Patients In Postoperative Period Research Articles

Лечение пациентов с повреждениями менисков коленного сустава

The aim: to study the results of surgical treatment of patients with injuries of the meniscus of the knee joint, in whom arthroscopic suturing of the meniscus was used according to the developed technique.Methods. In this paper, we studied the results of surgical treatment of 134 patients with chronic injuries of the meniscus of the knee joint, who were treated at the City Clinical Hospital No. 7 in Almaty for the period from 2017 to 2021. 70 (52.3%) patients made up the control group, who underwent meniscus resection using arthroscopic technique. The main group included 64 (47.7%) patients with ruptures of the meniscus of the knee joint. He performed a meniscus suture under arthroscopic control according to the method developed by us (RK patent No. 35413 dated 12/10/2021). Results. Clinical application of a new method of arthroscopic meniscus suturing in patients of the main group allowed to increase the frequency of excellent results by 7.3% (p=0.012), good treatment results by 19.7% (p<0.001) according to the Lysholm scale compared with the control group. The treatment outcomes of patients in the study groups, analyzed using the criteria of evidence-based medicine, indicate the effectiveness of a new method of arthroscopic meniscus suturing, which reduces the frequency of unsatisfactory outcomes in the long-term period of surgical treatment by 5.5% (p=0.184) compared with the control group.Сonclusions.The results of the research work support the arthroscopic repair of meniscal tears with good long-term results and a low risk of complications. Thus, a new method of arthroscopic suturing of the meniscus provides prevention of the development of contractures, gonarthrosis in the postoperative period in patients with injuries of the meniscus of the knee joint and allows for early functional treatment compared to traditional arthroscopic meniscectomy.Keywords: knee joint, menisci, meniscus injury, osteoarthritis, arthroscopy, meniscus suture, meniscus resection.

Hybrid transthoracic oesophagectomy due to carcinoma with complications after COVID-19 pneumonia - A case report.

Introduction and importanceThis case report describes postoperative complications in a patient after hybrid oesophagectomy for oesophageal carcinoma after COVID pneumonia. The global COVID-19 pandemic affected cancer patients indicated for surgery. Covid 19 may worsen the results of oesophageal cancer surgery. More similar studies are needed.Case presentationA 69-year-old male was diagnosed with squamous cell carcinoma of the middle oesophagus based on PET/CT without disease generalisation. His stenotic tumour required a nutritive jejunostomy, with subsequent neoadjuvant radiochemotherapy indicated according to the CROSS protocol. The patient developed COVID pneumonia during the cancer therapy. After managing the COVID pneumonia, oncological therapy was completed and a hybrid oesophagectomy was performed 8 weeks later. Serious complications (respiratory failure, septic shock, anastomosis dehiscence) developed during the postoperative period. All complications were managed therapeutically. The patient was type IVb according to the Clavien-Dindo classification.Clinical discussionPostoperative complications may develop in any patient operated for oesophageal carcinoma, especially if high-risk predictive factors are present. The question arises as to how much the post-COVID condition affected the onset of these serious complications.ConclusionPost-COVID patients are at a risk of developing post-COVID syndrome, which may lead to a wide range of symptoms in the affected organs. Further studies on the relationship between COVID-19 and oesophagectomy for oesophageal carcinoma will be necessary to clarify the relationship between the complications during the postoperative period in patients with oesophageal malignancy.

General magnet therapy and low-frequency electrostatic field in the postoperative period in patients with breast cancer

To compare the efficacy of general magnetic therapy and low-frequency electrostatic field on days 2-4 after the radical surgical treatment of breast cancer and 1.0-1.5 months after radiation therapy in combination with therapeutic physical training, motor-cognitive training, and sessions with a psychologist. Examination and medical rehabilitation of 131 patients after radical surgical treatment of breast cancer were performed. Age ranged from 30 to 75 years. Group 1 included 66 patients who received medical rehabilitation on days 2-4 after the surgery and 1.0-1.5 months later in addition to adjuvant radiotherapy; Group 2 included 65 patients who received medical rehabilitation only after 1.0-1.5 months in addition to adjuvant radiotherapy. It was shown that two courses of medical rehabilitation with the addition of physiotherapeutic treatment on days 2-4 and 1.0-1.5 months after radical breast cancer surgery in addition to radiation therapy contribute to a significant reduction of functional disorders severity in patients versus initiation of medical rehabilitation 1.0-1.5 months after the surgery in addition to radiation therapy. The feasibility of including general magnetic therapy procedures and low-frequency electrostatic field exposure in the medical rehabilitation course was demonstrated as it results in pain relief, postoperative edema reduction, and quicker recovery of the shoulder joint mobility that promotes long-term clinical benefit.

METHODS OF SURGICAL INTERVENTIONS FOR ACUTE INTESTINAL OBSTRUCTION AND PERULICARITIES OF POSTOPERATIVE MANAGEMENT

The aim of the study was to investigate the characteristics of surgical interventions and the features of the postoperative period in patients with acute intestinal obstruction. Materials and methods. The study was based on the results of treatment of 154 patients with acute benign intestinal obstruction, who underwent various types of surgical interventions for this pathology. There were 87 men (56.5%) and 67 women (43.5%), their age ranged from 18 to 78 years; most of the patients were residents of Baku (124 patients, 80.5%), 30 patients (19.5%) were residents of the regions of the Azerbaijan Republic. Results. Sigmoid colon resection was performed on in 25 patients (16.2% of cases); resection of various parts of the small intestine was performed on in 26 patients (16.9% of cases). To determine the boundaries of viable parts of the intestine and the extent of resection in the patients, the common and classical criteria were used: pulsation of the mesentery vessels, the presence of peristalsis, and colour of the serous covering after warming of an intestinal segment of questionable viability with hot wet wipes. Hagen-Thorn surgery was usually performed on in elderly patients with acute intestinal obstruction as a result of sigmoid colon inversion that made up 8.4% of all operations performed. Subtotal colectomy with ileorectoanastomosis was performed on in 7 patients (4.6% of cases). Operations of the Hartmann type despite the aetiology were performed in 31 patients (20.1% of cases). Right-sided hemicolectomy with ileotransverse anastomosis was performed in 4 patients (2.6% of cases). Enterotomy with the removal of stones or foreign bodies followed by suturing of the defect in the intestinal wall was performed in 5 patients (3.3% of cases).All the patients were subject to one of the main stages of intra-abdominal intervention – the simultaneous intraoperative decompression of the intestinal tract by evacuating the contents using one of the generally accepted standard techniques (by using intestinal tube, emulging, enterotomy, etc.). Conclusions. Although the duration of the preoperative preparation itself was individual for each patient and depended on the specific circumstances, in general, it was 3.6±0.8 hours in the patients with acute intestinal obstruction. During this short time, infusion therapy was performed on in all patients, a nasogastric tube was also inserted to all patients and, when possible, more stagnant contents were emulged out of the upper digestive tract. Cardiac functioning was corrected when necessary; the measures to reduce the intensity of intoxication, including antibacterials, were performed. In special cases, during the short-term preoperative preparation of the patients, additional medication correction of concomitant diseases was mandatory. To prevent the development of thromboembolic complications in the early postoperative period, all patients were required to take the necessary preventive measures before and after the surgical intervention.

Прогнозування ризику розвитку післяопераційної злукової кишкової непрохідності в дітей

Прогнозування ризику розвитку післяопераційної злукової кишкової непрохідності в дітей

Особливості післяопераційного періоду у хворих на хронічний дакріоцистит та цукровий діабет 2-го типу після проведення ендоскопічної ендоназальної дакріоцисториностомії залежно від ступеня компенсації цукрового діабету

The aim. To identify the features of the postoperative period in patients with chronic dacryocystitis and type 2 diabetes mellitus (DM2) after endoscopic endonasal dacryocystorhinostomy (DCR), depending on the degree of compensation of DM. Materials and methods. The study involved 30 DM2 patients with chronic dacryocystitis who underwent endoscopic endonasal DCR according to standard methods. The patients were divided into groups according to the degree of compensation of DM2: 6 patients with compensated, 7 patients with subcompensated and 17 patients with decompensated DM2. The results of the operation were evaluated after 2 months, 6 months and 2 years. In addition to standard methods, ophthalmic examination included nasolacrimal duct probing, lacrimal duct lavage, and endoscopic examination of the nasal cavity. Results and discussion. The efficiency of endoscopic endonasal DCR in decompensated DM2 after 2 months (58.8 ± 11.9 % of patients) on average was 1.4 times, and after 6 months (52.9 ± 12.1 % of patients) and 2 years (41.2 ± 11,9 % of patients) – it was 1.5 times less than that in subcompensated and compensated DM2 (p < 0.05). In patients with decompensated DM2, tearing was observed in 41.2 ± 11.9 % of patients after 2 months, in 47.1 ± 12.1 % of patients after 6 months and in 58.8 ± 11.9 % of patients after 2 years post-op, which was, on average, 2.7 times, 2.1 times and 1.5 times more often than that in subcompensated and compensated DM2, respectively (p < 0.05); there were no significant differences between the values (p > 0.05). Conclusions. Features of the postoperative period in patients with chronic dacryocystitis after endoscopic endonasal DCR depend on the degree of compensation of DM2. The efficiency of endoscopic endonasal DCR in decompensated DM2 after 2 months is on average 1.4 times, and after 6 months and 2 years it is 1.5 times less than that in subcompensated and compensated DM2. Keywords: type 2 diabetes mellitus, degree of compensation of diabetes mellitus, chronic dacryocystitis, efficiency of endoscopic endonasal dacryocystorhinostomy, features of postoperative period.

A nomogram model can predict the risk of venous thromboembolism in postoperative patients with gynecological malignancies.

To explore independent factors influencing the risk of lower extremity deep vein thrombosis during the postoperative period in patients with gynecological malignancies by constructing a predictive model. In our study, we collected 573 patients with gynecological malignancies in the postoperative period between September 2016 and September 2020, who were divided into a modeling (n=402) and verification group (n=171) according to a ratio of 7:3. Univariate and multivariate regression analyses were used to determine independent factors influencing deep vein thrombosis (DVT). A nomogram model was created and a risk score was calculated. Multivariate regression analysis showed that the independent factors affecting DVT among these patients included age, hyperlipidemia, abnormal uterine bleeding, degree of anemia, D-dimer, operation time, and intraoperative blood loss. By incorporating these factors into a nomogram, we determined that the C-index and calibration curve of the two groups both showed that the model distinguishes and fits well. Further comparing between the high- and low-risk groups, we found that the model has favorable predictive performance. The predictive nomogram for the risk of DVT in patients with gynecological malignancies in the postoperative period demonstrated good calibration and recognition accuracy. Further independent research is necessary to verify our results.

VAK-therapy as a variant of local treatment of destructive forms of erysipelas

Purpose of the study. Improve postoperative treatment of phlegmonous and necrotic forms of erysipelas by alternating HAC therapy of wounds and staged necrectomies, reduce the time of cleaning and preparation of the wound for dermatoplasty.
 Materials and metods. The results of treatment of 87 patients with complicated forms of erysipelas who were treated in the purulent-septic center of KNP «City Hospital № 3» in Zaporozhye for the period 2020–2021 were analyzed.
 Results. The effectiveness of treatment, including topical therapy, was evaluated by improving laboratory parameters (leukocyte formula), the number of microbial bodies per 1g of tissue and the duration of wound cleansing. In the phlegmonous form of erysipelas, normalization of the leukocyte formula was observed on day 3, which is probably faster than among patients in the control group – on day 4 (t = 4,01375; P = 0,000182). In patients with necrotic form of erysipelas in the main group, the normalization of the leukocyte formula occurred probably faster, almost 2 days, than in the control group – 4 and 6 days, respectively (t = 2,16682; P = 0,042499). At the same time there was a decrease in microbial contamination of wounds. The terms of wound cleansing in the postoperative period in patients of the main group were probably shorter than in patients of the control group – by 1,87 ± 0,23 days in phlegmonous form (t = 3,75213; P = 0,000320) and 2,89 ± 0,34 in necrotic (t = 2,33969; P = 0,026659).
 Conclusion. Improvement of postoperative local treatment of patients with phlegmonous and necrotic forms of erysipelas allowed to significantly reduce the length of stay of patients in the hospital by 3,26 ± 0,43 days (t = 6,47461; P < 0,000001).

Differentiated approach to surgical treatment of adrenal glands tumors

Objective – to improve the results of treatment of adrenal tumors by optimizing a differentiated approach based on the analysis of the results of various surgical invasions. The paper analyzed the results of treatment of 145 patients with various adrenal tumors, which were divided into 2 groups: І (n=71) - patients after adrenalectomies, II (n=74) – after adrenal resections. Organ-preserving invasions showed better results during the early and long-term postoperative period in patients with corticosteromas, pheochromocytomas and incidentalomas by reducing the severity of fluctuations in hemodynamic parameters and the frequency of adrenal insufficiency. Due to the introduction of the treatment algorithm, the number of adrenal resections increased by 26.6% in patients with neoplasms more than 4,0 cm in diameter (p=0.0001). The choice of surgical invasion should be individualized, taking into account the clinical features of the disease, hormone indicator parameters, the size of tumors, the comprehensiveness of the adrenal gland lesion and the ratio of the latter to nearby organs and structures. Adrenal insufficiency was detected 14.2% more often after adrenalectomies (р=0.044) compared to adrenal resections. Treatment according to the developed algorithm reduced the incidence of adrenal insufficiency by 5.8% (p=0.028). In the long-term postoperative period, contralateral gland tumors occurred with the same frequency (4.8%) among patients after adrenalectomies and resections. Relapse of the neoplasm after resections was detected in 3 (7.1%), as a result of which 2.4% underwent repeated operations with the final removal of the gland. An increase in the size of a single adrenal gland was more common by 21.4% after adrenalectomies.

Analysis of the Major Factors Affecting the Course of the Immediate Postoperative Period with Stab and Cut Wounds of the Heart in a Multidisciplinary Surgical Hospital

Introduction. Heart injury can be attributed to one of the most severe traumas. According to the data presented in the literature, such wounds are not common and account for 5-7% of the total number of wounds that penetrate the pleural cavity. However, despite rare incidence, such injuries are accompanied by a fairly large number of complications reaching 47.9%, and lethality at the level of 34.1%. This is due to the fact that diagnosis of such injuries causes some difficulties, and various methods including thoracoscopy are currently proposed to solve them. The issue of diagnostics and treatment of heart injuries has received much attention in the literature, but this problem has not been completely solved, since there are many factors that influence the course of the immediate postoperative period with such injuries.
 The aim of the study was to analyse major factors that affect the course of the immediate postoperative period in patients with stab-cut heart injuries.
 Materials and methods. The study involves a retrospective analysis of the immediate postoperative period of 86 patients operated for a penetrating chest wound with the heart and pericardium wound. Patients were treated in the surgical department of "Emergency Medical Hospital of Engels" from 1988 to 2019. Of the total number of patients, 76 (88,3%) were male and 10 (11,6%) were female. It should be noted that the majority of males - 47 - were in a state of alcoholic intoxication of varying severity.
 Results. According to the analysis, out of 86 patients admitted to the medical facility on an emergency basis, 73,2% were included in group A, 26.7% of the wounded were included in group B. The data demonstrated that the vast majority of the wounded were delivered as soon as possible from the moment of injury, which could not but affect the course of the immediate postoperative period. It should be noted that 72,1% of the wounded were delivered by ambulance, 27,9% of patients by the meeting traffic. In the group of wounded who were delivered by the meeting transport, and who were provided first aid by non-medical workers, the results were significantly worse. In patients of this group, first aid was provided to only 13,9% of the wounded, in all cases it was wound processing and the aseptic bandage application, and in 10.5% of cases the first aid can be described as inadequate. When analyzing the course of the immediate postoperative period, we found that the development of complications was noted in 45,3% of patients. The distribution of the number of complications by groups showed that the largest number was 25,6% in group B, in group A complications were noted in 19,8% of cases. Further analysis showed that the number of complications in two groups directly depends on the severity of the condition of the wounded at the time of admission. The main complication that developed in the postoperative period in operated patients was purulent septic complications, noted in 22,1% of the wounded. The largest number of complications - 12.8% - was detected in group A, in group B such complications developed in 9.3% of cases. Of the total number of patients admitted with heart injuries, 23.2% of patients died. The mortality rate was 6.9% in group A, and 16.3% in group B.
 Conclusion. Based on the analysis, it can be concluded that the heart injury is accompanied by a large number of complications in the immediate postoperative period - 45.3% and deaths - 23.2%. Among the major factors contributing to the development of complications and deaths are the following:
 
 Timely, complete and competent assistance at the pre-hospital stage.
 The condition and severity of damage to the wounded at the time of delivery.
 The use of Damage Control tactics in cases where the condition of the wounded person at the time of admission is severe or extremely severe.

Letter to the Editor Regarding “Reduced Pain and Opioid Use in the Early Postoperative Period in Patients Undergoing a Frontotemporal Craniotomy under Regional versus General Anesthesia”

Letter to the Editor Regarding “Reduced Pain and Opioid Use in the Early Postoperative Period in Patients Undergoing a Frontotemporal Craniotomy under Regional versus General Anesthesia”

Endolaryngeal surgery of benign vocal fold lesions with a 445 nm semiconductor laser: postoperative management

Introduction. Today the high prevalence of benign vocal fold lesions is shown (up to 55-70%). The possibilities of surgical management of this pathology are very extensive. Laser technologies are becoming more and more popular among high-tech treatment methods. However the comprehensive postoperative management of these patients is equally important.The aim of the study was to assess the features of the postoperative period in patients undergoing the endolaryngeal surgery using a semiconductor laser with a wavelength of 445 nm.Material and methods. On the basis of Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech from February to June 2021 20 patients with benign vocal fold lesions 6 women and 14 men from 24 to 67 years old were examined and treated. All the patients underwent endolaryngeal surgery with direct microlaryngoscopy using a new semiconductor 445 nm laser in an inert gas atmosphere (intraoperative helium supply). After surgical treatment, the patients observed vocal rest, received antiinflammatory, antibacterial therapy, inhalations, as well as the drug Homeovox® according to the standard scheme.Conclusion. Endolaryngeal surgery with the removing of benign vocal fold lesions using a semiconductor laser with a wavelength of 445 nm has been proven to be safe and effective. According to the results of video laryngostroboscopy, acoustic analysis of the voice (the questionnaire “Voice handicap index-30”) it was noted that the laryngeal functions were restored in a short time. The inclusion of Homeovox® in the complex postoperative treatment had a favorable effect on the restoration of the phonatory function.

Role of Cardio-Biomarkers (NT-Pro BNP and Troponin I) in Cardiac Risk Stratification of Patients Undergoing Major Vascular Surgeries

Objective: The objective is to assess the role of cardio-biomarkers, namely, N-Terminal Pro-hormone Beta Natriuretic Peptide (NT-ProBNP) and Cardiac Troponin I (cTnI) in prediction of postoperative cardiac events (POCEs) in noncardiac patients undergoing major vascular surgery and compare their efficacy with Revised Cardiac Risk Indices (RCRI) in preoperative period. Materials and Methods: Quantitative analysis of cTnI and NT-ProBNP was done in pre- and post-operative period in patients, who underwent elective major vascular surgeries between April 2018 and April 2020 at a tertiary care hospital. The ability of both the cardio-biomarkers, either alone or in combination were assessed for the prediction of POCE and results were compared with RCRI in preoperative period. The relationship between postoperative quantitative values of both the biomarkers and development of POCE were also analyzed. Results: A total of 170 patients were enrolled and the incidence of POCE was observed in 15.9% (27) of our patients. The “cut-off” values of cTnI, and NT-ProBNP in preoperative period were found to be 0.011 μg/L and 335 pg/mL and in postoperative period were 0.024 μg/L and 438 pg/mL, respectively. In preoperative period, biomarkers, either alone or in combination, outperformed RCRI in prediction of POCE and when individual biomarker was assessed, NT-ProBNP had better efficacy than cTnI. In postoperative period, predictive ability of both the biomarkers were similar, however, combination of both significantly improved the prediction of POCE as represented by increase in area under the curve, sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy. Conclusion: As compared to RCRI, cardio-biomarkers were better predictor of POCE in preoperative period and their efficacy in forecasting POCE continued even in postoperative period.

Serial change in perfusion\u2013metabolism mismatch after coronary artery bypass grafting

ObjectiveMyocardial ischemia is known to suppress fatty acid metabolism and favor glucose metabolism. However, changes in myocardial metabolism after coronary revascularization are not fully elucidated.MethodsThirty-eight patients with coronary artery disease were retrospectively enrolled. These patients had undergone stress perfusion single photon emission computed tomography (SPECT) and 123I-BMIPP SPECT in both the short-term (6.4 ± 4.7 months) and mid-term (29.9 ± 7.2 months) after isolated coronary artery bypass grafting. Tracer uptake was graded using a 17-segment, 5-point scoring model. Serial changes in SRS (summed rest score), SDS (summed difference score), the BMIPP score (total defect score of BMIPP), and the mismatch score (BMIPP score–SRS) were evaluated. In addition, persistent perfusion–metabolism mismatch (PM) was defined as mismatch score minus SDS of 3 or more during the mid-term postoperative period. The clinical parameters associated with PM were examined.ResultsFrom short- to mid-term postoperative period, the extent of infarcted myocardium (SRS) did not change significantly (7.8 ± 8.0 to 7.1 ± 7.0, P = 0.117). The extent of ischemic myocardium (SDS), the BMIPP score and the mismatch score, which reflects perfusion–metabolism mismatch, were significantly improved (2.0 ± 2.8 to 0.7 ± 1.0, P = 0.010; 12.2 ± 9.0 to 9.5 ± 7.9, P < 0.001; 4.4 ± 3.7 to 2.5 ± 2.6, P < 0.001; respectively). Remarkably, perfusion–metabolism mismatch persisted in 13 patients (34%) even in the mid-term postoperative period. eGFR and SYNTAX score were independent predictors of persistent perfusion–metabolic mismatch in multivariable analysis (OR = 0.951, 95% CI 0.898–0.985, P = 0.010 and OR = 1.126, 95% CI 1.011–1.254, P = 0.031, respectively). The mismatch score both in the short- and mid-term significantly correlated with SYNTAX score (r = 0.400 and r = 0.472, respectively).ConclusionsFatty acid metabolism disturbance improved from short- to mid-term postoperative period in patients with successful reperfusion by coronary artery bypass grafting. However, in patients with severe atherosclerosis, impaired fatty acid metabolism was sustained until the mid-term postoperative period, even though ischemia had resolved.

EFFECTS OF BONE AUGMENTATION MATERIALS ON PECULIARITIES OF POSTOPERATIVE PERIOD IN PATIENTS AFTER IMPACTED THIRD MOLAR EXTRACTION AND THEIR CLINICAL EFFICIENCY

The article presents a comparative analysis of the clinical effectiveness of bone augmentation materials, in particular, compositions including multipotent mesenchymal stromal cells of adipose tissue and platelet-enriched plasma, used to fill bone defects during the operation of third molars extraction. The criteria for the effectiveness of treatment at the stage of the early postoperative period in the participants included the assessment of the pain intensity, collateral oedema and hyperaemia of the oral mucosa after the surgery. The aim of the study is to determine the clinical efficiency of osteoplastic materials and to determine the feasibility of using tissue equivalents of bone tissue based on multipotent mesenchymal stromal cells of adipose tissue for healing of bone defects in patients with impacted third molars. Methods and participants. The study was conducted on the basis of the Department of Surgical Dentistry and Maxillofacial Surgery of Bukovynian State Medical University, Chernivtsi, Ukraine. Extraction of impacted third molars surgery was performed on 72 patients. After the tooth extraction, 31.94% of them underwent bone augmentation by osteoplastic material “Colapan–L” (group A); 41.67% of patients had bone augmentation with a combination of multipotent mesenchymal stromal cells of adipose tissue+”Colapan–L”+platelet-rich plasma (group B), and in the rest, 26.39% of patients, wound healing occurred under a blood clot (group C). Postoperative pain syndrome was assessed using the Numerical Rating Scale (NRS) based on patients' subjective feeling of pain. Visual assessment of the severity of collateral oedema and hyperaemia of the oral mucosa after surgery was also performed. A scoring system was used to determine the severity of collateral oedema. To assess the state of the postoperative period in patients of all study groups, a protocol was completed daily during the hospital stay period that reflected the most important data of an objective and subjective nature.&#x0D; During the procedure of morning dressings, we analyzed patients' complaints and evaluated general and local status: presence of appetite, quality of sleep, wound pain, postoperative oedema, hematoma, and hyperaemia of the oral mucosa, presence of secretions from the wound, body temperature, and type of wound healing. The study has demonstrated that at the final stage of postoperative follow-up the 89.31% of patients who received a combination of “Colapan–L” with multipotent mesenchymal stromal cells of adipose tissue and platelet-rich plasma reported no pain that is 1.2 times p1&lt;0.05 and 1.3 times p2&lt;0.05 higher than in the patients of groups A and B. Collateral oedema was absent in 98.47% of the group B patients that exceeded 1.2 times p1&lt;0.05 the number of such individuals in group A, where the bone defect was augmented with the osteoplastic material “Colapan–L”, and in 1.4 times higher, p1&lt;0.01, p1&gt;0.05 that the indicators of group B, where the healing of the bone defect developed without osteoplastic materials. The absence of hyperaemia of the oral mucosa was found in 92.37% of the patients in groups B, which was 1.3 and 1.4 times higher than the values obtained in groups A and B, p1&lt;0.05, p2&lt;0.01.

Vladimir Alexi‐Meskishvili (1941–2021)

Vladimir Alexi‐Meskishvili (1941–2021)

Constrictive pericarditis: portal, splenic, and femoral venous Doppler pulsatility: a case series.

Pulsatile flow of the portal vein has been implicated as an indicator of right ventricular dysfunction in cardiac patients. In patients with significantly elevated right atrial pressure, pulsatile venous flow may be transmitted to the portal, splenic, renal, and femoral veins. We describe the evolution of these echocardiographic findings in four patients with constrictive pericarditis (CP) undergoing pericardiectomy with simultaneous hemodynamic waveform and cerebral oximetry monitoring in the operating room and in the intensive care unit. Patient 1 presented classic signs of CP, including equalization of left and right diastolic pressures, a "square root" sign on the diastolic portion of the right ventricular pressure curve, and elevated right atrial pressure. Preoperative transesophageal echocardiography showed a hyperdynamic left ventricle and dilated right ventricle with abnormal pulsatile waveforms in the portal and splenic veins. Surgical decompression of the pericardium gradually normalized the Doppler waveforms. Increased venous return following pericardiectomy during surgery in patients 2 and 3 and during the postoperative period in patient 4 resulted in right ventricular (RV) failure due to significantly increased preload. Venous pulsatility was also observed in the portal, splenic, and femoral veins. In patients with CP, changes in hemodynamic and echocardiographic signs of RV dysfunction are rapidly reflected by changes in peripheral venous velocities. Identifying signs of splanchnic and peripheral vascular venous congestion could help identify patients at higher risk of developing postoperative complications following pericardiectomy.

Evaluation of the Effectiveness of Using the Post-Isometric Relaxation (PIR) Technique and Exercises on the Mechanotherapy Apparatus in the Postoperative Period in Patients with Damage to the Rotator Cuff of the Shoulder

Objective: to evaluate the effectiveness of performing exercises on an innovative mechanotherapy apparatus and the PIR technique for the recovery of patients with damage to the rotator cuff of the shoulder at the postoperative stage.&#x0D; Materials and Methods. The study involved 46 patients after arthroscopic intervention due to damage to the structures of the shoulder joint. The reasons for arthroscopic intervention were: adhesive capsulitis (3 patients), damage to the rotator cuff of the shoulder (39 patients), and impingement syndrome (4 patients). The average age of patients was 44.7±8.3 years. All patients were divided into 2 groups: the control group (CG, n=21) and the main group (MG, n=25). The beginning of rehabilitation among patients averaged 4.9±2.4 weeks after the surgery. The duration of treatment was 4.5±3.2 weeks. The study was carried out on the basis of the Department of Rehabilitation of the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” during 2020-2021.&#x0D; Results and Discussion. According to the VAS results, the pain level after the rehabilitation program significantly decreased in both groups (p&lt;0.05). In the MG, the dynamics of pain syndrome according to the VAS ranged from 6.2±1.2 cm to 0.9±0.7 cm 6 weeks after the surgery. In the CG, the majority of patients also noted an improvement in the level of pain after surgery (from 6.5±1.1 cm to 1.1±1.2 cm); no significant differences after treatment in terms of the level of pain between the patients in the MG and the CG (p&gt;0.05) were observed. Also, patients who were included in the main group and did exercises with a simulator and elements of PIR according to the rehabilitation program showed generally better indicators of recovery of the function of the shoulder joint, namely there was a higher dynamics in increasing the amplitude of movements in the shoulder joint (112.5±10.60 flexion before physical rehabilitation (PR), 173.2±5.50 after РR). In the CG, the positive dynamics was less pronounced (107.7±6.80 flexion before PR, 151.2±6.50 after PR). Similar results were found according to the data of manual muscle testing (MMT).&#x0D; Conclusions. Therefore, the method of post-isometric muscle relaxation using the proposed technique of training on a mechanotherapy apparatus for developing the shoulder joint is an effective method for treating postoperative contractures and can be recommended for the use in the complex rehabilitation of patients with contracture of the shoulder joint as a result of arthroscopic intervention in patients with injury of the rotator cuff of the shoulder.

The role of cytokines in the pathogenesis of infectious complications in surgical treatment of obstructive jaundice of gallstone origin

Aim. To study the content of cytokines in the blood serum of patients with obstructive jaundice of gallstone origin before and after surgical treatment, depending on the development of postoperative complications.Materials and methods. The treatment group consisted of 70 patients with the diagnosis of obstructive jaundice of gallstone origin, verified following a comprehensive clinical and instrumental examination. In 54 patients, the postoperative period was uncomplicated, and in 16 patients, various infectious complications in the postoperative period were revealed. The control group consisted of 125 healthy volunteers. The concentration of six cytokines (interleukin (IL)-2, IL-4, IL-18, IL-10, tumor necrosis factor alpha (TNFα), and interferon gamma (INF γ)) was determined using reagent kits manufactured by Vector-Best LLC (Novosibirsk, Russian Federation) by enzyme-linked immunosorbent assay on the Thermo Scientific analyzer (BioMerieux, France).Results. We identified significantly high concentrations of proinflammatory cytokines in the blood serum of patients with obstructive jaundice of gallstone origin upon admission, compared with the data obtained in the study of blood serum in the control group and in patients with obstructive jaundice after surgery. In the postoperative period in patients with obstructive jaundice without complications, the proinflammatory cytokines are significantly reduced and IL-4 is increased, whereas with the development of infectious complications, the level of proinflammatory cytokines is significantly elevated.Conclusion. In the pathogenesis of obstructive jaundice, a local inflammatory process plays an essential role. This is confirmed by statistically significant changes in the studied cytokines. The established increase in the concentration of IL-4, which has anti-inflammatory activity, indicates its importance in the mechanisms underlying the absence of infectious complications in the postoperative period of obstructive jaundice of gallstone origin. The revealed increase in the levels of IL-18, TNFα, and INFγ in the blood serum of patients suggests their role in the pathogenesis of infectious complications in the postoperative period of obstructive jaundice of gallstone origin.

LONG-TERM RESULTS AFTER VIDEO ENDOSCOPIC MYOTOMY BY HELLER WITH FUNDOPLICATION BY DOR IN PATIENTS WITH 2-4 STAGES OF ACHALASIA

Relevance. Treatment of achalasia of the cardia (AС) is currently palliative, aimed at reducing the manifestation of clinical symptoms of the disease. Together with instrumental methods of examination of esophageal function, the Eckardt scale and the GIGLI questionnaire are convenient and simple tools for evaluating results in the long-term postoperative period.The aim of the study was to evaluate the long-term results of surgical treatment of patients with 2-4 stages of AС, after laparoscopic Нeller myotomy with anterior hemiesophagofundoplication by Dor to the results of special methods of esophageal examination and patient questionnaires using the Eckardt scale and the GIGLI questionnaire.Materials and methods. The work included the results of examinations of 103 patients who underwent video laparoscopic Нeller myotomy, with anterior hemiesophagofundoplication by Dor. The period of examination in the postoperative period was from 3 to 7 years. The results of X-ray examination of the esophagus and stomach, manometry of the esophageal and esophageal-gastric junction before and after surgery were studied , and patients were also surveyed according to the Eckardt scale and the GIGLI questionnaire.Results. The analysis of the results of instrumental methods of studying the function of the esophagus in the pre – and postoperative periods showed that the given manometry of the esophagus and esophageal-gastric junction, X-ray of the esophagus and stomach significantly improved in the postoperative period in patients with all stages of the disease. The results of patients of 4th stage AC compared with the results of 2nd and 3rd stages patients were worse(p&lt;0,05).The leading symptom of AK-dysphagia in the long-term postoperative period decreased in all the studied patients, the results were better in patients with stage 2, worse in patients with stage 4 of AK (p&lt;0,05).The leading symptom of AK-dysphagia in the long-term postoperative period decreased in all the studied patients, the 2nd stage patients results were better, 4th stage patients results were worse (p&lt;0,05).Conclusions. After video-endoscopic Нeller myotomy with fundoplication by Dor, the indicators of esophageal manometry and esophageal and stomach radiography significantly improve, the results of the Eckardt scale and GIGLI questionnaire survey of patients show a significant decrease in the severity of clinical manifestations of AC in the balls. This method of surgical treatment can be recommended already at the 2nd stage of AC and as an organpreserving operation for 4th stage.