Organ-preserving Operation Research Articles

A clinical case of preservation of reproductive potential in a patient with invasive cervical cancer

Cervical cancer is a malignant tumor originating from the mucous membrane of the cervix (ectocervix or endocervix). In 2020, 604,000 new cases of the disease were registered, with 342,000 deaths. Today, a significant rejuvenation of this pathology is recorded – the highest incidence rate occurs in the age group from 15 to 39 years.The cause of the development of cervical cancer is the human papillomavirus of oncogenic genotypes, and in Russia, human papillomavirus types 16 and 18 are found in most patients. Risk factors: early onset of sexual activity, frequent change of sexual partners, refusal of “barrier” type contraceptives, smoking, immunosuppression, the question of the influence of various sexually transmitted infections is being discussed.The present article describes a clinical case of performing an organ-preserving operation: laparoscopic extended trachelectomy with sentinel lymph nodes determination, urgent cytological and histological studies, with the formation of the obturator apparatus with a soft titanium nickelide implant for invasive cervical cancer in a patient with unrealized reproductive function.Organ-preserving surgeries in patients with cervical cancer allow preserving childbearing function while maintaining oncological radicality of surgical treatment. A modern, multidisciplinary approach of an oncologist-gynecologist and a reproductologist is the basis of a modern strategy for managing a patient with cervical cancer and unrealized reproductive function.

ОПЫТ ОРГАНОСОХРАНЯЮЩЕЙ ТАКТИКИ ВЕДЕНИЯ ПРИ ВРАСТАНИИ ПЛАЦЕНТЫ

The purpose of this study is to substantiate the possibility of successful organ-preserving management tactics for placenta accretion based on the study of a clinical case. We studied the results of examination and treatment of a pregnant woman, a woman in labor and a maternity ward, 32 years old, who received medical care in inpatient conditions at the Perinatal Center of the V.D. Seredavin State Medical University. It can be assumed that the cause of the abnormal attachment of the placenta in this patient could be an infection, in particular, chronic endometritis. This is evidenced by the premature rupture of the fetal membranes, the cause of which is most often an infectious factor. Diagnosis of anomalies of placental attachment is based on the data of instrumental studies. It should be detected in the antenatal period with ultrasound. Despite the presence of placenta accretion, this pathology, unfortunately, was not detected at the stage of pregnancy, which would make it possible to draw up a plan for pregnancy and childbirth in accordance with the tactics recommended for this pathology. In this clinical case, an additional placental lobule isolated from the main part of the placental tissue apparently grew in, which made it possible to avoid massive bleeding in the postpartum period before attempting to separate this part. Careful observation of the patient in the postpartum period with dynamic ultrasound control allowed the diagnosis of placental ingrowth. With diagnostic hysteroscopy, the diagnosis was confirmed, an organ-preserving operation was performed: hysteroesectoscopy with electrosurgical resection of placenta increta. During the control examination, no pathology of the myometrium was detected. It is necessary to take into account the presence of all causes that can lead to abnormalities of placental attachment, in particular, an infectious factor. Active identification of risk factors and early diagnosis of placental abnormalities are the main conditions in the prevention of massive obstetric bleeding and reduction of maternal mortality rates. It is necessary to strive to perform organ-preserving surgical interventions, if there are conditions that ensure their implementation. In this clinical case, despite the presence of a difficult-to-diagnose variant of placental ingrowth, it was possible to perform an organ-preserving operation and preserve the patient's ability to realize reproductive function in the future.

OPEN SURGICAL TREATMENT OF BILATERAL CORALLOID AND MULTIPLE NEPHROLITHIASIS COMPLICATED WITH CHRONIC RENAL FAILURE

This articles describes the improved preoperative techniques for preparing to the surgical operations for bilateral coralloid and multiple nephrolithiasis complicated with chronic renal failure and discusses the treatment outcomes. Materials and methods. During 2000-2020, at the Department of Urology of the Azerbaijan Medical University, more than 3,000 open surgical operations were performed on for kidney and ureter stones. 974 (32.47±0.85%) paitents had the operations for coralloid and multiple nephrolithiasis; 700 (23.33±0.77%) of them were found to have unilateral and 274 (9.13±0.53%) had bilateral coral stones. Results. The results of open surgical operations of 274 patients operated on for bilateral coralloid and multiple nephrolithiasis in the 2000-2020 period were analyzed. 190 (69.3±2.8%) of them, 105 men and 85 women, had renal insufficiency, 162 (59.1±3.0%) patients (82 men, 80 women) had the diagnosis of chronic renal failure, and 28 (10.2±1.8%) patients (19 men, 9 women) had acute chronic renal failure. The implementation of the preoperative preparation techniques, taking into account the stage of chronic renal failure, was presented. Out of 274 operated patients, the intervention was performed in 47 (17.2±2.3%) with nephrostomy (24 right, 23 left), in 28 (10.2±1.8%) with pyelostomy (16 right, 12 left), in 110 (40.1±3.0%) with intrarenal stenting (60 right, 50 left), in 6 (2.2±0.9%) with nephrostomy and intrarenal stenting (2 on the right, 4 on the left). Along with this, 56 (20.4±2.4%) patients had clamping of the renal artery from one side or another. After surgery, 48 (17.5±2.3%) patients experienced the exacerbation of chronic pyelonephritis. In patients with diabetes, the exacerbation of chronic pyelonephritis had a more severe course. 26 (9.5±1.8%) patients experienced the exacerbation of chronic renal failure, of them, 6 (2.2±0.9%) had a creatinine level exceeding 500 mmol/l, that was the reason for haemodialysis. Anaemia was observed in 49 (17.9±2.3%) patients with chronic pyelonephritis and chronic renal failure in the postoperative period. In patients with anaemia, the haemoglobin level was 50-85 g/l (average 71.9 ± 0.4 g/l). 11 (4.0±1.2%) of them received blood transfusions in the postoperative period. In 5 (1.8±0.8%) cases, transfusion was performed during haemodialysis. In general, 270 patients out of 274 with bilateral coralloid and multiple nephrolithiasis had open surgical treatment completed successfully, and 4 (1.5±0.7%) had fatal outcomes. In 254 (92.7±1.6%) cases, an organ-preserving operation was performed on, and in 20 (7.3±1.6%) cases, surgical resections were carried out. The study has shown the preoperative preparation and the choice of the correct surgical tactics during the operation considerably contributes to successful treatment outcomes among the patients with severe chronic renal failure.

Features of the pathomorphosis of fire bullet wounds of the abdomen with damage of the colon

The article shows the features of the pathomorphosis of gunshot bullet wounds to the abdomen with damage to the colon. Various options for the course of repair and regeneration of the colon after surgical treatment and in the presence of postoperative complications in wounded patients with and without concomitant pathology of the colon are provided. It is shown that the etiology and pathogenesis of a penetrating gunshot wound of the intestine has mechanical and metabolic aspects. It has been proven that the greatest impact force on the intestine falls on the outside, on the peritoneum, which is often worn away from the longitudinal layer of the muscle wall of the intestine. It is given that the restructuring of the structure and function of the colon in chronic colitis after a gunshot wound leads to an exacerbation of the chronic process in all membranes. It is shown that damage to the intestinal mucosa occurs simultaneously with the destruction of intestinal tissues, but depends on general and local immunity. Infiltration of the site of the lesion by neutrophil granulocytes leads to the disposal of the entire wound or the development of complications. The structural and functional state of intestinal lymphatic follicles makes it possible to maintain intestinal immune protection, bacterial microflora and digestion. The method of choice for surgical repair of the consequences penetrating into the abdominal cavity of a gunshot wound will be the maximum resection of necrotic foci, large hemorrhages to avoid adhesion disease. At different levels, depending on the wound process, the structural and functional reconstruction is completely different, which is due to the individual feature of the structure and function, which affects the surgeon's desire for a justified radical or, on the contrary, for an organ-preserving operation. Keywords: histological examination, gunshot wound, colon injury.

Оrgan-preserving operations in the abdominal gun-shot penetrating woundings of large bowel. Experience of the medical help delivery in military environment Аntiterroristic operation/The Joint Forces Operation

Objective. To improve the results of treatment in injured persons with a gun-shot penetrating abdominal woundings with damages of large bowel, using introduction of principle for compliance between volumes of the damage and the primary operative intervention through organ-preserving operations.
 Materials and methods. There were analyzed 164 gun-shot abdominal woundings of large bowel in 151 injured persons. All the wounded persons were men, aged from 19 to 58 yrs old, (34 ± 5.2) yrs old at average. Penetrating cross-cutting abdominal woundings have occurred in 48 (31.8%) patients, the blunt – in 103 (68.2%). In accordance to character of the large bowel damage there were: deserozation - in 8 (5.3%) injured persons, the blunt wounding – in 57 (37.7%), and a through one – in 86 (57.0%). The bullet woundings have occurred in 31 (20.5%) injured persons, while the comminuted – in 120 (79.5%). The large bowel woundings have had following localizations: coecum – in 37 (24.5%) patients, ascending colon – 19 (12.6%), transverse colon – 32 (21.2%), descending colon – 18 (11.9%), sigmoid colon – 33 (21.9%), and several perts of large bowel – 12 (7.9%). The wounded persons were distributed into two groups, depending on volume of the operative intervention performed: the main – 49 (32.4%) wounded persons, in whom organ-preserving operations were performed, and a control one – 102 (67.6%) wounded persons, in whom resectional methods were applied. The large bowel wall defects suturing with or without formation of unloading colo- or enterostomy were considered as organ-preserving operations.
 Results. Definite decision, concerning the operative intervention volume, was made immediately after revision of the abdominal cavity organs, estimation of the damages character (special attention was drawn to dimensions, localization and quantity of intestinal defects, the state of its mesenterial edge and adequacy of a blood flow), presence and remoteness of extended peritonitis, general state of a wounded person (the blood loss volume, the sepsis features presence, hemodynamicac indices and common character of the woundings). Оne or several woundings of large bowel, including big in dimensions, were considered as indications for performance of organ-preserving operations (the intestinal wound suturing, the intestinal wound suturing with colo- or jejunostomy, extraperitonization). In patients of the main group, comparing with those of the control group, the stationary stay and the complications rate were reduced. After rehabilitation and staged closure of unloading stomas all wounded persons of the main group went back to service in Military Forces of Ukraine.
 Conclusion. Selecting the surgical treatment method for the gun-shot woundings of large bowel, it is necessary to base on complex analysis of the battle trauma character, the patient’s state and the risk for іntra- and postoperative complications. The first-line application of organ-preserving interventions as more physiological and those, which permit mostly rapid come back to the service duties functioning, is expedient. While choosing the organ-preserving operation volume, the surgeon must adhere to principle of compliance between the damage volume and prevalence, general state of a wounded person and the operative intervention volume.

Phyllodes breast tumor. From diagnostic to pathomorphological examination

Background. Phylloid tumors are a fairly rare pathology (about 0.3–0.5 % of all breast tumors), which is why there is no single protocol for the treatment of this pathology. Also, due to the lack of data and the rare occurrence, it is difficult to diagnose and choose the final management tactics of the patient. Phylloid tumors can be benign, borderline, and malignant neoplasms, which also complicates the treatment process. The final decision on the choice of patient management tactics can be made only after receiving the results of a planned pathomorphological examination.Materials and methods. In this article, we will discuss the results of major retrospective studies, including data on epidemiology, etiology, diagnostic approach, strategies and results of treatment of phylloid breast tumors, as well as present data on patients treated at the Russian Scientific Center of Radiology of the Ministry of Health of the Russian Federation for the period from January 2010 to February 2021.Results. The main methods of instrumental diagnosis of phylloid tumors are mammography, ultrasound and MRI. Morphological examination is important in making a diagnosis. Fine-needle biopsy often does not allow establishing an accurate diagnosis, and therefore the main method of diagnosis remains pathohistological examination. The main method of treatment of phylloid tumors remains surgical, where, depending on the trepan biopsy, the question of the feasibility of performing an organ-preserving operation is decided.Conclusion. Phylloid tumors are a rare type of breast neoplasm, which is the reason for the relatively small amount of scientific research that addresses this particular problem.

Closed kidney injuries in children

MATERIALS AND METHODS: Within 20 yrs, 76 children aged 28 yrs with kidney trauma were under observation, and 35 of them had associated trauma. Clinical, instrumental, and radiological methods were used in the diagnosis.
 RESULTS: Of the 76 children with closed kidney trauma, 23 were diagnosed with kidney contusion, 14 with kidney injury with subcapsular hematoma, 16 with kidney injury with rupture of the capsule and perirenal urohematoma, 21 with kidney rupture and damage to the calyxpelvic system, and 2 with traumatic hydronephrotic kidney. Conservative treatment was carried out in 49 (64.4%) children and surgical treatment in 28 (25.6%). In the long term, 28 children with kidney injuries and treated conservatively were examined. Complications were found in nine children: pyeloectasia, deformation of the calyxpelvic system, pyelonephritis, and renal hypertension. Organ-preserving surgery was performed in 22 (28.9%) children and nephrectomy in 5 (6.6%) children. As long-term results: the function of the operated kidneys was satisfactory, some changes occurred in the calyxpelvic systems, and no data for pyelonephritis was found.
 CONCLUSION: Renal injuries with subcapsular rupture and perirenal urohematoma should be surgically treated to prevent severe long-term complications. In unclear cases, the choice can be a two-stage organ-preserving operation for the so-called crushing of the kidney.

Endolaryngeal resection of the larynx for adenocystic cancer

Adenocystic carcinoma accounts for 3-5% of all malignant neoplasms of the head and neck organs. Due to the rarity of detecting this cancer in the larynx, treatment options are still controversial: surgery with postoperative radiation therapy or surgery alone. Patient A., 64 years old, turned to the City Clinical Oncological Hospital No. 1 in October 2019 with complaints of moderate pain when swallowing, sensation of a foreign body. Fibrolaryngoscopy revealed an exophytic form of growth bright red color formation with a small tuberous surface up to 12 mm in size in the area of the free left edge of the epiglottis. There was a thickening of the pharyngeal-epiglottis fold. Histological examination revealed adenocystic cancer. Diagnosed with Laryngeal cancer with cT1N0M0. On December 23, 2019, endolaryngeal resection of the larynx was performed using an operating microscope in the volume R0. This observation is of interest both in morphological terms (extremely rarely detected cancer of the larynx) and in terms of treatment (an organ-preserving operation was performed - endolaryngeal resection of the larynx).

Peculiarities of Immidiate Postoperative Period in Abdominal Trauma With Splenic Injuries

INTRODUCTION. Splenic injuries in abdominal trauma is one of the most common injuries in abdominal surgery. The damage to this organ occurs in 22.3–30%. This is the second most common injury among damages to parenchymal organs.AIM OF STUDY. To study the immediate results of treatment and to determine the factors that influence the choice of tactics for open injuries of the spleen.MATERIALS AND METHODS. The study included 75 patients with abdominal wound and damaged spleen. In 54 (72%) patients, stab and slash wounds were revealed, in 21 (28%) patients there were gunshot wounds (bullet or fragment). All patients were divided into two groups: Group A included 44 (58.6%) of patients, where the time gap between the time of injury and the surgery did not exceed 1 hour, and Group B, which included 31 (41.3 %) of cases, where the time gap between the moment of injury and surgical intervention exceeded 1 hour.RESULTS. As a result of the study, it was found that organ-preserving operations for open injuries of the spleen were possible in 33.3% of cases. The choice of surgical tactics for injuries of this organ depended on the type of damage to the organ: in case of gunshot wounds of the spleen, the organ-preserving operation was not possible at all, but this operation was performed for stab/slash wounds in 33.3% of cases. The development of complications and deaths directly depended on the journey time: in the case of that time gap up to one hour, complications developed in 27.3% of cases, and the mortality rate was 15.9%. If the time of journey exceeded 1 hour, the number of complications increased to 77.4%, and mortality rate grew up to 51.6%. According to our data, the number of complications and deaths depended more on the time of admission than on the type of operation performed. In addition, it is necessary to note one more factor that affected the lethal outcome and this was the type of the wound. Therefore, as a result of the study, it was found that mortality in the group with gunshot wounds amounted to 17 out of 21 (80.95%), and for stab/slash wounds it was 6 out of 54 (11.1%). It was found that the journey time and the type of operation performed operation affected the level of D-dimer in patients with splenic injuries. So, the level of D-dimer was 566±0.3 ng/ml in the group of the wounded, delivered within an hour after trauma, and 643±0.2 ng/ml in the group where the journey time exceeded an hour.CONCLUSIONS. 1. Performing organ-preserving operations with open injuries of the spleen is possible in 46.3% of cases and only for stab and slash wounds. Organ-preserving operations cannot be performed for gunshot wounds.2. The number of complications and deaths is more dependent on the journey time to the hospital than on the type of operation performed. If a patient is admitted within an hour after trauma, the complication rate is 27.3%, and mortality rate is 15.9%. If the journey time exceeds one hour, the complication rate is 77.4% and the mortality rate is 51.6%.3. In patients splenic inguries, the journey time and the type of the operation performed affect the level of the D-dimer, which may affect the course of the immediate postoperative period.

Intraoperative Tactics of Local Surgical Hemostasis in Injuries and Planned Operations on the Parenchymal Organs of the Abdominal Cavity

Currently, mortality rate in the liver and spleen injuries remains high, despite the present-day level of advances in the diagnosis and treatment of surgical diseases. Damage to parenchymal organs leads to the development of intra-abdominal bleeding. The severity of bleeding depends on the anatomical features of the blood supply to the damaged organ and the massiveness of the lesion, the type of traumatic agent. Intraoperative provision of reliable hemostasis is a significant problem in liver and spleen injuries. This paper summarizes the experience of Russian and foreign experts on surgical treatment of various types of parenchymal organ injuries. Stitching, adhesive compositions, biological and synthetic films, non-contact methods are used to achieve the final intraoperative hemostasis for parenchymal organ injuries; electrocoagulation is also very popular. Currently, the issues of surgical treatment tactics of spleen and liver injuries are not fully resolved. The search for optimal options, as well as technical advancement of organ-preserving operation techniques involving parenchymal organs, remains relevant. This depends on the structural features of these organs, availability of the methods of local hemostasis listed in this paper and surgeon's knowledge and manual skills. Moreover, at present, hemostatic application agents are widely introduced into clinical practice, parenchymal bleeding caused by superficial planar injuries of parenchymal organs being the main indication for the use of these agents.

Diagnosis and Surgical Treatment of Orbital Tumors of Various Localizations and Histostructures.

The article reviews and analyzes the results of treatment of 32 patients with orbital tumors operated in the clinic, neurosurgery until the period from 2015 till September 2019. Goals and objectives: coverage of clinical signs and symptoms, histology, diagnostic methods and treatment of patients operated on with orbital tumors during the period 2015-2019. Determination of optimal surgical approach to the tumors with different localization for performing the radical organ-preserving surgery, with maximal saving of visual functions, minimization of oculomotor disorders, patient disability. Materials and Methods: we analyzed the clinical cases of 32 patients undergoing treatment in DOKTMO with orbital tumors for the period from 2015 till September 2019. Patients were operated on with various approaches - transcutaneous, subconjunctive (without orbitotomy), fronto-orbito-zygomatic, pterional, subfrontal (neurosurgical approaches), transmaxillary, transethmoidal (ENT approaches). The choice of surgical approaches were individual. In 2 cases we become a backset of tumor growth: one patient with aggressive adenocarcinoma, after 18 months, leading to orbital exentration and the child, 9 years old with rhabdomyosarcoma after non-radical removal of tumors of subconjunctival approach. In all other cases, relapses were not detected, operation were organ-preserving oriented. Conclusions: the results of treatment of patients with tumors directly depend on the choice of radicality tumor removal, which is associated with the choice of surgical approach, chemical, radiation treatment in postoperative period depending on the histological response. From our point of view, the most universal method for tumor removal with various localizations and sizes is fronto-orbito-zygomatic approach which provides the performance of radical organ-preserving operation with maximal vision saving, minimizing oculomotor disorders, disability of the patient, despite its technical complexity for ophthalmologist surgeons. In this regard, surgery of orbital tumors is subject to the competence of doctors of related specialties.

Organ-preserving operation in case of massive testicular rupture

The objective is to present a clinical case of blunt trauma of the scrotum with a massive testicular crush. The presented nosology, methods of diagnosis and surgical treatment is highlighted.Clinical case. Patient, 18 years old, was admitted to the clinic with acute symptoms and complaints of pain and increased size of the right part of the scrotum. Questioning revealed that 48 hours prior the patient received a blunt injury of the scrotum. Ultrasound of the scrotal organs showed that in the right part of the scrotum testicle is not clearly differentiated, in the lower pole hypoechogenic signal is observed, no blood flow was evident using the color Doppler mode, but examination of the upper pole showed weak blood flow, the epididymis was partially differentiated. Hematocele was observed. The diagnosis of injury of the scrotal organs was confirmed, traumatic injury of the right testicle. Emergency surgery was performed: necrotized areas of the lower pole of the testicle were resected, plastic sealing of the upper pole of the right testicle to the epididymis was performed. Postoperative period was free of complications. The patient was discharged on day 6 after the surgery. Control ultrasound after 3 months showed that the right testicle was smaller, its echostructure was homogenous, blood flow in the testicular parenchyma was observed. Hormonal status, blood testosterone levels, ejaculate parameters were normal.Conclusion. The presented clinical observation confirms that organ-sparing interventions for massive crush injury of the testicle with minimal volume of viable tissue are possible but patient’s age and time after injury should be taken into account.

Experience of application of nadroparin calcium in a patient with melanoma after organ-preserving surgery with musculocutaneous flap-plasty on the vascular pedicle of the defect

Patients with malignant diseases belong to the high risk group for thrombosis and pulmonary embolism development [1-3]. Any reconstructive plastic surgery in such patients has potential complications that can reduce all efforts to zero [4-6]. Antithrombotic therapy is a complex problem of modern oncology [7-9]. For a long time, all patients with subungual melanoma underwent only one type of operation – amputation [10, 11]. In order to avoid mutilating surgery and preserve the maximum functionality of the limb, we have developed and proposed an organ-preserving operation with an optimal antithrombotic approach in the postoperative period. In the present scientificpractical article the clinical observation of the patient after removal of subungual melanoma (SM) with musculocutaneous flap-plasty on the vascular pedicle of the defect with the developed optimal approach of thrombosis and thromboembolism prophylaxis with the use of fraxyparine is presented. In the case of sonodoplerographic imaging of vessels of the I finger of the left hand, the passage of a. digitalis palmaris proprius is marked. A dissection of the vascular pedicle containing a. digitalis palmaris proprius, a fragment of m. interosseus dorsalis I, subcutaneous adipose tissue with subcutaneous venous system branches along the side surface of the I finger of the left hand to the projection of the phalangeal joint was performed. Mobilized musculocutaneous flap was placed on the defect and was fixed to the wound edges. The control of the vascular pedicle permeability by means of color and energy mapping of the blood flow was performed. The control of the flap was carried out on the 7th, 15th, 21st day [12, 13]. The flap engraftment is 100 %. The patient could already write with a pen and cut paper with scissors on the 7-10th day. She is currently in full clinical remission and has returned to her working life. Without proper thrombosis prophylaxis, it would be impossible to maintain the functionality of the vascular stem and, given the nature of malignant neoplasms, to reduce the risk of thromboembolism [14-17]. Presented experience of antithrombotic therapy opens new possibilities of surgical treatment with reconstructive-plastic component in patients with malignant neoplasms.

Endocrine and metabolic consequences of surgical interventions in uterine myoma: pathogenetic characteristic

This paper presents analysis results of the research on endocrine and metabolic disorders in women who underwent surgery interventions for uterine myomas. Uterine myoma is one of the most common gynecological diseases. Main types of surgical interventions to treat uterine myomas are: hysterectomy, which is an organ-removing operation with various volume of surgical intervention: supravaginal amputation or extirpation of the uterus. Another type is myomectomy — an organ-preserving operation — when myoma nodes are removed, but the uterus and ovaries are preserved if they have no pathology. Removal of the uterus with appendages or without ovaries results in a decreasing production of estrogens, which play a key role in regulation of metabolism and various functions of the body systems. Estrogen deficiency, occurring after hysterectomy, deprives patients of a comprehensive protective effect of female sex hormones in all types of metabolism and normal functioning of organ systems. Hypoestrogenemia leads to development of a post-hysterectomy syndrome that comes out in early development of atherosclerosis, circulatory diseases, osteoporosis, psychological status disorders and urogenital disorders. Hypoestrogenemia is a key link in the pathogenesis of endocrine and metabolic disorders after hysterectomy. Endocrine disorders can be found at almost all levels of the regulatory and executive axis of the endocrine system. So far, hormonal function of the peripheral endocrine glands after myomectomy has been poorly studied. Currently available publications give no data on endocrine and metabolic disorders in patients after the myomectomy.

Pathological anatomy of reparative processes in the resected kidney treated with α-tocopherol acetate in experiment

Violation of the integrity of the kidney parenchyma during organ-preserving surgery is always accompanied by functional impairment in that part of the organ. This is due to mechanical damage to the nephron and the development of aseptic necrosis in the area of the resection, followed by development of an ischemic zone that expands during the repair process due to disrupted parenchymal cell metabolism and pressure from regenerating connective tissue.
 Objective. To investigate the effect of α-tocopherol acetate on repair processes in the kidney parenchyma after an organ-preserving operation in a rat model.
 Materials and methods. An experimental study was performed on 60 white laboratory rats that underwent resection of the lower pole of the left kidney. Postoperatively, a study group (n = 30) underwent intramuscular injections of a 10% α-tocopherol acetate oil solution, 0.2 ml 2 times a day for 5 days. A control group (n = 30) were left untreated.
 Results. Compared with the control group, animals in the study group had a narrower zone of total necrosis and less pronounced inflammation and vascular stasis on days 7, 14, and 28 after the operation.
 Conclusion. Use of the natural antioxidant α-tocopherol acetate in the postoperative period of organ-preserving kidney surgery may accelerate reparative processes in the damaged parenchyma.

Опыт диагностики и лечения внутрипочечных опухолей

Цель. Выбор оптимального метода хирургического лечения внутрипочечных опухолей и расширение показаний к органосохраняющим операциям.
 Материалы и методы. В исследование, проведенное на клинических базах кафедры урологии Азербайджанского медицинского университета - Республиканской клинической больницы имени академика Мирасадуллы Миркасимова и Центральной больницы моряков, включили 37 пациентов с внутрипочечными опухолями, которых лечили в этих клиниках в 2006 - 2016 гг. Мужчин было 17 (45,9%), женщин - 20 (54,1%).
 Результаты. У 11 (29,7%) пациентов диагностировали опухоль верхнего полюса почки, у 19 (51,3%) - нижнего, у 7 (18,9%) - среднего сегмента почки. У 26 (70,1%) пациентов установили внепочечный тип опухоли, у 11 (29,9%) - внутрипочечный с прорастанием в более глубокие слои паренхимы почки. Размеры опухолей у 24 пациентов варьировали от 2,5 до 4,0 см, у 13 - от 4,0 до 7,0 см. Резекцию почки выполнили у 20 (54,1%) пациентов (у 13 - справа, у 7 - слева), энуклеацию опухоли - у 10 (27%) пациентов (у 3 - справа, у 7 - слева), энуклеорезекцию - у 7 (18,9%) пациентов (у 4 - справа, у 3 - слева).
 Выводы. Органосохраняющие операции выполнили у всех 37 пациентов с внутрипочечными опухолями стадии T1 - T2. Успех выполненных операций зависел от своевременной диагностики, точной оценки риска, правильного выбора типа органосохраняющих вмешательств и профессионализма хирурга.

Surgical Management of Gastric Gastrointestinal Stromal Tumours: Comparison of Outcomes for Local and Radical Resection.

Gastrointestinal stromal tumours (GISTs) most commonly originate from the stomach. Their treatment is dependent on size and whether they are symptomatic. Curative treatment requires surgery, which may be preceded by neoadjuvant imatinib if it is felt that this will aid in achieving clear (R0) resection margins. The aim of this study was to evaluate outcomes from patients that underwent a “local” organ-preserving operation, with those that required a more radical resection, and the influences on selecting a more radical resection. A retrospective review of patients undergoing surgery for symptomatic gastric GISTs from a single institution over 9 years was carried out. Patients were divided into three cohorts dependent on whether they had a “local” resection, “anatomical” resection, or “extended” resection. 71 patients were included. Overall, 5-year survival was 92%. Operating time, blood loss, and length of stay were significantly lower in the group undergoing local resection (p < 0.05). Tumour size was also smaller in the local group (median 4 cm versus 5 cm p < 0.05). Tumour location also influenced the type of surgery performed, with tumours at the cardia, gastroesophageal junction, and antrum all having “anatomical” resections. Lymphadenectomy did not appear to impact on outcomes. These findings indicate that local excision, where possible, does not impair oncological outcomes.

THE IMPORTANCE OF HYALURONIC ACID IN OPTIMIZATION OF THE RESULTS OF ORGANOS-CONSERVING OPERATIONS OF TRAUMATIC DAMAGE OF TESTICLES AND RESTORATION OF THEIR FUNCTIONS

One of the many causes of male infertility are traumatic damages of the scrotum organs, which in 80 % of cases are accompanied by rupture of the testicle and epididymis. With traumatic tearing of the testicles, the optimal method is an organ-preserving operation. For reliable recovery of the spermatogenesis process, an effective method is the implantation of a 30 % solution of hyaluronic acid, which helps protect the hematotestick barrier and restore spermatogenesis.

Experience of laparoscopic organ-preserving operations in patients with benign splenic lesions

Aim: To define proper surgical tactics in patients with focal splenic lesions. Materials and methods: More than 390 patients with focal splenic lesions were treated in the clinic from 1976. Concerning surgeries the preference was given to organ-preserving operations, otherwise heterotopic autotransplantation of splenic tissue was performed. In addition to traditional access spleen resection and laparoscopic procedures were performed. Successful laparoscopic operations were performed in 67 cases. The following surgeries were performed: fenestration-41 (robotic-assisted-6), resection-23 (anatomical-6, peritumoral-14, robotic-assisted-3), echinococcectomy-2, splenectomy due to echinococcosis-1, intervention due to complicated true cysts of accessory spleen-1. The morphological structure of the spleen diseases: non-parasitic cysts-46 (true-34), benign tumors-16, hydatid disease-2. In 3 cases laparoscopic procedures required conversion because of the pronounced bleeding. Results: Taking into account the post-operative results we began to complement the commonly used argon and/or coagulation de-epithelization of the remaining part of the cyst wall with the cyst alcoholization. The worst results were found in patients after organ removal. Conclusion: When benign origin of the splenic lesion is confirmed and at least a small part of the unaffected parenchyma remains the preference should be given to organ-preserving operation with the use of modern means of hemostasis and appropriate related techniques.

Laparoscopic resection of uncinate process of the pancreas

Solid pseudopapillary neoplasm of the pancreas is an uncommon but distinctive pancreatic neoplasm with low metastatic potential [1]. Therefore, whenever feasible, an organ-preserving operation should be performed. As previously reported, women with solid pseudopapillary neoplasm of the pancreas may be best treated by more conservative procedures [2]. Recently, laparoscopic pancreatic resections became more common and are being performed in highly specialized centers. There are only six cases of laparoscopic resection for solid pseudopapillary neoplasm of pancreas published in the English literature and, to our knowledge, laparoscopic resection of uncinate process of the pancreas has never been reported [3-6]. This video demonstrates the technical aspects of a totally laparoscopic resection of the uncinate process of the pancreas in a patient with solid pseudopapillary neoplasm. A 26-year-old woman with a 4-cm solid pseudopapillary pancreatic neoplasm was referred for surgical treatment. According to preoperative echoendoscopy, there was a safe margin between neoplasm and main pancreatic duct. The patient was placed in supine position with the surgeon standing between her legs. Four trocars, one 10-mm and three 5-mm, were used. At inspection, the inferior vena cava, transverse colon, duodenum, and pancreas are clearly identified. A Kocher maneuver was performed with complete exposure of pancreatic head and uncinate process. The uncinate process was dissected from the superior mesenteric vein and venous branches were divided between metallic clips or by use of laparoscopic coagulation shears (LCS; Ethicon Endo Surgery Industries, Cincinnati, OH, USA). Blood supply of the duodenum was preserved by ligature of small pancreatic branches from inferior pancreatoduodenal artery. Transection of pancreatic parenchyma was performed using laparoscopic coagulation shears, which is an effective tool for cutting the pancreas [7, 8]. Surgical specimen was removed through a suprapubic incision inside a retrieval bag. A hemostatic absorbable tissue (Surgicel; Ethicon Inc., Cincinnati, OH) was placed in the cutting pancreatic surface, and one round 19F Blake abdominal drain (Ethicon) was left in place. Operative time was 180 minutes and blood loss estimated in 40 ml with no blood transfusion. Hospital stay was 4 days. The patient did not have postoperative pancreatitis or pancreatic leakage, and the abdominal drain was removed on the tenth postoperative day. Final pathology confirmed the diagnosis of solid pseudopapillary neoplasm of pancreas with free surgical margins. The patient was well and asymptomatic 2 months after the procedure. Laparoscopic resection of uncinate process of the pancreas is safe and feasible and should be considered for patients suffering from pancreatic neoplasms.