Improvement of Medical Treatment Options of Proximal Deep Vein Thrombosis of Low Extremities Associated with Phlegmasia Alba Dolens

The aim of the study was to improve the conservative treatment options for proximal deep vein thrombosis of low extremities associated with phlegmasia alba dolens optimization of anticoagulant therapy and paravascular injection of the anti-inflammatory medical mixture in areas of the most intense inflammatory process.Materials and methods. The results of treatment of two statistically homogeneous groups of patients with proximal deep vein thrombosis of the lower extremities associated with white phlegmasia were compared. In the first group (n = 30), standard conservative treatment was carried out using rivaroxaban as an anticoagulant; in the second group (n = 30), initial heparin therapy was first performed and, additionally, the following mixture was administered in the places of the greatest severity of inflammatory process under ultrasound control: dexamethasone 16 mg, heparin 5 thousand units, 0.25% novocaine solution 20.0 ml. During treatment the incidence of hemorrhagic syndrome was recorded. The results were assessed after one year according to the degree of deep vein lumen restoration and the severity of venous outflow impairment according to the Villalta scale. Results. In patients of both groups, every tenth patient developed some minor manifestations of hemorrhagic syndrome during treatment with rivaroxaban that was corrected by a decrease in the dose of anticoagulant.Complete restoration of the lumen of the veins occurred in 20.0%, patients of the first group and in 40.0%, patients of the second group; partial, in 63.3% and 56.7% of patients, respectively, minimal - in 16.7% and 3.3% of patients, respectively.In the first group, clinical disorders of venous outflow were absent in 20.0% of patients, a weak degree of severity was registered in 23.3%, an average - in 40.0%, and a strong one in 16.7% of patients, and in the second group, in 40 %, 26.7%, 30% and 3.3% of patients, respectively.Different minor hemorrhagic complications after Rivaroxaban intake occurred equally in both groups in each of ten patients. These complications were treated by the reduction of the anticoagulants dose.Complete restoration of the vein lumen occurred in the first group in 20.0%, and in the second group in 40.0% of patients, partial restoration, in 63.3% and 56.7% of patients, minimal - in 16.7% and 3.3% of patients respectively.In patients of the first group clinical venous congestion was absent in 20,0% of patients, mild congestion was manifested in 23,3% of patients, moderate - in 40,0% of patients, and severe was in 16,7% of cases. In the second group, the obtained data was 40%, 26,7%, 30%, and 3,3% of patients, respectively. Conclusion. Starting therapy with heparin and paravascular injection of anti-inflammatory mixture helps improve treatment outcomes.

Method of Enteral Insufficiency Syndrome Correction in Patients with Generalized Peritonitis

Introduction. Mortality in generalized peritonitis (GP) reaches 30%, and with the development of multiple organ failure, the lethal outcome is observed in 80-90% of cases. Enteral insufficiency syndrome (EIS) plays a leading role in the progression of generalized peritonitis. The aim of the study was to develop a differentiated approach of enteral insufficiency syndrome correction in patients with generalized peritonitis. Material and methods. This research was a retrospective prospective study. The study included 50 patients with GP, who received treatment at the Surgery Department of the Samara Regional Clinical Hospital in the period from 2017 to 2019. Depending on the chosen treatment tactics, the patients were divided into two clinical groups. Group I included 29 patients, admitted in the period from 2017 to 2018, who had received the standard GP treatment. A long-term endogenous intoxication in patients of this group associated with the progressive enteric failure led to the repeated surgeries; at the same time, a high frequency of postoperative complications was preserved. The analysis of the results in patients of Group I necessitated development of the therapeutic and diagnostic algorithm aimed at early diagnostics and timely correction of EIS. Group II included 21 patients with GP, admitted in the period from 2018 to 2019, who was treated using the new algorithm. Results. The objective criteria for the relief of EIS in GP in patients of the study groups were a decrease in the level of serum albumin and C-reactive protein, a significant decrease in the amount and qualitative change in the intestinal discharge via an intestinal tube, a decrease in the recovery time of the functions of the small intestine and start of defecation. On the 6th postoperative day, in patients of Group II there was no significant albumin level reduction in comparison with the 1st day of monitoring (28.310.77 g/l vs 37.334.69 g/l). Whereas in Group I the albumin level was significantly lower (19.30.51 g/l) than the same parameter in Group II, and in comparison with the 1st day of monitoring (19.30.51 g/l vs 39.56.05 g/l; р = 0.00001). On the 6th postoperative day, the C-reactive protein level differed significantly between the groups as well: Group I 104.7613.49 mg/l, Group II - 58.0029.05 mg/l, p = 0.003. The control of GP in patients of the Group I was reached after 4.52.5 repeated abdominal interventions, while in patients of Group II generalized peritonitis was arrested after 2.30.9 surgical interventions (p = 0.000171), which is 1.9 times less. Conclusions. The proposed algorithm of EIS control is based on the individual approach to the treatment of patients with GP. The developed EIS rating scale allows determining not only the degree and dynamics of the pathological process, but also monitoring the effectiveness of treatment options applied in a particular patient.

History of Development and Potentials of Plasma Surgery

Two hundred years have passed since the moment when Michael Faraday suggested the existence of substances of the fourth aggregate state. A long way has been spent studying plasma and its properties, searching for possible applications in various directions. Many specialists in various fields of medicine have conducted research on the use of unique properties of plasma for sterilization of equipment, treatment of various diseases and prevention of their complications. However, the potential of plasma use continues to open up novel ways of its application.

Changes in Coxo-Vertebral Parameters in Scoliotic Deformity of the Spine

Considering the pathology of the spine and hip joint, it is necessary to take into account their biomechanical relationships under axial loading. Scoliotic deformity leads to the development of compensatory misalignment and inclination of the pelvis, resulting in a functional shortening of one of the lower extremities, which, in turn, leads to the formation of degenerative changes in the hip joint. The development of degenerative changes in the hip joint depends on the degree of scoliotic deformity, taking into account changes in the sagittal and frontal balance. However, research studies state that scoliotic spinal deformity 40 did not cause a pronounced degenerative process in the hip joint area. In our review we studied and analyzed clinical and radiological data of patients operated on for 4 years at the spine surgery department of the National Medical Research Center of Traumatology and Orthopedics named after R.R. Vreden for scoliotic deformity 3-4 degrees. All patients underwent a teleroentgenogram of the spine with the capture of the upper third of the thigh in two projections. According to X-ray data, the angles of the lumbar lordosis, the inclination of the sacrum, the inclination of the pelvis, the deviation of the pelvis from the vertical, the angles of misalignment of the pelvis, the determination of the angle of inclination of the acetabulum in the vertical plane (Sharpe's angle)), sagittal and frontal balance were assessed. The presence of concomitant diseases of the hip joints was separately registered. To assess the correlation, Kendall's coefficients and Student's t-test were used. The study involved 60 patients (47 women and 13 men), aged on average 29.7. When evaluating the correlation, it was found that the Sharpe angle on the left (S) correlates with the Sharpe angle on the right (R), the Sharpe angle (R) correlates with hip dysplasia, where Lumbar lordosis (GLL) correlates with Sacral slope (SS), Sacral slope (SS) correlates with the pelvic incidence (PI). Pelvic deviation from the vertical (PT) correlates with PI, PI before surgery most strongly correlates with PI after surgery (for all values p 0.01). In addition, PI in patients with unilateral lesions of the hip joint is higher than in patients with bilateral lesions, which proves that there is no relationship between PI and GLL in this category of patients. According to the results of our study, changes in coxo-vertebral parameters did not change significantly in the pre and postoperative period, with the exception of lumbar lordosis and sagittal balance.

Transpleural Сontralateral Occlusion of the Left Main Bronchus Stump in a Patient with Bronchopleural Fistula and Chronic Pleural Empyema

Bronchopleural fistula (BPF) is a pathological communication between the bronchial tree and the pleural cavity, the most common complication of anatomical lung resection.BPF rarely closes spontaneously and almost always requires surgical or bronchoscopic interventions.The main methods of treatment are sanitation of the pleural cavity with the development of empyema and re-occlusion of the bronchial stump. The development of this complication in the postoperative period is accompanied by an increase in hospitalization time, a high risk of chronic pleural empyema, exacerbation of chronic diseases and death. The mortality rate ranges from 18 to 67%. Most often, BPF is manifested after removal of the right lung (8-13%), compared with the left side (1-5%), which is due to the anatomical features of the main bronchus.The presented clinical case describes a non-standard surgical approach in the treatment of bronchopleural fistula and chronic empyema of the residual pleural cavity in a young patient.

Bubbling Treatment Option in the Complex Therapy of Diabetic Foot Syndrome

Diabetes mellitus (DM) is the most common and socially significant endocrine disease that leads to early disability and is the most common cause of mortality in patients after cancer and cardiovascular pathology. The cost of managing patients with diabetes can reach 30% of the country's health budget, 90% of which is spent on the treatment of its complications. Diabetic foot syndrome (DFS) is developed in 20-80% of patients and is one of the most dangerous late complications. In clinical practice, various approaches to its treatment are used, but the number of high amputation and mortality rate in this group of patients remains significant. The aim of the study was to improve the results of treatment of patients with diabetic foot syndrome (DFS) by including the bubbling treatment method in the program of therapeutic measures. Forty-eight patients with neuropathic and neuroischemic forms of DFS were treated. The control group consisted of 23 patients receiving conventional treatment, the main group included 26 patients, who were applied bubbling treatment option locally. The analysis of groups of patients showed no significant differences by gender, age, stages of diabetic foot syndrome, depth of necrotic defect, complications and concomitant diseases. The use of the bubbling treatment method in the complex treatment of patients with DFS allowed more effectively arresting symptoms of local (edema, hyperemia, wound exudate, necrolysis) and general inflammation, anemia and intoxication syndromes, contributed to the activation of regeneration processes in soft tissues, which, combined with complex FDS treatment, together, reduced the number of amputations by 18.7%.

Increased Effectiveness of Sclerotherapy as a Treatment Option for Hemorrhoidal Disease in the Elderly and Senile Outpatients

Background. The number of elderly and senile people is about 15% in the population. Together they account for 50% of emergency and 85% of planned hospital admissions to surgical hospitals. One of the most common causes for a patient to see a surgeon is manifestations of hemorrhoids, which affect 10-36% of the population (number increases with age).The aim of the study is to improve results of the outpatient treatment of elderly and senile patients with internal hemorrhoids stages II-III by optimizing the method of sclerotherapy and indications for its application.Material and methods. The results of outpatient treatment of 60 elderly and senile patients for chronic hemorrhoids stages II-III were analyzed. The patients were divided into 2 groups. In the control group (30 patients) standard treatment was performed, including sclerotherapy of internal hemorrhoids with 2-3% solution of aethoxysklerol. One-percent solution of aethoxysklerol was used to perform sclerotherapy in the main group (30 patients). The indication for its administration was low compliance in patients and/or presence of anemia, inability to cancel antiplatelet drugs, continued bleeding. Groups were valid for comparison.Results. There was a decrease in the severity of postoperative pain syndrome by 36.8%, postoperative complications from 20,0% to 6,7%, the average period of temporary disability was from 1.80.4 to 1.00.5 days, the frequency of relapses of the disease in 6 months after sclerotherapy was from 10% to 6.7% in the main group compared to the control one.Conclusion. The proposed method reduces the intensity of postoperative pain, the percentage of postoperative complications and the frequency of relapses of the disease.

Postradiation Regression of Locally Advanced Rectal Cancer: Two Clinical Cases

In the Russian Federation, the incidence of malignant neoplasms is more than 50 thousand new cases per year. Since 1990 the combined treatment method is the standard in the treatment of patients with locally advanced rectal cancer. During the evolution of this method, preoperative radiation / chemo-radiation therapy has taken a strong position in the standards for treatment of rectal cancer. Currently, preoperative remote radiation therapy at a dose of 45-52Gy is included in treatment standards for rectal cancer. The main objective of neoadjuvant treatment is to achieve tumor regression. When a complete regression of the tumor is achieved, the task of choosing tactics arises - to carry out surgical treatment, or to apply expectant tactics. In the first clinical case, the patient underwent preoperative chemoradiation treatment with 40.8 Gy combined with capecitabine, after which 4 courses of consolidating chemotherapy were carried out followed by surgery. In the second case, the patient underwent neoadjuvant chemoradiation therapy with 52.5 Gy combined with capecitabine. Given the pronounced positive dynamics, 4 courses of consolidating chemotherapy were performed. After the control study, a complete tumor response to the therapy was revealed. Considering the MRI data and the pronounced positive dynamics, the decision of the multidisciplinary team was the tactics of dynamic observation of the patient.

Post-Resection Biliar Complications

As a result of the analysis of modern Russian and foreign literature, it was found that in the structure of postoperative complications after liver resections, biliary complications are the leading ones today. The main risk factors for the development of biliary complications and predictors of prognosis were determined at the different stages (preoperative, during the operation and postoperative period). The necessity to apply a complex of instrumental investigation methods in the postoperative period for early detection of bile leakage, clarification of its causes and forms of manifestation is determined; their importance for choosing a method of elimination is emphasized. The ways of improving the results of liver resections due to the prevention and effective elimination of bile leakage are outlined.Possibilities of prognosis of biliar complications after liver resections were analyzed. The available assessment systems can be considered uninformative, which demands development and implementation of more modern and more effective programs for predicting biliary complications after liver resections.

Sergey Sergeyevich YUDIN - Academician of the USSR Academy of Medical Sciences (to the 130th of birthday)

Sergey Sergeevich was born in 1891. He graduated from the medical faculty of Moscow University. He served as an ordinary doctor, head of a sanitary detachment, a doctor of an infantry regiment, a surgical infirmary, a surgical department of the Tula Zemsky hospital, the Zakharino sanatorium near Moscow, a factory hospital in Serpukhov. From 1925 to 1927, S. S. Yudin worked as a private assistant professor, since 1928-head of the surgical department of the N. V. Sklifosovsky Research Institute of Emergency Medicine. In 1930, he first performed a transfusion of fibrinolysis blood to a person. During the Great Patriotic War, he was a senior consultant inspector at the Chief surgeon of the Soviet Army, N. N. Burdenko. In 1948, he was awarded the State Prize and arrested as an "enemy of the Soviet state". During his stay in prison (1948-1952), Sergey Sergeevich, despite having suffered another heart attack, writes a book "Reflections of a surgeon", which is published after the author's death. In March 1952, S. S. Yudin was exiled in the city of Berdsk, and then in Novosibirsk, where he continues to conduct surgical interventions. In 1953, S. S. Yudin was rehabilitated by the decision of a Special meeting under the Minister of Internal Affairs of the USSR. S. S. Yudin died of a heart attack on June 12, 1954. Sergey Sergeyevich Yudin is the author of 15 monographs and 181 printed scientific papers, including the monograph "Spinal anesthesia", recognized as the best book on medicine in the USSR, the two-volume manual "Notes on military field surgery" and the book "Reflections of a surgeon".Sergey Sergeyevich Yudin-academician of the USSR Academy of Medical Sciences (1944), honorary member of the English, American, French, Czech Societies of Surgeons, Honorary Doctor of the Sorbonne (1946). He was awarded the Orders of Lenin (1943), the Red Star (1942), the Red Banner (1944, 1945) and the St. George Medal. Memorial plaques dedicated to S. S. Yudin are installed on the facades of the buildings of the N. V. Sklifosovsky Institute (1959), the historical building of the Serpukhov Central Hospital. A bust of S. S. Yudin is installed in front of the building of the Children's Clinical Hospital in Novosibirsk.