Central Military Hospital Research Articles

Comparative characteristics of the amount of cytokines in patients with hepatitis B and C

The problem of viral hepatitis is also important for the Armed Forces, which are the guarantor of the independence of each state. Timely diagnosis of viral hepatitis among new recruits, as well as among military personnel already in service, is distinguished by its importance. Undiagnosed viral hepatitis can later lead to the spread of viral infection among other military personnel. The diagnosis of the virus has an significant strategic importance among those in the service for the prevention of liver failure and cirrhosis due to the damaging effect of that virus on the liver in the future. The purpose of the study: Study of the amount of cytokines and TNF-alpha in the blood of military personnel with latent hepatitis infection, comparing the results with patients with steatosis and practically healthy individuals. Material and methods: The material of the study was composed of 89 military personnel examined at the Central Military Polyclinic and Military Hospital of the Ministry of Defense of the Republic of Azerbaijan. Patients were divided into 3 main groups: hepatitis B group consisted of 45 people (50.6%), hepatitis C group 21 people (23.6%), steatohepatosis group consisted of 23 people (25.8%). Conclusion: Determination of immune response parameters and cytokines in the blood during hepatitis B and C virus infections among military personnel has important perspectives as a new direction in the diagnosis of viral hepatitis. Thus, the results of general and biochemical analysis of blood may not show specific changes during examination of military personnel infected with hepatitis B and hepatitis C viruses.

Prevalencia de trastornos musculoesqueléticos en el cuidador primario de pacientes con discapacidad física

Objective: To estimate the prevalence of musculoskeletal disorders in the primary caregiver of patients with physical disabilities at the Central Military Hospital. Methodology: Participants who were caregivers of pa tients with a disability were sought to complete the questionnaire. A sociodemographic questionnaire was applied to each person, the Nordic questionnaire for the detection of musculoskeletal symptoms and the Zarit questionnaire to assess the caregiver’s burden, descriptive statistics of these questionnaires were performed. Results: The final sample was 29 people, the sociodemographic questionnaire showed that the primary caregiver is usually a single woman aged 40 (± 11.5) years, with a daughter relationship, who is dedicated to household activities. The Nordic questionnaire showed that 21% of the caregivers reported pain, the largest areas with pain were back (45 %), shoulder and neck (both with 21 %). The Zarit questionnaire indicated that nearly 90 % of the patients did not present activity overload. Limitations of the study: Being a study carried out in a military hospital, the results may not be representative of the Mexican population. Originality: Few are the works focused on the study of the Primary Caregiver both nationally and internationally. Conclusions: The informal primary caregiver is usuallya vulnerable population with a low educational leveland without any economic remuneration, and whichcontributes a lot to the care of patients with disabilities,therefore measures must be implemented to help trainthem to care for their integrity and that of their relatives.

Study of Two Sedative Protocols for Drug-Induced Sleep Endoscopy: Propofol versus Propofol-Remifentanil Combination, Delivered in Target-Controlled Infusion Mode.

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep-disordered breathing pathology with significant clinical consequences, including increased cardiovascular risk and cognitive decline. Continuous positive airway pressure (CPAP) is the gold-standard treatment, but alternative strategies are sometimes needed for patients intolerant to CPAP. Drug-induced sleep endoscopy (DISE) is a key diagnostic tool for assessing upper airway obstruction in OSA patients and subsequently tailoring a surgical approach, with sedation protocols playing a crucial role in its efficacy and results accuracy. This study aimed to investigate the effect of adding remifentanil to a propofol target-controlled infusion (TCI) regimen on the sedation parameters and procedural outcomes of DISE. Materials and Methods: The study was conducted at the Central University and Emergency Military Hospital "Dr. Carol Davila" and Ria Clinic in Bucharest between July 2021 and October 2023. Thirty-one patients were enrolled and randomised into two groups: a propofol group (P group, n= 11) and a remifentanil-propofol group (R-P group, n = 20). DISE was performed using standardised protocols, sedative drugs were administered in TCI mode, and data on sedation levels, respiratory and cardiovascular parameters, and procedural incidents were collected. Results: The addition of remifentanil at 1 ng/mL effect-site concentration significantly reduced the effect-site concentration of propofol required for adequate sedation (3.4 ± 0.7 µg/mL in the P group vs. 2.8 ± 0.6 µg/mL in the R-P group, p = 0.035). The time to achieve adequate sedation was also shorter in the R-P group (7.1 ± 2.5 min vs. 9.5 ± 2.7 min, p = 0.017). The incidence of cough, hypoxemia, and cardiovascular events did not significantly differ between the two groups. Conclusions: Adding remifentanil to a propofol TCI regimen for DISE effectively reduces the required propofol effect-site concentration and shortens sedation time without increasing the risk of adverse events. This combination may enhance the safety and efficiency of DISE, offering a promising alternative for patients undergoing this procedure.

#1888 Association between intrapatient variability of serum tacrolimus levels with the development of diabetes in post-kidney transplantation patients

Abstract Background and Aims Kidney transplantation is the most cost-effective renal replacement therapy compared to dialysis. Diabetes is main cause of increased cardiovascular risk and death. Post-transplant Diabetes Mellitus (PTDM) it refers to presence of diabetes in an environment after kidney transplantation; According to the ADA (American Diabetes Association) criteria, the diagnosis must be made with a tolerance test with 75 grams of oral glucose (Oral glucose tolerance test-OGTT) or the determination of glycosylated hemoglobin 1Ac (Hb1Ac) in a post-transplant period of stability of the immunosuppression dose and without infections. There are various risk factors for the development of PTDM: hypomagnesemia, glucocorticoids, calcineurin inhibitors (tacrolimus and cyclosporine); hepatitis C virus and cytomegalovirus infections. In a Mexican kidney transplant recipients in Guadalajara, Andrade SG demonstrated that the incidence of PTDM was 10.1% at 1 year post-transplant. In the Spanish population, Porrini E demonstrated that tacrolimus represents a risk factor for the development of PTDM, increasing the incidence of prediabetes by 33% at 12 months post-transplant. Several mechanisms have been implicated in the association of calcineurin inhibitor and PTDM: decreased insulin secretion, glucose intolerance, reduced pancreatic beta cell mass, increased islet apoptosis and decreased insulin gene expression. Studies mention that tacrolimus (FK) is more diabetogenic than cyclosporine (CsA) especially at levels above 20 ng/mL. The DIRECT study (Diabetes Incidence after Renal Transplantation) showed the incidence in 73 kidney transplant patients with CsA (26%) and 96 FK patients (33.6%, p = 0.046). By the other side, Malik RF mentions that FK levels aren´t a risk factor for the development of PTDM. To demonstrate that the high intrapatient variability of tacrolimus/cyclosporine serum levels correlates with the development of diabetes (PTDM) in kidney transplant recipients at the central military hospital in Mexico City. Method Observational, analytical, longitudinal and retrospective study. All kidney transplant recipients from living donors and cadaveric donors from January 2002 to December 2020 were included. FK and CsA were used as maintenance immunosuppression. Serum levels of FK/CsA, Hb1Ac and glucose were measured at months 0, 3, 6, 9 and 12 and intra-patient variability (IPV) of FK/CsA levels was calculated for each patient. The patients were separated into 2 groups, IPV low and IPV high according to the mean the coefficient of variability (CV). The IPV of the calcineurin inhibitor was estimated by calculating the CV in each patient according to the following equation: CV(%)= (SD/mean trough concentration of FK/ CsA)×100. The diagnosis of PTDM followed the criteria of the American Diabetes Association. The Mann Whitney U test was used. Results 638 kidney transplant recipients were included. The mean age of the recipients was 36.78 (±12.81) years. At the time of kidney transplant, the BMI was 22.67 (±3.90) and 25.76 (±3.99) kg/m² BS at 1 year post-transplant for whole cohort. At 1 year post-transplant, 72.3% patients were on FK and 27.7% on CsA. Hb1Ac for whole cohort was 4.81 (±0.71)% and 4.84 (±0.77)% at month 0 and 12 post-kidney transplant, respectively. FK and CsA levels were 12.41 (±5.31) and 234.34 (±87.80) ng/mL and 9.13 (±5.3) and 194.38 (±92.44) ng/mL in the PTDM and non-PTDM groups, respectively (p = 0.029). 17.96% of patients developed PTDM. Mean CV of the entire cohort was 33.84 (±20.41)%. When performing the analysis of the IPV coefficient by subgroups of maintenance immunosuppression used at 1 year post-transplant: the IPV of FK was 43.39 (±18.49)% and 29.99 (±17.56)% in the PTDM and non-PTDM groups respectively, p = 0.000, which shows that patients with a high IPV coefficient of tacrolimus developed more PTDM than those with low variability, student's t-test to compare IPV was 0.03. The IPV of CsA was 38.61 (±18.76)% and 37.51 (±25.67)% in the PTDM and non-PTDM groups respectively, p = 0.819. Conclusion High intrapatient variability of tacrolimus was correlated with the development of PTDM in Mexican kidney transplant recipients.

ROLE OF RIGHT VENTRICULAR–PULMONARY ARTERY COUPLING IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION

Objectives: To describe the clinical characteristics, right ventricular pulmonary artery (RV-PA) coupling and assess the correlation between RV-PA coupling and six-minute walk distance (6-MWD) in patients with heart failure with reduced ejection fraction (HFrEF). Subjects and methods: A prospective study with 39 patients with heart failure with HFrEF was recruited at 108 Central Military Hospital from December 2022 to October 2023. Results: A total of 39 patients were enrolled to the study with a majority of male (76.9%), mean age 63.7±15.7 years. Based on univariate and multivariate analysis, there is no correlation between right ventricular pulmonary artery coupling and 6-MWD, as evidenced by parameters including TAPSE/PASP (r=0.111, β=37.09, p=0.499), FAC/RVSP (r=0.012, β=1.29, p=0.944), and S’/RVSP (r=0.216, β=105, p=0.186). Nevertheless, there is a negative correlation between FAC/RVSP and S'/RVSP with LAVi, with respective values of (r = -0.522, β = -11.97, p-value = 0.001) and (r= -0.487, β = -0.005, p-value = 0.002). Conclusion: RVPAc cannot be used to predict exercise in HFrEF. Among echocardiographic RVPAc ratios, FAC/RVSP and S'/RVSP are correlated with left atrial volume index.

CLINICAL CHARACTERISTICS OF AURICULAR KELOIDS TREATED SURGICALLY AT 108 MILITARY CENTRAL HOSPITAL

Purpose: to describe the clinical characteristics of surgically treated auricular keloids. Subjects and methods: Cross-sectional descriptive study on 45 patients with auricular keloid surgery at 108 Military Central Hospital during the period from June 2020 to June 2023. Study subjects had their past medical history taken, clinical examination, and lesion size measured to record research indicators. Results: The study subjects had an average age of 20.7 ± 4.4 years old, all patients were female, accounting for 100%. The main cause of keloids is ear piercing, accounting for 97.7%. Surgical auricular keloids have an average size of 4 ± 3.5 cm2, the main location of keloids is in the helix accounting 44.1% and the earlobe accounting for 41.93%, the number of keloids is from 1 to 5. Conclusion: auricular keloids are mainly found in teenagers with an average age of 20.7 years old, 100% are female patients, 97.7% are caused by piercing. The location of keloids treated by surgery is in the earlobe and helix areas account for 44.1% and 41.93%, respectively; On average, there are 1.76 keloids/person, the average auricular keloid size is 4.07±3.58 cm, mainly in groups 3 and 4 according to Michael Tirgan's classification (1).

Robotická pankreatická chirurgie v České republice – první zkušenosti

Robotic surgery is experiencing considerable development across surgical disciplines worldwide. The increasing number of robotic centres, as well as the expansion of the spectrum of robotically assisted minimally invasive procedures contribute to the increase in the number of performed procedures. Compared to laparoscopy or open surgery, robotic surgery offers several advantages, while maintaining adequate safety and oncological radicality of the operations. Pancreatic surgery is currently a hot topic in robotic surgery worldwide. Czech Republic is also following this trend. Robotic surgery is gradually being introduced to established pancreatic centres. The Department of Surgery of the 2nd Faculty of Medicine of Charles University and the Central Military Hospital in Prague ranks among the pioneers of this industry. In this communication, we present a summary of our first experiences with robotic pancreatic surgery. Keywords robotic pancreatic surgery, miniinvazivní chirurgie, robotic surgery, robotic pancreatoduodenectomy, robotic distal pancreatectomy

Evaluation of echocardiography and computed tomography characteristics related to aortic valve replacement technique through the right anterior thoracotomy at the 2nd intercostal space

Objective: evaluate echocardiographic and computed tomography characteristics related to minimally invasive aortic valve replacement technique through the right anterior thoracotomy at the 2nd intercostal space. Methods: study on 74 patients undergoing aortic valve replacement surgery through the right anterior thoracotomy at the 2nd intercostal space at Hanoi Heart Hospital and 108 Military Central Hospital, from October 2019 to December 2022. Patients underwent preoperative echocardiography and multiple slices computed tomography to assess the lessons of aortic valve, valve annulus diameter, and intercostal space width. Results: The ratio of aortic valve stenosis is 55.4%, stenosis combined with regurgitation is 31.1%, and aortic regurgitation is 13.5%. The average valve annulus diameter on computed tomography scans is 26.5 ± 3.1 mm (smallest 20; largest 36); average 2nd intercostal space width 18.1 ± 3.1 mm (smallest 11; largest 25). Valve annulus diameter measured by computed tomography correlates closely with actual prosthetic valve size (r = 0.54, p < 0.001); measured by echocardiography had a weak correlation and not statistically significant. The prosthetic valve size to be replaced is smaller than the valve annulus diameter measured on computed tomography, with an average of 4.8 ± 2.7 mm in aortic valve stenosis, 5.7 ± 2.0 mm in combined stenosis and regurgitation, and 7.2 ± 2.9 mm in aortic regurgitation, in which the difference between valve stenosis and regurgitation is statistically significant (p = 0.01). Conclusions: Minimally invasive aortic valve replacement technique through the 2nd intercostal space right thoracotomy, with cutting the 3rd rib, is suitable for Vietnamese anatomy. Valve annulus diameter measured by computed tomography has a good linear correlation and can be a predictor for prosthetic valve size before surgery.

Rhino-orbital cerebral mucormycosis : Case report and its approach at Central Military Hospital of Mexico

Mucormycosis is a disease with a high percentage of mortality. This opportunistic disease is caused by pathogens of the Zygomicota family of the order Mucorales, which affect considerably, mainly immunocompromised patients. We present the case of a patient approached at the Central Military Hospital of Mexico, diagnosed with rhino-orbito-cerebral mucormycosis, with histopathological report of non-septated hyaline hyphae of 90º, referring to the aforementioned diagnosis. A multidisciplinary approach to the pathology was carried out with diagnosis, timely medical and surgical treatment, achieving a favorable evolution and prognosis in a condition whose outcome is usually fatal.

Factors related to waiting time for medical examination at outpatient department – 108 Military central Hospital

Objectives: Describe factors related to waiting time for examination at the outpatient department - 108 Military Central Hospital. Research participants and methods: Cross-sectional descriptive study analyzing 800 patients on medical examination from April 2022 to December 2022. Results: The longest waiting time for medical examination for people under 18 years old was 283.2 ± 173.9 minutes, and the shortest was for people over 60 years old: 189.5 ± 131.8 minutes. Among the participants, the longest medical examination time was 253.7 ± 111.8 minutes, the shortest was the health insurance group: 183.2 ± 131.4 minutes. The relationship between waiting time for medical examination and the day of medical examination, Tuesday was the day with the highest number of medical examinations (190 patients) and also the day with the longest medical examination time: 245.1 ± 132.9 minutes (4 hours 05 minutes). Waiting time for medical examination is, as a rule, the more clinical tests are performed, the more waiting time for medical examination increases. For 4 tests, the longest waiting time for medical examination was 331.3 ± 122.6 minutes (5 hours 31 minutes), and no test had the shortest time of 50.7 ± 772.9 (51 minutes). The waiting time for medical examination among the group of patients who had blood tests, ultrasound, X-ray, functional diagnosis, and gastrointestinal endoscopy was longer than the group who did not perform these techniques. Conclusion: Factors are statistically significantly related to patient waiting time for examination including age, education level, occupation, mobility, number of medical examinations, hospital distance, time to register for medical examination and treatment, and number of paraclinical tests.

Medication compliance and related factors among readmission people with type 2 diabetes at 108 Military central Hospital

Objectives: Survey on medication compliance rate and related factors in people with type 2 diabetes readmitted for inpatient treatment at 108 Central Military Hospital. Participants and methods: A cross-sectional descriptive study was conducted on 168 patients with Type 2 diabetes readmission from January 2021 to December 2022. The study assessed medication adherence using the MARS–5 questionnaire (Medication Adherence Report Scale 5). Results: The rate of medication compliance in patients was 21.8%, non-compliance accounted for 78.2%. Patients who occasionally forget to take medication account for the highest rate of 51.8%, arbitrarily reducing the dose to less than the prescribed dose accounted for 32.1%, rarely skipping doses, and stopping medicine for a period of time accounted for 35.7% and 50.2%, respectively. There was a relationship between age and current medication and medication compliance. The difference was statistically significant(p < 0.05). Conclusion: The medication compliance rate in diabetic patients readmitted to the hospital in the study was low, only 21.8%, of which patients forgot to take medication and arbitrarily reduced the dose and stopped using medication for a period of time accounting for the highest proportion. high rate. Strengthening health education on medication adherence during follow-up examinations for patients and caregivers is extremely necessary to reduce the risk of hospital readmission, maintain blood sugar at normal levels, and minimize diabetes complications.

STUDY ON STAT6 rs324015 POLYMORPHISM IN HEPATITIS B VIRUS-RELATED HEPATOCELLULAR CARCINOMA PATIENTS

Objectives: To determine the genotype frequency of the STAT6 rs324015 polymorphism and its association with cancer risk in hepatitis B virus (HBV) -related hepatocellular carcinoma (HCC) patients. Methods: A cross-sectional descriptive study on 118 HBV-related HCC patients, compared to 86 HBV-related cirrhosis patients and 195 healthy people at 108 Military Central Hospital, Military Hospital 103, and Can Tho General Hospital from July 2017 to August 2020. Polymorphism analysis of the STAT6 rs324015 gene was conducted from peripheral blood samples of subjects using the Sanger sequencing method at Apical Scientific Sequencing Company (Malaysia). Results: The AG/GA heterozygous genotype of the STAT6 rs324015 polymorphism accounted for the highest rate in HCC patients at 51.7%, higher than the corresponding index in the cirrhosis group at 39.5%, and healthy people (48.2%); the GG genotype was the highest in cirrhosis patients (40.7%), the difference was not statistically significant, p > 0.05. Conclusion: STAT6 rs324015 polymorphism is not associated with cancer risk in patients with HBV-related HCC.

Type 2 diabetes mellitus and recurrent Tuberculosis: A retrospective cohort in Peruvian military workers

BackgroundThe role played by type 2 diabetes mellitus (DM2) in the occurrence of recurrent tuberculosis is still uncertain. Military personnel are an occupational group with an increased risk for tuberculosis exposure due to their activities. Methods. We conducted a retrospective cohort to study the association between DM2 and recurrent TB in military workers who have been previously treated for tuberculosis at the Central Military Hospital in Lima, Peru, between 2016 and 2017. We evaluated the risk between DM2 and recurrent TB using Nelson-Aalen graphical analysis and Cox regression stratified by TB cured with hazard ratio (HR) calculation adjusted for confounders. Results. We evaluated 220 workers with a mean age of 23.2 ± 7.8 years (96.8 % male). DM2 and recurrent TB frequency were 11.8 % and 5.0 %, respectively. Those with DM (36.5 %) presented a greater proportion of recurrent TB than those without DM2 (10.5 %). The cumulative risk for recurrent TB increases faster among workers with DM2 (p = 0.025, LR chi-squared test). Cox regression stratified by type of cured TB did not show an association between DM2 and recurrent TB (HR: 3.67; 95 %CI: 1.00–13.46). Conclusion. The cumulative risk for recurrent TB increases faster in patients with DM than in those without DM2. DM2 is not associated with the time of apparition of recurrent TB in military workers.

Adult-to-adult right lobe graft living donor liver transplantation for acute-on-chronic liver failure: a single-centre retrospective study in Vietnam.

Acute-on-chronic liver failure (ACLF) has a high mortality rate, and liver transplantation is considered a definite treatment for patients with this condition. This study aims to evaluate the outcomes of living donor liver transplantation (LDLT) in ACLF patients in a single centre in a lower middle-income country, Vietnam. This was a retrospective study at the 108 Military Central Hospital (Hanoi, Vietnam), enroling 51 patients diagnosed with ACLF based on Asian Pacific Association for the Study of the Liver (APASL) criteria who underwent LDLT with a right lobe graft from December 2019 to December 2022. The authors utilize the model for end-stage liver disease (MELD) and APASL ACLF Research Consortium (AARC) scores to evaluate and stratify the severity of ACLF. The average age of all patients was 47.27±13.61, with 88.24% being male. The average BMI was 22.78±2.61. The most common underlying liver disease was chronic viral hepatitis B (88.2%). The average MELD score of the patients was 34.90±5.61, with 33.3% having MELD score greater than or equal to 40. In terms of ACLF severity, five patients (9.8%) had grade I ACLF, 35 patients (68.6%) had grade II ACLF, and 11 patients (21.6%) had grade III ACLF. The average AARC score was 9.43±1.68. The duration of treatment in the ICU was 8.59±7.27 days, and the length of hospital stay was 28.02±13.45 days. The most common post-transplant complication was biliary complication (19.61%). Death occurred in 7 patients (13.7%). The survival rates at 6 months, 1 year, and 3 years were 84%, 81.7%, and 81.7%, respectively. Living donor liver transplantation for ACLF patients is safe and has a high post-transplant survival rate. Multidisciplinary care before, during, and after surgery, and the decision to do a liver transplant early, is essential in saving the lives of ACLF patients.

EVALUATION OF EMOTIONAL DISTRESS IN A COHORT OF NEWLY DIAGNOSED CANCER PATIENTS: A STUDY OF 67 INDIVIDUAS

Purpose: To evaluate distress in newly diagnosed cancer patients. Subjects and Methods: Cross-sectional prospective study of 67 newly diagnosed patients at the Department of Pain management and Palliative Care, 108 Military Central Hospital, from August to October 2023. The patient's level of distress was assessed by the Distress Thermometer - DT and the Problem List (PL) of NCCN February 2022, Vietnamese version. Results: The average distress score among newly diagnosed cancer patients was 4.42 ± 2.237, with 3% reporting no distress, 44.8% experiencing mild distress, and 52.2% reporting moderate to severe distress (≥ 4 points). Common sources of distress among the participants included physical discomfort (94.0%), with 73.1% reporting sleep problems and 71.6% experiencing fatigue. Emotional challenges were prevalent as well (91.0%), with 49.3% reporting feelings of sadness and 47.8% experiencing anxiety. Additionally, concerns regarding self-care (53.7%) and financial worries (43.3%) were notable contributors to distress, accounting for 76.1% of the participants' concerns overall. The rate of moderate and severe distress in newly diagnosed cancer patients were statistically significantly related to age (more prevalent in patients under 60), gender (higher in females) education level (more in those with secondary school education or less), income (higher in those with below-average incomes), health insurance benefits (higher in patients with less comprehensive coverage).

Effect of Donors' Biliary Variation on Postoperative Biliary Complications in Living Donor Liver Transplantation: A Single-Center Observational Study in Vietnam

Our study aims to evaluate the biliary anatomy variation according to the Varotti classification and its correlation with surgical outcomes for both donors and recipients undergoing living donor liver transplants (LDLTs). A retrospective analysis of 150 LDLT cases performed at a single center in Vietnam with preoperative radiologic evaluations and intraoperative surgical assessments to identify biliary variant anatomy. Postoperative biliary complications were documented and analyzed. Statistical analysis was performed to determine any significant associations between biliary variations and post-transplant outcomes. One hundred fifty cases of LDLT at 108 Military Central Hospital from October 2017 to December 2022 were included in our study. Among the donors, the mean age was 30.89 ± 7.23, with male predominance (77.3%). The prevalence of type 1 biliary anatomy was 84.67%. Type 2, 3a, 3b, 4a, and 4b accounted for 5.33%, 2.67%, 5.33%, 0.67%, and 1.33% of cases, respectively. Donors' complications were witnessed in 7 cases (4.67%), and all needed intervention (Clavien-Dindo grade 3). Biliary complications were found in 36 (24.0%) recipients, with 22 (14.67%) cases of biliary stenosis and 16 (10.67%) cases of biliary leak, including 2 cases encountering both complications. Age, gender, graft type, preoperative liver function, biliary variant anatomy, number of graft orifices, Model for End-Stage Liver Disease score, and blood loss were not significant risk factors for recipients' biliary complications. Cold ischemia time significantly increased the biliary complication rate. This study shows that biliary variant anatomy is common in living liver donors. Such variations should not be a contraindication to liver donation. However, accurate pre- and intraoperative radiologic and surgical evaluations are fundamental for a careful reconstruction plan.

Pre-operative total neoadjuvant therapy in locally advanced rectal cancer patients: Initial results of Vietnamese patients.

To evaluate the initial results of neoadjuvant chemoradiation followed by consolidation chemotherapy (total neoadjuvant therapy - TNT) in locally advanced rectal cancer (LARC) and its side effects. A prospective study in 75 patients with stage II and III rectal cancer at 108 Military Central Hospital and Nghe An Oncology Hospital from April 2022 to January 2024 who received total neoadjuvant therapy (preoperative chemoradiation of 50.4 Gy concurrent with Capecitabine 825 mg/m², twice a day for 5 days per week, then added neoadjuvant chemotherapy with the mFOLFOX6 or CAPEOX regimen) and subsequently underwent surgery. The median age was 60.07. Males accounted for 58.7%. Most patients in the study group exhibited tumor stage T3, accounting for 88.0% of the total. The percentages for lymph node stages N0, N1, and N2 were 14.7%, 40.0%, and 45.3%, respectively. 20.09% of patients exhibited a positive result for CRM on magnetic resonance imaging. CEA levels measured before and after using TNT were stati-stically significantly lower than before TNT. After treatment, 25 out of 75 patients (33.3%) had a pathological complete response (pCR). Side effects were mainly grade 1 or 2. Leukopenia was the most common side effect in both neoadjuvant chemoradiotherapy and consolidation chemotherapy. The patients underwent TME (60%), Miles (26.7%), LAR-RAR (12%), and ISR (1.3%). 10.6% of the patients experienced postoperative complications. Total neoadjuvant therapy is an effective and safe treatment and results in acceptable rates of pathological complete response.

Aortic valve neocuspidization using the Ozaki Technique for bicuspid aortic valve: The first case at Central Military Hospital of Azerbaijan

Conventional aortic valve replacement (AVR) remains the standard treatment for aortic valve stenosis or insufficiency, but emerging techniques focus on valve reconstruction rather than replacement. One such method is the Ozaki procedure, which involves replacing each valve leaflet with glutaraldehyde-treated autologous pericardium to restore the natural anatomy of the aortic valve. Although challenging, especially for bicuspid aortic valves, this technique has shown success after a learning period. We report the case of a 54-year-old woman with a history of colorectal cancer, who underwent surgery for severe stenosis of a bicuspid aortic valve using tricuspidization with glutaraldehyde-treated autologous pericardium.

Outcomes of laparoscopic choledochotomy using cholangioscopy via percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis: A preliminary Vietnamese study.

Hepatolithiasis and choledocholithiasis are frequent pathologies and unfortunately, with the current treatment strategies, the recurrence incidence is still high. This study aimed to assess the outcomes of laparoscopic choledochotomy using cholangioscopy via the percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis in Vietnamese patients. A cross-sectional study of patients with hepatolithiasis and/or choledocholithiasis who underwent laparoscopic choledochotomy using intraoperative cholangioscopy via percutaneous-choledochal tube at the Department of Hepatopancreatobiliary Surgery, 108 Military Central Hospital, from June 2017 to March 2020. A total of 84 patients were analyzed. Most patients were females (56.0%) with a median age of 55.56 years. Among them, 41.8% of patients had previous abdominal operations, with 33.4% having choledochotomy. All patients underwent successful laparoscopic common bile duct exploration followed by T-tube drainage without needing to convert to open surgery. Most patients (64.3%) had both intrahepatic and extrahepatic stones. The rate of stones ≥ 10 mm in diameter was 64.3%. Biliary strictures were observed in 19.1% of patients during cholangioscopy. Complete removal of stones was achieved in 54.8% of patients. Intraoperative complications were encountered in two patients, but there was no need to change the strategy. The mean operating time was 121.85 ± 30.47 minutes. The early postoperative complication rate was 9.6%, and all patients were managed conservatively. The residual stones were removed through the T-tube tract by subsequent choledochoscopy in 34/38 patients, so the total success rate was 95.2%. Laparoscopic choledochotomy combined with cholangioscopy through the percutaneous-choledochal tube is a safe and effective strategy for hepatolithiasis and/or choledocholithiasis, even in patients with a previous choledochotomy.

Stroke in young adults

Objective: Stroke is an important cause of morbidity and mortality in young adults especially in developing countries. This study aimed at reviewing epidemiology, types, etiologies, risk factors in the young adults in 108 Military Central Hospital. Subject and method: This study retrospectively reviewed consecutive acute stroke patients aged 16-45 years admitted to the 108 Military Central Hospital between February 1, 2022, and September 18, 2023 to analyze epidemiology, types, etiologies, risk factors, compare the age groups of 16-30 and 31-45 years. Result: Among 319 young stroke patients (mean age at onset 36.4 ± 8.1 years; male 71.5%), there were nontraumatic spontaneous hemorrhagic stroke (including 156 intracerebral hemorrhage (ICH) and 47 subarachnoid hemorrhage, (SAH)), 106 ischemic stroke and 10 cerebral venous thromboses. Notably, ICH was more prevalent in patients aged 16-30 than in those aged 31-45 (63.2% vs 45.8%). Specifically, structural vasculopathy (e.g., arteriovenous malformation, cavernoma) was the most common etiologic subtype in patients aged 16-30 (80.6%), whereas hypertensive ICH was the most common subtype in patients aged 31-45 (57.1%). On the other hand, the top ischemic subtype for both age groups was other determined diseases (e.g., arterial dissection, autoimmune diseases, moyamoya disease, etc.) rather than large artery atherosclerosis. Hyperlipidemia, heart disease and cigarette smoking, excessive alcohol intake were more common risk factors for infarction than ICH. Conclusion: An aggressive approach to elucidate the etiology of stroke must be indicated for all young stroke patients. Structural vasculopathy was the most common etiology in patients aged 16-30, whereas hypertensive ICH was the most common in patients aged 31-45. For ischemic stroke, in addition to common causes such as cardiac embolism, atherosclerotic cerebrovascular disease... Other causes including arterial dissections, autoimmune diseases, moyamoya disease, cancer-related thromboembolisms, cerebral thrombosis venous complications, hematologic disease...