Results Of Operative Treatment Research Articles

Latissimus dorsi flap (LD-flap) or endoprosthesis for breast reconstruction? Which is optimal for immediate reconstruction after a nipple-sparing mastectomy in breast cancer patients?

The article analyzes two methods of breast reconstruction: breast reconstruction with an implant or an LD‑flap after a subcutaneous nipple‑sparing mastectomy in the case of complex treatment of stage I — III breast cancer. In many works, the advantages and disadvantages of different types of reconstruction are indicated and contradictions can often be found, although most prefer reconstruction with implants.
 Objective — to compare the results of immediate breast reconstruction using an implant or an ­LD‑flap after a subcutaneous nipple‑sparing mastectomy in patients with I — III stages of breast cancer.
 Materials and methods. We conducted a comparative study of the results of immediate reconstruction of the mammary gland after a subcutaneous nipple‑sparing mastectomy using the method of putting a silicone implant (endoprosthesis) or the method of LD‑flap reconstruction. Randomization was not carried out. The results of operative interventions were retrospectively and parallelly compared in two groups: reconstruction of the mammary gland with an implant (1) or LD flap (2). In both groups of 30 patients, all patients were diagnosed with stage I — III breast cancer and in most cases (80 — 83 %) received preoperative chemotherapy for regression and reduction of the stage of the process. The evaluation of the treatment result was carried out according to aesthetic indicators, oncological survival indicators, and the subjective evaluation of the aesthetic result by patients.
 Results. During the observation period since 2018, the analysis of the frequency of development in the groups of relapses and metastases during the 4‑year observation period (since 2018), the frequency of development of local complications in both groups: hematomas, skin necrosis, implant extrusions, seromas, lymphorrhea, capsular contractures, liponecrosis, lymphostasis of the upper extremity on the side of the operation, the degree and duration of the pain syndrome in the postoperative area, and the possibility of a full course of treatment did not show significant differences during the observation period. The quality of life in both groups, according to the Spitzer scale, was comparable (in the first group, 64 %, and in the second group, it was 63 %). Only the duration of postoperative bed rest was longer in the LD flap reconstruction group.
 Conclusions. The results of the analysis of the study’s data showed that there are advantages and disadvantages to both methods. According to the findings, it is difficult to conclude which of the methods is more optimal, but it is necessary to choose the technique based on the constitutional characteristics of the patient and the size and shape of the mammary gland. An individualized and comprehensive approach is important.

Rice straw pretreatment using cow breeding wastewater for methane production

The aim of this study was to investigate the pretreatment of rice straw using cow breeding wastewater. The effects of filtering cow breeding wastewater through rice straw and microaerobic treatment on the pretreatment characteristics and methane production of rice straw were investigated. Generally, the filtration improved the pretreatment effect by adsorbing ammonium nitrogen and achieved higher solids loading for pretreatment. Although airtight treatment was optimal, the lignin removal and methane production of semi-sealed rice straw were only slightly lower than those of sealed rice straw. However, the results of open treatment were similar to those of the control. The maximum lignin removal and methane production reached 68.08% and 292.62 L/kg volatile solids (VS), respectively, for the filtered rice straw soaked in cow breeding wastewater again during pretreatment, and 61.26% and 274.18 L/kg VS, respectively, for the filtered rice straw pretreated directly without soaking.

Open Repair for Juxtarenal Aortic Aneurysm: Short and Long-term Results

The recent technological evolution has also allowed for the treatment of juxtarenal aortic aneurysm (JAA) with an endovascular technique, but short- and long-term results must be compared with the results of open treatment, which is the gold standard. In this study, we analyzed the short- and long-term results of open surgical treatment (open repair) in patients with JAA in our series. From January 2006 to December 2016, 155 patients were treated for JAA with open repair; the data were analyzed retrospectively. The mean age was 71.17years (standard deviation [SD] 7.1), and mean size of aneurysm was 6.15cm (SD 1.1). The ASA classes 2, 3, and 4 were 20%, 74% and 6%, respectively. Follow-up included clinical visit and abdominal aorta Duplex scan after 1 and 6 months and annually. The mean follow-up interval was 48.6 (SD 32.4) months. The mean surgical time was 256min (SD 69), the mean stay in the intensive care unit was 1.6days (SD 1.2), and the mean total hospital stay was 10.2days (SD 4.3). Aortic cross-clamping was usually suprarenal (110, 71%); in 39 (25%), the aortic clamping was between the renal arteries, and 6 patients (4%) required a supraceliac cross-clamping. The mean renal ischemia time due to aortic clamping was 17min (SD 3.5). In 32 patients (21%), the left renal vein was sectioned for performing proximal aortic anastomosis and then reconstructed. Twelve patients (8%) required a renal revascularization, and in 49 patients (32%), an hypogastric bypass was performed. The 30-day mortality rate was 0.6%, and only 1 patient died in the postoperative due to intestinal infarction. The postoperative morbidities occurred in 15 cases (10%). Six patients had dehiscence of the laparotomy without the involvement of the muscle, 4 patients had an asymptomatic small increase of the troponin, and in 3 patients, there was an increase in creatinine >1.8mg/dL. No dialysis was performed. Two patients had peripheral embolism in the lower limbs. Twenty-six patients (15%) died in the follow-up, but causes have never been related to aortic disease. Open repair of JAA is still safe, effective, and durable also in the long-term period and even in patients with multiple cardiovascular risk factors.

Хірургічне лікування вторинного гіперпаратиреозу у пацієнтів з хронічною хворобою нирок

Мета. Дослідити ефективність оперативного лікування вторинного гіперпаратиреозу (ВГПТ) у пацієнтів з хронічною хворобою нирок (ХХН).
 Матеріали і методи. Проведено ретроспективне дослідження результатів оперативних втручань на прищитоподібних залозах (ПЩЗ) та оцінено клініко-лабораторні показники у пацієнтів з ВГПТ.
 Результати. Шляхом дослідження операційного матеріалу ПЩЗ 62 пацієнтів дифузну гіперплазію встановлено у 8 (12,9%, 95% довірчого інтервалу (ДІ), 4,6 - 21,2%), мікроаденоматоз – у 14 (22,6%, 95% ДІ 12,2 – 33,0%); макроаденому – у 40 (64,5%, 95% ДІ 52,6 - 76,4%). Із 40 пацієнтів з макроаденомами пухлини з головних клітин діагностовано у 32 (80%, 95% ДІ 67,9 – 92,4%), онкоцитарні пухлини – у 8 (20%, 95% ДІ 7,6 – 32,4%). Відношення шансів (OR) – 16,0; χ2 – 26,45; р < 0,0001.
 Порівняння клініко-лабораторних показників через 1, 6 і 12 міс після оперативного втручання на ПЩЗ, а також з показниками у пацієнтів, яким не виконували оперативного втручання, виявило статистично достовірні результати нормалізації рівнів паратиреоїдного гормону (ПТГ), кальцію (Са), фосфору (Р) і лужної фосфатази (ЛФ) у крові.
 Висновки. Хірургічна операція при ВГПТ є ефективним методом лікування, який сприяє нормалізації лабораторних показників і попереджає важкі ускладнення.

Does diverting ileostomy improve the outcome in children with tuberculous small bowel obstruction requiring surgical intervention?

Abdominal tuberculosis is fairly common in children. The most common clinical presentation is bowel obstruction. Depending upon the presentation, the intestinal obstruction can be either managed conservatively or by operative intervention. There are various options in patients who undergo operative treatment. This study was undertaken to analyze the results of operative intervention with and without ileostomy. This is a retrospective study carried out over a period of 10years on 32 children who were operated for small bowel obstruction due to abdominal tuberculosis. The patients were divided into two groups (A: with ileostomy and B: without ileostomy). The relevant data and the defined outcome measures were statistically analyzed. A total of 32 children with tuberculous bowel obstruction requiring surgical intervention were studied. The patient of group A had mean duration of postoperative ileus for 2.55 days, restoration of enteral feeding within mean period of 3.55 days and had a primary hospital stay for a mean period of 9.0 days. These outcomes when compared with group B patients were statistically significant. In children with bowel obstruction due to tuberculosis, diverting ileostomy decreases the morbidity by allowing early return of enteral motility, early institution of feeding and first-line ATT and decreasing the primary hospital stay.

SIMULTANEOUS ESOPHAGO-GASTRECTOMY WITH COLONIC INTERPOSITION AS A METHOD OF SURGICAL TREATMENT OF GASTROESOPHAGEAL CANCER WITH HIGH INVOLVEMENT OF THE ESOPHAGUS

In the current oncological practice surgical treatment of gastroesophageal cancer with high involvement of the esophagus can extend to total esophago-gastrectomy with colonic interposition as the main method of radical treatment. However the technical complexity and high risk of the intervention are factors in determining the divergent views on the operation itself, testimony for the criteria of patient’s selection, choice of surgical access and the formation of a colonic graft in conjunction with method of esophageal reconstruction. The long-term results of operative intervention depend primarily on the extent of tumor process but obviously higher than after conservative treatment. This article presents a brief critical overview of the main aspects of the simultaneous application of esophago-gastrectomy in surgery of gastroesophageal cancer with high esophageal involvement and our clinical case of successful surgical treatment of a woman with pregnancy-associated gastroesophageal cancer.

Endovascular treatment in patients with combined pathology

Aortic valve stenosis is one of the most common diseases from the group of acquired heart disease, especially in elderly patients. Aortic valve replacement has become the “gold standard” and gives excellent results in all age groups of patients. For aortic valve replacement is sent to only one third of patients due to high risk due to age, severity of the defect, reduced contractility of the left ventricle, pulmonary hypertension and other comorbidities. One of the attempts to reduce the frequency of complications and mortality in this group of patients, and subsequently to make it possible to perform other surgical interventions, including aortic valve replacement, which is considered inoperable patients is holding a less traumatic surgery - aortic balloon catheter valvuloplasty. In the clinical observation deals with the case of heart disease - critical aortic stenosis, ischemic heart disease complicated by pulmonary hypertension and severe heart failure, in combination with gynecological diseases (uterine fibroids, endometrial hyperplasia in postmenopausal women), complicated by uterine bleeding and hemorrhagic anemia. Consider the risks of different surgical interventions. The possibility of modern endovascular care of patients in this situation simultaneously perform operations on uterine artery embolization, coronary angioplasty with stenting and aortic catheter balloon valvuloplasty. Also shown is the nearest and remote results of operative intervention.

Open Ostectomy of Anterior Impingement Syndrome: Comparison of Athletes and Nonathletes

Purpose : To analyse the clinical results of open treatment of anterior impingement syndrome of the ankle and to determine if being athletics or nonathletics affects the result. Materials and Methods : This study included 54 consecutive patients who had undergone surgery with an open modality. All had been diagnosed with anterior impingement syndrome and received conservative therapy for more than at least 3 months prior to surgery. Among them, 22 patients were high-level athletes. The patients were evaluated with a physical examination and simple radiograph. A bone scan or MRI were added if necessary. The patients were categorized into four groups according to the McDermott's grading system based on the lateral radiograph. Patients with Mc-Dermott's grade 4 change and with osteochondral lesions were excluded. The results of the Ogilvie-Harris score, a visual analogue scale of the patient satisfaction and the time to return to full activity were assessed. Results : The mean follow-up was 32 months, 82% of patients had good or excellent results. In general, the Ogilvie Harris score improved postoperatively. However, there was no significant difference between groups. There was no statistical significance between the athletics and nonathletics in terms of the improvement in the Ogilvie-Harris score. 91% of patients were satisfied in the final follow-up (more than 80% in the visual analogue scale). The mean time to return to full activity was 10.5 weeks with the athletes and 8.8 weeks with the nonathletes. Conclusion : Open surgical treatment for anterior impingement syndrome may be an effective modality regardless of the patient being an athlete or non-athlete.

Chronic Radial Head Dislocation in Children, Part 2: Results of Open Treatment and Factors Affecting Final Outcome

Fifteen elbows (3 congenital, 12 traumatic) in 14 children (mean age 9.5 years) with chronic radial head dislocation for at least 3 months (range 3-180 months) underwent radial head-sparing reconstructive surgery and were followed up at an average of 43.5 months postoperatively (range 12-105 months). At follow-up, the patients were evaluated radiographically and clinically using range-of-motion measurements and an elbow performance score based on four parameters (deformity, pain, motion, function). Ten cases had excellent results, two had good results, two had fair results, and one case had poor results. Scores at follow-up were evaluated with seven preoperative factors. Among those, the degree of preoperative carrying angle asymmetry associated with flexion contracture correlated significantly with the elbow scores. The most common complication was loss of pronation. The authors advocate radial head reduction and reconstruction in chronic radial head dislocations in children after obtaining informed consent from patient and parents.

Operative Treatment in 120 Displaced Intraarticular Calcaneal Fractures

From January 1987 to September 1990, 132 displaced intraarticular calcaneal fractures were treated operatively using a lateral approach, lag screws, and side plate without bone graft. To evaluate the results, a classification for intraarticular calcaneal fractures was developed, based on standardized coronal and transverse computed tomography (CT) scans of both feet. Type 1 fractures were nondisplaced (and received nonoperative treatment); Type II were two-part or split fractures; Type III were three-part or split depression fractures; and Type IV were four-part or highly comminuted articular fractures. Results were evaluated using the Maryland Foot Score and repeat CT scans. One hundred twenty cases were available for a minimum of one year follow-up evaluation (range, 12-56 months; mean, 29.3 months). Roentgenographic evaluation of calcaneal body dimensions showed restoration of heel height (98%), width (110%), and length (100%) to virtually normal in all cases, regardless of preoperative displacement. Roentgenographically, articular reduction was anatomic in 68 of 79 (86%) Type II fractures, 18 of 30 (60%) Type III fractures, and 0 of 11 (0%) Type IV fractures. Excellent or good clinical results occurred in 58 of 79 (73%) Type II fractures, 21 of 30 (70%) Type III fractures, and one of 11 (9%) Type IV fractures. When excellent and good clinical results were compared by year, a distinct learning curve appeared (1987, 27%; 1988, 54%; 1989, 74%; 1990, 84%). Despite an improved outcome for Type II and III fractures with increasing surgical experience, the results of operative intervention in Type IV fractures were no better, even after four years.(ABSTRACT TRUNCATED AT 250 WORDS)

Simultaneous dislocations of the, interphalangeal and carpometacarpal joints of the thumb : A case report

A case of simultaneous dislocations of the interphalangeal and carpometacarpal joints of the thumb after a fall is described. We believe this is a unique situation not reported before in the literature. The results of operative intervention of the open IP joint and closed CMC joint dislocations resulted in a stable pain-free thumb with a good range of motion.

変性々腰椎疾患における後方手術例の検討

328 cases of degenerative lumbar diseases were treated by posterior approach operation for past 11 years. They consisted of lumbar disc herniation (LDH) in 190 cases, lumbar spinal canal stenosis (LCS) in 109, osteochondrosis intervertebralis in 12 and lumbar spondylolysis or olisthesis in 15. We sent these patients postcards and gathered information by questionaires. 219 postcards (66.8%) were returned to us. The results of operative intervention were fair or poor in 11 cases (9%) of LDH and in 12 cases (16.4%) of LCS. These fair or poor cases were studied. In LDH, some of patients with severe pain and numbness of legs had sequestrated or large hernia. Patients with low back pain had disc instability and narrowing on X-ray.In LCS, many patients of fair or poor results had complications or postoperative stenosis. All of 8 patients who had drop foot caused by LDH or LCS have severe numbness of legs.

The natural history of anterior knee pain in adolescents.

Anterior knee pain in adolescents is generally recognised as a common but benign self-limiting condition. Although many operative procedures for its treatment have been proposed, there is little statistical evidence that they are more effective than expectant management. A group of 54 adolescent girls has been followed for two to eight years from presentation with anterior knee pain. Although some pain persisted in the majority, in many the symptoms declined in severity. This study provides a baseline for comparison with the results of operative intervention; it is suggested that surgical treatment is unproven and unnecessary.