Prophylaxis of complications in operations for cancer of middle and lower thirds of the esophagus

Objective. Improvement of the surgical treatment results in esophageal cancer. Маterials and methods. Results of surgical treatment of 43 patients, having cancer of middle and lower thirds of the esophagus, were analyzed. Lewis operation was performed in 38 patients, and Garlock operation – in 5. Circular suture stapler with second row of a П-like manual sutures was applied in 28 patients. In 15 patients anastomosis was formatted, using hand-sewn two-row suture. The method of anastomosing choice had depended upon local and general factors: the tumor localization, the esophageal wall changes in anastomotic site, degree of the water-electrolyte disorders, the protein balance, concurrent pathology. Prophylaxis of postoperative morbidity consisted of preoperative correction of laboratory indices, treatment of concurrent pathology, choice of the anastomosis formation method, postoperative intensive therapy. Results. Postoperative complications had occurred in 1 (2.3%) patient. Mostly frequent postoperative complication after resection for esophageal cancer constitute insufficiency of esophago-gastric anastomosis, which occurs under impact of general and local factors. General factors: disorders of the blood circulation, caused by cardiac insufficiency, hypoxia due to pulmonary insufficiency, coagulopathy, disorders of the protein and water-electrolyte metabolism. Reduction of influence of general factors on the postoperative morbidity occurrence was achieved using the intensive preoperative preparation conduction. Conclusion. The postoperative morbidity prevention turns effective while its accomplishment on all stages of treatment: during preoperative preparation, intraoperatively and postoperatively.

COMPREHENSIVE PREOPERATIVE APPROACH AND ENDOVENOUS ELECTRIC WELDING IN THE TREATMENT OF CHRONIC VENOUS INSUFFICIENCY C6 CLINICAL CLASS

The evaluation was done in the sphere of preoperative preparation trophic ulcer in patients with CVI using the proposed tactics of mechanochemical debridement and elimination of vertical venous reflux EVEZ method, in comparison with standard preoperative management tactics and EVLT of saphenous veins. It is established that the proposed tactics of preoperative preparation are more effective than classical approaches. Purpose. The use of the EVEZ method in combination with the proposed preoperative preparation of trophic ulcers in the treatment of CVI was determined to be effective. Materials and methods. An analysis of the treatment of 68 patients with CVI C6 clinical class was performed. The patient of the main group received the EVEZ treatment tributaries and perforating veins with preoperative trophic preparation ulcers, which includes: active mechanochemical debridement and control moisture balance in the wound, installation of negative pressure wound therapy system, platelet rich plasma therapy, application drugs based on diosmin and hesperidin. The proposed scheme of preoperative preparation has the following algorithm: Taking a smear from the sore to determine the bacterial spectrum and subsequent rational antibacterial therapy following the results of the antibioticogram; Active mechanochemical debridement with solutions of 0.1% polyaminopropyl biguanide + 0.1% surfactant, povidone-iodine + ethanol + glycerin + laureate 9 and control of moisture balance in the wound with modern hydrogel sore dressings; Installation of VAC system with a constant negative pressure of 120 mm Hg for 3 days for the first 3 performances of the system. Subsequently, VAC therapy was performed in a constant mode with a pressure of 80-120 mm Hg. in patients with insufficient wound cleanliness; After active cleaning, PRP therapy was performed, which involves the introduction of platelet-enriched plasma along the edge of the wound to a depth of 3 to 5 mm. The amount of PRP used depended on the size of the defect and ranged from 1 to 2 ml. All patients of the main group underwent correction of concomitant pathology with systemic use of capillary stabilizing drugs based on diosmin / hesperidin. Patients in the comparison group received standard preoperative preparation and EVLT. Patients of both groups were outpatient for 6 months. 39 of them (57.35%) were women and 29 (42.65%) were men aged 36 to 78 years. The duration of ulcers ranged from 3 months to 7 years. The following localization of venous trophic ulcers was observed: in the area of the medial bone - in 49 (72%) patients, 10 (14.7%) - on the anterior surface, 9 (13.3%) - on the lateral, posterior, anterior medial or anterolateral surface of the tibia. Results. Tactics of preoperative preparation that is offered allowed to achieve: reduction of redness and swelling in the main group on 7.3 ± 0.8 days (comparison group 10.2 ± 0.7 days); complete cleaning of the wound from fibrin and necrotic tissues at 9.1 ± 0.5 days (15.0 ± 1.1); the appearance of granulation tissues at day 12.6 ± 0.9 (18 ± 0.7); the appearance of marginal epithelialization at 15.3 ±0.7 days (20 ± 1.1). Conclusions. The proposed tactics can reduce the term by 1.7 times the preparation of the ulcer for surgery and 1.6 times the healing time of ulcers. The EVEZ method allows performing ablation efficiently and safely trunk great saphenous vein. The use of phlebotonic drugs, which is called Normoven, allows you to accelerate the healing of ulcers and prevent their recurrence.

Perioperative Anesthetic Management in Preterm 12 Days Infants with Giant Meningoencephalocele at Mid Occipital and Secondary Trigonocephaly

Introduction: A meningoencephalocele is herniation of neural element along with meninges through a congenital defect in cranium. The incidence of encephalocele is approximately 1/5000 live births; occipital encephalocele is more common in females than males. It is called as giant meningoencephalocele when the head is smaller than the meningoencephalocele. These giant meningoencephaloceles harbor a large amount of cerebrospinal fluid (CSF) and brain tissue, so there occur various surgical challenges and anesthetic challenges in positioning and intubation. Case: A 12 days neonate was consulted to the neurosurgery department with complaints of large swelling over the back of head and difficulty in feeding. She was diagnosed with ventriculomegaly and meningoencephalocele since 32-33 pregnancy. The swelling was small at the time of birth, but it gradually increased in size. The child was born by section caesarean because of fetal distress and meningoenchepalocele. The neonate current weight was 3.195 grams with Post Conceptional Age (PCA) 35-36 weeks. On examination, the patient large spherical swelling was present over occipital region and there was no head control. The patient was active, conscious with no impression of focal neurological deficit. Systemic examination was unremarkable. The head circumference was 30 cm and circumference of occipital swelling was 40 cm. Potential problems in this patient include preoperative preparation and optimization of general condition, difficulty in positioning the patient, difficult airway (intubation), periodic apnea and potential hemodynamic disturbances and a sudden decrease in intracranial pressure during cele resection. Conclusion: Perioperative management in this case started from preoperative to postoperative evaluation. Preoperative preparation in anticipation of airway difficulties and communication with the operator is very important. Appropriate anesthetic techniques should aim to maintain stable hemodynamics and oxygenation and prevent a sudden increase or decrease in intracranial pressure.

Endovideosurgical technology in the diagnosis and treatment of benign ovarian tumors

The article deals with the new possibilities of laparoscopic technique in diagnosis and treatment of ovarian tumors. The authors elaborate the criteria of differential diagnostics of benign and malignant ovarian tumors at early stages. The research is based on the analysis of 222 cases of different ovarian tumors. The authors state the necessity of rational preoperative preparation and obligatory screening in patients with ovarian tumors before and after the operation with the use of tumor marker CA-125.

Surgical Treatment of Ruptured Infectious Femoral Pseudoaneurysms Caused By Intravenous Drug Abuse: A Nonemergent (Postponed) Operation Pattern May Be a Possible Alternative

Objective: To evaluate the possibility of surgical treatment of ruptured infectious femoral pseudoaneurysms caused by intravenous drug abuse in a nonemergent operation pattern, with retrospective analysis of clinical data and experience at a single center.Methods: Clinical data of 85 consecutive patients presenting with groin area active or recent hemorrhage due to a ruptured infectious femoral artery pseudoaneurysm related to drug abuse who were treated in the First Hospital of Changsha, China, from July 2008 to June 2020 were collected and analyzed.Results: A total of 74.1% of patients presented with active hemorrhage, and 36.5% presented with significant hypotension at admission. The average interval between arrival and operation was 34.7±4.7 hours. Vital physiological parameters and overall situation improved significantly after sufficient preoperative preparation. Satisfactory hemostasis can be achieved by bandage compression or local skin suture. No case was transferred to urgent operation due to severe bleeding, and 1 postoperative death case was observed in the cohort. The main operative- and postoperative-related indicators were satisfactory and close to those in the emergent operation pattern.Conclusion: While emergent or urgent operation is the mainstream surgical treatment for ruptured infectious femoral pseudoaneurysms, nonemergent (postponed) operation with sufficient preoperative preparation might also be an acceptable and comparable choice in some cases.

Some peculiarities of preoperative care of patients with biliopancreatoduodenal area focal diseases complicated by mechanical jaundice

The aim of the current research was to compare the early results of pancreatoduodenal resection performing in patients with focal diseases of the biliopancreatoduodenal area complicated by obstructive jaundice syndrome, depending on the type of preoperative preparation. The results of surgical treatment of 272 patients who had been underwent pancreatoduodenal resection for focal diseases of the biliopancreatoduodenal zone complicated by the development of obstructive jaundice syndrome were analyzed. Patients, depending on the type of preoperative preparation, were randomized into two groups: the main group included 112 patients, who were prepared for surgery and predicted the course of the perioperative period in accordance with the original algorithm; and a comparison group (160 patients), in which the preparation was carried out only in a conservative way. Due to the original algorithm of detoxification with the use of biliary decompression in patients of the main group, the level of total bilirubin on the eve of pancreatoduodenal resection was 112.3 ± 2.7 μmol / L, while in the comparison group, where the preparation of patients for radical surgery was carried out without biliary drainage – 198.3 ± 3.3 μmol / L. The activity of alkaline phosphatase on the eve of PDR was 104.8 ± 1.3 U / L in the main group, and 270.8 ± 1.9 U / L in the comparison group (p <0.05). On the eve of PDR, the activity of γ-glutamyltransferase decreased insignificantly – to 529 ± 29 U / L in the comparison group and to 485 ± 33 U / L in the main group (p <0.05). The number of cases of life-threatening postoperative complications in the main group was 42 (37.5%), and in the comparison group – 102 (63.8%). Postoperative mortality in the main group was 6.3%, and in the comparison group – 11.9%.

Results of combined treatment of uterine leiomyoma in women of reproductive age

The purpose of the work. To study the effectiveness of the combined treatment of uterine leiomyoma (UL), taking into account the possibility of realizing reproductive function.Material and methods. The total number of women of reproductive age examined with a large UL (a dominant node more than 50 mm in diameter) was 94. At the first stage, all patients received preoperative preparation. At the first stage all patients received preoperative preparation. 35 patients with concomitant endometrial hyperplasia and/or with the presence of the progesterone receptor gene polymorphism PGR progins received aGn-RH in an average therapeutic dose once in 28 days, 3 injections. 59 patients with the reference genotype without endometrial pathology received mifepristone 50 mg daily for 3 months. After preoperative preparation, the patients underwent conservative myomectomy by laparotomy. Menstrual function, pelvic pain syndrome, size of leiomatous nodules, drug tolerance, frequency of pregnancy and recurrence were assessed. Statistical data processing was performed using Microsoft Excel software. The main statistical indicators such as frequency, mean and standard deviation were taken into account. The results were considered significant at p < 0.05.Results. Excessive menstruation and AUB occurred in 81.9% of patients. Amenorrhea occurred in 79.8% of patients after 1 month of therapy and in all patients after 3 months. Recovery of menstruation was noted in 10.6% of patients a month after the operation, in 59.6% of patients after two months and on the third cycle menstruation resumed in all patients. The frequency of pain syndrome unrelated to the menstrual cycle decreased from 52.1% to 9.6%, dyspareunia from 12.8% to 4.3%, dysmenorrhea from 47.9% to 8.5%. According to ultrasound data, after 1 month in the group of women receiving aGn-RH the size of the nodules decreased by an average of 22.9%, and after mifepristone by 16.9%, and after 3 months by 51.4% and 45.8%. The uterine volume decreased by 28.6% and 30.5%. Starting from the second month of treatment, symptoms caused by estrogen deficiency were noted in 39.4% of patients treated with aGn-RH and 20.3% in the mifepristone group. Overall, the treatment was defined as effective in 88.6% of the women treated with aGn RH and 93.2% of those treated with mifepristone. Relapse occurred in 11.4% of women after aGn-RH and in 5.1% of those in the mifepristone group. Pregnancy occurred in 69.2% of patients and resulted in delivery in 90.8% of cases.Conclusions. The use of preoperative hormonal preparation and a differentiated approach to medication selection leads to normalization of the patient's condition and a reduction in the size of the nodules, which allows organ-preserving surgical treatment with minimal uterine trauma. Preference should be given to anti-gestagens because, with equal efficiency compared to aGn-RH, they are better tolerated by patients and have a more pronounced positive effect on process stabilization and disease recurrence. This combined approach improves treatment efficiency to 91.5%, preserves the uterus in reproductive-age women and promotes pregnancy in 69.2% of cases.

Surgical treatment of goiter

Surgical treatment of goiter does not cease to attract the attention of doctors. Although the disease is well studied and an extensive literature is devoted to it, there are still a number of controversial issues regarding preoperative preparation and treatment tactics.

Perioperative Anesthetic Management in Preterm 12 Days Infants with Giant Meningoencephalocele at Mid Occipital and Secondary Trigonocephaly

Introduction: A meningoencephalocele is herniation of neural element along with meninges through a congenital defect in cranium. The incidence of encephalocele is approximately 1/5000 live births; occipital encephalocele is more common in females than males. It is called as giant meningoencephalocele when the head is smaller than the meningoencephalocele. These giant meningoencephaloceles harbor a large amount of cerebrospinal fluid (CSF) and brain tissue, so there occur various surgical challenges and anesthetic challenges in positioning and intubation. Case: A 12 days neonate was consulted to the neurosurgery department with complaints of large swelling over the back of head and difficulty in feeding. She was diagnosed with ventriculomegaly and meningoencephalocele since 32-33 pregnancy. The swelling was small at the time of birth, but it gradually increased in size. The child was born by section caesarean because of fetal distress and meningoenchepalocele. The neonate current weight was 3.195 grams with Post Conceptional Age (PCA) 35-36 weeks. On examination, the patient large spherical swelling was present over occipital region and there was no head control. The patient was active, conscious with no impression of focal neurological deficit. Systemic examination was unremarkable. The head circumference was 30 cm and circumference of occipital swelling was 40 cm. Potential problems in this patient include preoperative preparation and optimization of general condition, difficulty in positioning the patient, difficult airway (intubation), periodic apnea and potential hemodynamic disturbances and a sudden decrease in intracranial pressure during cele resection. Conclusion: Perioperative management in this case started from preoperative to postoperative evaluation. Preoperative preparation in anticipation of airway difficulties and communication with the operator is very important. Appropriate anesthetic techniques should aim to maintain stable hemodynamics and oxygenation and prevent a sudden increase or decrease in intracranial pressure.

Innovative food technologies in the treatment of cardiac surgery patients with concomitant obesity

Purpose. The aim of the study was to develop a technology for dietary correction of nutritional and metabolic status disorders in patients with coronary heart disease with concomitant obesity in the system for comprehensive preoperative preparation.Material and Methods. The study was performed in the Department of Cardiovascular Pathology and Diet Therapy of the Federal Research Center for Nutrition, Biotechnology and Food Safety. The study comprised a total of 76 patients with coronary artery disease and obesity who required surgical myocardial revascularization and received the course of specialized targeted diet therapy. Patients were assigned to two groups: control group comprised 16 men and 25 women aged 65.6 ± 1.37 years; main group comprised 12 men and 20 women aged 66.0 ± 1.87 years. Patients of control group received a reduced calorie diet during 30-day treatment. Patients of main group additionally received a specialized food product for therapeutic dietary nutrition developed specifically for this category of patients (modified diet therapy). The effects of diet therapy on the parameters of nutritional and metabolic status were assessed.Results. The study showed that administration of modified diet therapy allowed to achieve more pronounced reduction of body weight and body mass index as well as optimization of body composition, basal metabolic rate, and blood lipid profile including a significantly more pronounced decreases in the levels of total cholesterol (p < 0.001), triglycerides (p < 0.05), low density lipoprotein cholesterol (p < 0.01), and atherogenic coefficient (p < 0.01).Conclusion. The proposed technology of nutritional care for patients with coronary artery disease and obesity may be used for the purpose of preoperative preparation for surgical myocardial revascularization.