ORIGINAL ARTICLES
Background: Cutaneous melanoma is an extremely aggressive disease with an unpredictable prognosis. Even among patients with similar tumor parameters and extent of surgical treatment, survival may vary. The extent of surgical resection of primary cutaneous melanoma is well-established, and a BRAF mutation in the tumor is an unfavorable prognostic factor for patient survival. The mutation presence is mainly used as a marker for prescribing targeted therapy. The impact of the extent of surgery and the method for restoring a tissue defect on survival of patients with similar stages remains unexplored. The impact of the BRAF mutation in the tumor on survival of patients with cutaneous melanoma depending on the surgery method has also not been studied. We analyzed the surgical treatment outcomes of 221 patients with primary cutaneous melanoma (stages 0-IIA and IIB-IIC) who were found to have the BRAF mutation and underwent different extents of tumor excision with closure of the surgical tissue defect.
Objective: To analyze the impact of the BRAF mutation in the tumor on 5-year survival of patients with primary cutaneous melanoma (stages 0-IIA and IIB-IIC), depending on the extent of surgery and the method of replacing the tissue defect.
Materials and methods: We used data from 221 patients with primary cutaneous melanoma (stages 0-IIA and IIB-IIC) and assessed their BRAF mutation status, extent of tumor excision, and method of closing the tissue defect. The patients were divided into 2 groups: the main group (wide excision of the tumor and plastic replacement of the tissue defect) and the comparison group (standard margin and linear closure of the tissue defect). After surgery, all the patients underwent tumor analysis for the BRAF p.V600E/K mutation using real-time PCR. DNA was isolated using the cobas® DNA Sample Preparation Kit on a cobas® z 480 analyzer. We used the following statistical methods: frequency analysis, z test to check the equality, and Kaplan-Meier survival analysis and such software as MedCalc 12.5 (1993-2013, MedCalc Software) and SPSS 26 (IBM Corp, 2019, IBM SPSS Statistics for Windows, Armonk, NY, USA). Results: Wide excision of primary cutaneous melanoma (stages 0-IIA and IIB-IIC) was found to increase 5-year progression-free survival in patients with subsequent plastic replacement of the tissue defect compared with patients with standard margin and linear closure of the tissue defect and 5-year overall survival in patients with stage 0-IIA melanoma. In patients with 0-IIA stage melanoma and positive BRAF mutation test results, wide excision with reconstructive and plastic defect closure improved the 5-year progression-free survival. Conclusions: The 5-year progression-free survival and 5-year overall survival increased by 20.9% (P = .005) and 13.0% (P = .031), respectively, in patients who underwent wide excision of primary cutaneous melanoma followed by plastic replacement of the tissue defect compared with patients with standard excision of primary tumors and linear closure of the tissue defect. The 5-year progression-free survival increased by 23.7% (P = .017) in patients with stage IIB-IIC melanoma, regardless of the BRAF mutation. In patients with 0-IIa stage melanoma and positive BRAF mutation test results who underwent wide excision, the 5-year progression-free survival increased by 20.7% (P = .047) compared with patients who underwent tumor excision with a standard margin.
Objective: To analyze short-term outcomes of anatomical lung resections using video-assisted thoracoscopic surgery (VATS) and thoracotomy approaches.
Materials and methods: Our retrospective study included 530 patients who underwent surgery for various lung diseases in the thoracic surgery unit of City Multidisciplinary Hospital No. 2 (Saint Petersburg, Russian Federation) between 2014 and 2021. The patients were grouped based on the surgical approach: group 1 for patients who underwent VATS (n = 378), group 2 for patients who underwent thoracotomy (n = 120), and group 3 for patients who underwent conversion from VATS to thoracotomy (n = 32).
Results: Tumor size, paranodal and peribronchial changes were unfavorable prognostic factors for conversion from VATS to thoracotomy (odds ratio [OR] = 1.032, CI: 1.013-1.051, P < .001; OR = 4.416, CI: 2.100-9.283, P < .0005; OR = 3.109, CI: 1.496-6.462, P < .002). Patients from group 1 and group 3 mostly had minor complications, whereas 32 patients (53%) from group 2 developed grade III-V complications according to Thoracic Morbidity and Mortality classification system. High Charlson Comorbidity Index (CCI), thoracotomy approach, emphysematous changes, adhesions, and absence of interlobar fissures were independent unfavorable prognostic factors for complications in the early postoperative period (OR = 1.665, CI: 1.031-2.691, P < .05; OR = 1.874, CI: 1.1433.070, P < .05; OR = 1.8803, CI: 1.126-2.888, P < .05; OR = 1.548, CI: 1.010-2.370, P < .05; OR = 1.612, CI: 1.053-2.466, P < .05).
Conclusions: VATS is an effective and safe approach for anatomical lung resection. Tumor size above 40 mm, significant paranodal and peribronchial changes were risk factors for conversion from VATS to thoracotomy. CCI above 5, thoracotomy approach, emphysematous changes, adhesions, and absence of interlobar fissures were independent unfavorable prognostic factors for complications in the early postoperative period.
Objective: To assess and compare the potential of transthoracic echocardiography (TTE) and cardiac computed tomography (CT) in determining severity of pulmonary artery hypoplasia in children with pulmonary atresia with ventricular septal defect (PA-VSD) during preoperative planning.
Materials and methods: The study included 38 children (mean age, 1.5 years; 97% of the patients younger than 1 year) with a clinical diagnosis of PA-VSD. All the patients underwent TTE; 36 of them underwent cardiac CT, while 33 children had direct angiocardiography. During all diagnostic methods we performed morphometry of the pulmonary trunk (if any) and proximal and distal parts of right and left pulmonary arteries, calculated z score for every vessel, Nakata index, and McGoon ratio. All the results were compared with fi
of direct angiography and/or intraoperative data. The interval between TTE, cardiac CT, and angiocardiography or open surgery was less than 10 days. The criterion for hypoplasia of the pulmonary artery and its branches was z score deviation less than (−2) from reference values. Nakata index less than 200 mm2/m2 and McGoon ratio less than 1.0 were considered contraindications for radical correction.
Results: We found no statistically significant difference (P > .05) when comparing the potential of TTE and cardiac CT with direct angiography/intraoperative data in terms of morphometry of the proximal parts of the right and left pulmonary arteries and calculating z scores. All the methods demonstrated high diagnostic efficacy. We found statistically significant differences when comparing the potential of TTE and cardiac CT in pulmonary trunk angiometry: the results of pulmonary trunk measurement using TTE were statistically significantly different from the findings of cardiac CT and angiography/intraoperative data with significant underestimation of vessel diameters (P < .05). The results of measurements of the distal parts of the pulmonary artery using TTE were statistically significantly different from those of cardiac CT and direct angiography/intraoperative data with significant underestimation of vessel diameters (P < .05). There were no statistically significant differences between CT and direct angiography/intraoperative data in assessing the diameters of the distal branches of the pulmonary artery. When assessing McGoon ratio and Nakata index using TTE, we found statistically significant differences (underestimation of values) in comparison with direct angiography (P < .05). Comparison of McGoon ratios measured by TTE and cardiac CT also demonstrated their statistically significant underestimation by TTE (P < .05). The calculated McGoon ratio during cardiac CT did not differ significantly from the direct angiography findings.
Conclusions: TTE cannot be considered the final method for preoperative assessment of the pulmonary artery system development in children with PA-VSD due to the limited visualization of the distal parts of the right and left pulmonary arteries and significant underestimation of the pulmonary trunk diameter and indices. Cardiac CT proved its high effectiveness in assessment of hypoplasia severity and can be an alternative to direct angiography.
Background: As the survival of patients with malignant neoplasms is improving, the urgent need for cardioprotective agents to counteract toxic effects of chemotherapy is growing.
Objective: To compare the cardioprotective efficacy of sacubitril/valsartan and candesartan in women with chronic heart failure and baseline reduced left ventricular ejection fraction (LVEF) during a 5-year prospective follow-up after chemotherapy for breast cancer.
Materials and methods: In this randomized study, 127 women with chronic heart failure and reduced LVEF after radical surgical treatment of breast cancer received potentially cardiotoxic adjuvant polychemotherapy (fluorouracil+ doxorubicin + cyclophosphamide). In addition, the patients received sacubitril/valsartan at a dose of up to 97/103 mg twice daily (n = 63) or candesartan at a dose of up to 32 mg once daily (n = 65), and this treatment was monitored for 5 years.
Results: The combination of sacubitril/valsartan was significantly superior to candesartan in improving left ventricular function and reducing the burden of ventricular arrhythmias and the risk of cardiovascular death (P = .039) at the long-term follow-up. Sacubitril/valsartan group and candesartan group did not differ in terms of mortality due to breast cancer progression or recurrence (P = .628).
Conclusions: Sacubitril/valsartan can be considered an effective and safe option for protecting the cardiovascular system during potentially cardiotoxic polychemotherapy for breast cancer in patients with chronic heart failure and baseline reduced LVEF.
Introduction: A number of studies uses severity of lung damage as a predictor of lung changes in the long-term period.
Objective: To evaluate computed tomography (CT) findings in the long-term period after extremely severe lung damage (CT-4) caused by COVID-19 during different pandemic waves and compare those with clinical data.
Materials and methods: The study included 51 patients (51.0% of them were women; age, 57 ± 12 years [95% CI, 53-60]) that were treated for COVID-19 with lung damage (CT-4) in O.M. Filatov City Clinical Hospital No. 15 (Moscow, Russian Federation)
and gave their consent for examination after discharge. The patients underwent chest CT and dyspnea assessment (Medical Research Council [MRC] dyspnea scale) in the long-term period and were grouped based on the pandemic wave and dyspnea grade. Twelve patients from the first pandemic wave were examined 12.5 months after discharge; 13 patients from the second pandemic wave were examined in 6.5 months, and 26 patients from the third pandemic wave were examined in 8 months. The group with MRC dyspnea grade 0 included 19 patients, whereas 32 patients comprised the group with MRC dyspnea grades 1 and 2.
Results: CT revealed changes in 50 (98.0%) of the examined patients, with fibrotic-like changes (88.2%), areas of consolidation (47.1%), and ground-glass opacity (13.7%) being the most common findings. All 3 patterns were equally common, regardless of the pandemic wave. No dyspnea higher than MRC grade 2 was observed. Fibrotic-like changes were found in 100.0% of the patients with MRC dyspnea grades 1 and 2, whereas they were detected only in 68.4% of the patients with MRC dyspnea grade 0, P = .002. The multivariate analysis showed that fibrotic-like changes were the only factor associated with dyspnea higher than grade 0.
Conclusions: After extremely severe lung damage (CT-4) CT changes were present in almost all the patients. The study results highlight clinical significance of these changes and demonstrate the rehabilitation potential of this group.
Materials and methods: At stage I, we retrospectively studied histories and outpatient medical records of 766 patients with chronic limb-threatening ischemia (from 2006 to 2020) to identify hemorrhagic complications and potential risk factors for their development. We analyzed the effectiveness of different scores for assessment of the bleeding risk. Based on the obtained data, measures to prevent hemorrhagic complications in this cohort of patients were improved. During stage II, 114 patients with 1 or several risk factors for major bleeding underwent surgery between 2021 and 2023. We used the proposed and improved preventive measures for all the patients. Follow-up periods were during the hospital stay and in 6 and 12 months.
Results: At stage I, 44 (5.74%) patients were found to have hemorrhagic complications in the early postoperative period: retroperitoneal hematoma, bleeding from an operating wound, and pulsating hematoma (15.9%); gastrointestinal hemorrhage (31.8%); gross hematuria (13.7%), and hemorrhagic stroke (6.8%). The most significant risk factors for bleeding were endovascular intervention using brachial and femoral approaches (P = .000), hybrid intervention (P = .000), dual antiplatelet therapy (P = .014), surgery duration above 60 minutes (P = .001), triple antithrombotic therapy (P = .001), and significant vascular calcification (P = .023). The PRECISE-DAPT score has proven to be of prognostic value (P = .073; odds ratio, 2.88). At stage II, due to the proposed preventive measures, bleeding that required blood transfusion was found in 5 (4.38%) of 114 patients: of them, 1 (0.9%) patient had acute coronary syndrome. There were no major amputations, whereas 3 (2.63%) patients underwent minor amputation. In 6 and 12 months of the follow-up, the total frequency of major cardiovascular complications (cardiac death, myocardial infarction), major and minor amputation was 0.9% and 2.6%, 0% and 1.75%, and 0.9% and 2.6%, respectively.
Conclusions: Surgical treatment of patients with chronic limb-threatening ischemia and risk factors for hemorrhagic complications who underwent surgery with the proposed preventive measures demonstrated high efficiency in reducing the number of hemorrhages and associated cardiac complications and low frequency of major and minor amputations in the long-term follow-up.
Introduction: The leading cause of hemorrhagic stroke is a ruptured cerebral aneurysm (CA), accounting for 70%-85% of nontraumatic subarachnoid hemorrhages. The primary goals of CA treatment are to prevent a rupture, thrombosis, or symptoms of mass effect. The main treatment options for intracranial aneurysms are open clipping, flow-diverter device implantation, resection and stenting of aneurysms. Treated aneurysms should be monitored to assess the stability of the occlusion because more than 20% of surgically treated aneurysms are known to recur. Magnetic resonance angiography (MRA) has recently become increasingly attractive for the follow-up of surgically treated CAs because it is noninvasive, does not require hospitalization, and reduces complications associated with the frequent use of cerebral angiography.
Objective: To evaluate capabilities of dynamic MRA in postoperative monitoring of patients with CAs.
Materials and methods: The study was conducted at the premises of the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation). In a hospital setting, 38 patients with CAs were examined in the late postoperative period. All the patients underwent magnetic resonance imaging, 3-dimensional time-of-flight (3D-TOF) MRA, and dynamic MRA followed by cerebral angiography. Imaging findings (MRA, dynamic MRA, and cerebral angiography) were evaluated by radiologists, x-ray surgeons, and neurosurgeons. They assessed treated aneurysms according to the Raymond-Roy occlusion classification: complete obliteration (class 1), residual neck (class 2), and residual aneurysm (class 3). Untreated aneurysms in patients with multiple CAs and de novo aneurysms were also assessed, and we looked for other vascular malformations.
Results: The study was conducted in the late postoperative period from 6 to 18 months. A total of 38 patients participated in the study; of them 27 were women (age, 32-77 years) and 11 were men (age, 32-65 years). Dynamic MRA detected neck remnants of 4 clipped aneurysms and 2 embolized ones, which was confirmed by cerebral angiography. According to the dynamic MRA results, in case of clipped aneurysms neck remnants were found in the anterior communicating artery (n = 2), internal carotid artery (n = 1), and anterior choroidal artery (n = 1). In case of embolized aneurysms, neck remnants were revealed in the internal carotid artery (n = 1) and basilar artery (n = 1). Dynamic MRA also detected 5 additional aneurysms: 2 internal carotid artery aneurysms, 1 basilar artery aneurysm, 1 anterior cerebral artery aneurysm, and 1 anterior communicating artery aneurysm. These findings coincided with those of cerebral angiography. Based on the results of our study, the sensitivity and specificity of dynamic MRA in detecting CA neck remnants and untreated aneurysms were 100%.
Discussion: Dynamic MRA findings are fully consistent with those of cerebral angiography in terms of determining an aneurysm occlusion status during postoperative follow-up. As for evaluation of de novo intracranial aneurysms, dynamic MRA is also superior to noncontrast 3D-TOF MRA in assessment of aneurysm shape and neck detection. Therefore, dynamic MRA can clearly visualize the structure of cerebral vessels mainly due to the effect of blood flow and static tissue contrast, and the principle is mainly the effect of multiphase scanning and accumulation of contrast agent.
Conclusions: Dynamic MRA has a number of advantages over cerebral angiography, such as noninvasiveness, high-resolution images of the cerebral arteries, absence of radiation exposure, use of iodinated contrast agent, and absence of artifacts from metal clips or embolic material.
Background: Patients with gastric cancer (GC) are at high risk of nutrient deficiencies (ND) that can negatively affect the postoperative period and long-term treatment outcomes.
Objective: To assess the nutritional status (NS) and skeletal muscle condition in patients with resectable stage I-III GC.
Materials and methods: Our study included 102 GC patients: 64 men (62.7%) and 38 women (37.3%) aged 31 to 77 years. During the assessment we used the NRS-2002 system, determined laboratory markers of the NS, calculated the Nutritional Risk Index (NRI), and evaluated the condition of adipose tissue and skeletal muscles using computed tomography.
Results: We found that 70.6% of the patients had ND: NRS-2002 score < 3 points (52%) and NRS-2002 score ≥ 3 points (18.6%). Risk factors for ND were tumor localization in the cardia and stage III GC. Laboratory markers of ND were transferrin and NRI. Among the examined patients (n = 80) sarcopenia was detected in 10 (12.5%) patients: 1 patient (1/25; 4.0%) from the group without ND, 6 patients (6/42; 14.3%) from the group with NRS-2002 score < 3 points, and 3 patients (3/13; 23.1%) from the group with NRS2002 score ≥ 3 points, (P = .212). In multivariate logistic regression analysis, independent factors associated with sarcopenia were age, body mass index, and total protein.
Conclusions: All GC patients selected for radical surgery should undergo nutritional assessment using special tools (NRS-2002, NRI) and evaluation of the skeletal muscle condition. Sarcopenia may occur in patients with no clinical or laboratory evidence of ND. In GC patients at nutritional risk, preand postoperative nutritional support should be considered to reduce the ND-related risks.
Introduction: Ureteral stents have been widely used for drainage of the upper urinary tract during both emergency and elective surgical procedures since 1967. The main pathology in which these stents are used is urolithiasis.
Objective: To present our experience with the surgical treatment of patients with “forgotten” encrusted ureteral stents using a combined endourological approach.
Materials and methods: Patients with encrusted ureteral stents who underwent endourological procedures from 2016 to 2022 were prospectively evaluated. They were grouped based on the degree of stent encrustation according to the FECal classification. The duration of stent placement, number and types of surgical procedures, number of procedures before complete removal of the stent and concrements, surgery duration, hospital stay, complications, concrement analysis, and frequency of complete concrement removal per surgery were compared between the groups. The combined endourological procedure was performed with the patient placed in the Galdakao-modified supine Valdivia position. This position allows simultaneous antegrade and retrograde endourological access.
Results: The study included 46 patients grouped according to the FECal classification. In 38 patients, stents were successfully removed in a single procedure. The mean operative time, concrement-free status, and complication rate were 90.2 ± 19.8 minutes, 78.3%, and 32.6%, respectively. Total encrustation volume was higher for grades IV and V (5.6 ± 1.8 and 7.6 ± 2 cm3) compared with all the other grades. Percutaneous nephrolithotripsy and cystolithotripsy were the most common procedures in grades IV and V. Lithotripsy was commonly used for ureteral stent encrustation, especially in the groups with grades I and III. The operative time was longer in groups IV-V compared with groups I and II because percutaneous nephrolithotripsy was more frequent in these cases. Retrograde intrarenal surgery was performed in 88% of the cases with the combined approach to check whether concrements were present in the renal calyces and pelvis. In 5 cases, a flexible ureterorenoscope was advanced antegradely through a percutaneous access to disintegrate the encrustation of the proximal part of the stent’s ureteral section. Complications occurred in 32.6% of the patients. Most complications (26%) were minor: fever, pain, or gross hematuria. One case required segmental renal artery embolization for bleeding, and antibiotic therapy associated with an attack of pyelonephritis was adjusted in 2 cases.
Conclusions: The endoscopic combined approach in the Galdakao-modified supine Valdivia position is a safe and effective technique that allows removal of “forgotten” encrusted stents, in most cases, in a single procedure. The FECal classification seems to be useful for surgical planning and prognosis.
Background: Cerebral contusions occur in approximately 43% of blunt head trauma cases. The gyri are predominantly affected, although severe traumatic brain injury (TBI) may damage the subcortical white matter and deep structures within the brain. Computed tomography (CT) of the brain is used to evaluate all forms of intracranial injuries, fractures, cerebral edema, and other associated injuries.
Objective: To analyze the CT potential in the diagnosis of cerebral contusions during the acute phase of TBI in children younger than 3 years.
Materials and methods: In 2021-2022 we performed CT using a Philips Ingenuity Elite 128 slice CT scanner in 1334 children with TBI (730 boys and 604 girls younger than 3 years). The area of interest in the examined children was the skull and cervical spine. We did not use enhancement. The effective dose range varied from 1.27 to 1.91 mSv.
Results: Of 510 children, 448 (87.84%) patients had skull fractures that combined with intracranial injuries in 366 (81.7%) children, with 262 (71.58%) of them having severe injuries (Glasgow Coma Scale ≤ 8) and 36 (9.83%) of them undergoing surgery. Cerebral contusions were diagnosed in 58.5% (214 of 366) of children. Contusions (98% of which were hemorrhagic) had different volumes and degrees of hemorrhage and edema. The foci of contusions were in the frontal (37.1%), temporal (34.3%), parietal (20.6%), and, less often, occipital (8%) lobes.
Conclusions: CT is the preferred imaging modality in acute TBI, which enables to accurately detect and adequately treat cerebral contusions, preventing secondary injuries. CT is the main diagnostic tool and should be performed in all children with TBI within the first hours after injury.
Background: Bone density has prognostic significance in planning the surgical phase with implant-supported fixed prostheses and affects the surgical success and choice of implant design and shape.
Objective: To determine bone biotypes in a region of maxillary teeth in adult men.
Materials and methods: We studied cone beam computed tomography findings of 38 patients aged 20 to 53 years and conducted bone densitometry in a region of each tooth. The obtained values were converted to bone biotypes according to Misch bone density classification. We used statistical methods to identify the most common bone biotypes in each tooth region in men.
Results and discussion: Based on the statistical analysis results, in more than half of the adult men D2 and D3 bones were observed in the region of maxillary premolars and molars, while D2 and D1 were found in the region of maxillary incisors and canines.
Conclusions: We found that D2 and D3 are the most common bone biotypes in the region of maxillary teeth. These findings can be used as one of prognostic criteria in planning the surgical phase with implant-supported fixed prostheses.
Objective: To study catalytic properties of lactate dehydrogenase (LDH) and some physical and chemical characteristics of blood in patients with thermal injuries.
Materials and methods: We examined blood samples from 24 patients with contact burns involving 10%-40% of the body surface area and studied erythrocyte LDH activity in forward and reverse reactions, kinetic characteristics of this process, and protein concentration. We used teziocrystalloscopy to evaluate crystallogenic properties of blood serum of the examined patients with thermal injuries.
Results: Thermal injuries were shown to cause a 2-fold decrease in LDH activity in the reverse reaction. Analysis of crystallogenic properties of blood serum of the patients with contact burns revealed that development of a complex response to a burn injury is accompanied by a moderate decrease in the structure index and crystallizability and a signifi decrease in the clearity of the marginal protein zone. In case of burn disease, we also observed a decrease in the initiative potential of the biological fl In addition, microscope slides of the dried blood serum revealed a tendency to randomization of the sample similar to that found in crystalloscopic facies.
Conclusions: The local thermal effect leading to a complex response to a burn injury was found to cause significant transformation of physical and chemical characteristics of blood. Thermal injuries cause a decrease in LDH activity in the reverse reaction leading to a disturbance of the lactate-to-pyruvate ratio in the cell and significant shifts in the blood serum composition and properties, which are manifested in a significant change in blood serum crystallogenic and initiating properties.
EXPERIMENTAL RESEARCH
Background: Current studies show that hollow conduits in combination with various synthetic and biological fillers significantly accelerate functional recovery of peripheral nerves. One of such fillers can be a hydrogel based on the extracellular matrix of the dermis, which contains surface ligands capable of providing topographic and biological signals for nerve regeneration.
Objective: To evaluate the effectiveness of rat sciatic nerve regeneration using a collagen conduit filled with dermal hydrogel in an in vivo experiment.
Materials and methods: We evaluated the effectiveness of the NeuraGen® collagen conduit filled with dermal hydrogel and compared it with that of an autograft and the NeuraGen® hollow collagen conduit in experimental treatment of rat sciatic nerve defects larger than 1 cm. Male Wistar rats underwent sciatic nerve resection. We calculated the Sciatic Functional Index (SFI) and ratio of the calf circumference in an operated limb to that in an intact limb on days 30, 60, and 90 after implantation. We performed electrophysiological tests and explanted samples for hematoxylin-eosin staining on day 90 of the experiment.
Results: When assessing the SFI and electrophysiological parameters, the group of animals with autografts and the group with the NeuraGen® collagen conduits filled with dermal hydrogel demonstrated similar results. We observed muscle atrophy, low SFI scores, and low velocity and short duration of the action potential in the group with the hollow NeuraGen® collagen conduits. Histological analysis of explanted samples of the collagen conduits filled with dermal hydrogel demonstrated areas of glial proliferation and the absence of pronounced degeneration of nerve fibers throughout the implant compared with autografts, indicating functional regeneration of nerve fibers.
Conclusions: Evaluation of the effectiveness of rat sciatic nerve regeneration showed that the NeuraGen® collagen conduit filled with dermal hydrogel provides functional and morphological integration with the nerve compared with an autograft. Our findings can be used for further development and improvement of nerve conduits.
Objective: To study peculiarities of skin wound healing under ischemic conditions with topical treatment using a combination of benzalkonium chloride and dexpanthenol.
Materials and methods: We conducted an experiment on a rat model of skin wound healing under ischemic conditions. Male Wistar rats were divided into 4 groups, with 30 rats in each group. Group 1 received no treatment; group 2 was treated with the Levomecol ointment; group 3 and group 4 were treated with benzalkonium chloride immobilized based on the carboxymethylcellulose sodium salt and a combination of benzalkonium chloride and dexpanthenol immobilized based on the carboxymethylcellulose sodium salt, respectively. We used planimetric and biochemical (alkaline phosphatase [ALP] level) methods, measured the pH of the wound surface and wound bed temperature, determined the hydroxyproline concentration in the wound defect tissues, and performed statistical processing of the data.
Results: Group 4 had the largest percentage of wound surface area reduction and pH values. Thermometry on day 10 showed a decrease in wound temperature in groups 2 and 4, whereas groups 1 and 3 demonstrated maximum values. By the end of the experiment, group 4 had the maximum hydroxyproline concentration that was significantly higher than the amino acid content in groups 1, 2, and 3: 1.2, 1.1 and 1.1 times higher, respectively. Maximum ALP levels were observed on day 5 in group 4, whereas in groups 2 and 3 they were observed on day 8 and only on day 10 in group 1.
Conclusions: Skin wound healing under ischemic conditions was faster in the group in which topical treatment involved a combination developed by us: benzalkonium chloride and dexpanthenol immobilized based on the carboxymethylcellulose sodium salt.
CASE REPORTS
Objective: Anatomy of the ophthalmic artery (OA) is of great practical importance in surgery for anterior circulation aneurysms. In most cases, the OA arises from the supraclinoid segment of the internal carotid artery (ICA) and enters the orbit through the optic canal inferolaterally to the optic nerve. The OA arising from the anterior cerebral artery (ACA) and entering the optic canal above the optic nerve is extremely rare.
Clinical case: We report a case of a 29-year-old female patient admitted to Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) with a ruptured true aneurysm of the left posterior communicating artery (PCoA) and an abnormal origin of the OA from the ACA. The disease manifested itself as ischemic stroke in the basal ganglia on the left causing diagnostic difficulties during initial hospitalization. Cerebral angiography confirmed a PCoA aneurysm and origin of the OA from the ipsilateral ACA. During surgery the neck of the aneurysm was clipped, and the aneurysm dome was opened to control the extent of clipping and remove thrombotic masses. During their removal, hemorrhage appeared from the posterior pole of the aneurysm. During the exploration it was found that the aneurysm was a dilated PCoA connecting the right ICA with the right posterior cerebral artery (PCA). A thrombosed anterior thalamoperforating artery emerged from the superior surface of the dome, and its junction with the precommunicating segment of the right PCA was detected in the region of the posterior pole of the aneurysm. The second clip was placed at the communication site between the aneurysm and the right PCA. The patient was discharged in satisfactory condition with a stable neurological status.
Conclusions: The combination of abnormal anatomy of arteries at the base of the brain and cerebral aneurysms increases the risk of tactical errors and perioperative complications. Each such case requires a careful comparison of the clinical, imaging, and intraoperative findings. In the presented case of the patient with the ruptured rare PCoA aneurysm, the disease manifested atypically due to the partial thrombosis of the aneurysm and hemorrhage into the aneurysmal wall. The imaging findings revealed lacunar stroke in the thalamoperforating artery basin and an ICA aneurysm with no signs of subarachnoid hemorrhage. During the surgery the aneurysm was initially regarded as typical saccular. The opening of the dome and removal of all thrombotic masses made it possible to determine the eccentric fusiform nature of the aneurysm, perform its radical exclusion, and prevent fatal hemorrhage in the postoperative period.
REVIEWS
Subdural hygromas occur after various brain interventions, are often asymptomatic but sometimes may require surgical treatment. They can develop in the immediate postoperative period, but they are more common a few weeks or even months after surgery. Subdural hygromas are particularly common after decompressive craniotomy in patients with traumatic brain injury or massive stroke. The pathogenesis is explained by the fact that a large bone defect causes a pressure difference in the skull, and a concomitant displacement of the ventricular system disrupts the normal cerebrospinal fluid circulation, contributing to the redistribution of cerebrospinal fluid flow into the subdural space.
We review data from contemporary studies on subdural hygromas after decompressive craniotomy, their risk factors, and management strategies. We also present our case of recurrent subdural hygroma in a patient operated on for a ruptured aneurysm of the middle cerebral artery.
Background: Pelvic floor dysfunction is a widespread, multifactorial disease that progresses slowly with age and occurs in 77% of postmenopausal women.
Objective: To evaluate the effectiveness of conservative treatment of pelvic floor dysfunction in women and the possibility of preventing pelvic organ prolapse.
Materials and methods: We analyzed literature data (PubMed, eLibrary, Scopus) on treatment and prevention of pelvic floor dysfunction in women using various conservative treatment options.
Results: The conservative approach is the only preventive measure and a first-line treatment of pelvic organ prolapse, especially at the disease onset. It involves lifestyle changes, physical therapy, and pessary insertion. Physical therapy includes pelvic floor muscle training with or without biofeedback, vaginal cones, electrical stimulation, etc.
Conclusions: Despite the large number of available conservative treatment options, their effectiveness should be further studied, and preventive measures aimed at strengthening pelvic floor muscles should be actively promoted and included in the routine medical use and daily life of women to prevent pelvic organ prolapse.
We review the current understanding of pathophysiology and pathobiochemistry of conditions following extensive resections of the liver parenchyma and describe potential ways of surgical and metabolic correction, including promising molecular targets for therapy. Reduced residual tissue volume (small-for-size syndrome), parenchymal edema due to hyperperfusion and impaired venous blood outflow, septic complications, organ ischemia-reperfusion, mitochondrial dysfunction, and oxidative stress are considered key pathogenetic factors in liver failure development following extensive resections of the liver parenchyma. Given the above, promising ways of managing posthepatectomy conditions are the use of agents reducing portal pressure (octreotide [somatostatin analogue], terlipressin [vasopressin analogue], and propranolol), energotropic metabolic drugs (combined preparations of succinate and antioxidants, gasotransmitter donors), and antibiotics and synbiotics for prevention of infectious complications. The approaches currently used in clinical practice cannot always effectively manage complications following extensive hepatectomy, so fundamental research should focus on searching and creating effective strategies for prevention and therapy of posthepatectomy liver failure.