Analysis Of Long-term Results Research Articles

Analysis of headache in children's patients, its relationship with chronic rhinosinusitis at the sanatorium-resort stage of treatment

To determine the structure and nature of headache in pediatric patients, as well as its relationship with chronic rhinosinusitis, to develop an effective rehabilitation course for pediatric patients with headache at the sanatorium-resort stage. The study included 100 patients aged 8 to 17 years who received a course of sanatorium treatment. Patients were divided into groups: with primary headache and with secondary headache in chronic rhinosinusitis. The results of a comprehensive otorhinolaryngological and neurological study made it possible to determine the mechanism of development, structure, and nature of the predominant types of headache in children and to develop a course of rehabilitation treatment. An analysis of the effectiveness of the rehabilitation course showed that it was possible to achieve a positive result in 88% of children with primary and secondary headache. The necessity of interdisciplinary participation of otorhinolaryngologists and neurologists in the examination and treatment of patients complaining of headache at the sanatorium-resort stage is substantiated. The effectiveness of the proposed rehabilitation course of headache treatment of various origins in children has been proven, the analysis of long-term results allows us to recommend it during staged therapy.

RESULTS OF SURGICAL CORRECTION OF POSTOPERATIVE COMPLICATIONS IN ANORECTAL MALFORMATION IN CHILDREN

The high frequency of postoperative complications (POС) in the anorectal zone remains an urgent problem of pediatric surgery.Satisfactory results after a single intervention are 50-80%. After the correction of anorectal postoperative malformation (APM),functional disorders of the sphincter apparatus of the rectum are observed in 30-60% of patients, which further leads to fecal incontinence (FI) and chronic constipation (CC). We retrospectively analyzed the causes of the most common recurrent pathological conditions in the anorectal zone in children as well as tactical approaches, methods of software correction, and considered ways to prevent them.The aim. The goal is to improve the results of surgical correction of postoperative complications (POC) in the anorectalzone in children.Material and methods. 78 patients with POC in the anorectal zone after primary and repeated correction of anorectalmalformations (ARM) were examined. 197 reconstructive operations were performed. The diagnostic algorithm consisted ofclinical, X-ray, laboratory examination, MRI and endoscopic examination methods.The study has been carried out in accordance with the principles of the Helsinki Declaration. The research protocol wasapproved by the Local Ethics Committee (LEK) of all participating institutions. The informed consent of the children’s parentswas obtained for the research. The authors declare that there is no confl ict of interest.Statistical processing of the study results was carried out using standard methods with the calculation of the absolute numberof observations (n) and the percentage ratio (%).Results and discussion. The analysis of long-term results after the primary and repeated correction of the ARM showedthat unreliable primary diagnosis, inadequate preoperative preparation, and the choice of the operation method led to thedevelopment of postoperative anal sphincter insuffi ciency (PASI), which required a large number of repeated operations. Thecauses of complications were studied, errors were analyzed, indications, timing, accesses, volume and methods of repeatedsurgery were optimized. The optimization of tactical approaches, methods of surgical and rehabilitation treatment led to theimprovement in the results of treatment of PASI up to 85.3%.Conclusions: 1. Indications and the choice of method for repeated correction of pathological conditions in the anorectal zone inchildren are determined taking into account the degree of PNAS. 2. Analysis of the causes of errors, optimization of diagnostics, tactics of intraoperative surgical correction and postoperative preventive measures contribute to improving the results of treatment of children.3. Optimization of tactical approaches, methods of surgical and rehabilitation treatment led to an improvement in the resultsof treatment of PNAS up to 85.4%.

Mini-gastric bypass with Nissen fundoplication for the treatment of obesity and gastroesophageal reflx disease

Aim. To develop bariatric and antireflx surgery for the treatment of patients with obesity and GERD, and to assess its effectiveness and safety.Methods. A prospective controlled study included 28 patients who underwent laparoscopic mini-gastric bypass with Nissen fundoplication, and their progress was monitored for three years postoperatively. This study covered the surgical procedure and its technical aspects. Surgical treatment was evaluated using GERD-HRQL, BAROS, and GIQLI questionnaires, as well as instrumental studies (esophagogastroscopy and X-ray of the esophagus and stomach).Results. According to the GERD-HRQL questionnaire, mini-gastric bypass with Nissen fundoplication demonstrated excellent control over GERD symptoms during all stages of postoperative follow-up. The most signifiant reduction in body weight occurred within the fist year after the operation, with sustained effects throughout the observation period. The maximum percentage of excess body weight loss was observed two years post-operation. The GIQLI questionnaire showed an average score increase of 54 % three years after surgical treatment compared to baseline. Evaluation of the bariatric treatment’s effectiveness using the BAROS system criteria consistently indicated «excellent and very good results» throughout the entire postoperative follow-up period. No signifiant postoperative complications were identifid, both in the early and long-term periods.Conclusion.The developed mini-gastric bypass with a Nissen fundoplication proves to be a safe and effective surgical treatment method for patients with obesity and GERD. Following further clinical studies and the analysis of long-term results, the proposed operation could be recommended as an alternative to RYGB and MGB-OAGB for patients with obesity and GERD.

Сравнение ранних результатов и безопасности различных способов пилинга внутренней пограничной мембраны сетчатки в хирургическом лечении диабетической ретинопатии

Relevance. Surgical treatment (VRS) of diabetic retinopathy (DR) is the method of choice in the development of its complications and in combination of DR with other vitreoretinal diseases. The procedure of the retinal inner limiting membrane (ILM) peeling is a debatable stage of the VRS, there is no single concept for its application, and the analysis of its results provides conflicting data. The purpose of the study was a comparative analysis of various methods of retinal ILM peeling in terms of safety, functional and anatomical results in the early postoperative period (up to 3 months). Material and methods. A randomized study was conducted on three comparable groups of patients with proliferative DR (PDR). All patients underwent comparable VRS treatment, the groups differed only in the stage of ILM peeling: in group 1, ILM peeling was not performed, in group 2, it was performed within the inter-arcade space, in group 3, dosed center-sparing ILM peeling was performed. Results. ILM peeling methods were comparable in terms of safety. However, in group 2, a lamellar macular hole (LMH) formation was noted in two cases. Also intraoperatively among patients of group 2, five cases of transient retinal neuroepithelial detachment (tNED) associated with ILM peeling were detected. Functional and anatomical results in the groups were comparable and did not differ significantly. A possible predictive role of the central macular volume in the prognosis of postoperative diabetic macular edema (DME) was revealed. A relationship between tNED and the risks of developing DME and LMH after surgery has been established. Conclusion. In the early postoperative period, the results of treatment using different methods of ILM peeling are comparable. Their further study and analysis of long-term results are required. Keywords: diabetic retinopathy, diabetic macular edema, vitreoretinal surgery, ILM peeling, dosed center-sparing ILM peeling, optical coherence tomography, lamellar macular hole.

Laparoscopic resections of the liver and the colon in patients with synchronous colorectal metastases: a case series

Aim. To evaluate the results of laparoscopic simultaneous colorectal and liver resections in patients with synchronous liver metastases.
 Materials and methods. From July 2019 to July 2021 9 patients with synchronous liver metastases of colorectal origin underwent one-stage mini-invasive surgery in the Department of Oncology №4 City Clinical Oncological Hospital №1. There were 4 totally laparoscopic procedures while 5 patients had laparoscopic colon resection and an open hepatectomy. A laparoscopic rALPPS right hepatectomy with sigmoid colon resection was performed in one case.
 Results. There were no deaths during hospitalization or within 90 days after surgery. There were no severe complications requiring repeated surgeries or long-term intensive therapy (DindoClavien IIIBIVB grade). Two patients needed an ultrasound-guided drainage of hematoma and biloma, respectively. There was one case of grade A of liver failure and one case with prolonged antibacterial therapy caused by unclear fever. The average duration of interventions was 401121 min, the average volume of blood loss was 383331 ml. Mean post-operative hospital stay was 104 days.
 Conclusion. Our initial experience in the implementation of one-stage laparoscopic surgery in the treatment of patients with synchronous liver metastases of colorectal origin is promising and requires further research and analysis of long-term results.

Implants Versus Lipograft: Analysis of Long-Term Results Following Congenital Breast Asymmetry Correction

AimsCongenital breast asymmetry represents a particular challenge to the classic techniques of plastic surgery given the young age of patients at presentation. This study reviews and compares the long-term results of traditional breast augmentation using silicone implants and the more innovative technique of lipografting.MethodsTo achieve this, we not only captured subjective parameters such as satisfaction with outcome and symmetry, but also objective parameters including breast volume and anthropometric measurements. The objective examination was performed manually and by using the Vectra® H2 photogrammetry scanning system.ResultsDifferences between patients undergoing either implant augmentation or lipograft were revealed not to be significant with respect to patient satisfaction with surgical outcome (p = 0.55) and symmetry (p = 0.69). Furthermore, a breast symmetry of 93 % was reported in both groups. Likewise, no statistically significant volume difference between the left and right breasts was observed in both groups (p < 0.41). However, lipograft patients needed on average 2.9 procedures to achieve the desired result, compared with 1.3 for implant augmentation. In contrast, patients treated with implant augmentation may require a number of implant changes during their lifetime.ConclusionBoth methods may be considered for patients presenting with congenital breast asymmetry.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Аналіз віддалених результатів оперативного лікування вивихів акроміального кінця ключиці

Актуальність. Вивихи акроміального кінця ключиці є доволі поширеним травматичним пошкодженням апарату руху та опори і, за даними різних авторів, становлять від 3 до 26,1 % від вивихів інших локалізацій і близько 10 % у структурі гострих пошкоджень плечового пояса, займаючи третє місце після вивихів плеча та передпліччя. Зустрічаються переважно у чоловіків молодого, найбільш працездатного віку, що зумовлює соціальну значущість даного пошкодження. Мета дослідження: визначити чинники, що негативно впливають на анатомо-функціональний результат оперативного лікування вивихів акроміального кінця ключиці. Матеріали та методи. За період з 2015 по 2020 рік проведений ретроспективний аналіз 93 пацієнтів, яким було виконане оперативне втручання з приводу вивиху акроміального кінця ключиці. Стабілізація акроміального кінця ключиці забезпечувалась фіксацією за Вебером і використанням Hookplatе. Результати. Хороші результати отримані в 49,5 % випадків, задовільні — у 31,2 %, незадовільні — у 19,3 % пацієнтів. Незадовільні результати лікування пацієнтів мають прямий зв’язок зі зростанням тяжкості пошкодження. Так, при використанні способу фіксації за Вебером при вивихах II типу за Tossy незадовільні результати становлять 9,7 %, в той час як при вивихах III типу за Tossy — 27,0 %, при застосуванні Hookplatе— 15,8 та 29,4% відповідно. Висновки. Причиною незадовільних результатів оперативного лікування вивихів акроміального кінця ключиці є тяжкість пошкодження та відсутність діагностично-лікувального алгоритму при діагностиці та лікуванні. При вивихах III типу за Tossy фіксація за Вебером або використання Hookplatе та ушивання пошкоджених акроміально-ключичних зв’язок не забезпечує достатньої ефективності оперативного втручання.

ЭФФЕКТИВНОСТЬ И БЕЗОПАСНОСТЬ ДЕЛАМАНИД-СОДЕРЖАЩИХ РЕЖИМОВ У ПАЦИЕНТОВ С ЛЕКАРСТВЕННО УСТОЙЧИВЫМ ТУБЕРКУЛЕЗОМ И КОМОРБИДНОЙ СЕРДЕЧНО-СОСУДИСТОЙ ПАТОЛОГИЕЙ

Aim. To study the effectiveness of treatment with delamanid-containing regimens in patients with multidrug-resistant and extensively drug-resistant tuberculosis and comorbid cardiovascular diseases, to assess the frequency, structure, and severity of adverse events in the cardiovascular system in this group of patients. Materials and methods. The study included 125 adult patients with multidrug and extensive drug resistance who started treatment with delamanid-containing regimens from July 2016 to February 2018 at the Republican Research and Practical Center for Pulmonology and Tuberculosis and six regional anti-TB institutions. The main group included patients with multiple and extensive drug resistance and comorbid cardiovascular diseases (N = 46). The control group included patients with multiple and extensive drug resistance without comorbid cardiovascular diseases (N = 79). The formulation and coding of the diagnosis (the underlying disease and comorbid diseases (conditions)) corresponded to the International Classification of Diseases (ICD) of the 10th revision. Adverse events were classified according to the international dictionary MedDRA (Medical Dictionary for Regulatory Activities). The severity of adverse events classification complied with CTCAE (Common Terminology Criteria for Adverse Events). The severity of adverse events was determined in accordance with the definitions of ICH (The International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use), and the treatment outcomes were identified in accordance with clinical guidelines and WHO recommendations. The study materials were the data from the medical records of the patients in the E-Register "Tuberculosis". Sputum culture conversion was defined as two consecutive negative test results. Treatment outcomes were classified as successful and unsuccessful. For the analysis of adverse events, each event was considered as a unit of analysis both in the aggregate of all adverse events in the cardiovascular system and in groups of patients. Testing of statistical hypotheses was carried out at a critical level of significance p = 0.05, i.e. the difference was considered statistically significant if p &lt; 0.05. Results. The effectiveness of treatment with delamanid-containing regimens in the group of patients with comorbid cardiovascular diseases was 88.0%, sputum conversion after 6 months of treatment (abacillation by culture) was observed in 93.0% of patients in this group, when compared no statistical difference was present in the effectiveness of treatment (p = 3.841) of the patients of the main group and those of the comparison group. In the analysis of long-term results, only one patient with cardiovascular comorbidity (3.0%) had a relapse of tuberculosis more than one year after successful treatment. 78.0% of patients of the main study group (with comorbid cardiovascular diseases) and 70.0% of the comparison group manifested cardiovascular adverse events during treatment. The most common adverse event in both groups was prolongation of the QTcF interval, which was recorded in 37.0% of patients with comorbid cardiovascular diseases and in 42.0% of patients without cardiovascular diseases (p = 0.597). Timely correction and careful monitoring of adverse events made it possible to avoid the development of life-threatening conditions in both groups of patients. In this regard, no withdrawal of anti-tuberculosis drugs was registered due to cardiovascular adverse events, including those due to the prolongation of the QTcF interval. The highest frequency of cardiovascular adverse events was detected during the first month of treatment of patients, then, in the course of treatment, it decreased, which may indirectly indicate the absence of a cumulative cardiotoxic effect of delamanid-containing treatment regimens. Conclusions. Treatment with delamanid-containing regimens in adult patients with multidrug-resistant tuberculosis and comorbid cardiovascular disease was effective and had an overall favorable cardiovascular safety profile comparable to the comparison group. Despite a large number of cardiovascular adverse events, they were manageable at the program level (prevailing at the initial stages of treatment, having light, mild or moderate severity, having been relieved), which made it possible to complete anti-tuberculosis treatment with delamanid-containing regimens.

Microvascular decompression for trigeminal neuralgia, long-term follow-up results and assessment of possible prognostic factors: a single-center retrospective cross-sectional cohort study

Aim: Prognostic factors detection and analysis of long-term results of microvascular decompression for trigeminal neuralgia. Materials and methods. 161 cases of trigeminal neuralgia (TN) treatment by MVD technique without preliminary invasive interventions within 10 years were analyzed. Two blocks of information were designed which included objective case data (8 factors) and patient satisfaction survey (5 questions). Follow-up minimal cut-off was 1 year (median 5.8 years). The primary end point is the proportion of pain free patients and BNI (Barrow Neurological Institute) score at last follow-up. The secondary end point is the assessment of possible risk factors of treatment failure: symptoms duration, decompression type, affected nerve branches, neurovascular conflict visible on MRI, different indications for surgery. Logit-regression analysis was carried out. Significance level was set at p&lt;0,01. Results. Among the studied factors as predictors for pain recurrence all but one failed to reach significance threshold. Conflict on MRI (p=0,231), involved nerve branches (p=0,340), indications for surgery (p=0,659), number of involved vessels (p=0,834), achieved decompression type (p=0,157), venous compression (p=0,143), gender (p=0,150), affected side (p=0,934) did not reach the significance level. For symptoms duration p=0,0012. Conclusions. As a result of multifactorial analysis of study results, the only significant prognostic factor for treatment failure (pain recurrence or worsening of obtained result) was symptoms duration at the time of surgery.

Віддалені результати хірургічного лікування доброякісної вогнищевої патології щитоподібної залози

Проведено аналіз віддалених результатів органозберігаючих операцій на щитоподібній залозі з приводу доброякісної вогнищевої патології. Виявлені закономірності виникнення рецидивів залежно від обсягу операції, морфологічного типу вузлів, їх множинності. Також вивчений вплив радіаційного опромінення, отриманого в 1986 р. внаслідок аварії на ЧАЕС, на розвиток рецидивів доброякісної вогнищевої патології щитоподібної залози.

Fifteen years of experience in plastic liquor fistulas using high-intensity laser radiation

Introduction. The need to close liquor fistulas as early as possible is associated with a high risk of intracranial complications. Certain difficulties in closing bone defects are due to the variability of the exact localization of the fistulous canal, the choice of the surgical approach, and the reliability of the plastic material. The literature describes various methods for eliminating basal liquorrhea, however, the advantage of none of them has not been proven, which determines the relevance of the search for new methods.Objective. Based on the analysis of long-term results, to study the efficiency of plastic closure of cerebrospinal fluid fistulas using high-intensity laser radiation.Materials and methods. An analysis of 15 years of experience in studying the effectiveness of plastic closure of cerebrospinal fluid fistulas in 126 operated patients with basal liquorrhea was carried out. The duration of the disease ranged from 2 months to 1.5 years. The main group consisted of 94 patients who underwent plastic closure of CSF fistulas using high-intensity laser radiation with a wavelength of 0.97 pm and a power of 2.5-3.5 W. The control group consisted of 32 patients who did not receive coherent laser radiation. In addition to the generally accepted methods of postoperative management, low-frequency ultrasonic cavitation irrigation of the operated cavities was used to accelerate the reparative processes in all patients.Results and discussion. The average follow-up period after surgery was over 13 years. When comparing the results of treatment, the main criterion for evaluating the effectiveness of the operation was the frequency of relapses. In 15 (12.3%) cases, a relapse was noted, of which 5 (3.71%) were patients in the main group and in 10 (8.32%) patients in the control group, who were closed by repeated surgeryConclusion. The clinical features of the basal liquorrhea include the variability in the localization of the fistulous canals, certain difficulties in their detection, a wide variety of plastic closure methods, and a high percentage of relapses. A prospective uncontrolled study has shown that this method of CSF fistula plasty using improves the efficiency of surgical treatment.

Структурно-функциональные особенности центрального отдела сетчатки и совершенствование хирургического лечения больных с диабетическим макулярным отеком и эпиретинальной мембраной

Purpose. Improving the efficiency of surgical treatment of patients with diabetic macular edema and epiretinal membrane. Material and methods. Clinical studies were based on the analysis of morphological and functional parameters of the central retina. Patients with diffuse diabetic macular edema (DME) and epiretinal membrane (ERM) made up group A (main) of 96 people (96 eyes). Group B (control) included 22 patients (44 eyes) without ophthalmological diseases. Depending on the chosen method of surgical treatment, patients in group A were divided into three subgroups. Results. According to the data of optical coherence tomography, it was revealed that the average index of retinal thickness as a result of edema increased by 1.35 times (p=0.011) compared with group B. When conducting microperimetry in the macular zone in patients of group A, the total light sensitivity was reduced in 1.88 times compared with group B (p=0.028). Comparative analysis of long-term results of surgical treatment of patients with DMO and ERM showed that complex simultaneous vitrectomy and administration of an angiogenesis inhibitor is preferable compared to delayed administration of drugs, which is confirmed by a decrease in the total thickness of the retina in 78.3% of cases, preservation of the total photosensitivity of the central part of the retina on average, up to 15.3±3.24 dB, visual acuity - up to 0.51±0.22, no recurrence of edema in 63.4% of patients and the development of ERM - in 100% of cases. Conclusion. If the central thickness of the retina at the preoperative stage is less than 400 microns, it is possible to use a step-by-step method (vitrectomy + intravitreal administration of an angiogenesis inhibitor after 1 month). The use of the proposed one-step operation technique is preferable when the retina thickness is more than 400 microns. Vitrectomy with peeling of the internal limiting membrane in patients with cysts in the retinal edema zone with a diameter of more than 200 µm does not lead to a positive anatomical and functional result. Key words: diabetic macular edema, angiogenesis inhibitor, vitrectomy, microperimetry, epiretinal membrane.

Local Excision ± Chemoradiotherapy vs. Total Mesorectal Excision for Early Rectal Cancer: Case-Matched Analysis of Long-Term Results.

Background: Our aim was to compare the bowel function and oncologic outcomes following these two treatment modalities.Materials and methods: This was a single-center study with 67 patients included between 2009 and 2018. A total of 32 patients underwent total mesorectal excision (TME) group and 35 transanal local excisions (LE) ± chemoradiation. We performed a case-matched analysis: we matched the patients by age, cancer stage, and comorbidities. Duration of operation, postoperative complications, length of hospital stay, and long-term functional and oncological outcomes were compared. We calculated oncological outcomes using Kaplan–Meier Cox diagrams. In addition, we used a low anterior resection syndrome (LARS) score for the bowel function assessment.Results: Mean operation time in the LE group was 58.8 ± 45 min compared with the TME group that was 121.1 ± 42 min (p = 0.032). Complications were seen in 5.7% in LE group and 15.62% in TME group (p = 0.043). ~85.2% of the patients had no LARS in LE group compared with 54.5% in TME group (p = 0.018). Minor LARS was 7.4% in LE group compared with 31.8% in TME group (p = 0.018); major LARS was 7.4 and 13.7%, respectively (p = 0.474). Hospital stay was 2.77 days in LE group compared with 9.21 days in TME group (p = 0.036). The overall survival was 68.78 months in LE group compared with 74.81 months in TME group (p = 0.964).Conclusion: Our results of a small sample size showed that local excision ± chemoradiation is a rather safe method for early rectal cancer compared with gold standard treatment. In addition, better bowel function is preserved with less postoperative complications and shorter hospital stays.

The first experience of arthroscopy in the case of aseptic necrosis of the femoral head

Observation of patients with avascular necrosis of the femoral head formed a hypothesis about inability to eliminate the hip contracture by tunneling the femoral head on the background of drug therapy and therapeutic exercises, which causes an unsatisfactory outcomes. Therefore, the was idea to use arthroscopy for performing capsulotomy, synovectomy and removal of free cartilage and bone fragments. Objective. To evaluate efficiency of arthroscopy in patients with avascular necrosis of the femoral head. Methods. In the period from 2010 to 2018, 60 patients were observed. With the I–II stages, absence of inflammatory processes in the joint, body mass index less than 35. In the comparison group (28 patients) we made only tunneling of the femoral head, in the study group (32) at first we performed arthroscopy of the hip joint, capsulotomy, synovectomy, removal of cartilage fragments, and only then — tunneling. We analyzed the proportion of hip joint replacement that was performed in the long term follow up and the intensity of pain by visual analog scale. Results. During arthroscopy we often revealed the joint cartilage lesions — 30 %, articular labrum lesions — 5 %, synovitis — 100 %, CAM impingement — 90 %. In the study group in the first 2 weeks after surgery, the pain was severe more than in the comparison group. Then the pain rate became the same in both groups. In the control group in the period from 3 to 5 years after tunneling of the femoral head, arthroplasty was performed in 11 patients (39.3 %), in the study group for 2 to 3 years after surgery — 8 (25.0 %). Conclusions. Analysis of long-term results of tunneling of the femoral head with arthroscopy of the hip joint in patients with avascular necrosis of the femoral head showed improvement in hip function, no disease progression in 60–75 % patients in 2–3 years after surgery.

Glucocorticoid with cyclophosphamide for oral paraquat poisoning.

Glucocorticoid with cyclophosphamide for oral paraquat poisoning.

Comparative analysis of long-term results of external beam and combined radiotherapy in high-risk prostate cancer patients

Prostate cancer (PCa) of high risk is one of the crucial problems in urological oncology. Radiation therapy (RT), along with radical prostatectomy, is an important component of the complex treatment of patients with high‑risk PCa. To improve the long‑term oncological results of RT dose escalation is advocated. Currently, dose escalation can be reached via external beam irradiation and interstitial RT techniques. The study included 109 patients with high‑risk PCa who underwent either external beam RT up to 76 Gy, or combined RT (external beam + interstitial RT) using 125I sources with long‑term androgen deprivation therapy. Comparative analysis of long‑term results of patients with high‑risk PCa treatment showed an improvement in 5‑year disease‑free survival rates after combined RT compared with external beam RT. Acute rectal toxicity was decreased in combined RT group compared to patients after external beam RT: 13.2 % and 46.4 %, respectively (p &lt; 0.01).

Psychological status of patients after coronary artery bypass grafting: Data from a 5-year-follow-up study

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Federal State Budgetary Scientific Institution “Research Institute for Complex Issues of Cardiovascular Diseases” Negative psychological status is acknowledged as one of risk of development of cardiovascular pathology. However, predictive value of type D personality (psychosocial distress) in different cultures and the countries are not fully understood. Purpose: Study aim was to investigate the association of type D personality and quality of life (QoL) with the development of cardiovascular complication in patients in five years after coronary artery bypass grafting (CABG). Materials and Methods: Evaluation of psychological status and combined risk of nonfatal (strokes, nonfatal myocardial infarctions, repeat procedures of revascularization and hospitalization due to relapse or progression of angina pectoris) and fatal (general and cardiovascular mortality) cases before and in five years after CABG. Patients with chronic ischemic heart disease (n = 602, 112 (18.5%) females and 490 (81.5%) males, mean age = 57.7 ± 7.3 years.) who had had CABG were included in the study. Who were formed in two groups: patients with the presence of type D (n= 134) and patients without type D (n = 468). The study of the psychological status was carried out using questionnaire DS-14. Analysis of long-term results were assessed using the Kaplan–Meier method. Data was collected by a SF-36 questionnaire, comprising of 36 questions divided in 8 domains. The score was designated as 0 to 100; with the higher score being indicative of a better QoL. Results: Frequency of fatal cases in both groups amounted 8.3% and 8.1% (p = 0.145), in turn nonfatal end-points in group with type D amounted 31.8%, and 15.9% in group without type D (p = 0.044) in during the 5 years. Presence of type D personality at initial examination increased 3.21 times combined risk of nonfatal and fatal cases (OR 3.21, 95% CI 2.02-6.14, p = 0.002). In long term period there were no differences in survival between groups type D and without type D (95.5% vs. 96.8%), There were differences in groups type D and without type D in nonfatal events (strokes, nonfatal myocardial infarctions, secondary endpoint: repeat procedures of revascularization and hospitalization due to relapse or progression of angina pectoris) (respectively, 97.1% vs 88.0%, (p = 0.341). Findings showed that 75% of subjects reported well QoL, while the mean score regarding QoL in patients with type D personality, were higher than in patients without type D in all health related dimensions. Based on t-test difference, the of QoL in in patients with type D and in patients without type D for physical health (p &amp;lt; 0.015), mental limitation (p &amp;lt; 0.043), somatic pain (p &amp;lt; 0.022) and mental health (p &amp;lt; 0.041) was observed. Conclusion: Type D patients had a greater risk for nonfatal cardiac events and lower QoL indicators, compared with non Type D patients. Accumulated proofs indicate that in detection of patients at risk of development of stress induced cardiac complications after CABG it is reasonable to use approach which involves consideration of personality type.

Choice of cerebral protection devices for carotid stenting

The article analyzes a retrospective analysis of long-term results of 316 carotid stentings performed in patients with atherosclerotic stenosis of the extracranial parts of the internal carotid arteries using various types of cerebral protection devices – filters and proximal protection devices and their combinations. As a result of the analysis, we obtained data on the influence of the choice of cerebral protection devices on the risks of ischemic complications. The topic under consideration will be of interest to specialists in X-ray endovascular diagnostics and treatment, cardiovascular surgeons, and neurologists.

DIAGNOSTICS AND TREATMENT OF PURULENT ARTHRITIS OF THE STERNOCLAVICULAR JOINT

Summary. Inflammatory lesion of the sternoclavicular joint (SCJ) is a rare disease that requires surgical treatment. Traditional radiography reveals osteolysis and osteosclerosis, however, at the onset of the disease, such changes are absent. Difficulties in diagnosing this disease require further study of the problem and the development of new therapeutic and diagnostic approaches.&#x0D; Aim of the work: to study the role of sonography in the diagnosis of purulent arthritis of SCJ and the choice of treatment tactics.&#x0D; Materials and methods. Prospective single-center study of 28 cases of acute nonspecific arthritis of SCJ. The patients were divided into 2 groups: the first included patients who received drug therapy, the second included patients subject to surgical treatment.&#x0D; Results and discussion. Ultrasound scanning of SCJ identified 3 sonographic variants of the lesion: exudative, destructive with synovial hyperperfusion, and destructive with synovial hypoperfusion.&#x0D; The duration of hospital stay in both groups did not differ statistically: 12 (12; 13.5) vs 14 (12; 14) days, p = 0.194.&#x0D; Analysis of long-term results in patients of the first group established the progression of the disease with the development of osteomyelitis or recurrence of arthritis in 3 cases (30 %). Among the patients of the second group, no complications or recurrence were detected during the indicated observation period.&#x0D; Conclusion. Sonography is diagnostically significant in the diagnosis of SCJ arthritis. It allows you to determine the group of patients subject to mandatory surgical correction. Intravenous drug addiction associated with bacteremia is a predictor of poor drug treatment outcomes and an indication for active surgical tactics.

Передние диафрагмальные грыжи у детей. Отдаленные результаты хирургического лечения

Anterior diaphragmatic hernia (ADH) is a rare congenital pathology that occurs in children with a frequency of 1:4800 (1–6% of all congenital diaphragmatic hernias). There are many controversial aspects in the surgical treatment of patients with ADH: the choice of surgical approach, the method of diaphragmatic repair and the feasibility of excision of the hernial sac. Objective. To conduct a comparative analysis of the surgical treatment of patients with ADH in different clinics, assessing longterm outcomes. Patients and methods. The medical records of 7 children with ADH who underwent surgical repair in different clinics (in time period from 2009 to 2019) were retrospecively reviewed. Evaluating the long-term results of ADH repair was made by telephone and online surveys of the parents of patients and by outpatient examination of children (chest x-ray in two projections). Results. In a ten-year period, 7 patients (4 boys and 3 girls) were operated on with a diagnosis of “anterior diaphragmatic hernia” at the age of 3 months to 12 years. In most children, a hernia was discovered accidentally by chest x-ray. Laparoscopic correction was performed in 5 (71%) cases, thoracoscopic correction – in 2 cases (29%). The main difference in surgical tactics in ADH patients was the manipulation with the hernial sac – the hernial sac was excised in 4 (57%) patients, but it was left in three cases (43%). The defect closure was performed by “full-thickness” separated sutures that fix the diaphragm to the anterior abdominal wall during laparoscopy (5) and to the chest tissue during thoracoscopy (2); in some cases, additional fixation to the rib (4) was performed. Sutures were tied extracorporeally and buried in the subcutaneous layer in 6 (86%) patients. Average follow-up was 7 years. While evaluating long-term outcomes no ADH recurrence were found. Conclusions. There are still many controversial aspects in the surgical treatment of ADH patients. In our opinion, multicenter studies with complex analysis of long-term results are required to standardize the surgical treatment of such patients. Key words: anterior diaphragmatic hernia, Larrey hernia, long-term outcomes, Morgani hernia