Risk Of Inflammatory Complications Research Articles

OPTIMIZATION OF SURGICAL INTERVENTION METHODS IN THE TREATMENT OF ODONTOGENIC CYSTS OF THE UPPER JAW

Abstract: The therapy of odontogenic cysts of the upper and lower jaws, both conservative and operative, is of a complex nature – the frequency of this disease, according to the data, does not decrease. A number of researchers believe that the risk of inflammatory complications in odontogenic cysts is very high. The result of the injection of an odontogenic cyst of the upper jaw can be the occurrence of acute osteomyelitis with the development of a fistula and the outflow of purulent discharge into the maxillary sinus, which can later lead to the development of chronic odontogenic sinusitis. Studies of pus and granulations and analysis of the results obtained in most cases indicate a mixed microflora (staphylococcus, streptococcus, proteus, etc.). Also, when analyzing the literature, it was noted that the surgical treatment of odontogenic cysts localized on the upper jaw, as well as the use of osteoplastic materials for filling bone defects is very ambiguous and contradictory. The authors justify this fact by the fact that there is a high risk of relapses, in particular, after cystectomy, the probability of relapse is at least 17.8%. The usual scenario for conducting such nosologies is radical excision of odontogenic cysts of the jaws, after which a long time is needed to restore the bone defect, as well as adequate subsequent prosthetics. Based on these data, modern authors develop low-traumatic, sparing methods of surgical treatment of odontogenic cysts, especially of the upper jaw, including using endoscopic techniques. Based on the above, an urgent task for dental surgeons is to optimize the methods of surgical treatment of odontogenic cysts of the upper jaw, in particular with a decrease in the volume of the operating field.

Complications of implantation of aesthetic foreign bodies depending on their chemical composition

The study was aimed to assess the frequency of implantation of aesthetic foreign bodies depending on their chemical compositionThere was demonstrated that 49.4% of patients with complications after auricular piercing have jewelry made of gold and silver, less commonly used titanium. The most common complications for patients wearing silver ear piercing ornaments are atheromas (12,9%), gold - infection (11,8%), for composite alloys – infection and perichondritis (8,6% each) and for titanium – ear laceration and other mechanical defects (7,6%)The highest risk of inflammatory complications was determined for the groups using gold earrings (375 millesimal finenesses) and stainless earrings.

Medical and social rehabilitation following testicular prosthesis in post-orchiectomy patients

Aim. The aim of this study was to optimize indications and techniques and to develop the optimal timing for testicular prosthesis following inversion in adolescence considering the assessment of quality of life of patients at different times following the surgery. Materials and methods. We observed 70 patients with gonadal loss following critical ischemia (torsion) at ages 11-18 years (average, 15.5 ± 2.3 years). In total, 49 patients underwent joint replacement after orchiectomy due to torsion. In 21 patients, prosthetics were preceded by orchiectomy for testicular atrophy as a result of twisting. The interval from an acute episode to joint replacement ranged from 6 months to 15 years. Three techniques for testicular prosthesis implantation were applied: prosthetics with inguinal access without suturing the scrotal entrance (n = 14); prosthetics with inguinal access with suturing the scrotal entrance by the originally developed technique (n = 34); and a prosthetic scrotum (n = 22). Patient satisfaction was assessed based on the different outcomes of testicular inversion according to the originally developed questionnaire. Results. Suturing the scrotal entrance reduces the risk of implant migration in the proximal direction due to anatomical prerequisites. Scrotal access does not have this drawback but increases the risk of inflammatory complications. The esthetic result of prosthetics depends on patient’s age during orchiectomy. Older patients tend to have better cosmetic results. The most favorable results of prosthetics are noted at the time that has passed since the turn - no more than 3 years; all unsatisfactory results are noted at the time of more than 5 years since the twist. Testicular prosthesis increases social adaptation of patients after gonadal loss and improves their quality of life. Conclusions. 1. Testicular prosthesis is an essential stage of patient rehabilitation after an orchiectomy for inversion. 2. Prosthetic inguinal access by the originally developed technique is optimal from a technical perspective and provides the most physiological standing of the implant. 3. Prosthetics results directly depend on the period following the initial operation. 4. Testicular prosthesis complications can be minimized with the accumulation of knowledge and surgical experience and their rational prevention. 5. Assessment of patients’ quality of life illustrates the necessity of gonadal prosthetics for cosmetic compensation of organ loss and psycho-emotional and social rehabilitation. (For citation: Shormanov IS, Shchedrov DN. Medical and social rehabilitation following testicular prosthesis in post-orchiectomy patients. Urologicheskie vedomosti. 2018;8(2):43-52. doi: 10.17816/uroved8243-52).

Первый опыт комбинированного лечения пациентов с диабетическим макулярным отёком и осложненной катарактой

Diabetic cataracts in combination with diabetic macular edema (DME) is a leading cause of vision loss i n patients with diabetes mellitus. Purpose . To evaluate the efficacy and safety of one-stage combined treatment of patients with diabetes complicated by DME and cat aract. Material and methods . This study involved 16 patients with diabetes of the type 2 (32 eyes). The main group included 16 eyes with complicated cataracts, who underwent the simultaneously performed phacoemulsification of cataract (FEC) with IOL implantation and intravitreal implantation of the «Ozurdex» implant. The second (retrospective control) group included 16 fellow eyes, where a standard FEC with IOL implantation was performed. Results . Six months after the treatment, the main group showed a BCVA stabilization at a level 0.25±0.12 (0.1-0.4). In the retrospective group, the BCVA decreased and reached a baseline level 0.1±0.05 (0.05-0.2), in 5 patients the BCVA became below the baseline values. In all cases in the main group, a partial resorption of «solid» exudates was observed in the macular area. Edema of the retina decreased by 102-275 microns in comparison with preoperative indicators, the average retinal thickness was 385±58 microns in fovea area. Diffuse macular edema with a deposition of «solid» exudates remained in the retrospective control group, all patients had an increase in the amount of intra-etinal hemorrhages. In 5 patients, not only an increase in the number of «solid» exudates was revealed in the dynamics, but also their spread to the fovea region, in 3 cases the exudation foci acquired the form of hyper-reflective layers. The increase in the edema height occurred in all cases by 74-144 microns, index of average retinal thickness was 598±76 microns. In 7 cases, the dynamics showed an increase in flat subfoveal detachments of the neurosensory retina. Conclusions . The complex effect of the OzurDex drug in the combined treatment of diabetic cataracts in combination with DME reduces a risk of inflammatory complications in the early postoperative period, and also provides a reduction in the height of edema and partial resorption of «solid» exudates.

Ryzyko zaburzeń powierzchni oka w aspekcie stosowania miejscowych niesteroidowych leków przeciwzapalnych – podstawowe fakty kliniczne

The risk of inflammatory complications after cataract surgery is one of the most important challenges of modern ophthalmic surgery. Topical non-steroidal anti-inflammatory drugs since the 1970s have been used in perioperative and postoperative procedures, but due to the potential side effects associated primarily with disturbances in the eye surface (conjunctiva and cornea), their use has raised a number of doubts. The introduction of modern drugs from this group, one of which is nepafenac characterized by unique pharmacological properties and high clinical efficacy, has significantly reduced this problem. The mechanism of action of nepafenac significantly differs from its predecessors and on the one hand significantly improves safety of treatment and on the other thanks to excellent permeability to the posterior segment of the eye provides effective anti-inflammatory activity in the retina reducing the risk of vascular leakage and local edema changes that can negate the success of cataract surgeries especially in patients with diabetes.

PROSTHESIS OF THE TESTICLE IN PERSONS WHO HAVE UNDERGONE HIS TWITCH AT ADOLESCENCE

Relevance . Prosthesis of the testicle is a matter that is sharply discussed in the literature, accompanied by significant polarity of opinions regarding indications, techniques, choice of implant and evaluation of results. Publications relating to prosthetics about the bloat in childhood, are single and do not give an unambiguous answer to emerging questions. Goal . Optimize the indications, techniques and develop optimal terms for prosthetic testis after its turn in adolescence. Materials and methods .70 patients who lost gonad after torsion with critical ischemia at the age of 11-18 years, an average of 15.5 ± 2.3 years. In 49 patients, endoprosthetics were performed after orchiectomy for torsion. In 21 patients, orthhectomy was preceded by prosthetics due to the atrophy of the testicle preserved after the twist. The interval from an acute episode to endoprosthetics was from 6 months to 15 years. Three techniques of implantation of the prosthetic testis were used: prosthetics with inguinal access without suturing the entrance to the scrotum (n = 14); prosthetics by inguinal access with suturing the entrance to the scrotum according to the original developed technique. (n = 34); prosthetics with scrotal access (n = 22). Results . Sewing the entrance to the scrotum reduces the risk of implant migration in the proximal direction, due to anatomical prerequisites. Access through the scrotum is free from this deficiency, but increases the risk of inflammatory complications. The aesthetic result of the prosthesis directly depends on the age at which the orchiectomy is performed - the older the patient who underwent the operation, the better the cosmetic effect. Inguinal access with suturing the entrance to the scrotum with a comparable number of good results makes it possible to obtain a greater number of satisfactory and does not lead to complications. The most favorable results of prosthetics are noted at the time that has elapsed since the moment of turning - not more than three years; all unsatisfactory results were noted at a term of more than five years from the moment of torsion. Conclusions . 1. Prosthesis of the testis is an integral stage in the rehabilitation of the patient after an orchectomy for a bloat. 2. Prosthetic groin access according to the proposed original technique is optimal from a technical point of view and provides the most physiological standing of the implant. 3. The results of prosthetics directly depend on the period after the primary operation. 4. Complications of prosthetic testis can be minimized with the accumulation of experience and their rational prevention.

COMPUTER MODELING AND LASER TECHNOLOGIES IN REHABILITATION OF PATIENTS WITH MIDFACIAL TRAUMA

Aim: To assess the kind of damage of musculoskeletal apparatus of eye and orbit. To develop algorithm of laser therapy to restore orbital circulation and algorithm of transcranial laser therapy to improve microcirculation in maxillofacial muscles. Materials and methods: 75 patients with midfacial trauma were examined using laser spectrophotometry and computer modeling of orbital structures in frontal, sagittal, and inclined planes with SSD, MPR and VRT reconstructions (with Mimics software (Materialise, Leuven, Belgium)). To study orbital and maxillofacial microcirculation complex Spectrotest was used. Tissue oxygen concentration (SatO2) and blood filling volume index of microcirculation (Vbf) were measured. Results: After computer modeling, several variants of damage of musculoskeletal apparatus of eye and orbit were identified including oculomotor muscle entrapment in 60% of patients, angular deviation of muscle belly in 30%, muscle contusion – in 45%, orbital hematoma – in 18%, scarring of musculoskeletal apparatus of orbit – in 40%. During early period of trauma of orbital wall and maxillary sinus, Vbf decreased by a mean of 12.5 ± 0.5% compared to normal values, whereas contralateral microcirculation increased by a mean of 28.5 ± 0.1% compared to normal values. Abnormal blood distribution persisted in the long-term, after bone reposition: blood flow increase was found only in 10% of patients. In severe trauma and chronic scarring, local laser irradiation was associated with increase of Vbf bilaterally, but chronically and significantly increased SatO2 indicated impaired tissue trophics and high risk of inflammatory complications. Conclusion: Computer modeling is of great value in the diagnosis and rehabilitation planning in patients with injuries of musculoskeletal apparatus of eye and orbital structures. Laser spectrophotometry is useful for the monitoring of microcirculation before, after the operation and during rehabilitation.

Early and late postoperative inflammatory and collagen deposition responses in three different meshes: an experimental study in rats

Although meshes reduce abdominal hernia recurrence, they increase the risk of inflammatory complications. This study aimed to compare the early and late postoperative inflammation and collagen deposition responses induced by three meshes. Rats were allocated into three groups. In group I, a polypropylene (PP) mesh was implanted in the abdominal wall. In groups II and III, PP + polyglactin (PP + PG) and PP + titanium (PP + TI) meshes were employed, respectively. On the seventh (7th) postoperative day, collagen deposition and inflammation were evaluated, and immunohistochemistry was performed on abdominal wall biopsies. These data were compared with those obtained on the fortieth (40th) postoperative day in a previous study. The early inflammatory responses were the same in all groups. With time, it decreased in group I (p = 0.047) and increased in group II (p = 0.003). Group I exhibited early elevated VEGF (p < 0.001), COX2 (p < 0.001), and collagen (p = 0.023) levels, and group II exhibited the most severe inflammatory tissue response. On the 40th postoperative day, the VEGF (p < 0.001) and collagen (p < 0.005) were reduced as compared with the 7th postoperative day in all groups. Belatedly, the inflammatory reaction decreased in PP mesh group and increased in PP + PG mesh group. The PP mesh induced early great elevations in VEGF, COX2 and collagen levels, whereas the PP + PG mesh caused severe tissue inflammation with small elevation in these levels. PP + TI mesh induced inflammatory response levels between the others. In conclusion, the inflammatory response depends on the mesh density and also the mesh material with clinical implications.

Antianemic therapy as an important component of treatment of uterine leiomyoma

Anemia correction in the treatment of symptomatic uterine leiomyoma is an important step that signifi cantly improves the quality of life of women with this pathology, thereby increasing the effi ciency of organ surgery, reducing the risk of complications. Anemia treatment in the preoperative period contributes to a more favorable course of the postoperative period after embolization of uterine vessels, reduces the severity and duration of the postembolization syndrome, accelerates the timing of rehabilitation, reduces the risk of infl ammatory complications. When you selecting drugs for the treatment of iron defi ciency anemia should be preferred non-ionic iron drugssuch as the iron hydroxide polymaltose complex as the most safe and highly eff ective.

Elevated Serum 8-Oxo-dG in Hemodialysis Patients: A Marker of Systemic Inflammation?

Does inflammation, as assessed by high sensitivity C-reactive protein (hs-CRP), in patients with end-stage renal disease (ESRD) tightly associate with increased serum levels of 8-oxo-7,8-dihydro-2'-deoxyguanosine (8- oxo-dG)? Increased oxidative stress and inflammation have both been highlighted among several nontraditional risk factors for cardiovascular disease, which is the main cause of mortality in ESRD patients. In contrast to oxidative stress effects on proteins and lipids, DNA base damage has not been well demonstrated in ESRD. Two groups of hemodialysis patients were studied, one group with persistent inflammation (n = 13, with constant elevation of CRP > 10 mg/L for 6 months) and one group of noninflamed patients (n = 19, with constant CRP < 10 mg/L for 6 months). Serum 8-oxo-dG was significantly elevated in persistent inflammation in comparison to noninflamed patients. At an individual level, a significant correlation was found between serum 8-oxo-dG and hsCRP. Extracellular 8-oxo-dG leads to intracellular oxidative damage on the nucleotide pool, thus providing a sensitive marker for inflammatory response. Serum levels of 8-oxo-dG, in combination with other inflammatory markers, serve as useful diagnostic tools for identification of patients in risk for inflammatory complications.