Stilespuckett2474
The authors reviewed the main researches devoted to pathophysiological mechanisms and international classification of diverticulitis, analyzed multiple-center retrospective and randomized prospective studies. Modern diagnostic and therapeutic approaches, certain unsolved problems in indications for surgeries and their technique, as well as the role of surgical interventions in prevention of recurrences and severe complications of diverticulitis are demonstrated.Connective tissue dysplasia (CTD) is an urgent problem, especially in young and employable people. Damage to cardiovascular system and, in particular, aorta is predominant factor determining the incidence of various complications and mortality in patients with CTD. The authors report surgical treatment of aortic hypoplasia in an adolescent patient with connective tissue dysplasia syndrome and combined deficiency of coagulation factors.We report the results of open surgical correction of a giant false aneurysm of the distal anastomosis in long-term period after iliofemoral bypass surgery. Preoperative diagnostic procedures made it possible to determine the most appropriate treatment strategy. Aneurysm resection was followed by distal anastomosis repair on the right with prosthesis 10 mm. Postoperative imaging is presented. The authors concluded the effectiveness of revascularization strategy.Today, the number of endovascular procedures is steadily growing. For example, there were 40.005 endovascular interventions in 2018. Most patients are discharged within 1-2 days after intervention due to its effectiveness and minimal invasiveness. However, physicians do not always note local postoperative complications. Multidisciplinary approach in follow-up and treatment of such patients is important. In particular, we talk about awareness of doctors of polyclinics about possible complications after arterial puncture. Effectiveness and favorable result of surgical treatment of local postoperative complications after arterial puncture are reported in the manuscript.Duodenal duplication cyst (DDC) is a rare form of intestinal malformation (2-12% of all gastrointestinal duplications). There are many difficulties in diagnosis and management of DDC. We present a case of successful endoscopic transluminal treatment of DDC in a 30-year-old female. She complained of epigastric pain, nausea and vomiting, weight loss of 5 kg over the past 3 months. Laparoscopic cholecystectomy for gallstone disease was performed 18 months prior to admission. Examination revealed a cyst 52×60?35 mm in descending part of duodenum. There was a calculus inside the cyst. Transluminal endoscopic cyst fenestration was performed. Histological examination confirmed DDC. According to control duodenoscopy data, cyst was collapsed. The patient remains asymptomatic three months after surgery. DDC is a rare disease of gastrointestinal tract, which should be differentiated first with choledochocele Todani type III and intraluminal duodenal diverticulum. Endoscopic treatment may be an adequate alternative to traditional interventions in some cases.Two patients with locally advanced gastric cancer are reported. Both patients underwent colonoscopy in preoperative period. Preoperative examination revealed synchronous colorectal cancer. Preoperative colonoscopy in patients with gastric cancer ensured timely diagnosis of synchronous colorectal cancer and adequate minimally invasive treatment with favorable results.We evaluated the possibility and effectiveness of transaxillary gas-free approach for minimally invasive Zenker's diverticulectomy. A 64-year-old patient with large Zenker's diverticulum (6 cm) and pathognomonic symptoms is presented. Transaxillary gas-free minimally invasive diverticulectomy was performed using an endoscopic linear stapler. Surgery time was 137 min. There were not any postoperative complications including recurrent laryngeal nerve injury. X-ray examination after 2 postoperative days revealed no signs of anastomotic leakage, so the patient was allowed to drink and consume liquid food from the 3rd day. Patient was discharged on the 7th day. Minimally invasive surgical technology ensures effective and radical transaxillary diverticulectomy in patients with Zenker's diverticulum. The advantages of this method are good and detailed exposition of surgical field, including recurrent laryngeal nerve, more precise and less invasive manipulations and better cosmetic effect. The method may be an alternative to traditional and endoscopic diverticulectomy for a certain group of patients. However, experience accumulation and further prospective studies are required.
To determine the most optimal period of surgical treatment after previous stroke.
There were 186 patients with significant ICA stenosis and previous unilateral stroke for the period 2008-2014 at the Pletnev Hospital (Moscow). Surgical approach was used in 136 (73.1%) patients (group I), conservative treatment at the neurological department - in 50 (26.9%) patients (group II). We analyzed neurological and cognitive status in both groups, regression of symptoms depending on the period after stroke, early and long-term postoperative outcomes.
In early postoperative period, 7 (5.1%) cerebral ischemic events (transient ischemic attack (TIA) and stroke) occurred in the 1st group. No correlation of neurological complications and type of intervention was revealed. In long-term period, stroke occurred in 3.6% in the first group and in 14% in the second group over the same period. Surgical treatment was followed by more complete recovery of neurological functions (NIHSS score 6.2±0.5 versus 7.0±0.8; modified Rankin score 1.5±0.2 versus 2.1±0.5,
<0.05) and cognitive mechanisms (MoCA score 22.04±1.48 versus 20.04±1.48,
<0.05).
Carotid endarterectomy and carotid artery stenting are effective for prevention of recurrent stroke. Carotid artery repair accelerates recovery of cognitive functions and regression of neurological symptoms in these patients.
Carotid endarterectomy and carotid artery stenting are effective for prevention of recurrent stroke. Carotid artery repair accelerates recovery of cognitive functions and regression of neurological symptoms in these patients.
To evaluate the early outcomes of simultaneous surgeries in patients with concomitant lung cancer and coronary artery disease.
We retrospectively reviewed 37 consecutive patients who underwent CABG with adjunct endarterectomy (
=21) or long segmental coronary artery reconstruction (
=25) and lung resection between 2003 and 2019. Mean age was 61.4±6.7 (range 58-71) years. Males prevailed (
=32, 86.4%). Median sternotomy was used in all patients. Myocardial revascularization was followed by on-pump lung resection. The most common procedure was lobectomy (94.6%) of the right upper lobe (83.7%). Lymph node dissection was performed in all patients.
CPB time was 162±19.3 min, aortic cross-clamping time 71±14.2 min. There was no in-hospital mortality. Incidence of perioperative myocardial infarction was 5.4%. Postoperative complications were atrial fibrillation (
=6, 16.6%), re-exploration for bleeding (
=1, 2.7%), pneumonia (
=2, 5.4%). Mean hospital-stay was 14.4 days (range 11-21).
Simultaneous lung resections and coronary artery reconstruction is a safe and reliable surgical method in patients with diffuse coronary atherosclerosis and lung cancer. Daporinad datasheet The developed system of choice, evaluation and surgical treatment of patients with concomitant cardiopulmonary pathology is fundamental for successful treatment of these difficult patients. We need larger randomized studies for certainty.
Simultaneous lung resections and coronary artery reconstruction is a safe and reliable surgical method in patients with diffuse coronary atherosclerosis and lung cancer. The developed system of choice, evaluation and surgical treatment of patients with concomitant cardiopulmonary pathology is fundamental for successful treatment of these difficult patients. We need larger randomized studies for certainty.
To show the efficacy of innovative hybrid intraperitoneal alloplasty in patients with parastomal hernia.
Treatment outcomes were assessed in 60 patients with parastomal hernia using computed tomography.
The innovative hybrid intraperitoneal alloplasty reduces the risk of recurrence by 7 times (
=0.01).
The innovative hybrid intraperitoneal alloplasty reduces the risk of recurrence by 7 times (p=0.01).
To analyze the factors of mortality in patients with acute adhesive small bowel obstruction (AASBO).
A retrospective multiple-center study included 143 (85.6%) patients with AASBO out of 167 consecutive patients with small bowel obstruction for the period 2017-2019. All patients were divided into 3 groups early surgery group (within 12 hours after admission), late surgery (after 12 hours), non-surgical management group. The outcomes and Kaplan-Meier survival were compared in all groups.
AASBO was resolved without surgery in 77 (53.8%) patients 19.6±17.4 (M=14) hours. In the Early Surgery Group (
=36), 24 patients had strangulation, 12 ones had non-strangulated bowel obstruction. In the Late Surgery Group (
=30), 15 patients had strangulation and 15 ones had no strangulation. Mortality was similar in early and late surgery (
=0.287), early and late surgery in patients with strangulation (
=0.940), early and late surgery in patients without strangulation (
=0.76). Patients died (
=10) after surgery only. Thus, postoperative mortality was 15.2%, overall mortality - 7.0%. All patients who underwent surgery after 24 hours (
=14) survived. Surgery increased the mortality risk compared to non-surgical management (95% CI 0 - 15.9,
=0.001). There was no effect of surgery time (more or less than 12 hours) on mortality for strangulation (95% CI 13.0-16.7, p 0.788) and non-strangulated obstruction (95% CI 29.4-5.4,
=0.061), bowel resection (95% CI 33.3-14.0,
=0.187), presence of bowel ischemia (95% CI 14.3-17.9, p 0.613).
Delayed surgery may be advisable in patients with AASBO and no obvious signs of strangulation due to less mortality.
Delayed surgery may be advisable in patients with AASBO and no obvious signs of strangulation due to less mortality.
To report initial experience of endoscopic transluminal drainage of infected pancreatic necrosis.
There were 8 patients with acute severe pancreatitis and large-focal pancreatic necrosis who underwent transluminal drainage of destruction zones for the period from December 2018 to October 2019.
Transluminal drainage of pancreatogenic destruction zones in acute severe pancreatitis can be considered as the only surgical approach in 50% of cases that is comparable with literature data.
Transluminal drainage of pancreatogenic destruction zones in acute severe pancreatitis can be considered as the only surgical approach in 50% of cases that is comparable with literature data.
To evaluate the features of «hypervascular rim», tumor dimensions and density as prognostic factors of differentiation of pancreatic head adenocarcinoma.
Pancreatoduodenectomy was performed in 311 patients with pancreatic head adenocarcinoma for the period 2013-2019. A retrospective study included 81 patients who met the following criteria available data of morphological and immunohistological examination indicating tumor grade from Grade 1 to Grade 3, as well as available preoperative CT images in four phases (native, arterial, portal and delayed). Tumor dimensions, density of the pancreas, adenocarcinoma and abdominal aorta by the phases of contrast enhancement were analyzed in all patients. Moreover, we estimated coefficient of relative enhancement change. Perifocal hypervascular enhancement was assessed in arterial and portal phases. Contrast-enhanced MRI was performed in 15 out of 81 patients. MR images were analyzed regarding a hypervascular rim, and the last one was compared with CT images.
There was no significant difference in density values between different tumor grades.
