Patients In Postoperative Period Research Articles

Features of the clinical course of penile cancer

Introduction. Penile cancer (PC) is one of the rare tumors, accounting for 1-2% of all neoplasms of the genitourinary system. The clinical course of the cancer process raises many questions among both urologistsoncologists in hospitals and outpatient doctors. A retrospective analysis of articles indicates that this process has not been sufficiently studied and requires more clinical observations to determine the diagnosis and correct treatment tactics for such patients.Materials and methods. Clinical observations of the development of human cancer in patients are presented. An analysis of original articles was also carried out in the following databases: Pubmed, Scopus, Scopus, Web of Science from 2007 to 2022, dedicated to this disease.Results. When a tumor of the penis was detected, one patient underwent surgical intervention to the extent of amputation of the glans penis. In the second patient, total damage to the penis was revealed, which required more radical surgical treatment including: Emasculation with urethroplasty. The third patient underwent radiation therapy and subsequently circumcision of the foreskin. The postoperative period in patients was without complications. No relapse was observed.Conclusion.Penile cancer, despite its rarity, is a pressing problem in modern oncology. Even with proper examination and treatment, it is difficult to predict the further development of the disease. These clinical cases force specialists to examine patients more carefully so as not to miss pathology that can cripple the patient and change his future lifestyle, and also shows different options for treatment outcomes for penile cancer.

The significance of clinical and morphological characteristics of spinal cord astrocytomas in the choice of surgical tactics

Objective — to determine the factors affecting the dynamics of the neurological status in the postoperative period in patients with intramedullary spinal cord astrocytomas (SCA) in order to improve the results of their surgical treatment. Materials and methods. Between 2010 and 2019, we conducted a retrospective study on the surgical treatment outcomes of 39 SCA patients operated on at the SI “Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine”. The age of the patients ranged from 19 to 67 years, with an average age of 41.4 years. Out of the total, 25 patients (64%) were men and 14 patients (36%) were women. We observed cervical localization in 11 (28%) clinical cases, thoracic localization in 25 (64%), and conus medullaris in 3 (8%). All patients underwent a comprehensive clinical and instrumental examination using magnetic resonance imaging with intravenous enhancement, computed tomography, and spondylography. The dynamics of neurological symptoms were evaluated using the modified McCormick before surgery, at the time of the patient’s hospital discharge, and during follow‑up examinations. Results. Total removal of SCA was performed in 7 (18%) patients, subtotal in 25 (64%), and partial in 7 (18%). Pilocytic astrocytoma (PA) (World Health Organisation (WHO) grade I) was detected in 19 (49%) patients, diffuse astrocytoma (DA) (WHO grade II) in 17 (43%), and anaplastic astrocytoma (AA) (WHO grade III) in 3 (7%). Partial regression of neurological symptoms was noted in 29 (74%) patients, the neurological status remained at the preoperative level in 6 (15%) patients, and a slight increase in the neurological deficit was noted in 4 (10%) patients. Age <60 years is significantly more frequently associated with the growth of PA, while age >60 years is significantly more frequently associated with the growth of AA. The duration of anamnesis (< 1 year and >1 year) and the degree of radicality of the operation were identified as significant factors that can influence the neurological status in the late postoperative period, mainly in patients with PA and DA. However, such factors as tumour location and the degree of infiltration of nearby structures are not statistically significant. AA is associated with an unfavourable prognosis across all important criteria. Conclusions. The most important determinants of SCA prognosis are preoperative and postoperative neurological condition, resection extent, and histological grade. Patients with minor neurological damage at the time of surgery, those under the age of 60, and those with highly differentiated SCA had the greatest surgical treatment outcomes. Assessment of the preoperative neurological status and determination of the histological type of the tumour are important factors in choosing the optimal surgical tactics, which сan improve treatment outcomes and the quality of life in SCA patients.

The effects of smoking on pain scores, vital signs, and analgesic consumption in patients undergoing tympanomastoidectomy surgery.

In this study, we investigate the effects of smoking on pain scores, vital signs, and analgesic consumption in the intraoperative and postoperative period in patients undergoing tympanomastoidectomy surgery. A total of 100 patients with American Society of Anesthesiologists I-II status, aged 18-55 years, and who were planned to undergo tympanomastoidectomy surgery were divided into two groups: smokers (Group 1) and non-smokers (Group 2). The patients were compared for preoperative, intraoperative, and 24-hour postoperative carboxyhemoglobin, blood pressure, oxygen saturation, respiratory rate, heart rate, pain intensity and verbal numerical rating scales, the extent of patient-controlled tramadol dose, nausea, and vomiting. There were 50 individuals in each group. Postoperative analgesic consumption and pain scores were higher in Group 1, and the first postoperative pain was felt earlier. Furthermore, in Group 1, preoperative carboxyhemoglobin levels and postoperative nausea were statistically higher before, after, and at the tenth minute after induction, whereas oxygen saturation was lower. The two groups had no statistical difference regarding intraoperative and postoperative vital signs. Postoperative analgesic consumption was not affected by age or gender. Smoking changes postoperative pain management, especially for this kind of operation, and these patients feel more pain and need more postoperative analgesic doses. Therefore, effective postoperative pain control should take account of smoking behavior, and analgesic doses may need to be adjusted for patients who smoke.

Intranasal Tapentadol Versus Intravenous Paracetamol for Postoperative Analgesia in Lower Limb Orthopaedic Surgeries Under Spinal Anaesthesia: A Single Blind RCT.

We aimed to compare the analgesic effectiveness of intranasal tapentadol nasal spray 44.5mg and intravenous (IV) paracetamol 1gm during the postoperative period in patients undergoing lower limb orthopedic surgeries under spinal anesthesia. This prospective, randomized, single-blind clinical trial was carried out in a tertiary care teaching hospital. Patients aged between 18 and 60 years of physical status ASA grade 1-3 were included in the study. Postoperative pain scores were measured using the visual analog scale (VAS) in centimeters (cm) every 12 hours in 37 patients per group. The patients were administered either intranasal tapentadol or IV paracetamol every 6 hours for 72 hours, beginning 3 hours after surgery. There was a significant group by intervention effect favoring intranasal tapentadol, suggesting a greater reduction in VAS pain scores after the intervention at 72 hours (estimate: -1.58 cm; SE:0.2; P<0.001). Group by time effect for all the measured time frames, except for 36 hours, favored intranasal tapentadol with estimated values for greater reduction in VAS pain scores ranging from -0.8 cm to -1.6 cm. The results of the present study suggests that intranasal tapentadol results in a greater reduction of postoperative pain compared with IV paracetamol in lower limb orthopedic surgeries. The ease of administration of tapentadol may make it a preferred option over IV paracetamol in such surgeries.

Evaluation of effects of intravenous infusion of dexmedetomidine or lignocaine on stress response and postoperative pain in patients undergoing craniotomy for intracranial tumors: A randomized controlled exploratory study

Background: Goals of anesthesia in neurosurgery include stable cerebral hemodynamics and provide relaxed brain to surgeon. Dexmedetomidine and lignocaine as an adjuvant can fulfill these criteria but literature comparing the two are sparse. We compared the effects of intravenous infusion of dexmedetomidine or lignocaine on stress response, postoperative pain, and recovery in patients undergoing craniotomy for intracranial tumors. Methods: Approval was obtained from IEC, and the study was prospectively registered (CTRI/2022/11/047434). Written and informed consent was obtained from 105 patients fulfilling inclusion criteria, and they were divided into three groups. Group D received intravenous infusion of dexmedetomidine 1 mcg/kg over 15 minutes followed by infusion at rate of 0.5 mcg/kg/h, Group L received intravenous infusion of lignocaine 2 mg/kg over 15 minutes followed by infusion at rate of 1.5 mg/kg/h, and Group N received intravenous infusion of normal saline at the rate of 4–8 ml/h till skin suturing. SPSS v23 (IBM Corp.) was used for data analysis. Results: There was a significant difference between groups in terms of intraoperative hemodynamic variations, brain relaxation score, extubation criteria, postoperative pain, stress indicator response, and quality of recovery. Conclusions: Dexmedetomidine as an adjuvant to anesthetic drugs has a better profile than lignocaine in suppressing stress response and preventing hemodynamic variations at intubation, skull pin application, and surgical incision. Dexmedetomidine increases the duration of effective analgesia more than lignocaine, in postoperative period in patients undergoing craniotomy.

Prevention of chronic postoperative pain syndrome after Lichtenstein hernioplasty

THE OBJECTIVE was to analyze the development of chronic pain syndrome after performing standardized Lichtenstein hernioplasty.METHODS AND MATERIALS. The prospective single-center study was conducted with 40 patients with inguinal hernias (20 patients in the study group and 20 patients in the control group) who underwent Lichtenstein hernioplasty with adherence to standardization criteria and without. The comparative analysis of the early and long-term postoperative periods was performed.RESULTS. When comparing the early and long-term postoperative periods in patients after standardized Lichtenstein hernioplasty, the following data were obtained: pain syndrome according to the Visual Analogue Scale (VAS) was less pronounced after applying standardization criteria (p &lt; 0.001), and statistically significantly lower number of complications (seroma, paresthesia) developed (p=0.045, p=0.019). In the group of patients who underwent standardized Lichtenstein hernioplasty, chronic pain syndrome was not observed in the long-term postoperative period (p &lt; 0.001).CONCLUSIONS. Prevention of chronic postoperative pain syndrome after hernioplasty using the Lichtenstein method is the significant issue. This article emphasizes the importance of considering various factors and implementing preventive strategies to minimize the risk of this complication and ensure optimal surgical outcomes.

Incidence of acute kidney injury and its associated risk factors in patients undergoing elective oesophagectomy surgeries at a tertiary care cancer institute - A pilot prospective observational study.

Acute kidney injury (AKI) is a significant postoperative complication. Multiple perioperative factors are implicated in the causation of AKI in the postoperative period in patients with oesophageal cancer. The study aimed to find out the incidence, causes and effects of AKI following oesophagectomy surgery. A prospective observational study was conducted in consecutive adult patients undergoing elective oesophagectomy at a tertiary cancer care hospital. Patients with preoperative chronic renal insufficiency (serum creatinine >1.5 mg/dl), AKI in the past and a history of renal replacement therapy were excluded. Serum creatinine values were measured on postoperative days 1, 3, 5, the day of discharge or day 15 and on the day of first follow-up or day 28, following oesophagectomy surgery. The incidence of AKI was measured using the 'Kidney Disease Improving Global Outcome' (KDIGO) criteria. The incidence of AKI was 14.7% [95% confidence interval (CI) 9.9%, 20.7%] (i.e., 27/183) in patients who underwent elective oesophagectomy. AKI was associated with prolonged hospital stay [median- 13 days (interquartile range {IQR} 11-21.5) versus 9 days (IQR 8-12), P < 0.001] and increased in-hospital mortality (14.8% versus 1.3%, P 0.004, odds ratio = 13.2, 95% CI 2.3, 77.3). After multivariate analysis, age, anastomotic leak and use of vasopressors in the postoperative period were independent predictors of AKI. The incidence of AKI was 14.7% after elective oesophagectomy. AKI was associated with prolonged hospital stay and in-hospital mortality. Higher age, anastomotic leak and use of vasopressors in the postoperative period were independent predictors of AKI.

Efficacy and Safety of Paragastric Neural Blockade in Controlling Pain, Nausea, and Vomiting After Sleeve Gastrectomy: A Randomized Controlled Trial.

There are difficulties in controlling the symptoms of pain, nausea, and vomiting after laparoscopic sleeve gastrectomy (LSG). This study aimed to evaluate the efficacy and safety of PGNB on pain and nausea and vomiting in the early postoperative period in patients who underwent LSG. In this prospective, randomized, controlled, double-blind study, the patients were divided into two equally formed groups: patients who underwent PGNB after LSG and the control group. Postoperative pain symptoms were evaluated using the visual analog scale (VAS) scores, and nausea and vomiting symptoms were evaluated using the postoperative nausea and vomiting (PONV) scores. The study was completed with 90 patients, 45 patients in each group. The VAS scores measured at postoperative hours 1, 6, and 12 were statistically significantly lower in the PGNB group. There was no significant difference between the two groups in terms of the 24th hour VAS scores. The mean PONV scores of the PGNB and control groups were 0.47 ± 0.89 and 1.67 ± 1.95, respectively, revealing a significantly higher value for the controls. The mean time to first mobilization in the postoperative period was significantly shorter in the PGNB group. Upon the evaluation of patient satisfaction, it was determined that the satisfaction score of the PGNB group was significantly higher. PGNB is an effective and safe method for managing pain, nausea, and vomiting that occur in the early period after LSG.

Retrospective analysis of the adverse events during intra-operative and post-operative period in patients who received anesthesia at a tertiary care center in India

Background: Anesthesia is a critical component of modern surgical procedures ensuring patient comfort and safety during surgery. With the increase in life expectancy, more and more geriatric population with various systemic comorbidities have been coming for surgeries. Along with the newer advances in surgical fields, there is increasing demand on the anesthetists to handle complicated cases with innovative solutions. Despite all efforts by a skillful anesthetist, adverse events are bound to occur which needs to be analysed to prevent such adverse events in the future. Hence, this study aims to analyse the adverse events occurring in intra-operative and post-operative period who received anesthesia in our tertiary care centre. Methods: This study is a retrospective cross-sectional study of 5-year duration from January 2018 to January 2023 done at Bhaktivedanta hospital and research institute post obtaining approval from the institutional ethics committee. A total of 163 patients who developed perioperative adverse events were included in the study and their nature of adverse events were analysed. The data was obtained from the registers of the anesthesia department and descriptive statistical analysis of the data was done accordingly. Results: Most common adverse events were of cardiovascular and respiratory origin, followed by miscellaneous and regional anesthesia adverse events and then, very few drug-related adverse events. The patients who developed these adverse events were evidently of ASA grade I and II, implying no direct correlation between adverse events and grading. Conclusions: Reporting and analysis of the adverse events will help better understanding of the lacunae of the reporting system as well as in the development of quality improvement strategies in the future.

Analysis of the course of the early postoperative period in patients with diastasis of the rectus abdominis after different methods of its surgical correction

Objective. To compare the indicators of the early postoperative period in patients with diastasis of the rectus abdominis after suture plication and after mesh implantation. Materials and methods. The study included 120 patients with diastasis of the rectus abdominis muscles. In 60 patients (group 1), a suture was used to correct the diastasis, and in another 60 patients (group 2), a prolene mesh was used. Results. The regression of pain in patients of group 1 on the 1st and 3rd postoperative days was more dynamic than in patients of group 2: pain decreased by 3.0 and 2.5 times, respectively. Mesh placement increased the risk of hyperthermia by 61%. The number of patients with complications in the groups was not statistically significant (p=0.265), but the difference between the number of patients with several complications was statistically significant (p=0.018). The use of mesh increased the risk of seroma by 64% (p=0.046), haematoma by 19% (p=0.819), wound infection by 36% (p=0.741), and paresthesia by 64% (p=0.025). Conclusions. The correction of diastasis of the rectus abdominis muscles with a suture is more acceptable than the correction with the help of mesh placement.

The course of the early recovery period after total arthroplasty in patients with diabetes

More than 20% of patients undergoing total joint arthroplasty (TJA) have diabetes mellitus (DM), which is one of the risk factors for complications in the postoperative period. The aim: to determine the peculiarities of the course of the postoperative period in patients with diabetes after TJA, in particular, after hip and knee arthroplasty (HKA). Materials and methods. A retrospective analysis of the inpatient charts of 50 patients who underwent HKA operations against the background of concomitant DM was performed. All patients were divided into two groups: 1) patients with hip arthroplasty, 2) patients with knee arthroplasty. The course of the intraoperative and postoperative (p/o) periods and the development of complications were analyzed. The results. All patients were aged from 38 to 86 years, had increased weight (BMI — 26.0-29.42 kg/m). Among the complications, arterial hypertension was most often observed (in groups 64.0% and 68.0%, respectively), nausea and vomiting were often observed (32.0% and 28.0%, respectively), disturbances in the rhythm and depth of breathing (16.0% and 20.0% respectively). The need for analgesia in the p/o period was 96.0% and 100.0% of patients, which indicates insufficient quality of analgesia. Other clinical and anamnestic indicators, the course of the perioperative period and the development of complications were similar in patients undergoing both hip and knee replacement surgeries (p&gt;0.05). Conclusions. Clinical and anamnestic data, the spectrum of existing concomitant pathology, characteristics of carbohydrate metabolism and its disorders, features of the course of the perioperative period and detected complications were of the same type in patients regardless of the location of the intervention. There was no significant difference in the studied parameters (p&gt;0.05). Identified complications and insufficient effectiveness of p/o analgesia dictates the need to find optimal methods of perioperative analgesia during HKA operations.

Cavernomas of cavernous sinus

Background. Cavernoma of cavernous sinus is a fairly rare benign neoplasm, accounting for less than 3 % of all neoplasms in this area. Due to the rarity of this pathology, a standardized protocol for diagnosis or treatment has not been developed. Surgical and radiosurgical methods are used for treatment.Aim. Analysis of the results of treatment of patients with cavernous sinus cavernomas operated at the N. N. Burdenko National Medical Research Center of Neurosurgery from 2000 to 2022 using endoscopic transnasal access.Materials and methods. We present our own experience in the treatment of 9 patients who underwent transnasal endoscopic removal of cavernous sinus cavernoma.Results. A total of about 300 cases of treatment of patients with cavernous sinus cavernomas have been described in the literature, and endoscopic removal has been described in only 12 cases.As a result, subtotal removal was achieved in 7 cases. In 2 cases, the removal was partial. The postoperative period proceeded in all patients without peculiarities and without complications.Conclusion. Endoscopic transnasal access allows partial or subtotal removal of the formation without risk of injury to cranial nerves and with minimal soft tissue injury, which has a positive effect on the postoperative period of patients. In combination with radiosurgical methods, it is possible to achieve satisfactory treatment results.

Anthropometric and bioimpedansometric predictors of postoperative complications in patients with gastric and cardioesophageal junction cancers

BACKGROUND: Among the most common intra-abdominal complications of surgical treatment of gastric and cardioesophageal junction cancers are acute postoperative pancreatitis and abdominal abscesses.&#x0D; AIM: Identification and study of anthropometric and bioimpedansometric predictors of the complicated course of the postoperative period in patients with gastric and cardioesophageal junction cancers.&#x0D; MATERIAL AND METHODS: 250 patients with gastric and cardioesophageal junction cancers, 123 men and 127 women, were examined. All subjects underwent radical surgical treatment. In the postoperative period, postoperative complications were recorded in 40 patients. All subjects underwent anthropometric and bioimpedance examination. Height and body weight, transverse diameter of the chest, width of the shoulders and pelvis, waist and hip circumference, and body morphotype were determined. Bioimpedansometric examination was carried out before surgery and in the postoperative period using a domestic hardware and software complex with determination of the body component composition and the phase angle value. The phase angle of impedance reflected the metabolic rate in the body. The results were statistically processed using descriptive statistics methods. The Shapiro–Francia, Kolmogorov–Smirnov tests, Student's t-test, Mann–Whitney test, and the logistic regression method were used. Differences were considered statistically significant at p 0.05.&#x0D; RESULTS: Women of the gynecomorphic body type were characterized by a significant decrease in the relative values of active cellular and skeletal muscle mass (p=0.001; p=0.001), and the phase angle value until 12–14 days after surgery (p=0.001). Men of the andromorphic body type were characterized by a significant decrease in the relative values of active cell mass (p=0.001) and the phase angle until 12–14 days after surgery (p=0.001). In women of a gynecomorphic morphotype, the likelihood of postoperative complications was 4 times higher than in women of an andromorphic morphotype (p=0.001). Representatives of the mesomorphic body morphotype of both sexes were characterized by stable bioimpedance measurements during the entire postoperative period.&#x0D; CONCLUSION: Low values of the phase angle in men and women, as well as the classic gynecomorphic body type in women can be used in oncoabdominal surgery as predictors of a high risk postoperative complications developing in patients with gastric and cardioesophageal junction cancers.

Role of tramadol as an adjuvant in ultrasound-guided serratus anterior muscle block for modified radical mastectomy - A randomized control trial.

Modified radical mastectomy (MRM) is associated with significant acute post-operative pain that may progress to chronic pain syndromes in 25-60% of patients. Serratus anterior muscle (SAM) block has proved to be an excellent analgesic option in patients undergoing MRM. Although many adjuvants have been utilized for the prolongation of analgesia, the role of tramadol in SAM has not been studied as yet. We hypothesize that the addition of tramadol to ropivacaine for SAM block may reduce morphine consumption in the post-operative period in patients undergoing elective MRM surgeries. The primary aim of the study was to compare cumulative post-operative morphine consumption over 24 h in patients receiving SAM block with or without tramadol. The secondary aims were to observe adverse events related to the procedure or medications. The other parameters recorded were non-invasive blood pressure (NIBP), pulse rate, respiratory rate, and nausea or vomiting. Patients scheduled to undergo MRM were randomly allocated by block randomization into two groups. The study group (Group T) received a SAM block with 0.25% ropivacaine (18 ml) with tramadol 100 mg while the control group (Group P) received a SAM block with 18 ml of 0.25% ropivacaine and 2 ml of saline. Patients were assessed for pain scores, analgesic requirement, time to first analgesic request, hemodynamic variables, and any side-effects at 30 min, 1 h, 4 h, 8 h, 12 h, and 24 h post-operatively. Cumulative morphine consumption over 24 h in the post-operative period was less in the group T (3.06 ± 1.53 mg vs 4.34 ± 1.53 mg; P 0.001). Time to the first analgesic requirement was more in group T (10.44 ± 5.04 h vs 6.11 ± 2.73 h; P < 0.001). Pain scores were significantly lower in the group T at all time points. Tramadol, when used as an adjuvant to ropivacaine for SAM block reduces post-operative pain scores in the first 24 h and prolongs the time of first morphine requirement.

State of the microbial spectrum (microbiome) of the ocular surface of patients with cataracts and glaucoma in the early postoperative period

Background. The occurrence of infectious complications in the early postoperative period in patients undergoing ophthalmic surgery remains a persistent challenge in contemporary clinical practice. Typically the treatment regimen involves the administration of a combination of antibiotics and corticosteroids, often utilized in a fixed-dose combination for simplicity. Despite the prevalent use of these regimens, there’s a notable disregard for comprehensive microbiological diagnostics of the conjunctiva in surgical patients, attributed to various socio-economic factors. However, the significance of such diagnostics in forecasting postoperative outcomes is indisputable. Purpose of the study: to determine the medical and economic feasibility of prescribing individual antibacterial and anti-inflammatory medications in fixed combinations (FC) in postoperative treatment regimens for patients scheduled ophthalmic surgeries. Materials and methods. The study included data from 99 patients (65 males and 34 females, mean age 74 (70–77) years) admitted for elective surgery to address cataracts or glaucoma from May to September 2023. Patients were randomly divided to 2 observation groups. The division into groups was carried out according to the drugs (medicines) used in the postoperative treatment regimens, each of which was further divided into 2 subgroups in accordance with ophthalmopathology. The first group of patients received postoperative therapy with the levofloxacin/dexamethasone FC (L-dexopt, RK.O. Rompharm Company S.R.L., RU LP-007490), the second group was treated with a tobramycin/dexamethasone FC (Tobrazon, Kadila Pharmaceuticals, RU P№015176/01). All subjects underwent a comprehensive ophthalmological examination, as well as a microbiological examination of the conjunctival cavity before surgery and 8 days after surgical treatment. Additionally, all patients completed the Ocular Surface Disease Index (OSDI) questionnaire. Results. Analysis of microbial flora changes during therapy revealed an increase in cultures exhibiting a “zero” degree of growth by 29 and 11,1 % in the “cataract” and “glaucoma” subgroups of the fi rst observation group, respectively. The second group showed a similar increase. “zero” degree of growth (11,7 and 28,6 %, respectively). The treatment costs for patients undergoing cataract surgery and receiving the FC levofloxacin/ dexamethasone were 105.9 rubles per treatment course, compared to 40.5 rubles for those undergoing surgery for glaucoma or complicated cataracts. The cost-effectiveness for those treated with the FC tobramycin/dexamethasone in the early postoperative period was 21,6 and 51,9 rubles. respectively. The OSDI scores across in all subgroups ranged from 16,6 to 25,0 points indicating normal values. The administration of FC levofloxacin/dexamethasone and tobramycin/dexamethasone in the early postoperative period for patients with cataracts and glaucoma was clinically effectively in managing the inflammatory process by influencing the microbial spectrum (microbiome) of the ocular surface. No significant differences were observed in the degrees of microflora growth during the preoperative period between the “cataract” and “glaucoma” subgroups, which does not support the hypothesis regarding the antiseptic action of topical antiglaucoma medications in patients with glaucoma at this stage. Conclusions. The conducted medical and economic analysis proved the feasibility of using both drug combination with a slight preference FC levofloxacin/dexamethasone in patients undergoing surgery for glaucoma and FC tobramycin/dexamethasone for those with uncomplicated cataracts in the early postoperative period.

Biomechanics of the Patient with Bisphonate Osteonecrosis According to the Diagnosis Neurophysiological Monitoring

Effective rehabilitation of patients with volumetric jaw defects at the present stage of development of science and technology is impossible without a comprehensive analysis of biomechanical disorders and improvement of technical aspects of operational ways to eliminate them. The aim of the study was to analyze the biomechanical activity of the chewing muscles in patients with bisphosphonate osteonecrosis based on the results of neurophysiological monitoring. 184 patients with bisphosphonate osteonecrosis of the mandibular bone were monitored, 112 of whom were men and 72 women, group 1 included 60 % of patients who had an apparatus for extracellular osteosynthesis of jaw bones fixed, and group 2 – 40 % of patients whose jaw fragments were fixed with bone mini-plates of various profiles and cross-sections. In the preoperative period, all patients underwent general clinical studies, multispiral computed tomography, and monitoring of quality of life criteria using a modified questionnaire "The MOS 36-item Short-From Hervey". Results and discussion. Indicators in the long-term postoperative period in patients of group 1 approached the physiological norm on the healthy side and significantly improved on the affected side, compared with patients from group 2 who did not receive devices for extracellular osteosynthesis in the postoperative period. Conclusions. Ensuring the positioning of jaw bone fragments in three mutually perpendicular planes restores biomechanical balance in the dental and maxillary apparatus, which accelerates the rehabilitation of patients and predicts a favorable outcome of surgery.

CLINICAL FEATURES OF OROANTRAL COMMUNICATION MANAGEMENT USING BUCCAL FAT PAD BY TUNNEL METHOD

Background: Today, there is a wide variety of techniques for eliminating oroantral communication. One of them is the tunnel technique using a flap of the buccal fat pad. The introduction of this technique into clinical practice and the determination of the characteristics of the clinical course of the postoperative period in patients with the elimination of the oroantral communication using the tunnel method with the buccal fat pad determined the purpose of this work. Objectives: To determine the features of the clinical course of the postoperative period in patients with elimination of the oroantral communication using the tunnel method with the buccal fat pad. Materials and methods: In 30 patients aged from 35 to 72 years at the Department of Surgical Dentistry of ROSUNIMED was carried out the management of oroantral communication arising during the extraction of maxillary molars using the buccal fat pad by tunnel method. Results: In all cases of elimination of the oroantral communication after maxillary molars removal, the tunnel technique was used without completely covering the flap of the buccal fat pad with a vestibular flap. There was a general tendency for the severity of pain and swelling to increase on the 3rd day after treatment and decrease by the 7th day. During control examinations, no cases of recurrence of oroantral communication were detected. Complete epithelization of the postoperative area was observed in 29 patients (96.7%) on day 30. Conclusions: The emerging specific features of the postoperative period allow us to recommend the tunnel method of the oroantral communication management using the buccal fat pad.

Relation between neutrophil-to-lymphocyte ratio with epidural analgesia timing and thoracotomy pain.

This study investigated the relationship of the pre-operative neutrophil/lymphocyte ratio (NLR) to the timing of epidural analgesia administration and post-operative acute and chronic pain in thoracotomy. The study was conducted on 60 patients, with NLR ≥ 2 (Group A) and NLR < 2 (Group B). Each group was divided into subgroups pre-emptive analgesia (Group P) and control group (Group C). Epidural analgesic solution was administered as a bolus before the surgical incision in Group P and at the end of the operation in Group C. NRS was questioned postoperatively at the 2nd, 4th, 8th, 12th, 24th h, 1st, and 3rd months and also additional analgesic needs were recorded. In Group A, the pain scores of the patients who received pre-emptive epidural analgesia were lower at the post-operative 2nd, 4th, and 8th h and analgesic consumption was less in the post-operative first 24 h. It was observed that pre-emptive epidural analgesia reduced pain levels and additional analgesic consumption in the acute post-operative period in patients with pre-operative NLR ≥ 2.

Results of Primary Arteriovenous Fistulas Formation with Different Types of Anastomoses in the Early Postoperative Period in Patients on Programmed Hemodialysis

The study includes the analysis of the results of using the different types of arteriovenous anastomoses in the formation of arteriovenous fistulas and their impact on fistula maturation in the early postoperative period. One of the main aspects of the work is to determine the optimal type of anastomosis to ensure the proper functioning of arteriovenous fistula that is an important element of vascular access in patients on renal replacement therapy. It is important to consider such factors as the diameter of formed arteriovenous fistula, the blood flow velocity through it, the incidence of complications and the duration of its functioning. The study also takes into account the impact of patients’ characteristics, such as age, condition of arteries and veins, as well as general health indicators on the results of surgery. Taking these factors into account allows to identify the groups of patients who can benefit most from a particular type of anastomosis.&#x0D; During the sample period, 384 patients with terminal stage of renal failure aged 20 to 84 years undergoing programmed hemodialysis, the native arteriovenous fistula was formed. It was found that 94.01 % of arteriovenous fistulas were successful in the early postoperative period. The average age of these patients was 44.2 years, while unsuccessful cases developed in people with an average age of 66.8 years. It was also found that within an hour after surgery for the formation of an arteriovenous fistula with the type end-to-side anastomosis, its diameter increases from 2.08±0.42 mm to 2.96±1.68 mm, and the blood flow velocity increases from 21.4±7.6 ml/min to 212.4±74.6 ml/min. The risk factor for effective fistula formation, in addition to age, is the diameter of vessels, anatomical features of the venous system, the presence of concomitant pathology (primarily diabetes mellitus).&#x0D; The obtained results can serve as a basis for the developing of recommendations for the optimal choice of anastomosis type for certain categories of patients who will undergo renal replacement therapy. The study is aimed at improving the results of surgical treatment and increasing the quality of life of patients with chronic renal failure.

A comparative study of postoperative acidemia after intraoperative administration of balanced crystalloid (Plasma-lyte A@) versus 0.9% sodium chloride in gastrointestinal surgery

Background: The administration of intravenous fluids is one of the most common and universal interventions in medicine. Fluid therapy is the most challenging and debated aspect of perioperative care. Plasma-lyte A® Injection (multiple electrolytes injection, type 1, USP) is indicated as a source of water and electrolytes or as an alkalinizing agent. 0.9% sodium chloride is an isotonic crystalloid solution having a sodium concentration higher is useful in replacing fluid and electrolyte loss. Aims and Objectives: The study was designed to compare the effects of intraoperative administration of balanced crystalloid solution (Plasma-Lyte A®) and 0.9% NaCl on acid-base balance in the post-operative period in patients undergoing gastrointestinal surgery. Materials and Methods: Eighty consenting patients of ASA-l and ASA-II who underwent Gastrointestinal surgery were at first randomly allocated to 2 groups. One group received Plasma-Lyte A® as the sole crystalloid and the other group received 0.9% sodium chloride. Results: Serum Na+ conc. of the groups were comparable and no difference was shown at the time of induction, but postoperatively at 12 h, there was a significant increase in group 2. There was no significant difference in serum K+ concentration in both the groups except at 6 h postoperatively when there was an increase in K+ concentration in group 1. Serum Cl− concentration was having no significant difference at the time of induction and 1 h intraoperative, but postoperatively at 1, 6, and 12 h the Cl− concentration significantly increased in group 2. HCO3− concentration of the two groups had no difference between them throughout the study period. The pH of patients in both the groups showed no statistically significant difference during the entire procedure (P&gt;0.05). A significant decrease in pH observed in 0.9% sodium chloride group in comparison to Plasma-Lyte® group when the duration of surgery increased to more than 120 min. Conclusion: Both plasma-lyte A and 0.9% sodium chloride can be used safely as intravenous infusion fluid without altering pH status and blood electrolyte concentration in patients undergoing gastrointestinal surgery.