Patient Satisfaction Based on IOL Implantation Results

Purpose: to found the relationship between the obtained postoperative visual acuity, the increase in visual acuity in the lines and the subjective satisfaction of patients with the results of the operation.Material and methods. The study included 165 patients (186 eyes) who received cataract phacoemulsification surgery with IOL implantation (n = 170) or refractive lensectomy with IOL implantation (n = 16). The average age of the subjects was 70.23 ± 10.14 years. The group included patients without concomitant systemic or ophthalmic pathology, without previous surgical interventions in the eye for any purpose. At least 1 month after the operation, patients filled out a questionnaire in order to find out the subjective satisfaction with the treatment (scale from 0 to 4 points). The results of the questionnaire were compared with postoperative BCVA, and increased vision (postoperative BCVA — preoperative BCVA). Preoperative BCVA — Me 0.4 (Q1–Q3: 0.1–0.68), postoperative BCVA — Me 1.0 (Q1–Q3: 0.95–1.0), increased vision — Me 0.6 (Q1–Q3: 0.3–0.9) according to Snellen’s table.Results. Visual acuity in satisfaction subgroups: 0 points — Me 1.0 (Q1–Q3: 0.9–1.0) / n = 5 (2.7 %); 1 point — 1 case, postoperative BCVA 1.16 (0.5 %); 2 points — Me 0.95 (Q1–Q3: 0.84–1.0) / n = 14 (7.5 %); 3 points — Me 1.0 (Q1–Q3: 0.9–1.16) / n = 57 (30.6 %); 4 points — Me 1.0 (Q1–Q3: 0.96–1.0) / n = 109 (58.6 %). Postoperative BCVA and increased in visual acuity do not have statistically significant differences depending on satisfaction with treatment (p > 0.05). The correlation between postoperative BCVA and satisfaction is not statistically significant (p = 0.65; rxy = 0.136), as well as between vision improvement and satisfaction (p = 0.55; rxy = 0.141).Conclusion. There was a lack of a statistically significant relationship between postoperative BCVA and improved vision with subjective patient satisfaction with treatment. Identification of factors affecting subjective assessment requires a deeper analysis. Practicing ophthalmologists should remember the importance of the dialogue between the doctor and the patient at the preoperative stage, informing the patient about the expected results of the operation and the possible course after the operation period.

Macular edema after surgical treatment of rhegmatogenous retinal detachment – the possibilities of its prediction

The aim: to develop a mathematical model for predicting macular edema based on the informativeness of clinical and instrumental predictors of its occurrence.Materials and methods. To determine the risk factors for macular edema 64 patients (64 eyes) with macula-off rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy (grade Cp 1–2) were selected. A retrospective analysis of the surgical treatment results was carried out. The age of the patients ranged from 30 to 81 years (28 women and 36 men).Results. Using regression analysis, two signifi cant factors were identifi ed: the sum of 8 meridians of the visual fi eld before surgery (p = 0.015) and the number of detached quadrants (p = 0.021). Based on the identifi ed factors, a model was obtained for predicting the occurrence of macular edema in the postoperative period for the patients with rhegmatogenous retinal detachment. Conclusion. Based on the analysis of clinical and instrumental indicators in patients with rhegmatogenous retinal detachment, a mathematical model has been developed that allows predicting the occurrence of macular edema in the postoperative period.The application of the proposed prediction model makes it possible to determine the tactics of treatment (peeling of internal limiting membrane) and predict the appearance of macular edema at the preoperative stage.

THE ROLE OF CALCITONIN IN THE PREOPERATIVE STAGE AS THE PREDICTOR OF MEDULLARY THYROID CANCER METASTASES

the aim of the stydy was to analyze the detectability of medullary thyroid metastases in patients at treatment and diagnostic stages, to investigate the applicability of serum calcitonin level as predictor of possible presence of medullary thyroid metastases. The study included data from 148 patients who underwent surgical treatment for the initial diagnosis of medullary thyroid cancer. The age of patients ranged from 12 to 83 years, the mean age was 48,2±1,9 years; the distribution by gender was as follows: men – 34 (23%), women – 114 (77%). Patients were divided into two groups depending on the pathomorphological report: 1 group (100 (67,6%) – patients without metastases), 2 group (48 (32,4%) – patients with locoregional metastases). Among 148 studied patients with medullary thyroid cancer, as a result of the histopathological conclusion, in 48 (32,4%) metastases were detected in regional lymph nodes, among which 10 (6,7%) patients had metastases only in the central collector and 38 (25, 7%) –both in the central and lateral collectors. At the preoperative stage, the level of undiagnosed metastases by ultrasound was 64,58% (31 patients). Subsequently, at the intraoperative stage, during the rapid histological biopsy, the number of undiagnosed metastases decreased to 37,5% (18 patients), and in the postoperative period, according to the results of histopathological examination, the remaining patients were diagnosed with the medullary thyroid cancer metastases. Ultrasound helped to detect metastases in 17 patients, which was 35,42% of all detected metastases. At the stage of intraoperative study, the detection of metastases increased and amounted to 30 (62,5%), and in the postoperative period as a result of histopathological examination metastases were confirmed in 48 patients (100%). Quantitative indicators of both detected and undiagnosed metastases at all stages of treatment and diagnostic search are statistically significant (p<0,01). The detection of metastases in the central lymphatic collector (N1a) at the preoperative stage was 2,08%, this index has doubled (to 4,16%) after intraoperative rapid histological conclusion, and after histopathological conclusion the index has increased more than 10 times (20,84 %). This tendency to grow of metastaseses detection was followed also on lateral collectors: N1b and psilateral were observed at 15 (31,2%) patients at the preoperative stage, their number increased to 23 (47,9%) intraoperatively and to 31 (64,6%) postoperatively; N1b contralateral was observed in 1 (2,1%), 5 (10,4%) and 7 (14,6%), respectively. Such a low percentage of metastases detection at the preoperative stage by ultrasound prompted to CT level study as the predictor of possible metastases. We investigated the preoperative basal blood CT value as a marker of the medullary thyroid cancer metastases presence probability. Due to the small number of the group (n=10) with N1a, the association of CT (cut-off level 137 pg/ml) with the possible presence of metastases was not significant (AUC = 0.594), while in the group with N1b there was a more significant difference. Thus, CT cut-off levels of 358 pg/ml for N1b ipsilateral, and 498 pg/ml for N1b contralateral detection of possible metastases in collectors, with AUC: 0.877 and 0.832, respectively, which justifies the importance of the lateral neck dissection in addition to the mandatory central dissection in order to remov possible medullary thyroid cancer metastases. Thus, ultrasound is insufficiently reliable method of metastases verifying in medullary thyroid cancer (DE = 35.4% at d mts <0.6 cm). In the absence of ultrasound data (or fine needle aspiration (FNA) biopsy results) on the presence of metastases to raise awareness of the disease prevalence, to clarify the prognosis of its development it’s important to use the additional criterion – the calcitonin level. Basal calcitonin level is the reliable predictor of the medullary thyroid cancer metastases. Its cut-off level of 137 pg/ml indicates the possible presence of metastases in the central group (N1a) (AUC=0,594). The CT cut-off level – 358 pg/ml (AUC=0,793) suggests the presence of the medullary thyroid cancer metastases (N1a+N1b). CT cut-off levels – 358 pg/ml for N1b ipsilateral, and 498 pg / ml for N1b contralateral (AUC: 0,877 and 0,832), respectively. The calculated values of the countersensitivity test to detect metastases for different levels of basal CT in the preoperative stage in the clinical setting will help the practitioner in deciding on treatment tactics to determine the extent of surgery in patients diagnosed (or suspected) with the medullary thyroid cancer metastases.

A 5-Year Satisfaction Outcome Study of Patients Receiving Six-Implant-Supported Fixed Prosthesis

The aim of the study was to analyze the satisfaction of patients treated with a protocol of six-implant-supported fixed prosthesis (6IFP) throughout 5 years of service. This retrospective study collected the data of all patients who had full-arch rehabilitations using 6IFP and followed them for 5 years. After applying the research inclusion/exclusion strategy, 37 cases were finally included in the study. All the patients had no previous complete dentures because they were partially edentulous, not interested in pursuing complete denture rehabilitation, had immediate dental extractions, implantation used the 2-stage protocol, and there was minor peri-implant socket grafting. Cases with severe bone loss that required extensive grafting were excluded. A total number of 222 implants were placed in the maxillary or mandibular arches in a total of 37 patients. The data presented the satisfaction outcomes concerning mastication, phonetics, and comfort during the first 5 years of the recall plan. The former was achieved based on the clinical record reviews, follow-up visits, and recall phone calls at the preoperative stage as well as annually thereafter. The mean satisfaction rate was 94.5%, with a mean record of 8.21 ± 1.7 out of 10, there was no gender predilection significance, and no age range variation significance was validated. Regarding the smoking status, the t-test score exhibited no significant effect on phonetics and mastication (p = 0.12, p = 0.16, respectively), whereas comfort was found to be significantly affected (p = 0.03). The comfort level was found to be slightly less at the immediate postoperative period among smokers when compared to non-smokers. In conclusion, partially edentulous patients who received the rehabilitation plan of arch dental extractions, six immediate implantations, and delayed prosthetic loading were found to be highly satisfied.

Features of TLIF/PLIF in lumbar spine nerve root anomalies. The literature review and own experience

Introduction. Anomalies of the roots of the lumbar spine are often not diagnosed at the preoperative stage and may cause technical difficulties during performing decompression‑stabilization surgeries of spine.Purpose of the study. To study the clinical features of patients with anomalies of the lumbar roots on the background of de‑ generative diseases of the spine, to develop techniques to protect abnormal nerve roots from damage during TLIF/PLIF.Materials and methods. Performed retrospective analysis of the results of treatment of 9 patients whom were done TLIF/PLIF for degenerative‑dystrophic diseases of the lumbar spine in the period from 2018–2019 was. The distribution of changes detected in the spine was carried out according to the classification of Schizas, Meyerding and Neidre & Macnab.Results. The study group of patients was 0.63 % of all operated patients using the TLIF/PLIF technique (n = 1432). Developmental anomalies of the nerve roots were not identified during routine MRI in all patients. In six patients (66.7 %), radicular pain manifested in two dermatomes; intraoperatively, these patients had conjoint roots (Ia). Three pa‑ tients (33.3 %) had radicular pain in several (>2) dermatomes. The root tension sign (Lasegue sign) was negative in eight (88.9 %) patients. The intensity of the preoperative pain syndrome in the leg averaged 6.44 (VAS), in the back 6.11, and in the postoperative period it decreased to 0.7 and 2.1, respectively.Conclusion. Clinical preoperative markers for the presence of root anomalies can be two‑dermatomal radicular mani‑ festations in the presence of a single‑level process, as well as the absence of a Lasegue sign in severe radiculopathy. Intraoperative detection of anomalies requires a balanced approach to the choice of the method of surgical intervention from the surgeon. To prevent iatrogenic damage of anomaly roots at the stage of surgical treatment, it is necessary to change the preoperative planning strategy in favor of choosing the contralateral side for interbody fusion. In addition, root traction and interbody distraction should be minimal.

The role of ct-perfusion for diagnostic of solid renal tumors

Introduction. Nowdays, CT and/or MRI do not have sufficient specificity for the differential diagnosis of benign renal masses (oncocytoma and angiomyolipoma with minimal fat) from malignant tumors, and therefore all patients undergo surgical treatment.Purpose and objectives. The aim of the study was to evaluate the diagnostic effectiveness of perfusion computed tomography (PCT) for the differential diagnosis of solid renal masses.Materials and methods. The data of 60 patients (61,28±8,46 years) with primary founded solid renal tumors, who underwent PCT at the preoperative stage, were analyzed. Four perfusion indicators, such as BV, BF, PS and MTT, for the renal masses and normal cortex were evaluated.Results. According to the results of the statistical analysis, the perfusion parameters BV, BF, PS of the renal cortex were significantly higher than in tumors of any histological type (p<0,05). A statistically significant difference was found between clear cell, chromophobe and papillary types of renal cell carcinoma in terms of BV and BF (p<0,05), between benign and malignant tumors — in MTT.Conclusions. PCT has great potential in the assessment of neoangiogenesis and differential diagnosis of solid renal masses.

Clinical and morphological factors that increase the risk of locoregional metastasis of papillary thyroid cancer

Background. The sensitivity of the ultrasound method to determine lymph node metastases of papillary thyroid cancer (PTC) to the central lymphatic collector of the neck at the preoperative stage is low, 49 % only, therefore assessment of the factors leading to the prolongation of the process is of great importance in the development of surgical treatment tactics.Aim — to evaluate factors that increase the risk of locoregional metastases of papillary thyroid cancer and substantiate the advisability of systematic central neck dissection (SCND).Materials and methods. A retro-prospective single center study of the risk of PTC prolongation in the form of locoregional metastases (LRM) was carried out. The data of 514 patients operated for papillary thyroid disease were processed. The main group included 240 patients in whom LRM was found according to the results of histopathological examination (HPE), control group consisted of 274 patients without LRMsigns. The following signs were taken into account: multifocal lesions of the thyroid gland, the patients’age, gender, presence of thyroiditis, the size of the dominant tumor, invasion of adipose tissue. In order to substantiate the expediency of the SCND, retrospective processing of the data of 514 patients, operated from 2018 to 2020, was carried out for PTC, in which the presence of metastases was not cytologically confirmed at the preoperative stage (cN0).Results. The mean age of patients of the main group was lower than in the control group (p < 0.001). The median size of the primary tumor in patients of the main group was significantly higher than in the control group (p < 0.001). The men portion in the main group was significantly higher than in the control group, and the part of women vice versa (p < 0.05). Invasion of the tumor into the adipose tissue in the main group occurred almost twice as often (p < 0.01). The number of patients with multifocal lesions in both groups was practically the same and did not differ statistically (p > 0.05). Ipsilateral and contralateral localization of tumors in both groups did not differ significantly (p > 0.05). The presence of thyroiditis in the control group was higher than in the main group (p < 0.05). The diagnostic efficiency (DE) of accounting for the factor of invasion into adipose tissue was 64.8 %, tumor size over 1.3 cm — 66.7 %, age up to 47 years — 60.0 %. The frequency of detecting metastases with cN0 at the preoperative stage, according to HPE results, was 25.8 %.Conclusions. The reliability of preoperative imaging and diagnostic methods does not allow to ignore the likelihood of LRM and not perform SCND. According to the obtained data, in 25.8 % of casesmetastases were verified based on HPE owing to thesystematic central neck dissection. Male gender (p < 0.01), age of patients (p < 0.001), size of primary tumor (p < 0.001), invasion of adipose tissue (p < 0.01) can serve as predictors of the increased LRMPTC risk. The presence of invasion of adipose tissue (diagnostic efficacy 64.8 %), tumor size more than 1.3 cm (66.7 % DE) and age < 47 (60.0 % DE) increased the risk of LRMPTC. The presence of thyroiditis (the frequency of thyroiditis exposure in control group was higher than in the main group (p < 0.05)), contralateral lesions of the thyroid gland (p > 0.05), multifocal lesions (p > 0.05) cannot serve as reliable prognostic factors for the increased LRMrisk.

Peritonitis and splenitis caused by MAC-infection in an immunosuppressed patient

Primary (hematogenic) peritonitis caused by non-tuberculosis mycobacteria is extremely rare in the clinical practice. The main number of reported episodes of primary intraabdominal infection is associated with M. tuberculosis and the development of granulomatous inflammation of the peritoneum visually similar to carcinomatosis. The vast majority of reports of peritonitis associated with non-tuberculosis mycobacteria are interlinked with chronic peritoneal dialysis or foreign bodies of the abdominal cavity, when an infection is carried out by the contact through a dialysis catheter, prosthesis or a gastric banding device. The article describes a clinical case of peritonitis and splenitis caused by M. avium with hematogenic spread of infection from the primary pulmonary focus in a young patient with immunosuppression. Diagnosis of such peritonitis at the preoperative stage is extremely difficult due to the similarity of symptoms with atypical appendicitis or infected ascites. The intraoperative picture also did not allow us to assume a mycobacterial etiology of the process, and the absence of a focal point of peritonitis made it necessary to thoroughly understand the situation. Only a peritoneal biopsy and a complete laboratory examination of exudate allowed us to verify the diagnosis, to understand the pathogenetic mechanisms of the disease and to start a timely etiotropic therapy.

Castleman lymphadenopathy: case review

Background. While examining regional lymph nodes removed with the tumor, the pathomorphologist is often limited to the exclusion of metastases, omitting changes in lymphoid tissue. The aim of the work is to describe a rare variant of Castleman-like lymphadenopathy in the surgical material obtained during the removal of colon cancer with regional lymph nodes. Methods. Pathomorphological examination of removed lymph nodes using histological and immunohistochemical methods (CD23). Results. A 73-year-old patient underwent surgery for rectal cancer. Pathomorphological analysis diagnosed adenocarcinoma of high degree of differentiation (G1) and revealed Castleman-like changes in some of the enlarged regional mesenteric lymph nodes: signs of different stages of development of lymphoid follicles, including their hyperplasia, atresia and fragmentation with preservation of activated CD23+ follicular dendritic cells and reaction of microvasculature, including vascular proliferation in the interfollicular areas with uneven narrowing of the sinuses. The discussion analyzes the probable genesis of changes in lymphoid tissue, which may be a reflection of the early stage of Castleman's disease, complication of radiation therapy performed in the preoperative stage, or a consequence of impaired immune status due to tumor growth, in particular with antigenic overloading of draining lymphoid tissue, effects of cytokines produced by inflammatory infiltrate cells that accumulate directly near the tumor, and the formation of a state of genetic instability, which progresses under the influence of radiation. Conclusion. Despite the rarity of Castleman-like lymphadenopathy, in each case of examination of lymph nodes in the surgical material it is necessary to conduct a thorough analysis of lymphoid tissue, as this may be important both to assess the prognosis and to select adequate therapy.

Hypoxic-ischemic brain injuries after cardiosurgical interventions: clinical options of somatogenic asthenic symptom complex in patients in the preoperative period

Annotation. The article presents the results of studying the symptomatology of different clinical variants of somatogenous asthenic symptom complex (SASC). The primary material of the study was a specially developed thematic map, the completion of which involved the implementation of clinical and anamnestic study and taking into account about 30 symptoms. Clinical and statistical methods were used: anamnestic quantitative analysis, variation statistics, probabilistic distribution of clinical signs with assessment of the reliability of the obtained results. It was found that in the structure of SASC the largest share belongs to the asthenic variant: is – 40.7%, while astheno-anxiety – 26.3%, astheno-subdepressive – 20.3%, and the smallest – dissomnic (12.7%). The symptomatic structure of SASC variants is characterized by the prevalence of the phenomena of physical and mental asthenia with symptoms of bodily synthesis, which allows to determine the most characteristic symptomatic complexes for cardiac surgery patients. The symptom complexes defined in research on each of variants of SASC allow to objectify at a preoperative stage a psychosomatic condition for maintenance of the integrated neurologic support of cardiosurgical patients.