PHARMACOECONOMICS OF APPLICATION OF HEPATOPROTECTORS IN THERAPY OF DRUG-INDUCED LIVER INJURY AFTER CHEMOTHERAPY

One of the major problems of modern oncology drug is liver damage, requiring additional costs for its treatment. The aim of our work was to study medical and economic efficiency of various schemes of hepatoprotective treatment of toxic liver damage. The paper presents the use of pharmacoeconomic studies in the treatment of hepatic drug-induced hepatitis, which occurs after chemotherapy in patients with Hodgkin's lymphoma. The study was conducted in the two comparison groups on a "cost - effectiveness". This method was chosen because it is in effect depending on the process (method), treatment was varied, as well as costs incurred. The unit of the effect of the number of days required for the relief of hepatic failure has been selected. Economic analysis of the work includes not only toxic hepatitis therapy, and treatment of any disease complications such as hepatic encephalopathy. The study revealed that the effectiveness of therapy increased 1.4 times and the economic costs were 51.8 % reduced with hepatoprotective drug "remaxol"

Pseudomembranous colitis complicated by toxic megacolon in oncological patients

In recent years, information on the increase in the incidence of  infection associated with Clostridioides difficile (CDI) has appeared in the literature. It is known that C. difficile which causes pseudomembranous colitis (PMC) most often affects debilitated patients who receive treatment for the main pathology for a long time. That is why PMC is most common in cancer patients receiving long-term and aggressive anticancer treatment, which is often accompanied by the use of several courses of antibiotics. The result of the irrational use of antibiotics, incorrect PMC therapy may be the  formation of toxic megacolon, intestinal perforation, sepsis, which in turn is fraught with a fatal outcome. It is this state of affairs that aroused our interest in the study of this topic. The steady increase in the incidence of Clostridioides difficile infection makes it particularly relevant to study CDI problem in relation to cancer patients, since they most often have a wide range of risk factors for developing clostridial infection. The article presents an overview of domestic and foreign sources describing this pathology, discusses epidemiology, pathogenesis, clinical picture and current understanding of the CDI treatment. At the end of the review, we present a case of successful treatment of pseudomembranous colitis after stoma closure, which was complicated by the development of toxic megacolon. Colproctectomy was performed as part of the complex treatment of this pathology. The patient received respiratory, renal replacement, hepatoprotective, antibiotic and antifungal therapy and other treatments

A Case of Successful Treatment of Gram-Negative Sepsis Associated with Toxic Myelosuppression in a Patient with HIV-Associated Non-Hodgkin’s Lymphoma

This article presents a clinical case of successful treatment of gram-negative sepsis in a patient with HIV-associated non-Hodgkin’s lymphoma. The patient was admitted to the intensive care unit in critical condition after the third course of polychemotherapy according to the ICE scheme. The severity of the condition was due to nosocomial pneumonia, septic shock, multiple organ failure, immunosuppression against the background of PCT and HIV infection, and the lack of specific treatment for HIV infection. Despite the absence of a positive blood culture throughout the entire treatment period, the diagnosis of sepsis was not in doubt, according to the criteria of the 2001 International Consensus Conference on Sepsis. The cause of the septic state was the combined effect of bacteria (Pseudomonas aeruginosa) and fungi (Candida albicans, Candida krusei) against the background of persistent HIV infection. The patient’s pneumonia was destructive and was twice aggravated by spontaneous pneumothorax. At the initial stage, intensive therapy led to positive dynamics. The severity of the systemic inflammatory response decreased, the acute respiratory insufficiency regressed, the X-ray pattern improved, and laboratory parameters stabilized. Despite the continued intensive therapy in the former volume on day 19, a sharply negative dynamics was noted, which led to a re-transfer of the patient to artificial ventilation of the lungs. The replacement of antibiotics and the specific treatment of HIV infection led to the patient’s recovery. In the future, chemotherapy was not carried out. Remission of the disease lasts six years

RENAL REPLANTATION AT EXTENDED AND COMBINED RESECTION OF RETROPERITONEAL LIPOSARCOMA (CASE REPORT)

Non-organ retroperitoneal liposarcoma is the most frequent initial malignant tumor in retroperitoneal space and it comprises 40 % of all non-organ retroperitoneal tumors. Difficulty of early diagnostics and complex antitumor treatment of patients with non-organ retroperitoneal tumors is one of the most actual and complicated issues in oncosurgery. Nonorgan retroperitoneal liposarcoma is a problematic issue because of complicated topographic and anatomic position, adjacency to retroperitoneal organs and great vessels and frequent loco-regional recurring. The most effective treatment mode of non-organ retroperitoneal tumors is surgical. Traumatic multivisceral resections are needed in 50 % of observations, including nephrectomy in 35-39 % of cases. Morphological invasion of the tumor into organs is confirmed in 35.7 % of cases. According to the most observations (70 %), there are no signs of invasion into kidney. Today, the treatment of tumors is being reconsidered. Nowadays, the enhancement of professional knowledge and technological advancement provides an opportunity to implement kidney-preserving surgeries, which improve life quality of the patients. In our opinion, using renal autotransplantation is very promising. It is widely used in pathology, in non-urgent and urgent urology, oncourology, vascular surgery. Our clinical case has demonstrated the technique of extracorporal resection of giant liposarcoma from involved kidney. Further steps include temporary kidney conservation, precise dissection from tumor and replantation of iliac vessel under emergency morphological control. Follow-up period is 18 months. According to the instrumental examination, no indices of backset and of tumor growth were revealed and the kidney's integrity was saved

Некоторые аспекты послеоперационного ведения пациенток с раком яичников после циторедуктивных операций с применением гипертермической внутрибрюшинной химиотерапии

The objective. Analysis of the course of the postoperative period and number of complications in patients with ovarian cancer during cytoreductive operations with hyperthermic intraoperative intra-abdominal chemotherapy.Subjects and Methods. We assessed the number of bed-days, the volume of infusion-transfusion therapy, diuresis, the volume of enteral feeding, the level of leukocytes, urea, creatinine, and lipocalin associated with gel in 45 patients with ovarian cancer after cytoreductive surgery with hyperthermic intraoperative intra-abdominal chemotherapy.Results. All patients developed polyuria while reference parameters of urea and creatinine were stable. Due to these changes, additional markers of acute renal damage were searched for. 15.9% of cases developed leukopenia on days 7–10. The number of complications and deaths does not exceed the world level.Conclusion. A multicomponent and versatile approach to the postoperative management of patients allows minimizing the level of complications and deaths. A search for a more sensitive marker of acute kidney injury is needed.Цель: проанализировать течение послеоперационного периода и количество возникших осложнений у пациенток с раком яичника при циторедуктивных операциях с гипертермической интраоперационной интраперитонеальной химиотерапией.Материалы и методы. У 45 пациенток с раком яичника после выполнения циторедуктивной операции с гипертермической интраоперационной интраперитонеальной химиотерапией оценивали количество койко-дней, объем проводимой инфузионно-трансфузионной терапии, диуреза и энтерального кормления, уровень лейкоцитов, мочевины, креатинина и липокалина, связанного с желатиназой нейтрофилов.Результаты. У всех пациенток выявлено развитие полиурии на фоне стабильных референтных показателей мочевины и креатинина. Данные изменения заставляют искать дополнительные маркеры острого почечного повреждения. Лейкопения на 7‒10-е сут развивается в 15,9% случаев. Количество осложнений и летальных исходов не превышает значений, известных в мировой практике.Заключение. Многокомпонентный и разносторонний подход послеоперационного ведения пациенток позволяет минимизировать количество осложнений и летальных исходов. Необходим поиск более чувствительного маркера острого почечного повреждения

НЕКОТОРЫЕ АСПЕКТЫ АНЕСТЕЗИОЛОГИЧЕСКОГО ОбЕСПЕЧЕНИЯ И ПОСЛЕОПЕРАЦИОННОЙ ИНТЕНСИВНОЙ ТЕРАПИИ ПРИ АУТОТРАНСПЛАНТАЦИИ ПОЧКИ В ХИРУРГИИ РЕТРОПЕРИТОНЕАЛЬНЫХ САРКОМ

The article presents a retrospective analysis of anesthesia and postoperative period of five patients to whom was used autotransplantation of the kidney as a component of an operation of removing of the retroperitoneal sarcoma. To all patients were used anesthesia according to modern concepts of multimodal anesthesia based on low-flow anesthesia with Sevoflurane, thoracic epidural analgesia with Narupin and intravenous administration of Fentanyl. The following indicators were analyzed: doses of anesthetics, hemodynamic parameters, the volume of intraoperative infusion therapy, the volume of diuresis during the operation and in the postoperative period, the duration of postoperative administration of anticoagulants, the use of antibacterial drugs, the days of patients in the intensive care unit and the number of bed days spent in Hospital. It has been shown once again that the combination of low flow anesthesia with Sevoflurane, thoracic epidural analgesia with Narupin and intravenous administration of Fentanyl is a priority in the anesthetic support of such operations. Number of bed-days spent in intensive care and inpatient. Decreases with the improvement of both surgical techniques, both intra- and postoperative management of patients.Представлен ретроспективный анализ анестезиологического пособия и послеоперационного периода пяти пациентов, которым была произведена аутотрансплантация почки как компонент операции по удалению забрюшинной саркомы. Всем пациентам проведено анестезиологическое пособие согласно современным представлениям о мультимодальной анестезии на основе низкопоточного наркоза севофлюраном, грудной эпидуральной аналгезии наропином и внутривенным введением фентанила. Проанализированы следующие показатели: дозы анестетиков, гемодинамические показатели, объем интраоперационной инфузионной терапии, объем диуреза во время операции и в послеоперационном периоде, длительность послеоперационного введения антикоагулянтов, применение антибактериальных препаратов, дни нахождения пациентов в палате интенсивной терапии и количество койко-дней, проведенных в стационаре. Продемонстрировано, что сочетание низкопоточного наркоза севофлюраном, грудной эпидуральной аналгезии наропином и внутривенного введения фентанила является приоритетным методом при анестезиологическом обеспечении таких операций. Количество койко-дней, проведенных в реанимации и стационаре, снижается при совершенствовании как хирургической техники, так интра- и послеоперационного терапевтического сопровождения пациентов

Анестезиологическое обеспечение циторедуктивных операций с применением гипертермической внутрибрюшинной химиотерапии у больных раком яичника

The objective of the study: to analyze the experience of anesthesia when performing cytoreductive surgeries using hyperthermic intraperitoneal chemotherapy in patients with advanced forms of ovarian cancer.Subjects and methods. A pilot study of anesthetic management was conducted in 30 patients with ovarian cancer who underwent multiorgan cytoreductive abdominal resection with hyperthermic intraperitoneal chemotherapy.Results. The risk of anesthesia was 5.18 ± 0.39 points (which corresponded to the III degree of risk) according to the recommendations of the Moscow Scientific Society of Anesthesiology Reanimatology (MSSAR). The total volume of infusion‒transfusion therapy (ITT) was 11.070,0 ± 2.243,5 ml. with the hour rate of 21.7 ± 6.1 ml/kg-1/h-1, due to increase in the volume of crystalloids. Important components of anesthetic management were the patient's thermal stability and antiemetic therapy.Conclusion. As a result of the study, it was revealed that anesthesia in patients during cytoreductive operations with HIPEC was fairly complex and required the participation of a well-trained anesthesiological team. The issue of choosing the scale to assess anesthetic risk due to the lack of optimal one for this type of operations, requires further research. Although in our opinion, the scale of anesthesiological risk of the Moscow Scientific Society of Anesthesiologists-Resuscitators is more preferable. In such operations, the volume of ITT should be increased primarily through balanced crystalloids.Цель исследования: анализ опыта анестезиологического пособия при выполнении циторедуктивных операций с использованием гипертермической интраоперационной интраабдоминальной химиотерапии (ГИИХ) у пациентов с запущенными формами рака яичника.Материалы и методы. Выполнено пилотное исследование анестезиологического пособия при лечении 30 пациенток с раком яичника, которым проведена мультиорганная циторедуктивная резекция органов брюшной полости с гипертермической внутрибрюшинной химио-терапией.Результаты. Риск анестезии составил 5,18 ± 0,39 балла (что соответствует III степени риска) по рекомендациям Московского научного общества анестезиологов-реаниматологов. Общий объем инфузионно-трансфузионной терапии (ИТТ) составил 11 070,0 ± 2 243,5 мл, с почасовой скоростью 21,7 ± 6,1 мл · кг-1 · ч-1, за счет увеличения объема кристаллоидов. Немаловажными компонентами анестезиологического сопровождения стали термостабильность пациента и антиэметическая терапия.Заключение. Анестезия при проведении циторедуктивных операций с гипертермической химиоперфузией требует участия подготовленной анестезиологической бригады. Для оценки анестезиологического риска может быть применена шкала МНОАР, хотя и она в полной мере для данных пациентов не подходит. При таких операциях следует увеличивать объем ИТТ прежде всего за счет сбалансированных кристаллоидов

ОПЫТ ПРИМЕНЕНИЯ ТЕХНОЛОГИИ ЦИТОРЕДУКТИВНОЙ ХИРУРГИИ С МЕТОДОМ ИНТРАОПЕРАЦИОННОЙ ИНТРАПЕРИТОНЕАЛЬНОЙ ГИПЕРТЕРМИЧЕСКОЙ ХИМИОТЕРАПИИ В ЛЕЧЕНИИ БОЛЬНЫХ РАСПРОСТРАНЕННЫМ РАКОМ ЯИЧНИКОВ

We present our experience in using cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer patients treated at Irkutsk Regional Cancer Center. All patients were divided into 2 groups. Group I  consisted of 15 patients, who underwent cytoreductive surgery only.  Group II comprised 17 patients, who underwent surgery and HIPEC.  The main eligibility criteria for this study were verified peritoneal carcinomatosis and resectable ovarian cancer. The primary analysis of these groups included: preoperative period, length of  operation, postoperative length of stay, and postoperative  complications. The technique of performing HIPEC using Performer  HT® (RAND, Medolla (MO), Italy) was completely described. Further study is required to estimate the difference in overall and disease-free survival between study groups.Представлен первый опыт применения технологии циторедуктивной хирургии и технологии интраоперационной интраперитонеальной гипертермической химиотерапии (ГИИХ) в  практике работы Иркутского окологического диспансера. Пациентки с диагнозом рак  яичников были разделены на 2 группы: 1-я – 15 больных, подвергшихся циторедуктивной  операции, 2-я – 17 пациенток, которым выполнен аналогичный объем операции и  проведена процедура ГИИХ. Обязательным условием отбора в исследование являлось  наличие верифицированного канцероматозного поражения брюшины, резектабельный процесс, общий статус больных. При первичном анализе этих групп в  расчет брались временные показатели (период до операции, продолжительность операции,  послеоперационный койко-день), а также наличие и характер осложнений в  послеоперационном периоде. Дано полное последовательное описание методики  проведения процедуры ГИИХ на аппарате Performer HT® [RAND, Medolla (MO), Italy]. Исследование носит проспективный характер, наблюдение за исследуемыми группами продолжается. Ожидаемыми результатами будет значимое расхождение общей и  безрецидивной выживаемости в исследуемых группах

SOME ASPECTS OF ANESTHETIC MANAGEMENT AND POSTOPERATIVE INTENSIVE THERAPY IN PATIENTS SUBJECTED TO KIDNEY AUTOTRANSPLANTATION DURING SURGERY FOR RETROPERITONEAL SARCOMA

The article presents a retrospective analysis of anesthesia and postoperative period of five patients to whom was used autotransplantation of the kidney as a component of an operation of removing of the retroperitoneal sarcoma. To all patients were used anesthesia according to modern concepts of multimodal anesthesia based on low-flow anesthesia with Sevoflurane, thoracic epidural analgesia with Narupin and intravenous administration of Fentanyl. The following indicators were analyzed: doses of anesthetics, hemodynamic parameters, the volume of intraoperative infusion therapy, the volume of diuresis during the operation and in the postoperative period, the duration of postoperative administration of anticoagulants, the use of antibacterial drugs, the days of patients in the intensive care unit and the number of bed days spent in Hospital. It has been shown once again that the combination of low flow anesthesia with Sevoflurane, thoracic epidural analgesia with Narupin and intravenous administration of Fentanyl is a priority in the anesthetic support of such operations. Number of bed-days spent in intensive care and inpatient. Decreases with the improvement of both surgical techniques, both intra- and postoperative management of patients

Autotransplantation of the kidney in surgery of retroperitoneal sarcomas

The paper presents the analysis of 5 clinical cases that demonstrate the potential of using organ-saving technologies in surgery of locally advanced retroperitoneal sarcomas. The clinical example shows step by step the technique of organ-preserving surgical intervention: an extended tumour nephrectomy followed by the extracorporeal precise dissection of the kidney from the tumor bulk with inducing a reversible pharmaco-cold ischemia and the isolated kidney autotransplantation into a heterotopic position with regard to intraoperative rapid cytology monitoring results. The article describes the characteristics of anesthesia, the early postoperative period, subsequent rehabilitation, and prophylactic medical screening of this group of patients