Principles Of Surgical Treatment Research Articles

Obstetric perineal trauma

Obstetric perineal trauma is a common pathology that complicates up to 90% of vaginal deliveries. The true incidence of injuries (and their severity) is usually underestimated and higher than reported. Obstetric perineal injuries have a serious impact on a woman’s well-being and have medical, emotional, social and psychological aspects. Their negative consequences can persist for many years after childbirth and have a potentially devastating impact on a woman’s quality of life, lead to severe morbidity due to persistent pain, pelvic floor dysfunction, urinary and faecal incontinence, sexual problems, high risk of re-injury during future childbirth, etc. The article presents an overview of existing national guidelines for the prevention and treatment of perineal injuries. The data on the frequency and risk factors of perineal tears are systematized, and a modern classification is presented. Particular attention is paid to obstetric anal sphincter injuries (OASIS) for a better understanding of this pathology by partitional doctors. Training and awareness of obstetricians about OASIS should help to identify patients at risk, more accurately diagnose and choose the right tactics. The article also describes the main preventive interventions during pregnancy and childbirth, discussing the advantages and disadvantages of each. Given the high frequency of episiotomy for the prevention of OASIS, the advantages and disadvantages of various options, as well as the correct 45-60˚ technique, are presented. The emphasis is placed on the fact that it is necessary to perform selective episiotomy rather than routine episiotomy in the presence of clear indications according to the national standard. Reducing the frequency of episiotomies should lead to a decreased number of iatrogenic perineal injuries. The general principles of surgical treatment of perineal injuries, various suturing techniques, suture material characteristics, postoperative management of patients and counselling for future births are also presented.The use of these recommendations by obstetricians will be useful for their practice and will help improve the quality of medical care.

Traits of intrauterine pathology management in the peri- and postmenopausal period

Increasing number of anovulatory cycles in the perimenopause, leading to relative hyperestrogenism, and persistent hypoestrogenism in postmenopause, increase the proliferative activity and change the endometrium morphology. That is associated with higher rates of intrauterine pathology. The prevalence of atypical hyperplasia and endometrial cancer in women of the peri- and postmenopausal periods reaches its maximum values. Therefore, one of the most important concepts of patient’s management is to exclude malignant and precancerous endometrial pathology. Significant hormonal changes leads to important confounders in diagnostic and therapeutic algorithms. It could lead to both hypo- and hyperdiagnosis. The review analyzes the main causes of abnormal uterine bleeding, the features of their clinical manifestation, taking into account probable iatrogenic causes, extrauterus and extragenital sources of spotting. This article reviews the principles of ultrasound examination, considering menstrual cycle phase, duration of menopause, hormone treatment, as well as indications for endometrial biopsy, in case of inconsistency of clinical presentation, ultrasound results, menopausal status and iatrogenic factors. We describe the relevant principles of medical correction, wait-and-see tactics and surgical treatment of abnormal uterine bleeding, both in the presence of organic pathology of the endometrium, and in its absence.

Basic principles of surgical treatment of distal radius fractures

Distal radius fractures are one of the most frequent fractures of the upper extremities. The decision for conservative or surgical treatment is made after appropriate diagnostics using conventional radiographic and usually computed tomography imaging examinations. If the indications for surgical treatment are present, various options for reduction and fixation are available. The spectrum ranges from closed to open procedures up to accompanying arthroscopic support. Appropriate preoperative patient education about the procedure and the planned postinterventional treatment is essential. The goal of treatment is to restore wrist function while maintaining mobility and strength with alow risk of complications. All surgical procedures share the principle of reduction to restore anatomical relationship followed by fixation. Closed procedures include fixation with Kirschner wires and the construction of an external fixator. Volar locking plate osteosynthesis has become established in recent years as the method of choice for the majority of the fractures to be treated. For special fracture patterns and the treatment of accompanying injuries, arthroscopic support can be indicated. There is no uniform consensus on the best choice of procedure. This article discusses the possible procedures including the approaches, fixation techniques and specific follow-up treatment.

Lumbar Spinal Stenosis Due To Spodylolisthesis- Surgical Compared With Nonsurgical Treatment

Background: Lumbar spinal stenosis with spondylolisthesis stands for severe pain and dysfunction because of the narrowing of the spinal canal and vertebral slip. With patients being treated either surgically or by other methods, distinction between the two is necessary to resolve controversies. Objectives: To conduct a comparative analysis between surgery and non-surgery in the management of lumbar spinal stenosis with spondylolisthesis using observational and randomized control study groups. Study Design: A Observational and randomized cohort comparative study Place and duration of study : department of neurosurgery lady reading hospital Peshawar from jan-2020 to jan-2023 Methods: Based on the observational and randomized cohort study conducted in the period jan-2020 to jan-2023 in the Lady Reading Hospital, 604 patients were included in the study. Collectively, treatment embraced either surgical untethering or other mean. Specific patient outcomes such as pain relief and functional gain were measured during the follow-up which ranged up to 3 years. Results: In terms of body pain, surgical intervention provided statistically significant and more superior results in a mean of 18. 1 as compared to nonsurgical management over 3 years of follow up, similarly for physical functions the mean improvement was of 18. 3 and for Oswestry Disability Index it was 16. 7. Conclusion: The decision of preferring surgical intervention for the treatment of lumbar spinal stenosis with spondylolisthesis correspond to the maximum long term advantages of surgical over non surgical treatment principles focusing on the pain relief and functional recovery. Therefore, the present outcomes favour surgical management as the most preferred treatment approach with the adoption of individualised management plans following thorough clinical examinations of the patients. Keywords: Spinal Stenosis, Spondylolisthesis , Surgery Outcomes

Oralno hirurško zbrinjavanje pacijenata obolelih od hemofilije

Introduction: Haemophilia is one of the most common haemorrhagic diseases from the group of coagulopathies and results from a deficiency of factors responsible for the first phase of coagulation. Aim: This informative paperwork aims to highlight the principles of oral surgical treatment of patients with haemophilia. Material and methods: The available literature was analysed to indicate the basic characteristics of haemophilia (clinical manifestation, possibilities of treatment and prophylaxis of the disease) with special reference to specificity and principles of dental oral surgical treatment of patients with haemophilia. Conclusion: The treatment of patients with haemophilia is considered one of the riskiest in everyday dental practice. Despite this, dental interventions can be successfully and safely performed. However, the dentist must be acquainted with the nature of the disease, its symptoms and the severity of the clinical picture. Furthermore, the dentist needs to know what kind of therapy the patient receives for the treatment of haemophilia, whether the patient has been diagnosed with inhibitors to the coagulation factor, and whether the patient has concomitant diseases with special reference to possible infectious diseases. Along with that, the key to a successful and safe intervention lies in a well-planned preoperative, perioperative and postoperative treatment of patients with haemophilia.

Cervicothoracotomy for right upper sleeve lobectomy with carinal resection in the treatment of central lung cancer

We demonstrated successful treatment of patients with complicated central lung cancer, who underwent right upper sleeve lobectomy with carinal resection. We have used the following options for carinal reconstruction: anastomosis of trachea with the left main bronchus and anastomosis of intermediate bronchus with the left main bronchus (clinical case No. 1) or with trachea (clinical case No. 2). Cervicothoracotomy provided correct N-staging and mobilization of trachea with left main bronchus. This approach provided compliance with oncological principles of surgical treatment of lung cancer and significantly reduced tension of anastomosis. These aspects are important for satisfactory immediate functional and oncological results after right upper sleeve lobectomy with carinal resection.

Many years of experience of spontaneous pneumothorax treatment within one medical center

The objective: to analyze results of surgical treatment of the patients with spontaneous pneumothorax.Subjects and Methods. Medical records of patients with spontaneous pneumothorax (SP) who were treated in Surgical Thoracic Department of Ryazan Regional Clinical Hospital from 1998 to 2021 were retrospectively analyzed. The article describes the experience of treatment of 738 cases of spontaneous pneumothorax within one medical center. The evolution of tactics and principles of surgical treatment over a 23-year period is presented. The incidence of spontaneous pneumothorax and efficacy of different surgical options were analyzed. The recurrence of spontaneous pneumothorax was recorded in the following cases: after pleural cavity drainage – in 19.7%, after videothoracoscopic resection of bullous parts of the lung in combination with subtotal parietal pleurectomy – in 2.1%.

Surgical treatment of the acromioclavicular joint dislocation: modern trends and prospects

Background. Acromioclavicular joint dislocations constitute from 6.8 to 26.1 % of all dislocations and rank third after dislocations of the shoulder and forearm. In the structure of acute traumatic injuries to the shoulder girdle, the proportion of acromioclavicular joint dislocations is above 12 %. These injuries are more common in men of the most working age (from 30 to 40 years) and in athletes engaged in contact sports. Poor outcomes of surgical treatment vary from 9 to 12 %. The aim of the study: to determine modern principles of surgical treatment for acromioclavicular joint dislocations, problematic issues and advanced solutions. Materials and methods. Analysis of literature sources was carried out using PubMed, UpToDate, Scopus, Web of Science, MEDLINE, The Cochrane Library, Embase, Global Health, CyberLeninka databases by search: acromioclavicular joint dislocations, surgical treatment. Results. The most common classification of acromioclavicular joint dislocations is Rockwood classification that includes six dislocation types. Despite the quite detailed classification of injuries to the acromioclavicular ligament according to Rockwood, the Tossy classification is more simplified, but meets practical needs, and distinguishes three types of damage. Stabilization of the clavicle with metal structures is realized by fixing to the coracoid process or acromion of the scapula, the latter is a priority. The disadvantages of the most used metal fixators were identified that require their optimization and development of innovative structures. The reasoned direction regarding static stabilizer restoration is plastic replacement of both ligamentous complexes. Conclusions. A priority direction is to stabilize the clavicle by fixing its acromial end to the acromion of the scapula with metal structures among which a hook plate and the Weber method are the most used. However, significant disadvantages in their use necessitate the development of innovative designs. A promising direction for the restoration of static clavicle stabilizers is surgical methods that combine the restoration of the coracoclavicular and acromioclavicular ligaments. The objective need to create channels for grafts leads to a weakening in the mechanical strength of the bony structures, so research regarding the direction, diameter, and location of these channels requires further investigation.

Inpatient surgical treatment in mass casualty situations and disasters-Principles, targets, concepts, preparation

The war in Ukraine and the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic have moved the resilience of the healthcare system in Germany into the focus of a broad discussion. The preparation for such a damage situation is characterized by the relationship between the available treatment capacity and needs which go far beyond the norm. The aim of a resilient healthcare system must be to adequately react to such exceptional situations. Particularly in acute disaster and mass casualty situations, medical standards and an individualized surgical treatment must be maintained for as long as possible. The aim of this article is to elucidate the current terminology on medical treatment of patients in disasters from a surgical perspective, to further develop available concepts and possible concepts of crisis management based on three schematically presented scenarios. Furthermore, the general reaction possibilities for mobilization of treatment capacities are described. In order to uniformly collate the quality of medical treatment in a damage situation, it is meaningful to include the stages of individualized treatment, compensated crisis care and decompensated crisis care. Within the framework of a mass casualty situation or a disaster, traumatological and surgical patients are predominant and the aim must be to maintain or restore the stage of a compensated crisis management. Depending on the extent of the damage situation, this can only be realized in a timely manner independent of state boundaries and by a superordinate central management structure. For a comprehensive provision of surgical treatment capacities, the depiction of a continuous overview of the situation with current resources and structural data of the hospitals in the affected region is necessary. The aim of all efforts and preparations must therefore be to durably strengthen hospitals and to train and develop this with respect to coping with a damage situation in disaster medicine. In this respect it is important to establish a consensus on terminology, the type of treatment and the tactical strategic principles of surgical treatment to cope with a disaster or damage situation.

Changes in Oncological Surgical Principles Driven by Advances in Preoperative Treatments.

From a surgical point of view, the development of preoperative oncological treatment has had a profound effect on the surgical treatment trends of cancer as well as on the outcomes of cancer patients. Consequently, these changes have challenged formerly entrenched oncological surgical principles. In our short report, we aimed to summarize the main shifts regarding the surgical principles of cancer treatment due to the development of preoperative oncological therapy in recent years. As a result of successful preoperative treatment, surgeons may perform less radical surgeries, the required free resection margin has been narrowed down to a few millimeters in dimension and preoperative treatment is justified in both definitely resectable tumors and in oligometastatic tumors as well. For prognosis assessment, the post-preoperative oncological treatment stage is now considered decisive, rather than the pretreatment stage as previously thought. Other changes include the introduction of the watch and wait strategy and the reverse order of treatment of the primary tumor and metastasis. Observing the continuously improving outcomes of cancer patients and the developments in oncological treatment modalities, a further expansion of the indication of preoperative treatments is to be expected.

The Unique Practice of the Clinical Nurse Specialist.

The Unique Practice of the Clinical Nurse Specialist.

Surgical intervention on the wound channels of gunshot non-penetrating craniocerebral injuries

Objective – to optimize of surgical approaches to damaged tissues of the head and methods of primary surgical treatment for gunshot non-penetrating gunshot craniocerebral injuries in accordance with the principles of comprehensive and single-stage surgical treatment accepted in military field surgery. Materials and methods. An analysis of the surgical treatment of 155 wounded people with non-penetrating gunshot wounds of the skull vault and brain for the period from 2014 to 2020 was carried out. Anatomical and morphological features of wound canals were studied depending on the traumatic agent. Variants of surgical approaches for the primary surgical treatment of non-penetrable gunshot wounds of the skull and brainwere developed based on the clinical X-ray and computed tomography characteristics of the affected head tissues. Results. The choice of surgical approaches depends on the nature of the wound canals (single fragment blind, multiple fragment blind, ball and fragment tangent) and the presence of concomitant epidural and subdural hematomas. Primary plasty of the skull defect with a titanium plate during primary surgical treatment is indicated for gunshot impenetrable craniocerebral injuries with a single fragmental blind wound channel. Such plastic surgery was performed in 33.5% of cases with a favorable postoperative course. Peculiarities of surgical approaches to damaged tissues of the head in case of single fragmentary, blind wound canal; with multiple blind fragmental wound canals, the adjacent wound canal and the sequence of their surgical treatment were established. Conclusions. Planning of surgical approaches to damaged tissues of the head in case of gunshot impenetrable craniocerebral wounds in modern local wars should be carried out taking into account clinical and computed tomography data. The high proportion of comprehensive and one-time early primary surgical treatments (92.9%) performed on the first day after the injury testifies to the high efficiency of the system of providing specialized medical care during the local war.

Latest technologies of diagnostics and treatment of diseases of the musculoskeletal system

This lesson outlines the latest data on bone structure and physiology, as well as those related to the mechanisms of bone development and regeneration. The most common diseases of musculoskeletal system are caused by genetic and metabolic disorders, infectious agents, andmechanical stress, all of which are discussed. Innovative technologies for diagnosing osteoporosis (X-ray absorptiometry, quantitative computed tomography (QCT), ultrasonic bone densitometry, etc.) are shown. The joints diseases (arthropathies) followed by inflammation are highlighted. The basic principles of conservative and surgical treatment of arthrosis are explored. Different types of bone injuries caused by mechanical stress are thoroughly described as well as the latest technologies and equipment used in modern trauma centers. Basic orthopedic aids for disabled patients are listed. The main directions for improving the diagnosis and conservative treatment of diseases of the musculoskeletal system, as well as methods for prosthetics of large joints are described.

Урок врачебной антиэтики

Monitoring the posttraumatic chronic subdural hematoma is analyzed from the viewpoint of medical ethics. The meurosurgeons' actions were contrary to the justified modern principles of surgical treatment of encapsulated intrathecal hemorrhage, generally accepted ethical principles and caused harm to the patient.

Similarities and special features of modern approaches to surgical treatment of intra-articular fractures of tibial proximal and distal metaepiphyses

SummaryIntroduction. Analysis of special scientific literature concerning the modern principles of diagnostics, preop-erative planning and surgical treatment of intra- articular fractures of two localizations: proximal and distal me-taepiphyses of the tibia, was carried out. Aim of the review. To evaluate, through the analysis of specialized scientific publications, similarities and differences in classification approaches, diagnostic methods, princi-ples of planning and performing osteosynthesis in pa-tients with intra-articular fractures of the proximal and distal metaepiphyses of the tibia. It is noted that the modern classifications of both tibial plateau and pilon fractures are based on the column theory. A thorough analysis of computed tomography data is necessary to precisely determine the fracture pattern. On this ba-sis, osteosynthesis surgeries are planned as to provide fixation of all damaged columns. Authors discuss the combinations of surgical approaches necessary for this purpose. Variants of osteosynthesis are also considered, with special attention paid to fixation of the posterior aspects of the tibial plateau and pilon. The differences in approaches to surgical treatment of patients with frac-tures of the tibial plateau and pilon are primarily due to a significant difference in the overall size of the tibia in the area of the knee and ankle joints and, in particular, with a significantly smaller volume of soft tissues at the level of the distal metaepiphysis of the tibia. These dif-ferences in anatomy should be taken into account by surgeons when choosing surgical approaches for osteo-synthesis of the discussed fractures. Conclusion. Adher-ence to the classical principles of surgical treatment of intra-articular fractures with the use of modern surgical approaches and osteosynthesis techniques is a sure way to improve specialized trauma care for a complex category of patients with intra-articular fractures of the proximal and distal tibial metaepiphyses, which should help to reduce the incidence of postoperative complica-tions and improve treatment outcomes.

70 лет нейрохирургической клинике госпиталя им. Н.Н. Бурденко. Накопленный опыт лечения огнестрельных ранений центральной и периферической нервных систем

The article highlights the historical aspects of the origin of neurosurgery as a specialty within the walls of the Main Military Clinical Hospital named after Academician N.N. Burdenko. Based on the clinical experience of the neurosurgical center, the principles of diagnosis and surgical treatment of gunshot wounds of the central and peripheral nervous systems are described.

Military doctor V.V. Fialkovsky: life path and contribution to the development of military maxillofacial surgery and dentistry

On the page of memory among domestic dentists and maxillofacial surgeons, it is impossible not to recall a prominent figure in domestic maxillofacial surgery and military dentistry, Vladimir Vasilyevich Fialkovsky. The purpose of the study was to highlight the scientific, clinical, pedagogical, and social activities of a prominent maxillofacial surgeon, candidate of medical sciences, associate professor, and colonel of the medical service V.V. Fialkovsky, as well as his services to military medicine. Based on the analysis of Russian literature and the life, professional activity, scientific works of the candidate of medical sciences, associate professor, colonel of the medical service V.V. Fialkovsky, this paper presents his role in the formation and development of military dentistry, maxillofacial surgery, and military medicine in Russia. The paper also presents the life transformation of Vladimir Vasilyevich Fialkovsky as a military doctor, researcher, and teacher which began during the battle in Lake Khasan and Khalkhin-Gol River, SovietFinnish (Winter) War, and the Great Patriotic War. The main directions of his scientific activity touched upon the development and improvement of methods for the treatment of gunshot wounds and inflammatory diseases of the maxillofacial region and injuries and pathology of the masticatory apparatus in radiation sickness. V.V. Fialkovsky clarified the function of the maxillary sinuses and the physiological significance of its walls and described the age and functional restructuring of the bone tissue of the upper jaw under the maxillary sinuses and its significance for direct prosthetics. Vladimir Vasilyevich studied in detail the possibility of bone grafting of gunshot defects of the lower jaw in acute radiation sickness, plasticizing soft tissue defects by free skin and mucous membrane grafting, and flaps on the feeding leg. He also described the manifestations of chronic radiation sickness in the oral cavity, their treatment, and prevention and revised some erroneous attitudes in the principles of surgical treatment of wounds in those exposed to radiation. The study also described the personal qualities of V.V. Fialkovsky, attitude of the leader of the Kirov Military Medical Academy, and the staff of the Department of Maxillofacial Surgery and Dentistry to him. V.V. Fialkovsky was one of the pioneers of Russian military dentistry.

Large esophageal gastrointestinal stromal tumors resected thoracoscopically after oral imatinib therapy: a report of two cases

Esophageal gastrointestinal stromal tumors (GISTs) are very rare, accounting for 2–5% of all GISTs. As with other GISTs, the principle of surgical treatment is complete resection with negative margins. In addition to biological grades of GISTs itselves, local recurrence due to capsular damage is a known risk. We describe two cases of massive esophageal GISTs that were successfully resected thoracoscopically after 2 months administration of 400 mg imatinib, with some discussion of the literature. Case 1, the patient was a 51-years-old man. After treated with 400 mg of imatinib as preoperative chemotherapy for 2 months, we performed surgery that included right thoracoscopic subtotal esophagectomy, gastric tube reconstruction, and jejunostomy. The resection specimen and histopathology were esophageal GIST-LtMtAeG, 110 × 95 mm. The postoperative course was uneventful, and was discharged on postoperative day 14. The patient has been recurrence free for 11 months postoperatively. Case 2, the patient was a 70-years-old man. After treated with 400 mg of imatinib as preoperative chemotherapy for 2 months, we performed surgery that included right thoracoscopic subtotal esophagectomy, gastric tube reconstruction, and jejunostomy. The resection specimen and histopathology were esophageal GIST-LtAeG, 90 × 52 mm. The postoperative course was uneventful, and was discharged on postoperative day 14. The patient has been recurrence free for 9 months postoperatively.

Evolution of shoulder arthroplasty

In the more than century-long history of shoulder arthroplasty, scientists have gone from primitive ivory designs to high-tech implants made of rare metal alloys. Along the way, surgeons and inventors have faced challenges, made mistakes, and succeeded. This literature review reflects trends in the development of shoulder arthroplasty, evolutionary changes in endoprosthesis designs and principles of surgical treatment of shoulder pathology, from the late 19th century to the present. This paper details the stages of formation of the major modern philosophies of shoulder arthroplasty, such as those of Ch. Neer (anatomical prosthetics), P.M. Grammont (reversible prosthetics), and J. Zippel (surface prosthetics). In the 70s and 80s of the 20th century the components of shoulder prostheses as well as their fitting techniques continued to be improved from a biomechanical point of view. It was found that if the shoulder head and scapular component have different radii of curvature during arthroplasty, a shoulder-b lade mismatch is formed. A non-congruent joint (the radius of curvature of the head is smaller than the radius of curvature of the glenoid component) increases eccentric loads on the scapula joint implant, increases the risk of implant fracture, and reduces stability in the joint. However, such a joint allows reproduction of the natural gliding of the head. Restricting the required glide increases stress at the fixation site and can lead to loosening of the glenoid component. A number of studies have shown that a mismatch of more than 10 mm increases the risk of loosening and fractures of the scapular component, while a mismatch of 5-7 mm can be considered optimal, as it provides long-term survival of the glenoid component and the best reproduction of normal movements in the shoulder joint.

Дирофиляриоз: а если гельминта два?

In the report, dirofilariasis is considered on the example of clinical cases: the main patients' complaints, the clinical picture and principles of surgical treatment, subsequent histopathological examination to verify the diagnosis. Such patients are not rare, the clinical picture in the case of the helminth's death is very similar to an abscess of the eyelids or eyebrows. But there are also non-standard situations, as in our clinical case. The detected helminth was not the only one. After the detection of the first helminth, a pregnant patient was successfully operated on, the female dirofilaria was extracted. No specific treatment was prescribed given the patient's 27–28 weeks' gestation. After 3 weeks, the patient's complaints about movement under the skin of the eyelids, under the oral mucosa reappeared. But during this period between 32 and 33 weeks of gestation occurs antenatal fetal death. After discharge from the perinatal center, the patient returns to our clinic. During the operation, the second helminth is removed. The report presents the results of the study of the fetus and placenta. Is dirofilariasis harmless? Keywords: dirofilariasis, microfilariae, helminths, D. repens