Patients In Postoperative Period Research Articles

Comparison of the results of preoperative assessment of cardiovascular risk and outcomes of surgical interventions for locally advanced abdominal cancer

This retrospective study analyzed the structure of complications and mortality cases in 351 patients (men, n = 199; women, n = 152) aged 3389 years with locally advanced abdominal cancer and different cardiovascular risks in the early postoperative period, and two patient groups were formed. The main group consisted of 81 (23.1%) patients who died in the early postoperative period. The comparison group included 270 (76.9%) patients. In total, 311 (88.6%) patients underwent radical surgical intervention, whereas 40 (11.4%) underwent minimally invasive surgical treatment. Perioperative cardiovascular risk was stratified by calculating cardiac risk indices and using the database of the National Program for Improving the Quality of Surgical Care Myocardial Infarction and Cardiac Arrest. Fatal complications in the early postoperative period after surgical treatment of locally advanced abdominal cancer is significantly more often observed in patients with a more pronounced degree of tumor invasion, lymph node lesions, high class according to the standards of the American Society of Anesthesiologists, reduced functional status, prior hormone therapy, and combined anesthesia. The majority of fatal cases were associated with three complications, i.e., ventricular arrhythmias (53%), acute decompensation of heart failure (46%), and multiple organ failure (43%). Approximately 95% of deaths were associated with increased postoperative cardiovascular risk, and 52% were medium-risk cases. Hospital mortality at low risk was noted in 4.9%, average in 27.8%, and high in 32.7% of the patients. In cases with a favorable course, surgical complications were predominant over cardiovascular ones. The use of calculated cardiac risk indices and database of the National Program for Improving the Quality of Surgical Care Myocardial Infarction and Cardiac Arrest confirmed their high ability to predict the development of cardiovascular complications, which are the leading causes of death in the early postoperative period in patients who underwent surgical interventions for locally advanced abdominal cancer.

Influence of general anesthesia on the postoperative sleep cycle in patients undergoing surgery and dental treatment: a scoping review on the incidence of postoperative sleep disturbance.

General anesthesia may influence the postoperative sleep cycle; however, no clinical studies have fully evaluated whether anesthesia causes sleep disturbances during the postoperative period. In this scoping review, we explored the changes in postoperative sleep cycles during surgical procedures or dental treatment under general anesthesia. We compared and evaluated the influence of general anesthesia on sleep cycles and sleep disturbances during the postoperative period in adult and pediatric patients undergoing surgery and/or dental treatment. Literature was retrieved by searching eight public databases. Randomized clinical trials, observational studies, observational case-control studies, and cohort studies were included. Primary outcomes included the incidence of sleep, circadian cycle alterations, and/or sleep disturbances. The search strategy yielded six studies after duplicates were removed. Finally, six clinical trials with 1,044 patients were included. In conclusion, general anesthesia may cause sleep disturbances based on alterations in sleep or the circadian cycle in the postoperative period in patients scheduled for elective surgery.

ЭФФЕКТИВНОСТЬ ПРИМЕНЕНИЯ ИСКУССТВЕННОГО ПНЕВМОПЕРИТОНЕУМА ДО И ПОСЛЕ ПНЕВМОНЭКТОМИИ У БОЛЬНЫХ РАСПРОСТРАНЕННЫМ ДЕСТРУКТИВНЫМ ТУБЕРКУЛЕЗОМ ЛЕГКИХ

Aim: to evaluate the effectiveness of artificial pneumoperitoneum (APP) in the pre-operative and post-operative period in patients, who underwent pneumonectomy due to advanced destructive pulmonary TB. Materials and methods. We studied 104 patients, who underwent pneumonectomy with anterior mediastinal plasty (AMP) due to advanceddestructive pulmonary TB. The patients were divided into two groups. The main group consisted of 34 patients enrolled prospectively, who underwent APP before and after pneumonectomy with AMP. The comparison group consisted of 70 patients enrolled retrospectively, who did not undergo APP before and after pneumonectomy with AMP. Treatment effectiveness was estimated based on the parameters of the early course and late course (after 2 months) of post-operative period and dynamic chest X-ray signs. We also performed morphological and bacteriological studies of resection samples to estimate TB activity and bacterioexcretion massivity. Results. The effectiveness of APP for prevention of mediastinal lung hernias (MLH) was 93.3%. The studies of resection samples from the main group patients revealed decreased incidence of lymphohematogenic or bronchogenic dissemination, as well as more pronounced organization of granulomas and small foci as compared to resection samples from the controls. The comparison of key spirometry parameters in the groups did not reveal significant differences. Conclusion. The use of APP before and after pneumonectomy with AMP is a safe and highly effective method for prevention of MLH. It also contributes to stabilization of TB process in the remaining lung.

НОВЫЕ ПОДХОДЫ В КОМПЛЕКСНОМ ЛЕЧЕНИИ ЗАКРЫТЫХ СЕГМЕНТАРНЫХ И МНОГООСКОЛЬЧАТЫХ ДИАФИЗАРНЫХ ПЕРЕЛОМОВ КОСТЕЙ ГОЛЕНИ

The analysis of the world and domestic literature devoted to modern approaches to the complex treatment of closed segmental and multi-fragmented diaphyseal fractures of the lower leg bones in people of working age is carried out, as well as the pathogenetic mechanisms of remodeling in the fracture zone are consecrated. To date, there is no comprehensive information on the required number of sessions and their duration when using hyperbaric oxygenation and antioxidants in the pre- and postoperative periods in patients with fractures of the lower leg bones. This justifies the relevance of further research in order to develop a new concept of complex treatment, which consists in a differentiated approach to the use of hyperbaric therapeutic oxygen in combination with antioxidants in patients with fractures of the lower leg bones.

Postoperative Remission of Diabetes Mellitus After Gastrectomy in Patients With Diabetes Mellitus and Gastric Cancer.

We investigated the postoperative treatment status for diabetes mellitus and perioperative HbA1c levels in patients with diabetes mellitus and examined the effects of clinical factors on the remission of diabetes mellitus. In this study, 126 patients with gastric cancer were considered to have diabetes mellitus preoperatively, of whom 79 were treated with oral antidiabetic drugs and/or insulin treatment. We compared diabetic treatment status and HbA1c values between the preoperative and postoperative periods in patients who underwent gastrectomy and examined the effects of clinical factors on improving diabetes mellitus. Of the 79 patients treated preoperatively for diabetes mellitus, 34 (43%) discontinued all medications for diabetes mellitus and for 37 (47%) the therapeutic dose was reduced or switched from insulin to oral antidiabetic drugs. Total gastrectomy was an independent factor for remission of antidiabetic treatments after gastrectomy. Concerning HbA1c levels, only the absence of preoperative insulin use was an independent factor for improvement. However, reconstruction was not a significantly correlated factor for the improvement of postoperative HbA1c levels and reduction of antidiabetic medications after distal gastrectomy. Almost all patients discontinued or had their dose of antidiabetic medications reduced after gastrectomy in clinical practice, and special attention should be paid in the management methods for diabetes mellitus in patients who underwent total gastrectomy for gastric cancer.

Evaluation of Thirst in the Early Postoperative Period in Patients Undergoing Orthopedic Surgery

Thirst, is a subjective symptom that has a high incidence in the early postoperative period and causes patients to experience intense discomfort. The aim of this study is to determine thirst and the factors affecting thirst in the early postoperative period in patients undergoing orthopedic surgery. The research was carried out as a descriptive-cross sectional study with 177 patients between September 2021 and January 2022. Data were collected using the "Descriptive and clinical features form," "Thirst and Symptoms Associated with Thirst Evaluation Form." For descriptive analysis, frequency, percentage distribution, mean, and minimum-maximum values were analyzed. The Chi-square test was used to compare the data according to the groups. Before starting the research, necessary ethics committee and institutional permission were obtained. The mean perioperative thirst time of the patients was 15.25 ± 3.61 hours and the mean anesthesia time was 2.32 ± 1.13 hours. When the perioperative thirst duration was compared with the type of surgery, duration of operation, type of anesthesia, duration of anesthesia, duration of fasting, intubation and duration of stay in PACU, there was a statistical significance between them (P > .05). The most common symptoms in patients undergoing orthopedic surgery were thirst and dry mouth. Surgery type, operation duration, anesthesia type, anesthesia duration, fasting duration, intubation status and duration of stay in PACU were the factors affecting the perioperative thirst status of the patients.

Comparative Assessment of the Influence of the IOL Position on the Aberrometry Parameters after Suture Fixation of the IOL-Capsule Bag Complex to the Iris

Relevance. Suture fixation of dislocated IOL capsule-sac complexes to the iris is widely used at present. Violation of the correct position of the IOL affects the decrease in contrast sensitivity, the appearance of dysphotopsias and aberrations. Determining the dependence of the parameters of the IOL position on the quantitative characteristics of wave front aberrations in the delayed period will allow us to consider the applied methods of surgical treatment from the position of influencing the quality of vision.Purpose: to conduct a comparative assessment of the effect of IOL tilt and decentration on aberrometry indicators in the delayed postoperative period in patients with suture fixation of the IOL capsular-bag complex to the iris.Patients and methods. The main group consisted of 46 eyes operated on in 2014–2016 for the dislocation of capsule-bag complex by suture fixation to the iris for 2 arches. Comparison group — 30 eyes with articulation without suture fixation, having high uncorrected visual acuity (0.8–1.0). According to the study design, the indicators of both groups were determined at least 5 years after the operation. All patients had spherical IOLs. The determination of the IOL position (tilt and decentration) was carried out on RTVue OCT (Optovue, USA). Aberrometry was carried out on the OPD-Scan III, a comparative assessment of the wavefront indicators was performed: the mean square error of the total wavefront (Total RMS), general internal aberrations, tilt aberrations — “tilt”, total high-order aberrations “high”, oblique ray aberrations “Coma”.Results. Indicators of the IOL position. The main group. The average value of the angle of inclination in the horizontal meridian of the IOL was 3.07 ± 0.35°, in the vertical meridian 2.35 ± 0.25°. The decentration relative to the center of the pupil was 387.0 ± 3.4 mkm in the horizontal meridian, 443.0 ± 4.3 mkm in the vertical meridian. The comparison group. The average value of the angle of inclination in the horizontal meridian of the IOL was 3.04 ± 0.35°, in the vertical meridian 1.43 ± 0.13°. The decentration relative to the center of the pupil was 190.0 ± 2.8 mkm in the horizontal meridian, 259.0 ± 3.4 mkm in the vertical meridian. Aberrometry indicators. The main group: total RMS 0.52 ± 0.04, total internal aberrations 0.96 ± 0.04, tilt aberrations — “tilt” 0.31 ± 0.02, total high-order aberrations “high” 0.29 ± 0.01, oblique ray aberrations “Coma” 0.201 ± 0.010. The comparison group: total RMS 0.29 ± 0.03, total internal aberrations 0.66 ± 0.08, tilt aberrations — ““tilt” 0.202 ± 0.02, total high-order aberrations “high” 0.19 ± 0.07, oblique ray aberrations “Coma” 0.088 ± 0.010.The differences in the compared groups were significant (p < 0.05).The calculation of the correlation coefficient, when comparing the parameters of IOL decentration and the quantitative characteristics of aberrations, revealed a weak positive dependence, which indicates a slight influence of the obtained IOL decentration parameters on both internal aberrations and the RMS integral indicator.Conclusion. Thus, a comparative assessment of the indicators of the IOL position (tilt / decentration) and the number of wave front aberrations did not reveal a significant correlation. The correct central position of the IOL reduces wavefront aberrations and ensures high quality of vision. The method of suture fixation of the capsule-bag complexes to the iris provides a high functional and qualitative result in a delayed period.

RELATIONSHIP BETWEEN SEDATION, PATIENTS' LEFT VENTRICULAR EJECTION FRACTION AND FREQUENCY OF NEED FOR SYMPATHOMIMETIC AND INOTROPIC SUPPORT IN PATIENTS AFTER CARDIAC SURGERY IN THE EARLY POSTOPERATIVE PERIOD

Introduction: Most patients who are indicated for cardiac surgery are patients with reduced left ventricular ejection fraction (LVEF). Also, most patients after cardiac surgery receive sedation, which, in combination with reduced LVEF, can lead to severe hemodynamic disturbances. Whether there is a relationship between the drug for sedation in the early postoperative period in patients after cardiac surgery and the initial left ventricular ejection fraction until the end, there is still no consensus.
 Purpose: To monitor the relationship between the drug for sedation, the patients' initial left ventricular ejection fraction and the frequency of the need for sympathomimetic support and inotropic support in the early postoperative period.
 Materials and methods: A randomized controlled parallel study was conducted. The study included 194 patients over 18 years of age who underwent cardiac surgical treatment using artificial blood circulation. The control point for evaluating the effect of sedation on hemodynamics was the use of inotropic and sympathomimetic therapy and the analysis of the frequency of use in groups with different ejection fractions of the left ventricle. An assessment of the frequency of vasopressor/inotropic therapy without taking into account the sedation strategy was also carried out. Statistical data processing was carried out on the basis of GraphPad Prism 9.0 software.
 Results: In the group receiving propofol sedation (n=95), 83.16 % (n=79) of patients received inotropic/vasopressor therapy, which is 40.72 % of the total number of patients in all 3 groups (n=194). In the group receiving received sedation with dexmedetomidine (n=16), 81.25 % (n=13) received supportive inotropic/vasopressor therapy, which is 6.7 % of the total number of patients in all 3 groups (n=194). Patients who were sedated with a combination of these drugs (n =83) received supportive inotropic/vasopressor therapy in 91.57 % (n=76) of cases, which is 39.18 % of the total number of patients in all 3 groups (n=194). (p = 0.2093). When analyzing the frequency of use of inotropic therapy in each LVEF group, regardless of the type of sedation, it was found that the frequency of use depended on the fraction of LVEF emission below 55 % (p=0.0484). When comparing the groups of patients with LVEF ≥ 55 % and LVEF 40 – 30 %, more patients with PV 40 – 30 % received inotropic support (p=0.0299 RR 0.7878 95 % CI 0.6542-0.9528). No difference was found in the frequency of use of inotropic support when comparing LVEF ≥ 55 % and LVEF≤ 30% (p=0.7474 RR 0.9103 95% CI 0.7255-1.275), PV 55 – 40% and PV 40 – 30 % (p=0.4527 RR – 1.592)
 Conclusions: According to the conducted study, in patients in the early postoperative period after cardiac surgery, no influence was found between the strategy of sedation, the output fraction of the left ventricle and the frequency of use of norepinephrine, dobutamine, dopamine or their combination (p=0.2093). But it was found that inotropic/vasopressor therapy was more often needed in patients with LVEF less than 55 % regardless of the sedation strategy. The doses of dobutamine and dopamine were the same in all 3 sedation groups, which can speak in favor of the absence of a difference in the frequency of the syndrome of decreased cardiac output. During the analysis, it was also found that the doses and frequency of norepinephrine use were higher in the group where sedation was carried out with propofol (p=0.0011), which may indicate that sedation with propofol leads to a higher frequency of hypotension, the correction of which requires higher doses of norepinephrine.

Tactics of Surgical Treatment of Slipped Capital Femoral Epiphysis Associated With Mild Chronic Epiphyseal Displacement

Background. The appearing of data on cam-type FAI in patients with sequelae of slipped capital femoral epiphysis characterized by mild chronic epiphyseal displacement suggests that along with fixation of the proximal femoral epiphysis, modeling of the head-neck transition and restoration of the femoral offsets using arthroscopic techniques should be performed. Meanwhile, it is well known that after epiphyseal fixation, complete remodeling of the epimetaphysis and, consequently, disappearance of the morphological substrate of potential FAI can occur due to the ongoing enchondral and echondral growth. In this regard, the issue of indications for intraarticular interventions in studied patients remains currently open. The aim of the study was to determine the incidence of FAI in the postoperative period in patients with slipped capital femoral epiphysis characterized by mild chronic epiphyseal displacement, and to estimate the requirement of further surgical treatment. Methods. The results of the examination of 32 patients with mild chronic epiphyseal displacement in the typical posterior inferior direction who underwent cannulated epiphyseal screw fixation were analyzed for the severity of epimetaphysis remodeling and the presence of FAI in the postoperative period. Clinical, radiological, magnetic resonance, and statistical methods were used. Results. At the age of 18-19 years, FAI with pain syndrome in everyday life was found in 9 (28.1%) patients 8 of them did not have even partial remodeling of the femoral component of the joint, another 9 (28.1%) patients did not suffer from pain syndrome in everyday life, but had other clinical, radiological and MR signs of cam-type FAI. Complete or almost complete remodeling of the proximal femoral epimetaphysis occurred in 14 (43.8%) patients. Conclusion. In our opinion, therapeutic and diagnostic arthroscopy of the hip joint for the purpose of modeling the head-neck transition at the age of 18-19 years is indicated for more than one quarter (28.1%) of the investigated patients because of the presence of reliable signs of FAI.

Multimodal analgesia in the postoperative period in patients with abdominal pathology in the Republic of Uzbekistan.

Pain is an unpleasant sensory and emotional experience associated with actual or perceived tissue damage. (World Health Organization. International Classification of Diseases 11th Revision. Geneva: World Health Organization; 2019). Postoperative pain of varying intensity occurs after any operation, both after minimal outpatient interventions and after highly traumatic hours-long operations. Postoperative pain is not just an acute pain syndrome, it is also a strong trigger of the surgical stress response, which causes the activation of the autonomic nervous system and has a negative impact on almost all vital organs and systems.

Comparative Analysis of Early Postoperative Period in Patients with Total Arterial Revascularization and Conventional Coronary Artery Bypass Grafting

The use of total arterial myocardial revascularization in patients with multivessel lesions of the coronary arteries has a number of advantages, namely the duration of functioning or patency of the grafts. The level of total arterial myocardial revascularization implementation in developed and developing countries remains quite low.
 The aim. Based on the analysis of our own experience, to determine the influence of the technique of total arterial revascularization on the frequency of complications in the early postoperative period.
 Materials and methods. From February 22, 2016 to December 24, 2020, 390 consecutive patients were operated at the Ukrainian Children’s Cardiac Center. The patients were divided into two groups: participants of the group I underwent total arterial myocardial revascularization, and those includedin the group II underwent conventional coronary artery bypass grafting (CABG). The inclusion criteria were: ischemic heart disease, stable angina or exertional angina, multivascular coronary artery disease, absence of valvular pathology.
 Results. There was zero 30-day mortality in both groups. The frequency of postoperative bleeding was higher in group II and amounted to 1.6%. Surgical wound complications (infection) were also more common in the group II: 1.2% versus 0.69% (p=0.906) in the group I. Similarly, laboratory parameters such as the level of creatine kinase-MB were almost identical.
 Conclusions. Total arterial myocardial revascularization is a safe method with good immediate results. The frequency of complications in total arterial myocardial revascularizationdoes not differ from that in conventional CABG. For a wider application of the total arterial myocardial revascularization,it is necessary to continue toconduct studies of the remote postoperative period.

Применение препарата экстракта простаты у пациентов после трансуретральной биполярной резекции по поводу доброкачественной гиперплазии

The purpose of the study is to study the efficacy and safety of the prostate extract (GEROFARM LLC, Russia) in the postoperative period in patients after transurethral bipolar resection of the prostate.The clinical study included 127 men aged 50 to 78 years with grade II benign prostatic hyperplasia (adenoma) who underwent a typical bipolar transurethral resection of the prostate. Patients of the main (n=60) group received tamsulosin 0.4 mg/day for 30 days in the postoperative period in combination with prostate extract 10 mg rectally for 21 days. In the control group (n=67) - tamsulosin 0.4 mg/day for 30 days as monotherapy. To assess the results of treatment, the questionnaire of the international system of total assessment of symptoms in prostate diseases (IPSS) with the definition of quality of life (QoL), the international index of erectile function (IIEF-5) and uroflowmetry were used. The control was carried out in terms of 1 and 3 months after the operation.In the main group, in the observation period of 1 and 3 months after the operation, a decrease in the average IPSS score by 40.2% and 52.9% was revealed, and an improvement in the quality of life by 45% and 64.7%, respectively, was noted. In the control group, at the same time of observation, a decrease in the average IPSS score by 34% and 44.7%, respectively, was revealed, and the quality of life improved by 25.5% and 37.3%, respectively. The increase in the average rate of urination in the main group by the end of 1 and 3 months of treatment was 59.2% and 85.7%, respectively, and in the control group, these figures were 40.5% and 50%. The positive effect of the proposed combination therapy on erectile function in the main group by the end of 1 and 3 months of treatment was 5.2% and 9.2%, respectively, and in the control group, these figures were 2.9% and 5.2%.There is a significant decrease in the symptoms of the lower urinary tract in the group of patients who received the drug Prostateks (GEROFARM LLC, Russia).The efficacy results of Prostatex (GEROFARM LLC, Russia) (reduced symptom severity on IPSS (11.7 1.2 ) and QoL (2.3 0.3)) scales are comparable to those of Vitprost Plus which allows you to evaluate the effectiveness of two drugs equally.

Impact of Early Enteral Nutrition on Delayed Gastric Emptying and Nutritional Status After Pancreaticoduodenectomy.

Although early enteral nutrition (EEN) is an accepted practice after pancreaticoduodenectomy (PD), the impact of EEN on postoperative complications or nutritional status remains unclear. We aimed to investigate the impact of EEN on delayed gastric emptying (DGE) and nutritional status after PD. A total of 143 patients underwent PD between January 2012 and September 2020. We excluded patients who underwent a two-stage pancreatojejunostomy, in whom the enteral tube was accidentally pulled out, or with insufficient information in their medical records. The incidence of postoperative complications was compared between patients who received EEN (EEN group, n = 21) and those who did not (control group, n = 21) after propensity score matching. Univariate and multivariate analyses were performed to identify the risk factors affecting the incidence of these complications. Nutritional status was assessed at postoperative months 1, 3, and 6. The incidence of grade B/C DGE in the EEN group was significantly lower than that in the control group (4.8% vs. 28.6%, p = 0.03). There was no significant difference in overall morbidity, incidence of any other postoperative complications, or all-grade DGE. In multivariate analysis, EEN was associated with a reduction in the incidence of grade B/C DGE (p < 0.01). In the analysis of nutritional status, EEN was significantly associated with better nutritional status at postoperative month 1. EEN can lead to a lower clinically relevant DGE rate and better nutritional status in the early postoperative period in patients undergoing PD.

Risk Factors of Sudden Cardiac Arrest during the Postoperative Period in Patient Undergoing Heart Valve Surgery

Sudden cardiac arrest (SCA) is the sudden cessation of normal cardiac activity with hemodynamic collapse. This usually leads to sudden cardiac death (SCD) when cardiopulmonary resuscitation is not undertaken. In patients undergoing heart valve surgery, postoperative SCA is a complication with a high risk of death, cerebral hypoxia and multiple organ dysfunction syndrome (MODS). Therefore, knowledge of the predictors of postoperative SCA is extremely important as it enables the identification of patients at risk of this complication and the application of the special surveillance and therapeutic management in this group of patients. The aim of the study was to evaluate the usefulness of selected biomarkers in predicting postoperative SCA in patients undergoing heart valve surgery. This prospective study was conducted on a group of 616 consecutive patients with significant valvular heart disease that underwent elective valve surgery with or without coronary artery bypass surgery. The primary end-point at the intra-hospital follow-up was postoperative SCA. The secondary end-point was death from all causes in patients with postoperative SCA. Patients were observed until discharge from the hospital or until death. Logistic regression was used to assess the relationships between variables. The postoperative SCA occurred in 14 patients. At multivariate analysis, only NT-proBNP (odds ratio (OR) 1.022, 95% confidence interval (CI) 1.012-1.044; p = 0.03) remained independent predictors of the primary end-point. Age and NT-proBNP were associated with an increased risk of death in patients with postoperative SCA. The results of the presented study indicate that SCA in the early postoperative period in patients undergoing heart valve surgery is an unpredictable event with high mortality. The potential predictive ability of the preoperative NT-proBNP level for the occurrence of postoperative SCA and death in patients after SCA demonstrated in the study may indicate that the overloaded and damaged myocardium in patients undergoing heart valve surgery is particularly sensitive to non-physiological conditions prevailing in the perioperative period, which may cause serious hemodynamic disturbances in the postoperative period and lead to death.

Early Postoperative Iatrogenic Neuropraxia After Lumbar Disc Herniation Surgery: Analysis of 87 Cases

Postoperative early neuropraxia after lumbar disc herniation surgery is common. The emergence of new paresthesia findings with increased sensory and motor deficits in the postoperative period suggests iatrogenic neuropraxia. This study aimed to discuss the causes and prognosis of iatrogenic neuropraxia detected in the early postoperative period in patients who have been operated on for lumbar disc herniation. Cases with postoperative iatrogenic neuropraxia were determined retrospectively. Deficits were evaluated at intervals of 0-2hours, 2-12hours, 12-24hours, and 24-48hours. The cases were evaluated in 2 groups as those who underwent aggressive discectomy and simple discectomy. In addition, the treatment results were compared between the 2 groups as the cases that were treated and not treated with methylprednisolone. The iatrogenic neuropraxia rate was significantly higher in patients who underwent aggressive discectomy. Although it was observed that paresthesia findings improved more rapidly in cases treated with methylprednisolone, no difference was found between the 2 groups in terms of its effects on the motor deficit. Iatrogenic neuropraxia is a finding whose cause cannot be determined by quantitative criteria. It is common in patients who underwent aggressive discectomy. Methylprednisolone treatment is effective in recovering the paresthesia finding faster and may show that the radicular injury is in the neuropraxia stage in the early period.

Features of cataract surgery and the postoperative period in patients with glaucoma (part 2)

According to the results of various studies, in up to 50% cases after cataract phacoemulsification patients with glaucoma experience ophthalmic hypertension on the first day. This occurs due to the mechanical retention of aqueous humor in the anterior chamber. Temporary decrease in the function of the eye drainage system is explained by pigment particles, viscoelastic, erythrocytes, protein cells, product of postoperative inflammation and lens particles obstructing the trabecula. In the long-term period after phacoemulsification in glaucoma patients there is a decrease in the intraocular pressure in up to 74% of cases.A decrease in the density of endothelial cells in these patients occurs as a result of fluctuation of intraocular pressure, prolonged application of hypotensive drops, surgical intervention and presence of drainage devices after antiglaucoma surgery. This leads to the increase of inflammatory reaction of the cornea in the form of edema of up to 16.9% after cataract phacoemulsification.Phacoemulsification also provides a significant hypotensive effect (up to 34%) and is a preventive measure for an acute attack in patients with angle-closure glaucoma. However, the state of acute glaucoma attack leads to difficulties in phacoemulsification in the form of high intraocular pressure, corneal edema and small chamber. Cataract extraction under such circumstances causes an increase in postoperative corneal edema and eye inflammation of up to 22.85%.

Comparative assessment of the intra- and early postoperative period in patients of elderly and old age after various methods of surgical treatment of large benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is one of the most common diseases in older men. Its significance is determined not only by a decrease in the quality of life of men, but also by the development of a number of complications as a result of infravesical obstruction. About 70% of patients with symptomatic BPH require surgical treatment due to the ineffectiveness of conservative therapy. At the moment, there are many methods of surgical treatment of this pathology in the arsenal of urologists, but there is no consensus on the choice of one or another method of surgical treatment of BPH.&#x0D; Aim. To study the results of modern and most common surgical methods of large BPH in patients of the older age group.&#x0D; Materials and methods. The study included 243 patients who were hospitalized at Saint Petersburg City Hospital No. 15 for BPH in the period from November 2019 to November 2021. Control examination after surgery was carried out on days 57, 3 and 6 months after surgery.&#x0D; Results. The first group of patients underwent bipolar transurethral resection of the prostate (n=67), the second group underwent bipolar plasma-kinetic enucleation of prostate adenoma (n=69), the third group of patients underwent thulium laser enucleation (n=75), and the fourth group of patients performed laparoscopic adenomectomy (n=32). An assessment of intraoperative parameters was carried out: the duration of the operation, the duration of postoperative irrigation, bladder catheterization, bed-day spent in the hospital. In the late postoperative period (after 3 and 6 months), patients were invited for a follow-up examination. In comparison with the initial values, a significant increase in indicators was determined, characterizing the improvement in the quality of life of patients.&#x0D; Conclusion. In the study, thulium laser enucleation proved to be the most effective and sparing method of BPH surgery in age-related comorbid patients, demonstrating a relatively short operation time, radical method, reduced hospital stay, early rehabilitation of patients, and high efficiency in the late postoperative period.

PSUN195 Use of Anti-Hyperglycemic Agents Before and After Roux-en-y Gastric Bypass (RYGB) and Laparoscopic Sleeve Gastrectomy (LSG)

Abstract Introduction Currently there is no standardized approach or guideline regarding use of anti-hyperglycemic agents in the pre and postoperative diabetes management of patients undergoing bariatric surgery. There is a need to investigate the efficacy of current anti-hyperglycemic medications in the context of bariatric surgery. Methods The primary aim was to describe the patterns of use of anti-hyperglycemic agents in the pre-operative and post-operative period in patients undergoing bariatric surgery. A secondary aim was to evaluate the association between various anti-hyperglycemic agents on diabetes control. This study was a single-center retrospective chart review that identified patients with type 2 diabetes and obesity who underwent bariatric surgery between the years 2013 to 2020. Patients were identified using ICD-10 codes and surgical CPT codes. Demographic data, anthropometric data, and markers of diabetes were collected immediately preoperatively, day of surgery, 6 months postoperatively and 1-year postoperatively. Results 132 patients with obesity and T2DM underwent RYGB (n=61) and LSG (n=71). The RYGB group had significantly higher pre-surgery weight (132+30 kg vs 125+27kg, P=0.066), BMI (45.0+6 kg/m2 vs 42.7+5.7 kg/m2, P=0.013), and HbA1c (7.44+0.9% vs 7.2+0.7%, P=0.062) compared to the LSG group. Post-surgical weight loss was greater in the RYGB group 38+14 kg (29% TBWL) compared to the LSG group 30+14 kg (25% TBWL) (p=0.004) at 1-year. HbA1c reduction was significantly better in RYGB group 1.52% (n=42) compared with the LSG group 1.05% (n=47) (P=0.034) at 1-year. Medication analysis prior to surgery showed that 88% (n=113) were taking at least 1 anti-hyperglycemic agent, with a mean of 1.6 medications per patient. The last dose of all anti-hyperglycemic agents was the day prior to surgery. In the immediate postoperative course, no agents were initiated in both groups. Post-surgical medication analysis at 1-year showed complete elimination of anti-hyperglycemic agent use in 42% (n=26) of RYGB group and 59% (n=42) in LSG group. Patients on metformin prior to bariatric surgery had a greater delta 1-year post-operative HbA1c (mean -0.558+0.2786) (p=0.05) compared to patients not on metformin in LSG group. This trend was not seen in patients on metformin therapy in the RYGB group. Patients on insulin prior to bariatric surgery had a positive delta 1-year post-operative HbA1c (mean 0.781+0.2761) (p=-.007) compared to patients not on insulin in LSG group. These trends were not seen in patients using either metformin or insulin therapy in the RYGB group. Conclusion In patients with T2DM undergoing bariatric surgery, metformin monotherapy was associated with greater post-operative 1-year HgA1c reduction in LSG group. This suggests possible benefit from treatment with metformin in patients undergoing LSG bariatric surgery. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Application of infrared-beam laser therapy in the postoperative period in patients with nodular toxic goiter

The question of postoperative management for patients with nodular toxic goiter (NTG) using an infrared-wave laser remains poorly investigated and highly debatable, which creates conditions for further investigation of this issue. Aim. To evaluate the results of infrared-beam laser therapy in patients with NTG in the early and long-term postoperative periods after organ-preserving surgical interventions and thyroidectomies. Materials and methods. The main group of 35 (50.7 %) patients was examined after additional postoperative infrared-beam laser therapy (1–3 courses) while the comparison group of 34 (49.3 %) patients did not receive this treatment. Results. Thyroidectomy prevailed in the structure of surgeries in the main group (20 (57.1 %) cases). Organ-sparing surgeries were performed in 15 (42.9 %) patients. In the comparison group, 18 (52.9 %) thyroidectomies and 16 (47.1 %) thyroid resections were performed. Conclusions. Almost half of NTG cases (14 (41.2 %) in the main group and 15 (42.9 %) in the comparison group were unifocal mono- or lobar nodular affection which provided an opportunity to perform organ-sparing surgeries. No postoperative hypoparathyroidism was observed in the patients who underwent surgical resection. All the cases of this disorder were observed in patients after total thyroidectomy – 7 (35.0 %) in the main group and 8 (44.4 %) in the comparison group, P = 0.2956. The application of infrared-beam therapy to the postoperative area stimulated blood flow in the tissues and led to renewal of the parotid function: the parathormone level in the main group was restored in the average period of 3.5 (1.5; 6.0) months and in the comparison group – in 6.5 (3.5; 9.0) months, P = 0.0412. The postoperative use of infrared-beam laser therapy in patients with organ-sparing surgical interventions allowed reducing the dose of replacement therapy from 25.0 (25.0; 50.0) µg in the comparison group to 12.5 (12.5; 25.0) µg in the main group, P = 0.0341.

O110 / #828 THE EXPERIENCE OF PERIOPERATIVE SPINAL CORD STIMULATION TO PREVENT POST-CABG ATRIAL FIBRILLATION: TRACK 4: CARDIOVASCULAR DISORDERS / NEURAL ENGINEERING

Spinal cord stimulation (SCS) is effective in the treatment of chronic pain and intractable angina pectoris. Recently, animal studies have demonstrated that SCS can also suppress atrial fibrillation (AF). Our study aimed to test the safety and efficacy of temporary SCS to prevent the occurrence of AF in the early postoperative period in patients undergoing elective coronary artery bypass grafting (CABG).