scholarly journals Preoperative Preparation of Patients with Anemia before Shoulder Replacement

2021 ◽  
Vol 18 (3) ◽  
pp. 53-57
Author(s):  
S. V. Sokolov ◽  
V. А. Gluschenko

The preoperative anemia in patients increases the risk of perioperative blood transfusion, myocardial infarction, ischemic stroke, acute kidney injury, and higher nosocomial and 30-day mortality, lengthens the duration of treatment, and increases the risk of re-hospitalization.The objective: to improve treatment results of patients after revision shoulder replacement through management of preoperative anemia.Subjects and methods. 170 medical files of patients who underwent revision shoulder replacement from 2014 to 2021 were retrospectively analyzed. On the day when they were examined by the physician, all patients had blood hemoglobin level below 130 g/l. The patients were divided into two groups that were comparable in their characteristics. Patients of the Main Group (n = 90) received preoperative preparation with iron carboxymaltate in combination with recombinant human erythropoietin 4 weeks before the expected date of surgery. Patients of the Control Group (n = 80) did not have any specific preparation.Results. The data obtained showed that the volume of intraoperative and postoperative drainage blood loss did not differ statistically between the groups; hemoglobin blood level in patients from the Main Group was statistically significantly higher both before the surgery and on the first day after it, and no hemotransfusion was indicated. In the Control Group, a statistically significantly greater decrease in hemoglobin level was observed in the postoperative period; 3 (3.8%) patients in the Control Group required RBC-transfusion. Complications in the early postoperative period (myocardial infarction, pulmonary embolism, and cardiac arrhythmia) were significantly less frequent in the Main Group versus the Control one (4.5% of cases vs. 8.8%; p < 0.05).Conclusion. The use of iron carboxymaltate at the dose of 1,000 mg once and, if necessary, repeatedly in 14 days in combination with recombinant human erythropoietin at the dose of 150 IU/kg allows preparing patients for revision shoulder replacement within the period from two weeks to one month. Preoperative management of anemia until the hemoglobin concentration reaches 130 g/l using the proposed regimen can significantly reduce the need for blood transfusion and frequency of somatic complications in the early postoperative period.

2021 ◽  
Vol 1 ◽  
pp. 75-79
Author(s):  
Yu.P.  Vdovichenko ◽  
V.I.  Boyko ◽  
V.A.  Terehov

The objective: to analyze the results of repeated laparoscopy in gynecological patients with suspected intraperitoneal postoperative complications.Materials and methods. The study involved 42 patients (mean age 46±11,3 years), in whom postoperative abdominal complications after surgical treatment of various gynecological diseases required repeated operations. Depending on the method of re-intervention, the patients were divided into 2 groups: the main group (n=20) – women who only used laparoscopy to correct postoperative complications; control (n=22) – women who were given indications for relaparotomy to correct postoperative complications during diagnostic laparoscopy. Relaparotomy was performed in 8 patients of the control group. All patients underwent a comprehensive examination using clinical, instrumental and laboratory research methods. The groups were homogeneous in terms of age and structure of operations performed on the pelvic organs, and statistically comparable.Results. During the study, the results of repeated laparoscopy of 34 gynecological patients with suspected intraperitoneal postoperative complications were analyzed. In all patients of the main group (47,6%), laparoscopy was revealed as the only and final method of treatment of postoperative complications, while in 7 women repeated relaparoscopy was used from 2 to 4 times, and in 13 women laparoscopy was performed once. In the control group (53,3%), 10 patients during diagnostic laparoscopy were exposed to indications for relaparotomy, in 4 patients the capabilities of the operating team and laparoscopic technique allowed performing some elements of the operation and completing it with a minilaparotomy approach, and 8 patients underwent relaparotomy immediately.Peritonitis and intraperitoneal bleeding prevail in the structure of early abdominal complications. The use of the video laparoscopic technique made it possible in 28,6% of patients with diffuse peritonitis to successfully eliminate the developed complication, eliminate its source and sanitize the abdominal cavity. Laparoscopic hemostasis was successfully performed in 7 patients.Compared with the standard, the use of video endoscopic technique allowed improving the indicators of diagnostic value: to increase the sensitivity level by 1,07 times, specificity by 1,39 times and diagnostic accuracy by 1,11 times.Conclusion. In general, in the early postoperative period, 47 relaparoscopies were performed for suspected complications, which is explained by programmed abdominal sanitization and the use of dynamic laparoscopy to control the course of intraperitoneal complications. Based on the analysis of the material under study, we proposed general indications and contraindications for relaparoscopy in the early postoperative period in order to diagnose and treat postoperative complications. Justifying each of the points, we were guided by the real possibilities of the method in general clinical practice, which in some cases are inferior in their effectiveness to relaparotomy.


2021 ◽  
Vol 18 (3) ◽  
pp. 539-545
Author(s):  
N. V. Maychuk ◽  
I. A. Mushkova ◽  
M. R. Obraztsova

Relevance. Corneal refractive surgery is a modern, dynamically developing segment of ophthalmology that provides highly predictable, safe and stable refractive results in patients with a wide range of ametropias. Corneal refractive surgery, usually is chosen by patients who lead an active lifestyle and need rapid medical and social rehabilitation, people with high requirements for the quality of life and showing increased expectations for the result of correction. Perhaps this is due to the fact that, according to a survey at the exit of the Department of refractive laser Surgery of the S.N. Fyodorov Eye Microsurgery Federal State Institution of the Russian Ministry of Health, Moscow, conducted after consulting a surgeon with a description of the course of the operation and the postoperative course, about 1 % of patients refuse surgery, fearing painful sensations in the postoperative period, and 23.4 % of the expected postoperative discomfort causes strong concerns.Purpose. To study the clinical efficacy and safety of Broxinac (0.09 % bromfenac solution) in the early postoperative period of corneal refractive surgery.Materials and methods. The study included 168 patients (168 eyes) with moderate and high myopia after PRK (24 eyes), FemtoLASIK (78 eyes) and ReLEx SMILE (66 eyes), divided into equal subgroups: in the main group, Broxinac was instilled once 30 minutes after the operation, and in the control group — placebo. In the PRK subgroup of the main group, daily instillations of Broxinac were continued until complete reepithelization. The severity of the indicators “eye pain”, “photophobia”, “lacrimation”, “foreign body sensation” was evaluated on a five-point scale, the state of the corneal epithelium when stained with fluorescein, and overall satisfaction with the operation.Results and discussion. It is established that the analgesic effect occurred on average after 4.4 ± 0.6 minutes. Broxinac had a rapid, pronounced analgesic effect in patients in the early postoperative period after keratorefractive surgery, without slowing of corneal reepithelization, and can be recommended for use in clinical practice for analgesia and relief of aseptic inflammatory reaction in the early postoperative period after FemtoLASIK and PRK. The ReLEx SMILE does not require pain relief.Conclusion. Analgesia of the early postoperative period increases patient satisfaction with the result of the operation, popularizes it and helps to attract patients who previously refused surgical correction of ametropia due to fear of painful sensations.


2021 ◽  
pp. 68-71
Author(s):  
V. N. Gornostaev ◽  
R. A. Gurtskoy ◽  
V. V. Shulzhenko

The article reflects the results of the use of physical factors to restore the renal parenchyma in the early postoperative period after percutaneous nephroscopy in patients with urolithiasis. Material and methods: the study included 80patients with concretions of the renal pelvis after percutaneous nephroscopy (45men and 35women, average age — 46 years), who were divided into 2 comparable groups: groupI (main group) — 40 patients who underwent intravenous laser blood irradiation (ILBI) and ozone therapy — 6 procedures in the preoperative period, and polarized light and ILBI — 6 procedures in the early postoperative period; groupII (control group), which served as a background in the main group, were prescribed non-steroidal anti-inflammatory drugs after the surgery, taking into account bacterial urine culture. Inclusion criteria: patients with urolithiasis aged 28 to 62 years; indications for percutaneous nephroscopy. Exclusion criteria: concomitant diseases; compliance; pregnancy; acute inflammatory kidney diseases; abnormalities of the upper urinary tract. Results: The combined use of ILBI, ozone therapy and polarized light in the pre- and early postoperative period in patients with urolithiasis after percutaneous nephrolithotripsy allowed improving clinical, laboratory, subjective and objective indicators, as well as shortening the recovery period of the renal parenchyma, which was confirmed by the data of ultrasound studies in the dynamics in the form of a significant reduction in the recovery period of the index of renal vessels resistance and reduction of edema of the renal parenchyma. As a result of the application of the developed complex, the total bed-day of patients’ stay in the hospital decreased, and there was a rapid recovery of capacity to work. Conclusion: The developed method of the combined use of ILBI, ozone therapy and polarized light in the pre- and early postoperative period in patients with urolithiasis after percutaneous nephrolithiasis is pathogenetically justified and highly effective, which allows us to recommend it for wide use in urological practice.


2017 ◽  
Vol 95 (5) ◽  
pp. 445-450
Author(s):  
M. M. Petrova ◽  
S. V. Prokopenko ◽  
O. V. Eremina ◽  
E. Yu. Mozhejko ◽  
D. S. Kaskaeva ◽  
...  

Aim. The detection of cognitive deficiency after heart bypass surgery, the evaluation of the influence of piribedil on the higher cerebral function in the early postoperative period during the follow-up. Materials and methods. 64 patients with ischemic heart disease were examined. They were divided into two groups. Patients of the main group (n=32) were treated with pronoran (piribedil) at a daily dose of 50 mg for 3 months. 32 patients of the control group received standard therapy in the postoperative period. All patients had undergone heart bypass surgery. Cognitive functions were examined before operation, 10 days , three and six months after surgery. Results. Positive dynamics of all tested parameters was documented in the patients of the main group within 6 months after the onset of therapy. In control patients, cognitive disorders remained at the preoperative level based on the results of three tests. Conclusion. The positive results of piribedil therapy suggest that piribedil has positive effect on memory, attention and psychomotor activity of the patients


2019 ◽  
Vol 9 (3) ◽  
pp. 13-20
Author(s):  
Olga S. Streltsova ◽  
Dmitry P. Pochtin ◽  
Tatiana A. Gorbunova ◽  
Valery F. Lazukin ◽  
Ilya L. Sidnev

Inflammatory changes in the kidney that occurred in the early postoperative period due to surgical trauma, deterioration of microcirculation, hypoxia, are significant risk factors for the development of renal function violation. The aim of this work is to study the effect of the combined drug Uriclar (Asfarma-Ros) on the kidneys adaptive capability in the early postoperative period as a response to operative trauma of patients with complicated urolithiasis. The effect of surgical intervention percutaneous puncture nephrolithotripsy on the blood content of proteins of the acute phase of inflammation and cystatin C was studied. The results of examination of 35 patients (20 the main group and 15 the control group) were analyzed. The median age was 51 8.4 years. 20 patients of the main group began receiving Uriclar 2 capsules (430 mg) twice a day for 5 days before surgery and continued it for 1 month after surgery. Patients from the control group in the pre- and postoperative periods didnt receive Uriclar. The median age was 51 8.4 years. There was a statistically significant increase in the level of cystatin C and changes in biochemical markers in the patients of the main group only that indicates the presence of adaptogenic effect of Uriclar. Thus, the inclusion of a combined drug Uriclar in a complex treatment of patients with urolithiasis allows disturbed biological and adaptive functions of the kidneys to be corrected in the early postoperative period.


Author(s):  
A.L. Charyshkin ◽  
E.A. Keshyan

Surgery is the main method to treat obstructive intestinal obstruction. Stoma formation is desirable in emergency colon surgery. The aim of the study was to compare the results of the newly developed and traditional stoma formation techniques according to the number of wound purulent-inflammatory complications in the early postoperative period in patients with acute intestinal obstruction. Materials and Methods. The authors examined 62 patients with acute intestinal obstruction. The patients were divided into two groups according to the method of stoma formation. The comparison group consisted of 30 patients, who underwent traditional colostomy after obstructive resection of the sigmoid colon (rectosigmoid part of the colon). The main group included 32 patients in whom a stoma was formed using a newly developed method (patent No. 2704477). In patients of the main group, the paracolostomy space was isolated from the abdominal cavity, the preperitoneal and subgaleurotic zones of the paracolostomy space were drained. During the postoperative period local anesthetics and antibacterial drugs were administered through the drain tube. Results. Patients of the comparison group demonstrated more purulent-inflammatory complications of the median postoperative and paracolostomy wounds than those of the control group, 20.2 % (p=0.047) and 23.6 % (p=0.024), respectively. Conclusion. The proposed method of stoma formation helps to reduce wound purulent-inflammatory complications and can be used in the surgical treatment of patients with intestinal obstruction. Keywords: colon cancer, acute intestinal obstruction, postoperative complications, new method of stoma formation. Основным методом лечения обтурационной кишечной непроходимости является оперативное вмешательство. В экстренной хирургии толстого кишечника показано формирование колостомы. Цель исследования – сравнение результатов применения разработанной и традиционной методик наложения колостомы по количеству раневых гнойно-воспалительных осложнений в раннем послеоперационном периоде у больных с острой обтурационной кишечной непроходимостью. Материалы и методы. Клинический материал составили 62 пациента с острой обтурационной кишечной непроходимостью, которые в зависимости от способа формирования колостомы были разделены на две группы. Группу сравнения составили 30 больных, у которых после обструктивной резекции сигмовидной кишки (ректосигмоидного отдела ободочной кишки) выполняли традиционное наложение колостомы. В основную группу были включены 32 пациента, у которых колостома наложена разработанным способом (патент № 2704477). Суть способа состоит в изоляции от брюшной полости параколостомического пространства, дренировании предбрюшинной и подапоневротической зоны параколостомического пространства, введении местных анестетиков, антибактериальных препаратов по дренажу в послеоперационном периоде. Результаты. В группе сравнения гнойно-воспалительных осложнений срединной послеоперационной и параколостомической ран было больше, чем в контрольной группе, на 20,2 % (р=0,047) и 23,6 % (р=0,024) соответственно. Выводы. Предложенный способ формирования колостомы способствует снижению раневых гнойно-воспалительных осложнений и может быть использован в хирургическом лечении больных с обтурационной кишечной непроходимостью. Ключевые слова: рак ободочной кишки, острая обтурационная кишечная непроходимость, послеоперационные осложнения, оригинальный способ формирования колостомы.


2021 ◽  
Vol 23 (3) ◽  
pp. 250-255
Author(s):  
Khassan M.A. Diab ◽  
◽  
Khassan M.A. Diab ◽  
Nikolai A. Daikhes ◽  
Nikolai A. Daikhes ◽  
...  

The article is devoted to an urgent problem – the correction of hearing impairment in patients with concomitant diseases. The results of a comparative analysis of data from patients with somatic diseases who underwent cochlear implantation (CI) for severe to profound hearing loss hearing loss of the fourth degree and deafness under local and general anesthesia are presented. Materials and methods. On the basis of the National Medical Research Center for Otorhinolaryngology of the Federal Medical-Biological Agency of Russia, CI was performed under local anesthesia for 10 patients with concomitant diseases, which represented difficulties for the use of general anesthesia (main group). All patients in the preoperative stage precisely informed about each stage of the surgery and with the cue-cards (with questions) to maintain contact with them during CI. The control group consisted of 10 patients who underwent CI under general anesthesia. CI was performed according to a standard technique. After the operation, a survey of patients of both groups about subjective sensations during the operation and in the early postoperative period was carried out. Results. CI under local anesthesia takes an average of 18±5.2 min, taking into account the time of anesthesia, which is 15±5.3 min less than with general anesthesia (p<0.001). When performing CI under local anesthesia, clear thresholds for recording acoustic reflexes stapedial muscle are determined, since in this case the effect of muscle relaxants is excluded. Against the background of local anesthesia, the necessary effect was achieved rather quickly, there was no increase in blood pressure to high numbers, patients answered all the signs and questions by reading the information from the cue-cards. A survey of patients revealed a good tolerance to local anesthesia. The number of patients in the main group which had a complaints in the early postoperative period was less than in the control group (p<0.05). The duration of hospital staying in patients of the main group averaged 1.15 days (from 1 to 3 days), which is significantly less than in the control group – from 3 to 7 days, on average 4.05 days (p<0.05). When conducting CI under local anesthesia, none of the patients showed a destabilization of comorbidity pathology in the postoperative period. Conclusion. CI under local anesthesia in patients with concomitant pathology has several advantages over general anesthesia. The use of local anesthesia will increase the availability of CI for elderly comorbid patients and mitigate the risks of general anesthesia.


Author(s):  
Vladimir Bereznyuk ◽  
Alexander Chernokur ◽  
Oleg Gospod

Relevance: Modern endonasal surgery allows to remove polyps from all affected paranasal sinuses, following the principles of minimal invasiveness. Minimal traumatic of surgical intervention gives the best results, accompanied by less progression of the disease. Minimal invasiveness of surgical intervention and its obligatory combination with postoperative medical treatment are common practice in many countries. One of the drugs that actively effect the restoration of the mucous membrane of the nasal cavity and paranasal sinuses in the early postoperative period is Nazomer, which includes sodium hyaluronate and dexpanthenol in saline solution. The purpose of the study is to investigate the effectiveness of the drug Nazomer in patients with polyposis rhinosinusitis after endoscopic polyposynosotomy. Results and discussion: The main group consisted of 30 patients with polyposis rhinosinusitis, who were prescribed Nasomer in addition to standard treatment in the postoperative period. The control group included 30 patients who underwent standard treatment in the postoperative period. As criteria for clinical efficacy, data from endoscopic examination of the nasal cavity and indicators of anterior rhinomatometry, measured by the «Optimus» device, were selected. In the main group, the index of nasal breathing according to rhinomatometry was better than the results of patients in the control group on the 3rd and 5th day of the postoperative period by 26% and 24%, respectively. Conclusion: The use of the drug Nazomer in the postoperative period in patients with polyposis rhinosinusitis contributes to more active restoration of respiratory function of the nasal cavity compared with the control group, according to rhinomatometry, up to 26%. Based on the results obtained, the drug Nazomer is an effective anti-inflammatory and regenerative agent in the postoperative period in patients with polyposis rhinosinusitis.


2013 ◽  
Vol 38 (3) ◽  
pp. 119-123 ◽  
Author(s):  
BHN Yasmeen ◽  
MAKA Chowdhury ◽  
MM Hoque ◽  
MM Hossain ◽  
R Jahan ◽  
...  

Premature infants especially those with birth weight <1500 g suffer from Anaemia of prematurity (AOP) and associated problems. Erythropoietin therapy is a safe effective way to prevent and to treat anaemia of prematurity. To evaluate the effect of short term administration of recombinant human erythropoietin (rHuEPO) with iron and folic acid in very low birth weight (VLBW) neonates in the prevention of anaemia of prematurity. A randomized controlled trial was carried out at Dhaka Shishu Hospital. Sixty preterm very low birth weight (PTVLBW) babies were enrolled in this study. Thirty were assigned to rHuEPO group and 30 as control. Baseline haematologic values were estimated before administration of rHuEPO. From day 7 of life rHuEPO-200 IU/kg/dose subcutaneously every alternate day for 2 weeks was administered to rHuEPO group. All infants in both groups have received oral iron, folic acid from day 14. Clinical and haematological assessment was done at 6 and 10 weeks of life. Baseline clinical characteristics and haematologic values were almost similar in both groups. This study has shown increase in haematological values(haemoglobin and haematocrit) and reduction in the number of blood transfusions during both the 1st and 2nd follow up in rHuEPO group in comparison to control group (p<0.01). Short term rHuEPO appears to be very effective in prevention of Anaemia of prematurity. DOI: http://dx.doi.org/10.3329/bmrcb.v38i3.14340 Bangladesh Med Res Counc Bull 2012; 38(3): 119-123 (December)


2011 ◽  
Vol 18 (4) ◽  
pp. 3-10
Author(s):  
A V Krut'ko ◽  
Shamil' Al'firovich Akhmet'yanov ◽  
D M Kozlov ◽  
A V Peleganchuk ◽  
A V Bulatov ◽  
...  

Results of randomized prospective study with participation of 94 patients aged from 20 to 70 years with monosegmental lumbar spine lesions are presented. Minimum invasive surgical interventions were performed in 55 patients from the main group. Control group consisted of 39 patients in whom decompressive-stabilizing operations via conventional posteromedian approach with skeletization of posterior segments of vertebral column were performed. Average size of operative wound in open interventions more than 10 times exceeded that size in minimum invasive interventions and made up 484 ± 56 and 36 ± 12 sq.cm, respectively. Mean blood loss was 326.6 ± 278.0 ml in the main group and 855.1 ± 512.0 ml in the comparative one. In the main group no one patient required substitution hemotransfusion, while in 13 patients from the comparative group donor erythrocytic mass and/or fresh-frozen plasma were used to eliminate the deficit of blood components. Intensity of pain syndrome in the zone of surgical intervention by visual analog scale in the main group was lower than in comparative group. In the main and comparative groups the duration of hospitalization made up 6.1 ± 2.7 and 9.7 ± 3.7 bed days, respectively. In no one patient from the main group complications in the zone of operative wound were noted. Three patients from the comparative group required secondary debridement and in 1 patient early deep operative wound suppuration was observed. Application of low invasive surgical techniques for the treatment of patients with degenerative lumbar spine lesions enabled to perform radical surgical treatment with minimal iatrogenic injury. The method possessed indubitable advantages over the conventional open operations especially intraoperatively and in early postoperative period.


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