Surgical Treatment Of Patients Research Articles

DYNAMICS OF MORPHOFUNCTIONAL PARAMETERS OF RESISTANT DIABETIC MACULAR EDEMA AFTER SURGICAL TREATMENT

Anti-angiogenic injections are currently established as the «gold standard» for treating diabetic macular edema (DME). Vitreoretinal surgery is indicated in cases involving an epiretinal membrane or vitreoretinal traction syndrome. Some physicians consider it feasible to perform vitrectomy with the removal of the internal limiting membrane in patients with this condition.The objective of this study is to assess changes in the morphofunctional parameters of the retina in patients with resistant forms of DME who have undergone surgical intervention. At the N.I. Pirogov National Medical and Surgical Center, 75 patients diagnosed with DME unresponsive to conservative therapy (anti-vascular proliferation therapy, retinal laser coagulation) were operated on. All patients were divided into three groups based on the type of intervention.Evaluation of best-corrected visual acuity after surgery revealed a statistically significant improvement in this parameter among patients in the second and third groups compared to those in the first group six months post-operation. Patients in the third group showed a notable reduction in retinal thickness in the foveal area one month after the intervention. A significant decrease in edema was observed in patients from the second and third groups compared to those in the first group over the period from one month to one year. When assessing light sensitivity, a significant improvement in parameters was noted in patients from the second and third groups compared to the data from the first group one week after the surgery.The results confirm the high effectiveness of vitreoretinal surgical intervention in patients with resistant diabetic macular edema, affirming the possibility of selecting a surgical approach.

THE IMPORTANCE OF REMOVING THE INNER BOUNDARY MEMBRANE IN THE TREATMENT OF DIABETIC MACULAR EDEMA: A SERIES OF CLINICAL CASES

Vitreoretinal surgery (VRH) is recognized as the preferred method of treating diabetic macular edema (DMO), concomitant with additional pathology of the vitreomacular interface (VMI). Empirical data obtained as a result of numerous studies give contradictory results, therefore, the need for peeling of the internal limiting membrane (VPM) remains unresolved.Purpose. To find out the results of surgical intervention in patients with DMO as a result of epimacular fibrosis (EMF) by comparing cases with and without HPV peeling.Materials and methods. This manuscript presents a comparative assessment of three clinical cases. The patients had similar clinical manifestations and historical medical data. In all cases, patients underwent HRH for DMO combined with EMF. In two cases, the VPM was peeled, and in the third case, the VPM was preserved.Results. An analysis of the observational data and an assessment of anatomical and functional parameters revealed complications in the first and second patients at the late postoperative stage, while in the third patient the condition stabilized. Conclusion. The presented clinical cases show that anatomical and functional results are not always correlated. The increased risk of complications associated with a violation of the architecture and functionality of the retina during peeling requires a critical assessment of the clinical justification of this method.

Sexual outcomes following the surgical treatment of traumatic rupture of the corpora cavernosa.

Penile fracture is a post-traumatic condition affecting the tunica albuginea of the corpora cavernosa when erect. Clinical diagnosis and urgent surgical intervention are crucial to avoid severe functional complications, particularly erectile dysfunction. We aimed to evaluate male sexual function after surgical treatment in patients with penile fracture and to identify predictive factors of postoperative erectile dysfunction. We underwent a hospital-based retrospective study on patients who underwent surgical repair for fractures of the corpora cavernosa between 2012 and 2023. Included in this study were all patients who have a postoperative follow-up of at least 12 months. Patients were clinically evaluated for the presence of erectile dysfunction and the presence of postoperative penile curvature. The patients were asked to answer the structured questionnaire of the International Index of Erectile Function (IIEF-15). We included 87 patients. The mean age was 38 ± 12years. Fourteen patients (16%) developed a fibrous plaque, with a median onset time of 30days postoperatively. Erectile dysfunction was noted in forty-four patients (51%). Active smoking (p < 0.002), the surgical approach (p = 0.02), a consultation time > 7.5h (p = 0.01), a length of the discontinuity of the corpora cavernosa > 2.5cm (p = 0.01) and the use of an erection inhibitor postoperatively (p = 0.021) were independent predictive factors of erectile dysfunction at 1 year postoperatively. Considering the results of our study, we propose rapid and urgent surgical management for penile fractures, and an elective surgical approach may be considered. We emphasize the fundamental role of sexual education, especially for young people, in preventing this sexual accident that could negatively impact their sexual life.

Study of the effectiveness factors of microsurgical treatment of cerebral arterial aneurysms

BACKGROUND: Despite improvements in diagnostic methods and microsurgical techniques for treating arterial aneurysms of the cerebral vessels, there remains a high probability of mortality and persistent disability among the working population. AIM: To determine the factors influencing the effectiveness of surgical interventions in patients with cerebral arterial aneurysms. MATERIALS AND METHODS: This scientific work presents the results of examination and surgical treatment of 86 patients operated on from 2017 to 2023 y. at the Neurosurgery Clinic of the National Hospital. The age of the patients ranged from 23 to 78 years (average age - 47±1.7 years), among them there were 48 (55.8%) men, 38 (44.2%) women. All patients underwent MRI or CT angiography of cerebral vessels; in 47 (54.6%) patients, cerebral aneurysm was confirmed by selective cerebral angiography. The size of the aneurysms ranged from miliary (3.0 mm to giant sizes 25.0-30.0 mm). RESULTS: The clinical picture of patients with ruptured arterial aneurysms was associated with the prevalence of subarachnoid hemorrhage, the location and volume of formed intracerebral hematomas in patients in the pre-hemorrhagic period with unruptured aneurysms - with the location and size of arterial aneurysms. One of the serious complications that arose during operations was intraoperative rupture (15.1%) of the aneurysmal sac at different stages of operations. The worst results with mortality up to 4.17% were observed in patients with ruptured arterial aneurysms, on the HH scale III, IV and 7-8, 9-10 points on the Glasgow scale. In cases where direct access to the aneurysm is difficult, it is advisable to perform subpial microresection of the altered medulla around the aneurysm. This allows you to avoid traumatic damage to the walls of the aneurysm and the development of spasm of arterial vessels. In order to avoid aneurysm rupture when isolating the aneurysm neck, it is advisable to temporarily apply special removable (temporary) clips to the proximal and distal segments of the supporting vessel of the aneurysm. After it was possible to isolate the neck of the aneurysm, a special clip was applied and, if possible, the patency and integrity of the vessel carrying the aneurysm and its branches were preserved. To determine the absence of blood flow in the aneurysm and assess the patency of arterial vessels, it is recommended to use intraoperative microvascular doplefography. CONCLUSION: The results of surgical treatment for ruptured aneurysms depended on the preoperative condition of the patients. Microsurgical clipping of arterial aneurysms effectively prevents the risk of recurrent subarachnoid hemorrhage. The absence of complications in patients during surgery and the early postoperative period does not guarantee the possibility of developing delayed complications that may require repeated operations.

Physical justification of the safety of using a surgical laser with a wavelength of 445nm during stapedoplasty

Abstract Introduction. Surgical lasers with different wavelengths are used in the surgical treatment of patients with otosclerosis. There are undoubted advantages of using surgical lasers during stapedoplasty at its various stages. At the same time, there is a risk of negative consequences for the structures of the inner ear due to the transition of light energy into thermal energy. Currently, the search for modern optimal surgical lasers for stapedoplasty continues. Aim ofthe study. To substantiate the safety of using a laser beam with a wavelength of 445nm during stapedoplasty using an experimental physical model. Materials and methods. Together with physicists from the Russian Engineering Club LLC, a physical experimental model was created to theoretically substantiate the use of a surgical laser with a wavelength of 445nm during stapedoplasty at its various stages. Results. Based on the physical calculations carried out during our study, we came to important conclusions regarding the effect of laser radiation on the structures of the inner ear during the stapedoplasty process. It was found that even if the value of the parasitic (damaging) radiation energy is 10 W (maximum value) with an average pulse duration used for perforation of the footplate of the stirrup is 0.15 s, then its effect will not lead to any significant thermal effect on the perilymph. Conclusions. The obtained data serve as a basis for further research and improvement of laser technologies in the field of otosurgery. As part of our study, we anticipate the need for additional histological analysis based on the results obtained. Despite encouraging findings regarding the safety of parasitic laser radiation in the context of thermal exposure to perilymph, histological examination represents an important next step for a deeper understanding of structural changes in the tissues of the inner ear.

Condylar Volumetric Asymmetry Predicts Need for Surgical Intervention in Patients With Cleft Lip and/or Palate.

In this study, the authors investigate the associations between the mandibular condyle and facial asymmetry in patients with cleft lip and/or palate (CLP). Condylar volume was calculated by measuring the bony volume of the posterior mandible superior to the sigmoid notch in skeletally mature patients with CLP and controls. Relationships between condylar asymmetry, facial deviation, and malocclusion were compared using t-tests, correlation analysis, and receiver operating characteristic curves. This study included 118 patients: 60 with CLP preparing for orthognathic surgery, 17 with CLP who did not undergo orthognathic surgery, and 41 controls. Condylar volumes in patients with CLP preparing for orthognathic surgery were more asymmetric than those with CLP not requiring surgery (16.4 ± 17.4% vs 7.1 ± 6.0%, P = 0.03). Patients with CLP who did not undergo orthognathic surgery and controls had similar degrees of condylar asymmetry (7.1 ± 6.0% vs 5.9 ± 3.8%, P = 0.35). Condylar asymmetry correlated with chin deviation (P < 0.01). Patients with CLP and clinically significant chin deviation (>4mm) had more asymmetric condyles than those without significant chin deviation, and the chin usually deviated toward the smaller condyle (P = 0.03). Condylar asymmetry >11% predicted undergoing orthognathic surgery in CLP with 70% sensitivity and 67% specificity. Condylar asymmetry is associated with facial asymmetry in patients with CLP, and the facial midline often deviates towards the smaller condyle. Condylar volumetric asymmetry in patients with CLP may be a predictor for needing orthognathic surgery, useful information for surgeons and families alike.

Photodynamic therapy – modern views and innovations in dentistry

Photodynamic therapy (PDT) consists of three elements: a photosensitizer, light and oxygen. The photosensitizer has the property of selective accumulation in target tissues without harming healthy cells. This innovative therapeutic method has already been successfully adapted in many areas of medicine, such as dermatology, gynecology, urology and oncology. PDT is also beginning to be introduced in dentistry. The antibacterial and fungicidal properties of the photosensitizer are used to achieve better results in the medical and surgical treatment of patients. Objective. To analyze current scientifi data on the application of photodynamic therapy (PDT) in various fi of dentistry, evaluate its effectiveness, and assess prospects for development. Materials and methods. A review of recent scientifi literature was conducted, including original studies, systematic reviews, and meta-analyses focused on PDT application in dentistry. Data on mechanisms of action, clinical efficacy, and new developments in PDT were analyzed. Results. High effi of PDT was established in the treatment of periodontal diseases, peri-implantitis, endodontic infections, and oral oncological diseases. Advantages of combined application of PDT with other treatment methods were noted. Promising directions for PDT development were identifi including the creation of new photosensitizers and technological innovations in equipment. Conclusions. PDT is a promising treatment method in dentistry, demonstrating high efficacyand safety. Further research is aimed at optimizing treatment protocols, developing personalized approaches, and integrating PDT with other modern technologies.

Augmentation cystoplasty in children with neuropathic bladder: long-term outcomes after 30 years experience.

Augmentation cystoplasty (AC) is a useful alternative for the treatment of neuropathic bladder, although there are few studies reporting long-term results. We assess our experience over the last 30-years. A retrospective study was conducted in patients with neuropathic bladder in whom AC was performed in our institution between 1990-2020. Demographic variables, pre- and post- AC urodynamic studies, long-term outcomes and postoperative complications were collected. Eighty-six patients (43 males and 43 females) underwent AC surgery with a median age of 12.8 years (interquartile range 9.6-15.1). Bladder augmentation was performed with ileum in 49 cases (57%), sigma in 32 cases (37.2%) and ureter in 5 cases (5.8%). In 27 patients an artificial urinary sphincter (AUS) was placed at the same intervention. The mean preoperative bladder capacity was 117 mL (SD 40), which was increased to 430 mL (SD 64) one year after surgery, this difference being statistically significant (P<0.001). Median follow-up was 24.5 years (interquartile range 17.5-26). Vesico-ureteral reflux improved after AC in 78.9% with no other surgical interventions. Seven mechanical complications associated with AUS were reported. Bladder lithiasis was reported in 9 patients. No bladder perforations were described. One patient developed bladder squamous cell carcinoma 16 years after AC, requiring radical cystectomy and Hautmann neobladder. Long-term results of this study demonstrate that AC is an effective surgical treatment in patients with neuropathic bladder patients without proper response to medical treatment. The risk of developing complications long after bladder augmentation makes close clinical follow-up of these patients essential.

Safety and efficacy of combined acetabular reconstruction and microwave ablation in the treatment of periacetabular metastatic disease: a retrospective clinical evaluation.

The periacetabular bone defects caused by metastatic disease often necessitate acetabular reconstruction and various techniques have been employed with varying degrees of success. The purpose of this study was to evaluate the efficacy and safety of acetabular reconstruction in conjunction with adjuvant microwave ablation as a surgical intervention for patients with periacetabular metastases. Between January 2019 and September 2023, 17 consecutive patients with different tumor subtypes required surgical intervention for periacetabular metastases. The acetabular reconstruction was performed by utilizing an acetabular reconstructive cage and cement total hip arthroplasty with microwave ablation. A retrospective review was performed to assess pain relief, intraoperative details and postoperative complications. Functional status following procedures was determined by the 1993 Musculoskeletal Tumor Society (MSTS) score and the overall survival of patients was estimated by Kaplan-Meier analysis. In total, 8 males and 9 females were included with an average age of 48.6 years (range 34-66). Patients reported a significant improvement in the level of pain and the mean VAS score declined from 7.7 preoperatively to 2.2 postoperatively. Of the 17 patients, 16 could ambulate either independently (6 patients) or using a walking aid (10 patients) with a mean MSTS score of 18.9. The median follow-up was 9.0 months. Nine patients were alive at the most recent follow-up with overall survival of 40.9% at 12 months and 30.7% at 36 months, respectively. In selected patients with periacetabular metastasis, the utilization of an acetabular cage and cement total hip arthroplasty presents a less invasive reconstruction technique. The incorporation of adjuvant microwave ablation has shown promise in providing long-lasting pain relief, reducing intraoperative bleeding, and improving local tumor control. However, further research and extended follow-up are necessary to establish the effectiveness of this procedure.

Intra-arterial chemoembolization as a component of neoadjuvant treatment of rectal cancer. Literature review

Interventional oncology is a rapidly evolving field of cancer treatment. Minimally invasive techniques, such as transarterial embolization with chemotherapeutic and radioactive agents, are common treatments and are found in many guidelines for the treatment of primary and metastatic liver lesions. It is known that the growth and development of a malignant neoplasm is primarily determined by angiogenesis. Rapid growth is ensured where the formation is directly related to the arterial bed. Therefore, when the drug is injected into the target vessel and providing tissue ischemia, it is possible to achieve a high degree of tumor pathomorphosis. This technique has an advantage for patients who, in some cases, cannot be treated surgically, and also increases the effectiveness of the chemotherapeutic effect. With the advent of necessary equipment in hospitals and the accumulation of experience in the use of minimally invasive interventions, it became possible to implement a new method of treating tumors of various localizations. In this review, we consider the results of domestic and foreign authors on the topic of intra-arterial chemoembolization before surgical treatment in patients with rectal cancer. It is noted that the analysis of the literature revealed a small number of works devoted to the chosen topic, despite the relevance of this problem for modern oncology.

A real-world evidence study of interhospital variability in the surgical treatment of patients with benign prostatic hyperplasia: the REVALURO study.

Lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) is a growing condition in males associated with a high clinical, economic and humanistic burden. Several surgical techniques are available for the treatment of LUTS/BPH; thus, the aim of this study was to describe and explore the variability in the use of surgical procedures among Spanish hospitals. The REVALURO was a retrospective, observational study conducted by collecting data from the clinical records of patients with LUTS/BPH aged ≥ 35years, from 5 national reference hospitals, who were surgically treated between 2018 and 2022. Among the 3038 patients who underwent 3084 surgeries, 66% were invasive (2018: 57.5%, 2022: 71.5%), 22% were minimally invasive (MISTs) (2018: 20.7%, 2022: 20.2%) and 12% were highly invasive (2018: 21.8%, 2022: 8.4%). A total of 22.4% of patients' complications, with a maximum incidence of 28.6% (open prostatectomy) and a minimum 0.8% (water vapor thermal therapy (WVTT)] (p < 0.001). The reintervention rate was 1.5% over the study period. The median length of hospital stay after surgery increased from 0days (interquartile range [IQR]: 0) with WVTT to 5days (IQR: 4-8) with open prostatectomy (p < 0.001). Trends in surgical treatment showed that the use of invasive techniques increased, while the use of highly invasive techniques decreased, and the use of MISTs remained constant. However, given the heterogeneity among hospitals, national clinical guidelines and recommendations are needed to guide the decision on which technique should be used and to homogenize the criteria.

Machine Learning Predicts the Need for Surgical Intervention in Adhesive Small Bowel Obstruction.

To explore the predictive performance on the need for surgical intervention in patients with adhesive small bowel obstruction (ASBO) using machine-learning (ML) algorithms and investigate the optimal timing for transition to surgery. One hundred and six patients with ASBO who initially underwent long transnasal intestinal tube (LT) decompression were enrolled in this retrospective study. Traditional logistic regression analysis and ML algorithms were used to evaluate the risk of need for surgical intervention. Non-operative management (NOM) by LT decompression failed in 28 patients (26%). Multivariate logistic regression analysis identified a drainage volume ≥665 ml via LT on day 1, interval between ASBO diagnosis and LT intubation, and small bowel dilatation at 48 h after LT intubation to be independent predictors of transition to surgery (odds ratios 7.10, 1.42, and 19.81, respectively; 95% confidence intervals 1.63-30.94, 1.00-2.02, and 3.04-129.10; P-values 0.009, 0.047, and 0.002). The random forest algorithm showed the best predictive performance of five ML algorithms tested, with an area under the curve of 0.889, accuracy of 0.864, and precision of 0.667 in the test set. 97.4% of patients without transition to surgery (n=78) had passes of first flatus until three days. This is the first study to demonstrate that ML algorithm can predict the need for surgery in patients with ASBO. The guideline recommended period for initial NOM of 72 h seems to be reasonable. These findings can be used to develop a framework for earlier clinical decision-making in these patients.

Investigating the long-term outcomes and efficacy of surgical intervention in patients with adolescent idiopathic scoliosis and Cobb angles ranging between 40 and 50 degrees.

Patients with adolescent idiopathic scoliosis (AIS) are either managed with non-operative strategies or surgery depending on the severity of lateral curvature and impact on quality of life. However, supportive evidence for the appropriate treatment approach is lacking in AIS patients with Cobb angles between 40 and 50 degrees. Therefore, we investigated differences in long-term patient-centered outcomes in AIS patients with Cobb angles between 40 and 50 degrees who received either operative or non-operative management. A total of 919 patients aged 10-21years old with adolescent idiopathic scoliosis and 40-50 degree Cobb angles were identified from the HARMS Study Group (HSG) registry and dichotomized based on operative or non-operative management. Baseline and 2year follow-up SRS-22 scores from these patients were analyzed for significant differences between the total score values, domain values, and the magnitude of score change over time using multiple comparisons analyses. Multivariable regressions adjusting for age, body mass index, location of spinal deformity, and management strategy were also performed. Operative versus non-operative strategy was significantly, independently associated with differences in SRS-22 total and domain scores over time (effect likelihood ratio test, p < 0.03 for all regressions). Operatively managed patients had significantly greater improvement in SRS-22 total and domain scores over the follow-up duration compared to non-operatively managed patients (p < 0.02 for all comparisons). This preliminary analysis suggests that operatively managed patients may have had better long-term outcomes than non-operatively managed patients within this AIS subpopulation. These findings support the need for further prospective investigation to determine the optimal management strategy to improve evidence-based, patient-reported outcomes for AIS patients with Cobb angles between 40 and 50 degrees. Level III.

Detachment of a Guidewire Tip as an Intraoperative Complication during Revascularization of Chronic Coronary Artery Occlusion: A Clinical Case

Introduction. Cardiovascular diseases occupy a leading position in the structure of mortality in the world. In particular, coronary heart disease causes mortality in 48% of cases among cardiovascular diseases. Surgical treatment of patients with coronary heart disease is aimed at eliminating stenotic or occlusive lesions in the coronary arteries by heart bypass and/or percutaneous coronary intervention with stenting. The success rate of the procedure accounts for about 85%. In the remaining 15%, revascularization fails to achieve its goal, which may be caused, among other things, by a pronounced calcification of the occlusive segment of the coronary artery. Aim: to demonstrate the development of one of complications after revascularization of chronic coronary artery occlusion and a method for its elimination. Materials and methods. The paper demonstrates a clinical case of an 86­year­old patient with coronary heart disease treated in a non­emergency hospital. Coronary angiography revealed a multivessel lesion. Coronary artery bypass grafting was recommended after an intraoperative consultation with a cardiologist and a vascular surgeon. The next day, the patient underwent emergency coronary angiography in order to revascularize chronic occlusion. Results and discussion. The patient underwent attempted revascularization of chronic calcified occlusion, which resulted in such a complication as deformities and “detachment” of the distal tip of the guidewire. This complication was resolved with the help of a trifold snare and the creative and cold­blooded thinking of the operating surgeon. Conclusion. The clinical case shows that, despite any encouraging statistical success rate, the operating surgeon should be ready for possible intraoperative complications. The key to solving this problem lies in the availability of modern medical tools for coronary interventions, as well as in relevant experience of an operating surgeon and creativity in making certain decisions.

Classical surgical treatment of acute pleural empyema

Objective. To determine the need for open surgical treatment in patients with acute pleural empyema with and without the use of video thoracoscopic rehabilitation interventions. Materials and methods. We analyzed the results of treatment of 426 patients with acute pleural empyema in the period 2008–2022, of whom 109 (25.6%) required open surgery after pleural cavity rehabilitation. Results. This study allowed us to form an idea of the need for open surgery at different periods from the beginning of complex treatment of acute pleural empyema, the nature and extent of surgical interventions, complications and their consequences. Conclusions. The need for operations such as pneumonectomy and pleuropneumonectomy after the rehabilitation of the pleural cavity in acute pleural empyema remains at the level of 3.6–6.9%.

Efficacy and safety of short segment pedicle screw fixation in patients with neurologically intact burst fractures of the lower thoracic and lumbar spine: a meta-analysis of studies published over the last 20 years

Objective. To conduct a systematic review and meta-analysis of studies on the surgical treatment of patients with uncomplicated burst fractures of the lower thoracic and lumbar spine and to determine the effectiveness and safety of short transpedicular fixation (TPF) in this patient group.Material and Methods. The study included articles with the following criteria: publication date from January 1, 2004, to December 31, 2023; patient sample descriptions involving uncomplicated burst fractures from T10 to L5; TPF involving one segment adjacent to the fractured vertebra in both cranial and caudal directions without spinal fusion; descriptions of treatment outcomes or complications; and an average follow-up period of at least 12 months. Meta-analysis was conducted using the Comprehensive Meta-Analysis software, version 2.2.064. Depending on the level of heterogeneity (I² test), either a fixed-effects or random-effects model was applied. Begg’s or Egger’s test was used to assess publication bias, and any bias present was corrected using the trim-and-fill method.Results. The application of TPF resulted in a significant reduction in the overall Cobb angle by 5.9 degrees in the percutaneous group and by 7.6 degrees when using a midline approach. Regarding AVBCR (anterior vertebral body compression ratio), a reduction of 24.0 % and 24.8 % was observed in both groups, respectively. The overall complication rates were as follows: superficial infection, 2.2 %; deep infection, 2.0 %; and implant-associated complications, 5.6 %. No patient developed a neurological deficit. The levels of work adaptation W1 and W2 on the Denis scale were achieved in 70.9 % of patients. The overall quality of life, as measured by the Oswestry Disability Index, averaged 13.4 %.Conclusions. Short transpedicular fixation without additional spinal fusion or laminectomy appears to be an effective and safe method for treating burst fractures of the lower thoracic and lumbar spine without neurological deficits. This method allows for regression of kyphotic deformity in the long-term post-injury period by at least 5.9 degrees and restoration of anterior vertebral height by 24 %. The approach demonstrated relatively low overall postoperative complication rates. More than 90 % of patients were able to return to full-time work, either in their previous position or with reduced physical demands.

Immediate and Long-Term Results of Portacaval Shunt Surgeries in Portal Hypertension: 10-Year Clinical Experience of a Regional Vascular Surgery Department

INTRODUCTION: The number of patients with liver cirrhosis (LC) makes 20–40 cases per 100 thousand populations and rises steadily. A five-year survival rate of patients with LC in the compensation stage is 50%–62%, in the decompensation stage — 11%–40%. In the overwhelming majority of patients (80%–90%), LC leads to the compensatory formation of esophageal and gastric varices (EV and GV, respectively), which is further complicated with a life-threatening bleeding in 30% of patients. AIM: To evaluate 5-year results of partial portacaval shunt surgeries. MATERIALS AND METHODS: The paper describes a 10-year clinical experience of the vascular surgery department of Yaroslavl Regional Clinical Hospital in surgical treatment of patients with LC with a clinical presentation of portal hypertension, with recorded esophageal and gastric variceal bleeding. The study included 26 patients (of them 11 men; the mean age 48 ± 7.3 years) with LC (A and B classes on Child-Pugh scale), who underwent planned reconstructive surgery on the portal system. By the type of anastomosis, the patients were divided into 3 groups: group 1 — mesocaval anastomosis (n = 6); group 2 — distal splenorenal anastomosis with preservation of spleen (n = 10); group 3 — splenorenal H-shaped shunt. The primary end points of the study were survival of the patients, rebleeding from EV, shunt patency. Secondary end points were dynamics of EV size, changes in the spleen size, dynamics of the portal and splenic veins size, blood flow directions in the portal system, the presence of hepatic encephalopathy. Postoperative mortality was 3.8%. RESULTS: Survival at 1, 3 and 5 years was 96%, 90% and 58, respectively, and patency of anastomoses was 96%, 96% and 91%, respectively. Rebleeding at 1 year made 4% (n = 1), at 3 years — 0, at 5 years — 17% (n = 2). Changes in the hemodynamics of the portal system were recorded after formation of all types of anastomoses: reduction of the diameter of the portal vein by on average 5 mm, of the splenic vein by 3 mm, of the spleen size by 210 cm3. Shunt thrombosis occurred in two of 26 patients (7.7%) at 1 year (splenorenal H-shaped shunt with use of prosthesis) and 4 years (splenorenal autovenous shunt), respectively. CONCLUSION: The formation of partial portacaval anastomoses in patients with portal hypertension and episodes of bleeding from esophageal varices is a reliable prevention of rebleeding. The first bleeding episode is an indication for an open surgery in case the transjugular intrahepatic stenting is impossible. Survival rate of patients after portacaval shunt surgeries is determined by the initial degree of hepatic failure and patency of the formed anastomoses.

Surgical treatment of chronic pancreatitis with an inflammatory pancreatic head mass: a retrospective study

BackgroundConservative treatment of chronic pancreatitis has only a limited effect in most patients. Surgery offers very good long-term results, even in the early stages of the disease. Unfortunately, only a minority of patients undergo surgical treatment. The aim of this work was to summarise the current treatment options for patients with an inflammatory mass of the pancreatic head. Data from patients in our study demonstrates that the surgery is a safe method, and here we compare the perioperative and early postoperative outcomes of patients who underwent a pancreatoduodenectomy and duodenum-preserving pancreatic head resection for chronic pancreatitis.MethodsAll patients who underwent a pancreaticoduodenectomy or a duodenum-preserving pancreatic head resection in our department between 2014 and 2022 were included in this study. Perioperative and early postoperative results were statistically analysed and compared.ResultsThirty-eight pancreaticoduodenectomies and 23 duodenum-preserving pancreatic head resections were performed. The overall mortality was 3%, whereas the in-hospital mortality after pancreaticoduodenectomy was 5%. The mortality after duodenum-preserving pancreatic head resection was 0%. No statistically significant differences in the hospital stay, blood loss, and serious morbidity were found in either surgery. Operative time was significantly shorter in the duodenum-preserving pancreatic head resection group.ConclusionsBoth pancreatoduodenectomy and duodenum-preserving pancreatic head resection are safe treatment options. Duodenum-preserving pancreatic head resection showed a statistically significant superiority in the operative time compared to pancreaticoduodenectomy. Although other monitored parameters did not show a statistically significant difference, the high risk of complications after pancreaticoduodenectomy with a mortality of 5%; maintenance of the duodenum and upper loop of jejunum, and lower risk of metabolic dysfunctions after duodenum-preserving pancreatic head resection may favour duodenum-preserving pancreatic head resection in recommended diagnoses. Attending physicians should be more encouraged to use a multidisciplinary approach to assess the suitability of surgical treatment in patients with chronic pancreatitis.

Proximal Hamstring Avulsions: Surgical Versus Conservative Treatment Using a Shared Decision-Making Strategy

Background: Surgical treatment of patients with proximal hamstring avulsions provides good results; however, less is known about the outcome in patients who are offered conservative treatment. Purpose: To investigate the effect of surgical or conservative treatment (decided by a shared decision strategy) of proximal hamstring avulsions. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 24 patients with magnetic resonance imaging–verified proximal hamstring avulsion were included and had either surgical treatment (11 patients, 45% women; mean age, 50 ± 16 years) or conservative treatment (13 patients, 46% women; mean age, 50 ± 17 years). At baseline, 6 months and 12 months, all patients answered the Perth Hamstring Assessment Tool (PHAT) (0-100 scale) and Hip Sports Activity Scale (0-8 scale). Patients had their maximal hip extension strength and maximal strength at 30° and 90° of knee flexion measured in newton meters per kilogram using a handheld dynamometer. A minimal important change in PHAT was considered &gt;7 points and a minimal important change in strength was considered &gt;0.15 N·m/kg, respectively. Results: The surgical group had a shorter time from injury to initiation of treatment compared with the conservative group (median: 15 vs 64 days; P = .02). The surgical group had a greater amount of retraction of the tendons compared with the conservative group (3 vs 2 cm; P = .04). From baseline to 12-month follow-up, the surgical and conservative groups improved their mean PHAT scores (35 points [95 CI, 24-45 points] and 20 points [95% CI, 9-31 points], respectively) reaching a median of 79 points (interquartile range [IQR], 66-95 points) in the surgical group and 75 points (IQR, 66-85 points) in the conservative group at the 12-month follow-up. Their Hip Sports Activity Scale levels at 12 months were 3 points (95% CI, 1-4 points) and 1 point (95% CI, 0-3 points) (not significant). Furthermore, the surgical and conservative groups improved their maximal hip extension strength by 0.61 N·m/kg (IQR, 0.42-0.80 N·m/kg) and 0.62 N·m/kg (IQR, 0.13-1.10 N·m/kg), respectively. Their maximal knee flexion strength at 30° improved by 0.52 N·m/kg (IQR, 0.29-0.74 N·m/kg) and 0.32 N·m/kg (IQR, 0.12-0.52 N·m/kg) and their maximal knee flexion strength at 90° improved by 0.28 N·m/kg (IQR, 0.19-0.37 N·m/kg) and 0.22 N·m/kg (IQR, 0.02-0.41 N·m/kg). At the 12-month follow-up, the side-to-side difference in maximal muscle strength was 6% and 7%, respectively, during hip extension and 19% to 25% and 16% to 17%, respectively, during knee flexion. Conclusion: Twelve months after treatment of proximal hamstring avulsion, good clinical outcomes were seen when using a shared decision strategy regardless of whether the strategy led to surgical or conservative treatment.

Subjective and objective evaluation of nasal obstruction in patients treated at the Hospital de Clínicas, Paraguay

Nasal obstruction is characterized by insufficient airflow and increased resistance in the nasal cavities, affecting patients’ quality of life and sleep. This study aims to compare the efficacy of medical and surgical treatment in patients with Nasal obstruction, using subjective evaluations (NOSE and VAS scales) and objective evaluations (active anterior rhinomanometry). This is an experimental and prospective longitudinal study conducted at the Hospital de Clínicas, Paraguay. Forty patients with Nasal obstruction were included, divided into medical treatment (nasal corticosteroids) and surgical treatment (turbinoplasty, septoplasty, or both) groups. Pre- and post-treatment evaluations were performed using the NOSE and VAS scales, and active anterior rhinomanometry. The sample included 52.5% men and 47.5% women, with an average age of 32.18±11.59 years. The main cause of Nasal obstruction was chronic rhinitis (62.5%). Treatments showed significant improvements in subjective and objective evaluations. In the medical group, VAS improved by 2.63 points in women and 2.00 in men, while the surgical group showed more pronounced improvements. The NOSE also showed significant reductions, especially in patients undergoing combined turbinoplasty and septoplasty. Active anterior rhinomanometry reflected an increase in overall nasal flow in all treated groups. Both medical and surgical treatments are effective in improving Nasal obstruction, with greater benefits observed in surgical treatments. Subjective and objective evaluations are valuable and complementary tools for assessing treatment in patients with Nasal obstruction. These results highlight the importance of a comprehensive evaluation in the management of Nasal obstruction.