Objective: To study the peculiarities of regional blood circulation stimulation by indirect revascularization in patients with critical limb ischemia (CLI) on the background of distal steno-occlusion of arteries.
Materials and methods: study was carried out in 210 patients with CLI on the background of distal steno-occlusion of arteries. 48 patients conducted standard treatment (control group). Regional blood flow was stimu-lated in 42 patients with a standard operation of revascularizing osteotrepanation (ROT) (group I), in 51 patients with lumbar sympathectomy (LSE) (group II), in 38 patients - LSE + ROT (group III), in 31 patients - modified with intraosseous laser irradiation (ROT with IOLI) (IV group). The following indicators of arterial and venous blood flow were determined: rheographiy index (RI), linear blood flow velocity (LBV) in the popliteal artery, standing and lying, regional systolic pressure (RSP) standing and lying, regional systolic pressure gradient (RSPG), post-occlusal ve-nous pressure (POVP) standing and lying, the gradient of post-occlusal venous pressure (GPOVD), venous arterial flow index (VAFI) standing and lying. Oxygen saturation of skin (OSS) in the distal part of the foot was also studied. The parameters of regional arterial and venous blood circulation were compared with identical parameters of 48 practically healthy individuals (“reference group”).
Results: upon admission to the clinic, patients revealed a sharp violation of the arterial and venous parts of the regional macro- and microhemodynamics. Indirect methods of revascularization, in comparison with the initial data, reliably mobilize regional blood circulation, reduce the degree of chronic ischemia, which is accompanied by an increase in the number of patients with significant and moderate improvement in clinical status. Statistical analysis showed that the mobilization of arterial and venous blood flow reliably depends on the method of stimula-tion (p <0.05 -0.001). In the I and II group of patients, a weak correlation was revealed (r = 0.3), and in the III and IV group of patients, a moderate correlation was found (r = 0.5-0.6). Leveling of RI, LBV and OSS parameters reliably (p <0.05-0.001) depends on the method of blood circulation stimulation with weak (r = 0.3) correlation in group I patients and moderate (r = 0.4-0.6) correlation in II, III, IV groups of patients. These positive results were most pronounced in patients who underwent ROT surgery with IOLI.
Conclusion: stimulation of peripheral blood flow by indirect methods of revascularization is reasonable (p <0.05-0.001 with r = 0.3-0.4-0.5-0.6), if shunt operations in patients with CLI on the background of distal steno-occlusion of arteries is not possible to perform, allowing you to maintain the supporting function of the limb and improve the quality of life.
Today, damage to the hand and fingers is the predominant number of injuries of the musculoskeletal system, which is due to the acceleration of the pace of life. Damage of the type “mallet finger” (“hammer finger”) is often 1.5-3% among all injuries of the brush. The urgency of this problem is due not only to the increase in the frequency of injuries among the working-age population, but also to the severity of their consequences for the person and society.
Liver transplantation is the only treatment for the decompensated level of cirrhosis. Due to improvement of the surgery methodology and management of patients, the survival rate of patients up to 1 year is 90%, and 5-year to 80%. However, post-transplantation complications remain the main cause of recipient morbid-ity and mortality. The basic reasons for the development of strictures of the bile duct after transplantation depends on: 1. The type of transplant. 2. The number and type of bile ducts carried out for the application of anastomoses, in particular liver transplantation from a living donor. 3. Type of anastomosis (biliary-biliary or choledochojejunoanastomosis). Most complications after surgery are diagnosed after live-donor liver transplantation. Since the transplant is one of the lobes with ducts of smaller diameter. Given the above, the complications of the biliary duct system after transplantation from a cadaveric donor is 5-15%, and after live-donor it reaches up to 38%. Including, when taking the right lobe of the liver in living donors, the percentage of complications varies from 24% to 60%.
Congenital long QT syndrome (LQTS) is an abnormally prolonged repolarization of the stomach due to hereditary defects in the sodium and potassium channels of the heart, which predispose patients with syn-cope, gastrointestinal arrhythmias, and sudden cardiac death. Early diagnosis and prophylactic treatment play an important role in preventing sudden cardiac death in patients with congenital LQTS. The diagnostic criteria for congenital LQTS are based on specific electrocardiographic data, clinical data, and adrenaline test. results. Recently, a genotype-specific electrocardiographic pattern of congenital LQTS has also been described. Recent studies suggest the feasibility of genotype-specific treatment for LQTS, and soon, muta-tion-specific treatment is likely to become a new approach to this potentially deadly syndrome. We present a case report that is verified by electrocardiographic and clinical diagnostic criteria, indicat-ing LQTS. In this case, the cardioverter-defibrillator is implanted to the patient for the secondary preven-tion of sudden cardiac death. The patient experiences attacks of sudden palpitations with fainting, and the implanted defibrillator leads therapy from life-threatening ventricular tachycardia.
Urolithiasis is an urgent worldwide public health problem, as it remains one of the most common diseases. Therefore, the study of factors that increase the effectiveness and safety of treatment of patients with nephrolithiasis is an important task of urology. This article provides a comparative analysis of the effectiveness of minimally invasive methods, such as retrograde pyelolithotripsy (RPL) and percutaneous nephrolithotripsy (PCNL) for nephrolithiasis. Purpose of the study. Conduct a comparative assessment of the effectiveness of minimally invasive treatment for kidney stones..
Materials and methods. In the study, 109 patients with kidney stones who were hospitalized at the Scientific Center of Urology from 2017 to 2018. Retrograde pyelolithotripsy (RPT) was performed in 66 (60.5%) patients. Percutaneous nephrolithotripsy (PCNL) in 43 (39.4%) patients. Of these, 54 (49.5%) are men and 55 (50.5%) are women.
Conclusion: A comparative analysis of the results of treatment of patients with kidney stones showed that RPT is not inferior to PCNL in its effectiveness. Moreover, the percentage of intraoperative and postoperative complications is higher with PCNL. The effectiveness of PCNL immediately after surgery was 76.5%, RPT - 78.8%. Efficiency after 1 month was 82.8% and 88.1%, respectively. After PCNL, a significant decrease in glomerular filtration rate is determined, which is not observed after RPT. Improving the surgical treatment of urolithiasis will improve the quality of life of the population suffering from urolithiasis, reduce the incidence and disability of the population, reduce the length of hospital stay and rehabilitation.
Combined surgical pathology of the abdominal cavity is one of the serious problems of modern surgery. This article analyzes the results of surgical treatment of 110 patients with combined surgical pathology of the abdominal organs. According to the purpose of the study, 2 comparison groups were formed: the control group, where patients underwent phased surgical treatment of combined abdominal pathologies (СAP), and the main group, where patients underwent simultaneous surgery to eliminate СAP. As a result of the study, an algorithm for the diagnosis and treatment of patients with СAP was developed. The proposed algorithm is a reliable guarantee for improving the results of surgical treatment of СAP.
The article provides a brief review of the literature on the effectiveness of the method of intrarenal sur-gery - retrograde pyelolithotripsy (RPT) in urolithiasis. The method has been actively introduced since 2005 with the development of flexible ureteroscopes. In our center, the method has been introduced since 2015. There is a sufficient number of studies on the use of retrograde pyelolithotripsy with kidney stones more than 2 cm, the effectiveness, minimally invasiveness and safety of this method have been proved so far. There are few studies to study the possibilities of using RPT for staghorn calculi and multiple stones, which confirms the relevance of research in this direction. The purpose of this work is to analyze literature data on the topic of intrarenal surgery for staghorn and multiple stones.
Methods: We conducted a systematic search of literature data and selected sources from the Cochrane database, MEDLINE, PubMed, EMBASE, Google Scholar, as well as research works and online educational publications in Russian. Twenty works were included that met inclusion criteria.
Results: The review article describes the method of surgical treat-ment of patients with kidney stones, indications and contraindications. Evaluation of the effectiveness of the method is assessed by the complete release of the cavity system from concernments (stone-free rate).
Conclusion: Thereby, the problem of the study of RPT and its effectiveness in the treatment of nephroli-thiasis is undoubtedly relevant and requires further study. RPT is a good method of choice, with anatomical difficult accesses, with obesity and prolonged use of anticoagulants. But this is a relatively effective method in the treatment of patients with staghorn stones, and is the method of choice for a certain contingent of patients in whom the formation of percutaneous access to the stone is impossible or is associated with a high risk of complications.
The article presents the current views on diagnostics and surgical treatment of tetralogy of Fallot. The described methods of palliative and radical correction of tetralogy of Fallot, presents an immediate and re-mote results of surgical treatment. Particular attention is paid to new innovative methods for the restoration of anatomical and hemodynamic disorders in tetralogy of Fallot. correction, the results
Coronary shuntography represents the “gold standard” of evaluating the coronary bypass grafting re-sults. Today it is practically the only method allowing: detailed analysis of complications; the possibility of direct visualization of shunts of all types and localizations; the detection of occlusion and stenosis, their localization, severity and extension; the possibility of simultaneous direct reliable assessment of the proxi-mal and distal coronary bed state; determination of progression degree and localization of atherosclerosis – which in turn helps to increase the effectiveness of direct revascularizing operations in patients with coronary artery disease.
