scholarly journals Early and late results of surgical treatment of multifocal epilepsy

2009 ◽  
Vol 8 (1(2)) ◽  
pp. 42-45
Author(s):  
V. R. Kasumov

Studies of surgical outcomes in multifocal epilepsy patients showed them to depend on epileptic foci sites in two groups of the diseased according to J. Engel scale (1993): 92 early postoperative period patients (group 1), and 30 late one patients (group 2). Of 92 group 1 patients unilateral cortical epileptic foci were diagnosed in 62 (51.7%), bitemporal ones in 30 (20.0%) patients. Of 30 group 2 patients – unilateral cortical in 17 (42.5%), and bitemporal in 13 (32.5%) patients. In group 1 remission of the seizures and decrease of their frequency over 80.0% was achieved in 80.4% of the patients, in group 2 – decrease of seizure frequency over 50.0% in 67.7%, and recurrent seizures in 26.7% of the patients.

Author(s):  
С.В. Журавель ◽  
Н.К. Кузнецова ◽  
В.Э. Александрова ◽  
П.В. Гаврилов ◽  
А.М. Талызин ◽  
...  

Введение. Терапевтическое использование раствора человеческого альбумина у пациентов в периоперационном периоде трансплантации печени (ТП) представляет интерес в контексте осложнений и исходов операции. Цель исследования: оценить влияние интраоперационной трансфузии 25% раствора человеческого альбумина на течение раннего послеоперационного периода при ортотопической ТП от посмертного донора. Материалы и методы. В исследование включены 47 пациентов, которым была выполнена трупная ТП. Были сформированы 2 группы: пациенты группы 1 (n = 21) получали трансфузию 25% раствора человеческого альбумина в конце операции ТП и через 24 ч после операции; пациенты группы 2 (n = 26) получали трансфузию 25% раствора человеческого альбумина в первые сутки послеоперационного периода. Осуществляли контроль лабораторных параметров крови пациента перед началом оперативного вмешательства, через 24 ч и через 48 ч после операции. Интраоперационно оценивали значения систолического (САД) и диастолического (ДАД) артериального давления, частоту сердечных сокращений (ЧСС), дозу вазопрессоров, объем инфузионно-трансфузионной терапии, кровопотерю и диурез. В послеоперационном периоде фиксировали возможные осложнения, проведенные сеансы заместительной почечной терапии (ЗПТ), а также количество дней в стационаре. Результаты. Оценка значений САД, ДАД и ЧСС в начале и конце операции показала достоверно лучшие показатели гемодинамики и снижение дозировок вазопрессорной поддержки в конце вмешательства в группе 1 по сравнению с группой 2 (p < 0,05). В послеоперационном периоде инфекционные осложнения зарегистрированы у одного пациента группы 1 и у трех пациентов группы 2. Проведение ЗПТ потребовалось двум пациентам из группы 2. Все пациенты обеих групп были выписаны из стационара, при этом число дней госпитализации в группе 2 было статистически значимо больше по сравнению с пациентами группы 1: 26,9 ± 3,9 против 17,2 ± 4,3 (p < 0,05). Заключение. Интраоперационная инфузия 25% раствора альбумина позволяет стабилизировать показатели гемодинамики в конце операции ТП, снизить потребность в кардиотонической поддержке и сократить время госпитализации у пациентов после ТП. Background. The therapeutic use of human albumin solution in patients in the perioperative period of liver transplantation (LT) is of interest in the context of complications and outcomes of surgery. Objectives: to assess the effect of intraoperative transfusion of 25% human albumin solution on the early postoperative period in orthotopic LT from a postmortem donor. Patients/Methods. The study included 47 patients who underwent cadaveric LT. Two groups were formed: patients in group 1 (n = 21) received transfusion of 25% human albumin solution at the end of LT and 24 hours after surgery; patients in group 2 (n = 26) received transfusion of 25% human albumin solution on the first day of the postoperative period. The laboratory parameters of the patient’s blood were monitored before surgery, 24 hours later, and 48 hours after surgery. Intraoperatively, the values of systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), dose of vasopressors, volume of infusion- transfusion therapy, blood loss and diuresis were assessed. In the postoperative period, possible complications, renal replacement therapy (RRT) sessions performed, and the number of days in the hospital were recorded. Results. Assessment of SBP, DBP and HR values showed significantly better hemodynamic parameters and reduced dosages of vasopressor support at the end of surgery in group 1 compared to group 2 (p < 0.05). In the postoperative period, infectious complications were registered in one patient of group 1 and in three patients of group 2. Two patients from group 2 required RRT. All patients were discharged from the hospital, while the number of hospitalization days in group 2 was statistically significantly greater than in patients in group 1: 26.9 ± 3.9 versus 17.2 ± 4.3 (p < 0.05). Conclusions. Intraoperative infusion of 25% albumin solution allows stabilizing hemodynamic parameters at the end of LT surgery, reducing the need for cardiotonic support and shortening the hospitalization time in patients after LT.


2020 ◽  
Vol 10 (1) ◽  
pp. 19-24
Author(s):  
Igor Sergeevich Shormanov ◽  
Marina S. Los ◽  
Maxim V. Kosenko ◽  
Natalia S. Shormanova

Objective. To study the adaptive capacity of a single remaining kidney in the early postoperative period of nephrectomy in an experiment. Materials and methods. The experiment involved 35 laboratory white rats, which were divided into three experimental groups. Group 1 (n = 5) intact animals, group 2 (n = 15) animals underwent nephrectomy on the left; group 3 (n = 15) animals underwent nephrectomy and additionally were created 90 minute hypoxic hypoxia. Histological material was collected on the 5th, 21st and 60th days after surgery. Results. Characteristic morphological changes in the only remaining kidney were an increase in the size of the glomeruli and a decrease in their number. Nephron fibrosis was detected, accompanied by increased production of antigens by the tubular epithelium, which is likely a response to a cascade increase in oxidative stress and increased release of cytokines that stimulate the production of intrarenal collagen. Conclusion. Nephrectomy and hypoxia are provocateurs for the development of systemic distress syndrome, the result of which is the formation of a vicious pathogenetic circle, which reduces the functionality of the renal tissue. This can be considered as one of the early preclinical mechanisms for the initiation of single kidney disease in the future.


Perfusion ◽  
2005 ◽  
Vol 20 (2) ◽  
pp. 71-75 ◽  
Author(s):  
Edmundas Sirvinskas ◽  
Tadas Lenkutis ◽  
Laima Raliene ◽  
Audrone Veikutiene ◽  
Jolanta Vaskelyte ◽  
...  

Autotransfusion of the residual blood from the cardio-pulmonary bypass (CPB) circuit is considered to be one of the methods enabling reduction in the need for transfusion, the possible adverse effects of which are well known and documented. The aim of the study was to evaluate the effectiveness of the autologous autotrans-fusion of centrifuged red blood cells from the residual blood of the CPB circuit in patients following heart surgery. Three groups of patients who underwent heart surgery were examined. The first group (Group 1) consisted of 37 patients who received all of the residual blood in the bypass circuit after CPB (collected into sterile plastic bags) during the early postoperative period. The second group (Group 2) consisted of 45 patients who did not receive the residual blood following CPB. The third group (Group 3) consisted of 42 patients who underwent re-infusion of centrifuged red blood cells from the residual blood remaining in the CPB circuit during the early postoperative period. Hematocrit (Hct) values 12 hours after the operation were found to be higher in Group 3 compared with those of the first and the second groups (by 13.2% and 11.1%, respectively). Blood loss during the first 12 hours after the operation and during the time spent in the intensive care unit did not differ between the groups. The number of transfusions was significantly lower in Group 3 (28.57%) in comparison with that of Groups 1 and 2 (37.83% and 38.10%, respectively). The rate of infective complications in Group 3 was lower in comparison with both Group 1 and Group 2 (9.2% and 18.1%, respectively). The duration of in-hospital stay in Group 3 was 25.8% shorter than Group 1. We conclude that autotransfusion of centrifuged red blood cells processed from the residual blood of the CPB circuit after CPB was effective in increasing Hct values 12 hours postoperatively, reducing the need for donor blood product transfusions, the rate of infective complications and lenght of stay in hospital.


2020 ◽  
Vol 8 (08) ◽  
pp. 387-395
Author(s):  
İsmail Kaya ◽  
İlker Deniz Cingöz ◽  
Nurullah Yüceer

Introduction and Objectives: We aimed at evaluating retrospectively effects of surgery on the clinical symptoms and signs and imaging parameters in the patients with Chiari's malformation undergoing surgical treatment. Materials and Methods: Medical charts and radiological images of the patients with Chiari's Malformation type I who had surgical treatment between January 2008 and July 2014 were reviewed retrospectively. The patients were classified as those having good (in whom the symptoms disappeared or reduced), stabilized (with preoperative symptoms persisting without any progression), or poor (with preoperative symptoms progressing in the postoperative period) outcomes. Findings: All patients underwent FMD, Cl laminectomy and duraplasty. Seventeen subjects underwent removal of arachnoid adhesions, 10 subjects underwent opening of the fourth ventricle, and one subject underwent subpial resection. Of the patients, 28 were female and 11 were male with ratio of females to males being 25:1. The youngest patient was 5 years old and the eldest one was 51 years old, and mean age of the patients was 3231 ± 3131 years. The subjects were divided in two groups based on presence or absence of associated syringomyelia: those with syringamyelia (Group 1, n = 15) and those without syringomyelia (Group 2, n = 24). Postoperatively, in the Group 1 (SM 1- CM) 10 (66.7%) patients had good, 3 (20%) had stabilized and 2 (133%) patients had poor surgical outcomes. In the Group 2, 23 (918%) subjects had good and 1 (4.2%) subject had stabilized outcomes. For the Group 2, rate of recovery was higher than in the Group 1 (918% and 66.7%, respectively; Pearson's chi-square test, P = 0.014). Rate of recovery in 21 subjects with degree of tonsillar herniation being more than 11 mm (95.2%) was statistically significantly higher than 18 subjects with degree of tonsillar herniation being less than 11 mm (72.2%) (Pearson's chi-square test, P = 0.047). Results: FMD is a safe and efficient surgical method for the Chiari malformations with or without associated syringomyelia. The subjects without associated syringomyelia benefited more from the surgery. Complications related to CSF may be reduced using additional tissue glues. Studies with greater number of cases should be conducted on the effect of degree of tonsillar herniation on surgical outcomes.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 717-718
Author(s):  
S. Avetisov ◽  
I. Razumova ◽  
K. Avetisov ◽  
A. Godzenko

Background:Uveitis is a common extra-skeletal manifestation of various systemic diseases, in particular, spondyloarthritis (SpA). Uveal cataract is the frequent complication of endogenous uveitis. Surgical treatment of uveal cataracts is associated with certain problems, the main being a potential risk of recurrence of uveitis, especially in the case of intraocular lens (IOL) implantation.Objectives:To analyse the results of surgery of complicated uveal cataract in patients with SpA and other rheumatic disorders.Methods:30 pts (34 eyes) with uveal cataract as a result of systemic immuno-inflammatory diseases were assessed in the “Research Institute of Eye Diseases” in the period from 2006 to 2018. The postoperative follow-up period ranged from 2 to 12 years. 20 pts had different variants of SpA (Group 1):7 (7 eyes) - ankylosing spondylitis, 1 (1 eye) –reactive arthritis, 1 (1 eye) - psoriatic arthritis, 4 (6 eyes) – juvenile spondyloarthritis, 8 (8 eyes) non-radiological SpA. 10 patients (11 eyes) had other systemic diseases (Group 2): 1 (1 eye) Behcet’s disease, 1 (1 eye) - multiple sclerosis, 3 (3 eyes) - Fuchs heterochromic cyclitis, 2 (2 eyes) -cutaneous psoriasis, and 3 (4 eyes) -uveitis of unknown etiology. 4 pts (6 eyes) with juvenile arthritis and pronounced corneal ribbon degeneration were underwent standard intracapsular cryoextraction of the cataract, followed by optical correction of aphakia using spectacle lenses. In other cases, ultrasound phacoemulsification with IOL implantation was used as a surgical aid. All patients had a period of uveitis remission before opreation for at least 2 months.Аnti-inflammatory therapy using local glucocorticoid and local and systemic nonsteroidal antiinflammatory drugs was prescribed 2 weeks before and within a month after the operation. Intra and postoperative complications, fluctuations in intraocular pressure (IOP), improvement of visual acuity, and the frequency of uveitis flares after surgery were assessеd as the main criteria for analyzing the results of surgery.Results:А statistically significant decrease in the number of uveitis exacerbations was observed in all pts: in group 1 - from 2,5 ± 0,65 to 1, 2 ± 0,65 per year (p<0.0001), in group 2 - from 2,55 ± 0,21 to 0,89 ± 0,21 per year (p<0.0001), while there were no statistically significant differences between the groups (p=0.31). Statistically significant increase in maximum visual acuity was observed in all groups: in group 1 - from 0,2± 0,38 to 0,58 ± 0,74, p<0.0001, in group 2 – from 0,24 ± 0,05 to 0,69 ± 0,07, p<0.0001. No complications were observed during operations. The phenomena of bullous keratopathy after intracapsular extraction were noted in 2 pts with juvenile arthritis and ribbon-like corneal degeneration. No рrogression of corneal changes was observed. Opacity in the central zone of the posterior capsule in the period from 2 to 24 months after surgery occurred in 7 cases. In all cases, laser dissection of the posterior lens capsule was performed. Transient increase in IOP in the early postoperative period, normalized by local hypotensive therapy, occurred in 8 cases in groups I. In the long- term follow-up period (2-24 months), persistent IOP decompensation occurred in 6 cases in groups 1 and in 3 cases in groups 2, which required various types of anti-glaucoma operations. Cystic macular edema developed in one case 5 months after surgery as a result of uveitis exacerbation and was stopped by corticosteroid therapy.Conclusion:Surgery of uveal cataracts in pts with SpA and other immuno-inflammatory diseases providing adequate pre- and postoperative аnti-inflammatory therapy improves visual acuity and reduces the frequency of uveitis relapses. Monitoring of IOP is necessary in the postoperative period.References:[1]Mora P., Gonzales S., Ghirardini S. et al. Perioperative prophylaxis to prevent recurrence following cataract surgery in uveitis patients a two-centre, prospective, randomized trial. Acta Ophthalmol. Scandinavica Fondation. 2016 Sept.; 94(6): e 390-394. http//doi. 10.1111/aos.12955. Epub 2016 Feb 5.Disclosure of Interests:None declared


2020 ◽  
Vol 27 (2) ◽  
pp. 38-48
Author(s):  
L. A. Bokeria ◽  
V. S. Arakelyan ◽  
V. G. Papitashvili ◽  
S. Sh. Tzurtzumia

Aim. To compare the results of lower limb revascularization in patients with diffuse lesions of lower limb arteries who underwent femoral-distal bypass surgery and isolated reconstruction of the deep femoral artery (DFA) in the immediate postoperative period.Materials and methods. The study included 86 patients with diffuse arterial lesions of lower extremities, 52 (60.4%) men and 34 (39.6%) women with the average age of 67.3 ± 16.8 years. All patients had diffuse lesions of the arteries below the Poupart’s ligament; the condition of the lower leg arteries was 5–8.5 points on the Rutherford scale. Trophic ulcers were present in all cases. Group 1 included 48 patients who underwent reconstruction of lower leg arteries. Group 2 included 38 patients whose surgical intervention was limited to endarterectomy from the common femoral and deep femoral arteries.Results. In the early postoperative period, 1 (2.1%) patient (from group 1) died from developed myocardial infarction. The patient underwent a femoral-popliteal-tibial bypass surgery with a composite Y-shaped graft. In group 2, no fatal complications were observed. After the operation, all patients demonstrated an increase in the linear blood flow velocity in the arteries of the foot and the transcutaneous oxygen tension (TOT). The TOT level 14 days after surgery comprised 44.1 mm Hg and 39.9 mm Hg (p> 0.05) in groups 1 and 2, respectively.Conclusions. In 86.8% of patients, isolated profundoplasty followed by vasotropic therapy allows the target values of TOT to be obtained, which is necessary for successful healing of lower limb trophic ulcers.


2015 ◽  
Vol 18 (3) ◽  
pp. 32
Author(s):  
E. R. Charchyan ◽  
A. B. Stepanenko ◽  
N. A. Galeev ◽  
A. A. Skvortsov ◽  
A. P. Gens

The problem of sternal osteosynthesis after cardiac surgery is relevant because of a relatively high incidence of postoperative complications associated with inadequate sternal consolidation. The use of nitinol clips is one of the reliable and versatile methods of sternal osteosynthesis. Our research included 208 postoperative patients with different cardiac surgical pathologies. All interventions were carried out with cardiopulmonary bypass using median sternotomy. Patients were divided into 2 groups according to sternal fixation methods: group 1 (105 patients) - wire suture osteosynthesis, group 2 (103 patients) - nitinol clips closure. The short-term postoperative results were analyzed by using the major criteria for comparison. Radiographically confirmed varying degrees of sternal defects in the immediate postoperative period were observed in 15.2% of patients in group 1 and 3.8% of patients in group 2. In group 1 significant sternal defects requiring sternal refixation were observed in 4.8% of patients; in group 2 no such cases were identified. The mean blood loss in the drainages for 24 hours after surgery in group 1 was 351 65 ml; in group 2 - 192 43 ml. The total number of resternotomies for bleeding in group 1 was 6.7% of cases, with half of them being the patients with the source from the sternum in the site of wire sutures, while in group 2 4.9% patients underwent resternotomy, with no bleeding from the sites of clip fixation. Thus, the use of nitinol clips after longitudinal median sternotomy is a more reliable method of sternal osteosynthesis (as compared with the classical method), which enables us to minimize the risk of damage to the retrosternal structures, preserve sternal consolidation and reduce blood loss in the drainages in the early postoperative period.


2020 ◽  
Vol 5 (1) ◽  
pp. 39-43
Author(s):  
A. Shaumarov ◽  
Kh. Shaikhova ◽  
J. Djuraev.

The study included 45 patients, combined into three groups. In group 1, endoscopic septoplasty was used, in group 2 -standard septoplasty, and in group 3 -modified septoplasty using a hemostatic sponge, which acted as an alternative to nasal tampons.


2014 ◽  
Vol 21 (3) ◽  
pp. 67-71
Author(s):  
I. A Norkin ◽  
S. P Shpinyak ◽  
M. V Girkalo ◽  
A. P Barabash

Surgical outcomes were analyzed for 108 patients with infectious complications developed at different terms after large joints arthroplasty. When complications develop in the early postoperative period than independently of the process depth and in stable implant components radical surgical debridement of the inflammation focus is indicated. In the rest of cases the removal of all implant components with subsequent either joint arthrodesis or revision arthroplasty using spacers of different modifications should be performed. We consider spacer application to be a method of choice as it enables to preserve extremity function and to perform revision arthroplasty in future.


2020 ◽  
Vol 87 (5-6) ◽  
pp. 41-45
Author(s):  
Ya. P. Truba ◽  
M. P. Radchenko ◽  
I. V. Dzyurii ◽  
O. S. Golovenko ◽  
V. V. Lazoryshynets

Objective. To analyze immediate and late results of a one-stage surgical treatment of the main arteries transposition in conjunction with obstruction on the level of aortal arch. Materials and metods. For the period 2010 - 2019 yrs in Amosov National Institute of Cardiovascular Surgery and Scientific-Practical Medical Centre of Pediatric Cardiology and Cardio-Surgery in 52 newborn babies a one-stage correction of the main arteries transposition with obstruction on the level of aortal arch was conducted. In the investigation were included only the patients with a two-ventricle physiology and further two-ventricle correction. There were 35 (67.3%) boys and 17 (32.7%) girls. Average age of the patients was (0.6 ± 0.3) mo, average body mass - (3.6 ± 0.8) kg. The main method of diagnosis in determination of the failure and estimation of immediate and late results was echocardiographic examination. In 24 (46.2%) of the patients while doing reconstruction of the aortal arch a selective antegrade cerebral perfusion was conducted. Results. Hospital mortality have constituted 3.8% (n=2). Duration of artificial blood circulation have constituted (194.3 ± 73.1) min, aortal clamping - (108.5 ± 35.6) min, selective cerebral perfusion - (19.6 ± 7.2) min. In early postoperative period 6 (11.5%) patients have been with desintegrated sternum. Average duration of observation have constituted (3.7 ± 2.8) yr (from 1 no to 9.yrs). In late period one child died. In 5 (9.6%) patients in postoperative period restenosis in aortal arch have developed, who was successfully curated endovascularly, using balloon dilatation in 3 patients, In two secondary plasty of aortal arch was done surgically. Tracheal or the main bronchi compression, neurologic complications were not observed in remote period. Conclusion. One-stage correction of the main arteries transposition together with the aortal arch hypoplasia - an effective and secure method of treatment of a newborn children with good immediate and late results. The investigation conducted gives a background to conclude, that this surgical strategy constitutes the affordable alternative to two-staged surgical treatment of this complex pathology.


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