Search

Background: Reduced-port laparoscopic surgery (RPLS) uses the minimum possible number of ports or small-sized ports in laparoscopic surgery. The combination of RPLS and natural orifice specimen extraction (NOSE) minimizes the procedural damage. Methods: A total of 17 patients diagnosed with right colon cancer were included: 5 patients in the RPLS + NOSE group and 12 patients in the conventional laparoscopic surgery (CL) + mini-laparotomy (ML) group. We highlight the key steps of the RPLS + NOSE procedure and compare the clinicopathological characteristics and short-term postoperative outcomes of the two groups. Results: Compared to CL + ML, RPLS + NOSE was associated with short hospitalization (8.80 ± 1.30 vs 13.75 ± 2.63, p = 0.001), faster first flatus (1.80 ± 0.45 vs 3.4 ± 0.90, p = 0.020) and less postoperative pain on the first day (2.40 ± 0.55 vs 4.25 ± 1.60, p = 0.025). Regarding operation time, intraoperative bleeding, tumor size, proximal and distal margin, number of lymph nodes harvested, number of positive lymph nodes, R0 resection, bowel movements, postoperative complications, Clavien-Dindo classification, Benz’s classification and postoperative pain on day 1, day 3 and day 5, no significant difference was observed. Conclusion: In selected patients, RPLS with D3 lymph node dissection and transvaginal specimen extraction results in fast recovery and is indicated for colon cancer patients. [ABSTRACT FROM AUTHOR]

Voice alterations after thyroidectomy with mobile vocal folds are common. Ultrasonography has been used to assess the mobility of the vocal folds after thyroidectomy. Fifty-four patients underwent thyroidectomy. Indirect laryngoscopy, ultrasonography, and GRBAS (grade, roughness, breathiness, asthenia, strain) scoring were performed preoperatively, 3 days, 2 and 6 months, postoperatively. On the third postoperative day, the mobility of the vocal folds was preserved in 52 patients and pareses were recorded in 2 patients. All patients after thyroidectomy noted the presence of voice alteration in the absence of the postoperative paresis of the vocal folds. On the third postoperative day, the voice was impaired by all criteria of the GRBAS scale, but mainly due to roughness (85%). Sixth month postoperatively, 62% of the subjects considered the voice to be altered. Asthenia was observed in 39%. On the third postoperative day indirect laryngoscopy revealed the unchanged vocal folds, the edema and the shortening of one of the vocal folds in 56%, 42%, and 1.9%. Six months postoperatively, the vocal folds returned to their original form. Indirect laryngoscopy and ultrasonography had 100% concordance in assessing the mobility of the vocal folds. Patients with edema of the vocal folds had a significantly higher mean GRBAS grade than patients without edema. The mean GRBAS score decreased from 3.36 to 0.90, 3 days and 6 months, postoperatively. Voice alteration after thyroidectomy is always present. Postoperative edema represents a likely main cause of voice alteration and resolves within 6 months. Ultrasonography is recommended as alternative to indirect laryngoscopy in assessing of the vocal folds after thyroidectomy. [ABSTRACT FROM AUTHOR]

A specialized experimental device for acting on biological tissues by means of cold plasma glow discharges operating at a frequency of 6.78 MHz is described. Activation of repair processes in tissues in the bedsore zone by cold plasma discharges at 6.78 MHz was shown to be more effective than at frequencies of 2.64 or 0.11 MHz. When a needle electrode with diameter 0.3 mm and length 6 mm was used in the activation procedure, the optimum parameters were: power, 5.0 ± 1.5 W; duration, 1.0-3.0 s. Marked activation effects were obtained in the period from 14 to 21 days. The efficacy of the method in terms of the rate of wound healing was 15-17% depending on the etiology of bedsore wounds. Morphological analysis of the activation process was by comparing histological samples of decubital ulcer specimens from patients in the experimental and control groups. The results led to the conclusion that the therapy of bedsores by activation of repair processes with plasma glow discharges induced by a current at the optimal frequency was an effective component of the complex treatment of bedsores. [ABSTRACT FROM AUTHOR]

The results of a clinical study of the complex treatment of pressure ulcers using the method of activation of reparative processes in tissues by cold plasma discharges initiated by high-frequency current are presented. Activation was carried out with a specialized device generating cold plasma discharges at frequencies of 0.11, 2.64, and 6.78 MHz. It was shown that the process of activation in the skin and muscle tissues of the bedsore zone proceeds most efficiently when using a current with a frequency of 6.78 MHz as compared to currents with a frequency of 2.64 and 0.11 MHz. For a needle electrode with a diameter of 0.3 mm, the optimal exposure parameters were power—(5.0 ± 1.5) W and time—(2.0–3.0) s. The results of the analysis of histological samples, histochemical, and bacteriological analysis confirmed the effect and showed the dynamics of the process of activation of reparative processes in the tissues of the bedsore wound under the influence of cold plasma discharges and a decrease in microbial contamination. The most pronounced effect of activation was formed during the period from 14 to 21 days. The effectiveness of therapy by the method of activation of reparative processes with cold plasma discharges, according to the criterion of the rate of wound healing, ranged from 14 to 16%, depending on the etiology of the decubitus wound. It is concluded that the activation of tissue reparative processes by glow-type plasma discharges as an integral part of the treatment of decubital ulcers is an effective link in the complex treatment of pressure sores. [ABSTRACT FROM AUTHOR]

Objective: This review article summarises the latest evidence for preventive central lymph node dissection in patients with papillary thyroid cancer taking into account the possible complications and risk of recurrence. Background: Papillary thyroid cancer is the most frequent histological variant of malignant neoplasms of the thyroid gland. It accounts for about 80-85% of all cases of thyroid cancer. Despite good postoperative results and an excellent survival rate in comparison with many other malignant diseases, tumor metastases to the cervical lymph nodes are frequent. Most researchers agree that the presence of obvious metastases in the lymph nodes requires careful lymph node dissection. It was suggested to perform preventive routine lymphadenectomy in all patients with malignant thyroid diseases referred to surgery. Methods: It was performed the literature review using the "papillary thyroid cancer", "central lymph node dissection", "hypocalcemia", "recurrent laryngeal nerve paresis", "metastasis", "cancer recurrence" along with the MESH terms. The reference list of the articles was carefully reviewed as a potential source of information. The search was based on Medline, Scopus, Google Scholar, eLibrary engines. Selected publications were analyzed and their synthesis was used to write the review and analyse the role of preventive central lymph node dissection in patients with papillary thyroid cancer. Conclusions: The necessity of preventive central lymph node dissection in patients with differentiated papillary thyroid carcinoma is still controversial. There is much evidence that it increases the frequency of transient hypocalcemia. Due to the fact that this complication is temporary, its significance in clinical practice is debatable. It can also be assumed that an extant of surgery in the neck area is associated with an increased risk of recurrent laryngeal nerve injury. However, most studies indicate that this injury is associated more with thyroidectomy itself than with lymph node dissection. Recurrent laryngeal nerve dysfunction is also a temporary complication in the vast majority of cases. At the same time, a large amount of data shows that central lymph node dissection reduces the risk of thyroid cancer recurrence in two times. [ABSTRACT FROM AUTHOR]

Present study aimed at improving the outcomes in patients with gastric cancer through the application of molecular genetic methods for examination of the gastric mucosa at the preoperative stage. The study included 156 patients: 106 patients with gastric cancer (main group) and 50 with cholelithiasis, as a comparison group with unchanged gastric mucosa. All 106 patients with gastric cancer underwent scheduled surgical intervention: in the form of gastrectomy (n=42) or gastric resection (n=64). Genetic tests of the resected tumor material and distant gastric mucosa in the main group and the comparison group were performed. Locally advanced gastric cancer was verified in 80 (76%) patients of the main group; 58 (72.5%) of them underwent adjuvant chemotherapy with 5-fluorouracil. To assess the efficacy of 5-fluorouracil-based chemotherapy, polymorphisms of the TYMS and TP53 genes, which are detected in locally advanced gastric cancer, were studied. Genetic tests in patients with gastric cancer reliably confirmed (p<0.01) an increase in expression of hTERT, MMP7, BIRC5 markers, as well as telomerase activity, at the same time statistically significant reduction in the surrounding mucosa located 5 cm below and above the tumor node. When assessing the relationship of TYMS gene polymorphisms with the long-term results of combined treatment of patients with locally advanced gastric cancer: the mean relapse-free survival in patients with the 3R/2R genotype was 34.6±2.2 months, the mean relapse-free survival in patients with the 3R/3R genotype was 25.8±2.5 months. For TP 53 gene polymorphisms: mean relapse-free survival in Arg/Arg genotype is 29.1±2.2 months. Mean relapse-free survival in Arg/Pro genotype is 29.5±3.3 months. Mean relapse-free survival in Pro/Pro genotype is 20.0±3.5 months. In patients with gastric cancer, analysis of molecular genetic markers is recommended, since the data obtained allow to assess the genetic potential of the mucosa without gross changes and reduce the extent of surgical intervention, as well as to predict the effect of 5-fluorouracil-based adjuvant chemotherapy in patients with locally advanced gastric cancer. [ABSTRACT FROM AUTHOR]

Viral infections are considered as etiologic factors of subacute thyroiditis. The true incidence of subacute thyroiditis, caused by SARS‐CoV‐2 infection, is probably considerable since it is often masked by more dramatic affection of the respiratory system. This report presents two female patients who developed de Quervain's thyroiditis after COVID‐19 disease. [ABSTRACT FROM AUTHOR]

We present here the results of clinical studies of the treatment of bedsores by activation of repair processes in integument tissues using pulsed cold plasma discharges in patients in a chronic critical state. An experimental device for radio-frequency current treatment is described and exposure specifications are presented. The mechanism of activation by cold plasma discharges in the tissue electrolyte matrix is described. The results reliably show that the action of radio-frequency current pulses with optimum parameters reduces the in-patient treatment period by an average of seven days, or by 16%, compared with the control group. [ABSTRACT FROM AUTHOR]

We present here results obtained using hightech bipolar instruments with an electrosurgical device and a non-linear dynamic feedback system for excision of large tissue blocks. The effectiveness of using bipolar scissors with blades made of nanostructured zirconium dioxide and thermostabilized bipolar forceps was assessed using high amputation of the lower limbs as an example. Significant results were obtained showing that the use of innovatory electrosurgical technologies for transfemoral amputation in patients with terminal-stage peripheral arterial disease increases the typical clinical measures of efficacy by an average of 39%. The results can be taken as the basis for a new method of using electrosurgical technology for high amputations of the lower limbs. [ABSTRACT FROM AUTHOR]

We present here the results of studies of laser-induced shockwave destruction of biological tissues obtained experimentally and by computation. In the experiments, microexplosion dynamics were studied by analysis of acoustic pulses induced by explosion of activated charcoal during laser heating of unbound water. The computational method was based on automodel solution of the Stefan problem using a quasilinear approximation. Good agreement was obtained between computation and experimental data for assessment of the main parameters of acoustic waves arising as a result of thermal explosion of microparticles. Morphological studies and clinical testing of the method provided the evidential aspect of the proposed description of the mechanism of shockwave actions. [ABSTRACT FROM AUTHOR]

Background: Heparin therapy and prophylaxis may be accompanied by bleeding and thrombotic complications due to individual responses to treatment. Dosage control based on standard laboratory assays poorly reflects the effect of the therapy. The aim of our work was to compare the heparin sensitivity of new thrombodynamics (TD) assay with sensitivity of other standard and global coagulation tests available to date. Study population and methods: A total of 296 patients with high risk of venous thromboembolism (deep vein thrombosis (DVT), early postoperative period, hemoblastosis) were enrolled in the study. We used a case-crossover design to evaluate the sensitivity of new thrombodynamics assay (TD) to the hemostatic state before and after unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) therapy/prophylaxis and to compare it with the activated partial thromboplastin time (APTT), anti-Xa activity test, thrombin generation test (TGT) and thromboelastography (TEG). A receiver operating characteristic (ROC) curve analysis was used to evaluate changes before and after heparin prophylaxis and therapy. Blood was sampled before heparin injection, at the time of maximal blood heparin concentration and before the next injection. Results: Hypercoagulation before the start of heparin treatment was detected by TD, TGT and TEG but not by APTT. The area under the ROC curve (AUC) was maximal for TD and anti-Xa, intermediate for TGT and TEG and minimal for APTT. Conclusions: These results indicate that TD has a high sensitivity to the effects of UFH and LMWH after both prophylactic and therapeutic regimes and may be used for heparin monitoring. [ABSTRACT FROM AUTHOR]

We present here the results obtained during the development of an experimental apparatus for transmyocardial laser revascularization based on an Nd:YAG laser. Use of laser irradiation with a wavelength of 1.44 μm was shown to be effective in producing targeted angiogenesis in transmyocardial laser revascularization in experimental studies using a model of ischemic myocardium. The optimum regimes for pulsed Nd:YAG laser irradiation of the myocardium with thermal tissue damage were established. Morphological changes in the transmyocardial laser channels in pig myocardium were studied. The objective of the experiments was to confirm the efficacy of using this apparatus for transmyocardial laser revascularization with an Nd:YAG laser for the treatment of patients with diffuse lesions to the coronary arteries. [ABSTRACT FROM AUTHOR]

Background: The development of endoscopic techniques motivated surgeons to search for alternative and more cosmetic approaches for thyroid and parathyroid surgery. Several variations of transoral access to the anterior neck areas were applied in recent years. One of them is a premandibular access proposed by Nakajo et al, it is performed through the oral vestibule by creating the working space by means of the lifting method. Materials and methods: Nineteen unfixed human cadavers were used to develop the endoscopic access to the thyroid gland and surgical techniques of its resection. The Nakajo access was modified by altering the spatial location of the working instruments, resulting in practically no impact on the cosmetic outcome but providing a more comfortable operation for the thyroid gland. We determined evaluation criteria of the cadaver model before initiation of the experimental trial. Parameters that influence on alteration of these criteria were registered. Results: Of the 19 operated objects, the first 7 were used to practice the access technique from the incision in the oral vestibule to the thyroid gland in order to evaluate the possibility of endoscopic dissection of the important anatomical. The next 12 surgeries were carried out by manipulating the thyroid gland in the settings maximally close to real. Access implied good cosmetic results, less surgical traumatic due to a smaller area of detachment of the musculocutaneous flap. Conclusions: The achieved results show feasibility of introducing the described modification of transoral thyroidectomy into clinical practice. [ABSTRACT FROM AUTHOR]

This article describes the use of nanostructured zirconium dioxide to provide high performance characteristics for novel electrosurgical instruments. Design solutions providing major functional improvements are described. A clinical study evaluated the effectiveness of using the new electrosurgical instruments with a special high-frequency generator in surgical operations on the thyroid gland. [ABSTRACT FROM AUTHOR]

Background: Daptomycin has proven efficacy in patients with Gram-positive complicated skin and soft tissue infections (cSSTIs), including those caused by Staphylococcus aureus, regardless of methicillin susceptibility. Objective: This study was undertaken to evaluate the efficacy and safety of daptomycin in elderly patients. Study Design: This was an open-label, multicentre, randomized phase IIIb study conducted in hospitalized patients Patients: Patients aged ≥65 years with a diagnosis of Gram-positive cSSTIs with or without bacteraemia were included. In addition, infections were required to be of sufficient severity to require inpatient hospitalization and treatment with parenteral antibiotics for at least 96 h. The main exclusion criterion was the presence of a non-complicated SSTI that could heal by itself or be cured by surgical removal of the site of infection. Intervention: Patients were randomized (2:1) to intravenous daptomycin or pooled intravenous standard therapies (semi-synthetic penicillin or vancomycin, referred to as the 'comparator'). Duration of treatment was between 5 and 14 days for cSSTIs without bacteraemia and between 10 and 28 days for cSSTIs with bacteraemia. Main Outcome Measure: The primary objective was descriptive comparison of clinical success in clinically evaluable patients at test of cure, 7-14 days post treatment. Secondary objectives were microbiological outcome, duration of treatment and safety. Results: In total, 120 patients were randomized (81 to daptomycin; 39 to the comparator) and 102 patients completed the study. Baseline characteristics were similar between the two groups. Common infections included cellulitis, ulcers and abscesses; six patients had bacteraemia [five documented (daptomycin, n = 3; comparator, n = 2); and one suspected (daptomycin, n = 1)]. Test-of-cure clinical success rates were numerically higher for daptomycin than for the comparator [89.0 % (65/73) vs. 83.3 % (25/30); odds ratio 1.65 (95 % confidence interval 0.49-5.54)]. For patients with S. aureus infections, cure rates were 89.7 % (35/39) versus 69.2 % (9/13), respectively; percentage points difference, 20.5 (95 % confidence interval −12.2 to 50.9)]. Rates of adverse events (AEs) and serious AEs were similar in both treatment arms; however, discontinuation rates for AEs/serious AEs were lower for daptomycin than for the comparator (3.8 % vs. 10.0 %). Three serious AEs were considered to be related to the study drug: one case each of pancytopenia (semi-synthetic penicillin), renal failure (vancomycin) and asymptomatic increase in creatine phosphokinase concentrations (daptomycin). Conclusion: In elderly patients, for whom data were previously limited, the efficacy and safety of daptomycin have been confirmed, including for infections caused by S. aureus, regardless of methicillin susceptibility. [ABSTRACT FROM AUTHOR]

The choice of an optimum constructional material for the electrosurgical cutting tools based on nanostructured crystals of partially stabilized zirconia (NPSZe) is substantiated on the basis of criteria of operational stability and functional efficiency. The results of research into adsorption of organic molecules on the surface of the material are used to study the adhesion characteristics of NPSZe. The models of the innovative tools, such as curved bipolar electrosurgical scissors, bipolar forceps, tweezers, and dissectors with nonstick spray, are presented. An experimental model of a high-frequency generator necessary for optimal tool operation is considered. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic adrenalectomy is an excellent alternative to open surgery, while there are doubts in regard to laparoscopic treatment of pheochromocytoma due to its unsteady intraoperative hemodynamics. The goal of the study was to define optimal surgical approach to pheochromocytoma. Methods: A total of 99 patients with pheochromocytoma were operated from 1990 to 2002. Nine, 28, 40, and 22 patients were operated respectively through laparoscopic (group 1), thoracophrenotomic (group 2), lumbotomic (group 3), and laparotomic (group 4) approaches. Intraoperative parameters including those related with hemodynamic stability were studied. Post- operative analgesic medication, complications, and hospital stay were registered. Results: Mean operative time was 132 ± 49 min, 104 ± 29 min, 81 ± 30 min, and 129 ± 40 min, respectively, in groups 1, 2, 3, and 4. Thoracophrenotomic approach had a minimal time from starting of adrenal dissection to central adrenal vein crossing on the right side and lumbotomic approach on the left side. Laparoscopy showed longest length of that period on both sides. However, we observed more stable intraoperative dynamics during laparoscopic adrenalectomy in comparison with any traditional open approaches on both sides. Mean blood loss was 178 ± 112 ml, 410 ± 255 ml, 314 ± 163 ml, and 420 ± 398 ml, respectively, in groups 1, 2, 3, and 4. Blood transfusions were required in 0%, 35.7%, 20%, and 13.6% of cases, respectively, in groups 1, 2, 3, and 4. Using laparoscopic approach resulted in significant decrease of prescription of opoids, postoperative hospital stay, and rate of postoperative complications. Among traditional approaches lumbotomy presented better postoperative results due to its less invasive nature. Conclusion: Laparoscopy is a method of choice to pheochromocytoma in experienced hands. Open approaches are still feasible. Among traditional approaches lumbotomy should be preferred. Thoracophrenotomy can be justified only for major tumors on the right side. Laparotomy is indicated in selected cases of extraadrenal pheochromocytoma. [ABSTRACT FROM AUTHOR]