Morphological evaluation of anal canal wound healing after combined operations for combined anorectal pathology

The urgency of the problem of postoperative wound healing after combined operations for combined pathology of the anal canal and rectum is quite high and contributes to the introduction into the practice of coloproctologists of new modern surgical technologies for the treatment of this pathology. The aim of the study was to conduct a comparative morphological assessment of postoperative wound healing in patients with combined pathology of the anal canal and rectum after combined operations using modern high-frequency electrosurgical and radiosurgical technologies. The results of surgical treatment of 689 patients with combined pathology of the anal canal and rectum using high-frequency electrosurgery and radiowave surgery with morphological assessment of wound healing on 3, 5, 7, 14, 21 days of the postoperative period, which were divided into 4 study groups. Using of “Surgitron” and “KLS Martin” devices for the treatment of patients with combined pathology of the anal canal and rectum was accompanied by the formation of the thinnest layers of coagulation necrosis in tissues with a depth of 0.189±0.085 mm and 0.194±0.090 mm respectively and as result patients of the first and fourth study groups had the shortest duration of inpatient treatment, which was 3-5 days and the average time of wound healing, which was 14-15 days. Patients in these study groups had the lowest inflammatory neutrophil reaction in postoperative wounds on day 3, which rapidly disappeared by day 5, on days 7-14 they had active reparative processes with the appearance of fibroblasts and connective tissue fibers, and on 21 day squamous epithelial cells, which indicated the processes of active epithelialization of wounds. The effect on the tissues of the devices “EFA” and “ERBE ICC 200” was deeper than in the above groups, forming a layer of coagulation tissue necrosis with a depth of 0.208±0.097 mm and 0.302±0.107 mm respectively, which was accompanied by patients of the third and second study groups with longer terms of inpatient treatment, which amounted to 5-7 days and increase the duration of wound healing, which amounted to 16-19 days. Patients in the 2nd and 3rd study groups showed a more pronounced inflammatory neutrophilic reaction in postoperative wounds on the 3rd day, which did not disappear until the 5th day and in half of the cases the presence of a significant number of segmental neutrophils and bacterial accumulations persisted. On days 7-14 they had weak reparative processes with the appearance of single fibroblasts and a small number of connective tissue fibers and on the 21st day single squamous epithelial cells, which indicated slow processes of wound epithelization. Using of radio-wave surgery and high-frequency electrosurgery devices promotes active epithelialization of tissues preventing scar strictures of the anal canal and improves the rehabilitation of patients in the postoperative period.

A Concurrent Testing Facility Approach to Validate Small Satellite Combined Operations

Federated remote laboratories allow for the execution of experiments ex situ. The coordination of several laboratories can be used to perform concurrent experiments of combined space operations. However, the latency of the communications between facilities is critical to performing adequate real-time experiments. This paper presents an approach for conducting coordinated experiments between floating platforms at two remote laboratories. Two independently designed platforms, one at Luleå University of Technology and the other at La Sapienza University of Rome, were established for this purpose. A synchronization method based on the Simple Network Time Protocol was created, allowing the offset and delay between the agents to be measured.Both platforms exchange data about their measured time and pose through a UDP/IP protocol over the internet. This approach was validated with the execution of simulated operations. A first demonstrative experiment was also performed showing the possibility to realize leader/follower coordinated operations. The results of the simulations and experiments showed communication delays on the order of tens of milliseconds with no significant impact on the control performance. Consequently, the suggested protocol was proven to be adequate for conducting coordinated experiments in real time between remote laboratories.

Inventors and Innovators: Naval Lighterage and Anglo-American Success in the Amphibious Invasions of German-Occupied Europe

The amphibious invasions of Sicily, Salerno, and Normandy all made ample use of US Navy landing pontoons. The simple steel box pontoons were the brainchild of civil engineer Captain John N. Laycock, who developed and perfected his inventive design on the eve of American entry into World War II. Once in the conflict, a Royal Navy reserve officer assigned to Combined Operations Headquarters, Captain Thomas A. Hussey, conceptualized innovative uses for the American pontoons for offensive amphibious operations. Working together, these men developed pontoon causeways and massive lighterage barges which ensured logistical success in the invasions of German-occupied Europe. Les invasions amphibies de la Sicile, de Salerne et de la Normandie ont toutes fait appel aux pontons de débarquement de la Marine américaine. Les simples pontons flottants en acier ont été créés par le capitaine John N. Laycock, ingénieur civil, qui a développé et perfectionné sa conception géniale à la veille de l’entrée des États-Unis dans la Seconde Guerre mondiale. Une fois le conflit déclenché, le capitaine Thomas A. Hussey, officier de réserve de la Marine royale affecté au quartier général des opérations combinées, a mis au point des utilisations novatrices des pontons américains pour les opérations amphibies offensives. La collaboration de ces deux hommes a permis de développer des chaussées de pontons et d’énormes barges de chalandage qui ont assuré le succès logistique des invasions de l’Europe occupée par les Allemands.

Comparative estimation of a pain syndrome in patients after combined operations for coexistent pathology of anal channel and rectum with application of modern and standard surgical technologies

Objective. Comparative estimation of the pain syndrome in patients with concomitant pathology of anal channel and rectum after performance of combined operations, using modern high-frequency electro-surgical and radio-surgical apparatuses, as well as conventional scalpel. Materials and methods. The results of surgical treatment of 689 patients with concomitant pathology of anal channel and rectum, using apparatuses of a high-frequency electro-surgery and radio-wave surgery, were analyzed, using the pain syndrome estimation on 1-7th postoperative day. The patients were distributed into 4 investigation groups and a control group, consisting of 112 patients, operated on using metallic conventional surgical scalpel. Results. The pain syndrome on the first postoperative day was mostly expressed in patients of control group, for anesthesia they needed (4 ± 1) ml of 2% solution of promedol, while the patients of the first, third and fourth groups investigated, in which, accordingly, apparatus of radio-wave surgery «Surgitron» and high-frequency electro-surgical apparatuses «EFA» and «KLS Martin» were used, needed for anesthesia (2 ± 1) ml of 2% solution of promedol. While application of the electro-surgical high-frequency apparatus «ERBE ICC 200» the necessity for the 2% solution of promedol for anesthesia have constituted (3 ± 1) ml. Conclusion. Combined operations, using modern apparatuses of high-frequency electro-surgery and radio-wave surgery give significantly better results, than application of conventional surgical metallic scalpel, because it produces significantly reduced pain syndrome due to thin layer of coagulation necrosis, promoting formation of delicate elastic cicatrix and preventing development of cicatricial strictures of anal channel in postoperative period.

Surgical methods to correct arteriogenic erectile dysfunction

The study objective is to define the state of the problem of surgical methods for the treatment arteriogenic forms of erectile dysfunction (ED) in the Republic of Belarus, to systematize surgical methods for the correction of arteriogenic ED, to evaluate the results of interventional, surgical and combined methods of the treatment of arteriogenic forms of ED in the Republic of Belarus.Materials and methods. A comprehensive examination was carried out 65 men with arteriogenic ED (average age 52.2 ± 2.2 year, International Index of Erectile Function – 9.6 ± 1.3 points; the hardness of erection – 2.2 ± 0.3 according to the Yunem scale) included ultrasound, multispiral computed angiography, as results of stenosing and occlusive lesions of the aorto-iliac segments, internal pudendal artery (IPA) and distal branches were revealed. Of these, as a result of atherosclerotic damage to arteries – 59 (91 %) patients, hypoplasia of the IPA – 4 (6 %) patients and in 2 (3 %) – cases due to post-traumatic damage to the IPA during fracture of the pelvic bones. Pro- and retrospectively performed analysis of the results of endovascular, surgical and combined correction of chronic arterial insufficiency of penis. Based on the results of the study, blood flow deficiency was simulated in order to determine the possible level and method of its elimination. Subsequently, 34 reconstructive operations were performed, including endovascular: superselective stenting of IPA – in 1 case, angioplasty of IPA – one-bilateral – in 4 cases, stenting of the iliac arteries – in 14 cases, in 4 cases – aorto-femoral bypass or prosthetics. Microsurgical operations with epigastric-penile anastomosis were performed in 9 cases (Virag II type in 8 cases, Michal II – Scharlip in 1 case), including in 3 cases as a second stage to increase arterial perfusion of penis after endovascular interventions. In 3 cases, for severe arteriogenic ED and endothelial insufficiency, endophalloprosthesis was implanted (AMS-Spectra).Results. According to the results of testing of patients after endovascular intervention or microsurgical reconstruction, as well as after a two-stage correction that included both methods, patients showed a statistically significant improvement in erectile function on the scale of the International Index of Erectile Function – from 9–12 points (10.0 ± 0.31 points) before surgery to 16–19 points (17.5 ± 0.25 points) 12 months after surgery (p = 0.0009).Conclusions. Interventional methods of correction after micro surgical and combined operations in patients with arteriogenic ED allow achieving a satisfactory result during the first year after surgery, provided that patients are carefully selected using a comprehensive examination, including various ultrasound techniques, multispiral computed angiography, as well as the selection of an appropriate type of revascularization.

SURGICAL TREATMENT OF COMBINED ANORECTAL PATHOLOGY USING CURRENT TECHNOLOGIES

Objective. To evaluate the effectiveness of application radio-wave surgery device “Surgitron” and high-frequency electrosurgery devices “ERBE ICC 200”, “EFA”, “KLS Martin” for treatment of patients with combined anorectal pathology. Methods. The treatment results of patients (n=635) with a combined anorectal pathology have been analyzed. The use of the «Surgitron» radio-wave surgery apparatus 245 (38.6%) patients were operated on, the «ERBE ICC 200» high-frequency electrosurgery apparatus - 169 (26.6%) patients, the «EFA» high-frequency electrosurgery apparatus - 114 (17.9 %) patients, «KLS Martin» high-frequency electrosurgery apparatus - 107 (16.9%) patients. After those surgical interventions to assess the effectiveness of the abovementioned current technologies, patients were conducted a morphological examinationto determine the depth of the necrosis of tissues. Results. According to the study results it has been established that application of the “Surgitron” radio-wave surgery device, “ERBE ICC 200” high-frequency electrosurgical devices “EFA”, “KLS Martin” reduces duration of the operation up to 15-30 min, the volume of bleeding - up to 10-30 ml, need in narcotic drugs - up to 1-4 ml, period of hospitalization - up to 3-6 days. Using these technologies prevented the formation of anal strictures and scar pararectal deformations due to the insignificant depth of tissue necrosis (the depth 0,036 -l 0,453 mm), ensuring the cosmetic effect of combined operations. Conclusion. Application of the “Surgitron” radio-wave surgery device and “ERBE ICC 200” high-frequency electrosurgical devices, “EFA”, “KLS Martin” for treatment of patients with combined anorectal pathology reduces the operation duration, volume of bleeding and intensity of the postoperative pain. Use of these current technologies promotes the formation of a delicate elastic scar causing faster healing of postoperative wounds and improving the terms of patients’ rehabilitation. What this paper adds A comparative evaluation of the effectiveness of using high-frequency electrosurgery devices “ERBEICC 200”, “EFA”, “KLSMartin” and radio-wave surgery device “Surgitron” for treatment of patients with combined anorectal pathology has been firstly made; also a degree of pathomorphological changes in tissues of anal canal and rectum after using the aforementioned current technologies has been studied to assess the effectiveness of their use for treatment of combined anorectal pathology.

Role of Hemostatic Agents in Simultaneous Surgical Interventions in the Nasal Cavity

Modern medical advances allow us to expand a range of combined surgical interventions. The literature to this day does not cover issues regarding the implementation of typical options for combined operations with deformities of the nasal septum, structures of the lateral wall of the cavity, nose, pathological processes in the hole of the paranasal sinuses; with perforated odontogenic maxillary sinusitis; racemose, sprains of the paranasal sinuses, combined with damage to the orbit. Since during combined operations the mucous membrane in various parts of the nasal cavity is injured to one degree or another, the problem of prevention and treatment of postoperative traumatic rhinitis is extremely important.

Modern methods of surgical treatment of anal canal and rectum combined pathology

Objective. To evaluate the effectiveness of surgical treatment of anal canal and rectum combined pathology, through combined surgical interventions using modern electro- and radiosurgical technologies. Materials and methods. A comparative evaluation of the results of surgical treatment of 681 patients with combined pathology of the anal canal and rectum, who underwent combined single-stage operations using high-frequency electrosurgery and radio-wave surgery. Results. In case of application the device for radio-wave surgery "Surgitron", and also devices of high-frequency electrosurgery "ERBE ICC 200", "EFA", "KLS Martin" duration of operation is reduced to (15 - 25 ± 3) minutes, volume of blood loss decreases to (15 ± 6) ml, the need for narcotic analgesics decreases up to (2 ± 1) ml, the duration of inpatient treatment was reduced up to (4 ± 1) days. Conclusions. The use of modern radio- and electrosurgical technologies for the treatment of combined anorectal pathology prevents the occurrence of anal canal strictures and scarring of the perianal areas, causing the cosmeticity of combined operations.

Anatomically Complete Supraclavicular Reoperation for Recurrent Neurogenic Thoracic Outlet Syndrome: Clinical Characteristics, Operative Findings, and Long-term Outcomes

Background: The clinical outcomes of reoperations for recurrent neurogenic thoracic outlet syndrome (NTOS) remain undefined. Methods: From 2009 to 2019, 90 patients with recurrent NTOS underwent anatomically complete supraclavicular reoperation after previous operation(s) performed at other institutions using either supraclavicular (Prev-SC = 48), transaxillary (Prev-TA = 31), or multiple/combination (Prev-MC = 11) approaches. Prospectively maintained data were analyzed retrospectively. Results: The mean patient age was 39.9 ± 1.4 years, 72% were female, and the mean interval after previous operation was 4.1 ± 0.6 years. The mean Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score was 62 ± 2, reflecting substantial preoperative disability. Residual scalene muscle was present in 100% Prev-TA, 79% Prev-SC, and 55% Prev-MC ( P < .05). Retained/residual first rib was present in 90% Prev-TA, 75% Prev-SC, and 55% Prev-MC ( P < .05). There were no differences in operative time (overall 210 ± 5 minutes), length of hospital stay (4.7 ± 0.2 days), or 30-day readmissions (7%). During follow-up of 5.6 ± 0.3 years, the improvement in QuickDASH scores was 21 ± 2 (36% ± 3%) ( P < .01) and patient-rated outcomes were excellent in 10%, good in 36%, fair in 43%, and poor in 11%. Conclusions: Anatomically complete decompression for recurrent NTOS can be safely and effectively accomplished by supraclavicular reoperation, regardless of the type of previous operation. Residual scalene muscle and retained/residual first rib are more frequently encountered after transaxillary operations than after supraclavicular or multiple/combined operations. Supraclavicular reoperation can achieve significant symptom reduction and functional improvement for approximately 90% of patients with recurrent NTOS.

Morphological Aspects of Acute Renal Injury in Cardiac Surgery

Summary. The use of endoscopic transsphenoidal access is an effective and safe method for the surgical treatment of pituitary adenomas (PA). In endoscopic transsphenoidal surgeries, there is a need to control intracranial pressure (ICP) for reposition and expansion of the tumor capsule. Currently, the main method for reducing ICP in transsphenoidal surgery is installation of an external lumbar drainage, which is associated with a number of complications.Aim of study. To improve the results of surgical treatment of patients with arterial hypertension using hypertonic saline solution.Material and methods. A clinical and anatomical analysis of material from 27 deceased patients who were treated in the cardiac surgery department of the Institute was carried out. Valve replacement was performed in 11 patients, aortic replacement - 2, valves and aorta - 7, combined operations - 7. The patient’s records, autopsy protocols, results of histological examination of surgical and autopsy material were studied. Already on the next day after surgery, an increase in serum creatinine by more than 25% was noted under the conditions of CBR. Morphological examination of the kidneys revealed acute pathological processes - necrosis of nephrocytes of the convoluted tubules in 59.3% of cases and dystrophic changes in 40.7% of cases against the background of chronic pathology (nephrosclerosis, vascular atherosclerosis, glomerulosclerosis, pyelonephritis, secondary contracted kidney). After coronary angiography with a radiopaque contrast agent (RCA), signs of excretory nephrosis were noted, often with fixation of the RCA in the loop of Henle, with tubulorexis and the formation of cell casts.