Experimental and Clinical Surgery. 2022;15(4):354-361
pages 354-361 views

History of surgery

Israil PERELMAN: the shore of his life, or the distance of youth lived (to the 130th of birthday)
Larichev A.B.
Abstract

For Professor Israil Moiseevich Perelman (1892-1954) the events of the second half of 1951 unfolded tragically. The release from the head of the department of general surgery and the appointment to the post of head of the department of topographic anatomy with operative surgery of the Yaroslavl Medical Institute deprived him of the opportunity to practice practical surgery. Such objections were not accepted, and I.M. Perelman was fired from the institute as not starting work. In the spring of 1952, the disgraced professor returned to Belarus. Having visited Minsk and found himself on the banks of the post-war Svisloch, he poignantly felt the atmosphere of Lyakhovka half a century ago. Memory brought him back to the summer of 1905, when he became a student of the Minsk real school – a storehouse of knowledge for those who, following the results of their studies, were willingly enrolled in metropolitan universities. Talented teachers took an active part in shaping the personality of Israil Perelman, including Samoilo I.I., Gurvich O.Ya., Pionier L.O., Skokanek A.I. The period of adolescence was also enriched by the first charm of the soul, when Israil experienced sympathy for the one who became the secret of ardent feelings. Their reciprocity turned out to be fragile, short-lived and irretrievably gone into the distant past. In a real school, fate brought the young man to O.L. Lunts, who served here as a staff doctor. As an experienced clinician and an outstanding public figure, the doctor shared his life experience. His stories strengthened the desire to engage in healing and instilled faith in the correctness of the choice of the future profession. The logical result of seven years of study in a real school was the receipt of a certificate of complete secondary education, bringing Israil Perelman one step closer to achieving his main dream – to be a doctor.

Journal of Experimental and Clinical Surgery. 2022;15(4):362-368
pages 362-368 views

ANNIVERSARY

Mikhail Arkadyevich GUBIN - Professor, Honored Maxillofacial Surgeon (to the 80th of birthday)
Haciev G.A.
Abstract

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Journal of Experimental and Clinical Surgery. 2022;15(4):369-369
pages 369-369 views

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