scholarly journals Experience in the treatment of patients with fusiform aneurysms of cerebral vessels

2020 ◽  
Vol 30 (4) ◽  
pp. 23-30
Author(s):  
D.V. Shchehlov ◽  
Ya.E. Kudelskyi ◽  
O.A. Pastushyn ◽  
O.E. Svyrydiuk ◽  
O.M. Goncharuk
Keyword(s):  
Postoperative Period ◽  
Neurological Deficit ◽  
Clinical Symptoms ◽  
Control Period ◽  
Clinical Manifestations ◽  
Clinical Results ◽  
Early Postoperative Period ◽  
Neurological Symptoms ◽  
Selection Of Patients ◽  
Selection Of

Objective – to analyze there sults of treatment of patients with fusiform aneurysms (FA) depending on localization and type of surgery.Materials and methods. In the period from 2007 to 2019 127 patients with intracranial fusiform cerebral aneurysms underwen treatment in Scientific and Practical Center of Endovascular Neuroradiology of the National Academy of Medical Sciences of Ukraine. 133 fusiform aneurysms were identified. The following neuroimaging methods were used to diagnose FA: magnetic resonance imaging, multispiral computed tomography and cerebral selective angiography according to Seldinger. In this study, patients with fusiform aneurysms are divided according to localization in the FA of the carotid poolsand the FA of the vertebrobasilar basin. Patients with FA of carotid basins were 56 (27 (29 (51.8 %) men and 48.2 %) women). The average age of patients was 45.2 year. 31 (55.3 %) patients were operated. Patients with FA in the vertebrobasilar basin were 71 (43 (60.6 %) men and 28 (39.4 %) women). The average age of patients was 54.5 year. It was operated 48 (67.6 %) patients.Results. It was possible to completely eliminate FA from the bloodstream intraoperative in 16 (51.6 %) patients. In the early postoperative period in this group 5 (16.1 %) patients had a decrease in disease symptoms, in 3 (9.6 %) patients neurological symptoms increased. In other patients the dynamics of neurological manifestations remained unchanged. There were nofatal out comes in either the early or late post operative period. According to the extended Glasgow outcome scale at the time of discharge from the hospital 22 (71 %) patients had > 5 points, 9 (29 %) – 4 points. In the period from 3 to 5 weeks 2 symptomatic thromboses of flow-directingstents were noted, in the form of clinical manifestations of ischemic stroke. In the period from 3 to 6 months 22 (71 %) patients underwent control examination. Angiographically in 19 (86.3 %) revealed a completes hut down of FA from the bloodstream, in 3 (13.7 %) – decrease of volume of FA > 65 %. Clinical symptoms completely regressed in 16 (72.7 %) patients, partially regressed – in 3 (13.7 %), increased – in 2 (13.6 %). In the period from 12 to 18 months 7 (31.8 %) patients underwent control examination. Total FA shut down from the bloodstream was detected in 5 (71.4 %) patients, in 2 (28.6 %) aneurysms decreased by 80 %. Eighteen-month survival was 100 %.It was possible to intraoperatively switch off FA in the vertebrobasilar basin from the bloodstream in 11 (22.9 %) cases. In the early postoperative period a partial regression of neurological symptoms was observed in 7 (14.5 %) patients. In 10 (20.8 %) cases a new or increasing neurological deficit was observed after intracranial stent implantation, which partially regressed against the background of conservative treatment. Four (8.3 %) deaths were recorded in the early postoperative period. The clinical results of 48 patients on the Glasgo woutcome scale at the time of discharge were > 5 points in 27 (56.2 %) patients, 4 points – in 17 (35.4 %) and 1 points – in 4 (8.3 %). In the period from 3 to 6 months 19 (39.5 %) patients underwent control examination. Angiographically in 14 (73.7 %) patients the aneurysm was completely turned off from the blood circulation, in 2 (10.5 %) the decrease in the volume of the aneurysm was > 70 %, in 3 (15.8 %) patients the decrease in the volume of the aneurysm was 47–64 %. Clinical symptoms regressed in 7 (36.8 %) patients, a decrease in neurological deficit was noted in 2 (10.5 %) patients, an increase in neurological deficit in 3 (15.8 %) patients. Three deaths were recorded. In the period from 12 to 18 months, 12 (25 %) patients underwent control examination. Angiographically in 10 (83.3 %) patients FA was excluded totally from the bloodcirculation, in 2 (16.7 %) – the volume of aneurysm was reduced by 80 %. Clinical symptoms regressed in 8 (66.6 %) patients and increased in 1 (8.3 %). During the control period 2 patients died. The 18-month survival rate was 89.5 %, 5 (10.5 %) patients died.Conclusions. Fusiform aneurysms are more common in people of working age, more common in men. A more unfavorable course of the disease occursin patients with symptomatic FA of the vertebrobasilar basin, due to the compression and dysfunction of the brainstem and stem structures. Deconstructive methods for eliminating FA from the bloodstream provide long-termsatis factory treatment results, butrequire careful selection of patients for such in terventions. Endovascular treatment should be considered as the main treatment, asitentails fewer risks for the patient. For aneurysms that cannot be treated with endovascular methods, microsurgical treatments hould be considered. The main forsuccess ful treatment of patients with fusiform aneurysms is th ecareful selection of patients and individual approach to the choice of treatment based on the shape, location and size of the FA.

Surgical treatment of bilateral temporal lobe pharmacoresistant epilepsy

2020 ◽  
pp. 60-82
Author(s):  
Igor Sergeevich Trifonov ◽  
Mikhail Vladimirovich Sinkin ◽  
Elena Vladimirovna Grigoryeva ◽  
Rashid Abdurakhmanovich Navruzov
Keyword(s):  
Surgical Treatment ◽  
Temporal Lobe ◽  
Clinical Picture ◽  
Clinical Manifestations ◽  
Epileptogenic Zone ◽  
Pharmacoresistant Epilepsy ◽  
Modern Methods ◽  
Selection For ◽  
Selection Of Patients ◽  
Selection Of

Surgical treatment of bilateral temporal lobe pharmacoresistant epilepsy is associated with some difficulties: particularly, the lack of stereotypical clinical picture in the same patient and controversial data on modern methods of diagnostics — all these statements make identifying epileptogenic zone more difficult and lack of clear criteria for the selection of patients for surgical treatment. In this review, issues of aetiology, pathogenesis, clinical manifestations and criteria for the selection for surgical treatment suggested by different authors are presented.

Noncemented Hip Replacement using a Conical Screw-In Cup and a Straight Press-Fit Stem. A Six to Eight-Year Clinical and Radiological follow-up Study

1998 ◽  
Vol 8 (4) ◽  
pp. 208-218 ◽  
Author(s):  
G. Köster ◽  
S. Leib ◽  
H.-G. Willert
Keyword(s):  
Hip Replacement ◽  
Clinical Symptoms ◽  
Bone Ingrowth ◽  
Control Period ◽  
Clinical Results ◽  
Harris Hip Score ◽  
Radiographic Appearance ◽  
Press Fit ◽  
Bone Atrophy

Noncemented hip replacement using a conical titanium metal-backed screw-in cup to be implanted with precutting of the threads (TITAN-METAL-BACKED, AlloPro, Baar, Switzerland), in combination with a straight conical press-fit stem (Zweymüller-“hochgezogen”, AlloPro, Baar, Switzerland) was evaluated clinically and radiologically in 64 consecutive primary arthroplasties with an average 7.2 year follow-up. The clinical results compare very favourably with other cementless systems. The Harris hip score revealed an improvement from 45 to 84. The Merle d'Aubigné index showed an increase during the case-control period from 16 to 26. Thigh pain was practically absent except in one patient. A radiographic appearance of bone ingrowth around the acetabular component was found in nearly all cases. Only one cup migrated in a patient with a large cystic lesion in the acetabular roof, which was not grafted, with no other signs of loosening. Additionally this patient had chemotherapy. In all other cases there were no signs of cup migration, significant radiolucency, osteolysis or definite cup loosening. Around the stem, primary cortical contact was mainly located in the distal zones. Radiolucent lines appeared only proximally, with few exceptions, and were, except in four cases, always smaller than 2 mm. They were never circumferential and usually combined with sclerotic lines. Only one stem subsided, but the patient remained asymptomatic. There was a high incidence of proximal bone atrophy, distal cortical thickening and endosteal bone formation, not correlating with radiological loosening or clinical symptoms. Signs of femoral osteolysis were absent. No patient had to be revised.

scholarly journals SYNTHETIC PATCH INFECTION IN CAROTID ENDARTERECTOMY

2019 ◽  
pp. 126-129
Author(s):  
I. S. Pulyaeva
Keyword(s):  
Postoperative Complications ◽  
Carotid Endarterectomy ◽  
Operative Treatment ◽  
Postoperative Period ◽  
Neurological Deficit ◽  
Internal Carotid ◽  
Clinical Status ◽  
Infectious Complications ◽  
Early Postoperative Period ◽  
Direct Results

Aim. To define tactics of treatment of patients with infecting of synthetic patch after carotid endarterectomia(CEA). Materials and methods. As a result of treatment of 123 patients with hemodynamically meaningful stenosises of carotids and/or presence of embolic plate in SI «Zaycev V.T. IGUS of NAMSU» from 2014 for 2018 51 CEA was executed with in seaming of patch. In 5 cases autove in used as a patch, at 46 patients were used synthetic patch. As a rule, this group was entered by patients with extensive stenosis (more than 2 cm) - 33 patients, patients with insufficient retrograde pressure and/or presence of neurological deficit in the period of crossclamping of internal carotid — 18 patients. Results. The direct results of operation we estimated complex on the basis of degree of change of clinical status and presence of postoperative complications. At 43 patients in a postoperative period are not educed complications. At 8 patients an early postoperative period was complicated by bleeding from a patch, that demanded the repeated operative treatment. In two cases through 2 and 2,5 year, infecting of synthetic patch, that demanded urgent operative intervention as excision of synthetic patch and inseaming of autovein patch, was educed. To the patients control of passableness of carotids was executed through every 6 months Hemodynamically meaningful Restenilооm was observed in 3 cases at this group of patients. Conclusion. At hemodynamically meaningful extensive stenosises of carotids and insufficient level of retrograde arteriotony it is necessary to execute CEA with inseaming of synthetic patch. In case of the repeated interference on a carotid careful hemostasis and antibacterial therapy allows to bring down the level of infectious complications.

scholarly journals Brachicefalinių arterijų chirurginės korekcijos rezultatai

2003 ◽  
Vol 1 (4) ◽  
pp. 0-0
Author(s):  
Ilona Bičkuvienė
Keyword(s):  
Health Status ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Postoperative Period ◽  
Clinical Symptoms ◽  
Neurological Symptoms ◽  
Surgical Correction ◽  
Control Group ◽  
Combined Lesions ◽  
Brachiocephalic Arteries

Ilona BičkuvienėVilniaus universiteto Neurologijos ir neurochirurgijos klinikaVilniaus greitosios pagalbos universitetinės ligoninėsNeuroangiochirurgijos centrasŠiltnamių g. 29, LT-2043 Vilnius Įvadas / tikslas Įvertinti vertebrobazilinės ligos klinikinę raišką ligoniams, kuriems yra įvairi brachicefalinių arterijų patologija, iki ir po šių arterijų rekonstrukcijos. Ligoniai ir metodai Ištirti 288 ligoniai, kuriems pasireiškė vertebrobazilinės ligos klinikiniai simptomai ir įvairi brachicefalinių arterijų patologija. Chirurgiškai gydyti 228 ligoniai, o konservatyviai – 60 ligonių, kurie sudarė kontrolinę grupę. Visi ligoniai ištirti neurologo, jiems atliktas brachicefalinių arterijų dvigubas skenavimas ir aortos lanko šakų angiografija. Operuotų arterijų neurologiniai klinikiniai pokyčiai ir kraujotaka buvo vertinama per 3 metų laikotarpį. Rezultatai Paroksizmai yra būdingi neurologiniai simptomai esant brachicefalinių arterijų patologijai. Šių arterijų chirurginė korekcija atliekama, jei konservatyvus gydymas buvo neveiksmingas, o neurologinė simptomatika progresavo. Chirurginiam gydymui įvertinti ligoniai tirti po operacijos praėjus ne daugiau kaip 2 savaitėms, iki 1 metų ir nuo 1 iki 3 metų. Pagrindinis dėmesys buvo sutelktas į neurologinių simptomų pokyčius trečiuoju pooperaciniu laikotarpiu. Teigiami klinikiniai pokyčiai (paroksizmai po operacijos visiškai nebesikartojo) nustatyti daugiausia tiems ligoniams, kuriems buvo brachicefalinių arterijų anomalijos (82,86%) ir deformacijos (72,54%). Chirurginis gydymas buvo neveiksmingas 30% ligonių, kuriems yra brachicefalinių arterijų ateroskleroze, ir 21% – mišri patologija. Papildomų simptomų, kurių iki operacijos nebuvo, atsirado mišrios patologijos grupės ligoniams (3,41%). Chirurginio gydymo veiksmingumui įrodyti ištirta 60 kontrolinės grupės ligonių. Teigiamų sveikatos būklės pokyčių nenustatyta. Ketvirtadalio ligonių sveikatos būklė nepakito, kitų – pablogėjo dėl naujų praeinančių smegenų išemijos priepuolių ir insultų. Išvados Teigiami pooperaciniai pokyčiai per trejų metų laikotarpį leidžia teigti, jog subjektyvūs ir objektyvūs neurologinai vertebrobazilinės ligos simptomai siejasi su įvairia brachicefalinių arterijų patologija. Tais atvejais, kai konservatyvus gydymas neveiksmingas, galima chirurginė brachicefalinių arterijų korekcija. Prasminai žodžiai: brachicefalinės arterijos, vertebrobazilinė liga, chirurginis gydymas, pooperaciniai rezultatai Vertebrobasilar disease. Results of surgical correction of brachiocephalic arteries Ilona Bičkuvienė Background / objective The aim of this study was to analyze preoperative and 3-year follow-up postoperative symptoms of vertebrobasilar disease due to the pathology of brachiocephalic arteries. Methods 288 patients with symptoms of vertebrobasilar disease due to the pathology of brachiocephalic arteries have been examined. 228 patients were operated on and 60 (control group) were treated conservatively. All the patients were examined by the neurologist, duplex scanner and angiographycally. Neurological clinical dynamics and blood flow in operated on arteries were evaluated in a 3-year period. Results Paroxysms are characteristic of the lesions of the brachiocephalic arteries. Surgical correction of the lesions was performed if the conservative treatment had no effect and the neurological symptoms were progressing. To evaluate the effectiveness of surgical treatment, the patients were examined in the early postoperative (2 weeks after operation) and late postoperative period: 1) until 1 year and 2) from 1 to 3 years. Attention was focused on the dynamics of the neurological symptoms in the third postoperative period (from 1 to 3 years). Positive clinical dynamics (paroxysms disappeared) was ascertained mostly in the groups with anomalies of the brachiocephalic arteries (82.86%) and deformations (72.54%). This surgical treatment was ineffective in 30% of cases in the group with atherosclerotic and in 21% with combined lesions of brachiocephalic arteries. New additional symptoms after operation were ascertained in the group with combined lesions (3,41%). To approve the effectiveness of surgical treatment, 60 patients (control group) were examined. They had been treated conservatively, without a positive dynamics of their health status. There were no changes in the health status for the quarter of the patients. In all the others the health status worsened – TIA and strokes appeared. Conclusions A 3-year positive postoperative dynamics allow us to conclude that the subjective and objective clinical symptoms are connected with various types of pathology of brachiocephalic arteries. In cases when conservative treatment is unsuccessful, surgical treatment of brachiocephalic arteries can be applied. Keywords: brachiocephalic arteries, vertebrobasilar disease, surgical treatment, postoperative results

scholarly journals Simultaneous operations in gynecology: assessment of effectiveness

2005 ◽  
Vol 54 (4) ◽  
pp. 11-16
Author(s):  
A. I. Ischenko ◽  
L. S. Alexandrov ◽  
А. М. Shulutko ◽  
N. V. Vedernikova ◽  
М. N. Golobova ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Clinical Results ◽  
Control Group ◽  
Individual Selection ◽  
Preoperative Preparation ◽  
Basic Group ◽  
Substantial Growth ◽  
Simultaneous Operations ◽  
Selection Of Patients ◽  
Selection Of

272 patients have been included in the lead clinical research. The basic group was made of 218 women after simultaneous operations with application as miniinvasive, and traditional methods; control group 54 patients after isolated operative pelvic surgeries. The estimation of the received clinical results shows, that at individual selection of patients in view of possible contra-indications, compensation opportunities of the organism, adequate preoperative preparation, the all-round complex preoperative inspection, correctly chosen method of operative intervention, the increase in volume of operation does not render appreciable influence on a degree traumatic operation, does not promote substantial growth of number of postoperative complications and lethal outcomes.

Simultaneous hybrid peripheral re-vascularization: early results

Vascular ◽  
2013 ◽  
Vol 21 (5) ◽  
pp. 279-285 ◽  
Author(s):  
Ismail Yurekli ◽  
Orhan Gokalp ◽  
Tevfik Gunes ◽  
Levent Yilik ◽  
Ali Gurbuz
Keyword(s):  
Peripheral Arterial Disease ◽  
Operating Room ◽  
Postoperative Period ◽  
Clinical Symptoms ◽  
Arterial Disease ◽  
Primary Patency ◽  
Early Postoperative Period ◽  
Graft Occlusion ◽  
Early Results ◽  
Peripheral Arterial

Endovascular and open surgical interventions may be combined in treatment of peripheral arterial disease. In this study, we presented our simultaneous hybrid peripheral interventions under the light of current literature data. Eleven patients who were operated for occlusive peripheral arterial disease without aneurysms between June 2008 and November 2010 at our hybrid operating room were investigated retrospectively. Generally, endovascular intervention was performed initially, and then followed by surgery. After hybrid interventions, control angiograms were held during the same session. None of the patients experienced either stent or graft occlusion during early postoperative period. Primary patency rate was found to be 100% for the postoperative first six months. Ankle-brachial indices (ABI) increased significantly during postoperative period and clinical symptoms were relieved in all patients (mean preoperative ABI: 0.43 ± 0.08, mean postoperative sixth month ABI: 0.87 ± 0.08). Peripheral hybrid interventions may be performed both in separate sessions and also simultaneously by experienced teams if an angiography device is available within the operating room.

scholarly journals ECTOPIC PREGNANCY AND ACUTE APPENDICITIS DURING INTRAUTERIN PREGNANCY AFTER IN VITRO FERTILIZATION

2018 ◽  
Vol 2 (5) ◽  
pp. 169-172
Author(s):  
Наталья Протопопова ◽  
Natalya Protopopova ◽  
Елена Дружинина ◽  
Elena Druzhinina ◽  
Альбина Лабыгина ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Ectopic Pregnancy ◽  
Postoperative Period ◽  
Clinical Symptoms ◽  
Uterine Cavity ◽  
Early Postoperative Period ◽  
Chlamydia Infection ◽  
Surgical Department ◽  
Ultrasound Study

The paper presents a clinical case of the Patient T., 34 years old, who underwent the treatment in the Department of ART of the Regional Perinatal Center for tubal peritoneal infertility for seven years. In the anamnesis: one spontaneous uterine pregnancy, culminating in medical abortion for up to 12 weeks, treatment for chronic salpingo-oophoritis, tu- bectomy on the right side for a progressing ectopic pregnancy. The patient denied the presence of Chlamydia infection in the anamnesis. Studies on sexually transmitted infections before the IVF program were negative. During laparo- scopic tubectomy, no endometriotic foci were found. There were four programs of ART in anamnesis: in 2009, 2012, 2014, 2016. During the fourth ART program in 2016, two embryos were transferred to the uterine cavity, resulting in a uterine pregnancy in combination with an ectopic pregnancy diagnosed in the ultrasound study at 4 to 5 weeks of gestation, in the absence of clinical symptoms. The patient underwent emergency laparoscopic tubectomy on the left, the course of the postoperative period proceeded without complications. Later, in the period of uterine pregnancy of 7–8 weeks, with a clinical picture of acute appendicitis, the woman was hospitalized in the surgical department where she underwent laparoscopic appendectomy. Later the pregnancy proceeded without complications, at 39 weeks the planned cesarean section was performed, a girl weighing 3480 grams, 51 cm long with an Apgar score of 9–10 points was extracted on the operation. The course of the early postoperative period without complications, the patient was discharged with the child on the 4th day.

scholarly journals ЭКСТРАКОРПОРАЛЬНАЯ КОРРЕКЦИЯ В РАННЕМ ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ У БОЛЬНЫХ С ТЯЖЕЛОЙ ОСТРОЙ ИШЕМИЕЙ НИЖНИХ КОНЕЧНОСТЕЙ

World Science ◽  
2019 ◽  
Vol 1 (7(47)) ◽  
pp. 43-47
Author(s):  
О. А. Зарудный ◽  
Ю. В. Иванова ◽  
Б. В. Гилёв
Keyword(s):  
Renal Dysfunction ◽  
Postoperative Period ◽  
Creatine Phosphokinase ◽  
Clinical Presentation ◽  
Limb Ischemia ◽  
Clinical Results ◽  
Early Postoperative Period ◽  
Preoperative Level ◽  
Total Creatine ◽  
Blood Creatinine

The clinical results of the use of Continuous Veno-Venous High Flux Dialysis (CVVHFD) in the early postoperative period in 37 patients with severe lower limb ischemia and an elevated preoperative level of blood creatinine were studied. The dynamics of total creatine phosphokinase, myoglobin, potassium in the early postoperative period was studied. The use of CVVHFD before the manifestation of the classic clinical presentation of renal dysfunction reduces the risk of adverse cardiopulmonary events from 26.1% to 14.3% and decreases the incidence of clinical renal dysfunction from 30.4% to 14.3%.

scholarly journals LONG-TERM RESULTS AFTER VIDEO ENDOSCOPIC MYOTOMY BY HELLER WITH FUNDOPLICATION BY DOR IN PATIENTS WITH 2-4 STAGES OF ACHALASIA

2021 ◽  
pp. 40-49
Author(s):  
V. A. Gankov ◽  
E. A. Tseimakh ◽  
G. I. Bagdasaryan ◽  
A. R. Andreasyan ◽  
S. A. Maslikova
Keyword(s):  
Surgical Treatment ◽  
Postoperative Period ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Long Term Results ◽  
Esophageal Function ◽  
X Ray ◽  
Leading Symptom ◽  
Instrumental Methods

Relevance. Treatment of achalasia of the cardia (AС) is currently palliative, aimed at reducing the manifestation of clinical symptoms of the disease. Together with instrumental methods of examination of esophageal function, the Eckardt scale and the GIGLI questionnaire are convenient and simple tools for evaluating results in the long-term postoperative period.The aim of the study was to evaluate the long-term results of surgical treatment of patients with 2-4 stages of AС, after laparoscopic Нeller myotomy with anterior hemiesophagofundoplication by Dor to the results of special methods of esophageal examination and patient questionnaires using the Eckardt scale and the GIGLI questionnaire.Materials and methods. The work included the results of examinations of 103 patients who underwent video laparoscopic Нeller myotomy, with anterior hemiesophagofundoplication by Dor. The period of examination in the postoperative period was from 3 to 7 years. The results of X-ray examination of the esophagus and stomach, manometry of the esophageal and esophageal-gastric junction before and after surgery were studied , and patients were also surveyed according to the Eckardt scale and the GIGLI questionnaire.Results. The analysis of the results of instrumental methods of studying the function of the esophagus in the pre – and postoperative periods showed that the given manometry of the esophagus and esophageal-gastric junction, X-ray of the esophagus and stomach significantly improved in the postoperative period in patients with all stages of the disease. The results of patients of 4th stage AC compared with the results of 2nd and 3rd stages patients were worse(p<0,05).The leading symptom of AK-dysphagia in the long-term postoperative period decreased in all the studied patients, the results were better in patients with stage 2, worse in patients with stage 4 of AK (p<0,05).The leading symptom of AK-dysphagia in the long-term postoperative period decreased in all the studied patients, the 2nd stage patients results were better, 4th stage patients results were worse (p<0,05).Conclusions. After video-endoscopic Нeller myotomy with fundoplication by Dor, the indicators of esophageal manometry and esophageal and stomach radiography significantly improve, the results of the Eckardt scale and GIGLI questionnaire survey of patients show a significant decrease in the severity of clinical manifestations of AC in the balls. This method of surgical treatment can be recommended already at the 2nd stage of AC and as an organpreserving operation for 4th stage.

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