Method Of Surgical Treatment Research Articles

Двухэтапное хирургическое лечение регматогенной отслойки сетчатки, осложненной выраженной пролиферативной витреоретинопатией, с применением первичной круговой ретинотомии и отсроченной эндолазеркоагуляцией сетчатки в уменьшенном объеме

Abstrakt Primary retinotomy in the surgical treatment of complicated rhegmatogenous retinal detachment with severe proliferative vitreoretinopathy D.O. Shkvorchenko, B.E. Malyugin, A.Yu. Kornienko, E.S. Khrisanfova, O.B. Klepinina S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation Purpose. To develop a method of surgical treatment of rhegmatogenous retinal detachment with severe proliferative retinopathy (stage C) using primary circumferential retinotomy, short-term perfluorocarbon liquid (PFCL) endotamponade and deferred laser endophotocoagulation in a reduced volume. To evaluate the effectiveness of the developed method in the treatment of complicated rhegmatogenous retinal detachment with severe proliferative vitreoretinopathy. Material and methods. 12 patients (12 eyes) with the diagnosis of rhegmatogenous retinal detachment with severe proliferative retinopathy were operated using developed method of two-stage surgical treatment with a reduced volume of laser endophotocoagulation. All 12 patients had a concomitant diagnosis of complicated cataract. Results. A new method of two-stage surgical treatment with reduced volume of laser endophotocoagulation was developed in the S. Fyodorov Eye Microsurgery Federal State Institution. After the follow-up period of 12 months retina was attached in all 12 cases, best corrected visual acuity (BCVA) was 0.38±0.08; 5 eyes had silicone oil endotamponade, in 7 cases silicone oil was removed. Conclusion. Primary 360-degree retinotomy is an effective method of surgical treatment of rhegmatogenous retinal detachment with severe proliferative retinopathy. The most preferable in these cases is to carry out surgical treatment in several stages with short-term PFCL tamponade, which allows to achieve maximum adaptation of the retina. Laser retinopexy in the PFCL environment during the second stage of surgery allows it to be carried out fully and at the same time in a minimal volume. Key words: retinal detachment, proliferative vitreoretinopathy, primary retinotomy, circumferential retinotomy, perfluorocarbon liquid, laser endophotocoagulation

Modern Diagnostic Approaches and Management Tactics for Patients with Chronic Colonic Stasis in Decompensated Forms of Colon Dysfunction

Today, colonic stasis is a significant medical and social problem worldwide. According to research by a number of authors, in developed countries, constipation affects to varying degrees from 30 to 50% of the working-age population and from 5 to 20% of children. Constipation occurs 5 times more often in the elderly than in young people. The etiology of chronic colonic stasis is diverse: from functional disorders of gastrointestinal motility to intestinal abnormalities, in some cases leading to disability and a significant decrease in the quality of life of patients. Prolonged, sometimes unsuccessful, medical treatment of chronic colonic stasis ultimately raises the question of the need for surgical intervention. The purpose of this review was to study and summarize the results and experience of researchers over the past 10 years devoted to the search for the most effective methods of surgical treatment of chronic colonic stasis in decompensated form of colon dysfunction (including dolichosigmoid) in combination with drug therapy. The search for information for the review was carried out on the following resources: PubMed, MEDLINE, Embase, Springer, ScienceDirect, journals of the CIS countries and the Republic of Kazakhstan.

Post-covid Syndrome in the Form of Venous and Arterial Thrombosis Complicated COVID-19

Post-covid syndrome in the form of thrombosis is a common and dangerous complication of COVID-19. To identify the localization, frequency, timing of thrombosis in patients who have undergone COVID-19, the frequency of surgical treatment methods used. A retrospective observational study of 239 case histories of patients (138 women and 101 men) who had COVID-19 in the Department of Vascular Surgery of the National Hospital of the Ministry of Health of the Kyrgyz Republic within the period from August to December 2020. A 42-year-old patient who underwent COVID-19 in March 2020, which gave a post-covid complication in the form of a chronic aneurysm of the infrarenal abdominal aorta five months later. Venous thrombosis as a post-covid syndrome is 74% more common than arterial thrombosis. The incidence of thrombotic post-covid syndrome in women compared to men is 15.4% higher. This trend is most pronounced in the disabled aged 61 and over. Venous thrombosis was most often localized in the veins of the lower extremities, and open surgical interventions were most often performed. People with concomitant diseases, in particular, with diseases of the cardiovascular system, are more susceptible to post-covid complications in the form of thrombosis and thromboembolism. Out of 239 people, 138 people (58%) had concomitant diseases, 101 people (42%) did not have them. Basically, open surgical interventions were performed. In 50% of cases with arterial thrombosis, thromboembolectomy was performed, with venous thrombi, the ligation of the great saphenous vein according to Troyanov accounted for 78% of operations. In the case of an individual clinical patient, laparotomy, nephrectomy on the right, elimination of an aortic aneurysm, aorto-femoral bifurcation prosthetics with an ECOFLONprosthesis were performed. Post-covid syndrome after COVID-19 is mainly localized in the veins of the lower extremities and is much more common among the female population with concomitant diseases. Open surgical operations can effectively eliminate the post-covid syndrome.

Foramen magnum stenosis in patients with mucopolysaccharidoses: diagnosis and surgical treatment. Review of literature

Cervico-medullary compression and atlantoaxial dislocation syndromes are the dominant clinical manifestations of mucopolysaccharidoses at the craniovertebral level. The review provides an analysis of international literary sources concerning modern aspects of diagnosis and neurosurgical correction of the foramen magnum stenosis in patients with different types of mucopolysaccharidoses. The existing surgical approaches to determining the indications and choosing the method of surgical treatment and some aspects of the use of enzyme replacement therapy and hematopoietic stem cell transplantation are presented. A variety of options for surgical correction of pathology at the craniovertebral level have been demonstrated in patients with different types of mucopolysaccharidosis, however the described recommendations can be considered from the point of view of traditions of the hospitals or personal experience of surgeons, but not as recognized standards of treatment this pathology. Further accumulation of individual observations or clinical series is required to conduct a comparative analysis of the effectiveness of various approaches on a sufficiently large and homogeneous material to determine standards for the diagnosis and treatment of craniovertebral junction pathology in patients with mucopolysaccharidoses.

New method for surgical treatment of pancreatic head cysts

Aim. To evaluate the clinical efficacy of a new method for drainage of pancreatic head cysts. Materials and methods. The results of treatment of 3 patients with pancreatic head cysts were analyzed in a new way. In all patients, cysts developed against the background of recurrent pancreatitis; the etiology of pancreatitis was alimentary. All cysts were located in the pancreatic head, mainly on its posterior surface, communicating with the ductal system. Results. No intra- and postoperative complications were revealed. Patients were discharged from hospital on the 8–12th day after surgery. In all observations, good results were obtained: no pain syndrome reported; psychological status and food intake normalized. α-amylase in urine and plasma has not increased. No recurrence of cysts and no hospitalizations for acute pancreatitis were reported. Conclusion. The developed method for treating pancreatic head cysts communicating with the ductal system proved to be physiological, low-traumatic and can be used in surgical practice.

ЛАПАРОСКОПИЧЕСКОЕ УДАЛЕНИЕ КИСТЫ ЗАБРЮШИННОГО ПРОСТРАНСТВА С РЕЗЕКЦИЕЙ И ПЛАСТИКОЙ ДИАФРАГМЫ

Background. Due to some challenges in diagnosis and surgical decision-making of retroperitoneal tumor-like masses, their treatment is regarded as a current issue in surgery. Objective. To demonstrate surgical treatment outcomes of a patient with a retroperitoneal tumor. Material and methods. The article presents our own clinical observation of a surgical removal of a tumor-like retroperitoneal tissue mass on the right with diaphragm resection as well as drainage of the pleural and abdominal cavities. Results. Based on laboratory and instrumental studies, the patient was clinically diagnosed with Chronic calculous cholecystitis as well as Parasitic cyst of the right liver lobe. A tumor-like posterolateral wall mass, about 5 cm in diameter, located retroperitoneally and associated with the right dome of the diaphragm was visualized intraoperatively. Laparoscopic removal of the mass within healthy tissues with resection and plastic of the right diaphragm dome was performed. The patient was discharged in a satisfactory condition, without complaints, for further outpatient follow-up by a surgeon at his place of residence. There were no repeated clinic visits or readmissions. Conclusions. The clinical observation indicating difficulty in diagnosis of retroperitoneal tumors in the preoperative period, it should be taken into consideration when planning surgery. When choosing a surgical treatment method, priority should be given to modern minimally invasive interventions, even in case of adjacent organs involvement.

Academician Fyodor Grigorievich Uglov (1904–2008)

An outstanding surgeon, a prominent scientist, a teacher, a talented leader, Academician of the USSR Academy of Medical Sciences (1967), Academician of the Russian Academy of Sciences (1991), Winner of the Lenin Prize (1961), winner of the international prize of the Holy All-Laudable Apostle Andrew the First-Called and the Center of National Glory of Russia «For Faith and Fidelity» with the award of the Order of Andrew the First-Called on a blue moire ribbon (2003), laureate of the Academician A. N. Bakulev Prize (2004), Professor Fyodor Grigorievich Uglov was born on October 5, 1904 in the village of Chuguevo, Kirensky district, Irkutsk region. In 1923, Fyodor Grigorievich entered Irkutsk University, then transferred to Saratov University and graduated with honors in 1929. He studied at the internship at the clinic of Professor V. A. Oppel (1931–1933). In 1937, he entered the postgraduate course of the Department of Surgery of the Leningrad State Institute for Advanced Medical Training named after S. M. Kirov. He defended his PhD thesis in 1939 and his doctoral dissertation in 1949. Fyodor Grigoryevich Uglov worked at the Department of the Academician N. N. Petrov until 1950. The next 58 years of Fyodor Grigoryevich’s working activity was associated with the Medical University named after Academician I. P. Pavlov (1 LMI, Pavlov University). During this period of time, he performed unique operations, developed new methods of surgical treatment of diseases in almost all sections of surgery. Being an excellent teacher, Fyodor Grigoryevich Uglov brought up excellent surgeons. Many of them became doctors of sciences, academicians, and heads of surgical departments. Fyodor Grigoryevich also founded a bright school of thoracic and cardiac surgeons.. Academician F. G. Uglov died on June 22, 2008 and was buried on June 25, 2008 at the Nikolsky Cemetery at the Alexander Nevsky Lavra in St. Petersburg.

Alternative method for surgical treatment of a semi-impacted lower third molar – a case report

Alternative method for surgical treatment of a semi-impacted lower third molar – a case report

Better Local Disease Control With Mastectomy in Metaplastic Breast Carcinoma: Findings of a Retrospective Cohort.

Metaplastic breast cancer (MBC) is a rare type of breast carcinoma with clinicopathological differences. The prognosis and treatment strategies for MBC are usually conflicting. In this study, we aim to present the clinicopathologic features, treatment strategies, and prognosis of our MBC patients. In our retrospective study, 18 metaplastic breast cancer patients treated in our institution between January 2005 and December 2022 were evaluated. Demographic and clinicopathological characteristics, surgical and systemic treatment options, locoregional recurrences, distant metastases, and overall survival (OS) of the MBC patients were retrieved from the patient files. All patients were female; the median age was 54.42 ± 12.37 years. Most of the patients (n = 15, 83.33%) presented with palpable masses. Tumors were mostly triple-negative, with a high grade and a high Ki‑67 proliferation index. Spindle cell carcinoma and MBC with mesenchymal differentiation were the most common subtypes. Most of the patients underwent mastectomy (n = 11, 61.11%); breast-conserving surgery (BCS) was performed on seven (38,88%) patients. Lymph node positivity was detected in six of 18 patients (33.33%). Fewer patients (n = 4, 22.22%) received neoadjuvant chemotherapy. While local recurrence developed in two out of seven patients (28.57%) who underwent BCS, there was no local recurrence in patients who had mastectomy. The OS time varied according to tumor size and the presence of lymph node metastases (p <0.001; p = 0.005). Metaplastic breast cancer is genetically heterogeneous and resistant to conventional treatment strategies. Mastectomy is still the surgical treatment method that is performed more frequently and provides better local control for patients with metaplastic breast cancer.

Comparative assessment of structural changes in the prostate after bipolar plasma and thulium fiber laser enucleation of benign prostatic hyperplasia

Background. Benign prostatic hyperplasia (BPH) is a common disease in older men. Transurethral surgery in BPH is the gold standard for treatment, but the techniques differ in the energy used. Considering the different mechanisms of action of bipolar plasma and thulium fiber laser energy on prostate tissue, the study of structural changes under their influence is relevant.The aim. To study the features of structural changes in the prostate during bipolar plasma and thulium fiber laser enucleation of benign prostatic hyperplasia.Methods. Thirty one patients with BPH were divided into two groups. Group 1 (n = 17) underwent transurethral plasma enucleation of the prostate; Group 2 (n = 14) underwent transurethral thulium fiber laser enucleation. Fragments of the surgical prostate capsule were collected intraoperatively and were processed according to standard examination protocols using light and electron microscopy. The width of coagulation necrosis, the relief of the dissection line, the severity of cell and the prostate intercellular matrix destruction were taken into account.Results. Studies have shown the clinical and functional perioperative homology of the compared methods of surgical treatment of BPH. Data from light and electron prostate microscopy showed a greater damaging effect of bipolar plasma energy, which is manifested by a larger width of the zone of coagulation necrosis, a torn and raised appearance of the dissection line, and pronounced integrity violations of cellular elements and intercellular matrix components. Laser exposure causes less pronounced changes, which indicates a more gentle effect of the thulium fiber laser on the prostate components.Conclusion. The obtained microscopy results indicate that the intraoperative action of a thulium fiber laser is less traumatic for the cells and intercellular matrix of the surgical prostate capsule compared to bipolar plasma exposure.

Long term follow up on treatment of hallux sesamoid fracture with temporary first metatarsal joint internal fixation

Fracture of the hallucial sesamoids is a pathology that causes difficulty for surgeons and patients. Because of the low incidence and the fact that up to 64–90 % heal with non-operative management, there is a lack of clear guidance in the literature for the surgical treatment of sesamoid fracture in cases of failure of non-operative management. Here long term follow up of an alternative method of surgical treatment of sesamoid fracture recalcitrant to nonoperative management is presented.32 individuals were treated with temporary surgical immobilisation of the 1st metatarsophalangeal joint using either crossed wires or two orthogonally placed two hole plates. The patients then underwent removal of the construct at 8 weeks post op after confirmation of healing on a CT scan. There was a 94 % union rate. Return to work was 61 days (15–90) return to sport 80 days (64–112) with no immediate complications and no recurrence. At last follow up mean 10 years (4–16) only 2 patients had gone on to asymptomatic non-union and one patient developed arthritis between the sesamoid and the metatarsal head. No patient has required further surgical intervention.This retrospective cohort of patients demonstrate that this method of treatment is a valuable option in the management of sesamoid fracture which does not alter the biomechanics of the foot and has none of the long term complications of sesamoidectomy or partial sesamoidectomy.

Modern methods of treatment of anal stenosis

Objective. To develop and put into practice a new combined method of anal stenosis surgical treatment based on laser plastic surgery of tissues with a diode laser. Assess the effectiveness of the technique based on the analysis of immediate and long-term results, postoperative complications, peculiarities of technical implementation, and features of the quality of patients` life. Materials and methods. The study involved 68 patients with anal stricture after the anal and (or) rectal surgery. All patients underwent laser correction of postoperative scar tissue. According to indications, botulinum toxin was injected into the internal sphincter and (or) PRP autoplasma perarectally. Surgery was performed under intravenous anesthesia with the addition of tumescent anesthesia or local anesthesia. Laser radiation from a diode device with a wavelength of 1.56 microns and a power of 10 W was applied. Results. There are no restrictions on laser correction of anal stenosis regardless of the type and complexity of anal stenosis, it is technically easy to use, minimizes the risk of postoperative complications and relapse of the disease, and has a highly effective treatment result. Conclusions. The technique is characterized by versatility and ease of use, highly effective results, high quality of patients` life, and it can be used routinely on an outpatient basis.

Minimally invasive method of surgical treatment of Peyronie's disease

Objective. To improve the results of surgical treatment of Peyronie's disease. Materials and methods. 20 patients with Peyronie's disease aged 22 to 60 were treated in the urological departments of the Private Clinical Hospital “Russian Railways Medicine” and Astrakhan City Clinical Hospital No. 3 named after. C.M. Kirov. A method of surgical treatment of Peyronie's disease using a shortening technique without opening the tunica albuginea includes the application of a pressure tourniquet to the base of the penis, puncture of the cavernous bodies, injection of sterile saline into them until an erection is achieved, determination of the angle of curvature of the penis, removal of the tourniquet and surgery to eliminate curvature of the penis. Results. Neither postoperative complications nor formation of hematomas were observed. The patients were discharged on the 4th day in satisfactory condition. 1.5 years` observation showed no progression of angular deformation of the penis which could impede sexual intercourse. The mobility of the skin of the penis was preserved. Conclusions. In addition to the correction of penile deformity, our method eliminates the need for extensive incisions and preserves the physiological functions of the penis. As a result of using this surgical method, the following goals are achieved: minimal trauma to tissues in the surgical area, absence of scar processes in the plastic area and preservation of the skin of the penis mobility, absence of pronounced postoperative tissue edema, no need to drain the wound, reduction of the duration of the operation and minimal blood loss, short postoperative and rehabilitation period.

Problems of treating facial nerve paresis after removal of vestibulocochlear neurinoma

Surgical treatment of facial paralysis after removal of tumors of the posterior cranial fossa and lateral part of the base of the skull remains a relevant issue and one of the most difficult problems in modern medicine and neurosurgery. Severe dysfunction of the facial nerve, accompanied by cosmetic, functional, and psychological disorders, is the cause of social maladjustment of patients. Based on current literature, the article provides an overview of various methods of surgical treatment of this pathology aimed at restoring facial expressions and symmetry.

Chemotherapy for cervical cancer and contraception: discussion issues and clinical case

Cervical cancer occupies one of the leading places in the structure of oncological diseases of the Female Reproductive System. In the treatment of this pathology, along with the surgical method of treatment, chemotherapy and radiation therapy are used. According to clinical guidelines, in the presence of cervical cancer stages IIB–IIIA, it is allowed to carry out 2–4 cycles of neoadjuvant chemotherapy in order to create conditions for the possibility of performing extended hysterectomy according to Meigs. Pregnancy during chemotherapy is unique and extremely rare.The article presents a clinical case of pregnancy during chemotherapy (performed according to the scheme: taxanes and platinum-containing drugs) in a 27-year-old patient. According to the clinical picture and results of cervical biopsy, the diagnosis was made: invasive nonkeratinizing squamous cell carcinoma of the cervix IIB (cT2bNxM0) G2, right-sided parametric variant, nonspecific (with unspecified HPV status). Taking into account the presence of parametrial infiltration, the age of the patient, the oncological council prescribed from 2 to 4 cycles of chemotherapy according to the TC scheme (paclitaxel, carboplatin) with an interval assessment. After the second cycle of chemotherapy, an early pregnancy was diagnosed – a medical abortion was performed. Against the background of 3 cycles of chemotherapy, the conditions for surgical treatment were formed – surgical treatment was performed in the amount of extended hysterectomy according to Meigs (type III according to Piver/C2 Morrow) with transposition of the ovaries. The postoperative period was uneventful; the patient was discharged in a satisfactory condition.The described case of pregnancy on the background of chemotherapy is of scientific and practical interest, initiating a discussion on the need to counsel such patients regarding reliable contraception, taking into account the eligibility criteria, which will avoid undesirable outcomes during cancer treatment.

Clinical case of median arcuate ligament syndrome in the practice of a pediatric surgeon

Recurrent abdominal pain in childhood and adolescence may be indicative of chronic mesenteric ischemia with median arcuate ligament syndrome as a result of compression of the celiac artery by the median arcuate ligament of the diaphragm and its internal crura, neurofibrous tissue of the celiac plexus. The presence of symptoms characteristic of various diseases of gastrointestinal tract organs, absence of pathognomonic signs and complex approach in diagnostics of abdominal cavity vascular system, insufficient awareness of specialists of children’s outpatient clinics determine the urgency of timely diagnostics and treatment of patients with this pathology. Median arcuate ligament syndrome, or Dunbar syndrome, is more often a congenital malformation. This syndrome can be considered as an acquired pathology in the case of compression of the celiac artery by enlarged lymph nodes and neurofibrous tissue of the celiac plexus. In addition to hemodynamically significant disorders of blood supply to the gastrointestinal tract, Dunbar syndrome in children and adolescents is also accompanied by psycho-emotional disorders due to the presence of unstable stools, recurrent abdominal pain, and often repeated ineffective requests for medical care. Clinical observation, methods of diagnosis and surgical treatment of median arcuate ligament syndrome in a 14-year-old patient are presented in the study.

Surgical Management for a Giant Hydatid Cyst of the Lung using Hugon Technique

Human echinococcosis is a zoonosis caused by Echinococcus Granulosis. It occurs in rural regions where sheep and goat farming is widespread like Algeria. It constitutes a real public health problem. The lung occupies the second location after liver. The managment of pulmonary hydatid cyst is essentially surgical. In giant and large pulmonary hydatid cysts, pulmonary resection is the usual method of surgical treatment. We report a case of a patient presenting with a giant hydatid cyst of the lung and treated surgically by Hugon technique which is a conservative technique and consists of enucleation of the cyst.

Intramedullary stabilization of dislocated clavicle fractures with a compression rod

Despite the favorable prognosis of conservative treatment for clavicle fractures, unsatisfactory consequences reach 10–30 % cases. Surgical methods of treatment for dislocated clavicle fractures, such as osteosynthesis with a plate or an elastic titanium rod, are mostly used in practice. The disadvantage of the latter is the possible migration of the implant with perforation of the skin. The purpose was to study the effectiveness of an intramedullary rod, improved by us, for osteosynthesis of dislocated clavicle fractures type OTA 15A and OTA 15B according to the AO/ASIF classification. The essence of the improvement was the possibility of closed minimally invasive intramedullary osteosynthesis of the clavicle body, with a simplified technique of the surgical intervention itself, prevention of implant migration. The latter was achieved by the fact that one of the ends of the rod had a drill, which eliminated the need for predrilling the medullary cavity of the clavicle to insert the rod, and its opposite end had a thread onto which a nut is screwed to achieve compression between the clavicular fragments. Forty-two patients with closed dislocated clavicle fractures were under supervision in the clinic of traumatology and orthopedics of Kyiv City Clinical Hospital 6. They underwent intramedullary osteosynthesis for clavicle fractures with an improved compressing rod (closed in 28 cases, open in 14) under regional anesthesia. In dyna-mics of the postoperative period, a clinical and radiological examination was performed, the severity of the pain syndrome and the function of the upper limb were assessed according to the visual analog scale (VAS), Disability of Arm, Shoulder and Hand (DASH). As shown by the results of X-ray examinations, the average period of clavicle fracture union was 10.1 ± 1.4 weeks (range 8–12 weeks). During the observation of the patients, favorable dynamics on the VAS and DASH were noted; by the end of the study (12 months after the operation), the functional capabilities of the upper limb on the DASH corresponded to 1.54 ± 0.84 points, VAS score was 9.60 ± 2.11 points. The improved construction of the intramedullary rod for osteosynthesis of dislocated clavicle fractures of the OTA 15A and OTA 15B type can be recommended for use in practice, as it has demonstrated favorable clinical, radiological, and functional outcomes.

Surgical methods of treatment for tibial diaphyseal fractures

Background. Bone fractures are a public health concern. In recent years, there has been an upward trend in body weight of people of all age groups. Obesity has long been thought to help protect against fractures, but recent studies have shown that for every 5 cm increase in waist circumference, the risk of any fracture is 3 % higher. The purpose: according to the meta-analysis of modern medical literature, to determine the main directions of surgical treatment for long bone fractures, their advantages, and disadvantages, including in overweight patients, the features of diaphyseal fracture fixation in overweight patients. Materials and methods. A meta-analysis of special literature from scientific databases was conducted: Cochrane Library, Scopus, National Library of Medicine — National Institutes of Health, ReLAB-HS Rehabilitation Resources Repository. One hundred and thirty articles were analyzed, from them 31 were selected, which, in our opinion, reflect the purpose of the study. Results. All methods of surgical fixation of fractures have their advantages and disadvantages. The frequency of nonunions caused by intramedullary fixation of the femoral shaft can reach 10 %, and varus/valgus and rotational deformities and shortening can also be observed. But the use of locking screws prevents the occurrence of most complications. When fixing the fractures with plates, the main complications are related to superficial and deep infections, which were more often observed in overweight patients. The analysis demonstrated that in overweight and obese patients, the main complicating factor is not the method for fixing the fracture zone, but factors related to the health of the patient himself. So, despite the fact that the results of treatment of fractures in patients with normal weight and obesity did not have a statistically significant difference, an increase in cardiovascular complications, exacerbation of chronic respiratory diseases was observed. Moreover, it is the presence of concomitant diseases that often makes surgical intervention impossible. Conclusions. There is a large amount of research on surgical methods of fixing tibial diaphyseal fractures, but data on the choice of fixation method in overweight and obese patients as a separate approach were not found. There are data on complicating factors of excess weight in the treatment of fractures and surgical interventions. Systematic studies related specifically to the algorithm for choosing the method of fracture fixation and complications have also not been found.

An Updated Review on the Diaphragmatic Hernia in Bovines

An Updated Review on the Diaphragmatic Hernia in Bovines