Endoluminal prolonged endoscopic vacuum-assisted closure therapy in the treatment of patients with perforation of the thoracic segment of the esophagus

Departament Chirurgie №1, Departament Endoscopie, Spitalul Aleksandrovsky, St. Petersburg, Federația Rusă, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Perforația esofagului este un eveniment care pune în pericol viața. Tratamentul chirurgical presupune operații de urgență și acestea adesea sunt asociate cu un risc ridicat de complicații postoperatorii. In cazul asocierii mediastinitei mortalitatea este inalta - 40-80%. Principalele cauze ale letalitatii sunt mediastinita, empiemul pleural, complicatile septice. Căutarea unor metode eficiente de corectare a complicațiilor postoperatorii este o problemă stringentă. Material şi metodă: Sub supravegherea noastră în perioada aprilie-mai 2019, au fost trei pacienți cu perforații al segmentului toracic al esofagului.Tuturor pacientilor a fost aplicat tratamentul endoscopic vacuum-asistat (E-VAC). Pentru crearea presiunii negative intraluminale în zona insuficientii suturilor si la nivelul perforării esofagului, a fost utilizată o constructie constând din sonda nasogastrica cu un burete poliuretanic fixat în portiunea distală. Poziționarea acestei construcții în esofag a fost efectuată sub control endoscopic; pacientul a fost supus unei anestezii intravenoase. Nivelul țintă al presiunii negative a fost de 100-150 mmHg. Buretele este înlocuit la fiecare trei-cinci zile. Rezultate: În urma tratamentul endoscopic vacuum-asistat a avut loc inchidera completa a defectului esofagian, manifestările mediastinitei si empiemului pleural au fost cupate. Durata tratamentului spitalicesc a fost în medie 25 de zile. Concluzii: În cazul insuficientei suturilor esofagului operat sau a perforatilor esofagiene, pentruprevenirea patrunderii in mediastin și cavitatea pleurală a sucurilor digestive și a alimentelor; crearea condiților favorabile pentru stimularea proceselor de reparație în zona afectata tratamentul endoscopic vacuum-asistat poate fi recomandată pentru utilizarea pe scară largă.Introduction: Perforation of the esophagus is a life-threatening situation. Surgical treatment demand immediate surgery and is often accompanied by the high risk of the postoperative complications. Mortality, according to different authors, exceeds 80%. The main causes of death are progressive mediastinitis, empyema and sepsis. The searching of effective ways of correcting postoperative complication are a current problem. Material and methods: Under our supervision from April to May 2019, there were three patients with perforations of the thoracic segment of the esophagus. All patients received endoscopic vacuum-assisted treatment (e-vac). For the creation of negative intraluminal pressure at the level of perforation of the esophagus, a construction consisting of nasogastric probe with a polyurethane sponge was used. The positioning of this construction in the esophagus was carried out under endoscopic control; the patient underwent intravenous anesthesia. The target level of negative pressure was 100-150 mmHg. Spongу is replaced every three to five days. Results: Following the endoscopic vacuum-assisted treatment, the complete closure of the esophageal defect took place; the manifestations of mediastinitis and pleural empyema were cupped. The duration of hospital treatment was on average 25 days. Conclusions: in case of insufficiency of the suture of the operated oesophagus or esophageal perforations, for prevention of penetration into the mediastinum and pleural cavity of digestive juices and food, creating favorable conditions for stimulating the repair processes in the affected area, endoscopic vacuum-assisted treatment can be recommended for widespread use

Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe†‡

OBJECTIVES To conduct a survey across European cardiac centres to evaluate the methods used for cerebral protection during aortic surgery involving the aortic arch. METHODS All European centres were contacted and surgeons were requested to fill out a short, comprehensive questionnaire on an internet-based platform. One-third of more than 400 contacted centres completed the survey correctly. RESULTS The most preferred site for arterial cannulation is the subclavian-axillary, both in acute and chronic presentation. The femoral artery is still frequently used in the acute condition, while the ascending aorta is a frequent second choice in the case of chronic presentation. Bilateral antegrade brain perfusion is chosen by the majority of centres (2/3 of cases), while retrograde perfusion or circulatory arrest is very seldom used and almost exclusively in acute clinical presentation. The same pumping system of the cardio pulmonary bypass is most of the time used for selective cerebral perfusion, and the perfusate temperature is usually maintained between 22 and 26°C. One-third of the centres use lower temperatures. Perfusate flow and pressure are fairly consistent among centres in the range of 10-15 ml/kg and 60 mmHg, respectively. In 60% of cases, barbiturates are added for cerebral protection, while visceral perfusion still receives little attention. Regarding cerebral monitoring, there is a general tendency to use near-infrared spectroscopy associated with bilateral radial pressure measurement. CONCLUSIONS These data represent a snapshot of the strategies used for cerebral protection during major aortic surgery in current practice, and may serve as a reference for standardization and refinement of different approache

GoLoco motif proteins binding to Gαi1: insights from molecular simulations

Molecular dynamics simulations, computational alanine scanning and sequence analysis were used to investigate the structural properties of the Gαi1/GoLoco peptide complex. Using these methodologies, binding of the GoLoco motif peptide to the Gαi1 subunit was found to restrict the relative movement of the helical and catalytic domains in the Gαi1 subunit, which is in agreement with a proposed mechanism of GDP dissociation inhibition by GoLoco motif proteins. In addition, the results provide further insights into the role of the “Switch IV” region located within the helical domain of Gα, the conformation of which might be important for interactions with various Gα partners

ECOLOGICAL APPROACHES OF AGRO-RECREATIONAL LAND USE

The article discusses the land-use problem of mountain and semi-desert landscapes of Dagestan caused by the need to improve the ecologization of traditional pastures as well as perspective tourism and recreational land use. Aim. A comprehensive geographic study of land use in the republic is crucial for the formation of ecologically sustainable distillation and nomad livestock and tourist-recreational land use on the natural, zonal and high-belt mountain-semi-desert landscapes that are not fully developed and are not suitable for farming. Discussion. Ecological and economic effects are revealed due to the combined use of semi-desert-mountain pastures and tourist-recreational areas represented by the population carryng capacity, the ecologization of pasture land use and a significant increase in the total livestock production. Improved combined interzonal use of lands with different natural rhythms of vegetation development contributes, first of all, to maintaining the equilibrium and integrity of the regional ecological system; secondly, to the ecological orientation of pasture-livestock and tourist-recreational land use; and thirdly, to the restoration and the functioning of the quality of natural semi-desert and mountain pasture lands. Conclusion. Ecological and landscape improvement within mountain pasture land use is proposed on the basis of the ecological and economic efficiency of the annual cycle of high-altitude sheep keeping with the regular change of pasture lands of different productivity levels by different sex and age groups of pastured livestock

Minimally invasive methods of local treatment for colorectal cancer liver metastases: state-of-the art (a review of literature)

The paper reviews the data available in modern Russian and foreign literature on the existing minimally invasive methods of local exposure of colorectal cancer liver metastases, which include ablation procedures (radiofrequency ablation, laser thermal ablation, and cryoablation), stereotactic radiotherapy and radiosurgery, as well as X-ray endovascular procedures (chemoinfusion, chemoembolization, and radioembolization). The characteristics of some treatment options and a surgical procedure, as well as those of each other were compared

Complex forms of choledocholithiasis: modern approaches of the treatment

Departament Chirurgie №1, Departament Endoscopie, spitalul Aleksandrovsky, St. Petersburg, Rusia, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: O problema actuală și nerealizată a chirurgiei moderne este coledocholitiaza, frecvență cărei în colelitiază conform diferitor autorilor variaza de la 10% la 23%.Operatile de urgenta pentru coledocholitiaza, sint însoțite de un număr mare de complicații, iar rata mortalității atinge 15-22%.Tratamentul pacienților cu forme dificile de coledocholitiază este o sarcină actuala, destul de complexă și necesită o abordare strict individualizată în alegerea tacticii tratamentului. Material şi metodă: In anumite circumstanțe, utilizarea metodelor standard este ineficientă în tratamentul coledocholitiazei și apare necesitatea utilizarii unor metode terapeutice complexe sau a tehnicilor endobilare minimal invazive. O metodă simplă și eficientă de tratare a calculilor cu dimensiuni mai mari de 15 mm sau în cazul calculilor aflați mai sus de strictura căilor biliare este dilatarea mecanică cu balotului endoscopic de înaltă presiune urmată de litoextracție. În cazul insuccesului se efectuează coledoscopia retrogradă cu litotripsie intraluminală laser-asistata. Coledochoscopia se realizează utilizând sistemul de vizualizare directă SpyGlass®. În cazurile pacientilor cu anatomie alterata (stomac operat), când canularea papilei duodenale principale este imposibila; accesul se efectueaza transhepatic sau laparoscopic prin coledotomie cu litoextratie si/sau litotripsie laser-asistată. Rezultate și concluzii: Utilizarea tehnicilor endobilare minimal invazive la pacienții cu forme dificile de coledocholitiază îmbunătățește semnificativ rezultatele tratamentului si reduc trauma operatorie.și in comparație cu intervențiile chirurgicale tradiționale, sunt însoțite de un procent mic de complicații.Introduction: The relevant and still not completely solved problem of modern surgery is the choledocholithiasis, the frequency of which in cholelithiasis is, according to different authors, from 10% to 23% .The surgery of choledocholithiasis, which are specially carried out in the emergency, are followed by a large number of complications, and lethality reaches 15-22%. Treatment of patients with complex forms of choledocholithiasis represents difficult and relevant tasks, and demands strictly individualized approach to the choice of tactics of the carried-out treatment. Material and methods: Endoscopic surgery is now the "gold standard" in the treatment of choledocholithiasis. In most situations, endoscopic sphincterotomy in a combination of a lithoextraction with a basket and/or a balloon catheter is sufficient for the achievement of effect. A simple and effective method of treating "large stones" of 15 mm in size or larger or in the presence of stones above the structure of the bile ducts is the use of mechanical lithotripsy and/or endoscopic balloon dilation with a high-pressure balloon followed by lithoextraction. However, if this does not help, a retrograde choledochoscopy with laser endoluminal lithotripsy is performed. In cases of the changed anatomy when it is difficult to reach the zone of the major duodenal papilla, transhepatic access or laparoscopically assisted cholangioscopy with lithoextraction or with laser lithotripsy is used. Results and conclusions: The use of minimally invasive endobiliary technologies in patients with complex forms of choledocholithiasis allows for stage treatment to improve significantly the results of the treatment and reduces the number of postoperative complications

Clinical Analyses of Efficiency of Multicomponental, Vitreoretinal Surgery of Eye Trauma

Eye trauma is one of the leading causes of blindness and low vision in young working age people. It gives this particular group of diseases a special social significance. The absence of a universal surgical treating tactic is explained by the variety of traumatic agents and the various types of injuries. Penetrating wounds with the introduction of a foreign body, accompanied by detachment of the retina, vascular membrane, hemorrhagic and infectious complications are the most difficult in the clinical plan.Material and methods: 103 with penetrating eye injuries were operated during the period from 2015 to 2017. 29 of them were involving the introduction of foreign bodies, which were removed at different times: 18 eyes (62 %) — at 7–10 days, 8 eyes 27.5 %) — 14–28 days after injury and 3 eyes (10.3 %) — more than 1 month. In all cases, subtotal vitrectomy 25G (68.9 %) was performed, in some cases, 23-hedge vitrectomy was preferred (31 %) due to pronounced fibro-proliferative changes in the vitreous body. In the case of a foreign body impacted into the shells with dimensions greater than 4 mm, the real cavity was tamped with PFOS.Results. The adherence of the detached retina was achieved in 14 cases, adherence of the choroid — 4 cases. Uveitis was observed in 5 cases, ophthalmic hypertension in 12 patients in the early postoperative period. Hypertension was compensated by using the antihypertensive regimen. 5 patients at the time of hospitalization had a Vis = 0, the operation was of a diaphragm-preserving nature, since a foreign body that was not removed was the cause of the development of subatrophy of the eyeball in 16 % of cases. The remaining patients had stable, positive dynamics of visual functions in the postoperative period.Conclusion: Surgery tactics for extensive eye injuries are individual, and the amount of intervention depends largely on the parameters of the traumatic agent, so planned surgery is preferable to emergency because it allows for detailed preoperative examination and to get valuable information about the condition of the eye. The exceptions are injuries with symptoms of acute endophthalmitis. Multi-unit operations provide optimal conditions for the preservation of the eye as an organ and contribute to the restoration of visual functions