THE PECULIARITIES OF PERIOPERATIVE CLINICAL CHARACTERISTICS OF PATIENTS WITH GENITAL ENDOMETRIOSIS ASSOCIATED WITH HYPOTHYROSIS

Purpose: to elucidate the peculiarities of perioperative clinical characteristics of female patients with genital endometriosis associated with hypothyrosis. To attain our object, the following tasks had to be accomplished: to determine the localization of endometrioid heterotopia and severity of endometriosis in patients with hypothyrosis; to study the types of surgical interventions in patients with endometriosis associated with hypothyrosis; to assess the frequency of endometriosis recurrence after surgical treatment in patients with endometriosis associated with hypothyrosis. Material and methods. We examined 100 female patients: 40 patients – with endometriosis associated with hypothyrosis (main group – group I); 60 patients – with endometriosis and without thyroid pathology (group of comparison – group II). We analyzed the results of clinical, laboratory and instrumental examination, including radiological methods (CT-scan, X-ray). The diagnosis in all the patients was based on pathohistological verification. All surgical interventions were performed by the use of endovideosurgical technology. Results and discussion. According to the results of patients` examination, we identified the following localization of endometrioid heterotopia and severity of endometriosis: Stage I – 38,0 % of patients with ovarian endometrial cysts and adenomiosis; Stage II – 27,0 % of patients with peritoneal endometriosis and adenomiosis; Stage III – 23,0 % of patients with ovarian endometrial cysts, adenomiosis, peritoneal and urinary tract endometriosis; Stage IV – 12,0 % of patients with ovarian endometrial cysts, adenomiosis, peritoneal and retrocervical endometriosis. The 80,0 % of patients underwent organ-preserving procedures, and radical surgery was performed in 20,0 % of cases. We used the following surgical approaches to the endometrial lesions: 56,0 % − combined laparoscopy and hysteroscopy; 42,0 % − transvaginal laparoscopy; and only in 2,0 % of cases – conversion to laparotomy. The frequency of endometriosis recurrence after surgical treatment in patients with hypothyrosis was established: 4,0 % − at 6-month follow-up; 6,0 % − at 9-month follow-up; and 10,0% − at 12-month follow-up. We observed complete relief from the endometriosis symptoms in 80,0 % of patients after the surgical procedure. Additionally, the reproductive function was recovered in 24,0 % of females. Conclusions. The surgical treatment of patients with endometriosis associated with hypothyrosis should be based on the principle of radical removal of endometriotic lesions, particularly through the combined simultaneous procedures in case of advanced extragenital endometriosis. Additionally, several aspects should be taken into account, namely: localization of endometrioid heterotopia and severity of endometriosis; the age of patients and their interest in the preservation of reproductive function; the presence of the highly qualified surgeons (gynecologists, general surgeons, urologists), as well the high level of anesthetic support with thorough postoperative monitoring.

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Surgical correction of prolapse of anterior wall of the vagina and cervix using titanium mesh implants

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1123 ◽

2020 ◽

Vol 75 (1) ◽

pp. 18-26

Author(s):

Anatoly I. Ishchenko ◽

Leonid S. Aleksandrov ◽

Anton A. Ishchenko ◽

Anton A. Kazantsev ◽

Irina D. Khokhlova ◽

...

Keyword(s):

Surgical Treatment ◽

Titanium Implants ◽

Surgical Correction ◽

Valsalva Manoeuvre ◽

Titanium Mesh ◽

Group Iii ◽

Female Patients ◽

Pelvic Exam ◽

Group I

Background: Regardless of a variety of surgical techniques and hi-tech materials for pelvic prolapse treatment, there is no decrease in the disease recurrences. Aims: Evaluation of the efficacy of the developed method of surgical correction of IIIV degree colpoptosis anterior combined with IIIII degree C-prolapse with the use of titanium mesh implants in reproductive, pre- and postmenopausal female patients. Methods: Female patients (group I, n = 25) with colpoptosis anterior and cervical prolapse were examined and operated on according to the developed know-how technique with the use of titanium mesh implants. Evaluation of the efficacy of surgical correction of the disease was performed using questioning, pelvic exam with Valsalva manoeuvre, transvaginal and transperineal ultrasound, pelvis MRI. The findings were compared with the result of surgical treatment of 46 (group II) and 32 (group III) female patients operated on without the use of titanium implants. After surgical treatment according to the three-stage surgical program that provides for multifocal fixation of anatomical formations with the use of titanium implants, the case follow-up was performed in 321 months. Results: Questioning the patients in group I demonstrated their satisfaction with the surgical treatment results that positively affected the quality of life, mood, and contributed to an increase in sexual activity and community commitment. Check-up showed that the surgical correction of prolapse was completely preserved in the patients of group I during 1821 months. Pelvic exam at rest and with Valsalva manoeuvre, transvaginal and transperineal ultrasound, pelvis MRI did not reveal any significant extrusion of the pelvic organs or titanium implants. No mesh-associated complications were observed during the follow-up. Recurrence of genital prolapse was diagnosed in 12 (26%) patients of group II, mesh-associated complications were detected in 6 (18.8%) women of group III. Conclusions: The preserving three-stage surgical program, developed by us, contributed to optimize the results of surgical treatment, decrease the rate of the disease recurrence, and reduce the risk of the development of mesh-associated complications.

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Surgery of cholesteatoma: Surgical technique and cholesteatoma recurrences

Acta chirurgica iugoslavica ◽

10.2298/aci0401103a ◽

2004 ◽

Vol 51 (1) ◽

pp. 103-107

Author(s):

Nenad Arsovic ◽

Radomir Radulovic ◽

Snezana Jesic ◽

S. Krejovic-Trivic ◽

P. Stankovic ◽

...

Keyword(s):

Surgical Treatment ◽

Surgical Technique ◽

Complete Removal ◽

Initial Surgery ◽

Group I ◽

Number Of Patients ◽

Significant Difference ◽

Diffuse Form ◽

Surgical Failure

Past experience with open and closed techniques of tympanoplasty in surgery of cholesteatoma has shown that recurring illness is one of the major causes of surgical failure. The literature has reported varying trend of surgical treatment of cholesteatoma. The objective of the study was to analyze the significance of surgical technique in relation to the incidence and most frequent localization of recurrent cholesteatoma. Our study analyzed 120 patients operated on for cholesteatoma. The patients were divided into two groups, group I (45) with recurring disease and group II (75) without any recurring condition, which were followed up three years. Statistical analysis was carried out by modified t-test. The largest number of patients was re-operated in the first two years from the initial surgery (50%), In the majority of patients (50%), recurrent cholesteatoma was most commonly localized (stage I) in attic (20%) and much rarely in mesotympanum (11,9%). Stage III recurrent cholesteatoma was verified in 35% of patients, most frequently diffuse form (13,4%). The involvement of attic by all three stages of disease accounted for over 60%. The analysis of the used techniques of surgical treatment in both groups revealed significant difference. Open techniques of tympanoplasty were used in 60% of patients with no recurrence. Closed techniques were used more frequently in patients with recurring disease, i.e. in over 90% of cases. Recurrent cholesteatoma develops, in the majority of cases, during the first two years after the surgical intervention. Attic is the most common localization of cholesteatoma. More frequent utilization of open technique of tympanoplasty for surgery of cholesteatoma significantly reduces the incidence of recurring condition. The indications for CWD technique are the initial spread of cholesteatoma, possibility of complete removal of cholesteatoma and postoperative follow-up of patients.

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Surgical Correction of Penoscrotal Web: A Case Series With Literature Review

The Journal of Tepecik Education and Research Hospital ◽

10.5222/terh.2020.62134 ◽

2020 ◽

Author(s):

Volkan Sarper Erikçi

Keyword(s):

Surgical Treatment ◽

Clinical Characteristics ◽

Surgical Techniques ◽

Case Series ◽

Scrotal Skin ◽

Penile Skin ◽

Surgical Experience ◽

Postoperative Results ◽

Pediatric Urologist

INTRODUCTION: Penoscrotal webbing (PSW) is an anomaly of penis and it includes penile and scrotal skin aberration. There are various surgical techniques for repairing PSW with different terminologies. Herein we present our surgical experience of Z-plasty procedure in these cases. METHODS: In this retrospective study, 5 patients with an average age of 46 months who were diagnosed and under follow-up for PSW, between June 2017 and May 2019 were included. Along with demographic and clinical characteristics, treatment and follow-up records were collected. RESULTS: Isolated PSW was observed in 4 patients and one patient had an associated megameatus intact prepuce (MMIP) of a hypospadias variant in addition to PSW. Circumcision and ventral prepuce reconstruction of the penis with the aid of "Z-plasty" solved problem and acceptable postoperative results were obtained. DISCUSSION AND CONCLUSION: PSW is a condition that warrants surgical treatment. During the management of these children, in the case of suspicion of penile skin abnormality at the time of circumcision, it should be deferred and should be consulted to a pediatric surgeon or a pediatric urologist. Gentle surgical treatment is recommended for a favourable surgical and psychological result

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Evolving Solutions in the Surgical Treatment of Isolated Pulmonary Valve Stenosis

10.37191/mapsci-jccr-2(3)-044 ◽

2021 ◽

Author(s):

Sonia B. Albanese Albanese

Keyword(s):

Surgical Treatment ◽

Pressure Gradient ◽

Pulmonary Valve ◽

Balloon Valvuloplasty ◽

Pulmonary Valve Stenosis ◽

Group I ◽

Mean Pressure ◽

Valve Function ◽

Group Ii

Background: Surgical treatment of isolated pulmonary valve stenosis in infants and children has evolved over the years, shifting from the original exclusive aim at lowering right ventricle pressure to the current concomitant focus on preserving pulmonary valve function. In our study, we sought to analyze the effect of such evolving philosophy on long-term results. Methods: All consecutive patients treated in our center between July 1983 and March 2019 were included. Patients were categorized into 2 groups based on the introduction into treatment practice of sparing valve techniques (1995). Actuarial survival, freedom from reintervention on the right outflow tract, transvalvular mean pressure gradient decrease, and pulmonary valve function at follow-up were analyzed. Results: One hundred twenty-three patients operated before (Group I, n=81) or since (Group II, n=42) 1995 were enrolled in the study. Mean age and weight were 3.0 ± 0.36 years and 16.6 ± 1.7kg, respectively. Early mortality occurred exclusively in 3 patients of Group 1. Transvalvular mean pressure gradient decreased in the entire patient population (from 63.28 ± 12.9mmHg to 16.46 ± 7.9mmHg). At a mean follow-up interval of 4.9 ± 33 years, freedom from death was comparable, but freedom from right ventricular outflow tract reintervention was significantly greater in Group II. Although the transvalvular gradient remained stable over time in non-reoperated survivors (mean value of 16.46 ± 7.9mmHg), pulmonary valve function on 2D-Echo showed severe incompetence in 2 patients of Group I and just mild to moderate incompetence in 20 patients of Group II, with a significantly negative effect of unsuccessful preoperative pulmonary balloon valvuloplasty (14/20 vs 6/20, p=0.025) in the latter. Conclusion: Current pulmonary valve sparing techniques are associated with better results, particularly in terms of freedom from re-interventions and pulmonary valve function at follow-up. Balloon valvuloplasty prior to surgery may worsen operative results, promoting pulmonary insufficiency and therefore should probably be avoided in all patients in whom anatomical characteristics predict failure of percutaneous therapy.

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Effects of Surgical Stress on Serum Cortisol Level: A Comparative Study between Elective and Emergency Surgery

Journal of Bangladesh Society of Physiologist ◽

10.3329/jbsp.v2i0.981 ◽

1970 ◽

Vol 2 ◽

pp. 28-33

Author(s):

SM Selimuzzaman ◽

Noorzahan Begum ◽

Nadira Islam ◽

Shelina Begum

Keyword(s):

Surgical Treatment ◽

Cortisol Level ◽

Surgical Stress ◽

Serum Cortisol ◽

Study Groups ◽

Serum Cortisol Level ◽

Control Group ◽

Surgical Interventions ◽

Group I ◽

Healthy Control

The study was designed to observe the effects of surgical stress on serum level of cortisol in patients undergoing surgical treatment and to find out any differences in hormonal response between elective and emergency surgical procedures. A total number of 60 male subjects aged between 18 and 45 years were included in the study. Of them, 20 were healthy control (Group I), 20 underwent elective surgical treatment (Group II) and emergency surgical interventions were applied in rest 20 subjects (Group III). Study Groups were further divided into subgroups A (preoperative samples were collected 1- hour before operation), B (postoperative samples were collected 1-hour after the end of the operation) and C (postoperative samples were collected 24-hours after operation).Serum cortisol level was estimated by invitro-immunolytic test.Statistical analysis was done by paired, unpaired ‘t' test and regression analysis. The preoperative mean serum cortisol concentration in elective surgical cases was almost similar to that of healthy control. On the contrary, in the emergency surgical cases, a significantly increased mean cortisol level were observed (I vs IIIA and IIA vs IIIA; P < 0.05). The serum cortisol concentrations were increased both in elective and emergency surgical cases after operations but the magnitude of rise was more marked in emergency group of patients (IIB vs IIIB; P < 0.05). Therefore, this study reveals that surgical intervention causes increase in serum cortisol which is more marked in emergency procedure. Key Words: Stress; Cortisol; Surgery DOI:10.3329/jbsp.v2i0.981 J Bangladesh Soc Physiol. 2007 Dec;(2): 28-33.

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Surgical Treatment of Juvenile Femoral Head Epiphysiolysis in Children

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201623140-47 ◽

2016 ◽

Vol 23 (1) ◽

pp. 40-47

Author(s):

D. B Barsukov ◽

A. I Krasnov ◽

M. M Kamosko ◽

V. E Baskov ◽

I. Yu Pozdnikin ◽

...

Keyword(s):

Surgical Treatment ◽

Magnetic Resonance ◽

Femoral Head ◽

Femoral Neck ◽

Surgical Intervention ◽

Treatment Results ◽

Surgical Interventions ◽

X Ray ◽

Endochondral Growth

To optimize the anatomical and functional surgical treatment results in patients with early (I-II) stages of juvenile femoral head epiphysiolysis both pre- and postoperative data of clinical, x-ray and magnetic-resonance examinations were analyzed for 120 patients aged 11 - 15 years. Maximum follow up period after surgical interventions, i.e. femoral head epiphysiodesis (n=60) and femoral head epiphysis fixation (n=60) made up 23 and 3 years, respectively. It was shown that surgical intervention for the fixation of femoral head epiphysis ensured reliable stability of the epiphysis preventing the latter from displacement development and progression, and did not exert significant influence upon either femoral neck and head endochondral growth or the length of the upper extremity.

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FEATURES OF SURGICAL APPROACHES TO THE DIAGNOSIS AND TREATMENT OF THYROID DISEASES IN PATIENTS OF OLDER AGE GROUPS

Journal of Volgograd State Medical University ◽

10.19163/1994-9480-2020-3(75)-26-33 ◽

2020 ◽

Vol 75 (3) ◽

pp. 26-33

Author(s):

Yu.V. Kukhtenko ◽

◽

L.A. Ryaskov ◽

O.A. Kosivtcov ◽

I.V. Mikhin ◽

...

Keyword(s):

Surgical Treatment ◽

Thyroid Gland ◽

Clinical Characteristics ◽

Age Groups ◽

Older Age ◽

Surgical Approaches ◽

Topical Issue ◽

Thyroid Pathology ◽

High Comorbidity ◽

Surgery In Elderly

Diagnostics, tactics of medical and surgical treatment of various diseases of the thyroid gland is a topical issue in patients of older age groups. The peculiarity of this category of patients is high comorbidity, so the volume of surgery should be determined not only by the type and severity of the course of thyroid pathology, but also by the clinical characteristics of concomitant diseases. To date, the issue of choosing the volume of surgery in elderly and senile patients remains debatable.

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Combined Treatment Method Comparison Of Medical And Surgical Treatment In Idiopathic Granulomatous Mastitis

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v5i4.05 ◽

2018 ◽

Vol 5 (4) ◽

pp. 3737-3742

Author(s):

Ebubekir Gündeş ◽

Mehmet Aykut Yildirim ◽

Tevfik Küçükkartallar ◽

Faruk Aksoy ◽

Ahmet Tekin ◽

...

Keyword(s):

Surgical Treatment ◽

Combined Treatment ◽

Granulomatous Mastitis ◽

Selective Treatment ◽

Idiopathic Granulomatous Mastitis ◽

Therapy Algorithm ◽

Group I ◽

Significant Difference ◽

The Mean

Aim: Our aim in conducting this study was to ascertain the clinical, pathological, and radiological characteristics of patients diagnosed with idiopathic granulomatous mastitis in our clinic and to contribute to related literature by creating a therapy algorithm for granulomatous mastitis. Method: A total of 62 patients diagnosed with granulomatous mastitis in our clinic were classified into three groups as per the mode of treatment they received. Among these, 20 patients who had only been administered corticosteroids were allocated to Group I, while 18 patients who had received surgical treatment in addition to corticosteroid treatment were allocated to Group II, and 24 patients who had only received surgery were allocated to Group III. Results: All the cases were female patients. The mean age of the patients was 33.67 ± 6.35 (21-48). No statistically significant difference was found among the groups as per the mean age figures, pregnancy, breastfeeding, oral contraceptive administration, smoking and alcohol use, and family history (p>0.05). 49 (77.4%) patients were diagnosed with granulomatous mastitis by thick-needle biopsy, 7 (11.2%) by incisional biopsy, 4 (6.4%) by excisional biopsy, and 3 (4.8%) by fine-needle aspiration biopsy (FNAB) before the onset of treatment. The median value for the follow-up of the patients was 40 (6-81) months and there was no statistically significant difference among follow-up periods (p: 0.51). 15 (24.1%) patients among all the cases had recurrence. There was a statistically significant difference among the groups with regards to recurrence (p: 0.015). Conclusion: Granulomatous mastitis may simulate breast cancer both clinically and radiologically. Recurrence is observed in patients who only received corticosteroid or surgical treatment. The combination of corticosteroid and surgical treatment significantly reduces the rate of recurrence. Therefore, this combination can be recommended as selective treatment.

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Perceval Sutureless Bioprosthesis for Degenerative Aortic Valve Stenosis: Initial Experience With 67 Patients

The Heart Surgery Forum ◽

10.1532/hsf.4027 ◽

2021 ◽

Vol 24 (6) ◽

pp. E1065-E1069

Author(s):

Dejan Lazovic ◽

Mladen Kocica ◽

Filip Vucicevic ◽

Milica Kocica ◽

Milos Grujic ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Surgical Approaches ◽

Biological Prosthesis ◽

Group I ◽

Postoperative Time ◽

The Right

Objective: The objective of this prospective study was to evaluate the characteristics (positive and negative) of Perceval S valve in patients undergoing aortic valve replacement with a biological prosthesis. The study included 67 patients operated on at our institution and a mean follow-up period of 18 months. Methods: From June 2016 to November 2019, 209 patients underwent aortic valve replacement with a biological prosthesis. Of these, 67 patients were included in the study based on the exclusion and inclusion criteria set before the study began. Their data were recorded during their hospital stay (preoperative, intraoperative, and early and late postoperative time). Results: Fifty-four patients underwent isolated aortic valve replacement (group I) with a Perceval S prosthesis, and 13 patients had combined aortic valve replacement procedures and CABG procedures (group II). Patients were implanted with the following prosthesis sizes: S (N = 12), M (N = 18), L (N = 28), or XL (N = 9). The Perceval S valve successfully was implanted in 67 (91.8%) patients (in 6 patients, the preoperative transthoracic echocardiographic data did not coincide with intraoperative TEE and surgical measurement of the size of the annulus in the suture). Surgical approaches in patients were medial sternotomy (N = 48), mini sternotomy (N = 15), and thoracotomy through the second intercostal space to the right (N = 4). The mean clamping time of the aorta and CPB length for isolated cases was 54 and 82 minutes, respectively, and 96 and 120 minutes for combined procedures. Four (5.9%) patients died within 30 days. Conclusion: Early postoperative results showed that the Perceval S valve was safe. Further follow up is required to evaluate the long-term duration of patients with this bioprosthesis.

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INTENSIFICATION OF COMBINED THERAPY IN PATIENTS WITH FOOT PHLEGMON

Ulyanovsk Medico-biological Journal ◽

10.34014/2227-1848-2019-3-28-33 ◽

2019 ◽

pp. 28-33 ◽

Cited By ~ 1

Author(s):

A.V. Edilov ◽

V.K. Tat'yanchenko ◽

V.L. Bogdanov ◽

Yu.V. Sukhaya

Keyword(s):

Surgical Treatment ◽

Compartment Syndrome ◽

Clinical Laboratory ◽

Combined Therapy ◽

Diagnostic Algorithm ◽

High Strength ◽

Diagnosis And Treatment ◽

Efficacy Evaluation ◽

Tissue Pressure ◽

Group I

The purpose of the work is to improve surgical treatment of foot phlegmon by developing a method for diagnosis and treatment of compartment syndrome (CS). Materials and Methods. The study involved 64 patients with foot phlegmon of non-diabetic etiology. The patients were divided into two groups. Group I (control, n=31) suggested traditional treatment techniques. Group II (main, n=33) provided a new algorithm for the diagnosis and treatment of compartment syndrome (patent No. 2683855), along with ultrasonic cavitation and ozone therapy. To assess the severity of the purulent-inflammatory process in the foot, the authors suggested to include a tissue pressure measurement technique in the diagnostic algorithm. The obtained indicators contributed to the diagnosis of the compartment syndrome and, thus, administration of decompressive fasciotomy in fascial foot structures with a high strength level and elastic modulus. The authors also evaluated the degree of reparative processes in the postoperative wound and the level of its microbial contamination (CFU calculation). Results. It was estimated that the increase in tissue pressure by more than 25 mm Hg in 87.9 % of patients is an indication for a know-how decompressive fasciotomy. The obtained results of clinical, laboratory and instrumental research allowed the authors to develop an algorithm for treatment efficacy evaluation. Conclusion. The positive treatment results observed in 90.9 % of patients make it possible to recommend the developed algorithm for implementation in clinical practice. Keywords: phlegmon, tissue pressure, surgical treatment, fasciotomy. Цель работы – улучшение результатов хирургического лечения флегмоны стопы путем разработки способа диагностики и лечения компартмент-синдрома (КС). Материалы и методы. В исследовании участвовали 64 пациента с флегмоной стопы недиабетической этиологии, разделенных на две группы. В I группе (контрольной, n=31) использовалась традиционная методика лечения, во II группе (основной, n=33) – разработанный алгоритм диагностики и лечения компартмент-синдрома (патент на изобретение № 2683855), а также методы ультразвуковой кавитации и озонотерапии. Для оценки тяжести течения гнойно-воспалительного процесса в области стопы было предложено включить в диагностический алгоритм методику измерения тканевого давления. Полученные показатели послужили основанием для диагностики компартмент-синдрома и выполнения по показаниям декомпрессивной фасциотомии в области фасциальных структур стопы, обладающих высокими уровнем прочности и модулем упругости. Также оценивались степень репаративных процессов в послеоперационной ране и уровень ее микробной обсемененности по значению КОЕ. Результаты. Установлено, что увеличение тканевого давления более чем на 25 мм рт. ст. у 87,9 % пациентов является показанием для выполнения декомпрессивной фасциотомии по оригинальной методике. Полученные результаты клинических, лабораторных и инструментальных методов исследования позволили выработать алгоритм оценки эффективности лечения. Выводы. Отмеченные у 90,9 % пациентов хорошие результаты лечения дают возможность рекомендовать разработанный алгоритм для внедрения в клиническую практику. Ключевые слова: флегмона, тканевое давление, хирургическое лечение, фасциотомия.

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