The late results of the combined treatment of kidney cancer patients

Randomized study with inclusion of certain types of immunotherapy in the schedule of complex treatment was conducted in 89 patients with kidney carcinoma after the operation. In 63 patients the tumor was in stage T3N0M0. The patients were separated into 4 groups after the operation. Group 1 consisted of 23 patients in whom no additional therapeutic measures were applied in the postoperative period; 8-year survival was 48%. Group 2 was made up of 23 patients who received immunotherapy with the BCG vaccine in the postoperative period; 8-year survival was 60.5%. Group 3 consisted of 9 patients who were given levamisole for immunotherapy in the postoperative period; 8-year survival was 44%. Group 4 consisted of 8 patients who were treated by a combined method in the postoperative period: administration of the BCG vaccine, a placental suspension, and cyclophosphamide; 8-year survival was 75%. Multiple metastases occurred in 26 patients. Nineteen patients did not receive additional treatment in the postoperative period; 2 patients survived for 1 year, none of the patients lived longer than 2 years. Seven patients were given immunotherapy with the BCG vaccine in the postoperative period; 6 patients survived 1 year, 4 patients--2 years. Measures for increasing the activity of the immune and macrophagal systems should be included in the schedule of complex treatment for patients with carcinoma of the kidney.     

单用他达拉非及联用硫辛酸治疗2型糖尿病性ED的比较

目的探讨单用他达拉非5mg/日以及联用硫辛酸治疗糖尿病性ED的临床疗效。方法选择2017年1月至2018年12月就诊我科的糖尿病性ED患者181例,经第一阶段他达拉非5mg/日治疗12周后,仍诉勃起功能障碍及部分合并射精功能障碍的43例患者纳入最终研究统计并接受第二阶段治疗;第二阶段采用他达拉非5mg/日联合硫辛酸治疗12周。最终纳入研究统计患者在治疗前及第一、第二阶段治疗后均使用IIEF-5、Rigiscan及男性射精功能评分量表分别评估勃起满意度、勃起功能、射精功能等并记录。通过三次结果分析单用他达拉非5mg/日及联用硫辛酸治疗糖尿病性勃起功能障碍及合并射精功能障碍的疗效。结果他达拉非5mg/日联合硫辛酸治疗较单用他达拉非5mg/日及治疗前均显著提高患者IIEF-5分值,差异有统计学意义(P<0.05);单用他达拉非5mg/日及联合硫辛酸治疗较治疗前Rigiscan检测参数均有提高,差异有统计学意义(P<0.05),他达拉非5mg/日联合硫辛酸相比单用他达拉非5mg/日除阴茎头部胀大活力单位(Tumescence Activity Units TAU)差异无统计学意义(P>0.05),其余参数差异均有统计学意义(P<0.05)。糖尿病性ED伴Ej D患者单用他达拉非5mg/日治疗后男性射精功能评分较治疗前差异无统计学意义(P>0.05);联用硫辛酸治疗后部分射精功能评分项改善,较治疗前及单用他达拉非5mg/日治疗差异有统计学意义(P<0.05)。结论单用他达拉非5mg/日或联用硫辛酸均可改善糖尿病性ED患者的勃起功能,联用硫辛酸可改善部分射精功能。     

Topical 5% alpha lipoic acid cream in the treatment of cutaneous rhytids

Background: Topical 5% alpha lipoic acid cream has been reported to improve the appearance of facial lines associated with photoaging. Objective: The purpose of this study was to determine the efficacy of 5% alpha lipoic acid cream in the treatment of photodamaged skin. Methods: Alpha lipoic acid was placed in a lecithin-based cream at a concentration of 5% in combination with the penetration enhancer dimethylaminoethanol and applied to subjects' faces twice a day for 12 weeks. Results: Topical alpha lipoic acid cream, at a concentration of 5%, resulted in the reduction of facial lines, and almost complete resolution of fine lines in the periorbital region and upper lip was noted in most patients. Also noted was a 50% reduction in depth of medium vertical lines on the upper lip, a significant reduction in pore size, and overall improvement in skin color and texture in all patients. There were no instances of irritation or peeling. Conclusions: Topical 5% alpha lipoic acid cream is effective in the treatment of photo-damaged skin with no apparent adverse side effects.     

Correction of a connective tissue dysplasia in the treatment of postoperative abdominal hernias

There were analyzed the results of treatment of 112 patients, suffering postoperative abdominal hernia, in whom the anterior abdominal wall alloplasty was performed as well as postoperative pathogenetically substantiated complex therapy, taking into account the presence of a connective tissue dysplasia syndrome (CTDS) and the early and late postoperative complications prophylaxis. The peculiarities of postoperative period course and late follow-up results were studied up. Phenotypic features of CTDS were revealed in 53 (47.3%) patients, immunohistochemical features of a connective tissue dysplasia (a failed collagen type I and III ratio, manifested by increase of a collagen type III fibers quantity in 3 or more times) were revealed in 78 (69.6%) patients, in whom the processes of a collagen and its supermolecular formations synthesis were stimulated, using a magnesium orotate (Magnerot), which was prescribed in 1 g dose twice a day during 4 - 6 weeks. Application of composite nets, owing big pores, in a complex with a postoperative pathogenetically substantiated therapy conduction have positively influenced the disease course and the late follow-up results achieved.     

Amino acid-induced thermogenesis reduces hypothermia during anesthesia and shortens hospital stay

Amino acid infusion during general anesthesia induces thermogenesis and prevents postoperative hypothermia and shivering. We propose that amino acid prevention of hypothermia during anesthesia shortens the hospital stay. Core temperatures and pulmonary oxygen uptake were measured in 45 patients, receiving an IV amino acid mixture, 126 mL/h, before and/or during isoflurane anesthesia and 30 control patients receiving acetated Ringer's solution. At awakening, mean core temperature was 36.5 degrees+/-0.1 degrees C in the amino acid group and 35.7 degrees+/-0.1 degrees C (P < 0.001) in the controls. Energy expenditure increased by 54%+/-9% from baseline in amino acid patients in whom shivering was uncommon, but only by 5%+/-4% (P < 0.001) in control patients, of whom the majority developed postoperative shivering. The estimated difference in hospital stay between the two groups was 2.7 days (CI 95%: 1.3-4.0). Multiple regression analysis showed that the variables best predicting hospitalization were duration of surgery, amino acid treatment, and awakening temperatures. Duration of surgery was similar in the two groups and core temperatures at awakening were a result of amino acid infusion, which indicates that amino acid infusion during anesthesia and surgery was the most important factor for the shorter hospitalization. IMPLICATIONS: Amino acid infusion during general anesthesia induces thermogenesis and prevents postoperative hypothermia and shivering. Multiple regression analysis indicated that this resulted in a shorter hospital stay.     

Intra-operative epidural blockade with local anaesthetics and postoperative protein breakdown associated with hip surgery in elderly patients

The effect of epidural anaesthesia of limited duration on postoperative protein breakdown was studied in elderly patients undergoing hip arthroplasty. Two groups of six patients each were studied. One group with halothane (C) and one with an epidural block, T8-S4, (E) as part of their general anaesthetic for surgery. The urinary excretion of urea nitrogen and 3-methylhistidine (3-MeH), an indicator of muscle protein breakdown, increased significantly in both groups after surgery, by the same amount (P less than 0.05). The total concentration of plasma and muscle aminoacids decreased after surgery in both groups. Muscle glutamine was decreased by 50% after surgery on the fourth postoperative day in both groups (P less than 0.05). Therefore epidural anaesthesia, limited to the period of surgery, did not attenuate the loss of body proteins which occurred during the postoperative period.     

Application of the composit allotransplants in the treatment of postoperative abdominal wall hernia

There were analyzed the results of treatment of 75 patients, in whom postoperative abdominal wall hernia (POAWH) have occurred. The anterior abdominal wall alloplasty using polipropilene endoprostheses was performed in 50 patients and the large pore lightened composit nets--in 25. Peculiarities of postoperative period course and follow-up results were studied. First experience of application of the composit endoprostheses is positive according to reduction of the complications rate. Further studying of the application peculiarities of the lightened composit nets in patients suffering POAWH is imperative because of the patients quantity and follow-up shortage.     

Surgical tactics in cancer of the colon complicated by intestinal obstruction

Operations were carried out on 128 patients with cancer of the colon complicated by the intestinal obstruction. In right localization of the tumor, 25 patients were subjected to one-stage hemicolectomy, ileotransversoanastomosis was established in 6 patients. In left localization, the tumor was removed with the formation of colostomy in 54 patients, double-barrel colostomy or by-pass intestinal anastomosis were created in 36 patients. Among 63 patients with stage III carcinoma in whom obstruction was relieved and the tumor removed simultaneously, 6 died in the postoperative period. There were no fatal outcomes of two-stage radical operations conducted on 9 patients. A total of 33 (25.8%) patients died in the postoperative period. On the basis of the obtained results, the authors consider treatment of intestinal obstruction by removal of the tumor justified.     

Laparoscopy and re-laparoscopy in the diagnosis and treatment of postoperative complications

Experience of repeated laparoscopic surgeries in early and late postoperative period in 112 patients is analyzed. In early postoperative period repeated laparoscopy was performed in 75 patients for prevention, diagnosis and treatment of postoperative complications. In 54 patients repeated laparoscopy was carried out for programmed control for pathologic process. Laparoscopic surgery for diagnosis and treatment of postoperative complications was performed in 27 patients. In this group complications were seen in 2 patients. Technical features of repeated laparoscopy are demonstrated. Laparoscopic surgeries after laparotomic and laparoscopic operations are a good component of complex treatment and prophylaxis of severe complications in abdominal surgery. Prior performed abdominal operation is not contraindication for laparoscopy.     

Clinical application of the plasma substitutes in patients with postoperative complications after surgeries for brain meningioma

The issues on optimization of the restoration treatment of patients, suffering the brain meningioma, were discussed, basing on analysis of 498 observations. Tactics of the patients management in noncomplicated, complicated and severe course of postoperative period is adduced. The indices of survival and lethality, peculiarities of the infusion therapy were analyzed. The role of plasm-restituting preparations was demonstrated in complicated course of postoperative period. Rational complex approach to the restoration measures and intensive therapy conduction promotes the treatment efficacy raising, the patients fair quality of life securing in the brain meningioma in postoperative period.     

Surgical treatment of phlegmons of the maxillofacial region

A method was developed for active surgical treatment of phlegmons of the maxillofacial region with the application of intraarterial regional drug therapy. The suggested method was used in operations on 75 patients. The results were compared with those in 65 patients who were treated by the traditional method--opening of the phlegmon. In 95.7% of patients in whom the active method of surgical treatment was applied, the postoperative wound healed by first intention. The treatment produced the best clinical and aesthetic effect. The period of incapacity of the patients reduced almost by half.     

Experience of application of the mixed enteral preparation Peptamen after performance of radical operations for malignant gastroduodenal tumor

Results of application of nutritional mixture Peptamen (Nestle, Switzerland) in the early period after performance of radical operations for gastroduodenal tumor were summarized. Application of balanced nutritional mixtures in complex of treatment of the patients permits to restore the gut content passage and, accordingly, to transverse them toward complete enteral feeding more early. The conversion of catabolic processes into anabolic occurs faster. In the patients, to whom the balanced nutritional mixtures were administered, the leucocytes formula had normalized more quickly, witnessing faster restoration of the organism immune system. Using enteral nutritional mixtures the hemodynamic and allergic complications do not occur. Economic expediency of the mixtures for enteral nutrition application was noted, because their cost is lower than that of the complete parenteral feeding in 3-5 times.     

The use of plasma from donor convalescent patients in the combined treatment of peritonitis]

The article analyses the treatment of 12 patients with diffuse purulent peritonitis in whom the titers of specific antibodies against microflora causing peritonitis were corrected in the period of secondary immunodeficiency. The authors suggest a new method for the treatment of peritonitis which is based on inclusion of convalescents' plasma after peritonitis in the therapeutic complex. This plasma contains specific antibodies against the cultured microflora in high titers and is a polyvalent hyperimmune medium which makes it possible to cause an effect on the level of humoral immunity. This improved the results of treatment: the titres of specific antibodies against the cultured microflora grew, such complications of diffuse peritonitis as the formation of circumscribed abscesses in the abdominal cavity and suppuration of the postoperative wound were encountered less frequently, mortality reduced by 16.6% as compared to the control group. The efficacy of the suggested methods was also proved in experiments on 164 animals.     

The use of low-intensity laser irradiation in the immediate postoperative period in patients with gastroduodenal ulcer]

In patients with an ulcer of the stomach and duodenum at the immediate postoperative period in the complex of treatment, the low intensity laser irradiation of the anastomosis (after gastric resection) and ulcer (after the organ-preserving operations) according to the developed method by means of the modified LG-75 apparatus was used. The use of a helium-neon laser contributed to development of the severe form of anastomositis and subsequent gastrostasis. In study of gastric secretion, no considerable changes in acid formation were revealed.     

Recognition of adrenal insufficiency in the postoperative patient

The signs and symptoms of adrenal insufficiency in the postoperative patient are generally nonspecific, and the diagnosis is usually made at postmortem examination. Two patients in whom adrenal insufficiency developed in the postoperative period are reported on (one had metastatic carcinoma to the adrenal glands and in the other bilateral adrenal hemorrhage developed during anticoagulant treatment). Both patients survived multiple, successive stressful episodes before the diagnosis of adrenal insufficiency was established by the alpha^1–24 corticotropin stimulation test.     

Does a postimplantation syndrome following endovascular treatment of aortic aneurysms exist?

The postimplantation syndrome (PIS) is a weakly defined condition that has been observed following endovascular treatment of aortic aneurysms; the postulated criteria include significant leukocytosis, fever, and/or coagulation disturbances. Among the factors that are supposed to contribute to this syndrome are contact activation by the stent covering with consecutive endothelial activation. Associated clinical parameters of a PIS were perioperatively monitored in the postoperative phase in a total of 69 patients with infrarenal aortic aneurysms treated with Y-stent grafts. C-reactive protein (CRP)-levels, leukocyte concentrations, and body temperature curves were directly compared to those of 50 patients undergoing conventional transperitoneal aneurysm resection. A subgroup of 10 patients of the endovascular group was compared with 13 operated-on patients with regard to an ischemia-reperfusion syndrome of the lower extremities. The mediator determinations were performed on venous (femoral vein) as well as in systemic (arterial) blood samples. The incidence of temperature values above 38 degrees C was higher in patients following endovascular treatment (72%) compared to conventionally operated-on patients (28%). CRP levels were not significantly different within the first 8 post-operative days. During open surgery, significantly higher values for lactate and lower pH levels were observed (p<0.01), as well as higher 6 keto prostaglandin F1alpha (PGF1alpha) levels. There was a short peak of PGF1alpha during eventeration of the intestine during the operative procedure that could not be detected during endovascular manipulations. The clinical and biochemical parameters do not prove the presence of a PIS following endovascular treatment of aortic aneurysms. In contrast, during open surgery the unspecific inflammatory reaction is higher, but not long-lasting. In the future, the suggested phenomenon of a decreased antiinflammatory cytokine response during endovascular surgery needs to be further examined.     

Intensive preoperative hypoxic radiotherapy in combined treatment of patients with cancer of the colon

Efficacy of combined treatment (203 patients) and surgical treatment (200 patients) alone was analyzed. In combined treatment either radiation therapy (RT) in the dose 20 Gy over 5 days (group 1) or hypoxyradiotherapy (HRT) in the same doses but in combination with hypoxia (10% oxygen and 90% nitrogen--hypoxic gas mixture HGM-10--group 2) were used in preoperative period. In group 3 HGM-9 (9% oxygen and 91% nitrogen) was used as radioprotector in preoperative period but in increased by 25% radiation doses: total 25 Gy, 5 Gy for 5 days. In the control group only radical surgical treatment was performed. Preoperative irradiation didn't increase the rate of postoperative complications. At the same time the 5-year survival rate was higher in all the groups of patients on combined treatment than in the group of patients on surgical radical treatment. In the group with HGM-9 and increased by 25% radiation doses postoperative complications rate was lower, recurrences and distant metastases occurred less frequently.     

Urological problems following treatment of carcinoma of the cervix

One thousand one hundred and sixty-one cases of carcinoma of the cervix presenting over a 20-year period to 1982 were considered: 326 (28%) of these women developed urological problems, of whom 82 (7%) had major complications. Fistula formation occurred in 46 cases (4%), and was associated with active malignant disease in 33. Significant progressive ureteric obstruction occurred in 15 patients, 11 of whom had active malignancy. Overall, 35 (43%) of 82 patients with major urological problems had no evidence of active disease. Urinary diversion by ileal conduit proved to be a relatively simple and effective way of dealing with the serious problems, especially for patients with fistula formation and progressive ureteric obstruction, 67% and 73% of whom, respectively, underwent this procedure. More complex reconstructive surgery proved successful in a small number of selected patients, in whom there was no evidence of active tumour. Attempts to compromise with less definitive or over-ambitious procedures resulted in further complications and prolonged hospitalisation.     

Long-term follow-up of the modified Delorme procedure for rectal prolapse

HYPOTHESIS: The modified Delorme operation is a safe, effective, and durable treatment for complete rectal prolapse. DESIGN: Retrospective analysis of outcomes in adult patients undergoing the modified Delorme operation. SETTING: Community-based tertiary referral center with a 5-year general surgery residency program. PATIENTS: A total of 52 consecutive patients undergoing surgery for the treatment of complete rectal prolapse during the 26-year period ending December 2001. INTERVENTIONS: Modified Delorme operation.Main Outcomes Measured Method of anesthesia, morbidity, mortality, recurrence rates, length of follow-up, and incontinence. RESULTS: In the 52 patients, the mean length of prolapse was 8.2 cm. The mean operating time was 75 minutes. Forty-five patients were administered general anesthesia, 4 were administered spinal anesthesia, and 3 were administered local anesthesia. The mean postoperative stay was 4.9 days for 1975 through 2001 and 2.8 days for 1990 through 2001. No patients died as a result of the procedure. Patients were followed up for 61.4 months. Major medical comorbidities occurred in 40 patients. Preoperative incontinence was present in 12 patients, 10 of whom improved after the procedure, and postoperative incontinence in 8. The recurrent postoperative prolapse rate at 5 years was 6% (3/52) and the recurrent postoperative prolapse rate to the end of the study was 10% (5/52). Two patients (4%) had complications that required operative intervention in the postoperative period. CONCLUSIONS: The modified Delorme operation is a safe and effective surgical treatment for complete rectal prolapse. The risk of recurrent prolapse is low, and the procedure may be safely performed in patients with significant medical comorbidities.