Immediate Results Of Treatment Research Articles

Differentiated approach to the treatment of femoral fractures in children 0–7 years old using osteosynthesis with flexible titanium rods

Background. Fractures of the femur, especially its diaphysis, are quite common in pediatric practice. One of the priorities in the treatment of hip fractures in children is elastic stable intramedullary osteosynthesis with flexible titanium rods (ESIN/TEN), however, the frequency of using conservative methods also remains high. Aim. To differentiate the approach to the treatment of femoral fractures in children aged 0–7 years. Materials and methods. The immediate results of treatment of femoral fractures in 118 children aged 0 to 7 years (mean age 3.3±1.8 years) were studied. The main group consisted of 62 children who underwent surgical treatment of diaphyseal femoral fractures, while ESIN osteosynthesis was performed in 56 patients. The reference group was formed by a retrospective analysis of the medical records of 56 children who received conservative treatment of hip fractures. Results. Compared with conservative methods, with ESIN, the overall rate of early complications (skin reaction) was significantly lower, there were no complications from the internal organs (kidneys, lungs), and there were 3 (4.8%) cases of fixative migration. The severity of pain after 3 weeks from the start of treatment in the main group decreased to 2.4±0.1 points (mild pain), and in the reference group – to 4.5±0.3 points (moderate pain; p=0.013). The average length of stay of patients in the hospital in the main group was 7.3±2.4 days, in the reference group – 21.2±5.9 days (p=0.008). Conclusion. ESIN is the optimal method of stabilization for diaphyseal fractures of the femur in children aged 0 to 7 years. The advantages of ESIN over conservative methods are lower morbidity, greater pain relief, and shorter hospital stays for children.

INDIVIDUALIZED APPROACH TO UPPER URINARY TRACT DRAINAGE AFTER RETROPERITONEOSCOPIC URETEROLITHOTOMY

Aim. To clarify the indications for the use of ureteral stents during retroperitoneoscopic ureterolithotomy (RULT). Materials and methods. We analyzed the results of treatment of 53 patients who underwent RULT for ureteral stone. In 18 (34%) patients, a stent was not placed after the operation (group 1), and in 35 (66.0%) patients, a stent was placed (group 2). Indications for stent placement were determined during surgery. Results. When performing RULT for the treatment of patients with ureteral stones, postoperative complications were not severe, resolved on their own or required a slight increase in therapy in the postoperative period. These complications did not significantly affect the duration of treatment or its results. There were no significant differences in the main clinical and laboratory parameters in both groups 2 weeks after surgery. The incidence of complications was low and did not differ significantly in both groups. Conclusions. No significant differences were found in terms of the immediate results of treatment of patients with ureterolithiasis after RULT, depending on whether a stent was used to drain the ureteral lumen in the patient or not, when a stent was used according to indications. Complications after RULT are infrequent, transient, and require only minimal therapeutic correction. Stenting of the ureter is expected to lead to a significant increase in the duration of surgery. Drainage of the ureter by placing a stent is an absolutely justified procedure in the presence of severe changes in the ureteral wall, manifested by edema of all layers, the presence of mucosal ulcers, as well as perifocal inflammation in the surrounding tissues surrounding the ureter. On the other hand, stenting of the ureter after RPU is not a routine procedure, and in the absence of the above changes, it can be abandoned without any complications.

To assess the effectiveness of treatment methods for patients of different age groups with basal cell cancer of the skin of the nose and ears

The relevance of the problems of diagnosis and treatment of skin cancer is currently determined not only by the high incidence rate, but by the existing difficulties in differential diagnosis and treatment with traditional methods. For localizations of basal cell skin cancer (BCSC) that are "inconvenient" for treatment, such as the external auditory canal, auricle, and wing of the nose, treatment is associated with certain difficulties and the possible appearance of a cosmetic defect, therefore, when choosing a treatment method, the anatomical features of these organs are taken into account. It has been determined that the effectiveness of treatment for primary BCSC of the nose and auricles is higher than recurrent one, and among the various treatment methods, the most effective and radical is the surgical method. The immediate results of treatment of BCSC in the form of PR by surgical method were 86.7%, which is statistically significant compared with other types of treatment (p < 0.05). Long-term treatment results with the surgical method are also higher (77%) compared to other methods, which is also statistically significant (p < 0.05).

ANTEGRADE METHODS OF BILIARY DECOMPRESSION IN TUMOR OBSTRUCTION OF THE BILIARY TRACT

Percutaneous transhepatic endoscopic ultrasound-guided intervention is a crucial method for addressing mechanical jaundice. This technique for restoring bile outflow enables the resolution of several medical and diagnostic issues with minimal invasiveness and fewer complications compared to traditional open surgical treatments. Most often, antegrade cholangiostomy is used in oncological practice, where the variety of clinical situations determines the indications for performing this intervention in different variants and with different goals. According to the world literature, at the moment, sufficient experience of transdermal technologies has been accumulated, their application in clinical practice has been worked out, which allows to recognize them, to a certain extent, as routine. The purpose of this work is to optimize biliary decompression in patients with tumor obstruction of the biliary tract, to improve the prevention of complications, to enhance the immediate results of treatment and the quality of life for this group of population. The study analyzed the examination and surgical treatment outcomes of 64 patients with tumor-related mechanical jaundice treated in surgical hospitals from 2017 to 2023. All patients underwent antegrade biliary drainage procedures, specifically percutaneous transhepatic cholangiostomy and bile duct stenting under ultrasound guidance, to achieve biliary decompression. Percutaneous transhepatic endoscopic interventions have become the primary method for biliary decompression in cases of bile duct obstruction due to tumors. These procedures, particularly for malignant tumors, are associated with relatively few complications and low mortality rates.

Photodynamic therapy of leukoplakia of the oral mucosa: experience of using method in 223 patients

The aim of this study was to analyze the immediate and long-term results of using photodynamic therapy (PDT) in patients with leukoplakia of the oral mucosa. The retrospective study included 223 patients with morphologically verified leukoplakia of the oral mucosa. Patients received treatment at the hyperthermia and photodynamic therapy department from 2013 to 2023. The average age was 51.9±8.9 years. Clinically, 211 patients (94.6%) had a flat form of the disease, 12 patients (5.4%) had a verrucous form. The photosensitizer (PS), based on chlorin e6, was administered intravenously once in doses of 1.7 to 2.5 mg/kg body weight. Irradiation of pathologically changed lesions was carried out 2-2.5 hours after the end of its infusion, using a semiconductor laser device “UPL PDT”, with a wavelength λ=665±5 nm. The laser radiation dose density varied from 25 to 100 J/cm², the power density from 0.07 to 0.32 W/cm², the duration of one irradiation field - from 2 to 13.5 minutes, depending on its linear dimensions. The severity of adverse reactions was assessed on days 1-30 after treatment using the CTCAE 4.03 scale. The immediate results of treatment were assessed up to 3 months after PDT, with morphological confirmation of the response to treatment. No serious adverse reactions were observed during PS infusion and irradiation. No symptoms of dermal phototoxicity were reported. During control examinations, up to 3 months after irradiation in patients with flat and verrucous forms, the frequency of complete regressions was 97.1% (n=205) and 58.3% (n=6) cases, partial regressions - 2,9% (n=7) and 25% (n=3) of cases, respectively. Objective response rates were observed at 100% and 83.3%, respectively. The period of observation of patients varies from 3 to 120 months. (average 66 months). The frequency of disease relapses during this period was 9%. Patients with partial regression and identified relapse were treated with repeated PDT sessions. PDT is a well-tolerated and effective treatment method for patients with leukoplakia of the oral mucosa, which has significant advantages over traditional methods of treating this precancerous pathology. These include minimal toxicity to the normal tissues surrounding the pathological foci due to the selective accumulation of PS in leukoplakia tissues, a slight risk of serious adverse reactions, the possibility of an outpatient session, the possibility of repeated treatment over a large area of damage and good cosmetic results).

Роль определения хромогранина А в лечении больных кастрационно-резистентным раком предстательной железы.

Introduction. Chromogranin A has the greatest diagnostic value in detecting neuroendocrine differentiation (NED) of a tumor. This work is devoted to the study of the therapy of castration-resistant prostate cancer (CRPC) using somatostatin (AS) analogues based on the assessment of the neuroendocrine status of the tumor. Material and methods. The study included 89 patients with CRPC aged 72.2±1.4 years. Localized prostate cancer was diagnosed in 6 (6.7%), locally distributed prostate cancer (T3-4N0M0) in 12 (13.5%) patients, metastatic (T3-4N0-1M1)–in 71 (79.8%). An increase in CgA was observed in 31.5% (n=28) of CRPC patients. Combination therapy was performed with Octreotide depot (Pharm–Sintez, Russia) according to the scheme: 20 mg n/a once every 28 days in combination with dexamethasone at a dose of 4 mg per day for 1 month. Then the dose of dexamethasone was reduced. Patients were monitored every 28 days. The effectiveness was evaluated by the dynamics of PSA and CgA, as well as (ultrasound, abdominal MSCT, pelvic MRI and osteoscintigraphy). According to PSA, the answer was considered to be a decrease in the median PSA, or a lack of growth of more than 10%. Results. In patients with normal levels of CgA after 3 months of treatment, the median PSA significantly increased: from 57.0 [29.8; 94] ng/ml initially to 89.0 [47.4; 131.9] ng/ml, which was 56.1%, the decrease in CgA was 9.5% (from 2.1 to 1.9 nmol/l). In patients with elevated levels of CgA, there was a decrease in the median PSA value by 35.7%, from 169.5 [66.3; 235.3] ng/ml to 109.0 [44.8; 236.9] and CgA by 25% – from 5.2 [3.6; 7.1] to 3.9 [2.3; 5.2]. The median values and the proportion of PSA reduction in the group of «responders» stratified by CgA levels before and after 3 months of treatment were, respectively: in the group with normal CgA values – 43.0 [16.5; 154.3] nmol/l and 15.2 [7.2; 48.8] nmol/l or 64.7%; with CgA 3-7 nmol/l – 160.5 [35.1; 278.6] nmol/l and 42.4 [14.1; 88.4] nmol/l or 73.6%; in patients with CgA more than 7 nmol/L – 166.5 [28.0; 222.0] nmol/l and 81.7 [16.4; 151.0] nmol/l or 50.9%. Conclusion. Early detection of NED in CRPC with the use of the CgA marker makes it possible to stratify patients according to its severity and off r combination therapy with the inclusion of AS. An analysis of the immediate results of treatment with octreotide depot in combination with GnRH agonists and dexamethasone showed significantly higher efficacy in patients with initially increased levels of CgA, and the results achieved look preferable in patients with a moderate increase in this marker (within 3-7 nmol/l).

Treatment results of acute arterial obstruction of the lower limbs during advanced stages of ischemia

Objective. To analyze the immediate results of treatment of patients with acute arterial obstruction of the lower limbs during advanced stages of ischemia.Material and methods. The results of a comprehensive examination and treatment of 244 patients (135 men, 109 women, average age 67,2±8,4 years) with acute arterial obstruction of lower limbs were analyzed. Acute thrombosis was observed in 105 (43,1%) patients and embolism of the main arteries in 139 (56,9%) patients. 197 (80.7%) patients had ischemia of one (102 left, 95 right lower limbs) and 38 (15.6%) of both lower limbs. In 244 patients acute ischemia was noted in a total of 281 lower extremities. 86.9% of patients were hospitalized 24 hours after the onset of the disease. In 190 cases the affected limbs had II degree ischemia (54 cases (19,2%) of IIA degree, 136 (48,4%) IIB degree), and 91 (32,4%) patients had ischemia of III degree.Results and discussion. The main component of the operation for vascular embolism was thromboembolectomy (n=110), which in 56 cases was supplemented by vessel reconstruction (n=13), fasciotomy (n=34), and necrectomy (n=12). Primary amputation of the limb was performed in 13 cases. Conservative angiotropic therapy was performed in 16 cases.In acute thrombosis of lower limb arteries, conservative treatment was performed in 28 cases, primary limb amputation was performed in 10 cases, thrombectomy with a local reconstruction of the vessel (n=31), also with bypass (n=14), with reconstruction and fasciotomy of the tibia (n=13) and with reconstruction and necrectomy (n=7) were performed in 93 cases.Conclusion. Despite the delayed treatment in 67.6% of cases, the acute ischemia presented less severely, suggesting that the level of obstruction is more influential than the timing of the onset in the development of ischemic limb injuries. The choice of treatment method and extent at advanced stages of limb ischemia primarily depends on the degree and severity of ischemic disorders. The outcomes of treatment were less satisfactory in acute arterial thrombosis than in embolism, largely due to chronic obliteration of the distal arterial channel.

ОСТРЫЙ ГНОЙНЫЙ ДВУСТОРОННИЙ ПИЕЛОНЕФРИТ: ДИАГНОСТИКА И ЛЕЧЕНИЕ

Background. Acute purulent bilateral pyelonephritis is the most severe form of acute pyelonephritis. The disease is often accompanied with oligo- or anuria and is complicated by urosepsis. Purpose of the study. To analyze information content of diagnostic methods and immediate results of treatment of patients with acute bilateral pyelonephritis in the phase of purulent inflammation. Material and methods. 44 patients with acute bilateral pyelonephritis were observed. The purulent process in both kidneys was diagnosed by ultrasound and contrast-enhanced computed tomography (CT). Urosepsis was laboratory confirmed in 34 patients. All patients were operated on both sides. Organ-preserving surgeries were performed in 43 cases, and both kidneys were removed in one patient. Histological examination of fragments of the kidney parenchyma confirmed the purulent process in 41 patients. After surgery all patients received targeted antibacterial and detoxification therapy. Results. After operations 5 patients died due to the progression of multiple organ failure. After surgery two patients required hemodialysis due to the development of anuria. 37 patients were discharged from the clinic in a satisfactory condition. 1 year after the operation 19 were diagnosed with chronic renal failure stage III. Conclusions. 1. CT with contrast enhancement is the best method for detecting foci of purulent destruction in the renal parenchyma. 2. Acute purulent bilateral pyelonephritis in 77.3% is complicated by urosepsis which requires intensive complex treatment: surgical debridement of purulent foci in both kidneys followed by long-term targeted antibacterial and detoxication therapy. 3. The prognosis for acute purulent bilateral pyelonephritis is always uncertain for life and poor for recovery.

Resection interventions in the treatment of hepatocellular cancer in a specialized surgery center

Background. The relevance of the treatment of hepatocellular cancer (HCC) is determined by a significant increase in the incidence rate and its high prevalence among primary malignant hepatic tumors.The aim of the study. To summarize the experience of providing specialized medical care to patients with hepatocellular cancer.Methods. We studied the direct results of treatment of patients with primary hepatic cancer treated at the Kuzbass Regional Hepatological Center for the period from January 2015 to August 2022. The materials for the study were medical records of patients with an established diagnosis of primary hepatic cancer, surgical records, results of pathohistologic examination. The exclusion criterion was diagnosed cholangiocellular carcinoma.Results. During the period from 2015 to 2022, 59 patients with primary hepatic cancer were treated at the Kuzbass Regional Hepatological Center. Among them, hepatocellular cancer was diagnosed in 48 cases, cholangiocellular cancer – in 11 cases; radical surgery was performed in 12 patients with hepatocellular cancer; fatal outcome was noted in 1 (2.1 %) patient, complications in the postoperative period developed in 5 (41.7 %) cases and were ranked as I-3, IIIb-1 and IVb-1 according to Clavien – Dindo classification.Conclusion. The degree of risk of severe post-resection hepatic failure should be considered one of the main criteria in choosing a strategy for radical surgical treatment. New surgical approaches (laparoscopic vascular isolation of the portal blood flow, using temporary hemostasis in laparoscopic hepatic resections and the device for its implementation) in resection surgery of primary hepatic cancer can improve the immediate results of treatment.

Systematic Review of the Clinical Efficacy of Various Terms of Non-Surgical Treatment in Patients With Acute Adhesive Intestinal Obstruction

BACKGROUND The question of the duration and volume of conservative measures in patients with acute adhesive intestinal obstruction (AAIO) remains the subject of numerous discussions. Aim of study To evaluate the efficacy and safety of various periods of conservative therapy in patients with AAIO using a systematic review. MATERIAL AND METHODS Criteria for inclusion in the systematic review were cohort studies investigating various regimens and duration of conservative therapy in adult patients with AAIO. The search for primary sources was carried out in the CENTRAL, PubMed and eLibrary databases. The assessment of the safety of various terms of AAIO was carried out by comparing the immediate results of treatment. RESULTS The review included 19 papers with a total of 2,570 observations. At the first stage, the effectiveness of various conservative therapy regimens was evaluated by calculating the risk ratio for the success of non-surgical treatment. Taking into account the significant statistical heterogeneity of the participants, the calculation of the final risk ratio was carried out using a random effects model. The hazard ratio for nonoperative success was 1.91 (95% CI 1.2–3.1) in favor of gastrografin and 3.71 (95% CI 1.3–10.6) in favor of preoperative intestinal intubation. Taking into account the multidirectional pathogenetic action of the studied methods of conservative therapy, the obtained results suggested that the probability of success of non-surgical treatment correlates to a greater extent with the total duration of the AAIO episode than with the duration of conservative therapy, which was indirectly confirmed by constructing scattering graphs with approximation lines and calculating the coefficients determination, which amounted to 0.69 and 0.77 for the subgroups of standard therapy and undiluted gastrografin, respectively. Subsequently, the impact of different duration of an episode of AAIO on the immediate outcomes was assessed: mortality, frequency of resection interventions, complications, and total bed-day. There were no statistically significant differences in favor of early interventions (up to 48 hours) for all compared parameters; an increase in the total duration of AAIO up to 89 hours was not associated with worse results. CONCLUSION The total duration of the episode of acute adhesive intestinal obstruction, including both the pre-hospital duration and the duration of non-surgical treatment is prognostically significant. In other words, when calculating the allowable duration of conservative measures, one should proceed from the total duration of intestinal passage disturbance, which should not exceed 89 hours.

MANAGEMENT OF TUMOUR OBSTRUCTIONS OF DISTAL PART OF COMMON BILE DUCT USING RETROGRADE BILIARY STENTING

The aim of this study is to improve endobiliary stenting in patients with tumour obstruction of the distal part of common bile duct, as well as to promote the prevention of complications, and improve immediate results of treatment and quality of life of patients.&#x0D; The study included 68 patients who took the course of treatment at surgical hospitals from 2018 to 2022 and underwent endoscopic transpapillary stenting of the common bile duct for mechanical jaundice. In 37 patients, stenting was performed using a plastic stent, in 31 patients stenting was performed using a nitinol stent. Results of endobiliary stenting, complications, effectiveness and safety of stenting were evaluated.&#x0D; All patients underwent stening of the common bile duct. During endoscopic retrograde biliary stenting, only 5 patients had complications in the form of bleeding from the area of large duodenal papilla that was stopped endoscopically. In early postoperative period, 12 patients had following complications: migration of plastic stent into duodenum (3 cases), obturation of plastic stent (1 case), acute secondary pancreatitis (6 cases), and cholangitis (2 cases). In 64 out of 68 patients, endobiliary stenting provided satisfactory outcomes resulting in the decompression of external bile ducts.&#x0D; Endoscopic transpapillary stenting of common bile duct is a low-traumatic, safe and effective method of the decompression of biliary tract when it is obstructed by a tumour. Depending on the expected life expectancy we should use nitinol stents (≥ 6 months) or plastic one (of ≤ 6 months).

Short- and long-term outcomes of laparoscopic resections for intrahepatic cholangiocellular carcinoma

Aim. To evaluate short- and long-term results of laparoscopic and open surgeries for intrahepatic cholangiocellular carcinoma.Materials and Methods. The paper presents the retrospectively studied results of laparoscopic and open liver resections in 53 patients (2015–2020). The selection of patients for laparoscopic surgery consisted in maintaining the possibility of performing an R0 resection. A comparison was made before and after the alignment of the groups in relation to the complexity of resection due to the exclusion of resections and the reconstructions of vessels and bile ducts.Results. 53 patients were operated on; 19 patients underwent laparoscopic resection. In the open group, resection and reconstruction of vessels and bile ducts were performed significantly more often. A significantly lower incidence of severe complications and bile leakage was noted in the laparoscopic group, which did not affect the duration of hospital stay. After eliminating the differences in resection complexity, the comparison showed lower blood loss and biliary complications as well as a higher R0 resection rate in the laparoscopic group. The overall and recurrence-free four-year survival did not differ in the groups before and after aligning in terms of resection complexity.Conclusion. The first experience of using laparoscopic access for intrahepatic cholangiocellular carcinoma indicates that it is possible to improve the immediate results of treatment without worsening short- and long-term oncological outcomes.

ОСТРЫЙ ГНОЙНЫЙ ПИЕЛОНЕФРИТ ЕДИНСТВЕННОЙ ПОЧКИ

Background. One of the life-threatening diseases among patients with a single kidney is acute purulent pyelonephritis (APP). The disease is accompanied by oliguria or anuria and in many cases comes with the development of multiple organ dysfunction. Objectives. To present the features of the clinical manifestations of APP of a solitary kidney, the results of clinical and laboratory examination, the role of kidney imaging methods (USG, MRI and contrast-enhanced CT) in identifying foci of purulent destruction in the parenchyma, and the immediate results of treatment of patients with APP of a solitary kidney. Material and methods. 10 patients with APP of a solitary kidney were observed. The role of imaging methods (USG, CT and MRI) of the kidney in the detection of purulent destruction in parenchyma is shown. Methods of treating patients are considered: open organ-preserving surgery, nephrectomy; installation of an internal ureteral stent followed by antibiotic therapy and puncture nephrostomy followed by antibiotic therapy. Results. The best immediate results were noted in the group of patients who underwent open organ-preserving surgery in the volume of decapsulation of the kidney, excision of carbuncles, opening of abscesses and drainage of the calices-pelvis system of the kidney with nephrostomy. 3 out of 10 patients needed hemodialysis. Conclusion. Open organ-preserving surgery remains a reliable adequate method of surgical treatment of APP of a solitary kidney. In case of a single focus of destruction in the kidney parenchyma up to 3 cm in diameter or with signs of apostematous pyelonephritis, an effective method of treatment is the installation of an internal ureteral stent followed by antibiotic therapy. 30% of patients with APP need hemodialysis treatment.

Experience in the treatment of spinal tumors complicated by compression of the spinal cord and its roots

Objective: Improvement of the results of treatment of vertebral tumors with neural compression by means of analyzing the authors’ experience.Material and methods: The study included 151 patients with primary and metastatic vertebral tumors, operated in the neurosurgical departments of three large medical institutions from 01.01.2014 to 31.12.2020.Results: Most of the patients underwent palliative interventions. Radical surgery (marginal or wide resection of the tumor) was performed in 8 (5%) patients. Surgical treatment as the only method of treatment was used in 75 (50%) cases, combined treatment was used in 42 (28%) people, complex treatment – in 34 (22%). The immediate results of treatment of 91% of patients were characterized by the absence of negative dynamics in the neurological status and in 50% of cases by positive dynamics in the functional state. Among patients with malignant tumors and a traced catamnesis, the one-year survival rate was 66%, three-year – 52%, five-year – 47%. The median overall survival rate was 12.8 months, the median event-free survival rate was 12.55 months.Conclusion: The use of non-radical interventions in the surgery of vertebral tumors with neural compression expands the possibilities of minimizing surgical trauma, while maintaining the neurological and improving the functional status of the patient.

Minimally Invasive Osteosynthesis in Patients with Severe Combined Trauma and Polytrauma

Introduction. Treatment of patients with combined trauma and polytrauma is one of the most difficult issues in traumatology characterized by high mortality, long-term disability and high level of disability. In recent decades, there has been an increase in combined injuries in Russia, primarily associated with an increased number of road accidents (crashes) - up to 53.19 %, - and industrial injuries - about 23.4% of cases. Apparently, this trend will only increase in the coming decades. Such injuries are accompanied by formation of traumatic foci, which are the trigger mechanism of pathologies such as traumatic diseases, multiple organ dysfunction and multiple organ failure. Even when it is possible to bring the patient out of shock and avoid multiple organ failure a multi-month period of delayed convalescence or a period of trophic disorders of traumatic disease often results in the disability of the rescued patient. These circumstances, on the one hand, force surgeons to choose an active, more aggressive" tactic for osteosynthesis to early activate a patient; on the other hand, - to search for less "aggressive" methods of osteosynthesis. In recent years, new, specially designed minimally invasive systems for surgical treatment of fractures have been developed in Russia; this being the reason for the revision of traditional osteosynthesis expanding the possibility of active surgical tactics in patients with severe combined trauma and polytrauma. The aim of the study was to improve clinical outcomes of patients with severe combined trauma and polytrauma, to develop a model of early trauma care.Materials and methods. The study included clinical findings of 636 patients with severe combined trauma and polytrauma, 223 patients in the control group, and 413 patients in the main group. Long-term anatomical and functional and labor outcomes, the quality of life from 3 to 5 years after injury were studied. Immediate results of treatment were studied in all 497 patients, long-term results in 414. The effectiveness of fracture treatment was evaluated according to the Neer-Grantham-Shelton scale, which is based on a score of 5 clinical and 1 X-ray signs. During the study, the developed intraosseous, bone fixators and methods of osteosynthesis were applied. Results. The study demonstrated that the proposed tactics for treating patients with severe combined trauma and polytrauma, which included the application of new methods and devices developed for minimally invasive osteosynthesis, resulted in the improved clinical outcomes: an increased number of positive outcomes by 14.2%, a decreased number of satisfactory outcomes by 10.24%, and unsatisfactory outcomes by 4.02 %. Conclusions. Thus, high operational activity in the acute period of traumatic disease based on the objective criteria for the severity of the patient's condition and prognosis of shock is a must in the treatment of patients with severe combined trauma and polytrauma. The time, volume and method of operational assistance depend on the patients condition, which prognostic group the patient is included, the result of dynamic prognosis. Early fixation of injuries performed by minimally-traumatic methods (with external fixators), closed intramedullary osteosynthesis with locking screws contributes to the prevention of complications of early and subsequent periods of traumatic illness.

Negative dynamics of the hepatic artery resistive index as a predictor of early arterial thrombosis after deceased donor liver transplantation

Aim. The study aim was to assess the negative dynamics of the hepatic artery resistive index as a reliable predictor of early thrombosis in liver transplant recipients from a postmortem donor, to determine risk factors and to identify a group of patients with an increased risk of this complication.Material and methods. From July 2018 to August 2021, 92 orthotopic liver transplants from a deceased donor were performed at the Surgical Clinic of the City Clinical Hospital n.a. S.P. Botkin. All liver grafts were taken from donors with brain death. Control Doppler ultrasound examination of hepatic blood flow in all patients was performed on days 1, 3, 5, 7, if necessary, daily. The hepatic arteries resistive index was considered normal at values from 0.55-0.79, high at 0.8-0.89, extremely high above 0.9. Depending on the resistive index value on the 1st postoperative day and its further dynamics, we divided the patients into 3 groups. In each group, we analyzed the incidence of hepatic artery thrombosis and assessed the impact of various risk factors on the resistive index elevation on the 1st day after surgery and on its growth during dynamic observation in the early postoperative period.Results. Of 92 liver transplants, in three cases, we recorded hepatic artery thrombosis (3.2%), which was not associated with technical difficulties of arterial reconstruction. No mortality was recorded in all three cases. In patients with a normal or high resistive index on the 1st day, without its increase during dynamic observation, the incidence of arterial thrombosis was 0%. In patients with a normal or high resistive index on the 1st day, and its increase during dynamic observation, as well as in patients with an extremely high resistive index on the 1st day, the incidence of arterial thrombosis was 18.1% and 11.1%, respectively. The risk factors of thrombosis were the age of the recipient over 50 years old in an extremely high resistive index on the 1st postoperative day (p=0.024), and the age of the donor over 50 years old in the growth of the resistive index during follow-up (p=0.04).Conclusion. The lack of positive dynamics in the hepatic artery resistive index reduction may be an additional predictor of arterial thrombosis after liver transplantation. This fact makes it possible to identify a high-risk group of arterial thrombosis, to take additional preventive measures in these patients and to improve the immediate results of treatment in this group of patients.

Results of endovascular treatment of patients with acute myocardial infarction complicated by cardiogenic shock

The article presents the immediate results of treatment of patients with acute myocardial infarction complicated by cardiogenic shock. Outcomes were analyzed, predictors of unfavorable outcomes in the early hospital period were assessed. The discussion presents the modern criteria of cardiogenic shock in patients with myocardial infarction, prognostic scales, emphasis is placed on the controversial and poorly studied provisions of the recommendations and issues requiring further study.

Immediate results of treatment of patients with metastatic uveal melanoma using isolated liver chemoperfusion. The first domestic experience

Introduction. Uveal melanoma is the most common primary intraocular tumor in adults. Despite some achievements in primary tumor treatment, 50% of patients develop distant metastases in various times (3 years to decades). Hematogenous spread is typical for uveal melanoma, and in 90% of the cases liver is the target. Median survival of patients with liver metastases is 4 to 9 months according to various researchers. And the result of treatment is extremely poor, unlike the results of skin melanoma treatment.The aim is to evaluate the immediate results of treatment of patients with uveal melanoma metastatic to the liver using isolated hepatic perfusion technique.Materials and methods. Considering a high risk of developing a metastatic liver disease in patients with uveal melanoma, local therapy is particularly interesting. This article describes the results of 10 metastatic uveal melanoma patients’ Isolated Hepatic Perfusion (IHP) Treatment. IHP was conducted using the standard methods with 100 mg of Melphalan for 60 min.Results and discussion. IHP treatment shows low complication rate. The data for response assessment is available on 9 out of 10 patients, because 10th patient received this treatment less than a month ago. Follow-ups a month after 9 patients underwent IHP showed an objective response to treatment in 6 patients (complete response in 1, partial response in 5 patients).Conclusion. The use of isolated liver chemoperfusion in a small group of patients according to the standard procedure allowed achieving an immediate response in 67% of cases.

Comprehensive assessment of hemorrhoidectomy with lateral ultrasonic dissection in the “cut” mode

The effectiveness of the original technique of hemorrhoidectomy with lateral ultrasonic dissection in the cutting mode was analyzed from a clinical standpoint and studied according to pathomorphological changes in tissues during its use. A comparative assessment of the immediate results of treatment as well as pathomorphological changes in the tissue of removed hemorrhoids in two groups of patients was performed. The main group included 30 patients in whom the original hemorrhoidectomy technique with lateral ultrasound dissection in the cutting mode was used. The control group consisted of 30 patients who underwent Milligan Morgan hemorrhoidectomy using electrocoagulation. No significant difference was found between these groups in terms of the age and sex structure of patients, as well as the main clinical characteristics of the disease. In a comparative analysis of the immediate treatment results, the intensity of the pain syndrome and the incidence of postoperative complications were lower in the main group than in the control group. In the assessment of pathomorphological changes, the depth of coagulation necrosis and the severity of necrobiotic changes in the underlying layer after hemorrhoidectomy with lateral ultrasonic dissection in the cutting mode were significantly less than those after Milligan Morgan surgery using electrocoagulation. A significant difference was also revealed in the timing of tissue regeneration. The formation of active granulations in the postoperative wound area in the main group was noted on postoperative days 1416, while this process developed no earlier than on postoperative day 20 in the control group. As a result, complete epithelialization of wounds after hemorrhoidectomy with lateral ultrasound dissection in the cutting mode occurred much earlier, i.e., postoperative days 2630. A similar process after the Milligan Morgan hemorrhoidectomy using monopolar coagulation was completed only on postoperative days 3638. Thus, the use of the original technique of lateral ultrasound dissection provides a more sparing effect on tissues, which is the key to a favorable course of the postoperative period and rapid rehabilitation of patients.

Efficacy Evaluation of Comprehensive Preformed Physical Factors Application against Retinal Complications in the Early Postoperative Period after Cataract Surgery on Eyes with High Myopia

Currently, modern high-tech methods of cataract surgery do not always guarantee high visual acuity after surgery, and are not always insured against the development of early postoperative complications in the eyes with concomitant ocular pathology. Aim. Development and analysis of the preformed physical factors comprehensive application efficacy against retinal complications in the early postoperative period after cataract surgery in patients with high myopia. Material and methods. The study involved 75 patients (75 eyes) with high myopia, aged 58 to 79 years with developing macular edema on the second day after cataract surgery. Patients from the first group (25 people) received standard medical treatment, the second group (25 people) additionally received low-frequency magnetotherapy course, and the third group received extended standard treatment with combined application of low-frequency magnetotherapy and endonasal electrophoresis with pentoxifylline. Assessment of treatment efficacy was performed according to visual acuity data and morphometric parameters of the central retinal zone using optical coherence tomography. The results of Statistica 12.0 (StatSoft, USA) program was used for statistical analysis. Results and discussion. Immediate results of treatment and long-term results up to one month in all groups were objectively confirmed by the morphometric parameters of the central retinal zone. Macular edema reduction in height and area of distribution was significantly different in the third group compared with the first and second groups immediately after treatment and with the continuation of positive dynamics after a month. In the third group, high clinical results were objectively confirmed by the restoration of normal parameters of the central retinal zone after one month of observation. In the first and second groups, lower treatment results were confirmed by the preservation of morphometric signs of edema in the macular region, that required the continuation in the patients’ rehabilitation. Conclusion. Combination of complex application of preformed physical factors with standard medical therapy of exudative processes in the macula after cataract surgery reliably increases functional (visual) result of treatment and reduces rehabilitation period in the majority of patients with high-grade myopia. Thus, the expediency of physiotherapeutic support in relief of retinal edema in the early postoperative period of cataract surgery on eyes with high degree myopia has been substantiated.