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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]

In Russia and European countries, the incidence of pressure (decubitus) ulcers in sedentary patients with severe comorbidities, spinal trauma, and cerebral accident sequelae varies from 3 to 40 %, reaching 80 % in the chronic critical illness. The final result of conservative treatment of pressure ulcers (PU) with adequate correction of comorbidities and proper care of the immobilized patient depends largely on the choice of local interventions. Aim of the review: to demonstrate the range of effective methods of physical treatment of pressure ulcers suitable for conservative treatment. Materials and methods. We selected and analyzed 80 scientific publications. Sources were selected from the PubMed, Scopus, and RSCI databases of medical and biological publications. The following methods were covered: negative pressure wound therapy, ultrasonic methods, hydrosurgical treatment, plasma flows, laser therapy (including low-level laser therapy), «hardware» acceleration of regenerative processes, including electrical stimulation, as well as a combination of these methods. Results. The variety of physical methods of wound treatment, on the one hand, provides an opportunity to select an individual therapy program. On the other hand, each method has its own limitations and contraindications. That is why in practice various combinations of these methods are reasonable. Conclusion. For several objective reasons, no reduction of PU incidence in clinical practice is expected. Therefore, studying the issues of evidence-based clinical effectiveness and economic feasibility of various conservative techniques of decubitus treatment to find best solutions in this area is warranted.

ObjectiveThis 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.BackgroundPapillary 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.MethodsIt 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.ConclusionsThe 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 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.

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.

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.

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.

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]

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]

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]

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]