SURGICAL TREATMENT OF HYPERTENSION-DUCTAL TYPE OF CHRONIC PANCREATITIS, IN COMBINATION WITH BILIARY OBSTRUCTION SYNDROME

Background. The frequency of chronic pancreatitis and its complications is steadily increasing, which makes the problem of treating this pathology one of the most urgent and significant. Objective. Improvement of the results of surgical treatment of patients with hypertension-ductal type of chronic pancreatitis with extended stricture of the intrapancreatic part of the common bile duct. Material and methods. During the period 2006–2021, 328 operations were performed in the Grodno University Clinic due to chronic pancreatitis with pathology of the ductal system in combination with pancreatic cysts. The total number of complications was 5,1%. 18 patients with chronic recurrent pancreatitis, ductal hypertension in combination with a cyst of the head pancreas, also with extended stricture of the terminal part common bile duct and mechanical jaundice were operated on according to the methods developed in the clinic: 12 patients underwent choledochopancreatoejunostomy, 5 patients underwent choledochocystopancreatoejunostomy, choledochocystoduodenostomy was performed in 1 case. Results. The developed methods make it possible to perform adequate internal drainage of the ductal system of the pancreas and bile ducts, as well as cystic formations. Conclusions. The application of the developed methods improves the results of surgical treatment complicated chronic pancreatitis.

THE ROLE OF THE INSTUMENTAL EXAMINATIONS IN DIAGNOSTICS AND STAGING OF LOCALY DISTRIBUTED STOMACH CANCER

Objective. Improvement of algorithm of diagnostics of patients with complicated stomach cancer. Materials and methods. It was shown the analysis of results of surgical treatment of 418 patients with complicated stomach cancer, which got the hospital treatment at GI “V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine “ from 2010 till 2019, aged 29 till 76. Results. Patiens were examinated with using of combination of instrumental methods. Goal is total detal examination of pathologic process. SCT has precission of 95-97 % at detecting of cancer, definition of stage – 77-80 %. Endoscopy allows to define the location, spreading of process, to find a pathologic process at starting and precancer stages. There no any ideal oncomarker. Diagnostic precission of CA 72-4 is 28-80 % (40-46 % on the average). According to international guides [7], all patients were performed the diagnostic laparoscopy with researching of washout liquids of abdomen in uncertain cases. Conclusion. Only complex examination of patients with stomach cancer with using combination of SCT of abdomen, FEGDS with biopsy, laparoscopy can provide total volum of examination, staging and surgical aid.

Post-coronavirus disease 2019 polyneuropathy with significant response to immunoglobulin therapy: a case report

Background The symptoms of coronavirus disease 2019, caused by the novel severe acute respiratory syndrome coronavirus 2, were originally assumed to be mainly respiratory. With increasing knowledge, however, it turned out that the spectrum of complaints varies broadly with age and concomitant diseases. While many neurological symptoms were reported in the context of the disease, ranging from permanent fatigue to recurrent headaches and concentration disturbance, treatment approaches are still in development. This case discusses a possible treatment approach with immunoglobulin therapy and its outcomes. Case presentation We present the case of a 56-year-old Caucasian female patient who, following coronavirus disease 2019, developed peripheral sensory and autonomic disturbances that fell within subacute demyelinating neuropathy. Because a significant improvement in symptoms as well as in the results of clinical and electrophysiological examination was reported after immunoglobulin therapy, long-term therapy does not appear to be necessary. Conclusion Given the significant subjective and objective improvement reported, this case provides additional evidence that immunoglobulin therapy can be considered in post-coronavirus disease 2019 syndrome.

Key Considerations in Practices and Principles of Endoscopic Septoplasty: Lessons, Mistakes and Future

Background: Conventional surgeries of the nasal septum improve the nasal airway but recent development and advancement of the knowledge about the endoscopic septoplasty has significantly changed the treatment modality and had brought focus over several aspects of possible advantages. This study aims to see the advantages, complications and limitations of endoscopic septoplasty. Methods: It was an observational prospective study conducted over 90 patients of symptomatic deviated nasal septum. It evaluated symptoms, anterior rhinoscopy and nasal endoscopy findings, objective and subjective improvement of symptoms using the nasal obstruction symptom evaluaiton (NOSE) score, post-operative pain using the visual analogue scale (VAS) and complication following the surgery. Results: Deviated nasal septum (DNS) either left or right side was the most common examination finding 97.78%. Post-operatively there was a good symptom relief and significant subjective improvement in NOSE scores with average decline in the score by 96.26%. Objective assessment of all patients showed improved airway. The complication rate was minimum 7.78%. Conclusion: Endoscopic septoplasty (ES) was found to have distinct advantages with good subjective and objective improvement of symptoms and lesser rate of complications. It should be an option offered to all patients requiring septoplasty. We also found that it helps in improving the learning curve and surgical skill of the trainees. Bangladesh J Otorhinolaryngol 2021; 27(2): 170-176

RETROSPECTIVE MULTICENTRIC STUDY ON THE POST-SURGERY SYMPTOMATIC AND OBJECTIVE IMPROVEMENT OF BENIGN PROSTATIC HYPERPLASIA PATIENTS

Objectives: To evaluate patients of benign prostatic hyperplasia (BPH) preoperatively and identify those who would benefit from surgery, to evaluate outcome of surgery for BPH with respect to symptomatic and objective improvement of patients, and to compare the results of different surgeries for BPH being done different hospitals at Bhopal, which included transurethral resection of the prostate (TURP), transurethral incision of prostate (TUIP)/bladder neck incision (BNI), and Freyer’s prostatectomy? Methods: The present study was carried out at different hospitals of Bhopal. Patients presenting to the surgery outpatient department with symptoms of obstruction, namely, weak urinary stream, frequency hesitancy, intermittency, urgency, nocturia, etc., were included in the study. Some of the subjects included were patients presenting during emergency timings with complaints of retention of urine or occasionally other symptoms. The American Urological Association (AUA) Symptom Index questionnaire was administered to all such patients. They were also evaluated by ultrasound examination and patients having BPH on ultrasound (USG) were further evaluated by uroflowmetry. Results: Prostatic weight correlated well with the maximum urinary flow rates with an inverse relationship. Both maximum and average urinary flow rates (Q max and Qav) were improved by all the three surgeries However, TURP and Freyer’s prostatectomy showed greater improvement as compared to TUIP/BNI. Combination of AUA scoring, USG, and uroflowmetry helped us document improvement in our BPH patients and compared it favorably with other studies. Conclusion: Uroflowmetry was a simple assessment tool easy to learn and use. It was also inexpensive and formed a useful extension to clinical examination providing objective evidence of obstruction. It also helped to indirectly quantity the severity of obstruction. Symptom severity did not correlate with prostate size. Small prostates caused symptoms in the severe range also while even large prostates sometimes caused little symptoms. Prostatic weight correlated well with the maximum urinary flow rates with an inverse relationship.

IMPACT OF HIRDOTHERAPY ON VEGETATIVE DIS-ABILITIES AFTER CORONAVIRUS INFECTION

Вегетативно сосудистые и вегетативнотрофические изменения наблюдались у абсолютного большинства пациентов с ПКВИ с преобладанием частоты эмоциональных нарушений (страха смерти) 100%, генерализованный гипергидроз у 75,9%, наличие гипервентиляционного синдрома 71%, субфебрилитет, наличие вегетососудистых кризов, мигрени, склонности к обморокам 50,6%, боли в икроножных мыщах 48,1%, чувствительность к перемене климатических условий при ПКВИ наличие ухудшения самочувствия при смене погоды у 48,1% пациентов. Дисдинамические и дизритмические расстройства лабильности артериального давления (АД) с тенденцией к повышению и сердечного ритма с тенденцией к тахикардии 46,9% больных с ПКВИ. Под влиянием пятикратной и десятикратной применение грудотерапии обшое количество баллов симптомов вегетативных расстройств после перенесенной КВИ составили 557 баллов и 31 баллов и снизились на 82,4% и 99,1%. Индекс выраженности вегетативных нарушении сизились от 2,23±0,11 условных единиц (уе) на 0,39±0,01 и 0,02±0,001 уе.Результаты нейропсихологического тестирования у больных, принимавших гирудотерапии, показали объективное улучшение у них вегатативных нарушении, средний балл индекс выраженности вегетативных нарушении достоверно снизился после пятикратного и 10 дненого применение на 82,6% и 99,1% (р < 0,001) по сравнению с фоновым показателем.Таким образом, у больных с ПКВИ, принимавших 10 дневный курс гирудотерапии, показали объективное улучшение у них вегатативных функций. Autonomic vascular and autonomictrophic changes were observed in the vast majority of patients with PCVI with a predominant frequency of emotional disturbances (fear of death) 100%, generalized hyperhidrosis in 75.9%, the presence of hyperventilation syndrome 71% , subfebrile, presence of vegetovascular crises, migraine, tendency to fainting 50.6% , calf pain 48.1% , sensitivity to changes in climatic conditions in PCVI presence of worsening of wellbeing at a change of weather in 48.1% patients. Dysdynamic and dysrhythmic disorders of arterial pressure (BP) lability with a tendency to increase and cardiac rhythm with a tendency to tachycardia 46.9% of patients with PKVI. Under the influence of fivefold and tenfold application of chest therapy, the total score of symptoms of autonomic disorders after CPVI was 557 and 31 and decreased by 82.4% and 99.1%, respectively. The index of severity of autonomic disturbances sized up from 2.23±0.11 conventional units (ue) by 0.39±0.01 and 0.02±0.001 ue.The results of neuropsychological testing in the patients who took hirudotherapy showed the objective improvement of vegetative disturbances in them, the average index score of vegetative disturbances expression reliably decreased after 5 and 10 day application by 82,6 % and 99,1 % (p <0,001) in comparison with the background index.Thus, patients with PKVI who underwent hirudotherapy for 10 days showed objective improvement of vegetative functions.

EFFECT OF HIRUDOTHERAPY ON INSOMNIA DISORDERS AFTER A CORONAVIRUS INFECTION

Индекс выраженности бессонницы (ISI) у больных после перенесенной коронавирусной инфекции составили 17,5±1,05, при норме 5,4±0,21, значение шкалы сонливости по Эпворту (ESS) 11,8±0,59 при норме 4,2±0,19 баллов. Индекс качества сна (PSQI), уменьшился и средний балл после пятикратного и 10дневного применения на 24,6 % и 46,5 % (р < 0,001), среднее значение по шкале оценки индекса выраженности бессонницы (ISI) и сонливости по Эпворту (ESS) у больных с ПКВИ уменьшилось после применения 10дневного курса гирудотерапии на 50,9 % и 42,4 %.Индекс выраженности инсомнических нарушений после пятикратного и 10дневного применения гирудотерапии снизились на 24,5% и 47% по сравнеию с исходными даннымиТаким образом, у больных с ПКВИ, принимавших 10дневный курс гирудотерапии, показали объективное улучшение у них инсомнических функций. The insomnia severity index (ISI) in patients after coronavirus infection was 17.5±1.05, with a norm of 5.4±0.21, the Epworth sleepiness scale (ESS) value was 11.8±0.59 with a norm of 4.2±0.19. The index of sleep quality (PSQI), the average score after 5day and 10day course of hirudotherapy decreased by 24,6% and 46,5% (p < 0,001), the average value of the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) in patients with PCVI decreased by 50,9% and 42,4% after 10day course of hirudotherapy.The index of insomnia disorders expression after 5 and 10day hirudotherapy decreased by 24,5% and 47% in comparison with the initial data.Thus, patients with PKVI who underwent hirudotherapy for 10 days showed objective improvement of insomniac functions.

Hydroxychloroquine availability during COVID-19 crisis and its effect on patient anxiety

ObjectiveTo report the results of a survey exploring the experience of patients with SLE facing hydroxychloroquine (HCQ) shortage that occurred during the early phases of the COVID-19 pandemic.MethodsA survey was designed by Lupus Europe’s patient advisory network and distributed through its social media, newsflash and members' network. People with lupus were asked about their last HCQ purchases and their level of anxiety (on a 0–10 scale) with regard to not being able to have access to HCQ, once in April 2020 (first wave) and after 11 August (second wave). The results were compared.Results2075 patients responded during the first wave; 1001 (48.2%) could get HCQ from the first place they asked, 230 (11.1%) could get the drug by going to more than one pharmacy, 498 (24.0%) obtained HCQ later from their usual pharmacy and 126 (6.1%) from other sources. 188 (9.1%) could not get any; 32 (1.5%) did not respond to this question. All countries showed significant improvement in HCQ availability during the second wave. 562 (27.4%) patients reported an extremely high level of anxiety in wave 1 and 162 (10.3%) patients in wave 2; 589 (28.7%) and 268 (17.1%) patients reported a high level of anxiety in wave 1 and wave 2, respectively.ConclusionsThe HCQ shortage had a significant impact on patients with SLE and has been responsible for psychological consequences including anxiety. Indeed, despite an objective improvement in drug availability, the event is leaving significant traces in patients’ mind and behaviours.

Objective Improvement in Cognitive Function following Aortic Coarctation Repair in an Adult

Coarctation of the aorta is a rare finding in adults and can present with vague symptoms. We report a case of a 64-year-old cognitively impaired female who presented with fatigue and tinnitus. After extensive workup, she was diagnosed with coarctation of the aorta and subsequently underwent repair. After operative intervention for her coarctation, her cognitive impairment was found to have an objective improvement evidenced by the Montreal Cognitive Assessment.