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.     

Disorders of erythrocyte deformability in patients with acute suppurative-septic diseases of the lung and pleura]

In 163 patients with acute suppurations of lungs and pleura a substantial reduction of deformability of erythrocytes was established. The maximum increased rigidity of blood red cells was noted at the peak of the pyo-destructive process and postoperative period as well as in the complicated course of the postoperative period. The curative plasmapheresis, general hyperbaric oxygenation exert positive influence upon plastic properties of erythrocytes.     

Status of natural immunity and the ways of its enhancement in patients with goiter

Disease caused by goiter is marked by changes in cellular and humoral unspecific resistance before and after operation, which at times is of decisive importance in the course of the postoperative period. Natural resistance is inhibited, to a greater measure, in patients with a long history of the disease and in those with diffuse toxic goiter. The work deals with the study of natural resistance in 98 patients with goiter before and after the operation in dynamics. The immunostimulator lysozyme was used for a more favourable course of the postoperative period. This promoted increase of the organism's natural resistance. which had a favourable effect on the course of the postoperative period.     

Clinico-morphological characteristics of the methods of connection of the postoperative wound edges

The decision for the method of connection of the skin wound edges should be based on specific reconstruction of the injured tissues depending on the suture material and kind of the skin suture. An alternative of the classical suturing of the postoperative wound is a sutureless fixation of the skin edges--a method of using adhesive plaster. The work includes a clinico-morphological comparison of the course of the process of regeneration when using the intracutaneous suture and the adhesive plaster. The macroscopic and pathologic-histological estimation of the healing of the postoperative wound of the skin has shown that a smoother course of the postoperative period is noted in the groups where the adhesive plaster was used.     

Use of the indices of the kallikrein-kinin system of the blood in evaluating the efficacy of the prevention and treatment of postoperative purulent complications in oncologic patients

The kallikrein-kinin system of the blood was studied in 59 patients with tumours of the abdominal cavity and small pelvis. In 33 patients, the postoperative course was complicated by wound suppuration, formation of intraabdominal and pelvic abscesses. It was established, that the development of purulent complications was accompanied by regular activation of the system of proteolysis and increase in the blood level of the middle molecular mass substances. The changes in the indices of kallikrein-kinin system can serve as an additional criterium of the effectiveness of treatment and prophylaxis of postoperative complications.     

Impact of anesthesia methods on the course of perioperative period in endoprosthesis of the hip joint

The impact of methods of anesthesia on the course of perioperative period was studied up in 132 patients, to whom the total endoprosthetics of the hip joint was performed. The occupation in the operation room term and analysis of the postoperative pain syndrome occurrence with its cupping served as comparative categories for general and regional methods of anesthesia. Central neuronal blockade, epidural and spinal anesthesia have predominant significance for enhancing of the intraoperative and postoperative analgetic defense.     

Esophageal leiomyoma enucleated under the thoracoscopy; report of a case

We report a case of a 40-year-old male with a posterior mediastinal mass that was 8 cm in size and located behind the trachea. The thoracoscopic surgery was performed. The tumor was located from the level of left brachiocephalic vein to the carina. The mediastinal pleura over the tumor was longitudinally opened by cautery-scissors. The azygos vein lying over the tumor was divided by means of an endoscopic stapler. The muscular layer of the esophagus was also longitudinally opened. The tumor was enucleated. Then, the dissected proper muscle layer of the esophagus was suture-closed. The postoperative course was uneventful. On the first postoperative day Gastrografin was swallowed, showing the absence of leaks. The patient was discharged on the fourth postoperative day. The advantages of the thoracoscopic surgery are as follows: rapid, full recovery of the patient; decreased postoperative pain; short postoperative hospital stay. Esophageal leiomyoma in selected patient was suitable for thoracoscopic enucleation.     

Variation in the course of vessels in the vicinity of the hepatic port in biliary atresia

Among 114 patients with biliary atresia, the type of obstruction of the extrahepatic bile duct and the course of the hepatic artery, cystic artery, and portal vein were determined and analyzed from the view point of their mutual relationships and in comparison with postoperative bile excretion. As a result, the following findings characteristic of biliary atresia were obtained: (1) The course and location of the extrahepatic bile duct did not deviate greatly from normal conditions, excluding some exceptional cases, but the site of the origin of the cystic artery differed from that in normal cases. (2) The pattern of the course of the vessels varied among different types of obstruction of the extrahepatic bile duct. (3) There was a difference in postoperative bile excretion in relation to the type of obstruction of the extrahepatic bile duct, the course of the vessels, and their combinations.     

The use of the Papineau bone-grafting technique in salvage of the infected total joint implant

The development of osteomyelitis after first metatarsophalangeal total implant-arthroplasty can be a complication encountered by any foot surgeon. The postoperative course is often long with a guarded to poor prognosis. The authors present a salvage procedure for this surgical complication utilizing aggressive surgical debridement followed by an autogenous bone graft. The technique, as described by Papineau, was developed to shorten hospitalization time and reduce deformity. A case presentation is given to illustrate the successful use of this procedure in the treatment of postoperative osteomyelitis of the foot without systemic antibiotics.     

The significance of serum mitochondrial aspartate aminotransferase activity in the surgical field

A study was carried out on the clinical significance of changes in the serum level of mitochondrial aspartate aminotransferase before and after surgery on patients suffering from varous hepato-biliary diseases. The patients included those whose livers were impaired with cirrhosis, jaundice, or direct surgical intervention such as hepatectomy. It was found that the postoperative liver function of patients whose preoperative values of serum mitochondrial aspartate aminotransferase had been less than 10 Karmen units recovered with a favorable course, whereas that of patients whose values had exceeded 20 units deteriorated with persistent jaundice, ascites or hepatic insufficiency. Both the sensitivity and specificity of respective liver function tests were examined by the preoperative values of routine liver function tests and the postoperative liver functions. The results revealed the serum value of mitochondrial aspartate aminotransferase to be more sensitive than the other tests, while specificity was not significantly different. A safety limit for a favorable postoperative course in terms of liver function was observed in patients showing a preoperative serum mitochondrial aspartate aminotransferase activity of below 10 units. Thus, serum mitochondrial aspartate aminotransferase activity could be applied as a useful marker for hepato-biliary surgery.     

Soluble P-selectin and the postoperative course following cardiopulmonary bypass in children

BACKGROUND: Cytokine-inducible leucocyte-endothelial adhesion molecules were shown to affect the postoperative inflammatory response following cardiopulmonary bypass (CPB). Soluble P-selectin (sP-selectin) is one of these molecules. We investigated the correlation between plasma sP-selectin levels and the intra- and postoperative course in children undergoing CPB. METHODS: Serial blood samples of 13 patients were collected preoperatively upon initiation of CPB and seven times postoperatively. Plasma was recovered immediately and frozen at - 70 degrees C until use. Circulating soluble selectin molecules were measured with a sandwich enzyme-linked immunoabsorbent assay technique. RESULTS: The significant post-CPB changes in sP-selectins plasma levels were associated with patient characteristics, operative variables and postoperative course. sP-selectin levels correlated significantly with surgery time, aortic cross-clamping time and inotropic support, as well as with the postoperative Pediatric Risk of Mortality score, hypotension and tachycardia. CONCLUSIONS: A relation between CPB-induced mediators and both early and late clinical effects is suggested. The up-regulation and expression of sP-selectin indicate neutrophil activation as a possible mechanism for the increase, and inhibiting it may reduce the inflammatory response associated with CPB.     

Predictive value of the APACHE and TISS indices on the postoperative morbidity in vascular surgery

The predictive value of age, weight, APACHE score (preoperative and 48 hours after surgery), and TISS index (24 and 48 hours after surgery) on morbidity has been studied on a group of 101 patients undergoing diverse vascular surgical procedures, with a complication rate of 47%. The 48 hour after surgery TISS alone, could correctly predict the postoperative course in 78% of the cases. This index, combined with the preoperative APACHE score, adequately predicted the course in 79% of the patients. When the 48 hour postoperative APACHE score was added to these two, the prediction was correct in 80%. A discriminant function including both APACHE scores, the 24 hour postoperative TISS, and age allows a proper classification in 81% of the cases. When the same criteria were used in another group of 56 patients--with 38% of postoperative complications--the results obtained showed no statistically significant difference. We conclude that both, the bayesian criterium, and the discriminant function can successfully be used for the prediction of the postoperative morbidity in vascular surgery.     

The significance of serum mitochondrial aspartate aminotransferase activity in the surgical field

A study was carried out on the clinical significance of changes in the serum level of mitochondrial aspartate aminotransferase before and after surgery on patients suffering from various hepato-biliary diseases. The patients included those whose livers were impaired with cirrhosis, jaundice, or direct surgical intervention such as hepatectomy. It was found that the postoperative liver function of patients whose preoperative values of serum mitochondrial aspartate aminotransferase had been less than 10 Karmen units recovered with a favorable course, whereas that of patients whose values had exceeded 20 units deteriorated with persistent jaundice, ascites or hepatic insufficiency. Both the sensitivity and specificity of respective liver function tests were examined by the preoperative values of routine liver function tests and the postoperative liver functions. The results revealed the serum value of mitochondrial aspartate aminotransferase to be more sensitive than the other tests, while specificity was not significantly different. A safety limit for a favorable postoperative course in terms of liver function was observed in patients showing a preoperative serum mitochondrial aspartate aminotransferase activity of below 10 units. Thus, serum mitochondrial aspartate aminotransferase activity could be applied as a useful marker for hepato-biliary surgery.     

Comparison of procalcitonin and CrP in the postoperative course after lung decortication

Objective: The objective of this prospective study was to compare the clinical value of procalcitonin (PCT) and C-reactive protein (CrP) plasma concentrations in their postoperative course after decortication. Methods: Twenty-two patients requiring surgery for pleural empyema were chosen for this prospective study. Routine blood samples including CrP and PCT plasma concentrations were taken before the operation and on the 1st, 2nd, 3rd, and 7th postoperative day. Results: Due to infection PCT and CrP were elevated preoperatively. In the postoperative course both PCT and CrP reached peak-levels on day 2 with values up to 43.55 ng/ml and 384.00 mg/l, respectively. In PCT the rise was followed by a clear decrease in 20 (90.9 %) patients until day 7. In contrast the CrP levels decreased slowly and only seven (54.5%) patients had values of 100 mg/l or below on day 7. PCT showed a better correlation with the clinic in case of septic course than CrP does. Conclusions: PCT reflects postoperative clinical course more accurately than CrP. Therefore, PCT is a more appropriate laboratory parameter to monitor patients after surgery for pleural empyema.     

胃肠道癌患者围手术期输血与术后感染

目的为了观察胃肠道癌患者围手术期输血与术后感染的关系。方法作者回顾性地分析了２８９例此类患者术后感染的多种因素。结果２８９例中有１０５例进行了围手术期输血,其感染率为３４２８％（３６例）;围手术期未输血的１８４例中,术后感染率为３８０％（７例）,两者比较有显著性差异（Ｐ＜０．０５）。术后感染发生随输血量而增大（Ｐ＜０．０１）。结论胃肠道癌肿患者围手术期输血会增加术后感染并发症的发生。故在保证患者能够耐受麻醉,手术治疗及术后恢复顺利的情况下,应尽量不输血或少输血。对确需输血者应采取红细胞成份输血,提高输血质量。     

Torsion of the spleen and associated 'prune belly syndrome'. A case report and review of the literature.

Splenic torsion as a complication of wandering spleen is rare. We report the clinical findings, diagnostic problems and treatment of a 1-year-old Coloured child (with classic 'prune belly syndrome') in whom the spleen had undergone torsion, thus simulating an intra-abdominal abscess. The postoperative course was uneventful.     

Hyperglycemic syndrome at the early postoperative period

An analysis of treatment of 141 patients with hyperglycemic syndrome at the early postoperative period was made, which was 1.3% of all the patients operated on during this period. Inflammatory postoperative complications took place in 30 (21.3%) patients in the group of patients with hyperglycemic syndrome. It suggests that hyperglycemia at the early postoperative period should be considered not simply as criterion of a severe state, but also as a factor having a direct influence on the course of the pathological process. So, these patients should be given sugar-decreasing therapy with monitoring of the glucose level.     

Thickness of the renal pelvis smooth muscle indicates the postoperative course of ureteropelvic junction obstruction treatment

ObjetiveTo investigate the relationship between the histopathologic findings and the postoperative course of children surgically treated for ureteropelvic junction (UPJ) obstruction.Material and methodsTwenty-eight patients operated for unilateral UPJ obstruction from 1998 to 2005 with adequate histopathologic specimens and postoperative follow up were retrospectively reviewed. Specimens were stained using elastic van Geisson to differentiate smooth muscle from collagen and elastin. Postoperative follow up included renal ultrasound (U/S) and diuretic renogram studies.ResultsTwelve patients with mean renal pelvis smooth muscle thickness (mRPSMT) of 136.97 ± 34.17 improved on the 6^th postoperative month. Nine patients that improved after 9 months postoperatively had mRPSMT=173.61 ± 33.91. The rest 7 patients that improved on the 12^th postoperative month had mRPSMT=258.78 ± 96.09. Correlation between renal pelvis smooth muscle and time of postoperative improvement was extremely significant (r = 0.7928, p < 0.0001).ConclusionThe thickness of the renal pelvis smooth muscle is significantly correlated to the postoperative course of patients with UPJ obstruction and can be used as a prognostic tool for the onset of their improvement.     

两种术式治疗肛裂前后肛管直肠压变化的比较

通过对两种术式治疗肛裂前后肛管直肠压的变化观察,探讨可能造成肛裂术后肛门失禁的原因,为寻找更优的手术方法提供依据。将确诊的100例肛裂患者随机分成治疗组和对照组,治疗组50例采用肛门内括约肌侧位切断术,对照组50例采用肛门内括约肌后位切断术。对两种治疗肛裂的术式手术前后肛管直肠压、疗程及术后并发症、术后疼痛、术后排便等指标进行观察统计。结果显示,治疗后两组患者症状评分均较治疗前降低,两组近期疗效、术后并发症（创13水肿、创口感染、肛门狭窄、术后排尿困难）、术后排便情况差异无统计学意义（P〉0．05）,在疗程、术后出血、术后疼痛及肛管直肠压方面治疗组优于对照组（P〈0．05）。结果表明,肛门内括约肌侧位切断术较肛门内括约肌后位切断术治疗肛裂具有创口小、愈合快、痛苦小、并发症少、安全性高等优点。     

Laparoscopic enucleation of insulinoma in the pancreas: case report and review of the literature

We report a case of islet cell tumor of the pancreas managed by laparoscopic surgery. A 27-year-old woman was admitted to the hospital after fainting from hypoglycemia. Diagnostic imaging showed a small tumor 1 cm in diameter in the body of the pancreas. Laparoscopic enucleation of the tumor was performed with laparoscopic coagulating shears. The operation time was 210 minutes, and there were no perioperative complications such as pancreatic leakage. The postoperative course was uneventful, and the patient was discharged from the hospital on the seventh postoperative day. The histopathologic diagnosis was insulin-producing islet cell tumor. This method is technically feasible and safe for the management of small islet cell tumors located on the surface of the pancreas.