Follicular Occlusion Syndrome — a Possible Option of Follicular-Retension Origin of Pilonidal Sinus

Аim: to analyze and evaluate the clinical and morphological manifestations of pilonidal sinus disease (PSD) as a part of follicular occlusion syndrome (FOS).Materials and methods. In the Clinic of Coloproctology and Minimally Invasive Surgery, 80 patients with PSD underwent surgeries from November 2018 to December 2019: 62 (77.5 %) patients — with primary PSD, 18 (22.5 %) — with recurrence of the disease.Results. There were 80 patients, 6 patients (9.7 %) with primary and one (5.6 %) patient with recurrent cyst had concomitant manifestations of follicular occlusion syndrome. Thus, the frequency of combination of PSD with other variants of FOS course amounted to 8.8 %. Hidradenitis suppurativa of axillary and inguinal areas was found in 5 out of 7 patients. Acne conglobata, as one of the components of FOS, was noted in three patients. Dissecting cellulitis of the scalp was diagnosed in one patient. Follicular occlusion triad was observed in two patients. Follicular occlusion tetrad was not noted in any observation. All patients were treated with excision of the pilonidal sinus disease with local tissue-plasty of the defect. At present, no recurrences have been noted in any of the cases, and the mean follow-up time was 14 ± 5.6 months (6–27 months). PSD as a manifestation of follicular occlusion syndrome is characterized by a more cranial and more superficial location of the cavity in the sacrococcygeal region. According to the data of histologic examination of patients with FOS, the morphologic picture is identical with patients with isolated PSD. All patients with confirmed FOS have received pathogenetic local and conservative therapy. After the therapy remission of combined diseases is noted.Conclusion. Deroofing of the lining of the cavity, often used in dermatologic practice, along with complex treatment within the framework of multidisciplinary (together with a dermatologist) management of patients with FOS, looks promising

Использование интраоперационного нейромониторинга для определения вегетативных нервов малого таза при хирургическом лечении рака прямой кишки: обзор литературы и первичный опыт клиники

Introduction. Urogenital and anorectal functional disturbances associated with the pelvic autonomic nerve damage are common complications of rectal cancer surgery. the search for methods of intraoperative identification of the autonomic nerve plexus is currently one of the key tasks in modern surgery of rectal cancer. the purpose of our study is to evaluate the role of intraoperative neuromonitoring in rectal cancer surgery.Material and methods. In 2017 we performed intraoperative neuromonitoring during rectal cancer surgery in two cases. the superior hypogastric plexus and the inferior hypogastric plexus were identified and the pelvic autonomic nerve was preserved in both patients. urogenital and anorectal functional outcomes were assessed in the postoperative period.Results. Satisfactory functional outcomes in the late postoperative period and at the 12-month follow-up suggest that intraoperative neuromonitoring may be useful in identification and prevention of the pelvic autonomic nerve damage in patients with rectal cancer.Conclusion. This method would be difficult to use routinely for intraoperative identification of the autonomic nerve plexus but could be especially useful for the study of pelvic physiology. With further development, the method of intraoperative neuromonitoring could help discover a technique that will improve the surgical treatment of rectal cancer. Further research using intraoperative neuromonitoring is needed to more precisely determine its value in the preservation of urinary, anorectal and sexual function.Введение. Расстройство мочеполовых функций и анальная инконтиненция – частые осложнения хирургического лечения рака прямой кишки, которые связаны с повреждением вегетативных нервных стволов малого таза. Поиск методов интраоперационной идентификации вегетативных нервных сплетений – одна из задач современной хирургии рака прямой кишки.Цель исследования – оценить возможности интраоперационного нейромониторинга при хирургическом лечении рака прямой кишки.Материал и методы. В 2017 г. на базе клиники проведены 2 операции по поводу рака прямой кишки с интраоперационным нейромониторингом. Во время операций идентифицированы поясничные внутренностные нервы, гипогастральные нервы, нижние гипогастральные сплетения, выполнен запланированный объем оперативного лечения с сохранением элементов вегетативной нервной системы. В послеоперационном периоде проводилась оценка функционального состояния мочеполовой сферы, анальной континенции, пациентам проводились периодические исследования в соответствии с программой мониторинга колоректального рака.Результаты. Удовлетворительные функциональные результаты в позднем послеоперационном периоде и через 12 мес наблюдения позволяют говорить о том, что интраоперационный нейромониторинг при резекциях прямой кишки может быть использован для идентификации и предотвращения повреждения вегетативных нервных сплетений малого таза у пациентов с диагностированным раком прямой кишки.Заключение. В качестве интраоперационного метода определения вегетативных нервных сплетений данный метод в настоящее время сложно рассматривать как основной, но он имеет перспективы с точки зрения изучения физиологии малого таза. При дальнейшем развитии интраоперационного нейромониторинга можно будет получить методику, совершенствующую технические приемы оперативного лечения рака прямой кишки. Необходимо продолжить исследования с использованием интраоперационного нейромониторинга и определить его значение для сохранения мочевой, аноректальной и половой функций

Short-term results of ileal pouch anastomosis in early and late terms after urgent surgery for complicated ulcerative colitis

Aim of investigation. To estimate short-term results of ileal pouch anastomosis after urgent colon surgery at complicated ulcerative colitis. Material and methods. Two peer groups including 26 patients each after multi-stage surgical treatment were analyzed. In the first group of patients ileal pouch was created in less than 12 month after primary resection operation, in the second - in more than 12 months. Results. No statistically significant differences between groups were found by any of short-term result scores (p>0.05), including operation time (p=0.48) and volume of blood loss (p=0.88). No significant differences in morbidity rate were found at any stage, including the rate of ileal pouch-anal anastomosis incompetence (p=1.0). Conclusions. Technically ileal pouch anastomosis can be created both several months or several years after colectomy. Time span from subtotal colectomy performance before ileal pouch does not influence short-term treatment results

Short-term results of ileal pouch anastomosis in early and late terms after urgent surgery for complicated ulcerative colitis

Aim of investigation. To estimate short-term results of ileal pouch anastomosis after urgent colon surgery at complicated ulcerative colitis. Material and methods. Two peer groups including 26 patients each after multi-stage surgical treatment were analyzed. In the first group of patients ileal pouch was created in less than 12 month after primary resection operation, in the second - in more than 12 months. Results. No statistically significant differences between groups were found by any of short-term result scores (p>0.05), including operation time (p=0.48) and volume of blood loss (p=0.88). No significant differences in morbidity rate were found at any stage, including the rate of ileal pouch-anal anastomosis incompetence (p=1.0). Conclusions. Technically ileal pouch anastomosis can be created both several months or several years after colectomy. Time span from subtotal colectomy performance before ileal pouch does not influence short-term treatment results

Safety and efficacy of total colectomy with D3 lymph node dissection at colorectal cancer, developed at inflammatory bowel diseases (case control study)

Aim of investigation. To compare results of radical surgery in IBD-associated colorectal cancer (IBD-CRC) and sporadic colorectal cancer (spCRC) patients. Material and methods. The main group included retrospective cases of IBD-CRC with total colectomy and D3 lymph node (LN) dissection. The control group included matched cases of spCRC in 1:3 ratio according to localization and stage. Results. Overall 6 IBD-CRC and 18 spCRC patients were matched. IBD-CRC patients had longer operation time (313±37 vs 240±16 min, p=0.05), while there was no significant difference in mean volume of blood loss and postoperative stay duration (383±145 and 186±29 ml, p=0.24; 15.7±3.2 and 14.1±0.9 days, p=0.5 respectively). IBD-CRC patients spent longer time in ICU than spCRC (2.3±0.6 and 1.17±0.2 days, p=0.02) and had later bowel peristalsis restoration (2.0±0.4 and 1.3±0.1 days, p=0.02), however, time to first gas and stool discharge via stoma didn’t differ (2.5±1.4 and 2.1±0.6 days, p=0.5; 4.2±3.4 and 2.4±0.7 days, p=0.3). Tumor grade, histological type and adenoma rate didn’t differ between groups. Average number of involved LN in IBDCRC and spCRC was 39±16 and 30±5 (p=0.6). The rate of metastatic LN was 33.3% in both groups. The mean follow-up time was 27.3±5.3 months. Distant metastases were detected in 33.3% and 16.7% of IBD-CRC and spCRC cases respectively (p=0.4), without local recurrence in both groups. Conclusion. Tumor and LN characteristics in spCRC and IBD-CRC were similar, therefore radical surgery with extended LN dissection is recommended for IBDCRC patients

Intraoperative neuromonitoring of pelvic autonomic nerves during surgigal treatment of colorectal cancer: a review of the literature and the initial experience of our clinic

Introduction. Urogenital and anorectal functional disturbances associated with the pelvic autonomic nerve damage are common complications of rectal cancer surgery. the search for methods of intraoperative identification of the autonomic nerve plexus is currently one of the key tasks in modern surgery of rectal cancer. the purpose of our study is to evaluate the role of intraoperative neuromonitoring in rectal cancer surgery.Material and methods. In 2017 we performed intraoperative neuromonitoring during rectal cancer surgery in two cases. the superior hypogastric plexus and the inferior hypogastric plexus were identified and the pelvic autonomic nerve was preserved in both patients. urogenital and anorectal functional outcomes were assessed in the postoperative period.Results. Satisfactory functional outcomes in the late postoperative period and at the 12-month follow-up suggest that intraoperative neuromonitoring may be useful in identification and prevention of the pelvic autonomic nerve damage in patients with rectal cancer.Conclusion. This method would be difficult to use routinely for intraoperative identification of the autonomic nerve plexus but could be especially useful for the study of pelvic physiology. With further development, the method of intraoperative neuromonitoring could help discover a technique that will improve the surgical treatment of rectal cancer. Further research using intraoperative neuromonitoring is needed to more precisely determine its value in the preservation of urinary, anorectal and sexual function

Creation of high-energy phonons by four-phonon processes in anisotropic phonon systems of HeII

The problem of the creation of high-energy phonons (h-phonons) by a pulse of low-energy phonons (l-phonons) moving from a heater to a detector in superfluid helium, is solved. The rate of h-phonon creation is obtained and it is shown that created h-phonons occupy a much smaller solid angle in momentum space, than the l-phonons. An analytical expression for the creation rate of h-phonon, along the symmetry axis of a pulse, are derived. It allows us to get useful approximate analytical expressions for the creation rate of h-phonons. The time dependences of the parameters which describe the l-phonon pulse are obtained. This shows that half of the initial energy of l-phonon pulse can be transferred into h-phonons. The results of the calculations are compared with experimental data and we show that this theory explains a number of experimental results. The value of the momentum, which separates the l- and h-phonon subsystems, is found

Four- and three-phonon scattering in isotropic superfluid helium

We analyse the important role of four-phonon processes (4pp) in isotropic phonon systems of superfluid helium. The matrix elements and the rate of four-phonon processes are calculated. Special consideration is given to the 4pp in the momentum range where three-phonon processes are allowed. In this momentum range, we show that the 4pp scattering rate, at small angles, is equal to the scattering rate due to three-phonon processes. Then we show that the coefficient of first viscosity of superfluid helium is caused by two processes, the first is due to the transverse relaxation caused by many three-phonon processes and the second is due to four-phonon processes. The relaxation time that governs the viscosity is obtained from the sum of the rates from these two processes. The temperature dependence of the attenuation coefficient of a pulse of high-energy phonons in He II, due to scattering with thermal phonons, is also calculated. The theoretical results are compared with experimental data and found to be in good agreement