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Introduction. Preoperative, in particular, antiseptic, preparation of the external auditory canal (EAC) is an important issue for the otosurgeon to take in mind, especially with endaural approach.The aim of the study is to assess the skin microbiota of the EAC and the effectiveness of antiseptic treatment before endaural intervention.Materials and methods. A prospective study including 19 patients who underwent ear surgery by endaural approach: 10 stapedoplasty; 9 tympanoplasty. Ear swabs culture were taken from all the patients preoperatively and after removing the tamponade. Of the 10 patients with otosclerosis, 5 underwent skin preparation with 10% povidone iodine and a swab culture.Results. According to the microbiological examination results, Staphulacoccus Auricularis prevailed in the first smear - 52.6%. In 5 patients with otosclerosis, in comparison to the 1st swab: one case with absence of microorganisms growth, in the other 4 -decrease in the degree of contamination by half. In the 3rd swab, there was no growth in these patients and in the rest, who didn't undergo antiseptic preparation. Patients, without antiseptic preparation of the ear canal, after tympanoplasty (9 patients) in the second smear, had an increase of contamination (from 105 to 106 CFU/ml).Conclusions. Analysis of the microbiome before and after the operation revealed the growth of predominantly (94.7%) opportunistic microorganisms. Preoperative antiseptic preparation reduces the degree of contamination of the skin, which, in our opinion, prevents complications and improves the healing process.

Transplantacija bubrega predstavlja najbolju metodu liječenja terminalne faze kronične bubrežne bolesti. Pripremu pacijenata za zahvat vodi tim u koji su uključeni nefrolog, kirurg – urolog, anesteziolog te liječnik obiteljske medicine, čija je međusobna suradnja nezaobilazni dio skrbi o pacijentu. U prijeoperacijskoj pripremi anesteziolog se susreće s brojnim komorbiditetima, kompleksnom anamnezom te širokim spektrom pacijentove medikamentozne terapije uz naglasak na kardiovaskularne bolesti koje predstavljaju najčešći uzrok smrtnosti u ovoj skupini pacijenata. Pojavnost hematoloških, metaboličkih, respiratornih i endokrinih bolesti česta je, te je iznimno važna optimalizacija pacijentova općeg stanja prije operacijskog zahvata. Transplantacija bubrega je zahvat koji se obično ne može planirati i prema njemu se treba ponašati kao prema hitnom zahvatu, čime se povećava rizik razvoja komplikacija. Za vrijeme samog zahvata koji se izvodi u općoj, balansiranoj anesteziji, uloga anesteziologa je poznavanje farmakokinetike i farmakodinamike lijekova te vođenje anestezije koja će omogućiti urednu funkciju perfuzije presatka, što se postiže održavanjem adekvatnih vrijednosti krvnog tlaka. Važno je pravovremeno započinjanje antibiotske i imunosupresivne terapije uz zadovoljavajuću analgeziju. U daljnjem poslijeoperacijskom tijeku nužno je rano prepoznavanje i prevencija mogućih komplikacija kako bi se spriječilo neželjeno odbacivanje bubrežnog presatka., Kidney transplantation represents the best method for treating end-stage renal disease. The procedure is led by a team involving a nephrologist, a urologist, an anesthesiologist and a family medicine doctor whose cooperation is an indispensable part of patient care. The anesthesiologist encounters numerous patient’s comorbidities with a complex medical history and a wide range of medications. The emphasis is set on cardiovascular diseases which are the most common cause of mortality in this group of patients. The incidence of hematological, metabolic, respiratory and endocrine diseases is common, and it is extremely important to optimize the patient’s general condition prior to surgery. Kidney transplantation usually cannot be planned so it should be treated as an emergency, increasing the risk of complications. During the procedure that is performed under general, balanced anaesthesia, the role of the anesthesiologist is to know pharmacokinetics and pharmacodynamics of the drugs. Maintenance of blood pressure during anesthesia ensures an adequate kidney transplant perfusion. Early antibiotic and immunosuppressive therapy with satisfactory analgesia is important. In the postoperative course, early identification and prevention of possible complications is necessary to prevent unwanted kidney transplant rejection.

Background Before and after major surgery, access to information in a user-friendly way is a prerequisite for patients to feel confident in taking on the responsibility for their surgical preparation and recovery. Several e-health applications have been developed to support patients perioperatively. The aim of this review was to give an overview of e-health applications designed for self-care associated with surgery by providing a scoping overview of perspectives from providers and patients. Methods We searched the following data sources to identify peer-reviewed quantitative and qualitative studies published between 2015 and 2020: CINAHL, Google Scholar, MEDLINE, PsycInfo, Web of Science, and Scopus. After identifying 960 titles, we screened 638 abstracts, of which 72 were screened in full text. Protocol register: 10.17605/OSF.IO/R3QND. Results We included 15 studies which met our inclusion criteria. Data from several surgical contexts revealed that the most common self-care actions in e-health applications were preoperative preparations and self-assessments of postoperative recovery. Motivational factors for self-care were information, combined with supportive reminders and messages, and chat features. Although there was great variance in research designs and technical solutions, a willingness to engage with and adhere to e-health seemed to increase patients’ self-care activities and thereby accelerate return to work and normal activities. In addition, the need for physical visits seemed to decrease. Even though age groups were not primarily studied, the included studies showed that adult patients of any age engaged in surgical self-care supported by e-health. The providers’ perspectives were not found. Conclusions E-health applications supporting perioperative self-care indicated a positive impact on recovery. However, experiences of healthcare professionals delivering e-health associated with surgery are missing. Additionally, studies based on patients’ perspectives regarding willingness, adherence, and motivation for self-care supported by e-health are sparse. A need for studies examining the supporting role of e-health for self-care in the surgical context is therefore needed.

Introduction. Augmentation urethroplasty using buccal mucosa is currently the optimal method for treating extended urethral strictures. However, this surgery is associated with a fairly high frequency of relapses and complications. One of the reasons that can determine the success or negative outcome of surgery is the morphological structure of the graft, which requires more in-depth research. Purpose of the study . To evaluate the initial morphological state of the buccal mucosa in men and determine the feasibility of its pharmacotherapeutic preparation as a predictor of improving the quality of autograft engraftment in augmentation urethroplasty. Materials and methods . The morphological structure of buccal mucosa fragments was studied in 20 patients with extended strictures of the spongy urethra. The objects of morphological research were intact oral mucosa before augmentation urethroplasty (1 biopsy) and mucosal fragments after 7 days of oral treatment with «Listerine» antiseptic solution (2 biopsies). The biopsy material was examined microscopically using standard staining (hematoxylin-eosin) and immunohistochemical methods. Results. The initial histological structure of the buccal mucosa in every third patient was accompanied by inflammatory infiltration at the level of the subepithelial layer with desquamation of the epithelium. a pronounced increase and strengthening of intercellular contacts in grafts proved histologically and immunohistochemically, which was characterized by pronounced expression of antibodies throughout the thickness of the epithelial layer, after week-long handling of the oral cavity with an antiseptic. At the same time, there is a «self-organization» of the submucosal base by reducing oedema, strengthening intercellular and focal adhesion contacts, with an increase in the components of the vascular bed and the number of vascular «plumules». Conclusion. Thus, a week-long preoperative treatment of the oral cavity allows stopping damage to the epithelium and inflammatory infiltration in the submucosal base with an improvement in its vascularization, which can be regarded as a positive factor for subsequent graft implantation.

Patients with severe postmenopausal genital prolapse (GP) are the most clinically difficult group of women, in which surgical treatment with mesh implants presents significant difficulties due to the duration of lesions amid pronounced structural changes in the tissues of the urogenital tract under conditions of hormone deficiency. That is why it is of particular importance to study the histological characteristics of the vaginal mucosa in women with GP, who must conduct surgical treatment of vaginal access. Aim. To study the histological features of the vaginal mucosa in postmenopausal women with severe GP in preparation for surgical treatment with vaginal access. Materials and methods. The study involved 70 postmenopausal women suffering from GP of stage III, IV in combination with genitourinary menopausal syndrome. Patients were randomized blindly into two groups. The therapy was carried out using vaginal forms of estrogen and progesterone preparations in combination with lactobacilli. In the comparison group, preoperative preparation was not performed. All patients underwent clinical and laboratory examination: general examination and gynecological examination, morphological examination of biopsy samples of the mucous membrane of the anterior vaginal wall, which were obtained during subsequent surgical treatment of GP. Methods of parametric statistics were used. Results. It was established that focal dystrophy, acanthotic severity, keratinization of the vaginal epithelium, moderate inflammation are characteristic morphological changes in the vaginal mucosa in women with postmenopausal GP. Application at the stage of preparation for surgical treatment using vaginal forms, as a result of which estrogen and progesterone enhance the inflammatory process in the ulcerative vagina, reduce dystrophic changes and their severity in relation to complex changes and differentiation of the vaginal epithelium and activation of regeneration processes in tissues. Conclusion. Reducing inflammation and the severity of dystrophic processes in vaginal enemas at the stage of preoperative preparation of women with postmenopausal GP favorably affects the regeneration processes, which in the first place can improve the outcome of surgical treatment.

Сardiac complications are the most frequent non-surgical complications after surgical interventions, increasing the length of the patient’s stay in the hospital, the economic costs and the percentage of deaths. The frequency of patients with cardiovascular diseases who require surgery is also high. Optimization of drug therapy in the perioperative period is one of the factors of successful outcome of the surgical intervention.The pathophysiological basis for the development of many cardiac events in the postoperative period is an increase in the activity of the sympathetic nervous system, which leads to an increase in heart rate (HR) and myocardial oxygen demand. These changes may increase the risk of myocardial ischemia, arrhythmias, and other cardiovascular events in the early postoperative period. For example, the development of myocardial infarction (MI) in the perioperative period leads to an increase in hospital mortality by 15–25 %, and increase in the risk of developing cardiac death in the next few months.The main group of drugs for relieving these effects is beta-blockers (BB). This drug class has a wide range of applications: treatment of angina, arrhythmias, hypertension, MI, heart failure. Currently, there is a large evidence for the possibility and feasibility of using BB in patients undergoing surgery.In this article, the authors highlights the issues of prescribing BB in patients with comorbid pathology in the perioperative period. The analysis and comparison of studies on various aspects of BB use in the perioperative period performed. Currently, there is a mixed opinion about the benefits and risks of perioperative therapy of BB, which causes the high relevance of this issue for discussion.

The aim– to study the effectiveness of endoscopic photodynamic therapy as a preoperative preparation of the tracheobronchial tree in patients with lung cancer. Materials and methods.The study included 181 patients with II-III stage of lung’s cancer. Diagnose of lung’s cancer was confirmed with a morphologically and concomitant endobronchitis. During the preoperative preparation, we used a technique developed by us introducing into the tracheobronchial tree an aqueous solution of brilliant green at concentration of 0.04 %, followed by irradiation of this solution with laser radiation with the wavelength of 0.63 μm (AFL-2 helium-neon laser) in an independent form and in combination with traditional anti-inflammatory therapy. Endoscopic endobronchial sanitation therapy was carried out by low-intensity radiation of the red part of the spectrum (λ=0.63–0.66 μm) in a pulsed mode, with a power of 12 mW. Results.After 3–5 days of the start preoperative preparation and 1–2 sessions of endoscopic bronchosanation, the general state of patients was improved, the amount of sputum decreased and was changing from mucopurulent to mucous. To completely stop the clinical phenomena of endobronchitis, it was necessary to conduct 5-6 sessions of endoscopic photodynamic therapy according to our methodology, with the introduction of our method. In patients without pronounced clinical symptoms of concomitant chronic bronchitis, it was enough to complete only 3 sessions of bronchosanation. Conclusion.Endoscopic photodynamic bronchosanation in the preoperative period in patients for correcting accompanying endobronchitis can significantly reduce or completely stop the clinical manifestations of endobronchitis in the shortest time and leads to a significant decrease in the number of endobronchial complications in surgical and combined treatment of lung cancer.

Cardiac complications are currently the leading cause of early mortality following liver transplantation. Guidelines for the cardiac workup prior liver transplantation are limited. In this review we are discussing commonly modalities used for cardiovascular evaluation of liver transplant candidates.Authors declare no conflict of interest.

Highlights • Ectopic pheochromocytoma seldom occurs on the diaphragm and is hard to diagnose. • Combination of catecholamine, CT and especially MIBG can assist in diagnosis of ectopic pheochromocytoma. • Surgery may the first-choice treatment for ectopic pheochromocytomas., Background Ectopic pheochromocytomas, the incidence of which is >15%, can occur throughout the entire body but seldom on the diaphragm. Surgery may the first-choice treatment for ectopic pheochromocytomas. Presentation of case We herein describe a 61-year-old woman with an atopic diaphragmatic pheochromocytoma. She had a 7-year history of paroxysmal headaches, palpitations, and hypertension with no obvious causes; these symptoms were alleviated by nifedipine and metoprolol. Computed tomography (CT) revealed a slightly hypodense lesion on top of the right hepatic lobe. A Metaiodobenzylguanidine (MIBG) scan showed increased radioactive in the lesion. After adequate preoperative preparation, we removed the mass. During the operation, we found that the mass was located on the diaphragm. The pathological examination showed that the main pathologic change was paraganglioma. The patient recovered well after surgery with no recurrence of her hypertension, palpitation, or headache. Conclusions Diaphragmatic pheochromocytoma is a rare kind of ectopic pheochromocytomas, which can also affect the patient’s quality of life. Combination of qualitative and positioning tests can assist in diagnosis of ectopic pheochromocytoma. Surgical resection is an effective treatment method.

Introduction: Ebstein anomaly, a congenital heart defect characterized by a morphological and functional abnormality of the tricuspid valvula while moving the mouth of the tricuspid valvula towards the apex of the right chamber. Case report: A patient aged 39 years on the Department of Surgery was admitted under the image of an acute abdomen and the need for emergency surgical treatment. Routine preoperative preparation, laboratory treatment, examination of internist and examination of anesthesiologist on the part of the part was carried out. He has a history of occasional breathing problems during respiratory infection, a smoker. Clinical status, other than primary problems, is orderly. Operational treatment passed neatly, on the fourth postoperative day the patient complained of suffocation, lack of air and chest pain, translated into intensive care monitored (spo2 87% f about 110/min TA 90/60), blood gas analysis done and laboratory treatment (fibrinogen, D dimer) due to suspected pulmonary thromboembolia consulted cardiologist, dilation of the right atrium seen by ultrasound. Discussion: Non-cardiac surgeries in patients with pre-existing congenital heart defects are high-risk surgeries with increased mobility and mortality in the perioperative period. In accordance with the accompanying pathoanatomical and pathophysiological changes that define the congenital heart defect, a detailed plan must be made - anesthesiological management for each patient separately. Hemodynamic and respiratory stability with avoidance of hypoxia and paradoxical arrhythmias are the basic postulates in patients with Ebstein's anomaly.

Endophthalmitis remains a serious complication following intraocular procedures. Preoperative prophylactic measures for endophthalmitis decrease the morbidity associated with this disease and represent a standard of care prior to ophthalmic surgery. The literature supports as measures for ocular antisepsis: povidone-iodine solution for ocular surface preparation, chlorhexidine in patients with iodine allergy and application of topical antibiotics. Povidone-iodine is regarded as the most effective antiseptic associated with significant reduction in ocular surface bacterial counts. Currently, the recommended preoperative management is the application of 5% povidone-iodine solution in the conjunctival fornix, prior to surgery. This paper reviews the preoperative measures for ocular antisepsis, used in order to decrease the risk of culture-proven endophthalmitis.

BackgroundHemodynamic instability is frequently observed during adrenalectomy for pheochromocytoma (PCC). Guidelines recommend liberal preoperative volume administration. However, it is unclear whether fluid deficiency or vasoplegia causes shifting hemodynamics and whether minimally invasive hemodynamic monitoring with esophageal Doppler (EDM) can help visualize intraoperative changes avoiding volume overload and complications.MethodsTen patients with biochemically verified PCC and five patients with hormonally inactive adrenal tumors (HIAT; control group) were treated following a strict protocol. During laparoscopic adrenalectomy, goal-directed fluid therapy was performed using EDM. Hemodynamic and biochemical data were documented. The primary outcome variables were fluid requirement and hemodynamic parameters.ResultsApplying EDM, total intraoperative fluid administration was slightly higher in PCC patients than in patients with HIAT (2100 ± 516 vs. 1550 ± 622 ml,p = 0.097; 12.9 ± 4.8 vs. 8.3 ± 0.7 ml kg−1h−1,p = 0.014). Hemodynamics varied considerably within the PCC group and was associated with type and level of secreted catecholamines. Arterial blood pressure and systemic vascular resistance index reached their minimum in the 10-min period after resection of PCC. Without liberal fluid administration, an increase in cardiac index was observed in both groups comparing baseline measurements to end of surgery. This increase was statistically significant only in PCC patients (PCC: 2.31 vs. 3.15 l min−1m−2,p = 0.005; HIAT: 2.08 vs. 2.56 l min−1m−2,p = 0.225).ConclusionsAs vasoplegia, but not hypovolemia, was documented after tumor resection, there is no evidence that PCC patients profit from liberal fluid administration during laparoscopic adrenalectomy. To avoid volume overload, noninvasive techniques such as EDM should be routinely used to visualize the variable intraoperative course.Trial registration: ClinicalTrials.gov, Identifier: NCT01425710.

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Purpose The COVID-19 pandemic has placed extraordinary demands on healthcare services worldwide. Some have reported increased viral transmission to healthcare workers during aerosol-generating procedures such as intubation. We report our experience with universal preoperative and preprocedural screening for COVID-19 in children requiring general anaesthesia with low risk of having the infection. Methods This was a data review involving children aged

В исследование было включено 450 пациентов (средний возраст 65,2 ± 6,1 года), прооперированных в отделении урологии: 128 пациентов после обширных операций и 322 пациента после операций среднего объема. Послеоперационные осложнения нехирургического профиля наблюдались у 175 пациентов (39%), включая 17 летальных исходов (3,8%). Периоперационный инфаркт миокарда диагностирован у 6 пациентов (1,3%). Сердечно-сосудистые осложнения составили 58% от числа всех серьезных осложнений у пациентов, перенесших плановые операции. Сердечно-сосудистая летальность у пациентов в общей выборке составила 1,7%, у пациентов, перенесших обширные операции, – 4,7%, а у пациентов, перенесших операции среднего объема, – 0,6%., The study included 450 patients (mean age 65.2 ± 6.1 years) who underwent surgery at the urology department: 128 patients after major interventions and 322 patients after medium-sized interventions. Non-surgical postoperative complications were observed in 175 patients (39% of cases), including 17 deaths (3.8% of cases). Perioperative myocardial infarction was diagnosed in 6 patients (1.3% of cases). Cardiovascular complications accounted for 58% of all serious complications in patients underwent elective surgery. Cardiovascular mortality in patients of general sample was 1.7%, in patients underwent major interventions – 4.7%, in patients underwent medium-sized interventions – 0.6%.

The aim of study: to estimate the frequency of postoperative complications and the ways of their reduction in patients after performing «large volume» surgical interventions on the example of radical cystectomy (RCE). Materials and methods . The study included 73 patients who underwent RCE. All patients were divided into 2 groups: the main group consisted of 29 patients who remained under the active supervision of the therapist throughout the entire hospitalization and underwent preoperative preparation (cardiac examination, correction and prescription of medication). The comparison group comprised 44 patients whose medical history was retrospectively analyzed. Patients of this group did not undergo advanced therapeutic monitoring, both in the preoperative and postoperative period. Results. In patients of the main group, despite the presence of concomitant pathology in most cases, including cardial pathology, the frequency of postoperative complications was statistically significantly lower than in the comparison group. There were no lethal cases from cardioembolic complications in patients undergoing active therapeutic monitoring. The observation of the therapist throughout the entire hospitalization, as well as the use of the surgical protocol of early activation of the patient, significantly reduced the length of hospitalization, as well as the length of stay in the intensive care unit. Conclusion. The introduction of the program of preoperative preparation and therapeutic postoperative monitoring led to a reduction in the incidence of cardiac death and duration of hospitalization in patients undergoing extensive surgical intervention.

Purpose Preoperative preparation for adrenalectomy for pheochromocytomas and paragangliomas (PPGL) is universally recognized as necessary, while the optimal strategy remains controversial. Our aims were to increase intraoperative hemodynamic stability, expedite postoperative recovery, decrease side effects and reduce costs for patients with PPGL undergoing adrenalectomy. Methods We identified 526 patients undergoing open adrenalectomy for PPGL in the West China Hospital of Sichuan University between May, 2007 and December, 2016. 149 patients received preoperative selective α-blockade with phenoxybenzamine, and 377 patients received non-selective α-blockade with prazosin, doxazosin or terazosin. There were no statistical differences between groups regarding preoperative patient and tumor characteristics. Operations were planned once hypertensive patients were well-controlled with blood pressure ≤130/85 mmHg. Intraoperatively, all patients received arterial blood pressure monitoring, and indwelling urinary catheters to record urine output. We recorded intraoperative hemodynamics, status in the postanesthesia or intensive care unit, postoperative recovery and complications. Results Patients in the non-selective group showed a more significant decline in postoperative systolic blood pressure than the selective group (P = 0.041). Also, patients in the non-selective group appeared to receive a long-term anti-hypertensive effect, especially for diastolic blood pressure (P = 0.037), which was a novel finding, based on the current literature. Conclusions Our results confirmed that non-selective α-blockade produced a more significant anti-hypertensive effect than selective α-blockade. However, we found no significant difference in intraoperative hemodynamic instability, postoperative recovery and postoperative complications between groups.

Colorectal cancer is a frequently encountered disease. In most countries, it represents the second leading cause of cancer death. The treatment with radical intent of this condition is surgical. Objective: Through this study, we want to update some data regarding the impact of nutrition and the preoperative mechanical bowel preparation on postoperative complications, in patients who need surgical treatment for colorectal cancer. Material and Method: Relevant articles in the field, contained in international databases were analysed, with no language exclusion, including clinical trials and meta-analyses performed between 1994 and 2015. Conclusions: Preoperative preparation is particularly important in the postoperative evolution of the patients with colorectal cancer and it is based on several main principles: nutritional support, antimicrobial treatment and mechanical bowel preparation.

Enhanced recovery pathways are a novel approach focused on enhancing the care of surgical patients. “Prehabilitation” is the term applied to any intervention administered before surgery to reduce surgery-related morbidity, decrease the length of hospital stay, expedite the return of organ function, and facilitate the patient's return to normal life. A PubMed search was performed with the following key words: enhanced recovery, preoperative preparation, cessation of smoking and euvolemia. The results from this Pubmed search revealed that female patients may have higher levels of anxiety than male patients. Intensive smoking and alcohol cessation 6–8 weeks before elective surgery may reduce the incidence of postoperative morbidity. Preoperative exercise can be effective for reducing the postoperative complications like pulmonary complications and shortening the length of hospital stay. It is safe to allow patients to drink clear fluids up until 2 h before elective surgery (Level II evidence). Perioperative normoglycemia is the single most important factor to prevent surgical site infection. Intermittent pneumatic compression devices and low molecular weight heparin are effective in preventing postoperative thromboembolism. No advantage is gained by preoperative mechanical bowel preparation in elective colorectal surgery. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. Mild perioperative hypothermia may promote surgical wound infection by triggering thermoregulatory vasoconstriction, which decreases subcutaneous oxygen tension.

the article considers the problem of genital prolapse in women. This is not a rare pathology to date. On the basis of clinical hospital, the authors conducted the study, the statistical data and the results of observations of patients. The researcher also described the classification and different ways of treatment of this pathology, developed a new method of surgical treatment of genital prolapse (circular hemostatic suture in vaginal extirpation of the uterus). At the end of the article the conclusions have been made.

This article will provide a framework for producing immersive 360-degree videos for pediatric and adult patients in hospitals. This information may be useful to hospitals across the globe who may wish to produce similar videos for their patients. Advancements in immersive 360-degree technologies have allowed us to produce our own “virtual experience” where our children can prepare for anesthesia by “experiencing” all the sights and sounds of receiving and recovering from an anesthetic. We have shown that health care professionals, children, and their parents find this form of preparation valid, acceptable and fun. Perhaps more importantly, children and parents have self-reported that undertaking our virtual experience has led to a reduction in their anxiety when they go to the operating room. We provide definitions, and technical aspects to assist other health care professionals in the development of low-cost 360-degree videos.

Comparative analysis of results of treatment of prolapse of the internal reproductive organs 132 patients. The patients were operated by vaginal access. The patient was subjected to questioning on a specialized questionnaire, a standard medical examination before surgery. As preoperative preparation 44 patients received standard rehabilitation of the vagina with antiseptic solutions, 1 per day, a 46 — treatment of the walls of the vagina and cervix with ointment for external use levomekol 1 time per day, a 42 — irrigation of the vaginal walls and cervix spray olazol. Application levomekol allowed to improve the results of treatment of 5,0%, olazol 8,9%. Use levomekol reduced the treatment time of 1,9 days, olasol 4 days.

A comparative analysis of subjective and objective criterion was made in order to evaluate efficacy of preoperative preparation in 101 patients with pheochromocytoma of different clinical course. It was shown the reasonability of monitoring usage of noninvasive method of assessment of systemic hemodynamics (bio-impedance reo-vasography and daily monitoring of arterial pressure) for evaluation of preoperative preparation adequacy. The need of differentiated approach and strategy of preoperative preparation were based on clinical course of pheochromocytoma.

Autism is a disease of the brain. It affects 6 in every 1000 children from all races, ethnical and social groups. Most of the physicians say it is more of a condition, rather than a disease. Children who suffer from autism have problems with communication and lack social skills. This is why they have to be under anesthesia when various medical manipulations or operations are performed. Prior to all those interventions are necessary not only consultations with pediatrician, anesthesiologists and other specialists but also close collaboration with psychologists who know the specific character of this condition.

ABS TRACT Objective: Pre o pe ra ti ve pre pa ra ti on of hyperth yro id pa ti ents is ex tre mely im por tant to avo id comp li ca ti ons du e to se ve re thyro to xi co sis during surgery. We in ves ti ga ted the ef fects of lu gol’s so lu ti on (LS) with or wit ho ut thi o na mi des in the ra pid pre pa ra ti on of the patients for thy ro id sur gery and com pa red the ef fect of LS in pa ti ents with Gra ves’ di se a se (GD) and to xic mul ti no du lar go i ter (TMNG). Material and Met hods: Da ta we re col lec ted ret ros pec ti vely from 44 pa ti ents with hyperth yro i dism who we re fol lo wed up in our cli nic. Twenty-two pa ti ents with GD, 19 pa ti ents with TMNG and three pa ti ents with so li tary to xic ade no ma we re en rol led in to the study. To res to re euth yro i dism be fo re sur gery, 27 pa ti ents we re tre a ted with LS (gro up 1) whi le 17 pa ti ents re ce i ved LS and thi o na mi des (gro up 2). Re sults: Me an da ily to tal do sa ge of LS and du ra ti on of tre at ment to res to re euth yro i dism we re not sta tis ti cally dif fe rent bet we en gro ups 1 and 2. When the two tre at ment gro ups we re com pa red, the re was no sig ni fi cant dif fe ren ce in ba se li ne pa ra me ters and per cen ta ge of chan ges of se rum fT4 and fT3 le vels. Du ra ti on of LS tre at ment and do sa ges of LS and thi o na mi des we re al so si mi lar in pa ti ents with GD and TMNG. Per cen ta ge of chan ges in se rum fT4 and fT3 le vels af ter LS tre at ment we re not sta tis ti cally dif fe rent in two gro ups of pa ti ents. All pa ti ents we re cli ni cally euth yro id be fo re sur gery. Conc lu si on: LS tre at ment, ei t her alo ne or to get her with an tith yro id drugs, is a sa fe and ef fec ti ve cho i ce for the ra pid pre pa ra ti on of hyperth yro id pa ti ents for thyro i dec tomy, in de pen dent from the eti o logy of hyper th yro i dism.

The paper demonstrates that in case of acute gastroduodenal hemorrhages of ulcerons and cancerous origin there occurs a disturbance of the indices of homeostasis and peripheral hemodynamics. A timely and adequate treatment makes it possible to stabilize relatively the general conditionof a patient over a short period of time and create a more favourable background for surgical intervention depends on the general condition of a patient, the results of an endoscopic examination and the degree of destructive-degenerative changes of local tissues., В работе показано, что при острых гастродуоденальных кровотечениях язвенного и ракового происхождения происходит наруше-ние показателей гомеостаза и периферической гемодинамики. Своевременное и адекватное лечение позволяет за короткий период времени относительно стабилизировать общее состояние больного и создать более благоприятный фон для оперативного вмешательства. Объем операции зависит от общего состояния больного, результатов эндоскопического обследования и степени деструктивно-дегенеративных изменений местных тканей., У роботі показано, що при гострих гастродуоденальних кровотечах виразкового і ракового походження порушуються показники гомеостазу та периферійної гемодинаміки. Своєчасне та адекватне лікування дозволяє за короткий проміжок часу відносно стабілізувати загальний стан хворого і створити сприятливіші умови для оперативного втручання. Обсяг операції залежить від загального стану хворого, результатів ендоскопічного обстеження та ступеня деструктивно-дегенеративних змін місцевих тканин.

Проведена комплексная оценка показателей гемодинамики у 30 больных феохромоцитомой с использованием методов эхокардиографического обследования, суточного мониторирования артериального давления и биоимпедансной реовазографии по технологии «Кентавр». Изучен характер гемодинамических нарушений у больных феохромоцитомой на различных этапах лечения в зависимости от качества предоперационной подготовки. Выявлено достоверное положительное влияние селективных а-адреноблокаторов на параметры кровообращения у больных феохромоцитомой в предоперационном периоде. Доказана эффективность применения неинвазивных методов оценки гемодинамики для объективизации качества предоперационной подготовки. Heamodynamics parameters of 30 pheochromocytome patients with use of methods of echocardiographies inspections, daily monitoring of arterial pressure and bioimpedance reographia on technology are studied «The Centaur». The comparative analysis of heamodynamics infringements character among pheochromocytome patients at various stages of treatment depending on quality of preoperative preparation is lead. Authentic positive influence is revealed a-adrenoblocks on parameters of blood circulation of patients with pheochromocytome in preoperative periods. Efficiency of application of nonivasive methods of heamodynamics estimation for specification qualities of preoperative preparation is proved. Сергийко СВ., кандидат медицинских наук, доцент кафедры общей хирургии Челябинской государственной медицинской академии (г. Челябинск);тел. 8-351-23267-94. Sergijko S.V., the candidate of medical sciences, the senior lecturer of chair of the general surgery of the Chelyabinsk state medical academy (Chelyabinsk); ph.8-351-23267-94. Привалов В.А., доктор медицинских наук, профессор, заведующий кафедрой общей хирургии Челябинской государственной медицинской академии (г. Челябинск); тел. 8-351-232-69-11. Privalov V.A., the doctor of medical sciences, the professor managing chair of the general surgery of the Chelyabinsk state medical academy (Chelyabinsk);ph. 8-351-232-69-11. Лукьянов С.А., врач-хирург Городская клиническая больница №1 (г. Челябинск); тел. 8-351-2326891. Lukjanov S.A., the doctor-surgeon City clinical hospital № 1 (Chelyabinsk); ph. 8-351-2326891

Introduction: We report an unusual case of normotensive pheochromocytoma detected incidentally, presenting a pre-operative management problem. Case Note: A 40-year-old lady with vague abdominal symptoms was initially discovered with a left adrenal incidentaloma by ultrasound abdomen, which was also revealed in computed tomography (CT). After exclusion of all the causes with possible necessary investigations, pheochromocytoma was confirmed with elevated 24 hour urinary metanephrine and normetanephrine. Her blood pressure was in low to normotensive range all throughout. She was attempted to be prepared with combined alpha and beta blockade but could not tolerate this regimen due to symptomatic hypotension. Subsequently, surgical preparation was planned cautiously with alpha-adenergic blockade only. With intensive monitoring, she underwent uneventful left adrenalectomy, and surgical pathology was consistent with pheochromocytoma. Conclusion: This case illustrates an unusual presentation of normotensive pheochromocytoma as adrenal incidentaloma. Pre-operative preparation in these patients can be achieved with alpha-adrenergic blockade, adequate hydration, and liberal salt intake.

Context: Robot-Assisted Laparoscopic Radical Prostatectomy (RALRP) requires significant preoperative setup time for the room, staff, and surgical platform. The utilization of a dedicated robotics operating room (OR) staff may facilitate efficiency and decrease costs. Aims: We sought to determine the degree to which preoperative time decreased as experience was gained. Materials and Methods: A total of 476 patients with a mean age of 60.2 years were evaluated (11/2006 to 1/2010). Data was assimilated through an institutional review board approved blinded, prospective database. Utilizing time from patient arrival in the OR to robot docking as preoperative preparation, our experience was evaluated. Age, body mass index (BMI), and American Society of Anesthesiologists risk scores (ASA) were compared. Statistical Analysis Used: Analysis of variance; Two-sample t-test for unequal variances. Results: The first and last 100 cases were found to have similar age (P=0.27), BMI (P=0.11), and ASA (P=0.09). The average preoperative times were 66. 4 and 53.4 min, respectively (P