Pub Date : 2022-06-30DOI: 10.21688/1681-3472-2022-2-91
I. A. Zhabinets, A. M. Goritsky, I. A. Ostaltsev, S. Krasilnikov
Background. In 5–10% of cases, renal cell-cancer is complicated by the formation of a tumor thrombus in the inferior vena cava, which requires surgical intervention of nephrectomy with thrombectomy, which is essentially the only method of treatment for this category of patients. This operation is associated with technical difficulties and with the risk of intra- and postoperative complications.Aim. To retrospectively analyze the results of surgical treatment of patients who underwent nephrectomy with inferior vena cava thrombectomy. To present a case from the clinical practice of the oncology department, share experience and demonstrate the results of successful surgical treatment of renal cell-cancer.Methods. Retrospective analysis of 28 case histories of patients who underwent nephrectomy with inferior vena cava thrombectomy in the Oncology Department of the Meshalkin National Medical Research Center since 2014.Results. 28 case histories were analyzed from 2014, the average age of patients was 59 years (min 48, max 83), the dominant histological form was renal cell-cancer in 26 cases (92,8%) and nephroblastoma in 2 cases (7,2%). Complications developed in 2 (7,2%) clinical cases in the form of intraoperative bleeding, one of which turned out to be fatal. In 2022, the laparoscopic technique was implemented into clinical practice (4 operations were performed).Clinical case. Patient S., 57 years old, was hospitalized at the Meshalkin National Medical Research Center to the Department of Oncology. According to MSCT data — the formation of the right kidney with invasion into the adipose capsule, a thrombus of the renal vein with prolapse in the inferior vena cava up to 1 cm. Diagnosis — Tumor of the right kidney, tumor thrombus of the renal and inferior vena cava, T3bNxMx. The patient underwent nephrectomy of the right kidney with thrombectomy of the thrombus from the inferior vena cava. According to the results of pathohistological conclusion — renal cell-cancer of the right kidney G2 with invasion into adipose tissue, germination into the renal vein, T3bN0M0. The postoperative period passed without complications, the drainage was removed on the 2nd day, the patient was discharged on the 4th day in a satisfactory condition.Conclusion. Surgical treatment of renal cell-cancer complicated by tumor thrombosis is advisable to be carried out in multidisciplinary hospitals. Although venous invasion worsens the prognosis, a radically performed surgery gives a chance to increase life expectancy. An individualized approach to treatment planning, as well as non-standard surgical tactics involving an oncourologist and a cardiovascular surgeon in the team, allow you to carry out a full-fledged treatment, including with laparoscopic access, avoiding potentially fatal complications.
{"title":"Renal cell-cancer with thrombosis in the inferior vena cava: Nephrectomy with thrombectomy","authors":"I. A. Zhabinets, A. M. Goritsky, I. A. Ostaltsev, S. Krasilnikov","doi":"10.21688/1681-3472-2022-2-91","DOIUrl":"https://doi.org/10.21688/1681-3472-2022-2-91","url":null,"abstract":"Background. In 5–10% of cases, renal cell-cancer is complicated by the formation of a tumor thrombus in the inferior vena cava, which requires surgical intervention of nephrectomy with thrombectomy, which is essentially the only method of treatment for this category of patients. This operation is associated with technical difficulties and with the risk of intra- and postoperative complications.Aim. To retrospectively analyze the results of surgical treatment of patients who underwent nephrectomy with inferior vena cava thrombectomy. To present a case from the clinical practice of the oncology department, share experience and demonstrate the results of successful surgical treatment of renal cell-cancer.Methods. Retrospective analysis of 28 case histories of patients who underwent nephrectomy with inferior vena cava thrombectomy in the Oncology Department of the Meshalkin National Medical Research Center since 2014.Results. 28 case histories were analyzed from 2014, the average age of patients was 59 years (min 48, max 83), the dominant histological form was renal cell-cancer in 26 cases (92,8%) and nephroblastoma in 2 cases (7,2%). Complications developed in 2 (7,2%) clinical cases in the form of intraoperative bleeding, one of which turned out to be fatal. In 2022, the laparoscopic technique was implemented into clinical practice (4 operations were performed).Clinical case. Patient S., 57 years old, was hospitalized at the Meshalkin National Medical Research Center to the Department of Oncology. According to MSCT data — the formation of the right kidney with invasion into the adipose capsule, a thrombus of the renal vein with prolapse in the inferior vena cava up to 1 cm. Diagnosis — Tumor of the right kidney, tumor thrombus of the renal and inferior vena cava, T3bNxMx. The patient underwent nephrectomy of the right kidney with thrombectomy of the thrombus from the inferior vena cava. According to the results of pathohistological conclusion — renal cell-cancer of the right kidney G2 with invasion into adipose tissue, germination into the renal vein, T3bN0M0. The postoperative period passed without complications, the drainage was removed on the 2nd day, the patient was discharged on the 4th day in a satisfactory condition.Conclusion. Surgical treatment of renal cell-cancer complicated by tumor thrombosis is advisable to be carried out in multidisciplinary hospitals. Although venous invasion worsens the prognosis, a radically performed surgery gives a chance to increase life expectancy. An individualized approach to treatment planning, as well as non-standard surgical tactics involving an oncourologist and a cardiovascular surgeon in the team, allow you to carry out a full-fledged treatment, including with laparoscopic access, avoiding potentially fatal complications.","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"345 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74250971","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}
Pub Date : 2022-06-30DOI: 10.21688/1681-3472-2022-2-85
A. O. Shumeikina, E. A. Samoylova, K. V. Vavilov, S. Krasilnikov, N. M. Pasman
Background. The incidence of cervical cancer (CC) in the world is 500,000 new cases per year. In the structure of mortality from malignant neoplasms in women under 45 years of age, CC ranks 1st. Aim. To conduct a multivariate analysis of CC relapses, taking into account the results of primary treatment of CC patients for the subsequent choice of treatment methods for CC recurrences.Methods. Retrospective analysis of 105 case histories of patients for the period 2011–2021 who were treated at the Meshalkin National Medical Research Center and received therapy for recurrences of CC. Results. Stage I — 19 (18.1%), II — 32 (30.5%), III — 50 (47.6%), IV — 4 (3.8%). Primary methods of treatment: combined radiotherapy — 51 (49%), surgical method — 18 (17%), chemoradiotherapy — 18 (17%), surgery in combination with adjuvant radiotherapy — 15 (14%), polychemotherapy (with palliative purpose) — 1 (1%). In the structure of types of relapses: locoregional relapses — 42 (39%), local relapses — 31 (29%), metastatic hematogenous — 22 (20%), metastatic lymphogenous — 13 (12%). Late relapses (more than 12 months) — 65 (62%), early (6–12 months) — 22 (21%), progression (up to 6 months) — 18 (17%). Localizations for the occurrence of distant cervical cancer metastases: bones — 11 (39.3%), lungs — 10 (35.7%), brain — 3 (10.7%), liver — 4 (14.3%), lymphogenous metastases: supraclavicular lymph nodes — 5 (35.7%), inguinal lymph nodes — 8 (57.1%), abdominal lymph nodes — 1 (7.2%).Conclusion. In 62% there were late relapses, in 48% — in patients with initial stages, more frequent and longer follow-up with an oncogynecologist is indicated. Patients need treatment by an oncologist, radiologist, neurosurgeon, chemotherapist regardless of the stage, timing of occurrence, localization of relapses.
{"title":"Many years of experience in the treatment of recurrent cervical cancer","authors":"A. O. Shumeikina, E. A. Samoylova, K. V. Vavilov, S. Krasilnikov, N. M. Pasman","doi":"10.21688/1681-3472-2022-2-85","DOIUrl":"https://doi.org/10.21688/1681-3472-2022-2-85","url":null,"abstract":"Background. The incidence of cervical cancer (CC) in the world is 500,000 new cases per year. In the structure of mortality from malignant neoplasms in women under 45 years of age, CC ranks 1st. Aim. To conduct a multivariate analysis of CC relapses, taking into account the results of primary treatment of CC patients for the subsequent choice of treatment methods for CC recurrences.Methods. Retrospective analysis of 105 case histories of patients for the period 2011–2021 who were treated at the Meshalkin National Medical Research Center and received therapy for recurrences of CC. Results. Stage I — 19 (18.1%), II — 32 (30.5%), III — 50 (47.6%), IV — 4 (3.8%). Primary methods of treatment: combined radiotherapy — 51 (49%), surgical method — 18 (17%), chemoradiotherapy — 18 (17%), surgery in combination with adjuvant radiotherapy — 15 (14%), polychemotherapy (with palliative purpose) — 1 (1%). In the structure of types of relapses: locoregional relapses — 42 (39%), local relapses — 31 (29%), metastatic hematogenous — 22 (20%), metastatic lymphogenous — 13 (12%). Late relapses (more than 12 months) — 65 (62%), early (6–12 months) — 22 (21%), progression (up to 6 months) — 18 (17%). Localizations for the occurrence of distant cervical cancer metastases: bones — 11 (39.3%), lungs — 10 (35.7%), brain — 3 (10.7%), liver — 4 (14.3%), lymphogenous metastases: supraclavicular lymph nodes — 5 (35.7%), inguinal lymph nodes — 8 (57.1%), abdominal lymph nodes — 1 (7.2%).Conclusion. In 62% there were late relapses, in 48% — in patients with initial stages, more frequent and longer follow-up with an oncogynecologist is indicated. Patients need treatment by an oncologist, radiologist, neurosurgeon, chemotherapist regardless of the stage, timing of occurrence, localization of relapses.","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81132306","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}
Pub Date : 2022-06-30DOI: 10.21688/1681-3472-2022-2-9-16
R. Komarov, V. K. Noginov
The Bentall procedure is the gold standard for the treatment of bicuspid aortic valve insufficiency, aortic root aneurysm and ascending aortic aneurysm today. Valve-sparing methods of reconstruction of the aortic root are becoming increasingly common, with the accumulation of experience in the reconstruction of the bicuspid aortic valve and more favorable hemodynamic characteristics of the native valve compared to any prosthesis. The purpose of our study is to determine the indications for surgical correction of BAV-related aortopathy and the most effective method of surgical treatment. We performed a literature review of the variants of valve-sparing surgical treatment of bicuspid aortic valve syndrome, which have shown satisfactory med-term and long-term results. The article will be interested to cardiovascular surgeons and cardiologists.Received 6 December 2021. Revised 15 February 2022. Accepted 5 March 2022.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
{"title":"The possibilities of valve-sparing surgical treatment of bicuspid aortic valve syndrome","authors":"R. Komarov, V. K. Noginov","doi":"10.21688/1681-3472-2022-2-9-16","DOIUrl":"https://doi.org/10.21688/1681-3472-2022-2-9-16","url":null,"abstract":"The Bentall procedure is the gold standard for the treatment of bicuspid aortic valve insufficiency, aortic root aneurysm and ascending aortic aneurysm today. Valve-sparing methods of reconstruction of the aortic root are becoming increasingly common, with the accumulation of experience in the reconstruction of the bicuspid aortic valve and more favorable hemodynamic characteristics of the native valve compared to any prosthesis. The purpose of our study is to determine the indications for surgical correction of BAV-related aortopathy and the most effective method of surgical treatment. We performed a literature review of the variants of valve-sparing surgical treatment of bicuspid aortic valve syndrome, which have shown satisfactory med-term and long-term results. The article will be interested to cardiovascular surgeons and cardiologists.Received 6 December 2021. Revised 15 February 2022. Accepted 5 March 2022.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75789511","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}
Pub Date : 2022-06-30DOI: 10.21688/1681-3472-2022-2-66-72
A. Romanov, A. Filippenko, V. Beloborodov, I. Mikheenko, V. Shabanov
Post-incisional heart rhythm disturbances are one of the most frequent complications after open cardiac surgery. Lession in the atrial myocardium create conditions for slowing impulse conduction, formation and circulation of reentry. Case series included 8 patients after correction of complex congenital heart disease (CHD) with post-incisional atrial flutter (AF), despite treatment with antiarrhythmic drugs. All patients underwent interventional AF treatment using the robotic magnetic navigation (RMN) system. Perioperative complications, duration of surgery, time of fluoroscopy and efficacy (free of atrial tachyarrhythmias 3 months after the ablation procedure) of treatment were assessed during a follow-up period of 12 months.The article presents a series of clinical cases of RMN application for the treatment of post-incisional AF in patients with CHD after open cardiac surgery. The first Russian experience of using RMN for the treatment of post-incisional AF in patients with CHD after open cardiac surgery demonstrated safety and high efficiency both in the early and long-term follow-up periods. More experience and multicenter studies in a large cohort of patients are needed to determine the role of RMN as the first line of therapy for performing catheter ablation in this category of patients.Received 12 November 2021. Accepted 6 December 2021.Informed consent: The patient’s informed consent to use the records for medical purposes is obtained.Funding: The work is supported by a grant of the President of the Russian Federation No. МД-1997.2020.7Conflict of interest: Authors declare no conflict of interest.Contribution of the authorsLiterature review: V.V. Beloborodov, A.G. FilippenkoDrafting the article: A.B. Romanov, V.V. Beloborodov, A.G. FilippenkoCritical revision of the article: A.B. Romanov, A.G. Filippenko, V.V. Beloborodov, V.V. ShabanovSurgical treatment: A.B. Romanov, V.V. ShabanovFinal approval of the version to be published: A.B. Romanov, A.G. Filippenko, V.V. Beloborodov, I.L. Mikheenko, V.V. Shabanov
{"title":"The first experience of using robotic magnetic navigation for interventional treatment of post-incisional atrial flutter in patients with congenital heart defects after surgical correction: case series","authors":"A. Romanov, A. Filippenko, V. Beloborodov, I. Mikheenko, V. Shabanov","doi":"10.21688/1681-3472-2022-2-66-72","DOIUrl":"https://doi.org/10.21688/1681-3472-2022-2-66-72","url":null,"abstract":"Post-incisional heart rhythm disturbances are one of the most frequent complications after open cardiac surgery. Lession in the atrial myocardium create conditions for slowing impulse conduction, formation and circulation of reentry. Case series included 8 patients after correction of complex congenital heart disease (CHD) with post-incisional atrial flutter (AF), despite treatment with antiarrhythmic drugs. All patients underwent interventional AF treatment using the robotic magnetic navigation (RMN) system. Perioperative complications, duration of surgery, time of fluoroscopy and efficacy (free of atrial tachyarrhythmias 3 months after the ablation procedure) of treatment were assessed during a follow-up period of 12 months.The article presents a series of clinical cases of RMN application for the treatment of post-incisional AF in patients with CHD after open cardiac surgery. The first Russian experience of using RMN for the treatment of post-incisional AF in patients with CHD after open cardiac surgery demonstrated safety and high efficiency both in the early and long-term follow-up periods. More experience and multicenter studies in a large cohort of patients are needed to determine the role of RMN as the first line of therapy for performing catheter ablation in this category of patients.Received 12 November 2021. Accepted 6 December 2021.Informed consent: The patient’s informed consent to use the records for medical purposes is obtained.Funding: The work is supported by a grant of the President of the Russian Federation No. МД-1997.2020.7Conflict of interest: Authors declare no conflict of interest.Contribution of the authorsLiterature review: V.V. Beloborodov, A.G. FilippenkoDrafting the article: A.B. Romanov, V.V. Beloborodov, A.G. FilippenkoCritical revision of the article: A.B. Romanov, A.G. Filippenko, V.V. Beloborodov, V.V. ShabanovSurgical treatment: A.B. Romanov, V.V. ShabanovFinal approval of the version to be published: A.B. Romanov, A.G. Filippenko, V.V. Beloborodov, I.L. Mikheenko, V.V. Shabanov","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84135054","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}
Pub Date : 2022-06-30DOI: 10.21688/1681-3472-2022-2-89
D. Sirota, M. Zhulkov, D. Khvan, A. G. Makaev, A. Fomichev, H. Agaeva, A. Sabetov, B. Kozlov, A. Chernyavskiy
Aim. Comparative assessment of long-term results of bare metal stents and frozen elephant trunk prosthesis using in aortic dissection I DeBakey type.Methods. The retrospective comparative evaluation of different surgery results (2001–2017) in 213 patients with DeBakey type I aortic dissection was performed. Patients was divided in to 3 groups: Group 1 — standard treatment (hemiarch or total arch replacement) (n = 121), Group 2 — arch reconstruction with bare metal stent (n = 55), Group 3 — arch reconstruction with frozen elephant trunk prosthesis (n = 37). For groups equation we used propensity score matching analysis (PSM).Results. A pairwise comparison with the formation of three groups equated by the PSM method was performed. Long-term mortality in PSM 1 was 88 [82; 96] % (Group 1) и 89 [79; 100] % — (Group 2) respectively (p = 0.893). Long-term mortality in PSM 2 was 85 [71; 100] % in Group 1 and 94 [84; 100] % — Group 3 respectively (p = 0.342). Long-term mortality in PSM 3 was 88 [77; 100] % in Group 2 и 80 [64; 100] % — Group 3 respectively (p = 0.457). Freedom from aortic and mortality events (surrogate end point) in PSM 1 was 68% and 75% (p>0.999), PSM 2 was 50% and 100% (p = 0.006), PSM 3 was 73% and 89% (p = 0.22).Conclusion. There were no any statistical differences in long-term mortality and in surrogate end point (aortic events and mortality) between groups, but there was a trend to better results in Group 3.
{"title":"Long-term results of bare metal stents and frozen elephant trunk prosthesis using in aortic dissection surgery","authors":"D. Sirota, M. Zhulkov, D. Khvan, A. G. Makaev, A. Fomichev, H. Agaeva, A. Sabetov, B. Kozlov, A. Chernyavskiy","doi":"10.21688/1681-3472-2022-2-89","DOIUrl":"https://doi.org/10.21688/1681-3472-2022-2-89","url":null,"abstract":"Aim. Comparative assessment of long-term results of bare metal stents and frozen elephant trunk prosthesis using in aortic dissection I DeBakey type.Methods. The retrospective comparative evaluation of different surgery results (2001–2017) in 213 patients with DeBakey type I aortic dissection was performed. Patients was divided in to 3 groups: Group 1 — standard treatment (hemiarch or total arch replacement) (n = 121), Group 2 — arch reconstruction with bare metal stent (n = 55), Group 3 — arch reconstruction with frozen elephant trunk prosthesis (n = 37). For groups equation we used propensity score matching analysis (PSM).Results. A pairwise comparison with the formation of three groups equated by the PSM method was performed. Long-term mortality in PSM 1 was 88 [82; 96] % (Group 1) и 89 [79; 100] % — (Group 2) respectively (p = 0.893). Long-term mortality in PSM 2 was 85 [71; 100] % in Group 1 and 94 [84; 100] % — Group 3 respectively (p = 0.342). Long-term mortality in PSM 3 was 88 [77; 100] % in Group 2 и 80 [64; 100] % — Group 3 respectively (p = 0.457). Freedom from aortic and mortality events (surrogate end point) in PSM 1 was 68% and 75% (p>0.999), PSM 2 was 50% and 100% (p = 0.006), PSM 3 was 73% and 89% (p = 0.22).Conclusion. There were no any statistical differences in long-term mortality and in surrogate end point (aortic events and mortality) between groups, but there was a trend to better results in Group 3.","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"140 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81771744","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}
Pub Date : 2022-06-30DOI: 10.21688/1681-3472-2022-2-73-78
K. Kuatbekov, A. Mishin, A. Sepbayeva, G. Nigay, D. Kanzhigalin
The combination of monoventricular congenital heart disease with total anomalous pulmonary vein drainage and pulmonary atresia, is a rare pathology and characterized by an extremely severe course with the highest mortality. In the presented work we described a clinical case of the first and successful experience of two-stage treatment of an infant with total anomalous pulmonary vein drainage combined with single ventricular heart disease and pulmonary atresia in the Republic of Kazakhstan. For total anomalous pulmonary vein drainage correction we used a sutureless technique — primary sutureless repair, which is used in our center as a primary one. Due to severe anatomy of the defect, we used unusual area of the distal end of the central systemic-pulmonary artery anastomoses during primary surgery at the mouth of the severed patent ductus arteriosus in the area of pulmonary artery bifurcation, where it is associated with high surgical risks. Taking into account the presence of an additional obstacle to pulmonary blood flow in the form of left branch pulmonary artery orifice stenosis, we performed one-stage dilatation plasty of the pulmonary artery branch bifurcation with autopericardium. During the repeated surgery we faced such a serious complication as aortic damage for the first time, thanks to emergency actions it did not turn out to be fatal. We also managed to perform the most preferable dilation of hypoplastic branches of the pulmonary artery by plasty with the own tissues of the superior vena cava during the formation of Glenn-anastomosis.Received 29 November 2021. Revised 21 December 2021. Accepted 22 December 2021.Informed consent: Informed consent was obtained from the patient's mother for the publication and use of the patient's medical data for scientific purposes.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authorsLiterature review: A.V. MishinDrafting the article: A.V. MishinCritical revision of the article: K.N. Kuatbekov, A.D. SepbayevaSurgical treatment: K.N. Kuatbekov, A.V. Mishin, A.D. Sepbayeva, G.S. Nigay, D.M. KanzhigalinFinal approval of the version to be published: K.N. Kuatbekov, A.V. Mishin, A.D. Sepbayeva, G.S. Nigay, D.M. Kanzhigalin
单室先天性心脏病合并肺静脉完全异常引流和肺闭锁是一种罕见的病理，其特点是病程极其严重，死亡率最高。在提出的工作中，我们描述了一个临床病例的第一个和成功的经验两阶段治疗的婴儿完全异常肺静脉引流合并单室心脏病和肺闭锁在哈萨克斯坦共和国。对于完全异常肺静脉引流矫正，我们使用无缝线技术-初级无缝线修复，这是我们中心使用的主要技术。由于严重的解剖缺陷，我们在原发性手术中在肺动脉分叉区切断的动脉导管未闭口处使用了中央系统-肺动脉吻合处远端不寻常的区域，该区域手术风险高。考虑到肺动脉左分支口狭窄对肺血流的额外障碍，我们对肺动脉分支进行了一期心包自闭扩张成形术。在反复的手术过程中，我们第一次遇到了严重的并发症，如主动脉损伤，幸亏采取了紧急措施，没有致命的危险。在格伦吻合形成的过程中，我们还利用上腔静脉自身组织进行了最理想的肺动脉发育不全分支扩张。收到2021年11月29日。2021年12月21日修订。2021年12月22日接受。知情同意:为科学目的出版和使用患者的医疗数据已获得患者母亲的知情同意。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者贡献文献综述:A.V. Mishin文章起草:A.V. Mishin文章关键性修改:K.N. Kuatbekov, A.D. Sepbayeva手术治疗:K.N. Kuatbekov, A.V. Mishin, A.D. Sepbayeva, G.S. Nigay, D.M. Kanzhigalin最终审定版本:K.N. Kuatbekov, A.V. Mishin, A.D. Sepbayeva, G.S. Nigay, D.M. Kanzhigalin
{"title":"First experience of staged treatment of an infant with heterotaxy syndrome with total anomalous pulmonary vein drainage combined with a single ventricular heart and pulmonary atresia","authors":"K. Kuatbekov, A. Mishin, A. Sepbayeva, G. Nigay, D. Kanzhigalin","doi":"10.21688/1681-3472-2022-2-73-78","DOIUrl":"https://doi.org/10.21688/1681-3472-2022-2-73-78","url":null,"abstract":"The combination of monoventricular congenital heart disease with total anomalous pulmonary vein drainage and pulmonary atresia, is a rare pathology and characterized by an extremely severe course with the highest mortality. In the presented work we described a clinical case of the first and successful experience of two-stage treatment of an infant with total anomalous pulmonary vein drainage combined with single ventricular heart disease and pulmonary atresia in the Republic of Kazakhstan. For total anomalous pulmonary vein drainage correction we used a sutureless technique — primary sutureless repair, which is used in our center as a primary one. Due to severe anatomy of the defect, we used unusual area of the distal end of the central systemic-pulmonary artery anastomoses during primary surgery at the mouth of the severed patent ductus arteriosus in the area of pulmonary artery bifurcation, where it is associated with high surgical risks. Taking into account the presence of an additional obstacle to pulmonary blood flow in the form of left branch pulmonary artery orifice stenosis, we performed one-stage dilatation plasty of the pulmonary artery branch bifurcation with autopericardium. During the repeated surgery we faced such a serious complication as aortic damage for the first time, thanks to emergency actions it did not turn out to be fatal. We also managed to perform the most preferable dilation of hypoplastic branches of the pulmonary artery by plasty with the own tissues of the superior vena cava during the formation of Glenn-anastomosis.Received 29 November 2021. Revised 21 December 2021. Accepted 22 December 2021.Informed consent: Informed consent was obtained from the patient's mother for the publication and use of the patient's medical data for scientific purposes.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authorsLiterature review: A.V. MishinDrafting the article: A.V. MishinCritical revision of the article: K.N. Kuatbekov, A.D. SepbayevaSurgical treatment: K.N. Kuatbekov, A.V. Mishin, A.D. Sepbayeva, G.S. Nigay, D.M. KanzhigalinFinal approval of the version to be published: K.N. Kuatbekov, A.V. Mishin, A.D. Sepbayeva, G.S. Nigay, D.M. Kanzhigalin","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73431974","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}
Pub Date : 2022-06-30DOI: 10.21688/1681-3472-2022-2-30-37
V. Akulov, S. Alsov, D. Sirota, M. Lyashenko, A. Chernyavskiy
Historically, exoprosthetics is one of the first surgical procedures used for aneurysmal dilatation of such great vessels as the aorta. Despite the acceptable results of this method it is not widespread now because of the possible negative consequences of aortic wall wrapping (rupture or dissection).According to the latest guidelines, it is necessary to consider prosthetics of the ascending aorta by the patients with aortic valve surgery and aneurysmal dilatation of the ascending aorta more than 45 mm. However, early postoperative mortality reaches 20 % by elderly patients with severe comorbidities. In such situations, it is worth to choose a less traumatic surgical approach. Exoprosthetics of the aorta reduces the invasiveness of procedure, time of artificial circulation and aortic occlusion thereby taking down the risks of early postoperative complications.The purpose of this literature review is to analyze the current data on the technique of exoprosthetics of the aorta by the patients with moderate ascending aorta dilatation. The Scopus, Web of Science, PubMed databases were used for searching and selecting literature sources.The results demonstrate that aortic wrapping is a safe method causing rapid and permanent aortic remodeling. The technique has comparable long-term results with prosthetics of the ascending aorta despite the presence of histological changes in the aortic wall with a changing in its mechanical properties.Received 28 September 2021. Revised 19 January 2022. Accepted 20 January 2022.Funding: This work was carried out within the framework of the state task of Ministry of Health of Russian Federation No. 121032300337-5.Conflict of interest: Authors declare no conflict of interest.Contribution of the authorsConception and study design: S.A. Alsov, D.A. SirotaDrafting the article: V.A. AkulovCritical revision of the article: S.A. Alsov, D.A. Sirota, M.M. Lyashenko, A.M. ChernyavskiyFinal approval of the version to be published: V.A. Akulov, S.A. Alsov, D.A. Sirota, M.M. Lyashenko, A.M. Chernyavskiy
{"title":"Wrapping of the ascending aorta: history and prospects","authors":"V. Akulov, S. Alsov, D. Sirota, M. Lyashenko, A. Chernyavskiy","doi":"10.21688/1681-3472-2022-2-30-37","DOIUrl":"https://doi.org/10.21688/1681-3472-2022-2-30-37","url":null,"abstract":"Historically, exoprosthetics is one of the first surgical procedures used for aneurysmal dilatation of such great vessels as the aorta. Despite the acceptable results of this method it is not widespread now because of the possible negative consequences of aortic wall wrapping (rupture or dissection).According to the latest guidelines, it is necessary to consider prosthetics of the ascending aorta by the patients with aortic valve surgery and aneurysmal dilatation of the ascending aorta more than 45 mm. However, early postoperative mortality reaches 20 % by elderly patients with severe comorbidities. In such situations, it is worth to choose a less traumatic surgical approach. Exoprosthetics of the aorta reduces the invasiveness of procedure, time of artificial circulation and aortic occlusion thereby taking down the risks of early postoperative complications.The purpose of this literature review is to analyze the current data on the technique of exoprosthetics of the aorta by the patients with moderate ascending aorta dilatation. The Scopus, Web of Science, PubMed databases were used for searching and selecting literature sources.The results demonstrate that aortic wrapping is a safe method causing rapid and permanent aortic remodeling. The technique has comparable long-term results with prosthetics of the ascending aorta despite the presence of histological changes in the aortic wall with a changing in its mechanical properties.Received 28 September 2021. Revised 19 January 2022. Accepted 20 January 2022.Funding: This work was carried out within the framework of the state task of Ministry of Health of Russian Federation No. 121032300337-5.Conflict of interest: Authors declare no conflict of interest.Contribution of the authorsConception and study design: S.A. Alsov, D.A. SirotaDrafting the article: V.A. AkulovCritical revision of the article: S.A. Alsov, D.A. Sirota, M.M. Lyashenko, A.M. ChernyavskiyFinal approval of the version to be published: V.A. Akulov, S.A. Alsov, D.A. Sirota, M.M. Lyashenko, A.M. Chernyavskiy","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74362426","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}
Pub Date : 2022-06-30DOI: 10.21688/1681-3472-2022-2-87
M. Kilchukov, R. Kiselev, V. Murtazin, K. Orlov
Background. Critical limb ischemia is defined as persistent ischemic pain attributed to a variety of severely compromised blood flow to affected extremities. The treatment of non-reconstructable critical limb ischemia is still challenging; the amputation rate was 9.3%, and mortality rate was 23.2% within 24 months. Spinal cord stimulation (SCS) has become an alternative clinical practice for the treatment of intractable pain of the extremities.Aim. To determine whether high-frequency spinal cord stimulation (SCS) is better than low-frequency SCS for pain relief in chronic limb-threatening ischemia treatment.Methods. Throughout enrollment 56 patients were examined, of whom 6 rejected to participate in the study. The participants were randomly allocated to high-frequency (HF) or low frequency (LF)-SCS groups of 25 patients each by an external statistician, using an online tool. The patients were examined by a neurosurgeon and a vascular surgeon to assess pain intensity by visual analog scale, quality of life by short-form-36 health survey (SF-36), and functional status by walking impairment questionnaire in 3 and 12 months. Tissue perfusion by transcutaneous oxygen tension measurement was also measured in 12 months.Results. Intention-to-treat analysis demonstrated comparative advantage of HF-SCS over LF-SCS in 3 months with mean visual analog scale score 2.8 [95% CI, 2.4; 3.2] and 3.3 [95% CI, 3.0; 3.6] respectively (p = 0.031). Clinical superiority of HF-SCS persisted at 12 months follow up (p<0.001). HF-SCS produces significantly greater pain relief by walking impairment questionnaire in 3 (p<0.001) and 12 months (p = 0.009). Accordingly, general and mental health domains of SF-36 were significantly better in HF-SCS in 12 months. Despite a tendency toward better resting oxygen pressure in HF-SCS group, there was no intergroup difference by transcutaneous oxygen tension (p = 0.076).Conclusion. High-frequency spinal cord stimulation imposes better pain relief, life quality and functional activity in patients with chronic limb-threatening ischemia in short-term follow up.
{"title":"High-frequency spinal cord stimulation in treatment of chronic limb-threatening ischemia (HEAL-SCS): short-term results of a randomized trial","authors":"M. Kilchukov, R. Kiselev, V. Murtazin, K. Orlov","doi":"10.21688/1681-3472-2022-2-87","DOIUrl":"https://doi.org/10.21688/1681-3472-2022-2-87","url":null,"abstract":"Background. Critical limb ischemia is defined as persistent ischemic pain attributed to a variety of severely compromised blood flow to affected extremities. The treatment of non-reconstructable critical limb ischemia is still challenging; the amputation rate was 9.3%, and mortality rate was 23.2% within 24 months. Spinal cord stimulation (SCS) has become an alternative clinical practice for the treatment of intractable pain of the extremities.Aim. To determine whether high-frequency spinal cord stimulation (SCS) is better than low-frequency SCS for pain relief in chronic limb-threatening ischemia treatment.Methods. Throughout enrollment 56 patients were examined, of whom 6 rejected to participate in the study. The participants were randomly allocated to high-frequency (HF) or low frequency (LF)-SCS groups of 25 patients each by an external statistician, using an online tool. The patients were examined by a neurosurgeon and a vascular surgeon to assess pain intensity by visual analog scale, quality of life by short-form-36 health survey (SF-36), and functional status by walking impairment questionnaire in 3 and 12 months. Tissue perfusion by transcutaneous oxygen tension measurement was also measured in 12 months.Results. Intention-to-treat analysis demonstrated comparative advantage of HF-SCS over LF-SCS in 3 months with mean visual analog scale score 2.8 [95% CI, 2.4; 3.2] and 3.3 [95% CI, 3.0; 3.6] respectively (p = 0.031). Clinical superiority of HF-SCS persisted at 12 months follow up (p<0.001). HF-SCS produces significantly greater pain relief by walking impairment questionnaire in 3 (p<0.001) and 12 months (p = 0.009). Accordingly, general and mental health domains of SF-36 were significantly better in HF-SCS in 12 months. Despite a tendency toward better resting oxygen pressure in HF-SCS group, there was no intergroup difference by transcutaneous oxygen tension (p = 0.076).Conclusion. High-frequency spinal cord stimulation imposes better pain relief, life quality and functional activity in patients with chronic limb-threatening ischemia in short-term follow up.","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82097950","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}
Pub Date : 2022-06-30DOI: 10.21688/1681-3472-2022-2-38-48
Y. Sinelnikov, E. N. Orekhova, S. A. Orekhov, T. V. Matanovskaya
Aim. Evaluation of echocardiographic parameters to characterize the hemodynamics phenotype in children after Fontan procedure.Methods. 30 children aged 8.06 ± 4.3 years, body surface area 0.95 ± 0.33 m2, 12 boys (40%) with a functionally single ventricle after total cavopulmonary connection with extracardiac conduit fenestration. In addition to traditional echocardiographic parameters we assessed: systemic ventricular preload (stroke volume index, SVI), ventricular afterload (arterial elastance), arterial compliance, end–systolic ventricular elastance (VE), ventricular–arterial coupling (VAC), transpulmonary gradient (TPG).Results. In 33.3% (n = 10) children, the parameters of the single ventricle function were comparable to the normative values in biventricular hemodynamics. In 3 (10%) patients decreased values of the single ventricle systolic function were found (ejection fraction 40.0 ± 3.5%, fraction area changes 44.6 ± 3.5%, longitudinal strain −4.03 ± 0.87%), preload (SVI 13.30 ± 0.64 ml/m2), arterial compliance, (0.47 ± 0.17 ml/mm Hg), increased VAC (1.81 ± 0.10). In 36.6% of children (n = 11), a decrease in preload was found (SVI 27.4 ± 1.2 ml/m2), an increase in ventricular-arterial coupling (2.17 ± 0.16), and a decrease VE (1.98 ± 0.45 mm Hg/ml), an increase E/e´ (13.2 ± 1.7). In 20% of cases (n = 6) an increase in TPG was determined (11.6 ± 0.9 mm Hg).Conclusion. In children after Fontan procedure, 4 hemodynamic phenotypes were revealed in accordance with echocardiographic parameters: compensated, hypocontractile, with impaired diastolic properties of the systemic ventricle and with increased pulmonary vascular resistance. With a hypocontractile phenotype of hemodynamics, a significantly increased concentration of the pro-brain natriuretic peptide is determined. The phenotype of hemodynamics with increased pulmonary vascular resistance is more often associated with a higher functional class of heart failure.Received 10 September 2021. Revised 4 October 2022. Accepted 14 December 2022.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
{"title":"The choice of echocardiographic parameters for determining the hemodynamics phenotype in children after Fontan procedure","authors":"Y. Sinelnikov, E. N. Orekhova, S. A. Orekhov, T. V. Matanovskaya","doi":"10.21688/1681-3472-2022-2-38-48","DOIUrl":"https://doi.org/10.21688/1681-3472-2022-2-38-48","url":null,"abstract":"Aim. Evaluation of echocardiographic parameters to characterize the hemodynamics phenotype in children after Fontan procedure.Methods. 30 children aged 8.06 ± 4.3 years, body surface area 0.95 ± 0.33 m2, 12 boys (40%) with a functionally single ventricle after total cavopulmonary connection with extracardiac conduit fenestration. In addition to traditional echocardiographic parameters we assessed: systemic ventricular preload (stroke volume index, SVI), ventricular afterload (arterial elastance), arterial compliance, end–systolic ventricular elastance (VE), ventricular–arterial coupling (VAC), transpulmonary gradient (TPG).Results. In 33.3% (n = 10) children, the parameters of the single ventricle function were comparable to the normative values in biventricular hemodynamics. In 3 (10%) patients decreased values of the single ventricle systolic function were found (ejection fraction 40.0 ± 3.5%, fraction area changes 44.6 ± 3.5%, longitudinal strain −4.03 ± 0.87%), preload (SVI 13.30 ± 0.64 ml/m2), arterial compliance, (0.47 ± 0.17 ml/mm Hg), increased VAC (1.81 ± 0.10). In 36.6% of children (n = 11), a decrease in preload was found (SVI 27.4 ± 1.2 ml/m2), an increase in ventricular-arterial coupling (2.17 ± 0.16), and a decrease VE (1.98 ± 0.45 mm Hg/ml), an increase E/e´ (13.2 ± 1.7). In 20% of cases (n = 6) an increase in TPG was determined (11.6 ± 0.9 mm Hg).Conclusion. In children after Fontan procedure, 4 hemodynamic phenotypes were revealed in accordance with echocardiographic parameters: compensated, hypocontractile, with impaired diastolic properties of the systemic ventricle and with increased pulmonary vascular resistance. With a hypocontractile phenotype of hemodynamics, a significantly increased concentration of the pro-brain natriuretic peptide is determined. The phenotype of hemodynamics with increased pulmonary vascular resistance is more often associated with a higher functional class of heart failure.Received 10 September 2021. Revised 4 October 2022. Accepted 14 December 2022.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86195242","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}
Pub Date : 2022-06-30DOI: 10.21688/1681-3472-2022-2-88
A. M. Goritsky, I. A. Zhabinets, I. A. Ostaltsev, O. Pashkovskaya, T. G. Vorobyeva, O. Krestyaninov, S. Krasilnikov
Background. The use of radiotherapy at the treatment of prostate cancer makes it possible to radically cure the neoplasm, but does not reduce infravesical obstruction. With localized prostate cancer, the cause of acute urinary retention is concomitant benign prostatic hyperplasia. X-ray endovascular occlusion of the prostate vessels is based on a decrease in arterial inflow to the prostate gland, which leads to a decrease in its volume and a decrease in the severity of symptoms of obstruction.Aim. To evaluate the effectiveness of the use of X-ray endovascular occlusion of the prostate vessels as a combined treatment for prostate cancer in order to reduce infravesical obstruction.Methods. 15 patients with severe lower urinary tract symptoms scheduled for RT for prostate cancer. Average age is 68 years. Inclusion criteria: Qmax <10 ml/sec, prostate volume >50 cm3, residual urine volume >50 ml. In the conditions of the X-ray operating room, a puncture of the common femoral artery was performed, a microcatheter was carried out to the arteries of the prostate gland and their selective embolization with microparticles with a diameter of 250–500 microns.Results. 1 patient underwent unilateral embolization, 1 patient failed to embolize the arteries on both sides, 1 patient underwent embolization after remote radiation therapy due to the development of obstruction. 2 patients with locally advanced and metastatic prostate cancer without radiotherapy. There were no complications during the treatment and in the postoperative period. All patients noted positive dynamics in assessing the quality of urination. All patients had a decrease in prostate volume and urodynamic parameters (14 to 30 days) after embolization. No significant positive dynamics was achieved in 2 patients.Conclusion. X-ray endovascular occlusion of the prostate vessels is an effective minimally invasive method, can be considered as an independent technique and used to reduce the volume of the prostate in preparation for subsequent radiotherapy. The technique expands the doctor's arsenal when choosing a method for treating prostate cancer, improves the results of treatment, and also has a positive effect on the quality of life.
{"title":"Application of X-ray endovascular occlusion methods in the treatment of prostate cancer","authors":"A. M. Goritsky, I. A. Zhabinets, I. A. Ostaltsev, O. Pashkovskaya, T. G. Vorobyeva, O. Krestyaninov, S. Krasilnikov","doi":"10.21688/1681-3472-2022-2-88","DOIUrl":"https://doi.org/10.21688/1681-3472-2022-2-88","url":null,"abstract":"Background. The use of radiotherapy at the treatment of prostate cancer makes it possible to radically cure the neoplasm, but does not reduce infravesical obstruction. With localized prostate cancer, the cause of acute urinary retention is concomitant benign prostatic hyperplasia. X-ray endovascular occlusion of the prostate vessels is based on a decrease in arterial inflow to the prostate gland, which leads to a decrease in its volume and a decrease in the severity of symptoms of obstruction.Aim. To evaluate the effectiveness of the use of X-ray endovascular occlusion of the prostate vessels as a combined treatment for prostate cancer in order to reduce infravesical obstruction.Methods. 15 patients with severe lower urinary tract symptoms scheduled for RT for prostate cancer. Average age is 68 years. Inclusion criteria: Qmax <10 ml/sec, prostate volume >50 cm3, residual urine volume >50 ml. In the conditions of the X-ray operating room, a puncture of the common femoral artery was performed, a microcatheter was carried out to the arteries of the prostate gland and their selective embolization with microparticles with a diameter of 250–500 microns.Results. 1 patient underwent unilateral embolization, 1 patient failed to embolize the arteries on both sides, 1 patient underwent embolization after remote radiation therapy due to the development of obstruction. 2 patients with locally advanced and metastatic prostate cancer without radiotherapy. There were no complications during the treatment and in the postoperative period. All patients noted positive dynamics in assessing the quality of urination. All patients had a decrease in prostate volume and urodynamic parameters (14 to 30 days) after embolization. No significant positive dynamics was achieved in 2 patients.Conclusion. X-ray endovascular occlusion of the prostate vessels is an effective minimally invasive method, can be considered as an independent technique and used to reduce the volume of the prostate in preparation for subsequent radiotherapy. The technique expands the doctor's arsenal when choosing a method for treating prostate cancer, improves the results of treatment, and also has a positive effect on the quality of life.","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"177 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79892258","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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