Results Of Operations In Patients Research Articles

Comparative Study of the Results of Operations in Patients with Tumor and Non-Tumor Obstructive Jaundice Who Received and Did Not Receive Antioxidant Therapy for the Correction of Endotoxemia, Glycolysis, and Oxidative Stress.

Purpose: To compare the results of surgical treatment and changes in biomarkers of cholestasis, endotoxicosis, cytolysis, lipid peroxidation, glycolysis disorders, and inflammation in patients with benign and malignant obstructive jaundice (OJ) in patients receiving and not receiving antioxidant pharmacotherapy (AOT). Patients and methods: The study included 113 patients (aged 21–90 years; 47 males and 66 females) who received surgical intervention for OJ due to non-malignant (71%) or malignant tumor (29%) etiologies. Patients were divided into two groups: Group I (n = 61) who did not receive AOT and Group II (n = 51) who received AOT (succinate-containing drug Reamberin) as part of detoxification infusion therapy. The surgical approach and scope of interventions in both groups were identical. Dynamic indicators of endotoxicosis, cholestasis, and cytolysis (total, direct, and indirect bilirubin, alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [AP] and gamma-glutamyltransferase [GGT]), kidney function (urea), lipid peroxidation (malonic dialdehyde, MDA), inflammation (leukocytosis), and glycolysis disorders (lactate dehydrogenase (LDH), glucose) were evaluated. Results: Tumor jaundice, unlike non-tumor jaundice, persisted and was characterized by a more severe course, a higher level of hyperbilirubinemia, and lipid peroxidation. The prognostic value of the direct (and total) bilirubin, MDA, glycemia, and leukocytosis levels on the day of hospitalization, which increased significantly in severe jaundice and, especially, in deceased patients, was established. Decompression interventions significantly reduced levels of markers of liver failure, cytolysis, cholestasis, and lipid peroxidation on day 3 after decompression by 1.5–3 times from initial levels; this is better achieved in non-tumor OJ. However, 8 days after decompression, most patients did not normalize the parameters studied in both groups. AOT favorably influenced the dynamics (on day 8 after decompression) of total and direct bilirubin, ALT, AST, MDA, and leukocytosis in non-tumor jaundice, as well as the dynamics of direct bilirubin, AST, MDA, glucose, and LDH in tumor jaundice. Clinically, in the AOT group, a two-fold reduction in the operative and non-operative complications was recorded (from 23% to 11.5%), a reduction in the duration of biliary drainage by 30%, the length of stay in intensive care units was reduced by 5 days, and even hospital mortality decreased, especially in malignancy-induced OJ. Conclusion: A mechanism for the development of liver failure in OJ is oxidative stress with the appearance of enhanced lipid peroxidation and accompanied by hepatocyte necrosis. Inclusion of AOT in perioperative treatment in these patients improves treatment outcomes.

Retrospective analysis of vitreoretinal surgery outcomes in diabetic retinopathy

Purpose. To analyze the clinical and functional results of vitreoretinal operations in patients with type II diabetes mellitus and diabetic retinopathy (DR).Materials and methods. A retrospective analysis of vitreoretinal surgery outcomes in DR was performed in 421 patients (421 eyes), with type II diabetes mellitus and DR, with no previous history of retinal laser coagulation. The follow-up period was at least 4 years. Patients were divided into two groups depending on the postoperative course of the disease. Group I included 338 patients (338 eyes) with a single vitreoretinal intervention followed by stabilization of the pathological changes over the whole follow-up period. Group II consisted of 83 patients (83 eyes), ca. 20 % of the cohort, with repeated vitreoretinal operations required by DR progression. In addition, the groups were analyzed according to the best corrected visual acuity (BCVA).Results. The initial BCVA of less than 0.1 was noted in 69 % of cases in Group I with a single surgery while that in Group II claimed 80.7 % of cases. By the 6th month, BCVA values revealed an average increase from 0.05 to 0.20 in Group I and an average increase from 0.05 to 0.08 in group II. In Group I, at the end of the follow-up the mean BCVA remained stable and was higher than before the operation, while in Group II it dropped and remained significantly lower than in Group I. Also, by the end of the follow-up the patients given a single vitreoretinal intervention whose BCVA was below 0.1 showed an increase in the mean BCVA value, whilst those with initial BCVA of 0.4–0.6 showed BCVA stabilization. Patients with repeated operations and initial BCVA below 0.1 showed no noticeable BCVA changes but those with BCVA 0.1–0.6 revealed a drop.Conclusions. Modern technologies of vitreoretinal surgery of severe DR stages ensure a stable anatomical outcome following a single surgery in 80 % of cases, a stable functional result in 59 % of cases. In 20 % of cases, relapses and the need for repeated operations are associated with the initially more pronounced diabetic alterations of the retina, probably due to the patients’ late referral. Timely detection of DR and referral of such patients to a specialized ophthalmology center is a necessary task.

Advantages of modern methods of prevention of thrombotic complications in patients with critical ischemia of lower limbs after reconstructive operations

Aim. To evaluate and improve the results of reconstructive operations in patients with obliterating atherosclerosis with critical ischemia of the lower limbs through reduction of the rate of thrombotic complications by improvement of diagnosis of risk factors for thrombosis on the basis of coagulogram and Thrombodynamics T-2 test data.
 Materials and Methods. In the I group of patients (n=48) reconstructive operations were performed on the arteries of lower limbs and anticoagulant therapy with unfractionated heparin (UFH) with control of hemostasiogram before the operation, in 6 hours and 6 days after the operation and with additional control of APTT 30 minutes before introduction of UNH. In the II group (n=34) reconstructive operations were performed with selection of anticoagulant therapy using parameters of hemostasiogram and laboratory-diagnostic system Thrombodynamics Recorder T-2 with control before the operation, in 6 hours, 6 days after the operation and with additional control of APTT in 30 minutes before introduction of UFH.
 Results. Analysis of the data of coagulogram and Thrombodynamics T-2 test showed statistical significance of APTT, fibrinogen, delay and initial speed of clot growth, a combination of which permits a possibility for correction of heparin therapy for prevention of thrombosis.
 Conclusions. The dynamics of the parameters of Thrombodynamics T-2 test in selection of UFH dose proves high effectiveness of this method for selection of adequate doses of anticoagulant drugs for prevention of postoperative thromboses in patients with critical ischemia of the lower limbs.

Dual-port operations in surgery of bullous lung emphysema

The purpose of the study is to assess the perioperative period and the immediate results of dual-port operations in patients with bullous emphysema. Material and methods. The analysis of the perioperative period and the immediate results of two-port operations in patients with bullous emphysema of the lungs were performed. This surgical intervention was performed in 36 cases with bullous emphysema of the lungs (men – 31, women – 5). The average age of patients was 28.91 years. In all cases, the diagnosis was made on multispiral computer tomography of the chest. The duration of the surgical intervention, the periods of lung spread, the duration of the pleural drainage standing, the assessment of the pain syndrome, intra- and postoperative complications were assessed. Results and discussion. The intervention duration ranged from 70 to 125 minutes at the stage of implementation of the dual-port operations procedure. Now the intervention duration does not exceed 80 minutes for most cases. There were not registered any intraoperative complications. The duration of air leakage through pleural drainage was up to 1 day in 27 (75 %) patients. The duration of postoperative pain in most cases (28) did not exceed 1 day. Early postoperative complications were in 2 cases (1 intrapleural bleeding; 1 – postoperative wound seroma). These complications were cured in both cases. The proposed access method for the surgery of bullous emphysema of the lungs can be used in a wide clinical practice. To determine the location of this method, it is necessary to compare it with other minimally invasive interventions.

ПОКАЗАНИЯ К ОБЪЕМУ ОПЕРАЦИИ И ОСОБЕННОСТИ ТЕХНИКИ ТИРЕОИДЭКТОМИИ У ПАЦИЕНТОВ С ЗАГРУДИННЫМ ЗОБОМ

The paper is devoted to determining the frequency, features of the clinical course and technique of safe thyroidectomy in patients with retrosternal goiter. Materials and methods. We analyzed the treatment of 26 patients with retrosternal goiter. All patients underwent the neck-approach thyroidectomy with the identification of the recurrent laryngeal nerve during surgery. Results. It was found that patients with Graves’ disease did not have retrosternal goiter, with mixed toxic goiter the frequency was 13.7%, with nodular euthyroid goiter – 26.1%. In 11.5% of patients with retrosternal goiter, the diagnosis was made by chest x-ray, in 76.9% - by ultrasound imaging, in 19.2% - by CT imaging. Of the 26 patients, 1 (3.8%) was hospitalized urgently due to respiratory failure and compression syndrome, and 25 (96.2%) were admitted as planned. Operations in 25 (96.2%) were performed under endotracheal, in 1(3.8%) – under mask anesthesia. Intraoperatively, it was found that the location of the recurrent laryngeal nerve changed in the case of chest goiter that required special care when mobilizing the posterior surface of the thyroid gland from the trachea in the zone of the lower thyroid artery and in Berry ligament. Technical manipulations aimed at preventing damage to the recurrent laryngeal nerve at different stages of thyroidectomy are proposed. Conclusion. The results of operations in patients with substernal goiter show that if it is carefully performed and the recurrent laryngeal nerve is preserved, the postoperative period does not differ from that in the usual location of the thyroid gland and even relieves, since the compression syndrome is eliminated.

The immediate results of combined operations in patients with advanced ovarian cancer: the experience of N. N. Blokhin National Medical research Center of Oncology, Ministry of health of russia

Objective: to analyze intraoperative and postoperative complications in patients who underwent combination surgeries for advanced ovarian cancer.Materials and methods. This retrospective study included patients that underwent primary or interval cytoreductive combination surgeries for advanced (grade III–IV) ovarian cancer at N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia between 2000 and 2017.Results. We analyzed medical records of 144 patients with grade III–IV ovarian cancer who underwent combination surgery at some stage of their treatment. Almost two-thirds of patients (64.8 %) had complete or optimal volume of surgery. Intraoperative complications were registered in 7 % of patients (n = 10), while postoperative complications were observed in 38.2 % of cases (n = 55). The postoperative death rate was 0.7 % (n = 1).Conclusions. Higher frequency of complete and optimal cytoreduction, as well as acceptable level of intra- and postoperative complications confirm the need for combination surgeries in patients with advanced ovarian cancer. Aggressive surgical tactics should be used only in specialized cancer hospitals with the involvement of a multidisciplinary team that includes cancer surgeons and anesthesiologists in order to improve both short-term and long-term treatment outcomes in patients with advanced ovarian cancer.

Substantiation of Organ-Saving Operations in Renal Tumours

Purpose of the study:to analyse the results of organ-preserving operations in patients with localized renal cell carcinoma.Materials and methods. The results of treatment of 458 patients who underwent organ-preserving treatment for renal cell carcinoma between 2009 and 2017 were analysed and evaluated. Of these, 286 were men (62.4 %) and 172 were women (37.6 %) with an average age of 54.7 ± 2.25 years (between 23 and 84 years).Results. The size of the tumours ranged between two to eight centimetres (average tumour size 4.6 cm). The duration of “open” operations ranged from 30 to 110 minutes (average of 62 minutes); those using laparoscopy lasted between 85 and 180 minutes (average of 146 minutes). The volume of blood loss during the operation was an average of 133.6 ml (from 80 ml to 500 ml). In most patients, the tumour was in the first stage of the disease (443 cases, or 96.7 %). In 17 of patients operated on morphologically, invasion of paranephric fibre at the third stage (3.7 %) was detected. A further 8 patients had a second stage tumour more than 7 cm in size but without germination beyond the kidney (1.7 %). There were no cases of intra- or post-operative mortality. Discussion. No significant differences during the postoperative period were observed in patients undergoing “open” and laparoscopic surgery; the frequency of postoperative complications was also approximately the same in both cases.Conclusion. Improvements in contemporary diagnostic methods have led to a sharp increase in the detection rate of small tumours. The results of studies comparing nephrectomy and kidney resection with a healthy contralateral kidney indicate the validity of the organ-preserving approach with small tumour sizes and localisation convenient for resection. In this regard, recently there has been a trend towards a wider use of kidney resection in renal cell carcinoma. Increased emphasis on the quality of life of cancer patients has led to an active study of the possibilities of using modern technologies in kidney cancer surgery.

Clinical and Demographic Characteristics of the Patients Operated on for Glaucoma

Purpose: To analyze the results of operation in patients with glaucoma depending on its stage, terms of follow-up and detection.Patients and methods. 102 patients (204 eyes) operated on at IRTC “Eye Microsurgery” Tambov branch within October-November 2017 were examined. Mean age was 69.6 ± 9.5 years old. There were 58 male and 44 female. Patients’ eyes were divided into 4 groups: eyes with absolute glaucoma (33), III stage of glaucoma (71), I–II stage of glaucoma (54) and healthy eyes (46). The age of glaucoma patients in all groups was almost identical: age 60-69 years old (47.7%) and 70–79 (31.3%) prevailed.Results. The mean follow-up period was 2.2 years (from 1 week to 11 years), the average number of examinations per patient in a year was 5. Before the first surgery 16% of the eyes with absolute glaucoma were detected, 40% — with III stage glaucoma, 26.5% — I–II stage glaucoma, the rest 17.5% were healthy (paired) eyes. Within the total follow-up 211 antiglaucomatous and 36 cataract surgeries were performed. The marked visual improvement was not noted after antiglaucomatous surgeries. In 5 patients without any glaucoma symptoms but followed up during 5-10 years without interruption absolute glaucoma was revealed. Among the above mentioned patients 3 had a rather high level of tolerant pressure (17 mm Hg) and high true IOP (25 mm Hg), other 2 — low tolerant pressure (12–14 mm Hg) and normal true IOP (19–20 mm Hg).Conclusion. If glaucoma is diagnosed based on the examinations and patient received treatment, he/she should be under the supervision of an experienced ophthalmologist who determine and change treatment in time, including early surgery.

The Results of Cytoreductive Operations in Patients with Colorectal Cancer with Simultaneous Liver Polymetastases

Aim - to improve the long-term results of cytoreductive treatment of patients with simultaneous multiple bilobar liver metastases of colorectal cancer by the use of RFTA. Materials and methods. The study presents the results of treatment of 168 patients diagnosed with colorectal cancer of stage IV with simultaneous bilobar metastases in the liver. In the main group, cytoreductive tumor removal was accompanied by radiofrequency thermal ablation (RFTA) of metastatic formations. In the control group only the primary tumor was removed. Results. The use of RFTA during cytoreductive surgery does not worsen the immediate results of surgical treatment, in comparison with patients, where the effect on liver metastases has not been performed, but allows to increase medians of uneventful and overall survival from 9 and 22 months to 17 and 29 months, respectively. Conclusions. The use of RFTA for simultaneous multiple bilobar metastases in the liver during cytoreductive surgery makes it possible to achieve 22.7% of the three-year uneventfulness and 4.3% of the five-year overall survival.

Longterm results of aortic valve-sparing operations in patients with aortic valve insufficiency and aortic root aneurysm

Longterm results of aortic valve-sparing operations in patients with aortic valve insufficiency and aortic root aneurysm

Editorial Comment: Surgery for aneurysms of the ascending aorta: keep it simple, safe and straightforward

R. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg 1998; 115:1080–90. [18] Doenst T, Ivanov J, Borger MA, David TE, Brister SJ. Sex-specific longterm outcomes after combined valve and coronary artery surgery. Ann Thorac Surg 2006;81:1632–6. [19] Etz CD, Homann TM, Rane N, Bodian CA, Di Luozzo G, Plestis KA, Spielvogel D, Griepp RB. Aortic root reconstruction with a bioprosthetic valved conduit: a consecutive series of 275 procedures. J Thorac Cardiovasc Surg 2007;133:1455–63. [20] Benedetto U, Melina G, Takkenberg JJ, Roscitano A, Angeloni E, Sinatra R. (6)Surgical management of aortic root disease in Marfan syndrome: a systematic review and meta-analysis. Heart 2011;97:955–8.

Long Term Results of Valve Operations in Patients with Diabetes

Diabetes Mellitus (DM) adversely affects survival in patients with Coronary Artery Disease (CAD) undergoing Coronary Artery Bypass Grafting (CABG) surgery. The influence of diabetes on events after valve operations is less defined. We analyzed the effect of diabetes on short and long term outcomes in patients undergoing valvular operations. A total of 2200 patients had cardiac surgery at a single VA Medical Center between 1991 and 2008. 355 patients had undergone valve replacement or repair. Data documenting the presence of diabetes was collected prospectively and captured into the Veterans Affairs electronic medical record. Of the 355 patients who had a valvular operation, 259 (79%) had an Aortic Valve Replacement (AVR), 69 (20%) had a Mitral Valve Repair/Replacement (MVR), and 4 (1%) had a Tricsupid Valve Repair/Replacement (TVR), and 19% (n = 69) of all patients had diabetes. 44% of patients with DM and 38% of patients without DM had a combined valve and CABG procedure. During a total follow up of 18 yrs, 42 (60%) of patients with diabetes and 186 (65%) of patients without diabetes were alive (p = 0.118). At 1, 5, 10, 15 yrs survival in patients with versus without diabetes were 91% v 87%; 71% v 74%; 40% v 56%; 23% v 48% (p = NS). The presence of diabetes does not appear to adversely effect long-term survival in patients undergoing valve operations.

Expanding the indications for septal myectomy in patients with hypertrophic cardiomyopathy: Results of operation in patients with latent obstruction

Many patients with symptomatic hypertrophic cardiomyopathy have minimal left ventricular outflow tract gradients, and there is uncertainty whether their limitation is due to diastolic dysfunction or labile outflow tract obstruction. The purpose of this study was to characterize the clinical presentation and outcome of septal myectomy in patients with hypertrophic cardiomyopathy and latent obstruction. Among 749 patients who underwent septal myectomy, 249 had latent obstruction with minimal (0-30 mm Hg) resting gradients preoperatively. All were symptomatic and had more severe left ventricular outflow tract obstruction provoked by Valsalva maneuver or amyl nitrite inhalation during Doppler echocardiography or by stimulation with isoproterenol during catheterization. Clinical characteristics, survival, and functional outcome of these patients were compared with those of 500 patients with more severe resting left ventricular outflow tract obstruction who underwent myectomy during the same period. Compared with those with severe obstruction, more patients with latent obstruction were male (63% vs 52%, P < .003), but ages were similar (53 ± 14 years vs 52 ± 15 years). Preoperative symptoms and functional limitation were similar in the 2 groups with 86% and 85%, respectively, having New York Heart Association class III or IV disability. Among patients with latent obstruction, mixed venous oxygen saturation was 61.6% ± 19.0% of predicted compared with 56.8% ± 17.3% for those with severe resting obstruction (P < .008). Septal thickness was less in patients with latent obstruction (20 ± 9 mm vs 22 ± 15 mm, P < .001). Early mortality was 1% in each group, and survival at 5 and 10 years was 93% and 87%, respectively, for patients with latent obstruction compared with 93% and 74%, respectively, for patients with severe resting obstruction preoperatively (P = .34). Self-reported late functional status was similar; 3 to 5 years postoperatively, 81% of patients with latent obstruction preoperatively were in New York Heart Association class I or II compared with 77% of patients with severe resting obstruction. Patients with obstructive hypertrophic cardiomyopathy who have low resting gradients and latent obstruction may have limiting symptoms comparable to those of patients with more severe resting gradients. Septal myectomy should be offered to these patients because survival and symptom relief are excellent, suggesting that dynamic obstruction is the major hemodynamic problem rather than diastolic dysfunction.

Long-term results of aortic valve-sparing operations in patients with aortic valve insufficiency and aortic root aneurysm, a single centre experience

Long-term results of aortic valve-sparing operations in patients with aortic valve insufficiency and aortic root aneurysm, a single centre experience

Long-term Results of Keller-Brandes Hallux Valgus Resection Arthroplasty in Patients over 50 Years with Metatarsophalangeal Osteoarthritis

Purpose To analyze the long-term clinical, radiological and functional results of a significant number of patients operated on for hallux valgus with the Keller-Brandes technique and to identify factors that may lead to a poor prognosis. Materials and methods A clinical and radiological review was made of a group of 30 patients operated on for 55 instances of hallux valgus using the Keller-Brandes technique with a minimum follow-up of 8 years. Their mean age at the time of surgery was 62 years. Results Patients subjected to a resection arthroplasty showed a reduction in their metatarsophalangeal angle from 36.9° to 25.4° over a mean follow-up period of 9.6 years. At the same time, the intermetatarsal angle went from 14.9° to 11°. Reduction of the sesamoid-metatarsal head articulation was achieved in 65% of cases. Subjective results were excellent in 20% of patients, good in 38.2%, fair in 23.6% and poor in 18.2%. Radiological recurrences were 36% and residual metatarsalgias 24%. There was one single case (2%) of a cock-up deformity (2%) and no cases at all of residual varus. None of the patients had to be reoperated for any of the above mentioned complications. Conclusions In our experience, the long-term clinical and radiological results of the Keller-Brandes operation in patients over 50 years of age can be considered acceptable and show a low complications rate provided that the technique is applied carefully. For this reason, it should still be recommended as the technique of choice for patients over 50 years of age with low functional demands and degenerative joint disease.

The results of operation in patients with hypertrophic cardiomyopathy and pulmonary hypertension

The clinical course and hemodynamic results in patients undergoing operation for obstructive hypertrophic cardiomyopathy with preoperative pulmonary arterial hypertension were unknown. The hypothesis tested in this retrospective study was that operative relief of left ventricular outflow tract obstruction resulted in a substantial reduction in pulmonary artery pressures and mitral regurgitation without necessitating mitral valve replacement. Patients were included if their preoperative pulmonary systolic pressure was greater than 35 mm Hg and if they were without concomitant cardiac disease, with the exception of mitral regurgitation. Since 1962, 49 patients who fit our criteria underwent left ventricular myotomy and myectomy with 98% follow-up. Mean follow-up was 7.9 +/- 0.7 (mean +/- standard error of the mean) years with a range of 0.8 to 18.4 years. Early hospital mortality rate was 12% (n = 6); two deaths from low cardiac output and four from arrhythmia. There were 43 (88%) hospital survivors and 18 late deaths. Actuarial survival rate after operation was 87% +/- 5% (n = 31) at 5 years and 55% +/- 8% (n = 9) at 10 years. Thirty-nine of 43 survivors (91%) returned 9 +/- 1 months postoperatively for follow-up evaluation including cardiac catheterization. The majority (83%) were in New York Heart Association functional class I or II postoperatively. Cardiac catheterizations indicated a fall in pulmonary arterial systolic pressure from 62 +/- 3 (range = 36 to 105) to 38 +/- 2 (range = 21 to 65) mm Hg (p = 0.0001) with no difference in right atrial pressure or cardiac output. Pulmonary arterial wedge mean pressure decreased from 24 +/- 1 to 16 +/- 5 mm Hg (p = 0.0002) and preoperative mitral regurgitation improved or was abolished in 85% of patients studied (n = 13). Rest and maximal provocable left ventricular outflow tract gradients decreased from 81 +/- 7 and 103 +/- 5 to 14 +/- 3 and 45 +/- 8 mm Hg, respectively (p = 0.0001). Comparison of the above-mentioned patients, operated on since 1982, with a preoperatively matched group who underwent mitral valve replacement in the same interval showed no statistically significant difference in mortality, morbidity, hemodynamic outcome, or functional outcome with a mean follow-up of 2 years. We conclude that a consistent, significant reduction (mean = 40%) in preoperative pulmonary arterial systolic pressure, clinical symptoms, and mitral regurgitation occurs with relief of outflow tract obstruction by left ventricular myotomy and myectomy and that pulmonary hypertension and mitral regurgitation are not indications for mitral valve replacement in these patients.