Pub Date : 2020-11-06DOI: 10.24884/0042-4625-2020-179-4-36-43
I. Kostarev, D. Kiselev, L. A. Blagadarni, E. Zharkov, A. Titov, E. E. Bolkvadze, A. A. Mudrov, A. Matinyan
The objective of the study was to compare the results of two methods of thermo-obliteration of the fistula track by diode laser or monopolar electrocoagulation in patients with trans- and suprasphincteric anal fistulas. Methods and materials . 52 patients (men - 40, women - 12) were included in the study. 29 patients underwent laser coagulation (Laser group) and 23 patients underwent monopolar electrocoagulation (ME group) of fistula track combined with closure of internal fistula opening. Mean age of patients in Laser group was (46±13) years, in ME group - (41±12) years. In the Laser group, 11 (38 %) patients had suprasphincteric fistulae, and 18 (62 %) had transsphincteric fistulae passing through a superficial or deep portion of the external anal sphincter. In the ME group, 9 (39.1 %) patients had an suprasphincteric fistula and 14 (60.9 %) had a transsphincteric fistulae. The minimal period for assessing the healing rate was 2 months after surgery. Results. The average follow-up period after Laser was (9.5±3.0) (5-18) months, after ME - (12.2±7.3) (2-22) months. Primary healing of fistula in 2 months after surgery was 19/29 (65.5 %; 10 transsphincteric and 9 suprasphincteric fistulas) in the Laser group versus 7/23 (30.4 %; 5 transsphincteric and 1 suprasphincteric fistulas) in the ME group (p<0.05). There were no cases of fecal incontinence development after laser or monopolar coagulation of fistula track. Conclusion. A comparative analysis of the first results showed that although in both groups, after thermo-obliteration of the fistula track, the frequency of non-healing of fistula exceeds 30 %, in the group where a diode laser was used, the results were statistically significantly better compared to the group of monopolar electrocoagulation (65.5 against 30.4 %).
{"title":"Comparative analysis of the results of treatment of trans- and suprasphincteric anal fistulae by thermo-obliteration of fistula track with diode laser or monopolar electrocoagulation","authors":"I. Kostarev, D. Kiselev, L. A. Blagadarni, E. Zharkov, A. Titov, E. E. Bolkvadze, A. A. Mudrov, A. Matinyan","doi":"10.24884/0042-4625-2020-179-4-36-43","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-4-36-43","url":null,"abstract":"The objective of the study was to compare the results of two methods of thermo-obliteration of the fistula track by diode laser or monopolar electrocoagulation in patients with trans- and suprasphincteric anal fistulas. Methods and materials . 52 patients (men - 40, women - 12) were included in the study. 29 patients underwent laser coagulation (Laser group) and 23 patients underwent monopolar electrocoagulation (ME group) of fistula track combined with closure of internal fistula opening. Mean age of patients in Laser group was (46±13) years, in ME group - (41±12) years. In the Laser group, 11 (38 %) patients had suprasphincteric fistulae, and 18 (62 %) had transsphincteric fistulae passing through a superficial or deep portion of the external anal sphincter. In the ME group, 9 (39.1 %) patients had an suprasphincteric fistula and 14 (60.9 %) had a transsphincteric fistulae. The minimal period for assessing the healing rate was 2 months after surgery. Results. The average follow-up period after Laser was (9.5±3.0) (5-18) months, after ME - (12.2±7.3) (2-22) months. Primary healing of fistula in 2 months after surgery was 19/29 (65.5 %; 10 transsphincteric and 9 suprasphincteric fistulas) in the Laser group versus 7/23 (30.4 %; 5 transsphincteric and 1 suprasphincteric fistulas) in the ME group (p<0.05). There were no cases of fecal incontinence development after laser or monopolar coagulation of fistula track. Conclusion. A comparative analysis of the first results showed that although in both groups, after thermo-obliteration of the fistula track, the frequency of non-healing of fistula exceeds 30 %, in the group where a diode laser was used, the results were statistically significantly better compared to the group of monopolar electrocoagulation (65.5 against 30.4 %).","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69112090","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 : 2020-08-03DOI: 10.24884/0042-4625-2020-179-3-113-119
P. N. Romashchenko, N. A. Maistrenko, D. Krivolapov, D. O. Vshivtsev
Intraoperative identification of healthy parathyroid and parathyroid adenomas facilitate a favorable outcome of surgical treatment of patients with parathyroid diseases and various hyperparathyroidism’s forms. In doing so, it is important to preserve the entire parathyroid tissue, since unintentional damaging, removal or devascularization leads to the most common development of complication – hypoparathyroidism, which occasionally becomes permanent. Although, in case of surgical treatment of patients with hyperparathyroidism, the removal of the whole pathologically altered tissue is needed in order to avoid the persistence and recurrence hyperparathyroidism, as confirmed by intraoperative and postoperative parathyroid hormone examination. Up to recent time, surgeons could had relied only on pre-surgical localization of hyperfunctioning parathyroid glands, thorough knowledge of front neck anatomy and personal experience, which wasn’t always reliable to recognize the parathyroids intraoperatively and differentiate the healthy parathyroid tissue from adenoma. To solve these problems, the auxiliary navigation and visualization methods, based on application of radiopharmaceutical and fluorescent agents, tropic to parathyroid tissue, are being actively implemented to endocrine surgery nowadays. The comparative characteristic of modern methods for intraoperative visualization of the parathyroid glands, based on the worldwide literature data, is represented in this article.
{"title":"Radio navigation and photodynamic methods for intraoperative visualization of the parathyroid glands (review of literature)","authors":"P. N. Romashchenko, N. A. Maistrenko, D. Krivolapov, D. O. Vshivtsev","doi":"10.24884/0042-4625-2020-179-3-113-119","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-3-113-119","url":null,"abstract":"Intraoperative identification of healthy parathyroid and parathyroid adenomas facilitate a favorable outcome of surgical treatment of patients with parathyroid diseases and various hyperparathyroidism’s forms. In doing so, it is important to preserve the entire parathyroid tissue, since unintentional damaging, removal or devascularization leads to the most common development of complication – hypoparathyroidism, which occasionally becomes permanent. Although, in case of surgical treatment of patients with hyperparathyroidism, the removal of the whole pathologically altered tissue is needed in order to avoid the persistence and recurrence hyperparathyroidism, as confirmed by intraoperative and postoperative parathyroid hormone examination. Up to recent time, surgeons could had relied only on pre-surgical localization of hyperfunctioning parathyroid glands, thorough knowledge of front neck anatomy and personal experience, which wasn’t always reliable to recognize the parathyroids intraoperatively and differentiate the healthy parathyroid tissue from adenoma. To solve these problems, the auxiliary navigation and visualization methods, based on application of radiopharmaceutical and fluorescent agents, tropic to parathyroid tissue, are being actively implemented to endocrine surgery nowadays. The comparative characteristic of modern methods for intraoperative visualization of the parathyroid glands, based on the worldwide literature data, is represented in this article.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69110630","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 : 2020-08-03DOI: 10.24884/0042-4625-2020-179-3-13-18
И., О. Крицкая, Д. В. Свистов, В. Литвиненко, В. Сергеева, М. Н. Кравцов, Д. Мирзаметов, Н. П. Алексеева, А. Ю. Щербук, Ю. А. Щербук, Valentin I. Leonov, Irina O. Kritskaya, D. Svistov, E. Litvinenko, T. Sergeeva, Viktor V. Flud, M. Kravtsov, S. D. Mirzametov, N. Alexeyeva, Alexandr Yu. Shcherbuk, Yuriy A. Shcherbuk
The OBJECTIVE was to improve the results of surgical treatment of patients with discogenic radiculopathy by preoperative neuropsychological examination of patients with an increased risk of unsatisfactory outcome of the operation.METHODS AND MATERIALS. Neuropsychological status of 77 patients with discogenic radiculopathy in the preoperative period was studied. For this purpose, we assessed the intensity of pain, levels of personal and situational anxiety and the presence and severity of depression. The obtained data were compared with postoperative results of quality of life assessment for the main parameters, which include the level of pain and adaptation to daily activities.RESULTS. Data from neuropsychological tests were revealed, the presence of which in patients with discogenic pain syndrome suggests the risk of an unsatisfactory assessment of the operation performed by the patient. According to the long-term results of neurosurgical treatment, patients were divided into three groups: 1 – with a good result; 2 – patients with a number of preserved complaints, who rated the result of the operation as satisfactory; 3 – unsatisfactory outcome. In patients with unsatisfactory results of surgical treatment of discogenic radiculopathies with pain syndrome, patterns of psychological indices were found that were significantly associated with the outcome of treatment.CONCLUSION. Conducting a neuropsychological examination prior to surgery with the identification of predictors of chronic discogenic pain and patient dissatisfaction with the results of treatment can influence the surgical tactics and optimize the process of further treatment.
{"title":"Relationship of psychoalgological status and results of neurosurgical treatment of patients with discogenic radiculopathy","authors":"И., О. Крицкая, Д. В. Свистов, В. Литвиненко, В. Сергеева, М. Н. Кравцов, Д. Мирзаметов, Н. П. Алексеева, А. Ю. Щербук, Ю. А. Щербук, Valentin I. Leonov, Irina O. Kritskaya, D. Svistov, E. Litvinenko, T. Sergeeva, Viktor V. Flud, M. Kravtsov, S. D. Mirzametov, N. Alexeyeva, Alexandr Yu. Shcherbuk, Yuriy A. Shcherbuk","doi":"10.24884/0042-4625-2020-179-3-13-18","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-3-13-18","url":null,"abstract":"The OBJECTIVE was to improve the results of surgical treatment of patients with discogenic radiculopathy by preoperative neuropsychological examination of patients with an increased risk of unsatisfactory outcome of the operation.METHODS AND MATERIALS. Neuropsychological status of 77 patients with discogenic radiculopathy in the preoperative period was studied. For this purpose, we assessed the intensity of pain, levels of personal and situational anxiety and the presence and severity of depression. The obtained data were compared with postoperative results of quality of life assessment for the main parameters, which include the level of pain and adaptation to daily activities.RESULTS. Data from neuropsychological tests were revealed, the presence of which in patients with discogenic pain syndrome suggests the risk of an unsatisfactory assessment of the operation performed by the patient. According to the long-term results of neurosurgical treatment, patients were divided into three groups: 1 – with a good result; 2 – patients with a number of preserved complaints, who rated the result of the operation as satisfactory; 3 – unsatisfactory outcome. In patients with unsatisfactory results of surgical treatment of discogenic radiculopathies with pain syndrome, patterns of psychological indices were found that were significantly associated with the outcome of treatment.CONCLUSION. Conducting a neuropsychological examination prior to surgery with the identification of predictors of chronic discogenic pain and patient dissatisfaction with the results of treatment can influence the surgical tactics and optimize the process of further treatment.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69110809","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 : 2020-08-03DOI: 10.24884/0042-4625-2020-179-3-33-39
S. Plaksin, L. Farshatova, A. L. Lisichkin
The OBJECTIVE of the study was to assess the changes in blood supply of the bronchus stump following lung resection with lymph node dissection.METHODS AND MATERIALS. Bronchial microcirculation was studied in 8 patients during pneumonectomy of the wall of the main bronchus using laser Doppler flowmetry method. In this paper, we present our observations of postoperative necrotic ischemic bronchitis after lobectomy with associated formation of bronchopleural fistula of the main bronchus and the failure of the stump of the lobular bronchus.RESULTS. Mobilization of the bronchus decreased microcirculation rate to (3.3±0.3) conventional units (c. u.), or to 74.5 %; lymphatic dissection further reduced microcirculation rate to (2.6±0.2) c. u., or to 60.2 %. An additional twisted suture was found to worsen ischemia. The normalized value of the amplitude decreased during the second minute of the dissection of the bronchus, indicating hypoxia. A 61-year-old patient with diabetes showed damage to the wall of the main bronchus 0.6 cm in size 7 days after undergoing the right lower lobectomy with lymphatic dissection. On the 19th day after the same procedure, the same patient developed an insolvency of the stump of the lower lobe bronchus, which was classified as a manifestation of ischemia. Postoperative ischemic bronchitis can occur in a true ischemic or an ulcerative necrotic form, and it can be diagnosed using a macroscopic picture in the context of fibrobronchoscopy. It occurs in (2.5–3.2) % of patients who underwent lung resections for cancer with lymphatic dissection.CONCLUSION. Ischemia of the bronchial wall during its mobilization plays a significant role in the etiology of bronchopleural fistula. Lymphatic dissection worsens microcirculation of the bronchial wall. Ischemic necrotic bronchitis can lead to formation of the bronchopleural fistula outside of the stump. High-risk patients require additional coverage of the bronchus stump with muscle or fat tissue.
{"title":"Isсhemic change in bronchus stump after lung cancer resection","authors":"S. Plaksin, L. Farshatova, A. L. Lisichkin","doi":"10.24884/0042-4625-2020-179-3-33-39","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-3-33-39","url":null,"abstract":"The OBJECTIVE of the study was to assess the changes in blood supply of the bronchus stump following lung resection with lymph node dissection.METHODS AND MATERIALS. Bronchial microcirculation was studied in 8 patients during pneumonectomy of the wall of the main bronchus using laser Doppler flowmetry method. In this paper, we present our observations of postoperative necrotic ischemic bronchitis after lobectomy with associated formation of bronchopleural fistula of the main bronchus and the failure of the stump of the lobular bronchus.RESULTS. Mobilization of the bronchus decreased microcirculation rate to (3.3±0.3) conventional units (c. u.), or to 74.5 %; lymphatic dissection further reduced microcirculation rate to (2.6±0.2) c. u., or to 60.2 %. An additional twisted suture was found to worsen ischemia. The normalized value of the amplitude decreased during the second minute of the dissection of the bronchus, indicating hypoxia. A 61-year-old patient with diabetes showed damage to the wall of the main bronchus 0.6 cm in size 7 days after undergoing the right lower lobectomy with lymphatic dissection. On the 19th day after the same procedure, the same patient developed an insolvency of the stump of the lower lobe bronchus, which was classified as a manifestation of ischemia. Postoperative ischemic bronchitis can occur in a true ischemic or an ulcerative necrotic form, and it can be diagnosed using a macroscopic picture in the context of fibrobronchoscopy. It occurs in (2.5–3.2) % of patients who underwent lung resections for cancer with lymphatic dissection.CONCLUSION. Ischemia of the bronchial wall during its mobilization plays a significant role in the etiology of bronchopleural fistula. Lymphatic dissection worsens microcirculation of the bronchial wall. Ischemic necrotic bronchitis can lead to formation of the bronchopleural fistula outside of the stump. High-risk patients require additional coverage of the bronchus stump with muscle or fat tissue.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69110998","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 : 2020-08-03DOI: 10.24884/0042-4625-2020-179-3-85-90
A. Medvedev, S. Fedorov, V. Pichugin, A. Maksimov, M. B. Sukhova, A. V. Bogush, Q. B. Vepaev
A rare case of catheter-induced infectious endocarditis of the right heart chambers complicated by embolism of the left pulmonary artery and its successful surgical treatment is presented. We performed the operation to remove a foreign body and vegetations from the superior vena cava and the right atrium, embolectomy from the left main branch of the pulmonary artery, chemical sanitation of the right chambers of the heart and pulmonary artery under extracorporeal circulation.
{"title":"Catheter-induced infectious endocarditis complicated by pulmonary embolism: successful surgical treatment","authors":"A. Medvedev, S. Fedorov, V. Pichugin, A. Maksimov, M. B. Sukhova, A. V. Bogush, Q. B. Vepaev","doi":"10.24884/0042-4625-2020-179-3-85-90","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-3-85-90","url":null,"abstract":"A rare case of catheter-induced infectious endocarditis of the right heart chambers complicated by embolism of the left pulmonary artery and its successful surgical treatment is presented. We performed the operation to remove a foreign body and vegetations from the superior vena cava and the right atrium, embolectomy from the left main branch of the pulmonary artery, chemical sanitation of the right chambers of the heart and pulmonary artery under extracorporeal circulation.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69111228","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 : 2020-08-03DOI: 10.24884/0042-4625-2020-179-3-91-94
S. Timerbulatov, R. Akhmerov, M. V. Timerbulatov, V. M. Timerbulatov
We presents the clinical case of splenosis of the abdominal cavity, simulating carcinomatosis. Radiation methods (ultrasound, computed tomography, positron emission tomography) revealed multiple soft tissue tumors in the right iliac region, pelvis, bed of the removed spleen. The patient underwent a splenectomy 23 years ago for a spleen injury. Laparoscopy was performed, tumor formations in the right iliac region and pelvis were removed. Histological examination confirmed the diagnosis of splenosis.
{"title":"Peritoneal splenosis, simulating carcinomatosis","authors":"S. Timerbulatov, R. Akhmerov, M. V. Timerbulatov, V. M. Timerbulatov","doi":"10.24884/0042-4625-2020-179-3-91-94","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-3-91-94","url":null,"abstract":"We presents the clinical case of splenosis of the abdominal cavity, simulating carcinomatosis. Radiation methods (ultrasound, computed tomography, positron emission tomography) revealed multiple soft tissue tumors in the right iliac region, pelvis, bed of the removed spleen. The patient underwent a splenectomy 23 years ago for a spleen injury. Laparoscopy was performed, tumor formations in the right iliac region and pelvis were removed. Histological examination confirmed the diagnosis of splenosis.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69111288","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 : 2020-08-03DOI: 10.24884/0042-4625-2020-179-3-95-99
M. Ufimtseva, Y. Bochkarev, S. A. Chernyadev, E. Gurkovskaya, D. Zhunisova
A clinical case of gangrenous pyoderma is described, as well as the difficulty of differential diagnosis and treatment of this disease. We carried out a literature review of the materials of foreign and domestic authors describing the course of gangrenous pyoderma using search engines PubMed, Google Scholar, BioMed Central (55 articles).
{"title":"Pyoderma gangrenosum – interdisciplinary problem","authors":"M. Ufimtseva, Y. Bochkarev, S. A. Chernyadev, E. Gurkovskaya, D. Zhunisova","doi":"10.24884/0042-4625-2020-179-3-95-99","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-3-95-99","url":null,"abstract":"A clinical case of gangrenous pyoderma is described, as well as the difficulty of differential diagnosis and treatment of this disease. We carried out a literature review of the materials of foreign and domestic authors describing the course of gangrenous pyoderma using search engines PubMed, Google Scholar, BioMed Central (55 articles).","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69111360","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 : 2020-08-03DOI: 10.24884/0042-4625-2020-179-3-40-47
B. Kotiv, I. Dzidzava, T. Suborova, G. V. Valiev, O. V. Barinov, I. Deinega, T. M. Voroshilova, V. V. Lishenko, A. Platonova, V. V. Shvedyuc
The OBJECTIVE was to determine the possibility of using chromatography-mass spectrometry to select causal treatment for patients with pleural empyema.METHODS AND MATERIALS. The analysis of the results of examination and treatment of 207 patients with pleural empyema for the period from 2017 to 2018 was done. All patients underwent bacteriological examination, twenty patients from them underwent chromato-mass-spectrometric examination of pleural exudate.RESULTS. Patients were transferred to a specialized thoracic hospital from other medical institutions, where they received a course of empirical antibacterial therapy and drainage of the pleural cavity was performed. Bacteriological examination of the contents of the pleural cavity was positive in 112 (54.1 %) patients. The leading pathogens were gram-negative bacteria isolated from the contents of the pleural cavity in 45 % of patients with closed and 63.5 % – open pleural empyema. Polyantibiotic-resistant stocks of P. aeruginosa (30.4 %), K. pneumoniae (19.6 %) and A. baumannii (12.5 %) prevailed, which remained sensitive to polymyxin and, in some cases, to amikacin. In 25 (22.3 %) patients, micromycetes of the genus Candida were found. No growth of anaerobic microflora was detected. Chromato-mass-spectrometric examination of pleural exudate revealed markers of 30 taxa of bacteria, viruses and fungi that exceeded the norm by more than two times. Markers of gram-negative bacteria were not detected. The proportion of anaerobic microorganisms was 76.6 %, with the highest concentration found for bacteria of the genus Clostridium and Eubacterium.CONCLUSION. The choice of causal treatment for patients with pleural empyema is difficult due to the negative culturing from the contents of the pleural cavity in 45.9 % of patients, as well as the discordance between the results of bacteriological and chromato-mass-spectrometric studies. Diagnostic methods for detecting pathogens of pleural empyema require further improvement.
{"title":"Comparative analysis of the results of bacteriological and chromato-mass-spectrometric studies of pleural exudate in patients with pleural empyema","authors":"B. Kotiv, I. Dzidzava, T. Suborova, G. V. Valiev, O. V. Barinov, I. Deinega, T. M. Voroshilova, V. V. Lishenko, A. Platonova, V. V. Shvedyuc","doi":"10.24884/0042-4625-2020-179-3-40-47","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-3-40-47","url":null,"abstract":"The OBJECTIVE was to determine the possibility of using chromatography-mass spectrometry to select causal treatment for patients with pleural empyema.METHODS AND MATERIALS. The analysis of the results of examination and treatment of 207 patients with pleural empyema for the period from 2017 to 2018 was done. All patients underwent bacteriological examination, twenty patients from them underwent chromato-mass-spectrometric examination of pleural exudate.RESULTS. Patients were transferred to a specialized thoracic hospital from other medical institutions, where they received a course of empirical antibacterial therapy and drainage of the pleural cavity was performed. Bacteriological examination of the contents of the pleural cavity was positive in 112 (54.1 %) patients. The leading pathogens were gram-negative bacteria isolated from the contents of the pleural cavity in 45 % of patients with closed and 63.5 % – open pleural empyema. Polyantibiotic-resistant stocks of P. aeruginosa (30.4 %), K. pneumoniae (19.6 %) and A. baumannii (12.5 %) prevailed, which remained sensitive to polymyxin and, in some cases, to amikacin. In 25 (22.3 %) patients, micromycetes of the genus Candida were found. No growth of anaerobic microflora was detected. Chromato-mass-spectrometric examination of pleural exudate revealed markers of 30 taxa of bacteria, viruses and fungi that exceeded the norm by more than two times. Markers of gram-negative bacteria were not detected. The proportion of anaerobic microorganisms was 76.6 %, with the highest concentration found for bacteria of the genus Clostridium and Eubacterium.CONCLUSION. The choice of causal treatment for patients with pleural empyema is difficult due to the negative culturing from the contents of the pleural cavity in 45.9 % of patients, as well as the discordance between the results of bacteriological and chromato-mass-spectrometric studies. Diagnostic methods for detecting pathogens of pleural empyema require further improvement.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69111073","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 : 2020-08-03DOI: 10.24884/0042-4625-2020-179-3-58-61
I. H. Shidakov, B. M. Kalniyazov, E. Kuznetsova, L. I. Alakaeva
In the Republican perinatal center, there was a premature newborn girl who had a combination of various risk factors in the antenatal and postnatal period. From birth, the child was in the intensive care unit, required intensive care. Against the backdrop of positive dynamics, at the 4th week of life, the child’s condition worsened noticeably, signs of pneumoperitoneum appeared. After emergency laparocentesis, it took several days to stabilize the condition. Laparotomy was performed in a deferred order, in which isolated perforation of the posterior wall of the stomach was detected. The scope of the operation was limited to suturing the opening, since no other changes from the small and large intestine were detected. In the postoperative period, the child’s condition remained severe for a long time, was in the neonatal intensive care unit. The child was discharged home with recovery after 3 months.
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Pub Date : 2020-08-03DOI: 10.24884/0042-4625-2020-179-3-80-84
К. М. Вахитов, Г. Винцковский, I. S. Cherniakov, Karim M. Vakhitov, Stanislav G. Vintckovsky, Iliya G. Shatsman
This is the case report of successful treatment of the patient with acute stroke and tandem lesion of the intra- and extracranial divisions of the internal carotid artery.
本文报告一例成功治疗急性脑卒中合并颈内动脉颅外段串联病变的病例。
{"title":"Multidisciplinary approach in the treatment of a patient with acute stroke","authors":"К. М. Вахитов, Г. Винцковский, I. S. Cherniakov, Karim M. Vakhitov, Stanislav G. Vintckovsky, Iliya G. Shatsman","doi":"10.24884/0042-4625-2020-179-3-80-84","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-3-80-84","url":null,"abstract":"This is the case report of successful treatment of the patient with acute stroke and tandem lesion of the intra- and extracranial divisions of the internal carotid artery.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69111184","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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