Pub Date : 2024-01-01DOI: 10.17116/hirurgia2024101135
I P Mikhailov, V A Arustamyan, I A Eroshkin, B V Kozlovsky, E V Kungurtsev
Common femoral artery (CFA) bifurcation is a critical arterial segment of the lower extremities. Dos Santos J.C. first described endarterectomy from CFA in 1946. It is still preferable method for many patients with occlusion of CFA bifurcation. Although this technique is common in carotid artery surgery and much less common for atherosclerotic lesion of CFA bifurcation, some authors describe favorable results after eversion endarterectomy. Eversion endarterectomy is preferable if synthetic material and autologous veins are unavailable for repair.
股总动脉(CFA)分叉处是下肢的重要动脉段。多斯桑托斯-J.C.于1946年首次描述了股总动脉内膜切除术。对于许多闭塞 CFA 分叉的患者来说,这仍然是一种可取的方法。虽然这种技术在颈动脉手术中很常见,但对于 CFA 分叉处的动脉粥样硬化病变却不常见,一些作者描述了外翻内膜切除术后的良好效果。如果无法使用合成材料和自体静脉进行修复,最好采用内翻动脉内膜切除术。
{"title":"[Eversion endarterectomy from common femoral artery bifurcation].","authors":"I P Mikhailov, V A Arustamyan, I A Eroshkin, B V Kozlovsky, E V Kungurtsev","doi":"10.17116/hirurgia2024101135","DOIUrl":"https://doi.org/10.17116/hirurgia2024101135","url":null,"abstract":"<p><p>Common femoral artery (CFA) bifurcation is a critical arterial segment of the lower extremities. Dos Santos J.C. first described endarterectomy from CFA in 1946. It is still preferable method for many patients with occlusion of CFA bifurcation. Although this technique is common in carotid artery surgery and much less common for atherosclerotic lesion of CFA bifurcation, some authors describe favorable results after eversion endarterectomy. Eversion endarterectomy is preferable if synthetic material and autologous veins are unavailable for repair.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 10","pages":"135-142"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476635","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 : 2024-01-01DOI: 10.17116/hirurgia202401197
V I Panteleev, A G Kriger, A O Gushcha, M M Dzhigkaeva
We present a 36-year-old woman with small pelvis lipoma spreading to the gluteal region through the greater sciatic foramen. Resection of lipoma was performed via two accesses (lower median laparotomy and semilunar incision in the gluteal region). The tumor was the content of sciatic hernia that is extremely rare. Combination of surgical approaches can provide favorable outcomes in these patients.
{"title":"[Small pelvis lipoma spreading to the gluteal region].","authors":"V I Panteleev, A G Kriger, A O Gushcha, M M Dzhigkaeva","doi":"10.17116/hirurgia202401197","DOIUrl":"10.17116/hirurgia202401197","url":null,"abstract":"<p><p>We present a 36-year-old woman with small pelvis lipoma spreading to the gluteal region through the greater sciatic foramen. Resection of lipoma was performed via two accesses (lower median laparotomy and semilunar incision in the gluteal region). The tumor was the content of sciatic hernia that is extremely rare. Combination of surgical approaches can provide favorable outcomes in these patients.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"97-101"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139521961","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 : 2024-01-01DOI: 10.17116/hirurgia202402145
B S Sukovatykh, A V Sereditsky, V F Muradyan, M B Sukovatykh, N V Bolomatov, M Y Gordov
Objective: To improve the results of treatment of deep vein thrombosis of the upper extremities sing endovascular technologies.
Material and methods: We analyzed safety and effectiveness of treatment in 24 patients with deep vein thrombosis of the upper extremities. All ones were divided into 2 homogeneous groups by 12 people each. In the first group, conventional anticoagulation was performed. In the second group, we used additional regional catheter thrombolysis with alteplase and, if necessary, venous stenting or balloon angioplasty for residual stenosis. Patients received apixaban at baseline and throughout 6 postoperative months. After 12 months, we performed ultrasound and clinical examination to identify deep vein patency and venous outflow disorders. Vein recanalization was evaluated as follows: <50% - minimal, 50-99% - partial, 100% - complete. The quality of life of patients was studied using the SF-36 questionnaire.
Results: In the first group, we observed complete vein recanalization in 25% of cases, partial - in 33%, minimal - in 41% of cases; in the second group - 83.3% and 16.7% of patients, respectively. In the first group, clinical manifestations of venous outflow disorders were absent in 25% of patients, mild disorders - 25%, moderate - 8.3%, severe - 41.7% of patients. In the second group, venous outflow was not impaired in 83.7% of patients, mild violations occurred in 16.7% of patients. In the first group, physical health was equal to 44.2±1.7 scores, psychological health - 49.3±2.3 scores; in the second group - 69.3±5.7 and 71.3±5.4 scores, respectively.
{"title":"[Endovascular treatment of deep vein thrombosis of the upper extremities].","authors":"B S Sukovatykh, A V Sereditsky, V F Muradyan, M B Sukovatykh, N V Bolomatov, M Y Gordov","doi":"10.17116/hirurgia202402145","DOIUrl":"10.17116/hirurgia202402145","url":null,"abstract":"<p><strong>Objective: </strong>To improve the results of treatment of deep vein thrombosis of the upper extremities sing endovascular technologies.</p><p><strong>Material and methods: </strong>We analyzed safety and effectiveness of treatment in 24 patients with deep vein thrombosis of the upper extremities. All ones were divided into 2 homogeneous groups by 12 people each. In the first group, conventional anticoagulation was performed. In the second group, we used additional regional catheter thrombolysis with alteplase and, if necessary, venous stenting or balloon angioplasty for residual stenosis. Patients received apixaban at baseline and throughout 6 postoperative months. After 12 months, we performed ultrasound and clinical examination to identify deep vein patency and venous outflow disorders. Vein recanalization was evaluated as follows: <50% - minimal, 50-99% - partial, 100% - complete. The quality of life of patients was studied using the SF-36 questionnaire.</p><p><strong>Results: </strong>In the first group, we observed complete vein recanalization in 25% of cases, partial - in 33%, minimal - in 41% of cases; in the second group - 83.3% and 16.7% of patients, respectively. In the first group, clinical manifestations of venous outflow disorders were absent in 25% of patients, mild disorders - 25%, moderate - 8.3%, severe - 41.7% of patients. In the second group, venous outflow was not impaired in 83.7% of patients, mild violations occurred in 16.7% of patients. In the first group, physical health was equal to 44.2±1.7 scores, psychological health - 49.3±2.3 scores; in the second group - 69.3±5.7 and 71.3±5.4 scores, respectively.</p><p><strong>Conclusion: </strong>Endovascular treatment improved postoperative outcomes.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"45-51"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724308","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 : 2024-01-01DOI: 10.17116/hirurgia20240225
V V Osovskikh, L N Kiseleva, I N Kolokolnikov, M S Vasilieva, A E Bautin
Objective: To justify the optimal method for determining indocyanine green plasma disappearance rate (PDRICG).
Material and methods: We analyzed PDRICG in intensive care units. Indocyanine green was administered intravenously at a dose of 0.25 mg/kg. PDRICG was analyzed simultaneously by using of three methods: 1) PDD (PiCCO2 LiMON device), 2) SBS with analysis of plasma samples on precise spectrophotometer, 3) SBS with analysis of plasma samples on simple experimental photometer.
Results: PDD method was used for 346 PDRICG tests in 256 patients. Of these, 14.3% of measurements were erroneous. Paired tests using PDD and SBS methods were performed in 299 cases. SBS method resulted erroneous data in 0.6% of cases. Certain correlation (r=0.79, p<0.001) was found between the reference method (SBS with spectrophotometry) and the PDD method. Bland-Altman plot for these two methods showed that proportional bias of mean difference was caused by extremely high PDRICG of the PDD method (for example, more than 30%/min). Comparison of two SBS variants (spectrophotometer and experimental photometer) revealed good correlation (r=0.91, p<0.001).
Conclusion: SBS method for measuring PDRICG ensures accurate results under mechanical interferences in patients with impaired capillary blood flow. This eliminates the need for redo measurement. Duplication of the PDD and SBS methods is recommended when repeating the test is not possible (organ donors).
目的:论证测定吲哚菁绿血浆消失率(PDRICG)的最佳方法:证明测定吲哚菁绿血浆消失率(PDRICG)的最佳方法:我们分析了重症监护病房的 PDRICG。吲哚菁绿的静脉注射剂量为 0.25 mg/kg。同时使用三种方法分析 PDRICG:1)PDD(PiCCO2 LiMON 装置);2)SBS,使用精密分光光度计分析血浆样本;3)SBS,使用简易实验光度计分析血浆样本:结果:256 名患者的 346 次 PDRICG 检测使用了 PDD 方法。其中,14.3%的测量出现错误。使用 PDD 和 SBS 方法对 299 例患者进行了配对测试。SBS 方法导致 0.6% 的病例出现数据错误。PDD 方法的 pICG 具有一定的相关性(例如,超过 30%/分钟)(r=0.79)。两种 SBS 变体(分光光度计和实验光度计)的比较显示出良好的相关性(r=0.91,pCG):在毛细血管血流受损的患者中,SBS 测量 PDRICG 的方法可确保在机械干扰下得出准确的结果。这消除了重做测量的需要。如果无法重复测试(器官捐献者),建议重复使用 PDD 和 SBS 方法。
{"title":"[Analysis of indocyanine green plasma disappearance rate in clinical practice].","authors":"V V Osovskikh, L N Kiseleva, I N Kolokolnikov, M S Vasilieva, A E Bautin","doi":"10.17116/hirurgia20240225","DOIUrl":"10.17116/hirurgia20240225","url":null,"abstract":"<p><strong>Objective: </strong>To justify the optimal method for determining indocyanine green plasma disappearance rate (PDR<sub>ICG</sub>).</p><p><strong>Material and methods: </strong>We analyzed PDR<sub>ICG</sub> in intensive care units. Indocyanine green was administered intravenously at a dose of 0.25 mg/kg. PDR<sub>ICG</sub> was analyzed simultaneously by using of three methods: 1) PDD (PiCCO2 LiMON device), 2) SBS with analysis of plasma samples on precise spectrophotometer, 3) SBS with analysis of plasma samples on simple experimental photometer.</p><p><strong>Results: </strong>PDD method was used for 346 PDR<sub>ICG</sub> tests in 256 patients. Of these, 14.3% of measurements were erroneous. Paired tests using PDD and SBS methods were performed in 299 cases. SBS method resulted erroneous data in 0.6% of cases. Certain correlation (<i>r</i>=0.79, <i>p</i><0.001) was found between the reference method (SBS with spectrophotometry) and the PDD method. Bland-Altman plot for these two methods showed that proportional bias of mean difference was caused by extremely high PDR<sub>ICG</sub> of the PDD method (for example, more than 30%/min). Comparison of two SBS variants (spectrophotometer and experimental photometer) revealed good correlation (<i>r</i>=0.91, <i>p</i><0.001).</p><p><strong>Conclusion: </strong>SBS method for measuring PDR<sub>ICG</sub> ensures accurate results under mechanical interferences in patients with impaired capillary blood flow. This eliminates the need for redo measurement. Duplication of the PDD and SBS methods is recommended when repeating the test is not possible (organ donors).</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2. Vyp. 2","pages":"5-12"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913595","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 : 2024-01-01DOI: 10.17116/hirurgia202404138
S I Remizov, A V Andreev, V M Durleshter, S A Gabriel, O V Zasyadko
Objective: To develop a method for direct transfistulous ultrasound in minimally invasive treatment of infected pancreatic necrosis.
Material and methods: There were 148 patients with infected pancreatic necrosis between 2015 and 2019 at the Krasnodar City Clinical Hospital No. 2. Drainage with 28-32 Fr tubes was carried out at the first stage, endoscopic transfistulous sequestrectomy - at the second stage (19 (12.8%) patients). In 84 (56.8%) patients, we applied original diagnostic method (transfistulous ultrasonic assessment of inflammatory focus).
Results: There were 3 accesses to omental bursa in 93 (62.8%) patients and 2 in 43 (29.1%) patients. We also performed 2 access to retroperitoneal space in 63 (42.6%) patients and 1 access in 38 (25.8%) cases. Transfistulous ultrasound was used once in 19 (22.6%) patients, twice in 28 (33.3%) and 3 times in 37 (44.1%) patients. Examination was not performed in 18 (12.2%) patients due to the following reasons: migration of drainage catheters - 5, non-rectilinear fistulous tract - 13. No complications were observed.
Conclusion: Transfistulous ultrasound makes it possible to diagnose pathological changes in the pancreas and parapancreatic tissue at various stages of surgical treatment.
{"title":"[Direct transfistulous ultrasound in minimally invasive surgical treatment of infected pancreatic necrosis].","authors":"S I Remizov, A V Andreev, V M Durleshter, S A Gabriel, O V Zasyadko","doi":"10.17116/hirurgia202404138","DOIUrl":"https://doi.org/10.17116/hirurgia202404138","url":null,"abstract":"<p><strong>Objective: </strong>To develop a method for direct transfistulous ultrasound in minimally invasive treatment of infected pancreatic necrosis.</p><p><strong>Material and methods: </strong>There were 148 patients with infected pancreatic necrosis between 2015 and 2019 at the Krasnodar City Clinical Hospital No. 2. Drainage with 28-32 Fr tubes was carried out at the first stage, endoscopic transfistulous sequestrectomy - at the second stage (19 (12.8%) patients). In 84 (56.8%) patients, we applied original diagnostic method (transfistulous ultrasonic assessment of inflammatory focus).</p><p><strong>Results: </strong>There were 3 accesses to omental bursa in 93 (62.8%) patients and 2 in 43 (29.1%) patients. We also performed 2 access to retroperitoneal space in 63 (42.6%) patients and 1 access in 38 (25.8%) cases. Transfistulous ultrasound was used once in 19 (22.6%) patients, twice in 28 (33.3%) and 3 times in 37 (44.1%) patients. Examination was not performed in 18 (12.2%) patients due to the following reasons: migration of drainage catheters - 5, non-rectilinear fistulous tract - 13. No complications were observed.</p><p><strong>Conclusion: </strong>Transfistulous ultrasound makes it possible to diagnose pathological changes in the pancreas and parapancreatic tissue at various stages of surgical treatment.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"38-43"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860806","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 : 2024-01-01DOI: 10.17116/hirurgia20240315
A B Alkhasov, A S Gurskaya, R R Bayazitov, O N Nakovkin, M A Sulavko, I V Karnuta, E V Ekimovskaya, I A Kyarimov, D M Akhmedova, A A Klepikova, S A Ratnikov, A P Fisenko
Objective: To improve postoperative outcomes in newborns and infants with choledochal cysts and to determine the indications for surgery.
Material and methods: There were 13 children aged 0-3 months with choledochal cyst who underwent reconstructive surgery between 2019 and 2023. In all children, choledochal cyst was associated with cholestasis. Acholic stool was observed in almost half of the group (n=7). All children underwent cyst resection and Roux-en-Y hepaticoenterostomy.
Results: Symptoms of cholestasis regressed in all patients. Mean surgery time was 128±27 min. There were no complications. Enteral feeding was started after 1-2 postoperative days, abdominal drainage was removed after 6.2±1.6 days. Mean length of hospital-stay was 16±3.7 days. Adequate bile outflow is one of the main principles. For this purpose, anastomosis with intact tissues of hepatic duct should be as wide as possible. Roux-en-Y loop should be at least 40-60 cm to prevent postoperative cholangitis.
Conclusion: Drug-resistant cholestasis syndrome and complicated choledochal cysts (cyst rupture, bile peritonitis) are indications for surgical treatment in newborns and infants. When forming Roux-en-Y hepaticoenterostomy, surgeon should totally excise abnormal tissues of the biliary tract to prevent delayed malignant transformation.
{"title":"[Choledochal cysts: surgical treatment in newborns and infants].","authors":"A B Alkhasov, A S Gurskaya, R R Bayazitov, O N Nakovkin, M A Sulavko, I V Karnuta, E V Ekimovskaya, I A Kyarimov, D M Akhmedova, A A Klepikova, S A Ratnikov, A P Fisenko","doi":"10.17116/hirurgia20240315","DOIUrl":"10.17116/hirurgia20240315","url":null,"abstract":"<p><strong>Objective: </strong>To improve postoperative outcomes in newborns and infants with choledochal cysts and to determine the indications for surgery.</p><p><strong>Material and methods: </strong>There were 13 children aged 0-3 months with choledochal cyst who underwent reconstructive surgery between 2019 and 2023. In all children, choledochal cyst was associated with cholestasis. Acholic stool was observed in almost half of the group (<i>n</i>=7). All children underwent cyst resection and Roux-en-Y hepaticoenterostomy.</p><p><strong>Results: </strong>Symptoms of cholestasis regressed in all patients. Mean surgery time was 128±27 min. There were no complications. Enteral feeding was started after 1-2 postoperative days, abdominal drainage was removed after 6.2±1.6 days. Mean length of hospital-stay was 16±3.7 days. Adequate bile outflow is one of the main principles. For this purpose, anastomosis with intact tissues of hepatic duct should be as wide as possible. Roux-en-Y loop should be at least 40-60 cm to prevent postoperative cholangitis.</p><p><strong>Conclusion: </strong>Drug-resistant cholestasis syndrome and complicated choledochal cysts (cyst rupture, bile peritonitis) are indications for surgical treatment in newborns and infants. When forming Roux-en-Y hepaticoenterostomy, surgeon should totally excise abnormal tissues of the biliary tract to prevent delayed malignant transformation.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"5-13"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111736","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 : 2024-01-01DOI: 10.17116/hirurgia202406177
S V Dergal, V K Koryttsev, A V Mazokha, A Yu Shesterkin, O I Stakhanova
The authors present common bile duct reconstruction using the Kehr drainage.
作者介绍了使用 Kehr 引流管重建胆总管的情况。
{"title":"[Is there an alternative to Getz procedure for common bile duct disruption?]","authors":"S V Dergal, V K Koryttsev, A V Mazokha, A Yu Shesterkin, O I Stakhanova","doi":"10.17116/hirurgia202406177","DOIUrl":"https://doi.org/10.17116/hirurgia202406177","url":null,"abstract":"<p><p>The authors present common bile duct reconstruction using the Kehr drainage.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 6","pages":"77-80"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421257","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 : 2024-01-01DOI: 10.17116/hirurgia202406128
Z G Berikhanov, S N Avdeev, G V Neklyudova, Z M Merzhoeva, S A Ponomar, M S Goltseva
Objective: To demonstrate clinical features and outcomes in patients with cavitary lung lesions and COVID-19 associated pneumonia.
Material and methods: A retrospective analysis of electronic medical records of 8261 patients with COVID-19 was performed. We selected 40 patients meeting the inclusion criteria. Sex, age, hospital-stay, lung tissue lesion, comorbidities, treatment, methods of respiratory support, complications and outcomes were evaluated.
Results: Cavitary lung lesions were more common in men (67.5%). Age of patients ranged from 28 to 88 (mean 64.9±13.7) years. Hospital-stay in patients with cavitary lung lesions was 9-58 (median 27.5) days. There were 18 complications in 14 (35%) patients. Pneumothorax, isolated pneumomediastinum, pleural empyema, hemoptysis and sigmoid colon perforation were considered as complications of cavitary lung lesions. Nine (22.5%) patients died (5 of them with complications). Three patients died after surgical treatment. Long-term results were analyzed in 8 (25.8%) patients. Patients were followed-up for 3 months after discharge. Shrinkage of lesions occurred after 7-60 (mean 23) days, and complete obliteration of cavities came after 32 (range 14-90) days.
Conclusion: Cavitary lung lesions are a rare complication of COVID-19 pneumonia. There was no significant correlation of complications with age, sex, therapy, volume of lung lesions and non-invasive ventilation (NIV). Despite more common fatal outcomes in older patients undergoing NIV, the last one was prescribed exclusively due to disease progression and respiratory failure. Further research on this problem is necessary to identify possible risk factors of cavitary lung lesions.
{"title":"[Cavitary lung lesions in COVID-19 associated pneumonia: a single-center study of 40 cases].","authors":"Z G Berikhanov, S N Avdeev, G V Neklyudova, Z M Merzhoeva, S A Ponomar, M S Goltseva","doi":"10.17116/hirurgia202406128","DOIUrl":"https://doi.org/10.17116/hirurgia202406128","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate clinical features and outcomes in patients with cavitary lung lesions and COVID-19 associated pneumonia.</p><p><strong>Material and methods: </strong>A retrospective analysis of electronic medical records of 8261 patients with COVID-19 was performed. We selected 40 patients meeting the inclusion criteria. Sex, age, hospital-stay, lung tissue lesion, comorbidities, treatment, methods of respiratory support, complications and outcomes were evaluated.</p><p><strong>Results: </strong>Cavitary lung lesions were more common in men (67.5%). Age of patients ranged from 28 to 88 (mean 64.9±13.7) years. Hospital-stay in patients with cavitary lung lesions was 9-58 (median 27.5) days. There were 18 complications in 14 (35%) patients. Pneumothorax, isolated pneumomediastinum, pleural empyema, hemoptysis and sigmoid colon perforation were considered as complications of cavitary lung lesions. Nine (22.5%) patients died (5 of them with complications). Three patients died after surgical treatment. Long-term results were analyzed in 8 (25.8%) patients. Patients were followed-up for 3 months after discharge. Shrinkage of lesions occurred after 7-60 (mean 23) days, and complete obliteration of cavities came after 32 (range 14-90) days.</p><p><strong>Conclusion: </strong>Cavitary lung lesions are a rare complication of COVID-19 pneumonia. There was no significant correlation of complications with age, sex, therapy, volume of lung lesions and non-invasive ventilation (NIV). Despite more common fatal outcomes in older patients undergoing NIV, the last one was prescribed exclusively due to disease progression and respiratory failure. Further research on this problem is necessary to identify possible risk factors of cavitary lung lesions.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 6","pages":"28-35"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421252","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 : 2024-01-01DOI: 10.17116/hirurgia202407185
R M Zakhokhov, T G Tlupova, I B Zhurtova, A A Mukaev, Z N Bakov, D A Teuvazhukova
Objective: To evaluate the effectiveness of prevention of recurrent laryngeal nerve injury depending on thyroid gland lesion and extent of surgery.
Material and methods: There were 2412 thyroid surgeries between 2000 and 2020. Patients were divided into the main group (1689 patients) and the control group (729 patients). Patients with nodular thyroid gland lesions prevailed in both groups (987 (58.4%) and 415 (56.9%), respectively). All ones underwent atraumatic extrafascial desection and thyroid resection (ultrasonic scalpel).
Results. t: He upper laryngeal nerve injury occurred in 35 cases (1.4%). The number of surgeries with thyroid remnant preservation was significantly lower in the main group. The number of procedures with subtotal thyroid resection and thyroidectomy increased by 2.4 times (from 414 to 1010 operations, p<0.05).
Conclusion: Improvement of surgical treatment of thyroid gland lesions consisting in new operative technique of recurrent laryngeal nerve isolation using ultrasonic scalpel reduces the incidence of recurrent laryngeal nerve injury from 2.3% to 1%. At the same time, the number of extended procedures in the main group significantly exceeded that in the control group (by 2.5 times).
{"title":"[Efficacy of prevention of recurrent laryngeal nerve injury in thyroid surgery].","authors":"R M Zakhokhov, T G Tlupova, I B Zhurtova, A A Mukaev, Z N Bakov, D A Teuvazhukova","doi":"10.17116/hirurgia202407185","DOIUrl":"https://doi.org/10.17116/hirurgia202407185","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of prevention of recurrent laryngeal nerve injury depending on thyroid gland lesion and extent of surgery.</p><p><strong>Material and methods: </strong>There were 2412 thyroid surgeries between 2000 and 2020. Patients were divided into the main group (1689 patients) and the control group (729 patients). Patients with nodular thyroid gland lesions prevailed in both groups (987 (58.4%) and 415 (56.9%), respectively). All ones underwent atraumatic extrafascial desection and thyroid resection (ultrasonic scalpel).</p><p><strong>Results. t: </strong>He upper laryngeal nerve injury occurred in 35 cases (1.4%). The number of surgeries with thyroid remnant preservation was significantly lower in the main group. The number of procedures with subtotal thyroid resection and thyroidectomy increased by 2.4 times (from 414 to 1010 operations, <i>p</i><0.05).</p><p><strong>Conclusion: </strong>Improvement of surgical treatment of thyroid gland lesions consisting in new operative technique of recurrent laryngeal nerve isolation using ultrasonic scalpel reduces the incidence of recurrent laryngeal nerve injury from 2.3% to 1%. At the same time, the number of extended procedures in the main group significantly exceeded that in the control group (by 2.5 times).</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 7","pages":"85-91"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621126","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 : 2024-01-01DOI: 10.17116/hirurgia202407178
I A Vinokurov, Yu V Belov, D G Tagabilev, S A Yusupov
Objective: To analyze bone tissue damage at different stages of disease (El Oakley classification), treatment options for each clinical situation and results after each approach.
Material and methods: There were 45 patients with wound complications after cardiac surgery between October 2022 and September 2023. Thirty-eight (84.4%) patients underwent CABG, 7 (15.6%) patients - heart valve or aortic surgery. Mean age of patients was 68.1±10.3 years. There were 35 men (77.8%) and 10 women (22.2%). The first type was found in 11 (24.5%) patients, type 2-3 - 19 (42.2%), type 4 - 4 (8.8%), type 5 - 11 (24.5%) patients.
Results: Systemic inflammatory response syndrome was observed in 7 (36.8%) persons of the 1st group, 14 (73.7%) ones of the 2nd group, 4 (100%) patients of the 3rd group and 2 (18.2%) patients of the 4th group. C-reactive protein and procalcitonin increased in all patients with the highest values in groups 2 and 3. Redo soft tissue inflammation occurred in all groups after treatment. Mean incidence was 25%. Two (10.5%) patients died in the 2nd group and 1 (25%) patient in the 3rd group.
Conclusion: The modern classification of sternomediastinitis does not fully characterize severity of disease in a particular patient. Simultaneous debridement with wound closure demonstrates acceptable mortality (within 10%). The highest mortality rate was observed in patients with diffuse lesions of the sternum. Less aggressive treatment approaches are possible for stable anterior chest wall.
{"title":"[Postoperative sternomediastinitis: morphology of lesion, treatment strategy].","authors":"I A Vinokurov, Yu V Belov, D G Tagabilev, S A Yusupov","doi":"10.17116/hirurgia202407178","DOIUrl":"https://doi.org/10.17116/hirurgia202407178","url":null,"abstract":"<p><strong>Objective: </strong>To analyze bone tissue damage at different stages of disease (El Oakley classification), treatment options for each clinical situation and results after each approach.</p><p><strong>Material and methods: </strong>There were 45 patients with wound complications after cardiac surgery between October 2022 and September 2023. Thirty-eight (84.4%) patients underwent CABG, 7 (15.6%) patients - heart valve or aortic surgery. Mean age of patients was 68.1±10.3 years. There were 35 men (77.8%) and 10 women (22.2%). The first type was found in 11 (24.5%) patients, type 2-3 - 19 (42.2%), type 4 - 4 (8.8%), type 5 - 11 (24.5%) patients.</p><p><strong>Results: </strong>Systemic inflammatory response syndrome was observed in 7 (36.8%) persons of the 1<sup>st</sup> group, 14 (73.7%) ones of the 2<sup>nd</sup> group, 4 (100%) patients of the 3<sup>rd</sup> group and 2 (18.2%) patients of the 4<sup>th</sup> group. C-reactive protein and procalcitonin increased in all patients with the highest values in groups 2 and 3. Redo soft tissue inflammation occurred in all groups after treatment. Mean incidence was 25%. Two (10.5%) patients died in the 2<sup>nd</sup> group and 1 (25%) patient in the 3<sup>rd</sup> group.</p><p><strong>Conclusion: </strong>The modern classification of sternomediastinitis does not fully characterize severity of disease in a particular patient. Simultaneous debridement with wound closure demonstrates acceptable mortality (within 10%). The highest mortality rate was observed in patients with diffuse lesions of the sternum. Less aggressive treatment approaches are possible for stable anterior chest wall.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 7","pages":"78-84"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621132","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}