Comparative Analysis Of Treatment Results Research Articles

Clinical, Morphological Justification and First Experience in the Use of Radiofrequency as Well as Microwave Ablation Treatment Methods of Liver Echinococcosis.

The current study considers a new direction of surgical treatment of liver echinococcosis - the use of minimally invasive treatment methods of parasitic cysts. After clinical and morphological substantiation of the very possibility of carrying out such procedures, 9 microwave ablations (MWA) and 3 radiofrequency ablations (RFA) of cysts were performed in patients with liver echinococcosis from 2017 to 2021 in the surgical clinic of Botkin Hospital, Moscow, Russia. A comparative analysis of treatment results of patients with echinococcal liver cysts (12 patients who underwent "percutaneous puncture, aspiration, injection and reaspiration" (PAIR) procedure and 12 patients - MWA and RFA) was carried out. The number of complications according to Clavien-Dindo classification was as follows: 8 after PAIR procedure, 3 after RFA and 3 after MWA. The median hospital length of stay (LOS) after PAIR procedure was 6.46 days versus 4.7 and 4 in the groups of patients who underwent RF and MW ablation, respectively. The frequency of relapses within the first year after PAIR procedure was 25%. The patients who underwent ablation procedures had no relapses of liver echinococcosis during observation. The presented clinical and morphological substantiation and the experience of using various types of ablation techniques on echinococcal cysts, as well as a comparative analysis with a commonly used PAIR treatment method, demonstrated the safety of RFA and MWA for the patient and efficacy in relation to the hydatid process.

Experimental Study of Action Different Kinetic Energy on the Colon

The purpose of the study. To increase the effectiveness of surgical care for the wounded with combat trauma of the colon by studying of ballistic, morphological and functional features of the gunshot wounds. Patients and methods. A study of surgical treatment of 83 wounded with combat injuries of the colon, received in the area of anti-terrorist operation in the period from 2014–2018. For comparative analysis of treatment results, two clinical groups were formed: comparison and main. The comparison group included 42 wounded who were treated from April 2014 to February 2015 (the first and second periods of ATO), who used traditional surgical tactics. The main group included 41 wounded who were treated from March 2015 to 2018. Results. Analysis of the distribution of wounded with combat trauma by type of wound / injury revealed that the vast majority of them in both groups had shrapnel wounds – 49 (59.1%). There were 30 (36.1%) victims with bullet wounds, and 4 (4.8%) with closed injuries. The wounded patients with the battle trauma of the thick bowel by type of injury had missile wounds as a rule – 49 (59.1%). There were 30 (36.1%) patients with bullet wounds, and 4 (4.8%) with closed injuries. Most of the injuries were combined – 58 (69.9%), and with only abdominal injuries – 25 (30.1%), mostly multiple – 21 (25.3%). The great majority of the thick bowel injuries belonged to sigmoid – 32 (38.6%) and transverse colon – 21 (25.3%), which is explained by relatively large size of these parts of the intestine. Conclusions. The choice of surgical tactics and scope of surgical interventions on damaged organs and structures took into account the results of experimental study of mechanogenesis and pathomorphology of gunshot wounds of the colon, obtained in bench studies by modeling gunshot wounds on “thoracoabdominal ballistic material”.

Значение использования шкал оценки тяжести состояния при лечении пациентов с политравмой

The problem of treatment of patients with multiple and combined injuries remains one of the most relevant in modern medicine. According to modern statistical data, amount of traumas is growing worldwide, and among the able-bodied population polytrauma is one of the main causes for disablement and death. About 5 million people worldwide are injured every year, of which 15–21% have multiple and associated injuries. To improve the quality of medical care for patients with polytrauma and decrease the level of disablement and deaths, it is necessary to study the problem of rendering medical aid to patients with multiple and combined injuries. The purpose — to assess various scales of the condition severity of patients with polytrauma. Material and methods. A retrospective analysis of 120 patients was carried out, who from 2017 to 2020 were treated at City Clinical Hospital named after A.K. Eramishantsev, of them 66 (55%) women and 54 (45%) men. The age group was 25–75 years old. Results. One of the most adequate methods of assessing the condition severity of patients with polytrauma is a score-based approach, which allows determining the correct treatment tactics. Correct treatment tactics can reduce the time of disability, mortality and disability of patients. In modern traumatology and orthopedics, ISS scale is considered the «gold standard» for assessing the condition severity, but many doctors and authors mark that this scale is insufficiently informative. Our comparative analysis revealed that the NISS scale has greater accuracy in predicting mortality than ISS, especially in critical patients and patients with blunt trauma. Conclusion. A clear definition of the polytrauma concept with a single score assessment system for assessing the condition severity will allow to standardize treatment tactics, conduct an adequate comparative analysis of treatment results, objectively resolve issues of organization and financial provision of medical care to seriously injured patients, improve the quality of medical care, reduce mortality and disability of the able-bodied population, and provide full recovery and return to normal standard of living. The creation of a unified assessment system is difficult, which is associated with the polyphocality of injuries. We believe that further in-depth studies of patients with multiple and combined trauma are needed to develop modern guidelines and clinical recommendations, as well as a unified single-score assessment system.

Structural and Functional Criteria of Neuroprotection Effectiveness after Anti-VEGF Therapy in Patients with Neovascular Age-Related Macular Degeneration

Purpose . Estimate of clinical efficacy of combined use of aflibercept and meldonium at tachyphylaxis of neovascular age-related macular degeneration (nAMD) to ranibizumab. Patients and methods. Comparative analysis of treatment results of nAMD in 25 eyes (25 patients) aged from 52 to 79 years was carried out. Main criterion for the patients inclusion was presence of nAMD resistant to intravitreal injections (IVI) of VEGF inhibitor ranibizumab with visual acuity values of not less than 0.1. Patients with different ophthalmologic pathology, accompanied by development of macular edema, with glaucoma and after any eye operations, performed during study period, were excluded from study. Before using aflibercept, all patients were treated with ranibizumab for 1.5–2 years (from 5 to 7 injections). The lack of persistent positive result was cause for change of course treatment of this patients on aflibercept (3 monthly injections) for enhance anti-vasoproliferative effect. The patients were divided into two groups — main and comparison, comparable by sex, age, visual acuity and type of choroidal neovascularization. In the main group, 3 aflibercept IVI were supplemented parabulbar injections of 0.5 ml of meldonium (with concentration of 500 mg / 5 ml) daily for 10 days. Patients of the comparison group did not receive meldonium. Results. The supplement of meldonium in the main group, relative to the comparison group, led to increase in 1.5 times of best corrected visual acuity, in 1.2 times of b-wave amplitude of the electroretinogram, preservation of the neuro- and pigment epithelium of retina, complete regression of neovascularization. Conclusion . Findings results evidence about clinically advisable to use meldonium in course treatment in patients with nAMD, resistant to ranibizumab, with aflibercept IVI for increase visual functions and stabilize the degenerative changes in neurosensory retina, pigment epithelium and choriocapillary layer.

Сравнительный анализ результатов лапароскопической и ретроперитонеоскопической резекции почки в зависимости от вида временного и окончательного гемостаза

to carry out a comparative analysis of treatment results of patients with renal tumors who were undergone to nephron-sparing surgery, depending on the type of temporary and definite hemostasis. a total of 163 laparoscopic partial nephrectomies were performed by single surgeon from January 2015 to July 2018. The comparative analysis of treatment results of patients with renal tumors based on following parameters: tumor stage, features of the tumor site, the duration of surgery, the amount of blood loss, complications rate and grade as well as functional and oncological outcomes, depending on the type of temporary and definite hemostasis, was conducted. For preoperative planning the generally accepted nephrometric scale R.E.N.A.L. was used as well as 3D-reconstruction of the tumor. Of the 163 patients, 64 were women (39.3%). The mean age of patients was 56.7+/-11.1 (25-80 years). A clinical stage T1a, T1b, T2 and T3a was diagnosed in 77, 20, 2 and 64 cases, respectively. The average tumor size was 34.8+/-1.1 (11-78 mm). The mean operative time was 84.5+/-32.2 min (30-180). Laparoscopic transperitoneal access was used in 90 patients (55.21%), retroperitoneoscopic approach was chosen in 73 cases (44.79%). The tumor had exophytic growth in 110 cases (67.5%) and in 53 cases it was endophytic (32.5%), while in 59 cases it localized in renal sinus (36.2%). The operative time was significantly shorter in the Group of zero ischemia (72.2+/-29.02 [p<0.001]) and bipolar coagulation of the tumor bed (60.8+/-31.7 [p<0.001]). The mean volume of blood loss was 160.8+/-142.7 ml (30-900). A GFR calculated by the MDRD equation (mean level was 75.7 ml/min/1.73 m2) on the next day and 6 months after surgery showed a slight decrease in group of zero ischemia, compared to other groups: next day and 6 months after surgery it was 72.8+/-21.6 (p<0.001) and 72.01+/-16.6 (p=0.025), respectively. A simple enucleation was performed in 41 cases, while enucleoresection was done in 70 cases. A collection system was opened in 22 cases (13.5%+/-9.8). The suturing and clipping were performed in 20 and 2 patients, respectively. In 2 cases a stenting was performed. In 2 cases there was hemoglobin drop requiring blood transfusion (1.2%+/-3). An embolization due to refractory bleeding was required in 3 cases (1.8%+/-3.7). There was no conversion to open surgery or nephrectomy. Of the 163 tumors, a malignancy was diagnosed in 151 (92.6%+/-7.5) cases. There was no positive surgical margin and recurrence of the tumor. Laparoscopic partial nephrectomy can be successfully performed under zero ischemia. The intervention without clamping of renal blood vessels contributes to significant preservation of the renal function.

SENTINEL LYMPH NODE BIOPSY IN PREVENTING REGIONAL RELAPSES IN PATIENTS WITH LOCALLY ADVANCED CUTANEOUS MELANOMA

Objective. To determine an optimal method for preventing regional relapses in patients with locally advanced cutaneous melanoma (CM). Material and methods. The investigation included 755 patients with locally advanced CM who had been treated at the Medical Radiology Research Centre. Among them, 213 patients had wide excision only for the primary tumor; 242 patients were additionally treated with preventive lymphadenectomy (pLAE), and 300 patients underwent sentinel lymph node (SLN) biopsy. The groups were matched for the local extent of a tumor in the TNM staging (p = 0.178), which allowed a proper comparative analysis of treatment results. The Russian radiopharmaceutical 99mTc-Technefit having necessary lymphotropic properties was used to identify SLN. Intraoperative navigation was performed using a Radical handheld gamma probe counter (Amplitude Research and Technology Center, Russia). Results. Regional relapses were observed in 20.2% of cases in the primary CM excision group. In the pLAE group, latent regional lymph node metastases were detected in 10.7% of the patients; and 12.0% more of the patients developed subsequently regional relapses in the intact lymph nodes. The total number of latent regional metastases in this group was 22.7%; these were diagnosed as a result of pLAE in less than half of the cases (47.3%). SLN biopsy revealed subclinical regional metastases in 20.7% of the patients and regional relapses were seen only in 3.3%. Overall, SLN biopsy could detect latent lymph node metastases in 86.1% of all cases; these were demonstrated with clinical relapses only in 13.9%. The efficiency of SLN biopsy in preventing regional relapses was significantly higher than was achievable during pLAE (p =0.001). The five and seven-year survival rates were 61.5 ± 4.3 and 54.3 ± 4.6% in the CM excision group, respectively; 68.8 ± 0.35 and 61.3±3.9% in the pLAE group; and 84.8 ± 6.5 and 84.8 ± 6.5% in the SLN biopsy group (p = 0.001). Conclusion. The investigation of SLN is the most effective, safe, and reproducible technique for the early detection of subclinical regional metastases and for the prevention of regional relapses in patients with locally advanced CM. Reliable regional control in turn makes it possible to hope for the best long-term treatment results.

NEW TECHNOLOGIES IN TREATMENT OF FRACTURES OF THE UPPER EXTREMITIES IN PATIENTS WITH SEVERE MULTIPLE AND POLYTRAUMA

A comparative analysis of treatment results of fractures of long bones of the upper extremities was made in 172 victims with severe polytrauma. The traditional strategy of treatment was used in the first group. The new technologies such as prognostic tactics, method of Damage control orthopedics and low-invasive osteosynthesis developed by the authors were applied in the second group. The application of new technologies allowed doctors to improve the immediate and long-term results of surgery. The rate of lethality decreased in 1,6 times, incidence of complications reduced in 1,4 times. Hospital stay shortened in 2 times: for victims with favorable prognosis — on 7 days; for patients with unfavorable prognosis — on 13 days. The long-term results were studied in 154 (89,5%) patients. The common duration of treatment reduced on 30 days and the quantity of good results increased on 18,6%. The number of patients with vocational rehabilitation increased from 82,3 to 90,7%.

Reconstruction of Deltoid Ligament Using Low Invasive Surgical Technique at Treatment of Ankle Joint Fractures

Comparative analysis of treatment results of 68 patients with malleolus fractures and injury of deltoid ligament was performed. Depending on the treatment technique all patients were subdivided into four groups. Main group - surgical treatment of fractures and reconstruction of deltoid ligament with Twinflix screw (n=30), comparative groups - surgical treatment of fractures with transcutaneous suturing of deltoid ligament (n=10) and ligament plasty with Р -shaped sutures (n=8); control group - conservative treatment of fractures and deltoid ligament injury (n=20). Follow-up time made up 6 months - 2 years. Evaluation of treatment results was performed by adopted scale of American Orthopaedic Foot and Ankle Society. Patients were examined using clinical and roentgenologic methods as well as ultrasound and rheovasography. In the main group excellent result was achieved in 23.1%, good result - in 65.3%, satisfactory - in 11.6% of patients. In control group they made up 16.8%, 61.2% and 19.5%, respectively, with poor result in 2.5% of patients. It was demonstrated that application of low invasive osteosynthesis in combination with reconstruction of deltoid ligament using Twinfix screw reduced considerably the probability of posttraumatic arthrosis development as well as provided for complete restoration of the ligament with preservation of its elastic properties and joint stability.

Differentiational correction of muscles of external rotators of femur in congenital dislocation

External rotatory contracture in hip joint appears in some cases in the process of correction of the proximal part of femur. Incomplete and low dislocations of femur are stated to be characterized by absolute shortening of short external rotators and high forms of dislocations by shortening of middle gluteal muscle. The methods of correction of the length of these muscles in the process of treatment of the dislocation of femur are suggested. The comparative analysis of treatment results of the congenital dislocation of femur in 159 persons by the methods, developed by the authors and traditional methods is presented. The positive result of the treatment is received in 95,4% patients.

Intravaginal application of Efudex and CO 2 laser therapy of vaginal condylomatosis: A comparative analysis of treatment results

Intravaginal application of Efudex and CO 2 laser therapy of vaginal condylomatosis: A comparative analysis of treatment results

Pituitary tumors. Comparative analysis of treatment results

Pituitary tumors. Comparative analysis of treatment results

Comparative analysis of treatment results and complications in early cancer of the uterine cervix: surgery vs. radiotherapy

Comparative analysis of treatment results and complications in early cancer of the uterine cervix: surgery vs. radiotherapy