Prophylaxis of complications in operations for cancer of middle and lower thirds of the esophagus

Objective. Improvement of the surgical treatment results in esophageal cancer. Маterials and methods. Results of surgical treatment of 43 patients, having cancer of middle and lower thirds of the esophagus, were analyzed. Lewis operation was performed in 38 patients, and Garlock operation – in 5. Circular suture stapler with second row of a П-like manual sutures was applied in 28 patients. In 15 patients anastomosis was formatted, using hand-sewn two-row suture. The method of anastomosing choice had depended upon local and general factors: the tumor localization, the esophageal wall changes in anastomotic site, degree of the water-electrolyte disorders, the protein balance, concurrent pathology. Prophylaxis of postoperative morbidity consisted of preoperative correction of laboratory indices, treatment of concurrent pathology, choice of the anastomosis formation method, postoperative intensive therapy. Results. Postoperative complications had occurred in 1 (2.3%) patient. Mostly frequent postoperative complication after resection for esophageal cancer constitute insufficiency of esophago-gastric anastomosis, which occurs under impact of general and local factors. General factors: disorders of the blood circulation, caused by cardiac insufficiency, hypoxia due to pulmonary insufficiency, coagulopathy, disorders of the protein and water-electrolyte metabolism. Reduction of influence of general factors on the postoperative morbidity occurrence was achieved using the intensive preoperative preparation conduction. Conclusion. The postoperative morbidity prevention turns effective while its accomplishment on all stages of treatment: during preoperative preparation, intraoperatively and postoperatively.

Comparison of outcomes between medical and surgical treatment in dogs with prostatic adenocarcinoma: a retrospective study

Background Prostatic cancer is uncommon in dogs. Dogs with prostatic carcinoma have been reported to have a poor prognosis. Information regarding prognosis with various surgery options as well as prognosis with surgical vs. medical treatment is lacking. This retrospective study compares the outcomes of medical management to surgical treatment in dogs with prostatic adenocarcinoma and assesses the surgical outcomes of patients who underwent total prostatectomy (TP) and prostatocystectomy (TPC). The medical records of 41 dogs with prostatic adenocarcinoma, between February 2008 and June 2019, were reviewed for information on signalment, clinical signs in the initial evaluation, preoperative diagnostic imaging findings, treatment type (non-surgical or surgical), surgery type, postoperative complications, adjunctive medical therapy, and survival time. The dogs were divided into non-surgical (n = 12) or surgical (n = 29) groups. The surgical group was subdivided into the TP (n = 20) and TPC (n = 9) subgroups. Results Age was not significantly different between the surgical (median 13.1 years [8.4–15.4] years) and the non-surgical groups (median 10.8 [7.7–15.3] years). Body weight (BW) was also not significantly different between the surgical (median 6.8 kg [2.4–34.5 kg]) and non-surgical groups (median 6.4 kg [3.7–9.12 kg]). The overall median survival time (MST) from the initial evaluation was significantly longer in the surgical than in the non-surgical group (337 vs. 90.5 days). The postoperative MST was significantly longer in the TP group than in the TPC subgroup (510 vs. 83 days). As TPC was performed in cases of tumor progression, its postoperative complications were severe, resulting in a shorter MST. Ten (50%) and 6 patients (30%) in the TP subgroup postoperatively showed mild and severe urinary incontinence, respectively, whereas all patients in TPC subgroup did show severe incontinence. Conclusion Results of the study suggest that surgical treatment of prostatic carcinoma results in longer survival times over medical management alone. In particular, TP might be recommended for improving survival time and quality of life in canine prostatic adenocarcinoma that does not infiltrate the bladder. Early detection is key for a survival advantage with surgical treatment.

Theoretical Comparison of the Methods of Surgical Treatment of Deforming Arthrosis of the Knee Joint

Comparison of the techniques of valgus osteotomy with resection osteotomy of the fibula in combination with sanitation arthroscopy. Resection of the fibula, debridement arthroscopy is characterized by minimally invasiveness, targeted therapeutic effect on the focus of destruction of the cartilaginous cover, removal of inflammatory mediators with abundant lavage, low-trauma intervention. Abrasive chondroplasty, subchondral tunneling during arthroscopy make it possible to create conditions for reparative processes, and the formation of hyaline-like cartilage in the defect zone. Corrective osteotomy may result in fractures of the tibial plateau, fractures of the cortical loop (instability of fixation), false joints, and fractures of metal structures.

Surgical treatment of the bony mallet thumb: a case series and literature review

Introduction The aim of this study was to provide a more precise statement on the outcome after surgical treatment of a bony mallet thumb and possibly give a treatment recommendation regarding the surgical fixation method. Patients and methods All patients (n = 16) who underwent a surgical treatment for an acute bony mallet thumb fracture between January 2006 and July 2019 were enrolled. The surgical method, complications, the range of motion, tip pinch, lateral key pinch, overall grip strength, visual analog score, Disability of the Arm, Shoulder and Hand Score, Mayo Wrist Score, Patient-Rated Wrist Evaluation Score, Buck-Gramcko Score and radiologic parameters were evaluated. Further, a comprehensive literature search on PubMed was conducted covering a period from 1956 to 2021 to include all possible matching articles on the treatment of the bony mallet thumb (n = 21 articles). Results Surgical treatment was very inhomogenous including indirect and direct K-wire fixation, screw fixation, plate fixation and anchor fixation methods. The IP joint range of motion and thumb strength ranged from 66 to 94% in comparison to the contralateral side. An open reduction led to worse functional scores compared to a closed reduction. Treatment methods in the literature were also very inhomogenous with a very low patient count, often even pooling data of bony mallet thumb fractures with bony mallet finger fractures. The risk for infection was higher in K-wire fixation methods than in open reduction and internal fixation methods. Conclusion The evidence for the best treatment of a bony mallet thumb fracture is low. On one hand the functional outcome can be inferior using an open reduction approach, but on the other hand, K-wire fixation methods with a closed reduction approach showed a higher risk for infection. Future multi-center research must be conducted to find the best treatment procedure for the best outcome of the patient.

Recurrent Peptic Ulcer Perforation: A Case Report

Background: Refractory peptic ulcers are ulcers in the stomach or duodenum that do not heal after eight to twelve weeks of medical/surgical treatment or those that are associated with complications despite medical tssreatment. We herein present a case of a 44 year old man with a recurrent perforated duodenal ulcer requiring emergent surgical intervention.