2016 год, №5

Содержание выпуска
BIOMATERIALS ARE AN IMPORTANT AREA OF BIOMEDICAL TECHNOLOGIES
Shtilman M.I.
Стр. 4 — 13
The review describes the use of biomaterials (polymeric biomaterials in particular) in the development of medical and biological products and devices, such as implants and endoprostheses; components of bioactive and pharmaceutical agents; carriers for bioengineering applications; sorbent agents and membrane systems used for the purification and separation of biological media; artificial biocatalysts, and general purpose biodegradable products. This review is provided with a short reference list of relevant monographs and reviews predominantly by Russian authors.
THE USE OF IMPLANTS FOR SURGICAL TREATMENT OF CONGENITAL DIAPHRAGMATIC HERNIA IN NEWBORNS
Razumovskiy A.Yu., Mokrushina O.G., Shumikhin V.S., Schapov N.F., Petrova L.V.
Стр. 14 — 18
Congenital diaphragmatic hernia (CDH) is an absolute indication for surgical treatment. In case of extensive defects of the diaphragm, such as diaphragmatic aplasia, the use of implants is required. So far, there is no unanimous opinion on the type of the implant. The article presents a comparative analysis of treatment of 40 newborns with left pseuso-CDH. All patients received thoracoscopic repair of the diaphragmatic cupula. The patients were divided into two groups according to the type of the implant: 16 newborns received Ecoflon synthetic implants (Ecoflon Scientific and Production Complex, Russia) and 24 newborns received Permacol biologic implants (Tissue Science Laboratories, UK). The study demonstrated the advantage of the biologic implant over the synthetic one: the surgery took less time (106 minutes compared to 144 minutes with Ecoflon, p 0.05); no implant rejection was observed (with Ecoflon, two patients responded with inflammation, p
THE USE OF SYNTHETIC SLINGS IN SURGICAL TREATMENT OF EPISPADIAS IN BOYS
Demidov A.A.
Стр. 19 — 25
The treatment of urinary incontinence in epispadias, which is malformation of the lower urinary tract, is a pressing problem due to the severity of congenital anatomic and functional pathology and the lack of a universal treatment to achieve urinary control. The aim of the study was to develop basic principles of surgical treatment of epispadias-related urinary incontinence. Additionally, we aimed to introduce into clinical practice the use of synthetic implants (synthetic slings) and evaluate treatment outcomes. The total of 20 boys aged 7-15 years received surgical treatment for subtotal and total epispadias. The first stage of surgical reconstruction was Cantwell's phallo-urethroplasty followed by the placement of synthetic slings 7VT, TVT-O, and Advance. The children began to accumulate up to 250-550 ml of urine in any position of the body at relative rest and on effort, and were able to hold urine for up to 3 hours and to empty the bladder completely with normal flow. The total loss of urine per day decreased 10-15 times and did not exceed 10-30 ml. The lower urinary tract was evaluated using urodynamic (uroflowmetry, urethral profilometry) and electrophysiological (electroneuromyography) methods. Restoration of urethral anatomy leads to improved accumulative ability of the detrusor, and use of synthetic slings is a low-invasive and highly effective surgical method for treating urinary incontinence.
Ключевые слова
epispadias boy urethroplasty sling implant
TWO-STAGE REPAIR OF FINGER FLEXOR TENDONS IN CHILDREN WITH CHRONIC TENDON RUPTURES IN FIBRO-SYNOVIAL CANALS
Alexandrov A.V., Rybchenok V.V., Lvov N.V., Aleksandrova N.E., Palinkash A.M.
Стр. 26 — 30
Two-stage repair is a well-developed method that is commonly used to repair chronic ruptures of flexor digitorum profundus tendons. However, its use in pediatric hand surgery is limited due to the absence of tendon implants adapted for children. The article describes a modified Paneva-Holevich/Hunter technique for two-stage tendon reconstruction using original, oval, Lavsan-reinforced silicone prosthetic implants of four sizes (depending on patients’ age). The surgery was performed in 34 children aged 1.5-17 years. Long-term outcomes were assessed in 12 patients (8 boys and 4 girls) using the Total Active Motion scale. The follow-up period was 30 months. The average active range of motion accounted for 178.8° in boys and 218.8° in girls. The results of treatment (TAM %) were considered good in all the girls (average score of 84.3 %), and in those boys who received surgery for fingers IV and V (average score of 80.0 %). The boys who received tendon repair for fingers II and III had “good” and “poor” results (average score of 67.0 %). The proposed method of two-stage tendon repair of chronic tendon ruptures in fibro-synovial channels in children was shown to provide good results with minimal complication rates and acceptable donor site deficiency.
APPLICATION OF THE BALLOON SKIN EXPANSION METHOD IN PEDIATRIC RECONSTRUCTIVE SURGERY
Khagurov R.A., Alexandrov A.V., Rybchenok V.V., Samorukova N.N., Velskaya Yu.I., Lvov N.V., Koval S.Yu.
Стр. 31 — 35
The article describes the treatment of children with vast scar deformities and extensive benign soft tissue neoplasms. The method is presented in a clinical case of successful skin restoration using balloon skin expansion. The opinion and recommendations of the authors on optimal treatment of these defects and decrease of possible complications using laser Doppler flowmetry for evaluation of the state of microcirculation in the skin flap are based on the results of the long-term use of this method in the Department of Reconstructive and Plastic Microsurgery of Filatov Children’s Municipal Clinical Hospital No.13.
THE EFFICACY OF SYSTEMIC ENZYME THERAPY IN THE COMPLEX TREATMENT OF TROPHIC ULCERS OF VENOUS ETIOLOGY
Vasilev I.M., Bogdanec L.I., Shcherbin S.V.
Стр. 36 — 40
The current strategy for the treatment of venous trophic ulcers (VTU) suggests differentiated approach and a combination of conservative and surgical methods. This paper presents the results of the study of efficacy of systemic enzyme therapy (Phlogenzym by Mucos Pharma, Germany) in patients with varicose veins of lower extremities (CEAP class C6) and stage I, II and III VTU. The study included 38 patients aged 12 to 82 years. The patients were divided into the experimental (n = 20) and the control (n = 18) groups. The treatment lasted 1 month. Silcofix Professional wound dressings (Pharmaplast, Egypt) were used. All patients received Detralex (Les Laboratoires Servier, France) and wore class 2 and 3 knee-high compression socks. Patients of the experimental group also received Phlogenzym for 30 days (3 tablets 3 times a day). Total ulcer epithelization was observed in 8 (40 %) patients by week 3, and in 18 (90 %) patients by the end of treatment compared to 4 (22 %) and 9 (50 %) patients in the control group, respectively. In the control group, the regenerative process in the area of the ulcerous defect was less prominent compared to the experimental group. Immunoassays revealed a significant reduction in CD4CD25 cells and increased levels of CD4CD45RO T-lymphocytes in the experimental group, corresponding with the observed positive clinical response. The use of immunomodulatory drug Phlogenzym contributed to a more rapid regression of clinical symptoms of chronic venous insufficiency and faster healing of stage l-lll venous trophic ulcers.
A COMPARISON OF GENDER DIFFERENCES IN CLINICAL AND ANGIOGRAPHIC CHARACTERISTICS IN YOUNG ADULTS WITH MYOCARDIAL INFARCTION
Balaian N.M., Shebzukhova M.M., Grachev N.S., Muradianc A.A., Shostak N.A.
Стр. 41 — 47
The article presents the analysis of clinical and angiographic characteristics and risk factors of myocardial infarction (Ml) in men and women aged
TREATMENT AND REHABILITATION OF CHILDREN WITH ELECTROTHERMAL INJURY
Rubtsov V.V., Tsap N.A., Shtukaturov A.K.
Стр. 48 — 51
Electrothermal lesions are most often seen in pediatric injuries. This type of injury is uncommon, but is one of the leading causes of death and disability in children. Using medical records, we analyzed the outcomes of the treatment and rehabilitation of children with electrothermal lesions (n = 51) admitted to Pediatric Burn Center, Children’s City Clinical Hospital No. 9 (Yekaterinburg, Russia) over the period from 2010 to 2015. The patients were divided into two groups: Group 1 (39 children) had injuries from electrical household appliances and Group 2 (12 children) sustained high-voltage injuries. Primary surgical debridement was performed on all children; the extent and depth of the burns were established. The next step of surgical treatment for Group 1 included necrectomy and single-stage dermatoplasty; in Group 2 necrectomy and the first stage of skin grafting (formation of a skin flap) were performed. Subsequently, all patients in Group 2 received skin grafts for final closure of the skin defect. The duration of treatment in Group 2 was 2 times longer than in Group 1, due to larger burn areas (an average of 12 % vs. >5 %), longer burn shock (>24 h vs. 10 h), higher complication rate, and multiple stages of surgical treatment. Six patients from Group 2 received surgical amputation. However, the division into groups according to the physical properties of the electric current can be beneficial for the development of more effective treatment algorithms.
THE HYPOTHESIS OF TISSUE-SPECIFIC ACTION OF DIPHTHERIA TOXIN
Aleshin A.V.
Стр. 52 — 55
Diphtheria is an infection caused by toxigenic strains of . The pathogen releases the toxin that affects heart, kidneys, adrenal gland, as well as spinal and cerebral nerves. Tissue- and organ-specific action of diphtheria toxin is considered to be associated with the blood supply to these organs. We propose the hypothesis that takes into account the physical and chemical properties of the toxin molecule (positively charged R-domain in the В subunit) and cell expression of different types of the HB-EGF receptor and CD9 co-receptor, which are responsible for the toxin penetration into the cell. The proposed hypothesis explains the possible mechanisms of diphtheria complications.