Duration Of Surgical Intervention Research Articles

Endovideosurgical resections of the liver: experience of «Russian scientific center of radiology and surgical technologies named after acad. A. M. Granov»

The objectiveof the study was to evaluation the results of endovideosurgical resections of the liver.Material and methods. We analyzed the direct results of treatment of 153 patients with liver neoplasms operated in “Russian scientific center of radiology and surgical technologies n.a. acad. A. M. Granov” from 2012 to 2017 with the use of endovideosurgical techniques.Results.The duration of surgical interventions averaged (173±56) minutes (from 50 to 290 minutes). The degree of blood loss during the performed interventions did not exceed 800 ml and averaged (154.2±44.5) ml. Conversion due to bleeding, serious postoperative complications (Clavien IIIb and above), and also, mortalities were not observed. The postoperative hospital stay was (8.6±3.1) days.

Clinical retrospective study on effectiveness, duration of surgery and postoperative pain after placing single implants with and without Chair Side CAD CAM fabricated surgical guide

Background Successful dental implant rehabilitation requires precise treatment planning of surgical procedure and implant placement based on final prosthodontic planning. Lately the widespread use of cone beam computed tomography (CBCT) in dental industry has enabled the surgeons to evaluate and diagnose the jaws in three dimensions and thus help to virtually plan prosthesis and related implant positions before the surgery. Proper, prosthetically driven implant positioning is fundamental in order to ac Aim/Hypothesis It is assumed that computer-aided technologies open the opportunity to streamline workflows in implant rehabilitation concepts. Developments of CBCT and software planning include the reduction of the number of steps needed from the preoperative examination of the patient to the actual execution of Material and Methods A total of 41 patients requiring single tooth replacement were included in the assessment. 21 patients were selected for the use of the whole digital Cerec Guide workflow including Diagnostic phase with CBCT, intraoral scan and planning of the crown, planning of the implant position and fabrication of the guide, guided surgery and cerec Tbase scan and fabrication of Emax crown. Surgery was performed flapless or with minimum crestal incision flap and in 5 patient directly in extraction socket. A total of 20 patients were treated conventionally without guide, with the same planning, with either minimal invasive surgical technique or in 5 patients with immediate implant placement in extraction socket. Minimal invasive surgical technique means flapless technique or with crestal incision within the tooth gap only, excluding sulcus of neighbouring teeth and no hard or soft tissue graft used. For both groups, the workflow feasibility was assessed and effectiveness, planning time, time Results The use of CEREC guide 2 had an effectiveness of 90.5% (19 of 21 patients). In one case the Cerec Guide was ineffective due to incorrect case indication and in one case due to inappropriate fit of surgical sleeve into the Cerec guide 2. Postoperative pain within the first 3 days after surgery was slightly higher in patients with the guide, but this was mainly due to occurrence of aphtous stomatitis on the day 2 in two patients. When comparing durations of surgery, the surgery was faster with guides, but this was compensated with longer planning phase in the guided group. The overall CEREC guide 2 workflow times was markedly reduced as the familiarity and use of the software increased. Conclusions and Clinical Implications Within the limitations of the present study, we found no obvious differences between guided and conventional implant treatments regarding duration of surgical intervention and postoperative pain. It is clear that chairside approach has an immediate effect on surgical procedure as well as on prosthetic rehabilitation. Comprehensive learning curve in computer- guided implantology is necessary to obtain predictable results.

The results of surgical treatment of patients with large and complex incisional hernias of the anterior abdominal wall in a multidisciplinary hospital

Objectives. To evaluate the immediate results of surgical treatment of patients with large incisional hernia of the anterior abdominal wall with the use of the mesh implants.Materials and methods. The data were retrospectively collected and analyzed. The study included patients with a large and / or complex incisional hernia. There were 108 patients who underwent incisional hernia repair with mesh reinforcement in the period from 2012 to 2016. In all cases the repairs were made with mesh implants. The average age of patients was (56.4 ± 10.4) years. The body mass index (BMI) was on average (32.6 ± 6.24) kg/m2. The medial localization of the hernia was 102 (94.44%). The width of the hernia defect averaged (12.2 ± 3.7) cm. Implants were placement in onlay positions – 19 (17.6%), sublay – 49 (45.37%), IPOM (Intraperitoneal onlay mesh) – 30 (27.77%) patients, the component separation technique (CST) with mesh reinforcement was used in 10 (9.25%) patients. Active aspiration drainage was performed in 72 (66.66%) patients.Results. The average time for draining the postoperative wound was (5 ± 2.2) days. The number of wound complications was 23 (21.3%), the number of seromas of the postoperative wound prevailed was 16 (14.8%) patients, of which 2 (1.85%) were chronic abdominal wall seromas, hematoma occurred in 2 patients (1.85%), the number of prolonged serous exudation was 7 (6.5%), necrosis of the wound edges occurred in 4 (3.7%) patients. There was no mortality. Reliably more often wound complications occurred in patients with large hernia defects (p = 0.006), and also with an increase in the duration of surgical intervention (p = 0.01). The hospital-stay in patients with complications was significantly greater (p < 0.001), the need for analgesics also increased (p < 0.001).Conclusion. Prevention of wound complications after large and complex incisional hernia repair with mesh reinforcement is an important direction in improving the results of surgical treatment in this category of patients.

Laparoscopic inguinal hernia repair without fixation

Aim. Comparison of the immediate and long-term results of laparoscopic inguinal hernia repair with and without mesh implant fixation.
 Methods. The study included 145 patients over 18 years of both genders with inguinal hernias, including those with relapse after auto-hernioplasty. Patients underwent transabdominal preperitoneal hernioplasty with the application of mesh implant. Patients were randomly divided into two groups matched by age, sex and the type of hernias. In group 1 (n=71) patients underwent laparoscopic hernia repair without fixation, which in case of a direct inguinal hernia was supplemented with transverse fascia endoloop plication; and in group 2 (n=74) - laparoscopic hernioplasty using hernia stapler and/or endocorporal suture.
 Results. The duration of surgical intervention in compared groups did not differ significantly (p=0.92), there was no recurrence of hernia in either group. The patients of group 1 had less pain syndrome in the early postoperative period, which was expressed in a significantly lower need for narcotic analgesics in terms of the equivalent amount of morphine (p=0.03) and shorter duration of hospital stay (p=0.5). Advantages of laparoscopic hernioplasty without fixation are the following: (1) intensity of pain syndrome in patients operated by this method is less than in patients operated by the traditional method, during both the first 24 hours after the surgery (p=0.45) and on day 5 (p=0.69); (2) there is no need to purchase foreign-made devices (hernia staplers) and self-locking endoprostheses.
 Conclusion. The long-term and immediate results of laparoscopic inguinal hernia repair without mesh implant fixation are not inferior to the traditional methods of implant application; besides, the studied method has a raw of advantages.

COMPARISON OF THE USE OF PEDICLE SUBTRACTION OSTEOTOMY (PSO) IN PRIMARY AND REVISION OPERATIONS

Purpose of study: to evaluate clinical and roentgenologic results of the use of pedicle subtraction osteotomy (PSO) in primary and revision operations to determine the feasibility of radical spinal sagittal imbalance correction at primary surgical intervention.Patients and methods. Retrospective review of 42 patients (30 men and 12 women, mean age 58.5 years) with rigid spinal deformities who underwent PSO was performed. Revision interventions (group R) were performed in 23 cases, primary (group P) in 19 cases. The comparative analysis of spino-pelvic parameters and global spine balance, demographic indices, volume of intraoperative blood loss, duration of surgical intervention, complications in the late postoperative period and quality-of-life indices by SRS-22 and ODI scores was performed. Results. Minimum follow up period was 12 months. Osteotomy was more often performed at L3 level. No differences in the extent of fixation, duration of surgical intervention and degree of segmental correction were detected. The average blood loss was significantly lower in group P (p0.05). Analysis of the late postoperative period changes in roentgenologic parameters showed statistically significant differences for the lumbar lordosis index as well as inconsistency between the lumbar lordosis and pelvic index that were better in group P. Quality of life increased significantly in both groups with the only statistically significant difference in ODI that was better in group P. Serious complications were observed in 47.8 and 38.6% of cases in group R and group P, respectively (p0.05). Revision interventions were required in 26.1% of cases in group R and in 15.8% in group P. Conclusion. In primary surgical interventions use of PSO technique enables to correct global spinal sagittal balance more effectively. Its use in primary interventions ensures lower volume of intraoperative blood loss as well as lower risk of pseudarthrosis formation and neurologic disorders development.

SURGICAL TREATMENT OF ISOLATED ASEPTIC ACETABULAR LOOSENING IN PATIENTS WITH STABLE FEMORAL COMPONENT

Background: Aseptic acetabular loosening currently occupies the 1st place in the structure of delayed complications after total hip arthroplasty. The basis of treatment is the replacement of a loosening cup and a pair of friction. The tactics of surgical treatment of the stable correctly oriented femoral component have not been determined, thoroughly which confirms the relevance of the study.Aims: Compare the effectiveness of total hip revision and isolated acetabular revision in patients with aseptic acetabular loosening and stable correctly oriented femoral component.Materials and methods: The study presented the results of surgical treatment performed in 44 patients (45 revisions) with isolated aseptic acetabular loosening and stable correctly oriented femoral component were presented, Patients were divided into two groups depending on the severity of surgery. The first group included 16 patients with a total revision due to irregular cone of the stem. The second group included 28 patients (29 revisions) with an isolated replacement of the unstable cup and a pair of friction.Results: In the 1st group, revision surgery was performed to replace both cup with the friction pair and stable correctly oriented stem which finally results in lower postoperative red blood counts (erythrocytes, hemoglobin, hematocrit), as well as higher intraoperative blood loss volume and longer duration of surgical intervention if compare to the 2nd group where the stable correctly oriented femoral component was not changed. Postoperative results assessed using Harris scales and Oxford Hip Score in the comparison group were at a higher level during the whole period of follow-up. A moderate coorelation between the severity of the revision intervention and its results was detected.Conclusions: Preservation of a stable correctly oriented stem allows to reduce the severity of the revision intervention which improves the results and shortens the period of patient rehabilitation.

Predictors of prolongation of the hospital stay in patients with cholecystolithiasis after laparoscopic surgical interventions on the gallbladder

The purpose of the study is to identify predictors associated with prolongation of the period of hospital stay more than 48 hours in patients with cholecystolithiasis after laparoscopic surgery on the gallbladder (laparoscopic cholecystectomy and cholecystolithotomy). Material and methods. The one-center open prospective study involved 136 patients with cholecystolithiasis. The average age of the patients was 48.9 ± 12.6 years (from 22 to 78 years), 79.41 % – women. Laparoscopic cholecystectomy was performed in 103 patients, of which 53 patients had 4-port laparoscopic cholecystectomy (4PLC) and 50 patients – single-incision laparoscopic cholecystectomy (SILC). Laparoscopic cholecystolithotomy (LCLT) was performed in 33 patients. Groups of patients were comparable by age. The baseline indices of laboratory general-clinical and biochemical blood tests, ultrasound scan of the hepato-biliary system, the duration of surgical intervention and the duration of stay in the hospital were evaluated. Predictors were determined using binary logistic regression. Results. The average duration of laparoscopic cholecystolithotomy was 61.06 ± 13.27 minutes, which was significantly longer than the duration of laparoscopic four-port cholecystectomy (42.83 ± 16.97 minutes, P = 0.001) and single-port cholecystectomy (36.60 ± 14.37 minutes, P = 0.001). The average duration of SILC (36.60 ± 14.37 minutes) was significantly shorter than the mean duration of 4PLC (42.83 ± 16.97 minutes), (P = 0.039). The average stay in hospital after surgery (4PLC, SILC and LCLT) did not exceed 4.2 days, and the shortest period of postoperative hospital stay was in patients with the LCLT group, although the difference did not reach the limit of statistical probability. Most of the studied parameters, including anthropometric (body weight, height, body mass index, age, gender), had no probable effect on the duration of staying in hospital after surgery. The excess of fibrinogen in the blood serum from the baseline of over 2.2 g/L in patients with cholecystolithiasis increases the risk of delay in the hospital more than 48 hours after the intervention by 20 times (95 % CI 2.97–136.61; P = 0.002). The decrease of the hemoglobin level <135 g / L in the preoperative period was associated with an increase of odds ratio of prolonging the stay of patients in the hospital for more than 72 hours by 2.48 times (95 % CI 1.16–5.29), and the absence of an increase in body temperature on the first day after the operation on the gallbladder reduced the odds ratio of stay in the hospital by 66% (VS = 0.34; 95 % DI 0.1661–0.6885; P = 0.0028). Conclusions . The influence of the type of laparoscopic intervention (SILC, 4PLC, LCLT) on the duration of postoperative stay of patients with cholecystolithiasis has not been established. The predictor of staying in the hospital for more than 48 hours after operation in patients with cholecystolithiasis was the preoperative level of fibrinogen above 2.2 g/l. The level of hemoglobin before the surgery on the gallbladder less than 135 g/l increases the risk of prolonged postoperative stay of patients for more than 72 hours by 2.48 times, and the absence of increased body temperature on the first day after the operation reduces the risk of delay in the hospital for more than three days by 66 %.

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) adnexectomy for benign pathology compared with laparoscopic excision (NOTABLE): a protocol for a randomised controlled trial

IntroductionNatural orifice transluminal endoscopic surgery (NOTES) uses natural orifices to access the cavities of the human body to perform surgical interventions. NOTES limits the magnitude of surgical trauma and potentially...

PECULIARITIES OF SURGICAL TREATMENT OF BENIGN FORMATION OF MAMMARY GLAND

The effectiveness of the use of remote surgical approaches in patients with benign formation of mammary gland was studied in this paper,. Before surgery, all patients underwent a standard set of instrumental examinations: mammography, ultrasound examination of the mammary gland, puncture biopsy of the formation with subsequent cytology, which was also performed in the postoperative period. The use of remote access, taking into account the localization of formations of the mammary gland is a radical surgical intervention. The duration of surgical intervention among these accesses, the severity of pain in the postoperative period are identical, as with the use of traditional accesses. In these patients, a good cosmetic effect was observed in the early and late periods of surgical intervention, which makes it possible to recommend these surgical interventions for a broader introduction of surgical treatment of patients with benign formation of mammary gland to the technology.

Surgical site infections in spinal neurosurgery

The review presents current data on the problem of surgical site infections in spinal neurosurgery. Infectious complications are the most common cause of unsatisfactory results of surgical treatment and prolonged hospital stay of patients after spinal surgery. Clinical and economic analysis shows that each case of infection at the site of surgical intervention causes additional 7.3 days of hospital stay in the postoperative period and $3152 extra costs per patient. According to the world literature, the incidence of wound infection in spinal neurosurgery varies from 0.7 to 11.9%. The main risk factors for this complication are long period from the moment of hospitalization to the operation, significant blood loss and long duration of surgical intervention. In the article, special role in the development of wound infection is given to the malnutrition syndrome. Patients suffering from this syndrome are considered to be at high risk of surgical site infections developing. Insufficient amounts of protein and energy substances are the cause of disturbed reparative processes in the wound and decreased level of immune defense. Diagnosis of wound infection is based on a comprehensive analysis of clinical and laboratory-instrumental research methods. The review presents current data on the pathogens of surgical site infections, regimens of antibiotic prophylaxis and effective methods of treatment (local and systemic antibiotic therapy, vacuum-assisted closure, flow-washing drainage, hyperbaric oxygenation). Undoubtedly, early diagnosis and correctly chosen management of a patient allows to reverse signs of wound infection and to avoid unfavorable clinical outcomes after surgical interventions on the spine.

Perioperative intensive therapy of patients with bladder cancer in the underdeveloped stage

The tendency to increase the incidence of cancer occurring both in Ukraine and in the world and, accordingly, increasing the complexity and duration of surgical interventions, leads to the search for new and improved existing tactics of perioperative care in oncosurgery. The purpose of our study was to examine the relationship between the choice of anesthetic provision, the nutritional status of patients with local common metastatic bladder cancer (complicated by 46% of the major accompanying pathology) and the course of the early postoperative period. Materials, methods and results. A prospective study was conducted on the basis of the Department of Anesthesiology and Intensive Care of the National Cancer Institute (Kyiv). The study covered 46 patients operated under general inhalation anesthesia with sevoflurane in combination with intravenous fentanyl (at a dose of 2-3 мg / kg), divided into two groups. Patients in the 1st group also performed epidural analgesia, and in the early postoperative period (from the first day), parenteral nutrition was administered to a three-component mixture (proteins, carbohydrates, fat emulsions) in the order of 25 kcal/kg body weight per day. As a result of the study, it has been shown that in patients with bladder cancer there are violations of nutritional status, mainly in the form of obesity, which in the postoperative period leads to the development of insulin resistance and hyperglycemia. Conclusions. The use of multimodal analgesia on the basis of dexketoprofen and paracetamol with the epidural unit and the early onset of parenteral nutrition during radical cystectomy contribute to adequate anesthesia, stable hemodynamics, postoperative complications, early preservation of the native state, and a decrease in the duration of treatment for patients with bladder cancer in the onset stage, сomplicated by a signific ant accompanying pathology.

The possibilities of single-port laparoscopic access in cholecystectomy after operations on the abdominal cavity organs

Aim. To assess the possibility and effectiveness of single-port access in cholecystectomy using for chronic calculous cholecystitis in patients who were previously operated on the abdominal organs. Materials and Methods . For the period from September 2015 to March 2017, 27 patients were been operated by laparoscopic cholecystectomy using single-port access for chronic calculous cholecystitis. All patients were divided into 2 groups. The first group included 12 (44.4%) patients with previous surgery on the abdominal organs, who were performed laparotomy. The second group (2) included 15 (55.5%) patients who didn’t have surgical interventions on the abdominal organs. Results and Discussion . The average duration of surgical intervention in patients of the 1 st group (n = 12) was 87.66 ± 4.03 minutes. In all cases chronic calculous cholecystitis was observed. There was no transition to open cholecystectomy. The average bed-day was 2.41 ± 0.20. Drainage of the abdominal cavity was carried out only for 7 patients (58.3%). In 7 (58.3%) patients opioid analgesics were prescribed once to reduce postoperative pain. Activation of patients occurred on the first day after the operation. After 2 days the ultrasound of the abdominal cavity was performed. In 2 (16.6%) patients there was a slight accumulation of fluid in the region of the removed gallbladder that did not require puncture. Patients in the second group in all cases were performed a single-port cholecystectomy without additional trocars. The average duration of the operation was 38.93 ± 1.85 minutes. In all cases chronic calculous cholecystitis was observed. Conversions to the open methodology have not been noted. The average bed-day was 2.06 ± 0.07.Drainage of the abdominal cavity has not been performed. In 2 (13.3%) cases opioid analgesics were prescribed once for postoperative pain relieving. Activation of patients occurred on the next day after the operation. After 2 days on the day of releasing from the hospital the ultrasound of the postoperative zone was performed, fluid accumulation in the area of the gallbladder bed was noted in 1 (6.6%) of the patient. Conclusions. The use of single-port access in laparoscopic cholecystectomy performing is an effective way. The features of a single port structure provide the possibility of curved instruments additional application, increase the number of single-port laparoscopic interventions in patients with chronic calculous cholecystitis.

Efficacy of adding fixed dose dexmedetomidine to nitroglycerin for controlled hypotension in functional endoscopic sinus surgery

Background Functional endoscopic sinus surgery (FESS) is a surgical procedure during which all possible measures to minimize bleeding should be considered, as even small amount of blood may obstruct vision. Controlled hypotension is one of these measures used to limit intraoperative blood loss to provide the best possible surgical field. The aim of this study was to compare the effect of a fixed dose of dexmedetomidine (DEX) and nitroglycerin (NTG) with NTG alone on hemodynamic parameters, NTG dose, surgeon satisfaction, and blood loss during controlled hypotensive anesthesia in FESS. Patients and methods Fifty patients of both sexes, classified as American Society of Anesthesia physical status I and II, aged between 20 and 50 years, and candidates for FESS were randomly allocated into two groups by using the sealed envelope method. Group I (n=25) received hypotensive anesthesia with NTG and group II (n=25) received hypotensive anesthesia with NTG and DEX. DEX 1 μg/kg over 10 min was given, and then infused by a syringe pump at a fixed rate of 0.5 μg/kg/h before induction of anesthesia in group II only. After induction and intubation NTG was infused in both groups and titrated to obtain a target mean arterial blood pressure (MAP) of 55–65 mmHg. The MAP and heart rate (HR) were measured at baseline, and then periodically. The following parameters were also recorded: duration of surgical interference (time from the beginning to the end of surgical intervention), blood loss volume, surgeon satisfaction, time to achievement of the target MAP, time to reversibility of MAP to baseline, and the highest dose of NTG needed to reach target MAP. Results There was no significant difference between two groups regarding demographic data, basal hemodynamics, duration of surgical intervention, American Society of Anesthesia physical status, surgeon satisfaction, and all measurements of MAP except time of intubation, which was significantly less in group II. On the other hand, there was a significant difference between both groups regarding HR, time to achievement and reversibility of MAP, blood loss volume, and the highest dose of NTG needed to reach the target MAP, as all of these measurements were significantly lower in group II. Conclusion DEX (1 μg/kg bolus, followed by 0.5 μg/kg/h infusion) and NTG is superior to NTG alone in rapid achievement of target MAP with lower HR and lower NTG doses and in reducing blood loss volume during FESS.

Сervical microdiscectomy: method and surgical strategy

Objective. To implement the interlaminar lateral approach for extraction of herniated discs (HD) in the cervical spine. Materials and methods. During 2012–2015 in Regional psychoneurological hospital 56 patients with cervical HD were operated. There were 22 females, 36 males among them. Disc herniation at the CV–CVI level occurred in 21 cases, CVI–CVII in 20 cases. The main disease signs were cervicalgia, monoradiculopathy. Fifty patients with medial hernia were operated using anterior cervical microscopic discectomy approach to HP extraction and intervertebral cage implantation (PEEK material). Six patients with lateral hernia were operated using posterior interlaminar cervical microdiscectomy. Anterior approach was performed by a standard method using CODMAN retractor, high-speed drill Stryker TPS. The posterior interlaminar approach was performed using paramedian incision 3 cm, intermuscular approach to the posterior lateral mass and arch on the affected side with Medtronic Metrix system followed by interlaminectomy performed by high-speed drill not more than 1 cm that was rather enough for hernia extraction from under nerve root. Results. In all cases we managed to achieve the regression of radicular and cervicalgia syndromes. No complications were fixed during both surgical approaches. There was no difference observed in duration of surgical intervention using both methods, which was about (64±12) min. All patients were verticalized and activated in 3–4 hours after surgery. Conclusion. Cervical microdiscectomy is a standard method for cervical HD surgery. The posterior interlaminar approach is an effective method used for lateral herniations, especially sequestered ones. It promotes the preservation of intervertebral disc and reduction of the total cost of surgery due to no necessity to use the implants-prosthesis. We suppose the posterior cervical microdiscectomy of lateral, sequestered intervertebral disc herniations in cervical spine to become a standard method of treatment.

Total Knee Arthroplasty Outcomes Depending on the Degree 11 of Angular Deformity

The analysis of total knee arthroplasty results was performed in 106 patients operated on for III stage of deforming gonarthrosis. All patients were divided into 2 groups depending on the presence of the angular extremity axis deformity. Clinical and functional assessment was performed using visual analog scale, Joseph &amp; Kaufman scale, SF-36 questionnaire. Treatment results were evaluated in 3, 6 months and 1, 3, 5 years after intervention. In the group of patients with axial leg deformity the duration of surgical intervention, intraoperative blood loss and postoperative hospitalization period were higher than in patients with normal leg axis but the differences were not significant. The height of the implant insert was 12 (8-14) mm with normal axis and 14 (14-15) mm with axial deformity ( p =0.000187). Correction of the leg axis during arthroplasty required larger bone cuts and soft tissue release but the parameters characterizing leg axis normalization did not differ statistically significant between the groups. However in 5 years after intervention the patients with normal lower extremity axis showed reliably better results by all scales and questionnaires.

Efficacy of external warming in attenuation of hypothermia in surgical patients.

Hypothermia in surgical patients can be the consequence of long duration of surgical intervention, general anaesthesia and low temperature in operating room. Postoperative hypothermia contributes to a number of postoperative complications such as arrhythmia, myocardial ischemia, hypertension, bleeding, wound infection, coagulopathy, and prolonged effect of muscle relaxants. External heating procedures are used to prevent this condition. The aim of this study was to evaluate the efficiency of external warming system in alleviation of cold stress and hypothermia in patients who underwent major surgical procedures. The study was conducted in the Military Medical Academy in Belgrade. A total of 30 patients of both genders underwent abdominal surgical procedures, randomly divided into two equal groups: the one was externally warmed using warm air mattress (W), while in the control group (C) surgical procedure was performed in regular conditions, without additional warming. Oesophageal temperature (Te) was used as indicator of changes in core temperature, during surgery and awakening postoperative period, and temperature of control sites on the right hand (Th) and the right foot (Tf) reflected the changes in skin temperatures during surgery. Te and skin temperatures were monitored during the intraoperative period, with continuous measurement of Te during the following 90 minutes of the postoperative period. Heart rates and blood pressures were monitored continuously during the intraoperative and awakening period. In the W group, the average Te, Tf and Th did not change significantly during the intraoperative as well as the postoperative period. In the controls, the average Te significantly decreased during the intraoperative period (from 35.61 ± 0.35 °C at 0 minute to 33.86 ± 0.51°C at 120th minute). Compared to the W group, Te in the C group was significantly lower in all the observed periods. Average values of Tf and Th significantly decreased in the C group (from 30.83 ± 1.85 at 20th minute to 29.0 ± 1.39°C at 120th minute, and from 32.75 ± 0.96 to 31.05 ± 1.09°C, respectively). The obtained results confirm that the external warming using warm air mattress was able to attenuate hypothermia, i.e. substantial decrease in core temperature, compared with the similar exposure to cold stress in the control group.

Predictors of Vein Thrombosis at Lower Limb Joints Arthroplasty in Oncologic Patients

Purpose of the study was to detect the factors that stipulated risk of vein thrombosis at arthroplasty of lower limb joints in oncologic patients. Retrospective data on 374 patients after hip and knee arthroplasty aa well as after total femur replacement were studied. The following risk factors were studied: age, gender, weight, height, body mass index, preoperative hemoglobin level, tumor morphology, presence of pathologic fracture, use of tranexamic acid, tourniquet application, type of regional anesthesia, intraoperative blood loss, duration of surgical intervention. Statistical analysis was performed using the method of multifactorial logistic regression. Independent risk factor for perioperative vein thrombosis was the age of patient (likelihood ratio χ2=26,6; р=0,000) In patients of 40 years and older the rate of thrombosis was higher as compared to younger ones: 24.4% (31/127) versus 6.1% (15/247); p =0.000; odds ratio 5; 95% confidence interval 2.6 - 9.7. Preoperative risk of vein thrombosis increased not only with patient’s age but in presence of pathologic fracture as well (likelihood ratio χ2 = 29,8; р=0,000) Other studied factors did not increase the rate of thrombosis. In presence of pathologic fracture the possibility of early anticoagulant therapy should be considered. Both prolonged epidural and peripheral nerve blockades can be used at such surgical interventions without risk of vein thrombosis rate increase.

Predictors of Vein Thrombosis at Lower Limb Joints Arthroplasty in Oncologic Patients

Purpose of the study was to detect the factors that stipulated risk of vein thrombosis at arthroplasty of lower limb joints in oncologic patients. Retrospective data on 374 patients after hip and knee arthroplasty aa well as after total femur replacement were studied. The following risk factors were studied: age, gender, weight, height, body mass index, preoperative hemoglobin level, tumor morphology, presence of pathologic fracture, use of tranexamic acid, tourniquet application, type of regional anesthesia, intraoperative blood loss, duration of surgical intervention. Statistical analysis was performed using the method of multifactorial logistic regression. Independent risk factor for perioperative vein thrombosis was the age of patient (likelihood ratio χ2=26,6; р=0,000) In patients of 40 years and older the rate of thrombosis was higher as compared to younger ones: 24.4% (31/127) versus 6.1% (15/247); p =0.000; odds ratio 5; 95% confidence interval 2.6 - 9.7. Preoperative risk of vein thrombosis increased not only with patient’s age but in presence of pathologic fracture as well (likelihood ratio χ2 = 29,8; р=0,000) Other studied factors did not increase the rate of thrombosis. In presence of pathologic fracture the possibility of early anticoagulant therapy should be considered. Both prolonged epidural and peripheral nerve blockades can be used at such surgical interventions without risk of vein thrombosis rate increase.

Intramedullary Osteosynthesis by Fixion System at Treatment of Long Bones Diaphyseal Fractures

Treatment results for 61 patients with diaphyseal fractures of long bones of the extremities are presented. Fractures of the humerus were diagnosed in18 (29.5%) patients, femur - in 22 (36.1%) and tibia - in 21 (34.4%) patients. In most cases fractures of A1, A2, A3 and B1 were observed. For osteosynthesis blocking and non-blocking Fixion intramedullary nails were used. Long-term results (1 - 1.5 years) were analyzed for 42 patients and showed excellent and good results in 93% of patients. Nonunion and deformity was observed in 7% of observations. The advantages of the technique included low traumatization, short duration of surgical intervention, minimum (up to 200 ml) blood loss.

Intramedullary Osteosynthesis by Fixion System at Treatment of Long Bones Diaphyseal Fractures

Treatment results for 61 patients with diaphyseal fractures of long bones of the extremities are presented. Fractures of the humerus were diagnosed in18 (29.5%) patients, femur - in 22 (36.1%) and tibia - in 21 (34.4%) patients. In most cases fractures of A1, A2, A3 and B1 were observed. For osteosynthesis blocking and non-blocking Fixion intramedullary nails were used. Long-term results (1 - 1.5 years) were analyzed for 42 patients and showed excellent and good results in 93% of patients. Nonunion and deformity was observed in 7% of observations. The advantages of the technique included low traumatization, short duration of surgical intervention, minimum (up to 200 ml) blood loss.