Analysis and methods of prevention of cranial nerves injury during carotid endarterectomy

Aim. CEAE is an effective method of ischemic stroke prevention. However, as any invasive treatment method, CEAE is associated with a risk of complications in the early and late postoperative periods. One of the possible complications is intraoperative injury of cranial nerves.Material and Methods. From 2008 to 2014 in the department of vascular surgery in Pletnev City Hospital in Moscow, 172 patients with hemodynamically significant ICA stenosis who suffered ischemic stroke or TIA underwent surgery.Results. In the early postoperative period, 7 episodes of cranial nerve injury (4.0%) were detected. The following cranial nerves were most often damaged during surgery: the terminal branches of the facial nerve (VII), the hypoglossus nerve (XII), the glossopharyngeal nerve (IX), and the vagus nerve (X). Injuries were associated with coagulation damage or compression of nerves. In one case, the intersection of the hypoglossus nerve was recorded. In all cases except this one, nerve damage was reversible.Conclusion. It is impossible to avoid cranial nerves injury during carotid endarterectomy. However, the number of such complications can be reduced by the measures described in this article

Giant popliteal artery aneurysm

Introduction: Popliteal artery aneurysm is a pathology that appears regularly in daily practice of a vascular surgeon since the popliteal artery is the most common location of aneurysms (about 70%). A rare form of aneurysm of the popliteal artery is a giant aneurysm, the diameter of which is more than 7–8 cm. Giant aneurysms are of a great clinical importance due to the high risk of rupture and complications, and the fact that this pathology has its own peculiarities of surgical treatment.Material and methods: We conducted an electronic bibliographic search Pubmed, Cochrane Library, Wiley to find reports about treatment of giant popliteal aneurysms. According to its results the main features of the clinical picture, diagnosis and treatment of giant popliteal aneurysms have been identified.Results and discussion: Surgical treatment of giant popliteal artery aneurysms differs from the treatment of regular popliteal artery aneurysms and is associated with the choice of adequate access and the need for partial or full resection of the aneurysm. Endovascular treatment methods are used much less frequently, however, with the improvement of techniques and the emergence of new technologies, an increase in number of giant aneurysms successful treatment cases is expected

Perforated Peptic Ulcer Combined with Posttraumatic Diaphragmatic Hernia in Third Gestation Trimester: a Clinical Case

Background. Gastric and duodenal ulcers are extremely rare in pregnancy, according to published literature. Peptic ulcer is found in 1 per 4,000 pregnant women, a figure probably underestimated due to its hampered diagnosis in pregnancy. Pregnancy peptic ulcer is considered less expected. Perforated gastric and duodenal ulcers comprise about 1.5 % of total acute abdominal diseases, and the perforation rate in ulcer patients ranges within 5–15 %. This complication afflicts the ages of 20–40 years in men much more frequently than in women. Three perforation types occur: free into abdominal cavity (87 %), contained (9 %), into lesser omentum and retroperitoneal tissue (4 %).Materials and methods. The clinical case describes surgical management of posttraumatic diaphragmatic hernia-comorbid perforated gastric ulcer in a pregnant woman in third trimester. Surgery with postoperative patient management enabled for a favourable outcome.Results and discussion. Perforation-entailing gastric and duodenal ulcers in pregnant women have received negligible attention due to rarity in clinical practice. Paul et al. described 14 cases of duodenal perforation in pregnancy, all fatal.Conclusion. Early diagnosis of surgical pathology during gestation is still difficult contributing to the development of severe complications associated with high mortality. The patient’s admission to a level III interspecialty hospital was key to enable a timely consilium-driven decision of caesarean intervention for saving the child, diagnosing intraoperatively life-threatening complicated surgical diseases and opting for radical surgery that ended in a favourable outcome

К ВОПРОСУ О РЕЗЕКЦИИ ПЕЧЕНИ

Successes   of   surgical   hepatology  are   in  many   respects  caused   by  continuous improvement of  equipment of  liver resection. However   discussion   of  the  references containing the description of techniques of resections and necessary for carrying out these difficult  operations of  the  equipment, is complicated by a  variety  of  the  classification approaches used  by  various  authors when  the  same  intervention has  three  and  more various  names. At the  description of  liver resections of  different volumes  still there  is a terminological confusion. It is possible  to  call the  same  intervention «lobectomy», «an expanded hemihepatectomy», «treesegmentectomy» of that  is put in this concept though there  are  accurate anatomic definitions which  characterize a  certain  part  of  a  hepatic parenchyma.Успехи хирургической гепатологии во многом  обусловлены постоянным совершенствованием техники  резекции печени.  Однако  обсуждение литературных  источников,  содержащих описание технических  приемов резекций и необходимого для проведения этих сложных операций оборудования, затруднено разнообразием классификационных подходов, используемых различными авторами, когда одно и то же вмешательство имеет  до трех и более различных названий. При описании резекций печени разных  объемов до сих пор существует терминологическая путаница.  Одно и то же вмешательство можно  назвать «лобэктомией», «расширенной гемигепатэктомией», «трисегментэктомией» в зависимости от того, что вкладывается в это понятие, хотя существуют четкие анатомические определения, которые характеризуют определенную часть печеночной паренхимы

ОПТИМИЗАЦИЯ ДОСТУПА ПРИ РЕЗЕКЦИИ ПРАВОЙ ДОЛИ ПЕЧЕНИ

While performing surgery  on the right part of the liver, we used a T-shaped approach that  allowed  to make  complete revision of the  hepatoduodenal organs and  to perform a surgical intervention (rational proposal № 2675 of  24.10.03). It is to be noted that  after the intersection of the liver ligaments and use of a retractor – the Seagal elevator  of costal arches, direct visualization is exposed and the scope of surgery is widened. We applied this approach in 12 (24%) patients operated on. In conjunction with costal arches retractors our technique makes it possible to refuse thoracoabdominal approaches offered earlier.При выполнении оперативных вмешательств на правой доле  печени мы использовали Т-образный доступ,  который  позволяет произвести полноценную ревизию органов гепатодуоденальной зоны  и выполнить оперативное вмешательство (рац. предл.  № 2675 от 24.10.03). Следует отметить,  что после  пересечения связок  печени и при использовании ранорасширителя подъемника реберных дуг Сигала – открывается оптимальный простор,  и значительно увеличивается хирургическое поле действия. Данный доступ применен нами у 12 (24%) оперируемых больных. В сочетании с ретракторами реберных дуг разработанный нами  доступ  позволяет отказаться от предложенных ранее  торакоабдоминальных доступов

TO THE QUESTION OF LIVER RESECTION

Successes   of   surgical   hepatology  are   in  many   respects  caused   by  continuous improvement of  equipment of  liver resection. However   discussion   of  the  references containing the description of techniques of resections and necessary for carrying out these difficult  operations of  the  equipment, is complicated by a  variety  of  the  classification approaches used  by  various  authors when  the  same  intervention has  three  and  more various  names. At the  description of  liver resections of  different volumes  still there  is a terminological confusion. It is possible  to  call the  same  intervention «lobectomy», «an expanded hemihepatectomy», «treesegmentectomy» of that  is put in this concept though there  are  accurate anatomic definitions which  characterize a  certain  part  of  a  hepatic parenchyma

OPTIMIZATION OF ACCESS IN RESECTION OF THE RIGHT LOBE OF LIVER

While performing surgery  on the right part of the liver, we used a T-shaped approach that  allowed  to make  complete revision of the  hepatoduodenal organs and  to perform a surgical intervention (rational proposal № 2675 of  24.10.03). It is to be noted that  after the intersection of the liver ligaments and use of a retractor – the Seagal elevator  of costal arches, direct visualization is exposed and the scope of surgery is widened. We applied this approach in 12 (24%) patients operated on. In conjunction with costal arches retractors our technique makes it possible to refuse thoracoabdominal approaches offered earlier

The off-label use of drugs for parenteral nutrition as a solvent of substances slightly soluble in water in pharmacological research

Because of the problem to evaluate biological activity in water-soluble substances in all phases of preclinical and clinical studies, the research work enabled to develop the original solvent for poorly soluble compounds based on substances for parenteral nutrition. The main aim is to examine the impact of the original solvent based on substances for parenteral nutrition on biological systems exemplified by the hemostatic system, characterized by sensitivity and variability of the effects in response to any impact, and its comparison with the solvents that are conventional in pharmacological research. Experimental work is performed according to the “guidance on preclinical research of new pharmacological substances” in vitro. The findings show that traditional solvents at low dosages affect all the researched indicators of the hemostasis system. The smallest effect in respect of the hemostatic system was characterized by ethanol, and the most apparent antiaggregational effect was registered with dioxane. 10% concentration of original blend of lipids made no effect on hemostasis system. Thus, according to their own findings and experience in application of lipid emulsions as substances of parenteral nutrition, they can be considered to be an adequate solvent in all phases of preclinical and clinical studies of new drugs

Specific features of immunity in neonatal infants with localized and generalized bacterial infections

Cellular immunity indicators were investigated in infants with localized (и=10) and generalized (и=15) bacterial infections (sepsis). The blood levels of different groups of white blood cells (neutrophils, lymphocytes, monocytes) and lymphocyte subpopulations (CD3, CD4, CD8, CD16/56, and CD19) were estimated. The development of sepsis was accompanied by leukocytosis and leukopenia in 47 and 20% of the cases, respectively. In localized infections, there was leukocytosis in 30% of the infants and leukopenia in 10%. Absolute lymphopenia was present in 40% of the cases of sepsis and in 20% of those of localized infections. The acute period of neonatal sepsis was accompanied by a substantial reduction in the level of CD3+, CD4+, CD8+, and CD16/56+ lymphocyte subpopulations. The highest changes were recorded in the CD4+ and CD16/56+: their counts were decreased by an average of 3,9 and 3,6 times, respectively, compared to the control values; CD8+ lymphocytes dropped by 2,7 times. Localized infections were characterized by a predominant fall in the number of CD4+ and CD16/56+ subpopulations. Moreover, the level of CD4+ lymphocytes was significantly lower than that in the sepsis group. Thus, the acute period of both localized and generalized bacterial infections took place in the presence of cellular immunity suppression. The most marked changes were recorded in sepsis. The f

ARTERIAL HYPERTENSION AND LEFT VENTRICULAR REMODELLING IN ELDERLY PATIENTS

In total, 104 elderly patients with arterial hypertension (AH) and 20 healthy controls were examined. Thirty-four individuals had essential AH (EAH), and 70 – isolated systolic AH (ISAH). Statistically significant increase in blood pressure (BP) variability, reduction in night-time diastolic BP (DBP) combined with high systolic BP (SBP) level, and an increase in temporal index and night-time BP drop were maximal in ISAH patients. Disturbed systolic and diastolic left ventricular function was associated with transitory myocardial ischemia (79,7%) and silent night-time ischemia (SNI). SNI was characterised by higher SBP levels, and ISAH – by decreased night-time DBP. In elderly AH patients, cerebral perfusion was reduced, and in ISAH, adaptive and compensatory potential of cerebral vessels was also decreased