Tactics Of Surgical Treatment Research Articles

Comparative characteristics of sagittal balance in normal children and with spondylolisthesis

BACKGROUND: The measurement of sagittal parameters is an important part of preoperative planning and is also used to evaluate the results of surgical treatment. It is known that in spondylolisthesis (especially at high degrees) the sagittal parameters of the spine differ from those in healthy people. The difference in spinal-pelvic parameters in children and adults without orthopedic pathology has also been proven. One of the tasks of surgical treatment of spondylolisthesis is the restoration of sagittal balance or its maximum approximation to normal values. However, today there is no single accepted norm of sagittal parameters for children, therefore, the question of the optimal tactics of surgical treatment of spondylolisthesis in children remains open.
 AIM: To determine the parameters of the sagittal balance in normal children and in children with spondylolisthesis.
 MATERIAL AND METHODS: A retrospective analysis of postural radiographs of 68 children was performed. Patients were divided into 2 groups: group I 43 patients from 8 to 17 years old without spinal pathology. Group II 25 patients with spondylolisthesis from 8 to 17 years old. For each patient, the main spinal and pelvic parameters (PT; PI; SS; LL; PI-LL; TK) were measured and statistical analysis of the data was performed.
 RESULTS: The study proved that the main parameters of the sagittal balance (PI, PT, SS, LL, TK, PI-LL) in children and adults without pathological deformities of the spinal column are statistically significantly different. Also, there are statistically significant differences between the parameters of the sagittal balance in children and adolescents without spinal pathology and with spondylolisthesis (PI, PT, SS, LL, TK, SFD, PI-LL). In patients with high grade spondylolisthesis, the parameters of thoracic kyphosis and lumbar lordosis are significantly reduced, which should be assessed as a compensatory mechanism for maintaining the vertical position of the body. Children with spondylolisthesis are characterized by a significantly higher PI value.
 CONCLUSION: The sagittal parameters of the spine in children and adults are different, therefore, for correct preoperative planning, it is necessary to establish the norm of sagittal parameters for children. It is also necessary to take into account the high value of PI in children and adolescents with spondylolisthesis, which may be the etiological factor of this disease. The existing formulas for measuring sagittal balance for children with spondylolisthesis should be used with caution, because a high PI can lead to unreliable theoretical values of PT, SS, LL and TK. The cause of sagittal imbalance can be not only high degrees of spondylolisthesis, but also the tight hamstrings.

Endovascular treatment of the gluteal artery pseudoaneurysm: a case report

False aneurysms, also known as pseudoaneurysms, most commonly occur when the main arteries are injured in various ways. False aneurysms of smaller arteries located in the hard-to-reach areas are less common. These include aneurysms of the gluteal arteries. This disorder presents a serious problem due to both difficulties in diagnosis and in determining the tactics of surgical treatment. This article presents a case of successfully treated pseudoaneurysm of the gluteal artery in an elderly patient with underlying severe comorbidities. A 73-year-old patient was admitted to the clinic of vascular surgery with complaints of discomfort and pulsating sensation in the right gluteal region during exercise. Ultrasound examination and multislice computed tomography revealed a false aneurysm in the branch of the internal iliac artery measuring 57 × 36 × 46 mm, which was an indication for surgical treatment. The endovascular treatment scoped implantation of the occluder in the superior gluteal artery. The perioperative period was uneventful. According to the scheduled postoperative examination, the patient's condition was satisfactory. Of practical and clinical interest is the fact that the treatment of this disorder is a technically complex and time-consuming process. In this case, the endovascular treatment of aneurysm with an occluder resulted in an adequate therapeutic effect in the patient with underlying severe comorbidities and reduced the risk of perioperative complications. The patient returned to a normal life within a short time. Received 12 February 2022. Revised 3 April 2022. Accepted 4 April 2022. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsLiterature review: K.P. Moiseev, A.A. VlasovetsDrafting the article: N.V. Susanin, A.G. VanyurkinCritical revision of the article: N.V. SusaninSurgical treatment: M.A. Chernyavskiy, N.V. SusaninFinal approval of the version to be published: N.V. Susanin, M.A. Chernyavskiy, A.G. Vanyurkin, A.A. Vlasovets, K.P. Moiseev

MODERN INDIVIDUAL-COMPREHENSIVE APPROACH IN THE TREATMENT OF HEMORHOIDS

Objective. The aim of the study was to analyze the effectiveness of modern treatments in 485 patients with chronic hemorrhoids stage II-III-IV over the past 3 years.
 Results. An individual-combined approach to the treatment of hemorrhoids has been introduced, as many patients can have nodules at different stages of the disease at the same time. Used a combination of methods with different ways to influence the pathogenesis of hemorrhoids. Thanks to the introduction of a set of systemic measures, good results were obtained, namely the healing time of postoperative wounds was reduced by 35-40% and the intensity of postoperative pain was reduced by 3-4 points on a 10-point analog visual scale.
 Conclusions. The use of an individual integrated approach to each patient in choosing the tactics of surgical treatment of hemorrhoids and the widespread introduction of modern techniques, has reduced the duration of the postoperative period, preserve radical intervention and reduce the likelihood of recurrence.

The effect of surgical treatment in patients with proximal hip fractures during the COVID-19 pandemic

Annotation. The aim of our study was to provide a clinical description of the diagnostic process, surgical treatment tactics and its impact on treatment outcomes in patients with proximal femur fractures and COVID-19 infection. In our study, we analyzed the treatment of 43 patients with fractures of the proximal femur who were treated in one of the city hospitals of Kyiv in the period from September 2020 to March 2021. For screening of COVID-19, all patients with fractures of the proximal part of the hip planned for surgical treatment were sent for reverse transcription polymerase chain reaction (RT-PCR) analysis for the qualitative detection of SARS-CoV-2 nucleic acid. in swabs from the nasopharynx. Upon admission, 40 patients (93.0%) had symptoms characteristic of COVID-19, namely: headache, general weakness, subfebrile temperature, shortness of breath. In 7.0% of patients with proximal hip fractures, asymptomatic course of the disease of COVID-19 was detected, however, in the diagnostic process, the diagnosis was still made. Statistical processing was carried out using a non-parametric method, the method of calculating the coefficient of the Pearson polychoric relationship indicator was chosen. In all observation groups, an improvement in the general condition and laboratory parameters was noted already on the 3rd day of the postoperative period. A fracture of the proximal part of the hip is an injury that can threaten the patient's life, so the choice of the surgical intervention method and its timing play a key role in the recovery of this category of patients. An increase in the time of bed rest, connection of hypostatic phenomena, extension of the period of pain sensitivity can lead to deterioration of the condition of patients infected with COVID-19. Based on our research, we came to the conclusion that early surgical treatment of patients with fractures of the proximal part of the hip and COVID-19 has a positive effect on the general condition of patients, quickly mobilizes them, improves lung ventilation, which are factors of recovery.

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.

Parasagittal meningiomas: surgical treatment outcomes

Purpose: to improve the outcomes of surgical treatment of parasagittal meningioma patients by implementing a differentiated approach to the choice of surgical intervention, given the preoperative assessment of patency of the superior sagittal sinus (SSS) and collateral venous circulation. Materials and methods. Analysis of short-term and long-term outcomes of surgical treatment of 199 patients in the Department of Neurosurgery № 2, Mechnikov Dnipropetrovsk Regional Clinical Hospital was carried out. In the first follow-up period (2000 to 2012), the data were obtained retrospectively (95 cases). In the second follow-up period (2013 to 2021), the data were obtained prospectively (104 cases). The patients were assigned to the groups according to a differentiated approach (implemented in 2013) to the choice of surgical treatment tactics based on preoperative angiographic data (selective cerebral angiography and CT angiography). Results. In the first follow-up period, the completeness of surgical resection according to Simpson Grading Scale was: type I, 23 (24.2%) cases; type II, 37 (38.9%) cases; type III, 13 (13.7%) cases; type IV, 22 23.2%) cases. 53.7% of patients had intraoperative or postoperative complications. Among patients with tumors of the middle third of the SSS, 21 (41.2%) had their neurological status improved postoperatively. Mortality rate was 4.2%. 14 (14.7%) patients had further parasagittal meningioma growth after its removal grade II–IV according to Simpson Scale. In the second follow-up period, the completeness of surgical intervention according to Simpson Scale was: type I, 74 (71.2%) cases; type II, 26 (25%) cases; type III, 2 (1.9%) cases; type IV, 2 (1.9%) cases. 19.2% of patients had intraoperative or postoperative complications. Among the patients with tumors of the middle third of the SSS, 46 (79.3%) patients had postoperative improvement of neurological status. No lethal outcome was reported. 3 (2.9%) patients had further parasagittal meningioma growth after radical surgical removal according to Simpson grade II. Conclusions. Adequate analysis of instrumental methods of brain study using cerebral vasculature study, application of neuronavigation station (with brain MRI and/or CT angiography data available) and new microsurgical techniques contributed to the completeness of surgery and minimally invasive removal of parasagittal meningioma with reduced intraoperative and postoperative complications, which affected the immediate and long-term treatment outcomes.

Tactics of Surgical Treatment of Postinfarction Ventricular Septum Rupture Depending on the Time after the Development of an Acute Myocardial Infarction

The article is dedicated to topical issues of the tactics of surgical treatment of postinfarction ventricular septum rupture (PIVSR). Based on the study of the peculiarities of surgical treatment of ventricular septal defect in patients with different deadlines for surgical intervention after the development of acute myocardial infarction (AMI), the most appropriate approach to the correction of PIVSR in such patients was determined. In particular, taking into account mortality risk (42 %), the most reasonable is the use of wait-and-see tactics in the management of patients with PIVSR at the early stages after the development of AMI. At the same time, the decision on the timing of surgical intervention should be made individually, taking into account the clinical condition of the patient and the course of the postinfarction heart remodeling. Special attention is paid to the analysis of the effectiveness of the use of intra-aortic balloon counterpulsation and the time intervals of surgical intervention from the moment of hospitalization in patients with PIVSR. It was found that clinical course of coronary heart disease complicated by PIVSR can be extremely unpredictable not only in the early postinfarction period, but also up to 2 months after the development of AMI. In addition, when planning the amount of surgical intervention, it is necessary to take into account the presence of multivessel atherosclerotic lesions of the coronary arteries in patients with PIVSR, regardless of the timing after the development of AMI.

Comparison of the Methods of Surgical Treatment of Complex Congenital Heart Defects Combined with Right Ventricular Hypoplasia

Surgical treatment of complex congenital heart defects (CHD) in patients who cannot undergo radical correction due to pronounced hypoplasia or dysfunction of the right ventricle (RV) remains one of the most urgent problems in pediatric cardiac surgery. In 1989, Billingsley et al. first reported the addition of bidirectional cavopulmonary anastomosis to definitive biventricular repair in patients with RV hypoplasia, pulmonary artery atresia, and intact interventricular septum in four patients, and introduced the term one and half ventricle repair (1.5VR). The method of 1.5VR consists of bidirectional cavopulmonary anastomosis, which reduces the volume load on the RV, in addition to the complete repair of other CHDs.
 The aim. To assess perioperative characteristics of patients, immediate and long-term results after surgical correction of complex CHD through the method of 1.5VR.
 Materials and methods. In the period from 1996 to 2022, surgical correction was performed in 33 patients with complex CHD combined with hypoplasia and/or dysfunction of the RV at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. There were 21 male patients (64%) and 12 female patients (36%). The mean age of the patients at the time of surgery was 57.9 months. Me = 34 [3.5; 312] months. The main method of diagnosis in determining the defect and assessing the immediate and long-term results was echocardiographic examination and probing of the heart cavities, which made it possible to assess the morphology, kinetics of the heart structures, and hemodynamic state. Depending on the selected tactics of surgical treatment, all the patients were divided into two groups: group І (n=21) with patients operated through the method of 1.5VR, and group ІІ (n = 12) including those operated through the single ventricle pathway.
 Results. In the early postoperative period, there were 3 (9%) deaths in both groups: one (4.7%) death in group I, and 2 (16%) deaths among patients of group II. In all the deceased patients, the cause of death was acute heart failure, which subsequently led to multiple organ failure. In one patient of the group II, in addition to heart failure, acute cerebrovascular accident occurred. In the group I, the average indicator of systemic saturation (92±6.2%) at discharge from the hospital was higher, than that in group II (87±4.7%). Average duration of mechanical ventilation (10±7.3 vs. 15±7.8 hours), total exudation (65±34 vs. 88.8±39.9 hours), total duration of sympathomimetic support (71±27.5 vs. 108±75.5 hours) and its doses (4.8±2 vs. 6.5±3.8 μkg/kg/hour) were significantly lower in the group I, therefore, the patients of the group II stayed almost twice as long in the intensive care department (146±56 vs. 96±49.8 hours), although the total length of hospital stay did not differ significantly (25±3.8 vs. 26±12.3 days). An uncomplicated course of the early postoperative period was observed in 15 (46%) patients. Other 18 (54%) patients had complications: 8 patients (24%) of group I had 9 complications, and 10 patients (30%) of group II had 14 complications. The mean observation period was 48±29.8 months, (6 to 190 months). No deaths were observed during the observation period in 26 patients (79%) of both groups, 4 (12%) patients were lost to follow-up. Total cavоpulmonary anastomosis (Fontan procedure) was performed in 7 patients (58%) of the group II. Hemodynamic indicators in the examined 17 patients (81%) of the group I showed good long-term results that did not require other interventions. In 15% (3 of 20) of the patients of the group I, a high mean pressure in the right atrium of 14±1.8 mmHg attracts attention with dilatation of the inferior vena cava and hepatic veins, and 5 (20%) patients had high mean pressure of 16±2.7 mmHg in the superior vena cava. Transplantation-free survival during the observation period in patients of both groups was 100%.
 Conclusions. 1.5VR is a reasonable alternative to the palliative Fontan strategy in children in whom the anatomic or functional status of the RV is between biventricular reconstruction and the single ventricle pathway and shows good immediate and long-term results.

Factors Associated with Revision Surgery in Long Bones Metastases

Background. Bones as an organ are one of the most common targets for tumor metastasis. Currently, the number of patients undergoing surgical treatment for metastatic bone lesions is steadily increasing. In most patients, after surgical treatment, the manifestation of clinical symptoms decreases, primarily pain syndrome, which improves their quality of life. However, it should be noted that the number of patients with bone metastases who underwent revision surgery is also increasing. This article retrospectively analyzes the factors leading to revision after surgical treatment of metastases in long bones.
 The aim of this study was to identify factors leading to revision after surgical treatment of patients with metastases in long bones.
 Methods. A retrospective medical records analysis of 247 patients who underwent surgical treatment for metastases in long bones on the basis of the P.A. Herzen Moscow Research Institute of Oncology in 20062020 was performed. Of these, 33 patients underwent revision surgery. The median age was 62 years. The localization of the primary tumor was as follows: breast cancer 10 cases, kidney cancer 13, lung cancer 3, prostate cancer 2, rectal cancer 3, liver cancer and Ewings sarcoma with bone metastases 1 case each.
 Results. The following factors led to revision surgery: mistakes in preoperative diagnosis (3 patients); postoperative infectious complication (6 patients); dislocation of the endoprosthesis (4 patients); continued growth of solitary metastasis after osteosynthesis (5 cases); aseptic instability after intramedullary osteosynthesis (14 patients); traumatic fracture of the endoprosthesis stem (1 patient).
 Conclusions. Revision after surgical treatment of metastases in long bones, in addition to postoperative complications, lead to mistakes in diagnosis and incorrect choice of surgical treatment method. To reduce the risk of revision surgical interventions, a multidisciplinary approach is needed with the development of surgical treatment tactics in consultation and the use of specialized scales of oncological prognosis.

Rationale for minimally invasive surgery and its clinical use in early ANFH

Objectives. A study of the expedience of arthroscopic revision of hip cavity in conjunction with tunnelling, revision and sanitation of the femoral head necrosis site, followed by bone alloplasty early in disease, during surgical treatment of ANFH patients.Materials and methods. Minimally invasive two-stage decompression with bone alloplasty was performed as a surgical treatment in stage 0, 1, 2 ANFH patients at the orthopaedic unit of Vladimirtsev Territorial Clinical Hospital of Khabarovsk during 2017–2021. The survey included 60 patients examined as follows: clinical examination, radiography, multislice computed tomography and magnetic resonance imaging, with follow-ups in 6 and 12 months.Results and discussion. A detailed arthroscopy analysis was performed at different stages of the disease sequence, which allowed a comprehensive comparison of X-ray and intraarticular change data.Conclusions. The study demonstrated that therapeutic and diagnostic hip arthroscopy offers a number of clear advantages and allows decision on a surgical treatment tactics that minimises postoperative complications. The use of minimally invasive surgeries in early ANFH allows a stable regain of the patient social activity to postpone radical surgical interventions.

ENDOVASCULAR ANGIOPLASTY FOR MULTI-LEVEL STENOTIC-OCCLUSIVE LESIONS OF THE FEMORAL-DISTAL ARTERIAL BED IN CASES OF STENOTIC-OCCLUSIVE PROCESS OF THE TIBIAL ARTERIES

Background. Occlusive-stenotic lesions of the lower extremity arteries are the second in the structure of cardiovascular diseases, after only coronary heart disease. Surgical treatment of patients with infrainguinal atherosclerotic lesions of the arterial segment is challenging in a number of cases. At the same time, revascularizing surgical interventions on the femoral-distal artery and especially on the tibial arteries in chronic critical ischemia is the only chance to avoid amputation of the lower limb. In this regard, the search and study of optimal methods of revascularizing surgery on the infrainguinal artery for stenotic-occlusive lesions of the arteries of the tibial segment is urgent.
 Objective. This study is aimed at promotion of endovascular and hybrid technology in cases of stenotic-occlusive process of the tibial arteries and choosing the optimal surgical treatment tactics in this case.
 Methods. Endovascular interventions of the femoral-distal arterial bed in cases of stenotic-occlusive process of the tibial arteries performed for 135 patients at the Department of Vascular and Cardiac Surgery of Ternopil Regional Clinical Hospital have been analysed.
 Results. In most cases, endovascular angioplasty of two tibial arteries in hybrid and endovascular methods of revascularization of multilevel atherosclerotic process of the femoral-distal arterial segment of the lower extremity prevents development of thrombosis in tibial segment and allows maintaining the patency of the reconstruction segment and preservation of the lower extremity in 97.57% and 93.44% of cases, respectively.
 Conclusions. Endovascular angioplasty of two tibial arteries provides a better result than angioplasty of one isolated tibial artery and allows maintaining the patency of the reconstructed segment for more than 90 percent compare to one isolated angioplasty.

P9.50: Novel MLTR Classification of Portal Vein Thrombosis For Purposes of Liver Transplantation

Portal vein thrombosis (PVT) is a common complication of decompensated liver cirrhosis and occurs in 0.6-26% of patients on waiting lists. In a population of patients with liver cirrhosis, PVT develops within a year in 4.6-12.8%, in 10.2-20% within 5 years, and within 8-10 years in 38.7%. The Liver Transplant Center of the Sklifosovsky Institute in Moscow is the leading transplant center in Russia, which performs liver transplants for portal vein thrombosis - such patients occur on the waiting list of the center up to 30%. The practice of the center led to the need to create its own classification, which would allow making decisions on the waiting list and intraoperatively. For the purposes of liver transplantation, especially if transplantation is planned from a living related donor, it is possible to propose a classification of portal vein thrombosis that would be applicable to address tactical issues in liver transplantation. A variant of such a classification, which may be called MLTR, is given in Table 1. Table 1. - MLTR classification of portal vein thrombosis Letter Designation M Thrombosis of the mesenteric veins 0 - no thrombosis 1 - non-occlusive thrombosis of one of the veins 2 - occlusive thrombosis of one of the veins L Thrombosis of the splenic veins 0 - no thrombosis 1 - non-occlusive thrombosis 2 - occlusive thrombosis T Thrombosis of the portal vein 0 - no thrombosis 1 - non-occlusive thrombosis 2 - occlusive thrombosis R Thrombosis of the branches of the portal vein 0 - no thrombosis 1 - non-occlusive thrombosis 2 - occlusive thrombosis In the presence of calcification, the letters ca are added, in the presence of cavernous transformation ct. Visually, the classification is presented in fig. 1.The developed classification was introduced into the work of the liver transplantation center of the N.V. Sklifosovsky. The clinical material consisted of 650 patients of the liver transplantation center of the N.V. Sklifosovsky operated from 2000 to 2020. Patients with PVT M0L0T1R0 accounted for 25% of the total number of patients, with M1L0T2R0 - half, with M1L1T2R0-1 - 25%. Based on the developed classification, the tactics of surgical treatment of patients was determined as follows. The developed classification was used to determine intraoperative tactics. In the presence of M1-2L0-1, the retropancreatic portal vein and its confluence were mobilized, for which the head of the pancreas was mobilized. This technique made it possible in some cases to perform eversion thrombinthymectomy without performing plastic or bypass interventions. In the presence of T3, thrombinthymectomy was not performed; it was planned to perform shunting or prosthetics of the portal vein. The presence of R1-2 prior to transplantation was of little hemodynamic significance. Thus, we can conclude that the developed classification was used by us to make a decision during liver transplantation. The authors would like to thank Maria Kozhevnikova for her help in illustrating our work.

3D-TECHNOLOGIES IN MEDICINE AND FORENSIC MEDICAL PRACTICE: CURRENT STATUS AND PROSPECTS FOR IMPLEMENTATION

The article summarizes the literature data and analyzes the current state and prospects for the introduction of 3D-technologies in medicine and forensic practice. The importance of spatial three-dimensional modeling for medical imaging and diagnosis of diseases, tactics of surgical treatment, eff ective transplantation, manufacturing of individual prostheses, implants, creating training models and improving the objectivity and accuracy of forensic examinations is highlighted.

Combined complications of duodenal ulcer: classification and some aspects of pathogenesis and tactics of surgical treatment

Aim. To improve the existing classifications as the basis for the development of a pathogenetically substantiated treatment and diagnostic tactics that meets the modern requirements of surgical gastroenterology. Material and methods. The material is based on the results of diagnosis and surgical treatment of 658 patients with duodenal ulcerative colitis with combined complications. A combination of two or more complications occurred: stenosis + penetration - in 368 (55.9 %) patients, penetration + stenosis + bleeding - in 105 (16.0 %), penetration + stenosis + perforation - in 58 (8.8 %) ), perforation + bleeding - in 52 (7.9 %), perforation + penetration - in 18 (2.7 %), penetration + bleeding - in 51 (7.8 %) patients, a combination of multiple and rare complications - in 6 (0.9 %) patients, including penetration + stenosis + perforation + bleeding - in 1 (0.15 %) patient, a combination of penetration, stenosis and duodenocholedochal fistula - in 3 (0.45 %), a combination of penetration + bleeding + stenosis + chronic pancreatitis - in 1 (0.15%), a combination of penetration + choledochal stricture + obstructive jaundice - in 1 (0.15%) patient. Results and discussion. In the classification of each variant of combined complications, the main factors influencing the choice of treatment tactics are identified. The choice of the method of surgical treatment with a simultaneous combination of several complications, first of all, depends on the general condition of the patients, due to the severity of bleeding, the prevalence of peritonitis, and the stage of stenosis of the gastroduodenal junction. In emergencies, only intraoperative revision makes it possible to clarify the nature of the pathological process and the possibility of its elimination by radical or palliative methods. Conclusion. The proposed classification can become a new platform for conducting a pathogenetically substantiated diagnostic and therapeutic strategy with the possibility of improving the results of surgical treatment of patients with duodenal ulcerative colitis with combined complications.

Surgical Rehabilitation of a Posttraumatic Iris Cyst, Cataract and Astigmatism Patient. Clinical Case

Injuries cause serious disturbance of the form and function of the organ of vision due to the damage and accompanying or remote complications and therefore have a high proportion to the structure of low vision, blindness and disability. One of the complications of penetrating wounds of the eye is iris cysts. Iris cyst can increase and cause pupillary block, secondary glaucoma, uveitis, corneal dystrophy, and therefore it requires surgical intervention. The goal of surgical treatment of an iris cyst is to ensure complete removal of the cyst.Objective: to estimate the clinical and functional results of treatment in a posttraumatic iris cyst, posterior subcapsular cataract and myopic astigmatism patient.Patient and methods. Patient B., 49 years old with posttraumatic retention iris cyst, posterior subcapsular cataract, compound myopic high astigmatism was examined. To determine the tactics of surgical treatment of the patient, a complex of General ophthalmology was perfomed (visometry, IOP measurement, autorefractometry, biomicroscopy, ophthalmoscopy), as well as special (B-scanning, optical coherence tomography of the retina) research methods. The follow-up period was 1 year.Results and discussion. To improve visual functions and prevent the development of secondary glaucoma, the patient was offered surgery - excision of the iris cyst and cataract phacoemulsification with toric intraocular lens. Simultaneous carrying out of two stages of the operation reduced the risks of postoperative complications and shorten the rehabilitation period.Conclusion. Positive optical and therapeutic effects were achieved as a result of the surgical treatment 44 years after an open eye injury: the eye is calm, the iris cyst is not detected, visual acuity has increased. The postoperative period showed the saving the stable and high visual and functional result with no recurrence of the iris cyst.

РЕКОНСТРУКТИВНЫЕ И СТАБИЛИЗИРУЮЩИЕ ВМЕШАТЕЛЬСТВА В КОМПЛЕКСНОЙ ТЕРАПИИ ПАЦИЕНТОВ С СОЛИТАРНЫМИ МЕТАСТАЗАМИ ПОЗВОНОЧНИКА

Abstract. Introduction: The problem of diagnosis and treatment of patients with oncological pathology of the spine is relevant due to treatment complexity and the increasing number of patients’ morbidity. Secondary neoplastic processes are common in spine because of its anatomy, physiological features, complex biomechanics and enhanced vascularization. The main clinical manifestations of metastatic lesions of the spine are pain and neurological deficit. The development of spinal cord compression and pain syndrome leads to a sharp deterioration in the quality of life in patients with metastatic lesions of the spine. Despite the progress made in modern surgery of patients with oncological diseases with metastasis to the spine, mortality rates after surgery reaches 6.3% and complications appear in 23% of cases. Aim: Improving the results of treatment of patients with solitary spinal metastases and spinal cord compression. Methods and materials: Between 2010 and 2018, patients with spinal neoformations (N=240) received surgical treatment at Traumatology Unit of North-Western State Medical University named after I.I. Mechnikov. All patients were put into the categories according to their sex, age, histologic type and location of tumors. We assessed patients’ pain severity (BAIII), neurologic status (Frankel scale) and life span (by Kaplan-Meier method). Results: The study presents the analysis of the results of complex therapy of 183 patients with solitary metastases of the spine, who underwent the surgical stage of treatment. For these patients the epidemiological structure and the main clinical and radiological characteristics of solitary metastatic lesions of the spine were determined, a comparative assessment of the effectiveness of various options for surgical interventions in the complex treatment was carried out. To do so, all patients of the primary cohort were divided into 2 groups depending on the volume of surgery. The first group included 54 patients who underwent a radical resection of the affected vertebra in a single block with prosthetics of the anterior support column and posterior instrumental fixation. The second group included 129 patients after palliative decompressive and stabilizing operations from the posterior approach. Conclusion: There were no statistically significant differences between the two studied methods of surgical treatment in terms of the dynamics of the level of pain syndrome, regression of neurological deficit and life expectancy. When choosing the tactics of surgical treatment of patients with solitary spinal metastases, the main method is decompressive and stabilizing interventions, which helps to reduce the risk of surgical complications, improve the quality of life of the patient and continue the complex treatment of the underlying disease.

Identification of coronary artery lesions and tactics of surgical treatment in patients with chronic lower limb ischemia

Introduction. Ischemic heart disease is undoubtedly the main factor that significantly aggravates the condition of patients with chronic lower limb ischemia in the perioperative period.Aim. To establish the expediency of mandatory performance of selective polypositional coronary angiography in patients with chronic ischemia of the lower extremities to determine the stages of surgical intervention and prevent cardiac complications.Materials and methods. The study included 285 patients, treated to the Department of arterial pathology surgery of the Bakulev National Medical Research Center of Cardiovascular Surgery with a diagnosis of chronic lower limb ischemia. The patients were divided into 2 groups. The main group included 139 patients admitted in 2016. The control group – 146 patients admitted in 1989. In the main group, all patients underwent coronary angiography. In the control group, coronary angiography was performed only in patients with a clinical picture of coronary artery disease or in asymptomatic patients after positive stress tests.Results and discussion. After analysis of coronary angiograms in patients of the main group, out of 139 patients included in the study, 124 (89.2%) had a lesion of at least 1 coronary artery >50%; and in 101 (72.7%) patients, at least 1 coronary artery was affected >70%. In the main group, cardiac complications were noted in 6 (4.32%) patients, while in the control group they were detected in 21 (14.4%) cases. These complications appeared due to the underestimation of the state of the coronary bed, based only on the results of stress tests.Conclusions. Selective polypositional coronary angiography is the main method for detecting asymptomatic significant coronary artery disease in patients with CLCI, which improves the immediate results of surgical treatment by reducing the incidence of cardiac complications.

ДИФЕРЕНЦІАЛЬНА ДІАГНОСТИКА ЦЕРЕБРАЛЬНИХ СУДИННИХ ВАД І ОБ’ЄМНИХ НОВОУТВОРЕНЬ ФУНКЦІОНАЛЬНО ВАЖЛИВИХ ДІЛЯНОК МОЗКУ: КРИТЕРІЇ ВИБОРУ НЕЙРОХІРУРГІЧНОЇ ТАКТИКИ

Introduction. We believe, that in the planning of the surgical removal of cerebral vascular malformations (CVM) of eloquent brain areas, a question of whether they include the functionally sustainable brain tissue remains relevant. The question of whether the surgical procedure is safe is paramount. Aim. To assess the value of magnetic resonance (MR) tractography in deciding on the tactics of surgical treatment of CVM through comparison with morphological studies. Study methods. A review of the literature concerning the surgical treatment of cavernous malformations (CM) and arteriovenous malformations (AVM) localized in eloquent brain areas (EBA). Four patients with CVM of EBA were selected based on the availability of MR tractography data and histologic specimens. The method of optical microscopy was used to study microslides stained with the classic (hematoxylin-eosin) and specialized methods (Masson’s and Hart’s methods). Results. Patients’ MR-tractography data showed the presence of conductive paths in the tissues of CM and AVM and the reduced fractional anisotropy in the regions of interest, which indicates their involvement. During optical microscopy of specimens of CVMs, we found brain tissues between pathological vessels. To our opinion, this explains the visualization of conducting paths in CVMs during MR tractography. Conclusions. When planning surgeries in case of CVMs, attention should be paid to the results of conductive path visualization. According to MR tractography and morphological data, in some cases, there is brain parenchyma in the structure of CMs and AVMs, which may require additional attention in deciding on the radical resection of CVMs of EBAs.

Organization of specialized assistance to the patients with seriously thermal burn in Primorsky region

The review examines the organization of specialized medical care for victims having burn injury in Primorsky Region. Thermal injury continues to occupy a significant place in the structure of domestic and industrial injuries in the Russian Federation. Every year, more than 300 calls about patients having thermal damage are received in Primorsky Region TCDM. For five years (from 2017 to 2021), specialists of the Primorsky TCDM made 178 visits to regional medical institutions, 160 seriously burned people were delivered to the specialized department by ground and air transport. There is still a need for round-the-clock collection of medical and sanitary information about the severely burned patients in medical institutions of Primorsky Territory and the organization of interaction with a specialized department. The Regional TCDM organized timely evacuation of patients having deep thermal traumas to the burn unit of FEDMC. It allowed performing surgical treatment tactics, including effective early removal of necrotic tissues. An analysis of appeals to the dispatcher's office of the Territorial Center for Disaster Medicine regarding severe thermal injury, as well as a statistical analysis of victims from remote areas of the Primorsky Territory delivered to the burn department in Vladivostok were conducted. It is emphasized that timely transportation of patients having severe burn injuries is the first step in the system of active treatment of victims which allows conducting early surgical treatment and reducing the number of complications, and improving treatment results.

Algorithm of surgical tactics and surgical treatment of cholelithiasis complicated by multiple choledocholithiasis

Objective: Biliary stone disease is now one of the most common diseases, affecting 10-20% of the world's population. One of the most important problems in biliary tract surgery is the treatment of choledocholithiasis, which occurs in 10 to 38% of biliary stone disease according to different authors. Our research has allowed us to outline the most rational ways of treating patients in modern conditions. In our research, we focus on “the golden mean'” - a combination of staged minimally invasive interventions and standard interventions. Aim of our study was to evaluate the results of postoperative complications using the developed algorithm of surgical tactics and choledochoduodenoanastomosis from a minimally invasive approach. Methods: Overall, 35 patients who underwent surgical treatment of cholelithiasis, cholangitis, benign genesis obstructive jaundice (BGOJ) were included to the study. All patients were divided into two groups (main group and comparison group) depending on the method of treatment used. The study group consisted of 17 (48.6%) patients who underwent bile outflow restoration of choledochal outflow obstruction of the terminal section (choledochodenoanastamosis according to the developed by us procedure (Kazakhstan patent №108142, Algorithm of diagnostics and surgical treatment tactics of benign genesis obstructive jaundice - Author's certificate № 24754. Control group consisted of 18 (51.4%) patients who underwent cholecystectomy, choledocholithiasis by Jurash-Vinogradov and applied conventional algorithm of diagnostics and treatment of multiple choledocholithiasis with benign genesis obstructive jaundice. We assessed complications of procedures according to Clavien-Dindo and pain intensity level using visual analog score in both groups. Results: When using the proposed algorithm and new methods of surgical treatment in patients in the study group the rate of complication was lower in the study group as compared to control group (p=0.04): there was no deficiency and bleeding from the anastomosis, while in control group they turned out to be in 1 case. Complications in the form of seroma in 2 cases and bleeding into the subcutaneous tissue of the postoperative wound were in 1 case, being the same as in control group. No mortality was recorded in any group. The pain level was lower in the study group as compared to control group (p<0.05). Conclusions: Thus, the application of our algorithm for the diagnosis and surgical tactics of treatment of obstructive jaundice of benign genesis makes it possible to determine the tactics of surgical treatment of patients with obstructive jaundice. The developed technique for the surgical treatment of choledocholithiasis in cholelithiasis ensures the restoration of bile outflow in the duodenum, normalizes its morphofunctional state, prevents the development of various postoperative complications, in particular, there was no leakage and bleeding from the choledochoduodenoanastomosis in the main group.