Total Number Of Complications Research Articles

Misdiagnosed and maltreated scaphoid fractures - costly both for society and patients: A review of filed claims to the Swedish National Patient Insurance Company 2011-2018.

Misdiagnosed and maltreated scaphoid fractures filed to the Swedish National Patient Insurance Company (LÖF) 2011–2018 were analyzed in terms of complications and costs for society. All filed claims are database-registered (altogether 200 000 claims since 2000). This database was assessed in June 2019 through injury ICD10-SWE-diagnoses. Demographics, complications, complaints, corrective surgeries and costs were analyzed. The numbers of claims for scaphoid fractures were reviewed and compared with all claims.There was a statistically significant trend towards decreasing numbers of notified scaphoid fracture cases during this time. This is not the case compared with the total annually notified injuries to LÖF during the same time, where we instead can see statistically significant increased numbers.Median age for the 128 patients was 24 years. Men represented 76%. Seventy-eight of the 128 (61%) claims were judged as avoidable, compared with 42% in terms of all notified injuries. Pseudoarthrosis dominated as complication (n = 71). Total numbers of complications were 117, and 47 of the 78 patients had medical invalidity as a consequence. Up to six secondary corrective surgeries per patient were required. Complications and disabilities were more severe if patients needed more than one surgery. The total costs were calculated to €1 226 193.Level of Evidence: LoE III, Therapeutic.

Comparison of long-term results of trabeculectomy and phacotrabeculectomy in patients with pseudoexfoliation glaucoma and primary open-angle glaucoma: a single-center study.

To evaluate long-term surgical success and complications in pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG) after trabeculectomy or phacotrabeculectomy. 96 PEXG eyes and 114 POAG eyes who underwent primary trabeculectomy and phacotrabeculectomy were retrospectively evaluated considering intraocular pressure (IOP), the number of glaucoma medications, surgical success, and rate of complications. Two success criteria were used: Complete success comprised IOP of 5-18mmHg and 20% reduction of baseline IOP without medication. Qualified success comprised IOP of 5-18mmHg and 20% reduction of baseline IOP irrespective of medication. Success rates in PEXG and POAG groups, trabeculectomy and phacotrabeculectomy groups, and four groups divided according to surgery and etiology were analyzed via Kaplan-Meier survival analysis. The complete and qualified success were not different between PEXG and POAG groups. The qualified success curves show a similar pattern among the four groups throughout the follow-up of 1,2,3,5,7 and 9years. Baseline IOP and the number of medications were similar in all four groups (p = 0.275 and p = 0.209, respectively). IOP levels and the number of medications were not statistically different between the four groups during the follow-up of 2,5 and 7years. The total number of complications and interventions were similar between PEXG and POAG groups (p = 0.258). Phacotrabeculectomy is an effective procedure as trabeculectomy with similar surgical success rates and few surgical complications when it comes to treating PAOG and PEXG patients. Both approaches resulted in similar postoperative IOP levels and medication numbers in both groups.

Comparison of postoperative complication rates between a novel endoluminal balloon-assisted drainage and diverting stoma after low rectal cancer.

To introduce a novel endo-luminal balloon-assisted drainage (EBAD) and compare postoperative complication rates between EBAD and diverting stoma (DS) groups. The single center prospective non-random cohort study included a total of 163 patients in convenience patients with rectal cancer between January 2019 and January 2021. Out of 163 patients, 83 underwent DS and 80 EBAD. Primary endpoints were postoperative complication rate. The total number of complications was 28 in the DS group vs. 22 in the EBAD group (P = 0.388). 18 patients (21.7%) in the DS group and 14 patients (17.5%) in the EBAD group developed postoperative complication (P = 0.501). There were no differences identified for anastomotic leak rates between the two groups (P = 0.677). The rate of the pelvic abscess was lower in the EBAD group (1/80, 1.3%) than in the DS group (4/83, 4.8%) but with no statistical significance (P = 0.386). Compared with the DS group, the median operative time was shorter in the EBAD group (225 vs. 173.5min, P < 0.001). Regarding incomplete small bowel obstruction, a higher prevalence was observed in the DS group compared to the EBAD group (7.2% vs 2.5%, P = 0.301). 7 patients (11.3%) in the DS group developed a para-stomal hernia, while no patient suffered a catheter-related complication. The median postoperative hospital stay was shorter in the DS groups than in the EBAD group (7 vs 8days, P = 0.009). The median residence time of endo-luminal balloon-assisted drainage was 5.41days. The median average and total volume of drainage were 51.57ml/day and 255ml, respectively. EBAD is feasible and safe with similar postoperative complications when compared with a DS. EBAD may replace DS after rectum resection.

Структура осложнений у пациентов с различными вариантами нарушения костно-мышечного статуса, подвергшихся коронарному шунтированию

Th e aim of the research. To analyse the structure of complications in patients with coronary artery disease and different musculoskeletal disorders (MSD) undergoing elective coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass. Material and methods. From 2019 to 2020, a single-centre cohort study was conducted on 387 stable coronary artery disease patients aged over 50 before elective CABG. The following MSD were assessed: sarcopenia, osteopenia, and osteosarcopenia. Patients were divided into four groups according to the MSD type: group I included 52 (13.4 %) patients with sarcopenia, group II included 28 (7.2 %) patients with osteopenia, group III was composed of 25 (6.5 %) patients with osteosarcopenia, and group IV included 282 (72.9 %) patients without MSD. Patients underwent CABG using cardiopulmonary bypass. Cardiovascular, infectious and non-infectious complications, death, a composite endpoint including cardiovascular complications and death, as well as the total number of complications were analysed. Results. Infectious complications were revealed in 23 (5.9 %) patients. Th e highest frequency of infectious complications was noted in patients with osteosarcopenia while the lowest frequency was found in patients without MSD (24 % vs 5.8 % in group I, 7.1 % in group II, 4.3 % in group IV). The highest number of surgical complications was noted in patients with sarcopenia and osteosarcopenia (17.3 % in group I, 7.1 % in group II, 12 % in group III, 5.3 % in group IV; p = 0.002). The composite endpoint was significantly more prevalent in patients with osteopenia (32.1 vs. 9.6 % in group I, 12 % in group III, and 12.8 % in group IV). Th ere were no statistically signifi cant diff erences in the total number of complications between the groups of patients with MSD. Th e complications were 2-fold more likely to occur in patients with osteopenia and osteosarcopenia compared to patients without MSD. Moreover, MSD increased the risk of the composite endpoint by 1.7 times (odds ratio (OR) 1.73, 95 % confi dence interval (CI) 1.04-2.89; p = 0.035); osteopenia increased the risk of the combined endpoint by 3 times (OR 3.01, 95 % CI 1.02-8.9; p = 0.046). Surgical complications were associated with baseline MSD (OR 1.71, 95 % CI 1.06-2.76; p = 0.026); sarcopenia increased the risk of surgical complications by 2 times (OR 2.02, 95 % CI 1.05-3.88; p = 0.034). Conclusion. The frequency of complications in patients with MSD was 1.79-fold higher compared with patients without MSD. Cardiovascular and infectious complications as well as complications associated with surgical treatment were more common in patients with MSD. MSD can be used as a risk factor for the development of in-hospital complications because the presence of these disorders increases the risk of cardiovascular complications, non-infectious complications and death by 1.7 times. Moreover, osteopenia was associated with a threefold increase in the composite endpoint risk, while sarcopenia doubled the risk of non-infectious complications.

Comparison of Two Anterior Reconstructive Techniques in the Treatment of 3-Level and 4 Level Cervical Spondylotic Myelopathy: A Meta-analysis of Last Decade.

Study DesignA meta-analysis.ObjectiveAnterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are widely used in the treatment of cervical spondylotic myelopathy (CSM). However, the clinical outcomes and complications between ACDF and ACCF treating multi-level CSM remain poorly understood. Thus, we performed a meta-analysis to compare the clinical outcomes and complications of the two procedures in the treatment of 3-level and 4-level CSM.MethodsAn extensive search of the literature was performed in the English databases of PubMed, Embase, and Cochrane Library and the Chinese databases of CNKI and WANFANG. We collected factors, including demographic data, surgical factors, and complications. Data analysis was conducted with RevMan 5.3 and STATA 12.0.ResultsFinally, 14 articles (5429 patients) were included in our study. No significant difference was found in preoperative and 3-month follow-up Japanese Orthopedic Association (JOA) scores, neck disability index, preoperative C2-C7, segmental angle, operation time, as well as the number of dysphagia, hoarseness, cerebral fluid leakage, infection, epidural hematoma, axial pain, hardware breakage, and pseudarthrosis between ACDF and ACCF. However, our findings showed that blood loss (P < 0.00001), the number of total complications (P < 0 .00001), C5 palsy (P = 0.0004), graft dislodgement (P = 0.02), graft subsidence (P = 0.0003), and revision surgery (P = 0.0008) in ACDF were significantly less than in ACCF. Additionally, postoperative and change of C2-C7 (P < 0.00001), segment angle (P < 0.00001), and fusion rate (P = 0.001) in ACDF were significantly higher than in ACCF. Post-operative JOA in ACDF was significantly higher than in ACCF (P = 0.02).ConclusionsAlthough the clinical efficacy of both surgeries was similar, ACDF was superior to ACCF in the reconstruction of cervical lordosis and the number of complications in the treatment of 3-level and 4-level CSM.

Carotid body tumors: case series of extremely rare head and neck paragangliomas

Carotid body tumors, also commonly known as nonchromaffin paragangliomas and chemodectomas, is a slowly growing neoplasm originating from carotid body chemoreceptors. Herein we have presented a case series of surgical treatment of patients with carotid body tumors in National Scientific Center of Surgery named after AN Syzganov (2009-2020). Total number of patients was 10 with 11 neck mass, of which 7 (70%) were women, the average age was 47 (31-73) years, one case we faced with a bilateral location. The main complaint was slow-growing neck mass. On computed tomography angiography most of cases (70%) were of the 3th type according to the Shamblin grade with average size of 5.9 (4-8) cm. The main treatment was surgical excision in all cases. Mean duration of surgery 111.5 (75-190) min and hospital stay days 12.1(8-20) were registered. Total number of complications were 2 (20%), where in 1 case surgery complicated by bleeding more than 500 ml, and 1 patient presented dysphonia after the surgery, which resolved by time. Duration of surgery and hospital stay days were directly associated with size of mass and distance to base of skull. Pathology results showed that two patients (20%) had malignant cells, one of them with metastases to the nearest lymph nodes. Surgical resection is the treatment of choice for carotid body tumors. The large size of the masses and involvement of the carotid arteries and cranial nerves in the process directly affect the surgical approach and increase the risk of complications.

Evaluation of Surgical Complications of Mandibulectomy

Mandibulectomy is a surgery that leads to heavy aesthetic and functional sequelae. Surgical complications have been noted but have not yet been evaluated. The aim of this study was to evaluate the surgical complications of mandibulectomy. This is a retrospective descriptive and analytical study of patients who underwent mandibulectomy in the Department of Maxillofacial Surgery of the CHU JDR Befelatanana between January 2017 and December 2020. A correlation between the occurrence of complications, parameters related to the patients and those related to the surgery was sought. Patient-related parameters were: age and sex, comorbidities, toxic habits and body mass index. The parameters related to the surgery which were studied were the duration of the intervention, the size and the seat of the bone defect, the interruption or not of the mandibular continuity. Forty-six cases were selected. The average age was 36.98 years and the sex ratio was 0.7. Fifty percent of patients developed surgical complications. The total number of complications was 38. Salivary fistula was the most frequent complication (26.32%). No correlation was found between the occurrence of complications and patient-related parameters. There were 69.57% of complications when the procedure lasted more than 180 minutes (p = 0.003). A correlation was found between the occurrence of complications and the size of the resected bone (p = 0.009). Among the complications, 56.52% occurred when the size exceeded 130 mm (p = 0.03). The complication rate is high. The size of the resected bone and the duration of the operation influence the occurrence of complications.

Quality Assurance in Primary Total Knee Arthroplasty

This study aims to compare internal and external documentation methods, to assess differences in complication rates through time and the potential association of patient parameters with morbidity. Data concerning primary knee arthroplasties performed between 2004 and 2014 were prospectively collected. The Pearson’s chi-squared test or the Fisher’s exact test was used to compare internal with external data and complications documented during 2005-2009 and 2010-2014. The Mann-Whitney U test was used to compare continuous outcomes in the two periods. Furthermore, binary logistic regression analyses were performed with occurrence of surgical complications as dependent variable. The total number of knee arthroplasties was 2100. Postoperative complications were experienced by 212 patients (median age: 72 years) and 30% were male. A significant difference between the internal and external datasets was detected in the “inability to walk at discharge” (p<0.0001) and the “total number of complications” (p=0.02). A significant reduction of the complication rate was observed in the second observation period (p<0.0001). The variables “length of hospital stay” and “duration of operation” independently predicted the occurrence of complications. The observed reduction of complications through time may be attributed to acquired surgical experience and the application of quality assurance measures.

Непосредственные результаты органосохранных анатомических резекций и пневмонэктомий у больных раком легкого пожилого и старческого возраста

The aim of the research. The aim of the study was to conduct a comparative analysis of the immediate results of organ-preserving anatomical resections and pneumonectomy in elderly and senile patients with lung cancer. Material and methods. The study included 126 patients over 60 years of age, who were divided into 2 groups depending on the extent of the surgical intervention performed. Group A was represented by 63 patients who underwent organ-preserving anatomical resections and group B enrolled 63 patients after pneumonectomy. The groups were formed through retrospective analysis of prospective data obtained from the electronic registry. In all cases, the comorbid background was assessed, as well as options for preoperative correction of the concomitant pathology. In the postoperative period, the number and severity of complications were assessed using the TMM (Thoracic Morbidity and Mortality) System, and an intergroup comparative statistical analysis was performed. Results. According to the results of the study, postoperative complications among patients in group A were recorded in 22 (34.9%) cases, mortality was established in 4 (6.35%) patients. In group B, the number of complications and mortality were registered in 18 (28.6%) and 6 (9.52%) cases, respectively. Among the complications registered in group A, the most common were prolonged air discharge through the drainage and cardiac arrhythmias. In the group after pneumonectomy, complications associated with arrhythmia also prevailed, while the complication occurred statistically more often. Among the lethal outcomes in both groups, the main cause was progressive cardiovascular insufficiency against the background of arrhythmia, as well as failure of the bronchus stump and suture. Conclusion. Despite the absence of reliable differences in the total number of complications and mortality in the groups, there is a clear trend towards a higher frequency of fatal complications in the group after pneumonectomy. A feature was noted in the continuing risk of mortality, regardless of the severity of the complication. Among patients after organ-preserving anatomical resections, reversible deviations from the normal course in the postoperative period prevail. In addition, this extent of surgical intervention provides for better functionality and quality of life to elderly and senile patients.

Mid-Term Results of Total Hip Arthroplasty for Femoral Neck Nonunions in Long-Term Hemodialysis Patients

Background. Performing primary arthroplasty in patient with renal osteodystrophy is associated with a number of difficulties due to low bone mineral density, which complicates the fixation of the endoprosthesis components, the presence of bone defects, and functional insufficiency of the gluteal muscles. The aim of the study evaluation of the mid-term results of primary total hip arthroplasty using cemented femoral and acetabular implants in hemodialysis patients with nonunions of the femoral neck. Materials and Methods. The authors conducted a study of 26 hemodialysis patients with pseudarthrosis of the femoral neck. The patients were divided into 3 groups: group I (12 patients) classification type A of the femoral neck nonunion, group II (10 patients) classification type B, group III (4 patients) of type C who underwent total hip arthroplasty. Results. The longest surgery duration was observed in patients of the III study group 121.2519.26 minutes. There were no statistically significant differences between the patients of the II and III study groups. The smallest rate of intraoperative blood loss was noted among patients of the 1st study group 440.83133.65 ml, the statistical significance of the differences was obtained both between the 1st and II, and between the I and III study groups, respectively. The smallest total number of complications after surgery was obtained in the 1st group 4 (8.33%). Revisions were performed in 8 (30.7%) patients among all three groups. There was a significant improvement on the Oxford hip score after 12 months (mean 29.8) and 24 months (mean 33.1) in all groups compared with preoperative results (mean 12.5). Twelve 12 months after surgery, the average value of the pain severity was reduced by 72.6% and amounted to 2.01. The risk of getting any orthopedic complication in cemented total hip arthroplasty of the classification type A of the pseudarthrosis is 2.5, with type B 3.4, with type C 5.7. Conclusion. The classification of femoral neck nonunions in hemodialysis patients allows to determine the tactics of surgical treatment. Cemented dual mobility cups are effective in patients with any type of femoral neck nonunions.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ГИПЕРТЕНЗИОННО-ПРОТОКОВОГО ТИПА ХРОНИЧЕСКОГО ПАНКРЕАТИТА, В СОЧЕТАНИИ С СИНДРОМОМ БИЛИАРНОЙ ОБСТРУКЦИИ

Background. The frequency of chronic pancreatitis and its complications is steadily increasing, which makes the problem of treating this pathology one of the most urgent and significant. Objective. Improvement of the results of surgical treatment of patients with hypertension-ductal type of chronic pancreatitis with extended stricture of the intrapancreatic part of the common bile duct. Material and methods. During the period 2006–2021, 328 operations were performed in the Grodno University Clinic due to chronic pancreatitis with pathology of the ductal system in combination with pancreatic cysts. The total number of complications was 5,1%. 18 patients with chronic recurrent pancreatitis, ductal hypertension in combination with a cyst of the head pancreas, also with extended stricture of the terminal part common bile duct and mechanical jaundice were operated on according to the methods developed in the clinic: 12 patients underwent choledochopancreatoejunostomy, 5 patients underwent choledochocystopancreatoejunostomy, choledochocystoduodenostomy was performed in 1 case. Results. The developed methods make it possible to perform adequate internal drainage of the ductal system of the pancreas and bile ducts, as well as cystic formations. Conclusions. The application of the developed methods improves the results of surgical treatment complicated chronic pancreatitis.

Features of treatment of severe acute pancreatitis in obese patients

The purpose of the work is to improve the results of treatment of severe acute pancreatitis in obese patients and to develop an algorithm for comprehensive treatment. Materials and methods. Patients with severe acute pancreatitis and obesity (mean BMI 37.48 ± 2.19 kg/m2) were randomized into two groups. In the experimental group (n = 18; step-up approach),early resuscitation with Ringer's lactate solution and ulinastatin in the first 5 days of the disease was used. Unilastatin was administered at a dose of 200,000IU by 1-hourintra­venous infusion TID for 5 days. The first stage of surgery was a drainage under ultrasound control, the second stage (if necessary) was laparos­copic retroperitoneal necrectomy (video-assisted­retroperitoneal debri­de­ment — VARD). Open surgery was performed in case of development of abdominal compartment syndrome. In the control group (n = 18; standard approach), resuscita­tion was performed with 0.9 % sodium chlo­ride solution without ulinastatin. The first stage of surgery was draina­ge under ultrasound control, the second stage was traditional median laparotomy with laparostomy. Results. The use of resuscitation with Ringer’s lactate solution in combination with ulinastatin for 5 days contributed to a decrease of procalcitoninlevels by 1.8 times (2.89 ± 0.88 compared with 1.8 ± 0.23 ng/mg; p = 0.001; α = 0.05). The level of CRP during the period of ulinastatin decreased by 41.68 mg/l (267.28 ± 114.11 compared with 225.6 ± 84.9 mg/l; p = 0.01; α = 0.05). There was a statistically significant difference in procalcitonin levels between groups on the 10th day (1.83 compared with 3.32 ng/mg; p = 0.001; α = 0.05), on the 15th day (1.15 compared with 1 .83 ng/mg; p = 0.001; α = 0.05) and on the 45th day (0.35 compared with 0.55 ng/mg; p = 0.001; α = 0.05). These results confirm the effect of the proposed method of treatment by reducing the risk of infection. Conclusions. The effectiveness of the proposed treatment algorithm is evidenced by a statistically significant difference in the level of CRP between groups on the 10th day (p = 0.035; α = 0.05). The use of VARD in the experimental group as a second stage of surgery is a less traumatic but effective method (p = 0.001; α = 0.05), which reduces the total number of complications (χ² = 4.012; p = 0.046). Evaluation of data «before—after» revealed the effectiveness of treatment by step-up approach (χ² = 5.4; p = 0.021).

Treatment of cervical myelopathy by posterior approach: Laminoplasty vs. laminectomy with posterior fixation, are there differences from a clinical and radiological point of view?

IntroductionCervical degenerative myelopathy is a variable and progressive degenerative disease caused by chronic compression of the spinal cord. Surgical approaches for the cervical spine can be performed anteriorly and/or posteriorly. Regarding the posterior approach, there are 2 fundamental techniques: laminoplasty and laminectomy with posterior fixation (LPF). There is still controversy concerning the technique in terms of outcome and complications. The aim of the present work is to analyze from the clinical and radiological point of view these 2 techniques: laminoplasty and LPF. Materials and methodsA historical cohort of 39 patients was reviewed (12 LFP and 27 laminoplasty) including patients operated in a 10 years period at the Hospital Universitario La Paz with a follow-up of 12 months after surgery was carried out. The clinical results were analyzed and compared using the Nurick scale and the modified Japanese Orthopaedic Association Scale (mJOA) and the radiological results using the Cobb angle, Sagittal Vertical Axis, T1 Slope and alignment (measured by Cobb-T1 Sloppe). ResultsSignificant differences were observed in the postoperative improvement of the Nurick scale (p = 0.008) and mJOA (p = 0.018) in the laminoplasty group. In LFP there is a tendency to a greater improvement, but statistical significance is not reached due to the low sample size of this group. No statistically significant differences were observed in the radiological variables. Regarding the total number of complications, a higher number was observed in the laminoplasty group (7 cases) versus LFP (one case), but no statistically significant differences were observed. ConclusionsLaminoplasty and LFP are both safe and effective procedures in the treatment of cervical degenerative myelopathy. The findings of our study demonstrate statistically significant clinical improvement based on the Nurick and mJOA scales with laminoplasty. No significant differences in terms of complications or radiological variables were observed between the 2 techniques.

ВЛИЯНИЕ НА ТЕЧЕНИЕ И РЕЗУЛЬТАТ РОДОВ ОСТЕОПАТИЧЕСКОЙ КОРРЕКЦИИ ДИСФУНКЦИЙ ТАЗА У РОЖЕНИЦ С ДОРОДОВЫМ ИЗЛИТИЕМ ОКОЛОПЛОДНЫХ ВОД В ДОНОШЕННОМ СРОКЕ БЕРЕМЕННОСТИ

The eff ectiveness of applying osteopathic methods to patients with amniorrhea in case of full-term pregnancy was evaluated. 40 pregnant women with singleton full-term pregnancy without severe somatic and obstetric pathologies, with preterm amniorrheaunder the absence of regular labor activity were included into the study. The main group (n = 20) included women who underwent treatmentwith osteopathic methods.&#x0D; In the control group (n = 20) the labor was managed in accordance with the labor management protocol in case of amniorrhea.&#x0D; The osteopathic examination, which was performed in the course of the study, showed that all patients had biomechanical disorders at the pelvis level. The women in labor, who underwent osteopathic correction, started to deliver on their own in a greater percentage of cases as compared with the control group; there was a signifi cant decrease of frequency of labor anomalies and the total number of complications in labor and, as a consequence, a signifi cant decrease of obstetric aids and frequency of the emergency deliveryby cesarian section. A decrease in the frequency of episiotomy was noted. A decrease in the duration of the rupture-to-delivery interval was also noted.

Impact of musculoskeletal conditions on the perioperative period in patients with stable coronary artery disease

Abstract Background The aging of the population increases the number of elderly patients undergoing cardiac surgery. Despite the proven effectiveness of coronary bypass graft (CABG) surgery, it can lead to postoperative complications, similar to any other medical intervention. The early postoperative complications are associated directly with the clinical status of the patient. Most recent studies have focused on the effect of patient's musculoskeletal conditions on quality of life, disability and mortality. However, there are few studies devoted to assessment of the impact of musculoskeletal conditions on the course of the postoperative period in patients treated with CABG. Aim To evaluate the impact of musculoskeletal conditions on the early postoperative period in CABG patients with stable coronary artery disease (CAD). Materials and methods 387 patients aged 65 (59; 69) years with stable CAD, scheduled for CABG were enrolled in the study. Before enrollment all patients signed an informed consent form. For the assessment of the musculoskeletal function, sarcopenia was defined in accordance with the European Working Group on Sarcopenia in Older People (EWGSOP, 2019) and osteopenic syndrome (osteopenia/osteoporosis) was defined in accordance with the World Health Organization (WHO,2008). Osteosarcopenia was diagnosed in cases of co-existent sarcopenia and osteopenia/osteoporosis. The patients were divided into two groups according to the presence of musculoskeletal disorders. The 1st group included 105 (27.1%) patients: 52 (49.5%) with sarcopenia; 28 (26.7%) with osteopenic syndrome (osteopenia/osteoporosis) and 25 (23.8%) with osteosarcopenia. The 2nd group included 282 (72.9%) patients without musculoskeletal conditions. The analyzed groups were comparable in age, gender and comorbidities. CABG was performed via a midline sternotomy incision with the cardiopulmonary bypass. In the postoperative period, the total number of developed complications (cardiovascular, surgical, pulmonary) in patients with CAD was taken into account. Statistical analysis was performed using the Statistica software. Results In the early postoperative period, the total number of complications was statistically higher among patients who initially had musculoskeletal disorder. The prevalence of complications was higher in the 1st group of patients - 80 out of 105 (76.2%), while patients without musculoskeletal conditions demonstrated a 1.17 times lower prevalence - 183 out of 282 (64.99%), p=0.034. The incidence and the strength of association was estimated by the odds ratio (OR) and 95% confidence interval (CI). The presence of the initial musculoskeletal disorder was found associated with the 1.7 times increased risk of complications after CABG (OR =1.73, 95% CI: 1.03–2.89, p=0.035). Conclusions The presence of the musculoskeletal condition in CABG patients with CAD is a predictor of early adverse effects in the postoperative period. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The study was supported by Federal State Budgetary Institution of Higher Education “Kemerovo State University” (Contract No. 1327/2020/223, under the Agreement No. 075-15-2020-766 made as of 14th of December, 2020, entitled “Patient-centered care for patients with coronary artery disease and osteosarcopenia who underwent coronary artery bypass graft surgery”).

Prophylactic hyperthermic intraperitoneal chemotherapy in gastric cancer management: short- and long-term outcomes of a prospective randomized study

Introduction. Assessment of toxicity and long-term results of hyperthermic intraperitoneal chemotherapy (HIPEC) treatment administered to patients with resectable serosa-invasive gastric cancers. Material and methods. The study was carried out in 2008–2016 and is based on the results of the treatment of 154 gastric cancer patients (stage IIB–IIIC, III–IV Borrmann type) who were randomly assigned to two groups. 76 patients underwent HIPEC combined with radical gastrectomy (HIPEC group) and 78 patients underwent radical gastrectomy without HIPEC (control group). HIPEC was administered after alimentary tract reconstruction and wound closure and comprised 5–6 L of Ringer’s solution (cisplatin 50 mg/m2 + doxorubicin 50 mg/m2) infused at an inflow temperature of 42°C for 1 hour. Results. Although the total number of complications was higher in the HIPEC group than in the control group the difference was statistically insignificant — 20 (26.3%) and 12 (15.3%), respectively (p = 0.141). Surgery-related complications in the HIPEC and control groups were observed in 9 and 5 cases, respectively (p = 0.372). Non-surgical complications were recorded in 11 and 7 cases, respectively (p = 0.435). Overall, the proposed HIPEC regimen administered in combination with radical surgery demonstrated satisfactory patient tolerability. The frequency of grade III toxic reactions according to CTCAE version 5.0 was 9.2%, no grade IV–V toxicities were registered at that. These satisfactory short-term results were followed up with fairly good long-term treatment outcomes. There was an increase in 5-year progression-free survival (42.1 ± 6.3% vs. 16.3 ± 5.5%, p &lt; 0.001) and in dissemination-free survival (45.2 ± 6.3% vs. 19.4 ± 5.9%, p = 0.001) in the HIPEC group vs. the control group with a trend toward improving cancer-specific survival (CSS) in the HIPEC-treated patients [45.1.0 ± 6.4% vs. 27.0 ± 6.7% (p = 0.050)]. Conclusions. While substantially improving long-term GC therapeutic effect, the proposed HIPEC regimen using cisplatin 50 mg/m2 in combination with doxorubicin 50 mg/m2 made it possible to minimize complications (frequency of 26.3%) and toxic reactions [the frequency of grade III toxic reactions was 9.2% (CTCAE, version 5.0)].

CARDIAL MANIFESTATIONS OF NON-DIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA AND THEIR INFLUENCE ON PREGNANCY

Among the visceral manifestations of NDST in pregnant women most often diagnosed mitral valve prolapse (20-25%) that accompanied by more cardiovascular and obstetric complications during pregnancy. It demonstrates the high clinical significance of the problem of connective tissue dysplasia with mitral valve prolaps for pregnancy and requires adequate treatment programs for prevention of complications and management of pregnant women with connective tissue dysplasia. Aim. Determination of the frequency of pregnancy pathology in women with clinical signs of NDST and MVP complicated by extrasystolic arrhythmia. Materials and methods. 138 pregnant women with MVP and concomitant signs of NDST and 54 healthy pregnant women were selected for analysis. Clinical manifestations of NDST, different variants of arrhythmias and the total number of complications of pregnancy and childbirth were evaluated. Results. In pregnant women with clinical signs of NDST and MVP complicated by extrasystolic arrhythmia, cases of frequent sinus extrasystole were significantly more often compared to frequent ventricular arrhythmia (47.8% vs. 18.1%, p&lt;0.001) and cases of combination of frequent sinus extrasystole and ventricular arrhythmia (13.3 % vs. 1.5%, p &lt;0.05). They significantly more often identified both symptoms of arrhythmological nature and symptoms that indicated a violation of autonomic status. The presence of NDST syndrome is more often accompanied by the development of complications of pregnancy and childbirth. These pregnant women have genetic and phenotypic risk factors for the development of pathological pregnancy and childbirth, birth trauma, disability of mother and newborn, which justifies such patients in a separate risk group for individualized programs of the prevention and treatment of visceral (cardiac) manifestations of NDST and possible complications of pregnancy and childbirth. Conclusions. 3.1% of pregnant women are diagnosed with phenotypic signs (stigma) of undifferentiated connective tissue dysplasia, and the most common visceral cardiac manifestation is mitral valve prolapse. The presence of mitral valve prolapse and extrasystolic arrhythmia in pregnant women with NDST is accompanied by significantly more frequent development of pregnancy and childbirth complications in these patients.

Literasi Kesehatan pada Pasien Diabetes Mellitus Tipe 2

Background: Health literacy can play an important role in the quality of the provided care since patients with T2DM need long-term and high level of complex care. Inadequate literacy patients with DM related to less knowledge about diabetes and poorer health outcome.&#x0D; Objective: This study aimed to examine health literacy among patients with type 2 diabetes mellitus and its related factors.&#x0D; Methods: This study used cross sectional design. The respondents recruited with a convenience sampling in outpatient internal medicine department in a hospital located in Sleman regency from September 2017 to January 2018. The Charlson Comorbidity Index and the European Health Literacy Survey - Questionnaire 47 were employ. Data analysis involved descriptive and bivariate analysis.&#x0D; Results: A hundred and fifty two subjects enrolled in this research. The average score of health literacy was 29.5 (SD = 3.4). Factors related with health literacy were total number of complications (r = -.26; p = .001), education (p = .010) and monthly income (p = .000).&#x0D; Conclusion: Problematic health literacy has been found to be prevailing in patients with type 2 diabetes mellitus in Yogyakarta, Indonesia. Total number of complications, education, and monthly income were significantly correlated with health literacy in this population.

Long-term results of hip arthroplasty and determination of unfavorable risk factors for early development of osteonecrosis in patients with systemic lupus erythematosus

Aim of the study – to determine the risk factors for the early development of osteonecrosis and to analyze the results of surgical treatment of patients with systemic lupus erythematosus in the long term after total hip arthroplasty.Materials and methods. The study group included 42 patients with systemic lupus erythematosus (SLE) complicated by osteonecrosis (ON) of the femoral head, who underwent 59 total hip arthroplasty (THA) operations. Before surgery and 6–21 years after THA, in order to assess the long-term results of surgical treatment of patients, the following was assessed: activity of the underlying disease – according to the SLEDAI-2K (Systemic Lupus Erythematosus Disease Activity Index 2000); the severity of irreversible changes in internal organs – according to the SLICC/ACR index of damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology); the clinical and functional state of the hip joint – according to the HHS (Harris Hip Score); the intensity of pain syndrome – according to the visual analogue scale (VAS); quality of life (QOL) – using the SF-36 questionnaire. The concentration of antibodies to cardiolipin (aCL) of IgM and IgG isotypes was determined by enzyme-linked immunosorbent assay (normal range – 0.0–10.0 GPL for IgM, 0–7 MPL for IgG).Results. After 6–21 years of follow-up after THA, there was a statistically significant decrease in pain intensity according to VAS, improvement according to the HHS from 40.0±14.9 to 83.3±17.4 points, SLE activity according to the SLEDAI-2K from 0 to 20 points (median – 4 [4; 8] points) before surgery and from 0 to 41 points (median – 0 [0; 4] points) after a long period of observation. There was a pronounced statistically significant positive dynamics for all QOL indicators studied (p≤0.005 in all cases). The most significant changes were found on the scales RE (Role-Emotional), RP (Role-Physical Functioning) and BP (Bodily Pain). The early development of ON was associated with the degree of activity of the underlying disease, the cumulative dose of glucocorticoids, kidney damage and arthritis in the first year from the onset of SLE, as well as hematological disorders and the presence of aCL in the blood serum 3 years before the onset of ON. The total number of complications was 10.2%.Conclusion. Total hip arthroplasty in patients with systemic lupus erythematosus can achieve a statistically significant reduction in pain intensity, increase functional activity and improve their quality of life.

EARLY AND LATE POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH LOCALIZED AND LOCALLY ADVANCED RENAL CELL CARCINOMA

Background: Modern Russian statistics show that the percentage of renal cell carcinoma (RCC) among all oncological diseases has increased and amounted to almost 5% in 2019. The main method of treating RCC is radical nephrectomy in localized RCC, which is supplemented by the removal of regional lymph nodes in locally advanced RCC. Aim: To evaluate early and late postoperative complications in patients with localized and locally advanced renal cell carcinoma. Methods: We’ve analyzed the results of surgical treatment and postoperative complications in 378 patients with clinically proven localized and locally developed RCC. Results: The total number of complications after surgical treatment of patients with localized and locally advanced RCC was 24 (6.3%) patients. Moreover, in the treatment of the localized form of RCC, postoperative complications are 3 times less common than in the locally advanced form of RCC (p &lt;0.05). The most common complication after surgical treatment of RCC was bleeding which we observed in 11(2.9%) patients. Conclusion: After surgical treatment of RCC, the proportion of complications is not high, but they can have unpleasant consequences. In the late postoperative period the most common complication bleeding is followed by lymphorrhea and urinary tract infections.