Stage Of Preoperative Preparation Research Articles

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.

Первые результаты симультанных видеохирургических операций при двухсторонних опухолях почек

Objective. To improve the outcomes of treatment of patients with bilateral kidney tumours. Patients and methods. 30 patients with synchronous bilateral kidney tumours received laparoscopic and retroperitoneoscopic treatment in the Institute of Urology and Reproductive Health, I.M.Sechenov First Moscow State Medical University (Sechenov University) from March 2012 to August 2018. 22 patients underwent staged operative treatment, 8 patients had one-stage surgery. The patients’ stage of disease was classified as Т1аN0M0 to Т3аN0M0. In most cases, the histological type had a malignant character. Results. 22 patients underwent 3D modelling of pathological process at the stage of preoperative preparation. The classical triad of renal cancer symptoms was not found. 7 operations were performed by the retroperitoneoscopic access, the others laparoscopically. The number of operations with retro- and retro-approach was 1, retro- and laparo-approach was 3, with laparolaparo-approach was 4. Performance of bilateral laparoscopic resection takes more time as compared with the combination of retro- and laparoscopic approaches. Two resections performed from the retro- and laparoscopic accesses make possible an operation without the surgeons going to the opposite side and changing the position of the endosurgical equipment, which shortens preparation to the second step of surgery and the duration of anaesthesia. Apparently, division of the surgical approach to the kidneys into the abdominal cavity and the retroperitoneal space is preferable, since it allows an adequate evaluation of the course of the early postoperative period and a differential control over the development of complications, first of all, bleeding. Conclusion. First evaluation of the outcomes of treating 8 patients, who underwent one-stage surgery, showed that this approach is safe, since it is not associated with an increase of intraoperative blood loss or other complications as compared with two-stage operations. Also, the duration of anaesthesia is shorter in one-stage surgery than in staged treatment. Enhancement of the volume of operative treatment does not reduce the length of hospitalization but rules out the need for repeated hospitalisation. We have obtained positive results that encourage further enrolment of patients and assessment of long-term outcomes of treatment. Key words: bilateral kidney cancer, synchronous cancer, organ-preserving surgery, nephrectomy, simultaneous and staged surgery, laparoscopic and retroperitoneoscopic surgery

Integrated approach to the management of patients having cicatricial deformity of the uterine cervix

Introduction:Cicatricial deformity of the uterine cervix is a relevant and understudied problem in medicine. It is important to conduct preoperative preparation aimed at creating a favorable background for operative treatment as well as to conduct post-operative treatment for improving and accelerating the reparative processes.Objective:Improving the results of surgical treatment of cicatricial deformity of the uterine cervix with the help of preoperative preparation and evaluating the efficiency of application of the Flamena gel complex in the post-operative period.Method:There were 30 patients having cicatricial deformity of the uterine cervix aged 25 to 45 under observation. With all patients, the clinical, laboratory and instrumental examination was conducted which included: microscopic examination of the intensity of leukocytosis in the vaginal and cervical secretion, cytological examination, bacteriological inoculation from the cervical canal, the PCR method test for sexually transmitted infections (the STIs), detection of the human papillomavirus, the content of immunoglobulines (IgA, IgG, IgM) in the venous blood serum and in the mucous secretion of the cervical canal, colposcopy, ultrasonography, and histological examination of the uterine cervix.Results:After normalizing the biocenosis of the vagina, the Superlimf 25 units immunomodulating agent was prescribed to all patients, as another preoperative preparation stage. Then surgical treatment was performed. In the post-operative period, the Flamena gel complex was prescribed. The combined therapy contributed to improving the results of the surgical treatment.Conclusion:The algorithm suggested by the authors which includes preoperative preparation, surgical treatment and post-operative care can be used as an integrated approach to the management of patients having cicatricial deformity of the uterine cervix.

Optimization of treatment of patients with tuberculosis spondylitis

Tuberculosis spondylitis is 40–61.5 % in the structure of bonearticular tuberculosis in adults. Objective: to increase the efficiency of treatment of patients with tuberculous spondylitis of the thoracic and lumbar spine. Methods: the results of treatment of 60 patients with active tuberculosis spondylitis were analyzed. At the group (n = 30) — at the stage of preoperative preparation were prescribed an intensive course (2–3 weeks) of specific antibacterial therapy taking into account the results of bacteriological sensitivity of microbacterial tuberculosis to antibacterial drugs; then surgical treatment was made with telescopic titanium cages for the front spine fusion. Group II (n = 30) — got 3–5 specific antibacterial for 2–3 months; subsequent surgical intervention involving the usage of autografts for the anterior spine fusion. The groups were identical in age, sex, number of affected vertebral motor segments, and activity of the infectious inflammatory process. Results: excellent in the long follow-up period were obtained in 14 (54 %) patients in the 1st group and 8 (32 %) — II, good in 1 (24.7 %) and 7 (28 %); satisfactory — at 4 (15.4 %) and 7 (28 %) respectively. Only 3 (12 %) patients in group II were shown unsatisfactory results. Conclusions: the proposed method of surgical treatment of tuberculosis spondylitis with the usage of modern achievements (the use of telescopic titanium cages) after short-term intensive antibacterial therapy, taking into account etiological diagnosis, is considered to be promising. In patients of group I, the results of treatment were significantly better due to a significant shortening of pre-surgery period, reducing the number of complications, reducing the timing of inpatient treatment and improving the quality of life.

CHOICE OF SURGICAL TACTICS AT THE STAGE OF PREOPERATIVE PREPARATION OF PATIENTS WITH BILIARY SEPSIS

Introduction: There is a problem of choosing the optimal method for eliminating choledocholithiasis in accordance with one The lack of satisfactory results from the use of existing methods of surgical correction explains the constant interest of specialists to this problem, requires the improvement of the commonly accepted and the search for new approaches to the treatment of this concomitant disease. The aim: To substantiate the use of individual assessment at the stage of preoperative preparation for the purposeful differential tactic of surgical treatment of the biliary sepsis. Materials and methods: The basis of our research was the results of the analysis of treatment of 112 patients with biliary sepsis who were on treatment from 2010 to 2017 in the surgical clinic № 2. An assessment of systemic inflammation performed according to the recommended criteria of the Chicago Interventional Conference on Intensive Care (USA, 1992). The systemic inflammatory response syndrome (SIRS) was determined in the presence of 2 or more symptoms: 1) t body> 38 ° C or <36 ° C, 2) heart rate> 90 / min; 3) breathing frequency> 20 / min; 4) white blood cell count> 12 × 109 / l or <4 × 109 / l; or> 10% immature forms (SOFA score 4, 27 ± 0.6 points). Results: Based on the received pre-operative score, we proposed to optimize the differentiated selection of individualized surgical tactics, taking into account the available baseline conditions, to radically eliminate the cause of biliary sepsis and evaluate the measures of initial conservative therapy. In the course of work, anamnestic unit, clinical unit, laboratory-instrumental block used. The initial severity of the condition of each particular patient is calculate according to the received sum of points for each information block, which allows at the stage of preoperative preparation to standardize all patients in accordance with their score. Conclusion: Thus, the ball assessment of the severity of the condition of patients allows us to determine not only the optimal tactics, the size and type of surgical correction, but also to determine the effectiveness of the selected composition of preoperative preparation and postoperative treatment, carrying out its dynamic assessment.

THE USE OF COMPUTER TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING IN DIAGNOSIS OF AORTIC MALFORMATIONS IN CHILDREN OF THE CRIMEAN REGION

Objective.To assess the value of X-ray computer tomography with intravenous contrast agents and magnetic resonance imaging for diagnosis of aortic malformations in children of the Crimean region at the stage of preoperative preparation, choice of surgical procedure and postoperative follow-up. In the Republican Children’s Clinical Hospital (Simferopol) under our supervision were 44 children with aortic pathology, who underwent cardiac surgery. All children underwent dopplerography of head and neck vessels, xray computer tomography with intravenous contrast and/or magnetic resonance imaging.Results. Modern approaches to the visualization diagnosis of critical congenital heart defects in children are presented. The role of X-ray computer tomography with intravenous contrast agents and magnetic resonance imaging in the diagnosis of congenital aortic pathologies has been shown and a qualitative assessment of CT angiographic picture of aortic pathology was performed. This applies to the detailing of the defect anatomy, reliable morphometric indicators, diagnosis of pathology of aorta, pulmonary artery, right ventricle to assess ventricular-arterial connections and atrioventricular connections, as well as the assessment of the state of the vessels of the pulmonary circulation, bronchial tree and lung parenchyma. Our experience of using x-ray computer tomography and/ or magnetic resonance imaging in examining children with aortic pathology proves that these methods can provide more valuable diagnostic information than traditional methods, which determines their significance.

Математическая модель и программное обеспечение для прогнозирования вероятности летального исхода онкохирургических пациентов, подвергавшихся радиационному воздействию в условиях производства

Purpose: Identification of risk factors that influence the outcome of the patient, their ranking on the contribution to the outcome of treatment, as well as determining the possibility of their additional diagnostic evaluation and correction in the deviation at the preoperative preparation stage with the subsequent construction of a prognostic model. Material and methods: The study included patients who received treatment in the surgical department in A. I. Burnasyan Federal Medical Biophysical Center from January 2009 to July 2017, including workers of nuclear facilities that are exposed to ionizing radiation in professional conditions. The study was conducted in 112 patients, 42 of whom (37.5 %) were men and 70 (62.5 %) women aged 25 to 85 years (59.6 ± 13.2). Among the persons included in the study, 25 men and 26 women were exposed to long-term exposure to ionizing radiation from external sources under production conditions during labor activity within the limits of annual maximum permissible doses, averaged 124.6 ± 10.7 mSv. The work experience under conditions of exposure to ionizing radiation ranged from 5 to 35 years, an average of 24 years. The mean age was 59.1 ± 13.4 years. At the end of hospitalization after surgical treatment, 51 patients were discharged (45.5 %), and 61 (54.5 %) died. In all patients, the parameters of the functioning of various organs and systems were collected, including taking into account the anamnestic data of oncological patients, with differentiation in the final outcome of surgical treatment. To determine the leading risk factors for the lethal outcome of the oncosurgical patient, the Fisher criterion χ2 was used. Based on the leading risk factors for constructing mathematical models, the logistic regression equation was used. The mathematical models were analyzed by researching the area under the ROC curves. Results: Using the Fisher criterion χ2, factors were determined by which the groups of survivors and died patients differ: patient age, body mass index, history of heart rhythm disorders, fraction of cardiac output, Hb level in the blood, presence of protein in urine, INR indicator in coagulograms. Based on the identified factors, twelve mathematical models were constructed using the binary logistic regression method, allowing patients to be divided into groups with the outcomes of hospitalization died / survived after surgery. A mathematical model with the best discriminating ability was chosen. Based on the prognostic model, a decision rule was designed that allows to rank patients into three groups: green (patients with a minimal risk of death), yellow (patients who need preoperative correction), red (patients with the maximum risk of death, decision about surgery is necessary to be solved on a consultation).

Neuroendocrine tumors of the pancreas: from theory to practical recommendations

The article shows that a significant proportion of neuroendocrine tumors of the pancreas are non-functional, i.e., not secreting into the blood a variety of gastrointestinal hormones and polypeptides and as a result, not accompanied by typical clinical manifestations. Unfortunately, often the scan search starts in the detection of distant metastases of neuroendocrine tumors and development of cancer cachexia. Noted that the diagnosis of neuroendocrine tumors of the pancreas is a highly complex task, the solution of which depends on the choice of treatment and its remote results. Currently, the only radical method of treatment of hormonally functioning tumors of the pancreas is surgical. It is indicated that symptomatic therapy can be considered as a stage of preoperative preparation of the patient. The indication for surgical treatment in this situation, along with the ineffectiveness of conservative treatment is the size of detectable formations of 2 cm or more, which is a risk factor of distant metastases. Stressed that according to modern views of patients with nonfunctioning neuroendocrine tumors of the pancreas are subject to surgical treatment. Given that in 70-92% of cases they are malignant, most often used distal or extensive pancreatoduodenal resection. Currently, noted that the large size of the tumors are not a contraindication to surgery and if the tumor dormant, to 1 cm, the possibility of a short observation. Any tumors found in the pancreas, needs to be taken out of the context, or if it is possible – is widely excised. The article examines the rational and integrated use of modern Arsenal of surgical and therapeutic methods, which enable significantly prolong life, improve its quality in patients with metastatic forms of neuroendocrine tumors of the pancreas.

Оптимизация премедикации больных артериальной гипертензией и нарушениями ритма сердца с амиодарон-ассоциированным тиреотоксикозом I типа

The aim of the work was to reduce the risk of unstable hemodynamic reactions in patients with arterial hypertension and heart rhythm disorders against amiodarone-inducible thyroid dysfunction after neurosurgical operations due to pharmacological optimization of premedication. The study was conducted on 51 patients with arterial hypertension and amiodarone-associated thyrotoxicosis type I, which were divided into two groups. 1 group (n = 30) - at the stage of preoperative preparation, patients received prolonged premedication (for three days before the operation) with long-acting benzodiazepines (diazepam) and magnesium preparations. 2 group (n = 21) - benzodiazepines of short action (midazolam) were used for premedication before the operation. As a result of the study, it was established that in patients with arterial hypertension with cardiac arrhythmias and type I amiodarone-associated thyrotoxicosis, the use of long-acting benzodiazepine with diazepam in prolonged mode in combination with magnesium sulfate compared with short-acting benzodiazepine midazolam provides a more effective reduction intravitual, short-term and medium-term variability of blood pressure, increasing the variability of the duration of the cardiac cycle, which a more stable and predictable hemodynamics reaction.

К ВОПРОСУ ОБ УЛУЧШЕНИИ ИСХОДОВ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПРОЛАПСА ГЕНИТАЛИЙ В ПОСТМЕНОПАУЗЕ

Currently, the frequency of genital prolapse in the structure of common gynecological diseases has no tendency to decrease and may take up to 15% of large gynecological operations. With the aim of improving outcomes of surgical treatment of this category of patients, at the stage of preoperative preparation and the postoperative period used vaginal capsules containing Lactobacillus + progesterone 2 mg + estriol 0.2 mg (Triozhinal). The study included 239 patients in postmenopausal women with genital prolapse and phenomena cystourethroscopy and vaginal atrophy. Of these, the main group consisted of 122 women who underwent the proposed scheme of preoperative preparation and postoperative period. Group comparisons were presented 117 patients admitted to the gynecological Department for surgical treatment of prolapse with traditional preoperative and postoperative management. The results of the study showed that in the group of patients receiving local therapy estriola in combination with progesterone and lactobacilli, was observed a significant improvement of the clinical picture of urinary disorders, quality of life, symptoms of urogenital atrophy during surgical correction of urinary incontinence or genital prolapse, and this tactic can be recommended as in the pre-and postoperative periods.

Biplanar Fluoroscopy-Guided Percutaneous Lead Implantation for Spinal Cord Stimulation: Technical Note.

The correct positioning of spinal cord stimulator leads is assessed radiographically during their percutaneous implantation for trial stimulation. Usually the C-arm is repositioned several times to allow imaging in different planes, which may extend the total duration of surgery. The study aimed to evaluate whether the concurrent intraoperative use of 2 C-arms could safely reduce the duration of surgery. This retrospective study included cases of percutaneous implantation of a spinal cord stimulation (SCS) lead for trial neurostimulation between 2006 and 2011. The duration of the surgical intervention was recorded, along with the duration of the preparation stage in the operating room. In addition, total radiation exposure time per case was recorded. Ninety-four patients underwent percutaneous implantation of an SCS lead (72 thoracolumbar, 22 cervical). In 73 cases 2 C-arms were used, with 21 cases performed with a single C-arm. In both the cervical and thoracolumbar groups, a biplanar configuration was associated with significant reduction in the mean length of the surgical phase, by 29 minutes (P= 0.017) and 14 minutes, respectively (P= 0.016), albeit while increasing the duration of the preoperative preparation stage. There was no significant difference in the total duration in the operating room or in the total radiation exposure time between groups. Here we present a technical note on the use of a biplanar fluoroscopy configuration for percutaneous implantation of SCS leads. This arrangement correlated with a reduction in surgery duration without increasing total radiation exposure, representing a practical and safe adjustment to current practice.

УЛЬТРАЗВУКОВОЕ ИССЛЕДОВАНИЕ ТОПОГРАФО-АНАТОМИЧЕСКИХ ПАРАМЕТРОВ ПАХОВОГО КАНАЛА ПРИ ГРЫЖАХ У ЛИЦ МУЖСКОГО ПОЛА

Objectives.To study ultrasonic topographic and anatomical parameters of the inguinal canal with different types of hernias. Material and methods. 75 patients of young, middle and old age with inguinal hernias II, IIIa and IIIb types by L. Nyhus were examined. The height (H) of the inguinal gap (PP) and the length (L) of the inguinal canal (PC), the total thickness of the internal oblique and transverse abdominal muscles (STM), and the diameter of the deep inguinal ring (DGPC) were measured using ultrasonic method. Results. In elderly patients with all types of inguinal hernias a significant increase in height of PP and a decrease in STM the upper wall of the inguinal canal compared with younger patients were revealed. In young patients STM of the upper wall of the inguinal canal exceeded 7 mm, and in the elderly it was in the range of 4.5-5 mm. Conclusions. Ultrasound enables to assess anatomical parameters of PC which may be the criteria for choosing the method of hernioplasty at the stage of preoperative preparation.

CHARACTERISTICS OF EMERGENCY MULTISLICE COMPUTED TOMOGRAPHY ANGIOPULMONOGRAPHY

The paper gives the results of emergency contrast-enhanced multislice computed tomography (MSCT) (MSCT angiopulmonography) as a stage of preoperative preparation in 4 pregnant women in order to confirm fatal thromboembolism. Thromboembolectomy of the pulmonary artery branches were done as clinically indicated in all the women on the day of admission. The time from hospital admission to surgery was less than 1 hour (mean, 40 minutes). Good angiographic and clinical results were achieved in all cases. Two women (50%) delivered a baby simultaneously with thrombectomy; two women (50%) delivered 5 weeks and 9 weeks (mean, 7 weeks) after a cardiac surgical procedure. All the babies had an Apgar score of 7–9. MSCT angiopulmonoraphy is a reliable non-invasive examination in patients, including pregnant women with suspected or verified pulmonary embolism. Low-dose MSCT-angiopulmonography protocols and use of dual volume contrast media injectors can minimize testing time, radiation load, and injected contrast agent volume in order to obtain qualitatively adequate MSCT data for the choice of further patient management tactics, by lowering iatrogenic effects on the fetus.

Новый подход к профилактике операционных осложнений при коррекции сложного миопического астигматизма методом ReLEx® SMILE

Purpose. To study the efficiency of a preoperative inhalation session of oxygen-xenon mixture in the mode of analgosedation for stressunstable patients at the preoperative preparation stage for the ReLEx®SMILE method. Material and methods. The study group consisted of 11 patients (mean age 22.76±1.43 years) with a high degree of anxiety (>46 points), according to the Spielberger State-Trait Anxiety Inventory (STAI). The laser correction by the ReLex® SMILE technology was planned for them (average spherical equivalent (SE) 3.38±0.39D) using the VisuMax™ 500 kHz device (Carl Zeiss Meditec AG). As a preoperative preparation, they underwent the inhalation of an oxygen-xenon mixture in the analgosedation mode. The sessions were performed using the anesthesia XENA-01 device, operating on a closed loop, thereby the xenon exposure was carried out in sub-narcotic concentrations – 35-40% (up to 1/3 МАC). Results. During the analgosedation session with the oxygen-xenon mixture before the ReLEx® SMILE, the hemodynamic and ventilation parameters in the patients of the study group remained stable. By the 20th minute the patients calmed down, fell asleep, heart rate decreased up to 55.4±5.3 per minute. The 40% xenon exposition was 20 minutes. The xenon consumption was 4.5±0.7 liters per session. During the ReLex® SMILE, the patients, remaining fully conscious, behaved adequately and calmly. The stage of interface applanation to the cornea, its centering, femto-dissection occurred without complications in all patients. The planned refractive result was achieved in 100% of cases (the mean SE was 0.25±0.1D). The next day after the procedure, the UCVA in all patients was 0.9-1.0. Conclusion. The analgosedation session with an oxygen-xenon mixture provides an adequate nociceptive and anti-stress protection, guarantees safe laser ophthalmic interventions in emotionally labile patients. The obtained results of the study allow to consider this premedication method before the femto-laser correction of ReLEx® SMILE as a new approach to the prevention of such an intraoperative complication as the vacuum loss.

Primary bariatric operation as preoperative preparation stage for patients with incisional hernia with concomitant morbid obesity

Obesity is considered as the main risk factor of incisional hernia especially in patients with morbid obesity. Among factors of relapse risk are the next ones: considerable intra-abdominal hypertension, big number of wound complications, technical (intraoperative) difficulties of hernioplasty caused by obesity. Conservative treatment of the morbid obesity has no effect. Methods : There was carried out an analysis of treatment of patients with incisional hernia with concomitant morbid obesity (MO). They underwent bariatric operation before hernioplasty which was postponed till decrease and stabilization of body mass. Immediate and remote results were analyzed. Results: 3o patients who underwent bariatric operation (BO) before hernioplasty took part in the research. Body mass index (BMI) was ≥40 kg/m 2 (25 women, their mean BMI was 48,5±8,7 kg/m², intra-abdominal pressure (IAP) was 2,36±0,09 kPa. 19(63,3%) of patients underwent bending of stomach (BS), 11 (36,7 %) – shunting of stomach (SS). Three patients had complications: two seromas and pneumonia. The relapse of hernia was noticed in one patient (3,3 %). The mean loss of weight in 2 years after BS was 34,8±6,7 kg, after SS – 57,3±3,7 kg, intra-abdominal pressure – 1,31±0,08 kPa. The general number of preoperative concomitant diseases was 73. After two-year observation respiratory and metabolic disorders were completely compensated in 50 % of patients and considerably improved in 38 %. Conclusions: The use of phased tactics of treatment leads to the most favorable results. BO gives a possibility to improve the physical state of patient and prepare him for herniaplasty

316 Test de biocompatibilité dans la kératoplastie pour prévenir l’échec de la greffe

For preserving the isolated tissues in the state of their structural integrity and viability for their subsequent successful transplantation the storage method of donors’ cornea in a special container that has NSS (Nano-structured Surface) has been put forward before. Nevertheless, immunological allograft rejection is reported to be the leading cause of corneal graft failure, and it could not be prevented just by donor cornea quality or perfect surgical technique. Our investigation was aimed at establishing the individual donor-recipient compatibility by means of donor cornea placing into recipient blood plasma. After the exposition the plasma condition as well as the number, the density and the condition of donor cornea ECs (Endothelial Cell) have been estimated. Data obtained during this investigation have shown the strong correlation between the any precipitation or non homogeneity in recipient plasma and the severity of morphological changes occurred with donor cornea. By suggested individual compatibility test, the donor cornea could be considered as suitable or not suitable for future transplantation for a certain recipient at the stage of preoperative preparation when something can be done in advance for the prevention a possible postoperative complication and grafting failure. Besides the tissue typing of histocompatibility which had no significant long-term effect on the success of corneal transplantation, the determining of preoperative recipient-donor biocompatibility test is necessary.