Innovative Medicine of Kuban_#2_2016

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InnovativeMedicineofKuban #2 (2016)

CONTENTS

DIFFERENTIATED TREATMENT IN PATIENTS WITH TRAUMATIC VERTEBRAL CANAL STENOSIS AT LOWER THORACIC AND LUMBAR LEVELS

A.A. Afaunov, A.V. Kuzmenko, I.V. Basankin

Scientific Research Institute - Ochapovsky Regional Clinic Hospital #1, 167, 1st May street, Krasnodar 350086

Background we tried to justify differential approach to perform dural sac decompression in cases with damaged lower thoracic and lumbar spine accompanied by traumatic vertebral canal stenosis.

Materials and Methods We analyzed 264 adult patients with lower thoracic and lumbar spine injuries which were accompanied by traumatic vertebral canal stenosis. We included 170 patients in the main group and 94 patients in the control group. Immediate morphologival reasons of traumatic vertebral canal stenosis were examined. We defined 6 types of stenosis. In all cases we performed decompressive stabilizing operations with transpedicular fixation. In patients of the main group we preferred indirect repositioning decompression. Only in 47% patients we performed laminectomy. In the control group in cases with transpedicular fixation we performed decompressive laminectomy in 100%. At this we did not pay attention to possibilities of closed vertebral canal reformatting due to ligamentotaxis.

Conclusions 1. Traumatic stenoses of the vertebral canal at the levels of lower thoracic and lumbar spine with equivalent quantitative spondylometric findings and clinical evidence may show quite different morphological reasons.

2. In cases with transpedicular fixation potential possibility for dural sac repositioning decompression without laminectomy is defined by morphological causes of traumatic stenosis and timeline since the trauma onset.

3. Repositioning decompression of the dural sac is most effective at single bone fragment of the traumatized vertebra posterior part or two gross bone fragments without any reversion, in terms up to 10 days from the trauma onset or at

subluxation and luxation both in early and late terms.

4. In 90 of 170 patients (52.9%) from the main group applying differentiated approach to dural sac decompression performance we could avoid laminectomy while performing decompressive stabilizing operations. And anterior decompression in cases with subtotal corporectomy was undertaken only in 48 patients (28,2%) which is 1,73 time more infrequent than in patients in the control group.

Key words: vertebral spine, trauma, stenosis, decompression, ligamentotaxis.

ENDOVASCULAR CORRECTION OF COMPLICATED STENOTIC LESIONS IN BRACHYCEPHALIC ARTERIES

A.I. Beliy, O.S. Volkolup, R.S. Tupikin

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

Most often patients with multifocal sclerosis of brachycephalic arteries are refused to be surgically treated as these cases are complicated due to tandem lesions. The only way out for these patients is endovascular surgery. We have analyzed international experience and applied different methods of endovascular intervention in patients with difficult stenotic lesions of brachycephalic arteries, and became convinced that endovascular correction similar affections is

the main means to treat patients with multifocal atherosclerosis. It also could be used as primary treatment as possesses high efficiency, a low complication rate and shows favorable long-term results.

Key words: ischemic stroke, atherosclerosis, brachycephalic arteries, balloon angioplasty, vertebrobasilar insufficiency, tandem lesions.

MODERN TREATMENT FOR EXTREMITIES BORDER - LINE BURNS

S.V. Bogdanov, O.N. Afaunova

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

State Budget Educational Institution Kuban State Medical University, Department of Surgery № 1, Advanced Training Faculty and Post-Degree Professional Development, Krasnodar, Russia

About 80 % patients with thermal injury, referred to the in-patient hospital department, demonstrates border-line and surface burns. Regarding the number of the suffered patients the most important point refers to the treatment term reduction due to its improved efficiency and we consider it to be more essential as it has positive impact on treatment quality.

Aim We try to define efficiency of early surgical treatment in patients with extremity burns in our proposed way of complex treatment for skin boundary burns in comparison with traditional «waiting» technique of maintaining boundary

burns in patients who have been operated in later terms. The essence of this way is that during the first 2-7 days after receiving a boundary burn in the functional zones and zones inclined to scarring formation, we carry out necrectomy to

the lower layers of derma and autoplasty, and on other boundary sites with burns we remove fibrous and necrotic pellicle within surface dermal layers to the level of a bleeding layer and on the processed burn area we place a wound covering.

Materials and Methods We analyzed treatment results in 141 patients, age range 4 months to 65 years, which were treated in the Burn Department, SPHBI ‘SRI-ORCH’ № 1. The main group included 63 patients (43 infants and 20 adults) treated operatively in early terms. The comparative group included 78 patients (44 infants and 33 adults), all of those were treated with wet-to-dry dressing application and prolonged autodermoplasty as long as we observed formation of granulating wounds.

Conclusions This way for border – line skin burns complex treatment which we have developed comparing to traditional treatment, improves treatment quality in patients, reduces treatment terms and increases its efficiency. During the postoperative period it allows to prevent scar development and to achieve positive esthetic results.

Key words: border burns, surgical treatment, wound covering.

IMMEDIATE RESULTS OF TREATMENT THE PATIENTS WITH GETTING DEFECTS ESOPHAGEAL WALL AFTER ENDOSCOPIC VACUUM DRAINAGE

P. A. Kulish, A.Y. Popov, V.A. Porhanov, A.G. Baryshev, V.G. Slavinsky, A.L. Kovalenko, M.I. Bykov, I.Y. Sholin, V.V. Chaykin

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

We performed the first analysis of our clinical experience with endoscopic vacuum drainage in 10 patients with esophageal wall defects complicated by mediastinitis or peritonitis. We define this method efficiency to arrest local inflammatory process, it occurred possible to preserve impaired esophagus regardless the time of injury and this fact guarantees patient’s life quality management. Furthermore, while performing reconstructive interventions in cases with improved inflammations we could reduce of local and common complication development.

Key words: esophageal defect; endoscopic vacuum drainage; mediastinitis; pleural empyema.

MANAGEMENT OF CONGENITAL HEART DISEASES

WITH CONDUIT APPLICATION IN PULMONARY POSITION

IN NEWBORNS AND INFANTS

M.V. Boriskov, G.A. Efimochkin*, N.B. Karakhalis, T.V. Serova

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

History of conduits application in cardiovascular surgery extends back for more than 100 years. With their use it became possible to help newborns and infants with difficult congenital heart diseases. Various types of conduits are used and

well-known and have advantages and shortcomings, but it is difficult to choose an “ideal” conduit. The main problem of all types is repeated operations, which sometimes are repeated throughout the patient’s life.

Aim show immediate and medium term results with conduit application in pulmonary position in infants.

Methods From January 2006 to June, 2016 in our Clinic we have operated on 48 patients and performed reconstructions of the right ventricular outflow tract applying many different conduits. Age range was from 14 days to 1 year (4,82 ± 4,09 months), mean weight was 4,7 ± 2,3 kg (2,9–10,2 kg).

Results In immediate postoperative period 7 patients died (overall mortality rate was 14,59%). In all discharged patients according to ECG data mean blood flow rate on the conduit was 2,42 ± 0,72 m/s (from 1,3 to 3,9 m/s), and a mean gradient was 22,22 ± 17,17 mm Hg (from 4 to 60 mm Hg). We performed 18 repeated operations. Early reoperation was necessary in 3 cases(8,82%) (during the 1 year after the primary surgery), in cases the reason was conduit stenosis, in 1 patient there was a right ventricle aneurysm. We avoid repeated surgery in cases with conduit Contegra application with mean follow-up period 16,3 ± 11 months (1–62 months).

Conclusion 1. Conduit selection for implantation in the pulmonary position has a tendency to be a serious challenge in infants and newborns treated for complicated congenital heart disorders.

2. Repeated surgeries were not necessary when we applied conduits Contegra with mean follow-up 16,3+11 months (1–62 months), but to make some authentic conclusions a more prolonged follow-up period is required.

Key words: conduit, complicated congenital heart diseases, implantation in имплантацияв pulmonary place.

ONCE AGAIN ON SPASTICITY IN NEUROLOGY

(LITERATURE REVIEW)

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

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

Kuban State Medical University, Krasnodar, Russia


Now it is difficult to give exhaustive definition for spasticity taking into account its formation mechanisms as the neurobiology of the locomotion system is not studied regarding several aspects. The long term solution of this task will allow to define separate kinds of muscular hypertension, known for experts under the general name as a spasticity syndrome. At the same time for neurologists phenomenologically it is a rather clear question. Spastic paresis is the main reason of disability in neurologic patients as it develops in a great majority of diseases and damages of CNS. At the same time it limits physical activity in a patient by itself, but the expressed spasticity considerably aggravates motive violations, even more reducing functionality in a patient. While discussing approaches for spasticity treatment it is necessary to consider that this phenomenon is a very dynamic one. In this regard therapy of similar patients should be not only individual and carefully planned, but also constantly being

monitored. Patients with spastic paresis require long-term treatment therefore it is necessary to reconsider the purposes and problems of therapy regularly, to define new boundaries and to specify old ones. It is especially important in a case with

prolonged usage of muscle relaxants. The main treatment of a spastic muscular hypertension is a medical treatment. At the same time muscle relaxants are used both as monotherapy, and as a part of the general rehabilitation strategy.

These drugs provide useful basic effect which allows to stack the paralyzed extremity in the most comfortable position

or use the orthosis adequately.Thus, muscle relaxants impact a great number of neurophysiological and neurochemical mechanisms taking part in

spasticity formation which provides their more significant efficiency.

Key words: spasticity; muscle relaxants; paresis.

DATA ASSESSMENT OF CARDIO-VASCULAR SYSTEM REMODELING IN PATIENTS PRIOR AND AFTER KIDNEY TRANSPLANTATION

S.M. Martirosyan, E.D. Kosmacheva

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

Object of assessment is patients following kidney transplantation.

Aim we defined the grade of myocardial remodeling in patients after transplantation during the 1-year period.

Materials and Methods We analyzed 125 patients prior to transplantation, in 6 months and in 1 year postoperatively.

The comparative assessment of cardiovascular system remodeling indicators was carried out.

ConclusionsIn the analyzed population, frequency and myocardial hypertrophy of the left ventricle evidence showed tendency to decrease after kidney transplantation that was defined by targeted levels of arterial pressure achievement and improved indicators of the glomerular filtration.

Key words: transplantation, renal allotransplant, cardio-vascular risk, dyslipidemia, coronary disease, arterial hypertension, kidney host.

HEART RATE VARIABILITY WHILE ASSESSING TRANSPLANTED HEART REINNERVATION

M.Kh. Lepshokova, E.D. Kosmacheva

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

Key difference of the transplanted heart is its full surgical denervation which causes features of transplanted heart physiology. Eventually a great number of studies appeared and they showed signs of innervation partial restoration

and its influence on the subsequent social, physical and psychological rehabilitation of the recipients. In the conducted study we confirmed the fact of the transplanted heart re-innervation on the basis of heart rate variability data, and

the defined factors influencing indicators of heart rate variability Key difference of the transplanted heart is its full surgical denervation which causes features of transplanted heart physiology. Eventually a great number of studies

appeared and they showed signs of innervation partial restoration and its influence on the subsequent social, physical and psychological rehabilitation of the recipients. In the conducted study we confirmed the fact of the transplanted

heart re-innervation on the basis of heart rate variability data, and the defined factors influencing indicators of heart rate variability.

Key words: heart transplantation, denervation, reinnervation, heart rate variability.

BIOCHEMISTRY NAVIGATION APPLICATION WITH 5-ALA FOR SURGICAL TREATMENT OF CEREBRAL TUMORS WITH VARIOUS HISTOLOGICAL TYPES

G.I. Kovalev, V.E. Kocheryan, G.G. Muzlaev

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

State Budget Educational Institution Kuban State Medical University of Public Health Ministry of Russia, Krasnodar, Russia

Application of 5-aminolevulinic acid (5-ALA) in surgery for gliomas with high grade of malignancy according to clinic guidelines for intraoperative fluorescence diagnostics usage has become a standard modality. However possibilities

of intraoperative fluorescent diagnostics with 5-ALA in surgery for other cerebral tumors are not studied well enough.

Aim We analyzed usage results of biochemical navigation with 5-ALA in cases with cerebral tumors of various histological types.

Materials and Methods In the study we included 89 patients with various cerebral tumors: gliomas Grade I−IV WHO, metastatic spread and a single case with anaplastic meningioma of different localization. In our study we

applied the agent 5-ALA Alasens FGUP «SSC NIOPIK». All patients underwent tumor removal with microsurgical technique, intraoperative optics and metabolic navigation with 5 - ALA. Intraoperatively we applied following tools: a

microscope OPMI Carl Zeiss Pentero with fluorescent module. We performed expert quality evaluation of fluorescent grade according to 4-rating scale adopted in N.N. Burdenko Scientific Research Institution.

Results We received rather high frequency of fluorescence in all studies. High efficiency of this technique in surgery of gliomas with high malignancy degree was confirmed. High sensitivity during removal of gliomas with low malignancy

degree and metastasises was reached excluding the factors which are not connected with biochemical processes in a tumor. The single case of 5-ALA application with anaplastic meningioma confirms efficiency of this method to

identify tumorous invasion in visually not changed dura mater.

Conclusions Metabolic navigation at the majority of histologic types of tumors is the highly effective means of intraoperative timorous demarcation which does not depend on changes of intracranial volume relationships, allowing to gain rather quickly an impression on the metabolic status of a tumor and to reach the maximum radicalism.

Key words: fluorescence diagnostics; 5-ALA.