Laparoscopic Adrenalectomy: Preventive Principles in Intra- and Postoperative Complications

Background. Laparoscopic adrenalectomy is the current surgery of choice in most adrenal tumours, with a nearly 11 % complication rate and below 1 % mortality. Laparoscopy combines the advantages of minimally invasive surgery with well-known long-term prognosis of a traditional open surgery, at the same time requiring the surgeon’s skill of knowing the technique and avoiding complication.Aim. Concept definition of safe laparoscopic adrenalectomy.Materials and methods. A total of 28 patients with adrenal neoplasms were rendered laparoscopic adrenalectomy by same surgical team under benchmark recommendations during 2016–2019.Results. All patients have been discharged in satisfactory condition, with no intra-, postoperative complications or lethal outcomes.Discussion. Th e evidence presented displays feasibility of using the benchmark principles in laparoscopic adrenalectomy surgery. Laparoscopic adrenalectomy is superior in reducing the recovery time, surgical trauma, complication incidence, length of hospital stay, treatment cost, the improvement of overall wellbeing post-surgery and patients’ quality of life. Th ese principles proved effective to avoid intra- and postoperative complications of laparoscopic adrenalectomy and facilitated revamping of the operation technique in left -sided adrenalectomy.Conclusion. Th e benchmark principles of laparoscopic adrenalectomy enable the procedure higher efficacy and safety and require further implementation and long-term assessment of the outcome.

Tracheoarterial fistula as a complication of prolonged tracheostomy

The article presents a clinical case of a rare and severe complication of prolonged tracheostomy in the form of fistula formation between tracheal lumen and brachiocephalic artery and the development of massive bleeding from it. The patient’s treatment was urgent and successful. Operative intervention was performed with subsequent allografting of brachiocephalic trunk (vascular prosthesis Vascutek 8 mm was used) and the anastomosis was created using a continuous suture technique. The patient was discharged home in a satisfactory condition on the 17th post-operative day.

Shipboard tests of tribochemical lubrication mode

The article is devoted to the tests of the main marine engine 8CHRN 32/48 (8NVD-48A-2U) SRT "Captain Rogozin" of the Murmansk SPCRK, operated in the tribochemical lubrication mode in the Barents Sea. The satisfactory condition of the cylinder-piston group parts is shown. Analysis of changes in the physical-chemical parameters of engine oil showed that the tribochemical lubrication mode with the TVM-S device stabilizes the physical-chemical properties of the oil when refilling fresh oil "on the fumes" and ensures continuous operation (up to 10 thousand hours) in a long-term mode equal to two of its resources.

OPTIMIZATION OF OPERATIVE DELIVERY OF WOMEN IN LABOR WITH PLACENTA PREVIA

The aim – to evaluate the effectiveness of preventive ligation of uterine vessels during caesarean section in women with placenta previa. Material and Methods. The study was conducted on the basis of the Regional Perinatal Center and Maternity Hospital № 5 (Odessa) for 2000–2020 and performing the main stage of cesarean section after reducing perfusion in the placenta. Uterine ligation was performed after fetal removal. The volume of blood loss, the condition of the mother and fetus were monitored, and perinatal results were analyzed. Statistical processing was performed by methods of variance and frequency analysis using Statistica 13.0 software (TIBCO, USA). Results. The mean age of pregnant women was 33.4±1.2 years. The clinic of placenta previa during pregnancy was extremely scanty. As a rule, the diagnosis was made during ultrasound monitoring. In 16 (17.7 %) there was repeated bleeding from the genital tract without pain and increased uterine tone, with the development of anemia of moderate severity. Single bleeding was observed in 53 (58.9 %) women. Blood loss was 1380±112 ml in group I, 466±34 ml in group II (p<0.05). The frequency of anemia in the postoperative period was 38.0 % and 17.5 %, respectively (p<0.05). All newborns were discharged on the 5-7th day of the postpartum period in satisfactory condition. There were no cases of distress syndrome. Conclusions: 1. The method of control of blood loss during placenta previa by ligation of the uterine arteries is effective – blood loss was in group I 1380±112 ml, in group II – 466±34 ml (p<0,05). 2. The frequency of anemia in the postoperative period was 38.0 in group I and 17.5 % in group II (p<0.05).

Head, chest and limbs mine-explosive wounds

The article presents the experience of treating wounded K., 29 years old, who, as a result of the suicide bombing of a homemade shell-free explosive device in a moving car of the St. Petersburg Metro 03.04.2017 received a severe mine-explosive combined wound to the head, chest and limbs with a fragmented blind skull. The trauma was accompanied by brain damage, a fracture of the cranial vault bones, lungs contusion, and fragmented fracture of the right tibia bones. The patient underwent sequential bifrontal decompressive craniotomy, external fixation of the right shin bones fractures, blocked intramedullary osteosynthesis of the latter, dura mater plasty, cranioplasty with a titanium plate after its computer modeling. The complex treatment allowed the patient to be discharged from the hospital after 4 months in a satisfactory condition.

Emergency Carotid Endarterectomy for Internal Carotid Artery Thrombosis in the Course of COVID-19

A case of successful emergency carotid endarterectomy (CEE) in the acute period of ischemic stroke (within an hour after the onset of symptoms) in a patient with acute occlusive thrombosis of the internal carotid artery in the course of moderate-severe COVID-19 with a positive result of the polymerase chain reaction of the nasopharyngeal smear for SARS-CoV-2. The diameter of the ischemic focus in the brain according to multispiral computed tomography did not exceed 2.5 cm. The course of ischemic stroke was characterized by mild neurological deficit (score 5 according to National Institute of Health Stroke Scale). It was demonstrated that the severity of the patient’s condition was associated with bilateral, polysegmental, viral penvmonia with 65% damage to the lung tissue, a decrease in SpO2 to 93%. Laboratory noted coagulopathy with an increase in D-dimer (2837.0 ng/ml), prothrombin according to Quick (155.3%), fibrinogen (14.5 g/l) and signs of a “cytokine storm” with leukocytosis (28.4 10E9/l), an increase in C-reactive protein (183.5 mg/l), ferritin (632.8 ng/ml), interleukin-6 (176.9 pg/ml). The patient underwent glomus-sparing eversional CEE. The intervention was performed under local anesthesia due to the high risk of developing pulmonary barotrauma when using mechanical ventilation. To prevent the development of acute hematoma, a double active drainage was used into the paravasal space and subcutaneous fatty tissue (SFT). In case of thrombosis of one of the drainages, the second could serve as a spare. Also, upon receipt of hemorrhagic discharge from the drainage located in the SFT, the patient would not need to be transported to the operating room. Removal of skin sutures with revision and stitching of the bleeding source could be performed under local anesthesia in a dressing room. The postoperative period was uneventful, with complete regression of neurological symptoms. Used anticoagulant (heparin 5 thousand units 4 times a day s/c) and antiplatelet therapy (acetylsalicylic acid 125 mg at lunch). The patient was discharged from the hospital on the 12th day after CEE in satisfactory condition.

Surgical treatment of giant renal tumor: a case report

Renal tumors account for 2 to 3 % of all malignant tumors in adults. Of all patients with renal cell carcinoma, 30 to 40 % have advanced forms of the disease. In the literature, the term "giant renal tumor" is used for tumors larger than 20 cm. In this article, we report a case of surgical treatment for a giant malignant kidney tumor.Patient N., female, 54 years old, referred to an outpatient clinic with complaints of a change in the shape of the abdomen on the left with a palpable large tumor, abdominal pain, shortness of breath, weakness, constipation, episodes of blood in the urine and increased blood pressure. Body mass index 30.2 kg/m2. Ultrasound examination revealed a large tumor in the left retroperitoneal space. Laboratory testing of blood, urine was performed, findings were unremarkable. According to the data of magnetic resonance imaging, the left kidney was transformed into a large cystic solid formation, measuring 30.5 х 17.5 х 17.0 cm, heterogeneously accumulating a contrast agent with a solid component. Patient was admitted to the urology department for surgical treatment. We performed radical nephrectomy on the left with thoracolumbar laparotomy access on the left with resection of the 10th rib, resecting the renal tumor with the adrenal gland, total weight of the complex was 10.7 kg. The histological structure was determined as poorly differentiated renal carcinoma with invasion of the perinephric tissue. In the adrenal gland, fields of fresh erythrocytes with an admixture of tumor tissue were noted. Examined lymph node tissue was completely replaced by tumor cells. Postoperative period was characterized by episodes of dynamic intestinal obstruction. The patient was discharged from the department in a satisfactory condition on the 13th day after the operation, but died 1.5 months after discharge, the cause of death has not been established, as no autopsy was performed. Thus, the size of the tumor is not a contraindication to surgical treatment, which improves the survival rate of patients with malignant renal tumors.

LANDSCAPE-ENVIRONMENTAL ASSESSMENT OF THE PARK TERRITORY OF CULTURAL HOUSE 50-YEARS OF OCTOBER, VORONEZH

The results of the landscape-ecological assessment of the park territory of cultural house 50-years of October in Voronezh are presented. This work allows you to determine the state of the object for its further use. This facility is located in the South-West district of the city and is used for recreation of the local population. The indicators of landscape-ecological assessment were determined: type of landscape, type of spatial structure, sanitary-hygienic assessment, aesthetic assessment, stage of digression. The results of the research showed that the site is in a relatively good sanitary condition, the indicator of aesthetic assessment is at a fairly high level. We also studied the plant species, which grow on the object and their condition. The assortment available in the park is represented by the list of woody plants: Robinia pseudoacacia, Betula pendula, Ulmus pumila, Acer platanoides, Tilia cordata, Populus alba, Populus pyramidalis, Sorbus aucuparia.All woody plants in the park is in good and satisfactory condition. Based on the results of the assessment of the territory, it is possible to outline design measures that will improve the sanitary, hygienic and aesthetic conditions at the facility. There is a need to design small forms of architecture (benches, urns), organize additional planting of trees, pick up flowering shrubs and create flower beds to enhance the attractiveness of the object.

Assortment and condition of flower beds at the Soborniy district of Dnipro city

The assortment and condition of flower beds at the Soborniy district of Dnipro city were researched. 513 flower beds were identified on the territory of 18 objects (10 streets, 4 boulevards and 4 park zones). 151 flower beds, 21 ridges, 322 containers, 5 mixborders, 7 borders, 1 rockery, 6 near-barrel tree circle decorated with flowers were identified. The total area of flower beds is 7844.3 m2, of which almost 80 % falls on flower beds, about 10 % - on ridges, other types of flower beds make up an insignificant part. The assortment of flowering plants is represented by 15 species of annuals and 33 species of perennials. The leaders in the frequency of use in flower beds among annuals can be called brilliant salvia, marigolds erect and rejected, hybrid petunia, ever-flowering begonia. Garden roses, irises, stonecrops, hosts, perennial heliopsis prevail among perennial flowers. Analysis of the flower beds condition showed that landscaping objects located on boulevards look best. More than half of them are in good condition, the rest are in satisfactory condition. Flower gardens located in parks and squares are in poor condition. Only 5,7 % of flower beds were found in good condition - mainly on the territory of Shevchenko Park. Almost 40 % of flower beds are in poor condition, often completely overgrown with weeds. The flower beds located in the highways are also in most unsatisfactory condition due to the lack of regular professional care. Marigolds, ever-flowering begonia, hybrid petunia, rock alyssum retain the best condition among annuals by the end of the season. The most decorative during the season among perennials remained various types of sedum and hosta lancifolia. It is undesirable to use plants that quickly lose their decorative effect: irises, perennial heliopsis, whitewashed cornflower. Combined flower beds look best with the involvement of annual and perennial flowering plants, as well as ornamental shrubs.

Stem Cells in the Treatment of Renal Allograft Diseases

In recent years, there has been growing interest in the use of stem cells as a therapeutic agent for the restoration of the damaged tissues and organs. We present a clinical case. Male, 39 y.o. Diagnosis: Glomerulonephritis. On 10/09/2012, he underwent heterotopic renal allotransplantation from a live relative donor. On 09/23/2020, he was admitted to the hospital due to renal allograft pyelonephritis. On 10/28/2020, a cell based donor umbilical cord blood product was infused. Cell therapy enabled to minimize the consequences of the graft damage, to preserve the graft function and satisfactory condition of the recipient.