Pub Date : 2022-07-15DOI: 10.24060/2076-3093-2022-12-2-123-127
O. Galimov, V. O. Khanov, H. Karkhani, Sharma Bhawna, T. R. Ibragimov
Introduction. Wilkie syndrome is a pathological manifestation caused by an abnormal disorder of the superior mesenteric artery arising from the abdominal part of the aorta. As a result, the distal part of the duodenum is compressed between the abdominal aorta, spine, and SMA, which creates a hindrance for the passage of himus in the duodenum, creating a mechanical obstruction.Aim: To draw the surgeons’ attention towards the possibility of developing a rare complication of decreased aorto-mesenteric angle and the distance, highlighting the challenges in diagnosis and treatment.Materials and methods. This article presents a clinical case of WS diagnosed in the surgical department of the BSMU clinic. We hereby discuss the case report of a 28-year-old patient diagnosed at the initial stage of WS. The patient had been suffering from the symptoms of WS since 2018 but wasn’t able to identify the disease, but when he came to the surgical department of BSMU clinic based on the results of abdominal CT-scan with combined contrast of the stomach and duodenum per os with water-soluble contrast and computer angiography of the mesenteric vessels, the diagnosis was confirmed. The patient was treated with the duodenojejunostomy (laparoscopic Strong’s operation).Results and discussion. Absence of timely diagnosis of this disease can lead to life-threatening complications, and early diagnostics is complicated by similarity of initial manifestations with other gastropancreaticoduodenal diseases. One of the most promising approach in the diagnosis of Wilkie syndrome is the use of abdominal CT-scan with combined contrasting of the stomach and duodenum per os with water-soluble contrast and computer angiography of vessels. In the present clinical case due to the given combination of methods we can assess functional state of the stomach and duodenum, clearly visualize not only the organs topography but also estimate the aorto-mesenteric angle and distance, which can further determine the type and tactics of initial stage treatment, which we decided to perform surgery (laparoscopic Strong’s operation). The postoperative period was without complications. The patient noted an improvement in the state and the relief of pain in the epigastrium and was discharged after 9 days of hospitalization in satisfactory condition.Conclusion. For diagnosis and treatment in time as well as prevention of possible complications, it is necessary to improve surgeons’ information about this pathology, which if diagnosed and treated late can lead to severe, life-threatening complications up to death. The diagnosis at the initial stages, specifically with the assistance of computer tomography with contrast, angiography, and treatment in a timely manner, can preserve life and prevent the possible outcomes of fatal complications.
{"title":"The Complication Of Decrease In Aorto-Mesenteric Angle And Distance Its Diagnosis And Treatment: Case Report","authors":"O. Galimov, V. O. Khanov, H. Karkhani, Sharma Bhawna, T. R. Ibragimov","doi":"10.24060/2076-3093-2022-12-2-123-127","DOIUrl":"https://doi.org/10.24060/2076-3093-2022-12-2-123-127","url":null,"abstract":"Introduction. Wilkie syndrome is a pathological manifestation caused by an abnormal disorder of the superior mesenteric artery arising from the abdominal part of the aorta. As a result, the distal part of the duodenum is compressed between the abdominal aorta, spine, and SMA, which creates a hindrance for the passage of himus in the duodenum, creating a mechanical obstruction.Aim: To draw the surgeons’ attention towards the possibility of developing a rare complication of decreased aorto-mesenteric angle and the distance, highlighting the challenges in diagnosis and treatment.Materials and methods. This article presents a clinical case of WS diagnosed in the surgical department of the BSMU clinic. We hereby discuss the case report of a 28-year-old patient diagnosed at the initial stage of WS. The patient had been suffering from the symptoms of WS since 2018 but wasn’t able to identify the disease, but when he came to the surgical department of BSMU clinic based on the results of abdominal CT-scan with combined contrast of the stomach and duodenum per os with water-soluble contrast and computer angiography of the mesenteric vessels, the diagnosis was confirmed. The patient was treated with the duodenojejunostomy (laparoscopic Strong’s operation).Results and discussion. Absence of timely diagnosis of this disease can lead to life-threatening complications, and early diagnostics is complicated by similarity of initial manifestations with other gastropancreaticoduodenal diseases. One of the most promising approach in the diagnosis of Wilkie syndrome is the use of abdominal CT-scan with combined contrasting of the stomach and duodenum per os with water-soluble contrast and computer angiography of vessels. In the present clinical case due to the given combination of methods we can assess functional state of the stomach and duodenum, clearly visualize not only the organs topography but also estimate the aorto-mesenteric angle and distance, which can further determine the type and tactics of initial stage treatment, which we decided to perform surgery (laparoscopic Strong’s operation). The postoperative period was without complications. The patient noted an improvement in the state and the relief of pain in the epigastrium and was discharged after 9 days of hospitalization in satisfactory condition.Conclusion. For diagnosis and treatment in time as well as prevention of possible complications, it is necessary to improve surgeons’ information about this pathology, which if diagnosed and treated late can lead to severe, life-threatening complications up to death. The diagnosis at the initial stages, specifically with the assistance of computer tomography with contrast, angiography, and treatment in a timely manner, can preserve life and prevent the possible outcomes of fatal complications.","PeriodicalId":52846,"journal":{"name":"Kreativnaia khirurgiia i onkologiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44215032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-14DOI: 10.24060/2076-3093-2022-12-2-93-97
E. Kayukova, T. Belokrinitskaya, A. M. Ziganshin, V. A. Mudrov
Background. Current issues in the cytological assessment of cervical epithelium can hamper differential diagnosis of high-grade squamous intraepithelial lesion (HSIL) and cervical cancer.Aim. To determine the informativity of locally estimated values of odd-numbered higher fatty acids as differential markers in HSIL and cervical cancer.Materials and methods. Previous original data on the higher fatty acids content in cervical biopsy of primary pre-treatment HSIL and cervical cancer patients were analysed retrospectively. The study cohorts: clinical cohort I — 30 HSIL patients; clinical cohort II — 45 primary stage I squamous cervical cancer patients. Statistical methods included the analyses of ROC curves, sensitivity (Se), specificity (Sp) and accuracy (Ac).Results. Among all odd-numbered higher fatty acids, the following molecular markers (local thresholds) are differential for cervical cancer: C15:0 ≤1.91 %/cell (Se = 0.81; Sp = 0.84; Ac = 0.83; AUC = 0.81); C15:1 ≤1.72 %/cell (Se = 0.96; Sp = 0.91; Ac = 0.92; AUC = 0.96); C17:0 ≤2.95 %/cell (Se = 0.94; Sp = 0.93; Ac = 0.97; AUC = 0.97); C17:1 ≤1.11 %/cell (Se = 0.96; Sp = 0.98; Ac = 0.96; AUC = 1.0); C19:0 ≤1.17 %/cell (Se = 1.0; Sp = 1.0; Ac = 1.0; AUC = 1.0).Discussion. Tumour cells are known to possess atypical metabolism, which produces large amounts of higher fatty acids with odd numbers of carbon atoms. The study focused on the value of locally estimated odd-numbered higher fatty acids as differential molecular markers in HSIL and cervical cancer.Conclusion. The results suggest that C19:0 estimates are applicable in diagnosis of HSIL and cervical cancer.
{"title":"Informativity of Locally Estimated Odd-Numbered Higher Fatty Acids for Differential Diagnosis of HSIL and Cervical Cancer","authors":"E. Kayukova, T. Belokrinitskaya, A. M. Ziganshin, V. A. Mudrov","doi":"10.24060/2076-3093-2022-12-2-93-97","DOIUrl":"https://doi.org/10.24060/2076-3093-2022-12-2-93-97","url":null,"abstract":"Background. Current issues in the cytological assessment of cervical epithelium can hamper differential diagnosis of high-grade squamous intraepithelial lesion (HSIL) and cervical cancer.Aim. To determine the informativity of locally estimated values of odd-numbered higher fatty acids as differential markers in HSIL and cervical cancer.Materials and methods. Previous original data on the higher fatty acids content in cervical biopsy of primary pre-treatment HSIL and cervical cancer patients were analysed retrospectively. The study cohorts: clinical cohort I — 30 HSIL patients; clinical cohort II — 45 primary stage I squamous cervical cancer patients. Statistical methods included the analyses of ROC curves, sensitivity (Se), specificity (Sp) and accuracy (Ac).Results. Among all odd-numbered higher fatty acids, the following molecular markers (local thresholds) are differential for cervical cancer: C15:0 ≤1.91 %/cell (Se = 0.81; Sp = 0.84; Ac = 0.83; AUC = 0.81); C15:1 ≤1.72 %/cell (Se = 0.96; Sp = 0.91; Ac = 0.92; AUC = 0.96); C17:0 ≤2.95 %/cell (Se = 0.94; Sp = 0.93; Ac = 0.97; AUC = 0.97); C17:1 ≤1.11 %/cell (Se = 0.96; Sp = 0.98; Ac = 0.96; AUC = 1.0); C19:0 ≤1.17 %/cell (Se = 1.0; Sp = 1.0; Ac = 1.0; AUC = 1.0).Discussion. Tumour cells are known to possess atypical metabolism, which produces large amounts of higher fatty acids with odd numbers of carbon atoms. The study focused on the value of locally estimated odd-numbered higher fatty acids as differential molecular markers in HSIL and cervical cancer.Conclusion. The results suggest that C19:0 estimates are applicable in diagnosis of HSIL and cervical cancer.","PeriodicalId":52846,"journal":{"name":"Kreativnaia khirurgiia i onkologiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45960268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.24060/2076-3093-2022-12-1-13-20
E. A. Pushkarev, A. Vazhenin, K. I. Kulaev, I. M. Yusupov, K. S. Zuikov, I. A. Popova, A. S. Kazantsev
Background. Diagnosis and treatment of malignant lung neoplasms are pressing issues. Peripheral lung cancer verification rate with endobronchial ultrasound varies within 30–85 %.Aim. To advance endobronchial ultrasound precision, a modified biopsy technique has been developed and introduced into clinical practice at the Chelyabinsk Regional Clinical Centre for Oncology and Nuclear Medicine. The modification comprises real-time ultrasound image guidance of the biopsy forceps alignment and opening. The technique patent for invention is RU 2719666 C1.Materials and methods. Modified endobronchial ultrasound has been performed in 66 patients with suspected peripheral lung malignancy at the Centre’s Department of Endoscopy within 2019–2021. Bioptic material was delivered for histological and, when necessary, immunohistochemical examination.Results. Malignancy diagnosis was verified in 78.8 % cases. The modified technique is relatively safe, with complications detected in two patients (3.8 % cases) and managed conservatively with success. Discussion. The standard biopsy technique provided for a lung malignancy verification rate of 57.7 % over 2019–2021. Thus, the rate improvement by modified technique is 21.1 %. The modified technique is relatively safe, with complications reported in two patients (3.8 % cases) and managed conservatively with success. Modified endobronchial ultrasound was adequately tolerated, with no increase in patient examination time. The technique can supersede more invasive diagnostic procedures.Conclusion. We believe that the modified technique will improve the power of endobronchial ultrasound, reduce examination time and expedite prescription of special therapies.
{"title":"Modified Biopsy Assessment for Endobronchial Ultrasound in Diagnosis of Peripheral Lung Neoplasms","authors":"E. A. Pushkarev, A. Vazhenin, K. I. Kulaev, I. M. Yusupov, K. S. Zuikov, I. A. Popova, A. S. Kazantsev","doi":"10.24060/2076-3093-2022-12-1-13-20","DOIUrl":"https://doi.org/10.24060/2076-3093-2022-12-1-13-20","url":null,"abstract":"Background. Diagnosis and treatment of malignant lung neoplasms are pressing issues. Peripheral lung cancer verification rate with endobronchial ultrasound varies within 30–85 %.Aim. To advance endobronchial ultrasound precision, a modified biopsy technique has been developed and introduced into clinical practice at the Chelyabinsk Regional Clinical Centre for Oncology and Nuclear Medicine. The modification comprises real-time ultrasound image guidance of the biopsy forceps alignment and opening. The technique patent for invention is RU 2719666 C1.Materials and methods. Modified endobronchial ultrasound has been performed in 66 patients with suspected peripheral lung malignancy at the Centre’s Department of Endoscopy within 2019–2021. Bioptic material was delivered for histological and, when necessary, immunohistochemical examination.Results. Malignancy diagnosis was verified in 78.8 % cases. The modified technique is relatively safe, with complications detected in two patients (3.8 % cases) and managed conservatively with success. Discussion. The standard biopsy technique provided for a lung malignancy verification rate of 57.7 % over 2019–2021. Thus, the rate improvement by modified technique is 21.1 %. The modified technique is relatively safe, with complications reported in two patients (3.8 % cases) and managed conservatively with success. Modified endobronchial ultrasound was adequately tolerated, with no increase in patient examination time. The technique can supersede more invasive diagnostic procedures.Conclusion. We believe that the modified technique will improve the power of endobronchial ultrasound, reduce examination time and expedite prescription of special therapies. ","PeriodicalId":52846,"journal":{"name":"Kreativnaia khirurgiia i onkologiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49352401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.24060/2076-3093-2022-12-1-43-47
G. T. Gumerova, G. M. Gubaidullina, F. R. Nagaev, R. Bakiev, N. S. Suleymanova
Background. Nodular goitre is the commonest pathology of thyroid gland. According to published evidence, the endemic prevalence of iodine deficiency varies within 19–76 % population. The high rates and lack of symptoms at progressive nodules growth warrant the development of effective organ-preserving treatments. Imaging techniques for local precision targeting of individual lesions enable maximum-preserving interventions at thyroid tissue. Today’s world experience of percutaneous ethanol sclerotherapy and radiofrequency ablation is adequate. However, there exist no clear indications for sclerotherapy and radiofrequency ablation, and their consecutive use has not been assessed.Materials and methods. We analyse minimally invasive organ-preserving treatments of benign thyroid nodules (ethanol sclerotherapy, RFA) in 63 patients at the outpatient and general surgery units of BSMU Clinic and MEGI Medical Centre, Ufa, during February 2019 — December 2020.Results and discussion. Ethanol sclerotherapy was highly effective in 46.5 % patients, as evident from discontinued nodule’s blood supply in CDI and B-mode ultrasound, which remained stable in 10.5 % and restored after 3–4 weeks in 25 % patients. Sclerotherapy in colloid goitre was efficient only in 37.5 % patients. Ethanol sclerotherapy was RFA-followed in 25.4 % patients. RFA was favoured at a low-effective sclerotherapy providing for a weak positive dynamics of nodule size, local parietal blood flow preservation and intranodular vessels recanalisation at re-examination.Conclusion. Sclerotherapy was high-effective in cystic nodules. Radiofrequency ablation can be considered most adequate for treating solid nodules. RFA-followed sclerotherapy is a rational choice in treatment of large cystic nodules (>5 cm3 ).
{"title":"Minimally Invasive Treatment of Benign Thyroid Nodules","authors":"G. T. Gumerova, G. M. Gubaidullina, F. R. Nagaev, R. Bakiev, N. S. Suleymanova","doi":"10.24060/2076-3093-2022-12-1-43-47","DOIUrl":"https://doi.org/10.24060/2076-3093-2022-12-1-43-47","url":null,"abstract":"Background. Nodular goitre is the commonest pathology of thyroid gland. According to published evidence, the endemic prevalence of iodine deficiency varies within 19–76 % population. The high rates and lack of symptoms at progressive nodules growth warrant the development of effective organ-preserving treatments. Imaging techniques for local precision targeting of individual lesions enable maximum-preserving interventions at thyroid tissue. Today’s world experience of percutaneous ethanol sclerotherapy and radiofrequency ablation is adequate. However, there exist no clear indications for sclerotherapy and radiofrequency ablation, and their consecutive use has not been assessed.Materials and methods. We analyse minimally invasive organ-preserving treatments of benign thyroid nodules (ethanol sclerotherapy, RFA) in 63 patients at the outpatient and general surgery units of BSMU Clinic and MEGI Medical Centre, Ufa, during February 2019 — December 2020.Results and discussion. Ethanol sclerotherapy was highly effective in 46.5 % patients, as evident from discontinued nodule’s blood supply in CDI and B-mode ultrasound, which remained stable in 10.5 % and restored after 3–4 weeks in 25 % patients. Sclerotherapy in colloid goitre was efficient only in 37.5 % patients. Ethanol sclerotherapy was RFA-followed in 25.4 % patients. RFA was favoured at a low-effective sclerotherapy providing for a weak positive dynamics of nodule size, local parietal blood flow preservation and intranodular vessels recanalisation at re-examination.Conclusion. Sclerotherapy was high-effective in cystic nodules. Radiofrequency ablation can be considered most adequate for treating solid nodules. RFA-followed sclerotherapy is a rational choice in treatment of large cystic nodules (>5 cm3 ). ","PeriodicalId":52846,"journal":{"name":"Kreativnaia khirurgiia i onkologiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44685051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.24060/2076-3093-2022-12-1-21-27
O. Kit, D. E. Zakondyrin, E. Rostorguev, S. V. Yundin
Background. Epidural spinal cord compression (ESCC) is the most common neurological complication in metastatic spinal tumours.Materials and methods. The study included 87 spinal malignancy patients operated within 01.01.2014–30.09.2021. All patients had a type of palliative decompressive and stabilising surgery: standard posterior access (SPA, 55 patients), minimally invasive posterior access (MPA, 22 patients) or anterior access (AA, 10 patients).Results. The patient cohorts did not differ significantly by the duration of surgery, length of hospital stay, rates and types of postoperative complications. The AA cohort revealed a statistical difference by intraoperative blood loss. A Karnofsky performance status was statistically improved post- vs. pre-surgery (p < 0.05) at no significant change of Frankel neurological function status (p > 0.05). A Kaplan — Meier curve analysis showed no significant survival rate variation among the surgical techniques. Discussion. Our results suggest that posterior access interventions should be considered optimal. We report no statistical difference in the postoperative neurological and performance status dynamics between both cohorts, which encourages the MPA use in all patients with minimal epidural compression.Conclusion. Posterior access with cytoreductive tumour removal in anterior spinal cord compression is advantageous over anterior surgery. A posterior access surgery with minimal spinal canal decompression is recommended in all patients with grade 1 tumoural epidural compression.
{"title":"Specifics of Epidural Compression Syndrome Surgery in Patients with Spinal Malignancy","authors":"O. Kit, D. E. Zakondyrin, E. Rostorguev, S. V. Yundin","doi":"10.24060/2076-3093-2022-12-1-21-27","DOIUrl":"https://doi.org/10.24060/2076-3093-2022-12-1-21-27","url":null,"abstract":"Background. Epidural spinal cord compression (ESCC) is the most common neurological complication in metastatic spinal tumours.Materials and methods. The study included 87 spinal malignancy patients operated within 01.01.2014–30.09.2021. All patients had a type of palliative decompressive and stabilising surgery: standard posterior access (SPA, 55 patients), minimally invasive posterior access (MPA, 22 patients) or anterior access (AA, 10 patients).Results. The patient cohorts did not differ significantly by the duration of surgery, length of hospital stay, rates and types of postoperative complications. The AA cohort revealed a statistical difference by intraoperative blood loss. A Karnofsky performance status was statistically improved post- vs. pre-surgery (p < 0.05) at no significant change of Frankel neurological function status (p > 0.05). A Kaplan — Meier curve analysis showed no significant survival rate variation among the surgical techniques. Discussion. Our results suggest that posterior access interventions should be considered optimal. We report no statistical difference in the postoperative neurological and performance status dynamics between both cohorts, which encourages the MPA use in all patients with minimal epidural compression.Conclusion. Posterior access with cytoreductive tumour removal in anterior spinal cord compression is advantageous over anterior surgery. A posterior access surgery with minimal spinal canal decompression is recommended in all patients with grade 1 tumoural epidural compression. ","PeriodicalId":52846,"journal":{"name":"Kreativnaia khirurgiia i onkologiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46051974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.24060/2076-3093-2022-12-1-61-66
R. Nuriakhmetov, V. Panteleev, A. R. Zagitov, M. A. Nartailakov, M. Kornilov, I. I. Biganyakov
Background. The new SARS-CoV-2 coronavirus infection is understudied; despite its worldwide prevalence, case reports of organ transplant recipients are rare.Aim. A dynamics evaluation and treatment outcome improvement in a transplanted cadaveric kidney patient with 100% parenchymal lung damage caused by SARS-CoV-2 coronavirus bilateral pneumonia.Materials and methods. We describe a successful treatment case of a transplant kidney patient having the new coronavirus infection (COVID-19) (of 03.12.2020). COVID-19 pneumonia was diagnosed on day 7 of the early post-transplant period. On day 14, the patient was admitted to an infectious ward and transferred to intensive care upon disease aggravation. Despite ongoing treatment, pulmonary parenchymal lesion reached 100% in CT scan on 24.12.2020. The patient was transferred to Surgery Unit No. 3 for further therapy on 11.01.2021 upon revealing a clinical improvement, positive laboratory dynamics and SARS-CoV-2-negative smear PCR tests. The patient was discharged for outpatient treatment on day 10.Results and discussion. No evidence of focal infiltrative pulmonary change was detected in control chest CT after 4 months. Within 5 months since discharge, there were observed a general well-being improvement, 98% oxygen saturation, absent oedema, satisfactory transplanted kidney function.Conclusion. Post-kidney-transplant patients are particularly susceptible to infection due to inherent chronic immunosuppression. The presented case of a kidney transplant patient having a favourable COVID-19 outcome demonstrates the efficacy of a timely treatment.
{"title":"Successful Treatment of Transplanted Kidney Patient with 100% Lung Damage Caused by COVID-19 Bilateral Pneumonia: a Clinical Case","authors":"R. Nuriakhmetov, V. Panteleev, A. R. Zagitov, M. A. Nartailakov, M. Kornilov, I. I. Biganyakov","doi":"10.24060/2076-3093-2022-12-1-61-66","DOIUrl":"https://doi.org/10.24060/2076-3093-2022-12-1-61-66","url":null,"abstract":"Background. The new SARS-CoV-2 coronavirus infection is understudied; despite its worldwide prevalence, case reports of organ transplant recipients are rare.Aim. A dynamics evaluation and treatment outcome improvement in a transplanted cadaveric kidney patient with 100% parenchymal lung damage caused by SARS-CoV-2 coronavirus bilateral pneumonia.Materials and methods. We describe a successful treatment case of a transplant kidney patient having the new coronavirus infection (COVID-19) (of 03.12.2020). COVID-19 pneumonia was diagnosed on day 7 of the early post-transplant period. On day 14, the patient was admitted to an infectious ward and transferred to intensive care upon disease aggravation. Despite ongoing treatment, pulmonary parenchymal lesion reached 100% in CT scan on 24.12.2020. The patient was transferred to Surgery Unit No. 3 for further therapy on 11.01.2021 upon revealing a clinical improvement, positive laboratory dynamics and SARS-CoV-2-negative smear PCR tests. The patient was discharged for outpatient treatment on day 10.Results and discussion. No evidence of focal infiltrative pulmonary change was detected in control chest CT after 4 months. Within 5 months since discharge, there were observed a general well-being improvement, 98% oxygen saturation, absent oedema, satisfactory transplanted kidney function.Conclusion. Post-kidney-transplant patients are particularly susceptible to infection due to inherent chronic immunosuppression. The presented case of a kidney transplant patient having a favourable COVID-19 outcome demonstrates the efficacy of a timely treatment. ","PeriodicalId":52846,"journal":{"name":"Kreativnaia khirurgiia i onkologiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43394046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.24060/2076-3093-2022-12-1-56-60
A. Mohanty
Introduction. We have come a long way from the era of conventional rectal surgery, with most high-volume centres now practising various degrees of laparoscopy assisted colorectal surgeries, via extracorporeal suturing, ex vivo anastomoses, hand-assisted laparoscopic resection anastomoses to robotic rectal resections. However, the limitation to most such techniques remains the fact that these are not ‘completely’ laparoscopic, with varying degrees of open assistance being required, from mobilization, suturing and anastomoses to specimen extraction via separate abdominal incisions or port-site enlargements. These ‘large’ incisions negate some of the advantages of minimal access surgery and lead to complications at such sites, such as wound breakdown, infections, and incisional herniae. This led to the origin of NOTES (Natural Orifice Translumenal Endoscopic Surgery) and the still fairly new concept of NOSE (Natural Orifice Specimen Extraction).Aim. We aim to describe our application of this new frontier in laparoscopic colorectal surgery, doing away with large scars prone to complications.Materials and methods. We describe a case of completely laparoscopic resection rectopexy and trans-rectal extraction of the specimen, with a modified technique of anvil insertion, enabling the faster creation of a larger anastomosis with probably lower anastomotic morbidity.Results and discussion. The patient underwent a ‘completely’ laparoscopic resection rectopexy and had an uneventful immediate post-operative recovery. She had no delayed post-operative complications or recurrence of the rectal prolapse and remained free of constipation as well, over a follow-up period of 6 months.Conclusion. We conclude that this modification of the surgical technique reduces operative time, allows use of larger circular staplers, theoretically reducing the incidence of anastomotic stricture, and being easily reproducible, can be widely applied for better cosmetic and functional outcome.
{"title":"Modification of the anastomotic technique in completely laparoscopic resection rectopexy with NOSE — a case report","authors":"A. Mohanty","doi":"10.24060/2076-3093-2022-12-1-56-60","DOIUrl":"https://doi.org/10.24060/2076-3093-2022-12-1-56-60","url":null,"abstract":"Introduction. We have come a long way from the era of conventional rectal surgery, with most high-volume centres now practising various degrees of laparoscopy assisted colorectal surgeries, via extracorporeal suturing, ex vivo anastomoses, hand-assisted laparoscopic resection anastomoses to robotic rectal resections. However, the limitation to most such techniques remains the fact that these are not ‘completely’ laparoscopic, with varying degrees of open assistance being required, from mobilization, suturing and anastomoses to specimen extraction via separate abdominal incisions or port-site enlargements. These ‘large’ incisions negate some of the advantages of minimal access surgery and lead to complications at such sites, such as wound breakdown, infections, and incisional herniae. This led to the origin of NOTES (Natural Orifice Translumenal Endoscopic Surgery) and the still fairly new concept of NOSE (Natural Orifice Specimen Extraction).Aim. We aim to describe our application of this new frontier in laparoscopic colorectal surgery, doing away with large scars prone to complications.Materials and methods. We describe a case of completely laparoscopic resection rectopexy and trans-rectal extraction of the specimen, with a modified technique of anvil insertion, enabling the faster creation of a larger anastomosis with probably lower anastomotic morbidity.Results and discussion. The patient underwent a ‘completely’ laparoscopic resection rectopexy and had an uneventful immediate post-operative recovery. She had no delayed post-operative complications or recurrence of the rectal prolapse and remained free of constipation as well, over a follow-up period of 6 months.Conclusion. We conclude that this modification of the surgical technique reduces operative time, allows use of larger circular staplers, theoretically reducing the incidence of anastomotic stricture, and being easily reproducible, can be widely applied for better cosmetic and functional outcome. ","PeriodicalId":52846,"journal":{"name":"Kreativnaia khirurgiia i onkologiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42113954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.24060/2076-3093-2022-12-1-35-42
S. Timerbulatov, V. M. Sibaev, V. M. Timerbulatov, M. Zabelin, M. V. Timerbulatov, R. B. Sagitov, A. R. Gafarova
Background. Acute adhesive small bowel obstruction (AASBO) is a common surgical emergency requiring immediate interventions. AASBO is a usual indication for both small bowel resection and adhesiolysis. Postoperative adhesions cause 60% of small bowel obstructions.Materials and methods. An analysis of treatment outcomes is presented for 197 acute adhesive small bowel obstruction patients; 63 patients had urgent laparotomy, and 134 were scheduled for laparoscopy. The examination included physical, laboratory, radiological methods (abdominal radiography, ultrasound, CT scan), laparoscopy and intra-abdominal pressure monitoring.Results and discussion. Of 134 patients scheduled for laparoscopic adhesiolysis, only 46.2% had laparoscopy completed, and 53.8% required conversion to laparotomy. The main rationale for conversion were massive adhesions, intraoperative haemodynamic instability, a need for intestinal decompression, as well as rare complications. Laparoscopic operations were reported with the lower vs. laparotomy rates of surgical complications (6.4 vs. 12.69%), mortality (6 vs. 6.3%), shorter hospital stays (6.5 vs. 12 days) and operation times (75 vs. 118 min, respectively).Conclusion. Laparoscopic surgery in acute adhesive small bowel obstruction was feasible in 31.47% patients and in 46.2% — after a diagnostic laparoscopy; however, a thorough patients selection for laparoscopic adhesiolysis is necessary. The first estimated should be the patient’s haemodynamic stability, the severities of condition, adhesions and comorbid cardiorespiratory pathology. Grade I—II adhesions are an indication for laparoscopic surgery.
背景。急性粘连性小肠梗阻(AASBO)是一种常见的外科急诊，需要立即干预。AASBO是小肠切除术和粘连松解术的常用指征。术后粘连导致60%的小肠梗阻。材料和方法。对197例急性粘连性小肠梗阻患者的治疗结果进行了分析;紧急开腹63例，计划行腹腔镜检查134例。检查包括物理、实验室、放射学方法(腹部x线片、超声、CT扫描)、腹腔镜检查和腹内压监测。结果和讨论。在134例计划进行腹腔镜粘连松解术的患者中，只有46.2%的患者完成了腹腔镜检查，53.8%的患者需要转为开腹手术。转换的主要理由是大量粘连，术中血流动力学不稳定，需要肠减压，以及罕见的并发症。与剖腹手术相比，腹腔镜手术的手术并发症发生率(6.4 vs 12.69%)、死亡率(6 vs 6.3%)、住院时间(6.5 vs 12天)和手术时间(75 vs 118分钟)均较低。急性粘连性小肠梗阻的腹腔镜手术成功率为31.47%，诊断性腹腔镜手术成功率为46.2%;然而，一个彻底的病人选择腹腔镜粘连松解是必要的。首先应评估患者的血流动力学稳定性、病情严重程度、粘连和合并心肺病理。I-II级粘连是腹腔镜手术的指征。
{"title":"Acute Adhesive Small Bowel Obstruction: a Comparative Analysis of Open and Laparoscopic Surgery","authors":"S. Timerbulatov, V. M. Sibaev, V. M. Timerbulatov, M. Zabelin, M. V. Timerbulatov, R. B. Sagitov, A. R. Gafarova","doi":"10.24060/2076-3093-2022-12-1-35-42","DOIUrl":"https://doi.org/10.24060/2076-3093-2022-12-1-35-42","url":null,"abstract":"Background. Acute adhesive small bowel obstruction (AASBO) is a common surgical emergency requiring immediate interventions. AASBO is a usual indication for both small bowel resection and adhesiolysis. Postoperative adhesions cause 60% of small bowel obstructions.Materials and methods. An analysis of treatment outcomes is presented for 197 acute adhesive small bowel obstruction patients; 63 patients had urgent laparotomy, and 134 were scheduled for laparoscopy. The examination included physical, laboratory, radiological methods (abdominal radiography, ultrasound, CT scan), laparoscopy and intra-abdominal pressure monitoring.Results and discussion. Of 134 patients scheduled for laparoscopic adhesiolysis, only 46.2% had laparoscopy completed, and 53.8% required conversion to laparotomy. The main rationale for conversion were massive adhesions, intraoperative haemodynamic instability, a need for intestinal decompression, as well as rare complications. Laparoscopic operations were reported with the lower vs. laparotomy rates of surgical complications (6.4 vs. 12.69%), mortality (6 vs. 6.3%), shorter hospital stays (6.5 vs. 12 days) and operation times (75 vs. 118 min, respectively).Conclusion. Laparoscopic surgery in acute adhesive small bowel obstruction was feasible in 31.47% patients and in 46.2% — after a diagnostic laparoscopy; however, a thorough patients selection for laparoscopic adhesiolysis is necessary. The first estimated should be the patient’s haemodynamic stability, the severities of condition, adhesions and comorbid cardiorespiratory pathology. Grade I—II adhesions are an indication for laparoscopic surgery. ","PeriodicalId":52846,"journal":{"name":"Kreativnaia khirurgiia i onkologiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42371396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.24060/2076-3093-2022-12-1-81-86
L. I. Bashirova, A. Safonov, R. R. Kamilova, D. Lipatov, A. Bakirov, A. Samorodov
Background. According to some studies, nutrient deficiencies reach an over-70% prevalence in ovarian cancer, among other gynaecological malignancies, thus constituting an important risk factor for postoperative mortality, surgical complications and longer hospital stays. Therefore, effective nutrient deficiency correction methods are warranted to improve the ovarian cancer outcomes, especially in patients following radical surgical interventions. New systematic evidence emerges in literature on the impact of such novel methods on the critical status of variant-category patients. Meanwhile, such evidence bears a recommendatory value only, with no current standard or protocol assumed for nutrient deficiency management. This issue presently remains open and requires careful research and analysis.Materials and methods. The clinical case demonstrates the efficacy of nutrient deficiency correction in an ovarian cancer patient following an individualised radical surgery.Results and discussion. The energy supplied on day 1 was >42%, >83% on day 3, and the target values had been achieved by day 7 of intensive therapy. The nutrient deficiency marker dynamics revealed the growth of transferrin, triglycerides and peripheral blood lymphocyte counts as early as by day 3 post-surgery. Albumin was the latest to respond, increasing only on day 7.Conclusion. The introduction of novel nutrition strategies and knowledge of their impact depend on further high-quality research, especially prospective studies, incorporating a greater homogeneity of intervention types and clinical outcomes, as well as wider sampling of female ovarian cancer.
{"title":"Nutrient Deficiency Correction in Ovarian Cancer Patients Following Surgical Treatment: a Clinical Case","authors":"L. I. Bashirova, A. Safonov, R. R. Kamilova, D. Lipatov, A. Bakirov, A. Samorodov","doi":"10.24060/2076-3093-2022-12-1-81-86","DOIUrl":"https://doi.org/10.24060/2076-3093-2022-12-1-81-86","url":null,"abstract":"Background. According to some studies, nutrient deficiencies reach an over-70% prevalence in ovarian cancer, among other gynaecological malignancies, thus constituting an important risk factor for postoperative mortality, surgical complications and longer hospital stays. Therefore, effective nutrient deficiency correction methods are warranted to improve the ovarian cancer outcomes, especially in patients following radical surgical interventions. New systematic evidence emerges in literature on the impact of such novel methods on the critical status of variant-category patients. Meanwhile, such evidence bears a recommendatory value only, with no current standard or protocol assumed for nutrient deficiency management. This issue presently remains open and requires careful research and analysis.Materials and methods. The clinical case demonstrates the efficacy of nutrient deficiency correction in an ovarian cancer patient following an individualised radical surgery.Results and discussion. The energy supplied on day 1 was >42%, >83% on day 3, and the target values had been achieved by day 7 of intensive therapy. The nutrient deficiency marker dynamics revealed the growth of transferrin, triglycerides and peripheral blood lymphocyte counts as early as by day 3 post-surgery. Albumin was the latest to respond, increasing only on day 7.Conclusion. The introduction of novel nutrition strategies and knowledge of their impact depend on further high-quality research, especially prospective studies, incorporating a greater homogeneity of intervention types and clinical outcomes, as well as wider sampling of female ovarian cancer. ","PeriodicalId":52846,"journal":{"name":"Kreativnaia khirurgiia i onkologiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48284277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.24060/2076-3093-2022-12-1-48-55
K. Menshikov, A. V. Sultanbaev, S. Musin, A. Izmailov, I. Menshikova, N. Sultanbaeva, E. Popova, L. A. Khammatova
Pancreatic adenocarcinoma has a 5-year overall survival rate of 9 %, with an outlook of becoming the second leading cause of cancer mortality in the USA by 2030. Familial pancreatic cancer and genetic predisposition syndromes have attracted more interest in the perspective of targeted therapy. Various authors estimate genetic causes to account for 10–15 % of pancreatic cancers. The BRCA gene mutations comprise the today’s most relevant genetic predisposition syndrome. The frequency of BRCA1/2 and PALB2 germinal mutations in patients with pancreatic adenocarcinoma constitutes about 5–9 %. Over recent years, PARP inhibitors (PARPi) have composed a new targeted therapy class with a significant effect in breast and ovarian cancers. With the mechanism of action of the PARP inhibitor and platinum drugs targeting different DNA repair pathways, their combination therapy has been suggested as promising. We report studies of a combination treatment with veliparib, gemcitabine and cisplatin in germinal BRCA1/2-mutation patients with advanced wild-type pancreatic adenocarcinoma (WT). Recent advances have identified patients with germinal and somatic mutations in the BRCA1/2 and other genes. HRD-targeted therapy, including platinum and PARP inhibitor drugs, can significantly improve survival.
{"title":"Prospects of PARP Inhibitors in Treatment of BRCA-Mutated Pancreatic Cancer: a Literature Review","authors":"K. Menshikov, A. V. Sultanbaev, S. Musin, A. Izmailov, I. Menshikova, N. Sultanbaeva, E. Popova, L. A. Khammatova","doi":"10.24060/2076-3093-2022-12-1-48-55","DOIUrl":"https://doi.org/10.24060/2076-3093-2022-12-1-48-55","url":null,"abstract":"Pancreatic adenocarcinoma has a 5-year overall survival rate of 9 %, with an outlook of becoming the second leading cause of cancer mortality in the USA by 2030. Familial pancreatic cancer and genetic predisposition syndromes have attracted more interest in the perspective of targeted therapy. Various authors estimate genetic causes to account for 10–15 % of pancreatic cancers. The BRCA gene mutations comprise the today’s most relevant genetic predisposition syndrome. The frequency of BRCA1/2 and PALB2 germinal mutations in patients with pancreatic adenocarcinoma constitutes about 5–9 %. Over recent years, PARP inhibitors (PARPi) have composed a new targeted therapy class with a significant effect in breast and ovarian cancers. With the mechanism of action of the PARP inhibitor and platinum drugs targeting different DNA repair pathways, their combination therapy has been suggested as promising. We report studies of a combination treatment with veliparib, gemcitabine and cisplatin in germinal BRCA1/2-mutation patients with advanced wild-type pancreatic adenocarcinoma (WT). Recent advances have identified patients with germinal and somatic mutations in the BRCA1/2 and other genes. HRD-targeted therapy, including platinum and PARP inhibitor drugs, can significantly improve survival. ","PeriodicalId":52846,"journal":{"name":"Kreativnaia khirurgiia i onkologiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68976926","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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