Outcome analysis of early surgery and conservative treatment in neonates and infants with severe hydronephrosis

Objective The treatment strategy and timing of ureteropelvic junction obstruction (UPJO) in infants remain controversial. This study aimed to compare the effect of early surgical treatment (EST) and conservative treatment (CT) on neonates and infants with UPJO and their recovery of renal function and morphology. Methods Eighty neonates and infants with severe hydronephrosis were enrolled in this study. They received early pyeloureteroplasty or CT. Diethylenetriamine pentaacetate was used to assess renal function. Results There were no significant differences in renal function or renal indices at baseline between the two groups. At 3 and 6 months of follow-up, the anteroposterior diameter of the renal pelvis and the Society of Fetal Urology grade in the EST surgery group were significantly lower compared with those at baseline. The thickness of the renal cortex was greater in the EST group than in the CT group at 3 and 6 months of follow-up. After follow-up for 6 months, renal function in the EST group was significantly better than that in the CT group. Conclusion EST accelerates the recovery of renal morphological and functional indices in neonates and infants with severe hydronephrosis.

Sinonasal Tissue Remodelling during Chronic Rhinosinusitis

The purpose of this review is to summarise contemporary knowledge of sinonasal tissue remodelling during chronic rhinosinusitis (CRS), a chronic disease involving long-term inflammation of the paranasal sinuses and nasal passage. The concept of tissue remodelling has significant clinical relevance because of its potential to cause irreversibility in chronic airway tissues. Recent studies have indicated that early surgical treatment of CRS may improve clinical outcome. Tissue remodelling has been described in the literature extensively with no consensus on how remodelling is defined. This review describes various factors implicated in establishing remodelling in sinonasal tissues with a special mention of asthma as a comorbid condition. Some of the main histological features of remodelling include basement membrane thickening and collagen modulation. This may be an avenue of research with regard to targeted therapy against remodelling in CRS.

Clinico-diagnostic and pathophysiological grounds of conservative and early surgical treatment methods of Bell palsy in the acute period

Taking into account the frequency of its course and the severity of consequences, facial nerve palsy (FNP) is an urgent problem of modern medicine. Bell palsy is an autopathic form of FNP. The article represents clinical picture and advisable diagnostic study of this disease. Pathophysiology of facial muscles palsy development is discussed. The study is based on the theory of “tertiary ischemia” due to anatomic features of the nerve blood supply. The eff ectiveness of corticosteroids use in the acute period of FNP is analyzed. The advisability of performing surgical decompression of the facial nerve in the acute period in a number of clinical cases is proved.

Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

Background and Objectives: Appropriate timing of surgery for periprosthetic femoral fractures (PFFs) in geriatric patients remains unclear. Data from a large international geriatric trauma register were analyzed to examine the outcome of patients with PFF with respect to the timing of surgical stabilization. Materials and Methods: The Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) was analyzed. Patients treated surgically for PFF were included in this analysis. As outcome parameters, in-house mortality rate and mortality at the 120-day follow-up as well as mobility, the EQ5D index score and reoperation rate were analyzed in relation to early (<48 h) or delayed (≥48 h) surgical stabilization. Results: A total of 1178 datasets met the inclusion criteria; 665 fractures were treated with osteosynthesis (56.4%), and 513 fractures were treated by implant change (43.5%). In contrast to the osteosynthesis group, the group with implant changes underwent delayed surgical treatment more often. Multivariate logistic regression analysis of mortality rate (p = 0.310), walking ability (p = 0.239) and EQ5D index after seven days (p = 0.812) revealed no significant differences between early (<48 h) and delayed (≥48 h) surgical stabilization. These items remained insignificant at the follow-up as well. However, the odds of requiring a reoperation within 120 days were significantly higher for delayed surgical treatment (OR: 1.86; p = 0.003). Conclusions: Early surgical treatment did not lead to decreased mortality rates in the acute phase or in the midterm. Except for the rate of reoperation, all other outcome parameters remained unaffected. Nevertheless, for most patients, early surgical treatment should be the goal, so as to achieve early mobilization and avoid secondary nonsurgical complications. If early stabilization is not possible, it can be assumed that orthogeriatric co-management will help protect these patients from further harm.

Is Early Surgical Treatment for Benign Prostatic Hyperplasia Preferable to Prolonged Medical Therapy: Pros and Cons

Background and objectives: Treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) has shifted over the last decades, with medical therapy becoming the primary treatment modality while surgery is being reserved mostly to patients who are not responding to medical treatment or presenting with complications from BPH. Here, we aim to explore the evidence supporting or not early surgical treatment of BPH as opposed to prolonged medical therapy course. Materials and Methods: The debate was presented with a “pro and con” structure. The “pro” side supported the early surgical management of BPH. The “con” side successively refuted the “pro” side arguments. Results: The “pro” side highlighted the superior efficacy and cost-effectiveness of surgery over medical treatment for BPH, as well as the possibility of worse postoperative outcomes for delayed surgical treatment. The “con” side considered that medical therapy is efficient in well selected patients and can avoid the serious risks inherent to surgical treatment of BPH including important sexual side effects. Conclusions: Randomized clinical trials comparing the outcomes for prolonged medical therapy versus early surgical treatment could determine which approach is more beneficial in the long-term in context of the aging population. Until then, both approaches have their advantages and patients should be involve in the treatment decision.

The use of procalcitonin in patients with surgical forms of erysipelas

The ideal marker of bacterial infection should not only allow for early diagnosis, but also provide information about the course and prognosis of the disease. Nowadays the most well-studied and widely used in clinical practice is procalcitonin (PCT), but its value in surgical forms of erysipelas is insufficiently defined. The aim of the article is to determine the diagnostic and prognostic significance of procalcitonin in patients with surgical forms of erysipelas.114 case histories of patients who were hospitalized in the center of purulent-septic surgery of the Non-profit municipal enterprise "City Hospital №3" in Zaporozhye for 2019-2020 period were analyzed retrospectively and prospectively. It was found that most often the focus was localized on the lower extremities. In the complex treatment of patients with erysipelas, the main place belongs to antibiotic therapy (ABT) and early surgical treatment of the area of the pathological process. Determination of the level of procalcitonin in the serum makes it possible to assess the progression and generalization of the process and is a sensitive test for the effectiveness of treatment.Radical surgery and timely targeted ABT are key elements of success in the treatment of surgical forms of erysipelas and are not subject to revision. Procalcitonin is a diagnostic marker that can predict the development of sepsis.

Desmoplastic Malignant Melanoma with the Invasion of the Orbit

Malignant melanoma is one of the most aggressive skin tumors with an increasing incidence and high mortality. The aim of this article is to draw attention to the difficulties of differential diagnosis of malignant melanoma and the importance of early surgical treatment. The authors describe a case of locally advanced desmoplastic malignant melanoma located in the periorbital area of 73-year-old patient, causing massive ulceration, expansion to skull base and orbit, and psychological deterioration of the patient.