Robotinė chirurgija tiesiosios žarnos vėžiui gydyti: klinikiniai rezultatai ir pacientų gyvenimo kokybė. Chirurginių metodų palyginimas

Background. Rectal cancer is one of the most common oncological diseases in the world. In recent years, robotic surgery has been increasingly used to improve the outcome of this disease. Aim. To review the latest scientific literature on the application of robotic surgery in the treatment of rectal cancer and to evaluate clinical outcomes in patients. Material and methods. The research method is a literature review. Publications were researched in the PubMed and Google Scholar databases using the following keywords and their combinations in English: rectal cancer, robotic surgery, laparoscopic surgery, open surgery. Based on the inclusion and exclusion criteria, 68 scientific publications were included in the review. Results. The average duration of robotic surgery was longer (164.5±47.5–275±60.5 minutes) and was more expensive than other surgical methods. However, patients recovered faster, lost less blood and the hospitalization was shorter (on average 7 days), complications (7.7–22.1%) and local recurrences (0–8.3%) were less frequent and this surgery had better survival rates. The incidence of R0 resection was 90.3–100%, while the incidence of distant metastases was 0–21.1%. No deaths were recorded during the surgery. Conclusions. Robotic surgery is a safe and effective method for treating rectal cancer. It is associated with a lower risk of bleeding, shorter hospitalization, fewer local recurrences, fewer post-operative complications, faster recovery and better quality of life in the long term but requires more economic resources than other surgical approaches.Įvadas. Tiesiosios žarnos vėžys yra viena iš dažniausių onkologinių ligų pasaulyje. Pastaraisiais metais, siekiant pagerinti šios ligos gydymo rezultatus, vis plačiau taikoma robotinė chirurgija. Tikslas. Apžvelgti naujausią mokslinę literatūrą apie robotinės chirurgijos taikymą tiesiosios žarnos vėžiui gydyti, įvertinti klinikinius pacientų rezultatus. Tyrimo medžiaga ir metodai. Tyrimo metodas – mokslinės literatūros apžvalga. Publikacijų ieškota PubMed ir Google Scholar duomenų bazėse, naudojant reikšminius žodžius ir jų derinius anglų kalba: tiesiosios žarnos vėžys (angl. rectal cancer), robotinė chirurgija (angl. robotic surgery), laparoskopinė chirurgija (angl. laparoscopic surgery), atviroji operacija (angl. open surgery). Remiantis publikacijų įtraukimo ir atmetimo kriterijais, į apžvalgą įtrauktos 68 mokslinės publikacijos. Rezultatai. Palyginti su kitais chirurginiais metodais, robotinės operacijos trunka vidutiniškai ilgiau (164,5±47,5–275±60,5 min.) ir yra brangesnės, tačiau pacientai atsigauna greičiau, mažiau netenka kraujo, jų hospitalizacija trumpesnė (vidutiniškai 7 dienos), komplikacijos (7,7–22,1 %) ir ligos atkryčiai arba recidyvai (0–8,3 %) retesni, išgyvenamumas geresnis. R0 rezekcijos dažnis siekia 90,3–100 proc., tolimųjų metastazių – 0–21,1 proc. Operacijų metu mirčių nefiksuota. Išvados. Robotinė chirurgija – saugus ir efektyvus tiesiosios žarnos vėžio gydymo metodas. Palyginti su kitais chirurginiais metodais, robotinė chirurgija susijusi su mažesne kraujavimo rizika, trumpesne hospitalizacija, rečiau pasireiškiančiais lokaliais ligos recidyvais, retesnėmis pooperacinėmis komplikacijomis, greitesniu pacientų atsigavimu ir geresniais gyvenimo kokybės rodikliais ilgalaikėje perspektyvoje, tačiau šiam metodui reikia didesnių ekonominių išteklių

Pirminė ne Hodžkino limfoma smilkinkaulyje: klinikinio atvejo aprašymas

Lymphomas account for approximately 2.5% of head and neck malignancies, with primary temporal bone involvement being exceedingly rare. The diagnosis of lymphoma, as with other temporal bone malignancies, is often delayed, which adversely impacts both treatment outcomes and overall prognosis. We report a case of a 55-year-old male who presented to our hospital with left-sided facial palsy, unilateral hearing loss, and auricular pain. Biopsies taken during surgical intervention revealed diffuse large B-cell lymphoma infiltrating the mastoid process, external auditory canal, and tympanic cavity. This case underscores the diagnostic challenges posed by temporal bone lymphoma, particularly in presenting symptoms that mimic benign conditions. It emphasizes the importance of considering malignancy in patients with persistent otological symptoms and facial nerve palsy, warranting thorough investigation. Maintaining a heightened level of suspicion for neoplastic disease is crucial until a definitive diagnosis is confirmed. Early detection through comprehensive imaging and biopsy is essential for effective management and improved outcomes.Limfomos sudaro maždaug 2,5 proc. visų galvos ir kaklo piktybinių navikų, tačiau pirminis smilkinkaulio pažeidimas itin retas. Kaip ir kitų smilkinkaulio piktybinių darinių, limfomos diagnozė dažnai nustatoma pavėluotai, o tai daro neigiamą įtaką gydymo rezultatams ir prognozei. Straipsnyje aprašomas 55 m. vyro klinikinis atvejis. Pacientas atvyko į ligoninę dėl kairės pusės veido parezės, suprastėjusios klausos kaire ausimi ir kairės ausies skausmo. Operacijos metu paimta biopsinė medžiaga patvirtino difuzinę didelių B ląstelių limfomą, infiltruojančią speninę ataugą, išorinę klausomąją landą ir būgninę ertmę. Šis atvejis pabrėžia smilkinkaulio limfomos diagnostinius iššūkius, ypač kai klinikiniai požymiai primena nepiktybinius susirgimus. Pacientams, kuriems pasireiškia išliekantys otologiniai simptomai kartu su veidinio nervo pažeidimu, būtina atlikti išsamius diagnostinius tyrimus ir neatmesti piktybinio proceso tikimybės, kol bus patvirtinta galutinė diagnozė. Ankstyva diagnostika, taikant pažangius vaizdinius ir histologinius tyrimus, yra esminė, siekiant taikyti tinkamiausią gydymą ir užtikrinti geresnes išeitis

Pilvo traumos gydymas taikant laparoskopiją

Objective. To review scientific articles dealing with the use of laparoscopy in the treatment of abdominal trauma. Methods. The PubMed database was searched for scientific articles published between 2015-01-01 and 2024-09-01. The search keywords used were: laparoscopy, therapeutic laparoscopy, blunt abdominal trauma, penetrating abdominal trauma. Results. Four articles were included in the final evaluation. Methods, main findings, conclusions and recommendations are presented. Conclusions. Based on the results and conclusions of the published articles, the minimally invasive surgical technique of laparoscopy is an important and effective tool in the diagnosis and management of abdominal trauma. Laparoscopy has advantages over open surgery, including a lower risk of complications, faster recovery and better cosmetic results. It is important to consider the contraindications to laparoscopy and to select patients appropriately for this treatment. Adequate hospital infrastructure and qualified medical staff are also required to ensure the success of the operation. Laparoscopy is an effective treatment option for abdominal injuries, helping to reduce the risk of complications and the length of hospital stay.ikslas. Apžvelgti mokslinius straipsnius, kuriuose nagrinėjamas laparoskopijos taikymas gydant trauminius pilvo sužalojimus. Metodai. Atlikta mokslinių straipsnių, publikuotų nuo 2015-01-01 iki 2024-09-01, paieška PubMed duomenų bazėje. Paieškai naudoti reikšminiai žodžiai: laparoscopy, therapeutic laparoscopy, blunt abdominal trauma, penetrating abdominal trauma. Rezultatai. Į sisteminę apžvalgą įtraukti keturi straipsniai. Pateikiami atliktų tyrimų metodai, pagrindiniai rezultatai, išvados ir rekomendacijos. Išvados. Remiantis publikuotų straipsnių rezultatais ir išvadomis, galima teigti, kad minimaliai invazinis chirurgijos metodas – laparoskopija – yra svarbi ir efektyvi priemonė trauminiams pilvo sužalojimams diagnozuoti ir gydyti. Laparoskopija, palyginti su laparotomija, pasižymi šiais privalumais: mažesnė komplikacijų tikimybė, pacientas greičiau sveiksta, geresnis kosmetinis rezultatas. Svarbu atsižvelgti į laparoskopijos kontraindikacijas ir tinkamai atrinkti pacientus, kuriems taikytinas šis gydymo būdas. Siekiant užtikrinti operacijos sėkmę, taip pat svarbu tinkama ligoninės infrastruktūra ir kvalifikuoti medicinos specialistai. Laparoskopija efektyvi pilvo sužalojimams gydyti. Ji pasižymi maža komplikacijų rizika ir trumpa hospitalizacija

Kamptodaktilija: literatūros apžvalga ir klinikinis atvejis

Camptodactyly is a congenital hand deformity characterized by a fixed flexion contracture, most commonly affecting the fifth finger. This literature review and case report highlight the clinical manifestations, and treatment options for camptodactyly. Occurring in approximately 1% of the population, the condition may be unilateral or bilateral and varies widely in severity [1–3]. Camptodactyly often appears at birth or during puberty, linked to genetic mutations, usually sporadic or autosomal dominant in nature [4, 5] painless, non-neurogenic flexion deformity at the proximal interphalangeal joint of the little finger, which may occur in isolation or in various developmental dysmorphology syndromes. In a ten-year survey of almost 10,000 consecutive neurology outpatient referrals, using a passive case finding strategy, camptodactyly was observed with a frequency of 0.43%. All were cases of isolated camptodactyly, and all but one were asymptomatic. Camptodactyly was more often bilateral, often asymmetric, than unilateral. A family history was common, sometimes with intrafamilial heterogeneity (symmetry, degree of angulation. Treatment remains controversial, with non-surgical options preferred for mild cases. Surgical intervention is considered when functionality is impaired. In this case, a patient with bilateral fifth finger contractures since birth managed the condition without surgery [3, 6]. This report aims to illustrate current understanding of camptodactyly’s natural course and discusses therapeutic strategies for better clinical outcomes.Kamptodaktilija – įgimta rankos deformacija, pasireiškianti fiksuota lenkiamąja kontraktūra, dažniausiai paveikianti penktąjį pirštą. Šioje literatūros apžvalgoje ir klinikinio atvejo aprašyme nagrinėjamas kamptodaktilijos klinikinis pasireiškimas ir gydymo galimybės. Liga pasireiškia 1 proc. populiacijos, gali būti vienpusė ar abipusė [1–3]. Kamptodaktilija dažniausiai nustatoma gimus arba paauglystėje. Etiologija susijusi su genetiniais pakitimais, įprastai atsirandančiais atsitiktinai arba paveldimais autosominiu dominantiniu būdu [4, 5]painless, non-neurogenic flexion deformity at the proximal interphalangeal joint of the little finger, which may occur in isolation or in various developmental dysmorphology syndromes. In a ten-year survey of almost 10,000 consecutive neurology outpatient referrals, using a passive case finding strategy, camptodactyly was observed with a frequency of 0.43%. All were cases of isolated camptodactyly, and all but one were asymptomatic. Camptodactyly was more often bilateral, often asymmetric, than unilateral. A family history was common, sometimes with intrafamilial heterogeneity (symmetry, degree of angulation. Kamptodaktilijos gydymas išlieka diskutuotinas. Lengvesniais atvejais teikiama pirmenybė konservatyviam gydymui. Kontraktūroms ribojant plaštakos funkciją, taikomas chirurginis gydymas. Straipsnyje pateikiamas atvejis, iliustruojantis kamptodaktilijos diagnostiką ir gydymą

Colorectal Cancer: Post-operative Complications and Their Risk Factors

Background. Colorectal cancer is one of the most common cancers in the world, and surgery remains the only curative treatment. However, post-operative complications impact patients’ outcomes and quality of life. Identifying risk factors for these complications is essential for improving surgical outcomes and patient safety. Methods. We conducted a retrospective study of 277 patients who underwent CRC surgery at the Hospital of Lithuanian University of Health Sciences Kauno Klinikos between January 1 and December 31, 2023. Data were collected on demographic, clinical, and surgical variables. Statistical analyses were performed using IBM SPSS software and included univariate and multivariate logistic regression to identify independent risk factors for postoperative complications. Results. The overall postoperative complication rate was 22.7%, with anastomotic leakage being the most common complication (8.2%). Logistic regression analysis identified older age as the only statistically significant independent risk factor for postoperative complications (p = 0.016). While urgent surgery and intra-operative complications showed strong associations with increased risk, these were not statistically significant in multivariate analysis. Conclusion. Our study highlights older age as a critical risk factor for postoperative complications in CRC surgery. Although the study is limited by its retrospective design and single-center sample, it provides valuable insights for improving patient outcomes

Traumatic Brain Injury: A Study from the Middle-East

Background. Traumatic head injuries represent one of the major causes of mortality and long-term disability worldwide. This main objective of this study was to explore the patterns, severity, and outcomes of these injuries. Methods. An observational, descriptive, retrospective study was carried out utilizing a validated data collection sheet, after attaining a proper ethical committee approval. Well-defined exclusion and inclusion criteria were applied. Results. There were 185 patients enrolled in the study, including 153 (82.7%) males and 32 (47%) females, with a mean age of 41.5 years. Road traffic accidents were the most frequent cause of injury, followed by falls, machinery-related accidents, and assaults. A conservative strategy was used to treat 101 (54.6%) of the patients, whereas various surgical procedures were performed on 84 (45.4%). Outcomes were related to Glasgow Coma score on presentation and favorable in 135 (73%) patients. Conclusions. Road traffic accidents and falls from heights are the leading causes of traumatic brain injury. As a result, preventive measures including road safety and workplace regulations must be addressed

Krūtinės angos sindromas: literatūros apžvalga ir klinikinis atvejis

Thoracic outlet syndrome (TOS) is a clinical entity comprising a constellation of symptoms resulting from compression of the neurovascular bundle in the thoracic outlet. Vascular, neurological, and neurovascular types of TOS are distinguished according to the structures affected. The most common form of TOS is neurological, occurring in up to 95% of cases. TOS is a common neurological disease with a wide range of symptoms. It is still little known to medical professionals and is often undiagnosed or diagnosed late. This study provides a literature review of the symptomatology and treatment methods for TOS, highlighting certain symptoms not previously documented in the literature and presenting an illustrative clinical case. A 67-year-old female reported left arm pain following a muscle biopsy conducted for suspected polymyositis. The pain radiated to the inner arm, shoulder blade, and distal parts of the arm. The patient had been experiencing chronic facial and head pain, as well as nausea, for 35 years. Examination revealed arm weakness and positive thoracic outlet syndrome (TOS) provocation tests. Brachial plexus decompression were performed, resulting in an excellent treatment outcome. This case highlights the complexity of TOS presentations and the importance of considering TOS in differential diagnoses.Krūtinės angos sindromas (KAS) apima visumą simptomų, kylančių dėl neurovaskulinio pluošto kompresijos krūtinės angoje. Išskiriami kraujagyslinio, neurologinio ir neurovaskulinio KAS tipai [1]. Neurologinis KAS (nKAS) laikomas dažniausiu ir, kaip nurodoma kai kuriuose mokslo darbuose, pasireiškia iki 95 proc. atvejų. nKAS gali pasireikšti galvos, viršutinės galūnės, kardiologiniais ar kojų simptomais. Medicinos darbuotojams KAS dar mažai žinoma liga, dažnai neįtariama, diagnozuojama klaidingai arba vėlai. Šiame darbe sistemingai apžvelgiama ligos simptomatika ir gydymo metodai, pateikiami kai kurie mokslinėje literatūroje neminimi simptomai, aptariamas iliustratyvus klinikinis atvejis. 67 m. moteris skundėsi kairės rankos skausmu, kilusiu atlikus raumens biopsiją dėl įtarto polimiozito. Skausmas plito į žasto vidinę pusę, mentę, žemesnes rankos dalis. Pacientę 35-erius metus kankino veido ir galvos skausmai, pykinimas. Nustatytas rankos silpnumas ir teigiami KAS provokaciniai testai. Pacientei atlikta petinio rezginio dekompresija, pasiekta puikių gydymo rezultatų