Preoperative Examination Of Patients Research Articles

Placental Area in the Lower Uterine Segment, Cervical Length, and Clinical Outcome in Pregnancies With Complete Placenta Previa.

Complete placenta previa is associated with a higher percentage of adverse clinical outcomes and magnetic resonance imaging (MRI) is widely used in the preoperative examination of patients with placenta previa. To evaluate the effectiveness of the placental area in the lower uterine segment and cervical length in identifying the adverse maternal-fetal outcomes in women with complete placenta previa. Retrospective. A total of 141 pregnant women (median age, 32; age range, 24-40 years) with complete placenta previa were examined by MRI to evaluate the uteroplacental condition. A 3 T with T1 -weighted imaging (T1 WI), T2 -weighted imaging (T2 WI), and half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence. The association of the placental area in the lower uterine segment and cervical length measured using MRI with the risk of massive intraoperative hemorrhage (MIH) and maternal-fetal perinatal outcomes were determined. The adverse neonatal outcomes (preterm delivery, respiratory distress syndrome [RDS], admission to neonatal intensive care unit [NICU]) were analyzed in different groups. The t-test, Mann-Whitney U test, Chi-square, Fisher's exact test, and receiver operating characteristic (ROC) curve were used, and a P < 0.05 indicated a statistically significant difference. The mean operation time, intraoperative blood loss, and intraoperative blood transfusing were significantly higher in patients with large placental area and short cervix than in patients with the small placental area and long cervix, respectively. The incidence of adverse neonatal outcomes was significantly higher in the large placenta area group and short cervix group than in the small placenta group area and long cervix group, respectively, such as preterm delivery, RDS, and NICU. By combining placental area with cervical length sensitivity and specificity increased to 93% and 92%, respectively, for the identification of MIH > 2000 mL with area under the receiver operating curve (AUC) 0.941. Large placental area and short cervical length may be associated with a high risk of MIH and adverse maternal-fetal perinatal outcomes in patients with complete placenta previa. 2.

Апендикулярно-генітальний синдром у дітей

The importance of preserving the reproductive potential of the population of Ukraine is due to the increase in the number of women with infertility due to infectious and inflammatory diseases of the abdominal cavity and pelvic organs, which were suffered in childhood and adolescence. Purpose - to determine and systemize of the most significant factors of appendicular-genital syndrome depending on the primary pathological focus; to develop a practically significant classification signs and an algorithm for examination and treatment of girls with combined pathology to improve the results of treatment of this group of patients. Materials and methods. It was carried out an analysis of the medical records of inpatients, girls, for the period from October 2019 to May 2022, who were hospitalized for urgent indications and operated on for acute surgical pathology of the organs of the abdominal cavity and pelvis of an inflammatory nature. The age of the patients ranged from 4 to 17 years old (average age 11.0+0.5 years old). In the process of preliminary analysis, it was found that out of 203 patients who were to be treated surgically for the clinical picture of «acute abdomen», combined appendicular-genital pathology occurred in 13 girls. Results. It was determined that the key feature of appendicular-genital syndrome is the non-specificity of the clinical picture. In the appendicular form of the disease, the symptoms of acute appendicitis predominate in the pathological state, and in the genital form, the symptoms of acute adnexitis dominate. Connective appendicular-genital pathology in the catarrhal form of inflammation of the appendix was determined in 2 (15.39%) cases, in the phlegmonous form in 8 (61.54%) cases, in the gangrenous form in 2 (15.39%) cases, in periappendicular abscess - in 1 (7.68%) case. All patients in the study group underwent surgical treatment, the extent of which in each case was determined by the surgical findings and the prevalence of the pathological process. Most (61.58%) surgical interventions were performed laparoscopically, in compliance with the principles of maximally organ-preserving techniques (appendectomy, organ detorsion, stopping bleeding, excision of cysts, sanitation of the abdominal cavity, and, if necessary, drainage of the pelvic cavity). Only in 2 (15.38%) cases was the removal of the uterine appendages during their torsion, under the conditions of their obvious necrosis and the duration of the disease more than 72 hours. Conclusions. In order to improve the quality and speed of diagnosis of the combined inflammation of the appendix and uterine appendages, as structural elements of the syndrome «acute abdomen», the preoperative examination of patients should be multidisciplinary and necessarily include an examination by a pediatric surgeon, a pediatric gynecologist, and a pediatrician, with ultrasound of the abdominal cavity, pelvis, and retroperitoneal space. Frequency occurrence of appendicular-genital syndrome in girls is on average 6.4% of the total number of patients with the syndrome «acute abdomen». During the surgical remediation of the primary focus of inflammation relative to the appendages of the uterus, the tactics should be as organ-sparing as possible with extensive use of laparoscopic techniques for mandatory visual assessment of the organs of the abdominal cavity and pelvis. Patients who underwent surgical treatment for acute appendicitis in combination with diseases of the uterine appendages should form a separate dispensary group, in which preventive examinations are recommended once every 3 months during the first postoperative year, and thereafter once every 6 months until the moment of patient’s transfer to an adult medical and preventive institution. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Long-Term Prognosis after Coronary Artery Bypass Grafting: The Impact of Arterial Stiffness and Multifocal Atherosclerosis.

The aim of the study was to study the effect of arterial stiffness and multifocal atherosclerosis on the 10-year prognosis of patients after coronary artery bypass grafting. Methods. Patients with coronary artery disease (n = 274) who underwent coronary artery bypass grafting (CABG), in whom cardio-ankle vascular index (CAVI) was assessed using the VaSera VS-1000 device and the presence of peripheral atherosclerosis in Doppler ultrasound. Groups were distinguished with normal CAVI (<9.0, n = 163) and pathological CAVI (≥9.0, n = 111). To assess the prognosis, coronary and non-coronary death, myocardial infarction, acute cerebrovascular accident/transient ischemic attack, repeated CABG, percutaneous coronary intervention, carotid endarterectomy, peripheral arterial surgery, pacemaker implantation were analyzed. Results. During the observation period, mortality was 27.7%. A fatal outcome from all causes was in 37 (22.7%) patients in the group with normal CAVI and in 39 (35.14%) in the group with pathological CAVI (p = 0.023). Death from cardiac causes was more common in the group with CAVI ≥ 9.0—in 25 cases (22.52%) than in the group with CAVI < 9.0—in 19 (11.6%, p = 0.016). The combined endpoint in patients with pathological CAVI was detected in 66 (59.46%) cases, with normal CAVI values—in 76 (46.63%) cases (p = 0.03). The presence of diabetes mellitus, multifocal atherosclerosis (p = 0.004), pathological CAVI (p = 0.063), and male gender were independent predictors of death at 10-year follow-up after CABG. The presence of multifocal atherosclerosis and pathological CAVI during the preoperative examination of patients were independent predictors of the combined endpoint development. Findings. Patients with coronary artery disease with pathological CAVI before CABG were more likely to experience adverse events and death in the long-term follow-up than patients with normal CAVI. Further studies are needed to investigate the possibility of correcting pathological CAVI after CABG after secondary prevention and the possible impact of this correction on prognosis.

Preoperative examination and surgical treatment using a distraction apparatus for congenital malformations of the hand in children

Surgical treatment of 66 children with various malformations of the hand was carried out. The importance of serial angiography of the hand and forearm in the preoperative examination of patients is shown. The use of the distraction method using the apparatus developed in the department made it possible to increase the volume of local plastic resources in syndactyly and cicatricial deformities of the hand, and also made it possible to lengthen the underdeveloped bone segments in severe malformations of the hand. The majority of patients received good and satisfactory results

Olfactory dysfunction and olfactory bulb volume in patients with deviated nasal septum

The purpose of the study is to demonstrate the possibility and information content of olfactory bulb volume measuring in healthy volunteers and patients with deviated nasal septum, as well as the relationship between the volume of the olfactory bulb and olfactory function. Material and methods. 28 men with deviated nasal septum aged 24 to 35 years (main group) and 21 clinically healthy volunteers, men aged 23 to 33 years (control group) were examined. All patients underwent checkup of the ENT organs and examinations on a 1.5 T MRI machine with 12-channel head coil. The sense of smell was examined using the extended Sniffin Sticks test (SST) (“Buerhard”, Hamburg, Germany) with the definition of 3 parameters: threshold, identification and discrimination. Results. In accordance with the design of the work, threshold, discrimination, identification subtests and MRI examination of the head were performed with the measurement of the olfactory bulb volume of patients in the main group and volunteers in the control group. In all participants in the control group was diagnosed normosmia in accordance with the TDI indicator, and in patients with deviated nasal septum – hyposmia. Olfactory function in patients deviated nasal septum was significantly lower on the narrower side as indicated for odor thresholds, odor recognition, and odor identification (P&lt;0.01). It was found that olfactory bulb volumes are larger on the wider side than on the narrower side (P&lt;0.01). Conclusion. Asymmetry in the size and volume of OB is observed only in patients with deviated nasal septum, it is absent in healthy volunteers. MRI visualization and morphometry of olfactory bulb, in addition to identifying of the nasal cavity, paranasal sinuses state, are informative in the process of preoperative examination of patients with deviated nasal septum. Olfactory bulb volume definition should be used for personalized diagnosis and quantitative assessment of olfactory dysfunction.

FEATURES OF PREOPERATIVE MANAGEMENT AND METHODS OF EXAMINATION OF PATIENTS OF GROUPS UNDER RESEARCH

Despite the active ability to repair, it is frequently noticed that the independent potentialof bone tissue is insufficient, that is a serious problem in reconstructive maxillofacialsurgery, orthopedics and traumatology. In recent years, there has been an activesearch for implant material that would match the autologous bone in its properties andcharacteristics. Tissue engineering technologies allow to create tissue equivalents tobone tissue using autogenous stromal cells deposited on biocompatible or biologicalmaterial of tissue engineering design. The article presents the features of preoperativemanagement, description of the used examination methods and bone augmentationmaterials in patients of the groups under study.Objective – to use a set of adequate methods of examination and optimal preoperativemanagement of patients of the group under study during sinus lifting, post-extractionsocket preservation, osteosynthesis for mandibular fractures and impacted wisdom teethextraction, which were accompanied by the use of bone augmentation materials based onmultipotent mesenchymal stromal cells.Material and methods. 280 people aged 18 to 55 with partial or complete adentiaand atrophy of the alveolar process of the jaws, with chronic periodontium infectionand chronic generalized periodontitis, with fractures and impacted third molars wereexamined in the Department of Surgical Dentistry and Maxillofacial Surgery of theChernivtsi Regional Clinical Hospital. All patients were planned to make orthopedicstructures based on dental implants.Results. The use of computed tomography in preoperative examination of patients in thestudied group allows not only visually to examine the object, but also to perform directdensitometric analysis with measurement of attenuation coefficients in Hounsfield units,that is a significant advantage over X-ray examination.Conclusions. The use of bone augmentation materials based on multipotent mesenchymalstromal cells of adipose tissue during dental operations improves the regenerativeproperties of bone tissue and helps to reduce the duration of inpatient treatment.

Clinical effects of negative pressure wound therapy in treating the poor healing of incisions after different abdominal operations

Objective: To investigate the clinical effects of negative pressure wound therapy (NPWT) in treating the poor healing of incisions after different abdominal operations. Methods: The retrospective observational study was conducted. From June 2019 to December 2020, 42 patients with poor healing of incisions after abdominal surgery were admitted to Center of Burns and Trauma of the First Affiliated Hospital of Naval Medical University, including 29 males and 13 females, aged 23-81 years. The disease course of poor healing of abdominal incision was 3-60 d. The preoperative examination of patients was completed after admission, and NPWT was used after debridement. According to the dehiscence level of incision, the negative pressure value of -10.64 to -6.65 kPa was set. The incisions were sutured in the second stage when the incisions had good blood circulation. The cause of abdominal surgery, the dehiscence level and the cause of poor healing of abdominal incision were investigated, and the final healing of abdominal incision and the occurrence of complication were observed. Results: The causes of abdominal operations in this group of patients who ocurred poor healing of abdominal incisions were ranked according to the composition ratio, with the top 4 causes being colon cancer (9 cases, accounting for 21.4%), bile duct disease (8 cases, accounting for 19.0%), liver cancer (5 cases, accounting for 11.9%), and appendicitis (4 cases, accounting for 9.5%). There were 25 cases (59.5%) with dehiscence of abdominal incision in the deep fascia layer, and the other 17 cases (40.5%) with dehiscence of abdominal incision in the superficial fascia layer. The causes of poor healing of abdominal incision were ranked according to the composition ratio, with the top 3 causes being infection (24 cases, accounting for 57.1%), fat liquefaction (11 cases, accounting for 26.2%), and suture reaction (5 cases, accounting for 11.9%). The blood circulation in 40 patients was improved after being treated with NPWT, and the incisions were sutured in the second stage. The incisions healed well when the suture lines were removed in the second to third week. Intestinal fistula and bile leakage developed during the NPWT treatment, respectively in the other 2 patients, in which negative pressure equipment was removed subsequently, and the incisions healed after adequate drainage and conventional dressing changes. Conclusions: NPWT is effective in treating poor healing of abdominal incision after different abdominal surgeries. The clinicians need to comprehensively assess the patient's condition to determine when and how to use NPWT to avoid the occurrence of intestinal fistula, bile leakage, and other complications.

Surgical Treatment Of Obliterating Arterosclerosis

In the literature review, according to publications of recent years, the state of surgical treatment of obliterating atherosclerosis does not meet the requirements of the time. Currently, all research is aimed at improving the early diagnosis of the disease and their timely treatment by improving the quality and efficiency of surgical intervention.&#x0D; However, despite a large number of works devoted to diagnosis and prognosis of treatment, there are still many unresolved issues. The accumulated experience indicates the need to standardize the preoperative examination of patients in order to predict the outcome of treatment.&#x0D; One of the important aspects of this problem is the development of modern tactics and approaches to surgical treatment. Along with them, it is necessary to evaluate the results of treatment, analyze the quality and determine the effectiveness of traditional operations in modern angiosurgery. It should be noted that today there are a considerable number of new methods of treating atherosclerosis obliterans for early and effective diagnosis, prevention and therapy of the disease.&#x0D; However, some issues are insufficiently studied or contradictory and require further research.

Diastolic stress test in the preoperative non-cardiac surgery examination

Preoperative examination of patients undergoing high-risk elective non-cardiac surgery requires identifying factors associated with both the type of surgery and comorbidity profile of each patient. Determination of clinically significant echocardiographic changes, even without severe symptoms, can contribute to a change in management or revision of scheduled date and surgery tactics. The aspects of defining echocardiographic criteria for potential postoperative cardiovascular complications, especially in asymptomatic patients with preserved left ventricular ejection fraction, are an important clinical problem. The diastolic stress test, a relatively new type of exercise testing, is currently an additional diagnostic tool to detect heart failure in patients without reduced ejection fraction. The prospects of using this method before non-cardiac surgery in patients with preserved left ventricular ejection fraction is discussed in this article.

ВОЗМОЖНОСТИ МЕТОДОВ ЛУЧЕВОЙ ДИАГНОСТИКИ ПРИ ЗОБЕ БОЛЬШИХ РАЗМЕРОВ И МЕДИАСТИНАЛЬНОМ ЗОБЕ

The possibilities and effectiveness of various methods of radiation diagnostics at the stage of preoperative examination in patients with thyroid pathology accompanied by compression of the neck and upper mediastinum were studied. 69 patients with large goiter (average volume 231.51±102.27 cm3) were selected from the total number of operated patients, of which 11 (15.9%) had a cervical mediastinal goiter. Different diagnostic effectiveness of radiological methods for this pathology at the stage of preoperative preparation has been proved. Ultrasound examination due to the features of the method cannot be considered an objective and informative method of topical and differential diagnostics for large goiter. X-ray СТ and MRI are priority methods for the topical and differential diagnosis of mediastinal goiter and large goiter.

Preoperative assessment of medial acetabular wall bone stock in dysplastic deformation

Acetabular reconstruction remains to be one of the crucial aspects of total hip replacament in developmental dysplasia of the hip (DDH) that provides endoprosthesis’ long-term stability and general success of the operation. Among the parameters that influence surgical technique of acetabular reconstruction, medial wall bone stock of the endoprosthesis’ bed zone should be taken into consideration. Purpose of the work to assess medial wall bone stock in the site of acetabular component’s bony bed in normal and dysplastic deformed hips and to define correlation with indices of sphericity and sectoral deficiency of the acetabulum based on MSCT-morphomerty. Materials and methods. A complex comparative MSCT-mophometric investigation of 32 normal hips and 65 hips with DDH (Crowe I – 26 hips (40.0 %), Crowe II – 23 hips (35.4 %), Crowe III – 16 hips (24.6 %)) was performed. There were assessed width of the medial wall bone stock in the projection of the crucial ligament’s and acetabular component’s bony beds according to the proposed method; their correlation with indices of femoral head’s cranial migration and acetabular horizontal sphericity angle. Results. It has been revealed that measurements in he site of the crucial ligament’s bony bed based on pelvic images obtained by a conventional biplanar X-ray remains to be biased and doesn’t correspond to true width of medial acetabular wall bone stock. Absolute width of the medial acetabular wall in sites of the crucial ligament’s / acetabular component’s bony beds carried out through the special MSCT-recontruction methodic was defined as: 4.3 mm [3.3; 4.8]/7,2 mm [6.2; 7.8] for normal hips, 9.95 mm [7.5; 11.6]/11.85 mm [9.8; 13.5] for Crowe I hips,15 mm [11.7; 17.3]/15,7 mm [13,5; 17,3] for Crowe II hips and 15.45 mm [13.7; 19.8]/16.05 mm [12.8; 20.2] for Crowe III hips, respectively. Correlations between medial acetabular wall bone stock in site of acetabular component’s bony bed and indices of femoral head’s cranial migration and acetabular horizontal sphericity angle were defined as: r = 0.36 (P = 0.006); r = 0.36 (P = 0.007), respectively. Conclusions. Weak correlation of medial acetabular wall bone stock with indices of acetabular sphericity and sectoral deficiency requires the necessity of independent evaluation of this index during preoperative planning. Due to the impossibility of the index assessment based on the conventional pelvic X-ray, application of elaborated MSCT-morphometric methodic seems to be clinically valuable and should be applied during preoperative examination of patients with DDH.

Preoperative Evaluation of Iatrogenic Spinal Accessory Nerve Palsy: What Is the Place for Electrophysiological Testing?

Electrophysiological testing has been used for the early diagnosis of iatrogenic spinal accessory nerve palsy in clinical practice. However, the presence of low-amplitude compound action potential in 70% to 90% of the patients suffering from iatrogenic nerve transection was reported in several studies. We have encountered the same issue and made minor modifications to the methods of electrophysiological testing. The purpose of this study was to retrospectively evaluate the reliability of our modified electrophysiological testing as preoperative examination in patients receiving surgical revision. In this study, we compared preoperative electrophysiological testing results with intraoperative diagnosis in the 24 patients with iatrogenic spinal accessory nerve palsy who were referred to our hospital from 2009 to 2018. During operation, 20 patients were diagnosed with neurotmesis and the remaining 4 patients were found axonotmesis depending on the results of surgical exploration and intraoperative electrophysiological examination. Six of the 20 patients with neurotmesis demonstrated a low-amplitude compound muscle action potential of the upper trapezius during preoperative electrophysiological testing. Needle electromyography revealed voluntary motor unit potentials in 8 of the 20 patients. Meanwhile, concomitant great auricular nerve or dorsal scapular nerve injuries were preoperatively revealed in 7 of 24 patients. The rate of low-amplitude compound muscle action potentials in these patients suffering from spinal accessory nerve neurotmesis was about 30% with our modified electrophysiological testing. We should be aware of this pitfall before surgical nerve repair. Furthermore, electrophysiological testing is an informative preoperative examination revealing the concomitant nerve injuries.

Surgical treatment of frontopolar artery aneurysm: a case report

The study objective is to describe the results of surgical treatment of a patient with frontopolar artery aneurysm rupture. Materials and methods. A 22-year-old female patient in grave condition (Hunt and Hess grade 3, Glasgow coma score 14) was admitted to the Department of Neurosurgery on day 5 after hemorrhage. The patient presented with headache, nausea, weakness, and stiff neck. However, no hemodynamic, respiratory, motor, or sensitive disorders were observed. Computed tomography of the brain revealed a 35 cm3 intracerebral hemorrhage in the projection of the interhemispheric fissure and frontal lobes without transverse or axial dislocation. Computed tomography angiography demonstrated a distal aneurysm of the right frontopolar artery. Results. The patient underwent emergency osteoplastic craniotomy in the right pterional region followed by aneurysm excision and removal of intracerebral hemorrhage. The postoperative period was uneventful (Glasgow outcome score 5). The patient was discharged on day 14 postoperatively with no signs of focal neurological deficit. Conclusion. Thorough preoperative examination of patients with lobar hemorrhages prevents severe complications during surgery, such as uncontrolled intraoperative bleeding.

Endovascular and two-stage combined revascularization of the penis at arteriogenic erectile dysfunction

The possibility of application of endovascular and two-stage combined revascularization of the penis in the arteriogenic ED treatment is shown. Twenty male patients with multifocal atherosclerotic lesions of the aorto-iliac-femoral segments underwent the analysis of the branching patterns of the IPA according to the classifcation by Adachi and Yamaki followed by the interventional endovascular intervention (angioplasty, stenting) of the iliac arteries. Seventeen patients underwent the unilateral and three patients – bilateral stenting of the common and external iliac arteries. Three patients out of the total number of the operated ones additionally underwent an open revascularization of the penis by epigastric-penic anastomosis. A complex preoperative examination of patients – candidates for revascularization of the penis for arteriogenic erectile dysfunction was performed and included ultrasound, МCT-angiography of the pelvic arteries, and electroneuromyographic examination of atherosclerotic lesions of the pool vessels of the inner pudental artery. Subsequently, endovascular and combined open revascularization operations were performed on the iliac and penis vessels. The erectile function improvement according to the IIEF-5 scale (8–12 scores before the operation vs 16–19 points after the operation) was noted in 1, 3, 6, 12 months (p&lt; 0.05). Combined revascularization operations on the iliac and penis arteries (endovascular and open “bypass”) allow an adequate arterial blood perfusion to the penis in the steno-occlusive lesions of the pool vessels of the IPA affected by atherosclerosis.

Difficult airway. Clinical case: Lymphangioma of the neck in a child under one year old

The article describes an interesting clinical case of neck lymphangioma in a child under one year, as the cause of difficult airway during surgery. This case deserves the attention of anesthesiologists, surgeons, interns, considering the clinical features, these additional examination methods and features of anesthesia patients. There was emphasized the importance of pre-operative examination of patients, the use of additional tests and examination methods to determine further tactics. Based on this case, it was concluded that each anesthesiologist must have the skills and clearly know the clinical protocols for managing “difficult airway” and predict severe tracheal intubation.

Incidence and Risk Factors of Cardiac Abnormalities in Patients with Idiopathic Scoliosis

We sought to investigate the incidence of cardiac abnormalities in patients with idiopathic scoliosis and identify risk factors related to cardiac abnormalities. A cohort of 531 patients with idiopathic scoliosis requiring surgical treatment in our hospital from March 2009 to August 2017 were recorded. Clinical data including medical records, radiograph, and echocardiogram were collected. All patients were divided into groups: control, congenital heart disease (CHD), and other cardiac abnormalities (OCAs). The incidence and related factors for cardiac abnormalities were analyzed. The age of the study cohort was 17.8 ± 7.3 years. The average Cobb angle was 57.7 ± 16.5 degrees. Cardiac abnormalities were found in 149 (28.06%) patients, including 22 (4.14%) with CHD and 127 (23.92%) with OCAs. Atrial septal defect was the most common CHD with an incidence of 1.13% (6 of 531). Mitral valve prolapse was detected in 62 (11.68%) patients, which was the most prevalent OCA. Patients with CHD or OCAs weighed less as compared with patients without cardiac abnormalities. Low height was associated with CHD in patients with idiopathic scoliosis. Six patients with severe cardiac abnormalities must undergo cardiac intervention before scoliosis surgery. The overall incidence of cardiac abnormalities was 28.81% in patients with idiopathic scoliosis. An echocardiogram may be helpful as a preoperative examination for patients with idiopathic scoliosis before scoliosis surgery.

SURGICAL TREATMENT OF ELDERLY AND SENILE PATIENTS WITH DEGENERATIVE CENTRAL LUMBAR SPINAL STENOSIS

Objective. To analyze the results of surgical treatment of patients of the older age group with central spinal stenosis at the lumbar level. Material and Methods. A total of 107 patients of elderly and senile age with clinically significant degenerative central stenosis of the spinal canal were treated. They were divided into two groups: patients in Group 1 underwent bilateral decompression of nerve roots through unilateral approach; those in Group 2 - nerve root decompression supplemented with interbody fusion and transpedicular fixation. Results. The surgery resulted in statistically significant reduction in pain, improvement of the quality of life, enlargement of spinal canal dimension parameters, and increase in the distance of walking. Statistical difference in the quality of life between Groups 1 and 2 was revealed for the indicator characterizing the psychological component of the SF-36 questionnaire (p = 0.03); there were no statistical differences for the remaining indicators. The key parameter for assessing central stenosis is the cross-sectional area of the dural sac. Conclusion. Preoperative examination of patients of the older age group should be comprehensive and include CT myelography with 3D reconstruction. The cause of nerve root compression in central stenosis is a combination of various factors in 41.9 % of cases. Differential surgical tactics provides an improvement in the quality of life in 80 % of cases. Excessive decompression does not improve the quality of life of patients. Instrumental fixation does not improve the outcome of surgical intervention and should be used only for clinically significant instability of the spinal motion segment.

Detection of the Risk Factors for Postoperative Asthenopia in Patients with Refractive Disorders

Purpose: to identify risk factors for the development of asthenopic syndrome (AS) in patients with moderate to high myopia after keratorefractive surgery (KRS).Materials and methods. 122 patients (244 eyes) with medium and high myopia underwent a standard pre-operative examination of patients before KRS. The special methods of examinations were the study of reserves of relative accommodation (RRA) and the volume of absolute accommodation (VAA), and the accomodomography; the vision characteristics was determined on a four-point color test by E.B. Belostotsky, S.Y. Friedman. at distances of 5.00 and 0.33 m, fusional reserves — with synoptophor. Patients survey was held with CISS questionnaire to detect the presence of AS.Results: There were no complications after KRS in all cases. Uncorrected visual acuity was the same or higher than maximal corrected before surgery in 1 week after KRS. Patents were divided into 2 groups according to results of CISS survey: 88% — without AS, 12% — with signs of AS. Retrospective analysis of pre-operative data of the patients with AS has shown that a combination of an absence of binocular vision with a pronounced decrease in fusion reserves, reserves of relative accommodation and volume of absolute accommodation is prognostically unfavorable factors in patients with myopia.Conclusion: All patients with moderate and high myopia have the refractive errors, there is no binocular vision in 12.3% patients. More significant errors of accommodation and binocular function were registered in patients with postoperative AS vs. patients without AS. Low fusion reserves and absence of binocular vision don’t allow to adopt for KRS results. This group of patients should be separated for pre-operative functional preparation.

ON THE EXTENT OF PREOPERATIVE RADIOLOGICAL AND CT EXAMINATION OF PATIENTS WITH DEGENERATIVE DISEASES OF THE LUMBAR SPINE

Objective. To specify the extent of preoperative examination of patients with lumbar degenerative diseases and to study the effect of examination results on the tactics of surgical treatment. Material and Methods . The study included retrospective analysis of 1340 patients with lumbar degenerative diseases treated in the Neurosurgical Department No. 2 of Novosibirsk RITO n.a. Ya.L. Tsivyan during 2017. Results. The average height of the intervertebral disc as evaluated with MRI was 7.4 ± 1.8 mm, and that evaluated with MSCT – 4.9 ± 1.5 mm, with a statistically significant difference between them (p < 0.05). Immediate preoperative examination of patients with lumbar disc herniation showed reduction or lysis of the hernia fragment in some of them. Reduction of the leg pain and hernia size (by more than 50 %) and lysis of the herniated disc fragment evidenced by MRI were observed in 21 (3.2 %) patients. Comparison of the preplanned and actually performed extent of decompression and stabilization interventions showed that tactics and/ or extent of surgical treatment changed in 37.6 % of cases. Conclusion. The complex of instrumental radiological and neuroimaging studies, as well as methods of provocative procedure in the lumbar spine performed immediately before the planned surgical treatment allow choosing the proper treatment tactics, specifying or correcting the volume of surgical treatment, and to prognosing its outcome in lumbar degenerative diseases.

Применение рентгенологического метода исследования в предоперационном планировании пациентов с веногенной эректильной дисфункцией

Purpose: To study the effectiveness of dynamic computer cavernosography at the stage of preoperative examination of patients with venogenic erectile dysfunction (ED).&#x0D; Material and methods: 92 patients with venogenic erectile dysfunction were operated. Patients were divided into two groups depending on preoperative planning. Patients in group 1, pharma doppler sonography of the penis was used for preoperative planning. In group 2 – pharma doppler sonography of the penis and dynamic computer cavernosography were used. Resection of the deep dorsal vein of the penis was undergone in patients with proven distal type of shunt. A survey of patients was carried out before surgery and 12 months after surgical treatment according to the validated international rating scales of the erectile function.&#x0D; Results: After preoperative planning and surgical treatment scores of erectile function in both groups changed. In both groups the proportion of patients with a severe degree of ED significantly decreased. The level of assessment of the quality of erection in group 1 remained almost the same, but 26 % of patients recorded a maximum score of 4. In group 2 the majority of patients (56 %) described their condition with a maximum score of 4 points. The assessment of quality of life using a scale of “QOL” after surgical treatment was described by patients in the following way: “excellent”: in group 1 and 3 %, in group 2 and 7 %; “good”: in group 1 – 34 %, group 2 – 63 %; “satisfactory”: 3 % in both groups; “poor”: in group 1 – 50 %, group 2 – 15 %. These data confirm that resection of the deep dorsal vein of the penis statistically significantly (p &lt; 0.0001) improves the quality of life of patients with vein-occlusive mechanism of erectile dysfunction. However, in group 2 due to the proposed preoperative planning and pathophysiologically due to the definition of specific indications for surgical intervention we achieved the best estimates of quality of life (p = 0.0108).&#x0D; Conclusion: Preoperative planning based on the application of dynamic computer cavernosography, provides a statistically significant (p = 0.0061) improvement of the results of resection of the deep dorsal vein of the penis in patients with vein-occlusive mechanism of ED.