Number Of Complications In Group Research Articles

Total Knee Arthroplasty in Hemodialysis Patients: Routine or Complex Surgery?

Background. Chronic hemodialysis significantly increases the risks associated with knee replacement. Among the late complications of knee arthroplasty in hemodialysis patients, deep periprosthetic joint infection (PJI) and aseptic loosening are more frequent. The frequency of revision interventions in patients with end-stage kidney disease (ESKD) is substantially higher compared to patients with normal kidney function.
 The aim of the study — based on the perioperative parameters and midterm outcomes to justify the primary knee replacement in chronic hemodialysis patients as complex case of arthroplasty.
 Methods. A retrospective randomized single-center cohort study was conducted, including 62 patients with various forms of knee osteoarthritis. Patients were divided into two groups: Group 1 — 29 (46.8%) patients with end-stage renal disease (ESRD) undergoing dialysis, Group 2 — 33 (53.2%) patients without kidney pathology. The average follow-up period in both groups was 3.7 years (min — 1, max — 6). The following parameters were assessed: patient age, length of hospital stay, morphocortical index, body mass index (BMI), duration of hemodialysis, functional assessment of the knee joint using the KSS Function Score and Forgotten Joint Score-12 (FJS-12), radiological results on the KRESS, and the frequency of various complications.
 Results. In Group 1, patients had significantly lower BMI compared to Group 2. Length of hospital stay in Group 1 were 1.7 times longer. According to the KSS Function Score, no significant differences were observed between the groups in the first 36 months after the operation. However, by the 4th year of follow-up, average KSS Function Score in Group 1 decreased to 77.3 points, which was due to infectious complications. The FJS-12 showed worse scores in Group 2, averaging 68.7 points. After more than three years post-operation, no statistically significant differences were observed between the groups, which was associated with an increase in the number of complications in Group 1. Results on the KRESS after 43 months did not differ between the groups and averaged 4.8 points. Group 1 had more orthopedic complications and cases of PJI, accounting for 7 out of 37.
 Conclusion. Age and constitutional characteristics of patients undergoing hemodialysis significantly differ from the normal population. The frequency of complications in Group 1 was 23.5%. These patients require the implantation of more constrained implant components and modular systems. Therefore, primary knee replacement in hemodialysis patients can be classified as a complex case of arthroplasty.

Influence of radiation therapy on the development of complications in single-stage autologous breast reconstruction with a DIEP-flap in breast cancer patients: a retrospective study

Breast reconstruction after complex oncological treatment is an urgent issue due to the high incidence of breast cancer.
 Aim. To analyze the effect of postoperative radiotherapy on the incidence of fat necrosis in single-stage autologous breast reconstruction with a DIEP flap and to evaluate the number of complications in groups with and without postoperative radiotherapy, as well as to determine the risk factors for complications.
 Materials and methods. The medical records of 34 breast cancer patients who underwent one-stage breast reconstruction using a DIEP flap after skin-sparing/subcutaneous mastectomy with and without subsequent radiation therapy were retrospectively studied. The frequency of complications in groups with and without postoperative radiation therapy was assessed.
 Results. Complications developed in 22 (64.7%) patients out of 34. Mild complications developed in 6 (17.6%) patients (divergence of the edges of the postoperative wound of the anterior abdominal wall). Complications of moderate severity developed in 12 (35.3%) patients. Severe complications developed in 4 (11.8%) patients. Out of 22 patients, 6 (17.4%) patients developed areas of fat necrosis after remote radiation therapy in the delayed period, 4 (11.8%) patients, without ESWL, also developed fat necrosis of a part of the flap (areas up to 5 cm). Excision of the area of fat necrosis of the flap was performed in 2 (5.9%) cases under local anesthesia, the rest of the areas of fat necrosis were not excised. The percentage of complications was higher in the group of patients with obesity (20.6%), which indicates that obesity is a risk factor for the development of intraoperative and postoperative complications in patients with simultaneous breast reconstruction with a DIEP flap.
 Conclusion. During radiotherapy after breast reconstruction with a DIEP flap, the incidence of fat necrosis of the flap was higher. Obesity is a risk of intraoperative and postoperative complications in patients with simultaneous increased breast reconstruction with a DIEP flap, since the incidence of complications was in the group of patients with obesity.

COMPARISON OF EARLY TREATMENT- EMERGENT COMPLICATIONS OF STAGE III A NON-SMALL CELL CARCINOMA (NSCLC STAGE III A) IN PATIENTS TREATED WITH NEOADJUVANT CHEMORADIOTHERAPY (NHLT), (NCHT), AND NEOADJUVANT CHEMOTHERAPY AND ADJUVANT RADIATION THERAPY

Treatment of STAGE III A NSCLC is an extremely difficult problem for modern oncology, since the one-year survival rate from the moment of diagnosis according to the National Cancer Registry is up to 58%. At the same time, there is a situation of uncertainty in the clinical approach to the treatment of this pathology – neither NCCN nor other world scientific literature sources contain information regarding a specific treatment method. The advantage of none of the possible methods of treatment of stage III NSCLC (HCT, NHLT, HCT + adjuvant PT) is not proven in relation to others. The conducted study is devoted to comparing these methods in relation to each other and overall and relapse-free survival. According to the results of previous studies, the highest results of both general and relapse-free survival were shown by patients from the NHLT group. But an important aspect of treatment is the ratio of benefit and risk, that is, the number and severity of complications. The study and analysis of complications of treatment with the methods of NXT, NHLT and NXT + adjuvant PT was the task of the work. Goal. To investigate and determine the number of complications in groups with NCRT, NCT and NCT + adjuvant LT. Materials and methods. The study included 3 groups of patients – patients who received NHLT, NHT and NHT + adjuvant PT, a total of 304 people. All patients had the same chemotherapy regimen- Cisplatin / Docetaxel or Carboplatin / Paclitaxel, patients receiving radiation therapy received it in a total dosage of 30 Gy in both neoadjuvant and adjuvant regimens. The irradiation was carried out on the chest and mediastinum area. Patients underwent radical surgery in the form of lobectomy, bilobectomy or pneumonectomy. In early works on this topic, an analysis of survival on the Kaplan and Mayer scale was carried out. The article describes the conduct and study of treatment complications that were recorded during the stay of patients in the hospital both during chemotherapy, radiation therapy and in the postoperative period.

To Compare the Outcomes of Dartos Flap and Tunica Vaginalis Flap as Secondary Cover after Second Stage Durham Smith Repair in Reducing Post-Operative Complications

Background: Interposition flaps are mainstay in the success of hypospadias surgery because they lead to decrease in complications of hypospadias repair significantly especially urethrocutaneous fistula by buttressing the neo urethral suture line. Many interposition flaps have been tried with varying outcome results. Most commonly used interposition flaps are Tunica vaginalis flap and dorsal dartos flap however, recently interest have also researched in Durham smith de-epithelialized dartos based overlay flap. Though there are many publications comparing outcome of dorsal dartos and tunica vaginalis flap but hardly any study that has compared all three interposition flaps. So, we aimed to compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based overlay flap as interposition layer in TIP urethroplasty. Aim: To compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based flap as secondary interposition cover after Tubularized incised plate urethroplastyin reducing post-operative complication. Materials and Methods: A retrospective study was conducted in which case records of 78 patients who had undergone repair for distal and midpenile hypospadias with minimal chordee and favorable anatomy by the Tubularized incised plate urethroplasty with interposition flap over 2 years (2017-2019) were reviewed. Patients were divided in three groups with 26 subjects in each group. Group A consisted of patients with dorsal dartos interposition flap, Group B comprised of patients with Tunica vaginalis interposition flap and Group C consisted of patients with Durham smith deepithelialized dartos based overlay cover. Outcome variables noted were the complications including wound dehiscence, Urethrocutaneous fistula, Meatal stenosis, Penile torsion, skin necrosis and preputial edema. Statistical methods were applied to compare these complications in all three groups. Results: Total number of complications in group A were 11(42.3%) and most common complications were skin necrosis (n=7, 26.9%) and urethrocutaneous fistula (n=6, 23.1%). Total number of complications in group B were 7(26.9%) while Chordee and preputial edema (n=6, 23.1% each) were among the most common complications. 9(34.6%) patients developed complications in group C and most common complications were penile torsion (n=6, 23.1%) and urethrocutaneous fistula (n=4, 15.4%). Conclusion: We have seen in our study that TV flap is a good option as second cover with lesser complications especially in terms of fistula related complications while Durham smith onlay cover found to be equally better option as it showed no skin complications and other complications were almost comparable to TV flap cover.

Experimental Study of the Bone Marrow Aspirate Injection Effect into Denervated Muscle (Clinical Manifestations of Limb Denervation)

Relevance. Peripheral nerve injuries are potentially disabling lesions, which account for about 2-3% of all injuries. In order to study the clinical manifestations of limb denervation in the early and late stages, we conducted an experimental study.
 Objective: in the experiment, to study the effect of bone marrow aspirate injection into the target muscles on denervation-reinnervation processes by studying the clinical manifestations of denervation (presence of trophic ulcers, edema, or muscle wasting).
 Materials and Methods. The experiment was performed on 36 rabbits, which were divided into four groups: a group of pseudo-operated animals, group 1 (neurotomy and sciatic nerve suture), group 2 (on-time injection of bone marrow aspirate), and group 3 (delayed injection of bone marrow aspirate). Detection of hypotrophy or edema of the tibia was performed by determining the percentage of leg circumference of the operated on and intact limbs. Clinical manifestations of limb denervation were recorded during the examination of experimental animals before their euthanasia.
 Results. When comparing the number of complications in group 1 and group 2, more complications of the denervation process was observed in group 1. At the same time, no difference was found between group 1 and group 3, as well as between group 2 and group 3. When comparing the indicators of hypotrophy, the difference between group 1 and group 2, as well as a significant difference (p<0.05) between group 1 and group 3, with a predominance of hypotrophy in group 2 and group 3 were revealed.
 Conclusions. The injection of bone marrow aspirate into the target muscles during surgery and in the early stages of reinnervation helped to reduce the clinical manifestations of the denervation process. Delayed administration of bone marrow aspirate to target muscles significantly (p<0.05) helped to reduce edema of denervated target muscles.

PROSPECTS OF NEOADJUVANT CHEMORADIOTHERAPY IN PATIENTS WITH STAGE III A NON-SMALL CELL LUNG CANCER AS A METHOD OF IMPROVING SURVIVAL.

The aim: To study the survival rate and count the number of complications in groups with NCRT, NCT and NCT + adjuvant radiotherapy. Materials and methods: The studied patients were divided into three groups with a total number of 304 people, Patients who received neoadjuvant chemotherapy-149 people, who received neoadjuvant chemotherapy and adjuvant radiation therapy-90 people. Neoadjuvant chemoradiotherapy was performed in accordance with Cisplatin/Docetaxel or Carboplatin/Paclitaxel 4 Mg and simultaneous radiation therapy with a total radiation dose 30 gray with a single dose of 2 Mg. After neoadjuvant treatment, patients of all groups underwent radical surgery. It consisted of lobectomy, bilobectomy and pneumonectomy. Postoperative complications and the duration of stay in the clinic after surgery were studied. Survival was assessed on the Kaplan and Mayer scale. Results: The study analyzed the main results of treatment, which showed that the 5 years survival in the main group was 28.1±5.9 %, in the control groups-the first control group (neoadjuvant chemotherapy) - 10.4±3.8 % and the second control group (neoadjuvant chemotherapy and adjuvant radiation therapy) - 5.8±2.0 %, respectively. Conclusions: 1. The overall survival rate of patients receiving NCT compared to patients receiving neoadjuvant chemotherapy is higher than in the neoadjuvant chemotherapy group and 13 months higher than in the adjuvant radiation therapy group. 2. Patients who had the phenomenon of a complete morphological response have a significantly higher survival rate (45 and 39 months, respectively).

Surgical treatment of extended spongy urethral strictures in men: minimizing the risks of narrowing in the anastomotic zones between the buccal graft and the native urethra using the dorsal inlay technique

Introduction. Currently, the most common method of treating extended urethral strictures is augmentation urethroplasty using oral mucosa grafts. Analysis of the long-term outcomes of this surgery type shows a high incidence of relapses and complications.Purpose of the study. To improve the outcomes of augmentation urethroplasty, in particular the dorsal inlay (Asopa) technique, in patients with extended spongy urethral strictures by minimizing the risk of recurrent strictures.Materials and methods. The study is based on an analysis of the surgery in 90 patients (aged 18-72 years) with extended spongy urethral strictures. Seventy patients (group I) underwent dorsal inlay augmentation urethroplasty according to the Asopa technique, and 20 patients (group II) — according to the author's modified technique. Statistical data analysis was carried out using the SPSS ver.26 software (SPSS Inc. Chicago, IL, USA).Results. A comparative analysis of the course of the early postoperative period showed a lower number of complications in group II patients compared to group I — 20.0% versus 34.3%, respectively. The recurrent strictures were registered for groups I and II in 18.8% and 5.6% of cases 6 months after surgery, respectively. The recurrent urethral narrowing was most often localized in the area of distal anastomosis between the buccal graft and the native urethra in patients from both groups.Conclusion. The modified dorsal inlay augmentation urethroplasty technique developed and implemented in clinical practice by increasing the internal urethral lumen in the areas of proximal and distal anastomosis between the buccal graft and the native spongy urethral body allows minimizing the risks of recurrent urethral narrowing after augmentation urethroplasty.

Correction of Dysbiosis in Diversion Proctitis: Possibilities of Intraluminal Sanitation and the Prevention of Complications after Reconstructive Surgery

Background. Repeated surgical interventions aimed at the colostomy closure and restoration of intestinal continuity after obstructive resections are traumatic and complex reconstructive operations on the colon. The complications of recovery operations largely feature wound abscesses (30–60 %) and anastomotic leakage (5–23 %), with the mortality levels from these complications reaching 0.4–2.8 %. Pronounced dysbiotic changes, the progression of catarrhal or erosive diversion colitis and proctosigmoiditis are the risk factors for anastomotic leakage and postoperative bowel dysfunction. This determines the need for a therapeutic algorithm of intestine sanitation and the introduction of methods for preventing the anastomotic leakage after obstructive resection of the distal colon (Hartmann’s operation). Aim. To evaluate the capability and efficiency of the intraluminal application of rifaximin- α (Alfa Normix ® preparation, Alphasigma company) as a sanitising intestinal antiseptic for relieving diversion colitis and prevening postoperative complications of restorative operations after obstructive resection of the colon (Hartmann’s operation). Material and methods. A prospective comparative controlled study of the results of surgical treatment in 63 patients was conducted. The patients were divided into 2 groups, which were compared using the case-control principle. The operations included the colostomy closure and the restoration of intestinal continuity by applying a colonic anastomosis. In group I (main group, 30 patients), the original “Method of postoperative prevention of colonic anastomotic leakage” (Russian patent No. 2523822) was applied. In the control group (33 patients), routine methods for preventing anastomotic leakage and antibiotic prophylaxis were used. A comparative analysis of the number and severity of purulent-septic complications (taking into account the possibility of their relief), as well as the quality and rate of intestinal dysbiosis relief and the manifestations of diversion proctitis, was carried out. Results. The main group indicated the best results in terms of the main analysed parameters, fewer complications and anastomotic leakage. Thus, the total number of complications in groups I and II was 16.7 % and 27.3 %, respectively. The proportion of complications associated with the anastomotic leakage, inflammatory changes in this area and impaired patency in groups I and II was 6.7 % and 12.1 %, respectively. Rifaximin- α (Alpha Normix ® ) intolerance and pathological reactions associated with its use were not observed. The possibility for effective relief of the violations of quantitative and qualitative composition of the microflora in the colon stump was revealed. The main group showed better results in terms of eliminating local manifestations of diversion colitis and anorectal dysfunction compared to group II, where traditional schemes of postoperative therapy were used. Conclusions. Intraluminal dosed use of the Alpha Normix ® suspension with the rifaximin concentration of 100 mg per 5 ml is an effective method of postoperative prevention of purulent-septic complications associated with anastomotic leakage during reconstructive operations on the distal colon. The introduction of Alpha Normix ® in the scheme of postoperative treatment allows its results to be stabilised due to the sanitation of the intestinal lumen, the elimination of dysbiosis, the relief of inflammatory reaction and the elimination of factors supporting the development of diversion proctitis.

The results of use of myoplasty for closure of the pelvic floor defect after extralevator abdominoperineal excision of the rectum

Background. Extralevator abdominoperineal excision is associated with a high incidence of perineal wound complications. There is no uniform standard for choosing the method for pelvic floor reconstruction after extralevator abdominoperineal excision.The purpose of the study was to compare the results of extralevator abdominoperineal excisions of the rectum using various methods of perineal wound closure.Materials and Methods. Between 2014 and 2018, 120 patients underwent extralevator abdominoperineal excisions of the rectum using various options for closure of the pelvic floor. The patients were divided into 3 groups. Group I patients (n=64) underwent simple plasty of the peritoneal wound. Group II patients (n=43) underwent myoplasty using the gluteus maximus muscle. Group III patients (n=13) underwent myoplasty using the rectus abdominis muscle. The incidence of perineal wound complications in the early postoperative period was assessed.Results. The total number of perineal wound complications in Group I, II and III was 33 (51.5 %), 13 (30.2 %), and 6 (46.1 %), respectively. Grade IIIA-IIIB complications according to the Clavien-Dindo classification were observed in 25 % of Group I patients, in 18.6 % of Group II patients and in 7.7 % of Group II patients. Postoperative perineal wound complications occurred more often in Group I patients after simple plasty than in Group II and III patients after myoplasty (51.5 % versus 30.2 %). However, perineal wound complications were observed more often in Group III than in Group II (46.1 % versus 30.2 %, respectively). No significant differences in the frequency of complications between 3 groups were found.Conclusion. Using various options for closure of the pelvic floor after extralevator abdominoperineal excisions of the rectum, there was a tendency to reduction in the incidence of grade IIIA-IIIB perineal wound complications.

Facet Fixation Combined with Lumbar Interbody Fusion: Comparative Analysis of Clinical Experience and A New Method of Surgical Treatment of Patients with Lumbar Degenerative Diseases

For the treatment of patients with degenerative diseases of the lumbar spine the technique of pedicle fixation is widespread, when after open decompression channel structure locking screws are introduced into the vertebral body through the back vertebra legs. We first used a fundamentally new way of fixing the rear using the facet-boards Cage «Facet Wedge», when posterior fixation is done by closing the facet joints with minimally invasive, percutaneous method. We have not found data on the clinical efficacy of facet fixation in scientific literature. To compare the clinical efficacy of facet fixation combined with interbody fusion in the treatment of patients with degenerative lumbar spine disease. The study included 145 patients who were divided into 2 groups. The study group with long-term observation included patients (n=100) who underwent a new method for lumbar fixation; the method comprises unilateral or bilateral implantation of titanium Cage «facet Wedge» in the joint space facet joint in combination with the anterior, lateral, and transforaminal interbody fusion. Clinical comparison group (n=45) included retrospectively recruited patients who were performed titanium pedicle screw installation after open decompression and interbody fusion posterior lumbar fixation. Dynamic observation and comprehensive evaluation of the treatment clinical results was carried out for 18 months after surgery. Cage facet installation technology is quite simple, universal for the stabilization of the rear of the complex after interbody fusion from the front, side, and rear access; and does not require the intraoperative application of expensive high-tech equipment. Comparative analysis of the main group showed significantly better results in terms of the duration of the operation [CG 125 (90; 140) min, the CCG 205 (160; 220) min; p=0.01], the volume of blood loss [CG 80 (70; 120) ml, CCG 350 (300; 550) ml; p=0.008], activation time [CG 2 (1; 2) days, 4 CCG (3; 5) days; p=0.02], length of hospitalization [CG 9 (10; 11) days, the CCG 13 (12; 15) days; p=0.03], the level of pain on a visual analog scale [CG 3 (2; 4) mm, CCG 15 (12; 18) mm; p=0.001], quality of life (by index Oswestry) [CG 8 (6; 8) points, the CCG 23 (20; 28) points, p=0.003], and labor rehabilitation [CG 3 (2; 6) months, CCG 9 (6; 12) months; p=0.0001]. The number of postoperative complications in group 1 was 13%, in the 2nd ― 31,1% (p=0,0012). The new method involves fixing the back with considerably less surgical trauma of paravertebral soft tissue that results in early activation of patients, reduction of stay in hospital period, and better functional recovery of patients. The application of facet fixation combined with interbody fusion in the treatment of patients with degenerative diseases of the lumbar spine allows achieving the best clinical outcomes and fewer postoperative complications during the short and long-term follow-up if compared with the traditional method of transpedicular stabilization. The combination of low-impact and reliability facet fixation techniques for posterior stabilization of the operated segment creates favorable conditions for the restoration of a functional condition of patients, full social and physical rehabilitation.

Comparison of Mechanical Circulatory Support by the Use of Pulsatile Left Ventricular Assist Devices Polvad MEV and Continuous Flow Heart Ware and Heart Mate II in a Single-Center Experience

BackgroundMechanical circulatory support is increasingly used in patients with heart failure as a bridge to transplant or recovery. Results of use the Polish POLVAD MEV pulsatile circulatory support system and its comparison with novel devices never was done. We compared the course of patients with left ventricular circulatory support (left ventricular assist device [LVAD]) supported by POLVAD MEV or continuous flow devices Heart Mate II (HM II) and Heart Ware (HW) in single-center cohort. MethodsWe retrospectively reviewed 44 patients who underwent Polvad Mev (group P; n = 24 [21M/3F]) or HW or HM II (group C; n = 20 [20M/0F]) implantation between April 2007 and February 2014. Patients were in INTERMACS 1 (6 in group P and 1 in group C) or 2. Preimplant demographics, and perioperative and postoperative clinical outcomes were reviewed between groups. We analyzed baseline signs of heart failure, comorbidities, complications, and the 30- and 90-day results. ResultsAmong the groups, age, gender, weight, and cause of heart failure were comparable. Patients in group C suffered more frequently from hypercholesterolemia preoperatively. Patients in group P had more pulmonary complications (7 vs 0) after LVAD implantation and stay longer on intensive care unit than patients in group C (17.61 ± 16.96 vs 9.56 ± 9.42; P = .047). After exclusion, INTERMACS 1 patients it was not significant (14.8 ± 10.8 vs 9.8 ± 9.6 days; P = .065), the 30- and 90-day mortality was comparable. ConclusionsImplantation of pulsatile POLVAD MEV and continuous flow devices as LVAD support provides comparable results. A greater number of complications in group P can cause increased mortality over a longer observation period.