Innovative Medicine of Kuban_#3_2016

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InnovativeMedicineofKuban #3 (2016)

CONTENTS

Aortic Valve Reimplantation in Patients with Ascending Aorta

Pathology according to Kuban Cuff Technique

S.Y. Boldyrev 1,2, K.O. Barbukhatti 1,2, V.A. Porhanov 1

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

2 Department of Cardiac Surgery and Cardiology , Advanced Training Faculty, Kuban State Medical University, Krasnodar, Russia

In the present article we described a systemic approach to aortic valve reimplantation in patients with aneurysm and/or ascending aorta dissection and with aortic insufficiency. We highlighted several surgical aspects of reimplantation with so called Kuban cuff.

Key words: ascending aorta aneurysm, reimplantation, aortic insufficiency, Kuban Cuff.

TREATMENT OF PATIENTS WITH TRAUMATIC HAND DEFECTS IN KRASNODAR REGION

A.M. Aristov, A.A. Afaunov, S.N. Kurinny, A. V. Shevchenko

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

Traumatic defects of hand tissues require mostly plasty covering with vascularised flaps. There are a great number of various variants with tissue complexes applied for hand reconstruction. In the present study we demonstrate our clinical experience with plasty substitution of traumatic defects in 35 patients with free and non- free radial flaps, insular digital flaps on the digital neurovascular bundle, flaps on the dorsal metacarpal arteries, cross digital flaps, non-free inguinal flaps and those from the anterior abdominal wall, temporal palm flaps. We showed reconstruction of fingers and hands with their soft tissues total and subtotal defects. The aim of this study is to point the indications for reconstructive plastic treatment in patients with traumatic hand defects with vascularised flaps application depending on the defect location and size.

Key words: hand, traumatic defect, flap, plasty.

WOUND COMPLICATIONS IN CASES WITH INTERSTITIAL IMPLANTATIONS IN SPINE SURGERY

I.V. Basankin, S.A. Plyasov

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

In the present paper we demonstrated our experience of treatment 69 patients with various spine pathology. All of those patients had typical local wound complications after surgical interventions with interstitial implantations application. Our work was aimed at development of the principles and systematization of techniques against the superficial and deep wound complications which occurred in early and late terms. In 38 cases final recovery in optimal terms was caused by treatment. In other cases according to the offered techniques, we performed resetting of a metal construction, alternative fixing, or removal with the subsequent delayed fixing. Early surgical revision and wound isolation from external environment are could guarantee preservation of metal constructions and wound fastest healing. An effective way to treat patients with deep wound infections are replaceable VAC-dressings.

Key words: local wound complications, wound infection, VAC- dressing.

NEUROLOGIC PERFORMANCE OF LYMPHOGRANULOMATOSIS

O.V. Stoyanova, M.A. Barabanova, T.A. Petropavlovskaya,

I.A. Nikitina, E.M. Ivanova

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

Lymphogranulomatosis (Hodgkin lymphoma) is a timorous disease of the lymphatic system. Clinical manifestations may be polymorph with isolated or multiple organ and body system invasions which cause trouble while diagnosing and administrating specific therapy. Nervous system invasion occurs following neurogenesis compression or their infiltration from lymphogranulomatosis nodes, primary lymphoma in CNS, paraneoplastic reaction. Clinical findings from the lymphogranulomatosis onset as neurological evidences are demonstrated: myelopathy with upper thoracic segments invasions and lower paraplegia development. We performed diagnostic search, laparotomy with biopsy of retroperitoneal para-aortic lymph nodes, histopathologic examination of lymph nodes confirmed diagnosis of lymphogranulomatosis. We performed specific treatment in the department of hematology and observed complete regress of neurological symptoms.

Key words: lymphogranulomatosis, nervous system, myelopathy, lower paraplegia.

ASSESSMENT OF FUNCTIONAL EFFICIENCY DIFFERENT WAYS

TO RECOVERY SYSTEM DIGESTIVE AFTER GASTRECTOMY

A.G. Baryshev 1,2, N.V. Hachaturyan 1, D.A. Valyakis 2,

A.O. Lysenko 1, Y.S. Kalyncheva 1, M.V. Bodnya 1

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

 2 Department of Oncology with course of thoracic surgery, Advanced Training Faculty, Kuban State Medical University, Krasnodar, Russia

The article analyzes the functional results of the digestive system after a sweat gastrectomy for gastric cancer. A comparison of the frequency of postoperative complications functionality, characteristics of carbohydrate and protein metabolism in patients after gastrectomy with extended (D2) and standard (D1) lymph node dissection using wellknown methods and developed by the authors loop ezofagenterostomii and reservoir jejunogastroplasty.

Key words: stomach cancer, gastrectomy, functional complications after gastrectomy, esophagojejunostomia.

POSTTRAUMATIC RUPTURE OF INTERVENTRICULAR SEPTUM

O.J. Solodilova 1, E.V. Viskubova 1, I.A. Shelestova 1,2, K.O. Barbukhatti 1,2

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

2Kuban State Medical University, Krasnodar, Russia.

Cardiac rupture is a extremely acute condition, and it often results in fatality. Main causes of heart rupture are myocardial infarctions, traumas and infections. Recently we have observed increases post-traumatic heart diseases. Timely diagnostics substantially influences management of the patient and potential for survival. And the echocardiography is a reliable, noninvasive and high-informative method in early diagnosis of this pathology. We present a case of the post-traumatic interventricular septum rupture diagnosed by echocardiography and the subsequent xenopericardial patch repair.

Key words: cardiac rupture; posttraumatic rupture of interventricular septum, echocardiography.


A CASE WITH LATE SECONDARY INFECTIOUS ENDOCARDITIS

IN APATIENT AFTER BENTALL PROCEDURE

N.V. Soroka 1, S.J. Boldirev 1,2, L.K. Laypanova 1, I.A. Shelestova 1,2

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

2Kuban State Medical University, Krasnodar, Russia

We described a clinic case with a patient surgically treated for late infectious endocarditis after Bentall procedure. Patients who are indicated for re-operation on aortic valve and ascending aorta, are usually a very acute cohort and demonstrate high risk at repeated interventions eading to a rather high mortality rate.

Key words: secondary bacterial endocarditis, Bentall procedure, reoperations on aortic valve and ascending aorta; aortic root abscess, conduit detachment from fibrotic ring, echocardi-ography, trans-esophageal echocardiography.

CLINICAL CASE WITH ESSENTIAL PALATAL MYOCLONUS

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

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

Palatal myoclonus is a rare locomotion disorder which is characterized by unintentional soft palate muscle contraction. And this condition causes rhythmical «clicking» noise in ears (opening and closing of the eustachean tube). In the present article we describe a clinical case with essential palatal myoclonus. We showed characteristics of clinical presentation, diagnostics and effective means of treatment.

Key words: essential palatal myoclonus, botulinotherapy, «clicking noise», soft palate.

APPLICATION OF TWO-STAGED PLASTY FOR

POSTOPERATIVE DEFECT AFTER BUSCHKE-LOW ENSTEIN TUMOR REMOVAL

A.G. Baryshev 1,4, V.V. Polovinkin 1,2, A.S. Dikarev 1, S.B. Bogdanov 1,2,

N.V. Khachaturyan 1, D.A. Valyakis 1,4, I.V. Pavlov 1, A.J. Mostovaya 3

1State Public Health Budget Institution ‘Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 of Krasnodar Region Public Health Ministry, Krasnodar, Russia;

2State Educational Institution of Higher Professional Education «Kuban State Medical University», Ministry of Public Health, Russia, Department of Surgery #1 ATF, Krasnodar, Russia;

3State Educational Institution of Higher Professional Education «Kuban State Medical University», Ministry of Public Health, Russia, Department of Surgery #2 ATF, Krasnodar, Russia;

4State Educational Institution of Higher Professional Education «Kuban State Medical University», Ministry of Public Health, Russia, Department of Oncology with a Course of Thoracic Surgery ATF, Krasnodar, Russia.

The pointed condylomas caused by human papilloma virus (HPV) are more common seen among infections of anogenital area and they are sexually transmitted. Bushke-Lowenstein tumor which is also called huge acuminate condylomas is a rather infrequent pathology. This neoplasm has locally invasive growth, but in most cases histologically it is a benign tumor, cases with malignancy are quite rare. Considering the low frequency of its occurrence, today there aren’t enough data on the long-term results of treatment. In this paper we present our observation when after excision of a neoplasm by a two-staged method we applied plasty with VY – shift of vascularized perforated dermal and fascial flaps on the medial surface of hips and spare autodermal transplantation of the split dermal transplant.

Key words: Buschke-Lowenstein tumor, plasty for perineal postoperative wound.

CASE REP ORT OF INFE RIOR VEN A CAVA AND RIGHT ATRIUM FIBROMA DIAGN OSIS WITH TRANS THORACIC

AND TRANSES OPHAGE AL ECHOCARDIOGRAPHY

O.A. Rossokha, L.K. Laypanova, N.V. Soroka, I.A. Shelestova, K.O. Barbukhatti

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

We present a clinical case describing diagnosis and surgical treatment of a patient with atypically located fibroma – in the inferior vena cava and right atrium. Modern means of ultrasound heart examinations were demonstrated as well. We consider echocardiography to be the method of choice for present time as this means is safe, reliable and available. Information which we obtained during ultrasonic heart examination is a reason for further more precise patient examination. In the present literature resources we were not able to find any other case with a heart fibroma with such atypical location and structure.

Key words: heart fibroma, transthorathic echocardiography, transesophageal echocardiography.

MODERN MEANS OF ENDOSCO PIC DIAGNOSIS

FOR DYSPLA STIC CHANGES OF GASTRIC LINING

M.I. Bykov, T.A. Guchetl, R.A. Stash

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

Modern endoscopic technologies at careful mucous surface examination make possible diagnosis of early gastric cancer, or even absolutely small flat superficial epithelial neoplasms. Various endo-scopic methods were worked out to improve primary and precise clarifying diagnosis for dysplastic gastric lining changes and early gastric cancer. The international recommendations developed by the group of experts allow to define uniform tactics for maintaining patients with dysplastic changes of mucous membrane and early cancer. Wide-ranging studies of diagnostic endoscopy possibilities are going on together with development and improvement of available endoscopic technologies. In the present article we present a review of the modern endoscopic techniques for gastric mucosa dysplastic changes and early gastric cancer.

Key words: gastric lining dysplastic changes, early gastric cancer, Paris and Viennese classifica-tion, endoscopic diagnosis.

CURRENT TREAT MENT METHODS FOR INVASIVE CANDIDIASIS

IN DONOR ORGAN RECIPIENTS

E.V. Bolotova 1,2, L.V. Shulzhenko 1,2, V.A Porhanov 1,2,

A.E. Antinyan 1,2, O.V. Bozhko 1,2, A.A. Smolin 2

1 Kuban State Medical University, Krasnodar, Russian Federation;

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

In donor organ recipients development of invasive fungous infections, the majority of which is caused by Candida spp and Aspergillus spp, significantly increases. Invasive candidiasis clinical signs are diverse and this fact complicates early diagnostics.

At the same time, despite the relative frequency of invasive mycoses at transplantation, there are no certain accurate references on diagnostics, treatment and prophylaxis of invasive fungous infections. In most cases clinicians should rely, generally on their own clinical experience. Modern approaches to diagnostics and treatment for invasive candidiasis in recipients with donor organs are shown in the submitted review.

Key words: invasive candidiasis, donor organ recipient.

AORTIC COARCTATION IN NEWBORNS. MODERN STATE OF THE PROBLEM

M.V. Boriskov, P.J. Petshakovsky, T.V. Serova

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

Coarctation is found in 8% of all congenital heart diseases. Clinical course of this defect varies from cardiogenic shock while closing an arterial duct in newborns to an asymptomatic hypertonia. Infants with this pathology are often in a critical condition requiring an urgent intervention. Sometimes atypical clinical course of this defect causes difficulties for a cardiologist to make an exact diagnosis. There is no doubt in indications for surgery in cases with this anomaly. From the beginning of an era of prostaglandin patients with ductal-dependent blood circulation began referring to specialized clinic in a stable state that affected significant decrease in a hospital mortality [17].

However in this problem there is a number of topical issues. They are surgical methods of correction, their longterm results, recurrence rates, methods of correction for the accompanying arch hypoplasia, correction though one or two accesses in a case with arch obstruction combined with other intracardiac anomalies. In what terms it is necessary to carry out re-interventions and a role of balloon dilatation at recoarctation. The review sets the task to generalize the accumulated knowledge and to present treatment results of the most succeeded researchers on this problem.

Key words: aortic coarctation, aortic arch obstruction, cardiogenic shock, ductal-dependent congenital heart disease.