Innovative Medicine of Kuban #4 (2017)

InnovativeMedicineofKuban#4 (2017)

CONTENTS

METABOLISM IN VARIOUS EMBODIMENTS, THE RECOVERY

OF THE DIGESTIVE SYSTEM IN PATIENTS AFTER GASTRECTOMY

A.G. Baryshev 1,3, V.A. Porhanov 1,2, A.Y. Popov 1,3, A.N. Lishenko 1,3,

N.V. Hachaturyan 1,2, D.A. Valyakis 2, M.V. Bodnya 2, Y.V. Efremenko 3

1 Scientific Research Institute S.V. 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

3 Department of Surgery #1, Advanced Training Faculty, Kuban State Medical University, Krasnodar, Russia

Despite the relative decline in the incidence of cancer in Russia, stomach cancer continues to occupy the sixth place in the structure of cancer mortality. The surgical method is the main one in treatment, most often a gastrectomy with enlarged lymphodissection (D2) is performed. There remains the question of which method of digestive system reconstruction after gastrectomy that will provide a good quality of life and social rehabilitation of patients. Loop esophagoenteroanastomosis with intestinal sostem is the most simple option to restore the digestive system in which the passage of food off the duodenum, which in some patients leads to disruption of metabolic processes and development postgastrectomy functional disorders. To reduce the frequency of these problems using the recovery after gastrectomy physiological passage of food through the duodenum. Objective to study the characteristics of protein and carbohydrate metabolism in patients after gastrectomy and petilium option esophagoenteroanastomosis and reservoir enogastronomici with redoutensale. Materials and methods using samples with a double load Stаube-Traugott, hyperglycemic coefficient Bowden, determining the level of total blood protein and albumin-globulin ratio, were studied peculiarities of metabolic processes after gastrectomy in 25 patients, digestive system that was restored loop method esophageal-intestinal anastomosis and in 23 patients – enogastronomici. Results it was established an advantage in the recovery of protein and carbohydrate metabolism in the group of patients with a reservoir enogastronomico after 3 months after surgery. Tank possible small bowel transplant, replacement remote stomach and the reconstruction of the duodenal passage is allowed to eat more food in single dose (530±80 ml) than after loop reconstruction method (380±50 ml). Conclusion the best characteristics of protein and carbohydrate metabolism, as well as a good reservoir function of the proposed method gastric replacement with small intestine can achieve the optimum recovery of metabolic processes and to improve the quality of life of patients after gastrectomy.

Key words: gastric cancer, gastrectomy, gastric replacement with small intestine, protein and carbohydrate metabolism.

RELATION OF VOLEMIC SUPPORT TO ACUTE POSTOPERATIVE

RESPIRATORY INSUFFICIENCY DEVELOPMENT FOLLOWING

THORACIC ONCOLOGICAL SURGERY

V.A. Zhikharev 1, Y.P. Malushev 2, L.G. Shanina 1, O.I. Peschanskaya 3,

D.V. Rogovik 1, S.D. Sitnik 1

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

2 Kuban State Medical University, Krasnodar, Russia

3 Maternity hospital #1, Krasnodar, Russia

Acute postoperative respiratory insufficiency is a serious complication after thoracic surgery. Our aim is to define the relation of rate and volume of infusion during the operation with development of acute postoperative respiratory insufficiency in patients operated on for lung cancer. We performed a retrospective assessment of 416 patients with various rate of intraoperative infusion that were divided into 2 groups: with acute postoperative respiratory insufficiency (ARI, n – 53) and without it (n – 319).

As a continuous covariate in each group we analysed intraoperative infusion rate in the range 2, 3, 4, 5, 6, 7 and 8 ml/kg*h. Intraoperative infusion rate more than 5 ml/kg*h, positive fluid balance, low measurements SvO2 and lower PaO2/FiO2 ratio intraoperatively , are shown as valuable predictors for postoperative ARI development. Intraoperatively we found a strong correlation (r 0,915697) between infusion rate and frequency of postoperative ARI, and defined optimal infusion rate (to 5 ml/kg*h) which allowed to decrease possible development of ARI, length of hospital stay to 53,4 % and mortality from 11,3 % to 0%.

Key words: acute postoperative respiratory insufficiency, fluid maintenance, venous oximetry, PaO2/FiO2 ratio.

OUTCOME ANALYSIS FOR PATIENTS WITH SEVERE COMPOUND

FRACTURES OF LOWER EXTREMITY LONGITUDINAL BONES

IN THE REGIONAL GENERAL HOSPITAL

A.N. Blazhenko 2, S.N. Kurinniy 1, A.A. Blazhenko 1,2, A.V. Shevchenko 1

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

2 Kuban State Medical University, Krasnodar, Russiа

Background We have performed outcome analysis in patients treated for severe compound fractures of lower extremity longitudinal bones regarding a chosen treatment technique for initial surgical debridement and transfer terms in the regional general hospital.

Materials and methods We reviewed 151 patient reports treated in Scientific Research Institution – Ochapovsky Regional Clinic Hospital #1, Krasnodar, for 2012 – 2016. We defined four methods for initial surgical debridement at the first stage of surgery. Outcomes were analysed in patients regarding their initial surgical debridement and transfer terms into the regional general hospital from the primary admission sites.

Conclusions it is required to work out regional system for staged treatment in patients with severe compound fractures. At first stage initial surgical treatment is performed by techniques №2, 3 and then patients are transferred to the regional general hospital during the first day after being injured. In unstable patients initial surgical debridement should be divided in two stages.

Key words: compound fractures of lower extremities longitudinal bones, initial surgical debridement, staged treatment.

DIFINITION FOR LITHOGENICITY INDEX IN PATIENTS

WITH RECURRENT AND RESIDUAL CHOLEDOCHOLITHIASIS

BY INTEGRATED ASSESSMENT OF DYSCHOLIA INTENSITY

M.I. Bykov 1,2, V.A. Porhanov 1,2, I.M. Bykov 2

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

2 Kuban State Medical University, Krasnodar, Russia

In this article we presented study results characterizing the lithogenicity changes in cases with biliary tract obstruction based on assessment of lipidic exchange indicators and condition of pro-oxidant – antioxidant activity at the local level. It is determined that in group with primary choledocholithiasis we observed decrease of anti-oxidizing activity by 47,1%, in the absence of reliable changes of intensity for free radical oxidation, rise of general lipids level to 9,9% at simultaneous lack of authentic changes of cholesterol content which are followed by ascending integrated lithogenicity index indicator in average for 59,7%. Besides, it has been shown that in patients with a recurrence of mechanical jaundice (in terms from 2 to 7 months) integrated indicator of lithogenicity index was very high at primary assessment (16,27 U). The possibility to research metabolic disturbances expression for various diseases of a biliopancreato -duodenal area at the local level on the basis of an integrated lithogenicity index indicator allowed to optimize an algorithm for the choice of the biliary tract decompression referred on early endoprosthetic incrustation and also to provide adequate techniques for patients management postoperatively and prove the necessity of performing the certain treatment referred to prophylaxis of the remote complications of endobiliar stenting.

Key words: lithogenicity index, cholangiolithiasis, chemiluminescence, lipids, cholesterol.

SUCCESSFUL ASPIRATION OF THROMBOTIC MASSES OUT OF THE LEFT INTERNAL CAROTID ARTERY LU MEN USING A PROXIMAL EMBOLIC PROTECTION DEVICE IN THE CONDITIONS OF THROMBOLYTIC THERAPY PERFORMANCE

A.S. Nekrasov, A.I. Beliy, O.S. Volkolup, P.A. Tupikin

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

Combined techniques of treatment for ischemic stroke are even more often included into routine work of specialized teams. One of them based on a combination of systemic thrombolytic therapy and endovascular methods is characterized by a high rate of favorable outcomes. However, it is worth remembering that to achieve success it is necessary to keep within strictly limited therapeutic window, otherwise intravenous administration of a thrombolytic agent will be contraindicated that can significantly affect a positive outcome. Clinical observation for a combination with systemic thrombolytic therapy and endovascular mechanical thromboaspiration with use of the proximal embolic protection device at a total thrombosis of the left internal carotid artery lumen is presented in this article.

Key words: acute ischemic stroke, thromboaspiration, thrombolytic therapy, combined modality therapy, thrombolysis.

ENDOPROSTHESIS TRACHEAL REPLACEMENT IN ENDOSCOPIC

TREATMENT FOR CICATRICAL STENOSIS

I.N. Muntyan, V.A. Porhanov, I.E. Bondareva, A.I. Rassovsky

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


At present surgery is the main technique for cicatrical tracheal stenoses treatment. Sleeve tracheal resection is one of the radical operations which allows to repair tracheal patency. But, in some cases, performance of traumatic surgery could be limited by a severe patient condition or serious somatic disorders. In these patients, maintenance of a stable lumen in the invaded trachea is achieved by endoprosthesis replacement that is a method of choice among all endoscopic techniques. We present clinical experience of endoscopic stenting in 60 patients.

Background: analyze outcomes following stenting in patients treated for cicatrical tracheal stenosis.

Key words: tracheal stenosis, stent, endoprosthesis replacement.

DIFFERENTIAL DIAGNOSIS FOR NORMOTENSIVE

HYDROCEPHALUS SYNDROME

S.A. Zhade, E.R. Kharshudyan, E.I. Zyablova, V.V. Tkachev, G.G. Muzlaev

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

Normotensive hydrocephalus is a complex with symptoms including the following triad: walking disturbance, dementia and incontinence of urine. Existence of the specified disorders brings patients to physicians of various specialties. Knowing special features of Normotensive hydrocephalus manifestation, well-timed and correctly carried out diagnosis allows to avoid disease advancement and gives chance to this group of patients to improve life quality carrying out a neurosurgical intervention. We present two clinical observations on the basis of which the differential diagnosis for normotensive hydrocephalus is carried out. The literary review of examination technique, diagnostic criteria and approaches to surgical treatment for these patients is offered in discussions.

Key words: normotensive hydrocephalus, ventriculo- peritoneal bypass.

CLASSIFICATION FOR THYROID GLAND TUMORS (WHO, 2017):

ATTENTION TO PROGNOSTIC FACTORS

O.N. Ponkina

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

In this article we presented four main changes in the Classification for Thyroid Gland Tumors, the fourth revision (WHO, 2017) regarding the revision presented in 2004. The most essential of them are:

1) defining the «other encapsulated tumors of thyroid gland with a follicular pattern» group which are referred to the category containing boundary tumors and includes the following concepts: a follicular tumor of the uncertain malignant potential (FT-UMP), the high-differentiated tumor of the uncertain malignant potential (WDT-UMP) and a noninvasive follicular tumor with papillary and nuclear properties (NIFTP) and

2) the oncocytic tumors which were earlier considered in group of follicular adenomas / carcinomas are defined as a separate type of tumors with an independent biological entity.

Key words: WHO classification, tumors, thyroid gland.

GLUCOCORTICOIDS AND ARTERIAL HYPERTENSION

IN INTERNAL ORGANS RECIPIENTS

E.D. Kosmacheva 1,2, S.M. Martirosyan 1,2, N.A. Zubareva 1,2, A.E. Babich 1,2

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

2 Kuban State Medical University, Krasnodar, Russia

In this paper we present a review of literary data about the modern views on glucocorticoid arterial hypertension arrangement in donor organs recipients. Arterial hypertension is one of the main risk, pacing for cardiovascular complications development. In cases with glucocorticoids uptake arterial blood pressure develops approximately in 15–20%. We generalized the main schemes participating in genesis of the arterial hypertension induced by glucocorticoids: a time delay of sodium and increase in circulating liquid volume, GC -dependent vasoconstriction, increased synthesis of catecholamines and beta 1 – adrenergic receptor expression, change of noradrenaline sensitivity as a result of the increased endothelin synthesis. In a practical manipulation it is necessary to use non-steroid protocols or minimize doses in internal organs recipients, weighing risks of transplant rejection and possible undesirable side responses in cases with glucocorticoids administration.

Key words: transplantation, arterial hypertension, glucocorticosteroids.

CAROTID SURGERY PATTERNS FOR CRITICAL STENOSIS

IN INTERNAL CAROTID ARTERY AND ITS OSTIA CALCINOSIS

R.A. Vinogradov 1,2, D.A. Popov 2

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

2 Kuban State Medical University, Krasnodar, Russia

For many years cerebral circulation acute disorder occupies one of the leading reasons of mortality and disability among the population around the world. Despite extensive experience of surgical interventions for stroke prevention, there is a probability for serious complications emergence, including fatal ones. One of the numerous factors for their emergence is the missed morphology of atherosclerotic plaques in different patients preoperatively. The aim of this review was to confirm importance of the careful choice of surgical treatment and also to identify risk groups among intraoperative complications in patients with the stenosing process of carotids with calcification.

Key words: atherosclerosis, calcinosis, carotids, critical stenosis of internal carotid artery, carotid endarterectomy, carotid angioplasty, carotid angiostenting, risk stratification.