Failure In Postoperative Period Research Articles

Тенденції сучасного накісткового остеосинтезу дистального відділу стегнової кістки

Переломи дистального відділу стегнової кістки складні у лікуванні, особливо в літніх людей. Сучасні високотехнологічні фіксатори, зокрема LCP-пластини, при цих переломах забезпечують добрий результат при суворому дотриманні методики застосування. Наведено аналіз 22 випадків ускладнень і незадовільних результатів застосування LCP-пластин при зазначених переломах. Виявлено, що результат лікування переломів LCP-пластиною залежить від якості попередньо проведеної репозиції відламків. При поганому контакті уламків, їх блокуванні, відсутності мікрорухливості уламків консолідація неможлива. Особливо важливою є анатомічна репозиція при поперечних, косих внутрішньосуглобових переломах. Її відсутність при останніх, як правило, закінчується розвитком деформуючого артрозу. Помилки лікаря у виборі фіксатора і його установці можуть бути причинами невдач у післяопераційному періоді. Засоби для малоконтактного багатоплощинного остеосинтезу прості в користуванні. У 34 випадках при переломах нижньої третини стегнової кістки остеосинтез проводився за допомогою пристрою для фіксації кісткових відламків (патент України № 17502). Після репозиції фрагменти фіксуються 2–3 кортикальними гвинтами. Пристрій забезпечує стабільний остеосинтез косих переломів нижньої третини стегнової кістки при застосуванні пластини на 8–10 отворів. Дрібні уламки підводяться до материнського ложа. Репозиційний остеосинтез завдає мінімальну травму уламків, створює умови для їх первинного зрощення. При осколкових переломах дистального відділу стегнової кістки, надчерезвиросткових переломах остеосинтез у 58 пацієнтів проводився пристроєм для остеосинтезу стегнової кістки (патент України № 92097). Пристрій певною мірою подібний до DHS-фіксатора, проте його конструкція значно простіша, напрямна набагато коротша, компресійний стрижень має на робочому кінці свердло і мітчик, що полегшує процес накладання пристрою, не завдає фрагментам додаткової травми.

Comparative Evaluation Between 2mm Locking and 2mm Non-Locking Miniplate System for Open Reduction and Internal Fixation of Mandibular Parasymphysis Fracture

Aims: To compare the stability, rigidity, bone healing and functional outcome of 2mm locking and 2mm non-locking miniplate system in mandibular parasymphysis fracture. Material and method: The was conducted at dept. of oral and maxillofacial surgery, GNIDSR, Kolkata, India, from May 2016, to December, 2019, 34 patients (male 30 and female 4) were randomly divided into 2 groups. The patients underwent osteosynthesis—Group A (n=17, 15 males and 2 females) with orthomax 2-mm locking titanium miniplates(LMP) and Group B (n=17, 15 males and 2 females) with orthomax 2-mm nonlocking titanium miniplates(NLMP). The age, gender, operating time, pain and swelling, mobility, occlusion, chewing efficacy, bony healing with radiological evaluation were all reviewed. The assessment of the patients was done preoperatively and postoperative days at 1 day, 3 day, 7th day, 14th day, 1st month, 2nd month, and 3rd month using the clinical parameters, observation and radiology. Results: A total of 34 parasymphysis fractures met the inclusion criteria. In our study, a statistically significant difference was not found in the clinical parameters such as operating time, pain, swelling, occlusion, chewing efficacy, mobility between the fracture segments and infection, hardware failure in postoperative period. A statistically significant difference was found in the CT scan evaluation with pre-op and post op fracture width and hounsfield unit in between two groups at preop and 3rd month postop days and it was also supported by OPG findings. Conclusion: We concluded that Locking miniplates are technically not cumbersome than non-locking one – No significant increase in operating time. Use of two locking miniplates in the parasymphysis region placed on the Champy’s line of oesteosynthesis provides a better stability and oesteosynthesis at the 3rd month postoperative period than non-locking.

Renal replacement therapy after elective surgical procedures

Acute kidney injury (AKI) is not a rare postoperative complication in surgical patients. AKI dramatically affects patient's condition, increases hospital-stay and risk of lethal outcome. Moreover, AKI may be followed by deterioration of basic renal function in short- and long-term period. It seemed interesting to us to generalize the clinical data of general surgical patients treatment, which were need to use renal replacement therapy for acute renal failure in postoperative period. The analysis made us possible to draw conclusions that can broaden our understanding of the causes, course and outcomes of acute renal failure in such a patients.

X-RAY SURGERY FOR EXTRAHEPATIC BILE DUCTS INJURIES

Aim. To increase efficacy of X-ray surgical treatment of fresh bile ducts injuries. Material and Methods. Antegrade X-ray surgical intervention for iatrogenic bile ducts injuries during cholecystectomy or stomach resection was performed in 12 patients. Bile duct injury has been diagnosed for 5 days after previous surgery. Percutaneous transhepatic biliary drainage was carried out in all cases including 3 patients with non-dilated intrahepatic bile ducts. Results. Biliodigestive anastomosis with temporary preservation of transhepatic cholangiostomy in postoperative period was carried out in 5 patients with full transection of common bile duct in 1.5–3 months after antegrade transhepatic cholangiostomy. Antegrade recovery of common bile duct by the methods of intervention radiology (transhepatic biliary drainage dislocation in duodenum) was performed in 5 patients. Retrograde endoscopic common bile duct stenting using plastic stent was performed in 2 patients after antegrade biliary drainage. There were no deaths after surgery in this series. Follow-up varied from 3 months to 8,5 years. Conclusion. Early (within 5 days) iatrogenic bile duct injuries and sufficient surgeon's experience suppose reconstructive surgery with preservation of percutaneous transhepatic biliary drainage that prevents biliodigestive anastomosis failure in postoperative period. Percutaneous transhepatic biliary drainage should be transformed in antegrade biliodigestive stent in case of absence of technical or temporary possibility for early reconstructive surgery. Antegrade biliodigestive stenting combined with retrograde endoscopic stenting or without it should be preferred in surgical management of tangential iatrogenic bile duct injuries. Dissected common bile duct may be also restored using prolonged antegrade biliodigestive stenting.

Postoperative Acute Respiratory Failure In Patients Treated Surgically For Goiters.

The aim of the study was to present a clinical picture, treatment and prognosis regarding patients who developed acute respiratory failure (ARF) while treated surgically for a goiter. A total of 3810 patients were treated for goiters between 2008 to 2013. Symptoms of postoperative ARF were recognized in 39 (1%) patients. Symptoms of postoperative ARF were a postoperative hemorrhage in 31 (79.4%), lymphorrhagia in 1 (2.6%), bilateral paralysis of recurrent laryngeal nerves in 6 (15.4%) and acute circulatory - respiratory failure in 1 (2.6%). Postoperative hemorrhage appeared in 19 patients operated for nodular goiter, 4 with a retrosternal nodular goiter, 1x nontoxic recurrent retrosternal nodular goiter, 1x toxic recurrent retrosternal goiter nodular goiter, 2x Graves'goiter and 4x with malignant goiter. The cause of hemorrhage was parenchymal bleeding from the stumps and / or short neck muscles (29x), arterial bleeding (1x) and bleeding into the subcutaneous tissue (1x). Massive lymphorrhagia appeared as a result of damage to the thoracic duct after total thyroidectomy due to papillary thyroid carcinoma with cervical lymph node dissection on the left side. All patients who were diagnosed with bilateral paralysis of RLN, tracheostomy was performed. Of all 39 patients who underwent surgery two died - one in 6 days after surgery due to myocardial infarction, and another as a result of micropulmonary embolism and acute circulatory - respiratory failure in 18 hours after surgery. 1. The most frequent causes of acute respiratory failure in postoperative period are a hemorrhage from the operation site and bilateral paralysis of recurrent laryngeal nerves. 2. Acute postoperative respiratory failure is an indication for postoperative wound revision.

Paravertebral Block Combined with Sedation for a Myasthenic Patient Undergoing Breast Augmentation.

Paravertebral block is a unilateral analgesic technique that can provide adequate surgical anesthesia and great advantages in many types of surgery with a low side-effect profile. In this case we present combination of bilateral thoracic paravertebral block under ultrasound guidance with sedation which provides complete anesthesia and postoperative analgesia in a myasthenic patient undergoing cosmetic breast surgery. In myasthenic patients paravertebral blocks may be a better option for breast surgery with avoiding the need for muscle relaxants and opioids and risk of respiratory failure in postoperative period.

Is Severe Pulmonary Hypertension a Contraindication for Orthotopic Heart Transplantation? Not Any More

Pulmonary hypertension (PH) unresponsive to pharmacological intervention is considered a contraindication for orthotopic heart transplantation (OHTX) due to risk of postoperative right-heart failure. In this prospective study, we describe our experience with a treatment strategy of improving severe PH in heart transplant candidates by means of ventricular assist device (VAD) implantation and subsequent OHTX. In 11 heart transplantation candidates with severe PH unresponsive to pharmacological intervention we implanted VAD with the aim of achieving PH to values acceptable for OHTX. In all patients we observed significant drop in pulmonary pressures, PVR and TPG (p < 0.001 for all) 3 months after VAD implantation to values sufficient to allow OHTX. Seven patients underwent transplantation (mean duration of support 216 days) while none of patients suffered right-side heart failure in postoperative period. Two patients died after transplantation and five patients are living in very good condition with a mean duration of 286 days after OHTX. In our opinion, severe PH is not a contraindication for orthotopic heart transplantation any more.