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Innovative Medicine of Kuban #3 (2017)

InnovativeMedicineofKuban #3 (2017)

CONTENTS

TRANSPOSITION COMPLEX WITH AORTIC ARCH OBSTRUCTION:

OUTCOMES AFTER ONE-STAGE REPAIR IN NEWBORN PERIOD

G.А. Efimochkin, K.O. Barbukhatti, N.B. Karakhalis, A.K. Shadrin, М.V. Boriskov

Scientific Research Institution - Regional Clinical Hospital #1 S.V. Ochapovsky, Krasnodar, Russia

Introduction Aortic arch obstruction occurs in 5–9% cases with a combination of TGA and a ventricular septal defect (VSD), and with a double-outlet right ventricle (DORV) with a subpulmonary VSD (Taussig-Bing anomaly), the incidence of aortic arch obstruction is approximately 50%. In the past, surgical tactics with this combination consisted of a double-stage correction; this approach was accompanied by high hospital mortality – 31–64%. With the development of neonatal cardiac surgery, a one-step correction, first described by Pigot, was accepted as the preferred surgical tactic among centers with sufficient experience.

This report presents our experience of one-stage arterial switching with aortic arch reconstruction over the last 10 years (2007–2017).

Material and methods During the period from 2007 to August 2017, we performed 172 arterial switch operations; anomalies of the aortic arch occurred in 12 patients (6.97%), 7 patients with TGA with an ventricular septal defect (VSD), 5 with double outlet of the right ventricle (DORV) with an subpulmonary VSD (Taussig-Bing anomaly).

Anomalies of the aortic arch included isolated coarctation of the aorta (n = 2, 17.8%), aortic coarctation with aortic arch hypoplasia (n = 5, 41.6%) and interruption aortic arch (n = 5, 41.6%). The mean age at the time of admission was 2.36 + 1.54 days (1–7 days). The average day in the specialized cardio-resistance unit before the operation was 2.05 + 1.1 days (1–4 days), the average weight was 3.32 + 0.45 kg (2.9–4.1 kg).

Results There were no cases with early and late mortality. In the long-term follow-up period, 5 repeated surgeries (41.6%) were performed in 3 patients. In all cases, the cause was neo-pulmonary artery stenosis, 3 patients underwent balloon angioplasty of the pulmonary artery (18, 24 and 28 months after the initial correction); later, 2 patients required open pulmonary artery plastics (3 and 6 years after endovascular interventions). Residual aortic arch obstruction did not develop in any of the patients, nor did coronary problems and dilatation of the neo-aorta root.

Conclusions In patients with TGA with an ventricular septal defect (VSD), and with a double-outlet right ventricle (DORV) with a subpulmonary VSD (Taussig-Bing anomaly), a one-stage correction in the neonatal period is preferred, which is accompanied by low mortality and morbidity. Features of surgical techniques allow to improve the results of surgical correction. The main problem in the long-term period is the frequent development of stenosis on the neo-pulmonary artery, which requires further improvement of surgical techniques and methods of plasticity of the neo-pulmonary artery.

Key words: great arteries transposition, arterial switch operation, aortic arch reconstruction.

INTERRELATION BETWEEN COMORBIDITY AND MORTALITY RATES IN ELDER PATI ENTS WITH POLO - TRAUMAS

M.L. Mukhanov 1, A.N. Blazhenko 1, A.V. Shevchenko 2, A.K. Shkhalakhov 2, R.G. Oleynikov 1

1 Kuban State Medical University, Krasnodar, Russia

2 Scientific Research Institution – Ochapovsky Regional Clinical hospital #1, Krasnodar, Russia

Regarding world wide tendency to population ageing, active life style of the elderly leads to growing various traumas, including severe concomitant injuries. Comorbidity does not only complicate diagnosis process and treatment in non-advanced medical centres, but in cases with concomitant injuries may result in unexpected decompensation of patient condition, down to unfavourable treatment results. Thus, coexisting somatic pathology is a serious challenge for the public health system as several accompanying diseases exacerbate management and diagnosis procedures.

Aim Value influence of accompanying pathology on probable lethal outcome in elder patients with politrauma.

Materials and methods We analysed cases of elder patients with politraumas (n=163). To standardise studies and compare them properly we used Charlson comorbidity index.

Results Accompanying somatic pathology influences outcomes in patients with severe combined traumas: Charlson index ≥5, in patients older 60 years it’s prognostically unfavourable for life, irrespective of trauma severance.

Conclusions Application of comorbidity index allows to object life prognosis and possibility of surgical stage performance in elder patients with politraumas regarding the concept of injury dynamic control.

Key words: politrauma, the elderly, senile age, comorbidity, concomitant diseases.

MINI-INVASIVE TECHNIQUES FOR LATERAL VENTRAL HERNIA TREATMENT

A.V. Gubish 1,2, A.Y. Popov 1, S.E. Gumenyuk 2, A.G. Baryshev 1,2,

A.N. Lyschenko 1,2, A.N. Petrovsky1, V.Y. Lischishin 1, I.O. Lebedev 1

1 Scientific Research Institution – Ochapovsky Regional Clinical hospital # 1, Krasnodar, Russia

2 Kuban State Medical University, Krasnodar, Russia

After surgical interventions with approaches through abdominal oblique muscles, we could observe lateral ventral hernias in 40% patients. They are less frequent in the structure of postoperative ventral hernias as such surgical approaches are not often employed. However, technical difficulties of abdominal wall repair and unsatisfactory immediate and long-term treatment results are to be observed by surgeons. Recurrence rate of lateral hernias after autoplasty is 20-30%, and following meshed explants application – 5%. These unsatisfactory outcomes in the operated on patients necessitate analysis of complication and recurrence causes and search for their possible ways of solutions.

Aim Improve results of surgery in patients with lateral postoperative ventral hernias.

Methods For 2012–2017 we have operated on 36 patients with postoperative lateral ventral hernias: 15 with open approaches and 21 with laparoscopy. To analyse treatment results we have been monitoring early postoperative period for 7–10 days, analysed pain syndrome and complications - seromas, hematomas and wound complications. In 6 months and 1 year postoperatively we observed presence of chronic pain syndrome, satisfaction of patients with surgery results and lack of hernia recurrence.

Results After open surgery we observed 4 cases with seromas, pain syndrome according to VAS was from 7 to 8 points for 3-4 days. Hospital stay was 9±2 days. Two patients complained pain syndrome in 6 months postoperatively and in a year after conservative treatment none of those suffered any pain syndrome. In an early postoperative period after laparoscopy there were no complications observed. Pain syndrome was 4–5 points according to VAS. Due to minor pain syndrome and lack of wound complications mean period of hospital stay was 5±2 days. No pathological events in long term period linked to mesh transplant were not registered.

Conclusions Treatment of lateral hernias is complicated by lateral abdominal wall structure, presence of four nerve trunks and neuropathic element with hernia formation with denervation and lateral abdominal wall laxity.

Laparoscopy has several advantages for surgical treatment of these type of hernias.

Application of mini-invasive techniques for lateral ventral hernia treatment has impact on reduction of early postoperative complication rate and hospital stay and possible risk of pain syndrome development in a long-term postoperative period.

This application is limited only by presence of adhesions or unfavourable comorbidities that increase risk of intraoperative complications related to necessitated intra-abdominal pressure elevation. In cases with contraindications for mini-invasive techniques one should perform open intramuscular or preperitoneal hernioplasty.

Key words: Lateral ventral hernia, lateral hernia surgical treatment, laparoscopic hernioplasty.

TI-RADS CLASSIFICATION SYSTEM AND ITS FIRST APPLICATION IN THE ULTRA SOUND DIAGNOSIS DEPARTMENT IN THE MULTI -SPECIALITY HOSPITAL

А.А. Kvasova, A.N. Katrich

Scientific Research Institute - Ochapovsky Regional Clinic Hospital #1, Krasnodar, Russia

Introduction Ultrasonic examination is a most wide-spread method for thyroid gland visualizing and its structural pathology. But despite its high sensitivity while detecting nodal neoplasms, US is not a screening method, as it results in identification of a number of non-palpable nodes. After node detection the most important clinical issue is its malignant nature exclusion and we should determine indications for biopsy. In the world clinical experience to stratify the malignancy risk, various classification systems and scales have been developed. The most common classification system is TI-RADS.

Aim To evaluate the TI-RADS classification efficacy for the thyroid gland nodular tumor diagnosis in a multispecialty hospital.

Materials and methods We have analyzed ultrasound and cytological examination outcomes of the thyroid gland nodules were analyzed in 3383 patients (3758 nodes) by using our modified classification TI-RADS (J.Y. Kwak, 2011.).

Results and conclusions Due to TI-RADS classification application, the number of ultrasound detected and cytological verified cancers in 2016 was 9.2% (previous rate was 5%). Biopsy number was reduced by 23% compared to the previous period. The sensitivity index of the TIRADS classification in our study was 94%, 64% specificity, and diagnostic efficiency was 70%. The obtained outcomes confirm TI-RADS classification viability in our routine practice, as well as the necessity to continue work and advance this system.

Key words: ultrasound diagnosis; Thyroid gland disease; TI-RADS.

SURGERY FOR DEGENERATIVE STENOSIS OF LUMBAR SPINE

WITH DYNAMIC IMPLANT APPLICATION

M.M. Aleksanyan, A. G. Aganesov

Russian Scientific Surgical Center named after academician B.V. Petrovsky, Moscow, Russia

Aim Main purpose of the present paper is improvement surgical results following lumbar spine stenosis treatment. Materials and methods We have analysed outcomes of 124 operated on patients: 56 patients were operated on with wide decompression application and spondylosis formation (Group 1), 68 (Group2) had mini-invasive decompression (facetectomy, flavectomy, arch marginal resection) and placement of dynamic interspinal DIAM implants. We excluded patients with spondylolytic spondylolisthesis.

Results We have found no actual difference for the following up period (from 22 months to 10,5 years) between both techniques for leg pain control. In 16,7% patients ( had operation on 2 and more segments) we noticed postoperative pains lower and superior fixation area, in patients with DIAM implants after mini-invasive decompression there was no pain syndrome. In one case we found fixation system break down and it required repeated placement. Patients of both group with one-segment operation demonstrated no significant difference in spinal pain syndromes. And the patients of Group 2 had lower intraoperative blood loss and overall operative time.

Conclusions Mini-invasive decompression with dynamic implants placement is a safe and reliable alternative for spinal cord stenosis treatment comparing to wide decompression and spondylesis formation.

Key words: spinal cord stenosis, dynamic implants, DIAM, mini-invasive decompression.

CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS

FOR PARKINSONISM AND PARKINSON’S DISEASE IN KRASNODAR REGION

D.K. Sichinava, L.I. Bonzyuk, E.A. Kurynnaya, M.A. Barabanova

Scientific Research Institution – Ochapovsky Regional Clinical hospital #1, Krasnodar, Russia

Parkinson’s disease and parkinsonism are very socially significant as they impact life quality (early disability, noticeable kinetic and cognitive deteriorations). In this article we described incidence rate of Parkinson’s disease and parkinsonism, special features of medical care for patients with Parkinson’s disease in Krasnodar region.

Key words: Parkinson’s disease, incidence rate, epidemiology, morbidity, Parkinsonism.


CLINICAL TREATMENT FOR ANTERIOR DESCENDING

ARTERY THROMBOSIS IN APATIENT WITH ACUTE CORONARY

SYNDROME WITHOUT ST-SEGMENT ELEVATION

V.V. Efimov, A.N. Pakholkov, E. S. Suslov

Scientific Research Institution – Ochapovsky Regional Clinical hospital #1, Krasnodar, Russia

In this article we present a clinical case of successful treatment in a patient with acute coronary syndrome without ST-segment elevation with prolonged non-occlusive thrombosis of the anterior descending artery with means of thromboaspiration and distal protection.

We analysed literature sources of a series of studies performed in patients with acute myocardial infarction. In the present clinical case with a formed thrombus in the anterior descending artery we failed to achieve optimal outcomes by performing thromboaspiration. Thrombus formed in a «clear» artery without stenosis was removed with a filtertrap.

Key words: acute coronary syndrome, thromboaspiration, thrombextraction.

MULTISPIRAL CT POSSIBILITIES FOR COMBINED CARDIAC PATHOLOGY DIAGNOSIS PRE- AND POSTOPERATI

E.P. Yasakova*, E.I. Zyablova, N.V. Agurina, E.G. Shevchenko, S.A. Belash, S.Y. Boldyrev

Scientific research institution – Ochapovsky Regional clinic hospital #1, Krasnodar, Russia

Rapid technical development of multispiral computer tomography (MSCT) and possibility to perform researches with cardiosynchronization, considerably enlarged possibilities for non-invasive diagnostics of heart diseases and coronary arteries.With the advent of multidetector computer systems with 64, 256 and 320 series of detectors it significantly increased quality of the received images that allows to estimate not only a lumen of coronary arteries, status of cardiac cavities and wall thickness, but also analyse heart chamber functions, to reveal valvular pathological changes. The speed and reliability of diagnostics reached by means of MSCT led to fast introduction of this method in daily practice in cardiology and cardiac surgery.

Key words: mitral valve prolapse, CT, x-ray diagnosis, left ventricle analysis.

FATAL VASCULAR COMPLICATION AT PERIPHERIC VA ECMO.

IT IS POSSIBLE TO AVOID OR NOT?

E.S. Afonin, A.A. Skopets, E.S. Dumanyan

Scientific Research Institute – Ochapovsky Regional Clinic Hospital # 1, Krasnodar, Russia

This article describes the possible and fatal vascular complication after cannulation for peripheral eCPR (venoarterial ECMO). A patient with cardiac arrest was deemed to be placed to ECMO via cannulation of femoral artery and vein. During ongoing chest compressions femoral artery was cannulated and it was complicated by hemorrhagic shock. The consequent autopsy revealed a lengthwise arterials wall tear and abnormal position of artery and vein between each other. We believe that obtaining information about vascular bed (vessels dimension, location artery and vein and its’ branches) via any available imaging tool, ultrasound navigation, checking the proper position each line inside each vessel could help to avoid such tragic event.

Key words: ECMO, e-CPR, extracorporeal membrane oxygenation, vascular complication

SURGERY FOR CAVERNOUS MALFORMATION OF THE CEREBRAL TRUNK

V.V. Tkachev 1, L.V. Shagal 2, A.S. Mikhaleva 2, G.G. Muzlaev 1,2

1 State budget institution of public health «Scientific research institution - Ochapovsky Regional clinic hospital #1, Krasnodar, Russia

2 Kuban State Medical University, Krasnodar, Russia

We present a surgical case with a patient treated for multiple cerebral cavernomas, manifesting with trunk extravasations. This case has special feature as the patient’s twin-sister had asymptomatic cavernous malformation. Surgical technique and epidemiology are discussed for cerebral cavernous malformations.

Key words: cavernous malformation, cerebral trunk extravasation.

FIRST EXPERIENCE OF ZENKER’S DIVERTICULUM ENDOSCOPIC TREATMENT

M.I. Bykov, D.P. Grigorov, A.A. Taran

Scientific Research Institution – Ochapovsky Regional Clinical hospital #1, Krasnodar Region, Krasnodar, Russia

Zenker’s divirticulum is rather rare pathology that causes significant dysphagia, it critically reduces life quality in a patient. Standard management of this pathology is open surgical treatment: diverticulectomy with cricopharyngeus myotomy. Due to mini-invasive technique advancements we practise endoscopic diverticulum septotomy.

In the present article we describe our first experience with application of mini-invasive modification for Zenker’s diverticulum and early postoperative outcomes.

Key words: mini-invasive treatment, endoscopic diverticulum septotomy, Zenker’s diverticulum, diverticuloscope.

PRIMARY HYPERPARATHYROIDISM WITH ATYPICAL LOCALIZATION

S.V. Butaeva, N.S. Vanenkova

Scientific Research Institution – Ochapovsky Regional Clinic Hospital #1, Krasnodar, Russia

In the present article we described a case with atypical adenoma locating and primary hyperparathyroidism. This patient with a multinodal goiter and prolonged rise of Ca level in blood had CT scanning with contrast enhancement; we observed a superior mediastinal mass that intensively accumulated contrast agent. It is necessary to notice that when performing USE and scintigraphy we had no data on mass formation, so it proved necessity of further CT scanning in patients with prolonged hypercalcemia. This patient had a two-stage operative intervention with removal of parathyroid gland adenoma and her thyroid gland was also resected. Finally we could observe reliable clinical outcomes. Considering that primary referral of patients with HPT might be observed not only to endocrinologists, but also experts of other fields, it is important to enhance diagnostic vigilance of physicians. For this purpose carrying out wide-scale educational programs and screening of calcium level is necessary at routine blood test, especially in risk groups.

Key words: hypercalcemia, hyperparathyroidism, parathyroid gland adenoma.