scholarly journals PERIOPERATION CHANGES COLON AND RECTUM MICROBIOCINOSIS WITH COLORECTAL PATIENTS

2019 ◽  
Vol 65 (4) ◽  
pp. 516-523
Author(s):  
Aleksandr Zakharenko ◽  
Mikhail Belyaev ◽  
Oleg Ten ◽  
Anton Trushin ◽  
Vitaliy Rybalchenko ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Diagnostic Algorithm ◽  
Perioperative Period ◽  
Main Group ◽  
Long Term Results ◽  
Control Group ◽  
Colon And Rectum ◽  
Colorectal Cancer Patients ◽  
Stool Analysis

Most colorectal cancer patients prove to have dysbiosis of varying severity. Perioperative period contributes to the progression of the microbiocenosis disorders. It has been proven that a large role in the development of postoperative complications is played by the state of the colon microflora. Materials. 211 colorectal cancer patient’s (T1-4N0-2M0) colon microflora was studied by PCR. Surgeries were performed laparoscopically. In the main group, developed diagnostic algorithm was used, in which initial colon flora was studied with dysbiosis progression risk determination by developed logistic regression model and perioperative correction of revealed disorders. Standards of dysbiosis treatment were used. Results. 100% patients in control group proved to have dysbiosis of varying severity: 1 grade - 27,4% (n=14), 2 grade - 37,3% (n=19), 3 grade - 31,4% (n=16), 4 grade - 3,9% (n=2). Dysbiosis progression was observed in postoperative period: 1 grade - 7,8% (n=4), 2 grade - 51,0% (n=26), 3 grade - 29,4% (n=15), 4 grade - 11,8% (n=6). The same preoperative results were registered in main group. However, after perioperative correction there was 12,5% (n=6) 3 grade and no registered 4 grade patients. Long-term results were better in the main group than in the control group. Adverse events were significantly higher in the control group against the main group (15,7% (n=8) and 4,2% (n=2) respectively). Discussion. We recommend preoperative stool analysis with PCR for colon microflora determination in order to further dysbiosis correction and treatment long-term results assessment.

scholarly journals Structure, diagnosis, prevention and treatment of postoperative complications of childbirth perineal tears complicated by anal incontinence

2015 ◽  
Vol 96 (5) ◽  
pp. 779-783
Author(s):  
S G Sultanova
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Anal Canal ◽  
Anal Incontinence ◽  
Main Group ◽  
Long Term Results ◽  
Control Group ◽  
Perineal Tears ◽  
Second Degree

Aim. Improving the results of surgical treatment of complications of second and third degree perineal tears complicated by anal incontinence. Methods. The study included 248 patients aged 16 to 50 years. The patients were allocated to three groups: the first group - 40 women who underwent traditional surgery and conservative treatment; the second group - 128 women with second degree perineal tear; group III - 80 women who underwent sphincteroplasty (I option) and sphincteroplasty combined with levatorplasty (II option) in our modification (sphincter-saving surgery with precision sutures). The main group included 111 patients who additionally received conservative treatment [1 mL of 1% enoxaparin sodium intravenously and 1 ml of 30% vitamin E (alfa-tocopherol acetate) by intramuscular injection]; control group - 97 patients who underwent standard treatment. Long-term results were assessed by a survey, physical examination in the clinic, telephone and Internet surveys in 35 patients of the main group and 31 women of the control group. Results. In 91 (82%) patients of the main group, the pain intensity decreased after 7-10 days of treatment was antioxidants, 8 (7.2%) patients had pain in the perineum or anal canal, in 12 (10.8%) cases intense pain in the anal canal were still present. Long-term results were evaluated as good in 16 (51.6%) and 25 (69.4%) patients, as satisfactory - in 9 (29%) and 8 (22.2%) patients, as unsatisfactory - 6 (19.4 %), and 3 (8.3%) patients of the main and the control groups, respectively. The test group showed earlier formation of granulation tissue (3.1±0.3 days earlier compared to the control group). At sphincterometry on the 12th day, 6 patients of the control group had first degree anal incontinence, 3 - second degree anal incontinence compared with only 1 (1.8%) case in the study group (second degree sphincter incontinence). Conclusion. A proposed diagnostic strategy in women with anal incontinence due to perineal tears of II-III degrees after the labor trauma, allowed choosing the optimal method of surgical treatment and improving treatment outcomes.

scholarly journals Step by Step Extra-Focal Fixation of Unstable Pelvis with Separate Anterior and Posterior Modules

2014 ◽  
Vol 21 (4) ◽  
pp. 5-14
Author(s):  
I. V Borozda ◽  
N. A Ganzhurov ◽  
A. A Kapustyanskiy ◽  
R. V Nikolaev
Keyword(s):  
Functional Result ◽  
Pelvic Ring ◽  
Main Group ◽  
Long Term Results ◽  
Control Group ◽  
Residual Deformity ◽  
Pelvic Fixation ◽  
Vital Functions ◽  
External Fixation Device

Results of step by step treatment of 28 patients with disintegrative pelvic ring injuries are presented. In 14 patients (main group) step by step extra-focal pelvic fixation with application of anterior (antishock) and posterior modules was performed. In 14 patients (control group) osteosynthesis by external fixation device with circular support was used. Long-term results were assessed in1 year after injury. In control group residual deformity averaged 5 (4-7) mm and was noted in 10 (71.4%) patients. In the main group residual deformity was observed in 4 (28.6%) cases and averaged 2.5 (2-3) mm (p=0.0039). In the main group functional result by Majeed scale was also significantly better (p=0.000319). Excellent and good results were achieved in 9 (64.3%) and 5 (35.7%) of patients, respectively. In control group results were considered to be excellent in 3 (21.4%), good - in 6 (42.9%), satisfactory - in 4 (28.6) and poor - in 1 (7.1%) of cases. Advantage of the proposed transosseous osteosynthesis technique is the modular principle of the construction use that enables to perform separate fixation with anterior (antishock) module followed by final reposition of the pelvic ring with posterior module after stabilization of patient’s vital functions. This allows to increase the number of external pelvic fixation in patients with polytrauma.

scholarly journals The Results of Cytoreductive Operations in Patients with Colorectal Cancer with Simultaneous Liver Polymetastases

2018 ◽  
Vol 3 (2) ◽  
pp. 54-59
Author(s):  
SV V Kozlov ◽  
OI I Kaganov ◽  
AE E Orlov ◽  
AM M Kozlov
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Liver Metastases ◽  
Cytoreductive Surgery ◽  
Stage Iv ◽  
Long Term Results ◽  
Control Group ◽  
Results Of Treatment ◽  
Cytoreductive Treatment

Aim - to improve the long-term results of cytoreductive treatment of patients with simultaneous multiple bilobar liver metastases of colorectal cancer by the use of RFTA. Materials and methods. The study presents the results of treatment of 168 patients diagnosed with colorectal cancer of stage IV with simultaneous bilobar metastases in the liver. In the main group, cytoreductive tumor removal was accompanied by radiofrequency thermal ablation (RFTA) of metastatic formations. In the control group only the primary tumor was removed. Results. The use of RFTA during cytoreductive surgery does not worsen the immediate results of surgical treatment, in comparison with patients, where the effect on liver metastases has not been performed, but allows to increase medians of uneventful and overall survival from 9 and 22 months to 17 and 29 months, respectively. Conclusions. The use of RFTA for simultaneous multiple bilobar metastases in the liver during cytoreductive surgery makes it possible to achieve 22.7% of the three-year uneventfulness and 4.3% of the five-year overall survival.

scholarly journals An integrated approach to treatment of patients with complicated forms of gastroesophageal reflux disease

2020 ◽  
Vol 101 (4) ◽  
pp. 595-602
Author(s):  
A A Moroshek ◽  
M V Burmistrov
Keyword(s):  
Postoperative Complications ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Antireflux Surgery ◽  
Main Group ◽  
Long Term Results ◽  
Control Group ◽  
Peptic Stricture

Aim. To justify the appropriateness of applying the integrated algorithm of treatment, including the sequential application of conservative antireflux treatment and antireflux surgery, in patients with complicated forms of gastroesophageal reflux disease. Methods. The main group of the study included 554 patients with complicated forms of gastroesophageal reflux disease (erosive esophagitis in 301, peptic stricture in 36, Barrett's esophagus in 90 and a combination of several complications in 127 patients), and the control group included 229 patients with uncomplicated gastroesophageal reflux disease and indications for surgical treatment. At the diagnostic stage, fiberoptic esophagogastroduodenoscopy with chromoendoscopy using a double dye staining technique (Lugol and methylene blue) and biopsies of areas suspicious for metaplasia, as well as a barium contrast multi-positional radiographic examination of the esophagus and gastroesophageal junction were used. At the treatment stage, both groups received conservative antireflux treatment lasting 48 weeks, comprising lifestyle regulation, diet, antisecretory drug therapy (proton pump inhibitors omeprazole or rabeprazole 20 mg orally twice a day, antispasmodic agent domperidone 20 mg orally 3 times a day or itopride 50 mg orally 3 times a day), followed by either laparotomic or laparoscopic antireflux surgery. In the main group, antireflux surgery was supplemented with endoscopic argon plasma coagulation during the postoperative period in the patients with Barrett's esophagus and esophageal bougienage under endoscopic control during the pre- and postoperative period in the patients with a peptic stricture. Results. The frequency of intraoperative [6.3% (95% CI 1.45.8%), p=0.0462] and early postoperative complications [41.5% (95% CI 37.445.7%), p=0.0011] in the main group were statistically significantly higher than in the control group. There was no clinically important difference. Frequency of late postoperative complications in the main group [5.4% (95% CI 3.77.6%)] did not have statistically significant differences from the control (p=0.1239). The integrated algorithm of treatment has proven to be safe with provision for the need to develop measures to reduce the overall incidence of early postoperative complications. Excellent and satisfactory immediate treatment results were achieved in 91.7% (95% CI 89.193.9%), and excellent and satisfactory long-term results were achieved in 91.3% (95% CI 88.793.5%) patients of the main group, and were statistically significantly worse than in the control group, p=0.0008 and p=0.0021 for the immediate and long-term results, respectively. The difference was attributable to the extremely high efficiency of the treatment algorithm in the control group and had no clinical significance. Conclusion. The use of the integrated algorithm of treatment based on the implementation of antireflux surgery is appropriate in all patients with complicated forms of gastroesophageal reflux disease.

scholarly journals ANALYSIS OF SHORT AND LONG-TERM RESULTS OF RECONSTRUCTIVE- RESTORATIVE PHASE AFTER THE OPERATIONS LIKE HARTMANN

2016 ◽  
pp. 22-25 ◽  
Author(s):  
I. G. Gataullin ◽  
M. M. Khalikov
Keyword(s):  
Colorectal Cancer ◽  
Reconstructive Surgery ◽  
Long Term Results ◽  
Time Interval ◽  
Hartmann Procedure ◽  
Primary Surgery ◽  
Optimal Period ◽  
Short And Long Term ◽  
Colorectal Cancer Patients

AIM. To improve short and long-term results of reconstructive surgery in patients with complicated colorectal cancer. PATIENTS AND METHODS. Results of 63 patients who had Hartmann procedure for complicated colorectal cancer and thereafter undergone reconstructive surgery were analized. RESULTS. Restorative surgerys was performed at different time interval after the primary surgery. Sphincterometry was done in all patients with the aim to assess the functional integrity of the anal sphincter. CONCLUSION. Suggested optimal period for reconstructive surgery is 1-3 months after the primary surgery.

scholarly journals Laparoscopic extralevator abdominoperineal extirpation of the rectum: long-term results

2020 ◽  
Vol 10 (3-4) ◽  
pp. 34-42
Author(s):  
M. A. Danilov ◽  
A. V. Leontyev ◽  
A. B. Baychorov ◽  
Z. M. Abdulatipova ◽  
G. G. Saakyan
Keyword(s):  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Main Group ◽  
Long Term Results ◽  
Control Group ◽  
Free Survival ◽  
Significant Difference ◽  
Oncological Results ◽  
Disease Free

Objective: comparative assessment of long-term oncological results of laparoscopic extralevator and traditional abdominal-perineal resection (APR).Materials and methods. The analysis of immediate and long-term oncological results of treatment of 92 patients who underwent traditional laparoscopic and extralevator APR for low rectal cancer. Inclusion criteria were tumors of the lower ampullar rectum, excluding the performance of sphincter-sparing surgical interventions, and patients’ age up to 75 years. Exclusion criteria: distant metastases, histologically confirmed squamous cell carcinoma. Analysis of immediate and long-term results was carried out.Results. The main group included patients who underwent extralevator APR (n = 62), patients in the control group (n = 30) underwent traditional APR. There were no significant differences in the type of neoadjuvant and adjuvant treatment in the comparison groups (p >0.05). In the group of patients operated on in the volume of extralevator APR, 42 received neoadjuvant chemoradiotherapy versus 19 patients in the group of traditional APR, there was no statistically significant difference (p = 0.21). In the extralevator APR group, perineal plastic surgery was performed significantly more often than in the traditional APR group (p = 0.001). When evaluating the immediate results, there was a statistically significant difference in the total number of complications between the study groups, such complications as bladder dysfunction following after surgery, inflammatory pelvic disease in the perineal wound, perineal hernia occurred significantly more often in the traditional APR group than in the extralevator APR group (p >0.05). In terms of overall and disease-free survival, the groups differed statistically significantly: 5-year overall survival in the main group was 90 % versus 62.5 % in the control group (p = 0.03), 5-year disease-free survival in the main group was 98.5 % versus 65 % in the control group, respectively (p = 0.01).Conclusions. Extralevator APR of the rectum is the most radical surgical intervention than with the traditional APR technique due to the lower risk of a positive circumferention resection margin, therefore, reducing the incidence of local recurrence, and as a result, improving overall and disease-free survival rates compared to the traditional technique.

scholarly journals Step by Step Extra-Focal Fixation of Unstable Pelvis with Separate Anterior and Posterior Modules

2014 ◽  
pp. 5-14
Author(s):  
I. V. Borozda ◽  
N. A. Ganzhurov ◽  
A. A. Kapustyanskiy ◽  
R. V. Nikolaev
Keyword(s):  
Functional Result ◽  
Pelvic Ring ◽  
Main Group ◽  
Long Term Results ◽  
Control Group ◽  
Residual Deformity ◽  
Pelvic Fixation ◽  
Vital Functions ◽  
External Fixation Device

Results of step by step treatment of 28 patients with disintegrative pelvic ring injuries are presented. In 14 patients (main group) step by step extra-focal pelvic fixation with application of anterior (antishock) and posterior modules was performed. In 14 patients (control group) osteosynthesis by external fixation device with circular support was used. Long-term results were assessed in1 year after injury. In control group residual deformity averaged 5 (4-7) mm and was noted in 10 (71.4%) patients. In the main group residual deformity was observed in 4 (28.6%) cases and averaged 2.5 (2-3) mm (p=0.0039). In the main group functional result by Majeed scale was also significantly better (p=0.000319). Excellent and good results were achieved in 9 (64.3%) and 5 (35.7%) of patients, respectively. In control group results were considered to be excellent in 3 (21.4%), good - in 6 (42.9%), satisfactory - in 4 (28.6) and poor - in 1 (7.1%) of cases. Advantage of the proposed transosseous osteosynthesis technique is the modular principle of the construction use that enables to perform separate fixation with anterior (antishock) module followed by final reposition of the pelvic ring with posterior module after stabilization of patient’s vital functions. This allows to increase the number of external pelvic fixation in patients with polytrauma.

scholarly journals Role and effectiveness of complex and supervised rehabilitation on overall and hand function in systemic sclerosis patients—one-year follow-up study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Michał Waszczykowski ◽  
Bożena Dziankowska-Bartkowiak ◽  
Michał Podgórski ◽  
Jarosław Fabiś ◽  
Arleta Waszczykowska
Keyword(s):  
Systemic Sclerosis ◽  
Hand Function ◽  
Exercise Program ◽  
Rehabilitation Program ◽  
Long Term Results ◽  
Home Exercise ◽  
Control Group ◽  
Study Group

AbstractThe aim of this study was to estimate the long-term results of complex and supervised rehabilitation of the hands in systemic sclerosis (SSc) patients. Fifty-one patients were enrolled in this study: 27 patients (study group) were treated with a 4-week complex, supervised rehabilitation protocol. The control group of 24 patients was prescribed a home exercise program alone. Both groups were evaluated at baseline and after 1-, 3-, 6-, and 12-months of follow-up with the Disability of the Arm, Shoulder and Hand Questionnaire (DAHS) as the primary outcome, pain (VAS—visual analog scale), Cochin Hand Function Scale (CHFS), Health Assessment Questionnaire Disability Index (HAQ-DI), Scleroderma-HAQ (SHAQ), range of motion (d-FTP—delta finger to palm, Kapandji finger opposition test) and hand grip and pinch as the secondary outcomes. Only the study group showed significant improvements in the DASH, VAS, CHFS and SHAQ after 1, 3 and 6 months of follow-up (P = 0.0001). Additionally, moderate correlations between the DASH, CHFS and SHAQ (R = 0.7203; R = 0.6788; P = 0.0001) were found. Complex, supervised rehabilitation improves hand and overall function in SSc patients up to 6 months after the treatment but not in the long term. The regular repetition of this rehabilitation program should be recommended every 3–6 months to maintain better hand and overall function.

scholarly journals Influence of Postoperative Changes in Sarcopenia on Long-Term Survival in Non-Metastatic Colorectal Cancer Patients

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2410
Author(s):  
Chungyeop Lee ◽  
In-Ja Park ◽  
Kyung-Won Kim ◽  
Yongbin Shin ◽  
Seok-Byung Lim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Cancer Patients ◽  
Medical Center ◽  
The Body ◽  
Term Survival ◽  
Postoperative Changes ◽  
Asan Medical ◽  
Colorectal Cancer Patients

The effect of perioperative sarcopenic changes on prognosis remains unclear. We conducted a retrospective cohort study with 2333 non-metastatic colorectal cancer patients treated between January 2009 and December 2012 at the Asan Medical Center. The body composition at diagnosis was measured via abdominopelvic computed tomography (CT) using Asan-J software. Patients underwent CT scans preoperatively, as well as at 6 months–1 year and 2–3 years postoperatively. The primary outcome was the association between perioperative sarcopenic changes and survival. According to sarcopenic criteria, 1155 (49.5%), 890 (38.2%), and 893 (38.3%) patients had sarcopenia preoperatively, 6 months–1 year, and 2–3 years postoperatively, respectively. The 5-year overall survival (OS) (95.8% vs. 92.1%, hazard ratio (HR) = 2.234, p < 0.001) and 5-year recurrence-free survival (RFS) (93.2% vs. 86.2%, HR = 2.251, p < 0.001) rates were significantly lower in patients with preoperative sarcopenia. Both OS and RFS were lower in patients with persistent sarcopenia 2–3 years postoperatively than in those who recovered (OS: 96.2% vs. 90.2%, p = 0.001; RFS: 91.1% vs. 83.9%, p = 0.002). In multivariate analysis, postoperative sarcopenia was confirmed as an independent factor associated with decreased OS and RFS. Pre- and postoperative sarcopenia and changes in the condition during surveillance were associated with oncological outcomes.

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