Volume Of Blood Loss Research Articles

Clinical outcomes of nephroureterectomy with bladder cuff excision or radical cystectomy for distal ureteral carcinoma invaded muscle of the ureteral orifice

PurposeTo present the clinical outcomes of nephroureterectomy with bladder cuff excision (NU-BCE) or radical cystectomy (NU-RC) when distal ureteral carcinoma invaded muscle of the ureteral orifice using inverse probability of treatment weighting (IPTW).MethodsThis multicenter study retrospectively studied the demographics and perioperative outcomes of 59 patients who underwent NU-BCE or NU-RC between 2003 and 2024. Relapse-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were presented using Kaplan–Meier curves. Cox proportional hazard regression to find independent predictors.ResultsOf all patients, the median follow-up time for RFS was 8 months and 18 months for CSS and OS. After IPTW, the median RFS, CSS, and OS for patients who underwent NU-BCE and NU-RC was 9 vs. 27 months (p = 0.037), 18 vs. 40 months (p = 0.027), 18 vs. 30 months (p = 0.371), respectively. The mortality due to progression and complications in NU-BCE and NU-RC patients were 56.4% vs. 20.4% and 2.2% vs. 22.9% (p = 0.016). NU-BCE reduced the median operation time, blood loss, and drainage volume. Apart from NU-RC (HR, 0.18; 95%CI: 0.08–0.44; p < 0.001) (HR, 0.28; 95%CI: 0.1–0.79; p = 0.016) and tumor volume(HR, 1.17; 95%CI: 1.06–1.29; p = 0.002) (HR, 1.21; 95%CI: 1.11–1.31; p < 0.001), which are independent prognostic factors for RFS and CSS, another independent prognostic factor for CSS is the ureteral carcinoma with renal pelvic carcinoma (HR, 4.32; 95%CI: 1.28–14.511; p = 0.018).ConclusionsPatients who underwent NU-RC had better RFS and CSS than NU-BCE, but there was little difference in OS due to the higher mortality rate of postoperative complications in the NU-RC.

The results of the use of biological bone reconstruction in performing oncological revision knee replacement

Introduction. With an increase in revision surgeries for oncological knee prostheses replacement, one of the most significant challenges has been the need to address substantial intramedullary defects affecting the diaphysis and metaepiphyses in these patients. Our study is based on our experience with biological reconstruction methods used during such operations. We have developed both the methodology and necessary tools for its implementation, as well as conducted a comprehensive evaluation of its practical application results.Aim. To assess the effectiveness of using biological bone reconstruction techniques in oncologic revision knee arthroplasty.Materials and methods. A retrospective study included 57 patients who underwent revision total oncology knee arthroplasty with the use of biological reconstruction for intramedullary bone defects between 2017 and 2023, with a follow-up period of at least 12 months. Of these, 45 (78.9 %) were operated due to instability of the prosthetic components, while 12 (21.1 %) were treated in the second stage after spacer implantation due to infection.Distribution of patients by location of bone defect: 26 (45.5 %) had femoral bone defects, 4 (7 %) had tibial bone defects, and 27 (47.4 %) had combined lesions involving both bones. Among the participants, 59.6 % were female and 40.4 % were male. The median age was 48 years (Q1–Q3) 39.00–57.00; min 23 – max 72), and the median follow-up time was 48 months (Q1–Q3 28.00–60.00; min 12 – max 150). Median blood loss values were 900 ml (Q1–Q3 700.0–1100.0; min 400 – max 2200), operation duration was 220 minutes (Q1–Q3 190.0–240.0; min 140 – max 300), and patient weight was 85 kg (Q1–Q3 77.0–95.0; min 56 – max 180).We assessed complication risks, functional outcomes, and survival rates of the implants. All patients were divided into two groups: Group 1 (n = 37 or 64.9 %), operated before the introduction of new instruments, and Group 2 (n = 20 or 35.1%), operated after their introduction. Parameters such as operation duration and blood loss volume were compared between the groups.Results. Over the entire observation period from 2017 to 2024, three cases (5.3%) of complications were identified. Bone density assessment in the bone graft zone was performed via CT scan six months postoperatively, yielding a mean value of 690 HU (Q1–Q3 570.0 – 790.0; min 340 – max 980).Analysis of lower limb function dynamics according to the MSTS scale pre- and post-operation revealed statistically significant improvements (p &lt;0.001) (using Wilcoxon’s test).Five-year survival rate of knee prostheses after revision arthroplasty was 96 %.To analyze the effectiveness of introducing the newly developed instrumentation, we studied blood loss and operative times with and without its use. Using the instrumentation significantly reduced blood loss (p &lt;0.001) and operative time (p &lt;0.001) as determined by Mann-Whitney U-tests.Conclusion. The five-year survival rates for constructs in patients undergoing surgery with biological bone reconstruction are comparable to those observed after primary implantations of oncologic prostheses.

Clinical analysis of different intestinal reconstruction methods after primary cytoreductive surgery combined with rectal resection for advanced ovarian cancer

ObjectiveTo compare different intestinal reconstruction methods after intestinal resection for advanced ovarian malignancy.MethodsRetrospective data of patients with advanced ovarian malignancy were collected and then assigned into three groups: primary intestinal anastomosis, protective enterostomy and colostomy. General clinical characteristics, intraoperative findings and postoperative outcomes were compared between the three groups.ResultsA total of 530 cases were included for final analysis. The colostomy group had a lower serum albumin level, larger volume of ascites, higher likelihood of multiple intestinal resections and lower likelihood of rectal resection, lower peritoneal cancer index, more intraoperative blood loss, transfusions and infusions, lower likelihood of optimal cytoreductive surgery and shorter interval time to chemotherapy than the other two groups (p &amp;lt; 0.05). The primary intestinal anastomosis group exhibited a larger blood transfusion volume, higher incidence rates of anastomotic leak and electrolyte disturbance, and longer times to first flatus, first feeding and drain removal than the other two groups (p &amp;lt; 0.05).ConclusionsColostomy can be adopted for advanced ovarian cancer patients with a large ascites volume, hypoproteinemia, large intraoperative blood and fluid loss volumes, multiple intestinal resections, anastomoses located below the peritoneal reflection, high PCI and suboptimal cytoreductive surgery. For patients with good intraoperative and postoperative outcomes, one anastomosis, an anastomosis located above the peritoneal reflection, low PCI or optimal cytoreductive surgery, intestinal anastomosis can be carried out to restore the normal physiological function of the intestine. For patients with a large volume of ascites (≥500 mL), multiple anastomoses or an anastomosis located below the peritoneal reflection, intestinal anastomosis combined with protective enterostomy has an advantage over intestinal anastomosis alone.

Robotic-assisted costectomy using a Gigli saw for fibrous dysplasia

BackgroundFibrous dysplasia (FD) is the most common benign tumor of the ribs, with surgical resection being the preferred treatment modality for rib FD, leading to enhanced quality of life and favorable outcomes. The complexity of surgical intervention varies depending on the location of costal FD, presenting challenges for both open surgical and thoracoscopic approaches. In this study, we present a novel technique for three-port robotic-assisted costectomy utilizing a Gigli saw, detailing our initial findings and outcomes.MethodsWe reviewed five patients with benign rib tumors who underwent three-port robotic-assisted rib resection using a Gigli saw between May 2021 and December 2022. Data on patient characteristics, relevant short-term surgical outcomes and clinical long-term treatment effects were collected.ResultsThe surgery was successful in all five patients without any need for an additional port and emergency conversion to open surgery. Median operative time was 76.8 min (range, 73–116 min), and the median intraoperative blood loss volumes was 75 ml (range, 40– 105 mL). On average, chest tubes were removed 1.2 days postoperatively (range, 1–2 days), with a mean drainage volume of 93 ml on postoperative day 1 (range, 70–135 ml). Patients were discharged between the 2nd and 4th postoperative day. During 1-year follow-up period, no recurrence was observed in either patient.ConclusionsThe utilization of a three-port robotic-assisted costectomy in conjunction with a Gigli saw represents a viable, secure, and efficient approach for treating isolated benign rib lesions. Our aim is to provide clinical guidance on this technique and promote its broader application.

Anterior approach for the revision surgery following bone cement augmentation in osteoporotic vertebral compression fractures

To observe the clinical outcomes of anterior approach for the revision surgery following unsuccessful bone cement augmentation in osteoporotic vertebral compression fractures. A total of 10 patients who experienced unsuccessful bone cement augmentation underwent anterior revision surgery between January 2020 and December 2021. There were 2 males and 8 females. The age ranged from 55 to 83 years old. The reasons for revision surgery were postoperative infection in 2 cases, postoperative neurological symptoms in 3 cases, and kyphosis resulting from postoperative vertebral collapse in 5 cases. The involved segments included 2 cases of L1, 4 cases of L2, 3 cases of L3, and 1 case of L4. Among them, 2 patients underwent primary percutaneous vertebroplasty (PVP), while eight patients underwent primary percutaneous kyphoplasty (PKP). The time interval between the first and second surgeries ranged from 1 to 13 months. All patients presented with varying degrees of lumbar pain. X-ray, CT, and MRI scans were conducted prior to the revision procedure. Surgical duration, intraoperative blood loss, and any complications were documented. The surgical procedures were successful in all 10 patients, with 9 cases undergoing anterior reconstruction and posterior internal fixation through the interspace of the multifidus longissimus muscle. One patient underwent anterior reconstruction and anterior plate internal fixation. The duration of the anterior approach surgery ranged from 90 to 190 minutes, with a blood loss volume ranging from 130 to 480 ml. None of the patients experienced any intraoperative or postoperative complications such as nerve injury, cerebrospinal fluid leakage, major vessel damage, abdominal organ injury, incision infection, or bleeding. The follow-up period for 10 patients ranged from 3 to 20 months. Throughout the follow-up, none of the patients experienced complications such as displacement, cutting, or loosening of the artificial vertebral body. Prior to the operation, the visual analogue scale(VAS) ranged from 4 to 8 points, the final follow-up assessment ranged from 2 to 3 points. The Oswestry disability index (ODI) score a preoperative ranged from 17% to 37%, the latest follow-up evaluation ranged from 2% to 16%. Notably, significant correction in kyphosis angle was observed in 5 cases. Furthermore, there was notable improvement in VAS and ODI compared to preoperative values. Anterior corpectomy and artificial vertebral body implantation not only facilitate the removal of bone cement but also enable effective debridement and direct decompression. Moreover, by reconstructing anterior and middle column support, restoring vertebral height and local curvature, in combination with pedicle screw internal fixation, surgical segment stability can be achieved. Therefore, for patients requiring revision following failed bone cement augmentation, anterior surgery represents an ideal treatment option.

Comparison between minimally invasive surgery and open surgery in managing localized adrenocortical carcinoma treatment: Aretrospective propensity-matched study.

It was controversial to use open surgery or minimally invasive surgery (MIS) for adrenocortical carcinoma (ACC). This retrospective study aimed to evaluate the impact on prognosis between MIS and open surgery in patients with clinical stage I-II ACC. Patients with stage I-II ACC from December 2000 to October 2022 were retrospectively studied. The primary endpoint was recurrence-free survival time calculated by the Kaplan-Meier curves. In total, 95 patients were enrolled in this study (50 open surgery and 45 MIS). Propensity score matching identified 32 matched pairs of patients. Compared with the open surgery group, the MIS group had a shorter median operative time (150.0 vs. 120.0 min, p = 0.014), the lesser median volume of intraoperative blood loss (200.0 vs. 60.0 mL, p = 0.006), lower incidence of postoperative complications (59.4% vs. 28.1%, p = 0.023), and shorter median postoperative length of hospital stay (8.0 vs. 7.0 days, p = 0.001). After a median follow-up time of 20.5 months, no significant differences were observed in the local recurrence rate (62.5% vs. 78.1%), distant metastasis rate (15.6% vs. 6.3%), and median time to recurrence (15.0 vs. 20.0 months) between the two groups. The median recurrence-free survival time between the open surgery and MIS groups did not significantly differ (16.0 vs. 21.0 months). MIS might be a feasible option for treating localized ACC at a high patient's volume center with experienced surgeons.

Atlantodentoplasty using the anterior retropharyngeal approach for treating irreducible atlantoaxial dislocation with atlantodental bony obstruction: a retrospective study.

This was a retrospective study. The current study aimed to investigate the clinical efficacy of atlantodentoplasty using the anterior retropharyngeal approach against irreducible atlantoaxial dislocation with atlantodental bony obstruction. In cases of atlantoaxial dislocation with atlantodental bony obstruction, owing to the presence of an osteogenic mass between the atlas and odontoid process, reduction is challenging to complete using the posterior approach. Transoral odontoidectomy is technically demanding and is associated with several risks. The clinical data of 26 patients diagnosed with irreducible atlantoaxial dislocation complicated by atlantodental bony obstruction were analyzed retrospectively. All patients underwent anterior retropharyngeal atlantodentoplasty, followed by posterior occipitocervical fusion. Details including surgical duration and blood loss volume were recorded. Radiographic data such as the anterior atlantodental interval, O-C2 angle, space available for the cord, clivus-canal angle, and cervical medullary angle, and clinical data including the Japanese Orthopedic Association (JOA) score were assessed. The fusion time of the grafted bone and the development of complications were examined. In patients undergoing anterior retropharyngeal atlantodentoplasty, the surgical duration and blood loss volume were 120.1±16.4 minutes and 100.6±33.5 mL, respectively. The anterior atlantodental interval decreased significantly after the surgery (p <0.001). The O-C2 angle, space available for the cord, clivus-canal angle, and cervical medullary angle increased significantly after the surgery (p <0.001). The JOA score during the latest follow-up significantly increased compared with that before the surgery (p <0.001). The improvement rate of the JOA score was 80.8%±18.1%. The fusion time of the grafted bone was 3-8 months, with an average of 5.7±1.5 months. In total, 11 patients presented with postoperative dysphagia and three with irritating cough. However, none of them exhibited other major complications. Anterior retropharyngeal atlantodentoplasty can anatomically reduce the atlantoaxial joint with a satisfactory clinical outcome in patients with irreducible atlantoaxial dislocation with atlantodental bony obstruction.

Short-term outcomes of preoperative computed tomography angiography versus standard assessment in patients with BMI ≥ 25.0kg/m2 undergoing laparoscopic gastrectomy: the GISSG20-01 randomized clinical trial.

Laparoscopic gastrectomy lacks hand-direct tactile sense and has a limited surgical field compared to laparotomy. Apart from textbook classification, there are anatomical variations in the gastric arteries. Laparoscopic gastrectomy presents technical difficulties and necessitates a more comprehensive comprehension of regional anatomy than open surgical procedures. We aimed to compare efficacy and safety of preoperative computed tomography angiography (CTA) associated with surgical decision-making for laparoscopic gastrectomy. The GISSG 20-01 study was a multicenter, open-label, randomized clinical trial. The enrollment criteria mainly included histologically confirmed gastric cancer patients with BMI ≥ 25kg/m2. Eligible patients were randomly assigned to the CTA group or the non-CTA group in a 1:1 ratio. The primary endpoint was the volume of intraoperative blood loss. Between November 2020 and December 2021, 382 patients were enrolled and randomly assigned. After exclusion of 25 patients, 357 patients were included in the modified intention-to-treat population (179 in the CTA group and 178 in the non-CTA group). The mean intraoperative blood loss (CTA vs non-CTA; 74.2 vs 95.0mL, P = 0.005) and operation time (215.4 vs 231.2min, P = 0.004) was significantly lower in the CTA group. Total number of retrieved lymph nodes was similar in two groups (32.2 vs 30.2, P = 0.070). The CTA group had a significantly lower surgery task load index sore than the non-CTA group (36.6 vs 41.7, P < 0.001). There was no significant difference in postoperative complications rate of 14.5% in the CTA group and 22.5% in the non-CTA group (difference, -8.0% [95% CI, -16.0 to 0.1]; P = 0.053). Preoperative CTA associated with surgical decision-making could relieve surgery burden and lead to a better surgical performance compared with non-CTA support, which including decreased blood loss volume, vessel damage and operation time. NCT04636099.

A retrospective cohort study of the application of Santulli enterostomy in neonatal necrotizing enterocolitis

The use of Santulli enterostomy (SE) for necrotizing enterocolitis (NEC) has been limited to a small number of studies involving a small number of patients and no control group. Our study aimed to compare the clinical safety and efficacy of Santulli enterostomy with those of single- or double-lumen enterostomy for neonatal NEC through a retrospective cohort study. One hundred ten patients who met the criteria were divided into an SE group (64 patients) and a conventional enterostomy (CE) group (46 patients). The CE group underwent single- or double-lumen enterostomy. There were no significant differences in complication rates or prognoses between the two groups after either procedure. Although the stoma was positioned higher in the SE group, the length of the unused small intestine (USI) was not significantly different. Multivariate analysis revealed that the length of the USI influenced the likelihood of malnutrition after enterostomy (OR = 1.108, P = 0.008). After stoma closure, compared with those in the CE group, the operation time, intestinal recovery time, fasting time, hospitalization time, intraoperative blood loss volume and the incidence of complications requiring surgical reintervention was significantly lower in the SE group. In conclusion, Santulli enterostomy is not only a safe treatment option for NEC but also an effective method for increasing the length of the small intestine after enterostomy, thereby improving the patient’s postoperative nutritional status. In addition, the procedure is associated with good recovery and a reduced incidence of surgical reintervention after stoma closure.

Investigating the Effects of Performing the Early Mobilization Protocol on Postoperative Hemorrhaging in Cardiac Surgery Patients

Background: Most adverse effects following cardiac surgery, including hemorrhaging, are related to immobility. The early mobilization of the patient in enhanced recovery after surgery (ERAS) can counteract these adverse effects. Despite the awareness, however, the protocol has a low performance rate due to numerous barriers. The present research aims to investigate the effectiveness of performing the early mobilization protocol on hemorrhaging in cardiac surgery patients. Methods: This research is a clinical trial study conducted in 2023-2024 at Ali Ibn AbiTalib Hospital in Zahedan, Iran, on 100 patients undergoing cardiac surgery. Purposive sampling was used based on the inclusion criteria. Hemorrhaging risk assessment in patients was evaluated according to the preoperative checklist. The early mobilization protocol was performed on day 2 after surgery on patients in the intervention group with mild to low risk of hemorrhage. The statistical tests of repeated measures, chi-square, and independent t-test were used for data analysis in SPSS 26. Results: There were no statistically significant variations in the demographic characteristics of patients in the intervention and control groups. The mean and standard deviation (SD) of the blood volume loss in patients over three different time periods (days 2, 3, and 4 after surgery) were 326.500±16.81, 69.300±11.41, and 51.200±3.82 in the intervention group, respectively, and 350.00±16.81, 325.00±11.41, and 82.10±3.82 in the control group, respectively, indicating the effectiveness of performing the early mobilization protocol (P ˂ 0.001). Conclusion: Performing the early mobilization protocol can reduce the volume of bleeding after cardiac surgery and the early discharge of patients, thus leading to reduced complications. Nurses as the main care providers in intensive care units play a key role in performing the protocol.

Intraoperative complications in patients with systemic lupus erythematosus during total hip replacement

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic disease of unknown etiology characterized by systemic immuno-inflammatory damage to vital organs. A serious complication of SLE is aseptic bone necrosis, which is characterized by severe pain syndrome, impaired joint function, decreased quality of life and disability. Despite the fact that hip replacement is a technically proven method of surgical treatment, patients with SLE are still at increased risk of complications at all stages of the perioperative period.AIM: the aim of the work is to describe the effect of SLE on the development of intraoperative complications during hip replacement.MATERIALS AND METHODS: The study included 133 patients diagnosed with SLE who underwent total hip replacement between 1998 and 2021. All surgical interventions were performed in the traumatology and orthopaedic department. The group of patients with SLE was dominated by women, the ratio of women to men was 7.3:1, respectively. The average age of patients at the time of surgery was 36.6±12.6 years.RESULTS: Hip replacement in all patients (n=133) was performed as standard in the patient’s position on the healthy side from the anterolateral Harding access. In 75 cases (56.3%), additional fixation of the acetabulum component with screws was performed. In 10 cases, a cerclage was applied to the proximal femur due to a fracture that occurred during the development of the bone marrow canal. To clarify the factors influencing the development of an intraoperative fracture, patients with SLE were divided into 2 groups: the first group (n=10) — with an intraoperative fracture, the second (n=123) — without a fracture. The comparative characteristics of the first and second groups are carried out. Another complication at the stage of surgical treatment is an increased volume of blood loss, which required transfusion of erythrocyte suspension. There were 54 such patients (40.6%). In relation to patients with increased blood loss, we compared the clinical and laboratory characteristics of patients immediately before surgical treatment, with and without increased blood loss.CONCLUSION: In the study, we analyzed the resulting intraoperative complications. We have not received confirmation of the effect of daily and cumulative doses of HA, as well as the degree of activity and course of SLE on the risk of intraoperative fracture. The probability of fracture was significantly higher in patients with initially reduced bone mineral density. With regard to the increased volume of blood loss in patients with SLE, a significant association was found with baseline anemia (reduced hemoglobin and hematocrit levels) in the preoperative period (p&lt;0.001).

Severe maternal morbidity contributed by obstetric hemorrhage: Maryland, 2020-2022.

Obstetric hemorrhage is the leading cause of maternal mortality and severe maternal morbidity (SMM) in Maryland and nationally. Currently, through a quality collaborative, the state is implementing the Alliance for Innovation on Maternal Health (AIM) patient safety bundle on obstetric hemorrhage. To describe SMM events contributed by obstetric hemorrhage and their preventability in Maryland. This cross-sectional study used data from hospital-based SMM surveillance and review program in Maryland. Hospital-based SMM criteria include admission to an intensive care unit and/or transfusion of 4 or more units of blood products (of any type) during pregnancy or within 42 days postpartum. A total of 193 obstetric hemorrhage events that met the surveillance definition were identified in hospitals participating in SMM surveillance since inception on August 1, 2020 until December 31, 2022. We compared patient and delivery characteristics, practices done well, and recommendations for care improvement among patients with severe obstetric hemorrhage deemed preventable and non-preventable by hospital-based review committees. For obstetric hemorrhage events deemed preventable, we further identified factors that contributed to the SMM outcome at the provider, system, and patient levels. Uterine atony was the leading cause of obstetric hemorrhage events (37.8%), followed by uterine rupture, laceration and intra-abdominal bleeding (23.8%). Sixty-six (34.2%) obstetric hemorrhage events were preventable. Patients with preventable obstetric hemorrhage were significantly more likely to have an emergency than planned cesarean delivery and less likely to have a placental complication or >1500 mL blood loss volume. Hospital-based review committees determined that 81.8%, 30.3%, and 22.7% of preventable events could have been prevented or made less severe through changes to provider, system, or patient factors, respectively. Recommendations following event reviews aligned with the Alliance for Innovation on Maternal Health Obstetric Hemorrhage Patient Safety Bundle, particularly regarding elements in the Recognition and Prevention and Response domains. About one-third of SMM events contributed by obstetric hemorrhages were deemed preventable. Of AIM bundle elements, assessing hemorrhage risk on admission to labor and delivery, peripartum, and upon transition to postpartum care together with rapid, unit-standardized management of hemorrhage are likely to benefit more than half of patients with preventable SMM contributed by obstetric hemorrhage.

The differential approach to surgical treatment of the combined pathology of uterus and ovaries on a background pelvic organ prolapse

The objective: Decline of frequency of relapse of pelvic organ prolapse for women after surgical treatment of the combined pathology of uterus on the basis of development and promoting of the differentiated approach near the choice of method of operation.Materials and methods. At implementation of this research by us the conducted analysis of results of surgical treatment 90 patients which are operated concerning the of benign diseases of uterus and pelvic organ prolapse with the use of vaginal operative access. As a basic (base) operation to all patients was executed vaginal hysterectomy. Distinctive features had variants of vaginal operations for the patients of different clinical groups. Dividing of patients by clinical groups it is mine-out by us depending on testimonies for the delete of uterus, presence of concomitant pelvic organ prolapse (complicated or not by a stress incontinence of urine) and age of patients. 1 group – 30 patients in which was executed vaginal hysterectomy in combination with culdoplasty for Makkollu and colpoperineolevatoroplasty. 2 groups are 30 patients in which was executed vaginal hysterectomy for Meyo. 3 groups are 30 patients in which was executed vaginal hysterectomy in combination with front coplporrhaphy, colpoperineolevatoroplasty, fixing of dome of vagina to the sacrospinous ligament and urethrovesicvaginopexy (minimized sling). To the complex of the conducted researches clinical, laboratory, instrumental and statistical methods were included. Results.At surgical treatment of the combined pathology of uterus without and with pelvic organ prolapse it is necessary to give advantage to explorer anaesthesia (epidural anaesthesia or spinal anaesthesia), that allows to shorten duration of operation, decrease the volume of blood loss and risk of thromboembolic complications, accelerate and facilitate a postoperative rehabilitation for somatically weak patients and elderly patients and danced age. Efficiency of the differentiated approach at surgical treatment of the combined pathology of uterus with pelvic organ prolapse is 96,7 %, thus 83,3 % women are respect yourself completely cured. Most high-frequency of relapse (6,7%) takes place for women without pelvic organ prolapse, what hysterectomy was executed only concerning the of benign diseases of uterus and ovarieswith laparoscopic assistance.Conclusions. The results of the conducted researches testify that the use of the differentiated approach to surgical treatment of the combined pathology of uterus and pelvic organ prolapse allows to promote efficiency, reduce frequency of relapse and improve quality of life of women.Keywords:combined pathology of uterus and ovaries, pelvic organ prolapse, surgical treatment, differentiated approach.

ОСОБЕННОСТИ ИНФУЗИОННО-ТРАНСФУЗИОННОЙ ТЕРАПИИ ПРИ АНЕСТЕЗИОЛОГИЧЕСКОМ ОБЕСПЕЧЕНИИ ОПЕРАЦИЙ НА ГРУДНОМ ОТДЕЛЕ АОРТЫ

Objective: to determine the volume of blood loss and the volume of infusion-transfusion therapy in the intraoperative and early postoperative periods during operations on the thoracic aorta. Material and methods. 38 medical records of hospital patients who were treated in healthcare institutions from 2011 to 2024 for acute dissection of the ascending aorta and aortic arch type A have been analyzed. The age of the patients was 58 (52; 65.5) years, distribution by gender: men – 20 (51%), women – 18 (49%); height – 170 (166; 176) cm, body weight – 85.0 (76; 100) kg, body mass index – 27.9 (24.3; 30.9) kg/m2. All patients underwent cardiac surgery under artificial blood circulation. The volumes of blood loss from infusion-transfusion therapy in the intraoperative and early postoperative periods have been analyzed for each patient. The hemoglobin balance method was used to assess intraoperative blood loss. Results. The volume of blood loss in patients undergoing thoracic aorta surgery, evaluated by the hemoglobin balance method, was 2530 (2540; 3180) ml. The total volume of infusion-transfusion therapy in the groups is as follows: blood loss less than 40% of the circulating blood volume (CBV) – 2000 (1300; 2395) ml (p&lt;0.001), 40-80% of the CBV – 3360 (2590; 4330) ml, more than 80% of the CBV – 4270 (3490; 6100) ml (p&lt;0.001). The ratio of infusion therapy to transfusion therapy with blood loss less than 40% of the CBV is 1: 0.3; more than 80% – 1: 1.6. Conclusion. The work has analyzed the volume of blood loss and infusion-transfusion therapy during anesthesia for operations on the ascending aorta. That will help in further determining the optimal tactics, which may increase the survival rate of these patients.

Clinical efficacy of electrosurgery and steel scalpel surgery for umbilical herniorrhaphy in bovine calves: A comparative analysis.

Electrosurgery (ES) offers a promising alternative to conventional steel scalpel surgery (SSS), providing superior hemorrhage control and efficient tissue dissection with minimal invasiveness. Given the limited literature, this study aims to compare the clinical efficacy of ES with that of SSS in bovine umbilical herniorrhaphy. Fourteen crossbred male calves with reducible umbilical hernias, aged less than one month and weighing 25-47kg, were randomly assigned to two experimental groups: group A (ES) and group B (SSS), each containing seven calves. Clinical parameters, such as temperature, heart rate, respiratory rate, and SpO2, were recorded 10min preoperatively, intraoperatively at 20 and 40min, and 10min postoperatively. Hematobiochemical parameters, including total erythrocyte count, hemoglobin, packed cell volume, total serum protein, blood urea nitrogen, and creatinine, were also assessed at these intervals. Skin incision length, volume of blood loss, surgical duration, healing time, postoperative complications, and postoperative pain response were documented. Furthermore, a sonographic evaluation of postoperative wound healing was conducted. The clinical and hematobiochemical parameters did not vary significantly between the groups. However, significant variations (p<0.05) were noted in skin incision length, volume of blood loss, surgical duration, and healing time between the groups. Group A calves experienced smaller incisions, reduced blood loss, shorter surgical duration, quicker recovery, and fewer postoperative complications and pain. The ultrasonographic evaluation revealed superior postoperative wound healing in group A compared to group B. These findings suggest that ES is a more effective clinical approach than traditional SSS for umbilical herniorrhaphy in bovine calves.

Achıevements in the Surgıcal Treatment of Aneurysms of the Infrarenal Regıon of the Abdomınal Aorta

The article’s topic is devoted to the surgical treatment of aneurysms of the infrarenal aorta, the achievements we have achieved in the perioperative period, and the prevention of possible complications that may arise in the postoperative period. For this purpose, clinical materials from 125 patients were analyzed. Operation “Resection of the aneurysm using a synthetic aortic prosthesis” in 34 patients; “thromboendarterectomy from the abdominal aorta, biiliac bifemoral synthetic aortic prosthesis” was performed on 91 patients. In patients, the operation was performed using combined epidural intubation anesthesia. The duration of the operation was 293.0±11.87 minutes. The Cell-Saver apparatus was used for autotransfusion. The average volume of blood loss was 3252.5±219.12 ml. Mortality in the postoperative period occurred in 3.2% of patients. Cause of death; “Thrombohemorrhagic syndrome” developed as a result of internal bleeding in 1 patient; 1 patient had “intestinal obstruction”, and 2 patients had “acute myocardial infarction, pulmonary-heart-renal failure”.

DIAGNOSTICS OF THE DEGREE OF BLOOD LOSS BY THE METHOD OF STATISTICAL ANALYSIS OF MAPS OF OPTICAL ACTIVITY OF THE POLYCRYSTALLINE COMPONENT OF BIOLOGICAL TISSUES AND FLUIDS

The research was conducted to create a reliable and accurate approach to determining the volume of blood loss, which will allow forensic experts to increase objectivity and accuracy in establishing the causes and circumstances of death, as well as assessing the degree of traumatic injuries, and will help ensure more reliable examination results in forensic practice. The aim of the work is to develop and evaluate the effectiveness of a method for differential diagnosis of the degree of blood loss in corpses using statistical analysis of optical activity maps of the polycrystalline component of biological tissues and fluids. Material and methods. The study material was brain, kidney and blood samples (n=124) from corpses aged 18 to 60 years with a previously known blood loss volume from 0mm3 to 2500mm3. The study was conducted using the method of multiparametric differential Muller matrix tomography, which allows detecting changes in the structure of polycrystalline elements of biological tissues at different degrees of blood loss. Calculation of digital values was performed using a laser polarimeter of a standard scheme, further statistical processing was performed using MS® Excel® 2010™ and Statistica® 7.0 software. Results. For all studied biological samples, the method demonstrates high sensitivity in the range of blood loss volume from 0 мм³ to 1500 мм³ with an accuracy level of 86%-92%. Within the range of blood loss volume from 2000 мм³ to 2500 мм³ the accuracy of the method decreases to 56%-68%. The maximum level of accuracy is achieved for statistical parameters of kidney samples (SM4↔86%-92%), brain (SM4↔86%-90%) and blood films (SM2↔90%-92%), which characterize the Muller matrix maps of circular birefringence. Conclusions. Based on the conducted study, the high efficiency of the multiparametric Muller matrix differential tomography method in determining the degree of blood loss within the volume of lost blood ∆V=0mm3÷1500mm3 was established. The obtained results demonstrate that this method allows for an objective assessment of structural changes in biological tissues and fluids caused by blood loss. This makes it a unique tool for objectively determining the volume of blood loss.

Pain intensity and stress indicators after cemented total knee replacement with epidural application of morphine: prospective randomized study

The objective to perform the objective assessment of the intensity of pain syndrome after cemented total knee replacement with epidural analgesia with 0.2% ropivacaine solution and epidural analgesia with a combination of 0.2% ropivacaine solution with morphine was performed.Materials and methods. The study included 60 patients who underwent cemented total knee replacement for gonarthrosis under combined spinal-epidural anesthesia. In patients of the control group (n = 30), postoperative anesthesia was performed with 0.2% ropivacaine solution epidural through a catheter at the L2–3–L1–2 level in the form of a bolus followed by constant infusion. In patients of the main group (n = 30), analgesia was performed according to the same technique, but using a morphine solution of 1% – 0.3 ml (3mg) as part of a bolus of 0.2% ropivacaine solution epidural. The hemodynamics of the patients, the volume of intraoperative blood loss, and infusion therapy were homogeneous due to the carefully developed surgical procedure, had no significant differences and were not taken into account when publishing the data. The level of glycemia and cortisol in venous blood on the day of surgery (1 hour before surgery and 4 hours after surgery), age, and pain intensity on a numerical rating scale (NRS) were studied. Statistical processing was performed by MedCalc Software Ltd.Results. In the postoperative period, the level of venous blood cortisol in patients of the main group was 486.2 [470.6; 494.5] nmol/l, and in patients of the control group – 876.8 [803.7; 918.7] nmol/l (p &lt; 0.001 according to the Mann–Whitney U-criterion); pain intensity on the numerical rating scale in the main group was 1 [1; 1.5] score, in the control group was 4 [3; 5] scores (p &lt; 0.001, U–Mann–Whitney criterion). There was also a correlation between the value of glycemia and the pain intensity by NRS in the postoperative period (Spearman’s coefficient r = 0.669, 95% CI = 0.499–0.789, p &lt; 0.0001).Conclusions. As a result of the study, it was found that epidural analgesia with morphine leads to a lower increase in glucose and cortisol levels in the postoperative period, lower pain intensity when subjectively assessed using the numerical rating scale, which indicates a high quality of anesthesia.

Laparoscopic anatomical SVIII resection via middle hepatic fissure approach: Caudal or cranio side.

Laparoscopic hepatectomy is a proven safe and technically feasible approach for liver tumor resection, but laparoscopic anatomical SVIII resection (LASVIIIR) remains rarely reported due to poor accessibility, difficult exposure, and the deep-lying Glissonean pedicle. This study examined the safety, feasibility, and perioperative outcomes of LASVIIIR via a middle hepatic fissure approach at our institution. To investigate the safety, feasibility, and perioperative outcomes of LASVIIIR via a middle hepatic fissure approach at our institution. From November 2017 to December 2022, all patients with a liver tumor who underwent LASVIIIR were enrolled. The perioperative outcomes and postoperative complications were evaluated. Thirty-four patients underwent LASVIIIR via a middle hepatic fissure approach from the side or cranio side and were included. The mean operation time was 164 ± 54 minutes, and the intra-operative blood loss was 100 mL (range: 20-1000 mL). The mean operative times were, respectively, 152 ± 50 minutes and 222 ± 29 minutes (P = 0.001) for the caudal side and cranial side approaches. In addition, the median blood loss volumes were 100 mL (range: 20-300 mL) and 250 mL (range: 20-1000 mL), respectively, for the caudal and cranial sides (P = 0.064). Three patients treated using the cranial side approach experienced bile leakage, while 1 patient treated using the caudal side approach had subphrenic collection and underwent percutaneous drainage to successfully recover. There were no differences regarding postoperative hospital stays for the caudal and cranial side approaches [9 (7-26) days vs 8 (8-19) days] (P = 0.226). LASVIIIR resection remains a challenging operation, but the middle hepatic fissure approach is a reasonable and easy-to-implement technique.

Redefining Clinically Significant Blood Loss in Complex Adult Spine Deformity Surgery.

Retrospective analysis of prospectively-collected data. This study aims to define clinically relevant blood loss in adult spinal deformity (ASD) surgery. Current definitions of excessive blood loss following spine surgery are highly variable and may be suboptimal in predicting adverse events (AE). Adults undergoing complex ASD surgery were included. Estimated blood loss (EBL) was extracted for investigation, and estimated blood volume loss (EBVL) was calculated by dividing EBL by the preoperative blood volume utilizing Nadler's formula. LASSO regression was performed to identify five variables from demographic and peri-operative parameters. Logistic regression was subsequently performed to generate a receiver operating characteristics (ROC) curve and estimate an optimal threshold for EBL and EBVL. Finally, the proportion of patients with AE plotted against EBL and EBVL to confirm the identified thresholds. In total 552 patients were included with a mean age of 60.7±15.1 years, 68% females, mean CCI was 1.0±1.6, and 22% experienced AEs. LASSO regression identified ASA score, baseline hypertension, preoperative albumin, and use of intra-operative crystalloids as the top predictors of an AE, in addition to EBL/EBVL. Logistic regression resulted in ROC curve which was used to identify a cut-off of 2.3 liters of EBL and 42% for EBVL. Patients exceeding these thresholds had AE rates of 36% (odds-ratio: 2.1, 95% CI [1.2-3.6]) and 31% (odds-ratio: 1.7, 95% CI [1.1-2.8]), compared to 21% for those below the thresholds of EBL and EBVL, respectively. In complex ASD surgery, intraoperative EBL of 2.3 liters and an EBVL of 42% are associated with clinically-significant AEs. These thresholds may be useful in guiding preoperative-patient-counseling, healthcare system quality initiatives, and clinical perioperative bloodloss management strategies in patients undergoing complex spine surgery. Additionally, similar methodology could be performed in other specialties to establish procedure-specific clinically-relevant bloodloss thresholds.