scholarly journals Results of treatment for Boerhaave syndrome

2019 ◽  
Vol 27 (1) ◽  
pp. 66-74
Author(s):  
Aleksey V. Mikheev ◽  
Sergey N. Trushin
Keyword(s):  
Primary Care ◽  
Surgical Treatment ◽  
Spontaneous Rupture ◽  
Surgical Intervention ◽  
Esophageal Rupture ◽  
Results Of Treatment ◽  
Boerhaave Syndrome ◽  
The Moment ◽  
Suture Failure

Background. Spontaneous rupture of the esophagus (Boehaave syndrome, BS) is a rare pathology in the surgical practice. Esophageal rupture makes no more than 2-3% of all cases of damage to the esophagus and is associated with a significant number of diagnostic errors and with high mortality. Aim. The aim of the study was to analyze the quality of diagnostics and the results of treatment of patients with spontaneous rupture of the esophagus. Materials and Methods. We performed a retrospective analysis of medical histories and of treatment results of 10 patients with Boerhaave syndrome hospitalized in the department of thoracic surgery of the Ryazan Regional Clinical Hospital, Ryazan in 2007-2018. Results. Four of ten patients were transferred from other medical institutions. At the primary care stage six patients were misdiagnosed; two of them underwent diagnostic laparoscopy for suspicion of acute pancreatitis and perforated gastric ulcer. The average time from the onset of the disease to surgery was 71.723.4 hours. Closure of the esophageal perforation was performed in all cases. Regarding the timing of surgery, all patients with Boerhaave syndrome were divided into 2 groups: patients with early intervention (4 patients operated within 24 hours); patients with late intervention (5 patients operated after 48 hours from the onset of the disease). One patient underwent surgical treatment within 24 hours in a medical facility outside the Ryazan region. In nine out of ten patients the rupture was localized in a typical place in the lower third of the esophagus along the left lateral wall. In the postoperative period eight patients had complete or partial esophageal suture failure, which required prolonged inpatient treatment (54.712.1 days). Postoperative mortality was 10% (1 patient of 10) and was caused by the progressive multi-organ failure and the development of cerebral ischemic stroke. Conclusion. The quality of diagnostics of Boerhaave syndrome remains unsatisfactory: due to rare occurrence of this pathology, most specialists of primary care settings, including surgeons, are not well acquainted with the etiopathogenesis and peculiarities of clinical presentation of Boerhaave syndrome. Diagnostic and treatment errors in rendering primary medical assistance reaches 60%. Results of surgical treatment directly correlate with the time from the moment of perforation and development of septic complications. Even with early surgical intervention performed within 24 hours from the moment of perforation, esophageal suture failure may occur in up to 75% of cases. Thus, the success of treatment is determined by early diagnosis, timely hospitalization in a specialized facility, and adequate surgical intervention.

Resection and reconstruction of idiopathic scrotal elephantiasis: surgical approach and quality of life assessment

2021 ◽  
Vol 14 (10) ◽  
pp. e244018
Author(s):  
Hasan Gökcer Tekin ◽  
Karin Andersen ◽  
Vivi Bakholdt ◽  
Jens Ahm Sørensen
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Surgical Intervention ◽  
Life Assessment ◽  
Quality Of Life Assessment ◽  
Assess Patient Satisfaction ◽  
Industrialised Countries ◽  
Disease Specific

Scrotal elephantiasis (SE) is a condition considered rare in western industrialised countries but common in filaria prone regions. If no apparent causes are found for SE, it is called idiopathic SE. Medical and conservative therapies are ineffective against idiopathic SE, and surgical intervention is mandatory to treat this disabling condition. Nevertheless, it remains unclear whether surgical intervention improves quality of life among patients with idiopathic SE. Herein, we report a case of a 41-year-old man who underwent acute scrotal resection and reconstruction, secondary to haemorrhage from his idiopathic SE. The aim of this study was to describe the operative approach and assess patient satisfaction after surgical treatment. The patient had no recurrence of SE after surgical treatment at 6 months follow-up and had considerable improvements assessed by general and disease-specific quality of life questionnaires.

P166 SPONTANEOUS ESOPHAGEAL RUPTURE – BOERHAAVE SYNDROME

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
B  Movchan ◽  
O Usenko ◽  
A Zgonnyk ◽  
R Vynogradov
Keyword(s):  
Spontaneous Rupture ◽  
Pleural Cavity ◽  
Clinical Manifestations ◽  
Esophageal Rupture ◽  
Esophageal Stents ◽  
Spontaneous Esophageal Rupture ◽  
Timely Diagnosis ◽  
Boerhaave Syndrome ◽  
Surgical Tactics ◽  
Effective Drainage

Abstract Aim To study the most effective method of treatment in patients with spontaneous rupture of the esophagus. Background The timely diagnosis of Boerhaave syndrome presents great difficulties due to its rarity, a variety of clinical manifestations, often simulating different pathologies from other organs and are difficult to treat. Methods From 2003 to 2019 9 patients with Bourhave's syndrome were treated at the clinic, primary care was provided to 6 patients in the community. All patients were admitted to the clinic with external left-sided esophageal-pleural fistula, 1 patient had a spontaneous rupture of the esophagus in the cliniс, the defect of the esophagus wall defect was completed, which led to successful results. Results Treatment in the remaining patients was started with adequate enteral nutrition and effective drainage of the pleural cavity. As a result of the use of pleural double-lumen drainage with active sanation with antiseptics and subsequent aspiration, with the exception of feeding through the mouth in four patients, it was possible to eliminate the esophageal-pleural fistula, profuse bleeding and death of the patient. Against the background of ongoing conservative therapy in two patients, it was not possible to eliminate the esophago-pleural fistula. A left-sided thoracotomy was performed with excision of the fistula with the decortication of the lung and the extirpation of the esophagus with the formation of an esophagostomy. Subsequently, these patients underwent retrosternal colic esophagoplasty. Two patients underwent Lewis surgery with drainage of the pleural cavity. Conclusion Boerhaave syndrome has a very high mortality rate, however, with a timely diagnosis and adequate surgical tactics, it develops into the formation of an esophageal-pleural fistula. In this case, the most effective treatment is excision of the fistulous course with extirpation of the esophagus and subsequent esophagoplasty. The use of esophageal stents is possible in extremely depleted patients or in elderly patients, due to the frequent occurrence of hypergranular esophagitis. Esophageal stents should be removed as soon as possible when confidence in the elimination of the esophageal-pleural fistula occurs.

scholarly journals Clinical Experience in Management of Patients with Cervical Erosion and Ectopia

2020 ◽  
Vol 8 (B) ◽  
pp. 226-230
Author(s):  
Gulnara Zhetebaevna Sakhipova ◽  
Nurgul Abdullaevna Abenova ◽  
Tlesh Nabievna Zhumabaeva ◽  
Aniya Nurmakhanbetovna Seypenova ◽  
Dina Orynbasarovna Shamshaeva
Keyword(s):  
Surgical Treatment ◽  
Invasive Cervical Cancer ◽  
Vaginal Mucosa ◽  
Hpv 16 ◽  
Bacteriological Study ◽  
Vaginal Microflora ◽  
Results Of Treatment ◽  
Simplex Virus ◽  
Specific Symptoms

PURPOSE OF RESEARCH: The main objective of the study was to analyze the results of treatment of patients with cervical erosion and ectopia without surgical treatment. MATERIALS AND METHODS: To this end, a complete clinical examination of women with cervical erosion and ectopia was carried out: A smear for oncocytology, PCR for HPV 16–18, herpes simplex virus, chlamydia, colposcopy extended, and bacteriological study to identify the vaginal microflora. As a result of examinations, 30% of women without specific symptoms and complaints were diagnosed with cervical ectopia and assigned to the first group (practically healthy women). About 68% of women were assigned to the second group – with cervical erosion, who need conservative treatment, 2% – to the third group – women with invasive cervical cancer, who were sent to the oncology center. About 82% of L-SIL developed against the background of infection with highly oncogenic types of HPV, most often HPV 16, with 30% of them infected with more than 1 type of HPV. To eliminate concomitant inflammation of the cervix and vagina, hexicon was used in this group. After the rehabilitation of the vagina and cervix, the next step was to connect the drug depantol. RESULTS: The use of hexicon and depantol in the treatment of cervical erosion led to the regeneration of the defect of the cervical vaginal mucosa, bypassing the surgical treatment of cervical erosion. THE NOVELTY OF THE RESEARCH: As a result of the treatment of uncomplicated ectopia, there was no need to apply a surgical method of treatment in connection with the healing of ectopia. PRACTICAL APPLICATION OF THE STUDY: Such an approach to the treatment of women with cervical erosion among obstetrician-gynecologists would lead to the prevention of relapse and improve the quality of life of patients. After treating the cervix with solkovagin, healthy tissues begin to recover under these dead tissues, which in the process completely replace patients without scarring on the cervix.

scholarly journals Minimally invasive surgery for spine osteomyelitis treatment

2021 ◽  
pp. 104-110
Author(s):  
Ye.Ya. Kochnev ◽  
◽  
S.Vl. Lyulin ◽  
S.V. Mukhtyaev ◽  
I.A. Meshcheryagina ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Surgical Intervention ◽  
Life Quality ◽  
Pain Syndrome ◽  
Minimally Invasive Surgical ◽  
Minimally Invasive Surgical Treatment

The aim of the research is to study the results of minimally invasive surgery for the treatment of nonspecifi c infectious spine lesions, and to present personal experience. Material and methods. Three patients with purulent nonspecifi c spondylodiscitis of lumbar spine got minimally invasive surgical treatment. The essence of surgical intervention included X-ray-assisted placement of tubular retractors in the area of intervertebral disc aff ected by purulent process; debridement and irrigation with antiseptic solution of interbody space, and setting a drain tube. All patients were treated during the period from December 2016 to February 2019. They were examined before surgery and in 3 months aft er the discharge. Laboratory parameters (CBT, C-reactive protein, bacteriological analysis of intervertebral disc contents) and instrumental research methods (computer tomography, magnetic resonance imaging) were evaluated. ODI, VAS, SF-36 questionnaires helped to assess pain syndrome and life quality of patients. Results. In 100 % of studied cases infection was caused by Staphylococcus aureus. The result of treatment in all cases was assessed as good, because pain syndrome, neurological disorders and inflammatory process were arrested; there were no signs of disease progression. In all cases, life quality of patients was restored. In one case, additional surgical intervention was required (posterior instrumental fi xation of spine) because of instability signs. Conclusion. Minimally invasive surgical treatment of purulent single-level spondylodiscites can be recommended for practical use. The use of such approache allows to verify purulent infection agent, to damage soft tissues less getting proper sanitation of interbody space. It also allows to stop the infection and restore life quality of a patient

scholarly journals Giant primitive neuroectodermal pelvic tumour: a case report and literature review

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052090674
Author(s):  
Yuan-Wei Zhang ◽  
Wen-Han Xia ◽  
Wen-Cheng Gao ◽  
Ling Yan ◽  
Xin Xiao ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Intervention ◽  
Postoperative Radiotherapy ◽  
The Body ◽  
Preoperative Imaging ◽  
Round Cell ◽  
Current Case ◽  
Small Round Cell ◽  
Left Lower Extremity

Primitive neuroectodermal tumours (PNETs) are rare malignant small round cell tumours. Notably, despite widespread reports of PNET in multiple parts of the body, it is extremely rare in the pelvis. Here, a rare case of giant PNET of the pelvis, that was treated with surgical intervention comprising hemipelvectomy and amputation, is reported. A 42-year-old female patient presented with an enlarged mass on the left hip and severe pain in the left lower extremity for the previous 6 months. Preoperative imaging examinations indicated an irregular soft tissue-like signal shadow sized 19 × 15 × 12 cm at the left ilium and sacrum. After surgical intervention involving left hemipelvectomy and amputation, the tumour was diagnosed by pathology as PNET. During the courses of postoperative radiotherapy and chemotherapy, local recurrence and distant metastasis occurred, and the patient died 9 months following surgical treatment. To the best of the authors’ knowledge, the current case is the largest pelvic PNET resection reported to date. Pelvic PNET is extremely malignant and has a high mortality rate regardless of surgical treatment, however, surgical resection of the lesion may relieve the symptoms, extend life, and improve quality of life to a certain extent.

scholarly journals Surgical Treatment Of Obliterating Arterosclerosis

2020 ◽  
Vol 2 (09) ◽  
pp. 41-48
Author(s):  
Zainiddin Norman Ugli ◽  
Makhmudov K.O., ◽  
Tinibekov M.Х.
Keyword(s):  
Surgical Treatment ◽  
Surgical Intervention ◽  
New Methods ◽  
Diagnosis And Prognosis ◽  
Results Of Treatment ◽  
Effective Diagnosis ◽  
Atherosclerosis Obliterans ◽  
Timely Treatment ◽  
Preoperative Examination ◽  
Prevention And Therapy

In the literature review, according to publications of recent years, the state of surgical treatment of obliterating atherosclerosis does not meet the requirements of the time. Currently, all research is aimed at improving the early diagnosis of the disease and their timely treatment by improving the quality and efficiency of surgical intervention. However, despite a large number of works devoted to diagnosis and prognosis of treatment, there are still many unresolved issues. The accumulated experience indicates the need to standardize the preoperative examination of patients in order to predict the outcome of treatment. One of the important aspects of this problem is the development of modern tactics and approaches to surgical treatment. Along with them, it is necessary to evaluate the results of treatment, analyze the quality and determine the effectiveness of traditional operations in modern angiosurgery. It should be noted that today there are a considerable number of new methods of treating atherosclerosis obliterans for early and effective diagnosis, prevention and therapy of the disease. However, some issues are insufficiently studied or contradictory and require further research.

scholarly journals THE APPLICATION OF NAVIGATION SYSTEM BASED ON THE AUGMENTED REALITY TECHNOLOGY FOR THE SURGICAL TREATMENT OF ORBITAL TUMORS

2021 ◽  
Vol 29 (1) ◽  
pp. 67-74
Author(s):  
I.Y. Zherka ◽  
◽  
K.P. Zhiliayeva ◽  
L.V. Naumenka ◽  
Zh.V. Kaliadzich ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Augmented Reality ◽  
Navigation System ◽  
Preoperative Planning ◽  
Surgical Intervention ◽  
Intraoperative Navigation ◽  
Orbital Tumors ◽  
Bony Landmarks ◽  
Augmented Reality Technology

Objective. To assess the effectiveness and feasibility of using an intraoperative navigation system based on augmented reality technology in the surgical treatment of intra-orbital tumors. Methods. Two patients with intra-orbital tumors were operated on with the application of the intraoperative navigation system. The virtual volumetric model was designed on the basis of files in the Digital Imaging and Communications in Medicine (DICOM) format, taking into account the fact that the quality of reconstruction depends on the quality of the input data and the accuracy of the reconstruction system. The required structures and parameters of color rendering for inclusion in the model were selected taking into consideration a specific clinical situation. Then the model was subjected to processing and modification to facilitate visualization. The prepared and optimized model was loaded into Microsoft HoloLens2 augmented reality glasses. In the preoperative period, using the possibilities of full screen image zoom and rotation of 3D model, the planning of the surgical intervention was carried out with the participation of all members of the surgical team. Intraoperatively, a 3D skull model was superimposed on the patient along bony landmarks (lower orbital edge and nasal bones). Surgical access and surgery were performed in the projection of the visualized tumor. Results. In the first case, the surgical planningas the preoperative method of pre-visualising asurgical intervention was used by means of the possibilities of model zooming and rotating; a detailed preoperative tumor assessment was made. In the second case, the navigation system was used in the process of diagnostic orbitotomy to facilitate the access to the tumor. Conclusion. Augmented reality allows highly detail visualization of individual anatomical models. Models are interactive, adaptive to real time and manipulating does not require the special skills. The technologies are flexible and can be programmed to perform a number of tasks (diagnostics, preoperative planning and intraoperative navigation). Models might be used for surgical training of surgeons to possess the skills. What this paper adds For the first time, the possibility of a navigation system application based on augmented reality technology in the surgical treatment of intra-orbital tumors has been shown. The technique has been found to be useful both in the preoperative planning and during surgical intervention.

scholarly journals Surgical treatment of idiopathic normal pressure hydrocephalus (literature rewiew)

2019 ◽  
Vol 178 (2) ◽  
pp. 73-78
Author(s):  
G. V. Gavrilov ◽  
A. V. Stanishevskiy ◽  
B. V. Gaydar ◽  
D. V. Svistov
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Normal Pressure Hydrocephalus ◽  
Surgical Intervention ◽  
Pathological Condition ◽  
Cognitive Disorders ◽  
Normal Pressure ◽  
Ventriculoperitoneal Shunting ◽  
Pump Valve

Normal pressure hydrocephalus is a pathological condition characterized by ventricular expansion in combination with normal intracranial pressure and manifested by a specific triad of symptoms, including gait disorders, cognitive disorders and urinary incontinence. The prevalence of the disease has not been fully studied and according to various population epidemiological researches reaches 0.3–3 % among  patients older than 61 years. A feature that differs normal pressure hydrocephalus from other neurodegenerative diseases is the possibility of full or partial regression of neurological symptoms after surgical treatment. The most common surgical intervention for normal pressure hydrocephalus is ventriculoperitoneal shunting. It is an implantation of a system of catheters connected by pump-valve into the patient’s body, that drainage cerebrospinal fluid from ventricles to abdomen cavity. Correct and timely surgical treatment of normal pressure hydrocephalus allows increasing the quality of life of patients with normal pressure hydrocephalus and, as a result, the quality of life of their relatives and friends.

scholarly journals Surgical Treatment for Severe Decompensated Neuromuscular Scoliosis in Patient with Spinal Muscular Atrophy type II

2017 ◽  
Vol 24 (1) ◽  
pp. 73-76
Author(s):  
A. N Baklanov ◽  
A. N Shaboldin ◽  
B. Yu Barchenko
Keyword(s):  
Surgical Treatment ◽  
Spinal Muscular Atrophy ◽  
Surgical Intervention ◽  
Muscular Atrophy ◽  
Type Ii ◽  
Dorsal Approach ◽  
Spinal Muscular Atrophy Type ◽  
One Step ◽  
Trunk Balance

Treatment results for 16 years old patient with grade 4 thoracolumbar scoliosis on the background of Type II spinal muscular atrophy are presented. One step surgical treatment via dorsal approach was performed: posterior corrective two-rodtranspedicular corporal screw C7 - S1 fusion with fixationof iliac bones by transpedicular system with bone autoplasty + osteomatrix. Surgical intervention resulted in the formation of satisfactory trunk balance, reduction of pelvic distortion and improvement of the patient’s quality of life.

scholarly journals ESTIMATION OF RESERVES FOR IMPROVING THE RESULTS OF PATIENTS WITH MULTIPRESISTANT PULMONARY TUBERCULOSIS IN THE APPLICATION OF SURGICAL METHODS BASED ON ANALYSIS OF THE EFFICIENCY OF CONSERVATIVE TREATMENT OF A SPECIFIED COHORT

2018 ◽  
Vol 5 ◽  
pp. 33-39
Author(s):  
Oleg Khmel ◽  
Igor Kalabukha ◽  
Vladimir Ivashchenko
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Pulmonary Tuberculosis ◽  
Surgical Intervention ◽  
Cohort Analysis ◽  
Multidrug Resistant ◽  
Complete Cure ◽  
Results Of Treatment ◽  
Number Of Patients ◽  
Surgical Methods

In order to improve the results of treatment of patients with multi-resistant pulmonary tuberculosis with the use of surgical methods, the effectiveness estimation of conservative treatment of 176 patients with this form of tuberculosis according to cohort analysis data in two districts of Kyiv were done. In the list were included following parameters: type of the tuberculosis, its clinical-radiological form and the prevalence of the process, the results of conservative treatment in patients who completely finished the course of anti-TB chemotherapy and the results of conservative treatment of 81 patients who had indications for surgical treatment but had not been operated. Processing of the materials of the study was carried out with the use of licensed software products included in the Microsoft Office Professional 2007 package. The predicted results of treatment were calculated on the condition of surgical intervention. Out of the total sample of patients, 31.3 % of the patients completed treatment. Mortality was 16.5 %, transferred to palliative care 11.9 %. More than one in three patients (35.2 %) stopped treatment at different times from the start. According to the clinic of thoracic surgery SU "National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine ", the overall effectiveness of treatment for patients with limited multidrug-resistant tuberculosis with the use of surgical intervention is about 95 % in the absence of mortality. We have modelled the potential results of treatment of the selected cohort in case of the surgical stage is fully and timely applied in a complex of therapeutic treatment. If all 81 patients with indications for surgical treatment used that way, then, with the above efficiency, a complete cure could be predicted in 77 patients (44.5 % of the total number of observations), which in turn would allow predicting the achievement completion of treatment at 64.2 % with complete cure for 60.6 % of patients. Thus, it is established that the positive result of surgical treatment in the general complex of treatment measures in patients with multidrug-resistant pulmonary tuberculosis is able to improve the results of treatment of this contingent more than twice, reduce the mortality almost by three times, reduce the need for repeated courses of treatment from 7.4 % to 1.7 %, as well as to reduce the epidemiological reservoir of infection due to a significant decrease in the number of patients with failure to treat tuberculosis, interrupted and palliative treatment.

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