Pub Date : 2021-07-25DOI: 10.18484/2305-0047.2021.3.376
R. V. Ukrainets, Y. Korneva, A. V. Sergeev
The appendix anomalies are extremely rare malformations. Preoperative diagnosis of appendiceal duplication is often difficult and usually discovered incidentally during surgery forappendicitis. A clinical case of the development of chronic residual appendicitis in a 32-year-old woman with the abnormality of the vermiform appendix identified duplicity, type A according to the Cave-Wallbridge classification is described. During the first hospitalization, the patient was treated conservatively with a diagnosis of «a dense appendiceal infiltrate»; later, a planned appendectomy was performed. A duplication of the vermiform appendix type A was revealed during the examination of the removed appendix. Histopathological examination detected the underdevelopment of the wall of the accessory vermiform appendix - a complete absence of the outer longitudinal layer of the muscular membrane. The abnormally thin wall of the accessory appendix, as well as the related with it hypoperistalsis provoked the onset of chronic inflammation in the wall, which easily spread to the periappendiceal adipose tissue with the formation of a dense appendiceal infiltrate, which required surgical intervention. Thus, a rare clinical case of duplication of the vermiform appendix type A with forming of appendiceal infiltrate, associated with abnomality of muscular tissue, shown by the surgical findings and corroborated by pathology samples of intestinal tissue has been presented.
{"title":"PARTIAL DUPLICATION OF VERMIFORM APPENDIX AS A CAUSE OF THE APPENDICEAL INFILTRATE","authors":"R. V. Ukrainets, Y. Korneva, A. V. Sergeev","doi":"10.18484/2305-0047.2021.3.376","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.3.376","url":null,"abstract":"The appendix anomalies are extremely rare malformations. Preoperative diagnosis of appendiceal duplication is often difficult and usually discovered incidentally during surgery forappendicitis. A clinical case of the development of chronic residual appendicitis in a 32-year-old woman with the abnormality of the vermiform appendix identified duplicity, type A according to the Cave-Wallbridge classification is described. During the first hospitalization, the patient was treated conservatively with a diagnosis of «a dense appendiceal infiltrate»; later, a planned appendectomy was performed. A duplication of the vermiform appendix type A was revealed during the examination of the removed appendix. Histopathological examination detected the underdevelopment of the wall of the accessory vermiform appendix - a complete absence of the outer longitudinal layer of the muscular membrane. The abnormally thin wall of the accessory appendix, as well as the related with it hypoperistalsis provoked the onset of chronic inflammation in the wall, which easily spread to the periappendiceal adipose tissue with the formation of a dense appendiceal infiltrate, which required surgical intervention. Thus, a rare clinical case of duplication of the vermiform appendix type A with forming of appendiceal infiltrate, associated with abnomality of muscular tissue, shown by the surgical findings and corroborated by pathology samples of intestinal tissue has been presented.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48114282","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 : 2021-07-25DOI: 10.18484/2305-0047.2021.3.302
I. Ihnatovich, D.M. Bontsevich, B.A. Maslianski, Y. Nebylitsyn, N. Novikava, A. Kosinets, A. Mikhnevich, A. Pavlov
Objective. To study the implementation of medical recommendations regarding the use of compression therapy in patients with varicose veins of the lower extremities. Methods. A prospective comparative study, Patients Commitment to Compression Therapy (POMP), was conducted with the participation of phlebologist-surgeons who treat patients with chronic venous diseases in Minsk, Vitebsk, and Gomel. During 5 weeks each of the phlebologists included in the study patients with varicose veins who sought advice and needed compression therapy. 30-35 days after the consultation of the surgeon-phlebologist, an outsourcing call center conducted a telephone survey of patients in order to obtain information about the specifics of fulfilling medical recommendations. Results. The registration data base of the study contained individual data on 394 patients with varicose veins (C1-C6) who received recommendations to use compression therapy. After 30-35 days, 302 patients (aged 43, 18-84 (Me, IQR)) were available for telephone survey. There were 58 men (19.2%), 244 women (80.8%). Among them, class C1 was registered in 39 (12.9%), C2 - in 113 (37.4%), C3 - in 122 (40.4%), C4 - in 25 (8.3%), C5 - in 1 (0.3%), C6 - in 2 (0.7%) patients. It was found that 245 (81.5%) of the respondents either already had compression hosiery at the time of the consultation, or purchased it within 30 days. 228 (75.2%) respondents reported compliance with the recommendations. Patients who had already experience with compression therapy and patients with the history of venous thromboembolism showed higher commitment to compression therapy (p<0.001). There were no significant differences in the compliance of patients with different levels of education and professional characteristics. Conclusion. A high commitment of patients to compression therapy was established 1 month after receiving recommendations. To obtain more information about patient compliance, it is necessary to enlarge the follow-up period. What this paper adds In a prospective multicenter study a high commitment (75.2%) to compression therapy for patients with varicose veins was firstly defined 1 month after the recommendations made by a phlebologist to use it.
{"title":"THE APPLICATION OF COMPRESSION THERAPY IN PATIENTS WITH VARICOSE VEINS OF THE LOWER EXTREMITIES","authors":"I. Ihnatovich, D.M. Bontsevich, B.A. Maslianski, Y. Nebylitsyn, N. Novikava, A. Kosinets, A. Mikhnevich, A. Pavlov","doi":"10.18484/2305-0047.2021.3.302","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.3.302","url":null,"abstract":"Objective. To study the implementation of medical recommendations regarding the use of compression therapy in patients with varicose veins of the lower extremities. Methods. A prospective comparative study, Patients Commitment to Compression Therapy (POMP), was conducted with the participation of phlebologist-surgeons who treat patients with chronic venous diseases in Minsk, Vitebsk, and Gomel. During 5 weeks each of the phlebologists included in the study patients with varicose veins who sought advice and needed compression therapy. 30-35 days after the consultation of the surgeon-phlebologist, an outsourcing call center conducted a telephone survey of patients in order to obtain information about the specifics of fulfilling medical recommendations. Results. The registration data base of the study contained individual data on 394 patients with varicose veins (C1-C6) who received recommendations to use compression therapy. After 30-35 days, 302 patients (aged 43, 18-84 (Me, IQR)) were available for telephone survey. There were 58 men (19.2%), 244 women (80.8%). Among them, class C1 was registered in 39 (12.9%), C2 - in 113 (37.4%), C3 - in 122 (40.4%), C4 - in 25 (8.3%), C5 - in 1 (0.3%), C6 - in 2 (0.7%) patients. It was found that 245 (81.5%) of the respondents either already had compression hosiery at the time of the consultation, or purchased it within 30 days. 228 (75.2%) respondents reported compliance with the recommendations. Patients who had already experience with compression therapy and patients with the history of venous thromboembolism showed higher commitment to compression therapy (p<0.001). There were no significant differences in the compliance of patients with different levels of education and professional characteristics. Conclusion. A high commitment of patients to compression therapy was established 1 month after receiving recommendations. To obtain more information about patient compliance, it is necessary to enlarge the follow-up period. What this paper adds In a prospective multicenter study a high commitment (75.2%) to compression therapy for patients with varicose veins was firstly defined 1 month after the recommendations made by a phlebologist to use it.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49491308","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 : 2021-07-25DOI: 10.18484/2305-0047.2021.3.318
S. Panin, A. Bykov, A. Doronin, A. Kuznetsov, S. Shchelkov, A. A. Panina, E. A. Morozov, S. N. Karpenko
Objective. To study the peculiarities of diagnostics and treatment of urolithiasis complications among patients with new coronavirus infection COVID-19. Methods. The prospective cohort study evaluated the treatment outcomes of patients (n=146). The first group (n=30) included patients treated in infectious diseases hospital with a complicated urinary calculi disease and a new coronavirus infection COVID-19, the second group (n=116) included patients treated in the urological department of multidisciplinary non-infectious hospital due to complicated urinary tract stone disease who were not infected by new coronavirus infection COVID-19. As for COVID 19 diagnostics, patients of the first group were done PCR tests that were positive in 19 (63,3%) cases, and thoracic cavity computer tomography scanning (upon admission the percentage of pulmonary tissue involvement varied since 5% up to 90%). Results. Among the patients of the first group, elderly people prevailed (61+15 years) and there were more women among them (66%). The characteristic features of complicated urinary calculi disease in patients with COVID-19 are the prevalence of infectious and inflammatory complications (50%) and a combination of several complications of urolithiasis (40%). Among peculiarities of treatment, patients of the first group in 6.6% of cases underwent the lumbotomy with open nephrostomy, due to the spread of secondary suppurative process over the retroperitoneal space. According to the Clavien-Dindo scale, in the first group of patients the incidence of complications after surgery was 40%, in the second - 13.8%. Mortality rate in the first group reached 30%, in the second - 0.9%. The duration of hospital treatment among patients of the first group reached 21 (5-39) days, among patients of the second group - 8 (1-56) days. Conclusion. The specificity of the course associated with significant morbidity and mortality require further optimization therapeutic approachesto achieve success in patientswith complications of urolithiasis duringCOVID-19outbreak. What this paper adds The peculiarities of diagnostics and treatment of urinary tract stone disease complications among patients with new coronavirus infection COVID-19 have been studied. It is shown that the typical differences of patients with complicated urolithiasis and new coronavirus infection COVID-19 are elderly and old age, being a female, prevalence of pyelonephritis and paranephritis in clinical presentations, and presence of several combined complications of the urolithiasis. Mortality rate upon complicated urolithiasis and new coronavirus infection COVID-19 since the pandemic onset has reached 30% that demands optimization of treatment approaches in patients of this group.
{"title":"EVALUATION OF TREATMENT RESULTS OF UROLITHIASIS COMPLICATIONS AMONG COVID-19 PATIENTS","authors":"S. Panin, A. Bykov, A. Doronin, A. Kuznetsov, S. Shchelkov, A. A. Panina, E. A. Morozov, S. N. Karpenko","doi":"10.18484/2305-0047.2021.3.318","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.3.318","url":null,"abstract":"Objective. To study the peculiarities of diagnostics and treatment of urolithiasis complications among patients with new coronavirus infection COVID-19. Methods. The prospective cohort study evaluated the treatment outcomes of patients (n=146). The first group (n=30) included patients treated in infectious diseases hospital with a complicated urinary calculi disease and a new coronavirus infection COVID-19, the second group (n=116) included patients treated in the urological department of multidisciplinary non-infectious hospital due to complicated urinary tract stone disease who were not infected by new coronavirus infection COVID-19. As for COVID 19 diagnostics, patients of the first group were done PCR tests that were positive in 19 (63,3%) cases, and thoracic cavity computer tomography scanning (upon admission the percentage of pulmonary tissue involvement varied since 5% up to 90%). Results. Among the patients of the first group, elderly people prevailed (61+15 years) and there were more women among them (66%). The characteristic features of complicated urinary calculi disease in patients with COVID-19 are the prevalence of infectious and inflammatory complications (50%) and a combination of several complications of urolithiasis (40%). Among peculiarities of treatment, patients of the first group in 6.6% of cases underwent the lumbotomy with open nephrostomy, due to the spread of secondary suppurative process over the retroperitoneal space. According to the Clavien-Dindo scale, in the first group of patients the incidence of complications after surgery was 40%, in the second - 13.8%. Mortality rate in the first group reached 30%, in the second - 0.9%. The duration of hospital treatment among patients of the first group reached 21 (5-39) days, among patients of the second group - 8 (1-56) days. Conclusion. The specificity of the course associated with significant morbidity and mortality require further optimization therapeutic approachesto achieve success in patientswith complications of urolithiasis duringCOVID-19outbreak. What this paper adds The peculiarities of diagnostics and treatment of urinary tract stone disease complications among patients with new coronavirus infection COVID-19 have been studied. It is shown that the typical differences of patients with complicated urolithiasis and new coronavirus infection COVID-19 are elderly and old age, being a female, prevalence of pyelonephritis and paranephritis in clinical presentations, and presence of several combined complications of the urolithiasis. Mortality rate upon complicated urolithiasis and new coronavirus infection COVID-19 since the pandemic onset has reached 30% that demands optimization of treatment approaches in patients of this group.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67945023","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 : 2021-04-21DOI: 10.18484/2305-0047.2021.2.183
I. V. Shipitsyna, E. Osipova, A. A. Natalskiy, A. Pavlov, N. Pronin, A. Bogomolov
Objective. To determine the species composition of the associations isolated from osteomyelitis foci and to study the character of associate relationships based on the biofilm-forming ability data. Methods. The microbiological study included clinical isolates (n=184) obtained from associations (n=88) during primary inoculations from wounds and fistulas of patients (n= 88) with chronic osteomyelitis of long tubular bones. In order to obtain an associative biofilm in vitro, the cultures of competing bacterial strains were daily mixed in 1:1 ratio. The biofilms were grown on the surface of polystyrene plates with subsequent determination of the level of biofilm formation in 24 and 48 hours. Thecoefficient of relationship (CR) was calculated to evaluate the synergistic, neutral and antagonistic relationships between bacteria in the biofilms. Results. The associations of staphylococcus with gram-negative bacteria were most frequently recovered from osteomyelitis foci. On the 1st day of the experiment, 38,6 % of associations had a moderate biofilm-forming ability, and besides, associations of gram-positive + gram-negative bacteria were observed in 36,4%; 42,1% of associations had a low biofilm-forming ability; 19,3% - had a high biofilm-forming ability. After 48 hours the percentage of mild adhesive strains remained at the same level - 38,6%, as for the low adhesive ones it decreased to 36,4%, high adhesive - increased up to 25%. Most bacterial associations manifested antagonistic relationships. Synergism in biofilm-formingby the association of S. aureus + P. aeruginosa was observed in 2 cases,while the level of film-forming was high as on the first and the second day of the study. In several associations it transformed from antagonistic to synergistic or neutral relationships. Conclusion. It has ben established that among the identified associations, the largest specific weight falls on the associations of gram-positive + gram-negative bacteria , while S. aureus is one of the most common components. These associations were noted to have high and mild activity of biofilm -forming on the surface of polystyrene plates. Relationships between the microorganisms isolated from osteomyelitis foci in associations, as a rule, are antagonistic. What this paper adds For the first time, the nature of the relationship between microorganisms in the composition of associations isolated from the osteomyelitis focus has been studied on the basis of biofilm-forming ability data. It has been established that in microbiocenosis of the osteomyelitis foci, the greatest specific weight falls on the associations of S. aureus with gram-negative bacteria. These associations have a high and moderate activity of biofilm formation on the surface of polystyrene plates. The relationships between microorganisms isolated from the osteomyelitis focus as part of associations are usually antagonistic.
{"title":"SPECIES COMPOSITION OF ASSOCIATIONS AND RELATIONSHIPS BETWEEN MICROORGANISMS ISOLATED FROM OSTEOMYELITIS FOCUS","authors":"I. V. Shipitsyna, E. Osipova, A. A. Natalskiy, A. Pavlov, N. Pronin, A. Bogomolov","doi":"10.18484/2305-0047.2021.2.183","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.2.183","url":null,"abstract":"Objective. To determine the species composition of the associations isolated from osteomyelitis foci and to study the character of associate relationships based on the biofilm-forming ability data. Methods. The microbiological study included clinical isolates (n=184) obtained from associations (n=88) during primary inoculations from wounds and fistulas of patients (n= 88) with chronic osteomyelitis of long tubular bones. In order to obtain an associative biofilm in vitro, the cultures of competing bacterial strains were daily mixed in 1:1 ratio. The biofilms were grown on the surface of polystyrene plates with subsequent determination of the level of biofilm formation in 24 and 48 hours. Thecoefficient of relationship (CR) was calculated to evaluate the synergistic, neutral and antagonistic relationships between bacteria in the biofilms. Results. The associations of staphylococcus with gram-negative bacteria were most frequently recovered from osteomyelitis foci. On the 1st day of the experiment, 38,6 % of associations had a moderate biofilm-forming ability, and besides, associations of gram-positive + gram-negative bacteria were observed in 36,4%; 42,1% of associations had a low biofilm-forming ability; 19,3% - had a high biofilm-forming ability. After 48 hours the percentage of mild adhesive strains remained at the same level - 38,6%, as for the low adhesive ones it decreased to 36,4%, high adhesive - increased up to 25%. Most bacterial associations manifested antagonistic relationships. Synergism in biofilm-formingby the association of S. aureus + P. aeruginosa was observed in 2 cases,while the level of film-forming was high as on the first and the second day of the study. In several associations it transformed from antagonistic to synergistic or neutral relationships. Conclusion. It has ben established that among the identified associations, the largest specific weight falls on the associations of gram-positive + gram-negative bacteria , while S. aureus is one of the most common components. These associations were noted to have high and mild activity of biofilm -forming on the surface of polystyrene plates. Relationships between the microorganisms isolated from osteomyelitis foci in associations, as a rule, are antagonistic. What this paper adds For the first time, the nature of the relationship between microorganisms in the composition of associations isolated from the osteomyelitis focus has been studied on the basis of biofilm-forming ability data. It has been established that in microbiocenosis of the osteomyelitis foci, the greatest specific weight falls on the associations of S. aureus with gram-negative bacteria. These associations have a high and moderate activity of biofilm formation on the surface of polystyrene plates. The relationships between microorganisms isolated from the osteomyelitis focus as part of associations are usually antagonistic.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":"29 1","pages":"183-190"},"PeriodicalIF":0.0,"publicationDate":"2021-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42862470","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 : 2021-04-21DOI: 10.18484/2305-0047.2021.2.146
B. N. Gumenyuk, V. Popov, V. Lazorishinetz, T. Marchuk, D. Morozov
Objective. To study the effectiveness of the preoperative combined correction, using hydroxide of iron (III) and stimulation of hematopoiesis with erythropoietin on the postoperative anemia in patients, undergoning bloodless surgery (mitral valvere placement) in conditions of artificialblood circulation. Methods. A single-center prospective non-randomized and retrospective study involving patients (n=80) undergoning the operation for mitral valve disease was carried out. There were 54 men (67.5%) and 26 women (32.5%) with an average age of 52.8±4.9 years (M±σ). The patients were divided into three groups. Group A consisted of patients with normal serum iron levels undergoning of the application of blood component preparations. Group B included patients with normal serum iron levels who were undergoning bloodless surgery. In group C the patients with initially low levels of iron in the blood serum, preoperative correction of the saturating dose iron hydroxide and stimulation with erythropoietin were carried out, and bloodless procedure was applied while the operation. Results. The results of this study show that patients in group A require a sufficiently large volume of donor blood components during surgery. In group B, mitral valve replacement can be performed using bloodless technology without transfusion of donor blood components. Correction of a low preoperative serum iron level in group C increases its preoperative serum iron level by 7.4 times and Hb by 4.4% of the initial haemoglobin values. The level of postoperative anemia in group C (p>0.05) compared with group B (p>0.05) is 8.5% less (p>0.05). Conclusion. Correction of low preoperative iron levels and stimulation of erythropoiesis in patients with mitral heart disease after mitral valve replacement using a bloodless surgery reduces the postoperative anemia level. What this paper adds For the first time the impact of preoperative correction of anemia, using iron (III) hydroxide and stimulation of hematopoiesis, applying erythropoietin in patients undergoning the surgery for mitral valve defect using bloodless technology in conditions of artificial blood circulation (ABC) has been determined.
{"title":"IRON CORRECTION DURING BLOODLESS SURGERY IN PATIENTS WITH MITRAL HEART DISEASES","authors":"B. N. Gumenyuk, V. Popov, V. Lazorishinetz, T. Marchuk, D. Morozov","doi":"10.18484/2305-0047.2021.2.146","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.2.146","url":null,"abstract":"Objective. To study the effectiveness of the preoperative combined correction, using hydroxide of iron (III) and stimulation of hematopoiesis with erythropoietin on the postoperative anemia in patients, undergoning bloodless surgery (mitral valvere placement) in conditions of artificialblood circulation. Methods. A single-center prospective non-randomized and retrospective study involving patients (n=80) undergoning the operation for mitral valve disease was carried out. There were 54 men (67.5%) and 26 women (32.5%) with an average age of 52.8±4.9 years (M±σ). The patients were divided into three groups. Group A consisted of patients with normal serum iron levels undergoning of the application of blood component preparations. Group B included patients with normal serum iron levels who were undergoning bloodless surgery. In group C the patients with initially low levels of iron in the blood serum, preoperative correction of the saturating dose iron hydroxide and stimulation with erythropoietin were carried out, and bloodless procedure was applied while the operation. Results. The results of this study show that patients in group A require a sufficiently large volume of donor blood components during surgery. In group B, mitral valve replacement can be performed using bloodless technology without transfusion of donor blood components. Correction of a low preoperative serum iron level in group C increases its preoperative serum iron level by 7.4 times and Hb by 4.4% of the initial haemoglobin values. The level of postoperative anemia in group C (p>0.05) compared with group B (p>0.05) is 8.5% less (p>0.05). Conclusion. Correction of low preoperative iron levels and stimulation of erythropoiesis in patients with mitral heart disease after mitral valve replacement using a bloodless surgery reduces the postoperative anemia level. What this paper adds For the first time the impact of preoperative correction of anemia, using iron (III) hydroxide and stimulation of hematopoiesis, applying erythropoietin in patients undergoning the surgery for mitral valve defect using bloodless technology in conditions of artificial blood circulation (ABC) has been determined.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":"29 1","pages":"146-153"},"PeriodicalIF":0.0,"publicationDate":"2021-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44474589","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 : 2021-04-21DOI: 10.18484/2305-0047.2021.2.137
K. Morozov, O. Morozova, L. Severgina, T. Marchuk, D. Morozov
Objective. To determine the leading factor in the pathogenesis of intestinal anastomotic failure in peritonitis. Methods. The experiment was carried out on non-linear white rats (n=40), divided into 4 equal groups: with peritonitis (group 1), with hypovolemia (group 2), with peritonitis in combination with hypovolemia (group 3) and comparison (group 4). Colonic “end-to-end” anastomosis was performed in all rats. Peritonitis caused by injection of 10% unfiltered feces into the abdominal cavity. Hypovolemia was modeled during the operation by creating bleeding from the branch of the iliocolic artery.The rats were taken out of the experiment on the 3rd day after the operation, the state of the anastomosis and the abdominal cavity was assessed. The histological examination of the anastomotic sites was performed. The content of hypoxia biomarkers (HIF-1a, VEGF-C, VEGF-R1) in the intestinal tissue was also evaluated by ELISA. The experiment was approved by the local ethics committee. Results. In group 1, anastomotic failure was detected in rats characterized by a severe general condition due to peritonitis. In groups 2 and 3 statistically significant relationship was found between a decrease of rectal temperature (>2 °C) due to bleeding and colonic anastomotic failure (p<0.05). Morphological analysis showed the most pronounced inflammatory and microcirculatory changes in the group 3. Statistically significant differences in the level of the VEGF-C (p=0.0034) and VEGF-R1 (p=0.04795) were found between groups. Maximal ischemia of the anastomotic zone was found in rats of group 3. Conclusion. The leading factor in the pathogenesis of intestinal anastomotic failure is considered to be as a result of impairedblood supply of the anastomotic zone due to hypovolemia and depletion of mesenteric blood flow. Monitoring and successful correction of hemodynamic disturbances in the perioperative period may become a prospect for the treatment of patients with peritonitis requiring intestinal anastomosis under these conditions. What this paper adds For the first time determination of the leading factor in the pathogenesis of intestinal anastomotic failure in peritonitis has been studied. The leading factor in the pathogenesis of intestinal anastomotic failure has been found out to be the impairedblood supply of the anastomotic zone due to hypovolemia and depletion of mesenteric blood flow.
{"title":"THE CAUSES OF INTESTINAL ANASTOMOTIC LEAKAGE IN EXPERIMENTAL PERITONITIS","authors":"K. Morozov, O. Morozova, L. Severgina, T. Marchuk, D. Morozov","doi":"10.18484/2305-0047.2021.2.137","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.2.137","url":null,"abstract":"Objective. To determine the leading factor in the pathogenesis of intestinal anastomotic failure in peritonitis. Methods. The experiment was carried out on non-linear white rats (n=40), divided into 4 equal groups: with peritonitis (group 1), with hypovolemia (group 2), with peritonitis in combination with hypovolemia (group 3) and comparison (group 4). Colonic “end-to-end” anastomosis was performed in all rats. Peritonitis caused by injection of 10% unfiltered feces into the abdominal cavity. Hypovolemia was modeled during the operation by creating bleeding from the branch of the iliocolic artery.The rats were taken out of the experiment on the 3rd day after the operation, the state of the anastomosis and the abdominal cavity was assessed. The histological examination of the anastomotic sites was performed. The content of hypoxia biomarkers (HIF-1a, VEGF-C, VEGF-R1) in the intestinal tissue was also evaluated by ELISA. The experiment was approved by the local ethics committee. Results. In group 1, anastomotic failure was detected in rats characterized by a severe general condition due to peritonitis. In groups 2 and 3 statistically significant relationship was found between a decrease of rectal temperature (>2 °C) due to bleeding and colonic anastomotic failure (p<0.05). Morphological analysis showed the most pronounced inflammatory and microcirculatory changes in the group 3. Statistically significant differences in the level of the VEGF-C (p=0.0034) and VEGF-R1 (p=0.04795) were found between groups. Maximal ischemia of the anastomotic zone was found in rats of group 3. Conclusion. The leading factor in the pathogenesis of intestinal anastomotic failure is considered to be as a result of impairedblood supply of the anastomotic zone due to hypovolemia and depletion of mesenteric blood flow. Monitoring and successful correction of hemodynamic disturbances in the perioperative period may become a prospect for the treatment of patients with peritonitis requiring intestinal anastomosis under these conditions. What this paper adds For the first time determination of the leading factor in the pathogenesis of intestinal anastomotic failure in peritonitis has been studied. The leading factor in the pathogenesis of intestinal anastomotic failure has been found out to be the impairedblood supply of the anastomotic zone due to hypovolemia and depletion of mesenteric blood flow.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":"29 1","pages":"137-145"},"PeriodicalIF":0.0,"publicationDate":"2021-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46271425","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 : 2021-04-21DOI: 10.18484/2305-0047.2021.2.167
O. Tkachuk, R. Parakhoniak, S. Plaksin, A. S. Glushenkov, M. Fadeeva
Objective. To advance the patients’ rehabilitation after laparoscopic surgeries by using insufflation with argon gas for pneumoperitoneum formation. Methods. The given study is the investigation of sequentially admitted 360patients with gallstone disease (cholelithiasis). The patients have been randomly divided into 4 groups: Group1 - uncomplicated gallstone disease, carboxyperitoneum (n=192); Group1a - acute cholelithiasis (n=37), carboxyperitoneum; Group2 - uncomplicated gallstone disease, argonperitoneum (n=102); Group2a - acute cholelithiasis (n=29), argonoperitoneum. All the patients have undergone laparoscopic cholecystectomies. Subjective assessment of the pain syndrome intensity has been studied on the basis of patient-reported outcomes questionnaire according to the visual analogue scale (VAS), need for analgesic injections, presence and intensity of the shoulder pain syndrome as well as the duration of in-patient treatment. Results. In accordance with patient-reported outcomes (with argonperitoneum application) subjective pain sensation has proved to decrease by 1.5-2 fold. On the first day of the postoperative period both in uncomplicated gallstone disease and in acute cholelithiasis, argonperitoneum has statistically significantly reduced the need for analgesics. Pain in the shoulder girdle (omalgia) was observed in 48.9% of the patients having been applied carboxyperitoneum whereas it was noticed in only 5.3% of the patients having been applied argonperitoneum during the operation. Argonperitoneum application statistically significantly reduces in-patient treatment period by 30% (from 2.3 - to 1.6 days) in uncomplicated gallstone disease and by 23% (from 4.3 - to 3.3 days) in gallstone disease complicated by acute cholelithiasis. Conclusion. Application of argon for pneumoperitoneum formation in laparoscopic cholecystectomies reliably reduces pain syndrome intensity in the postoperative period. The number of postoperative omalgia cases is reduced by 42% in patients having undergone cholecystectomies with argonperitoneum application. Application of argonperitoneum in management of patients with cholelithiasis may reduce the hospitalization period by 25-30%. What this paper adds The effect of argon application as an insufflation gas in laparoscopic operations upon the intensity of the postoperative pain syndrome has been studied for the first time. Argonperitoneum application has been found to improve the postoperative course by reducing pain irritation. Argon application leads to reduce analgesics consumption.
{"title":"ARGON APPLICATION FOR CREATION OF PNEUMOPERITONEUM IN LAPAROSCOPIC SURGERIES","authors":"O. Tkachuk, R. Parakhoniak, S. Plaksin, A. S. Glushenkov, M. Fadeeva","doi":"10.18484/2305-0047.2021.2.167","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.2.167","url":null,"abstract":"Objective. To advance the patients’ rehabilitation after laparoscopic surgeries by using insufflation with argon gas for pneumoperitoneum formation. Methods. The given study is the investigation of sequentially admitted 360patients with gallstone disease (cholelithiasis). The patients have been randomly divided into 4 groups: Group1 - uncomplicated gallstone disease, carboxyperitoneum (n=192); Group1a - acute cholelithiasis (n=37), carboxyperitoneum; Group2 - uncomplicated gallstone disease, argonperitoneum (n=102); Group2a - acute cholelithiasis (n=29), argonoperitoneum. All the patients have undergone laparoscopic cholecystectomies. Subjective assessment of the pain syndrome intensity has been studied on the basis of patient-reported outcomes questionnaire according to the visual analogue scale (VAS), need for analgesic injections, presence and intensity of the shoulder pain syndrome as well as the duration of in-patient treatment. Results. In accordance with patient-reported outcomes (with argonperitoneum application) subjective pain sensation has proved to decrease by 1.5-2 fold. On the first day of the postoperative period both in uncomplicated gallstone disease and in acute cholelithiasis, argonperitoneum has statistically significantly reduced the need for analgesics. Pain in the shoulder girdle (omalgia) was observed in 48.9% of the patients having been applied carboxyperitoneum whereas it was noticed in only 5.3% of the patients having been applied argonperitoneum during the operation. Argonperitoneum application statistically significantly reduces in-patient treatment period by 30% (from 2.3 - to 1.6 days) in uncomplicated gallstone disease and by 23% (from 4.3 - to 3.3 days) in gallstone disease complicated by acute cholelithiasis. Conclusion. Application of argon for pneumoperitoneum formation in laparoscopic cholecystectomies reliably reduces pain syndrome intensity in the postoperative period. The number of postoperative omalgia cases is reduced by 42% in patients having undergone cholecystectomies with argonperitoneum application. Application of argonperitoneum in management of patients with cholelithiasis may reduce the hospitalization period by 25-30%. What this paper adds The effect of argon application as an insufflation gas in laparoscopic operations upon the intensity of the postoperative pain syndrome has been studied for the first time. Argonperitoneum application has been found to improve the postoperative course by reducing pain irritation. Argon application leads to reduce analgesics consumption.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":"29 1","pages":"167-174"},"PeriodicalIF":0.0,"publicationDate":"2021-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48557728","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 : 2021-02-23DOI: 10.18484/2305-0047.2021.1.38
A. Voronetsky, A. Danovich, I. Shanaev, A. A. Nekliudov, A. Tyshchenko, V. Vovk, M. A. Klosova, O. Volchenko
Objective. To evaluate the effect of neodymium laser application for successful decannulation in infants with a congenital and acquired tracheal stenosis and tracheostomy. Methods. 6 children were being treated in the 1st City Clinical Hospital of Minsk in 2011-2014. All children underwent tracheostomy with a prolonged tracheal intubation and subsequent development of tracheostenosis. The children were examined using X-ray, esophagogastroscopy (PentaxEG-16K10), and bronchoscopy (Olympus MAF TYPE GM). Tracheal stenosis was treated using a medical multifunctional laser complex Multiline (“Linline Medical systems” Ltd, Belarus) equipped with a high-energy neodymium laser emitter. Children with excessive growth of granulations in thelumenof thetrachea underwent vaporization of granulations by means of a bulbous probe with a neodymium laser emitter (wavelength of 1340 nm, power: 15 W, 2 sec. exposure). In cicatricial tracheal stenosis, incisions were made with a laser scalpel (the wavelength of 1064 nm, power of 20 W). Results. Effective decannulation was observed in 5 children, including 4 children who underwent3-5 treatment sessions. In 1 child with the congenital subglottic larynx stenosis, to perform the decannulation became possible after 2 years and 24 sessions of laser recanalizationofstenosis and ablation of granulations. One child, after 9 treatment sessions, dropped out of observation, the result has not been defined. Conclusion. Tracheostomy in children promotes the formation of granulations in the tracheal lumen with the formation of stenosis, which subsequently hinders a successful decannulation. The neodymium laser application with the endoscopic access provides the visual direct approach to the focus of impact with the aim of laser-induced vaporization of soft tissues and recanalization of the trachealmass in children with short tracheal stenosis leads to successful decannulation. What this paper adds Firstly the neodymium laser for the treatment of congenital and acquired tracheal stenosis in children after tracheotomy has been used. The method has been developed for restoring the tracheal lumen by laser-inducedvaporization of excessive tracheal granulation and making scalpel incisions in the scar area. It is shown the neodymium laser application with the endoscopic access provides the visual direct approach to the focus of impact. Laser-induced vaporization of soft tissues and recanalization of the tracheal lumen in children with short tracheal stenosis leads to successful decannulation.
客观的评价钕激光应用于先天性和获得性气管狭窄婴儿气管插管和气管造口术的效果。方法。2011-2014年，6名儿童在明斯克第一城市临床医院接受治疗。所有儿童都接受了气管造口术，延长了气管插管时间，随后出现气管狭窄。使用X射线、食管胃镜（PentaxEG-16K10）和支气管镜（Olympus MAF TYPE GM）对儿童进行检查。使用配备高能钕激光发射器的医疗多功能激光复合物Multiline（“Linline medical systems”Ltd，白俄罗斯）治疗气管狭窄。气管内颗粒过度生长的儿童通过带有钕激光发射器的球形探针（波长1340 nm，功率：15 W，暴露2秒）进行颗粒蒸发。在瘢痕性气管狭窄中，用激光刀（波长1064nm，功率20W）进行切口。后果在5名儿童中观察到有效的拔管，其中4名儿童接受了3-5次治疗。在1名先天性声门下喉狭窄的儿童中，经过2年24次激光再通狭窄和颗粒消融，拔管成为可能。一名儿童在9次治疗后退出观察，结果尚未确定。结论儿童气管造口术会促进气管腔内颗粒的形成，形成狭窄，从而阻碍拔管的成功。内窥镜下应用钕激光提供了一种直接到达撞击焦点的视觉方法，目的是激光诱导软组织汽化，并使气管短狭窄儿童的气管团再通，从而成功拔管。本文首先介绍了钕激光治疗儿童气管切开术后先天性和获得性气管狭窄的疗效。该方法已被开发用于通过激光诱导汽化过度的气管肉芽并在瘢痕区域进行手术刀切割来恢复气管管腔。研究表明，钕激光应用与内窥镜通道提供了视觉上直接接近冲击焦点的方法。激光诱导的软组织汽化和气管腔再通治疗儿童气管短狭窄，可成功拔管。
{"title":"NEODYMIUM LASER IN LARINGOTRACHEOSTENOSIS TREATMENT AFTER TRACHEOSTOMY IN CHILDREN","authors":"A. Voronetsky, A. Danovich, I. Shanaev, A. A. Nekliudov, A. Tyshchenko, V. Vovk, M. A. Klosova, O. Volchenko","doi":"10.18484/2305-0047.2021.1.38","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.1.38","url":null,"abstract":"Objective. To evaluate the effect of neodymium laser application for successful decannulation in infants with a congenital and acquired tracheal stenosis and tracheostomy. Methods. 6 children were being treated in the 1st City Clinical Hospital of Minsk in 2011-2014. All children underwent tracheostomy with a prolonged tracheal intubation and subsequent development of tracheostenosis. The children were examined using X-ray, esophagogastroscopy (PentaxEG-16K10), and bronchoscopy (Olympus MAF TYPE GM). Tracheal stenosis was treated using a medical multifunctional laser complex Multiline (“Linline Medical systems” Ltd, Belarus) equipped with a high-energy neodymium laser emitter. Children with excessive growth of granulations in thelumenof thetrachea underwent vaporization of granulations by means of a bulbous probe with a neodymium laser emitter (wavelength of 1340 nm, power: 15 W, 2 sec. exposure). In cicatricial tracheal stenosis, incisions were made with a laser scalpel (the wavelength of 1064 nm, power of 20 W). Results. Effective decannulation was observed in 5 children, including 4 children who underwent3-5 treatment sessions. In 1 child with the congenital subglottic larynx stenosis, to perform the decannulation became possible after 2 years and 24 sessions of laser recanalizationofstenosis and ablation of granulations. One child, after 9 treatment sessions, dropped out of observation, the result has not been defined. Conclusion. Tracheostomy in children promotes the formation of granulations in the tracheal lumen with the formation of stenosis, which subsequently hinders a successful decannulation. The neodymium laser application with the endoscopic access provides the visual direct approach to the focus of impact with the aim of laser-induced vaporization of soft tissues and recanalization of the trachealmass in children with short tracheal stenosis leads to successful decannulation. What this paper adds Firstly the neodymium laser for the treatment of congenital and acquired tracheal stenosis in children after tracheotomy has been used. The method has been developed for restoring the tracheal lumen by laser-inducedvaporization of excessive tracheal granulation and making scalpel incisions in the scar area. It is shown the neodymium laser application with the endoscopic access provides the visual direct approach to the focus of impact. Laser-induced vaporization of soft tissues and recanalization of the tracheal lumen in children with short tracheal stenosis leads to successful decannulation.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44833946","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 : 2021-02-23DOI: 10.18484/2305-0047.2021.1.13
M. Aliev, L. Zubekhina, K. I. Niiazbekov, N. Tushina
Objective. To evaluate the results and effectiveness of simultaneous operations for echinococcosis of the liver. Methods. Surgical diseases requiring surgical treatment (cholelithiasis: calculus cholecystitis, choledocholithiasis, nodular goiter, ventral postoperative hernia) were detected in 38 patients with echinococcosis of the liver. 23 patients underwent organ-preserving operations for echinococcosis, and 15 patients underwent radical operations, all operations were perfomed in combined with cholecystectomy, choledocholitotomy, thyroidectomy, and herniotomy (coating of a polypropylenemesh for hernia gate).Immediate and remote results were studied. Patients were reexamined 6 months after surgery within a 3-year period. The examination included the checkup, general blood test, liver and kidney tests, an ultrasound examination of the abdominal organs, and a chest x-ray once a year. Results. During theimmediate postoperative period 4 patients out of 38 (10.5%) had complications. After simultaneous operations using organ-preserving methods of echinococcectomy, 2 patients out of 23 (8.7%) had complications (pleuritis, wound suppuration), and 2 - out of 15 had radical operations (bile leakage, pleuritis). All complications had been cured by the time of discharge. The remote results were studied over a period of 6 months to 3 years. 34 patients were examined up to 1 year, 31 - from 1 to 2 years, 26 - from 2 to 3 years. Within the examination and follow-up periods no recurrence of echinoccosis was observed. Conclusion. During simultaneous operations and the echinococcectomy of the liver it is necessary to observe accurately the rules of aparasiticity and antiparasiticity.Simultaneous operations for the liver echinococcosis should be performed according to strict indications and by a highlyexperiencedandqualified surgeon. Patients who have undergone simultaneous operations was asked toundergoa medicalcontrol examination at least once a year. What this paper adds The possibility of performing simultaneous operations for echinococcosis of the liver has been defined. The sequence of operations for echinococcosis in combination with other pathologies requiring surgical treatment has been justified.
{"title":"SIMULTANEOUS OPERATIONS FOR LIVER ECHINOCOCCOSIS","authors":"M. Aliev, L. Zubekhina, K. I. Niiazbekov, N. Tushina","doi":"10.18484/2305-0047.2021.1.13","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.1.13","url":null,"abstract":"Objective. To evaluate the results and effectiveness of simultaneous operations for echinococcosis of the liver. Methods. Surgical diseases requiring surgical treatment (cholelithiasis: calculus cholecystitis, choledocholithiasis, nodular goiter, ventral postoperative hernia) were detected in 38 patients with echinococcosis of the liver. 23 patients underwent organ-preserving operations for echinococcosis, and 15 patients underwent radical operations, all operations were perfomed in combined with cholecystectomy, choledocholitotomy, thyroidectomy, and herniotomy (coating of a polypropylenemesh for hernia gate).Immediate and remote results were studied. Patients were reexamined 6 months after surgery within a 3-year period. The examination included the checkup, general blood test, liver and kidney tests, an ultrasound examination of the abdominal organs, and a chest x-ray once a year. Results. During theimmediate postoperative period 4 patients out of 38 (10.5%) had complications. After simultaneous operations using organ-preserving methods of echinococcectomy, 2 patients out of 23 (8.7%) had complications (pleuritis, wound suppuration), and 2 - out of 15 had radical operations (bile leakage, pleuritis). All complications had been cured by the time of discharge. The remote results were studied over a period of 6 months to 3 years. 34 patients were examined up to 1 year, 31 - from 1 to 2 years, 26 - from 2 to 3 years. Within the examination and follow-up periods no recurrence of echinoccosis was observed. Conclusion. During simultaneous operations and the echinococcectomy of the liver it is necessary to observe accurately the rules of aparasiticity and antiparasiticity.Simultaneous operations for the liver echinococcosis should be performed according to strict indications and by a highlyexperiencedandqualified surgeon. Patients who have undergone simultaneous operations was asked toundergoa medicalcontrol examination at least once a year. What this paper adds The possibility of performing simultaneous operations for echinococcosis of the liver has been defined. The sequence of operations for echinococcosis in combination with other pathologies requiring surgical treatment has been justified.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45909744","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 : 2021-02-23DOI: 10.18484/2305-0047.2021.1.101
A. Ovechkin, S. Sokologorsky, M. Politov, V. Lukach, E. N. Kakulya, G. Bajtugaeva, P. Arlou, O. Volchenko
Hypotension is the most common adverse effect of spinal anesthesia (SA). The insidence of SA-induced hypotension in the total population is 15-33%, in patients of older age groups it reaches 80%. At young and middle ages, the main determinant of SA-induced hypotension is considered to be a reduction of postload and venous reflux, due to blood deposition in capacitance vessels of the lower extremities. The aortocaval compressionsyndromeplays a significant role in obstetric practice, cardiac output does not change. In elderly patients, the main prerequisite for the development of hypotension is an enhanced basal sympathetic toneon the background of SA. In patients of this category, in addition to reducing the total peripheral vascular resistance (TPVR), a decline in cardiac output also plays a role. Risk factors for anesthesia-induced hypotension are the followings: (chronic alcohol consumption, history of hypertension, sensory block upper than Th6, and urgency of surgery). To prevent SA-induced hypotension it is advisable to reduce the doses of local anesthetics. Data from the most studies do not confirm the effectiveness of extended infusion therapy in the prevention and correction of hypotension. Vasopressors - phenylephrine in obstetric practice, ephedrine or dopamine in elderly patients are effectiveforpreventinghypotension.
{"title":"SPINAL ANESTHESIA AND HYPOTENSION: MECHANISMS, RISK FACTORS, PROPHYLAXIS AND CORRECTION","authors":"A. Ovechkin, S. Sokologorsky, M. Politov, V. Lukach, E. N. Kakulya, G. Bajtugaeva, P. Arlou, O. Volchenko","doi":"10.18484/2305-0047.2021.1.101","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.1.101","url":null,"abstract":"Hypotension is the most common adverse effect of spinal anesthesia (SA). The insidence of SA-induced hypotension in the total population is 15-33%, in patients of older age groups it reaches 80%. At young and middle ages, the main determinant of SA-induced hypotension is considered to be a reduction of postload and venous reflux, due to blood deposition in capacitance vessels of the lower extremities. The aortocaval compressionsyndromeplays a significant role in obstetric practice, cardiac output does not change. In elderly patients, the main prerequisite for the development of hypotension is an enhanced basal sympathetic toneon the background of SA. In patients of this category, in addition to reducing the total peripheral vascular resistance (TPVR), a decline in cardiac output also plays a role. Risk factors for anesthesia-induced hypotension are the followings: (chronic alcohol consumption, history of hypertension, sensory block upper than Th6, and urgency of surgery). To prevent SA-induced hypotension it is advisable to reduce the doses of local anesthetics. Data from the most studies do not confirm the effectiveness of extended infusion therapy in the prevention and correction of hypotension. Vasopressors - phenylephrine in obstetric practice, ephedrine or dopamine in elderly patients are effectiveforpreventinghypotension.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42656597","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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