Remote Postoperative Period Research Articles

Histological and immunohistochemical analysis of autografts and xenografts synergy in rectifying attached keratinized gingiva deficiency

Relevance. The complex, multi-stage surgical procedure aimed for replacing missing teeth often results in a deficiency of attached keratinized gingiva (AKG) in the intervened area. Despite numerous methods available for soft tissue volume and esthetics reconstruction, only a few demonstrate considerable long-term stability post-surgery. The quest to address this intricate issue has led to the combined utilization of autografts and xenografts Consequently, there is a need to evaluate the tissue structure obtained through this synergy via histological and immunohistochemical examination of the oral mucosa in the reconstructed region.Materials and methods. This study involved analyzing 87 biopsies of oral mucosa obtained from 57 patients aged 28 to 59 years who had undergone previous soft tissue volume and esthetics reconstruction in the AKG zone. Histological and immunohistochemical examinations were conducted on these biopsies, collected six weeks post soft tissue operation. A section of oral mucosa from the hard palate served as the reference sample.Results. The epithelial structure in the examined groups exhibited a well-defined basal layer with a continuous structure comprising two layers of cells without notable atypia, indicating a high cell proliferation capability. Immunohistochemical analysis targeting protein molecules revealed an absence of inflammation. The expression results of the Ki-67 antigen suggested the preservation of cell proliferation capacity and, consequently, the maintenance of tissue regenerative potential at a high level during the remote postoperative period, up to six weeks.Conclusion. This research showcases the efficacy of employing a combination of autografts and xenografts, a conclusion drawn from comprehensive histological and immunohistochemical analyses. Consequently, this approach presents a promising and innovative alternative to conventional methods for soft tissue volume and esthetics reconstruction.

THE RESULTS OF SEPTOPLASTY IN PATIENTS WITH VARIOUS FORMS OF DEVIATED OF THE NASAL SEPTUM USING THE TECHNIQUE OF EXTRACORPOREAL REMODELING AND REPLANTATION OF THE SEPTUM

Objective: To present the results of extracorporeal septoplasty in patients with various forms of deviated of the nasal septum, using the technique of replantation of the septum and to discuss the advantages and limitations. Materials and methods: The work is based on clinical observations of 164 patients with curvature of the nasal septum from 2018 to 2023. All patients underwent a standard otorhinolaryngological examination, spiral computed tomography CT of the nose and paranasal sinuses in coronary and axial projections. Endoscopic examination of the nasal cavity carried out by an endoscope of the Karl Storz company. Nasal breathing is objectively evaluated with the help of the "PC 300 nose manometer" by ATMOS, which allows to register the pressure in one half of the nose while the patient breathes through the other. A modified "extracorporeal" septoplasty is used, which consists in the complete isolation and temporary removal of the deformed quadrilateral cartilage, followed by its correction and reimplantation. The operation was performed under general anesthesia with performed oral intubation. Results: No complications were observed during the operation, the patients were satisfied with the aesthetic and functional results of septoplasty. Complications were noted in the remote postoperative period. long-term swelling of the mucous membrane of the nose (partially obstructed nasal breathing), which was stopped by taking antihistamines, in 5 patients. In all clinical observations, stable support of the cartilaginous part of the nasal septum and the absence of its secondary deviation were obtained, which also directly affects the harmonic aesthetic results of the shape of the external nose and free nasal breathing. The indicators of the rhinomanometer showed a significant improvement in nasal breathing and are approaching the values accepted as the norm. Conclusions: Extracorporeal septoplasty in patients with various forms of curvature of the nasal septum is an effective surgical technique that gives optimal functional results.

Volar Locking Plating of Extra-articular Distal Radius Fracture: A Retrospective Clinical Study Comparing Locking Screws versus Smooth Locking Pegs.

Background Open reduction and internal fixation of distal radius fractures is one of the most common procedures performed in wrist surgery. The use of volar locking plate has gained increasing interest in the past decade. Epiphyseal fixation can be done either with locking screws or smooth locking pegs, with no evidence supporting the use of one rather than the other. Purpose The aim of this study is to compare the stability of distal radius fixation by volar locking plate using locking screws or smooth locking pegs. Methods Adult patients with A2-A3 AO fractures treated with a volar plate with locking screws only or smooth locking pegs only were retrospectively included. Radiographic assessment was performed to evaluate extra-articular parameters in the intraoperative postreduction and fixation period and after bony healing. Forty-seven distal radius fractures were included. Results Twenty-four fractures had fixation with locking screws and 23 had fixation with smooth locking pegs. For both groups, all radiographic parameters measured showed a statistically significant difference between the intraoperative postreduction and fixation period and the remote postoperative period after union of the fracture ( p < 0.05) attesting a slight loss of reduction. Nevertheless, there were no significant differences between the groups in radiographic extra-articular parameters. Conclusion This clinical study shows that there is no difference in stability fixation between locking screws or smooth locking pegs in A2-A3 distal radius fractures. Clinical Relevance The use of smooth locking pegs only for epiphyseal fixation appears to be safe in volar plating of A2-A3 distal radius fractures in adult patients and could be an alternative to locking screws. More clinical data are needed to confirm these results. Level of Evidence Level III; retrospective comparative study.

Early and long-term results of endovascular treatment of cerebral aneurysms

Introduction. Postoperative angiographic examinations after endovascular treatment of cerebral aneurysms may demonstrate unstable results, both in the form of recurrence formation, and in the form of increased degree of occlusion with initially incomplete occlusion of the aneurysm sac. Cerebral aneurysm recurrences represent an important medical and social problem comparable in terms of hemorrhage risks with nonoperated aneurysms.Aim. To estimate the early and long‑term results of endovascular treatment of patients with cerebral aneurysms ope rated on using different endovascular techniques. Materials and methods. The present study included 167 patients (48 men and 119 women) with 195 cerebral aneurysms aged from 18 to 75 years who were operated on using endovascular techniques at the neurosurgical department No. 3 of the Russian Research Neurosurgical Institute named after Prof. A. L. Polenov from 2013 to 2016. The average age of the patients was 52 ± 12 years, the minimum age was 18 years, and the maximum age was 75 years. The choice of endovascular treatment method in the patients included in the study was based on anatomico‑topographic and morphometric features of aneurysm, as well as taking into account the period of aneurysmal disease course.Results. The study of data of control angiographic examinations after endovascular treatment of patients with cerebral aneurysms showed that in the remote postoperative period the degree of aneurysm occlusion may differ from that initially achieved. The probability of aneurysm recurrence after its isolated occlusion with coils may reach 13.1 % already in 6 months after surgical treatment, 31.7 % after 12 months and 22.3 % after 36 months, averaging 22.5 % (p &lt; 0.05).Conclusion. The personalized approach in choosing optimal surgical tactics for the treatment of patients with cerebral aneurysms allows to achieve stable radical aneurysm occlusion, to decrease the incidence of postoperative complications and aneurysm recurrences in the long‑term postoperative period.

Delayed fatal intracranial hemorrhage in a pediatric patient following resection and adjuvant cranial radiotherapy for ependymoma: illustrative case.

Cranial radiotherapy (CRT) is an important treatment modality for malignancies of the central nervous system. CRT has deleterious effects that are commonly classified into acute, early delayed, and late delayed. Late-delayed effects include weakening of the cerebral vasculature and the development of structurally abnormal vasculature, potentially leading to ischemic or hemorrhagic events within the brain parenchyma. Such events are not well reported in the pediatric population. The authors present the case of a 14-year-old patient 8.2 years after CRT who experienced intracerebral hemorrhage. Autopsy demonstrated minimal pathological change without evidence of vascular malformation or aneurysm. These findings were unexpected given the degree of hemorrhage in this case. However, in the absence of other etiologies, it was believed that late-delayed radiation effect was the cause of this patient's fatal hemorrhage. Although not all cases of pediatric spontaneous intracerebral hemorrhage will have a determined etiology, the authors' patient's previous CRT may represent a poorly defined risk for late-delayed hemorrhage. This correlation has not been previously reported and should be considered in pediatric patients presenting with spontaneous hemorrhage in a delayed fashion after CRT. Neurosurgeons must not be dismissive of unexpected events in the remote postoperative period.

ЭФФЕКТИВНОСТЬ ОТКРЫТЫХ ХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВ ПРИ ПАХОВЫХ ГРЫЖАХ У ПАЦИЕНТОВ ПОЖИЛОГО ВОЗРАСТА

Purpose. To evaluate the effectiveness of open methods of surgical treatment of inguinal hernia in elderly patients. Material and methods. The study includes 336 elderly patients with inguinal hernias. The Bassini hernioplasty was performed on 106 patients, the Liechtenstein technique was applied to 110 patients and the new tension-free method – to 120 patients. The effectiveness of hernioplasty was evaluated according to the results of the examination of patients in the early and remote postoperative periods, as well as the methodology for calculating the effectiveness of medical technologies in healthcare. Results. With open surgical interventions in patients with inguinal hernias in the early postoperative period there is an increase in the volume of the testicle on the side of surgery. In the remote period only after the Lichtenstein hernioplasty there was a decrease in the volume of the testicle (p&lt;0.05). The relapse of the hernia (1-3 years later) after the Bassini hernioplasty took place in 9.4% cases, after the Liechtenstein hernioplasty - in 3.6% patients, and after applying the new method of hernioplasty there was no relapse of hernia. The new technique of tension-free hernioplastics was characterized by the highest level of medical (Km=1.00) and social efficiency (Ks=0.86). Conclusion. The new technique of open tension-free inguinal hernioplasty is characterized by the highest level of medical and social efficiency.

The new prospects for the development of children cardiologic rehabilitation at sanatoriums of Yevpatoria health resort

The article discusses the prospects of rehabilitation of children with congenital cardiovascular anomaly, including those after surgery. The author provides evidence that it is essential to create a system of physical, psychological, and social rehabilitation for this category of patients at all stages of medical care: in hospital, at the sanatorium, and during the follow-up, taking into account the basic principles of rehabilitation (an early start, a stage-by-stage approach, coherence, continuity, consistency, individualization of the rehabilitation plan, etc.). The sanatorium treatment at the famous climatic and balneological children’s health resorts of the Black Sea coast appears to be the most physiologically relevant stage contributing to the improvement of the regulatory processes of cardiac activity and providing optimal results of restorative treatment and rehabilitation for the young patients with congenital heart defects in the remote postoperative period. The creation of the All-Russian Rehabilitation Center for children with cardiovascular pathology, including children after heart surgery, in the Republic of the Crimea should be considered in the context of the further development and implementation of measures in accordance with the List of Instructions of the President of the Russian Federation following the meeting of the Coordinating Council under the President of the Russian Federation on the implementation of the National Strategy of Action in the Interests of Children for 2012–2017 of March 31, 2017.

Sexual Dysfunction in Women Suffering from Gynecological Diseases

The analysis of long-term efficiency of operative treatment of pelvic prolapse for 213 women in periods ranging from 12 through questionnaire PISQ-12 (Pelvic Organ Prolapse and Incontinence Sexual Function Questionnaire), recommended for use in clinical practice of the international urogynaecologic Association and adapted by the authors for work . Method of evaluating the effectiveness of surgical treatment of pelvic and prostate has been streamlined through the introduction of a system of qualitative analysis of the results of the study of sexual function. Found that operational treatments pelvic prolapse have a positive effect on sexual function of women. Significant differences of sexual function in remote postoperative period depending on the type of operational benefits.The best effect with regard to the favourable dynamics of sexual function is achieved after laparoscopic operative treatment of pelvic prolapse compared with vaginal hysterectomy

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

The use of total arterial myocardial revascularization in patients with multivessel lesions of the coronary arteries has a number of advantages, namely the duration of functioning or patency of the grafts. The level of total arterial myocardial revascularization implementation in developed and developing countries remains quite low.&#x0D; The aim. Based on the analysis of our own experience, to determine the influence of the technique of total arterial revascularization on the frequency of complications in the early postoperative period.&#x0D; Materials and methods. From February 22, 2016 to December 24, 2020, 390 consecutive patients were operated at the Ukrainian Children’s Cardiac Center. The patients were divided into two groups: participants of the group I underwent total arterial myocardial revascularization, and those includedin the group II underwent conventional coronary artery bypass grafting (CABG). The inclusion criteria were: ischemic heart disease, stable angina or exertional angina, multivascular coronary artery disease, absence of valvular pathology.&#x0D; Results. There was zero 30-day mortality in both groups. The frequency of postoperative bleeding was higher in group II and amounted to 1.6%. Surgical wound complications (infection) were also more common in the group II: 1.2% versus 0.69% (p=0.906) in the group I. Similarly, laboratory parameters such as the level of creatine kinase-MB were almost identical.&#x0D; Conclusions. Total arterial myocardial revascularization is a safe method with good immediate results. The frequency of complications in total arterial myocardial revascularizationdoes not differ from that in conventional CABG. For a wider application of the total arterial myocardial revascularization,it is necessary to continue toconduct studies of the remote postoperative period.

Densitometric substantiation of the application regimes in a low-temperature electric welding of soft living tissues in phthisiosurgery

Objective. To determine the optimal regimes of application of a low-temperature electric welding of soft living tissues in formation of suture in pulmonary parenchyma, the pulmonary hilum preparation, and its lymph nodes ablation, basing on microbiological estimation of action of various regimes on the tuberculosis mycobacteria and densitometric indices of pulmonary parenchyma and to estimate its efficacy in far remote postoperative period.&#x0D; Materials and methods. The work is based on the results of postoperative investigations in 275 patients with the aim to determine the impact of a low-temperature electric welding of soft living tissues on pulmonary parenchyma and mediastinal lymph nodes.&#x0D; Results. There was established, that application of minimal automatic regime of a low-temperature electric welding of soft living tissues in phthisiosurgery guarantees effective elimination of microflora in 98.3% of patients. The revealed emphysematous processes and fibrous changes are occurring in parallel and essentially impacts the development of pulmonary-pleural complications. Conventional density of pulmonary parenchyma was noted in 57.5% of patients in the investigation group and in 49.7% patients of the control group. In both groups, the enhanced superdensity of pulmonary parenchyma in far remote postoperative period was not observed. Density of mediastinal lymph nodes was compared, and statistically significant difference between densitometric indices of mediastinal lymph nodes was absent. While application of a low-temperature electric welding of soft living tissues in minimal power regime of the complex there was noted essential characteristic as well: lesser rate of fibrous transformation of pulmonary parenchyma, than in the control group – in 13.3 and 15.5%, accordingly.&#x0D; Conclusion. Application of a low-temperature electric welding of soft living tissues in phthisiosurgical interventions for the lymph nodes ablation have shown the presence of effective bactericidal regimes with preservation of lymphatic circulation, and low rigidity of pulmonary parenchyma in postoperative period. While a low-temperature electric welding of soft living tissues applied, the signs of lymphostasis, the lymphatic outflow disorders and pulmonary-pleural complications in postoperative period after phthisiosurgical interventions with the lymph node ablation procedure do not occur, as well as the risk of iatrogenic damages while performing dissection and excision of mediastinal lymph nodes.

Choosing the tactics of surgical treatment of vascular leukomas based on impression cytology

Purpose: to provide clinical and morphological evaluation of the corneal epithelium phenotype in total vascular leukomas of varied etiologies and determine the optimal surgical treatment using impression cytology (IC).Materials and methods. 44 patients (44 eyes) with corneal vascular leukomas of various etiologies underwent optic keratoplasty preceded by IС. The patients were divided into 2 groups according to IC findings. Group 1 included 30 patients who were shown by IC to have corneal epithelium. These patients received penetrating keratoplasty (PK). Group 2 consisted of 14 patients whose epithelium was determined to be of conjunctival phenotype. Eight of group 2 patients had their corneal epithelium phenotype restored by limbal transplantation followed by PK. The remaining patients of group 2 were not operated for various reasons.Results. In the remote postoperative period (9–12 months after the operation) corrected visual acuity of group 1 patients ranged from 0.3 to 0.6 (ave. 0.450 ± 0.073). A relapse of corneal leukoma was observed in three patients of group 1 (10%). In group 2, a transparent vascular-free engraftment of keratotransplants was observed in 5 patients after limbal transplantation (the first stage of surgical treatment) and PK, their corrected visual acuity ranged from 0.1 to 0.5 (ave 0.37 ± 0.12), 1 (20%) patient had a relapse of the leukoma. Conclusions. Impression cytology is an acceptable and low invasive diagnostic technique that allows clinical and morphological evaluation of the epithelium phenotype that covers the vascular leukoma and helps determine validated indications for the choice of a surgical treatment technique for such patients.

Influence of different prevention options on cognitive dysfunction in the early and remote postoperative period in otolaryngological interventions with controlled hypotension

Annotation. Cognitive dysfunction complicates the course of the early postoperative period, and in the longer term worsens the quality of life of patients due to their professional, social and domestic maladaptation, so the prevention of cognitive disorders is an urgent problem of modern medicine. The aim of the study was to investigate the effect of drugs with antioxidant properties and effects on choline metabolism on the state of cognitive function of patients after otolaryngological surgery with controlled hypotension. The data of neurocognitive testing of 127 patients were analyzed, including: patients of group 1 (control, n=33) did not receive prevention of cognitive dysfunction, patients of group 2 (n=32) were prescribed ethylmethylhydroxypyridine succinate, patients of group 3 (n=30) – choline alfoscerate, patients of group 4 (n=32) – choline alfoscerate and ethylmethylhydroxypyridine succinate. The assessment of cognitive function of all patients was conducted before surgery, 7 days and 3 months after surgery using the Lurie test, the Toulouse-Pieron test, the Trial Making Test and the Stroop test. Statistical processing of the obtained data was performed in the statistical package “SPSS 20” (SPSS Inc.) using parametric and non-parametric methods of evaluation of the obtained results. The results of neurocognitive testing of otolaryngological patients who underwent surgery under general anesthesia using controlled arterial hypotension, showed that cognitive impairment, registered in the early postoperative period in 24.4% of patients, significantly decreased within 3 months after surgery and reached 11%. Perioperative use of choline alfoscerate reduces the incidence of postoperative cognitive dysfunction in the early postoperative period from 39.4% to 16.7%, while the combination of choline alfoscerate with ethylmethylhydroxypyridine succinate reduces the incidence to 12.5%. No significant effect of perioperative prophylactic medication on the frequency of cognitive dysfunction was found in the long postoperative period of otolaryngological interventions with controlled hypotension. The obtained results can serve as a justification for the subsequent purposeful determination of clinical predictors of postoperative cognitive impairment.

Prognostic value of matrix metalloproteinases and transforming growth factor – β in kidney cancer

Purpose of the study. The study's objective is to investigate the expression level of tissue and serum markers of oncogenesis and nephrofibrosis transforming growth factor beta (TGF‑β) and matrix metalloproteinase‑9 (MMP‑9) in patients operated for various stages of renal cell carcinoma.Materials and methods. The study prospectively included medical data of 60 patients with kidney cancer with T1–3N0M0 who received surgical treatment in the Clinic of Urologynamed after S. R. Mirotvortsev of the State Medical University from 2016 to 2019. The patients were divided into 3 groups: Group 1 included 20 patients who underwent laparoscopic kidney resection; Group 2–20 patients who underwent laparoscopic nephrectomy; Group 3–20 patients who underwent open nephrectomy. The control group consisted of 15 healthy volunteers without chronic kidney diseases. All patients signed an informed consent to participate in the study. All patients at the preoperative stage, in the early (7–10 days) and remote postoperative periods (after 1 and 2 years) were tested by solid‑phase ELISA on a StatFax 4200 analyzer using eBiosence and Cloud‑Clone Corp reagent kits for the serum concentration of oncogenesis markers MMP‑9 and TGF‑β1.Results. Initial increase of MMP‑9 concentration was detected in all groups of PCC patients compared to the control group (p ≤ 0.05). According to the results of ROC analysis, this indicator has high specificity and sensitivity for prognosis of preoperative stage of renal cell carcinoma. The sensitivity and specificity of MMP‑9 were 87.5 % and 62 %, respectively, and the diagnostically significant level of MMP‑9 was 958 ng/ml. A comprehensive analysis of the content of MMP‑9 and TGF‑β1 oncogenesis markers in serum and tumor cells revealed the correlation of these indicators in various biological objects.Conclusion. Markers of oncogenesis and nephrofibrosis TGF‑β1 and MMP‑9 provide an opportunity for non‑invasive monitoring of tumor progression and probability of metastasis in the clinical setting. Serum MMP‑9 are a reliable predictor of tumor growth. Serum TGF‑β1 concentration isn't a sufficiently reliable marker of tumor progression.

EFFECT OF HYSTERECTOMY WITH OPPORTUNISTIC SALPINGECTOMY FOR UTERINE FIBROIDS ON THE DEVELOPMENT OF METABOLIC SYNDROME AND WAYS OF ITS REDUCTION

The aim of the study – to determine the effect of hysterectomy with opportunistic salpingectomy for uterine fibroids on the manifestation and progression of metabolic syndrome and to develop ways of reducing the identified changes. Materials and Methods. A comprehensive clinical and laboratory evaluation of the influence of hysterectomy with opportunistic salpingectomy for uterine fibroids on the development of metabolic syndrome was performed in the Gynecological Department of Municipal Non-Profit Enterprise “Kyiv Perinatal Center”. 160 women were included in the study: 90 patients underwent vaginal hysterectomy including fallopian tubes (both classical and associated with laparoscopy), and 70 women underwent abdominal hysterectomy including fallopian tubes. Results and Discussion. The development and progression of hypoestrogenemia after hysterectomy with opportunistic salpingectomy contributes to the loss of cardioprotective effects of estrogen, accompanied by psychoemotional and vegetative-vascular dystonia in the early postoperative period of mild and moderate degree, mostly in women under 45 years (30.63 % and 71.86 %, respectively), while metabolic and endocrine abnormalities are practically absent. At the same time, 12 months after surgery, 56.9 % of patients undergo gradual formation of the main components of the metabolic syndrome – hyperglycemia, insulin resistance, dyslipidemia, increasing parameters of atherogenic lipid fractions, increased BMI and vegetative dystonia of the hypertensive type. Conclusions. The use of metabolic therapy in the remote postoperative period allowed to control blood pressure and improve the clinical and laboratory parameters, namely reducing the level of atherogenicity index by 1.3 times (p&lt;0.05), glycated hemoglobin, OGTT, HOMA index – by 0.8 times against baseline before treatment, which was accompanied by improvement of psycho-emotional and vegetative-vascular manifestations.

Effect of hysterectomy with opportunistic salpingectomy for uterine fibroids on the development of genitourinary syndrome and ways of its reduction

The article presents the assessment and analysis of the most important predictors and manifestations of genitourinary disorders in women of reproductive age after radical surgical treatment for uterine fibroids in the remote postoperative period. Ways of reducing the severity of symptoms are offered.&#x0D; The aim of the study – to establish the influence of hysterectomy with opportunistic salpingectomy for uterine fibroids on manifestation and progression of genitourinary syndrome and ways of the reduction in its severity.&#x0D; Materials and methods. Comprehensive clinical and laboratory assessment of the impact of hysterectomy with opportunistic salpingectomy for uterine fibroids on the development of metabolic syndrome was conducted at the gynecological department of the “Kyiv Perinatal Center”. The study included 160 women: 90 patients underwent vaginal classical and laporoscopic hysterectomy including fallopian tubes removal; and 70 patients underwent abdominal hysterectomy including fallopian tubes removal. Data on the assessment of pelvic floor condition and urogenital dysfunction were provided using a standardized POP-Q system, both at the stage of preoperative observation and for 1, 3 and 5 years after the surgery.&#x0D; Research results and their discussion. The most important risk factors that allow forming groups of patients requiring individualized approach in the choice of surgical techniques and rehabilitation program were pointed out. The obtained results allowed to isolate UCDT markers in fractions above 20%. 19 women (11.86%) underwent ovarian surgeries and used gonadotropin-releasing hormone agonists. Genitourinary and sexual disorders were diagnosed in 27 cases (19.3%) 12 months after surgery. Vaginoscopy, performed 12 months after surgery, revealed atrophic vaginitis in 58 cases (36.25%) without significant difference in groups. Microscopy of urogenital smears was in norm only in 51 patients (31.86%). Complaints of dysuria were most common among patients (59 – 36.85%). The combination of sexual disorders and other manifestations (flatulence and intestinal discomfort, stool problems, vaginal microbiota disorders, pelvic floor descent, etc.) was revealed in a quarter of women (28 – 17.50%), and more often – after vaginal hysterectomy (17 – 18.89%). Clinical symptoms of urinary incontinence were observed against the background of a negative cough test in almost a third of patients (49 – 30.63%). They were combined with pollakiuria, nocturia, and imperative urgency, exacerbated by alcohol and accompanied by cystalgia and genital prolapse. The use of low doses of estradiol in the rehabilitation program improved the clinical and laboratory parameters of the urogenital tract, reducing the incidence of vulvovaginal atrophy by 13%, normalizing the biocenosis and vaginal pH, reducing clinical manifestations of urinary incontinence (pollakiuria and nocturnal pollakiuria) by 14%, feeling of incomplete bladder emptying – by 15%, stress urinary incontinence – by 16%, vaginal prolapse – by 11%, compared to the group with standard postoperative management, as well as reducing the severity of psycho-emotional and vegetative-vascular manifestations.&#x0D; Conclusion. The expected effect of surgical recovery may be insufficient, and clinical symptoms of genitourinary syndrome may manifest in the postoperative period, which requires the development of clear algorithms for diagnosing urinary incontinence and pelvic floor failure in the preoperative stage and application of long-term preventive measures after hysterectomy in the remote postoperative period. There is no statistically significant difference in the development of genitourinary syndrome with different surgical approaches.

Пролонгована паравертебральна аналгезія для знеболювання у хворих після торакотомії

Актуальність. Торакотомія відноситься до одного з найбільш травматичних втручань в хірургії, що супроводжується вираженим гострим болем після операції та розвитком хронічного больового синдрому у віддаленому післяопераційному періоді. Мета дослідження. Порівняти ефективність та безпечність різних методів знеболювання хворих після торакотомії. Матеріали та методи. Після торакотомії 85 хворих було розподілено на три дослідні групи. Знеболювання проводили за допомогою пролонгованої паравертебральної аналгезії (ПВА) (19 хворих) і пролонгованої епідуральної аналгезії (ЕДА) (36 хворих) 0,2% розчином ропівакаїну зі швидкістю 6 мл/год (у паравертебральний або епідуральний простір). У контрольній групі (30 хворих) знеболювання проводилось внутрішньовенною, контрольованою пацієнтом аналгезією розчином морфіну. Як ад’ювантний анальгетик у всіх трьох дослідних групах використовували нестероїдний протизапальний препарат кеторолаку трометамін внутрішньом’язово. У ранньому післяопераційному періоді оцінювали рівень болю в стані спокою та під час фізичного навантаження дихальної мускулатури (виконання спірометрії), показники функції зовнішнього дихання (ФЗД), а також частоту та тип ускладнень застосованих методів знеболювання. У віддаленому післяопераційному періоді оцінювали частоту виникнення хронічного болю. Результати. У групах з пролонгованою ПВА і ЕДА інтенсивність больового синдрому протягом трьох діб післяопераційного періоду за візуальною аналоговою шкалою (ВАШ) у стані спокою була меншою порівняно з контрольною групою. У групі ПВА рівень болю був від 29,1 бала через чотири години після операції до 18,7 бала в кінці третьої доби; у групі ЕДА — від 24,2 до 20,3 бала відповідно; у контрольній групі — від 48,8 до 38,0 бала відповідно. Під час дослідження ФЗД інтенсивність болю в групах ПВА і ЕДА також була нижчою порівняно з контрольною групою і становила 33,8 бала в групі ПВА, 38,7 бала — в групі ЕДА, 61,2 — у контрольній групі. Частоту виникнення хронічного больового синдрому оцінювали через 6 місяців після операції. Було відібрано по 15 хворих із кожної групи. У контрольній групі хронічний больовий синдром розвинувся у 8 хворих (53 %), у групі ЕДА — у 5 хворих (33,3 %), у групі ПВА — у 3 хворих (20 %). Найменша кількість ускладнень і технічних невдач спостерігалась у групі ПВА. Висновки. У групі з пролонгованою ПВА порівняно з пролонгованою ЕДА рівень болю за ВАШ був нижчим, частота випадків хронічного болю меншою, а кількість побічних ефектів мінімальною. Пролонгована паравертебральна блокада у хворих після торакотомії дає змогу ефективно контролювати гострий післяопераційний біль та зменшує розвиток хронічного больового синдрому.

Assessing efficacy of endoscopic ventriculocisternostomy using a semi-rigid needle endoscope in сhildren with hydrocephalus and concomitant drug-resistant epilepsy: results of CT brain perfusion and time-frequency EEG analysis

Background. The probability of seizures after endoscopic surgical treatment of hydrocephalus may comprise up to 9.5%, therefore accounting for a need to find solutions for alleviating the surgical trauma to the brain. One option to this problem might be based on using “seamless” neurosurgery, particularly endoscopes with a minimal outer sheath diameter (needle endoscopes, shunt endoscopes).Objective: to evaluate major outcomes of surgically treated epilepsy, cerebral haemodynamics and electroencephalogram (EEG) in children with hydrocephalus and concomitant drug-resistant epilepsy before and after endoscopic ventriculocysternostomy of the third ventricular floor by using a semi-rigid needle endoscope.Material and methods. In the early and remote postoperative periods, no epileptic seizures were observed in 57.1% of subjects (Engel Class I). Mean seizure frequency decreased from 12.9±6.1 to 0.82±0.31 per month (p&lt;0.01). A significant decline in slow-wave amplitude and the paroxysmal index from 19.1±2.5% to 6.9±1.7% (p&lt;0.01) were observed, as well as improvement of cerebral hemodynamics in the form of increased mean cerebral blood flow by 29.1±4.3% (p&lt;0.01), mean circulating blood volume by 22.4±5.27% (p&lt;0.05) and decreased mean transit time by 12.8±2.5% (p&lt;0.05).Results. In the early and remote postoperative periods, no epileptic seizures were observed in 57.1% of subjects (Engel Class I). Mean seizure frequency decreased from 12.9±6.1 to 0.82±0.31 per month (p&lt;0.01). A significant decline in slow-wave amplitude and the paroxysmal index from 19.1±2.5% to 6.9±1.7% (p&gt;&lt;0.01) were observed, as well as improvement of cerebral hemodynamics in the form of increased mean cerebral blood flow by 29.1±4.3% (p&gt;&lt;0.01), mean circulating blood volume by &gt;&lt;0.01). A significant decline in slow-wave amplitude and the paroxysmal index from 19.1±2.5% to 6.9±1.7% (p&lt;0.01), mean circulating blood volume by 22.4±5.27% (p&lt;0.05) and decreased mean transit time by 12.8±2.5% (p&gt;&lt;0.05).

Complications of Surgical Treatment of Aortic Arch Hypoplasia in Infants

Aortic arch surgery in neonatal patients remains problematic despite the constant evolution and improvement of treatment methods. Even after successful correction, complications associated with aortic arch reconstruction are more common in young children. This is especially true for newborns and infants with concomitant complex congenital intracardiac abnormalities. Despite the risk of postoperative complications, the risk of surgical treatment of aortic arch hypoplasia is lower than the cumulative hazards associated with the natural course of this defect. That is why pediatric cardiologists are obliged to constantly monitor the operated patients in order to timely identify and treat complications.&#x0D; The aim. To analyze the complications in the early and remote postoperative periods after the reconstruction of the aortic arch in the neonatal period.&#x0D; Materials and methods. The work is based on a study of 445 patients under 1 year of age, who underwent surgical treatment of aortic arch hypoplasia from 2010 to 2019. The criterion for inclusion in the study group was the presence of isolated hypoplasia of the aortic arch and combination with other defects, which were corrected by two-ventricular repair. The majority of the treated patients were male (284 [63.8% of the total number of patients]). The median age of the patients was 0.7 months (0.3; 2.7). The median body weight of the patients was 3.7 kg (3.25; 4.59).&#x0D; Results. At the hospital stage, 12 patients died, which accounted for 3.1% of the entire cohort of operated patients. Complications occurring at the hospital stage were recorded in 75 (16.8%) patients. In the long term, a complicated course was observed in 72 (16.6%) children. Among them, the most frequent complications were: respiratory failure requiring prolonged mechanical ventilation (36.9%), dilated sternum due to severe heart failure (17.4%), diaphragmatic paresis (8.7%), chylothorax (5.4%). In the long term, 47 (10.5%) patients developed aortic arch restenosis, which required reinterventions. The proportion of patients without reoperations in the follow-up period according to the KaplanMeier analysis was 93.4% after 1 year, 91.2% after 4 years, and 76.5% after 9 years. Residual hypertension requiring medical treatment was reported in 59 (13.2%) patients.&#x0D; Conclusions. Aortic arch hypoplasia is a complex congenital heart disease; its surgical treatment is accompanied by the development of complications both in the early and in the long-term period. The main complications at the hospital stage were respiratory and heart failures which were associated with the presence and correction of concomitant congenital heart defects. The main complication of the follow-up period was reobstruction at the level of the aortic arch. Anatomical correction of reobstruction is safe with both endovascular and surgical treatments.

TREATMENT OF AORTA MESENTERIC COMPRESSION: CURRENT PROBLEMS AND PROSPECTS

Left renal vein compression between the aorta and the superior mesenteric artery at an acute angle of the origin of the latter (“the nutcracker syndrome”) often leads to phlebohypertension in the left renal vein causing a combination of structural and functional changes in the kidneys and pelvic organs, different clinical manifestations such as left-sided varicocele, hematuria, pelvic venous congestion syndrome, the development of renal failure.&#x0D; The objective of the research: to determine indications for surgical and conservative treatment of aorta mesenteric compression.&#x0D; Materials and methods. The study included 210 patients (142 men and 68 women) with suspected “nutcracker syndrome” who were referred to vascular surgeons for a consultation by urologists and gynecologists during the period from 1999 to 2020, mainly from the western regions of Ukraine (about 11 million population). The age of the patients ranged from 12 to 52. All patients were interviewed for specific complaints: pain in the left lumbar region and left half of abdomen, inability to eat large amounts of food, hematuria, proteinuria, hemospermia, erectile dysfunction, left sided varicocele in men, and left sided pudendal varicosity and dysmenorrhea in women. All referred patients with suspected “nutcracker syndrome” underwent color Doppler ultrasound to determine the presence of pathological reflux in the left renal and gonadal veins by measuring peak systolic velocities in order to confirm or exclude that pathology. The patients with confirmed left renal vein stenosis underwent CT angiography.&#x0D; Results. According to color Doppler ultrasound, different degree of aorta mesenteric compression was confirmed in 138 (65.7%) patients (83 men and 55 women), critical left renal vein stenosis was observed in 35 of them. Two patients were diagnosed with the retroaortic left renal vein (“posterior nutcracker”).&#x0D; According to observations, clinical manifestations of AMC syndrome severe forms occurred in case of an increase in the diameter of the distal part of the LRV compared to its proximal segment by 3-6 times as well as in case of an increase in peak systolic velocity in the stenosed proximal segment by 6-14 times (by 8.7 times on average) compared to the left renal vein distal segment.&#x0D; Conclusions. Color Doppler ultrasound with determination of peak systolic velocities and diameters of the left renal and gonadal veins, pathological reflux in them must be the obligatory diagnostic stage in the patients with suspected AMC. The choice of treatment approach should be made taking into account clinical and laboratory indices, as well as the assessment of AMC severity according to instrumental data (ultrasound, CT angiography, MRA, etc.). The severity of pathomorphological changes in the pelvic organs and their consequences proves the need to eliminate phlebohypertension in the left renal and gonadal veins. LRV transposition proves its effectiveness in the remote postoperative period.

Reproductive aspects of long-term consequences of ovarian apoplexy

The objective: to determine the long-term consequences of surgical treatment of ovarian apoplexy, taking into account the risk factors of this urgent pathology. Materials and methods. The study included 112 women (main group, n=112), who underwent surgery for ovarian apoplexy, and 40 patients in the control group (n=40), who had no history of this pathology. All patients underwent a comprehensive examination using clinical, instrumental and laboratory research methods. The groups were homogeneous in age (mean age was 23,6±4,2) and statistically comparable. Results. Based on the analysis of clinical and anamnestic data of patients who underwent surgical treatment of ovarian apoplexy, we identified the main risk factors for this pathology: chronic diseases of the urinary, respiratory and digestive systems, genital infantilism, ovarian retention cysts, chronic salpingo-oophoritis, menstrual disorders by type of hyperpolymenorrhea and/or algodysmenorrhea, family thrombophilic history, bleeding of various localizations in the anamnesis, artificial abortions, weight loss, smoking. Our proposed comprehensive two-stage rehabilitation system included treatment and prevention measures from the acute period of ovarian apoplexy to the time of reproductive function. The first stage of the treatment complex (early postoperative period) helped to eliminate the effects of ovarian injury, pain relief and hypercoagulable changes in the blood coagulation system, improving the quality of life during inpatient treatment. The second stage (2 months after surgery) provided the restoration of ovarian function and balance of the hemostasis system, thus preparing a woman’s reproductive system for future pregnancy and childbirth. In the remote postoperative period, the complex stage of rehabilitation in 23 treated patients resulted in the birth of healthy children and the absence of obstetric complications in 22 of them. Conclusion. Identification and structuring of risk factors for ovarian apoplexy is an important step for comprehensive treatment and prevention of recurrence of this disease. Eliminating or reducing the impact of these factors will help restore the reproductive system and improve quality of life. A comprehensive assessment of the state of the whole organism in the remote postoperative period indicates the need for rehabilitation measures aimed at increasing the natural resistance of the macroorganism and the effective restoration of reproductive function.