Stage Of Preoperative Preparation Research Articles

365 Days - Evolution and Rehabilitaton Strategy in a Uncemented Hip Replacement Prosthesis Case Study

Abstract Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. A total hip replacement (total hip arthroplasty or THA) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is currently one of the most common orthopaedical operations, though patient satisfaction short- and long-term varies widely. In this paper we present the case of a 75-year-old woman, with classic uncemented hip prosthesis intervention, from the preoperative preparation stage to 1 year after the intervention and the recovery phases and their evolution. Due to a quality management of the intervention and good hygiene and nutrition, the lack of osteoporosis and the absence of paleopathology, the patient recovered in a fast and correct manner, returning to a good functionality and state of health. Also, the cooperation between the patient, family, therapist, doctor and psychologist had a decisive role in the success of both the intervention and the postoperative period with optimal results for the age and possibilities of the patient.

Этические аспекты, проблемы безопасности кардиохирургического вмешательства и предикция неблагоприятных событий

In cardiac surgery, patient’s awareness and consent to surgery are problematic as due to the lack of previous medical background a patient can’t understand the processes occurring in the body and effects of exposure on them. Thus, provision of sufficient information by a doctor is a part of safe surgical strategy. An open randomized prospective trial involving 89 patients with stable coronary artery disease (CAD) was conducted. High rate of blood oxidation is believed to be an independent predictor of cognitive dysfunction development during the early postoperative period of coronary artery bypass grafting (CABG). Determination of blood oxidation rate is a tool of risk management during cardiac surgery starting from the stage of preoperative preparation, which is optimal to implement a safe strategy, including psychological and drug-induced support of the patient aimed at prevention of cognitive disturbances.

Anesthetic management of glycogen storage disease type 1b during liver transplantation: a case report

The glycogen storage disease type 1b is a rare metabolic disease caused by the glucose 6-phosphate transporter disorder. This study presents a 10-year-old female patient with growth retardation, neutropenia and inflammatory bowel disease, severe hypoglycemia attacks before and during the surgery, and hepatocellular carcinoma who underwent liver transplantation. A multidisciplinary approach from the preoperative preparation stage is essential in addition to intraoperative intervention for hypoglycemia and lactic acidosis in the anesthetic management of these patients.

HEART RATE VARIABILITY DURING PHYSICAL EFFORT IN PATIENTS WITH METASTATIC OVARIAN CANCER AND CONCOMITANT OBESITY

Introduction. One of the main factors affecting postoperative outcomes in patients with advanced ovarian cancer is the cardiopulmonary status. Several studies have reported that preoperative multifactorial rehabilitation and physical fitness can lead to reduced postoperative morbidity, mortality, shorter length of stay, and improved quality of life in cancer patients. The issue of adaptability to physical activity of overweight and obese patients who undergoing debulking surgery is insufficiently studied. The study of compensatory changes that occur in physically inactive obese patients remains relevant, especially against the background of neoadjuvant chemotherapy, in the conditions of preoperative preparation with ERAS-recommended physical activity.
 The aim of the study is to determine the differences between women with advanced ovarian cancer and obesity compared to women with normal weight in terms of heart rate variability during exercise. To assess the adaptive capabilities to physical activity of patients with advanced ovarian cancer and obesity at the stage of preoperative preparation, who undergoing debulking surgery.
 Result. Achieved METs, peak HR, CI, and HR recovery were higher in nonobese women, whereas training had no significant effect in obese women. Women who had already received neoadjuvant CT achieved a lower level of MET (6.8 ± 3.2 vs. 8.9 ± 4.1; P < 0.001). Also, peak HR and CI were lower in women after neoadjuvant CT (126±27 vs. 138±20; P = 0.001 and 0.65±0.22 vs. 0.71±0.22; P = 0.001, respectively). BMI was a significant predictor of exercise capacity only in the obese subgroup, whereas age, peak HR, and prior adjuvant HT were always significantly associated with METs achieved.
 Conclusions. No significant difference was found between trained and untrained women with comorbid obesity in HR behavior or physical capacity. Different heart rate behavior in patients of this group is thus explained by obesity as such, regardless of the degree of physical training.

THE INFLUENCE OF PREOPERATIVE INTERVIEW BY AN ANESTHESIOLOGIST WITH A VIDEO PRESENTATION ON THE LEVEL OF PREOPERATIVE ANXIETY IN PATIENTS WITH EXCESSIVE WEIGHT AND OBESITY

Introduction. The preoperative period is one of the most stressful stages of treatment. Anxiety is the first phase of stress, a universal reaction of the body to an extreme situation. During the anticipation phase of the threat, the human body mobilizes and tries to resist it by activating various compensatory reactions.
 Objective. To evaluate the influence of a preoperative interview by an anesthesiologist with a video presentation and without it on the level of anxiety during the preoperative preparation stage in patients with excessive weight and obesity.
 Materials and methods. The level of anxiety was assessed at the preoperative preparation stages in patients with surgical profiles, excessive weight, and obesity. The study included 145 patients, divided into two groups: Group 1–71 patients and Group 2–74 patients. A visual analog scale of anxiety (VAS-A) was used to assess the level of anxiety. The patient's level of anxiety was evaluated before the start of the interview with the anesthesiologist, after the preoperative examination, and before the beginning of the surgical intervention. The visual analog scale of anxiety at different stages of the study was provided on other questionnaire sheets to exclude visual comparison of the patient's previous result.
 Results. In Group 1, the classic interview significantly reduced patient anxiety (Z=2.62; p=0.008). The level of anxiety before the start of the surgical intervention significantly increased compared to the level of anxiety after the interview (Z=3.28; p=0.001) and compared to the level of anxiety before the start of the interview (Z=2.62; p=0.1), the indicator was higher, without statistically significant difference. In Group 2, the classic interview by the anesthesiologist supplemented with a video presentation significantly reduced anxiety (Z=2.4; p=0.01). The level of anxiety significantly increased before the start of the surgical intervention (Z=2.48; p=0.01), but compared to the anxiety before the beginning of the interview (Z=1.38; p=0.16), this indicator was lower, although without a statistically significant difference. Before the surgical intervention, most patients noted the usefulness of the video presentation, indicating a greater confidence in safety and trust in the surgical team
 Conclusion. A comprehensive and informative preoperative interview with an anesthesiologist reduces the patient's anxiety level before the operation.

Imaging methods in assessing the surveillance of type 2 diabetes mellitus for cerebrovascular reserve and brain disease in patients with hemodynamically significant carotid stenosis

Introduction. Type 2 diabetes is the most common form of endocrine disease. Diabetes is a well-established risk factor for stroke. Carotid endarterectomy (CEE) is the main method of preventing a serious complication of stroke in patients with carotid stenosis. Consequently, the assess of type 2 diabetes on the results of CEE is an urgent problem of angiosurgery.Aim: To assess effect of type 2 diabetes on cerebrovascular reserve capacity and brain structure in patients with carotid atherosclerosis by ultrasound and magnetic resonance diagnostic.Material and Methods. 44 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA), who underwent ultrasound and magnetic resonance examinations of the carotid arteries at the pre- and postoperative stages were included in this study. Two groups were formed: group I (n =15) – with a verified diagnosis of type 2 diabetes, group II (n = 29) – without diabetes. To assess the cerebrovascular reserve, functional hypercapnic and hyperoxic tests were performed.Results. The analysis of the results showed statistically significant differences in the ICA blood flow in both groups. Intergroup comparison before surgery in the middle cerebral artery on the side of hemodynamically significant stenosis revealed a statistically significant difference in pulsation and peripheral resistance index. In the common carotid arteries on both sides, significant intergroup differences were found in the velocity parameters of blood flow after the CEE operation. The reactivity index in patients with surgical stenosis with type 2 diabetes in the hyperoxic test was statistically significantly different on the side of the stenosis compared to the same indicator in the group without diabetes. There were no statistically significant differences in the hypercapnic test. The value of reactivity index indicates a negative or paradoxical reaction.Conclusion. The use of simple and accessible functional tests to assess cerebrovascular reserve, plaque structure and changes in the brain in patients with type 2 diabetes at the stage of preoperative preparation according to ultrasound and MRI studies allows us to correct the treatment and subsequent protection of the brain at the stage of surgery to prevent possible complications.

Iron deficiency in cardiac surgery patients and the possibility of its correction at the preoperative stage

Among cardio-surgical patients, the prevalence of iron deficiency conditions reaches 70 %, and anemia is detected in less than 50% cases. Meanwhile, both anemia and latent iron deficiency are risk factors for adverse outcomes in cardio-surgical patients. These conditions are associated with a high frequency and greater volume of blood transfusions as well as with a longer stay in the hospital. Timely diagnosis and correction of iron deficiency, regardless of the presence of anemia, are mandatory at the stage of preoperative preparation. The use of oral iron medicines is limited by their low efficacy in this category of patients and a high risk of adverse events. Intravenous iron medicines have a high potential for correcting iron deficiency, and their efficacy and safety have been previously demonstrated. Administration of ferric carboxymaltose has proved beneficial in studies on iron deficiency correction in cardiological and cardio-surgical patients. In these patients, ferric carboxymaltose improved the dynamics of ferritin and hemoglobin, reduced the risk of blood transfusion, and decreased the duration of stay in the hospital. Preoperative intravenous administration of ferric carboxymaltose to cardio-surgical patients can improve clinical outcomes and the cost effectiveness of cardiac surgery.

MODERN ULTRASOUND IMAGING TECHNOLOGIES IN THE DIAGNOSIS OF PAPILLARY THYROID CANCER

The aim of the study was to determine the opportunities of multiparametric ultrasound in the early detection of papillary thyroid cancer. Examination results of 258 patients with papillary thyroid cancer at the stage of preoperative preparation were analyzed. All patients underwent multiparametric ultrasound examination in grey-scale mode, in color Doppler mapping mode, in compression elastography mode and shear wave elastography, ultrasound with contrast enhancement. In papillary thyroid cancer, "cold" tones prevailed. the velocity of the shear wave was 4.61±1.33 m/s (95% CI), Young's modulus was 63.3±14.7 kPa (95% CI), the elasticity index (strain ratio) was 4.89±1.65 (95% CI) c.u. When assessing the qualitative parameters of ultrasound with contrast enhancement, it was noted that in papillary thyroid cancer, heterogeneous accumulation of ultrasound contrast agent prevailed (54.5%), there was a more pronounced intensive accumulation of ultrasound contrast agent (63.6%). when measuring TPI, the EC indicator was 20.64±4.37 s, PI – 31.08±1.65 dB, PI (DT/2) – 64.00±10.27 s. Thus, the study showed that the complex use of multiparametric ultrasound examination techniques (B-mode, color Doppler mapping, compression elastography, shear wave elastography, ultrasound with contrast enhancement) is highly informative and should be used in the differential diagnosis of papillary thyroid cancer in the preoperative assessment.

Психологічний та пупілоалгометричний моніторинги стоматологічних хворих під час їх антистресорної терапії

The purpose of the study was to investigate the psychological status and pain sensitivity by the pupillometric method in dental patients during preoperative antistress drug therapy. Materials and methods. In 100 patients, during their initial examination, signs of psychological stress were detected in them in social conditions during the last month before surgical interventions, using the PSM-25 scale of Lemoureux-Tessier-Fillion. The level of anxiety and depressive symptoms were determined using the Hospital Anxiety and Depression Scale. Pain sensitivity in patients was studied by measuring the reaction of the pupil of the eye to the action of an algogenic mechanical factor using the developed proprietary technique of digital pupillometry. Depending on the applied schemes of antistress drug therapy, patients were divided into two clinical groups. The control group included 50 people with different levels of psychological stress. During premedication, they were given Gidazepam for sedation. The main group included 50 patients who were under psychological stress. At the stage of preoperative preparation (for 7 days), they were prescribed a course of antistress therapy: enterally the drug “Antistress” (which contains L-tryptophan) and endonasally – dalargin solution. Results and discussion. Psychological stress acquired by patients in social conditions is a favorable background for the appearance of clinical manifestations of anxiety and depression before the start of operations. The use of Gidazepam by stress-labile dental patients of the control group during premedication made it possible to provide antistressor protection only in 8 cases. These patients had a moderate level of psychological stress. The results of psychological testing and pupillo-algometry confirm the need to use alternative medication schemes of antistressor protection for emotionally labile dental patients during their preparation for planned surgical interventions. In patients of the main group with an average level of psychological stress before surgical interventions, antistressor protection was achieved in 100% of cases. The effectiveness of the applied medicinal scheme was statistically significant in comparison with the standard scheme of treatment of psychoemotional tension used by patients of the control group – χ2 - 15.771 (р<0.001). Preoperative antistress therapy was not sufficiently effective for only 16.7% of patients in the main group with a high level of psychological stress. When comparing the results of stress-protective therapy with those of patients in the control group, statistically significant differences were also found – χ2 - 16.875 (р<0.001). Conclusion. In dental patients who are in a state of chronic psychological stress, psychoemotional tension (reactive anxiety) increases and pain sensitivity increases before the start of planned surgical interventions, which is confirmed by psychological tests and digital pupillo-algometry. One-time use of Gidazepam by stress-sensitive patients during premedication is not effective enough to normalize their psycho-emotional state. Prescribing a course of drug antistress therapy (L-tryptophan and dalargin) to dental patients diagnosed with chronic psychological stress allows to statistically reliably normalize their psychoemotional state and reduce pain sensitivity before the start of surgical interventions

COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF CONGENITAL HEART DISEASE

Aim of the study – Evaluate the value of multispiral computed tomography (MSCT) with intravenous contrast in the diagnosis of congenital heart disease (CHD) at the stage of preoperative preparation and choice of surgical tactics. Methods. Between January 2021 and June 2022, 30 CT cardiographies were performed in our center, of different age and mediastinal pathology. A 64-slice Somaton Siemens sensation 64 CT scanner complete with digital processing systems was used. The main vessels of the heart were examined with intravenous bolus injection of contrast agent. Image analysis included study of anatomy of the defect by three-plane tomograms and construction of multiplanar 3-D reconstructions. Results. Modern approaches to the imaging diagnosis of CHD in all age groups are presented. The role of CT-angiography with intravenous contrast in the diagnosis of congenital, acquired cardiovascular and thoracic pathology is shown. Qualitative assessment of CT-angiographic picture of CHD was performed. Conclusion. Our experience with CT cardiography in the examination of patients with CHD, in contrast to traditional ultrasound and invasive techniques, in most cases allows to obtain more valuable diagnostic information, especially extracardiac structures, which determines its significance in the examination of CHD. It details anatomy of malformations in reliable morphometric indices, diagnosis of aortic, pulmonary artery, right ventricular pathology, including pathology of its outflow tract, to assess ventricular-artery connections and atrialventricular connections.

Tumor thrombosis in extremity soft tissue sarcomas.

e23551 Background: Malignant tumors of bones and soft tissues often reach large sizes, compress and invade the major vessels, leading to the development of venous thrombosis. Venous thrombosis is difficult to distinguish from tumor thrombosis in the preoperative period. However, the management differs. Both conditions require anticoagulant therapy, but tumor thrombosis requires expanding intervention with the thrombus removal and major venous resection. The major vessel involvement complicates surgery. It is much more difficult to achieve negative resection margins. The risk of damage to the main vessels during tumor mobilization increases and, as a result, the risk of hemorrhagic complications increases as well. An interdisciplinary approach reduces the risk of surgical complications and helps achieve radical tumor resection. Our purpose was to analyze the rates of tumor thrombosis in malignant tumors of bones and soft tissues and evaluate the results of surgical treatment. Methods: 115 patients (mean age 46 years) with malignant tumors of bones and soft tissues received surgical treatment in 2020-2021. The most common histological subtypes were synovial sarcoma (25.3%), pleomorphic sarcoma (18.2%), and liposarcoma (15.6%). Venous thrombosis of the lower extremity veins was diagnosed at the stage of preoperative preparation in 17 patients (14.8%), the femoral segment was more often affected (70.6%). All patients received anticoagulant therapy. The tumor genesis of a thrombus was confirmed intraoperatively in 7 patients. Thus, the incidence of tumor thrombosis in malignant tumors of bones and soft tissues was 6%. All patients underwent tumor removal, thrombectomy, and the femoral or iliac venous segment resection. Results: The following complications were observed in the postoperative period: seroma - 5 cases (29.4%), lymphorrhea - 12 (70.5%), swelling of the lower limb - 12 cases (70.5%). Conclusions: Tumor thrombosis in malignant tumors of bones and soft tissues of the lower extremities is not a rare complication, it requires timely diagnosis and an expanded intervention to achieve negative resection margins and reduce the risk of embolism.

ANALYSIS OF THE FREQUENCY AND NATURE OF CONCOMITANT DISEASES AS A RISK FACTOR FOR COMPLICATIONS AND ADVERSE OUTCOME IN CORONARY ARTERY BYPASS GRAFTING IN ELDERLY AND SENILE PATIENTS

Abstract. Objective: to study the frequency of occurrence of concomitant pathology of the circulatory and respiratory system, digestive organs and urogenital system to improve the quality of prognosis of developing complications and adverse outcomes during coronary artery bypass grafting in elderly and senile patients with coronary heart disease, including taking into account gender differences. Materials and methods. 164 patients (70% - men), operated on a planned basis for coronary heart disease in the Altai Regional Clinical Hospital, were under observation. The average age of patients at the time of surgery was 58.7± 7.3 years. Coronary bypass surgery was performed according to indications in conditions of artificial circulation and pharmacoholodic cardioplegia. Results. The Charlson comorbidity index was 5.3 [4.4-5.9] points; in young and middle-aged patients 3.5 [3.0-4.3], in elderly and senile patients - 5.9 [4.9-6.3] (p=0.03). It correlated with the following surgical complications: heart failure that required inotropic support for more than 5 days (r=0.68); perioperative MI (r=0.61); acute cerebrovascular accident confirmed by computed tomography (r=0.52); cardiac arrhythmias (atrial fibrillation, paroxysmal ventricular tachycardia) (r=0.49); respiratory insufficiency, which led to prolonged artificial ventilation of the lungs for more than 5 days (r= 0.45). Conclusions: Comorbidity in CABG is characterized by a high risk of an unfavorable prognosis in elderly and senile patients (survival rate is less than 21% in the next 10 years). The presence of a significant frequency of both multi and comorbid diseases determines a high associated surgical and anesthetic risk, which must be taken into account at the stage of preoperative preparation in gerontological patients, requires additional examination, increased costs and mandatory medical correction.

Nutritional approaches to correction of metabolic syndrome before abdominoplasty

The aim of the study was to highlight modern approaches to the dietary correction of metabolic syndrome in patients who have decided to perform abdominoplasty. Materials and methods. The keywords driven search for scientific references was carried out in the PubMed, Google Scholar and elibrary.ru databases for the period from 2000 to 2020. 38 sources were selected from 159 received links. Results and Discussion. Current approaches to dietary therapy of obese patients who have decided to perform abdominoplasty, taking into account the comorbidity of patients, is provided. Particular attention is drawn to the subjects’ nutritional status periodical reassessment, the identification and comprehensive correction of carbohydrate and lipid metabolism disorders both at the stage of preoperative preparation and throughout subsequent life. The principles of calculating the daily caloric content and the nutrition planning are considered. A personalized interdisciplinary approach to patient management within the wide specialties spectrum (internist, endocrinologist, cardiologist, gastroenterologist, nutritionist, psychotherapist, plastic surgeon) cooperation and the application of digital technologies for remote life-long monitoring and counseling is discussed. Conclusion. A unified algorithm of actions of an interdisciplinary team of specialists, taking into account the personal characteristics and needs of patients, the possibilities of digital technologies, allows to reduce the risk of developing comorbid pathology, improve the results of abdominoplasty, the quality and life expectancy of the patient and ensure the best therapeutic and aesthetic result, as well as prevent relapses of weight gain during long-term follow-up of patients after abdominoplasty.

Особливості змін у неврологічному статусі в пацієнтів із спадковими полінейропатіями на етапі оперативного лікування

Актуальність. Спадкові полінейропатії належать до системних дегенеративних захворювань нервової і м’язової систем генної природи, що досить часто призводять до порушення опорно-рухового апарату. Метою нашого дослідження було оцінити неврологічний стан осіб із спадковими полінейропатіями на етапі передопераційної підготовки. Матеріали та методи. Обстежено 87 пацієнтів декретованої групи віком від 12 до 57 років. Контрольну групу становили 10 пацієнтів із травматичним ушкодженням м’яких тканин та периферичних нервів на нижній кінцівці і 10 пацієнтів із поздовжньою плоскостопістю ступнів молодого, середнього та похилого віку. Усі пацієнти підлягали детальному ортопедичному та неврологічному обстеженню. Результати. У всіх пацієнтів із спадковими полінейропатіями виявлено рівномірне, з обох сторін, зниження сухожилкових і періостальних рефлексів на нижніх кінцівках, що корелювало з тривалістю перебігу захворювання та характером генетичних мальформацій. Реєструвалось зниження больового відчуття за дистальним типом: при легкій формі ураження — на рівні пальців стоп, при середній такі порушення поши-рювалися до рівня гомілкових суглобів, а при тяжких формах сягали середньої третини гомілки або рівня колінних суглобів. При легкій формі спадкової полінейропатії знижувалась вібраційна чутливість у ступнях до 12–14 с (у пацієнтів контрольної групи вона була в межах 15–16 с і більше), при середньому ступені процесу — до 7–11 с, при тяжких формах — до 0–4 с. Рухливі порушення при полінейропатичній ступні зводились до симетричного зниження сили м’язів у дистальних відділах кінцівок, а у12 пацієнтів із тяжкою формою Шарко — Марі — Тутса спостерігався парез стоп, у 2 хворих були прояви проксимальної аміотрофії м’язів ніг. У переважної більшості пацієнтів відмічались значні вегетативно-трофічні порушення сегментарного рівня, переважно в дистальних відділах ніг. Зокрема, зміни стосувались самої шкіри. У дистальних відді-лах ніг у 48 пацієнтів вона була сухою, злущеною, з численними тріщинами, гіперкератозом, потертостями, мозолями (особливо в ділянці підошв). Діагностувались набряки по тильній поверхні ступнів та в нижній третині гомілок. Судинний рисунок був змінений у 36 пацієнтів за парасимпатикотонічним типом і в 19 — за симпатикотонічним. Нігті були атрофічними, із зміною їх забарвлення. Трофічні зміни спостерігались також і в глибше розташованих м’яких тканинах. Висновки. Спадкові полінейропатії супроводжуються тяжкими ортопедичними порушеннями, переважно в скелетних структурах стоп. Патогномонічними ознаками для вибору тактики хірургічного лікування осіб із спадковими полінейропатіями є характер вегетативно-трофічних порушень та ступінь змін складних видів чутливості на ногах, зокрема вібраційної чутливості.

A Deep Learning-Based Approach for Automated Coarse Registration (ACR) of Image-Guided Surgical Navigation

Coarse registration is the first step in determining the accuracy of surgical navigation. The purpose of this study was to present an automated coarse registration (ACR) methodology to improve the convenience and accuracy. For this purpose, a deep learning model based on a convolutional neural network was used. The input variable used for learning was virtual patient point-cloud (VPPC) generated based on medical image. Output variables were values of coordinate transformation obtained in the process of sending the VPPC to the surrounding space of a medical image. The ACR model consisted of a step of extracting global features of point-clouds from medical image and patient space and a step of predicting the information of 3-dimensional coordinate transformation through global features. The coefficients of determination that evaluated the similarity between predicted and actual rotation values on the x, y, and z axes were 0.993, 0.989, and 0.990, respectively. The coefficients of determination of the predicted and actual translation values on x, y, and z were 0.993, 0.989, and 0.994, respectively. As a result of coarse registration of three phantoms using the ACR, the registration errors between the patient and the computed tomography point-cloud were 3.813 ± 0.792, 3.786 ± 0.734, and 3.653 ± 0.668 mm, which were significantly improved over the conventional method’s registration error (4.671 ± 0.738, 4.865 ± 0.776, and 4.670 ± 0.455 mm). The proposed method can provide convenience in the pre-operative preparation stage by automating coarse registration. It is expected that repeatability and reproducibility can be provided by eliminating random errors that might occur by the operator.

Risk factors of unsatisfactory outcomes after percutaneous laser decompression of lumbar intervertebral discs

To study the risk factors of unsatisfactory clinical results after percutaneous laser decompression of the lumbar intervertebral disc (PLDD). A retrospective observational single-center study included medical records of patients who underwent lumbar PLDD for degenerative spine disease. We analyzed clinical and instrumental parameters potentially affecting the results of lumbar PLDD. Clinical study included 82 patients who underwent PLDD for lumbar intervertebral disc degenerative disease. Mean postoperative follow-up period was 30.8±13.3 months. In 22 (26%) patients, unsatisfactory clinical outcomes were observed. According to binary logistic regression model, comorbidities (p=0.03), duration of disease over 12 months (p=0.03), low preoperative quality of life according to ODI score (more than 50%) (p=0.04), high body mass index (over 25 kg/m2) (p=0.02), severe intervertebral disc (p=0.04) and facet joint degeneration (p=0.01) and intervertebral disc height decrease more than 50% (p=0.01) were significantly associated with unsatisfactory clinical outcomes after lumbar PLDD for degenerative spine disease. Identification of these risk factors of unsatisfactory clinical outcomes is important stage of preoperative preparation in patients scheduled for lumbar PLDD.

Характеристика изменений показателей липидного и углеводного обменов у больных морбидным ожирением до и после оперативного лечения в зависимости от вида хирургического вмешательства

Актуальность. Ожирение — хроническое заболевание обмена веществ, которое прогрессирует при естественном течении, имеет определенный круг осложнений и высокую вероятность рецидива после окончания курса лечения. Связь ожирения с различными метаболическими нарушениями делает его одной из наиболее важных проблем здраво­охранения как для развитых стран, так и развивающихся стран. Цель: проанализировать динамику показателей липидного и углеводного обмена у больных с морбидным ожирением (МО) до и после билиопанкреатического шунтирования (БПШ) в модификации Hess — Marceau и продольной резекции желудка. Материалы и методы. Выборку исследования составили 82 пациента с МО и сопутствующим метаболическим синдромом (МС) в возрасте от 21 до 62 лет (средний возраст — 40,60 ± 1,09 года), которые были про­оперированы по данному поводу и находились в послеоперационном периоде под наблюдением в клинике «Гарвис», которая является базой кафедры хирургии 1 ГУ «Днепропетровская медицинская академия МЗ Украины», в течение от 2 до 3 и более лет после операции. Распределение больных по группам проводилось в зависимости от примененного способа хирургического лечения. І клиническую группу составили 30 (36,6 %) больных с БПШ в модификации Hess — Marceau; II группу — 52 (63,4 %) пациента с продольной резекцией желудка. У разного количества больных в обеих группах в течение срока наблюдения проводили определение характеристик липидного и углеводного обмена с применением общих практических и клинических методов. Оценку результатов снижения массы тела, изменения со стороны маркеров липидного и углеводного обмена проводили в динамике наблюдения — при первом визите на этапе предоперационной подготовки, через 3, 6, 12, 18, 24 и 36 месяцев после оперативного вмешательства. Результаты. Анализ динамики показателей МО после оперативного лечения показал общие тенденции к достоверному (от p < 0,01 до p < 0,001) уменьшению показателей массы тела и индекса массы тела (ИМТ) у пациентов всех клинических групп уже через 3 месяца от начала лечения. В I группе существенное снижение показателей происходило в течение 18 месяцев, а во II — в период 6–12 месяцев. Дислипидемические нарушения у больных с МО достоверно коррелировали с показателями избыточной массы тела с различной степенью достоверности (от р < 0,05 до р < 0,01). Результаты исследования показателей углеводного обмена накануне оперативного лечения свидетельствовали о наличии существенной взаимозависимости уровней С-пептида, инсулина и глюкозы в крови от ИМТ пациентов (от p < 0,01 до p < 0,001). В динамике исследования установлены тенденции к нормализации показателей липидного и углеводного обменов у пациентов обеих групп в течение 2 лет после бариатрического вмешательства с наибольшими изменениями в группе после БПШ уже после 3 и 6 месяцев. Выводы. Прямая корреляционная зависимость, установленная между показателями липидного и углеводного обменов с показателем ИМТ и избыточной массой, доказывала необходимость применения у этих больных оперативного лечения. Тенденции к нормализации показателей липидного и углеводного обменов у пациентов обеих групп в течение 2 лет после бариатрического вмешательства свидетельствовали о его эффективности.

EFFECT OF EXOGENOUS NITRIC MONOXIDE THERAPY ON IMMUNOLOGICAL PARAMETERS IN BISPHOSPHONATE OSTEONECROSIS OF THE JAWS

Bisphosphonate osteonecrosis of the jaw (BONCH) is a drug-induced osteonecrosis in patients with a history of malignancies. It is characterized by progressive destruction of the jawbone with the development of a chronic inflammatory process in the parotid tissues. For the treatment of the disease, the use of exogenous nitrogen monoxide (NO) synthesized using the Plason device is proposed. The study of immunological parameters in patients with BONCH in the main group (n = 26), who received NO-therapy, and in the comparison group (пи = 27), who received traditional sanitation with 0,05 % chlorhexidine bigluconate. The dynamics of indicators in the main group - a decrease in the activity of the cellular link (activity of phago-quoting granulocytes and monocytes) to normal values, an increase in the intensity of local immunity (IgA) and a decrease in the concentration of humoral factors of acute (IgM) and chronic (IgG) inflammation p < 0,05) - confirms the anti-inflammatory and immunomodulatory effect of exogenous NO therapy. In the case of the comparison group, reducing only one indicator (AFM) to normal values does not allow us to prove the effect of traditional sanitation on immunological parameters in General. Thus, the use of exogenous nitrogen monoxide for patients with BONCH is justified both at the stage of preoperative preparation and as a basic conservative therapy if surgical treatment is not possible.

Influence of preoperative preparation on the vaginal architectonics of postmenopausal women with severe genital prolapse

Patients with severe postmenopausal genital prolapse (GP) are the most clinically difficult group of women, in which surgical treatment with mesh implants presents significant difficulties due to the duration of lesions amid pronounced structural changes in the tissues of the urogenital tract under conditions of hormone deficiency. That is why it is of particular importance to study the histological characteristics of the vaginal mucosa in women with GP, who must conduct surgical treatment of vaginal access.
 Aim. To study the histological features of the vaginal mucosa in postmenopausal women with severe GP in preparation for surgical treatment with vaginal access.
 Materials and methods. The study involved 70 postmenopausal women suffering from GP of stage III, IV in combination with genitourinary menopausal syndrome. Patients were randomized blindly into two groups. The therapy was carried out using vaginal forms of estrogen and progesterone preparations in combination with lactobacilli. In the comparison group, preoperative preparation was not performed. All patients underwent clinical and laboratory examination: general examination and gynecological examination, morphological examination of biopsy samples of the mucous membrane of the anterior vaginal wall, which were obtained during subsequent surgical treatment of GP. Methods of parametric statistics were used.
 Results. It was established that focal dystrophy, acanthotic severity, keratinization of the vaginal epithelium, moderate inflammation are characteristic morphological changes in the vaginal mucosa in women with postmenopausal GP. Application at the stage of preparation for surgical treatment using vaginal forms, as a result of which estrogen and progesterone enhance the inflammatory process in the ulcerative vagina, reduce dystrophic changes and their severity in relation to complex changes and differentiation of the vaginal epithelium and activation of regeneration processes in tissues.
 Conclusion. Reducing inflammation and the severity of dystrophic processes in vaginal enemas at the stage of preoperative preparation of women with postmenopausal GP favorably affects the regeneration processes, which in the first place can improve the outcome of surgical treatment.

Применение лизата богатой тромбоцитами плазмы как этап предоперационной подготовки пациентов с посттравматическим рубцеванием тканей век

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