Surgical Treatment Of Adult Patients Research Articles

Surgical treatment of spinal neurenteric cysts

Background. Spinal neurenteric cysts are very rare benign space-occupying lesions in the vertebral canal emerging due to anomalies of neural tube development during prenatal development of the fetus. Clinically, neurenteric cysts can manifest both in childhood and adulthood.Aim. To evaluate the results of surgical treatment of adult patients with spinal neurenteric cysts who were operated on at the Neurosurgery Division of the Clinic of Nervous System Diseases of the I.M. Sechenov First Moscow State Medical University.Materials and methods. The study group included 3 patients (2 women and 1 man) with mean age of 33 years. The main diagnosis method was magnetic resonance imaging. In all cases, radical cyst resection was performed with subsequent histological examination of cyst walls.Results. In all observations, cyst walls had local areas of increased density and thickness: a distinctive solid component accumulating the contrast agent in magnetic resonance images. This type of structure is considered extremely rare per descriptions presented in literature, but in our case series it was detected in all patients. Cyst resection led to pain syndrome regression and almost full regression of clinical manifestations of spinal cord compression which justifies active surgical tactics in this pathology.Conclusion. Neurenteric cyst of the vertebral canal can cause spinal cord compression. The main diagnostic method of this pathology is magnetic resonance imaging, however magnetic resonance semiotics of these cyst has not been standardized. The presence of constant pain syndrome without marked clinical signs of compression myelopathy is sufficient reason for cyst resection surgery. Cyst resection allowsto achieve regression of pain syndrome and neurological abnormalities caused by spinal cord compression.

Retrospective analysis of surgical treatment of adult patients with trauma and posttraumatic deformities of the middle zone of the facial skeleton

The issues of diagnosis, planning, timing and tactics of surgical treatment, possible risks of postoperative complications in patients with trauma of the middle zone of the facial skeleton have remained relevant for many years. Due to the prevalence and complexity of solving a number of problems facing specialists arising from post-traumatic deformities (PTD) in this area, the problem of treating this category of patients is not only medical, but also socio-economic. Purpose. To carry out a retrospective analysis of the data of medical documentation of adult patients with trauma and PTD of the middle zone of the facial skeleton. Material and methods. We analyzed statistical data on the provision of specialized medical care to patients with trauma and PTD of the middle zone of the facial skeleton in institutions subordinate to the Moscow Department of Health for 2021 and 2022. A sample of 32 495 medical records of patients who were hospitalized at the State Budgetary Healthcare Institution of the Department of Healthcare of the Moscow “Maxillofacial Hospital for War Veterans” was conducted from March 2015 to December 2023. Statistical processing of the obtained data from the study group of patients was carried out. Results. Information is presented on the specialized care provided to adult patients with trauma and PTD of the middle zone of the facial skeleton in institutions subordinate to the Moscow Department of Health for 2021 and 2022. Our study included 233 patients with trauma and PTD of the midfacial skeleton who underwent surgical treatment. Of these, 84.12% (n=196) were men and 15.88% (n=37) women. The average age of the patients was 35.74±11.11 years. The study group was divided into two subgroups: the 1st – patients with injuries to the bones of the midface (n=157, 67.38%), the 2nd – with PTD of the bones of the midface (n=76, 32.62%). The article presents the main characteristics of these patients. The methods of their examination at the prehospital stage are analyzed in detail; the time from the moment of injury to the moment of seeking specialized medical care; channels of hospitalization; causes of injuries; aesthetic and functional disorders as a result of injuries; types of injuries; applied methods and tactics of surgical treatment. Conclusions. The results of the study present a modern characterization of adult patients with trauma and PD of the middle zone of the facial skeleton. Recommendations are given on the use of four main fixation points during operations of metallosteosynthesis of the bones of the zygomatic complex, the need to reduce the time from the moment of injury to the moment of specialized medical care, the need for an integrated approach and treatment of patients with injuries and PTD of the bones of the middle zone of the face in specialized centers of maxillofacial-facial surgery.

Analysis of the quality of surgical care for patients with consequences of gunshot combat wounds of the maxillofacial area

One of the most pressing problems of maxillofacial surgery (MFS) is the provision of specialized medical care to the wounded and injured in combat conditions. Even more complex tasks are reconstructive surgical treatment at the stages of evacuation and the most complete rehabilitation of patients with the consequences of combat injuries to the maxillofacial area (MFA). Gunshot combat wounds of the MFA are characterized by severe anatomical and functional disorders, they can manifest themselves as significant defects and severe deformations, which in turn leads to an increase in sanitary losses of army personnel, disability of young and middle (working) age patients, a decrease in the quality of their life, long-term and expensive treatment that requires special knowledge and manual skills from specialists. All this determines not only the medical, but also the socio-economic significance of the topic of this study.Objective. Present an analysis of the quality of surgical care provided to patients with consequences of gunshot combat wounds of the MFA.Methods. The study was carried out by specialists from the State Budgetary Healthcare Institution «Maxillofacial Hospital for War Veterans» of the Moscow Department of Health, under the guidance of the chief, PhD, professor, main specialist in MFS – V.A. Belchenko, for the period from October 2022 to July 2023. Diagnosis, planning and surgical treatment of adult patients with the consequences of gunshot combat wounds of the MFA were carried out at the stages of treatment and evacuation measures. A sample of medical documentation was made, the data obtained was processed by the generally accepted statistical method. The results were analyzed and compared with data from similar studies.Results. The study group included 55 males, aged from 23 to 56 years, the average age of the patients was 36.16±7.79 years. We divided the studied patients into subgroups according to the conditional zones of damage to the MFA: 1st – upper zone of the face (n=3, 5.45%), 2nd – middle zone of the face (n=28; 50.91%), 3rd – lower zone of the face ( n=32; 58.18%). The number of patients with isolated injuries is 18.18% (n=10); with multiple – 81.81% (n=45); with combined – 72.72% (n=40). The article presents the characteristics of patients with the pathology under study, discusses some features of diagnosis and planning, discusses tactics and problems associated with the surgical stage of treatment, as well as further rehabilitation measures.Conclusion. Despite the emergence of new medical equipment, equipment for diagnostics, planning and solving complex problems of surgical intervention, there is a clear need for training specialists, developing and improving the applied medical recommendations, with a clear indication of the method of choosing tactics and methods of surgical treatment. Medical care for adult patients with the consequences of gunshot combat wounds of the MFA must be comprehensive and carried out on the basis of specialized centers, and must include both surgical and orthopedic components, which will minimize the number of errors and complications, increase the effectiveness of treatment and, as a result, make rehabilitation as complete as possible.

Endonasal endoscopic surgical treatment of craniopharyngiomas in adult patients. Our experience

Objective: to estimate the results of surgical treatment of adult patients with craniopharyngiomas (CP), who underwent endoscopic endonasal surgical treatment. Materials and methods. Treatment of 69 adult patients with CPs who underwent endonasal endoscopic surgery from 2014 to 2021 is described. Gender division: women 42% (60.9%), men 27 (39.1%). The minimum age of patients is 19 years (women 19, men 20), the maximum age is 73 years (women 73, men 66). The mean age of all patients in the group was 46.7±14.5 years, women 47.6±15.5 years, men 45.1±12.6 years. In 52 patients (75.4%) the surgical intervention was primary, and in 17 patients (24.6%) it was secondary. All patients were estimated for preoperative and postoperative endocrine and neuro-ophthalmological status in dynamics. Results. No hemorrhagic or access-associated complications have been reported. Major complications: postoperative CSF leak - 9 patients (13%), meningitis - 10 patients (14.5%), 7 out of 8 patients with CSF leak had meningitis. 7 out of 10 patients with meningitis also had CSF leak. Other complications: acute tension pneumocephalus (2 cases, 2.9%), electrolyte disturbances (45 cases, 65.2%), severe diencephalic dysfunction (SDD) (4 cases, 5.8%). The postoperative mortality rate was 3 cases (4.35%), of which 1 due to meningitis (33.3% of all deaths), due to SDD 2 cases (66.6%). The dynamic changes of visual function were as follows: improvement in 36 patients (66.7% of all patients with preoperative visual impairment), no significant change in 7 patients (13%), deterioration in 10 patients (18.5%), 4 of which were transient. 40 patients had hypopituitarism prior to surgery, 10 of whom also had diabetes insipidus. A worsening of hypopituitarism was observed in 13 patients (32.5% of all patients with preoperative hypopituitarism) and an onset of hypopituitarism in 18 patients (26.1%). The onset of diabetes insipidus in the postoperative period occurred in 23 patients (33.3%), 7 of whom with regression. Conclusions. Endonasal endoscopic approach is no longer an alternative for surgical treatment of certain forms of craniopharyngiomas, but it is a method of choice for most CP cases. The postoperative mortality is low. The quality of life of the operated patients is satisfactory due to a high percentage of improvement in visual function and preservation of endocrine function. The rates of CSF leak and purulent-septic complications correlate with the data of the world literature. Modern standards of treatment require the establishment of a multidisciplinary team of specialists in healthcare institutions to personalize the treatment process in patients with CPs.

Minimally invasive repair of pectus excavatum in adults: a review article of presentation, workup, and surgical treatment.

Pectus excavatum (Pex) is one of the most common congenital deformities of the chest wall, with pectus constituting 90% of all chest wall deformities and excavatum being reported in almost 1:400 to 1:1,000 live births with predominant occurrence in males up to five times more than in females. Depending on the severity, presentation varies from mild cosmetic complaints to life limiting cardiopulmonary symptoms. Patients may develop symptoms as they age, and these symptoms may worsen over the years. A technique for minimally invasive repair for pectus excavatum (MIRPE) was introduced with the concept of temporarily implanting metal bars to correct the deformity. This has rapidly become the standard of care for the pediatric and adolescent patients. The use of MIRPE in adults, however, has been slower to adopt and more controversial. This is largely due to the increased calcification and rigidity of the chest wall in adults which can make the repair more complex and lead to a higher risk of complications. We present a literature review of the presentation, workup, and surgical treatment of adult patients with Pex undergoing MIRPE. Adult patients can, with advanced preoperative evaluations and technique modifications, undergo a highly successful repair resulting in symptom resolution and satisfying results.

Evaluation of the results of surgical treatment of adult patients with neoplasms of the parotid salivary glands

BACKGROUND: The issues of the early differential diagnosis of patients with neoplasms of the parotid salivary glands (PSG), choice of the correct tactics of surgical treatment, tumor recurrence, and postoperative complications have remained relevant for many years.
 AIMS: To retrospectively analyze medical records of adult patients with neoplasms of the PSGs.
 MATERIALS AND METHODS: We analyzed a sample of patients who were hospitalized at the Maxillofacial Hospital for War Veterans of the Department of Health of the City of Moscow for the period from January 2017 to April 2022.
 RESULTS: The study included 302 patients (men, 38.41%; n=116; women, 61.59%; n=186). The mean age of the patients was 52.270.23 years. The study group was divided into three subgroups: the first group had benign neoplasms (n=258), the second group had malignancies (n=24), and the third group had tumor-like lesions (n=20). The article presents the main characteristics of these patients. Some features of diagnostics and planning were revealed. The authors discuss the choice of tactics of surgical techniques.
 CONCLUSIONS: Despite the significant development in diagnostic and surgical techniques, discrepancies between clinical and pathohistological diagnoses (28.15%) and unwanted postoperative complications remain relatively high.

Features of providing specialized medical care to adult patients with neoplasms of the parotid salivary glands

Introduction. For many years, the issues of diagnosis, planning and surgical treatment of adult patients with neoplasms of the parotid salivary glands (PSG) have remained relevant. Objective: to identify the features of the specialized medical care provided to adult patients with PSG neoplasms. Materials and methods. We analyzed the statistical data of specialized medical care provided to patients with PSG neoplasms in institutions of the Department of Health of the city of Moscow. To characterize the patients, a sample of medical documentation of 302 patients who were on inpatient treatment at the Maxillofacial Hospital for War Veterans was conducted for the period from January 2017 to April 2022. Results and discussion. The study group included 116 men (38.41%) and 186 women (61.59%), aged 19 to 81 years (mean age 52.27 ± 0.23 years). All patients underwent surgical intervention on the PSG with the dissection and preservation of peripheral branches of the facial nerve. As a result, the study group of patients was divided into 3 subgroups: the 1st – with benign neoplasms (n=258), the 2nd – with malignant neoplasms (n=24), the 3rd – with tumor-like lesions (n=20). Some features of diagnostics and planning are revealed, algorithm of surgical treatment are discussed. Conclusions. Despite the significant development of both diagnostic methods and surgical intervention techniques, there is a need to improve clinical recommendations and treatment protocols with a clearer indication of criteria in choosing surgical treatment. Medical care for adult patients with PSG neoplasms should be carried out on the basis of specialized centers, which will minimize the number of diagnostic errors and postoperative complications.

Efficiency of various options for surgical treatment and prevention of proximal junctional kyphosis in patients with lumbar spine deformities and concomitant osteoporosis

Objective. To conduct a comparative analysis of the effectiveness of various options for the prevention of proximal junctional kyphosis (PJK) in the surgical treatment of adult patients with deformities of the lumbar spine, including taking into account the degree of correction of the lumbar lordosis.Material and Methods. The results of instrumental fixation of the spine performed in 140 adult patients with severe frontal spinal deformity and/or sagittal imbalance corresponding to types III and IV according to Berjano and Lamartina were studied. The patients were divided into 4 clinical groups depending on the methods of surgical treatment: in 36 cases, correction of lumbar lordosis of no more than 30° was performed without the use of PJK prevention methods (Group I); in 24 – the same correction was supplemented with laminar fixation of the vertebra above the fusion zone (Group II); 20 patients underwent complete restoration of the sagittal and frontal balance with prophylactic vertebroplasty of the superjacent vertebra above the zone of instrumental fixation (Group III); and in 60 – the same intervention was performed without the use of the PJK prevention methods (Group IV).Results. Statistically significant differences in lumbar lordosis, difference in the pelvic angle and lumbar lordosis, and displacement of the sagittal vertical axis were found between the pairs of groups I and II, and III and IV. Postoperative values of the index of the proximal junctional angle (PJA) in patients of Group II differed significantly from the corresponding indicators of other groups. A statistically significant increase in the PJA after surgery was found in patients of groups III and IV. There was a statistically significant decrease in PJK cases in Group II in comparison with other groups (p = 0.001), as well as more pronounced trend to decrease in pain intensity and ODI score. Laminar fixation of the superjacent vertebra leads to a decrease in local kyphosis over the area of instrumental fixation and reduces the load on the ventral parts of the vertebra. Prophylactic vertebroplasty (Group III) provides better results compared to a comparable cohort (Group IV).Conclusion. Partial correction of lumbar lordosis (no more than 30°) and preventive laminar fixation of the superjacent vertebra showed significantly better clinical results (by more than 50 %; p = 0.001) compared with the other three clinical groups in terms of reducing the level of pain and improving the quality of life, as well as of decrease in number of cases of PJK development – by 16–28 % (p = 0.001).

Clinical course and surgical treatment in adult patients with craniofacial fibrous dysplasia. A case series

Clinical course and surgical treatment in adult patients with craniofacial fibrous dysplasia. A case series

State of the art: proximal junctional kyphosis-diagnosis, management and prevention.

Proximal junctional kyphosis (PJK) is a common problem that may occur following the surgical treatment of adult patients with spinal deformity. It is defined as the proximal junctional sagittal angle from the UIV and UVI + 2 of at least 10° AND at least 10° greater than the preop measurement. The reported incidence of radiographic PJK in the literature varies between 17 and 46%. A smaller subset of these patients may need revision surgery and are defined as proximal junctional failure (PJF), which can be associated with vertebral fracture, vertebral subluxation, failure of instrumentation, and neurological deficits. Several risk factors for development of PJK have been proposed. However, large-scale prospective studies are needed to better identify strategies to reduce the incidence of PJK.

Parapneumonic effusion and thoracic empyema in adults. Clinical aspects, microbiology and frequency of surgical outcome.

To date, information about the outcome of patients with parapneumonic effusion and empyema is limited. To describe the clinical characteristics, the microbiological study and the frequency and type of surgical treatment in adult patients with parapneumonic effusion or empyema. A prospective cross-sectional study of patients admitted with parapneumonic effusion or empyema, from August 2011 to July 2014, in a reference hospital for respiratory diseases in Mexico City, was conducted. Clinical characteristics, microbiology, risk categories for poor prognosis in empyema and frequency and type of surgical treatment were studied. We studied 284 patients whose median age was 47 years, 75% were men, and 57.7% were transferred from other hospitals. In 38.5% of the cases a microorganism was identified and there was a predominance of Gram negative. 153 (53.9%) required surgical treatment, of which 90% were thoracotomy with decortication. Hospital mortality was 5.63%. Most of the patients arrived in advanced stages of the disease, so more than half required surgery, of which 90% was decortication. It is desirable to favor mechanisms for early diagnosis and treatment to reduce the need for surgical treatment.

The Efficacy of Anti-Tumor Necrosis Factor Alpha for Symptomatic Stricturing Small Bowel Crohn's Disease.

IntroductionCrohn’s disease (CD) is a chronic inflammatory disease. Current treatment aims to prevent complications and the need for surgical intervention. In patients with symptomatic complications, such as strictures, the possible benefits of anti-tumor necrosis factor-alpha (anti-TNF-α) therapy are currently the subject of considerable debate. This study aims to determine whether anti-TNF-α therapy could decrease the need for or delay the time until surgery in patients with CD presenting with symptomatic strictures of the small bowel in the King Abdulaziz University Hospital (KAUH), Saudi Arabia.MethodsWe conducted a retrospective, single-center study that assessed the need for surgical treatment in adult patients with symptomatic stricturing CD who were treated conventionally or with TNF-α inhibitors. Simple logistic regression was used to examine the association between surgical resection and biologics therapy and stepwise elimination logistic regression analysis was used to identify predictors of surgical resection.ResultsIn total, 75 patients fulfilled the study criteria with 50 in the anti-TNF-α arm and 25 in the conventional arm. Surgical resection was required for six patients (12.2%) in the anti-TNF-α treatment arm and one patient (4%) in the conventional treatment arm (P=0.26). Endoscopic balloon dilatation was performed in two patients (4%) in the anti-TNF-α arm and one patient (4%) in the conventional arm (P=0.69). No statistically significant association was observed between surgical resection and treatment with biologic therapy (odds ratio [OR]=0.50, 95% CI: 0.16-1.53, P=0.22). Stepwise elimination identified age (OR=4.54, 95% CI: 0.79-25.11, P=0.09) and disease duration (OR=1.01, 95% CI: 1.00-1.02, P=0.004) as significant predictors of surgery.ConclusionsIn this cohort, anti-TNF-α therapy did not provide additional benefits with regards to avoiding or delaying surgery in CD patients with stricturing of the small bowel.

Surgical treatment of adult patients with thalamic tumors with the aid of tractography, fMRI, transcranial electrical stimulation and direct electrical stimulation of the subcortical white matter

The aim of investigation was to assess treatment outcomes in adult patients with thalamic tumors, operated on with the aid of tractography (DTI) and monitoring of motor evoked potentials (MEPs) generated due to transcranial electrical stimulation (TES) and direct electrical stimulation (DES) of the subcortical white matter.38 subsequent patients with thalamic tumors were operated on using tractography (DTI)-integrated neuronavigation, transcranial electrical stimulation (TES) and direct electrical stimulation (DES). The volumetric method was used to calculate pre- and postoperative tumor volume.Total tumor resection (100%) was performed in 18 (47%) patients, subtotal in 9 (24%) (mean extent of resection −89.4%) and partial in 11 (29%) patients (mean extent of resection −77.18%). The mean extent of resection for all surgical patients was 86.5%.Two (5.2%) patients died postoperatively. Preoperative hemiparesis was present in 18 (47%) patients. Postoperative hemiparesis was observed in 11 (29%) patients of whom only in 5 (13%) new paresis was noted due to surgical intervention. In patients with hemiparesis significantly more frequently larger tumor volume was detected preoperatively. Low mean normal fractional anisotropy (nFA) values in the internal capsule were observed statistically significantly more frequently in patients with preoperative hemiparesis as compared to the internal capsule of the unaffected hemisphere. Transcranial electrical stimulation helps to predict postoperative paresis of extremities. Direct electrical stimulation is an effective tool for intraoperative localization of the internal capsule thus helping to avoid postoperative deficit.In patients with tumor grade I and II the median time to tumor progression was 36 months. In the case of patients with grades III and IV it was 14 months. The median survival time in patients with grades I and II it was 60 months. In patients with grades III and IV it was 18 months. Basing on our results, patients with glioma grade I/II according to WHO classification are the best candidates for surgical treatment of thalamic tumors. In this group of the patients more often resection is radical, median time to progression and survival time are longer than in patients with gliomas grade III and IV. Within a 7-year follow-up none of the patients with GI/GII grade glioma died.

Health condition analysis in adults with surgically corrected congenital heart defect (on the example of atrioventricular canal defect)

The estimation of the surgery was carried out, the most common forms of the disorder, which occur after surgical treatment in adult patients with atrioventricular communication, were determined. The aim of research was to investigate the main clinical and echocardiography changes occurred in adults after surgery directed to atrioventricular communication for the further dispensary system improvement. Methods. Retrospective analysis of the spread of congenital heart disease - atrioventricular communication in 12 adults aged 18-28 years treated in Municipal Institution Lviv Regional Children's Hospital during 2009-2016. Statistical methods included relative and average values calculation, their average errors, the assessment of the probability of difference between the obtained results in the comparable groups using Student's t test. Results. It was found that both men and women after atrioventricular communication surgical treatment in childhood had poor quality of life due to physical and emotional condition worsening. Significant part of the patients still suffered from mitral and tricuspid insufficiency, heart failure of 1-2 degree, pulmonary artery regurgitation of 1 degree, and chamber hypertrophy. Conclusion. The mentioned group of patients needs lifelong medical care by specialists (cardiologists, surgeons, psychologists, physitians and other) for timely qualified care, prescriptions determination, and reoperations within optimal terms

Stenting right ventricular outflow tract in newborns and patients with tetralogy of Fallot

<p>The article looks at a few cases of stenting the right ventricular outflow tract (RVOT) as a possible alternative to aortopulmonary bypass in staged surgical treatment of adult patients and newborns with tetralogy of Fallot (TF). A comparative analysis of technical support and outcomes in adult and neonatal patients is performed. Emphasis is placed on the importance of endovascular techniques in treatment of patients with TF and the causes of a failure of intervention in adults. RVOT stenting in TF adult and newborn patients is found to be technically feasible, but it is essential to take into account the expressed hypertrophy of the right ventricle in adult patients, which requires the use of optimal stent length and diameter with high radial resistance.</p><p>Received 5 August 2016. Accepted 23 September 2016.</p><p><strong>Funding:</strong> The study has not been sponsored or awarded a grant.<br /><strong>Conflict of interest:</strong>The authors declare no conflict of interest.</p>

Espansione rapida palatale chirurgicamente assistita versus osteotomia di Le Fort I multisegmentata

ObjectivesThe aim of this work is to present, by means of an international literature review, a complete overview of the main methods of surgical treatment in adult patients with contraction of the maxillary transverse diameters, in order to assess risks and benefits of each. Materials and methodsA systematic review of the international literature was conducted on MedLine database (www.ncbi.nlm.nih.gov/pubmed). The chosen keywords were: “surgical palatal expansion”; “rapid palatal expansion”; “Le Fort I osteotomy”; “crossbite”; “transverse maxillary hypoplasia”. ResultsIn adult patients, the definitive therapy consists of a surgical treatment for restoring a correct relationship between the maxillary and mandibular bones. The two main options are Surgically Assisted Rapid Palatal Expansion (SARPE) and multisegmental Le Fort I osteotomy. ConclusionsThe SARPE technique seems to be the ideal treatment for the correction of isolated transverse maxillary deficiencies, including severe cases, whereas the multisegmental Le Fort I osteotomy is useful to correct transverse deficiencies ≤ 7-8mm, if associated with alterations on sagittal and vertical planes, thus solving the whole malocclusion in a single surgical step.

Reversibility of glomerular filtration rate after surgery for unilateral obstructive Uropathy

Introduction: Surgical treatment is increasingly finding a place in the treatment of unilateral obstructive uropathy. This study was designed to investigate the recoverability of renal function following surgical treatment of adult patients with unilateral obstructive uropathy using Lasix 99mTc-diethylenetriaminepentaacetate renography (DTPA-R) for measurement of glomerular filtration rate (GFR) before and after surgery. Methods: This was a prospective study which included 29 (20 males and 9 females) consecutive adult patients with a diagnosis of unilateral renal obstruction and a normal contralateral kidney. The obstruction and malfunction of the contralateral kidney were confirmed with Lasix DTPA-R. For all the patients, surgical treatment of the unilateral kidney obstruction was performed, and post-surgical measurement of the function of the treated kidney was also applied using Lasix DTPA-R. Results: The mean age of the patients was 42.24 years. According to our results, the average of pre-operation GFR was 17.48 ± 9.10 ml/minute/1.73 m2 and post-operation GFR was 26.4 ± 11.2 ml/minute/1.73 m2. It is approved that the GFR increased 8.92 ± 6.30 ml/minute/1.73 m2 after surgery. The most increased rate of GFR was observed in the group with the impaired kidney with GFR > 20 ml/minute. It is approved that the rate of recovery in the patients with preoperational total GFR > 75 ml/minute and also 50 10 ml/minute/1.73 m2 or total GFR > 25 ml/minute/1.73 m2 the functional recovery of damaged kidney could be expected following the removal surgery.

204 * CONGENITAL BRONCHIECTASIS

Objectives: Our aim is to improve the results of surgical treatment of congenital bronchiectasis. Congenital bronchial dilation leads to infection of the bronchial contents and re-aggravation of the inflammatory process, but some paediatricians have expressed reticence to conduct operations in children, adhering to long-term follow-up tactics for sick children. Methods: During the last 30 years, we have operated on 433 patients with congenital bronchiectasis, which amounted to 50.9% of all operated congenital lung diseases. The age of patients ranged from 2 to 65 years. There were more children and adolescents (60.9%) than adults (39.1%). Results: The most commonly performed operations were lower lobectomy (35.1%), extirpation of the bronchial tubes (22.2%) and combined resection (17.6%). The nature of the surgical interventions were similar in children and adults, except staged bilateral lung resections, which were performed more in adults (3.4% vs 10.0%). Adult patients have a longer anamnesis of disease, so there are more common (up 84.1%) dense and extensive adhesions in the pleural cavity. This leads to increased trauma in the operative and postoperative period. The frequency of early postoperative complications in children was 10.6%, and in adults reached to 20.7%. In the later postoperative period from 1 to 22 years, we examined 190 patients. Good results were observed in 63.8% of children, which is significantly higher than the results of surgical treatment of adult patients (47.9%) Conclusion: Examination of the patients in the late postoperative period showed that timely diagnosis and early surgical intervention reduces the risk of postoperative complications and improves long-term results.

A comparison of short-term clinical and radiological results of Tönnis and Steel pelvic osteotomies in patients with acetabular dysplasia

This study aims to compare short-term clinical and radiological results of adult patients with acetabular dysplasia undergoing Tönnis osteotomy or Steel triple pelvic osteotomy. Between March 2003 and January 2010, clinical and radiologic results in 61 patients who were operated due to acetabular dysplasia at Baltalimanı Bone and Joint Diseases Hospital were retrospectively analyzed. The patients were divided into two groups including those undergoing Tönnis osteotomy (Tönnis group) or Steel osteotomy (Steel group). For each patient, anteroposterior and false-profile radiographs of the pelvis were taken and anterior center edge (ACE), lateral center edge (LCE), Sharp angles and acetabular coverage were measured. The relationship between femoral head and acetabulum was assessed. Harris hip score was used for the clinical evaluation. According to the evaluation of the clinical and radiological results, postoperative scores were improved significantly in both groups, compared to preoperative scores (p<0.01). No statistically significant difference was found between the groups in terms of improvements in the radiological and clinical scores, except ACE angle (p<0.01). Our study results suggest that Tönnis and Steel osteotomies offer satisfactory short-term results in the surgical treatment of adult patients with mild to moderate dysplasia.

RESULTS OF COMBINED FIXATION OF SCOLIOTIC SPINAL DEFORMITY IN ADULTS

The results of surgical treatment of adult patients with scoliosis in the form of different fixation of L5-S1 segment. The best results were obtained in patients who underwent combined spinal fixation (transpedicular system and the system interspinous dynamic stabilization). In this group good indicators of quality of life of patients in the form of lack of pain and preservation of the normal volume movements in the lumbar spine were received.