Based on their own research and a review of the literature, the authors analyze the possible cellular mechanisms of the development of an inflammatory reaction after the obliteration of varicose veins with cyanoarylate adhesive compounds (CAO), which received the name phlebitis- Like abnormal Reaction (PLAR) in foreign sources. Despite the existing opinion about the “abnormal” nature of the inflammatory reaction, it is noted that the main stages of its development are fully consistent with the currently known molecular and cellular mechanisms of the response of biological tissues to contact with a foreign antigenic substance and are of a natural nature. The cause of the development of acute alterative inflammation in the vein wall is the direct contact of the endothelium with an aggressive environment, which is cyanoacrylate. A specific feature of the development of chronic inflammation in the vein wall is its productive interdaily character, which is replaced by proliferative processes. The main role in the development of successive stages of PLAR development is played by monocytic, mast and giant cells of foreign bodies, as well as the mechanisms underlying the regulation of the functional activity of these cells. During the period of cyanoacrylate biodegradation, its cellular environment corresponds to all morphological features of a phagocytoma, whose activity decreases with the biodegradation of cyanoacrylate with simultaneous connective tissue proliferation. The development of possible chronic granulomatous inflammation is based on a local autoimmune process associated with the formation of giant multinucleated epithelioid cells (Langerhans cells). In conclusion, it is emphasized that today, when using various cyanoacrylate compounds for the purpose of adhesive obliteration of veins, taking into account the accumulated clinical data and morphological studies, the final answers to the existing reasonable objections about the complete safety of the use of cyanoacrylates in clinical practice should be given by fundamental immunohistochemical and genetic studies.
{"title":"Possible mechanisms of phlebitis-like abnormal reaction (PLAR) after cyanoacrylate obliteration of varicose veins","authors":"A. B. Sannikov, E. Shaydakov","doi":"10.21518/akh2023-004","DOIUrl":"https://doi.org/10.21518/akh2023-004","url":null,"abstract":"Based on their own research and a review of the literature, the authors analyze the possible cellular mechanisms of the development of an inflammatory reaction after the obliteration of varicose veins with cyanoarylate adhesive compounds (CAO), which received the name phlebitis- Like abnormal Reaction (PLAR) in foreign sources. Despite the existing opinion about the “abnormal” nature of the inflammatory reaction, it is noted that the main stages of its development are fully consistent with the currently known molecular and cellular mechanisms of the response of biological tissues to contact with a foreign antigenic substance and are of a natural nature. The cause of the development of acute alterative inflammation in the vein wall is the direct contact of the endothelium with an aggressive environment, which is cyanoacrylate. A specific feature of the development of chronic inflammation in the vein wall is its productive interdaily character, which is replaced by proliferative processes. The main role in the development of successive stages of PLAR development is played by monocytic, mast and giant cells of foreign bodies, as well as the mechanisms underlying the regulation of the functional activity of these cells. During the period of cyanoacrylate biodegradation, its cellular environment corresponds to all morphological features of a phagocytoma, whose activity decreases with the biodegradation of cyanoacrylate with simultaneous connective tissue proliferation. The development of possible chronic granulomatous inflammation is based on a local autoimmune process associated with the formation of giant multinucleated epithelioid cells (Langerhans cells). In conclusion, it is emphasized that today, when using various cyanoacrylate compounds for the purpose of adhesive obliteration of veins, taking into account the accumulated clinical data and morphological studies, the final answers to the existing reasonable objections about the complete safety of the use of cyanoacrylates in clinical practice should be given by fundamental immunohistochemical and genetic studies.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139198701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. A. Matveev, A. I. Matveev, V. T. Dgebuadze, N. N. Povarnin, S. N. Zobov, L. A. Morozova, K. E. Kurakina
Introduction. Desarterization of hemorrhoidal arteries with mucopexia, a pathogenetically caused minimally invasive operation, is more often performed in stationary conditions under regional or general anesthesia. Aim. To study the results of desarterization of hemorrhoidal arteries in patients with hemorrhoids operated on an outpatient basis under local anesthesia.Materials and methods. 459 patients with chronic hemorrhoids of stage 2–4 with varying degrees of node prolapse under local infiltration anesthesia with Ultracaine were operated on by one surgeon. The duration of the intervention, the intensity of the pain syndrome, and the complications of treatment were studied. Results. The median duration of the operation is 25 minutes, the intensity of pain during the operation on a 10-point scale is 2 points, on the 3rd day of the postoperative period-2 points. Complications occurred in 6 (1.3%) people, in the 1st urinary retention, paraproctitis, and in the 4th – bleeding. Discussion. The obtained results of a longer procedure in patients with stage II hemorrhoids are associated with the training period. The intensity of pain during the HAL-RAR procedure performed under local anesthesia, including in patients of stage III-IV and IV, was acceptable and was tolerated by patients satisfactorily. The structure of the complications that have arisen is limited by a narrow range of pathology: bleeding, acute urinary retention, paraproctitis. Conclusion. Hemorrhoidal artery desarterization is an effective method of treating patients with chronic hemorrhoids on an outpatient basis: low duration ofsurgery, low frequency of complications. Local anesthesia during the ligation of hemorrhoidal arteries with mucopexia provides adequate anesthesia, patients tolerate the procedure and pain in the postoperative period, regardless of the stage of the disease, therefore, this method of treatment is advisable to use in outpatient practice.
导言。粘膜下痔动脉去瓣术是一种由病原体引起的微创手术，多在区域或全身麻醉下静止状态下进行。目的研究在局部麻醉下对门诊痔疮患者进行痔动脉去栓术的效果。459 名 2-4 期、不同程度结节脱垂的慢性痔疮患者在奥曲卡因局部浸润麻醉下由一名外科医生进行了手术。对干预的持续时间、疼痛综合征的强度以及治疗并发症进行了研究。结果显示手术时间中位数为 25 分钟，术中疼痛强度（10 分制）为 2 分，术后第 3 天为 2 分。6人（1.3%）出现并发症，第1人出现尿潴留、直肠旁炎，第4人出现出血。讨论对二期痔疮患者进行较长时间的手术所取得的效果与训练期有关。包括 III-IV 期和 IV 期患者在内，在局部麻醉下进行 HAL-RAR 手术时的疼痛强度是可以接受的，患者的耐受性也令人满意。出现的并发症结构受病理范围的限制：出血、急性尿潴留、直肠旁炎。结论痔动脉脱动脉术是一种在门诊治疗慢性痔疮患者的有效方法：手术时间短，并发症发生率低。痔动脉粘膜下结扎术中的局部麻醉提供了充分的麻醉效果，无论疾病处于哪个阶段，患者都能耐受手术和术后疼痛，因此，这种治疗方法适合在门诊使用。
{"title":"Desarterization of hemorrhoidal arteries in outpatient treatment of chronic hemorrhoids","authors":"I. A. Matveev, A. I. Matveev, V. T. Dgebuadze, N. N. Povarnin, S. N. Zobov, L. A. Morozova, K. E. Kurakina","doi":"10.21518/akh2023-022","DOIUrl":"https://doi.org/10.21518/akh2023-022","url":null,"abstract":"Introduction. Desarterization of hemorrhoidal arteries with mucopexia, a pathogenetically caused minimally invasive operation, is more often performed in stationary conditions under regional or general anesthesia. Aim. To study the results of desarterization of hemorrhoidal arteries in patients with hemorrhoids operated on an outpatient basis under local anesthesia.Materials and methods. 459 patients with chronic hemorrhoids of stage 2–4 with varying degrees of node prolapse under local infiltration anesthesia with Ultracaine were operated on by one surgeon. The duration of the intervention, the intensity of the pain syndrome, and the complications of treatment were studied. Results. The median duration of the operation is 25 minutes, the intensity of pain during the operation on a 10-point scale is 2 points, on the 3rd day of the postoperative period-2 points. Complications occurred in 6 (1.3%) people, in the 1st urinary retention, paraproctitis, and in the 4th – bleeding. Discussion. The obtained results of a longer procedure in patients with stage II hemorrhoids are associated with the training period. The intensity of pain during the HAL-RAR procedure performed under local anesthesia, including in patients of stage III-IV and IV, was acceptable and was tolerated by patients satisfactorily. The structure of the complications that have arisen is limited by a narrow range of pathology: bleeding, acute urinary retention, paraproctitis. Conclusion. Hemorrhoidal artery desarterization is an effective method of treating patients with chronic hemorrhoids on an outpatient basis: low duration ofsurgery, low frequency of complications. Local anesthesia during the ligation of hemorrhoidal arteries with mucopexia provides adequate anesthesia, patients tolerate the procedure and pain in the postoperative period, regardless of the stage of the disease, therefore, this method of treatment is advisable to use in outpatient practice.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"16 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139205892","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}
K. Gavrilov, V. А. Markina, K. S. Sevostyanova, A. I. Shevela
Varicose veins of the lower extremities is one of the most common diseases on Earth and its combination with other diseases is inevitable. The combination of diseases aggravates the course of each other. Rheumatoid arthritis worsens the course of varicose veins with trophic disorders – both independently – an increase in pro-inflammatory factors, a change in microcirculation, deformation of the limb axis with a violation of musculoskeletal function, and treatment of rheumatoid arthritis reduces the immune response of the body reducing the reparative capabilities of the body. Clinical case: a patient with a long course of rheumatoid arthritis and varicose veins. For a long time he used cytostatic drugs with a subsequent transition to hormonal drugs. For about 5 years, he noted the appearance of ulcers on both shins, which took a circular shape, which significantly reduced the quality of life and did not respond to conservative treatment. He repeatedly underwent inpatient treatment with intravenous administration of general restorative and vascular drugs. He was also constantly observed in the polyclinic at the place of residence with the implementation of local treatment of ulcerative surfaces. The patient was successively treated for varicose veins by endovenous laser coagulation of the trunks of large subcutaneous veins. The second stage was performed debridement of the wound surface and skin grafting with a free perforated flap. Between the stages, the appointment of drug therapy according to clinical recommendations. Rheumatoid arthritis and varicose veins aggravate each other, especially trophic manifestations. Treatment of such patients should be carried out by a team ofspecialists of various profiles together. Step-by-step treatment ofsuch patients with careful preparation for each of them shows excellent results. A special place is occupied by the patients’ commitment to treatment.
{"title":"Experience in the lower extremities trophic ulcers treatment in patient with combined pathologies: varicose veins and rheumatoid arthritis","authors":"K. Gavrilov, V. А. Markina, K. S. Sevostyanova, A. I. Shevela","doi":"10.21518/akh2023-020","DOIUrl":"https://doi.org/10.21518/akh2023-020","url":null,"abstract":"Varicose veins of the lower extremities is one of the most common diseases on Earth and its combination with other diseases is inevitable. The combination of diseases aggravates the course of each other. Rheumatoid arthritis worsens the course of varicose veins with trophic disorders – both independently – an increase in pro-inflammatory factors, a change in microcirculation, deformation of the limb axis with a violation of musculoskeletal function, and treatment of rheumatoid arthritis reduces the immune response of the body reducing the reparative capabilities of the body. Clinical case: a patient with a long course of rheumatoid arthritis and varicose veins. For a long time he used cytostatic drugs with a subsequent transition to hormonal drugs. For about 5 years, he noted the appearance of ulcers on both shins, which took a circular shape, which significantly reduced the quality of life and did not respond to conservative treatment. He repeatedly underwent inpatient treatment with intravenous administration of general restorative and vascular drugs. He was also constantly observed in the polyclinic at the place of residence with the implementation of local treatment of ulcerative surfaces. The patient was successively treated for varicose veins by endovenous laser coagulation of the trunks of large subcutaneous veins. The second stage was performed debridement of the wound surface and skin grafting with a free perforated flap. Between the stages, the appointment of drug therapy according to clinical recommendations. Rheumatoid arthritis and varicose veins aggravate each other, especially trophic manifestations. Treatment of such patients should be carried out by a team ofspecialists of various profiles together. Step-by-step treatment ofsuch patients with careful preparation for each of them shows excellent results. A special place is occupied by the patients’ commitment to treatment.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"113 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139203753","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}
B. Boldin, V. Y. Tsukan, I. M. Dizengof, A. A. Sergeev, S. I. Kolesova, D. A. Kobzarev
Elastofibroma is a rare, slow growing, benign soft tissue tumor characterized by a typical location in the subscapularis. It has a mesenchymal origin and consists of proliferating fibrous and adipose tissue with elastic and collagen fibers in its composition. Pain and discomfort in the subscapular region, restriction on movement are typical complaints for patients with elastofibroma, however, the absence of clinical symptoms and difficult differential diagnosis make it difficult to choose treatment tactics. A 70-year-old patient applied to a surgeon at the Clinical Diagnostic Center of the Central Clinical Hospital of St Alexis with complaints of a painless tumor-like subcutaneous mass in the region of the lower angle of the right scapula. She noted the presence of this formation 5 years ago, during this time the tumor gradually grew. When viewed on the back along the lower edge of the right shoulder blade, a volumetric tumor-like formation in the form of a ball measuring 7.5 × 6.0 × 2.0 cm, soft-elastic consistency is determined. On palpation, painless, not soldered to the skin. The skin over the formation is not changed. A preliminary diagnosis was established lipoma of the back. The diagnosis of elastofibroma was established after ultrasound of the posterior chest wall, MSCT of the chest. For differential diagnosis, the puncture biopsy material was sent for histological examination, the result of which confirmed the diagnosis of elastofibroma. Observational tactics in this case is preferable, since elastofibroma is not accompanied by pain, limitation of mobility, and does not bring discomfort when moving. Thus, at the moment, imaging methods allow establishing an accurate diagnosis, but histological examination is necessary for differential diagnosis. However, a histologically confirmed diagnosis will not always be an indication for surgery. In most cases, in the absence of clinical manifestations, observational tactics are followed in the treatment.
{"title":"Elastofibroma: a literature review and clinical case","authors":"B. Boldin, V. Y. Tsukan, I. M. Dizengof, A. A. Sergeev, S. I. Kolesova, D. A. Kobzarev","doi":"10.21518/akh2023-030","DOIUrl":"https://doi.org/10.21518/akh2023-030","url":null,"abstract":"Elastofibroma is a rare, slow growing, benign soft tissue tumor characterized by a typical location in the subscapularis. It has a mesenchymal origin and consists of proliferating fibrous and adipose tissue with elastic and collagen fibers in its composition. Pain and discomfort in the subscapular region, restriction on movement are typical complaints for patients with elastofibroma, however, the absence of clinical symptoms and difficult differential diagnosis make it difficult to choose treatment tactics. A 70-year-old patient applied to a surgeon at the Clinical Diagnostic Center of the Central Clinical Hospital of St Alexis with complaints of a painless tumor-like subcutaneous mass in the region of the lower angle of the right scapula. She noted the presence of this formation 5 years ago, during this time the tumor gradually grew. When viewed on the back along the lower edge of the right shoulder blade, a volumetric tumor-like formation in the form of a ball measuring 7.5 × 6.0 × 2.0 cm, soft-elastic consistency is determined. On palpation, painless, not soldered to the skin. The skin over the formation is not changed. A preliminary diagnosis was established lipoma of the back. The diagnosis of elastofibroma was established after ultrasound of the posterior chest wall, MSCT of the chest. For differential diagnosis, the puncture biopsy material was sent for histological examination, the result of which confirmed the diagnosis of elastofibroma. Observational tactics in this case is preferable, since elastofibroma is not accompanied by pain, limitation of mobility, and does not bring discomfort when moving. Thus, at the moment, imaging methods allow establishing an accurate diagnosis, but histological examination is necessary for differential diagnosis. However, a histologically confirmed diagnosis will not always be an indication for surgery. In most cases, in the absence of clinical manifestations, observational tactics are followed in the treatment.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"127 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139208516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Burleva, A. V. Peshkov, S. Tyurin, S. Belentsov, O. A. Vinogradov, A. Y. Leshchinskaya, O. A. Lobut, A. A. Zasorin
Introduction. The Russian Phlebological Register began work in 2016 under the patronage of the Association of Phlebologists of Russia. The creation of a phlebological register in a separate municipal center of the country complements and enriches national plans. Aim. Тo investigate the trends in the organization of medical care to the population with chronic venous diseases (CVD) of a large industrial center using the phlebological register over the past 20 years. Materials and methods. The data of municipal and private medical institutions of Ekaterinburg from 2003 to 2022 are analyzed. Data on municipal hospitals (MHs) are provided by the TFOMS of the Sverdlovsk region. Data on private medical centers (PMCs) are obtained by exporting them from the electronic databases of each center. The statistics of phlebectomies (PhE), outpatient minimally invasive interventions and procedures are summarized. Results. Over the entire period of time, the number of classical phlebectomies in MHs decreased by 4 times – from 2300 (2003) to 587 (2022). At the same time, the development of minimally invasive procedures on the main veins in the PMCs increased from 313 (2003) to 4364 (2022). This made it possible to double the coverage of patients suffering from CVD with specialized medical care. In the structure of patients operated in MHs, the proportion of persons with severe chronic venous insufficiency (CVD C4–6) significantly decreased. The number of patients with superficial thrombophlebitis had a steady downward trend: the first 5 years (2003–2007) – about 200 PhE/year, then 5 years (2008–2012) – about 120 PhE/year, and from 2013 to 2022 < 100 PhE/year. Discussion. Private medical centers have consistently introduced the latest technologies, but endovasal laser coagulation remains the leader. Conclusion. The analysis of the register revealed a number of systemic changes in the organization of phlebological care.
{"title":"The register as a tool for researching trends in phlebological care for the population of a large industrial center of Russia","authors":"E. Burleva, A. V. Peshkov, S. Tyurin, S. Belentsov, O. A. Vinogradov, A. Y. Leshchinskaya, O. A. Lobut, A. A. Zasorin","doi":"10.21518/akh2023-031","DOIUrl":"https://doi.org/10.21518/akh2023-031","url":null,"abstract":"Introduction. The Russian Phlebological Register began work in 2016 under the patronage of the Association of Phlebologists of Russia. The creation of a phlebological register in a separate municipal center of the country complements and enriches national plans. Aim. Тo investigate the trends in the organization of medical care to the population with chronic venous diseases (CVD) of a large industrial center using the phlebological register over the past 20 years. Materials and methods. The data of municipal and private medical institutions of Ekaterinburg from 2003 to 2022 are analyzed. Data on municipal hospitals (MHs) are provided by the TFOMS of the Sverdlovsk region. Data on private medical centers (PMCs) are obtained by exporting them from the electronic databases of each center. The statistics of phlebectomies (PhE), outpatient minimally invasive interventions and procedures are summarized. Results. Over the entire period of time, the number of classical phlebectomies in MHs decreased by 4 times – from 2300 (2003) to 587 (2022). At the same time, the development of minimally invasive procedures on the main veins in the PMCs increased from 313 (2003) to 4364 (2022). This made it possible to double the coverage of patients suffering from CVD with specialized medical care. In the structure of patients operated in MHs, the proportion of persons with severe chronic venous insufficiency (CVD C4–6) significantly decreased. The number of patients with superficial thrombophlebitis had a steady downward trend: the first 5 years (2003–2007) – about 200 PhE/year, then 5 years (2008–2012) – about 120 PhE/year, and from 2013 to 2022 < 100 PhE/year. Discussion. Private medical centers have consistently introduced the latest technologies, but endovasal laser coagulation remains the leader. Conclusion. The analysis of the register revealed a number of systemic changes in the organization of phlebological care.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139210254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Chernookov, M. R. Kuznetsov, S. Kandyba, A. Atayan, G. V. Sinyavin, E. Belykh, A. Nikolaev, T. I. Shadyzheva, A. Z. Pshmakhova
Introduction. Sclerobliteration of varicose veins of the lower extremities is one of the most common methods of treating patients with varicose veins. However, the main disadvantage of echosclerobedation of the trunks of the great and small saphenous veins is the possibility of recanalization of sclerosed veins. In this regard, it is of interest to compare the results of using radiofrequency vein obliteration and endovenous laser coagulation in these patients. Aim. To study the effectiveness, advantages and disadvantages of the use of radiofrequency vein obliteration and endovenous laser photocoagulation of recanalized varicose veins in patients undergoing sclerobliteration. Materials and methods. 44 patients aged 18 to 62 years underwent radiofrequency obliteration and endovenous laser coagulation of varicose veins after previous sclerobliteration. A comparative assessment of the duration of the operation, technical success, intensity of the pain syndrome, the level of postoperative complications and relapses of the disease after the use of these methods of recanalized saphenous veins after previous sclerotherapy was made. Results and discussion. The technical success of endovenous laser coagulation of reknalizirovanny varicose veins was 100%, radiofrequency obliteration of veins – 90.9%. The intensity of postoperative pain on the 7th day from the moment of radio wave exposure was 12.1% lower than after the use of endovenous laser coagulation, the average duration of laser thermolysis was 32 ± 0.6 minutes, radio wave – 39 ± 0.7 minutes. Conclusion. Laser coagulation compared to radiofrequency is a more reliable and feasible operation, but is accompanied by a higher level of postoperative pain and side effects.
{"title":"Comparative analysis of the use of endovenous laser coagulation and radiofrequency vein obliteration in patients who have previously undergone sclerobliteration","authors":"A. Chernookov, M. R. Kuznetsov, S. Kandyba, A. Atayan, G. V. Sinyavin, E. Belykh, A. Nikolaev, T. I. Shadyzheva, A. Z. Pshmakhova","doi":"10.21518/akh2023-021","DOIUrl":"https://doi.org/10.21518/akh2023-021","url":null,"abstract":"Introduction. Sclerobliteration of varicose veins of the lower extremities is one of the most common methods of treating patients with varicose veins. However, the main disadvantage of echosclerobedation of the trunks of the great and small saphenous veins is the possibility of recanalization of sclerosed veins. In this regard, it is of interest to compare the results of using radiofrequency vein obliteration and endovenous laser coagulation in these patients. Aim. To study the effectiveness, advantages and disadvantages of the use of radiofrequency vein obliteration and endovenous laser photocoagulation of recanalized varicose veins in patients undergoing sclerobliteration. Materials and methods. 44 patients aged 18 to 62 years underwent radiofrequency obliteration and endovenous laser coagulation of varicose veins after previous sclerobliteration. A comparative assessment of the duration of the operation, technical success, intensity of the pain syndrome, the level of postoperative complications and relapses of the disease after the use of these methods of recanalized saphenous veins after previous sclerotherapy was made. Results and discussion. The technical success of endovenous laser coagulation of reknalizirovanny varicose veins was 100%, radiofrequency obliteration of veins – 90.9%. The intensity of postoperative pain on the 7th day from the moment of radio wave exposure was 12.1% lower than after the use of endovenous laser coagulation, the average duration of laser thermolysis was 32 ± 0.6 minutes, radio wave – 39 ± 0.7 minutes. Conclusion. Laser coagulation compared to radiofrequency is a more reliable and feasible operation, but is accompanied by a higher level of postoperative pain and side effects.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139221110","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}
P. Turkin, A. A. Slesareva, V. A. Talanova, I. A. Burchakov, O. A. Stetsiuk, A. K. Dolgiev, P. Y. Golosnitskiy, E. P. Podoltseva, I. B. Dolgikh
Rapidly rising prevalence of ulcerative colitis in developed countries among young population compels the medical community to pay attention not only to the problems of early diagnosis and therapy of this disease, but also to preventing the development of complications, that may lead to disability. This article reviews a clinical case of the development of surgical complications in a patient with a long-term active course of ulcerative colitis, who has been also suffering from autoimmune hepatitis and primary sclerosing cholangitis for 20 years. The prolonged active course of the disease and total damage to the colon, association with primary sclerosing cholangitis, as well as the patient’s low adherence to therapy were risk factors for the development of adenocarcinoma of the ascending colon, which required radical surgical treatment. The formation of adhesive disease and multiple abdominal abscesses can be noted as long-term complications, which led to the repeated use of invasive methods of treatment. Over the next few months, the patient experienced 2 more episodes of local purulent complications that required surgical treatment due to the ineffectiveness of antibiotic therapy. All episodes of purulent complications were accompanied by progressive leukopenia due to prolonged use of immunosuppressive drugs. In our opinion, in patients with ulcerative colitis who take cytostatic agents for a long time, special attention should be paid to monitoring and correcting leukopenia, as well as preventing the development of purulent complications.
{"title":"A case report of surgical complications in a patient with ulcerative colitis","authors":"P. Turkin, A. A. Slesareva, V. A. Talanova, I. A. Burchakov, O. A. Stetsiuk, A. K. Dolgiev, P. Y. Golosnitskiy, E. P. Podoltseva, I. B. Dolgikh","doi":"10.21518/akh2023-036","DOIUrl":"https://doi.org/10.21518/akh2023-036","url":null,"abstract":"Rapidly rising prevalence of ulcerative colitis in developed countries among young population compels the medical community to pay attention not only to the problems of early diagnosis and therapy of this disease, but also to preventing the development of complications, that may lead to disability. This article reviews a clinical case of the development of surgical complications in a patient with a long-term active course of ulcerative colitis, who has been also suffering from autoimmune hepatitis and primary sclerosing cholangitis for 20 years. The prolonged active course of the disease and total damage to the colon, association with primary sclerosing cholangitis, as well as the patient’s low adherence to therapy were risk factors for the development of adenocarcinoma of the ascending colon, which required radical surgical treatment. The formation of adhesive disease and multiple abdominal abscesses can be noted as long-term complications, which led to the repeated use of invasive methods of treatment. Over the next few months, the patient experienced 2 more episodes of local purulent complications that required surgical treatment due to the ineffectiveness of antibiotic therapy. All episodes of purulent complications were accompanied by progressive leukopenia due to prolonged use of immunosuppressive drugs. In our opinion, in patients with ulcerative colitis who take cytostatic agents for a long time, special attention should be paid to monitoring and correcting leukopenia, as well as preventing the development of purulent complications.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139222934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. V. Buzlama, A. A. Verlina, A. Y. Kuznetsov, E. A. Aleksenko
Introduction. As there is insufficient evidence to date to determine phlebotropic drug preferences, further research in this area is warranted. Aim. To evaluate the effect of topical and oral phlebotropic agents on vascular wall permeability in preclinical studies. Materials and methods. The objects of the study were 6 phlebotropic agents for external and oral use, which were administered according to the recommendations specified in the instructions for use, 2 hours before the trypan blue. The model for preclinical studies: the xylene petechiae test with trypan blue staining. The evaluation criterion was the intensity of staining, which was expressed semiquantitatively (points). The test system was 100 white male outbred conventional mice. Results and discussion. Heparin + EPL + escin (Detragel) significantly reduces the intensity of staining in the xylene petechiae test. It was found that with a single external application reduces the intensity of staining by 25.0% compared to the control, which significantly by 60.0% exceeded the effectiveness of the drug heparin 1000 IU; with a course application of 15 days in 2 times, which significantly, least by 50%, exceeded the effect of the drug heparin 1000 IU and cosmetic product containing troxerutin. MPFF 1000 mg (Detralex) at a single oral administration significantly reduced the intensity of staining by 35.0% compared to the control group, which significantly by 69.2% exceeded the effectiveness of the reproduced preparations of MPFF and diosmin 600 mg. The indicated results are explained by differences in production technology, composition of components and are consistent with the known data on clinical efficacy of different groups of venotonics. Conclusion. In preclinical studies on the model of xylene petechiae with trypan blue staining, high efficacy of the original drug MPFF 1 (Detralex) at a single oral application and the drug heparin + EPL + escin (Detragel) at external single and course application for 15 days was established, which showed a significant difference with the control group, not less than 50% exceeded the efficacy of analogues and may indicate the effect on the permeability of the vascular wall.
{"title":"Comparative evaluation of effect of phlebotropic agents on vascular wall permeability in preclinical studies","authors":"A. V. Buzlama, A. A. Verlina, A. Y. Kuznetsov, E. A. Aleksenko","doi":"10.21518/akh2023-042","DOIUrl":"https://doi.org/10.21518/akh2023-042","url":null,"abstract":"Introduction. As there is insufficient evidence to date to determine phlebotropic drug preferences, further research in this area is warranted. Aim. To evaluate the effect of topical and oral phlebotropic agents on vascular wall permeability in preclinical studies. Materials and methods. The objects of the study were 6 phlebotropic agents for external and oral use, which were administered according to the recommendations specified in the instructions for use, 2 hours before the trypan blue. The model for preclinical studies: the xylene petechiae test with trypan blue staining. The evaluation criterion was the intensity of staining, which was expressed semiquantitatively (points). The test system was 100 white male outbred conventional mice. Results and discussion. Heparin + EPL + escin (Detragel) significantly reduces the intensity of staining in the xylene petechiae test. It was found that with a single external application reduces the intensity of staining by 25.0% compared to the control, which significantly by 60.0% exceeded the effectiveness of the drug heparin 1000 IU; with a course application of 15 days in 2 times, which significantly, least by 50%, exceeded the effect of the drug heparin 1000 IU and cosmetic product containing troxerutin. MPFF 1000 mg (Detralex) at a single oral administration significantly reduced the intensity of staining by 35.0% compared to the control group, which significantly by 69.2% exceeded the effectiveness of the reproduced preparations of MPFF and diosmin 600 mg. The indicated results are explained by differences in production technology, composition of components and are consistent with the known data on clinical efficacy of different groups of venotonics. Conclusion. In preclinical studies on the model of xylene petechiae with trypan blue staining, high efficacy of the original drug MPFF 1 (Detralex) at a single oral application and the drug heparin + EPL + escin (Detragel) at external single and course application for 15 days was established, which showed a significant difference with the control group, not less than 50% exceeded the efficacy of analogues and may indicate the effect on the permeability of the vascular wall.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"261 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139225088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. A. Matveev, S. V. Lipovoy, M. P. Kozlov, N. N. Povarnin
Picosulfate, a diphenylmethane derivative, belongs to a group of drugs called stimulant laxatives. It is widely used in surgery to treat various colon evacuation disorders due to its effectiveness, safety of use and ease of dosage selection, as well as the option to combine with other laxatives. It is administered much more frequently for colorectal cancer screening, when the colon is prepared using sodium picosulfate combined with other osmotic laxatives, most often polyethylene glycol, which allows to use smaller volumes of solution. According to the literature, this method for cleaning the colon is used most often, which is associated with better adherence of patients to the intake of small volumes of liquid, as shown by our observations. The article highlights the literature data, and the authors also present their own experience – a clinical case report of the treatment of a 30-year-old patient diagnosed with grade I external and internal hemorrhoids. Laser ablation of internal and excision of external hemorrhoids was performed under local anesthesia. Regulax® Picosulfate was included in the therapy in the postoperative period, along with topical and pain relief drugs. As a result, the patient had a comfortable, not very painful bowel movement on the following day after the surgery. The laxative was used to manage stool for a week. In conclusion, the authors draw attention to the fact that increased patient compliance in preparing the colon for examination leads to better cleaning and more informative results during colonoscopy. Therefore, Regulax® Picosulfate combined with other laxatives to prepare a patient for examination, in particular colorectal cancer screening, where it is used most often, applies to a huge number of patients, so the problem of further study of its use is socially significant.
硫酸吡考是一种二苯基甲烷衍生物，属于刺激性泻药。由于其疗效好、使用安全、剂量选择方便，还可与其他泻药联合使用，因此被广泛用于外科手术，治疗各种结肠排空障碍。在结肠直肠癌筛查中，皮下硫酸钠与其他渗透性泻药（最常见的是聚乙二醇）混合使用，可以使用较少的溶液量，因此结肠癌筛查中使用皮下硫酸钠的频率更高。根据文献记载，这种方法最常用于清洗结肠，这与患者更好地坚持摄入少量液体有关，我们的观察结果也证明了这一点。文章重点介绍了文献数据，作者还介绍了自己的经验--治疗一名被诊断为 I 级外痔和内痔的 30 岁患者的临床病例报告。在局部麻醉下进行了内痔激光消融和外痔切除术。术后治疗中使用了 Regulax® Picosulfate，同时还使用了外用药和止痛药。因此，患者在术后第二天就能舒适地排便，没有太大痛苦。患者在一周内一直使用泻药控制大便。总之，作者提请人们注意，在结肠镜检查前准备结肠时，如果患者能更好地遵从医嘱，结肠镜检查的清洁效果就会更好，检查结果也更有参考价值。因此，将 Regulax® Picosulfate 与其他泻药结合使用，让患者做好检查前的准备，尤其是结肠直肠癌筛查，这种泻药最常用于结肠直肠癌筛查，适用于大量患者，因此进一步研究其使用问题具有重要的社会意义。
{"title":"Sodium picosulfate in the clinical practice of a surgeon","authors":"I. A. Matveev, S. V. Lipovoy, M. P. Kozlov, N. N. Povarnin","doi":"10.21518/akh2023-016","DOIUrl":"https://doi.org/10.21518/akh2023-016","url":null,"abstract":"Picosulfate, a diphenylmethane derivative, belongs to a group of drugs called stimulant laxatives. It is widely used in surgery to treat various colon evacuation disorders due to its effectiveness, safety of use and ease of dosage selection, as well as the option to combine with other laxatives. It is administered much more frequently for colorectal cancer screening, when the colon is prepared using sodium picosulfate combined with other osmotic laxatives, most often polyethylene glycol, which allows to use smaller volumes of solution. According to the literature, this method for cleaning the colon is used most often, which is associated with better adherence of patients to the intake of small volumes of liquid, as shown by our observations. The article highlights the literature data, and the authors also present their own experience – a clinical case report of the treatment of a 30-year-old patient diagnosed with grade I external and internal hemorrhoids. Laser ablation of internal and excision of external hemorrhoids was performed under local anesthesia. Regulax® Picosulfate was included in the therapy in the postoperative period, along with topical and pain relief drugs. As a result, the patient had a comfortable, not very painful bowel movement on the following day after the surgery. The laxative was used to manage stool for a week. In conclusion, the authors draw attention to the fact that increased patient compliance in preparing the colon for examination leads to better cleaning and more informative results during colonoscopy. Therefore, Regulax® Picosulfate combined with other laxatives to prepare a patient for examination, in particular colorectal cancer screening, where it is used most often, applies to a huge number of patients, so the problem of further study of its use is socially significant.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"100 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139234427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. V. Vasilchenko, S. N. Skridlevskiy, A. Likutov, E. Merkulova
Introduction. There are opinions that the use of modern high-tech additional techniques, including a navigation system for positioning a colonoscope (MEI), can both increase the diagnostic efficiency of colonoscopy and its comfort for the patient, and do not affect the quality of colonoscopy. Aim. To determine the capabilities of MEI during colonoscopy without sedation. Materials and methods. The single-center, prospective, randomized study included 120 patients (from 20 to 82 years, mean age 51.8 years; 53% men / 47% women) who underwent routine diagnostic outpatient colonoscopy using a rotational technique by experienced endoscopists using MEI navigation system. The study took place in two stages: Stage 1 – randomization and assessment of group comparability (group 1 – MEI, n = 57 and group 2 – without MEI, n = 63); Stage 2 – determination of the number of patients with colon preparation for colonoscopy according to the Boston scale > 6 points (n = 112: 1st study-MEI group, n = 52 and 2nd control group, n = 60); comparative analysis between groups of the frequency of cecal intubation, time of cecal intubation, pain assessment on the VAS scale in cm. Statistical analysis was carried out using Fisher’s exact test, two-sided Mann-Whitney rank sum U test at a significance level of 0.05. Results and discussion. The groups were comparable in age, gender, preliminary indications for the study. The cecum was intubated significantly more often in group 1 (100% vs 90%, p < 0.05). There was no significant difference in the time required for cecal intubation (p = 0.258) and the difference in the mean time required for cecal intubation was 22 seconds. The VAS pain assessment also did not reveal significant differences (p = 1.023). We determined that the increase in the frequency of cecal intubation using MEI by experienced endoscopists increases by 10% and reaches 100%, while the opinion about reducing the time of cecal intubation and improving patient comfort were not confirmed. Conclusion. MEI during rotational colonoscopy performed by experienced endoscopists increases the likelihood of cecal intubation during routine colonoscopy by 10%. MEI does not increase the time required for cecal intubation and is not associated with the frequency or intensity of pain or discomfort on the VAS scale in colonoscopy without sedation.
导言。有观点认为，使用现代高科技附加技术，包括结肠镜定位导航系统（MEI），既能提高结肠镜检查的诊断效率，又能让患者更舒适，而且不会影响结肠镜检查的质量。目的确定无需镇静剂的结肠镜检查中 MEI 的功能。材料和方法。这项单中心、前瞻性、随机研究纳入了 120 名患者（20 至 82 岁，平均年龄 51.8 岁；53% 为男性，47% 为女性），他们在门诊接受了常规结肠镜诊断检查，由经验丰富的内镜医师使用 MEI 导航系统，采用旋转技术进行检查。研究分两个阶段进行：第一阶段--随机分组并评估各组的可比性（第一组--MEI，n = 57；第二组--无MEI，n = 63）；第二阶段--根据波士顿量表确定结肠镜检查前结肠准备大于6分的患者人数（n = 112：第一研究--MEI组，n = 52；第二对照组，n = 60）；比较分析各组之间的盲肠插管频率、盲肠插管时间、VAS疼痛评估（以厘米为单位）。统计分析采用费雪精确检验、双侧曼-惠特尼秩和 U 检验，显著性水平为 0.05。结果与讨论。两组患者在年龄、性别和初步研究适应症方面具有可比性。第 1 组插管盲肠的频率明显更高（100% vs 90%，P < 0.05）。盲肠插管所需的时间没有明显差异（P = 0.258），盲肠插管所需的平均时间差为 22 秒。VAS 疼痛评估也没有发现明显差异（p = 1.023）。我们确定，有经验的内镜医师使用 MEI 进行盲肠插管的频率增加了 10%，达到 100%，而关于缩短盲肠插管时间和提高患者舒适度的观点未得到证实。结论由经验丰富的内镜医师在进行旋转结肠镜检查时使用 MEI，可将常规结肠镜检查时进行盲肠插管的可能性提高 10%。MEI 不会增加盲肠插管所需的时间，也与无镇静剂结肠镜检查中 VAS 量表上疼痛或不适的频率或强度无关。
{"title":"Application of navigation system in colonoscopy","authors":"A. V. Vasilchenko, S. N. Skridlevskiy, A. Likutov, E. Merkulova","doi":"10.21518/akh2023-026","DOIUrl":"https://doi.org/10.21518/akh2023-026","url":null,"abstract":"Introduction. There are opinions that the use of modern high-tech additional techniques, including a navigation system for positioning a colonoscope (MEI), can both increase the diagnostic efficiency of colonoscopy and its comfort for the patient, and do not affect the quality of colonoscopy. Aim. To determine the capabilities of MEI during colonoscopy without sedation. Materials and methods. The single-center, prospective, randomized study included 120 patients (from 20 to 82 years, mean age 51.8 years; 53% men / 47% women) who underwent routine diagnostic outpatient colonoscopy using a rotational technique by experienced endoscopists using MEI navigation system. The study took place in two stages: Stage 1 – randomization and assessment of group comparability (group 1 – MEI, n = 57 and group 2 – without MEI, n = 63); Stage 2 – determination of the number of patients with colon preparation for colonoscopy according to the Boston scale > 6 points (n = 112: 1st study-MEI group, n = 52 and 2nd control group, n = 60); comparative analysis between groups of the frequency of cecal intubation, time of cecal intubation, pain assessment on the VAS scale in cm. Statistical analysis was carried out using Fisher’s exact test, two-sided Mann-Whitney rank sum U test at a significance level of 0.05. Results and discussion. The groups were comparable in age, gender, preliminary indications for the study. The cecum was intubated significantly more often in group 1 (100% vs 90%, p < 0.05). There was no significant difference in the time required for cecal intubation (p = 0.258) and the difference in the mean time required for cecal intubation was 22 seconds. The VAS pain assessment also did not reveal significant differences (p = 1.023). We determined that the increase in the frequency of cecal intubation using MEI by experienced endoscopists increases by 10% and reaches 100%, while the opinion about reducing the time of cecal intubation and improving patient comfort were not confirmed. Conclusion. MEI during rotational colonoscopy performed by experienced endoscopists increases the likelihood of cecal intubation during routine colonoscopy by 10%. MEI does not increase the time required for cecal intubation and is not associated with the frequency or intensity of pain or discomfort on the VAS scale in colonoscopy without sedation.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139231116","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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