Method Of Surgical Treatment Research Articles

Karydakis versus marsupialization – short-term comparative outcomes of intergluteal pilonidal disease treatment in men

Background: Intergluteal pilonidal disease (IPD) is a common chronic disease occurring in the natal cleft of the sacrococcygeal region. This disease may drastically decrease the quality of life, and lead to incapacity for work for up to several months. Various treatment methods are described in the literature, however, each of the methods has its privileges and disadvantages, and no final recommendations are available regarding a superior surgical treatment method. The present study aimed to contribute to filling the gap in the knowledge regarding the superiority of the available surgical techniques used in the treatment of IPD. Methods: The short-term outcomes of two surgical treatment options for IPD, namely the Karydakis procedure (n = 32) and the Marsupialization technique (n = 33), were retrospectively compared. The duration of complete scar formation, the rate of short-term postoperative complications, the persistence of postoperative pain and the recurrence rate during 3-month postoperative follow-up were investigated. The study was based on a retrospective analysis of data extracted from medical records of adult male patients treated for IPD. Results: The Karydakis procedure was found to be superior in terms of all the abovementioned parameters, except for the rate of short-term postoperative complications, where the two surgical techniques showed comparable results. Conclusions: The results of this retrospective study suggest that marsupialization technique could be mostly replaced by the Karydakis procedure in surgical practice. The latter appears to be associated with a faster return to daily activities and more cost effective.

Оцінка виразності післяопераційного набряку мошонки в дітей з патологією вагінального відростка очеревини при різних методах лікування

Congenital malformations, the cause of which is a disturbance of the obliteration of the vaginal process of the peritoneum, such as an inguinal hernia, hydrocele testis, occupy one of the leading places among childhood diseases. This explains the continuation of scientific observations and the analysis of various methods of treatment of patients with lesions of the vaginal process of the peritoneum. Researchers note the possibility of certain complications among male patients, such as swelling of the scrotum, postoperative hydrocele testis, iatrogenic retraction of the testicle (acquired cryptorchidism). This became the reason for additional study of such a complication as postoperative swelling of the scrotum. Purpose - to analyze the severity of postoperative swelling of the scrotum depending on the methods of surgical correction of the pathology in patients with nonoblitereted vaginal process of the peritoneum. Materials and methods. 91 children who underwent surgical correction of the pathology of nonobliterated vaginal process of the peritoneum (inguinal hernias, hydrocele testis) participated in the conducted scientific study. Patients were assessed for postoperative swelling of the scrotum depending on the method of surgical correction of the pathology. Results. The degree of postoperative swelling of the scrotum in patients with pathology of the vaginal process of the peritoneum is directly proportional to the severity of tissue injury during surgical correction in patients with nonoblitereted vaginal process of the peritoneum. Conclusions. Any surgical intervention entails certain consequences that are associated with a violation of the integrity of the body. And although these complications are temporary, a qualitative assessment of their severity can become the basis for choosing a particular method of surgical treatment. The obtained data show the severity of postoperative swelling of the scrotum and the dynamics of its changes depending on access for surgical manipulation. The less soft tissue is injured to access the internal inguinal ring, the smaller the postoperative swelling and the better its dynamics. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

Management of Persistent Syringomyelia in Patients Operated for Chiari Malformation Type 1

The treatment of persistent syringomyelia associated with Chiari malformation type 1 (CM1) is unclear. This study aims to evaluate the clinical and radiologic outcomes of syringo-subarachnoid shunt (SSS) as a treatment for persistent syringomyelia following posterior fossa decompression (PFD) for CM1. Forty-nine cases treated for CM1 associated syringomyelia at a single center were analyzed, 17 of them undergoing reoperation due to persistent syrinx formation. The patients' demographic data, neurologic presentations, and radiologic results were analyzed, including cerebellar herniation, posterior fossa volume, the level at which the syrinx started and finished, the size and diameter of the syrinx. Seventeen patients underwent SSS placement, with 1 minor surgical complication (a cerebrospinal fluid leak) occurring and requiring revision. No morbidity or mortality was observed. Among these 17 reoperated patients, partial or complete resorption of the syrinx was observed in all cases. The results suggest that if the syrinx diameter is >10 mm at its thickest point, extends for more than 10 vertebrae, and starts from the upper cervical region and extends to the upper thoracic region, the syrinx may not regress after the first surgery and potentially predicting the need for a second operation before PFD. SSS placement for persistent syrinx following PFD for CM1 is a safe and effective surgical treatment method. These criteria may also help predict the need for a second surgery and the overall disease outcome for both the surgeon and patient.

Surgical Treatment of Varicose Veins of the Lower Extremities

The review presents an analysis of relevant literature on the surgical treatment of varicose veins of the lower extremities. Modern methods of surgical intervention for varicose veins are considered: open operations, methods of thermal ablation of the main veins, non-thermal non-tumescent methods, vein-preserving surgery (ASVAL), methods of treating reflux in perforating veins and recurrent varicose veins. The effectiveness of each of the surgical treatment methods used was analyzed. The frequency of relapses and the likelihood of complications of the described operations are considered. All surgical treatment methods presented in the review were developed on the basis of modern ideas about the pathogenesis of varicose veins, the mechanisms of formation of chronic venous insufficiency, and have an evidence base. These techniques are reflected in the latest clinical guidelines and are widely used in medical practice.

LARGE INTESTINES COMPLICATED DIVERTICULITIS MODERN TREATMENT TACTICS USING VIDEOENDOSCOPIC EQUIPMENT

Abstract. Colonic diverticular disease (CDD) is an important problem in abdominal surgery for the majority countries of the world. The incidence of CDD is, unfortunately, progressing. The CDD relevance is determined by medical and economic aspects taking into account the disease frequent cases in working age persons. The tactics of CDD treatment is considered to be traditional and is determined according to the generally accepted modifi ed disease classifi cation according to E. J. Hinchey. Using daily the tactics of a personalized approach to patients we agree with the opinion of our colleagues and consider the choice of sigmoid colon acute diverticulitis and its complications optimal method of diagnosis and surgical treatment to be still arguing. Having considerable experience and treating patients with CDD for a long time, we try to use mostly the laparoscopic approach in surgical tactics the eff ectiveness of which we intend to summarize.The purpose. To determine the eff ectiveness of the laparoscopic method of surgical treatment of patients with CDD complicated clinical manifestation. Research material and methods. The treatment of 221 patients with 263 surgical interventions due to CDD and its complications was analyzed. CDD complicated forms were diagnosed in 186 (84.5 %) patients. 164 (62.4 %) operations were performed urgently, 102 (61.7 %) of which were performed using videoendoscopic equipment, 62 (38.3 %) were performed using the traditional open method. Open operations performed under urgent indications. Special attention was attracted to patients with bleeding as CDD complication. 9 patients (in 6 with initial intestinal bleeding and in 3 with CDD complicated by profuse bleeding) underwent operative treatment. All patients were treated in one stage.Results and their discussion. According to planned indications, 26 laparoscopic and 31 open resections of the large intestine were performed due to CDD. The source of infl ammation was localized in the sigmoid colon in all patients. Infl ammation of one diverticulum occurred in 56 (98.4 %) cases, two diverticulies – in 1 (1.6 %) observation. 49 patients were treated in 2 stages. Perforation of the diverticulum wall was detected in 79 (51.6 %) patients. The duration of operative treatment of patients with complicated CDD using videoendoscopic equipment was 73.4±6.2 min. The index of bed days duration with laparoscopic operations was 6.1±0.7. The patients’ stay in the hospital after scheduled videoendoscopic operations was 6.3±1.6 days. From 9 patients with bleeding in the absence of conservative therapy effi cacy and under the condition of the patient’s stable condition, 4 patients underwent laparoscopic left-sided hemicolectomy. Open surgical interventions were performed in 5 patients, mostly elderly and with severe concomitant pathology.Conclusions. In case of patients with a CDD complicated course treatment we consider a two-stage treatment preferable, when the second stage (left-sided hemicolectomy) is performed in a planned manner within 9 days to 6 months after the operation for urgent indications. Patients with complicated CDD operative treatment is better to be performed with the use of videoendoscopic equipment. It is better to perform repeated planned radical operations for CDD laparoscopically, which is evidenced by a lower number of complications. The use of laparoscopic technologies in case of colonic bleeding treatment as CDD complication is a promising direction in abdominal surgery and requires its e ffi ciency further study.

Minimally Invasive Endoscopic Interventions in the Treatment for Traumatic Intracranial Hematomas

Traumatic brain injuries are a global problem, with more than 50 million people suffering from brain injuries every year. A frequent consequence of severe traumatic brain injury is intracranial hematoma (ICH), causing mortality, disability, post-traumatic epilepsy. ICH has different clinical manifestations and physical characteristics. Standard treatment for ICH includes conservative monitoring for small volume hematomas or surgical evacuation of the hematoma. Craniotomy is often used to remove hematomas, because acute and subacute hematomas contain clots, and drainage of the hematoma cavity alone is not enough. In chronic hematomas, drainage through a hole is usually used, but this is effective only if the hematoma is represented by one cavity and its contents are completely liquid, which is not always the case. Thus, widely used techniques do not always meet modern requirements for effectiveness and low invasiveness of surgical treatment.The review considers endoscopic methods of surgical treatment for all variants of traumatic ICH; 31 publications have been found on this topic, mentioning 602 interventions. Differences in patient selection criteria make it difficult to compare the methods and outcomes. From the technical point of view, the procedures were also very diverse. The article analyzes the main features of different authors’ methods.None of the authors comes to the conclusion about outcome worsening after endoscopic intervention. With regard to acute and subacute hematomas, there are currently no reliable statistical data, but the results obtained can generally be assessed as positive.In acute and subacute hematomas, endoscopic intervention is perceived by the authors not as providing more opportunities, but only as a less invasive replacement for conventional craniotomy. In chronic hematomas, endoscopic intervention is considered to have more opportunities and advantages over the standard treatment.At present, the widespread use of endoscopic minimally invasive methods of surgical treatment for traumatic hematomas is hampered mainly by the lack of clear criteria for selecting patients and well-established methods of intervention. More high-quality research is needed to determine the role of these methods in general clinical practice.

Features of Angioarchitectonics of Uterus in Uterine Leiomyoma: a Series of Clinical Observations

INTRODUCTION: One of most important problems in the gynecological practice is the choice of the treatment method of uterine leiomyoma. Uterine artery embolization has been practiced in the Republic of Tatarstan (Kazan), since 2004. Individual peculiarities of blood supply to the uterus and ovaries become the cause of failure of the endovascular treatment of patients with uterine leiomyoma in 20%–25% of cases forcing the doctors to resort to traditional surgical methods. The article presents a series of clinical cases demonstrating variants of angioarchitectonics of uterus and the results of the analysis of uterine artery embolization (UAE, n = 1743) performed at the department of X-ray surgical methods of diagnostics and treatment in the Primary healthcare unit of Kazan (Privolzhsk) Federal University.
 CONCLUSION: Endovascular occlusion of uterine arteries in patients with uterine myoma is a fairly effective method of treatment of this disease, and an adequate assessment of the peculiarities of the angioarchitectonics of uterus in uterine myoma permits to considerably increase the effectiveness of treatment and reduce the frequency of complications. The presented series of clinical observations from the clinical archive of the authors’ team demonstrates the variants of angioarchitectonics of uterus.

Comparison of surgical outcomes of degenerative spondylolisthesis with open or minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF)

Introduction. One of the most commonly used surgical treatment methods for degenerative lumbar spondylolisthesis (DLS) is transforaminal lumbar interbody fusion (TLIF). It can be performed either with an open classic posterior midline approach or the minimally invasive (MIS) method using Wiltse paraspinal intermuscular accesses. Aim. To prospectively compare clinical and radiological outcomes of DLS treatment with open (O) or (MIS) TLIF. Materials and methods. Forty six surgically treated patients who met the study criteria were divided into two groups according to the access method used: O group – 24 patients, MIS group – 22 patients. Clinical and radiological outcomes were evaluated before and after the surgery and after the follow-up period in both groups. The clinical peri and postoperative parameters and complications, back and leg pain with the VAS scale, and the outcomes in the ODI scale were evaluated. Radiological outcomes were measured with the standing X-ray images in the AP and lateral projections, as well as MRI/CT and functional X-rays. During statistical comparisons, both groups were adjusted in terms of pre-operative and postoperative data. Results. Preoperative demographic data in both groups did not differ significantly, except for the follow–up period, which was longer for the O group (mean 33.2 months), and 19.5 months for the MIS group. Both VAS and ODI clinical outcomes improved in both groups. Patients from the MIS group achieved significantly better clinical results immediately after the procedure and in the early outcomes. After the follow–up period, no significant differences were found. In the MIS group, only blood loss and the length of the postoperative stay were significantly lower than in the O group. The X-ray doses were significantly higher in the MIS group. Postoperative X-ray parameters improved in both groups with no significant differences, except for the slip correction, which was better in the O group. Conclusions. Both TLIF methods lead to significant clinical and radiological improvement in patients with DLS. In certain aspects, MIS has advantages over the “open” TLIF technique in the surgical treatment of degenerative spondylolisthesis.

Efficiency of surgical treatment methods for chronic tonsillitis in a comparative perspective

Background: Tonsillectomy is a common surgical procedure performed for various indications, and different techniques have been developed for its execution. One such method is coblation, which utilizes controlled radiofrequency energy to remove tonsil tissue. In this study, we compared coblation with a new monopolar electrosurgical extracapsular tonsillectomy technique. Methods: A prospective clinical investigation was conducted at the Department of Otorhinolaryngology and Pediatric Otorhinolaryngology at the "Happy Life" Clinic. The study included 45 patients aged 6–18 years who had undergone extracapsular coblation and monopolar electrosurgical tonsillectomy for chronic tonsillitis. Data regarding age, gender, disease duration, operation duration, estimated intraoperative blood loss, postoperative pain assessment, post-tonsillectomy hemorrhage (PTH), and complications were collected. Results: Coblation exhibited significantly lower average pain scores than the monopolar technique on the first (p < 0.001) and second postoperative days (p = 0.02). However, pain assessments were comparable at all other time points. The monopolar group had significantly shorter operation times (16.09 ± 6.53 minutes) compared to the coblation group (20.12 ± 5.12 minutes, p < 0.001). Intraoperative blood loss did not significantly differ between the groups (p = 0.39). PTH occurred in 6 patients (13.3%) and required surgical intervention. Secondary PTH rates were 4.44% (2/45) and 2.2% (1/45) in the coblation and monopolar therapy groups, respectively (p < 0.001). Conclusion: Coblation and the new monopolar electrosurgical extracapsular tonsillectomy exhibited similar postoperative pain outcomes, except for the first and second postoperative days. Nevertheless, the monopolar technique provides substantial advantages with shorter operation times, reduced secondary PTH risk, and cost-effectiveness, making it a preferred choice, particularly in resource-constrained settings.

Characteristics of surgical treatment methods for umbilical hernias

Umbilical hernias in surgery are no less relevant than hernias of other localizations. The results of surgical treatment of 317 patients with umbilical hernias are presented. 213 patients (67.2 %) were operated on as an emergency, and 104 (32.8 %) — as planned. Surgical interventions for strangulated hernias were performed in accordance with the principles of emergency abdominal surgery. When examining the patients of the last group, the level of intra-abdominal pressure and blood lactate were taken into account. An informative method for studying the condition of tissues in the area of the hernial orifice is ultrasound. When selecting a method of surgical treatment, its criteria are the size of the hernial orifice, the state of the aponeurosis, and in emergency conditions — the degree of ischemic disorders of the strangulated organ and the severity of intra-abdominal hypertension. A differentiated approach to the choice of hernioplasty for umbilical hernias and the wider use of additional strengthening methods using mesh endoprostheses allow obtaining good results after surgical treatment.

Classic techniques used in laser microsurgery of chronic diseases of the larynx: a literature review

The topicality of the issue of treating chronic diseases of the larynx is beyond dispute. Given the increased load on the vocal apparatus, no downward trend in disease incidence is observed. The percentage of patient visits to an otorhinolaryngologist with complaints of prolonged changes in voice timbre, vocal fatigue, and difficulties with voice control is 7–12%. Chronic productive formations of the larynx account for up to 55–70% of pathologies in the proliferative upper respiratory disease pattern. If not treated promptly, chronic diseases of the larynx can significantly affect a person’s ability to speak, swallow and breathe normally. Today, various methods for surgical treatment of chronic diseases of the larynx are used: both classical cold instruments and high-energy laser systems. The history of laser medicine dates from the late 1960s and is associated with the introduction of a high-intensity device emitting a photon stream in the infrared range into medical practice. The first carbon dioxide lasers were difficult to use (they were large in size and had complex technical settings), but at the same time they showed high resection and coagulation qualities, and it earned them their popularity. Over 3 thousand new laser devices representing a practical interest for laryngeal surgery have appeared on the medical market for more than 60-year period. Despite the fact that fundamental research demonstrates the positive results of phonosurgery with high-power devices, many otolaryngologists continue be in awe of lasers. The article presents the results of the use of traditional devices in phonosurgery for chronic diseases of the larynx and draws conclusions about the effectiveness and safety of high-power devices.

Modern approaches to the diagnosis and treatment of patients with non-muscle-invasive bladder cancer

The review article discusses modern methods for diagnosing and treating patients with non-muscle-invasive bladder cancer. The search and analysis of information was carried out in the databases PubMed, Google Scholar, eLibrary. Information about photodynamic diagnostics, narrow-band imaging, mono- and bipolar transurethral resection, transurethral thulium and holmium laser resection, en-bloc resection of neoplasms, Nd:YAG laser ablation of the tumor bed is presented. The features, advantages and disadvantages of each of these methods, as well as their combinations and modifications are described in detail. Particular attention is paid to the use of laser technologies in the surgical treatment of patients with non-muscle-invasive bladder cancer. An analysis of the results of studies of the efficacy and safety of various methods of surgical treatment of non-muscle-invasive bladder cancer was carried out. The significance of the problem of increasing the efficiency of treatment of such patients, which is one of the priority areas of modern oncourology, is indicated.

Kuban School of Thought in Thoracic Surgery: History of Its Formation and Development

Introduction: The article discusses formation and development of the Kuban school of thought in thoracic surgery. We reviewed the main aspects of the accumulation of knowledge and experience in thoracic surgery and formation of a scientific association of thoracic surgeons that further developed into a school of thought first regionally, then internationally.Objective: To analyze the main stages of the development of the Kuban school of thought in thoracic surgery through the prism of scholars who made major contributions to the formation of the school’s research concept, as well as through succession (transfer of scientific and medical experience).Materials and methods: Our methodology involved a comparative historical analysis of the most important stages of the development of the school of thought in thoracic surgery, a retrospective evaluation of the contributions made by the surgeons who transformed the surgical community, and a comprehensive analysis of research materials on this subject. We used retrospective, biographical, analytical, and comparative research methods.Results: We identified the fundamental trends in the development of the Kuban school of thought in thoracic surgery, key directions for improving the methods of chest pathology diagnosis and surgical treatment that have been forming in the Kuban over the past 100 years.The education and training of staff, as well as formation of a scientific medical community and its international integration clearly demonstrated the transformation dynamics of the Krasnodar Krai’s research potential in thoracic surgery.

Surgical Treatment Methods for Tricuspid Valve Infective Endocarditis

Introduction: In recent years, there has been a significant increase in the incidence of tricuspid valve infective endocarditis (IE), which is associated with both the increased number of invasive examinations and procedures and the high rates of intravenous drug use. The initial treatment for tricuspid valve IE was surgical removal of the focus of infection and restoration of intracardiac hemodynamics.Reconstructive surgery aimed at preserving the valve is the preferred method of surgical treatment. If a valve-­preserving operation is not possible due to significant valvular apparatus destruction, implantation of artificial heart valves (both mechanical and biological) is the method of choice.Objective: To analyze the results of reconstructive valve-­preserving surgery and tricuspid valve replacement for tricuspid valve IE treatment.Materials and methods: In the Scientific Research Institute – Specialized Cardiac Surgery Clinical Hospital named after Academician B.A. Korolev (Nizhny Novgorod, Russian Federation) 110 patients underwent surgery for tricuspid valve IE. Primary surgery was performed in 97 patients, and 13 patients underwent repeated surgery. The patients were divided into 2 groups based on the chosen surgical method for correcting tricuspid valve disease. Group 1 included 62 patients who successfully underwent tricuspid valve replacement: mechanical prostheses in 10 patients and biological prostheses in 52 patients. Group 2 included 38 patients who underwent reconstructive valve­preserving surgery. All patients underwent De Vega annuloplasty. In 10 patients it was directly associated with bicuspidalization of the tricuspid valve and plastic surgery of intact leaflets. Two patients had suture annuloplasty of the tricuspid valve based on the modified technique. In 2 of 3 patients, an infected right atrial thrombus was removed. Three patients underwent removal of the left ventricular wall abscess and aortic valve replacement for critical stenosis. After translocation of the chords, triangular resection of the anterior leaflet was performed to separate the chord of the left side of the chest and the myxoma of the right and left chest.Results: In the early postoperative period, no valve­related complications were observed in group 1. The most common nonlethal complication was a third­-degree atrioventricular block. Multiple organ dysfunction syndrome occurred in 3 patients; cardiac tamponade was reported in 2 patients, and 1 patient had postoperative bleeding that required resternotomy for serous mediastinitis in the mid­term period and reosteosynthesis. At the hospital stage, 1 patient from group 1 died, whereas there were no deaths in group 2. In­-hospital mortality in the groups of operated patients was 0.9%.Functional ultrasound imaging findings in the postoperative period show that patients from group 1 had the peak gradient across the prosthetic tricuspid valve of 9.4 ± 1.8 mm Hg, while the mean gradient was 5.8 ± 1.75 mm Hg. There was a significant decrease in the estimated right ventricle pressure from 54.0 ± 16.2 to 35.0 ± 5.5 mm Hg. In group 2 tricuspid valve regurgitation was not observed in 27 patients, while mild and moderate regurgitation was reported in 8 and 3 patients, respectively. The peak gradient during the tricuspid valve reconstruction was 6.2 ± 1.7 mm Hg, while the mean gradient was 2.8 ± 0.75 mm Hg. The annulus fibrosus size during tricuspid valve annuloplasty averaged 30.8 ± 2.5 (28­33) mm. There was a decrease in the right ventricle pressure from 44.0 ± 18.4 to 32.0 ± 7.3 mm Hg. In the mid-­term follow­up, surviving patients were classified as NYHA classes I­-II. Of 110 patients discharged from the clinic, we were able to trace the fate of 69 patients, which accounted for 62.7%. In the long-­term period, 3 patients from group 1 died. Thus, long­term mortality in the general group was 2.72%.Conclusions: Reconstructive surgery has significant advantages over tricuspid valve replacement using various artificial heart valve models: lower rates of in-­hospital and long­-term mortality and specific complications, higher quality of life. Compliance with principles and methods of pathogenetic treatment of electrode­induced IE guarantees a success in the cohort of severe patients. The technique of reconstruction and restoration of tricuspid valve structures and functions in case of active tricuspid valve IE with detachment of the chords and destruction of the leaflets demonstrated high surgical efficiency.

Current State Diagnosis and Treatment of Abdominal Echinococcosis (Literature Review)

The essence of this article is about the state of diagnosis and treatment of echinococcosis of the abdominal cavity, namely the hepatoduodenal region. In this work, we studied the existing problems in the diagnosis and treatment of echinococcosis based on those studied and described in scientific works by various authors. And as sources showed us, the treatment of echinococcosis remains an incompletely resolved problem, despite a lot of work. The advantages and disadvantages of surgical interventions have been studied. The main surgical directions in the treatment of this pathology in hepatobiliary surgery, from minimally invasive interventions to traditional, radical methods of surgery, have been identified. Each method of operation made its contribution to the treatment of echinococcosis and determined its limits in application for a particular patient. Data from domestic and foreign literature have given their assessment that at the moment there is no gold standard in the treatment of echinococcosis of the hepatobiliary region. Many authors believe that the best treatment method is minimally invasive interventions, since they do not particularly affect the quality of life of patients in the long term, but there are disadvantages. Traditional methods of surgery are highly traumatic for patients, which worsens the quality of life. In this regard, the percentage of complications does not tend to decrease. As a result, it was found that there is no single gold standard for surgical treatment, which leaves the question open, relevant and requires research to develop new diagnostic algorithms, new methods of surgical treatment to improve the quality of life of patients with echinococcosis of the hepatobiliary region.

Modern view on the problems of secretory otitis media in children

Anti-inflammatory therapy as part of the treatment of exudative otitis media (EOM) that develops in rhinitis and rhinosinusitis is included in various treatment regimens. If conservative therapy for EOM is ineffective, surgical intervention in the form of various variants of adenotomy and removal of secretions from the tympanic cavity is considered. The authors selected and described in detail a clinical case of observation and treatment of EOM in a 7-year-old child, which allowed to highlight approaches to the diagnosis of the disease, assess her concomitant diseases, choose a method for surgical treatment and conservative therapy with a drug containing tuaminoheptane and acetylcysteine. Eustachian tube drainage followed by the use of an anticongestive drug to treat rhinosinusitis in a 7-year-old girl with EOM showed high effectiveness. The advantages of the drug are as follows: a direct unloading effect, the possibility of evacuation of thickening secretions from the nasal cavity and nasopharynx due to the drug containing acetylcysteine and tuaminoheptane. Thus, the tubular dysfunction in children can be associated with various reasons: inflammatory processes in the nasopharynx and paranasal sinuses (viral and bacterial infection), allergic (exposure to various allergens). EOM may develop in all types of tubular dysfunction in children. The adverse effects of long-term tympanostomy in chronic EOM has led to the search for alternatives. The long-term eustachian tube drainage can be regarded as this method. The anticongestive agent for rhinosinusitis can be used in children with EOM from the age of 6 years. The advantages of the drug include a direct unloading effect, minimal contraindications, restoration of nasal breathing without systemic exposure in frequently ill children, and the possibility of evacuation of thickening secretions from the nasal cavity and nasopharynx. In summary, an anticongestive agent containing acetylcysteine and tuaminoheptane can be recommended for use in paediatric otorhinolaryngological practice to treat acute and subacute rhinitis in children with EOM.

Neck Horn Formation After Jugular Vein Catheterization For Haemodialysis: Case Report

Background: Haemodialysis is an essential life-saving procedure for persons suffering from kidney failure. Haemodialysis is usually aceived by central venous catheterization. Neck hornformation is one of the most serious and seldom complications of the procedure.
 Case Report: A haemodialysis catheter was placed in a 43-year-old man's right internal jugular vein after his arteriovenous fistula failed. After having the catheter removed, a neck horn developed at the puncture site. Horn resection and thrombus evacuation were the surgical treatment methods used.
 Conclusion: Neck horn following an internal jugular catheter insertion might be dangerous if left untreated. The horn and thrombus are best removed surgically and treated with antibiotics.

Commentary on the publication of Yargunin S.A. et al. “Dynamics of changes in tumor-associated macrophages in patients with primary skin melanoma depending on the method of surgical treatment”

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Radical Hysterectomy or Total Mesometrial Resection-Two Anatomical Concepts for Surgical Treatment of Cancer of the Uterine Cervix.

A radical hysterectomy is the standard method of surgical treatment for patients with early-stage cancer of the uterine cervix. It was first introduced more than 100 years ago. Since then, various and many different radical procedures, which diverge in terms of radicality, have been described. Inconsistencies are clearly seen in practical anatomy, which were defined as surgically created artifacts. Moreover, the disparity of the procedure is most notable regarding the terminology of pelvic connective tissues and spaces. Despite these controversies, the procedure is widely performed and implemented in the majority of guidelines for the surgical treatment of cancer of the uterine cervix. However, a different and unique concept of surgical treatment of cervical cancer has been reported. It is based on ontogenetic anatomy and maps any tissue in the mature organism according to its embryologic development. The clinical implementation of this theory in the context of early cervical cancer is total mesometrial resection. The present article aims to describe and compare the anatomical and surgical basics of a radical hysterectomy (type C1/C2) and total mesometrial resection. Discrepancies regarding the terminology, resection lines, and surgical planes of both procedures are highlighted in detail. The surgical anatomy of the pelvic autonomic nerves and its surgical dissection is also delineated. This is the first article that compares the discrepancy of classic anatomy and ontogenic anatomy regarding surgical treatment of cancer of the uterine cervix. Clinical data, oncological outcome, and neoadjuvant and adjuvant treatment regarding both procedures are not the topic of the present article.

Клинический случай склеромаляции у пациента с ревматоидным артритом после интравитреальных вмешательств

One of the manifestations of scleritis is perforating scleromalacia (necrotizing anterior scleritis without inflammation), characterized by an almost complete absence of clinical manifestations and usually associated with systemic diseases or postoperative complications. Scleromalacia is a serious, progressive disease that is difficult to treat and can lead to vision loss, perforation and loss of the eye as an organ. Treatment of such patients requires an integrated approach together with rheumatologists and is difficult, despite the many already proposed methods of surgical treatment using various grafts and implants. The purpose of the presented clinical case is to increase the effectiveness of surgical treatment of scleromalacia by using a method of scleroplasty using an autograft of the temporal fascia using the example of patient K. with rheumatoid arthritis and a history of repeated to contents к содержанию microinvasive vitrectomy. Objective data of preoperative and postoperative diagnostics in the early and late postoperative periods are presented. The obtained result of the presented surgical treatment can be recommended as a method of treating scleromalacia in clinical practice. as well as postoperative diagnostics in the early and late postoperative periods. The obtained result of the presented surgical treatment can be recommended as a method of treating scleromalacia in clinical practice. Keywords: scleromalacia, rheumatoid arthritis, autograft, scleroplasty