scholarly journals EXPERIMENTAL STUDY OF CLINICAL INDICATORS OF INTRATISSUE PRESSURE IN DEEP CIRCULAR BURNS AND ITS DYNAMICS DEPENDING ON THE NATURE AND VOLUME OF SURGERY

2021 ◽  
pp. 22-26
Author(s):  
O. V. Kravtsov ◽  
T. A. Kurbanov ◽  
Yu. I. Kozin
Keyword(s):  
Experimental Study ◽  
Surgical Treatment ◽  
Compartment Syndrome ◽  
Surgical Intervention ◽  
Radical Excision ◽  
Tissue Pressure ◽  
Clinical Indicators ◽  
Experimental Animals ◽  
Rapid Decompression ◽  
Surgical Tactics

The purpose of research. To improve in the experiment the optimal variants of surgical tactics to eliminate the phenomena of compartment syndrome in circular deep burns on the basis of studying the dynamics of intratissue pressure. Materials and methods. An experiment to study the effectiveness of treatment of deep circular burns of III degree, accompanied by compartment-syndrome with objectification of intra-tissue pressure was performed on 18 male WAG rats weighing 190.0-200.0 g, which were divided into three groups depending from the nature and scope of surgery. Research results and their discussion. Based on the assessment of the dependence of the level of intratissue pressure in the tissues on the timing of modeling of deep circular burns in the experiment and tactics and volume of surgical treatment, a clear dependence of indicators in all groups of experimental animals. The primary necrectomy performed in the III main group due to the radical surgical intervention allowed to completely normalize the intratissue pressure within 24 hours. Conclusions. 1. Clinical indicators of intratissue pressure at deep circular burns depending on time of modeling of a thermal trauma and character and volume of surgical intervention are defined in experiment. 2. It is established that primary necrectomy due to radical excision of necrotized tissues and rapid decompression contributes to the nor malization of intratissue pressure.

INTENSIFICATION OF COMBINED THERAPY IN PATIENTS WITH FOOT PHLEGMON

2019 ◽  
pp. 28-33 ◽  
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.

DETERMINATION OF CLINICAL INDICATORS OF INTERSTITIAL PRESSURE IN DEEP AND BORDERLINE BURNS DEPENDING ON THE TIME OF THERMAL INJURY

2020 ◽  
pp. 44-50
Author(s):  
O. V. Kravtsov ◽  
T. A. Kurbanov ◽  
Yu. I. Kozin ◽  
A. A. Tsogoev ◽  
A.O. Gopko
Keyword(s):  
Compartment Syndrome ◽  
Thermal Injury ◽  
Infusion Therapy ◽  
Superficial Fascia ◽  
Interstitial Pressure ◽  
Drug Infusion ◽  
Tissue Pressure ◽  
Clinical Indicators ◽  
Ischemic Tissue ◽  
Muscle Groups

Summary. Objective. Improvement of the diagnosis of compartment syndrome depending on the time of thermal injury and the establishment of indications for draining operations. Materials and methods. Interstitial pressure was studied in 66 victims who were admitted to the burn center in the first 24 hours after the injury. The patients were divided into groups depending on the relative extent of the lesion and the length of hospitalization. The results of the study and their discussion. Upon admission of the patient to the department, a thorough sanitation of the burn surfaces was performed with antiseptic solutions (chlorhexidine, dekasan). In the burn area, the interstitial pressure was measured in all muscle groups deeper than the superficial fascia with a Kompartment druck Monitor System (MIPM Mammen dorfer Institut für Physik und Medizin Gmbh) apparatus for measuring interstitial pressure. Depending on the level of interstitial pressure, patients underwent conservative drug and infusion therapy aimed at reducing edema and hypoxia of damaged tissues. In the case of critical indicators of interstitial pressure, an urgent surgical intervention was performed for the purpose of decompression. When assessing the dependence of the pressure level in the tissues on the timing of burns, there is a clear dependence in all observation groups: late hospitalizations are accompanied by a large increase in pressure, the level of circular location of burns on the extremities is of great importance for high blood pressure. Conclusion. It has been determined that objectification of the diagnosis of the compartment syndrome in order to prevent ischemic tissue damage plays an important role in deep and borderline burns. Clinical indicators of tissue pressure in deep and borderline burns have been established, depending on the time of thermal injury, which allows the diagnosis of compartment syndrome and the establishment of indications for drug, infusion therapy and urgent drainage operations.

scholarly journals SURGICAL TACTICS IN THE TREATMENT OF GASTROINTESTINAL ULCER BLEEDING IN PATIENTS WITH CARDIOVASCULAR SYSTEM PATHOLOGY

2019 ◽  
pp. 16-20
Author(s):  
N. Trofimov ◽  
V. V. Kryshen ◽  
A. Chukhryenko ◽  
P. Lyaschenko
Keyword(s):  
Surgical Treatment ◽  
Gastrointestinal Bleeding ◽  
Postoperative Mortality ◽  
Underlying Disease ◽  
Ulcer Bleeding ◽  
Control Group ◽  
Radical Excision ◽  
Cardiovascular Pathology ◽  
Surgical Tactics ◽  
Stomach Resection

Summary. We analyzed the results of surgical treatment of 28 patients with gastrointestinal bleeding of ulcerative etiology. There are group of 16 patients in whom the underlying disease burdened by cardiovascular pathology and control group 12 patients. Resection techniques were used in 9 patients (32.2%), of them - Roux stomach resection - in 1 patient (3.6%), 1 patient (3.6%), to whom performed subtotal gastric resection, Billroth II stomach resection - 7 patients (25%), of which 1 patient (3.6%) in which the ulcer was localized in the duodenum and 6 (21.4%) - with gastric localization. Palliative surgical treatment methods performed in 7 patients (25%), there are gastrotomy, bleeding ulcer closure in 6 patients (21.4%), and 1 operation (3.6%) is closure gastrojejunostomy ulcer. The same operations performed, which were conditionally radical. Excision of the ulcer with pyloroplasty according to Finney and Heineke-Mikulich observed in 2 (7.1%) and 6 (21.4%) patients, antrumectomy plus truncal vagotomy - in 4 patients (14.3%). The general postoperative mortality in patients with gastrointestinal bleeding of the ulcerative origin was 10.7%. Postoperative mortality in the group of patients with concomitant cardiovascular pathology was 12.5%, in the control group - 8.33%.

Surgical treatment of extensive perianal hidradenitis

2020 ◽  
Vol 99 (9) ◽  
Keyword(s):  
Surgical Treatment ◽  
Hidradenitis Suppurativa ◽  
Soft Tissues ◽  
Case Reports ◽  
Radical Excision ◽  
Skin Flaps ◽  
Perianal Area ◽  
Apocrine Glands ◽  
Patient Preparation ◽  
Two Stages

Introduction: Perianal hidradenitis suppurativa is a chronic recurrent inflammatory, suppurative, and fistulising disease of apocrine glands, adjacent anal canal and soft tissues. Perianal area is the second most common affected area after axilla. There are three grades of the disease. Hidradenitis suppurativa represents a chronic, recurrent, deep-seated folliculitis resulting in abscesses, followed by the formation of sinus tracts and subsequent scarring. Perianal hidradenitis suppurativa is the last and the most serious grade of the disease and a specific access is needed for patient preparation and surgical treatment alone. The currently preferred method of treatment for patients with extensive perianal hidradentitis is excision and closure with combination of skin flaps, primary suture and skin graft in one or two stages. Case reports: There are three case reports of perianal hidradenitis suppurativa in this article. The local and overall initial treatment of patients followed by a radical excision and closure with a rotation skin flaps and skin grafts is described. The final results were satisfactory, with no recurrence or serious complication.

The Use of Eye Tracking to Discern the Threshold at Which Metopic Orbitofrontal Deformity Attracts Attention

2020 ◽  
Vol 57 (12) ◽  
pp. 1392-1401
Author(s):  
Mark P. Pressler ◽  
Emily L. Geisler ◽  
Rami R. Hallac ◽  
James R. Seaward ◽  
Alex A. Kane
Keyword(s):  
Surgical Treatment ◽  
Graduate Students ◽  
Eye Tracking ◽  
Dwell Time ◽  
Surgical Intervention ◽  
Three Dimensional ◽  
Average Dwell Time ◽  
Eye Tracker ◽  
Gaze Patterns ◽  
Areas Of Interest

Introduction and Objectives: Surgical treatment for trigonocephaly aims to eliminate a stigmatizing deformity, yet the severity that captures unwanted attention is unknown. Surgeons intervene at different points of severity, eliciting controversy. This study used eye tracking to investigate when deformity is perceived. Material and Methods: Three-dimensional photogrammetric images of a normal child and a child with trigonocephaly were mathematically deformed, in 10% increments, to create a spectrum of 11 images. These images were shown to participants using an eye tracker. Participants’ gaze patterns were analyzed, and participants were asked if each image looked “normal” or “abnormal.” Results: Sixty-six graduate students were recruited. Average dwell time toward pathologic areas of interest (AOIs) increased proportionally, from 0.77 ± 0.33 seconds at 0% deformity to 1.08 ± 0.75 seconds at 100% deformity ( P < .0001). A majority of participants did not agree an image looked “abnormal” until 90% deformity from any angle. Conclusion: Eye tracking can be used as a proxy for attention threshold toward orbitofrontal deformity. The amount of attention toward orbitofrontal AOIs increased proportionally with severity. Participants did not generally agree there was “abnormality” until deformity was severe. This study supports the assertion that surgical intervention may be best reserved for more severe deformity.

scholarly journals MEAN 6 YEAR CLINICAL OUTCOMES, SURVIVORSHIP, AND RETURN TO SPORTS AFTER ARTHROSCOPIC CAPSULAR REPAIR WITH SUTURE ANCHORS FOR ADOLESCENT MULTIDIRECTIONAL SHOULDER INSTABILITY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0002
Author(s):  
Brendon C. Mitchell ◽  
Matthew Y. Siow ◽  
Alyssa Carrol ◽  
Andrew T. Pennock ◽  
Eric W. Edmonds
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Shoulder Instability ◽  
Surgical Intervention ◽  
Operation Time ◽  
Demographic Variables ◽  
Return To Sports ◽  
Suture Anchors ◽  
Surgical Failure

Background: Multidirectional shoulder instability (MDI) refractory to rehabilitation can be treated with arthroscopic capsulolabral reconstruction with suture anchors. No studies have reported on outcomes or examined the risk factors that may contribute to poor outcomes in adolescent athletes. Hypothesis/Purpose: To identify risk factors for surgical failure by comparing anatomic, clinical, and demographic variables in adolescents who underwent surgical intervention for MDI. Methods: All patients undergoing arthroscopic shoulder surgery at one institution between January 2009 and April 2017 were reviewed. Patients >20 years old at presentation were excluded. Multidirectional instability was defined by positive drive-through sign on arthroscopy plus positive sulcus sign and/or multidirectional laxity on anterior and posterior drawer testing while under anesthesia. Two-year minimum follow-up was required, but those whose treatment failed earlier were included for reporting purposes. Demographics and intraoperative findings were recorded, as were Single Assessment Numeric Evaluation (SANE) scoring, Pediatric and Adolescent Shoulder Survey (PASS), and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) results. Results: Eighty adolescents (88 shoulders) were identified for having undergone surgical treatment of MDI. Of these 80 patients, 42 (50 shoulders; 31 female, 19 male) were available at a minimum of 2-year follow-up. Mean follow-up was 6.3 years (range, 2.8-10.2 years). Thirteen (26.0%) shoulders experienced surgical failure defined by recurrence of subluxation and instability, all of which underwent re-operation. Time to re-operation occurred at a mean of 1.9 years (range, 0.8-3.2). Our cohort had an overall survivorship of 96% at 1 year after surgery and 76% at 3 years. None of the anatomic, clinical, or demographic variables tested, or the presence of generalized ligamentous laxity, were correlated with subjective outcomes or re-operation. Number of anchors used was not different between those that failed and those that did not fail. Patients reported a mean SANE score of 83.3, PASS score of 85.0, and QuickDASH score of 6.8. Return to prior level of sport (RTS) occurred in 56% of patients. Conclusion: Multidirectional shoulder instability is a complex disorder that can be challenging to treat. Adolescent MDI that is refractory to non-surgical management appears to have long-term outcomes after surgical intervention that are comparable to adolescent patients with unidirectional instability. In patients who do experience failure of capsulorraphy, we show that failure will most likely occur within 3 years of the index surgical treatment. [Table: see text][Figure: see text]

Differential diagnosis of chiasmal-cellular cyst

2020 ◽  
pp. 47-59
Author(s):  
Nikita Sergeevich Puzakov ◽  
Vladislav Yurievich Cherebillo ◽  
Ilya Aleksandrovich Tregubenko ◽  
Evgeniy Igorevich Kozak ◽  
Yuliya Igorevna Ryumina
Keyword(s):  
Surgical Treatment ◽  
Pituitary Adenomas ◽  
Comparison Group ◽  
Clinical Symptoms ◽  
Differential Diagnostics ◽  
Diagnostic Features ◽  
Accurate Preoperative Diagnosis ◽  
Colloid Cysts ◽  
Surgical Tactics ◽  
Cellular Area

The clinical symptoms of chiasmal-cellular formations are similar, which significantly complicates its differential diagnostics. The differential diagnostics of chiasmal-cellular cysts, which include colloid cysts, arachnoid cysts, Rathke’s pouch cysts, epidermoid and dermoid cysts, is especially difficult. Nevertheless, an accurate preoperative differential diagnostics of chiasmal-cellular cysts is an important stage of preparation for surgical treatment, which allows determining the surgical tactics in advance, because each group of chiasmal-cellular cysts has its own features of surgical treatment, which significantly reduce the number of complications and minimize the number of recurrences. This study intended to improve the efficiency of diagnostics of the chiasmal-cellular cysts by determining the criteria for its differential diagnostics. 94 patients with chiasmal-cellular cysts and pituitary adenomas were examined and treated in the period of 2009 and 2018 for this purpose. As the most frequent pathology of the chiasmal-cellular area, pituitary adenomas were selected as a comparison group due to the fact that it is often necessary to differentiate chiasmal-cellular cysts with this pathology. Patients were divided into 5 groups according to the nosology of the disease. Clinical picture, laboratory analysis and MRI data were studied in each group. Statistical analysis and comparison of the data obtained among all groups were performed, and it allowed to determine the distinctive diagnostic features incidental to each group. It is possible to make an accurate preoperative diagnosis based on the specific features of differential diagnostics.

MORPHOLOGICAL EVALUATION OF EFFECTIVENESS OF NECROFASCIOTOMY AND INFILTRATION WITH OZONATED SALINE AREA OF DEEP CIRCULAR BURN OF SKIN WITH UNDERLYING TISSUES COMPLICATED BY COMPARTMENT SYNDROME

2020 ◽  
pp. 28-33
Author(s):  
Teimur Ahaliievich Kurbanov ◽  
O. V. Kravtsov ◽  
M. S. Myroshnychenko ◽  
Yu. I. Isaev
Keyword(s):  
Compartment Syndrome ◽  
Physiological Solution ◽  
Burn Wound ◽  
Local Pressure ◽  
Tissue Pressure ◽  
Surgical Interventions ◽  
Morphological Evaluation ◽  
General Pathology ◽  
Saline Area ◽  
The One

Compartment syndrome is one of the complications of tissue damage of various origins, the basis of which is the compression of blood vessels and disruption of blood supply to tissues due to an increased local pressure in the closed space of the fascial sheath. The consequences of compartment syndrome can be local and general. An effective treatment of compartment syndrome in burns is to perform a necrotomy, which due to decompression helps to reduce intra−tissue pressure and diminish the scale of necrotic changes in tissues. In order to morphologically evaluate the effectiveness of necrofasciotomy, as well as the one in combination with infiltration of ozonated saline area of deep circular skin burns with underlying tissues, complicated by compartment syndrome, an experimental study was conducted. Circular deep burns, complicated by the formation of compartment syndrome, were simulated in 18 WAG rats. To reduce the pressure in the burned and surrounding tissues, surgical interventions such as necrofasciotomy were performed, which provided a notable reduction in pressure. In parallel, infiltration of damaged tissues with ozonated saline was performed, which was bubbled for 15 minutes at a dissolved ozone concentration of 4.0±0.2 mg / l, which improved microcirculation and reduced tissue hypoxia. The findings indicate that the compartment syndrome is characterized by a significant severity of general pathology. Performance of necrofasciotomy of a burn wound with its infiltration by ozonated physiological solution in comparison with just necrofasciotomy has more positive medical effect, and efficiency of these medical measures increases when they are performed at early terms (day 1) of formation of a burn wound in comparison with late terms (day 3). Key words: burns, surgical treatment, compartment syndrome, histological examinations.

Predictors of Surgical Intervention in Patients with Inflammatory Bowel Disease

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Hamdy Abd El Megeed ◽  
Shereen Abou Bakr Saleh ◽  
Christina Alphonse Anwar ◽  
Ahmed Elkattary Mohamed Elkattary
Keyword(s):  
Inflammatory Bowel Disease ◽  
Surgical Treatment ◽  
Bowel Disease ◽  
Surgical Intervention ◽  
High Sensitivity ◽  
Medical Patients ◽  
Mayo Score ◽  
Calprotectin Level ◽  
Inflammatory Bowel ◽  
The Mean

Abstract Background Inflammatory bowel disease (IBD) is comprised of two major disorders: Ulcerative Colitis and Crohn’s disease. Ulcerative Colitis affects the colon, where as Crohn’s disease can involve any component of the gastrointestinal tract from the mouth to the perianal area. These disorders have somewhat different pathologic and clinical characteristics, but with substantial overlap; their pathogenesis remains poorly understood. Objective To determine & detect different predictors that help us to characterize patients with high probability of undergoing surgical intervention for inflammatory bowel diseases. Patients and Methods The present study was designed to detect & identify possible factors that can be used to predict surgical intervention in patients with IBD. The present study was a case control study that was conducted on 80 patients with inflammatory bowel disease (either controlled by medical treatment or needed surgical intervention as a part of disease control) who were recruited form Ain-Shams university hospitals and El Quabbary general hospital in Alexandria. In the present study, the mean age of the included patients was 36.67 ±8.5 years old and 50% of the patients were males. The mean age at the onset of the disease was 25.81 ±6.8 years old. Results In the present study, there were statistically significant differences between surgical and medical patients in terms of CDAI for CD (p &lt; 0.001) and Mayo score for UC (p &lt; 0.001). Surgical patients were more likely to have higher scores. CDAI and Mayo score were negative predictors of surgical treatment. CDAI score &gt; 287 and Mayo score &gt; 8.5 achieved high sensitivity and specificity for the detection of surgical treatment. In the present study, we found that there was statistically significant differences between surgical and medical patients in terms of Stool Calprotectin level. Surgical patients were more likely to have higher Stool Calprotectin level. Stool Calprotectin level was negative predictor of surgical treatment at a level of &gt; 341.5 microgm/gm with high sensitivity and specificity. Conclusion Surgical treatment is a common outcome in IBD. Certain clinical features and the extent of disease are risk factors for surgical intervention. Our study indicates that smoking, Chron’s disease, perianal disease, granulomas, higher severity scores, higher stool Calprotectin level, CRP, and ESR were associated with higher risks of surgical intervention. In addition, smoking, peri-anal disease, CDAI, Mayo score, Stool Calprotectin level, and CRP level were predictors of surgical treatment. The findings of our analysis have implications for practice, particularly in the promotion of preoperative individualized risk prediction. The ability to predict which patients will need surgery and target more intensive, early treatment to that group would be invaluable. Further research through large prospective cohort studies is needed to confirm our findings and conclusions.

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