Innovative Medicine of Kuban_#4_2016

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InnovativeMedicineofKuban #1(2016)


CONTENTS

VIDEOTHORACOSCOPIC LUNG RESECTIONS IN THORACIC SURGERY

V.A. Porhanov, I.S. Polyakov, V.B. Kononenko, V.V. Danylov, N.V. Naryzhny, V. A. Zhykharev

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

Background at present our aim is to reduce surgical intervention traumatism avoiding reduction of quality and treatment effectiveness. VATS is a perfect tool in this aspect but unfortunately we do not observe the unified opinion regarding its performance technique.

Materials and methods for the period from 2011 to 2015 we performed 447 VATS resections in Thoracic Surgery Department, SRI, Ochapovski Regional Clinic Hospital #1. In most cases we performed surgical procedures under the general anesthesia with separated bronchial intubation, but in 34 cases surgery was carried out without intubation.

Mean age was 53.9 years (age range 24–78), man to woman ratio was 212:235. The most common procedures was right upper lobectomy, 12 patients had VATS pneumonectomy for NSCLC. Most operations were performed with mini-access, 5 cm length and one port for optical instruments. And we performed 52 lobectomies and 2 left pneumonectomies through a single 5-cm port. We performed lung resection after hilum exposition and manipulations with hilar, lobar or segment elements. All patients underwent systematic lymph node dissection. Pleural cavity was drained with one tube.

Results In 9 cases we performed conversion in a standard thoracotomy. There was no cases of postoperative mortality. One year survival rate was 100% and all patients demonstrated survival without any signs of recurrence.

Conclusion Thus, we consider that applying mini invasive techniques we could easily perform VATS lung resections. This method shows minor traumatism, more prompt recovery and less pain syndrome in a postoperative period.

Key words: VATS, lung resection, complications, conversation to a standard thoracotomy

CORONARY ARTERY RECONSTRUCTION FOR DIFFUSELY DISEASED CORONARY ARTERIES (SINGLE CENTRE EXPERIENCE)

A.P. Bogdan, S.A. Belash, K.O. Barbuhatti, V.A. Porhanov

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

1.      Material and Methods Between 2003 and 2014, 535 patients (mean age 63±7,4 years) underwent long segmental reconstruction (≥2 cm) using the internal thoracic artery graft or vein graft, 149 patients underwent adjunctive coronary endarterectomy. Exclusion of atheromatous plaques from the coronary lumen are the bases of the technique. Angina 3–4rd CCS was present in 76% of patients and unstable angina in 24%. 64% had a recent myocardial infarction.

2.      Results. Operative mortality in CE group was 2,7% (4 patients). The rate of perioperative myocardial infarction was 4,9%. The mean intensive care unit stay was 1±1,8 (range 1–6 days), and the mean hospital length of stay was 9,7±1,4. Thirty-day mortality in no CE group was 1,3% (5 patients of 386). All survived patients had no angina pectoris symptoms.

3.      Conclusions. Long segmental coronary arteries reconstruction without endarterectomy shows excellent early outcomes in patients with diffusely diseased coronary arteries. Complete revascularization of the diffusely diseased LAD artery can be accomplished by adjunct endarterectomy without increased morbidity or mortality and with excellent angiographic results.

Key words: coronary arteries reconstruction, coronary endarterectomy, diffusely coronary disease, left internal mammary artery.

HEMODYNAMIC MANAGEMENT DURING CARDIOPULMONARY BYPASS IN NEWBORNS

N.B. Karakhalis, A.K. Shadrin, E.V. Pavlenko, V.G. Rasponomarev, V.U. Shibaev, V.I. Sadykov

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

The issues of hemodynamic management in newborns undergone the cardiopulmonary bypass surgery are still actual at present. The application of Urapidil for α-adrenergic blockade and choice of anesthetic protocol during the cardiopulmonary bypass permit to perform efficient control of circulatory and oxygen status, achieve the decreasing inotropic support in postoperative period, reduce respiratory support time and length of stay in ICU.

Key words: α-adrenergic blockade, cardiopulmonary bypass, oxygen delivery, oxygen consumption, cardiac surgical repair.

PRE- AND POSTOP REHABILITATION AS A BASIC COMPONENT IN THE PROGRAM OF ERAS IN THE TREATMENT OF THE COLORECTAL CANCER. OUR EXPERIENCE

V.V. Polovinkin, I.Ju. Sholin, E.A. Popov, N.A. Artjushina, B.S. Jezugbaja,

R.R. Ramazanov, L.V. Zhuchenko

Scientific Research Institute – S.V. Ochapovsky Regional Clinic Hospital #1, Krasnodar Region Public Health Ministry, Krasnodar, Russia

Introduction Application of a new concept for fast rehabilitation after the surgical treatment (ERAS) gives opportunity to decrease statistical rates of morbidity, pain syndrome and mortality as a result of oncopathology and colorectal cancer in particular.

Aim of the research Improvement of the postoperative results due to application of the ERAS and the program of adapted pre- and post- rehabilitation in the treatment of the colorectal cancer. Application of fast rehabilitation meth­ods in surgical patients is up-to-date.

Materials and methods We analyzed the results of investigation and treatment of the group of 347 patients with colorectal cancer. Study group was operated using a traditional approach. The average age was 60,1 (+/-) 13,2. It was formed two groups: main group (prospective ) n=70 patients, control group (retrospective) n=277. In the control group the aftercare was performed in the traditional way. In the main group the aftercare was performed according to the protocol Fast Track (ERAS) and the program of adapted pre- and post- rehabilitation.

Results and Discussion Average period of rehabilitation in the intensive care has reduced from 3,9 +/-1,0 (control group) to 2,0 +/- 1,1 (main group). The intensity of the pain syndrome in the main group was below the numbers in comparison to the control group (24,3% (17/70) and 85,9% (238/277). The frequency of pulmonary embolism in the control group decreased from 3,2% (9/277) to 1,4% (1/70). Gastrostasis and intestinal disorder appeared to be less frequent the main group (10% (7/70)) comparing to control group (39,9% (91/277)).

In the group of patients under Fast Track (ERAS) and the program of adapted pre- and post- rehabilitation aftercare occurred less psychotic disorders (1,4% (1/7)) versus 5,4% (15/277)). The frequency of postoperative pneumonia fell down from 7,2% (90/277) – control group to 1,4% (1/70) – main group.

Conclusion The application of the ERAS and the program of adapted pre- and post- rehabilitation reduces postop­erative complications, pain syndrome and intensive care rehabilitation.

Key words: Fast Track, ERAS, colorectal cancer, postop complications, physical rehabilitation

THE EFFICIENCY OF MODERN METHODS OF REPERFUSION THERAPY IN PATIENTS WITH ISCHEMIC STROKE IN THE NEUROLOGY # 2

O.N. Zhadan, A.N. Torgashovа, S.M. Andreev, N.V. Esipenko, L.V. Timchenko, A.A. Usachev, V.V. Efimov, A.I. Beliу, R.A. Vinogradov

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

The efficacy and safety of such common surgical procedures as carotid endarterectomy and carotid angioplasty in acute period of ischemic stroke remain a controversial and unproven question. Current recommendations limit re­canalization therapy using systemic and selective thrombolysis and thromboembolectomy. However, the active use of traditional surgical interventions can significantly improve the efficiency of treatment in patients with ischemic stroke within the first hours from the onset of the disease. The experience of the Regional Vascular Center in Regional Clini­cal Hospital № 1 in the use of carotid endarterectomy and carotid angioplasty in acute period of ischemic stroke, when the application is different from ordinary methods recanalization therapy was fully justified and was not accompanied by complications.

Key words: ischemic stroke, carotid endarterectomy, carotid angioplasty and stenting.

PLASTIC FULL THICKNESS SKINGRAFTS WOUNDS OF VARIOUS ETIOLOGIES

S.B. Bogdanov, R.G. Babichev, D.N. Marchenko, A.V. Polyakov,

Y.V. Ivashchenko

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


The wound of any etiology requires skingraft closure. The best is the full thickness skin autografts. There are known methods of plastics by Krasovitov and Parin performed in the first hours after the injury. This article presents a new method of plastic of face full thickness skingraft. The developed techniques of operations create conditions for the healing by full thickness skingraft on granulating wounds. According to this methodology were operated by 5 patients. This method makes it possible to achieve a positive postoperative period is not only functional, but also cosmetic result. The aim of this work is to analyze the performance of plastics full thickness transplants on wounds of various etiologies.

Key words: ski; full-thickness skingraft; treatment; skingraft.

POLYTRAMA FEATURES IN PATIENTS OLDER THAN 60 YEARS

A.A. Blazhenko, O.V. Sabodashevsky, M.L. Mukhanov, E.V. Konovalov, Y.V. Konovalov, D.A. Solodky, D.B. Tkachenko, S.E. Karagezyan

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

We presented an analysis of monitored patients with multiple injuries in elderly groups (108 patients). The aim of the present study was to analyze findings associated trauma patients older than 60 years. Analysis of the results in our research allowed to find out the nature of comorbidity and determine a high mortality rate in injured patients.

Key words: polytrauma, mortality, elderly patients.

QUALITY OF COLONOSCOPY PERFORMANCE AND ANALYSIS OF «QUACOL» PROJECT PARTICIPATION

M.I. Bykov, A.A. Taran

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

Colorectal cancer occupies one of the leading positions among oncological diseases, both in the regional and all Russian register. The only effective method to decrease mortality rate is proper screening and timely radical treatment. Endoscopic diagnosis for colonic malignancies is the most accurate and informative option. We have performed a major randomized assessment together with Russian Endoscopic Society (ROENDO) to define quality of colonoscopy. In the present paper we presented our analysis for 3 484 colonoscopies. In our center we performed about 89.3% of all procedures.

Polyp neoplasms rate was 36,3%, adenomas with low grade of dysplasia rate was 22,9%, and a rate of advanced adenomas was 7,6%. These results showed further prospectives for improving quality of endoscopic diagnosing and management of colonic pathology.

Key words: colonoscopy, colorectal cancer screening, large intestine polyps, polypectomy.

CLINICAL CASE OF MULTIPLE PANCREATIC PSEUDOCYSTS PREVALENT IN THE POSTERIOR MEDIASTINUM

Yu.S. Degtyareva, E.I. Zyablova, N.V. Agurina, E.G. Shevchenko

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

In the present paper, the following topics are under consideration: a clinical case of multiple pancreatic pseudocysts localized in the omental bursa, big lumbar muscle, perirenal fat and posterior mediastinum. Clinical picture features and radial methods of research possibilities are examined.

Key words: acute pancreatitis, pancreonecrosis, pancreatic pseudocyst, cyst of the posterior mediastinum, computed tomography.

DIAGNOSTIC ADVANTAGES OF LONGITUDINAL HOLTER MONITORINGCOMPARING TO 24-HOUR MONITORING

J. N. Gorozhantsev

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

We observed diagnostic advantages of the continuous 7-day ECG monitoring in comparison with the 24-hours of research.

Compact recorders and original software were applied. Our study showed significant diagnostic advantages over the traditional prolonged recording 24-hour study.

Key words: Holter, 7-day, prolonged, longitudinal ECG monitoring.

MODERN SONOGRAPHY IN DIAGNOSTICS OF THYROID MULTIPLE PRIMARY CANCER

A.A. Kvasova, A.N. Katrich, A.G. Baryshev

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

The paper represents the first experience with shear wave elastography and elastometry using wideband linear array 4-15MHz, gray-scale and Doppler examinations to diagnose synchronous multiple primary cancer of the thyroid.

Key words: ultrasound diagnostics, sonoelastography, multiple primary tumors, thyroid cancer.

ACCESS FORMATION TO RECTAL SHORT STUMP IN CASES WITH RESONSTRUCTIVE SURGERY ON COLON AND RESTUM

V.V. Polovinkin, A.N. Igolkin, R.S.Pryn, D.Z.Agadzhanjan

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

In complicated cancer and diverticulosis, traumas, Hartmann surgery is the most common intervention. Reconstructive surgery after colonic resection according to Hartmann is a rather complicated and traumatic intervention. Special attention should be paid to the patients with short stumps of the rectum.

Issues of access to a surgical field, providing constant direct vision, both at the stage of rectal short stump exposition in a narrow pelvis, and in the process of formation of a low colorectal anastomosis, have not been observed in scientific. Purpose: we provided information to experts involved in reconstructive surgery of the colon, and proposed the method of access formation to a short stump of rectum. Stumps were considered to be short if their length was less than 7,0 cm.

The essence of this method is the unilateral mobilization of the bladder and the pelvic ureter. In female patients we cut leaves of the uterine broad ligament, they are ligated and then we transect the round ligament of the uterus, uterine vessels, umbilical artery, upper and lower vesical arteries and veins, paravaginal ligament up to the level of the pelvic diaphragm. The mobilized organs are shifted to the contralateral side of the pelvis. At the level of the inner edge of puborectalis muscle we identify the muscle wall of the rectal stump. In male patients we transect the pelvic perito­neum, expose pelvic aspect of the VAS deferens, separates the pelvic area of the ureter from the wall of the pelvis and ligate and transect the umbilical artery, the upper and lower vesical arteries and veins. At the prostate gland edge we determine rectal stump wall.

We applied this method in 18 patients. It allows to create special conditions in narrow lined scar-changed tissues of the pelvis to access to the short stump and form a colorectal anastomosis under direct visual control, ensure the ability to stop bleeding in case of its development, reduce the operative time.

Key words: anterior resection, anastomosis leak, Hartmann’s procedure.