Preoperative 3D modeling splenectomy in patients with primary immune thrombocytopenia

СПЛЕНЭКТОМИЯТРОМБОЦИТОПЕНИЯ /ХИРТОМОГРАФИЯ РЕНТГЕНОВСКАЯ КОМПЬЮТЕРНАЯ3D МОДЕЛИРОВАНИЕГЕМОСТАЗВАСКУЛЯРИЗАЦИЯЦель. Изучить эффективность предоперационного 3-D моделирования на основе анализа данных мультиспиральной компьютерной томографии при выполнении лапароскопической спленэктомии по поводу первичной иммунной тромбоцитопении. Материал и методы. Пациентка, 55 лет с диагнозом идиопатическая тромбоцитопеническая пурпура, рецидивирующее течение. В течение 10 лет она наблюдалась и проходила неоднократные курсы консервативного лечения, принимала ежедневно до 60 мг преднизолона. Уровень тромбоцитов крови снижался ниже 30?109 /л. В связи с неэффективностью консервативного лечения была показана спленэктомия. Выполнена мультиспиральная компьютерная томография с болюсным контрастированием. На основе полученных данных в системе "Автоплан" была построена цветная 3-D модель области оперативного вмешательства. Система по планированию оперативного вмешательства объединяет медицинское оборудование, внутристационарную сеть архивирования и обмена данными с рабочими станциями врачей с возможностью использования на компьютерах и мобильных устройствах непосредственно в операционной. Пациентке выполнена лапароскопическая гибридная спленэктомия. Результаты. Согласно 3-D модели, у пациентки выявлен магистральный тип васкуляризации селезенки. Дистальная часть хвоста поджелудочной железы не доходила до ворот селезенки на 1,5 см. Добавочные селезенки и перипроцесс отсутствовали. Данные модели 3-D подтвердились интраоперационно и позволили выполнить лапароскопическую гибридную спленэктомию без технических трудностей прецизионно с минимальной кровопотерей. Послеоперационный период протекал без осложнений. Пациентка выписана на 5 сутки в удовлетворительном состоянии. Показатели уровня тромбоцитов достигли референтных значений (356?109 /л). Заключение. Предоперационное 3-D моделирование позволяет хирургу заранее планировать оперативное вмешательство с учетом знания индивидуальных топографо-анатомических особенностей области предстоящей операции. Знание индивидуальных особенностей васкуляризации селезенки и топографии поджелудочной железы в ее воротах позволяет прецизионно выделять и легировать сосуды, что повышает качество гемостаза, а также уменьшает вероятность травмы поджелудочной железы. Дооперационная визуализация добавочных селезенок повышает радикальность операции.Objectives. To explore the possibilities of preoperative 3D modelling and analysis system based on multislice computed tomography data, to evaluate its effectiveness in performing laparoscopic splenectomy for the primary immune thrombocytopenia. Methods. A female patient, (55 yrs) with the diagnosis of idiopathic thrombocytopenic purpura, recurrent course. For 10 years she had been observed and underwent the numerous courses of conservative treatment; she also took daily 60 mg of prednisolone. The blood platelet levels reduced below 30?109/l. The splenectomy was indicated due to the failure of conservative treatment. Multislice computed tomography with contrast bolus was performed. For preoperative planning a color 3D model of the surgical site was created on the basis of the obtained data in the "Autoplan" system. Systems giving the ability to plan surgical intervention combines the medical equipment, PACS system (picture archiving and communication system) available onsite advanced image-viewing workstations that can guide physicians; the ability to view images from various workstations via the network including the navigation enabling physicians to create the accurate and realistic models from stereo cameras, and to use computers as well as mobile computing devices directly in the operating room. The patient was underwent laparoscopic hybrid splenectomy. Results. According to the 3D model a main type of vascularization of the spleen was revealed. The distal part of the pancreatic tail did not reach (1.5 cm) the gate of the spleen. Accessory spleens and periprotsess were absent. The data of 3D model were confirmed intraoperatively and allowed performing a laparoscopic hybrid splenectomy without technical difficulties precisely with a minimal blood loss. The postoperative period was uneventful. The patient was discharged on the 5th day in a satisfactory condition. The parameters of platelet level have reached the reference values (356?109/l). Conclusion. Preoperative 3D modelling permits the surgeon to make pre-operative planning and provides him with important information on individual topographic and anatomic features in forthcoming operation sites. The information about the individual characteristics of the splenic vascularization and pancreatic topography in its gate lets to allocate and ligate vessels precisely, that improves the quality of hemostasis and also reduces the probability of the pancreatic injury. Preoperative visualization of accessory spleens increases the radicalism of the surgery

Возможности консервативного лечения пациентов с лимфедемой конечностей (обзор литературы)

The literature review describes various methods for treating patients with lymphedema of the extremities. Statistics show an increase in the incidence and disability of patients with this pathology. However, the possibilities of therapeutic measures in lymphedema are far from perfect.The analysis of literature data showed that the basis of treatment for lymphedema of the extremities is comprehensive conservative therapy with the use of pathogenetically grounded physical, mechanical, and medical methods. In complex schemes of conservative treatment for lymphedema, physiotherapy methods occupy a prominent place. The most common technique among them is regular combined decongestive therapy. This method is recognized by leading experts as the main one in treating patients with lower extremity lymphedema. Commitment of patients to treatment and their social and psychological counseling are of great importance. The choice of the volume and method of surgical intervention requires a difficult and individual assessment of pathological changes developing throughout the course of the disease.Despite certain improvements in treatment methods, lower extremity lymphedema is still an unsolved issue. The experience of most specialists involved in lymphedema treatment demonstrates a reasonable balance between basic conservative and surgical treatment methods. Undoubtedly, results of evaluation of these methods will improve the choice of an optimal technique for treating patients with lymphedema of the extremities. Представлен обзор литературных источников, посвященных различным методам лечения пациентов с лимфедемой конечностей. Статистические данные свидетельствуют о росте заболеваемости и инвалидизации пациентов с этой патологией. Вместе с тем возможности лечебных мероприятий при лимфедеме оставляют желать лучшего.Анализ литературных данных показал, что основу лечения лимфедемы конечностей составляют комплексные консервативные мероприятия, которые должны обеспечить применение патогенетически обоснованных физических, механических и медикаментозных методов. В комплексных схемах консервативного лечения лимфатических отеков значительное место занимают физиотерапевтические методы. Ведущим среди них является регулярная комплексная противоотечная терапия. Этот метод признается ведущими специалистами в качестве основного в лечении пациентов с лимфедемой. Большое значение имеют приверженность пациентов к лечению, их социальная и психологическая поддержка. Выбор объема и метода оперативного вмешательства требует осуществления трудной, индивидуальной оценки патологических изменений, развивающихся при заболевании.Несмотря на определенные достижения, результаты такого лечения далеки до удовлетворительных значений. Опыт большинства специалистов, занимающихся лимфедемой, свидетельствует о разумном балансе между базовой консервативной терапией и хирургическими способами лечения. Несомненно, результаты оценки этих методов позволят улучшить выбор оптимального метода лечения пациентов с лимфедемой конечностей.

ОЦЕНКА ЛИМФАТИЧЕСКОГО ОТЕКА НИЖНИХ КОНЕЧНОСТЕЙ ПО ДАННЫМ КОМПЬЮТЕРНОЙ ТОМОГРАФИИ

Lymphedema is a common disease, it is estimated that up to 10% of the population has it in varying degrees. Thus different methods are using in evaluating patients with lymphedema. Computed tomography allows to assess the condition and thickness of various layers of soft tissues, edema spread along the length of the limb and deeper spaces, objectify degree of edema and fibrotic changes in the skin and subcutaneous tissue, to obtain quantitative data of tissue density at any level and level of the limb. Comparison of clinical stage and CT data is not fully studied question. We examined 24 patients, made physical examination and lower limb MSCT. It was found that with an increase of the degree of edema increases limb volume, thickness of subcutaneous fat, increases the X-ray density of subcutaneous adipose tissue due to its edema and fibrosis. Thus, the use of MSCT saves physician's time for examination of patients with lymphedema and allows him to select the optimal treatment strategy.Лимфатический отек является широко распространенным заболеванием, считается, что до 10% населения подвержены ему в той или иной степени. При этом при оценке больных с лимфатическим отеком применяются разнообразные методики. Компьютерная томография позволяет оценить состояние и толщину различных слоев мягких тканей, распространение отека по длине конечности и в подфасциальные пространства, объективизировать степень отека и фиброзных изменений в коже и подкожной клетчатке, получить количественные данные о плотности тканей на любом уровне и участке конечности. Недостаточно изученным является вопрос сопоставления клинической стадии и данных компьютерной томографии. Обследованы 24 пациента, проводился физикальный осмотр и МСКТ нижних конечностей. Установлено, что с нарастанием степени отека увеличиваются объем конечности, толщина подкожной жировой клетчатки, возрастает рентгеновская плотность подкожной жировой клетчатки за счет ее отека и фиброзных изменений. Таким образом, применение МСКТ экономит время врача на обследование больных лимфедемой и позволяет выбрать оптимальную тактику лечения

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Pregnancy and Healthy Childbirth in a 37 Year-Old Patient with Diverticular Disease

Aim. To describe a clinical case of pregnancy and healthy labour in a young female patient with uncomplicated diverticular disease (DD).Key points. In recent years, DD is more frequently observed in younger patients. A 37-yo woman manifested the symptoms of periodic intense abdominal pain and constant abdominal discomfort. Colonic DD was diagnosed with irrigoscopy. A high-fibre diet, rifaximin-α at 400 mg twice a day for one week, once a month for six months, and topical anti-inflammatory therapy were prescribed. Clinical symptoms were eradicated upon the treatment. Unaware of pregnancy, the patient had another course of rifaximin-α at the second week of gestation, after which the therapy was stopped. Rifaximin-α, which has a poor intestinal absorption, did not affect the foetal development. A caesarean childbirth was healthy, the newborn was delivered on term with no complications (Apgar score 8).Conclusion. DD should be included in differential diagnosis for patients with non-specific symptoms (abdominal pain, bloating and discomfort), regardless of young age. No protocols are currently accepted for the DD management during gestation. In the clinical case reported, a patient having diverticular disease and a rifaximin-α therapy at an early term of gestation proceeded without complications for herself and the foetus

REGIONAL LASER THERAPY IN TREATMENT OF PATIENTS WITH STRANGULATED VENTRAL HERNIA

An analysis of treatment was made of 265 patients with strangulated hernia of the anterior abdominal wall. The patients were divided into main group (n=138) and control group (n=127). Nonstrain and conventional methods of hernioplasty and low-intensive laser radiation (LILR) were used for the patients of the first group. LILR wasn’t applied in the control group. The studied groups were statistically comparable on the basis of main disease, sex and age. Computed thermography was used in addition to standard methods of diagnostics in order to identify the wound complications in postoperative period. The application of low-intensive laser radiation for patients of main group allowed reducing the rate of development of local infectious complications in the area of plasty as compared with control group from 15,7 and 53,4% to 8,9 and 32,8% (

Experience of patient preparation for colonoscopy and colonic surgery with sodium phosphate

The article presents the experience of using sodium phosphate in patients, who were treated at the Clinic of Hospital Surgery of the Samara State Medical University Clinics in 2019.Purpose of the study: evaluate the quality of patient preparation for colonoscopy with sodium phosphate in surgical hospital environment. Material and methods. A total of 50 patients who were admitted for emergency indications to the Clinic of Hospital Surgery in 2019 were enrolled in the study. All patients were divided into two groups.The study included patients aged 24 to 69 years. The median age was 55.1 years in the treatment group and 56.2 years in the control group (p = 0.06). Men predominated in both groups: 16 (64%) in group 1 and 18 (72%) in group 2 (p = 0.08). The average time for submitting complaints about intestinal bleeding before seeking medical aid was 1.0 ± 0.70 days in the treatment group and 1.0 ± 0.35 days in the control group (p = 0.92). Group 1 included 25 patients, who were preparing for colonoscopy with sodium phosphate, Group 2 included 25 patients who were preparing for the examination with Macrogol.Results: the preparation quality was evaluated using the Boston Bowel Preparation Scale. Initially, the treatment and control groups did not have any statistically significant differences in all studied parameters. The colonoscopy identified the following nosologies. In Group 1, 9 patients had a diverticular disease of the colon; 4 – colon cancer; 12 patients continued treatment of grade 2–3 chronic internal hemorrhoids. In Group 2, the patients were distributed as follows: 10 patients were diagnosed with diverticular disease of the colon; 4 – colon cancer; 1 – an adenomatous polyp of the transverse colon and 10 patients had grade 2–3 chronic internal hemorrhoids. In addition, all patients filled out the questionnaire, which showed that the use of sodium phosphate is more convenient for the patient not only in terms of the dosage, but also due to relatively pleasant organoleptic properties. After examination of the colon, 45 patients received conservative treatment, five were operated following the colonoscopy and preoperative preparation.Conclusion: we believe that the quality of preparation of patients with intestinal bleeding with sodium sulphate and Macrogol does not differ, however, sodium sulfate is preferable because of its more pleasant organoleptic properties and the smaller volume of solution used

Activities of international, medical and humanitarian NGOs in Ukraine under martial law

As a result of Russia's full-scale military offensive on the territory of Ukraine, numerous international, non-governmental organizations have commenced providing assistance to the population through the implementation of different programs. Such assistance is manifested in various aspects, from humanitarian to financial. This article outlines the experience and legal basis for the operation of several international, non-governmental, medical and humanitarian organizations in Ukraine working under martial law imposed as a result of the war. To the purpose and objectives of the study, the work uses a combination of general and special methods of scholarly knowledge. The article uses the doctrinal provisions of science on the legal framework for the activities of international, medical and humanitarian, non-governmental organizations in Ukraine, as well as statistical data on the activities of public associations during the period of martial law. This study was conducted taking into account the experience of non-governmental organizations in other countries. The authors found that during the legal regime of martial law in Ukraine, international, non-governmental organizations such as Medecins Sans Frontieres, the International Committee of the Red Cross, and Oxfam play a leading role in providing humanitarian and medical assistance to war victims. These organizations play a key role in promoting democracy while helping to mitigate violence and the psychological trauma of war victims. It is the authors’ contention that such assistance furthers democratic governance, helps curb violence, and addresses the psychological trauma occasioned by the war