Postoperative Period Research Articles

EVALUATING GLIOMA PATIENT PERCEPTIONS TOWARDS REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION FOR REHABILITATION

Abstract AIMS Repetitive Transcranial Magnetic Stimulation (rTMS) is established for depression, chronic pain, and motor rehabilitation after stroke. It is an emerging tool for other purposes including cognitive rehabilitation. Recent evidence supports its use for motor rehabilitation after brain surgery. We sought to evaluate patient perceptions towards rTMS. METHOD Two studies were undertaken. Group 1 – patients who received seven days of rTMS for motor rehabilitation for post-operative weakness (MRC 0-1 in any limb) following resection of a glioma or other resective pathology were prospectively surveyed on the last day of their rTMS treatment, as well as their next of kin (NOK). Group 2 – patients who had previously been treated for a glioma but did not receive rTMS were retrospectively surveyed through two brain tumour charities, as well as their NOK. RESULTS Group1: 21 responses. 11 patients, 10 NOK. Commonest pathology was glioblastoma(n=3). Group2: 24 responses. 16 patients, 8 NOK. Commonest pathology was grade 2 glioma(n=7). Most Group1 respondents reported a positive experience with rTMS(n=15). Group1 patients experienced substantial subjective improvements in motor functioning(n=6), some improvements(n=3), or no change(n=2). None reported worsening. Experiencing adverse symptoms (e.g. headache) was associated with reduced likelihood of motor improvements(p=0.01). Most improvements were in gross rather than finer motor domains. Patients in Group2 were accepting of longer and more frequent rTMS sessions than Group1(p=0.03 and p=0.01 respectively). The commonest concerns raised pertained to seizures, side effects, and geographic availability. The commonest hope raised pertained to cognitive or motor improvements. CONCLUSION rTMS is well-tolerated and patients and their NOK support its use. Respondents would find longer and more sessions acceptable. Understandably, there is less tolerance for rTMS in the early post-operative period. However, enthusiasm for rTMS is substantial in the later stable post-operative phases. Our findings support the further development of rTMS as a tool for improving patient rehabilitation.

Perioperative changes of serum interleukin 6 levels in elderly male patients with intertrochanteric fracture

To investigate the perioperative changes in serum interleukin 6 (IL-6) levels in elderly male patients with intertrochanteric fractures, and provide evidence for inflammatory control in this patient population. The clinical data of 40 male patients aged more than 60 years with intertrochanteric fractures who met the selection criteria between January 2021 and December 2022 were retrospectively analyzed, including 25 non-osteoporosis patients (T value>-2.5, group A) and 15 osteoporosis patients (T value≤-2.5, group B). In addition, 40 healthy men aged more than 60 years old were included as controls (group C) according to the age matching rule. There was no significant difference in age, smoking history, drinking history, body mass index, complications (hypertension and diabetes), alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, and total protein among the 3 groups ( P>0.05). Serum samples were collected from group C subjects and from groups A and B patients preoperatively and on postoperative days 1, 3, 5, and 7. IL-6 levels were measured using ELISA assay. Pearson correlation analysis was used to assess the relationship between IL-6 levels and T values at various time points in groups A and B. Postoperative complications during hospitalization and 1-year mortality rates were recorded for groups A and B. Preoperative IL-6 levels were significantly higher in groups A and B than in group C ( P<0.05), with group B being significantly higher than group A ( P<0.05). In groups A and B, IL-6 levels increased significantly on postoperative day 1 compared to preoperative levels and then gradually decreased, approaching preoperative levels by postoperative day 7. IL-6 levels in group B were significantly higher than those in group A at all postoperative time points ( P<0.05). Correlation analysis showed that IL-6 levels were negatively correlated with T values at all perioperative time points in all patients from groups A and B ( P<0.05). Complications occurred in 4 patients (16.0%) in group A, including 2 cases of pulmonary infection, 1 case of urinary tract infection, and 1 case of heart failure, and in 3 patients (20.0%) in group B, including 2 cases of pulmonary infection and 1 case of gastrointestinal bleeding. There was no significant difference in the incidence of complications between the two groups ( χ 2=0.104, P=0.747). There were 2 cases (8.0%) and 4 cases (26.7%) died within 1 year after operation in groups A and B, respectively, and there was no significant difference in 1-year mortality rates between the two groups ( χ 2=2.562, P=0.109). Serum IL-6 levels significantly increase in the early postoperative period in elderly male patients with intertrochanteric fractures, especially in those with osteoporosis. Monitoring the inflammatory state and promptly controlling the inflammatory response during the perioperative period, may reduce complications and improve postoperative survival in this patient population.

ДЛИТЕЛЬНАЯ ПЕРСИСТЕНЦИЯ SARS-CoV-2 У ПАЦИЕНТА С ИНФЕКЦИОННЫМ ЭНДОКАРДИТОМ И COVID-19: КЛИНИЧЕСКИЙ СЛУЧАЙ

The literature contains isolated data on long-term persistence of the virus in the body in immunocompromised patients. The aim – to present a case of long-term persistence of SARS-CoV-2 in a patient with infective endocarditis. We retrospectively analysed the results of PCR assays for COVID-19 in a patient diagnosed with primary infective endocarditis and COVID-19. Despite the given therapy, the persistence of the virus in the patient amounted to 35 days. It was caused by infective endocarditis, a disease accompanied by changes in the organism's reactivity and immune response. COVID-19 affected the course of the postoperative period.

POSTOPERATIVE VISUAL fiELD DEfiCITS ARE NOT ASSOCIATED WITH REDUCTION IN QUALITY OF LIFE IN GLIOBLASTOMA PATIENTS

Abstract AIMS Preservation of functional integrity is a core goal of glioblastoma surgery. Visual field deficits can significantly impact quality of life and patient function. Both tumour and surgical effects may affect visual function in these patients. The objective of this Study was to evaluate the effect of visual field deficits on HRQoL in the preoperative and early postoperative period (prior to chemoradiotherapy). METHOD 48 patients with glioblastoma received preoperative, early postoperative (withon 1 week) and delayed postoperative testing (6 weeks) for visual function usinga combination of the OCS-Bridge neurocognitive screening tool and formal visual field testing. Patients also completed the EORTC QLQ C30 with BN-20 and VFQ-25 visual function questionaires at the same timepoints. Statistical tests were performed using R Statistical Software (v4.1.2; R Core Team 2021). RESULTS The proportion of patients with visual field deficits at preoperative, early postoperative and late early postoperative timepoints were 20 (41.7%), 28 (58.3%) and 24 (50%) respectively. Most patients without a preoperative deficit did not have an early 17/20 85% or late postoperative deficit 19/24 79.1%. The proportion of patients with deficits at early and late postoperative timepoints was significantly higher in patients with preoperative deficits compared to patients without preoperative deficits, (Chi square p = 0.004) and (p = 0.008) respectively. There was no significant differences between HRQoL measures between timepoints or between patients with deficits at any timepoint compared to patients without deficits. CONCLUSION Postoperative visual field deficits are related to preoperative tumour-effects rather than surgery. Patients can be counselled that while they do not recover following surgery, it is not associated with significant reductions in HRQoL. Patients with preoperative visual field deficits may be considered for resection without significant worry about the preservation of visual field function since these deficits do not recover postoperatively.

The impact of single-port robotic surgery: a survey among urology residents and fellows in the United States.

Our aim was to investigate the perception and future expectations of Single-Port (SP) surgery among urology trainees in the United States. A 34-item online survey was distributed to urological residency and fellowship programs across the US, covering demographic profiles, SP training opportunities, perceived educational impact, and future perspectives. Descriptive analysis and multivariable linear regression were used to assess predictors of SP adoption. 201 surveys were completed (28.6% completion rate). Among institutions with an SP platform, about 50% have used it regularly for over 2 years, though often in less than 50% of procedures. While robotic simulators are commonly available, only 17% offer both multi-port and SP simulators, and structured pre-clinical SP training is limited. Approximately 30% of respondents expressed concerns over limited hands-on experience and a steeper learning curve with SP. Around 40% felt that their robotic surgery exposure was negatively impacted by SP's introduction. SP surgery's benefits are seen mostly in the immediate post-operative period and a significant number of respondents foresee a major role for SP in urology. However, proficiency in SP surgery is not seen as crucial for career advancement or job opportunities. Academic job aspirations, SP platform availability, and SP surgery workload are predictors of future SP implementation. Trainees increasingly recognize the clinical benefits of SP procedures but express concerns about the potential negative impact on hands-on experience. Training programs should more systematically integrate SP technology into curricula. There is a correlation between training in high-volume SP centers and future SP adoption.

Enhanced wound closure in rabbit oral vestibule: a comparative analysis of suturing and laser tissue soldering

This study investigates the comparative effectiveness of laser soldering technique and conventional suturing methods for wound closure in rabbits. Over a 60-day post-operative period, scar formation and healing were monitored, with a particular focus on scar characteristics such as width, height, and overall appearance. Results indicate that the laser group exhibited improved scar characteristics, especially in the early stages (first and third days) of healing. By the seventh day, both groups demonstrated similar scar conditions, though the laser group showed a slightly faster recovery trajectory, with marginally lower scar height observed on the 21st and 60th days. While the laser technique showed some advantages in minimizing short-term complications, the long-term outcomes between the two methods were largely comparable. These findings suggest that the laser soldering method may offer some benefits over traditional suturing, particularly in the early stages of healing, but further research is needed to fully assess its clinical potential.

Comparative study of HIFU partial gland ablation and robot-assisted radical prostatectomy for localized prostate cancer: an evidence-based approach.

This research aims to use a data-driven analytical method to compare the effectiveness of High-Intensity Focused Ultrasound (HIFU) partial gland ablation with Robot-Assisted Radical Prostatectomy (RARP) for treating localized prostate cancer, evaluating variations in treatment results. We performed a systematic review of the literature, covering key databases including the Cochrane Library, PubMed, EMBASE, Web of Science, and Google Scholar, with the latest information updated until August 2024. We utilized Stata 18 for data analysis, computing weighted mean differences (WMDs) for continuous data and odds ratios (ORs) for categorical data, with all results reported alongside 95% confidence intervals (CIs). Additionally, the studies included were evaluated using the Newcastle-Ottawa Scale (NOS). This meta-analysis incorporated data from three paired studies, encompassing a total of 1,503 patients. Patients treated with HIFU experienced a shorter hospital stay (WMD = -2.78, 95%CI -5.14,-0.43; p = 0.02) compared to those who received RARP. Additionally, evaluations at 3 and 12months post-surgery revealed that the HIFU group exhibited better recovery in urinary continence and sexual function than the RARP group. However, there were no notable disparities in complication rates (OR = 1.48, 95%CI 0.92,2.40; p = 0.110) and the requirement for salvage therapy (OR = 2.92, 95%CI 0.60,14.33; p = 0.186) between the two treatment methods. In conclusion, this meta-analysis appears to suggest potential benefits of HIFU partial gland ablation in possibly reducing the length of hospital stays and seems to indicate that it might be associated with improved recovery in terms of urinary incontinence and sexual function, particularly during the early to mid-term postoperative period. Although the differences in complication rates and the requirement for salvage therapy between the two surgical methods were not statistically significant, the findings provided by this analysis are instrumental in guiding clinical decision-making.

Treatment Strategy for Catamenial and Endometriosis-Related Recurrent Spontaneous Pneumothorax

RELEVANCE. The problem of treating thoracic endometriosis complicated by recurrent spontaneous catamenial pneumothorax is associated with the widespread prevalence of endometriosis, the complexity of its treatment and unsatisfactory long-term outcomes. The diagnosis of catamenial pneumothorax can only be established with a carefully collected history and confirmation of its recurrent nature. Favorable results are achieved with complex therapy carried out by the thoracic surgeon and gynecologist, consisting of an adequate volume of surgical intervention and hormonal therapy with gonadotropin releasing hormone agonists.AIM OF STUDY. To improve the diagnosis of thoracic endometriosis and recurrent catamenial and endometriosis-related spontaneous pneumothorax. To optimize the currently available treatment tactics by reducing the incidence of early relapses of catamenial pneumothorax and creating favorable conditions for the formation of reliable pleurodesis.MATERIAL AND METHODS. We studied the immediate outcomes of complex treatment of 30 patients (14.7%) with right-sided recurrent catamenial (28) and endometriosis-related spontaneous pneumothorax (2), with a median age of 41 (37;44) years, for the period from 2011 to the first half of 2023. Surgical treatment via video-assisted thoracoscopic access was performed in 26 patients (86.7%). After surgery, all the patients were recommended a six-month course of hormonal therapy with gonadotropin releasing hormone agonists.RESULTS. Various types of mechanical pleurodesis were performed in 25 patients (96.1%), resection of the diaphragm — in 17 (65.4%), alloplastic reconstruction with a synthetic mesh implant — in 12 patients (46.1%), pulmonary resection — in 9 (34.6%). In 12 of 26 patients (46.1%) in the early postoperative period, 6 (3; 6.75) days after surgery, a recurrence of catamenial pneumothorax developed, which subsequently required repeated interventions. In 5 patients, the relapse clearly coincided with the menstrual cycle. Early recurrence of pneumothorax required repeated drainage of the pleural cavity in all the patients, chemical pleurodesis in 2, and prolonged drainage of the pleural cavity in 1.CONCLUSION. Surgeries involving resection and reconstruction of the diaphragm with a mesh implant, pleurectomy, lung resection do not ensure the removal of all endometrioid heterotopias of the diaphragm and lung, therefore, during the first mensis after surgery, in the early postoperative period, 46.1% of the patients had a recurrence of catamenial pneumothorax, with no formed pleurodesis, which contributes to the possibility of further recurrences of pneumothorax. Improving the immediate outcomes of complex treatment of catamenial pneumothorax is possible with the preventive administration of hormonal therapy 1.5–2 months before the planned surgical intervention, which requires a multidisciplinary approach of the thoracic surgeon and gynecologist.

Evaluating Predictive Factors for Lymphocele Formation Following Kidney Transplantation.

Lymphocele is a common complication post-kidney transplantation, influenced by various factors including surgical technique, graft vessel count, operator experience, body mass index, ischemia time, and immunotherapy regimens. The purpose of this study was to evaluate lymphocele risk factors, particularly focusing on the role of end-stage kidney disease. A retrospective study was conducted on renal transplant recipients from a single center (March 2020 to December 2022). Patients were categorized into those developing lymphocele and those without during the postoperative period. Data, including sociodemographic, personal history, graft-related variables, intervention, and postoperative outcomes, were collected from electronic medical records. Out of 291 renal transplant recipients, 57 (19.6%) developed postoperative lymphocele, with 15 (5.1%) being symptomatic. Patients with body mass index <24.9 kg/m2 have lower risk of developing lymphocele with an Odds Ratio of 0.538 (P=0.046). Higher lymphocele prevalence was noted in patients with chronic tubulointerstitial nephritis (46.2%; OR 3.815; P=0.024). Focal segmental glomerulosclerosis patients showed no lymphocele (0.0%; OR 0.123; P=0.048). Other factors, including autosomal dominant polycystic kidney disease, did not exhibit significant differences in lymphocele prevalence. The etiology of end-stage kidney disease can serve as a significant predictor of lymphocele development during the postoperative period following renal transplantation. Further larger prospective studies are required to comprehensively assess risk factors and explore end-stage kidney disease potential role in predicting lymphocele formation.

Selected Blood Biochemical Parameters after Right and Left Nephrectomy in Clinical Practice

Introduction. Radical nephrectomy is considered as a common operation associated with significant changes in the topography of the upper abdominal cavity which appear in the postoperative period. Analysis of the literature fails to provide sufficient information about functional changes in the parenchymatous abdominal organs that occur after nephrectomy. Aim. To investigate a number of liver and pancreatic enzymes in the blood of patients at the pre­ and post­ operative stages of the radical nephrectomy. Materials and methods. The study involved a retrospective analysis of medical records of 111 patients after radical nephrectomy. The patients underwent biochemical examination at the pre­operative stage, on day 1, and day 7 after the operation: ALT, AST, amylase, diastase. The examination was performed by means of biochemistry analyzers Bio Systems BA 400 and Beckman Coulter AU 480. Statistical data processing was carried out using Statistica 10.0. Results. The analysis of the obtained materials shows that the level of liver and pancreatic enzymes increases after radical nephrectomy. A side of the operation was revealed significant: left­sided nephrectomy leads to an increase in the level of blood amylase and diastase, right­sided nephrectomy results in an increase in the level of ALT and AST. No dependence on the sex of patients was determined. No increase in the level of the studied enzymes was found in a number of patients in the postoperative period; however, almost half of patients were detected with a significant, 1.5–2 times and higher, increase in the level of enzymes, thus requiring special control and correction. The maximum level of ALT reached 245 U/L (norm 0–35 U/L), the maximum level of AST comprised 184 IU/L (norm 0–35 IU/L). Discussion. The obtained results indicate the interrelation of functional disorders of the liver and pancreas and changes in their topography after radical nephrectomy. Conclusion. Radical nephrectomy is associated with significant functional disorders of the liver and pancreas depending on the side of the operation: the level of blood amylase and diastase increases after left nephrectomy, the level of ALT and AST grows after right nephrectomy. The level of enzymes exceeds the norm by 1.5–2 times in almost half of patients.

Modified infra-promontorium trans-channel approach to the petrous apex. Case report

This article describes the approach to the petrous pyramid developed at National Medical Research Center of Otorhinolaryngology, namely an endoscopy – microscopy-guided modified trans-channel infra-promontorium approach with internal carotid artery retraction maneuver in patients with lesions of the petrous pyramid but with preserved hearing. A clinical report describing the apical cholesteatoma of the petrous pyramid and the use of this approach are presented. Anatomical and functional features after the surgery are also described. The purpose of this paper is advancing of the surgical approach to the petrous pyramid with the possibility of hearing preservation. The results of surgical treatment in lesions of the petrous pyramid were evaluated in the immediate and distant periods. The functions of facial mimic muscles were evaluated immediately after the surgery, in 6 months, and in one year. The functions of facial mimic muscles remained at the baseline level during the whole follow-up period. The pure tone audiogram demonstrated the preserved hearing function in the postoperative period. Complete elimination of the pathological process was achieved in all cases (n=15); according to the MRI of the temporal bones, no relapses occurred in a year. The surgical approach proposed for patients with the lesions of the petrous pyramid enables complete removal of the pathological process from the petrous pyramid with the preservation of hearing and facial functions, based on the subjective examinations (audiometry, facial function diagnosis) and radiology (CT and MRI of temporal bones) at the preoperative stage.

Total Stripping of the Great Saphenous Vein in Varicose Vein Patients with Thrombophlebitis

Introduction. Patients with varicose disease of the lower extremities may suffer from subcutaneous vein thrombophlebitis with an incidence of more than 50%. However, saphenous vein thrombophlebitis occurs against the background of varicose veins in 80% of patients. Aim. To improve the efficacy of phlebectomy in patients with varicose veins complicated by saphenous vein thrombophlebitis. A modified method of total stripping of the great saphenous vein was developed and introduced into clinical practice in City Clinical Hospital No. 21 (Ufa, Russia). The modified surgical technique is aimed at reducing the severity of postoperative hematomas, increasing the cosmetic effect and reducing the incidence of damage to the cutaneous nerve located near the large saphenous vein. The surgery technique was patented (Patent No. RU2812293C1). Materials and methods. From 2022 to 2023, total stripping of the great saphenous vein was performed in 26 patients with varicose veins of the lower extremities and thrombophlebitis of the great saphenous vein in Cardiac Surgery Department of City Clinical Hospital No. 21. The examined patients were divided into a control group (18 patients) and a comparison group (8 patients). The quality of life of all patients was assessed before and after surgical intervention using the Visual Analog Scale (VAS). Results and discussion. All patients underwent total stripping of the great saphenous vein. Prior to surgery, no statistically significant difference was reported in the assessment of quality of life between the groups. The group of the modified stripping technique demonstrated positive clinical and aesthetic results after surgery. Performing total stripping of the great saphenous vein using the modified technique statistically significantly improved the quality of life in the postoperative period. Control points of examinations were on days 1, 7, 30, 90 after surgery. Conclusion. The comparative analysis of the treatment results proved the efficacy of the modified technique of total stripping in varicose vein patients with thrombophlebitis, including a higher level of quality of life, better clinical and aesthetic result of surgical treatment.

De-escalation of Radiation Therapy in the Treatment Plan of Patients with Stage I-IIV Breast Cancer after Subcutaneous/Skin-Sparing Mastectomies with Immediate Reconstruction

Introduction. Indications for radiation therapy after mastectomies with/without reconstruction at T1­2N0­1M0 remain unclear; treatment standards contain references to the possible administration of radiation therapy for factors that increase breast cancer recurrence. Materials and methods. A retrospective single­center, non­randomized study enrolled 984 breast cancer patients treated at P.A. Gertsen Moscow Cancer Research Institute from 2014 to 2022. Patients were divided into 2 groups: a radiotherapy group and a non­radiotherapy group. Results and discussion. The paper presents an analysis of patients’ age, the histological structure of the tumor, immunohistochemical characteristics, tumor grade, multicentricity, presence of lymphovascular invasion, tumor cells, the state of R1 and R0 margins, and the tumor stage at risk of recurrence. Overall survival in the recurrence group accounted for 95.1%, in the non­recurrence group – 98.4%. In the radiotherapy group (group I), the overall survival comprised 98.4%; metastases were diagnosed in 4.9% of cases. In thenon­radiotherapy group (group II), the overall survival amounted to 98.2%; metastases were revealed in 5.9% of cases. Conclusion. Univariate analysis in the study groups showed that radiation therapy reduced the risk of relapse by 3.5%. In case of positive R1 margin, radiotherapy is recommended, which was confirmed in our study, the difference accounted for 14.5%, and in the presence of R1, radiotherapy is claimed to be necessary in the postoperative period. When analyzing the stage of breast cancer and the risk of recurrence, the statistical difference was revealed only at stage IIA (T1N1M0); radiation therapy reduced the risk of breast cancer recurrence. The statistical difference in groups I and II was detected at Grade 2 tumor, Ki­67 level less than 50%, presence of tumor embolism and age of patients under 40 years. Radiation therapy after subcutaneous/skin­sparing mastectomy reduces the recurrence risk by 3.2%; however, the overall survival in group I and group II accounted for 98.4 and 98.2%, respectively; the difference is not statistically significant. In our study, the criteria for prescribing radiation therapy in the postoperative period include: young age of the patients, R1 resection margin, luminal/non­luminal HER2 positive type, cN1, presence of tumor embolism.

Methods of Controlling Postoperative Complications after Lymphadenectomy in Patients with Breast Cancer

Introduction. Reducing the aggressiveness of surgical tactics is currently considered a promising trend in medicine that is widely supported due to its better safety profile. However, a large percentage of patients need more intervention. In the treatment of breast cancer, the main difficulties in postoperative management are associated with lymphatic surgery. Aim. To perform a comparative analysis of techniques for intraoperative control of lymphorrhea in patients during lymph node dissection for breast cancer in Yaroslavl Regional Oncologic Hospital. Materials and methods. Case histories of 660 patients after axillary subclavian subscapular lymphadenectomy were analyzed. In the postoperative period, patients revealed prolonged lymphorrhea. Magnifying techniques (binocular lenses, microscope) were used during the interventions to detect and isolate lymphatic vessels in 108 patients. A double coagulation technique was used to ligate the lymphatic vessels. Sufficient coagulation surface was achieved by forming suture lines of an angle greater than 90°. When performing a mastectomy, the technique was supplemented by circular bandaging of the chest. Results and discussion. Analysis of case histories showed that lymphadenectomy proved to be the main significant factor influencing lymphorrhea. Sparing techniques reduced the risk of postmastectomy syndrome. Comparing the study group with the control group revealed a statistically significant reduction in the severity of lymphorrhea without an increase in the risk of other complications. Conclusion. The combination of these techniques demonstrated statistically significant advantages in controlling postoperative complications. The techniques are easy to perform, therefore, they can be introduced into practice with minimal costs. The economic benefits are associated with the absence of additional costs for surgery, as well as with a reduction in the duration of hospital stay for patients. All this significantly increases patient satisfaction with the treatment performed.

Venous Thromboembolism in Outpatient Elective Foot and Ankle Procedure Patients Who Is at Risk?

Venous thromboembolism (VTE) is a rare but potentially serious complication following elective foot and ankle (F&A) procedures. The absence of guidelines for thromboprophylaxis in elective procedures underscores the importance of identifying patients at risk. This study aimed to identify key risk factors of VTE in patients who underwent elective foot and ankle (F&A) operations. Data was collected from the IBM MarketScan Database (2009-2019) for patients >18 years old without prior VTE who underwent elective F&A procedures. Patients were divided into 3 groups based on region of operation (forefoot, mid/hindfoot, lower leg/ankle). VTE incidence (including deep vein thrombosis and/or pulmonary embolism) was recorded 30 and 90 days postprocedure. Risk factors for VTE were identified through multivariate logistic regression. Among the 301 256 patients who underwent elective F&A procedures, the overall 90-day incidence of VTE was 0.95%. The findings revealed that 31.9% of VTE incidents occurred within the first 2 weeks after operation, and 29.2% still occurred after 6 weeks. Analysis of the anatomical region of operation demonstrated that the lowest rate of 90-day VTE was amongst patients undergoing forefoot procedures (0.70%). There was a higher risk for VTE in patients undergoing midfoot/hindfoot procedures (1.22%, OR = 1.81) and lower leg/ankle procedures (1.76%, OR = 2.31). Additional risk factors for VTE included thrombophilia (4.02%, OR = 3.37), male sex (1.30%, OR = 1.47), increasing age (1.02% age 65+, OR = 1.41), and a high Charlson Comorbidity Index (1.12%, OR < 0.82 for scores <5). This study identifies the incidence and timing for VTE after elective F&A procedures. Furthermore, this study defines the risk factors associated with increased odds of VTE after elective F&A procedures. These findings are helpful in educating patients about a continued risk for VTE throughout the 90-day postoperative period and beyond. These results can also be utilized to stratify patients who need thromboprophylaxis based on the individual risk level. Level III: Retrospective cohort study.

Early arrhythmia after cardiac surgery in children with congenital heart disease

Objective. To analyze the frequency and risk factors for arrhythmia in children with congenital heart disease in the early period after cardiac surgery. Materials and methods. A retrospective analysis of the incidence and risk factors for arrhythmia in 285 children who underwent cardiac surgery in the Department of Surgical Treatment of Congenital Heart Diseases in Newborns and Young Children at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine for the period from 2021 to 2023 was performed. There were 202 children under the age of 18. Results. In the early postoperative period, heart rhythm disturbances occurred in 53 (26.2%) of 202 patients: 28 had supraventricular tachycardia, 16 had bradyarrhythmia (atrioventricular block), 6 had ventricular tachycardia, and 3 had nodal ectopic tachycardia. It was found that plastic surgery of the interventricular and atrial septal defect in isolation or in combination with interventions for other defects (Fallot's tetrad, transposition of the great vessels, atrioventricular communication) and bidirectional and total cavopulmonary anastomoses are associated with a high risk of arrhythmia. Statistically significant (p &lt; 0.05) risk factors for arrhythmia were: lactate level of more than 2 mmol/L, duration of cardiopulmonary bypass more than 185 minutes, duration of aortic clamping more than 67 minutes. Conclusions. Arrhythmia often complicates the course of the early period after cardiac surgery in children and requires timely and correct action. Prolonged cardiopulmonary bypass, aortic constriction, and lactatidosis are risk factors for arrhythmia. Plastic surgery of the interventricular and atrial septal defects, as well as palliative reconstructive heart surgery, are associated with frequent cardiac arrhythmias in the early postoperative period.

Experience of preputiotomy performing in bull with acroposthitis and fibrous affect of penis’ S-shaped curve

The aim of this study was to perform a preputiotomy with the formation of an artificial opening in a breeding bull to realize his reproductive potential. Scientific and production research was conducted in the spring of 2024. In a 3.5-year-old Holstein breeding bull, kept at a breeding station for keeping breeding bulls, acroposthitis and fibrous lesion of the penis in the area of the S-shaped bend were detected due to the developed infectious process caused by Pseudomonas aeruginosa. The resulting pathology prevented the penis from fully extending beyond the preputial sac when collecting sperm for an artificial vagina (the last sperm collection was performed on 02/07/2024). The operation performed consisted of the following stages: insertion of a thick-walled tube into the preputial sac for better orientation in the tissues; making a V-shaped incision of all layers of the prepuce near its fornix; excision of the prepuce section necessary for free removal of the penis when collecting sperm; formation of an artificial opening by connecting the parietal preputial layer to the skin with an interrupted suture. The postoperative period included daily monitoring of the animal's condition, antibiotic therapy (amoxicillin (0.15 g), three injections every 48 hours), and the use of non-steroidal anti-inflammatory drugs (meloxicam (0.002 g), 3 days). A month after the operation, sperm was collected (06.05.2024, three months later) and the presence of all unconditioned reflexes was noted. At the same time, the copulatory reflex was full, painless and ended in ejaculation. The obtained volume of sperm after two mountings was 2.5 ml, the concentration was 1.3x108, the activity was 8 points. Thus, preputiotomy is an effective method for surgical correction of lesions of the preputial sac and adhesions in the area of the S-shaped bend of the penis in breeding bulls.

Prediction of the risks of developing clinically significant frontal imbalance in surgical treatment of severe forms of idiopathic scoliosis with a primary thoracic scoliotic curve

Objective. To create a multifactorial model for predicting the risks of developing clinically significant frontal imbalance in surgical treatment of severe idiopathic scoliosis based on the identification of predictors influencing the main clinical parameters of trunk asymmetry.Material and Methods. The results of surgical treatment of 288 patients with severe forms of idiopathic scoliosis with a primary thoracic scoliotic curve of types 1, 2, 3 according to Lenke (mean 97.6° ± 15.5° according to Cobb) who underwent surgery in 1999–2019 using posterior segmental instrumentation with hook, hybrid and transpedicular fixation, were analyzed. There were 243 female (84.4 %) and 45 male patients (15.6 %). The average age of patients at the time of surgery was 15.3 [10–39] years. The average postoperative follow-up period was 3.5 [2.0–19.5] years. The analysis included clinical and radiological data obtained in the preoperative, postoperative and late postoperative periods. Predictors of the occurrence of frontal imbalance (the distance from the plumb line to the navel and intergluteal fold more than 15 mm, the tilt of the shoulder girdles more than 5° and the tilt of the scapula more than 15°) were identified by building single- and multivariate logistic regression models.Results. In the total cohort, 41 (14.2 %) patients with clinically significant frontal imbalance were identified, including 10 (3,0 %) – with an increase in the distance from the plumb line to the umbilicus of more than 15 mm, 12 (4.2 %) – with an increase in the distance from the plumb line to the intergluteal fold of more than 15 mm, 8 (2.8 %) – with a shoulder girdle tilt of more than 5°, and 11 (3.8 %) – with a scapular tilt of more than 15°. A significant predictor of the risk of developing frontal imbalance was determined as postoperative thoracic scoliotic curve of more than 63°. Multiplicative predictors of the risk of frontal imbalance were identified: postoperative increase in the distance from the plumb line to the umbilicus by more than 15 mm and a tilt of the shoulder girdles by more than 5° with a sensitivity of 88.9 % and 100.0 %, and a specificity of 89.5 % and 100.0 %, respectively (p &lt; 0.001).Conclusion. Identification of multiplicative predictors of the risk of frontal imbalance allows predicting the risk of increasing the distance from the plumb line to the navel by more than 15 mm and the risk of shoulder girdle tilt by more than 5°. To eliminate the risk of frontal imbalance, it is necessary to strive for maximum correction of the thoracic scoliotic curve. When planning surgical treatment using transpedicular fixation for the correction of severe thoracic scoliosis, it is necessary to take into account the patient’s gender and the presence of concomitant neurosurgical, cardiological and pulmonological pathology to prevent shoulder girdle imbalance.

Evaluation of lateral sagittal infraclavicular block according to inferior vena cava collapsibility index (VCI-CI): An observational study.

Depending on the total amount of fluid, changes occur in the amount of fluid in the peripheral area. The aim of this study was to observe the differences caused by hemodynamic changes after lateral sagittal infraclavicular block (LS-ICB) according to the inferior vena cava collapsibility index (VCI-CI). In this prospective, observational study (Clinical Trial Number: NCT05968105), patients undergoing elective hand and wrist surgery with LS-ICB were classified according to VCI-CI, with Group 1 defined as inferior vena cava (VCI) diameter < 1.5 cm and VCI-CI > 50% and Group 2 defined as VCI diameter > 1.5 cm and VCI-CI < 50%. Groups were compared for demographic characteristics, defined durations, rescue analgesics, and complications. Continuous hemodynamic parameters and pulsed wave Doppler were evaluated within groups. Demographic characteristics and time periods were comparable between the groups. Hemodynamic parameters and pulsed wave Doppler measurements showed no significant differences. However, while Group 1 remained consistent, Group 2 exhibited differences in axillary artery diastolic diameter and axillary artery contractility index. A significant statistical difference was observed in Group 1 for the perfusion index at 30 minutes and postoperatively, whereas Group 2 remained consistent. The dosage and number of patients requiring rescue analgesics were similar across both groups, and no complications were reported. Blood flow increased after LS-ICB without a corresponding increase in axillary artery diameter. Group 1 showed a tendency toward a lower perfusion index in the postoperative period.

KeraRing Implantation with Femtosecond Laser in Keratoconus Treatment at Different Stages

Objective: To investigate the reliability and effectiveness of femtosecond laser-assisted KeraRing (Mediphacos, Belo Horizonte, Brazil) implantation in treating keratoconus. Methods: Intrastromal corneal ring segments (KeraRing, Mediphacos, Brazil) were implanted in 15 eyes of 14 patients unable to tolerate contact lenses. Femtosecond laser (Intralase, 60 Hz) was used for corneal tunnel creation. Based on the distribution of ectatic area on the cornea, dual segments were implanted in 9 eyes, while single segments were implanted in 6 eyes. Preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), objective and subjective refraction, and topographic corneal curvature (K) values of the cases were compared using the Wilcoxon test. Results: The mean age of patients was 25±7.46 (range: 15-39) years, with a mean postoperative follow-up period of 10.8±7.37 (range: 1-24 months). BCVA improved in all eyes during the follow-up period, increasing from a mean of 0.12±0.1 to 0.38±0.24 (p