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Estudaram-se em 6 doentes com valvulopatias reumatismais, as variações da actividade enzimática no plasma, durante e apos a cirurgia cardíaca com circulação extra-corporal, para verificar a especificidade da isoenzima MB da creatinaquinase, comparando-a com a da CK. Estudaram-se também as variações da desidrogenase láctica no mesmo período. O protocolo de colheitas escolhido, procurava dissociar as variações enzimáticas correspondentes aos tempos anteriores a miocardiotomia, das relacionadas com a lesão cirúrgica das fibras miocárdicas. Os autores verificaram existir um paralelismo evidente entre as curvas referentes a CK total e a sua isoenzima MB. Esta última elevava-se mais tardiamente, apenas durante os tempos cardíacos da intervenção, atingia o máximo no final desta e voltava mais rapidamente aos valores iniciais. A CK-MB regressava aos valores basais no 3º dia do pós-operatório e a CK-total entre o 5.° e o 7º dia. Os autores concluem que a isoenzima CK-MB é um indicador fiel e pouco sujeito a erros para detecção precoce de sofrimento das fibras musculares cardíacas. Os valores da LDH sofreram variações mais irregulares, atribuíveis a interferência de diversos factores, mas pareceram de interesse na detecção de complicações durante o pós-operatório.

Made available in DSpace on 2022-04-29T08:32:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Purpose: The study aimed to evaluate the outcomes of flapless guided surgery related to surgery, patient, operator, assistant, and advisor, comparing it with conventional surgery performed by undergraduate students who had never placed implants in patients. Materials and Methods: A randomized controlled split-mouth clinical trial was carried out. Ten patients with bilateral mandibular posterior tooth loss received an implant on each side with conventional flap surgery or flapless guided surgery that was performed by undergraduate students. Surgery time, pain, patient satisfaction, quantity of consumed medications, time of procedure, ease of procedure, anxiety, and stress were assessed. Results: Conventional surgery showed statistically significantly inferior results compared with flapless guided surgery in terms of procedure time (56 minutes, 36 seconds ± 8 minutes, 38 seconds vs 30 minutes, 1 second ± 6 minutes, 2 seconds), consumption of analgesic medications (49 tablets vs 15 tablets), intraoperative (1.75 ± 1.56 vs 0.65 ± 0.64) and postoperative pain (4.62 ± 2.17 vs 1.17 ± 0.72), and operator anxiety (4.76 ± 1.66 vs 3.47 ± 1.50), respectively. Conclusion: Flapless guided implant surgeries performed by individuals with no previous clinical experience showed reduced surgery time and delivered better patient-reported outcomes both in the intraoperative and postoperative periods; reduced medication consumption; and showed better results in the operator and assistant perspectives Periodontics and Implantology FAESA Department of Diagnosis and Surgery FOAr/UNESP Department of Clinical Dentistry FAESA Department of Clinical Dentistry FAESA Department of Biologic and Materials Sciences and Prosthodontics University of Michigan School of Dentistry Department of Diagnosis and Surgery FOAr/UNESP Department of Clinical Dentistry FAESA

Objectives to discuss a five-year experience in surgical treatment of temporal bone paragangliomas from the point of view of U. Fisch and D. Mattox classification modified by М. Sanna in 2013. Material and methods. In the period from February 2015 till December 2020, we performed 130 operations to remove temporal bone paraganglioma. The examined and operated patients included 34 men and 96 women aged from 2 to 82 years. The paraganglioma types A, B and C were distributed as follows: type A in 22 patients (A1 12 cases, A2 10 cases); type B in 73 patients (B1 25 cases, B2 16 cases, B3 32 cases); type C in 35 patients (С1 10 cases, С2 12 cases, С3 7 cases, С4 5 cases) Results. The evaluated results included the quality of tumor removal, the auditory function and the function of the facial nerve in relation to the size of the neoplasm, registered during the early and late postoperative periods. Based on the study data, we developed an algorithm of tactics of surgical treatment of patients with this type of temporal bone pathology aimed to avoid damage to the vital structures of the lateral skull base.

Objectives: The aim of this study was to compare urodynamics parameters at pre- and postoperative periods in patients undergoing intrafascial or extrafascial abdominal hysterectomy. Background: Hys...

Let-down technique, in which high septal strip resection is performed, and conventional rhinoplasty using autospreader flaps were compared regarding nasal functions with Nasal Obstruction Symptom Evaluation (NOSE) and Sinonasal Outcome Test-22 (SNOT-22) quality-of-life scale questionnaires. A total of 54 patients who were included in the study were divided into two groups: group 1 (autospreader group; n = 27) and group 2 (let-down group; n = 27). Open technical septorhinoplasty operation using an autospreader flap was performed in group 1. Let-down rhinoplasty was applied in group 2. NOSE and SNOT-22 scales were filled for the groups in the preoperative and postoperative periods and were compared. Postoperative values were found to be significantly lower than preoperative values in both groups (p 0.05). There was also no significant difference between the groups regarding age and gender. Although there was no significant difference between the two techniques, both NOSE and SNOT-22 quality-of-life scales have shown improvement both in conventional rhinoplasty with autospreader flap and let-down technique.

Chronic dacryocystitis (CD) is a common pathology of the lacrimal ducts. The search for the optimal method of endonasal endoscopic dacryocystorhinostomy (EEDCR), which would give a quick, high-quality and lasting effect, as well as a lower percentage of disease relapses, remains relevant. The aim: to analyze the effectiveness of treatment of patients with chronic dacryocystitis in the early and late postoperative periods with the use of various modifications of EEDCR. Materials and methods: The study group (1st group) consisted of 45 patients with CD, who underwent EED-CR according to the developed method, the comparison group (2nd group) included 36 patients who, after performing the developed EEDCRa polyvinyl chloride (PVC) conductor was installed in the area of the dacryorhinostoma. The control group (3rd group) included 28 patients who underwent EEDCR according to the generally accepted method: with preservation and plastic placement of mucous flaps and with the installation of a PVC conductor. Patients of 1stand 2nd groups were divided into 2 subgroups: 1A and 2A included patients who underwent computed tomography of the lacrimal ducts in the preoperative period according to the developed method, and patients of subgroups 1B and 2B – according to the traditional algorithm. In the postoperative period, the severity of lacrimation was assessed according to the Munk scale, the degree of visualization of the dacryorhinostoma was determined, and the lacrimal function was investigated by advanced West nasolacrimal test under endoscopic control. The final treatment efficacy was assessed 1 year after surgery. Results: The best results when tested according to the Munk scale were recorded in subgroups 1A and 1B with a statistically significant difference from subgroups 2A, 2B and 3rd group throughout the early postoperative period and 1 month after surgery (p0.05).In the early postoperative period, visualization of the dacryorhinostoma was good in all patients. In the late postoperative period, the best results were in subgroup 1A, the worst in 3rd group, but without a statistically significant difference due to a small sample of patients (p>0.05).Reliably better results of the lacrimal function were obtained in subgroups 1A and 1B already from the 3rd day after surgery, as well as in the subsequent periods of the early postoperative period and 1 month after surgery (p0.05).The maximum paces of deterioration in visualization of dacryorhinostoma and lacrimal function were observed from the 3rd to 6th months after the operation. The proportion of positive treatment results in 1st group was 97.8%, in 2nd group – 94.4%, and in 3rd group – 85.7%, while the difference between groups 1 and 3 was statistically significant (p

An observational prospective feasibility study in which children received a tracker 2 weeks before a tonsillectomy and were required to wear it until four weeks postoperatively. The parents used a diary to log the estimated steps of their child. As primary endpoint, the compliance of complete datasets was compared between the tracker and the diary. As secondary endpoints, the agreement of steps between tracker and diary, and the recovery time after tonsillectomy were analyzed. Twenty-four patients (50% male) with a median age of 6 years were recruited. The tracker had a complete dataset compliance of 91.7% in the pre-operative and 58.3% in postoperative period, whereas the diary’s compliance was 62.5% in the pre-operative and 12.5% in the postoperative period. The difference of 29.2% and 45.8% in the pre-operative and postoperative periods between the tracker and the diary was significant (p < 0.005). The tracker and diary had a mean agreement difference of 1063 steps per day. Mean recovery time was 21 days after tonsillectomy. Conclusion: The results of this pilot study support the use of a tracker in terms of compliance and practicability. Consumer-level activity trackers are a viable alternative to conventional manual logging for clinical use in pediatric research. Trial registration: ClinicalTrials.gov Identifier: NCT03174496

Aim: To investigate the effects of using the active warming method on children with hypothermia in the perioperative period and examining the effects of hypothermia on awakening time, pain, shivering and hospital stay. Methods: This study included patients 18 years of age and younger who underwent surgery in the pediatric surgery department of a tertiary hospital. The active warming group consisted of 28 patients and the control group consisted of 29 patients. The first group of patients was actively warmed during the surgery and the second group was treated as the control group and did not actively receive any warming therapy. Preoperative body temperatures of the cases were measured. In addition, body temperatures were recorded every 15 minutes in the intraoperative and postoperative periods. Results: There was no statistically significant difference in preoperative body temperature between the control group and the active warming group. When body temperature were examined in the intraoperative period, there was no significant difference between the groups at the first 15 minutes of operation; however, the mean of the body temperature in active warming group was significantly higher than the control group at the 30th, 45th , and 60th minutes of operation. It was determined that patients in the control group had a longer stay in the hospital and the amount of time for waking at the end of the anesthesia was shorter in the active heating group than in the control group. Conclusions: The results of our study suggest that active heating with a carbon fiber resistant system is an effective method to prevent unplanned hypothermia in operated children.

Objective: to study the features of changes of the immune status of patients with gynaecological, surgical and simultaneous pathology in the pre- and postoperative periods for injury evaluation of surgical interventions.Material and methods. The study involved 97 patients who provided surgical service in the Department of Operative Gynaecology of SI «Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine». They were divided into two groups: group I comprised 70 patients with isolated gynaecological pathology, in group II included 27 women with simultaneous pathology. In the study 26 patients (group III) were also enrolled with isolated surgical pathology, who were provided a surgical care in the Surgical Department of Municipal Clinical Hospital No. 10 in Kyiv. The study was conducted within 10 months of 2017. The parameters of immune homeostasis in the pre- and postoperative periods were studied in 27 women with simultaneous operations, in 31 women operated for gynecological pathology, and in 26 women - for surgical pathology. Interleukin-6 was determined using Access 2 Beckman Counter's immune analyser, and C-reactive protein was measured with the Beckman Counter AU 480 immune analyser.Results. It was established that irrespective of the increasing extent of operation for simultaneous pathology as compared with isolated surgical interventions for gynaecological and surgical pathology, the degree of tissue injury or operational trauma is relatively the same, confirming the gradual reduction the concentration of interleukin-6 to almost reference values.Conclusions. The most informative indicator of the severity of surgical aggression is interleukin-6. It proportionally reflects the degree and dynamics of operational trauma. In turn, C-reactive protein indirectly reacts to injury and can be used as an additional indicator in monitoring in the postoperative period., Цель — изучить особенности изменений иммунного статуса пациенток с гинекологической, хирургической и симультанной патологией в пред- и послеоперационном периодах.Пациенты и методы. В исследовании взяли участие 97 пациенток, которым оказывали хирургическую помощь в отделении оперативной гинекологии ГУ «Институт педиатрии, акушерства и гинекологии имени академика Е.Н. Лукьяновой НАМН Украины». Их распределили на две группы: первую — 70 пациенток с изолированной гинекологической патологией; вторую — 27 женщин с симультанной патологией. В исследование также включены 26 пациенток (3-я группа) с изолированной хирургической патологией, которым оказывали хирургическую помощь в хирургическом отделении городской клинической больницы № 10 г. Киева. Исследование проведено в течение 10 месяцев 2017 г. Показатели иммунного гомеостаза в пред- и послеоперационном периоде изучены у 27 женщин с симультанными операциями, у 31 женщины, прооперированной по поводу гинекологической патологии, и у 26 женщин — по поводу хирургической патологии. Концентрация интерлейкина-6 определена с помощью иммунного анализатора Access 2 Beckman Couter, а концентрацию С-реактивного протеина — с помощью иммунного анализатора Beckman Couter AU 480.Результаты. Установлено, что независимо от увеличения объема операции при симультанной патологии по отношению к изолированным оперативным вмешательствам при гинекологической и хирургической патологии степень травматизации тканей или операционная травма сопоставимо одинаковы, что подтверждает постепенное снижение концентрации интерлекина-6 до почти референтных значений.Выводы. Наиболее информативным показателем степени тяжести хирургической агрессии является интерлейкин-6. Он пропорционально отображает степень и динамику хирургической травмы. В свою очередь, С-реактивный протеин опосредствовано реагирует на травму и может быть использован в качестве дополнительного исследования при мониторинге в послеоперационном периоде., Мета — вивчити особливості змін імунного статусу пацієнток із гінекологічною, хірургічною та симультанною патологією в перед- та післяопераційному періоді для оцінки травматичності оперативних втручань.Пацієнти та методи. У дослідженні взяли участь 97 пацієнток, яким надавали хірургічну допомогу у відділенні оперативної гінекології ДУ «Інститут педіатрії, акушерства і гінекології імені академіка О.М. Лук'янової НАМН України». Їх розподілено на дві групи: першу — 70 пацієнток з ізольованою гінекологічною патологією; другу — 27 жінок із симультанною патологією. До дослідження також залучено 26 пацієнток (3-тя група) з ізольованою хірургічною патологією, яким надавали хірургічну допомогу в хірургічному відділенні міської клінічної лікарні № 10 м. Києва. Дослідження проведено протягом 10 місяців 2017 р. Показники імунного гомеостазу в перед- та післяопераційному періоді вивчено у 27 жінок із симультанними операціями, у 31 жінки, прооперованої з приводу гінекологічної патології, та у 26 жінок — із приводу хірургічної патології. Концентрацію інтерлейкіну-6 визначено за допомогою імунного аналізатора Access 2 Beckman Couter, а концентрацію С-реактивного протеїну — за допомогою імунного аналізатора Beckman Couter AU 480.Результати. Встановлено, що незалежно від збільшення об'єму операції при симультанній патології відносно ізольованих оперативних втручань при гінекологічній та хірургічній патології ступінь травматизації тканин чи операційна травма порівняно однакові, що підтверджує поступове зниження концентрації інтерлейкіну-6 до майже референтних значень.Висновки. Найбільш інформативним показником ступеня тяжкості хірургічної агресії є інтерлейкін-6. Він пропорційно відображає ступінь і динаміку хірургічної травми. Своєю чергою, С-реактивний протеїн опосередковано реагує на травму і може бути використаний як додаткове дослідження при моніторингу в післяопераційному періоді.

Introduction: Giant occipital encephalocele (GOE) is a term used when the size of the OE is greater than or equal to the size of the head. It has been limited to case reports, with only sporadic exclusive series. This is a series of GOE managed at our center over time with emphasis on practical problems faced in management. Materials and Methods: This was a retrospective observational study. The patients were evaluated for the age of presentation, sex, and head size. Any associated neural tube defect was also looked for. Imaging was used for associated brain anomalies and to plan the surgical procedure. The requirement of ventriculoperitoneal (VP) shunt was also assessed. Results: During the study period of 7 years, 11 patients of GOE were admitted. Apart from one, all other patients were

The system of measures for conservative rehabilitation of patients with cicatricial lesions during pre- and postoperative periods of deformity reconstruction includes local, medication, physiotherapeutic, balneological means and methods of efferent therapy. A positive effect of measures is achieved by reducing the level of auto-aggressive factors, which is displayed in a favorable clinical course of the process. The application of the system of measures allows timely providing favorable conditions for compensating general condition of convalescents and restoring or improving the impaired functions of the affected segments according to objective estimates by 1.75 times and according to patients estimates by 1.44 times.

Objectives The aim of this study was to investigate the distribution of microbial agents in the early and late postoperative periods in patients with microbial keratitis (MK) after penetrating keratoplasty (PK). Materials and methods The records of 36 patients who were clinically diagnosed as having MK after PK were retrospectively reviewed. Culture results were obtained from microbiology records and the organisms that were produced were noted. A case was deemed as viral keratitis based on the clinical appearance, negative cultures, and response to antiviral treatment. Keratitis development times were evaluated in 2 categories: early (within the first year) and late (after year 1) postoperative period. Mann-Whitney U and Kruskal-Wallis tests were used to compare numerical variables that did not show normal distribution and chi-square test was used to compare categorical variables. Results The majority of MK cases were of bacterial origin (55.5%, n=20), followed by viral (41.7%, n=15) and fungal (2.8%, n=1). Of the 15 cases of early postoperative MK, 10 were bacterial, 4 were viral, and 1 was fungal; however, among cases of late postoperative MK, 10 were bacterial and 11 were viral. The majority (65%) of early and late bacterial infections were caused by gram-positive strains (most commonly staphylococci). Gram-positive bacteria caused keratitis significantly earlier than gram-negative bacteria (p=0.037). Viral and gram-negative bacterial MK was more frequent in the late postoperative period, but the difference was not statistically significant. Conclusion In our study, bacterial keratitis was more common in post-keratoplasty MK than viral and fungal keratitis. Gram-positive bacteria were the most common causative agents. The increased incidence of gram-negative bacterial agents and viral keratitis in the late postoperative period can be explained by long-term topical steroid use.

Purpose : To determine the effect of Inherited Cleft Lip and Palate Management on microbial migration in forked lip and palate (CLP) children. Material and methods: Fifteen forked lip and palate children and fifteen standard children (the control group), aged 3 months to 36 months were selected from the out clinic of Faculty of Dental Medicine, Al-Azhar University for Girls. Dribble samples were collected after the breakfast by inserting sterile cotton gauze in the entry from the jaws before and after construction of obturator. Results: The highest (mean±SD) value of log bacterial count (CFU/μl) was found in the cleft patients pre-operatively (5.64±1.06), while post-operatively there was a significant reduction in value (0.60±0.06) (P

Introduction. Corneal collagen crosslinking is a treatment method of advanced keratoconus, improving a «compaction» thickness or increasing a strength of corneal stroma. The high functional results and the shortened postoperative periods in patients during crosslinking using a femtosecond laser determine the prospects for a further study of this trend. Purpose. To study the conditions and to apply the femtocrosslinking method based on the standard flap formation options using the VisuMax femtolaser device. Material and methods . There were 20 patients under our observation with progressive keratoconus (20 eyes) who underwent femto cross-linking of corneal collagen using a VisuMax femto-laser. All patients were examined using the standard preoperative ophthalmologic methods (visometry, tonometry, keratorefractometry, pachymetry, keratotopography). The fact of progression of keratoconus was established on the basis of dynamic fellow-up for at least 6 months. Results. Features of the method of femto-cross-linking of corneal collagen using the VisuMax are: 1) extension of the flap leg in the operating settings (the angular size of the bridge increased to 320°); 2) formation of the circular corneal pocket parallel to the front surface via the femto-laser and one arcuate corneal incision depth of 140–160 µm, and the diameter of the pocket and the arcuate cut – 7.9–8.7 mm.All patients (20 eyes, 100%) were achieved the stabilization of ecstatic process within the follow-up period of 6 and 12 months. Conclusion. The conditions for the use of a laser installation VisuMax (Carl Zeiss) using the «FLAP» program in the operation of corneal collagen femtocroslinking have been determined. The advantage of this method is to simplify the classical way of doing cross-linking and increase its effectiveness. Promising is the further study of technology, dynamic control over patients and long-term results.

An appropriate perioperative infusion management is pivotal for the perioperative outcome of the patient. Optimization of the perioperative fluid treatment often results in enhanced postoperative outcome, reduced perioperative complications and shortened hospitalization. Hypovolemia as well as hypervolemia can lead to an increased rate of perioperative complications. The main goal is to maintain perioperative euvolemia by goal-directed therapy (GDT), a combination of fluid management and inotropic medication, to optimize perfusion conditions in the perioperative period; however, perioperative fluid management should also include the preoperative and postoperative periods. This encompasses the preoperative administration of carbohydrate-rich drinks up to 2 h before surgery. In the postoperative period, patients should be encouraged to start per os hydration early and excessive i.v. fluid administration should be avoided. Implementation of a comprehensive multimodal, goal-directed fluid management within an enhanced recovery after surgery (ERAS) protocol is efficient but the exact status of indovodual items remains unclear at present.

In response to an increase in osmolarity or a decrease in plasma volume, surgical patients often experience thirst during the perioperative period. Thirst causes intense discomfort for patients, but perioperative nurses and health care providers have received minimal direction on how to address this concern. This article presents evidence related to the advances in the management of patients' thirst and discusses clinical strategies that perioperative personnel can safely implement for their patients during the preoperative and postoperative periods. The Thirst Study and Research Group at Londrina State University, Brazil, developed the Thirst Management Model to provide a standardized method for perioperative personnel. Four pillars comprise this model: identification of thirst, measurement of thirst, safety assessment for the management of thirst, and application of relief strategies. This evidence-based model should assist perioperative nurses with translating knowledge and scientific evidence into clinical practice to provide safe patient care.

Background/Aim: The prognostic nutritional index (PNI) is reported to affect postoperative complications and survival of patients with esophageal squamous cell carcinoma (ESCC). The aim of this study is to investigate the clinical significance of PNI in treatment of ESCC. Patients and Methods: Two hundred and sixty-three patients who underwent radical esophagectomy were retrospectively analyzed. PNI was calculated in the pretreatment (pre-Tx), post-neoadjuvant chemotherapy (post-NAC), and postoperative periods. Results: Pre-Tx PNI positively correlated with prognosis irrespective of undergoing NAC (p

Objective: To evaluate intraobserver and interobserver reliability of the measurement of the mechanical axis of the lower limb by means of the panoramic radiograph of lower limbs by physicians with different levels of medical practice. Method: A retrospective cross-sectional study with preoperative and postoperative radiographic analysis of a group of 100 patients submitted to total knee arthroplasty. Results: It was observed that there is a highly significant intraobserver and interobserver agreement (p Conclusion: The panoramic radiograph of the lower limbs is a reliable method for measuring the mechanical axis of the lower limb in patients submitted to total knee arthroplasty, regardless of the level of medical practice of the evaluator.

Non-operating room anesthesia (NORA) represents a growing field of medicine with an increasing trend in the number of cases performed over the previous decade. As a result, anesthesia providers will need to enhance their familiarity with the resources, personnel, and environment outside of the operating room. Anesthesia delivery in NORA settings should be held with the same high-quality standards as that within the operating room. This review looks at special considerations in patient selection and the preoperative, intraoperative, and postoperative periods. In addition, there is a discussion on the unique aspects of specific NORA areas and the considerations that come with them.

Введение. Терапевтическое использование раствора человеческого альбумина у пациентов в периоперационном периоде трансплантации печени (ТП) представляет интерес в контексте осложнений и исходов операции. Цель исследования: оценить влияние интраоперационной трансфузии 25% раствора человеческого альбумина на течение раннего послеоперационного периода при ортотопической ТП от посмертного донора. Материалы и методы. В исследование включены 47 пациентов, которым была выполнена трупная ТП. Были сформированы 2 группы: пациенты группы 1 (n = 21) получали трансфузию 25% раствора человеческого альбумина в конце операции ТП и через 24 ч после операции; пациенты группы 2 (n = 26) получали трансфузию 25% раствора человеческого альбумина в первые сутки послеоперационного периода. Осуществляли контроль лабораторных параметров крови пациента перед началом оперативного вмешательства, через 24 ч и через 48 ч после операции. Интраоперационно оценивали значения систолического (САД) и диастолического (ДАД) артериального давления, частоту сердечных сокращений (ЧСС), дозу вазопрессоров, объем инфузионно-трансфузионной терапии, кровопотерю и диурез. В послеоперационном периоде фиксировали возможные осложнения, проведенные сеансы заместительной почечной терапии (ЗПТ), а также количество дней в стационаре. Результаты. Оценка значений САД, ДАД и ЧСС в начале и конце операции показала достоверно лучшие показатели гемодинамики и снижение дозировок вазопрессорной поддержки в конце вмешательства в группе 1 по сравнению с группой 2 (p < 0,05). В послеоперационном периоде инфекционные осложнения зарегистрированы у одного пациента группы 1 и у трех пациентов группы 2. Проведение ЗПТ потребовалось двум пациентам из группы 2. Все пациенты обеих групп были выписаны из стационара, при этом число дней госпитализации в группе 2 было статистически значимо больше по сравнению с пациентами группы 1: 26,9 ± 3,9 против 17,2 ± 4,3 (p < 0,05). Заключение. Интраоперационная инфузия 25% раствора альбумина позволяет стабилизировать показатели гемодинамики в конце операции ТП, снизить потребность в кардиотонической поддержке и сократить время госпитализации у пациентов после ТП. Background. The therapeutic use of human albumin solution in patients in the perioperative period of liver transplantation (LT) is of interest in the context of complications and outcomes of surgery. Objectives: to assess the effect of intraoperative transfusion of 25% human albumin solution on the early postoperative period in orthotopic LT from a postmortem donor. Patients/Methods. The study included 47 patients who underwent cadaveric LT. Two groups were formed: patients in group 1 (n = 21) received transfusion of 25% human albumin solution at the end of LT and 24 hours after surgery; patients in group 2 (n = 26) received transfusion of 25% human albumin solution on the first day of the postoperative period. The laboratory parameters of the patient’s blood were monitored before surgery, 24 hours later, and 48 hours after surgery. Intraoperatively, the values of systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), dose of vasopressors, volume of infusion- transfusion therapy, blood loss and diuresis were assessed. In the postoperative period, possible complications, renal replacement therapy (RRT) sessions performed, and the number of days in the hospital were recorded. Results. Assessment of SBP, DBP and HR values showed significantly better hemodynamic parameters and reduced dosages of vasopressor support at the end of surgery in group 1 compared to group 2 (p < 0.05). In the postoperative period, infectious complications were registered in one patient of group 1 and in three patients of group 2. Two patients from group 2 required RRT. All patients were discharged from the hospital, while the number of hospitalization days in group 2 was statistically significantly greater than in patients in group 1: 26.9 ± 3.9 versus 17.2 ± 4.3 (p < 0.05). Conclusions. Intraoperative infusion of 25% albumin solution allows stabilizing hemodynamic parameters at the end of LT surgery, reducing the need for cardiotonic support and shortening the hospitalization time in patients after LT.

Background Although the deterioration in sound quality is not as much as endotracheal intubation, it can also be seen after the use of laryngeal mask airway (LMA). The aim of this study is to investigate the effects of different LMA types on voice performance. Methods This study included 88 patients aged 18-80 years, whose surgical procedure was not planned to take longer than 120 minutes. In the acoustic voice analysis, F0, jitter%, and shimmer% were examined. In addition, the Voice Handicap Index (VHI)-30 questionnaire has completed an evaluation of voice quality. The patients were randomly divided into two groups (I-gel LMA [n=44]; Classic LMA [n=44]) according to the closed envelope method. Results A total of 88 patients were included in the study. Demographic data of the patients were statistically similar between the groups (p > 0.05). The changes in the preoperative and postoperative F0, jitter, and VHI-30 values in the I-gel group were statistically significant (p: 0.002, p: 0.001, p < 0.001). Shimmer values were not significantly different (p: 0.762). In the classical LMA group, preoperative and postoperative F0, jitter, shimmer, and VHI-30 values were statistically significantly different (p: 0.001, p: 0.012, p: 0.036, p < 0.001). Conclusion I-gel LMA and classic LMA negatively affect voice performance in the preoperative and postoperative periods. This situation was also observed in the VHI-30 index test. However, when this situation was evaluated in terms of shimmer analysis, the decrease in voice quality in the early postoperative period was more limited in the I-gel group.

Aim of the study. To reveal the psychological problems of patients with a stoma in the preoperative and postoperative periods. Methods. Analysis of scientific literature and quantitative research. A quantitative research was conducted to reveal the psychological problems experienced by patients with a stoma in the preoperative and postoperative periods. It also aimed at revealing the opinion of nurses about the psychological problems experienced by patients with a stoma in the preoperative and postoperative periods. Patients and nurses were provided with anonymous questionnaires. The study included patients with a stoma (N = 34) in one of the largest cities hospital X and nurses who were caring of them (N = 30). A descriptive statistics was used for analysis. Results. The majority of patients agreed that they had felt fear before the operation, and this was noticed by all the nurses in the study. Nearly half of patients agreed that after surgery they feared they would not be able to cope with a stoma, and almost all nurses agreed. Most patients agreed that they experienced the lack of information and psychological discomfort. However, the patients disagreed that they had felt lonely and unsup-ported after surgery. The patients noted the lack of theoretical knowledge about stoma care after surgery.

This retrospective, observational, longitudinal study performed a morphometric analysis of the pterygopalatine fossa (PPF) in patients undergoing surgically assisted rapid maxillary expansion (SARME) using cone beam CT (CBCT). CBCT scans of 41 consecutive patients were assessed and the following measurements were performed: PPF volume (PPFV), height (PPFH), length (PPFL) and angle (PPFA). The sample was divided into groups D (patients undergoing SARME; n=26) and control (n=15). Group D was subdivided into D+ (with pterygomaxillary disjunction – PMD) and D- (without PMD). The differences between the pre and postoperative periods were tested using the U Mann-Whitney or the t-test. Groups D+ and D- were compared using the one-way ANOVA or Kruskal-Wallis tests (level of significance set at 5%). In general, there were morphometric variations in PPF, with lower values after SARME. Differences for PPFH, PPFL and PPFA were not significant (p>0.05). On the right side, there were differences in PPFV, with lower values in patients from group D+ (p0,05). En el lado derecho, hubo diferencias en la PPFV, con valores más bajos en los pacientes del grupo D+ (p0,05). No lado direito, houve diferenças no PPFV, com valores mais baixos em pacientes do grupo D+ (p

Background: Artificial Intelligence (AI) is improving surgical practice with the technical advancement in imagery, navigation and robotic systems. Objectives: This review is aimed at assessing the role of artificial intelligence in surgical decision making during preoperative, intraoperative and postoperative periods to emphasize need of evidence-based protocols in this regard. Methods: The search strategy involving key terms pertaining to the concepts was utilized. In order to reach maximum sensitivity, a combination of the terms such as “Artificial intelligence”, “robotic surgery”, “surgical decision making”, “machine learning”, “deep learning” and “AI” were considered. Only articles that specifically discussed the role of artificial intelligence in surgical decision making were included. Results: Fifty five studies were retrieved with exclusion of forty six of them according to inclusion criteria. Thus, nine studies were included in the final review which were arranged in table to aid data review and analysis. Conclusion: The advancement of AI has turned modern medicine into a more effective and efficient practice to manage both acute and chronic illnesses. Important advances were made in pre-operative preparation, intra-operative support and post-operative care by using these approaches.

Providing optimal care to surgical oncology patients who cannot be transfused for religious or other reasons can be challenging. However, with careful planning, using a combination of blood-conserving methods, these "bloodless" patients have clinical outcomes that are similar to other patients who can be transfused. Bloodless surgery can be accomplished safely for most patients, including those undergoing technically challenging oncologic surgery. This article reviews best practices used in a bloodless program during the preoperative, intraoperative, and postoperative periods, with the aim of achieving optimal outcomes when transfusion is not an option for surgical oncology patients.

Epidural fibrosis is a common cause of a failed back surgery syndrome. The current scientific literature proposed many methods for prevention of epidural fibrosis, however, universal methods to fully solve the problem was not found. Prevention tasks in the preoperative period include the identification of risk factors for the development of epidural fibrosis with the correction of the revealed violations. Intraoperative prevention involves the development of barriers in the form of natural and synthetic polymeric materials that impede the formation of epidural fibrosis after laminectomy. The complex of measures to prevent the development of epidural fibrosis in the postoperative period is supposed to include a list of manipulations consisting of epidural blockades with a common complex anti-inflammatory drug therapy. The study presents an analysis of 63 literary sources from PubMed, EMBASE, Cochrane Library, and eLIBRARY databases most fully reflecting the pathogenetically substantiated prevention of the epidural fibrosis development in the preoperative, intraoperative and postoperative periods.

To compare bleb vascularity changes using optical coherence tomography angiography (OCT-A) between mitomycin-C (MMC)-augmented trabeculectomy and phacotrabeculectomy and to determine whether bleb vascularity measurements during preoperative and early postoperative periods could act as surrogate parameters to predict surgical outcomes. We retrospectively reviewed data for 72 eyes from 72 glaucoma patients who underwent MMC-augmented trabeculectomy with/without cataract surgery. Bleb area scans were obtained using OCT-A during the preoperative period; 1, 2, 4, and 6 weeks postoperatively; and 2, 4, and 6 months postoperatively. For conjunctival vascularity analysis, a semi-automated program was used to calculate color and brightness densities of the selected area. Color and brightness densities were decreased in the trabeculectomy group during all periods but not in the phacotrabeculectomy group at 4 and 6 weeks, as well as 2, 4, and 6 months postoperatively. Color and brightness densities were significantly higher in the phacotrabeculectomy group than in the trabeculectomy group after 6 weeks and 2, 4, and 6 months postoperatively. A Kaplan-Meier survival graph indicated that intraocular pressure differed according to glaucoma type but not surgery type. Logistic regression analysis revealed that brightness density 1 week postoperatively was correlated with reoperation. Changes in conjunctival vascularity density measured by OCT-A differed according to the surgical method. Following trabeculectomy with MMC, brightness density 1 week postoperatively may be a predictive index for surgical outcomes.

Aim : to аББевв dranges in liver pаrenсhymа in the еаг1у, tate аnd remote postoperative periods аfter сryodestruсtion (CD) of foсаl lesions by MRI with diffusion-weighted images (DWI). Mаteriаls аnd methods . Postoperative MRI monitoring wаs саrried out in 15 pаtients with mаlignаnt liver lesions. All pаtients were divided into two groups: with сomplete аnd inсumplete CD. All pаtients underwent MRI with dWi before surgery аnd in the postoperative period on the 1st dаy, 3 months, 6 аnd 12 months. Results. In group 1 - 100% “overlаp” of the pаthologiсаl foсus агеа of postoperative edemra ассording to T1WI аnd T2WI. Before surgery ~ ADC in the foсus wаs 0.86 mm 2 /s, in the 1st dаy - 1.00 mm 2 /s, 3 months - 1.03 mm 2 /s, 6 months - 1.30 mm 2 /s, 12 months - 1.30 mm 2 /s. Before surgery, the average size of the focus - 46 mm, in the 1st day - 57 mm, 3 months - 46 mm, 6 months - 45 mm, after 12 months - 39 mm. By the 12th month in group 1 ~ ADC in the focus increased by 51.20%, and the average size of the focus decreased by 16.00%. In group 2 - incomplete overlapping of the focus area of postoperative edema. Before surgery ~ ADC in the focus was 0.80 mm 2 /s, in the 1st day - 0.79 mm 2 / s, in 3 months -0.75 mm 2 /s, in 6 months - 0.66 mm 2 /s, in 12 months -0.55 mm 2 /s. Before surgery, the average size of the focus -44 mm, in the 1st day - 47 mm, in 3 months - 55 mm, in 6 months - 78 mm, after 12 months - 112 mm. 12 months after CD group 2 ~ ADC in the focus decreased by 31.30%, and the average size of the focus increased by 155.20% due to the continued growth of the tumor. Conclusion. MRI with DWI allows to assess changes in the liver and CD zone in the early, late and remote postoperative periods, to assess the completeness of the overlap zone of the CD focus and the dynamics of the continued growth of the tumor after incomplete CD.

The concept of early recovery after surgery (ERAS) consists of bundle interventions during the pre-, intra- and postoperative periods and team work. The ERAS, which is a multimodal strategy, enables one to limit the neurohumoral response to the surgery, maintain homeostasis, reduce the risk of complications, shorten the hospital stay, accelerate the return to everyday functioning, improve the patient's satisfaction, achieve a satisfactory quality of life and finally reduce the treatment costs and eliminate any redundant and ineffective practices. Almost every patient can be classified for the ERAS strategy except for patients undergoing urgent and emergency surgery. The necessity to give up ERAS can result from poor organisation and management. Moreover, the procedure itself can be the cause of the lack of adherence to the planned standard. It is necessary to use protocols and checklists. While fulfilling this doctrine, the anaesthesiologist becomes a perioperative specialist.Koncepcja ERAS określana jest w polskiej nomenklaturze jako protokół kompleksowej opieki okołooperacyjnej dla poprawy wyników leczenia. Realizacja koncepcji ERAS, która jest strategią multimodalną, prowadzi do ograniczenia odpowiedzi neurohormonalnej na uraz, zachowania homeostazy, ograniczenia ryzyka wystąpienia powikłań, skrócenia czasu pobytu w szpitalu, przyspieszenia powrotu do normalnego codziennego funkcjonowania, poprawy satysfakcji pacjenta, osiągnięcia zadowalającej jakości życia i ostatecznie redukcji kosztów leczenia, unikania niegospodarności i marnotrawstwa. Realizowana jest kompleksowo w okresie przed-, śród- i pooperacyjnym. Istotnym dylematem, który należy rozstrzygnąć, wdrażając strategię ERAS, jest selekcja pacjentów. Można zakwalifikować do niej prawie każdego pacjenta, z wyjątkiem chorych operowanych w trybie pilnym. Przyczyną niepowodzeń w realizacji strategii ERAS są czynniki związane z pacjentem, procedurą i zarządzaniem. Niedopełnienie protokołów przygotowania przedoperacyjnego, nieprzestrzeganie zasad znieczulenia, odzwyczajania od wentylacji mechanicznej płuc, nieprzestrzeganie protokołu sedacji czy schematu leczenia bólu to zdarzenia niepożądane o charakterze organizacyjnym. Konieczne jest stosowanie standardów, protokołów i list kontrolnych. W realizacji tej procedury anestezjolog staje się specjalistą okołooperacyjnym.

Objective. To develop a new method of the anastomoses formation, that would allow to form bilio-digestive and entero-entero anastomoses both on unchanged and inflamed tissues. Маterials and methods. In experimental on 50 laboratory rabbits the single-layer everting cholecysto-entero and entero-entero anastomoses on the Roux-defunctionalized loop of small intestine was created by the method of a high-frequency electric welding. The welding anastomoses were formed both on non-inflamed tissues and in the setting of biliary peritonitis. Patency, hermeticity, strength, macroscopic and microscopic pictures of the obtained joints were evaluated at different postoperative periods. Results. All anastomoses, formed by the method of a high-frequency electric welding, were not only patent and hermetic, but also sufficiently strong (40 – 100 mm Hg). The tissues were joined using thermo-adhesion; a coagulation scar was rather narrow, its complete epithelization was accomplished in 3 mo, and a scar maturation completed – in 6 mo. Conclusion. The method of a high-frequency electric welding permits to form both, bilio-digestive and inter-intestinal, anastomoses of equal reliability in the settings of non-inflamed and inflamed tissues.

The effect of bariatric surgery in renal function varies and the postoperative benefit time point remains unclear. We aim to assess the changes of renal function after bariatric surgery (BS) in different postoperative periods and subgroups. We searched the databases of PubMed and Cochrane from inception to December 14, 2020. Articles included in the study were drawn from all recipients of BS that provided assessments of renal function pre and post-surgery. Meta-analysis was performed to compare glomerular filtration rate (GFR), serum creatinine, albumin-to-creatinine ratio (ACR), and albuminuria before and after BS. The study included 49 articles involving 8515 patients. Compared with pre-operative renal function, the overall analysis showed that bariatric surgery significantly reduced serum creatinine levels, ACR, and albuminuria. There was significant increase of GFR in the CKD subgroup, yet a noticeable decrease in the hyperfiltration subgroup. The most significant improvement in GFR was seen 6–12 months after BS, while ACR dropped most dramatically 12–24 months after BS. Bariatric surgery can improve renal function in obese patients with kidney dysfunction, especially 1 year after surgery.

BACKGROUND The laryngeal tie-forward (LTF) procedure is commonly used to treat intermittent dorsal displacement of the soft palate (iDDSP). There is a wide range in reported efficacy of treating horses with and without a definitive diagnosis of iDDSP. OBJECTIVES To evaluate the racing performance of harness racehorses in which iDDSP had been definitely diagnosed and treated solely with the LTF procedure. STUDY DESIGN Retrospective case series. METHODS Ninety-five harness racehorses were treated with LTF for confirmed iDDSP. A definite diagnosis of iDDSP was made with high-speed treadmill or overground endoscopy. Upper respiratory tract (URT) disorders, short-term complications, and horses returning for recurrence of URT problems were recorded. Performance before and after LTF was assessed by reviewing career race records and comparing performance index (PI), and racing speed marks from the baseline, preoperative, and postoperative periods. The effect of basihyoid-cricoid (BC) net distance shortened on racing performance was assessed. RESULTS Postoperatively, PI increased in 36/54 (67%, 95% CI 54%-79%) of experienced racehorses, and 44/67 (66%, 54%-77%) established or improved their racing speed mark relative to the preoperative period. As a group, PI decreased by a mean (SE) of 0.9 (0.17) points (P

Spontaneous intra-abdominal hemorrhage is very rare in hemophilia A patients. High index of suspicion is necessary for successful management. Surgical intervention may be required in cases of diagnostic uncertainty and for adequate hemostasis. Here we report a case of spontaneous hemorrhage in the peritoneal cavity in hemophilia A patient, who was managed with surgery and factor VIII supplementation. Patient did well in the postoperative periods.

Background:. Facial transplantation (FT) is recognized as the ultimate reconstruction for severely disfigured patients. The substantial cost of these procedures in a nationalized health system has not been extensively published. The first Canadian FT performed in May 2018 was a great opportunity to address this subject and evaluate the viability of such a program. Methods:. A detailed patient chart review was performed and a cost per unit approach was used to estimate the procedure cost. The preoperative, operative, and the postoperative periods up to 1-year after the surgery were analyzed. Financial support from private sponsors and Hospital Fund donations were considered. The literature on international FT and national solid organ transplantation was reviewed. Results:. The overall 1-year cost was estimated at $440,224 (2018 CAD). The costs are explained by a long hospital length of stay, costly immunosuppressive therapy, and high immunosuppression-related complications. Those findings are consistent with international FT literature. The societal impact of the surgery was minimized with a $36,921 (2018 CAD) grant obtained from an external contributor. Interestingly, the hospital foundation sustained a 794% increase in donations ($1,787,148; 2019 CAD) the year following the surgery. Conclusion:. Our experience confirmed that the combination of private funding, with positive goodwill and hospital donations, is a workable model for innovative surgery in the setting of a nationalized health system with financial restrictions.

Surgical site infections (SSIs) are a common and potentially disastrous complication in the perioperative setting, resulting in increased morbidity, prolonged hospitalizations, and death. There are a number of different categorizations and risk factors for SSIs, all of which may be influenced by certain parameters in perioperative care. This chapter will discuss considerations for the pre-, intra-, and postoperative periods that will have an impact on a patient’s susceptibility for infection. Other things discussed will include treatment considerations, surgical concerns, and opportunities for quality improvement.

Background The pedicled nasoseptal flap (NSF) is the mainstay for endoscopic skull base reconstruction. We present a novel technique using a semirigid chondromucosal NSF that improves the reinforcement and protection of intracranial structures. Methods Composite NSFs were performed to repair intraoperative high-flow cerebrospinal fluid leaks in 2 patients who had undergone endoscopic endonasal resection of a suprasellar mass. The surgical technique and postoperative outcomes are described. Results The flaps were sufficient for defect coverage, and the patients did not experience any cerebrospinal fluid leak in the immediate and delayed postoperative periods. No complications related to the composite flap had developed. Conclusions The composite chondromucosal NSF is a reliable reconstruction option for select ventral cranial base reconstruction cases with the potential to improve the protection of intracranial structures. Additional surgical cases and longer follow-up are required for a better assessment of long-term outcomes.

The present study aimed to identify and evaluate nursing care in the postoperative period of cardiac surgery, a highly complex procedure with important organic repercussions, leading to a critical postoperative state and imposing intensive care for the individual's recovery. It is an integrative literature review carried out in the databases Latin American and Caribbean Literature in Health Sciences, Medical Literature Analysis and Retrieval System Online and Excerpta Medica database. Studies published in Portuguese, English and Spanish between 2009 and 2019 that answered the guiding question were included. Among the results found, the monitoring of vital parameters, elaboration and implementation of nursing care plans, use of automated systems, use of standardized instruments and the importance of professional training for such use stand out. This evidence can provide subsidies for carrying out the nursing process and contribute to improving the care of this population. El presente estudio tuvo como objetivo identificar y evaluar los cuidados de enfermería en el posoperatorio de cirugía cardíaca, un procedimiento de alta complejidad y con importantes repercusiones orgánicas, que conduce a un postoperatorio crítico e impone cuidados intensivos para la recuperación del individuo. Esta es una revisión integradora de la literatura realizada en las bases de datos de Literatura en Ciencias de la Salud de América Latina y el Caribe, PubMed / MEDLINE y Excerpta Medica. Se incluyeron estudios publicados en portugués, inglés y español entre 2009 y 2019 que respondieron a la pregunta orientadora. Entre los resultados encontrados se destacan el seguimiento de parámetros vitales, la elaboración e implementación de planes de cuidados de enfermería, el uso de sistemas automatizados, el uso de instrumentos estandarizados y la importancia de la formación profesional para tal uso. Esta evidencia puede brindar subsidios para la realización del proceso de enfermería y contribuir a mejorar la atención de esta población. O presente estudo teve por objetivo identificar e avaliar os cuidados de enfermagem no pós-operatório de cirurgia cardíaca, procedimento de alta complexidade com importantes repercussões orgânicas, levando a um estado crítico pós-operatório e impondo cuidados intensivos para a recuperação do indivíduo. Trata-se de uma revisão integrativa da literatura realizada nas bases de dados Literatura Latino-americana e do Caribe em Ciências da Saúde, PubMed/MEDLINE e Excerpta Medica database. Foram incluídos estudos publicados em português, inglês e espanhol, entre 2009 e 2019 e que respondessem à pergunta norteadora. Entre os resultados encontrados, destaca-se a monitoração de parâmetros vitais, elaborações e implementações de planos de cuidados de enfermagem, uso de sistemas automatizados, uso de instrumentos padronizados e a importância da capacitação profissional para tal utilização. Essas evidências podem fornecer subsídios para a realização do processo de enfermagem e contribuir para a melhora da assistência dessa população.

The article analyzes the interrelationships of conscious self-regulation, psychological well-being, coping strategies and cognitive regulation of emotions in the early and late rehabilitation period in individuals who have undergone high-tech operations on large joints. A sample of 69 people aged 19 to 70 years (46 men and 23 women) collected data twice — immediately after the operation and after a month and a half. The revealed groups with high, medium, and low levels of psychological well-being and conscious selfregulation differ in particularities of using coping strategies, and emotional regulation. Factors contributing to and hindering the improvement of psychological well-being in the postoperative period are identified. High self-regulation supports psychological wellbeing in a difficult period of rehabilitation through the use of strategies for finding social support, planning solutions to problems, and focusing on developing new plans for their lives. This group can positively re-evaluate the events and abandon strategies of escape and catastrophization. The results obtained can be used to create an effective, comprehensive rehabilitation program for people who have undergone high-tech operations.

ResumoO presente artigo aborda de forma ampla os aspectos que interferem no processo de cicatrização do manguito rotador. São considerados hábitos de vida como tabagismo e alcoolismo, fatores sistêmicos como diabetes mellitus, hipertensão arterial e obesidade bem como fatores locais, dentre os quais aqueles relacionados ao pré, per e pós operatório. A partir de uma extensa revisão da literatura, com a citação de 60 artigos científicos tanto da literatura ocidental como oriental, os autores pretendem aprofundar no tema trazendo para a prática médica condutas embasadas em novos conceitos estabelecidos.

Objective: The porous polyethylene implant (PPEI) is one of the most commonly used alloplastic materials in cranio-maxillofacial surgery. It is widely preferred because of its biocompatible, durable, flexible and thin nature as well as for its low complication rates. The purpose of the present study was to review the clinical and surgical outcomes of PPEI usage for orbital floor fractures.Methods: The present study included 76 patients who underwent orbital floor fracture reconstruction using PPEI between July 2000 and July 2018. All demographic characteristics of the patients were recorded and the patients were questioned and/or examined whether there was any complaint or complication secondary to the surgery.Results: The mean age of the patients was 35.2 years with a male predominance. The most common causes of injury were in-vehicle traffic accidents, falls, physical assaults and pedestrian accidents, respectively. 73 patients had other concomitant fractures of the facial bones along with the orbital floor fracture. The mean time between the injury and the surgical repair was eight days. Scleral show was observed in two patients (2.6%) due to scar contracture of the subciliary incision whereas one patient had surgical removal of the PPEI.Conclusion: The present study revealed that PPEI is a reliable and flexible material for the reconstruction of orbital floor fractures with a low risk of complications. To prevent or minimize postoperative complications, the orbital septum must be repaired meticulously.