Long-term Postoperative Period Research Articles

ENDOVASCULAR ANGIOPLASTY FOR REPEATED REVASCULARIZATION OF THE ARTERIAL BED IN PATIENTS WITH RECURRENT CHRONIC ARTERIAL INSUFFICIENCY

Aim. To improve the results of repeated reconstruction of the great vessels in case of relapse of chronic arterial insufficiency by differentiated use of popliteal tibial autovenous bypass grafting and endovascular angioplasty for revascularization of the arteries of the leg. Materials and methods. The long-term results of surgical treatment of 522 patients were examined, including 353 patients with bilateral atherosclerotic occlusion of the aortic-femoral zone and 159 patients with unilateral occlusion of the ileo-femoral segment. At the primary surgical intervention, 98 patients were diagnosed with chronic arterial insufficiency (CAI) of stage II B, in 228 – CAI of stage III, in 196 – chronic critical ischemia of the lower extremities, stage III – IV. In the long-term postoperative period, 146 (27.97 %) late complications were diagnosed, of which 78 (56.1 %) had a relapse of chronic arterial insufficiency. In 36 patients, CAI stage II B was established, and in 42 – CAI stage III. Patients were re-operated in the period of 5.4 ± 1.9 years after primary revascularization. All men were 64.4 ± 3.1 years old. Results. The multilevel atherosclerotic lesions of the reconstructed arterial bed, cicatricial changes after the initial surgical intervention, progressive atherosclerotic lesions of the outflow tract required multi-story shunting operations. The success of shunting surgery depends on sufficient revascularization of the outflow paths – the arterial bed of the ankle segment. Revascularization of the distal arterial bed was achieved using popliteal-tibial autovenous bypass grafting (19 cases) and endovascular angioplasty (30 observations). To reduce peripheral vascular resistance and increase the volume of the peripheral vascular bed in 19 (63.3%) cases, endovascular balloon angioplasty of two tibial arteries was performed simultaneously. The postoperative period in 10 (12.8%) patients was complicated by the development of thrombosis of the reconstruction segment. In 7 cases, thrombosis of the reconstruction segment was eliminated. The using of popliteal-tibial autogenous bypass grafting and endovascular angioplasty during revascularization of the ankle segment provided satisfactory results in repeated reconstructive operations in 87.2 % of cases. Conclusions. For the revascularization of the lower leg arteries, the use of popliteal autovenous shunting and endovascular angioplasty provides 87.2% satisfactory results in repeated reconstructive operations for chronic arterial insufficiency relapse.

Giant cell arteritis as a cause of extracranial internal carotid artery aneurysm: a case report

BackgroundThis report presents the management of patient with extracranial internal carotid artery pseudoaneurysm due to giant cell arteritis.Case presentationLeft internal carotid artery pseudoaneurysm was diagnosed in a 57-year-old Ukrainian woman, which became a direct indication for surgical treatment involving aneurysm resection and internal carotid artery reimplantation. The used reconstruction technique with oblique cutting of internal carotid artery, aneurysm resection, ellipse-form anastomosis formation, and distal intima fixation prevents the dissection, restenosis, and aneurysm of anastomosis in the long-term postoperative period. Histopathological examination revealed the giant cell arteritis of the internal carotid artery.ConclusionThis case emphasizes the importance of open surgical treatment of extracranial carotid artery aneurysms, which allows to perform optimal carotid artery reconstruction and also define the rare etiology of disease.

Comparative analysis of surgical treatment results for osteoporotic burst fractures of thoracolumbar vertebral bodies

Introduction Surgical methods for osteoporotic burst vertebral body fracture repair have their advantages and shortcomings. The use of circumferential stabilization and corrective vertebrotomies in elderly patients is highly invasive and carries great surgical risk. On the other hand, minimally invasive methods lead to recurrence of the deformity. Thus, in the treatment of patients with such pathology, it is necessary to choose a surgical method that allows achieving optimal results.Purpose of the work was to compare the results of surgical treatment for osteoporotic burst fractures in thoracolumbar vertebral bodies using the developed method and methods of circular and hybrid stabilization based on clinical and radiological criteria.Materials and methods The study was retrospective. Three groups of patients were formed according to the type of surgical intervention. Inclusion criteria were patients with primary osteoporosis who did not receive osteotropic therapy before surgery, with osteoporotic fractures (type OF3 and OF4) of the vertebral bodies of the thoracolumbar location (Th10–L2). The follow-up period was 12 months. The following criteria were assessed: the amount of kyphosis correction (according to the Cobb method), the amount of residual postoperative kyphotic deformity, as well as its recurrence in the long-term postoperative period; sagittal balance of the torso (Barrey index), subjective evaluation of the patient’s condition (VAS). Quality of life assessment was not performed.Results There were no statistically significant differences in the dynamics of sagittal balance during the follow-up period between the groups (p > 0.99). There was no difference between groups in clinical outcomes (VAS) at follow-up (p > 0.05). A statistically significant difference in the magnitude of kyphotic deformity and its correction in the specified postoperative periods was revealed between the hybrid fixation groups and the corrective vertebrotomy group. No difference was found with the circular stabilization group.Discussion Due to the high risks of poor outcomes of anterior spinal fusion, in particular, implant subsidence, to avoid anterior spinal fusion, we used a method of focal kyphosis correction and posterior spinal fusion with autologous bone. The method proposed by the authors for the correction of focal kyphotic deformity in the treatment of patients with osteoporotic burst fractures of the vertebral bodies combines satisfactory correction of focal kyphosis with minimal surgical invasiveness, which reduces the risks of complications and poor outcomes. The proposed method may also be combined with hybrid fixation.Conclusion The developed method for focal kyphotic deformity correction in the treatment of osteoporotic burst fractures of vertebral bodies provides satisfactory correction of focal kyphosis, reduces the risks of complications and poor outcomes in comparison with circular and hybrid stabilization.

Immediate and long-term results of closure of a functioning single-stem ileostomy

The aim of the work was to study and evaluate the immediate and long-term results after performing reconstructive and reconstructive operations to eliminate functioning ileostomes. Materials and methods: We operated on 30 patients with functioning single-stem ileostomes in 2019–2022. All interventions were performed as planned. The average age of patients at the time of reconstructive and reconstructive operations was in the range from 35 to 72 years. There were 18 men and 12 women. Results: When using in clinical practice the method of areflux small-colonic anastomosis developed by us in the early postoperative period, intestinal paresis and seromas of the postoperative wound were observed, which were resolved by conservative measures. No complications were observed in the long-term postoperative period. Conclusions: The developed valvular, areflux small-colonic anastomosis prevents reflux of the contents of the colon into the small intestine, thereby preventing the development of SIBR and the number of postoperative complications.

Особенности отдаленного наблюдения пациентов после оперативного лечения ретинопатии недоношенных

Case study Special features of long-term follow-up in patients after surgical treatment of retinopathy of prematurity E.E. Sidorenko, E.I. SidorenkoI, A.I. Krapivkin, O.A. Kushchuk, D.V. Miguel, E.V. Ermolaeva, V.E. Loskutova, H.T. Le Voino-Yasenetsky Scientific and Practical Center for Specialized Medical Care, Moscow, Russian Federation Pirogov Russian National Research Medical University, Moscow, Russian Federation This article describes a long-term clinical outcomes and functional outcomes of a patient with retinopathy of prematurity stage 4, plus disease, aggressive posterior, who has a history of 2 times treatment with laser retinal coagulation in both eyes, single injection of a vascular endothelial growth factor inhibitor in both eyes and vitrectomy in left eye. As a result of regular dynamic monitoring of the patient in the long-term postoperative period, application of modern and highly informative research methods, exudative macular degeneration was detecet – retinal detachment and vision loss was prevented timely. Key words: retinopathy of prematurity, laser coagulation of the retina, intravitreal injection of vascular endothelial growth factor inhibitor, vitreoretinal surgery, optical coherent tomography, assessment of cognitive functions using the WPPSI-IV method

Special features of postoperative long-term follow-up patients with retinopathy of prematurity

Background: Retinopathy of prematurity (ROP), leading to a high percentage of visual disability, continues to be one of the most complex and unresolved problems of pediatric ophthalmology. Some patients, despite successful surgical treatment and regression of ROP, lose their vision by the age of 25–35 years from the long-term consequences of ROP. That is why patients after surgical treatment of ROP, including those with peripheral chorioretinal dystrophy, need lifelong clinical follow-up in order to on time diagnose reactive conditions in the long-term postoperative period, leading to a significant loss of visual function. Methods: This paper presents a special case of a patient with stage 4 ROP and her long-term clinical and functional outcome. Conclusions: As a result of regular dynamic monitoring of the patient, using modern highly informative research methods, we promptly detected the formation of an exudative component of the macular area, which made it possible to prevent retinal detachment and loss of vision. Strengths of this study: This study presented a clinical case of a patient with ROP and long-term patient follow-up. This shows the importance of long-term monitoring of patients after treatment and the importance of combining treatment methods.

Assessment of structural and functional changes in recipient's transplanted heart in the long-term postoperative period

Introduction. Heart transplantation is an effective way of treating patients with end-stage heart failure. Echocardiography allows for the assessment of the transplanted heart functions at all stages of follow-up. The clinical implementation of myocardial deformation imaging by the speckle tracking echocardiography has made it possible to detect subtle changes in myocardial contractility.Objective. To study the structural and functional state of myocardium in recipients in the long term after orthotopic heart transplantation.Material and methods. The study included 13 orthotopic heart transplant recipients (11 men and 2 women) at a mean age of 54.1±9.1 years who underwent orthotopic heart transplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine. The mean follow-up period after orthotopic heart transplantation was 6±0.7 years. All patients underwent transthoracic echocardiography according to the standard protocol, including determination of left ventricular myocardial deformation.Results. The median volume of the left atrium was 60 (53;76) ml, the left ventricular end-diastolic volume was 76 (70;90) ml, and the end-systolic volume was 30 (24;36) ml. The median ejection fraction of the left ventricle in the studied sample was 64 (57;66)%. The median interventricular septum thickness was 12 (11;13) mm, the left ventricular posterior wall thickness was 9 (8;10) mm. At the same time, the left ventricular myocardial mass and the left ventricular myocardial mass index were within the normal range and amounted to 140 (121;155) g and 65 (58;76) g/m2, respectively. The right heart chambers were not dilated, as the volume of the right atrium was 41 (40;56) ml, and the right ventricular enddiastolic dimension was 32 (30;33) mm. The right ventricular systolic function was unimpaired: the tricuspid annular plane systolic excursion was 18 (17;19) mm, and the right ventricular fractional area change was 46 (37.5;47.0)%. The calculated systolic pulmonary artery pressure was within the normal range 24 (21;28) mm Hg. The measurements of left ventricle global longitudinal and circumferential strains were -19.6 (-18.6;-21.2)% and -30.9 (-28.8;-32.0) %, respectively. Patients in the study sample showed a decrease in the left ventricular global function index to 25 (24.2;29.6)%. The diastolic dysfunction of a restrictive type was present in 10 patients (76.9%).Conclusions. In the long-term period after heart transplantation, the recipients were found to have a low left ventricular ejection fraction and a diastolic dysfunction of the restrictive type. Considering the normal values of left ventricular myocardial strains, we can assume that after 6 years post-orthotopic heart transplantation, the recipients have restored the heart adaptive functions, and a favorable outcome has been achieved. However, long-term monitoring is required.

Quantitative Assessment of Condylar Remodeling After Open Reduction and Internal Fixation in Mandibular Condylar Head Fractures.

Open reduction and internal fixation (OR/IF) and closed treatments are viable options, with OR/IF gaining popularity in mandibular condylar head fracture (CHF). Sufficient research is lacking on long-term condylar morphologic changes. This study quantitatively evaluated the morphologic changes in the condylar head in patients who underwent OR/IF for CHF without the removal of osteosynthesis material. A retrospective study analyzed patients who underwent OR/IF for CHF between November 2010 and August 2022. The transverse/lateral condyle width and condyle height were radiologically analyzed using panoramic and reverse Towne view x-ray images at immediate (T0), short-term (T1), and long-term (T2) postoperative periods. The study involved 29 patients with 32 surgically treated CHF. Long-term condyle height decreased significantly from 18.9±0.8mm at T0 to 18.1±0.8mm at T1 (P=0.042), and further to 17.3±0.7mm at T2 (P=0.034). Transverse width slightly reduced from 18.7±0.7mm at T0 to 17.9±0.8mm at T1 (P=0.001) but remained stable from T1 to T2 (17.6±1.0mm, P=0.756). Following surgery, maximal mouth opening averaged 39.5±6.1mm, with one case of chin deviation and three cases of joint pain. The condyle undergoes long-term shortening without altering its width. Nevertheless, patients experience favorable functional outcomes, including satisfactory mouth opening and occlusion. In addition, it is advisable not to remove the osteosynthesis material, as the remaining material causes minimal functional impairment and bone resorption.

Quality of life of patients and distinctive properties of the postoperative period after minimally invasive video-assisted hemithyroidectomy

Objective: to study indicators of the quality of life of patients and features of the course of the postoperative period after minimally invasive video-assisted hemithyroidectomy (MIVAH) in comparison with traditional open hemithyroidectomy (OH).Materials and methods: an analysis of the quality of life and postoperative results was carried out in 92 patients with benign nodular neoplasms of the thyroid gland. The study group included 45 patients who underwent MIVAH. The control group included 47 patients who underwent OH.Results: pain levels were lower in the MIVAH group throughout the evaluation period. At the same time, the statistical significance of the differences (p<0.05) in the level of pain was noted at 24–-48 hours after the operation. Swallowing disorders were noted by patients less frequently in the MIVAH group (by 14.0% 1 month after surgery and by 8.0% after 6 months). Analysis of quality of life indicators on the SF-36 scale demonstrated that at 1 month after surgery, patients in the MIVAH group had higher values of the Physical Functioning (92.7±10.2 versus 83.1±15.3 points; p<0.05), Role-Physical Functioning (86.1±11.7 versus 63.0±14.8 points; p<0.01) and Social Functioning (82.4±13.9 versus 72.6±14.8 points; p<0.05). 6 months after surgery, all SF-36 scale indicators showed leveling off between the comparison groups.Conclusions: the MIVAH technique, compared with traditional open surgery, is characterized by an improvement in a number of indicators of the postoperative period. After MIVAH, the quality of life of patients is significantly higher in the early postoperative period, but in the long-term postoperative period, the quality of life shows comparable indicators both after MIVAH and after OH.

Зависимость частоты спонтанной люксации комплекса капсульный мешок-ИОЛ от материала и массы линзы

Abstract Spontaneous luxation frequency dependence of the «capsule bag-IOL» complex on the material and weight of the lens A.A. Ivanov , O.P. Mishchenko , T.N. Iureva S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk Branch, Irkutsk, Russian Federation Irkutsk State Medical Academy of Postgraduate Education – branch of the FSBEI APE RMACPE, Irkutsk, Russian Federation Irkutsk State Medical University, Irkutsk, Russian Federation Relevance.Spontaneous luxation of the «capsule bag – IOL» complex in the long-term postoperative period is a serious complication. The search for regulated risk factors, the limitation of which will reduce the frequency of this complication, is relevant. Purpose. To evaluate association between frequency of spontaneous luxation of the «capsule bag – IOL» complex and the number of surgeries, taking into account the characteristics of the lens. Material and methods. 69 IOLs from 14 medical companies and 2 capsule rings were examined. The weight was determined using trusted torsion scales (accuracy ± 1 mg) under hydration conditions. IOLs were divided into 3 groups: ≤18 D; 18.5–24.0 D; ≥24.5 D. A retrospective analysis of 159 cases of spontaneous IOL luxation into the vitreous body over 13 years (2007–2020) was carried out. Comparison of IOL implantation results/luxation was carried out from 2006 to 2010, taking into account luxations from 2007 to 2020. Additionally, the number of years from IOL implantation to spontaneous luxation, the axial length of the eye, and the presence of pseudoexfoliation syndrome were evaluated. Results. A multiple excess of the weight of hydrophilic compared with hydrophobic IOLs was found in three comparison groups with a comparable refractive power (p=0.0001). Hydrophilic lenses in various groups were 1.5–1.82 times heavier than hydrophobic lenses. Spontaneous luxation of hydrophobic IOLs occurred less frequently by 11.86–49.22% compared to lenses made of hydrophilic materials. Conclusion.The weight of the IOL may play an important role in the pathogenesis of dislocation of the artificial lens. In the future, it is possible to develop recommendations to reduce the risk of luxation of the «capsule bag – IOL» complex in the long term for patients with an initial combination of non-correctable risk factors complicating the condition of the ligamentous apparatus of the lens. Key words: IOL luxation, IOL weight, lens material, hydrophilic or hydrophobic IOLs

Percutaneous thermal radiofrequency rhizotomy of L2-S1 spinal nerve roots in children with cerebral palsy.

This study presents the results of an evaluation of the effectiveness of percutaneous thermal radiofrequency (RF) ablation of spinal nerve roots to reduce spasticity and improve motor function in children with cerebral palsy (CP). A retrospective analysis was conducted on the surgical treatment outcomes of 26 pediatric patients with severe CP (Gross Motor Function Classification System levels IV-V). The assessment protocol included muscle tone assessment using the modified Ashworth scale (MAS), evaluation of passive and active range of motion, gait video recording, and locomotor status evaluation using the Gross Motor Function Measure (GMFM)-88 scale. Thermal RF rhizotomy (ablation of spinal nerve roots) was performed on all patients at the L2-S1 levels at 70°C for 90 seconds. The statistical data analysis was conducted using the t-test and Mann-Whitney U-test. A p value < 0.05 was considered statistically significant. Before the operation, the average level of spasticity in the lower-limb muscles of all patients was 3.0 ± 0.2 according to the MAS. In the early postoperative period, the spasticity level in all examined muscle groups significantly decreased to a mean of 1.14 ± 0.15 (p < 0.001). In the long-term postoperative period, the spasticity level in the examined muscle groups averaged 1.49 ± 0.17 points on the MAS (p < 0.001 compared to baseline, p = 0.0416 compared to the early postoperative period). Despite the marked reduction of spasticity in the lower limbs, no significant change in locomotor status according to the GMFM-88 scale was observed in the selected category of patients. In the long-term period, during the control examination of patients, the GMFM-88 level increased on average by 3.6% ± 1.4% (from 22.2% ± 3.1% to 25.8% ± 3.6%). The findings of this study offer preliminary yet compelling evidence that RF ablation of spinal nerve roots can lead to a significant and enduring decrease in muscle tone among children with severe spastic CP. Further studies and longer-term data of the impact on functionality and quality of life of patients with CP after spinal root RF ablation are needed.

Prevention of chronic postoperative pain syndrome after Lichtenstein hernioplasty

THE OBJECTIVE was to analyze the development of chronic pain syndrome after performing standardized Lichtenstein hernioplasty.METHODS AND MATERIALS. The prospective single-center study was conducted with 40 patients with inguinal hernias (20 patients in the study group and 20 patients in the control group) who underwent Lichtenstein hernioplasty with adherence to standardization criteria and without. The comparative analysis of the early and long-term postoperative periods was performed.RESULTS. When comparing the early and long-term postoperative periods in patients after standardized Lichtenstein hernioplasty, the following data were obtained: pain syndrome according to the Visual Analogue Scale (VAS) was less pronounced after applying standardization criteria (p &lt; 0.001), and statistically significantly lower number of complications (seroma, paresthesia) developed (p=0.045, p=0.019). In the group of patients who underwent standardized Lichtenstein hernioplasty, chronic pain syndrome was not observed in the long-term postoperative period (p &lt; 0.001).CONCLUSIONS. Prevention of chronic postoperative pain syndrome after hernioplasty using the Lichtenstein method is the significant issue. This article emphasizes the importance of considering various factors and implementing preventive strategies to minimize the risk of this complication and ensure optimal surgical outcomes.

Clinical Neurophysiological Methods Verify Improvement in the Motor Neural Transmission in Patients with Surgically Treated Idiopathic Scoliosis in Long-Term Follow-up

The evaluation of patients after the surgical correction of idiopathic scoliosis in a long-term follow-up with clinical neurophysiological methods has not been presented in detail. This study aimed to compare the results of neurophysiological studies in 45 girls with scoliosis of Lenke types 1–3 performed pre- (T0) and postoperatively, 1 week after surgery (T1) and 6 months after surgery (T2). The parameter values of the surface electromyography while attempting maximal contraction (mcsEMG) and the transcranial motor-evoked potentials (MEPs) recorded in the anterior tibial muscles, as well as the electroneurography (ENG) of the peripheral transmission in the peroneal nerve motor fibers, were compared. The results indicate that efferent neural conduction function both centrally and peripherally, and TA muscle function slightly improved immediately after the surgical correction of scoliosis, and further normalization appeared after six months in the long-term follow-up (at p = 0.03). The sEMG recordings indicate that half a year after surgical treatment in IS patients, the TA muscle motor unit recruitment function, as well as the muscle strength evaluated with Lovett’s scale, was comparable to the normal condition. The ENG recording results indicated a gradual reduction in the motor fiber injury symptoms, mainly of the axonal type, in the peroneal nerves. The surgeries also improved the lumbar ventral roots’ neural transmission to a normal functional status. The MEP amplitude parameter values recorded after the surgical scoliosis corrections in T1 indicated a slight improvement in the efferent transmission of neural impulses within the fibers of the spinal tracts; in the long-term T2 observation period, they reached values comparable to those recorded in healthy volunteers, bilaterally. Preoperatively (T0), the results of all the neurophysiological study parameters in the IS patients were asymmetrical at p = 0.036–0.05 and recorded as worse on the concave side, suggesting the lateralization of neurological motor deficits. One week postoperatively (T1), this asymmetry was recorded as gradually reduced, showing almost no difference between the right and left sides six months later (T2). The presented algorithm for the neurophysiological assessments performed in the pre-, intra-, and long-term postoperative periods using the mcsEMG, MEP, and ENG neurophysiological examinations, together with the clinical studies, may help in the comprehensive functional evaluation of the spinal cord tracts and ventral root neural conduction, which allows the detection of the subclinical neurological changes related to scoliosis itself and the consequences of the corrective surgery. Such an evaluation can also be significant in making final decisions regarding IS surgeries and their personalization after attempting conservative treatments with bracing and kinesiotherapy. Neurophysiological studies, as a sensitive biomarker, allowed us to predict and ascertain the final result of IS treatment in the long-term follow-up, which showed the health status of patients as being comparable to that of healthy volunteers.

ВЛИЯНИЕ ГИПОТЕНЗИВНЫХ ПРЕПАРАТОВ В ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ У ПАЦИЕНТОВ С ПСЕВДОЭКСФОЛИАТИВНЫМ СИНДРОМОМ НА ФОНЕ ОСЛОЖНЕННОЙ КАТАРАКТЫ

In modern surgery of complicated cataracts, an important factor is the preservation of visual functions with minimal costs. The surgeon’s experience and modern technology, which makes it possible to identify hidden symptoms of certain pathologies at the diagnostic stage, allows for a favorable completion of surgery with minimal intraoperative complications. This article shows the approach and observations of patients at risk of increasing eye pressure in the postoperative period due to the anatomical structures of the eye (in these cases, patients with open-angle glaucoma) to antihypertensive drugs. 131 patients (134 eyes) with various signs of pseudoexfoliation syndrome participated in the observation. Before planned surgery for complicated cataracts, all patients underwent ophthalmological diagnostics, medical history, and laboratory tests according to generally accepted methods. All operations were performed by the same surgeon. Cataract surgery was performed according to the standard technique (Phaco + intraocular lens) through a 2.2 mm incision, two 1.2 mm paracentesis, but for some patients other components of surgical interventions were added. In the observation groups, for better fixation and a lower percentage of complications in long-term follow-up periods, RPR, T-19, Myol were implanted in 27.7%. A large percentage of 34% were implanted with the HO Acrylic IOL model lens, which requires a 2.2 mm corneal incision. In observation groups 2 and 3, 32.5 and 31.8% preferred lenses to the Acrysoft IQ model. And in 32.5% and 13.6%, respectively, the AFY model. The choice of the method of surgical intervention, as well as the model of intraocular lenses, made it possible to predict the long-term postoperative period with less toxicity for the patient’s condition. No intraoperative complications were observed; the administration of antihypertensive drops, both in combination and in monotherapy in the early stages of the postoperative period, allowed maintaining eye pressure within normal limits in all observation groups.

Single-center experience of thoracoscopic sympathectomy for palmar hyperhidrosis with long-term postoperative questionnaire survey

ObjectivesThoracoscopic sympathectomy is an effective treatment for palmar hyperhidrosis. However, compensatory hyperhidrosis occurs frequently as a postoperative complication of the procedure. The goal of this study was to elucidate the clinical significance of thoracoscopic sympathectomy using our surgical procedure.MethodsConsecutive 151 patients who underwent thoracoscopic sympathectomy for palmar hyperhidrosis were studied. In addition, to investigate patients’ satisfaction and long-term quality of life, 111 patients were asked to complete a mailing questionnaire survey, and 84 responded (response rate of 75.7%).ResultsAll of the 151 patients reported a reduction in palmar sweating during the immediate postoperative period. None of the patients had pneumothorax, hemothorax, Horner’s syndrome, or worsening of bradycardia. Based on the questionnaire, the surgical success rate was 98.8%. None of the patients had a recurrence of palmar hyperhidrosis during the long-term postoperative period. However, compensatory hyperhidrosis was reported in 82 patients (97.6%). In total, 94.0% of patients had high levels of postoperative satisfaction.ConclusionsThoracoscopic sympathectomy is an effective surgical treatment for palmar hyperhidrosis. By contrast, the careful preoperative explanation of compensatory hyperhidrosis is considered to be very important.

Long-term outcomes after formation of a low-flow STA-MCA bypass for treatment of symptomatic occlusion of the internal carotid artery

Aim. To evaluate short‑ and long‑term effectiveness of low‑flow bypass between superficial temporal artery and M4 segment of middle cerebral artery (low‑flow STA‑MCA bypass) in patients with symptomatic occlusion of the internal carotid artery (ICA).Materials and methods. Between 2016 and 2019 at the Department of Neurosurgery of the N. V. Sklifosovsky Research Institute of Emergency Medicine, 54 patients who underwent low‑flow STA‑MCA bypass formation at the side of symptomatic ICA occlusion between 2013 and 2015 were examined. Symptomatic ICA occlusion was more common in men than in women (7:1 ratio). Patient age varied between 48 and 73 years (mean age was 62 years).During low‑flow STA‑MCA bypass formation surgery for symptomatic ICA occlusion, intraoperative flowmetry was used in 52 (96 %) patients, in 2 (4 %) patients this diagnostic method was impossible to perform due to technical difficulties. The main examination methods in the long term after cerebral revascularization were evaluation of neurological status dynamics per the National Institute of Health Stroke Scale (NIHSS); modified Rankin scale; Rivermead mobility index; computed tomography angiography of the extra‑intracranial arteries; ultrasound (US) examination of the STA‑MCA bypass for eval uation of linear and volumetric blood flow velocities; single‑photon emission computed tomography. The type and size of trephination were evaluated, and operative time was taken into account.The patients were divided into 3 groups: group 1 included patients with follow‑up period of 1–2 years after cerebral revascularization, group 2 – 3–4 years, group 3 – 5–6 years. All results were compared to preoperative, early, and longterm measurements.Results. In the long‑term postoperative period between 1 and 6 years after cerebral revascularization, 54 patients were examined. Computed tomography angiography and US showed functioning STA‑MCA bypass in 53 (98 %) patients. According to single‑photon emission computed tomography of the brain, regional cerebral blood flow in the longterm postoperative period varied between 28 and 40 mL / 100 g / min, median regional cerebral blood flow in the long‑term postoperative period was 38 mL / 100 g / min. Intraoperative flowmetry was performed in 52 (96 %) patients, median was 15.5 mL / min. US showed that linear blood flow velocity in the STA‑MCA bypass varied between 20 and 95 cm / s, median was 49 cm / s. Volumetric blood flow varied between 30 and 85 mL / min with median of 75 mL / min.Resection trephination was performed in 36 (67 %) patients, mean size of trephination hole was 3 cm3. In the study, operative time was measured: mean value was 212 min; no significant correlation between operative time and trephination size was observed.Improved neurological status was observed in all study groups. Per the NIHSS, in group 1 (1–2 years) improvement was observed in 59 % of patients, in group 2 (3–4 years) in 48 %, in group 3 (5–6 years) in 47 %. Per the modified Rankin scale, in group 1 improvement was observed in 36.4 % of patients, in group 2 – in 48 %, in group 3 – in 42.9 %. Per the Rivermead mobility index, in group 1 improvement was observed in 63.3 % patients, in group 2 – in 56 %; in group 3 – in 57.1 %. The best outcomes were observed in group 1 (63.3 %).Conclusion. Instrumental diagnostic methods and evaluation of neurological status showed positive dynamics both in the postoperative period and in long‑term period between 1 and 6 years after low‑flow STA‑MCA bypass formation. In the long term, repeat abnormalities of cerebral blood flow of ischemic type and repeat transient ischemic attacks were not observed. Correct selection of patients in the preoperative period and comprehensive treatment including drug therapy in the postoperative and long‑term periods allow to prevent repeat ischemic cerebrovascular disease and therefore improve patients’ quality of life.

Biomechanics of the Patient with Bisphonate Osteonecrosis According to the Diagnosis Neurophysiological Monitoring

Effective rehabilitation of patients with volumetric jaw defects at the present stage of development of science and technology is impossible without a comprehensive analysis of biomechanical disorders and improvement of technical aspects of operational ways to eliminate them. The aim of the study was to analyze the biomechanical activity of the chewing muscles in patients with bisphosphonate osteonecrosis based on the results of neurophysiological monitoring. 184 patients with bisphosphonate osteonecrosis of the mandibular bone were monitored, 112 of whom were men and 72 women, group 1 included 60 % of patients who had an apparatus for extracellular osteosynthesis of jaw bones fixed, and group 2 – 40 % of patients whose jaw fragments were fixed with bone mini-plates of various profiles and cross-sections. In the preoperative period, all patients underwent general clinical studies, multispiral computed tomography, and monitoring of quality of life criteria using a modified questionnaire "The MOS 36-item Short-From Hervey". Results and discussion. Indicators in the long-term postoperative period in patients of group 1 approached the physiological norm on the healthy side and significantly improved on the affected side, compared with patients from group 2 who did not receive devices for extracellular osteosynthesis in the postoperative period. Conclusions. Ensuring the positioning of jaw bone fragments in three mutually perpendicular planes restores biomechanical balance in the dental and maxillary apparatus, which accelerates the rehabilitation of patients and predicts a favorable outcome of surgery.

Features of detrusor function disorders in patients with dysuria in the long period after transurethral resection of the prostate

BACKGROUND: Transurethral resection of the prostate (TURP) remains the “gold standard” for surgical treatment of patients with benign prostatic hyperplasia. At the same time, a significant number of patients continue to have urinary disorders after surgery. Dysuric disorders may be caused by detrusor dysfunction. AIM: The aim of the study was to determine the frequency, nature and clinical manifestations of detrusor dysfunction in patients with benign prostatic hyperplasia after TURP in the long-term postoperative period. MATERIALS AND METHODS: We examined 128 patients with benign prostatic hyperplasia aged from 56 to 87 years (mean 68.5 ± 7.1 years), who underwent TURP 12–36 months before inclusion in the study. All patients had urinary problems at the time of examination. All patients underwent a urological examination, which included a complex urodynamic study. The control group consisted of 48 patients with benign prostatic hyperplasia of comparable age, who did not have urinary disorders after TURP. RESULTS: Urodynamic signs of detrusor dysfunction were identified in 97 (75.8%) of 128 patients examined. Most often, isolated detrusor overactivity was detected (52.6%), less often a combination of detrusor over- and hypoactivity (25.8%) and isolated detrusor hypoactivity (21.7%). In patients with identified detrusor dysfunction, even before TURP, more pronounced urinary disorders were noted, which were characteristic of a certain type of detrusor dysfunction and persisted after surgical treatment. In patients with detrusor dysfunction, compared with patients from the control group, at the preoperative stage, urgency urinary incontinence, frequent urgency to urinate, diabetes mellitus, and a small volume of the prostate gland with the absence of intravesical protrusion were significantly more often detected. CONCLUSIONS: Detrusor dysfunction is an important cause of dysuria in patients with benign prostatic hyperplasia in the long-term period after TURP. It seems appropriate to conduct further research to clarify the indications for performing preoperative complex urodynamic study in patients with benign prostatic hyperplasia and lower urinary tract symptoms.

Клинический случай факоэмульсификации катаракты после термокератопластики в анамнезе

Purpose. To present a clinical case of cataract phacoemulsification in a patient with a thermokeratoplasty in anamnesis. Material and methods. Patient M., went to the clinic with complaints of decreased vision, “fog” in front of both eyes, especially in front of the right one. In the anamnesis 30 years ago, she had thermokeratoplasty for high degree hypermetropia (+8.00D) in both eyes. Due to the existing complaints and the presence of cataracts in both eyes, cataract phacoemulsification was performed with the implantation of toric IOLs in both eyes. Results. When evaluating the results in the longterm postoperative period (1 year after surgery), it was revealed that despite the difficulties that the surgeon faces when calculating intraocular lenses in patients after keratorefractive operations, we managed to achieve high visual acuity. Conclusions. The presented clinical case indicates that the measurement of the refractive power of the cornea using a modern scanning keratotopograph, the axial length of the eye using a noncontact biometer, the use of modern formulas for calculating the IOL, as well as the experience of an ophthalmic surgeon, allow achieving high functional results in the rehabilitation of patients with this pathology. Keywords: thermokeratoplasty, phacoemulsification of cataract, toric intraocular lens

Роль пилинга внутренней пограничной мембраны в хирургическом лечении диабетического макулярного отека (клинические наблюдения)

Vitreoretinal surgery (VRS) is the treatment of choice when diabetic macular edema (DME) is combined with other vitreomacular interface (VMI) anomality. Many studies give contradictory results and the question of the need to perform peeling of the internal limiting membrain (ILM) remains open. Purpose. To demonstrate the results of surgical treatment with and without ILM peeling in patients with DME combined with epimacular fibrosis. Material and methods. The article presents a comparative analysis of three clinical cases. The patients had similar clinical and anamnestic characteristics. In three cases, patients underwent VRS for DME in combination with epimacular fibrosis (EMF). In two cases, the ILM peeling stage was performed, in the third case, the ILM remained intact. Results. According to the results of observation and assessment of anatomical and functional parameters, complications in the long-term postoperative period were revealed in the case of the 1st and 2nd patients, and in the case of the 3rd patient — stabilization of the process. Conclusion. The presented clinical cases demonstrate that anatomical and functional results do not always correlate with each other. The high risk of complications with a violation of the architectonics and functions of the retina during the ILM peeling raises the question of the expediency of its implementation. Keywords: diabetes mellitus, diabetic retinopathy, diabetic macular edema, vitrectomy, ILMpeeling, optical coherence tomography