[Chest wall morphological changes after sternal reconstruction with titanium mesh implant in patients with sternum instability]. / Strukturnye izmeneniya perednei grudnoi stenki posle alloplastiki grudiny titanovym setchatym endoprotezom u patsientov s nestabil'nost'yu grudiny.

Sternal instability is the one of the unresolved problems in open cardiac surgery (1-8%). The risk of recurrence after repeated osteosynthesis is up to 20% in these patients. Repeated osteosynthesis is impossible in some cases, and this complicates anterior chest wall reconstruction. Among various methods of sternal reconstruction, there are options for repair with own tissues and various fixing devices. Mesh prostheses from titanium and its alloys are modern materials for chest defect closure. There are literature data on soft tissue structural changes after hernia repair with titanium mesh implants, but biological compatibility and advantages of titanium alloys for chest wall instability are unclear. We present 2 patients after sternal reconstruction with titanium mesh implant and subsequent partial removal of prosthesis for various reasons with morphological examination.

Structural and ultrastructural changes in the skeletal muscles of dysferlin-deficient mice during postnatal ontogenesis.

A number of sarcolemma proteins are responsible for muscle fiber repair. Dysferlin encoded by the DYSF gene is one of these proteins. Dysferlin promotes membrane repair in striated muscle fibers (MFs). Mutations in DYSF lead to loss of or decreased dysferlin expression, impaired membrane repair in MF, and its destruction, clinically manifesting as dysferlinopathy. Preclinical studies of cell and gene therapies aimed at restoring impaired muscle regeneration require well-characterized small animal models. Our investigation aimed to distinguish the histopathological features of a mouse strain lacking dysferlin expression (Bla/J strain). Ultrastructural changes in the sarcolemma, mitochondria and contractile apparatus were observed. It was shown that postnatal histogenesis of skeletal muscles in genetically determined dysferlin deficiency is characterized by a higher proportion of necrotic muscle fibers, compensatory hypertrophy of muscle fibers with their subsequent atrophy, and decreases in proliferative activity and the level of myogenic differentiation of myogenic progenitor cells compared to wild-type mice (C57Bl/6).

[Morphological justification of the effectiveness of ultrasonic cavitation with 0.2]. / Morfologicheskoe obosnovanie éffektivnosti primeneniia ul'trazvukovoi kavitatsii s 0,2 % rastvorom lavasepta pri lechenii gnoino-nekroticheskikh oslozhnenii sindroma diabeticheskoi stopy.

AIM: Structural and functional analysis of cells from purulent-necrotic wounds in patients with diabetic foot syndrome undergoing ultrasonic treatment with 0.2% Lavasept solution. MATERIAL AND METHODS: It is presented morphological/ultrastructural analysis of wound specimens in 90 (DFS) patients aged 27-80 years with diabetic foot syndrome and purulent-necrotic complications who were hospitalized in the department of wounds and wound infections of the Vishnevsky Institute of Surgery in 2013-2016. Main group consisted of 75 patients, control group - 15 patients. Mean age was 58.4±8.2 years. All patients had diabetes mellitus type II for previous 13±4.5 years. Severity of foot tissue damage was assessed according to Wagner classification (F. Wagner, 1981). 46 (51.1%) patients had Wagner III-IV, 44 (48.9%) patients - Wagner II. Complex treatment included radical surgical management of purulent lesion, surgical revascularization for critical limb ischemia and foot reconstruction at the final stage. Additional measures were complete unloading of the foot, correction of carbohydrate metabolism and concomitant diseases. Topical treatment between surgical stages included dressing with 1.0% betadine solution (once a day). Ultrasonic cavitation was additionally applied in the main group. Electron microscopic examination of specimens was used before treatment, after 3-5 and 7-10 days in order to assess effectiveness of ultrasound cavitation for purulent-necrotic complications of DFS. RESULTS: Ultrasound cavitation with 0.2% Lavasept solution effectively cleans wounds from microbial and cellular detritus, destroys cellular membranes of biofilm-forming microorganisms, prevents their redo development and reinfection of the wound. Effective management of the wounds accelerates reparative processes that allows to perform foot reconstruction early.

[Hybrid repair of postoperative ventral hernia]. / Gibridnaia metodika lecheniia posleoperatsionnoi ventral'noi gryzhi.

AIM: To develop new technique of abdominal wall repair for postoperative ventral hernia without disadvantages which are intrinsic for open and laparoscopic surgery. MATERIAL AND METHODS: Combined open and laparoscopic hernia repair was used in 18 patients with postoperative ventral hernia. Open stage provided safe dissection of abdominal adhesions and defect closure by autoplasty, laparoscopic procedure consisted of prosthesis deployment without separation of abdominal wall layers. Two types of composite endoprostheses with anti-adhesive coating were used for abdominal wall repair. RESULTS: There were no cases of recurrence or infectious complications in long-term period (from 3 to 106 months). CONCLUSION: Hybrid repair of postoperative ventral hernia is safe and effective procedure. Further studies are necessary to assess cost-effectiveness ratio of this method in view of expensive composite endoprostheses and laparoscopic supplies.

[Morphological and functional aspects of recurrent postoperative ventral hernias]. / Morfofunktsional'nye aspekty retsidiva posleoperatsionnykh ventral'nykh gryzh.

AIM: To define the optimal treatment of postoperative ventral hernias. MATERIAL AND METHODS: It was performed microscopic examination of intraoperative specimens which were obtained from 40 patients with medium, large and giant hernia. The aim was to reveal ultrastructural changes and morphological features which are associated with abdominal wall weakness in case of postoperative ventral hernia. There were 28 (70%) cases of primary postoperative hernia and 12 (30%) cases of recurrent and multiple-recurrent hernia. In 4 patients polypropylene mesh implants were implanted prior to recurrence. Tissue specimens were obtained from the top of herniation, hernial ring and in 6 cm from the hernial ring. RESULTS AND DISCUSSION: Electron microscopy showed that postoperative ventral hernias are accompanied by ultrastructural destructive changes in cells of the skin, aponeurosis and muscles that indicates on morphofunctional failure of abdominal wall tissues. Swelling and degradation of collagen, fibroblasts vacuolization, capillary sludge of erythrocytes, development of vacuum zones with the fragments of altered collagen fibrils, red blood cells and mast cells are morphological signs of micronecrosis followed by abdominal wall weakness and postoperative ventral hernias. CONCLUSION: Postoperative ventral hernias are associated with morphological and functional failure of abdominal wall due to tissue destructive changes. Therefore, this obviously defective tissue can not be used per se and especially with tension. Mesh implants should be applied.

[Microscopic investigation of vessel wall after endovascular catheter atherectomy].

Endovascular target catheter atherectomy (ETCA) - method of artery patency allowing to obtain occlusion substrate. Given the high destructive effect of atherectome's elements on tissue the objective was determination possibility of histological and electron microscopic investigation of this substrate after atherectomy. The research included 8 patients who underwent ETCA of legs arteries. It was observed substrate removal from broken stent in 1 case. 2 of 8 patients had diabetes. Obtained substrate was available for histological and electron microscopic investigation. Atherosclerosis was confirmed in all cases. It was not observed substrate significant morphological changes in patients with presence or absence of diabetes. Microscopic investigation of substrate from broken stent shows pronounced development of granulation tissue that was regarded as special form of reparative regeneration. Finding internal elastic membrane during microscopic investigation in some cases proves radical intervention. The authors consider that microscopic investigation of substrate after ETCA may be used for diagnosis verification, thorough analysis of morphological changes in lesion area and radicalism of atherectomy.

[Morphological and functional aspects of wound regeneration in the treatment by iodine-containing ointments].

The comprehensive morphological investigation indicated a high antimicrobial activity of iodine-containing ointments in the treatment of septic wounds from the first days of the ointments using. 3% ointment "Stellanin-PEG" helps to reduce the local inflammatory changes by activating neutrophils and macrophages. A management of wounds by 3% ointment "Stellanin-PEG" improves their condition by stimulating regeneration, which leads to an intensification of the proliferative and functional activity of granulation tissue. Clinical, morphological and cytological data are evidence of time reduction of relief of purulent process, which leads to an earlier (in comparison with the use of ointment "Betadine") wound epithelization.

[Rare forms of the ductal carcinoma of the pancreas].

Clinical cases of patients with rare forms of ductal pancreatic carcinoma are described. Difficulties of preoperative radiologic verification of ostheoclast-like giantcell tumor and cricoids-cell carcinoma of the pancreas are described. Morphologigic and immunohistochemical features of these tumors are highlighted. One of the clinical cases demonstrate the aggressive tumor behavior, led to liver metastases 4 months after the radical operation. Literature review highlights historical aspects and the state-of-art of diagnostics and treatment of rare forms of the ductal carcinoma of the pancreas.

[Functional state of stroma and capillaries by chronic pancreatitis].

The straight correlation between the intensity of stroma inflammatory infiltration and the vessel endothelium growth factor (VEGF) was registered. The progression of the pancreatic tissue fibrosis correlated with the decrease of endothelial and fibroblastic activity, increase of perivascular fibrosis and cellular expression of VEGF, as well as the decrease of compensatory capacity of pancreatic cells.

[Hormonally inactivated pituitary adenoma: morphological, immunohistochemical and electron-microscopic characteristic].

Morphology of hormonally inactivated pituitary adenoma can be different types of tumors. Morphological immunohistochemical and electron-microscopic researches of 23 hormonally inactivated pituitary adenomas has been carried out. We shown that more frequent morphological substrate was gonadotropinoma or "zero-cells" adenoma. According to our results, gonadotropinomas, "zero-cells" adenomas and oncocytomas have similar features and can be put into the same group of tumor Pathomorphologist has to differentiate this group of tumors from others "silent" pituitary adenomas because they have different prognosis for a disease. A research of somatostatin and dopamine receptors expression would be new area for differential diagnosis of these types of adenomas.

[Ultrastructural characteristics of hepatocellular carcinoma].

The results of a complex (histological and electron microscopic) study of surgical specimens from 22 patients (15 men and 7 women aged 17 to 72 years) are presented. The histological study diagnosed low-, moderate, and high-grade hepatocellular carcinoma in 5, 12, 5 patients, respectively. The electron microscopic study established that low-grade cancer cells preserved to a greater extent the principal specific ultrastructural organization that was characteristic of normal hepatocytes. The moderate-grade type was presented as different ratio of tumor cells of various grades. At the same time, the degree of ultrastructural differentiation of tumor cells did not depend on the histological (trabecular, solid) structure of the tumor. The high-grade type was characterized by the signs of significant cell structural and functional rearrangement; changes in the number, sizes, and shape of intracellular masses (a nucleus, mitochondria, endoplasmic network, lysosomes). Moreover, the destruction of the intracellular matrix and vascular basal membrane, reduced contacts between the tumor cells with the latter being attached to the thinned vascular wall underlie local infestation and neoplastic metastasis.

[The comparative characteristics of pulmonary and renal ultrastructural changes in burn sepsis].

The results of histological and electron microscopic studies of the lung and kidney from the patients who died from burn sepsis are presented. The lung and kidney showed blood circulatory disorders, reversible and irreversible damages, and cell necrosis. The most pronounced changes of lung cells were revealed near coccal bacteria.

[Cystic teratoma of the pancreas].

A case of pancreatic cystic teratoma is described in a 52-year-old woman. The tumor is macroscopically presented by an 8 x 8 x 7-cm multifocal cyst. Histological, immunohistochemical, and electron microscopic studies have revealed the derivatives of three germinal layers (ecto-, endo, and mesoderma).

Morphological changes in the implantation zone of Prolen and Esfil reticular endoprostheses.

Comparative histological and electron microscopic study of tissues in the zone of implantation of polypropylene endoprostheses Prolen and Esfil was carried out in mice. Implantation of a reticular endoprosthesis Esfil was associated with a more pronounced infiltration with neutrophilic granulocytes, macrophages, and lymphocytes. Both nets were characterized by pronounced integration in the adjacent tissues in the implantation zone and can be recommended for clinical use.

[The specificity of the ultrastructural pattern of neoplastic vessels of the retina in diabetic retinopathy]. / Osobennosti ul'trastrukturnoi kharakteristiki novoobrazovannykh sosudov setchatoi obolochki pri diabeticheskoi retinopatii.

The electron microscopy of 14 samples of epiretinal membranes obtained in the course of transciliary vitrectomy performed in proliferative diabetic retinopathy (PDR) showed a majority of neovascularized vessels to be represented by those of the venular type or capillaries. It can be concluded on the basis of examination results that the structures of neovascularized vessels can be highly diverse in diabetic retinopathy, which depends on a variety of factors: 1) proliferation stage; 2) division of the microcirculation bed; and 3) end of the epiretinal membrane where a given vessel is located as to the growth epicenter. Finally, described are both neo-vessels with a virtually normal structure of the vascular wall and atrophying vessels. The signs of vascular reduction grow to be more pronounced at later stages.

[Effect of serotonin-adipinate on the ultrastructure and synthetic activity of endotheliocytes of microhemocirculatory bed of human brain (autopsy material, early autopsies)]. / Vozdeistvie serotonina adipinata na ul'trastrukturu u sinteticheskuiu aktivnost' éndoteleotsitov mikrogemotsirkuliarnogo rusla golovnogo mozga cheloveka.

Electron-microscopic and radioautographic investigation showed the ability of brain capillary endotheliocytes for retaining functional activity in total ishemia. Administration of serotonin adipinate in an early postoperative period supports intracellular processes and plays a protective role.

[Electron-radioautographic study of differential influence of biologically active wound covering on the process of regeneration]. / élektronno-radiographicheskoe issledovanie differentsirovannogo vliianiia biologicheski aktivnykh ranevykh pokrytii ha protsessy regeneratsii.

It is established that local wound treatment with coverings is directed to both suppression of microflora and inflammatory process and stimulation of regeneration at early periods of wound healing, this favouring granulation tissues growth and wound epithelization. Mechanism of biologically active covering influence on the reparative regeneration lies in stimulation of fibroblast, endotheliocyte and pericyte proliferation and stimulation of granulation tissue cells functional activity.

[Development of new biologically active dressings and methodology of their use]. / Razrabotka novykh biologicheski aktivnykh pereviazochnykh sredstv i metodologiia ikh primeneniia.

Results of development of new biologically active dressings and up-to-date methodology of local treatment of wounds (based on their differential application according to phase and features of wound process) are demonstrated. Data about main properties and specific activity of new biologically active dressings based on natural and synthetic polymers with immobilized drugs are presented. Future trends and efficacy of their appliance in complex treatment of purulent and necrotic wounds are demonstrated.