Patients In Postoperative Period Research Articles

The disorders of blood oxygen transport function, hemostasis indicators and endothelium functional state in patients with ruptured arterial aneurysms and the development of delayed cerebral ischemia

Introduction. Rupture of cerebral aneurysms (CA) with the development of intracranial hemorrhage (ICH), complicated in some cases by vascular spasm and delayed cerebral ischemia (DCI), is due to the complex multifactorial genesis of the disease, including changes in the blood oxygen transport function (BOTF), activation of endothelial cells with a release of vasoregulators, reactive oxygen species, inflammatory proteins, as well as disturbances in the hemostasis system.Purpose – to study the indicators of BOTF, primary and secondary hemostasis and the content of some vasoregulatory metabolites in the pre- and postoperative periods in patients with ruptured CA with the development of DCI and without DCI.Materials and methods. The group with DCI included 45 patients; in the group without DCI were 14 people. Clinical-neurological and neuroimaging examinations were carried out, and parameters of BOTF, primary and secondary hemostasis, nitrate/nitrite, angiotensin-converting enzyme (ACE), and PAI-1 concentrations in venous blood were studied before and on days 10–12 after microsurgical clipping of the CA.Results. We diagnosed mild neurological disorders according to the NIHSS scale, confirmed by neuroimaging studies of the brain in the group of DCI patients. It was shown an increase in thrombin-dependent platelet aggregation velocity to 30.6 (24.3; 32.4) AU/min at norm 21.8 (20.3; 24.9) (U, p=0.009) before surgery; and after surgery it was up to 37.4 (30; 44.7) relative to the norm (U, p=0.001). Before surgery, the following was observed: PT shortening to 11.6±0.7 sec at norm 13.2±1.1 (t, p˂0.001), fibrinogen concentration increasing to 4.35 (3.8; 4.8) g/L at norm 3.9 (3.6; 4.1) g/L (U, p = 0.01) and PAI-1 up to 3.9 (2.6; 4.8) ng / mL at norm 2 .7 (2.2; 4.1). After surgery, PT was 11.9±1.1 (t, p˂0.001); fibrinogen - 4.4 (3.9; 4.8) (U, p=0.024), PAI-1 - 4.6 (4.1; 6.7) (U, p=0.0004) respectively. Before surgery, p50 was increased to 28.1 (26.2; 31.6) mm Hg at norm 25.2 (24.3; 26.8) (U, p=0.025); after surgery, it was up to 28.5 (26.8; 30.7) (U, p=0.03) and the ratio of nitrates/nitrites to ACE was reduced to 0.12 (0.08; 0.15) at norm 0.22 (0.15; 0.32) (U, p˂0.001); after - up to 0.11 (0.08; 0.19) (U, p˂0.001) respectively.Conclusion. There has been revealed significant disorders of primary and secondary hemostasis with fibrinolysis inhibition, a decrease in the affinity of hemoglobin to oxygen at the p50 rate and an imbalance of the content of vasoregulatory metabolites in patients with DCI before and after aneurysm clipping, which can be considered as significant factors in the development of DCI after aneurysmal ICH.

Predictive Risk Factors for Clinically Related Pancreatic Fistula After Pancreaticoduodenectomy: Analysis of 248 Patients

Objective: Postoperative pancreatic fistula (POPF) affects 13-50% of patients undergoing pancreaticoduodenectomy (PD), and remains the main source of post-PD morbidity and mortality. Therefore, determining predictive risk factors for POPF remains popular today. In this study, we aimed to determine the predictive risk factors for clinically related postoperative pancreatic fistula (CR-POPF) in the preoperative and early postoperative period in patients that underwent PD. Methods: This is a retrospective study involving 248 patients who underwent PD between January 2015 and December 2019 in our center. We compared the groups that did and did not develop CR-POPF. We determined the risk factors affecting CR-POPF by stepwise logistic regression analysis. Results: 141 (56.8%) of the patients included in the study were male and the median age was 63 (56-70)/year. The CR-POPF rate was 18.1%. We found a statistically significant difference (p <0.05) in the following parameters: diabetes, smoking, preoperative leukocyte, preoperative neutrophil, postoperative first day (POD1) amylase, POD1 AST, POD1 ALT, POD1 CRP, POD1 lymphocyte-CRP ratio (LCR), postoperative third day (POD3) lymphocyte, POD3 CRP, in POD3 neutrophil-lymphocyte ratio, POD3 platelet-lymphocyte ratio (PLR), POD3 AST-ALT ratio, POD3 LCR, surgeon experience, incision type, Wirsung diameter, pancreatic tissue and operation time. In the stepwise logistic regression model, we found POD1 AST, POD3 CRP, POD3 TLR, diabetes, surgeon experience, and Wirsung diameter as predictive risk factors. Conclusions: In our study, we found POD1 AST, POD3 CRP, POD3 TLR, diabetes, surgeon experience and Wirsung diameter as predictive risk factors for CR-POPF.

Outcomes of Patients Undergoing Major Surgery for Cancer with COVID-19 in the Postoperative Period.

The aim of our study was to report about the clinical outcomes of patients who underwent major surgery for cancer and developed COVID-19 in the postoperative period. A retrospective and observational study was done in the Surgical Oncology Division of a tertiary care cancer hospital in North-East India. The study period was from 1st April 2020 to 31st December 2021. Patients with a confirmed diagnosis of cancer who underwent a major surgery and developed COVID-19 in the postoperative period, within the same hospital stay were included in the study. Data was obtained from a prospectively maintained database and case records. Descriptive statistics were used to state the results in median values, range and percentages. A total of 22 patients developed COVID-19 in the postoperative period during the study period out of a total of 1402 patients operated during that time period (1.57%). The have been followed up for a median period of 16months (range 2 to 18months). The median age at presentation was 50years (range 25 to 74years). The incidence of co-morbidities was 27.3%. The median duration of ICU stay was 3days (range 0 to 9days) and median duration of hospital stay was 22days (range 9 to 55days).. The postoperative mortality rate was 18.2%. COVID-19 in the postoperative period in patients undergoing major abdominal and thoracic surgeries for cancer caused high postoperative mortality and prolonged hospital stay.

Ketamine as a pre-emptive analgesia in patients undergoing caesarean delivery under spinal anesthesia

BACKGROUND & OBJECTIVES: Lower segment caesarean section (LSCS) leads to moderate to severe pain in the patient. Pain severity is directly proportional to the functional limitations and depression in the postpartum period, making it essential to provide good pain relief after surgery. Maternal wellbeing and better nursing care of newborn requires good postoperative analgesia with minimal side effects. The main objective of the study was to evaluate the analgesic effect of intravenous low-dose ketamine, when administered pre-emptively, in patients undergoing caesarean delivery under spinal anesthesia.
 METHODOLOGY: Two groups were made, each with 50 full-term pregnant females with a plan of caesarean section under spinal anesthesia. Group-A received spinal anesthesia with bupivacaine 0.5% along with intravenous placebo of 2cc normal saline, whereas group-B received 0.5mg/kg ketamine intravenously after administration of spinal anesthesia but before the start of surgical incision. Pain intensity was monitored using a visual rating pain scale (VRS), till the need for the first analgesic dose postoperatively.
 RESULTS: Both groups were comparable in terms of age and weight. Analgesia was markedly prolonged, and postoperative pain scores were significantly less in Group-B (ketamine group) as compared to Group-A; with p-value< 0.001, demonstrating analgesic properties of ketamine when administered pre-emptively as an intravenous dose.
 CONCLUSION: Our study concluded that pre-emptive analgesic dose of ketamine (administered before surgical incision), leads to prolong analgesia in post-operative period in patients who underwent LSCS under spinal anesthesia.

ANEMIA AND LONG-TERM SURVIVAL OF PATIENTS AFTER MITRAL VALVE SURGERY

HighlightsThe authors have studied anemia`s impact on the long-term mortality after mitral valve surgery. The research results indicate the need to address this modifiable factor in the preoperative period. Aim. To analyze the impact of anemia on the long-term survival of patients after mitral valve surgery.Methods. The study included 103 patients, 46 of them were men, 57 were women. Thirteen patients presented with anemia before surgery, and 90 patients did not have anemia. The survival rate of patients was compared using the Kaplan-Meier estimate.Results. The survival rate after surgery in the group of patients without anemia was higher compared with patients with anemia (p = 0,002). By the end of the follow-up period, the survival rate among patients without anemia reached 50.2%, whereas among patients with anemia it was 0.0%.Conclusion. Anemia is an independent predictor of complications in the postoperative period in patients with low preoperative hemoglobin levels. According to the results, the presence of anemia increases the risk of adverse events by 7.71 times in the preoperative period. Moreover, patients without anemia had the highest (up to 50.2%) survival rate in the long-term period, while patients with anemia had a survival rate equal to 0.0%.

Effect of Different Methods of Abdominal Decompression on the Dynamics of Intra-Abdominal Pressure in the Early Postoperative Period in Patients with Secondary Diffuse Peritonitis: Observational Study

Background. Intra-abdominal hypertension complicates the course of secondary diffuse peritonitis in at least 60–70% of cases. Abdominal decompression is an essential component in the complex of therapeutic measures in patients with secondary diffuse peritonitis. However, no clear criteria for choosing the method and timing of abdominal decompression have been developed so far. The effectiveness of its use in various forms of peritonitis remains controversial.Objectives — to study the dynamics of intra-abdominal pressure in the early postoperative period when using various methods of abdominal decompression in patients with secondary diffuse peritonitis.Methods. The work was performed on the basis of an observational clinical study under the auspices of Regional Clinical Emergency Hospital over a period from January 2021 to December 2022. The authors studied intra-abdominal pressure in 74 patients with secondary diffuse peritonitis in the early postoperative period. In 39 (52.7%) patients (group 1), decompression was carried out in the form of prolonged nasogastric intubation. 15 (20.3%) patients (group 2) underwent nasointestinal intubation. Group 3 was represented by 10 patients (13.5%) which were affected by open abdomen technology and vacuum assisted closure (VAC). Group 4 included patients with vacuum-assisted laparostoma who underwent nasointestinal intubation. The severity of peritonitis was assessed using WSES cIAIs Score and Mannheim Peritonitis Index. The dynamics of intra-abdominal pressure was determined through the urinary catheter using the Uno Meter Abdo Pressure® Kit (Unomedical, Russia) before surgery and within 5 days of the postoperative period. Statistical analysis was based on non-parametric Wilcoxon test for comparing the values of the same group at different periods of observation. Mann-Whitney U-test was used to compare absolute values in different groups.Results. Nasogastric tube did not provide an acceptable reduction in intra-abdominal pressure, especially in patients with severe forms of peritonitis. Prolonged nasointestinal intubation contributed to a steady decrease in intra-abdominal pressure throughout the postoperative period, while simultaneous intubation resulted in an increase in intra-abdominal hypertension after a decline in values one day after surgery. The best results of intra-abdominal pressure dynamics were observed in case of vacuum-assisted laparostomy and its combination with nasointestinal intubation. Throughout the postoperative period, the intra-abdominal pressure did not exceed 15–17 mmHg. This method can be used only in treatment of the most severe forms of peritonitis, with indications for sanitation relaparotomy and in case of threatened abdominal compression syndrome.Conclusion. The data obtained enable the process of choosing surgical tactics and method of abdominal decompression to be optimized with respect to the severity of peritonitis and intra-abdominal hypertension.

Comparison of the effects of epidural analgesia and local infiltrative analgesia methods on pain control and stress response in patients undergoing total knee arthroplasty

Background: We compared the effects of epidural analgesia (EA) and local infiltrative analgesia (LIA) on pain control and stress response in the postoperative period in patients who underwent total knee arthroplasty.
 Methodology: The patients were divided into two groups as those who were administered EA (Group EA; n = 25) and those who were administered LIA (Group LIA; n = 26). Pain at rest and during movement at the incision site was evaluated in both groups with NRS. In order to evaluate the stress response; cortisol, insulin, ACTH and glucose levels in serum were measured.
 Results: All 51 patients included in the study were female, with a mean age of 63.4 ± 7.16 y and a body mass index of 32.4 ± 4.77 kg/m2 . There was no difference between the two groups in terms of NRS values, whether at rest or in moving. There was no statistically significant difference between the two groups in terms of serum cortisol, insulin, ACTH, and glucose levels.
 Conclusion: It was determined that both EA and LIA are similar effect in pain control at rest and movement, and both methods are effective in controlling the postoperative stress response in patients undergoing total knee arthroplasty.
 Abbreviations: ACTH-Adrenocorticotropic hormone; EA-epidural analgesia; LIA-local infiltrative analgesia; NRS-numeric rating scale; TKA-Total knee arthroplasty
 Key words: arthroplasty, epidural analgesia, local anesthesia, pain, stress response
 Citation: Çelik HK, Güzel N. Comparison of the effects of epidural analgesia and local infiltrative analgesia methods on pain control and stress response in patients undergoing total knee arthroplasty. Anaesth. pain intensive care 2023;27(3):379−388; DOI: 10.35975/apic.v27i3.2241
 Received: Feb 12, 2023; Reviewed: March 11, 2023; Accepted: April 12, 2023

Взаимосвязь показателей кислородного метаболизма нейтрофилов и антиэндотоксинового иммунитета как маркер течения послеоперационного периода у пациентов с острой толстокишечной непроходимостью

Острая толстокишечная непроходимость – одно из самых тяжелых распространенных заболеваний в абдоминальной хирургии, требующее экстренного оперативного вмешательства. Очаг гнойного воспаления в брюшной полости служит источником концентрации антимикробных механизмов, среди которых центральную роль выполняют нейтрофильные гранулоциты и кооперирующиеся с ними факторы. Целью настоящей работы было исследовать показатели кислородного метаболизма нейтрофильных гранулоцитов в послеоперационном периоде у пациентов с острой толстокишечной непроходимостью и маркера нарастающей эндотоксинемии. В статье отражены эффективные подходы к мониторингу течения послеоперационного периода у 157 пациентов, прооперированных по поводу острой толстокишечной непроходимости. Основную группу составили 97 (61,78%) пациентов, в брюшной полости которых выявлялся гнойно-воспалительный процесс. В группу сравнения вошли 60 (38,22%) пациентов с гладким течением болезни. Группой контроля служили 23 условно здоровых человека. Специальные методы исследования включали оценку состояния микробицидной функции нейтрофильных гранулоцитов с помощью реактивной спонтанной и индуцированной зимозаном люминолзависимой хемилюминисценции. Специфические показатели гуморального антибактериального иммунитета регистрировали путем определения концентрации антител к антигенам липополисахарида E. coli O14, гликолипида Re-мутанта Pseudomonas aeruginosa, Proteus mirabilis. Анализ показателей реактивной спонтанной люминолзависимой хемилюминисценции у всех пациентов при поступлении выявил их существенное повышение, причем в основной группе оно сохранялось и на 7-8 сутки. Иная динамика биоцидности нейтрофильных гранулоцитов была отмечена у данных пациентов при исследовании антибактериальной защиты. Путем динамического исследования показателей кислородного метаболизма и специфического антиэндотоксинового иммунитета грамотрицательной микрофлоры кишечника установлена их прямая зависимость от клинического течения и развития гнойно-воспалительных осложнений. Отмечено, что на 2-3 сутки после проведенного хирургического вмешательства у пациентов основной группы наблюдалось существенное снижение показателей гликолипида, липополисахарида E. coli O14 и Proteus mirabilis, что тесно коррелировало с дефицитом резервов антимикробной биоцидности нейтрофильных гранулоцитов. Замедленная стабилизация показателей предшествовала неблагоприятному исходу болезни. Установлена взаимосвязь между показателями кислородного метаболизма нейтрофильных гранулоцитов и специфического антиэндотоксинового иммунитета, что отражает характер течения послеоперационного периода у пациентов с острой толстокишечной непроходимостью. Тестирование показателей биоцидного резерва нейтрофильных гранулоцитов при помощи реакции индуцированной зимозаном люминолзависимой хемилюминисценции может быть использовано в качестве скрининговой индикации прогноза течения послеоперационного периода и формирования гнойно-воспалительных осложнений. One of the most severe common diseases in abdominal surgery requiring emergency surgical intervention is acute colonic obstruction. The focus of purulent inflammation in the abdominal cavity serves as a source of concentration of antimicrobial mechanisms, among which the central role is played by neutrophilic granulocytes and factors cooperating with them. The target was to study the indicators of oxygen metabolism of neutrophilic granulocytes at the stage of the postoperative period in patients with ABO and a marker of increasing endotoxinemia. The article reflects effective approaches to monitoring the course of the postoperative period in 157 patients operated on for acute colonic obstruction. The main group (first) consisted of 97 (61.78%) patients, in the abdominal cavity of which a purulent-inflammatory process was detected. The comparison group (second) included 60 (38.22%) patients with a smooth course of the disease. The control group consisted of 23 conditionally healthy people. Special research methods included the assessment of the state of the microbicidal function of neutrophilic granulocytes using reactive spontaneous (SSLCL) and zymosan-induced luminol-dependent chemiluminescence tests (ILZHL). Specific indicators of humoral AB immunity were recorded by determining the concentration of antibodies to lipopolysaccharide (LPS) antigens of E. coli O14, glycolipid (HLP) of Pseudomonas aeruginosa Re-mutant, Proteus mirabilis. An analysis of the SLCL parameters in all patients upon admission revealed their significant increase, and in the main group it persisted for 7-8 days. A different dynamics of neutrophilic granulocytes biocidal activity was noted in these patients during the study of AB protection. Through a dynamic study of the indicators of oxygen metabolism and specific antiendotoxin immunity of gram-negative intestinal microflora, their direct dependence on the clinical course and the development of pyoinflammatory complications was established. It was noted that 2-3 days after the surgical intervention in patients of the main group, there was a significant decrease in the indicators of HLP, LPS E. coli O14 and Proteus mirabilis, which closely correlated with the lack of reserves of antimicrobial biocidal activity of neutrophilic granulocytes. Delayed stabilization of indicators preceded an unfavorable outcome of the course of the disease. The relationship between the parameters of oxygen metabolism of neutrophilic granulocytes and specific antiendotoxin immunity was established, which reflects the nature of the course of the postoperative period in patients with AIO. Testing of indicators of the biocidal reserve of neutrophilic granulocytes according to the reaction of ILZHL can be used as a screening indication of the prognosis of the course of the postoperative period and the formation of pyoinflammatory complications.

Визуальные исходы факоэмульсификации катаракты у пациентов с сахарным диабетом и различной клинической рефракцией

Purpose. To study the results of phacoemulsification (PE) in patients with diabetes mellitus (DM) depending on the anterior-posterior axis (APA) and eye refraction. Material and methods. The study involved 57 patients (57 eyes) with insulin-dependent compensated or subcompensated DM (type II). All the patients underwent PE with IOL implantation. According to the nature of refraction, the patients were divided into 3 groups: group 1 — 16 patients (16 eyes) with moderate and high myopia, group 2 — 18 people (18 eyes) with hypermetropia, group 3 — 23 patients (23 eyes) with emmetropia. Distribution of the patients according to the length of the anterior-posterior axis (APA): with moderate myopia and APA from 25.01 to 26.5 mm (7), high myopia and APA above 26.51 mm (9), with emmetropia and APA from 22.2 to 23.8 mm (23) and APA less than 22.2 mm — hypermetropics (18). Results. VA in the early and late postoperative period in patients with DM and myopic refraction after PE was higher than in patients with hypermetropia and emmetropia. Visual acuity of 0.5 and higher was observed at discharge in 75.0 % of patients with myopia (and changes in the retina in the form of diabetic retinopathy were much less frequent) than in patients with hypermetropia (50.0 %) and emmetropia (52.2 %), and in long-term follow-up in 73.3 %, 37.5 % and 36.8 %, respectively. Destabilization of diabetic retinopathy with the transition to the next stage was observed twice less often in patients with myopia (13.3 %) than in patients with hypermetropia and emmetropia (25 % and 26.3 %, respectively). Conclusion. Visual outcomes after cataract surgery in diabetic patients are strongly affected by refraction and the axial length of the eyeball. At discharge visual acuity of 0.5 and higher was observed in 75.0 % of myopic patients, 50.0 % of hypermetropics and 52.2 % of emmetropic patients; and over 3 years of follow-up — in 73.3 %, 37.5 % and 36.8 % respectively. At hospital discharge diabetic retinopathy in myopic patients was observed 4.3 times less frequently than in patients with emmetropia and hypermetropia, and its destabilization with the transition to the next stage after 3 years of postoperative follow-up was twice less often: in 13.3 % vs. 25 % and 26.3 %, respectively. Keywords: diabetes mellitus, cataract, phacoemulsification, anterior-posterior axis of the eye, refraction, myopia, visual acuity, diabetic retinopathy

The results of the early postoperative period in patients with DM 2 subjected to aorto-coronary bypass

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Nutrition in congenital heart disease: consensus document

IntroductionThe prevalence of malnutrition among infants with congenital heart disease (CHD) is high. Early nutritional assessment and intervention contribute significantly to its treatment and improve outcomes. Our objective was to develop a consensus document for the nutritional assessment and management of infants with CHD. Material and methodsWe employed a modified Delphi technique. Based on the literature and clinical experience, a scientific committee prepared a list of statements that addressed the referral to paediatric nutrition units (PNUs), assessment, and nutritional management of infants with CHD. Specialists in paediatric cardiology and paediatric gastroenterology and nutrition evaluated the questionnaire in 2 rounds. ResultsThirty-two specialists participated. After two evaluation rounds, a consensus was reached for 150 out of 185 items (81%). Cardiac pathologies associated with a low and high nutritional risk and associated cardiac or extracardiac factors that carry a high nutritional risk were identified. The committee developed recommendations for assessment and follow-up by nutrition units and for the calculation of nutritional requirements, the type of nutrition and the route of administration. Particular attention was devoted to the need for intensive nutrition therapy in the preoperative period, the follow-up by the PNU during the postoperative period of patients who required preoperative nutritional care, and reassessment by the cardiologist in the case nutrition goals are not achieved. ConclusionsThese recommendations can be helpful for the early detection and referral of vulnerable patients, their evaluation and nutritional management and improving the prognosis of their CHD.

Pathogenetic variants of sepsis in oncologicy practice

Introduction Over the past 30 years, sepsis has been an urgent interdisciplinary problem of modern medicine due to the increase in morbidity and a consistently high mortality rate. Patients of oncological hospitals have a high predisposition to the development of sepsis, both in the postoperative period and in the departments of chemo and radiation therapy. In addition, sepsis may be a complication of the postoperative period in patients undergoing surgical treatment. Of interest is not only the clinical and laboratory diagnosis of sepsis in this category of patients, but also the features of its morphological picture, due to uniform diagnostic criteria. The greatest difficulties arise in the study of autopsies, after antitumor chemotherapy, which causes a secondary immunodeficiency condition characterized by the absence of a classical morphological picture of sepsis. The use of modern antibacterial drugs, as well as pathogenetic therapy of sepsis also leads to its pathomorphosis, which also complicates diagnosis.The aim of the study is to systematize the literature data and the results of our own research on the features of morphological manifestations of sepsis in oncological pathology, depending on cancer treatment.Material and methods The search and selection of literary sources was carried out in PubMed, GoogleScholar, electronic library systems elibrary.ru, the search depth is 30 years.Results and Discussion Sepsis in cancer patients after surgical interventions is characterized by hyperergic type of tissue reactions with hyperplasia of lymphoid and myeloid tissue and classic manifestations of septicopyemia of varying severity of purulent metastatic process: from macroscopically distinguishable abscesses to mini-foci of purulent inflammation. Against the background of antibiotic therapy, there is a pathomorphosis of sepsis with a predominance of microcirculation disorders and small focal ulcers. In patients after chemotherapy, accompanied by leukopenia and agranulocytosis, with sepsis, hypoplasia of myeloid and lymphoid tissue is noted, and in the internal organs, along with microcirculation disorders, foci of necrosis, severe dystrophic changes with the absence of neutrophil infiltration are found.Conclusion Sepsis in cancer patients from pathogenetic positions is heterogeneous, depending on the characteristics of the body and the nature of treatment, it should be divided into hyper- and anergic. The diagnosis of sepsis is clinico-morphological, which requires not only the use of clinical and laboratory diagnostic scales, but also the definition of criteria for morphological diagnosis.

Microbiota Metabolism Failure as a Risk Factor for Postoperative Complications after Aortic Prosthetics.

Postoperative complications in cardiovascular surgery remain an important unresolved problem, in particular in patients with aortic aneurysm. The role of the altered microbiota in such patients is of great interest. The aim of this pilot study was to determine whether the development of postoperative complications in patients with aortic aneurysm is related with initial or acquired disorders of microbiota metabolism by monitoring the level of some aromatic microbial metabolites (AMMs) circulating in the blood before the surgery and in the early postoperative period. The study comprised patients with aortic aneurysm (n = 79), including patients without complications (n = 36) and patients with all types of complications (n = 43). The serum samples from the patients were collected before and 6 h after the end of the surgery. The most significant results were obtained for the sum of three sepsis-associated AMMs. This level was higher before the surgery in comparison with that of healthy volunteers (n = 48), p < 0.001, and it was also higher in the early postoperative period in patients with all types of complications compared to those without complications, p = 0.001; the area under the ROC curve, the cut-off value, and the odds ratio were 0.7; 2.9 µmol/L, and 5.5, respectively. Impaired microbiota metabolism is important in the development of complications after complex reconstructive aortic surgery, which is the basis for the search for a new prevention strategy.

Dexmedetomidine ameliorates liver injury and maintains liver function in patients with hepatocellular carcinoma after hepatectomy: a retrospective cohort study with propensity score matching.

Although dexmedetomidine (DEX) is widely used during the perioperative period in patients with hepatocellular carcinoma (HCC), its clinical effects on liver function and postoperative inflammation are unclear. This study aimed to explore effects of DEX on postoperative liver function and inflammation in patients with HCC after hepatectomy. A retrospective cohort study with propensity score matching was performed. A total of 494 patients who underwent hepatectomy from June 2019 to July 2020 and fulfilled the eligibility criteria were included in this study. Baseline data, liver function indexes and inflammation-related biomarkers were collected and compared between the two groups. Survival analysis was conducted to investigate the effects of DEX on the overall survival (OS) of patients. Propensity score matching (PSM) was used to minimize bias between the two groups. The study cohort comprised 189 patients in the DEX-free group and 305 patients in the DEX group. Patients in the DEX group had lower levels of alanine transaminase (ALT, P = 0.018) and lactate dehydrogenase (LDH, P = 0.046) and higher level of serum albumin (ALB, P < 0.001) than patients in the DEX-free group before discharge. A total of 107 pairs of patients were successfully matched by PSM. Results consistently suggested that ALT and LDH levels were significantly lower (P = 0.044 and P = 0.046, respectively) and ALB levels were significantly higher (P = 0.002) in the DEX group than in the DEX-free group in the early postoperative period. No significant differences of inflammation-related biomarkers were observed between two groups after PSM. Neither the Kaplan-Meier survival analysis nor the multiple Cox regression survival analysis identified DEX as a contributing factor that would affect the OS of patients after PSM. DEX exerts protective effects on liver function while has little effects on inflammation-related biomarkers in the early postoperative period in patients undergoing hepatectomy due to HCC.

La nutrición en las cardiopatías congénitas: Documento de consenso

IntroductionThe prevalence of malnutrition among infants with congenital heart disease (CHD) is high. Early nutritional assessment and intervention contribute significantly to its treatment and improve outcomes. Our objective was to develop a consensus document for the nutritional assessment and management of infants with CHD. Material and methodsWe employed a modified Delphi technique. Based on the literature and clinical experience, a scientific committee prepared a list of statements that addressed the referral to paediatric nutrition units (PNUs), assessment, and nutritional management of infants with CHD. Specialists in paediatric cardiology and paediatric gastroenterology and nutrition evaluated the questionnaire in 2 rounds. ResultsThirty-two specialists participated. After two evaluation rounds, a consensus was reached for 150 out of 185 items (81%). Cardiac pathologies associated with a low and high nutritional risk and associated cardiac or extracardiac factors that carry a high nutritional risk were identified. The committee developed recommendations for assessment and follow-up by nutrition units and for the calculation of nutritional requirements, the type of nutrition and the route of administration. Particular attention was devoted to the need for intensive nutrition therapy in the preoperative period, the follow-up by the PNU during the postoperative period of patients who required preoperative nutritional care, and reassessment by the cardiologist in the case nutrition goals are not achieved. ConclusionsThese recommendations can be helpful for the early detection and referral of vulnerable patients, their evaluation and nutritional management and improving the prognosis of their CHD.

Профилактика эпиретинального фиброзирования в послеоперационном периоде при хирургическом лечении пролиферативной диабетической ретинопатии

Purpose. To improve the surgical technique for correcting the retinal central zone to prevent epiretinal fibrosis in the postoperative period in patients with proliferative diabetic retinopathy. Material and methods. The study included 104 patients (104 eyes) with proliferative diabetic retinopathy without signs of epiretinal fibrosis in macular area. All patients were divided into 4 groups: group 1 (n = 27) – vitrectomy with silicone oil tamponade; group 2 (n = 28) – vitrectomy with internal limiting membrane peeling and silicone oil tamponade; in groups 3 (n = 25) and 4 (n = 24) a similar volume of vitreoretinal intervention was performed with gas-air tamponade of the vitreal cavity. 3 months after primary vitrectomy, 61 patients (61 eyes) underwent additional vitreoretinal interventions due to the presence of epiretinal fibrosis with tangential traction syndrome and/or silicone oil tamponade of the vitreal cavity. The observation period was 6 months. Results. At postoperative period, in patients without internal limiting membrane peeling against the background of vitreal cavity tamponade with silicone oil, risk of epiretinal fibrosis increased by 2.7 times (p = 0.036 compared with data before treatment) and by 1.8 times (p = 0.048) against the background of gas-air tamponade. The presence of epiretinal fibrosis with tangential traction syndrome and/or silicone oil tamponade of the vitreal cavity after primary vitrectomy is an absolute indication for additional vitreoretinal interventions. The highest morphological and functional results were due to the absence of epiretinal fibrosis, due to the removed internal limiting membrane, which would serve as a substrate (platform) for cell proliferation on its surface. Conclusion. Optimal surgical technique performed during vitreoretinal intervention for proliferative diabetic retinopathy is internal limiting membrane peeling and use gas-air tamponade of the vitreal cavity, which provides effective prevention of epiretinal fibrosis in retinal central zone and improvement of morphological and functional parameters of patients' eyes. Keywords: proliferative diabetic retinopathy, vitreoretinal intervention, internal limiting membrane peeling, epiretinal fibrosis, tangential traction syndrome, vitreous cavity tamponade

Расстройства мочеиспускания и качество жизни у больных ДГПЖ после трансуретральной резекции предстательной железы.

Introduction. Transurethral resection (TUR) of the prostate remains the gold standard for surgical treatment of patients with benign prostatic hyperplasia (BPH). A proportion of patients who have undergone a prostatic TUR for BPH continue to have urinary dysfunction. Aim. The aim of the study was to determine the incidence of urinary disorders and quality of life in the long-term postoperative period in patients after prostatic TUR. Materials and methods. We interviewed and surveyed 176 patients who underwent prostate TUR between 2018 and 2021. To determine the prevalence of lower urinary tract symptoms (LUTs) after prostate TUR, we surveyed 176 patients between 12 and 36 months after surgical treatment. The age of the patients surveyed ranged from 47 to 89 years. Results. 53.4% of the patients were completely satisfied with the surgical treatment and 46.6% reported various urinary disorders. According to the questionnaire about the IPSS scale 47.7% patients moderate to severe symptoms persisted after prostate TUR. In 21.6% of the patients quality of life due to urinary disorders was unsatisfactory, poor and very poor. However, moderate and severe symptoms as well as worsening quality of life were more often observed in the older age groups. Conclusions. After prostate TUR, 10.2% of patients have severe and 37.5% have moderate urinary dysfunction in the long-term postoperative period. These urinary disorders worsen quality of life and are more frequent in older patients.

Comparative analysis of pain levels, preoperative anxiety, depression and laboratory parameters during uterine surgery

Introduction. Studies show a low efficiency of postoperative pain relief, especially in gynecological patients. The psychogenic component is of no small importance in the formation of postoperative pain syndrome. Purpose of the study was to determine the factors influencing the development of uncontrolled pain syndrome in patients who underwent uterine surgery. Materials and methods. We examined 30 patients who underwent elective surgery for hysterectomy, conservative myomectomy by laparoscopic or laparotomy access or in combination with perineal plastic surgery. Patients of the study subgroups did not differ in age, BMI, and somatic status. Epidural analgesia with 0.2 % ropivacaine solution was performed. We studied preoperative anxiety and depression scores (HADS scale), the dynamics of C-reactive protein level, glucose, lactate, acid-base status, hemostasis, and pain level initially and in the postoperative period, postoperative recovery rate of the patients and satisfaction with anesthesia. Results. The greatest number of reliable differences in the subgroups was obtained when dividing by the level of preoperative anxiety. Patients with an elevated level of preoperative anxiety were less active in the postoperative period and had three times higher levels of C-reactive protein on the day of discharge. Patients with depression had significantly higher glucose levels compared to the subgroup without signs of preoperative depression on the third postoperative day, and C-reactive protein levels on the second day. The data of regression analysis show the relationship between the level of preoperative anxiety and uncontrolled pain in the postoperative period in gynecological patients. Discussion. The dynamics of the laboratory indices testify in favor of adequate anesthesia and pain control in the study group. The protocol of pain control during uterine surgery that we use allows us to reduce the level of postoperative pain to acceptable values and increase patients' satisfaction with the recommended analgesia. The impact of anxiety and depression on the severity of pain and the course of the postoperative period among gynecological patients necessitates the use of the HADS scale in the preoperative period. Patients with symptoms of clinically pronounced preoperative anxiety should be prescribed counseling by a psychotherapist and anxiolytics at the preoperative examination stage. Conclusions. Prehospital anxiety level is a significant factor influencing the development of uncontrolled pain syndrome. The HADS scale identifies a "high risk" group for the development of uncontrolled pain in the postoperative period in patients awaiting uterine surgery and is a screening test.

Results of Swallowing Assessment in the Immediate Postoperative Period in Patients Following Surgery for Thyroid Malignancies.

Results of Swallowing Assessment in the Immediate Postoperative Period in Patients Following Surgery for Thyroid Malignancies.

Surgical disconnection of high delineated immature debilitating jejunal fistulas using posterolateral access

Objective. The aim of the study was to develop the safest technique for surgical disconnection of high, unformed jejunal fistulas, so as to avoid problems with detection the intestine leading to the fistula and to avoid complications of viscerolysis. Material and methods. The authors present their experience in surgical management of 35 patients with high delimited unformed debilitating jejunal fistulas. Of these, 22 patients were included in the comparison group; their fistulas were closed or disconnected with the known methods. Findings obtained from other 172 patients with adhesive intestinal obstruction after infectious complications of laparotomic wounds and topography of visceroparietal planar adhesions of the peritoneum were analyzed. After studying the nature and location of visceroparietal adhesions, the authors could develop a technique for proximal disconnection of high delimited unformed debilitating jejunal fistulas using posterolateral access which was applied in 13 patients from the studied group. Research results. The proposed technique of unilateral disconnection of high unformed jejunal fistulas reduces duration, damage and risk of prolonged bowel deserosing. As a result, a significant decrease in postoperative mortality from 59.1 ± 9.2% to 23.1 ± 11.2% (t=2.5; p&lt;0.05) was registered. Due to the preoperative endoscopic marking showing direction to the fistula of intestinal loop and duodenojejunal junction, intraoperative orientation was more accurate and took much less time than in the comparison group. The posterolateral surgical approach to the fistula in the jejunal loop reduced the risk of its damage, since there was no need for extensive enterolysis anymore. Therefore, postoperative period in patients of the studied group was better and with fewer complications than in the comparison group. Conclusion. The posterolateral access prevented extended viscerolysis and allowed to put a reliable and atraumatic interintestinal anastomosis so as to disconnect the fistula. The unilateral disconnection of the jejunal fistula at postoperative intestinal paresis unloaded the interintestinal anastomosis, similar to Meidl’s definitive jejunostomy. The abovementioned positive aspects of the proposed surgical intervention allowed to significantly decrease postoperative complications and mortality rate, if to compare with outcomes after known surgical interventions with a similar purpose.