Tactics Of Surgical Treatment Research Articles

Surgical treatment of locally advanced kidney cancer in the T3a–с stage

BACKGROUND: Kidney cancer is a common pathologic condition, which ranks the 3rd place among urologic cancers. In 4–10% of patients, while growing it metastasizes upward the venous vessels up to the thoracic vena cava and right atrium. Selection of the optimal tactics for surgical treatment of such patients still remains a complex and unsolved task. AIM: To assess the surgical treatment findings for the patients suffered from kidney cancer with tumor invasion in the renal and inferior vena cava. MATERIALS AND METHODS: 115 patients with renal cell carcinoma complicated by tumor invasion into renal and inferior vena cava have been operated in North-Western State Medical University named after I.I. Mechnikov from 2003 to 2023. They were 76 (66.1%) men and 39 (33.9%) women, their mean age was 67.0 ± 4.1. Stage T3a covered 53 (46.1%), T3b — 33 (28.7%) and T3c 29 (25.2%) patients. Metastatic lesion of one lymph node was observed in 21 (18.3%) and of multiple nodes in 6 (5.2%) patients. Distant metastases were found in 26 (22.6%) patients: in the lungs in 9.6% and in the adrenal glands in 5.2%. All patients were treated with radical nephrectomy, removing blood trombi from the inferior vena cava system. Eight (7.0%) of them, received the treatment by the method developed in the clinic, which consists in preliminary endovascular extraction of the cranial trombus part. Another 3 (2.6%) patients were treated using cardiopulmonary bypass machine. RESULTS: Early postoperative complications developed in 36 (31.4%) patients. The most common and severe of them were pulmonary embolism (4.4%) and acute cardiovascular insufficiency (10.4%). These complications appeared the causes of death of 4 patients. The mortality rate was 3.5%. The three year survival rate in the T3a group was 70.6%, T3b group — 66.0% and T3c group — 50.6% (p 0.05). CONCLUSIONS: Nephrectomy with vena cava thrombectomy is a radical surgical treatment. Its complexity increases as the tumor thrombus spreads further through the venous system and in some cases requires an interdisciplinary approach.

ANALYSIS OF OPTICAL COHERENCE TOMOGRAPHY DATA IN PATIENTS WITH VARIOUS VARIANTS OF THE GLAUCOMA PROCESS

Today, about 537 million people in the world aged 20 to 79 suffer from diabetes mellitus, in 3% of cases neovascular glaucoma is diagnosed, threatening vision loss. Neovascular glaucoma is one of the most aggressive forms of secondary glaucomas and is often refractory to standard treatment methods. In domestic and foreign literature, there is no single standard for choosing the tactics of surgical treatment of patients with neovascular glaucoma against the background of diabetic retinopathy. In this regard, studies aimed at studying the morphofunctional parameters of eyes with neovascular glaucoma against the background of diabetic retinopathy acquire not only theoretical but also obvious practical interest. In the course of further development of methods for complex effects on eye structures to reduce intraocular pressure and progression of the glaucoma process. An analysis of optical coherence tomography images of 51 patients (51 eyes) was conducted, and the main aspects were identified for further use in choosing the tactics of surgical intervention.

Analysis of the effectiveness of two-stage and one-stage surgical treatment for idiopathic scoliosis in children using various methods for deformity mobilization

Introduction. The correction potential of modern systems is limited by the natural mobility of scoliotic deformities, which sometimes require multiple discectomy and osteotomy. Choosing the optimal method of treatment for scoliosis in the thoracic and lumbar regions is difficult due to the variety of approaches and options available for osteotomies. There is no single algorithm for the treatment of idiopathic scoliosis, making it necessary to develop a differentiated approach and treatment strategies. Purpose of the study. To optimize the choice of surgical treatment tactics for children with idiopathic scoliosis based on a compa­rative analysis of the use of one-stage and two-stage surgical treatment. Materials and methods. The study subjects were ninety four patients with idiopathic scoliosis (Lenke type 1–4), operated on between 2017 and 2023. They were divided into three groups: group I (control) — 30 patients underwent one-stage dorsal correction with G1 osteotomy, group II — 31 patients who received two-stage treatment, and group III — 33 patients who underwent a one-stage correction with apical G2 osteotomy. Depending on the initial thoracic kyphotic angle, subgroups were defined as A (hypokyphosis), B (normokyphosis) and C (hyperkyphosis). The minimum follow-up period was 12 months. Results. The frontal balance in all examined patients was in a state of relative compensation, both before surgical treatment and in the postoperative period. When comparing the results in patients from the second and third groups, we found no significant differences (p > 0.05). The second group showed a higher degree of correction of the main arch of spinal deformity (p < 0.05) in the frontal plane compared to the control and third group patients. When analyzing the results of thoracic kyphosis formation, we obtained reliable results in formation more significant indices in patients after surgery in Group II (subgroups A and B), for whom a two-stage applied surgical method was supplemented with anterior release and halo pelvic traction. In Group III (subgroup C), we obtained significant results in thoracic kyphosis indices when using single-stage surgery performed from the dorsal approach supplemented with G2 osteotomy. Conclusion. The condition of the sagittal profile, including the severity of thoracic kyphosis, is an important criterion for choosing the tactics of surgical treatment of scoliotic deformities of the thoracic and lumbar spine. Two-stage treatment, including ventral release and halo-pelvic traction, is recommended for rigid deformities of the thoracic or thoracolumbar spine, under conditions of initial normal kyphosis or hypokyphosis. Severe deformities with initial hyperkyphosis should be corrected preferably in a single stage using posterior surgery, supplemented by G2-osteotomy. The use of G2-osteotomies in patients with initial normal- or hypokyphoses is impractical due to the risk of neurological complications, development of pseudoarthroses, and increase in volume of perioperative bleeding.

Features of acute coronary syndrome after a COVID-19 in the aspect of pulmonary hypertension

BACKGROUND: After recovery from COVID-19 patients may develop new risk factors that lead to changes in cardiopulmonary interactions, i.e. an increase in the afterload on the right ventricle due to increased pressure in the pulmonary artery and change in pulmonary vascular resistance. It can be assumed that the presence of such a spectrum of problems can influence the severity of dyspnea and the development of pathogenetic events (pulmonary hypertension, right ventricular failure, subendocardial ischemia), which in turn can determine the outcome. AIM: To identify the characteristics of acute coronary syndrome after a COVID-19, taking into account angiographic data on coronary artery lesions and hemodynamic manifestations. MATERIALS AND METHODS: A comparative analysis of the clinical and hemodynamic consequences of the COVID-19 and the development of acute coronary syndrome in 157 patients was carried out. The group 1 included 69 patients who had had COVID-19 (vaccinated — 24.6%) during the 6 months preceding acute coronary syndrome; group 2 — 88 patients without a history of COVID-19 (vaccinated — 42%). The 12-lead electrocardiogram has been used in the diagnosis of subendocardial ischemia in acute coronary syndrome. The ST segment displacement in lead aVR was analyzed. RESULTS: After COVID-19, dispnoe occurred in 52% of the patients and in 14.8% without previous infection. Echocardiographic signs of right ventricular overload were present in 42% of the patients in group 1 and 10.2% in group 2. The mean pressure in the pulmonary artery was increased after COVID-19 in 58% of the patients in group 1 and in 10.2% of group 2 in the range from 20 to 24 mm Hg and in the range from 25 to 36 mm Hg in 29% of the patients in group 1 and 2.3% of the patients in group 2. The average value of left ventricular ejection fraction in the patients who had had COVID-19 was 55.9 ± 14%, which was less than in the patients in the control group (63.2 ± 5.5%; p 0.001). ST segment elevation in lead aVr indicated high incidence of subendocardial ischemia. 40.6% in group 1, and 11.4% in group 2 (χ2 = 17.9; p 0.001); in group 1 vaccinated — 17.6%, and not vaccinated — 48.1% (χ2 = 4.9; p = 0.027), in group 2 vaccinated — 8.1%, and not vaccinated — 13.7% (χ2 = 0.7; p = 0.41). All the patients had drug-eluting stents implanted in the infarct-related artery. After stenting, no recurrence of pain or further increase in chest pain was observed. CONCLUSIONS: After coronavirus infection COVID-19, 58% of patients have increased mean pressure in the pulmonary artery in the range from 20 to 24 mm Hg and in the range from 25 to 36 mm Hg in 29%. Atherothrombosis is the main mechanism of acute coronary syndrome after COVID-19 coronavirus infection. The main feature of acute coronary syndrome after a coronavirus infection COVID-19 is increased pressure in the pulmonary artery after a lung injury, which must be taken into account when planning surgical treatment tactics and management tactics in the postoperative period.

Simulation of intestinal perforation in experiment

The current problem of neonatal and pediatric surgery remains the tactics of surgical treatment and postoperative management of patients with perforated peritonitis. Mortality with perforation of the stomach and intestines in children in the newborn period reaches about 40-80 %. The combination of the syndrome of increased intra-abdominal pressure and multiple organ failure causes the extremely serious condition of patients. In this connection, new approaches to the surgical treatment of such patients are currently being actively developed. For this, new medical devices are tested in experimental practice, but the problem of such studies, first of all, lies in the lack of an adequate model of the pathological process. The aim of the work is to analyze the methods of experimental modeling of intestinal perforations described in the public domain. For this, a study was conducted of the most significant scientific publications of such databases as Google Scholar, PubMed, Scopus, eLIBRARY. The present work provides a detailed description of existing options for modeling perforations of various parts of the gastrointestinal tract (stomach, small intestine and colon), depending on the goals of the experiment. Several rather rare techniques based on the introduction of microorganisms are also presented. In addition, the article describes the method proposed by the authors for modeling perforation using laparoscopic access.

A differentiated approach to the surgical treatment of intraarticular fracture of the proximal tibia

Background. For a long time, the question of optimal ways and methods of surgical treatment of fractures of the proximal part of the tibia (PPT) remains debatable. The purpose was to study the results of surgical treatment of fractures of the PPT using differentiated use of minimally invasive techniques. Materials and methods. The work consisted of a prospective analysis of the treatment outcomes of 87 patients who were treated 2018 to 2023. Fractures were classified according to Schatzker. The tactics of surgical treatment depended on the type of fracture, the age of the patients and the presence of concomitant diseases. A comprehensive assessment of knee function was performed using the Knee Society Score. For X-ray assessment of the degree of progression of post-traumatic arthritis, the Resnik/Niwoyama system was used. ­Results. The results of surgical treatment were studied in terms from 6 to 24 months. 19.8 % of excellent, 57.5 % good, 15.6 % sa­tisfactory and 7.1 % unsatisfactory treatment results were obtained. Progression of post-traumatic arthritis was observed in 36 patients (28 patients at one stage, 4 subjects at 2 stages and 5 patients at 3 stages). Of the complications, 7 (8.0 %) were surgical site infections, which required debridement of the focus and longer antibiotic therapy. Over time, loss of reposition and secondary displacement were identified in 5 (5.7 %) cases. The most common complications were the progression of knee osteoarthritis, the development of contractures in 11 (12.6 %) patients. Conclusions. The use of a differential approach to the surgical treatment of intra-articular fractures of PPT, based on the severity of injuries according to Schatzker, allowed to obtain positive functional results in 77.3 % of the victims. The negative consequences of intra-articular fractures of the tibial plateau that worsen the functional outcomes of treatment include the progression of knee osteoarthritis. The degree of its manifestations is largely determined by the severity of the injury, the quality of reduction, the stability of fragment fixation, and the rationality of restorative treatment and rehabilitation.

Results of surgical treatment of aortic stenosis in patients with a narrow aortic root after Ozaki surgery and bioprosthetics: A retrospective single-center study

BACKGROUND: Aortic stenosis (AS) itself is a common disease in patients of older populations, and its combination with a narrow aortic root puts the surgeon in front of choosing the most optimal option. The advantages of Ozaki's operation include hemodynamics close to the native aortic valve (AV) and the absence of the need for lifelong anticoagulant therapy. AIM: To evaluate the hospital and long-term results of surgical treatment of patients with AS and a narrow fibrous ring who underwent Ozaki surgery or AV prosthetics with a biological prosthesis. MATERIALS AND METHODS: In total, 836 isolated Ozaki operations or combined interventions of this kind were performed at the Federal Center for Cardiovascular Surgery (Penza). This retrospective single-center study included 150 patients with critical AC (effective opening area ≤1 cm2) in whose surgical treatment tactics Ozaki surgery or prosthetics with a biological prosthesis were used. RESULTS: In the early postoperative period, group 1 patients had significantly lower values of the average and maximum gradients on the aortic valve and a larger area of the effective opening of the aortic valve. Also, in group 1 patients, the postoperative period of stay in intensive care is significantly higher, which is a consequence of the longer duration of the operation, the time of artificial circulation and myocardial ischemia. Long-term mortality is higher in the group with prosthetics of AV (Log Rank=0.006). Freedom from re-operation according to the analysis, there was no significant difference between the groups (Log Rank=0.226). CONCLUSION: Ozaki surgery demonstrates the best hemodynamic characteristics on AV in comparison with a biological prosthesis in patients with a narrow fibrous ring of AV in the early and long-term follow-up periods.

Artificial intelligence in personalized selection of surgical treatment tactics for bone metastases

Artificial intelligence in personalized selection of surgical treatment tactics for bone metastases

Tactics of surgical treatment of recurrent glomus tumors of the skull base: A clinical case

AimThe purpose of the study is to build effective tactics of surgical treatment of pathology, and to increase the effectiveness of surgical treatment of patients with this diagnosis by optimising preoperative preparation, and the correct sequence of actions that will help prevent relapse. MethodsThe leading approach to the study is the description of a clinical case, which will help to carefully consider this issue from all angles, analyse the methodology of patient examination, and build highly effective tactics of surgical intervention to eliminate tumour-like masses, minimising the risks of recurrence. The second clinical case was also considered, and a comparative analysis was carried out on certain parameters. ResultsThe paper presents a clinical case with a practical aspect of surgical treatment of the pathology. The issue of detailed symptoms and manifestations of the disease is disclosed, and the course of surgical interventions is described in stages, in which no nerve is damaged, no complications are caused, and the desired result is achieved. The peculiarity of this case is the recurrence of the disease, and the ineffectiveness of previous treatment methods, including embolisation of the neoplasm and antromastoidotomy. ConclusionsThe results obtained in the course of this study and the formulated conclusions are of great importance for surgeons who are faced with patients with the stated diagnosis.

A clinical case report of aberrant pancreas in the practice of a general practitioner

An aberrant pancreas is a fairly rare developmental anomaly, which, de spite its congenital genesis, is most often found in people of the middle age group. The article presents a clinical case of an aberrant pancreas with localization in the antrum of the stomach in a 52-year-old patient. Congenital pathology has an asymptomatic course for a long time, which is subsequently associated with late diagnosis and the need for a comprehensive examination of the patient. Despite the long-term symptomless course of the pathology, the secretory activity of the ab errant pancreas contributes to persistent inflammation of the gastric and duodenal mucosa, potentiates irreversible pathological changes, and increases the risk of complications, including gastric intestinal metaplasia. The patient under consider ation was diagnosed with a multimorbid chronic pathology of the gastrointestinal tract, which, despite ongoing therapy, was characterized by frequent exacerbations. Due to the established diagnosis, it was possible to prescribe successful conser vative treatment and avoid surgical intervention in this patient. According to the literature, differential diagnosis with malignant neoplasms is necessary. The choice of surgical treatment tactics is determined by the development of complications, among which both obstructive complications (dysphagia, pyloric stenosis, intus susception, intestinal obstruction, obstructive jaundice) and complications specific only to pancreatic tissue, such as pancreatitis, cysts and pseudocysts, ulcerative defects with perforation of the hollow organ, benign and malignant neoplasms, are described. The question of the expediency of surgical treatment of patients in the absence of complications remains debatable to the present day, which causes diffi culties in the management of these patients.

Impression fracture of the lateral condyle of tibial plateau complicated by acute peri-implant infection: a case report

Introduction. Deep infection after open osteosynthesis of tibial plateau fractures occurs in 9.9%. This rate is significantly higher than in surgical treatment of closed injuries of other localizations. Many authors consider it necessary to improve management protocols for patients with complex plateau fractures in order to minimize or prevent the development of infectious complications. Aims of the study: 1) to discuss the treatment tactics of a patient with an intraarticular fracture of the tibial plateau after osteosynthesis complicated by the development of early deep surgical site infection (SSI), using clinical case as an example; 2) to carry out the analysis of medical care defects. Case description. A 71-year-old patient with compromised somatic status underwent osteosynthesis with a buttress plate and allogeneic bone grafting of the metaphyseal defect on the 12th day after injury. In 7 days after the occurrence of signs of infection, a revision surgery was performed. Later, a number of consecutive revisions were performed due to recurrences of the infectious process. The complex of measures against SSI included the use of vacuum drainage systems and antibacterial spacers. As a result, the wounds had healed. Two years after the injury, the patient had a good functional result. Conclusion. The presented clinical case has shown that even if the treatment tactic for early peri-implant infection is chosen correctly, there are several defects in our routine practice. First of all, inaccurate sampling of material for bacteriological study and inadequate duration of antibacterial therapy are to be mentioned. To successfully treat infectious complications of osteosynthesis, a team of like-minded specialists including traumatologists as well as physicians, microbiologists and clinical pharmacologists is needed. Undoubtedly, surgical treatment of fractures might develop into infectious complications. Their diagnosis and treatment are often accompanied by a number of various mistakes. The most important points are early radical revision of the postoperative wound, etiotropic antibacterial therapy, maintaining stability of fixation after primary osteosynthesis. If these standards are complied with, the outcome of surgical treatment might be satisfying even with such a severe complication as peri-implant infection. At the same time, we are planning further researches aimed at improving algorithms and tactics for surgical treatment of infectious complications, reducing surgery trauma level and upgrading quality of primary osteosynthesis.

Tactics of surgical treatment of complications of abdominal-perineal extirpation of the rectum in a patient with locally advanced cancer against the background of combined treatment of the progression of the process. Clinical observation

The paper presents a clinical case related to the implementation of a surgical step-by-step method of treating a patient with malignant rectal formation, progression of the underlying disease, against the background of a paravesical abscess in the pelvis, after previously comprehensive treatment. The tactics of therapeutic measures consisted, at the first stage, in the rehabilitation of the pelvis, the resolution of a paravesical abscess, followed by simultaneous excision of the soft tissues of the perineum, resection of the ileum, the formation of enteroenteroanastomosis, the formation of a heterotopic urinary reservoir according to Bricker, plasty of the defect of the perineum with a VRAM flap.An important condition for the implementation of the treatment plan is to conduct an interdisciplinary consultation with the involvement of specialists of various profiles, which is aimed at resolving the oncological process and complications of its treatment.

Assessing the need for improving tactics of surgical treatment in patients with elbow joint contractures (retrospective clinical study)

Objective: based on the analysis of the results of surgical treatment of patients with elbow contractures caused by ossification, assess the need to improve the planning and tactics of surgical interventions. Material and methods. According to the data of the primary medical documentation and a questionnaire, a retrospective analysis of the invasiveness of surgical intervention and the results of surgical treatment was performed, 406 patients of this category in the National Medical Research Center of Traumatology and Orthopedics n. a. R. R. Vreden in 2011-2021. Results. The development of late postoperative complications was characteristic of the overwhelming (about 80%) number of patients surveyed. The dominant (54.9%) complications were post-rehabilitation long-term pain and lack of movement in the operated joint. About 35% of patients rated the functional state of the operated elbow joint as satisfactory and poor. Approximately 30% of patients rated their general condition and quality of life below the average normal values. Conclusion. The existing technique of preoperative examination, planning and performing surgery for elbow contractures caused by ossification needs to be improved, since in about a third of patients it does not allow achieving stable results and does not provide a full volume of painless movements in the elbow joint in the medium and long-term observation periods.

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.

Surgical Treatment Tactics of Injuries of the Anterior Cruciate Ligament in the Acute Period (Literature Review)

Surgical Treatment Tactics of Injuries of the Anterior Cruciate Ligament in the Acute Period (Literature Review)

Treatment of renal artery fibromuscular dysplasia with drug-eluting balloon angioplasty and intravascular imaging: a case report

Fibromuscular dysplasia (FD) is a segmental, non-inflammatory and non-atherosclerotic disease of vascular smooth muscle of unknown etiology, which leads to stenosis of smalland medium-sized arteries. The choice of surgical treatment tactics for renal artery FD depends on the severity of clinical manifestations and the response to the conservative drug treatment used. Young age, female sex, high blood pressure with failure to achieve target values with therapy, as well as the absence of atherosclerotic involvement of other arterial systems gives reason to suspect renal artery FD. According to modern guidelines, the invasive treatment of hemodynamically significant renal artery stenoses includes transluminal drug-eluting balloon angioplasty. In this disease, renal artery stenting is not recommended. However, stent implantation is required if balloon angioplasty did not give the optimal result or in case of periprocedural complications, such as arterial dissection. Open reconstructive surgery is indicated for complex anatomy of the related artery, macroaneurysms in which stent grafts are ineffective, refractory intimal fibroplastic lesions, increased risk of endovascular treatment, or after unsuccessful endovascular intervention. The article presents a case of a young patient with renal artery FD, renovascular arterial hypertension, who successfully underwent renal artery transluminal drugeluting balloon angioplasty.

Results of a personalized approach to surgical correction of portal hypertension in patients with liver cirrhosis

Objective: to improve the results of treatment of patients with complicated intrahepatic portal hypertension by developing optimal surgical treatment tactics and choosing drug correction aimed at preventing thrombotic venous complications.Materials and methods: 82 patients with clinically significant portal hypertension of cirrhotic origin were examined and treated. The I group consisted of 24 patients who underwent transjugular intrahepatic portosystemic stent bypass surgery, the II group included 58 patients for whom the operation was supplemented with selective embolization of the gastric veins. Methods: clinical and laboratory examination, “Thrombodynamics” test using a “prognostic calculator” (RF patent), surgical, statistical.Results: it was established that 26,8% of patients had a risk of developing venous thrombotic complications: in group I 4/24 (16,6%), in group II — 18/58 (31,0%). Personalized drug correction carried out in the postoperative period led to the absence of risk in 2/22 (9,1%) patients in group I and in 8/53 (15,1%) in group II. The number of deaths in group I was 2/24 (8,33%) and in group II 5/58 (8,62%). Shunt thrombosis was detected in 3/22 (13,63%) patients of group I and in 1/53 (1,88%) patients of group II in the period from 24 to 32 months after surgery. Varicose esophageal-gastric bleeding occurred in 2/22 (9,00%) patients with shunt thrombosis of group I and in 1/53 (1,88%) of group II patients who underwent endoscopic ligation of esophageal varices.Conclusion: a method for predicting the risk of developing thrombotic complications in patients with liver cirrhosis is a convenient tool for risk stratification of patients. An individual approach ensures monitoring of the patient not only before, but also after the operation. Drug correction regimens for identifying high, moderate and low risks of complications made it possible to prevent them. TIPS surgery alone and in combination with selective embolization of gastric veins allows achieving comparable results in observation groups against the background of corrective therapy.

Tactics of surgical treatment of children with small intestinal polyps with Peutz–Jeghers syndrome and juvenile polyposis

Tactics of surgical treatment of children with small intestinal polyps with Peutz–Jeghers syndrome and juvenile polyposis

The use of additive 3D printing technologies in the training of vertebrologists

Additive technologies (3D printing) can be used in teaching surgical treatment of diseases and injuries of the spinal column due to the ability to produce both standard anatomical models and models based on patient imaging data. The presented opportunities allow you to practice and maintain manual surgical skills, choose the most appropriate surgical treatment tactics at the preoperative stage, taking into account the individual anatomical characteristics of the patients and the characteristics of the pathological process.

PSAMMOMA BODIES IN LYMPH NODES OF THE NECK: POSSIBLE PRECURSOR OF LOCOREGIONAL METASTASES OF PAPILLARY THYROID CARCINOMA

Background. Papillary thyroid carcinoma (PTC) is the most common type of well-differentiated thyroid cancer accounting for up to 80% of all thyroid neoplasms. Metastases to the regional lymph nodes (RLN) of the neck are a feature of its biological aggressiveness. The presence of psammoma bodies may be considered a pathomorphological feature of PTC in addition to the papillary structure of tumor and specific nuclear changes. The aim of the study was to evaluate a clinical value of psammoma bodies in the RLN of PTC patients. Materials and Methods. 91 patients with PTC who were surgically treated at the Verum Expert Clinic were enrolled in the study. The clinical and pathomorphological data were retrieved from the archival medical records. Results. According to the results of the clinico-morphological analysis, 51 patients (56%) with PTC had metastases in the RLN of the neck, and 40 (44%) patients had no metastases. Among 51 patients with metastases in the RLN, in 4 patients psammoma bodies in the RLN and tumor tissue were identified. In 3 of these 4 patients, the size of the primary PTC tumor was less than 10 mm, but an aggressive cancer course such as significant number of metastases in the RLN or multifocal growth was found in all these cases. Conclusions. The presence of psammoma bodies in RLN and primary PTC tumor could be suggested as a predictor of metastasis to lymph nodes. The detection of point echogenic foci in the lymph nodes by ultrasound at the preoperative stage is a sign of psammoma bodies. This finding can be useful for improving the efficacy in selection of surgical treatment tactics for the optimal neck dissection by planning neck dissection in the presence of such point echogenic foci at the preoperative stage and performing regular check-ups of the patients.