The literature review focuses on the controversial issues regarding the treatment of paraesophageal hernia. The limitations of the current classification of hiatal hernias are highlighted. It is irrelevant and does not meet clinical needs. Objective criteria for its improvement are proposed. Data on the prevalence and course of hiatal hernias are given. Their pathogenetic factors and diagnostic methods are underlined. Considerable emphasis is placed on the paraesophageal hernia treatment strategies in patients with an asymptomatic and mildly symptomatic clinical course of the disease. Arguments are presented in favour of both wait‑and‑see tactics and planned hernioplasty. The choice of hernioplasty technique, especially in the case of giant hernias, the feasibility and indications for the use of mesh implants depending on their shape and composition, and the potential complications of allogenioplasty are the main topics for discussion. The problem of selecting a fundoplication method is addressed while weighing the advantages and potential side effects of employing various fundoplication modifications. The effects of correcting a short esophagus and eliminating the axial pressure on the esophageal hiatus are thoroughly evaluated, as these conditions increase the risk of hernia recurrence. The authors concluded that there are many controversial issues in the treatment of paraesophageal hernia. A consensus is needed on the classification of paraesophageal hernias, which would meet the urgent needs of choosing the method of operative delivery, and, in particular, the definition of the concepts of «large hernia» and «giant hernia.» Further research is required on issues such as the indications for operative treatment of paraesophageal hernias, especially in the case of asymptomatic large hernias and incarcerated hernias; the feasibility of using implants for plastic surgery of the esophageal hiatus; the choice of a fundoplication method; the diagnosis and correction of a short esophagus; and methodology for evaluating long‑term treatment outcomes.
{"title":"Paraesophageal hernia: the state of the problem and controversial issues. Review","authors":"T. Tarasov, L. Markulan","doi":"10.30978/gs-2022-2-83","DOIUrl":"https://doi.org/10.30978/gs-2022-2-83","url":null,"abstract":"The literature review focuses on the controversial issues regarding the treatment of paraesophageal hernia. The limitations of the current classification of hiatal hernias are highlighted. It is irrelevant and does not meet clinical needs. Objective criteria for its improvement are proposed. Data on the prevalence and course of hiatal hernias are given. Their pathogenetic factors and diagnostic methods are underlined. Considerable emphasis is placed on the paraesophageal hernia treatment strategies in patients with an asymptomatic and mildly symptomatic clinical course of the disease. Arguments are presented in favour of both wait‑and‑see tactics and planned hernioplasty. The choice of hernioplasty technique, especially in the case of giant hernias, the feasibility and indications for the use of mesh implants depending on their shape and composition, and the potential complications of allogenioplasty are the main topics for discussion. The problem of selecting a fundoplication method is addressed while weighing the advantages and potential side effects of employing various fundoplication modifications. The effects of correcting a short esophagus and eliminating the axial pressure on the esophageal hiatus are thoroughly evaluated, as these conditions increase the risk of hernia recurrence. \u0000The authors concluded that there are many controversial issues in the treatment of paraesophageal hernia. A consensus is needed on the classification of paraesophageal hernias, which would meet the urgent needs of choosing the method of operative delivery, and, in particular, the definition of the concepts of «large hernia» and «giant hernia.» Further research is required on issues such as the indications for operative treatment of paraesophageal hernias, especially in the case of asymptomatic large hernias and incarcerated hernias; the feasibility of using implants for plastic surgery of the esophageal hiatus; the choice of a fundoplication method; the diagnosis and correction of a short esophagus; and methodology for evaluating long‑term treatment outcomes. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"153 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78660923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Khomenko, V. Shapovalov, O. Herasymenko, R. Gybalo, R. Yenin
Gunshot wounds to the abdomen frequently result in significant damage to the abdominal organs, which is accompanied by peritonitis and the further development of different complications (anastomotic leakage, formation of abscesses, repeated bleeding, etc.), which require repeated surgical interventions that contribute to the formation of postoperative ventral hernias. The surgical management of ventral hernias is challenging due to severe adhesion in the abdominal cavity (irrespective of the time period since the injury and the last surgical interventions), the difficulties in closing massive defects of the muscle‑aponeurotic component of the anterior abdominal wall, contracture of the anterior abdominal wall, and the development of the abdominal compartment syndrome in the postoperative period. As a result, there is still some debate over the best surgical treatment for postoperative ventral hernias. Objective — to carry out a comparative analysis of open and video‑assisted laparoscopic operations for the selection of the most optimal surgical strategy for the management of ventral hernias after gunshot wounds to the abdomen. Materials and methods. We analyzed the surgical treatment of 45 wounded patients with postoperative ventral hernias that developed after operations for abdominal gunshot wounds. The patients were treated at the Military Medical Clinical Center of the Southern Region (Odesa) from 2014 to 2021; 32 of them had penetrating gunshot wounds, and 13 patients had a closed gunshot wound to the abdomen with injuries to the abdominal organs. 66.7 % of those injured had one operation on their abdominal organs, 22.2 % had two operations, 6.7 % had three operations, and 4.4 % had five operations. The size of the hernia orifices and severity of recurrence risk were determined according to the SWE classification: W1 (width of the hernia orifices up to 4 cm) — 28.9 %, W2 (from 4 to 10 cm) — 44.4 %, and W3 (over 10 cm) — 26.7 % of patients. The patients who had laparoscopic hernia repair (LHR) (IPOM‑Plus method — 17 patients, sIPOM — 2 patients) belonged to the LHR group (n = 19). The patients who had open hernia repair (OHR) (IPOM‑Plus method — 7 patients, sublay technique — 11 patients, onlay technique — 8 patients) were added to the OHR group (n = 26). The patients of both groups did not statistically differ by age, nature of a gunshot injury, number of operations before hernia repair, or hernia parameters (all p > 0.05). Results. Postoperative hernias after gunshot wounds are associated with pronounced adhesions in the abdominal cavity. The mean value of the peritoneal adhesion index averaged 11.7 ± 0.7 points (from 5 to 23 points) and did not statistically differ between groups: in the OHR group — 12.4 ± 0.9 points, in the LHR group — 10.8 ± 0.9 points (p = 0.339). Laparoscopic and open hernia repair in injured patients did not differ in the frequency of intraoperative complications — 19.2 % and 15.8 %, respectively (p = 0.766). There we
{"title":"Ventral hernia repair surgery after abdominal gunshot wound","authors":"I. Khomenko, V. Shapovalov, O. Herasymenko, R. Gybalo, R. Yenin","doi":"10.30978/gs-2022-2-29","DOIUrl":"https://doi.org/10.30978/gs-2022-2-29","url":null,"abstract":"Gunshot wounds to the abdomen frequently result in significant damage to the abdominal organs, which is accompanied by peritonitis and the further development of different complications (anastomotic leakage, formation of abscesses, repeated bleeding, etc.), which require repeated surgical interventions that contribute to the formation of postoperative ventral hernias. The surgical management of ventral hernias is challenging due to severe adhesion in the abdominal cavity (irrespective of the time period since the injury and the last surgical interventions), the difficulties in closing massive defects of the muscle‑aponeurotic component of the anterior abdominal wall, contracture of the anterior abdominal wall, and the development of the abdominal compartment syndrome in the postoperative period. As a result, there is still some debate over the best surgical treatment for postoperative ventral hernias.\u0000Objective — to carry out a comparative analysis of open and video‑assisted laparoscopic operations for the selection of the most optimal surgical strategy for the management of ventral hernias after gunshot wounds to the abdomen.\u0000Materials and methods. We analyzed the surgical treatment of 45 wounded patients with postoperative ventral hernias that developed after operations for abdominal gunshot wounds. The patients were treated at the Military Medical Clinical Center of the Southern Region (Odesa) from 2014 to 2021; 32 of them had penetrating gunshot wounds, and 13 patients had a closed gunshot wound to the abdomen with injuries to the abdominal organs. 66.7 % of those injured had one operation on their abdominal organs, 22.2 % had two operations, 6.7 % had three operations, and 4.4 % had five operations. The size of the hernia orifices and severity of recurrence risk were determined according to the SWE classification: W1 (width of the hernia orifices up to 4 cm) — 28.9 %, W2 (from 4 to 10 cm) — 44.4 %, and W3 (over 10 cm) — 26.7 % of patients. The patients who had laparoscopic hernia repair (LHR) (IPOM‑Plus method — 17 patients, sIPOM — 2 patients) belonged to the LHR group (n = 19). The patients who had open hernia repair (OHR) (IPOM‑Plus method — 7 patients, sublay technique — 11 patients, onlay technique — 8 patients) were added to the OHR group (n = 26). The patients of both groups did not statistically differ by age, nature of a gunshot injury, number of operations before hernia repair, or hernia parameters (all p > 0.05).\u0000Results. Postoperative hernias after gunshot wounds are associated with pronounced adhesions in the abdominal cavity. The mean value of the peritoneal adhesion index averaged 11.7 ± 0.7 points (from 5 to 23 points) and did not statistically differ between groups: in the OHR group — 12.4 ± 0.9 points, in the LHR group — 10.8 ± 0.9 points (p = 0.339). Laparoscopic and open hernia repair in injured patients did not differ in the frequency of intraoperative complications — 19.2 % and 15.8 %, respectively (p = 0.766). There we","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81709365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lymphatic malformations (LMs) are rare congenital benign malformations of the lymphatic system, consisting of fluid‑filled cysts or channels with unusual growth. The low incidence of LMs leads to a challenging differential diagnosis and a complicated choice of further treatment strategies. In this study, we analyzed our experience in the treatment of abdominal and retroperitoneal cystic LMs and proposed an anatomy‑based treatment strategy that could improve the treatment outcomes. Objective — to prove that the anatomical localization of LM influences treatment effectiveness and should be taken into account when making treatment decisions. Materials and methods. Out of 240 pediatric patients who underwent treatment for cystic LMs at a single center from December 2012 to December 2020, 43 (19.1 %) were diagnosed with abdominal and retroperitoneal LMs. The follow‑up period was 3.50 ± 2.16 years. Results. Surgical resection of abdominal LMs without evident connection with cisterna chyli does not lead to a recurrence. Sclerotherapy is the best treatment option for retroperitoneal LMs. Diffuse mesentery affection can be successfully treated by sirolimus systemic therapy. According to a logistic regression model, initial choice of LM treatment without considering anatomical localization influences the risks of LM treatment failure (p = 0.000503). All patients in our study group received the following treatments: laparoscopic resections (n = 10, 23.2 %), videoassisted resections (n = 11, 25.5 %), laparotomy resections (n = 9, 20.9 %), sclerotherapy (n = 4, 9.3 %), sclerotherapy and surgery combination (n = 1, 2.3 %), sirolimus systemic therapy (n = 2, 4.6 %), and splenectomy (n = 1, 2.3 %). Six (13.4 %) patients are under dynamic observation. The recommended technique for treating abdominal LMs produced excellent outcomes in 35 (81.4 %) patients, good outcomes in 5 (11.6 %) patients, satisfactory outcomes in 2 (4.7 %) patients, and unsatisfactory outcomes in 1 (2.3 %) patient. Conclusions. Treatment strategies for abdominal and retroperitoneal LMs should be based on their anatomical localization. Retroperitoneal localization indicates a high risk of surgical treatment failure (p = 0.0006).
{"title":"Anatomy-based treatment strategy for abdominal and retroperitoneal cystic lymphatic malformations in children","authors":"D. Diehtiarova","doi":"10.30978/gs-2022-2-39","DOIUrl":"https://doi.org/10.30978/gs-2022-2-39","url":null,"abstract":"Lymphatic malformations (LMs) are rare congenital benign malformations of the lymphatic system, consisting of fluid‑filled cysts or channels with unusual growth. The low incidence of LMs leads to a challenging differential diagnosis and a complicated choice of further treatment strategies. In this study, we analyzed our experience in the treatment of abdominal and retroperitoneal cystic LMs and proposed an anatomy‑based treatment strategy that could improve the treatment outcomes. \u0000Objective — to prove that the anatomical localization of LM influences treatment effectiveness and should be taken into account when making treatment decisions. \u0000Materials and methods. Out of 240 pediatric patients who underwent treatment for cystic LMs at a single center from December 2012 to December 2020, 43 (19.1 %) were diagnosed with abdominal and retroperitoneal LMs. The follow‑up period was 3.50 ± 2.16 years. \u0000Results. Surgical resection of abdominal LMs without evident connection with cisterna chyli does not lead to a recurrence. Sclerotherapy is the best treatment option for retroperitoneal LMs. Diffuse mesentery affection can be successfully treated by sirolimus systemic therapy. According to a logistic regression model, initial choice of LM treatment without considering anatomical localization influences the risks of LM treatment failure (p = 0.000503). All patients in our study group received the following treatments: laparoscopic resections (n = 10, 23.2 %), videoassisted resections (n = 11, 25.5 %), laparotomy resections (n = 9, 20.9 %), sclerotherapy (n = 4, 9.3 %), sclerotherapy and surgery combination (n = 1, 2.3 %), sirolimus systemic therapy (n = 2, 4.6 %), and splenectomy (n = 1, 2.3 %). Six (13.4 %) patients are under dynamic observation. The recommended technique for treating abdominal LMs produced excellent outcomes in 35 (81.4 %) patients, good outcomes in 5 (11.6 %) patients, satisfactory outcomes in 2 (4.7 %) patients, and unsatisfactory outcomes in 1 (2.3 %) patient. \u0000Conclusions. Treatment strategies for abdominal and retroperitoneal LMs should be based on their anatomical localization. Retroperitoneal localization indicates a high risk of surgical treatment failure (p = 0.0006). \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89267771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Shumynskyi, M. Sabadosh, V. Gurianov, A. Kopchak
Multiple papers reveal no reliable difference between early and delayed maxillofacial injuries treatment in postoperative complications in patients with craniomaxillofacial trauma and polytrauma. A choice factor of the treatment tactics is the lethal outcome risk, as well as the lethal outcome prognosis. In order to objectivize the severity of trauma authors suggested the assessment scores which represent patient’s condition severity in points and provide lethal outcome risk estimation, — Injury Severity Score (ISS) and New Injury Severity Score (NISS), each with advantages and disadvantages of prognosing the lethal outcome. Though, the data on its preciseness and informativeness regarding patients with combined craniomaxillofacial trauma are limited, and the results, obtained from various authors, seem to be controversial. Objective — to identify and compare the threshold (critical) values of the ISS and NISS assessment scales which predict the lethal outcome risks in patients with craniomaxillofacial trauma and polytrauma. Materials and methods. During 2016 — 2019 years 503 patients were treated due to maxillofacial traumas and associated injuries. Patients age ranged from 18 till 91 years, (average age — 30.5 years). There was a male predominance in the sample (84.3 %). Facial bone fractures occurred in 70 % of cases (352 patients). Mainly after assaults (44 %), falls (20 %) and motor‑vehicle accidents (16 %). The other etiological factors included occupational traumas (0.5 %), sport traumas (1 %) and unknown aetiology traumas. The study evaluated patients with facial and concomitant injuries, who received multidisciplinary treatment in a specialized trauma hospital. Values of Injury Severity Score and New Injury Severity Score were statistically analyzed to evaluate effectiveness in prognosing lethal outcome risks. Results. Mortality in the sample was 3 % (15 patients). With the optimum cut‑off value of ISS > 24, lethal outcome prognosis model sensitivity yields 93.3 %, specificity — 91.4 %. With the optimum cut‑off value NISS > 36, the lethal outcome prognosis sensitivity yields 86.7 %, its specificity 92.4 %. Conclusions. ISS and NISS demonstrate similar effectiveness in prognosing lethal outcome risks. The difference of area under the curve of both trauma severity estimation methods is not statistically significant (р = 0.651). Both indicators could be used in daily practice in specialized hospitals to assess the patient’s condition and determine priority of treatment steps.
{"title":"Predicting lethal outcome risks in patients with craniomaxillofacial trauma and polytrauma by the ISS and NISS","authors":"I. Shumynskyi, M. Sabadosh, V. Gurianov, A. Kopchak","doi":"10.30978/gs-2022-2-13","DOIUrl":"https://doi.org/10.30978/gs-2022-2-13","url":null,"abstract":"Multiple papers reveal no reliable difference between early and delayed maxillofacial injuries treatment in postoperative complications in patients with craniomaxillofacial trauma and polytrauma. A choice factor of the treatment tactics is the lethal outcome risk, as well as the lethal outcome prognosis. In order to objectivize the severity of trauma authors suggested the assessment scores which represent patient’s condition severity in points and provide lethal outcome risk estimation, — Injury Severity Score (ISS) and New Injury Severity Score (NISS), each with advantages and disadvantages of prognosing the lethal outcome. Though, the data on its preciseness and informativeness regarding patients with combined craniomaxillofacial trauma are limited, and the results, obtained from various authors, seem to be controversial. \u0000Objective — to identify and compare the threshold (critical) values of the ISS and NISS assessment scales which predict the lethal outcome risks in patients with craniomaxillofacial trauma and polytrauma. \u0000Materials and methods. During 2016 — 2019 years 503 patients were treated due to maxillofacial traumas and associated injuries. Patients age ranged from 18 till 91 years, (average age — 30.5 years). There was a male predominance in the sample (84.3 %). Facial bone fractures occurred in 70 % of cases (352 patients). Mainly after assaults (44 %), falls (20 %) and motor‑vehicle accidents (16 %). The other etiological factors included occupational traumas (0.5 %), sport traumas (1 %) and unknown aetiology traumas. The study evaluated patients with facial and concomitant injuries, who received multidisciplinary treatment in a specialized trauma hospital. Values of Injury Severity Score and New Injury Severity Score were statistically analyzed to evaluate effectiveness in prognosing lethal outcome risks. \u0000Results. Mortality in the sample was 3 % (15 patients). With the optimum cut‑off value of ISS > 24, lethal outcome prognosis model sensitivity yields 93.3 %, specificity — 91.4 %. With the optimum cut‑off value NISS > 36, the lethal outcome prognosis sensitivity yields 86.7 %, its specificity 92.4 %. \u0000Conclusions. ISS and NISS demonstrate similar effectiveness in prognosing lethal outcome risks. The difference of area under the curve of both trauma severity estimation methods is not statistically significant (р = 0.651). Both indicators could be used in daily practice in specialized hospitals to assess the patient’s condition and determine priority of treatment steps.","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87967805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Khomenko, I. Tsema, K. Humeniuk, V. Slobodianyk, D. Rahushyn
Combat penetrating gunshot injuries are frequently associated with damage to the liver. A bile leak and an external biliary fistula (EBF) are typical complications. Biliary decompression is commonly applied for the management of EBF. Furthermore, there is insufficient data available regarding the characteristics of combat trauma and its management in the context of ongoing hybrid warfare in East Ukraine. A 23yearold male was admitted with a thoracoabdominal penetrating gunshot wound (GSW) that was caused by a highenergy multiple metal projectile (a fragmented sniper bullet). Damage control tactics was applied at all 4 levels of military medical care. Endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy, and placement of a biliary stent were used for evaluation and biliary decompression. Stent occlusion was treated with stent replacement and scheduled ERCP. Partial EBF was diagnosed based on the primary wound defect of the liver and was closed without surgical intervention on the 34th day after injury. Acute cholecystitis was associated with ERCP and was managed with cholecystostomy. The combination of operative and nonoperative techniques for the management of the combat GSW to the liver is effective, along with the application of damage control tactics. Scheduled ERCP is effective for the management of EBF, so liver resection can be avoided. The transpapillary intervention with stent placement was successfully used for biliary decompression. Early posttraumatic stent occlusion can be diagnosed and effectively managed by scheduled ERCP as well as stent replacement with a largediameter stent inserted as close as possible to the site of bile leak.
{"title":"Case of gunshot injury to the liver by a hand-made modified sniper bullet: organ-preserving surgical management with damage control tactics and transpapillary biliary decompression","authors":"I. Khomenko, I. Tsema, K. Humeniuk, V. Slobodianyk, D. Rahushyn","doi":"10.30978/gs-2022-2-64","DOIUrl":"https://doi.org/10.30978/gs-2022-2-64","url":null,"abstract":"Combat penetrating gunshot injuries are frequently associated with damage to the liver. A bile leak and an external biliary fistula (EBF) are typical complications. Biliary decompression is commonly applied for the management of EBF. Furthermore, there is insufficient data available regarding the characteristics of combat trauma and its management in the context of ongoing hybrid warfare in East Ukraine. \u0000A 23yearold male was admitted with a thoracoabdominal penetrating gunshot wound (GSW) that was caused by a highenergy multiple metal projectile (a fragmented sniper bullet). Damage control tactics was applied at all 4 levels of military medical care. Endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy, and placement of a biliary stent were used for evaluation and biliary decompression. Stent occlusion was treated with stent replacement and scheduled ERCP. Partial EBF was diagnosed based on the primary wound defect of the liver and was closed without surgical intervention on the 34th day after injury. Acute cholecystitis was associated with ERCP and was managed with cholecystostomy. \u0000The combination of operative and nonoperative techniques for the management of the combat GSW to the liver is effective, along with the application of damage control tactics. Scheduled ERCP is effective for the management of EBF, so liver resection can be avoided. The transpapillary intervention with stent placement was successfully used for biliary decompression. Early posttraumatic stent occlusion can be diagnosed and effectively managed by scheduled ERCP as well as stent replacement with a largediameter stent inserted as close as possible to the site of bile leak. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89759824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Nefodova, M. Rudyk, M. Pasichnichenko, R. Dovhyi, T. Dovbynchuk, G. Tolstanova, L. Skivka
Alzheimer’s disease (AD) and Parkinson’s disease (PD) are the two most prevalent neurodegenerative diseases, affecting millions of people globally and causing significant disability and mortality. Animal models are the final step in completing preclinical studies and the most appropriate approach for gaining a thorough understanding of disease pathophysiology. Modeling of idiopathic AD and PD in rodents requires stereotactic injections of disease‑triggering substances. The placebo surgery group is an integral component of the design of these experiments in order to diminish study bias as a result of animal stress and non‑specific surgical impact. Inflammation is the most commonly reported non‑specific post‑surgery phenomenon, which can manifest in different ways in animals of different ages used in these experiments. Objective — to compare the long‑term pro‑inflammatory effects of placebo surgery, commonly employed for PD and AD modeling, in rats of different ages. Materials and methods. Adult male Wistar rats aged 4 and 14 months were used in the study. The placebo surgery consisted of a stereotactic unilateral intracerebral infusion of buffer solution. Before the placebo surgery, animals were anaesthetized using ketamine or xylazine administered intraperitoneally. Intact animals of both ages were used as a control. The evaluation of pro‑inflammatory effects of placebo surgery was conducted using biomarkers of local and systemic inflammation: metabolic polarization of phagocytes (microglia, peripheral blood cells), C‑reactive protein (CRP) plasma level, and systemic inflammation indexes calculated from the hemogram study. Results. In young lesioned animals, a pronounced pro‑inflammatory functional shift of microglia and signs of the resolution of systemic inflammation (an anti‑inflammatory skew of circulating phagocyte metabolism as compared to age‑matched intact controls) were observed in the long term after the placebo neurosurgery. In old intact animals, hematological and immunological markers of low‑grade systemic inflammation were observed. In lesioned old rats, residual neuroinflammation along with pronounced systemic inflammatory responses (leukocytosis, substantially increased SIRI and SII values, pro‑inflammatory metabolic shift of peripheral blood phagocytes as compared to age‑matched intact controls) were registered. Conclusions. The effects of placebo neurosurgical manipulations in rats depend on age. Meta‑inflammation inherent to aged rats is aggravated by non‑specific post‑surgery inflammation, leading to pronounced, persistent systemic inflammatory responses.
{"title":"Pro-inflammatory effects of placebo neurosurgery in rats: age-related features","authors":"A. Nefodova, M. Rudyk, M. Pasichnichenko, R. Dovhyi, T. Dovbynchuk, G. Tolstanova, L. Skivka","doi":"10.30978/gs-2022-2-56","DOIUrl":"https://doi.org/10.30978/gs-2022-2-56","url":null,"abstract":"Alzheimer’s disease (AD) and Parkinson’s disease (PD) are the two most prevalent neurodegenerative diseases, affecting millions of people globally and causing significant disability and mortality. Animal models are the final step in completing preclinical studies and the most appropriate approach for gaining a thorough understanding of disease pathophysiology. Modeling of idiopathic AD and PD in rodents requires stereotactic injections of disease‑triggering substances. The placebo surgery group is an integral component of the design of these experiments in order to diminish study bias as a result of animal stress and non‑specific surgical impact. Inflammation is the most commonly reported non‑specific post‑surgery phenomenon, which can manifest in different ways in animals of different ages used in these experiments.\u0000Objective — to compare the long‑term pro‑inflammatory effects of placebo surgery, commonly employed for PD and AD modeling, in rats of different ages.\u0000Materials and methods. Adult male Wistar rats aged 4 and 14 months were used in the study. The placebo surgery consisted of a stereotactic unilateral intracerebral infusion of buffer solution. Before the placebo surgery, animals were anaesthetized using ketamine or xylazine administered intraperitoneally. Intact animals of both ages were used as a control. The evaluation of pro‑inflammatory effects of placebo surgery was conducted using biomarkers of local and systemic inflammation: metabolic polarization of phagocytes (microglia, peripheral blood cells), C‑reactive protein (CRP) plasma level, and systemic inflammation indexes calculated from the hemogram study.\u0000Results. In young lesioned animals, a pronounced pro‑inflammatory functional shift of microglia and signs of the resolution of systemic inflammation (an anti‑inflammatory skew of circulating phagocyte metabolism as compared to age‑matched intact controls) were observed in the long term after the placebo neurosurgery. In old intact animals, hematological and immunological markers of low‑grade systemic inflammation were observed. In lesioned old rats, residual neuroinflammation along with pronounced systemic inflammatory responses (leukocytosis, substantially increased SIRI and SII values, pro‑inflammatory metabolic shift of peripheral blood phagocytes as compared to age‑matched intact controls) were registered.\u0000Conclusions. The effects of placebo neurosurgical manipulations in rats depend on age. Meta‑inflammation inherent to aged rats is aggravated by non‑specific post‑surgery inflammation, leading to pronounced, persistent systemic inflammatory responses.\u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"337 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75932381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Zavernyĭ, T. Tarasiuk, Y. Tsiura, M. Kryvopustov
The article highlights the professional and scientific path of Professor Oleksiy Petrovych Krymov — professor of surgery and head of the Department of Faculty Surgery of the Kyiv Medical Institute.
{"title":"Professor Oleksiy Petrovych Krymov. An outline of the professional and scientific path of an outstanding surgeon","authors":"L. Zavernyĭ, T. Tarasiuk, Y. Tsiura, M. Kryvopustov","doi":"10.30978/gs-2022-2-6","DOIUrl":"https://doi.org/10.30978/gs-2022-2-6","url":null,"abstract":"The article highlights the professional and scientific path of Professor Oleksiy Petrovych Krymov — professor of surgery and head of the Department of Faculty Surgery of the Kyiv Medical Institute. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90220225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Advances in immunotherapy have changed approaches to the treatment of recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC). The US Food and Drug Administration (the FDA) has approved both pembrolizumab monotherapy for first‑line treatment of the tumours expressing the programmed cell death receptor‑1 (PD‑L1; combined positive score of ≥ 1) in patients with R/M HNSCC and pembrolizumab administration in combination with platinum and fluorouracil regardless of the level of PD‑L1 expression. Pembrolizumab is a humanized monoclonal antibody class drug that activates the anti‑tumour immune response. Objective — to present treatment outcomes for recurrent (unresectable) cancer of the lower lip that was treated using a pembrolizumab monotherapy regimen. Patient H., born in 1968, received a 20‑month combined therapy for cancer of the lower lip. He had radical surgical removal of the primary tumour and two surgical resections of metastases, as well as courses of both remote gamma‑therapy and polychemotherapy. Nevertheless, the disease progressed from T2N0M0 to T4N1M0. In the area of the chin and right cheek, the patient developed a defect of the skin and subcutaneous tissue measuring 18 ´ 10 cm with purulent‑necrotic margins and an external fistula of the oral cavity. He was also bothered by unbearable pain in the area of the tumour and an unpleasant odour from the mouth and from the tumour. The patient was prescribed immunotherapy with pembrolizumab since an immunohistochemical examination revealed an RD‑L1‑positive tumour. One year after the start of immunotherapy, which included 17 courses of cancer treatment, the wound healed and the patient’s quality of life significantly improved. No adverse reactions were observed during immunotherapy. Computed tomography revealed a 25 x 15 mm nodule at the level of the lower jaw on the right and a lymph node of about 10 mm in diameter in the area of the lower parts of the right parotid salivary gland. Distant metastases were not detected. Currently, immunotherapy is ongoing. The issue of surgical removal of pathological formations is under consideration. This case demonstrates the positive outcomes of a pembrolizumab monotherapy regimen in a patient with R/M HNSCC.
{"title":"Pembrolizumab as an immunotherapy drug in the treatment of a patient with recurrent (unresectable) cancer of the lower lip","authors":"L. Markulan, L. M. Makarevych","doi":"10.30978/gs-2022-2-75","DOIUrl":"https://doi.org/10.30978/gs-2022-2-75","url":null,"abstract":"Advances in immunotherapy have changed approaches to the treatment of recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC). The US Food and Drug Administration (the FDA) has approved both pembrolizumab monotherapy for first‑line treatment of the tumours expressing the programmed cell death receptor‑1 (PD‑L1; combined positive score of ≥ 1) in patients with R/M HNSCC and pembrolizumab administration in combination with platinum and fluorouracil regardless of the level of PD‑L1 expression. Pembrolizumab is a humanized monoclonal antibody class drug that activates the anti‑tumour immune response. \u0000Objective — to present treatment outcomes for recurrent (unresectable) cancer of the lower lip that was treated using a pembrolizumab monotherapy regimen. \u0000Patient H., born in 1968, received a 20‑month combined therapy for cancer of the lower lip. He had radical surgical removal of the primary tumour and two surgical resections of metastases, as well as courses of both remote gamma‑therapy and polychemotherapy. Nevertheless, the disease progressed from T2N0M0 to T4N1M0. In the area of the chin and right cheek, the patient developed a defect of the skin and subcutaneous tissue measuring 18 ´ 10 cm with purulent‑necrotic margins and an external fistula of the oral cavity. He was also bothered by unbearable pain in the area of the tumour and an unpleasant odour from the mouth and from the tumour. The patient was prescribed immunotherapy with pembrolizumab since an immunohistochemical examination revealed an RD‑L1‑positive tumour. One year after the start of immunotherapy, which included 17 courses of cancer treatment, the wound healed and the patient’s quality of life significantly improved. No adverse reactions were observed during immunotherapy. Computed tomography revealed a 25 x 15 mm nodule at the level of the lower jaw on the right and a lymph node of about 10 mm in diameter in the area of the lower parts of the right parotid salivary gland. Distant metastases were not detected. Currently, immunotherapy is ongoing. The issue of surgical removal of pathological formations is under consideration. \u0000This case demonstrates the positive outcomes of a pembrolizumab monotherapy regimen in a patient with R/M HNSCC. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89703754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective — to determine the feasibility and effectiveness of using custom‑made and 3D‑printed mandibular implants in patients with microgenia, and to investigate their quality of life and satisfaction with aesthetic results during a two‑year follow‑up. Materials and methods. 21 patients participated in the study, with 14 (66.7 %) women and 7 (33.3 %) men. The average age of patients was 23.4 ± 2.3 years. All patients had signs of microgenia. In our study, a CT scan of the skull without contrast enhancement served as the primary diagnostic tool. Polyetheretherketonen (PEEK) was the material of choice for the implants. Results. Among the early postoperative complications were alterations to the sensation of the skin overlying the lower lip, which was restored within 1 — 2 months, and bruising, which had a tendency to spread to the neck. None of the patients had impaired motor innervation of the lower lip. Hematoma and wound suppuration were not detected either. One or two years after surgery, none of the patients had any delayed complications, including implant displacement, bone resorption in the lower jaw, decreased motor activity of the facial muscles, or altered sensation affecting the lower lip. Aesthetic results were assessed after the one‑year follow‑up. In a sample of 21 patients, the aesthetic outcome was excellent in 18 (85.7 %) patients and good in 3 (14.3 %) patients. No patients had bad aesthetic outcomes. Conclusions. The absence of delayed complications and the low risk of early complications, which in 71.4 % of patients only present as a temporary alteration to the sensation affecting the lower lip, indicate the safety of the suggested method. In all patients after mentoplasty with custom‑made implants, the physical and mental components of health improved statistically (with all values p < 0.05). Excellent aesthetic outcomes were observed in almost all patients (85.7 %) after mentoplasty with custom‑made implants.
{"title":"Chin augmentation with custom-made implants for microgenia treatment: a two-year follow-up","authors":"I. Donets, O. Panchuk, K. V. Galperin","doi":"10.30978/gs-2022-2-20","DOIUrl":"https://doi.org/10.30978/gs-2022-2-20","url":null,"abstract":"Objective — to determine the feasibility and effectiveness of using custom‑made and 3D‑printed mandibular implants in patients with microgenia, and to investigate their quality of life and satisfaction with aesthetic results during a two‑year follow‑up. \u0000Materials and methods. 21 patients participated in the study, with 14 (66.7 %) women and 7 (33.3 %) men. The average age of patients was 23.4 ± 2.3 years. All patients had signs of microgenia. In our study, a CT scan of the skull without contrast enhancement served as the primary diagnostic tool. Polyetheretherketonen (PEEK) was the material of choice for the implants. \u0000Results. Among the early postoperative complications were alterations to the sensation of the skin overlying the lower lip, which was restored within 1 — 2 months, and bruising, which had a tendency to spread to the neck. None of the patients had impaired motor innervation of the lower lip. Hematoma and wound suppuration were not detected either. One or two years after surgery, none of the patients had any delayed complications, including implant displacement, bone resorption in the lower jaw, decreased motor activity of the facial muscles, or altered sensation affecting the lower lip. Aesthetic results were assessed after the one‑year follow‑up. In a sample of 21 patients, the aesthetic outcome was excellent in 18 (85.7 %) patients and good in 3 (14.3 %) patients. No patients had bad aesthetic outcomes. \u0000Conclusions. The absence of delayed complications and the low risk of early complications, which in 71.4 % of patients only present as a temporary alteration to the sensation affecting the lower lip, indicate the safety of the suggested method. In all patients after mentoplasty with custom‑made implants, the physical and mental components of health improved statistically (with all values p < 0.05). Excellent aesthetic outcomes were observed in almost all patients (85.7 %) after mentoplasty with custom‑made implants. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77002321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Karakaya, A. Akdur, H. E. Ayvazoğlu Soy, F. Özçay, S. Yıldırım, A. Sezgin, A. Torgay, G. Moray, M. Haberal
The only curative treatment for irreversible liver damage and chronic liver disease is liver transplantation (LT). Objectives: to determine long‑term follow‑up results, liver graft functions, and survival rates of pediatric LT recipients at our center. Materials and methods. All pediatric LT recipients performed between March 15, 1990 and August 11, 2022 were included in our study. Demographic characteristics, preoperative clinical features, LT indications, early and late postoperative complications, survival rates, and long‑term outcomes of pediatric LT recipients were evaluated. Results. Between March 15, 1990, and August 11, 2022, we performed 341 pediatric LTs (307 from living related donors and 34 from deceased donors). The most common indication for LT was biliary atresia. There were 3 hepatic vein, 5 portal vein, and 54 hepatic artery complications. Biliary stenosis was observed in 62 patients, and biliary leakage was observed in 54 patients. The overall five‑year survival rate was 84.1 %, and the 10‑year survival rate was 77.7 %. Conclusions. According to the long‑term outcomes of pediatric liver transplants performed in our center, liver transplantation is a successful treatment option for pediatric patients with end‑stage liver disease and irreversible liver damage. The patients’ survival rates are also satisfactory.
{"title":"Long-term follow-up results of pediatric liver transplants at our center","authors":"E. Karakaya, A. Akdur, H. E. Ayvazoğlu Soy, F. Özçay, S. Yıldırım, A. Sezgin, A. Torgay, G. Moray, M. Haberal","doi":"10.30978/gs-2022-2-9","DOIUrl":"https://doi.org/10.30978/gs-2022-2-9","url":null,"abstract":"The only curative treatment for irreversible liver damage and chronic liver disease is liver transplantation (LT). \u0000Objectives: to determine long‑term follow‑up results, liver graft functions, and survival rates of pediatric LT recipients at our center. \u0000Materials and methods. All pediatric LT recipients performed between March 15, 1990 and August 11, 2022 were included in our study. Demographic characteristics, preoperative clinical features, LT indications, early and late postoperative complications, survival rates, and long‑term outcomes of pediatric LT recipients were evaluated. \u0000Results. Between March 15, 1990, and August 11, 2022, we performed 341 pediatric LTs (307 from living related donors and 34 from deceased donors). The most common indication for LT was biliary atresia. There were 3 hepatic vein, 5 portal vein, and 54 hepatic artery complications. Biliary stenosis was observed in 62 patients, and biliary leakage was observed in 54 patients. The overall five‑year survival rate was 84.1 %, and the 10‑year survival rate was 77.7 %. \u0000Conclusions. According to the long‑term outcomes of pediatric liver transplants performed in our center, liver transplantation is a successful treatment option for pediatric patients with end‑stage liver disease and irreversible liver damage. The patients’ survival rates are also satisfactory. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76998010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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