Carotid endarterectomy in Russia. What if current guidelines do not answer difficult questions?

This literature review covers the publications of Russian vascular surgeons in recent years and deals with debatable issues of carotid surgery, including: 1. What is the best technique for carotid endarterectomy (CEA)? 2. Why does restenosis of the internal carotid artery (ICA) develop and how to eliminate it? 3. How to operate on bilateral ICA stenosis? 4. Should carotid glomus be preserved? 5. Is CEA safe in the acute phase of cerebrovascular accident (CVA)? 6. Is CEA safe in elderly patients? 7. How to operate on patients with combined internal carotid and coronary artery involvement? The evidence presented in this publication makes it possible to draw the following conclusions: 1. When choosing a CEA technique, the classical technique with patch angioplasty should be avoided due to the high risk of ICA restenosis. 2. To eliminate ICA restenosis, carotid angioplasty with stenting (CAS) should be used. When performing primary CEA with ICA transposition over the hypoglossal nerve, reCEA can be used 3. In the absence of contraindications, bilateral ICA stenosis can be operated at the same time using CEA. 4. CEA with carotid glomus preservation is the operation of choice in the treatment of patients with hemodynamically significant ICA stenosis due to the elimination of the risks of postoperative hypertension and the formation of hemorrhagic transformation. 5. If there are indications for cerebral revascularization in the most acute period of stroke, CEA should be abandoned in favor of CAS. 6. In old age, CAS is the safest treatment strategy. 7. In the presence of a combined ICA and coronary involvement, the choice of treatment tactics should be carried out only by a multidisciplinary commission, taking into account the risk stratification of adverse cardiovascular events

Внедрение лапароскопических технологий в хирургию колоректального рака на примере регионального онкологического центра

Objective: to evaluate complication rate, surgical operation time, mortality rate implementing minimally invasive surgical technique in colon and rectal surgery — a single cancer’s center experience.Matherials and methods. 124 patients underwent surgery in the period from 2016 to 2018 using laparoscopic technique for colorectal cancer. All patients were divided on 3 equal groups, depending on the time required to master laparoscopic technique: group A (1—40 procedure), group B (41—80 procedure) and group C (81—124 procedure). Outcome measures included operation time, mortality rate, readmission and postoperative complication rates, number of lymph nodes removed and time of impatient care.Results. Main outcome variables (operation time, number lymph nodes removed, time of impatient care, mortality rates, postoperative complication rates) reach a plateau in the learning curve after 54 operation. The study showed that the incidence of postoperative complications in all groups was 11.4 %, while the significantly high level of complications was in group A — 17.5 % (p = 0.023). Postoperative mortality in groups A and B was 2.5 % and 2.5 %, respectively.Conclusion. It is shown that the introduction of minimally invasive technologies into colorectal cancer surgery is relatively safe and possible under the given conditions, while the time of mastering the technique is comparable with the data available in the literature.Цель исследования — оценить частоту осложнений, время операции и летальность при внедрении минимально инвазивных хирургических технологий в хирургию колоректального рака на примере регионального онкологического центра.Материалы и методы. Проведен ретроспективный анализ 124 пациентов, оперированных минимально инвазивным доступом по поводу колоректального рака. В зависимости от времени освоения хирургической технологии все пациенты были разделены на 3 группы: А (операции с 1-й по 40-ю), В (с 41-й по 80-ю) и С (с 81-й по 124-ю). Анализировали следующие параметры: количество удаленных лимфатических узлов, частоту осложнений, летальность и продолжительность пребывания пациента в стационаре. Результаты. Достижение уровня плато основных анализируемых показателей наступило после 54-го вмешательства. Как показало исследование, частота послеоперационных осложнений во всех группах составила 11,4 %, при этом достоверно высокий уровень осложнений был в группе A — 17,5 % (p = 0,023). Послеоперационная летальность имела место в группах A и B — 2,5 и 2,5 % соответственно.Выводы. Внедрение минимально инвазивных технологий в хирургию колоректального рака относительно безопасно и возможно в условиях регионального онкологического стационара. Кривая обучения в региональной больнице сопоставима с данными, представленными в источниках литературы

Predictors of rethrombosis and death in patients with COVID-19 after lower limb arterial thrombectomy for acute ischemia

Aim. To identify predictors of rethrombosis and death in patients with coronavirus disease (COVID-19) after thrombectomy for acute lower limb ischemia.Material and methods. For the period from April 2020 to January 2022, 189 pa tients with acute arterial lower limb thrombosis and acute lower limb ischemia were included in this study. In all cases, a positive polymerase chain reaction test for SARS-CoV-2 was obtained. According to chest multislice computed tomography, bilateral multisegmental pneumonia was identified as follows: 76 patients — grade 2 (25-50% of lung tissue involvement); 52 patients — grade 3 (50-75%); 61 patients — grade 4 (>75%). Breathing was carried out as follows: in 88 patients — spontaneous; in 42 — with oxygen administration by nasal cannula; 26 — non-invasive ventilation; 33 had artificial ventilation. All acute arterial thromboses developed within the hospital at 4,5±1,5 days after hospitalization. The time between the onset to diagnosis verification was 27,8±5,0 min. The revascularization strategy was established by a multidisciplinary team meeting. The interval between the development of acute ischemia symptoms and surgery was 45,9±6,3 minutes. Thrombectomy was performed according to the standard technique, under local and/or intravenous anesthesia, using 3F-7F Fogarty catheters.Results. Retrombosis developed in 80,4% of cases 6,4±5,1 hours after surgery. In 59,8% of cases, retrombectomy turned out to be ineffective and the patient underwent limb amputation. In 65,6% of patients, a death was established due to multiple organ dysfunction. Among them, limb amputation was performed in 103 patients. Binary logistic regression identified following predictors of retrombosis/ death: age over 70 years (odds ratio (OR), 30,73; 95% confidence interval (CI), 11,52-33,7), obesity (OR, 15,53; 95% CI, 6,41-78,19), diabetes (OR 14,21; 95% CI, 5,86-49,21), vasopressor support (OR 8,55; 95% CI, 4,94-17,93), mechanical ventilation (OR 7,39; 95% CI, 4,81-16,52).Conclusion. Predictors of retrombosis and death in patients with COVID-19 after lower limb arterial thrombectomy are age over 70 years, obesity, diabetes, vasopressor support, and mechanical ventilation

Сравнительная характеристика различных способов изолированной химиоперфузии печени

Background. Metastatic liver injury is a  distinct oncological problem, irrespective of primary malignancy. Resection surgery is not always feasible in such patients. Isolated liver chemoperfusion is a promising treatment option in multiple small-focal metastatic organic lesions. This technique is technically complex, which limits its broader evaluation and adoption in clinical practice. The diversity of isolated liver chemoperfusion techniques does not allow an adequate assessment of world experience and requires further research. The important considerations with introducing isolated liver chemoperfusion are: an optimal surgical technique, liver isolation control method, as well as physiological arterial and portal blood flow maintenance.Materials and methods. A total of 21 patients were surveyed over June 2020 — December 2021. The patients were divided into 3 prospective cohorts: A) arteriocaval chemoperfusion, midline laparotomy access, technical-guided liver isolation, B) arteriocaval chemoperfusion, “in J laparotomy” access, ICG-guided liver isolation, C) arterio-porto-caval chemoperfusion, “in J laparotomy” access, ICG-guided liver isolation. A procedure’s tolerance was assessed with: the duration of surgery, postoperative ICU bed-days, total postoperative bed-days, hepatic cytolysis rates, chemotherapy side-effects severity.Results and discussion. The duration of surgery shortened with “in J laparotomy”. Haemotoxicity did not differ between cohorts A and B, albeit appearing significantly lower in cohort C. The cytolytic syndrome duration statistically significantly reduced in C vs. A and B cohorts.Conclusion. All the isolated liver chemoperfusion techniques employed are patient-safe. In ICG-guided liver isolation, the agent leakage into systemic blood flow is less likely, indicating a lower haemotoxicity. Arterioportal isolated chemoperfusion is more physiological compared to other techniques, thus facilitating lower hepatotoxicity. The use of “in J laparotomy” significantly reduces liver mobilisation and vascular cannulation times. Введение. Метастатическое поражение печени является отдельной проблемой онкологии независимо от первичного злокачественного заболевания. Резекционная хирургия не всегда осуществима у таких пациентов. При множественном мелкоочаговом метастатическом поражении органа многообещающим является лечение методом изолированной химиоперфузии печени. Эта методика технически сложна, что ограничивает её изучение и внедрение в широкую клиническую практику. Разнообразие способов проведения изолированной химиоперфузии печени не позволяет однозначно оценивать накопленный мировой опыт и требует дальнейшего изучения. В процессе внедрения изолированной химиоперфузии печени важными вопросами являются: оптимальная хирургическая техника, способ контроля изоляции печени, поддержание физиологичного артериального и портального кровотока.Материалы и методы. В исследовании принял участие 21 пациент в период с июня 2020 по декабрь 2021 г. Пациенты разделены на 3 проспективные группы: A) артерио-кавальная химиоперфузия печени, доступ через срединную лапаротомию, технический контроль полноты изоляции печени, B) артерио-кавальная химиоперфузия печени, доступ через J-лапаротомию, ICG-контроль полноты изоляции печени, C) артерио-порто-кавальная химиоперфузия печени, доступ через J-лапаротомию, ICG-контроль полноты изоляции печени. С целью оценки переносимости процедуры оценивались: длительность операции. послеоперационный койко-день в  отделении интенсивной терапии, общий послеоперационный койко-день, показатели печеночного цитолиза, выраженность побочных эффектов химиопрепарата.Результаты и обсуждение. Длительность операции сократилась с применением J-лапаротомии. Выраженность гематологической токсичности не различалась между группами A и B, однако значительно ниже в группе С. Длительность цитолитического синдрома статистически значимо снизилась в группе C при сравнении с группами A и B.Заключение. Все примененные нами способы изолированной химиоперфузии печени безопасны для пациента. При контроле изоляции печени с применением ICG снижается вероятность утечки химиопрепарата в системный кровоток, что показывает меньшую гематологическую токсичность. Проведение артерио-портальной изолированной химиоперфузии физиологичнее других примененных способов и способствует снижению гепатотоксичности. Применение J-лапаротомии значительно сокращает время мобилизации печени и канюляции сосудов.

IATROGENES OF MANIPULATOR CHARACTER IN ABDOMINAL SURGERY

The authors analyzed the data of 281 cases of iatrogenes of manipulator character in abdominal surgery in order to investigate the circumstances and character of origin. There were 187 cases of operative confirmation and 84 cases of unintentional intraoperative retained foreign bodies. It was detected, that primary planned intervention of higher category of complexity should be related to the high risk group of the development of the operative confirmation. Retained foreign bodies with soft fabric base were diagnosed in early postoperative period as the result of the beginning of postoperative complications. The retained foreign bodies with tough backer material as a rule didn’t cause the complications in early postoperative period. They were diagnosed in long-term postoperative period in majority of cases

Implementation of laparoscopic approach in colorectal cancer surgery — a single center’s experience

Objective: to evaluate complication rate, surgical operation time, mortality rate implementing minimally invasive surgical technique in colon and rectal surgery — a single cancer’s center experience.Matherials and methods. 124 patients underwent surgery in the period from 2016 to 2018 using laparoscopic technique for colorectal cancer. All patients were divided on 3 equal groups, depending on the time required to master laparoscopic technique: group A (1—40 procedure), group B (41—80 procedure) and group C (81—124 procedure). Outcome measures included operation time, mortality rate, readmission and postoperative complication rates, number of lymph nodes removed and time of impatient care.Results. Main outcome variables (operation time, number lymph nodes removed, time of impatient care, mortality rates, postoperative complication rates) reach a plateau in the learning curve after 54 operation. The study showed that the incidence of postoperative complications in all groups was 11.4 %, while the significantly high level of complications was in group A — 17.5 % (p = 0.023). Postoperative mortality in groups A and B was 2.5 % and 2.5 %, respectively.Conclusion. It is shown that the introduction of minimally invasive technologies into colorectal cancer surgery is relatively safe and possible under the given conditions, while the time of mastering the technique is comparable with the data available in the literature

Integration of data on the soils of Russia, Belarus, Moldova, and Ukraine into the soil geographic database of the European Community

The results of an international project aimed at the development of the European Soil Geographic Database for the territories of Russia, Belarus, Moldova, and Ukraine are discussed. For the first time, unified European standards for soil description and classification have been applied for a vast territory from the western boundary of the former Soviet Union to the Far East region of Russia, and a corresponding soil database has been developed. This database makes it possible to perform a simultaneous analysis of land resources and develop land-use policy, agricultural monitoring, and the assessment of environmental quality on a common basis. The geographic part of the database includes a soil map encompassing more than 40 000 soil polygons. The attribute database includes a comprehensive analytical characterization of more than 400 soil reference pro- files. Special attention is paid to the correlation between national soil classifications, mapping units used in the unified European Soil Geographic Database, and a system of soil units accepted in the World Reference Base for Soil Resources

Микроволновой способ экстракции биологически активных веществ (БАВ) из растительного сырья сахарным сиропом

Як відомо, простий цукровий сироп (Sirupus Sachari Simplex) у фармацевтичній практиці є одним з інгредієнтів складних сиропів і використовується в якості смакового коригента і базового розчинника деяких екстрактивних і хімічних речовин, в основному в дитячих лікарських формах (сиропи солодки, алтейний, шипшини, ревеневий, пертусин та ін.). Проте, крім складності виготовлення складних сиропів, вони протягом технологічного процесу втрачають свої властивості консерванта, які створюються додаванням простого цукрового сиропу, тому необхідно вводити інші консерванти, що небажано, особливо для дитячих лікарських форм. Так, до сиропу солодки додають 10 % 900 етанолу в якості консерванту.Developed technological process of extraction BASS from a digister by simple saccharine syrup. The of principle flow-chart of microwave technology of production of fitosiropov and chart of the vehicle providing is offered.Разработан технологический процесс экстракции БАВ из растительного сырья простым сахарным сиропом. Предложена принципиальная блок-схема микроволновой технологии производства фитосиропов и схема аппаратного обеспечения

Case of successful treatment of a patient with ischemictracheoesophageal and tracheopleural fistulas after a mckeown hybrid esophagectomy

The occurrence of tracheal fistulas of ischemic genesis combined with the failure of esophagogastroanastomosis and the communication between them is a rare and formidable complication after esophagectomy with mediastinal lymphadenectomy due to its anatomical position and extensiveness. However, it is insufficiently documented in the literature, both in terms of treatment and in terms of its causes. This observation aims to demonstrate the rare cause of this complication and the atypical successful treatment. In this case, a patient with squamous cell carcinoma G2 of the middle third of the esophagus and TNM stage cT3NxM0. On the McKeown thoracoscopic-laparotomy esophagectomy intraoperatively a short arterial vessel with a diameter of about 3 mm, which passed through the paracancerous infiltration and supplied blood to the esophagus and trachea revealed. The vessel was not isolated from the infiltrate, but was clipped and crossed between the aorta and infiltrate to maintain surgery ablastic. On the 7th day after the operation the insolvency of esophagogastroanastomosis, the fistula of the trachea with mediastinum and the communication between the leak of esophagogastroanastomosis and the fistula of the trachea were diagnosed. We consider this combination as a special case of esophagogastroanastomosis fistula, complicated by the communication between the right pleural cavity and pneumothorax. According to our experience, partial leak of esophagogastroanastomosis successfully heals by secondary tension within 10–15 days against the background of cervicotomic wound drainage and feeding through a nasointestinal tube. In this case there was a leak of saliva in the mediastinum and its penetration into the lumen of the trachea and the right pleural cavity. Surgical diversion of the fistula and stenting of the trachea were considered, but not applied, as the fistula in our opinion was controlled, but the aggressive content of the gastric conduit prevented healing. The patient was on assisted lung ventilation with minimal pressure support and inflow increased oxygen fractio. For this reason, we considered the best stenting of the esophagogastroanastomosis leak area to be covered with a stent in order to stop the aggressive content of the gastric stem from entering the fistula, which led to the successful treatment of the developed severe complication. It should be noted that this method of treatment may be ineffective in patients who need pressure support during ventilation