Tactics Of Patients Research Articles

Surgical treatment of hepatic alveococcosis in highly specialized centre of non-endemic region

Objective. To estimate the results of operative treatment of hepatic alveococcosis in conditions of surgical centre of non-endemic region.
 Materials and methods. From 2004 to 2020 yr in Department of Transplantation and Hepatic Surgery of Shalimov National Institute of Surgery and Transplantation NAMS of Ukraine 13 patients, suffering hepatic alveococcosis, were radically operated. General characteristic of patients, methods of preoperative preparation, іntraoperative data, the indices of morbidity and lethality were investigated.
 Results. In 11 (84.6%) patients the disease was diagnosed on late stages: IIIa-IV in accordance to pTNM by WHO classification. Preoperatively in 5 (38.5%) patients transcutaneous transhepatic cholangiostomy and in 8 (615%) patients - roentgenendovascular occlusion of the portal hepatic vein branches - were performed. In 12 (92.3%) patients extended hepatic resections were done, including in 2 (15.3%) - complete vascular hepatic exclusion with hyperthermic perfusion in situ. Postoperative complications rate of IIIa-IV degrees in accordance to Clavien-Dindo classification have constituted 30.7%, while postoperative mortality - 7.7%. Up to the end of follow-up the disease-free period have persisted in all the patients.
 Conclusion. Aggressive surgical tactics in patients, suffering hepatic alveococcosis, permits to obtain good immediate results in highly specialized centres. Today radical operative intervention continues to be the only one method of treatment in the patients, which may guarantee satisfactory late follow-up results.

Multimorbidity in Pediatric Dermatology: Clinical Case

Background. Nowadays, dermatoses with mixed clinical picture and resistant to classical management become more common. The presence of various genetic disorders typical for most chronic dermatoses may indicate possible combination of several nosologies.Clinical Case Description. The article presents the clinical case of multimorbid condition in 10 years old patient who has nucleotide variants in CARD14 and EXPH5 genes. Mutations in CARD14 gene are typical for patients with type 2 psoriasis and pityriasis rubra pilaris (autosomal dominant type), while mutations in EXPH5 gene are typical for patients with non-specific epidermolysis bullosa (autosomal recessive type). Mutation in the TGM1 gene that is described in patients with congenital ichthyosis (autosomal recessive type), pathogenic mutations in KRT74 gene typical for ectodermal dysplasia, hypotrichosis and uncombable hair syndrome, and mutations in the KRT86 gene typical for monilethrix were also revealed. Medical history taking and histological examination as well as clinical data evaluating are crucial for correct diagnosis. They allow to understand the absence of the such manifestations in relatives and reveal various pathological processes in the epidermis. Molecular genetic testing with new generation sequencing (NGS) helps to finally establish the diagnosis and determine the further tactics for patient management.Conclusion. Multidisciplinary approach and use of high-technology methods of examination and treatment (such as molecular genetic testing and biological therapy) are required for final diagnosis in severe forms of chronic dermatosis resistant to treatment and for decision on correct tactics for the further management of such patients.

Sternoclavicular joint purulent arthritis and its complications: tactics of surgical treatment, results of restoration

Aim: to improve the treatment and diagnostic tactics in patients with sternoclavicular joint purulent arthritis. Materials and methods. A prospective, single-center study was conducted which included 30 patients with acute purulent arthritis of the sternoclavicular joint and its complications. Patients were divided into 2 groups based on the operative technique: the main – 20 patients who were operated following the proposed surgical tactics, and the control – 10 patients. Results. The cause of sternoclavicular joint purulent inflammation, clavicle and rib osteomyelitis was a hematogenous dissemination of microbial infection with concomitant diseases in most cases (n = 22; 73.3 %). The criteria for the short-term treatment results assessment such as the surgery duration, total blood loss, termination of exudation and removal of drainage tubes, length of hospital stay, the dynamics of changes in the inflammatory response markers did not differ significantly between the groups. The dynamics of pain syndrome according to VAS did not differ on the second day 66.5 (65.0; 67.0) versus 64.5 (61.0; 69.0), P = 0.201). Similar result was obtained on day 5: 49.5 (47.5; 54.0) versus 53.5 (51.0; 54.0), P = 0.314. However, pain was significantly reduced in the main group on the 10th postoperative day 27.0 (23.5; 30.0) versus 37.5 (34.0; 39.0), P = 0.005. A much more restoration of the movement amplitude and better functional outcomes on the QuickDASH scale were obtained in the main group (P = 0.017). Conclusions. Diagnosis of sternoclavicular joint purulent arthritis includes an analysis of the clinical picture of the disease and the results of radiologic imaging. Active surgical tactics and anatomically determined choice of the clavicle resection site provide good short-term results. The introduced comprehensive approach to the diagnosis and surgical treatment of sternoclavicular joint purulent arthritis facilitate obtaining better functional outcomes in comparison with traditional multi-stage tactics.

Organization-methodological aspects of teaching interns the tactic of treatment of patients with acute abdominal surgical pathology

Objective. To improve the mastering of treatment tactics of patients with acute surgical abdominal pathology by interns of the specialty "Surgery".Material and methods. We performed an analysis of the effectiveness of the education-methodological process in interns of the specialty "Surgery" for mastering the surgical tactics of treatment of patients with acute surgical abdominal pathology at the Department of General Surgery of Bukovinian State Medical University during 2017-2020 years.Results. Optimization of intern training was carried out due to the introduction of modern minimally invasive methods of surgical interventions and the latest highly informative diagnostic and prognostic criteria for the complicated course of acute surgical abdominal pathology. The effectiveness of training is improved through the use of modern interactive technologies, for assessing the knowledge of interns the method of discussion polling is preferred.Conclusion. Perfect mastery of modern minimally invasive methods of interventional treatment, understanding of their place and significance is an important component of effective learning of treatment tactics of acute surgical abdominal pathology by interns in the specialty "Surgery".

Islam and urostoma: a modern view through the prism of a religiously traditional legal system

Patients who practice Islam often refuse the proposed type of treatment for malignant neoplasms, citing religious reasons. Most fear that complete or partial non-retention of urine, the presence of a urostoma (ileal conduit) will violate their ritual purity and, as a result, their religious duties. The consequence of such refusal of treatment may be a lower quality of life, compared with patients of other faiths. Unfortunately, a low awareness of religious responsibilities among surgeons performing pelvic exentesis, cystectomy, prostatectomy, may prevent a full-fledged discussion of these issues before surgery. The presented review of the literature examined studies, legal aspects, and religious arguments that assist doctors in choosing treatment tactics for patients.

Clinical and immunological variants of ANCA-associated systemic vasculitis: a look at the phenomenon of IgG4 overproduction. Literature review and own observations

Systemic vasculitis (SV) associated with anti-neutrophilic cytoplasmic antibodies is a multifactorial process characterized by the variability of the epitope specificity of anti-neutrophilic cytoplasmic antibodies and the diversity of clinical phenotypes of the disease. In recent years, there has been an increasing interest in the combination of AAV and the phenomenon of IgG4 hyperproduction, which varies widely within AAV, from anti-neutrophilic cytoplasmic antibodies products of IgG4 subclass of undetermined significance, the presence of IgG4 positive plasma cells in the foci of immunoinflammatory lesions in patients with a definite diagnosis of AAV, to the typical clinical manifestations of an IgG4-related disease (IgG4-RD). We introduce own clinical case and analyze the combined data of the literature, which included 35 cases of a combination of AAV and IgG4-related pathology, indicating existing differences in the clinical manifestations of classical IgG4-RD and when combined with AAV. The currently accumulated data allows us to discuss the allocation of a specific clinical and immunological variant of AAV with IgG4 hyperproduction, characterized by a combination of clinical manifestations of AAV and clinical and / or histological signs of IgG4-related pathology. It is important to emphasize that the allocation of phenotypes of AAV in the future may be important for the personalized choice of treatment tactics for patients.

The Choice of Treatment Tactics in Patients with Severe Acute Pancreatitis Taking Into Account the Factor of Intra-Abdominal Hypertension

Relevance. Increased intra-abdominal pressure (IAP) in patients with severe acute pancreatitis (AP) is one of the triggers for the development of a functional organ failure, which leads to death. In this case, the favorable outcome of treatment of patients with severe AP is largely determined by early diagnosis and timely elimination of intra-abdominal hypertension (IAH). At the same time, there is no unified and agreed opinion on the principles and specific methods of eliminating the IAH syndrome in patients with severe AP today, which greatly complicates the choice of treatment strategy and tactics.Aim of study. To assess the role and clinical significance of IAP monitoring in patients with severe AP with various manifestations of organ dysfunction and, offer a set of therapeutic measures aimed at resolving intra-abdominal hypertension.Material and methods. The current study included 199 patients with severe AP, divided into two groups depending on the chosen treatment strategy. Group I included 107 patients where the diagnosis and treatment of the disease corresponded to generally accepted standards. Group II included 92 patients, where, in order to objectify the severity and prognosis of the course of AP, along with standard studies, IAP and APACHE II scale indicators were additionally monitored during treatment, and the severity of organ dysfunctions was assessed. In these patients the choice of medical tactics, including the use of conservative and surgical interventions, was made on a differentiated basis, based on the severity of the disease and the dynamics of the IAH.Results. The role and significance of IAP monitoring and APACHE II scale indicators in the treatment of patients with severe AP were determined. The use of a differentiated approach to the choice of treatment strategies for patients with AP considering the severity of the disease and severity of IAH syndrome results in reduced hospital mortality by 10.3% and reduced postoperative mortality by 11.4%.Conclusion. Monitoring of intra-abdominal pressure and APACHE II scale indices in conjunction with standard clinical and laboratory parameters allows patients to be clearly stratified according to the severity of acute pancreatitis, which helps optimize the choice of treatment tactics, including methods and timing of surgery, as well as the use of a set of effective therapeutic measures aimed at eliminating intra-abdominal hypertension.

PROGNOSTIC CRITERIA FOR SURGICAL AND EVACUATION TACTIC IN PATIENTS WITH POLYTRAUMA

In order to develop criteria for substantiating surgical and evacuation tactics in patients with polytrauma in level II and III trauma centers, the existing prognostic scales for assessing the severity of the injury were studied and a comparative characteristic was given.

Prevention and treatment bile ducts injuries in patients with acute cholecystitis

Aim . To develop rational surgical tactics for the treatment and prevention of bile duct lesions in patients with acute calculous cholecystitis. Materials and methods . The results of examination and surgical treatment of 1,645 patients with acute calculous cholecystitis at the second and third levels of medical care were studied. The results of diagnostics and elimination of the bile ducts injuries in 21 patients who developed during laparoscopic cholecystectomy for acute cholecystitis in second-level medical institutions were analyzed. Integrative assessment of the examination results is based on taking into account the results of laboratory and instrumental examination. Based on the analysis, a rational treatment strategy for this category of patients was formed and tested. Results . The main factors that influenced the occurrence of bile duct injuries were: performing the operation in an inflammatory infiltrate and within 72 hours of the onset of the disease, intrahepatic location of the gallbladder, male gender and age over 63 years ( p ≤ 0.05). The provision of assistance in case of complete damage to the main bile ducts in medical organizations of the second level should be completed by performing external drainage with further evacuation of the patient, after stabilization of his condition, to medical institutions of the third level. Partial common bile ducts injury can be eliminated by performing restorative suturing of the defect of the common bile duct the T-drainage at all levels of healthcare organization. It was clarified that patients with acute cholecystitis Grade I are shown timely laparoscopic cholecystectomy within 72 hours from the onset of the disease. For patients with acute Grade II cholecystitis complicated by inflammatory infiltrate, without signs of destruction and blockage of the gallbladder at all levels of medical care it is advisable to conservative treatment, surgery after 3 months. With the progression of endogenous intoxication with destruction of the gallbladder, cholecystostomy is advisable. Patients with acute grade II cholecystitis and complicated course who are being treated in a second-level medical organization, are shown to be transferred to a third-level medical organization for endoscopic intervention on the duodenal papilla. Conclusion . Implementation of the proposed surgical tactics for patients with acute cholecystitis allows performing timely and rational surgical intervention, increasing the effectiveness of treatment, reducing the number of postoperative complications and mortality.

Changes in the management of patients with acute coronary syndrome - have the disease outcomes changed?

Aim To analyze results of changing the management tactics in patients with acute coronary syndrome (ACS) in clinical practice from 2004 through 2018 expressed as improvement in prognosis.Material and methods Results of two observational studies were analyzed: ORACLE I (2004-2007), which included 1193 patients with ACS (mean age, 61.1±11.69 years; men, 63.3 %) and ORACLE II (2014-2017), which included 1652 patients from 4 vascular centers (mean age, 64.61±12.67 years; men, 62.3 %).Results Patients included into the ORACLE II study in 2014 were significantly older and the proportion of patients with diabetes mellitus was greater than in the ORACLE I study (14.7 and 22.6 %, respectively). After matching the groups by major clinical characteristics, it was found that introducing the invasive management tactics for ACS patients was associated with a reduced rate of all-cause death (from 8.2 to 6.1 % for one year), a tendency towards decreased number of coronary death cases (from 5.6 to 4.0 %), and a decrease in risk of recurrent coronary complications (from 17.4 to 7.7 %).Conclusion Implementing the vascular program statistically significantly decreased the total death rate for at least one-year observation in comparable patient groups.

Modern view on management tactics of patients with endometrial pathologic processes in the perimenopausal period and postmenopause

Aim. To evaluate the effectiveness of combination therapy of pathological endometrial processes (benign forms) based on the determination of one of the variants of etiopathogenesis in patients of perimenopausal age and in postmenopause.
 Materials and methods. The examination included 34 patients with a diagnosis of endometrial hyperplastic processes in the perimenopausal period and in postmenopause. To verify the diagnosis, in addition to the results of a clinical examination (general and gynecological), the patients underwent laboratory (microscopic and molecular biological studies using real-time polymerase chain reaction method of aspirates from the uterine cavity), diagnostic (ultrasound, hysteroscopy) and morphological examination methods.
 Results. Conducting combined antimicrobial and antiviral therapy in patients with endometrial hyperplastic processes, endometrial polyp in combination with chronic endometritis, allowed us to eliminate microbial agents from the endometrium before starting hormonal therapy. A positive result of the combined approach showed the absence of recurrence of endometrial hyperplastic processes within 2 years in 91.17% of patients of the examination group.
 Conclusion. In our study, we evaluated the effectiveness of the combined treatment of endometrial hyperplastic processes in patients in the perimenopausal period and in postmenopause, against a background of chronic endometritis, using systemic therapy with antibiotics and antiviral drugs, followed by hormonal therapy. A clinical study allows us to formulate recommendations on the management of patients with endometrial hyperplastic processes, endometrial polyps in the perimenopausal period and in postmenopause.

Coronary Artery Disease with a High Risk of Complications: How to Identify Such Patients and Choose Management Tactics?

Patients with diagnosed coronary artery disease and/or peripheral arterial disease have a high risk of cardiovascular death and disabling vascular events, including stroke, myocardial infarction, and amputation. Secondary prevention in these high-risk patients should include control of modifiable risk factors for the progression of atherosclerosis and antithrombotic therapy to prevent atherothrombosis. Analysis of the literature from the databases PubMed, MEDLINE, HighWire Press was carried out to determine the modern possibilities of assessing the risk of ischemic and hemorrhagic events in a stable course of cardiovascular diseases caused by atherosclerosis, which can be used to determine the categories of patients with the greatest potential benefit from combination antithrombotic therapy. The results of a large randomized study COMPASS, their sub-analyses and the work of other authors, published over the last year, allow us to formulate reasonable conclusions that facilitate the adoption of medical decisions when choosing treatment tactics for patients with a stable course of atherosclerotic cardiovascular diseases. When using low doses of rivaroxaban and aspirin in high-risk groups, the rate of adverse events, including cardiovascular death, myocardial infarction, stroke, and vascular complications of peripheral artery disease, can be significantly reduced. High-risk criteria for severe cardiovascular complications are multifocal atherosclerotic lesions, heart failure, myocardial infarction, diabetes mellitus, or chronic kidney disease. Patients with the highest risk of vascular events will receive the greatest absolute benefit from this treatment. Secondary prevention in patients with chronic coronary syndromes, sinus rhythm and a moderate risk of cardiovascular complications using low doses of rivaroxaban and aspirin is justified, since the ratio of its risk and benefit remains favorable.

The level of expression of miR-196a in patients with chronic viral hepatitis C with the first genotype of HCV according to previous experience of antiviral therapy.

The authors present the study of the level of expression of miR-196a in 74 patients with chronic viral hepatitis C with the 1st genotype of HCV, based on previous experience in patients with antiviral therapy regimens containing interferon. The patients were divided into two groups, depending on the previous experience of antiviral therapy with circuits containing interferon – 21 patients who failed after antiviral therapy regimens containing interferon (group 1) and the comparison group (group 2) – 53 naive patients. To study the level of expression of miR-196a (miR-196a), a two-stage study according to the manufacturer's protocol was used. First, total RNA was isolated from the plasma by the method of phenol-chloroform extraction. Futher reverse transcription was performed using a kit for reverse transcription of miR TaqMan® (Applied Biosystems, USA), specific loop primers to achieve mature miRNA, snRNA U6 (as an endogenous control gene), and 10 ng of total RNA. Real-time quantitative PCR was performed using TaqMan® miRNA analysis. In order to optimize the prediction of response to antiviral therapy and the use of optimal treatment regimens for problem patients with treatment failure regimens containing interferon, analysis using ROC curves was used. The average level of expression of miR-196a in patients with chronic hepatitis C was evaluated. In the 1st group of patients it was 0.011 (IQR: 0.002; 0.310) and in the comparison group – 0.346 (IQR: 0.054; 1.239) at p=0.012 by U criterion. The conducted ROC analysis showed that the studied miR-196a could differentiate patients with chronic viral hepatitis C with HCV genotype 1, depending on previous experience of antiviral therapy, namely, patients with treatment failure regimens containing interferons and naive. AUC=0.688 (95% CI 0.570-0.791; p=0.017), J=0.40, Se=57.14%, Sp=83.02%. It gives additional opportunities for correction of therapeutic tactics. Therefore, the level of expression of miR-196a (<-1,75) may be an additional biomarker in the pathogenesis of HCV-infection, which can then be used in the monitoring and treatment of patients. Low expression of miR-196a may be the basis for prescribing more effective direct-acting antiviral therapy to patients and will allow personalizing therapeutic tactics in patients with chronic viral hepatitis C.

The use of methods of spatial displacement of the myocardial structure (speckle tracking) to determine the indications for coronary angiography in patients suffering from coronary heart disease

The indicators of global and segmental longitudinal deformation of the left ventricular myocardium are presented and analyzed in patients suffering from coronary heart disease. The latter, as before, remains one of the urgent diseases of the circulatory system. To verify and determine management tactics for patients suffering from coronary heart disease, coronary angiography is performed. Indications for its implementation are based on the results of exercise tests, in particular, stress echocardiography. However, its implementation can be difficult due to poor visualization of the walls of the left ventricle, and the conclusion is not without subjectivity. One of the modern methods for assessing the contractility of the left ventricular myocardium, both global and segmental, is the spatial displacement of the myocardial structure (speckle-tracking- echocardiography). The technique automatically calculates the longitudinal deformation of the myocardium, expressed as a percentage of the initial values. It was found that the global and segmental longitudinal deformation of the left ventricular myocardium in the majority of the evaluated segments in the examined patients did not differ before loading. When conducting a stress test, the exact opposite dynamics of changes in the parameters of the global and segmental longitudinal deformation of the left ventricular myocardium is observed. So, in patients with a high risk of complications of coronary heart disease, a decrease in these indicators was observed, in patients without a risk of complications, on the contrary, their increase was observed, which indicates an increase in myocardial contractility during physical exertion. It was revealed that the indicator of global longitudinal deformation of the left ventricular myocardium is highly informative. The lower value of the decrease in the global longitudinal deformation of the left ventricular myocardium was calculated, which can serve as an additional indication for coronary angiography.

Surgical treatment tactics for patients with combined pelvic and femoral injuries

Surgical treatment tactics for patients with combined pelvic and femoral injuries

Катамениальный пневмоторакс как особая форма спонтанного пневмоторакса (обзор литературы)

Spontaneous pneumothorax is a common (more than 12.5% of all urgent conditions in thoracic surgery) life-threatening condition, statistically more commonly found in men with pulmonary emphysema. However, a rare and difficult diagnostic form of spontaneous pneumothorax that develops in more than 73% of women of reproductive age with thoracic endometriosis is spontaneous catamenial pneumothorax. In the prevailing majority of patients, this pneumothorax turns out to be right-sided and recurrent in more than 70% of cases. The “gold standard” for verification of thoracic endometriosis is the visual inspection of the chest organs and biopsy using video-assisted mini-thoracotomy (VATS). The signs of thoracic endometriosis detected intraoperatively include the identification of fenestrations of the diaphragm, endometriosis of the visceral pleura, bullae of various calibers, cicatricial changes in lung parenchyma, etc. There is no consensus on the tactics of patients´ management, however, the primary importance in the treatment of thoracic endometriosis and spontaneous catamenial pneumothorax as its main manifestation should be given to surgical interventions: suturing diaphragm defects, typical (anatomical) or atypical resection of the lungs in different volumes, pleurodesis to prevent the recurrence of pneumothorax, etc. The most effective pleurodesis methods are chemical pleurodesis with sterile talc, the use of YAG-ND and CO2 lasers. Apical pleurectomy is actively used; various materials (fibrin gel, polyglycolic acid, etc.) are being studied as suture-line coverage to create aerostasis. Along with surgical methods, the use of COCs, analogues of gonadotropin-releasing hormone, danazole, progestins, and aromatase inhibitors minimizes the recurrence of spontaneous pneumothorax in patients with thoracic endometriosis.

Analysis of Providing Emergency Care to Patients with Myocardial Infarction without ST Segment Elevation

A high mortality rate due to acute myocardial infarction (AMI) stimulates the analysis of the quality of emergency medical care at the prehospital stage. Firstly, an analysis of the reasons for the treatment of patients with AMI to general practitioners is necessary. Secondly, the quality of the provision of medical services by general practitioners is one of the criteria for the effectiveness of the implementation of patient management protocols, which requires a systematic analysis and relevant studies.The objective: to analyze the provision of emergency medical care to patients with acute myocardial infarction without ST segment elevation (NSTEMI) when they seek medical care.Materials and methods. The referral routes for hospitalization of patients with acute coronary syndrome and clinical manifestations were analyzed among 280 patients with STEMI and 91 patients with NSTEMI. The assessment of treatment tactics in patients with NSTEMI was carried out in the following paragraphs of the emergency medical care protocol: determination of blood saturation, ensuring reliable venous access, administration of nitroglycerin in aerosol (1–2 doses or 0,4–0,8 mg), use of acetylsalicylic acid (ASA ) after chewing 160–325 mg, the use of clopidogrel 300 mg orally; the appointment of β-blocker; narcotic analgesic; anticoagulant. Statistical data processing was carried out using non-parametric criterion χ2.Results. Appeals to primary health care centers were significantly more frequent in patients with NSTEMI, due to the clinical course of the disease.Conclusion. At the stage of medical care by general practitioners, only the appointment of acetylsalicylic acid met the criteria for the implementation of the protocol for the provision of emergency medical care to patients with NSTEMI.

Аналіз надання екстреної медичної допомоги хворим на інфаркт міокарда без елевації сегмента ST при звернені по медичну допомогу

A high mortality rate due to acute myocardial infarction (AMI) stimulates the analysis of the quality of emergency medical care at the prehospital stage. Firstly, an analysis of the reasons for the treatment of patients with AMI to general practitioners is necessary. Secondly, the quality of the provision of medical services by general practitioners is one of the criteria for the effectiveness of the implementation of patient management protocols, which requires a systematic analysis and relevant studies.The objective: to analyze the provision of emergency medical care to patients with acute myocardial infarction without ST segment elevation (NSTEMI) when they seek medical care.Materials and methods. The referral routes for hospitalization of patients with acute coronary syndrome and clinical manifestations were analyzed among 280 patients with STEMI and 91 patients with NSTEMI. The assessment of treatment tactics in patients with NSTEMI was carried out in the following paragraphs of the emergency medical care protocol: determination of blood saturation, ensuring reliable venous access, administration of nitroglycerin in aerosol (1–2 doses or 0,4–0,8 mg), use of acetylsalicylic acid (ASA) after chewing 160–325 mg, the use of clopidogrel 300 mg orally; the appointment of β-blocker; narcotic analgesic; anticoagulant. Statistical data processing was carried out using non-parametric criterion χ2.Results. Appeals to primary health care centers were significantly more frequent in patients with NSTEMI, due to the clinical course of the disease.Conclusion. At the stage of medical care by general practitioners, only the appointment of acetylsalicylic acid met the criteria for the implementation of the protocol for the provision of emergency medical care to patients with NSTEMI.

The role of continuity of systematic treatment and rehabilitation in patients with metastatic colorectal cancer in elderly and senile age.

e16041 Background: The concomitant pathology, cancer and geriatric status affect the organism of a sick elderly person. In routine clinical practice elderly patients require comprehensive geriatric assessment (CGO). Despite many treatment strategies for elderly patients with metastatic colorectal cancer (mCRC), there are no use of rehabilitation programs and the assessment of their impact on the treatment tolerability and survival. Methods: The study includes patients with newly diagnosed mCRC stage IV, receiving the first line of chemotherapy (FOLFOX). Patients are given CGO before starting chemotherapy and in dynamics.The following scales are used for geriatric examination: Cumulative Illness Rating Scale for Geriatrics (CIRS-G); Activities of Daily Living (ADL); Daily instrumental activity scale (IADL); Mini nutritional assessment (MNA); Clock Drawing Test (CDT); Geriatric depression scale (GDS). Results: At the moment 29 patients are included in the study. According the results of CGO we determined that elderly and middle-aged patients are similar in cognitive, mental, and nutritional status, but they have statistically significant differences on the MMSE scale (P=0,014). In both groups patients have a decrease in IADL and cognitive functions, the presence of depression. Elderly patients (> 60 years old) are more likely to experience chronic pain (P<0.05) and increased blood pressure (P<0.05) (Table). Conclusions: The management tactics of patients with mCRC in elderly age shouldn't be based only on chronological age, ECOG or the Karnovsky index, that don't reflect functional disorders in patients of the older age group. It is necessary to define algorithms for medical rehabilitation in cancer patients of the older age group. A CGO is aimed at developing a medical rehabilitation plan together with an elderly patient and his environment, and an algorithm for supporting his health status during and after specialized treatment. [Table: see text]

Reduction of risk of perioperative complications in case of cardiac comorbidity

The objective: based on the published data to describe the conceptual issues of the problem of perioperative cardiac complications in non-cardiac surgery.Results: changes made to international guidelines over the past 3–4 years based on evidence-based studies and meta-analyzes have been analyzed. The article presents data on the etiopathogenesis of various postoperative cardiac complications, assessment of their risk based on the evaluation of functional activities of patients, cardiac risk indices, and modern biomarkers (B-type natriuretic peptides, cardiospecific troponins). The contemporary recommendations on adjuvant pharmacological cardioprotection and rational pharmacotherapy in the perioperative period are analyzed. The article describes specific parameters of diagnostic, treatment and prevention tactics in patients with coronary heart disease, hypertension, chronic heart failure, heart defects, and implanted electronic devices. It concludes that the implementation of the comprehensive strategy aimed at the reduction of risk of pulmonary complications should ensure the decrease in their frequency and mortality due to them.