scholarly journals Choledocholithiasis: modern possibilities of diagnosis and surgical treatment

2021 ◽  
Vol 23 (3) ◽  
pp. 109-116
Author(s):  
Eveniy S. Zherebtsov ◽  
Pavel N. Romashchenko ◽  
Nicolay A. Maistrenko
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Diagnostic Value ◽  
Alternative Methods ◽  
Two Stage ◽  
One Stage ◽  
Military Medical Academy ◽  
Rendezvous Technique ◽  
Medical Academy ◽  
Examination Methods

Studies have examined various approaches in the diagnosis and surgical treatment of patients with cholelithiasis complicated by choledocholithiasis, evaluated the possibilities of using modern methods of treating the disease, and proposed a strategy to prevent the abandonment of bile duct concretions. The relevance of this problem is related to the variety of diagnostic and surgical treatment methods of choledocholithiasis, high disease frequency, and nonexistence of a unified approach to the examination and choice of surgical treatment in patients with cholelithiasis complicated by choledocholithiasis. These issues indicate the need to study this problem and identify optimal approaches to examination and treatment, including modern minimally invasive methods of treatment. The analysis of the diagnostic value of various examination methods and surgical outcomes was based on the experience of treating 154 patients with cholelithiasis complicated by choledocholithiasis in the clinic of the S.P. Fedorov Faculty of Surgery of the S.M. Kirov Military Medical Academy. An algorithm for examining patients with cholelithiasis was formed based on the diagnostic value of various research methods, which allows timely detection of choledocholithiasis. The results of various approaches to the surgical treatment of patients with cholelithiasis complicated by choledocholithiasis were analyzed. In the absence of general somatic contraindications and the availability of technical capabilities, a one-stage approach to surgical treatment was suggested. Moreover, an individual approach is necessary for the treatment of patients with cholelithiasis complicated by choledocholithiasis, taking into account the nature of the disease course and its complications, comorbid status of the patient, and technical capabilities of a particular hospital. The sequence and timing of operations with a two-stage approach should be determined, taking into account the acute conditions and comorbidities of the patient. The use of modern minimally invasive technologies, such as transpapillary and trans-bubble choledochoscopy, dosed papillotomy, and rendezvous technique for the cannulation of the large papilla of the duodenum, allows us to improve the results of surgical treatment and reduce the risk of complications. Transpapillary and trans-bubble nanoelectroimpulse lithotripsy are alternative methods of resolving major choledocholithiasis in both one-stage and two-stage treatment.

scholarly journals Result of using a minimally invasive method of surgical treatment of purulent-necrotic complications in a patient with diabetic foot syndrome

2020 ◽  
Vol 39 (3) ◽  
pp. 60-64
Author(s):  
Sergey Y. Ivanusa ◽  
Boris V. Risman ◽  
Andrey V. Yanishevskiy
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Diabetic Foot ◽  
Pain Syndrome ◽  
Diabetic Foot Syndrome ◽  
Military Medical Academy ◽  
Results Of Treatment ◽  
Medical Academy ◽  
Invasive Method ◽  
Short Time

The article presents an analysis of the results of treatment of a patient with purulent-necrotic complications of diabetic foot syndrome, who, in the framework of surgical treatment, used a minimally invasive method of treatment of purulent-necrotic complications of diabetic foot syndrome, developed at the departments of general surgery and normal anatomy of the S.M. Kirov Military Medical Academy. The effectiveness of the developed method has been demonstrated, which makes it possible to sanitize the purulent cavity in a short time, stop pain syndrome and restore the support ability of the foot (4 figs, 1 table, bibliography: 7 refs).

scholarly journals Neuropsychological development of children with biliary atresia after liver transplantation

2021 ◽  
Vol 23 (3) ◽  
pp. 66-72
Author(s):  
A. V. Syrkina ◽  
I. E. Pashkova ◽  
A. R. Monakhov ◽  
O. V. Silina ◽  
E. V. Chekletsova ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Surgical Treatment ◽  
Biliary Atresia ◽  
Psychomotor Development ◽  
Two Stage ◽  
Neuropsychological Development ◽  
One Stage ◽  
The Difference ◽  
Group 2 ◽  
Group 1

Background. In young children, the most common liver disease leading to transplantation is biliary atresia. Liver transplantation has fundamentally improved the survival rate of children with biliary atresia. Studies on developmental outcomes in children are mostly limited to small samples; there are no such studies in the Russian Federation.Objective: to determine the cognitive outcomes in children undergoing one-stage or two-stage surgical treatment of biliary atresia.Materials and Methods. 83 children were divided into groups: 36 children underwent transplantation without previous surgical interventions (group 1), 47 children underwent the Kasai palliative portoenterostomy (group 2). Inclusion criteria: 24 months of age or younger at the moment of transplantation, no medical history of neurological pathology. All children were examined before transplantation and at 1, 3, 6 and 12 months after liver transplantation. Psychomotor development was assessed using the Griffiths Psychomotor Development Scale for children under 24 months (translated by E.S. Keshishian), the Griffiths Intellectual Development Scale for children aged 2 to 8 years, and the Modified Checklist for Autism in Toddlers, Revised, for children 16-30 months old.Results. All children had developmental delays at the time of transplantation. Up to 50% of the children had signs of cachexia, with a shoulder circumference of less than 3 percentile. Only two children showed obvious hepatic encephalopathy in the form of depressed consciousness. After liver transplantation, 94% of group 1 children recovered their preoperative psychomotor development levels, and only 68% in group 2 made these gains. At 3 and 6 months after transplantation, about 80% of group 1 children showed normal psychomotor development, whereas in group 2, only 61% did. By 12 months after liver transplantation, the difference between the groups was more evident: 83.3% of group 1 children and only 53.2% of group 2 children were developing according to age. The difference between the groups was statistically significant (p < 0.05).Conclusion. Children who received one-stage treatment of biliary atresia and underwent liver transplantation have better neuropsychological development within a year after surgery than children with two-stage surgical treatment.

scholarly journals Outcomes of ophtalmologic surgical procedures of esotropia in children and adolescents

2008 ◽  
Vol 65 (8) ◽  
pp. 627-631
Author(s):  
Tamara Kljakovic-Avramovic ◽  
Miroslav Vukosavljevic ◽  
Sinisa Avramovic
Keyword(s):  
Surgical Treatment ◽  
Prospective Study ◽  
Children And Adolescents ◽  
Deviation Angle ◽  
Group Iii ◽  
Military Medical Academy ◽  
Group I ◽  
Medical Academy ◽  
Group Ii ◽  
Common Manifestation

Background/Aim. Esotropia is the most common manifestation form of strabism accompanied by refraction deviations and amblyopia. The aim of this prospective study was to present the outcomes of surgical treatment of esotropia in children and adolescents. Methods. Within the period from January 1st 2006 to February 1st 2007 at the Clinic for Ophtalmology, Military Medical Academy, Belgrade a total of 25 patients with esotropia (34 eyes) and previously corrected refraction anomaly and treated amblyopia were operated on. The patients were 4-19-year of age. All of the patients were submitted to a complete ophtalmologic and orthoptic examination prior to the surgery, and a month, three months and six months after the surgery. The surgery was performed under general anesthesia. Out of the total number of the patients nine were operated on both eyes, while 16 patients on one eye with amblyopia or frequent esodeviation. Nine patients were submitted to retroposition of the inner straight muscle, two to myectomy of the outer straight muscle, while in 14 of the patients a combination of retroposition and myectomy was performed. The patients were divided into three groups according to the preoperative angle at the distance and followed-up accordingly after the surgery. Deviation angle at the distance in the group I was 18-25 DP, in the group II 26-35 PD, while in the group III it was 36-60 PD. Results. The most numerous, group I (12 patients; 48%), a month following the surgery showed angle reduction by 55.58%, after three months 63.25%, and after six months 63.92%. The group II consisted of 8 patients (32%) showed angle reduction by 70.75% a month following the surgery, by 76% after three months, and by 79.12% after six months. The group III (5 patients; 20%) showed angle reduction by 72.20% a month following the surgery, 79.20 after three months, and 80.12% after six months following the surgery. Conclusion. The best postoperative outcomes after a month, three and six months were obtained in the group of patients with the highest esodeviation angle at the distance solved by the surgery on both eyes. Timely surgical treatment befell into major precondition for developing and maintaining the elements of binocular vision in the operated on patients. .

Results of applying minimally invasive two-stage decompression with bone alloplasty for avascular necrosis of the femoral head

2021 ◽  
Vol 19 (3) ◽  
pp. 69-74
Author(s):  
A. V. ANTONOV ◽  
◽  
V. E. VOLOVIK ◽  
A. G. RYKOV ◽  
S. N. BEREZUTSKIY ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Femoral Head ◽  
Minimally Invasive ◽  
Avascular Necrosis ◽  
Hip Joint ◽  
Rapid Development ◽  
Young Patients ◽  
Walking Distance ◽  
Joint Function ◽  
Two Stage

Avascular necrosis of the femoral head is a complex medical and social problem. The rapid development of the disease, the complexity of diagnosis and the prevalence among young patients leads to impaired hip joint function and further disability. To improve the quality of life of patients, the Orthopedic Department of the Traumatology Center of Khabarovsk developed a method of minimally invasive two-stage decompression. Surgical treatment was performed in 30 cases in patients with ANFH of stages 0, 1, 2 (by ARCO). Evaluation of treatment results was carried out before operative treatment, after 6 and 12 months. 12 months after surgical treatment, positive dynamics was noted, namely, pain reduction, a walking distance increase, abandonment of crutches, opportunity to use public transport, ability to sit for a long time in one and the same position, to put on shoes, and the abandonment of constant intake of non-steroidal anti-inflammatory drugs. The assessment of hip joint function in 20% of cases showed an excellent result, in 26,6% of cases — a good result, in 40% — satisfactory, and in 13,3% (4 people) — unsatisfactory result, which proves the effectiveness of the proposed treatment method and the feasibility of its use.

scholarly journals Condition of hearing sense and tinnitus before and after the treatment of otosclerosis

2010 ◽  
Vol 63 (9-10) ◽  
pp. 648-651
Author(s):  
Negra Terzic ◽  
Vladimir Jakovljevic ◽  
Nada Milanovic ◽  
Violeta Jacimovic ◽  
Ljubica Zivic
Keyword(s):  
Surgical Treatment ◽  
Subjective Assessment ◽  
Hearing Improvement ◽  
Functional Diagnostics ◽  
Bony Labyrinth ◽  
Military Medical Academy ◽  
Medical Academy ◽  
Before And After ◽  
Stapes Prosthesis ◽  
One Year

Introduction. Otosclerosis is an osteodystrophy disease of the bony labyrinth of the ear which leads to stapes fixation and to bradyecoia of a conductive type. The microsurgical treatment by the use of a stapes prosthesis provides hearing improvement and a reduction or disappearing of tinnitus. The aim of our study was to determine the hearing condition and tinnitus before and after the treatment of otosclerosis. Material and methods. A hundred patients with otosclerosis, aged 20 to 70, were surgically treated at the Otorhinolaryngology Clinic and the Functional Diagnostics, Military Medical Academy, Belgrade. After the treatment, the audiometric examinations were performed in order to assess the hearing condition and tinnitus was assessed by a questionnaire. The subjective assessment of tinnitus was ranged as present, reduced or absent. Results. Before the treatment, hearing impairment was present in all the patients, while tinnitus was found in 91% of them. One year following the surgical treatment hearing improvement was found in 96% of the patients, and tinnitus cessation in 89% of them. Conclusion. The surgical treatment can result in hearing improvement and cessation or reduction of tinnitus.

Complications Following One-Stage Versus Two-Stage Surgical Treatment of Transverse Maxillary Hypoplasia

2021 ◽  
Author(s):  
Oliver da Costa Senior ◽  
Maximiliaan Smeets ◽  
Robin Willaert ◽  
Eman Shaheen ◽  
Reinhilde Jacobs ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Stage Versus ◽  
Two Stage ◽  
Maxillary Hypoplasia ◽  
One Stage

Surgical treatment of an unstable varus knee: one-stage or two-stage?

2008 ◽  
Vol 92 (2) ◽  
pp. 137-138
Author(s):  
Lamberto Felli ◽  
Roberto Binazzi ◽  
Luca Biglieni
Keyword(s):  
Surgical Treatment ◽  
Varus Knee ◽  
Two Stage ◽  
One Stage

scholarly journals Prognostic significance of tympanosclerotic plaques localization and their morphological and histological characteristics for the outcome of surgical treatment

2012 ◽  
Vol 69 (2) ◽  
pp. 190-194 ◽  
Author(s):  
Milanko Milojevic ◽  
Dragoslava Djeric ◽  
Dusan Bijelic
Keyword(s):  
Surgical Treatment ◽  
Middle Ear ◽  
Prognostic Significance ◽  
Morphological Characteristics ◽  
Histological Findings ◽  
Surgical Success ◽  
Surgery Outcome ◽  
Military Medical Academy ◽  
Medical Academy ◽  
Histological Characteristics

Background/Aim. Tympanosclerosis is a sequela of inflammation of the middle ear usually causing conductive hearing loss. The aim of the study was to determine the significance of tympanosclerotic plaques localization in the middle ear and their morphological and histological characteristics for surgical treatment outcome. Methods. This retrospective study included a total of 73 patients operated on for tympanosclerosis in the Clinic for Otorhinolaryngology, Military Medical Academy (MMA) in a period 1996-2010. The results of surgical treatment as well as the last audiometry findings were analyzed. considering follow-up periods of 6 months to 8 years. The patients were divided into 4 groups according to tympanosclerotic plaques localization in the middle ear and the classification suggested by Wieling and Kerr. The patients were also divided based on intraoperatively noticed morphological characteristics of tympanosclerotic plaques, while the third division was done as per histological findings. Surgical success was assessed using the suggestions of the Japan Otological Society. Results. The analyzed results showed the surgical success especially in the group II according to Wieling and Kerr, while histological findings had no impact on the outcome of the surgery. Conclusion. Surgical treatment has good results especially in patients with the mobile stapes. Results are satisfactory in other localizations, while various morphological and histological characteristics do not have impact on the surgery outcome.

scholarly journals Algorithm for Surgical Treatment of Children with Hirschsprung’s Disease

2019 ◽  
Vol 26 (3) ◽  
Author(s):  
Oleh Kurtash
Keyword(s):  
Surgical Treatment ◽  
Early Detection ◽  
Minimally Invasive ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Radical Surgery ◽  
Second Stage ◽  
One Stage ◽  
Surgical Methods ◽  
Protective Colostomy

Hirschsprung’s disease requires surgical treatment. Depending on the form of aganglionosis and severity of pathology, open or minimally invasive, one-stage or multi-stage radical surgery may be used. The objective of the research was to develop an algorithm for surgical treatment of children with Hirschsprung’s disease. Materials and methods. The analysis of surgical treatment of 1,129 children with different forms of Hirschsprung’s disease aged from birth to 18 years over the period 1980-2018 was conducted. All the patients underwent both traditional and minimally invasive radical surgery. Results and discussion. The patients were divided into three groups; each group was characterized by modernization of surgical methods, as well as intensification of diagnostics for early detection of such patients. Radical surgery without a protective colostomy was used in 773 (68.46%) cases, while in 356 (31.53%) cases, a protective colostomy was created. Due to the intensification of diagnostics that markedly contributed to early detection of patients with various forms of Hirschsprung’s disease, during each study period, there was observed a dramatic decrease in the number of stoma patients with a significant increase in the number of children diagnosed with Hirschsprung’s disease: from 68.54%  (1980-1992) to 37.93% (1993-2010) and 12.00% (2011-2018). Conclusions. Timely diagnostics contributes to early detection of children with different forms of Hirschsprung’s disease. In uncomplicated forms of Hirschsprung’s disease, it is reasonable to perform one-stage radical surgery, namely the resection of the aganglionic segment and the affected colon segment followed by colorectal anastomosis. In severe Hirschsprung’s disease, two-stage surgery should be used: creation of a protective colostomy (the first stage) and radical surgery (the second stage). In some cases, in colectomy, three-stage surgical approach is needed, namely the creation of a protective colostomy (the first stage), radical surgery (the second stage) and protective colostomy closure (the third stage).

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