scholarly journals Options for assessing renal function after organ-preserving operations in patients with renal cell carcinoma

2020 ◽  
Vol 13 (5) ◽  
pp. 36-40
Author(s):  
A.V. Seregin ◽  
◽  
T.R. Indarokov ◽  
N.A. Shustitsky ◽  
A.A. Seregin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Renal Function ◽  
Surgical Treatment ◽  
Functional Results ◽  
Main Task ◽  
Renal Pedicle ◽  
Central Segment ◽  
Significant Impairment ◽  
Oncological Results ◽  
Group 1

Introduction. Despite the improvement of various methods of surgical and ablative methods of treating kidney cancer, the question remains about the functional state of the kidney after surgical treatment. Along with the achievement of oncological results, the preservation of renal function is the main task in the treatment of tumorous diseases of the kidneys. Aim. To evaluate the functional results of organ-preserving operations with a preventive suture with preserved blood flow, as well as in patients who underwent a resection of the kidney with compression of the renal pedicle, using nephroscintigraphy. Material and Methods. The study included 175 patients in stages pT1a-T2bN0M0, which are divided into 2 groups. Group 1 – 150 patients who underwent organ-preserving options with the use of preventive hemostatic sutures, allowing operations to be performed without clamping the kidney leg. 25 patients underwent a resection of the kidney with compression of the renal pedicle. To assess renal function, patients underwent dynamic nephroscintigraphy. In the first group, the tumor was located in the central segment in 64 patients, in the upper segment in 45 patients, in the lower segment in 41 patients. Stage T1a was established in 74 patients, stage T1b in 53 patients, stage T2a in 4 patients. In 19 patients diagnosed with cystic T1a cancers. In the second group in the central segment – in 10 patients, in the upper segment in 7 patients and in 8 patients in the lower. According to the stages, patients were divided as follows – T1a – 16, T1b – 8, T2a – 1. Results. Organ-preserving operations were performed for all patients. In the first group, in no case did the renal pedicle be pinched. The average time of thermal ischemia in the second group was 13 ± 2 min. The perfusion and renal index for the operated kidney in both groups was comparable, and amounted to 54.13 ± 2% and 53.24 ± 4%. However, after surgical treatment, the indicators were significantly different. In the first group, the perfusion index was 46.82 ± 2.39% against 35 ± 1.52% in the second, the renal index in the first group was 46.82 ± 2.39%, against 39 ± 0.88% in the second. Conclusion. Thus, even short-term thermal ischemia leads to significant impairment of renal function. Preventive suture allows you to remove a tumor from any part of the kidney, while maintaining blood flow, and allows you to protect the renal parenchyma from ischemic damage.

scholarly journals POSSIBILITIES OF ORGAN-PRESERVING TREATMENT OF PATIENTS WITH MULTIPLE RENAL TUMORS

2017 ◽  
Vol 4 (2) ◽  
pp. 54-60 ◽  
Author(s):  
B. Ya. Alekseev ◽  
A. S. Kalpinskiy ◽  
I. A. Taraki ◽  
A. A. Mukhomed’yarova ◽  
K. М. Nyushko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
High Risk ◽  
Total Population ◽  
Surgical Intervention ◽  
Functional Results ◽  
Renal Tumors ◽  
Malignant Neoplasms ◽  
The World ◽  
Oncological Results ◽  
Low Incidence

Renal cell carcinoma (RCC) occupies one of the leading places in the world for morbidity among malignant neoplasms of the genitourinary system. The frequency of occurrence of bilateral RCC according to different authors is 2–6% of the total population of patients with RCC. Currently, the only effective method of treatment of bilateral RCC is surgical treatment. Patients with bilateral RCC are at high risk of dev eloping of local recurrence or progression of the disease after organ-preserving surgeries, which is why the surgeon is faced with a choice between a high risk of developing renal failure or relapse and/or progression of the disease, depending on the extent of the surgical intervention. According to the literature, in patients with bilateral RCC there was an increase in the incidence of papillary variant of RCC up to 19% and the presence of multifocal lesion. Surgical treatment of bilateral RCC is the only effective method to achieve satisfactory oncological results at a low incidence of complications. The m ost justified option for the treatment of bilateral RCC is the implementation of bilateral organ-preserving treatment, which allows achieving the optimal functional results. This article presents a clinical case of successful surgical treatment of a patient with bilateral RCC with multiple tumors.

Time Course of Systemic and Renal Plasma Prostanoid Concentrations and Renal Function in Ovine Hyperdynamic Sepsis

1994 ◽  
Vol 86 (5) ◽  
pp. 599-610 ◽  
Author(s):  
Andreas Weber ◽  
Ian M. Schwieger ◽  
Olivier Poinsot ◽  
Denis R. Morel
Keyword(s):  
Blood Flow ◽  
Renal Function ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Creatinine Clearance ◽  
Renal Blood Flow ◽  
Plasma Renin ◽  
Endotoxin Infusion ◽  
Group 2 ◽  
Group 1

1. We continuously recorded systemic and renal haemodynamic changes, and arterial, renal venous and urinary concentrations of thromboxane B2, 6-keto-prostaglandin F1α and prostaglandin E2, and determined their relationship to renal function in an ovine model of progressive hyperdynamic sepsis. 2. Nine chronically instrumented unanaesthetized sheep were given a continuous intravenous infusion of Escherichia coli endotoxin (20 ng min−1 kg−1) for 3 days. 3. Within the first 12 h of infusion, endotoxin induced a major hypotensive septic syndrome, including a persistent 30% reduction in mean arterial pressure, a 50% decrease in systemic vascular resistance and a 50% increase in mean pulmonary artery pressure, associated with severe lactacidaemia. 4. Renal blood flow decreased by 40%, and creatinine clearance, urine flow, and fractional sodium excretion decreased by more than 75%, of baseline values. After 12 h of endotoxin infusion, cardiac output increased two-fold and renal blood flow recovered to baseline values, whereas creatinine clearance remained depressed. Four sheep died between 13 and 22 h of endotoxaemia; these animals (allocated to group 1) presented a significantly and persistently more reduced renal blood flow (−23%) and creatinine clearance (−77%) after 4 h than the remaining five sheep (allocated to group 2), which survived more than 36 h (−16% and −21%, respectively), whereas systemic and pulmonary haemodynamic and gas exchange data remained similar in both groups. 5. The more pronounced decreases in renal blood flow, creatinine clearance and urine flow in group 1 were associated with higher plasma renin activity and plasma 6-keto-prostaglandin F1α concentrations and a lower fractional urinary excretion of 6-keto-prostaglandin F1α than in group 2, whereas plasma thromboxane B2 concentrations were similarly increased in both groups. Plasma prostaglandin E2 concentrations and urinary excretion were not notably affected by endotoxin infusion in either group. 6. Our results are not in favour of a significant renal production of any of these three prostanoids during endotoxaemia. In both groups, values of creatinine clearance were linearly correlated with simultaneous mean arterial pressure values after starting endotoxin infusion (group 1: creatinine clearance = 1.99 × mean arterial pressure −105, r = 0.95; group 2: creatinine clearance = 2.06 × mean arterial pressure −104, r = 0.80). 7. These findings indicate that during continuous endotoxin administration in sheep (1) the renal haemodynamic and functional responses are biphasic, (2) severe impairment of renal function is associated with elevated plasma renin activity and 6-keto-prostaglandin F1α plasma concentrations and with early fatality, and (3) renal filtration capacity directly depends on renal perfusion pressure, suggesting a loss of renal filtration autoregulation during endotoxaemia.

scholarly journals Surgical Treatment of Clubfoot in Children with Moebius Syndrome

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 310
Author(s):  
Maurizio De Pellegrin ◽  
Lorenzo Marcucci ◽  
Lorenzo Brogioni ◽  
Giovanni Prati
Keyword(s):  
Surgical Treatment ◽  
Functional Results ◽  
Foot And Ankle ◽  
Moebius Syndrome ◽  
Peritalar Release ◽  
Long Term Follow Up ◽  
Group 2 ◽  
Group 1

Moebius syndrome (MS) is a rare disease, with paralysis of the VI and VII cranial nerves, frequently associated with clubfoot (CF). The aim of this study was to evaluate surgical treatment of CF in MS, providing its peculiarities. Between 1990 and 2019, we collected data of 11 MS patients with unilateral (n = 5) or bilateral (n = 6) CF, for a total of 17 feet (9R,8L). Six patients (3M,3F) for a total of 10 feet (6R,4L) were treated elsewhere, performing first surgery at an average age of nine months, and in our hospital for relapse surgery at an average age of 4.5 years (Group 1). Five patients (3M, 2F), for a total of seven feet (3R,4L), were primarily treated in our hospital with a peritalar release according to McKay at an average age of 9.4 months (Group 2). Diméglio score was used to assess CF severity. Three questionnaires were submitted for evaluation of subjective and functional results: American Orthopedics Foot and Ankle Society for Hindfoot (AOFAS), Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM). Average AOFAS/FAOS/FAMM scores were 82.8, 84.8, and 82.3 for Group 1, and 93.2, 94.7, and 95.1 for Group 2 at an average follow-up of 16.9 and 13.3 years, respectively. The average Diméglio score improved from 15.5 to 4.8 in the long-term follow-up in Group 1 and from 14.6 to 3.8 in Group 2. The comparison between the groups showed better results for AOFAS, FAOS, and FAAM scores for Group 2, particularly for pain, function, and foot alignment and for the post-surgical Diméglio score. CF in MS is more severe and presented a higher relapse rate (58.8%) than idiopathic CF. Peritalar release showed no relapse and better subjective and functional results in the long-term follow-up compared to other surgical techniques

scholarly journals Surgical treatment of children with hip dysplasia complicated with avascular necrosis of the femoral head

2019 ◽  
Vol 7 (1) ◽  
pp. 25-34
Author(s):  
Mikhail P. Teplenky ◽  
Evgeny V. Oleinikov ◽  
Vyacheslav S. Bunov
Keyword(s):  
Surgical Treatment ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Hip Dysplasia ◽  
Hip Dislocation ◽  
Functional Results ◽  
X Ray ◽  
Group 2 ◽  
Time Of Operation ◽  
Group 1

Introduction. Avascular necrosis of the femoral head complicates the surgical treatment of hip dysplasia and aggravates the prognosis. Aim. We studied the immediate and medium-term results of reconstructive treatment in 18 children with hip dysplasia complicated by avascular femoral head necrosis, which developed after closed repositioning of a congenitally dislocated femur. Material and methods. Average age at the time of operation was 4.2 0.2 years. The patients were divided into two groups. Group 1 included 12 children with hip subluxation who underwent extra-articular reconstructions on articular components, spinal tunneling of the neck and head, and hardware unloading of the joint and group 2 included six patients with hip dislocation in whom an additional open reduction was performed. Functional results were estimated using DAubigne-Postel classification, whereas X-ray results were evaluated using Kruczynski classification. Results. Duration of observation was 37 years (average, 4.2 0.3 years). Functional results were good (1518 points) in nine joints in group 1, satisfactory (1214 points) in three joints in group 1 and five in group 2, and unsatisfactory (11 points) in one joint in group 2. X-ray results were good in six joints in group 1, satisfactory in six joints in group 1 and five in group 2, and unsatisfactory in one joint in group 2. Conclusions. Extra-articular reconstructive and stimulatory interventions combined with hardware decompression helps improve the shape and structure of the femoral head, and formation of congruent articular surfaces in children with subluxation of the thigh complicated by avascular necrosis.

scholarly journals Functional Comparison of Immediate and Late Weight Bearing after Ankle Bimalleolar Fracture Surgery

2015 ◽  
Vol 9 (1) ◽  
pp. 188-190 ◽  
Author(s):  
İsmail Ağır ◽  
Nejat Tunçer ◽  
Fatih Küçükdurmaz ◽  
Seyitali Gümüstaş ◽  
Esra Demirel Akgül ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Scoring System ◽  
Weight Bearing ◽  
Functional Results ◽  
The Other ◽  
Group 2 ◽  
One Year ◽  
Fracture Surgery ◽  
Group 1

Aim : The aim of the study is to compare immediate weight bearing with below-knee cast or immobilization with plaster splint in 6 weeks in patients after operative treatment for ankle bimalleolar fractures. Methods : Fifty-three patients with ankle bimalleolar fractures were treated operatively in 2005 to 2010 and then were randomly allocated to two groups. Immediately weight bearing in a below-knee cast (26 patients) and immobilization in a plaster splint for the first six postoperative weeks (27 patients). A mean age 37.9 (min 17; max 72). An average follow-up 26.1 months. (min 14; max 55). All fractures were classified with Lauge-Hansen classification. Functional results of both groups were evaluated with AOFAS for the postoperative one year after surgical treatment. Results : According to the AOFAS scoring system, results were excellent and good in 17 patients in group 1. On the other hand, results were excellent and good in 14 patients in group 2. Conclusion : As a result we think that weight bearing protocol should be advantaged for patients with ankle bimalleolar fractures after surgical treatment immediately.

scholarly journals Use of skin-fascial flaps on perforating vessels in the surgical treatment of skin melanoma

2020 ◽  
Vol 1 (3) ◽  
pp. 18-26
Author(s):  
Yu. V. Przhedetskiy ◽  
V. V. Pozdnyakova ◽  
N. A. Maximova ◽  
O. V. Khokhlova ◽  
N. A. Zakharova ◽  
...  
Keyword(s):  
Blood Flow ◽  
Surgical Treatment ◽  
Postoperative Period ◽  
Skin Color ◽  
Functional Results ◽  
Skin Defect ◽  
Skin Melanoma ◽  
High Viability ◽  
Digital Pressure ◽  
Muscle Fascia

Purpose of the study. Improving the results of surgical treatment of melanoma of the skin of the extremities by using skin-fascial flaps on perforating vessels.Patients and methods. In 42 patients with limb skin melanoma T1–3N0M0, the closure of a skin defect was performed by islet flaps on perforating vessels. Perforating vessels of the donor zone were detected with an assessment of the blood supply of the flaps in the pre- and postoperative period using ultrasound and marking of perforants with adjustment of the preliminary marking of the flaps.Results. Permanent perforating vessels with a diameter of more than 1 mm were used. After excision of the tumor, on the opposite sides of the wound defect, taking into account the location of the perforating vessels, flaps were taken, with further mobilization by excision of the fiber and muscle fascia, they were separated from the underlying tissues while maintaining the integrity of the supply vessels. The circulatory state of the selected flaps was determined by skin color and capillary response to digital pressure. The flaps were displaced to the center, covered the area of the defect and sutured with single sutures, the edges of the donor wound were mobilized, sutured with single sutures until light tension appeared and sutured into the remaining wound defect. In the postoperative period, the determination of the parameters of the blood flow of perforating vessels showed the absence of hemodynamically significant violations of the blood flow during the movement of the flap. Transient ischemia of one of the oncoming flaps after surgery developed in 11.9%, marginal necrosis of the distal flap — in 7.1% of cases. A normotrophic scar was formed, with a width of not more than 0.3 cm, which aesthetically satisfied 92.8% of patients. Assessment of two-year relapse-free survival showed a complete absence of local relapses.Conclusion. The flaps vascularized by perforating vessels have high viability, are identical in color and texture to the skin of the recipient area, and the close proximity to the receiving area contributes to minimal deformation of the donor area, which increases the radicality of the operation, reduces the incidence of postoperative complications and improves аesthetic and functional results.

scholarly journals Functional results of surgical treatment of retinal detachment

2020 ◽  
Vol 24 (2) ◽  
pp. 156-162
Author(s):  
O. E. Ilyukhin ◽  
M. A. Frolov ◽  
K. V. Ignatenko
Keyword(s):  
Blood Flow ◽  
Visual Acuity ◽  
Surgical Treatment ◽  
Retinal Detachment ◽  
Photoreceptor Cells ◽  
Functional Results ◽  
Scleral Buckling ◽  
The State ◽  
Visual Functions ◽  
Outer Segments

The article analyzes the state of patients visual acuity after successful surgical treatment of retinal detachment. On the basis of gathered data, it was concluded that in case of detachment of the macula only in 50% of cases it is possible to increase visual acuity to 0.4 and higher. Restoration of visual functions continues for at least 6 months after the operation and is determined by the restoration of the structure of the outer segments of the photoreceptor cells. During this time, it is advisable to conduct drug therapy aimed at normalizing blood flow and functional activity of the retina. Visual functions recovery continues for at least 6 months after the operation and is connected with the restored structure of the outer segments of the photoreceptor cells. Important prognostic factors of central vision restoration in the postoperative period are visual acuity before surgery, duration of existence and height of macular detachment. Data on which of the methods of surgical treatment of retinal detachment allows to achieve higher visual acuity are contradictory. There is practically no data on the comparison of the effect on visual acuity of scleral buckling and vitrectomy in the long-term period, in patients with phakic eyes and with artiphakia. On visual acuity after fitting detachment of the macula may affect macular edema, epiretinal membrane formation and retinal folds, and edema of the peripapillary optic nerve head, progressive deterioration of blood flow in the basin of the central retinal artery, short posterior ciliary arteries and ophthalmic artery. It is believed that these factors are significantly more pronounced after scleral buckling than after vitrectomy. Some indicators of optical coherence tomography correlate with visual acuity after surgical treatment of retinal detachment: the state of the articulation line of the external and internal segments of the photoreceptors, as well as the state of the external limiting membrane.

Postoperative features of the macular zone structure after surgical treatment of large full-thickness macular hole using various surgical techniques

2021 ◽  
pp. 130-134
Author(s):  
D.V. Petrachkov ◽  
◽  
L. Alkharki ◽  
A.G. Matyuschenko ◽  
V.M. Filippov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Macular Hole ◽  
Functional Results ◽  
Full Thickness ◽  
Zone Structure ◽  
Full Thickness Macular Hole ◽  
Air Tamponade ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Purpose. Comparative assessment of the retinal macular zone structure after surgical treatment of full-thickness macular hole (FTMH) by various methods. Material and methods. Patients with Gass stage III-IV FTMH were divided into 3 groups. Group 1 patients (20 eyes) underwent a standard operation (subtotal vitrectomy (sVE), aspiration convergence of the FTMH edges, gas-air tamponade of the vitreous cavity). Patients in group 2 (20 eyes), after sVE and ILM peeling, autologous conditioned plasma (ACP) were applied to FTMH area followed by air tamponade. Patients of group 3 (20 eyes) after sVE underwent FTMH closure using an inverted ILM flap with the rupture edges approached, followed by air tamponade. Results. The increase in BCVA after 1 month averaged from 0.23±0.1 to 0.41±0.13, (p<0.05) in patients in group 1, in group 2 from 0.15±0, 07 to 0.75±0.09, (p<0.05), in patients in group 3 from 0.14±0.05 to 0.78±0.08, (p<0.05). Anatomical results: in group 1, 17 patients who received standard surgical treatment, a month after surgery, had a satisfactory anatomical result (complete closure of the FTMH with restoration of the correct retinal architectonics in the foveal zone). In 3 patients, additional endovitreal intervention was required with successful FTMH closure. In all patients in group 2, according to OCT data, 5 days after the operation, hyperreflective tissue was detected in the FTMH area ("platelet plug"). When OCT was performed 1 month later, in all cases, the platelet plug resolved, and in all cases, restoration of the foveal profile architectonics was observed. In group 3, the closure of the FTMH on the 5th day of observation was recorded in all patients. When performing OCT after 1 month, complete closure of the neuroepithelium layer was recorded in all cases: in 13 patients - U-shaped closure and in 7 cases – V-shaped. The functional results in both groups were comparable; there was no statistical difference between them. Conclusion: The data obtained demonstrate the morphological features of the retinal foveolar zone postoperative restoration. There was no significant difference in functional results between study groups. Key words: full-thickness macular hole, vitreoretinal surgery, internal limiting membrane, inverted ILM flap, autologous conditioned plasma, optical coherence tomography.

1248: Impact of Surgical Treatment of Renal Carcinoma on Renal Function and Blood Pressure: A Race- and Age-Dependent Association

2007 ◽  
Vol 177 (4S) ◽  
pp. 411-412
Author(s):  
Javier Miller ◽  
Angela Smith ◽  
Kris Gunn ◽  
Erik Kouba ◽  
Eric M. Wallen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Surgical Treatment ◽  
Renal Carcinoma ◽  
Age Dependent

Postural Changes in Essential Hypertension under Treatment and their Effect on the Renogram

1971 ◽  
Vol 10 (01) ◽  
pp. 39-46
Author(s):  
C. Alexandrou ◽  
E. Papadakis ◽  
E. Gyftaki ◽  
J. Darsinos
Keyword(s):  
Renal Function ◽  
Essential Hypertension ◽  
Early Diagnosis ◽  
Postural Hypotension ◽  
Antihypertensive Treatment ◽  
Normal Subjects ◽  
Upright Position ◽  
Postural Changes ◽  
Significant Impairment

SummaryRadioisotope renograms were obtained in the upright and prone position in 9 normal subjects, in 5 patients with untreated essential hypertension and in 21 hypertensives under treatment, showing moderate postural hypotension.No significant renographic change were seen in the two positions in normal subjects and untreated hypertensives. Treated hypertensives with postural hypotension showed significant impairment of renal function in the upright position in 15 cases and no change in 6. Renal creatinine clearance was lower in the group that showed renographic changes. Renography in the upright position is suggested as a convenient test for early diagnosis and follow-up of the adverse effects of antihypertensive treatment.

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