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Background Biliary atresia (BA) is a rare disorder characterized by obstructive jaundice in infants, shortly after birth. Postoperatively, some patients exhibit portal hypertension and progressive liver fibrosis. Splenomegaly is a symptom of portal hypertension. We aimed to investigate splenomegaly as a marker for complications of portal hypertension and the relationship between splenomegaly and liver fibrosis in the long-term native liver (NL). Methods Between 1977 and 2018, 71 patients underwent hepaticojejunostomy. We included 54 patients (34 NL group, 20 liver transplant (LT) group) who fulfilled the eligibility criteria. Spleen volume (SV), total bile acids, hyaluronic acid, type IV collagen, and aspartate aminotransferase-to-platelet ratio index (APRi) were measured. Data were analyzed using Student's t-test, regression analysis, and receiver operating characteristic (ROC) curve analysis (P Results Total bile acids, hyaluronic acid, type IV collagen, and APRi increased in NL patients with a large SV at >25 years. SV and type IV collagen were correlated with NL for >25 years (r = 0.79 [P = 0.006], y = 1.1 - [0.03 × type IV collagen] [P = 0.008]). In the ROC curve analysis, the cutoff value for type IV collagen was 165 ng/mL (P = 0.07). Conclusions We suggest that SV as a prognostic index for End-Stage Liver Disease may be useful in biliary atresia. Long-term follow-up is necessary because the clinical course may be favorable in childhood but worsen during adulthood.

Purpose To evaluate the long-term outcomes of the palpebral fissure transfer (PFT) technique without lower eyelid spacer in chronic progressive external ophthalmoplegia (CPEO). DESIGN Retrospective interventional case series. METHODS Consecutive CPEO patients with PFT surgery (2006-2017) and a minimum follow up of 24 months were included. The PFT included simultaneous levator resection or frontalis sling (based on the levator function and Bell's phenomenon) and lower eyelid retractor recession without spacer. Primary outcome measures comprised the change in margin reflex distance 1 (MRD-1), MRD-2, and palpebral fissure height (PFH) in the course of time. Potential predictors of keratopathy were also explored. RESULTS There were 32 patients (64 eyelids) with the mean age and follow up of 34.1 years (15-56) and 37.9 months (24-72), respectively. Mean MRD-1 significantly increased from -0.9 mm to 3.4 mm in the postoperative week 1-2 and 1.8 mm at the last follow up. Mean MRD-2 significantly decreased from 5.6 mm to 3.7 mm in the postoperative week 1-2 and 5 mm at the last follow up. Eyes with frank lower eyelid retraction (MRD-2 > 5 mm) gained more reduction in MRD-2 compared to those with no sclera show (-0.9 mm vs. -0.3 mm, P CONCLUSION Lower eyelid retractor recession without spacer yields significant protective corneal coverage at the critical early postoperative period when the risk of keratopathy is highest.

STATEMENT OF PROBLEM: Evidence is sparse regarding the long-term outcomes of restorative treatment of patients with extensive tooth wear.PURPOSE: The purpose of this long-term prospective randomized clinical trial was to evaluate the performance and success rate of pressed lithium disilicate (LD) and translucent zirconia (TZ) crowns in participants with extensive tooth wear.MATERIAL AND METHODS: A total of 62 participants with extensive tooth wear (17 women, 45 men; mean age 44.8 years; range 25-63 years) received a total of 713 crowns, LD=362 and TZ=351. Both types of crowns had chamfer preparations and were adhesively luted with dual-polymerizing composite resin cement (PANAVIA F 2.0; Kuraray Noritake Dental Inc). The restorations were clinically reevaluated on average 14, 31, 39, 54, and 65 months after insertion of the crowns according to the modified United States Public Health Service (USPHS) criteria.RESULTS: After an observation period of up to 6 years, the survival rate for both types of crowns was 99.7%, with 1 lost LD crown after 1 year as a result of loss of retention and 1 lost TZ crown after 3 years because of tooth fracture at the cemento-enamel junction. The success rates were similar for both types of crowns: 98.6% for LD and 99.1% for TZ. Reasons for failures were that 3 participants in each group developed apical lesions, minimal ceramic fractures, or their crowns were rebonded after loss of adhesion. Assessment of color at baseline was significantly different with a better match for LD (84.8% Alfa, 15.2% Bravo) than for TZ crowns (36.5% Alfa, 63.5% Bravo), including TZ crowns with veneered porcelain (PCONCLUSIONS: No differences were found between the 2 types of ceramic materials concerning the long-term success and clinical performance, except that TZ crowns were rated by a blinded clinician as less esthetic than LD crowns. The use of high-strength ceramic materials, as well as reliable adhesive bonding, are probably the key factors in the long-term success of ceramic crowns in participants with extensive tooth wear independent of the specific etiology.

Актуальність. Серед онкоурологічних захворювань нирково-клітинний рак посідає третє місце після раку сечового міхура і передміхурової залози, а за рівнем смертності знаходиться на першому місці. За даними різних авторів, приблизно в 30–50 % пацієнтів у різні терміни після ­нефректомії з’являються метахронні метастази. Мета — аналіз віддалених результатів хірургічного лікування хворих на нирково-клітинний рак. Матеріали та методи. У дослідженні брали участь 120 пацієнтів. Серед них було 56 жінок (46,6 %) та 64 (53,4 %) чоловіки, середній вік яких становив 66,3 ± 1,8 року. До проспективного аналізу було включено пацієнтів із локальною формою нирково-клітинного раку — 95 осіб (79,1 %) та місцево-поширеною формою нирково-клітинного раку — 25 (20,9 %), до ретроспективного аналізу — 60 пацієнтів із дисемінованою формою. Результати. Віддалені результати хірургічного і комбінованого лікування 120 пацієнтів продемонстрували прогресування захворювання в 31,6 % хворих. Висновки. Медіана строку безрецидивного періоду перевищувала 9,0 ± 1,1 місяця в групі пацієнтів, яким проводилась передопераційна емболізація судинної ніжки. У групі хворих, яким була виконана типова радикальна нефректомія, безрецидивний період становив 5,3 ± 0,2 місяця. Збільшення ступеня анаплазії пухлини (GIII) призводило до зниження терміну безрецидивного періоду — середня тривалість життя становила 6–12 місяців, і лише у 12 (10 %) пацієнтів із цієї когорти вона була більше ніж 2 роки.

Проведено аналіз даних 52 хворих із нестабільністю та грижею диска в поперековому відділі хребта, аналіз близьких та віддалених результатів оперативного лікування, а також вивчені характер та особливості їх перебігу в цих періодах. Виявлено залежність частоти рецидиву больового корінцевого синдрому від вибору методу оперативного лікування.

To compare the long-term results of Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK) in fellow eyes for treatment of Fuchs endothelial corneal dystrophy.This study is a 2-centered, retrospective case series of 64 patients (128 eyes) with DSAEK followed by DMEK. The main outcomes measured were best spectacle-corrected visual acuity (BSCVA) and duration of time to achieve BSCVA as well as eye preference.Preoperative median logarithm of the minimum angle of resolution (logMAR) BSCVA was similar in eyes receiving DMEK 0.36 ± 0.26 and DSAEK 0.42 ± 0.34 (P = .266). The average follow-up time needed for the DMEK eyes to achieve BSCVA was faster than that of DSAEK (277 days vs 490 days, P = .0014). With long-term follow-up, the BSCVA of the DMEK eyes [0.09 ± 0.10 logMAR] and DSAEK eyes [0.11 ± 0.16 logMAR] did not show a statistically significant difference (P = .069). Twenty-two of the 64 preferred the DMEK eye, 17 patients preferred the DSAEK eye (P = .423), and 25 patients did not have a preference. In the DMEK group, the average spherical equivalent was -0.08 compared with the DSAEK group at 0.06 (P = .2854).In our fellow eye study with long-term follow-up, DMEK and DSAEK had comparable levels of BSCVA and patient satisfaction. The DMEK eyes reached their BSCVA sooner, whereas the DSAEK eyes improved over a longer time frame. A greater number of patients had 20/25 and 20/20 vision in the DMEK group; however, the difference was not statistically significant. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Introduction. Hilar cholangiocarcinoma (HC) is the tumor that requires multidisciplinary approach and treatment. The 3- and 5- year survivals of HC patients treated with surgery and palliative methods were evaluated in the study. Material and methods. A study covered 368 patients treated between 2000–2014. Of them, 137 patients were categorized for surgery (RT group), and 231 for palliative treatment (PT group). The overall 3- and 5- year survivals were determined by the log rank test. Cox hazard regression model revealed the relative prognostic factors. Results. The 3- and 5- year survival rates accounted for 38% and 21% after surgery, but 13% and 0 after palliative treatment (p < 0.0001). Radical tumor resection, negative lymph nodes, and early tumor T stage were the factors conducive to survival. Conclusions. Surgery, if the radical tumor resection is possible, offers a chance for long-term survival. The positive effects of surgery treatment are lost against most of the majority of palliative patients

Treatment of periodontitis plays an important role in preventing tooth loss. Over the years, various treatment modalities have been proposed, researched and applied in the dental practice. The non-surgical periodontal therapy of cleaning the root surfaces is still the golden standard in treatment of periodontitis. If pockets of ≥ 6 mm remain after the non-surgical therapy, surgical periodontal therapy could be considered. People with periodontal disease should agree with lifelong periodontal therapy, because after the 'active' (non-surgical and surgical) periodontal therapy, lifelong periodontal maintenance is the most important thing to guarantee periodontal health and stability. The ultimate goal of periodontal therapy is preservation of the natural dentition. Many studies have shown that this goal can be achieved, providing the following circumstances are met: a good oral hygiene and high patient motivation, optimal periodontal treatment, and smoking cessation.Behandeling van parodontitis is essentieel in het voorkomen van tandverlies. Verschillende behandelmodaliteiten zijn in de loop der jaren voorgesteld, onderzocht en in de praktijk toegepast. De niet-chirurgische parodontale behandeling bestaande uit reiniging van de worteloppervlakken is nog altijd de gouden standaard. Indien er daarna pockets van ≥ 6 mm resteren is een chirurgische parodontale behandeling te overwegen. Mensen met parodontitis gaan een ‘levenslange behandelovereenkomst’ aan met de behandelaar, omdat na ‘actieve’ (niet-chirurgische en chirurgische) parodontale behandeling levenslange parodontale nazorg belangrijk is om parodontale gezondheid en stabiliteit te kunnen borgen. Het ultieme doel van de parodontale behandeling is het behouden van de eigen dentitie. Vele onderzoeken hebben inmiddels aangetoond dat dat doel behaald kan worden, mits er aan de volgende voorwaarden wordt voldaan: een goede mondhygiëne en motivatie van de patiënt, een optimale parodontale behandeling en stoppen met roken.

Проведено аналіз віддалених результатів органозберігаючих операцій на щитоподібній залозі з приводу доброякісної вогнищевої патології. Виявлені закономірності виникнення рецидивів залежно від обсягу операції, морфологічного типу вузлів, їх множинності. Також вивчений вплив радіаційного опромінення, отриманого в 1986 р. внаслідок аварії на ЧАЕС, на розвиток рецидивів доброякісної вогнищевої патології щитоподібної залози.

Objective: The data on using novolimus-eluting DESolve bioresorbable scaffolds (BVS) for long-segment coronary artery lesions remains insufficient. In this study, our main objective was to assess the long-term effects of the overlapping applications of both DESolve-DESolve and the drug-eluting stent (DES)-DESolve. Methods: A single-centered study of 103 patients scheduled for DESolve placement for long-segment lesions (>28 mm) was conducted (October 2013 to November 2016). A DESolve-DESolve overlap was used on 43 patients and a DES-DESolve overlap on 60 patients. Acute procedural success and major adverse cardiac events (MACE) (stent thrombosis, targeted vessel revascularization, targeted lesion revascularization, and cardiac death) were evaluated. The patients were followed up for 48 months. Results: Revascularization was performed on 4 (6.7%) patients in the DES-DESolve group and 5 (11.6%) patients in the DESolve-DESolve group for target lesion revascularization. Among the study population, 10 (9.7%) patients had MACE, including 5 (8.3%) patients in the DES-DESolve group and 5 (11.6%) patients in the DESolve-DESolve group. Conclusion: The positive results of our study concerning the use of DESolve for the treatment of long coronary lesions demonstrate that BVS will emerge with new platforms and become non-inferior to the DES.

OBJECTIVE: The purpose of this study was to evaluate the long-term results of sub-trochanteric step-cut shortening osteotomy (SSCO) used in the total hip arthroplasty (THA) procedure for treatment of Crowe type IV dysplastic hips. MATERIALS AND METHODS: Crowe type IV dysplastic 35 hips of 31 patients were treated with cementless THA. Patients were followed up meanly 9.2 years (range 4–18). SSCO was applied to all hips to reduce the femoral head into the true acetabulum. Autologous bone grafts which were obtained by shortening the femur and cable cerclage wires were used for fixing the osteotomy site. The results were evaluated clinically and radiologically. In clinical evaluation, Harris hip score (HHS) and d'Aubigne hip evaluation criteria were used. RESULTS: The mean HHS increased from 40.6 to 92.5. Merle d’Aubigne hip evaluation score was increased on average from 1.76 to 5.8 in terms of pain and from 2.9 to 5.5 in terms of range of motion. In 9 hips (25.7%), medialization was achieved by creating a controlled fracture in the acetabulum. The hip rotation center was lowered by an average of 5.7 cm. The average leg lengthening was 3.4 cm. No more than 4 cm lengthening was made. Dislocation did not develop in any of the patients. CONCLUSION: It was concluded that the long-term results were found to be successful in the THA with SSCO in Crowe type IV dysplastic hips, since nerve complications were reduced, leg-lengthening was achieved, and a painless and mobile hip joint could be achieved.

Актуальність. Пошкодження задньої хрестоподібної зв’язки (ЗХЗ) відноситься до найбільш тяжких пошкоджень у колінному суглобі. Точне знання анатомії, біомеханіки і механізмів пошкодження колінного суглоба і його зв’язкового апарату — неодмінна умова при постановці діагнозу, реконструкції та подальшому лікуванні. Дані про випадки пошкодження ЗХЗ дуже варіабельні. Такі пошкодження зустрічаються набагато частіше, ніж гадають. Це пояснюється тим, що розриви ЗКС рідко спостерігаються в клінічній практиці, тому часто пропускаються, і пацієнти лише через роки звертаються з приводу болю в стегні і надколіннику, а також больових відчуттів у медіальному компартменті коліна. Методом вибору реконструкції ЗХС є відновлювальні операції з використанням одно­ або двухпучкового трансплантату. Незалежно від обраної техніки реконструкції для функціонального результату вирішальним найбільш впливовим фактором є позиціонування трансплантату ЗХЗ. Дискусія щодо методу пластики ЗХС обумовлена відсутністю консенсусу з найбільш прийнятною методикою і малою питомою вагою результатів з повним відновленням стабільності колінного суглоба. Мета: на основі аналізу функціональних і радіологічних результатів, а також ускладнень оцінити ефективність пластики задньої хрестоподібної зв’язки автотрансплантатом із сухожиль згиначів гомілки транстибіальним методом. Матеріали та методи. За період з 2004 по 2015 рік було прооперовано 47 пацієнтів (38 чоловіків і 9 жінок) з приводу гострої або хронічної нестабільності ЗХЗ. У дане дослідження включені як ізольовані реконструкції ЗХЗ, так і комбіновані мультилігаментарні реконструктивні операції. Ревізійних операцій не було. У 7 (14,89 %) випадках були ізольовані розриви ЗХЗ, а в 40 (85,11 %) — комбіновані пошкодження. У 23 (48,94 %) випадках розрив зв’язок стався внаслідок спортивних травм, у 12 (25,53 %) — у результаті автодорожніх пригод і в 12 (25,53 %) випадках — через інші причини. Операції виконувалися артроскопічно за допомогою звичайної техніки свердління каналів: стегновий — через антеролатеральний портал і великогомілковий — транстибіально. Використовували трансплантат із полусухожильного і ніжного м’язів (один пучок). Якщо мало місце комбіноване ушкодження ЗХЗ з розривом задньолатерального кута колінного суглоба, то ми використовували методику R. LaPrade. П’ятеро пацієнтів (10,64 %) раніше перенесли операції на колінному суглобі: у 2 випадках (4,46 %) їм відновлювали передню хрестоподібну зв’язку (ПХЗ), 1 пацієнту (2,13 %) — ПХЗ, ЗХЗ і медіальну коллатеральну зв’язку, у 2 випадках (4,46 %) — ЗХЗ. Результати. Суб’єктивна оцінка показала наступні позитивні результати. Задоволені результатом лікування 23 пацієнти з 27, обстежених у віддаленому періоді, переважна кількість хворих не мали суттєвого болю за даними візуально­аналогової шкали, і 81,15 % хворих були задоволені результатом і готові були прооперуватися ще раз на разі потреби. Об’єктивні дані функціональних шкал: Lysholm і Gillquist — у середньому 76,75 ± 17,18 (38–100), Tеgner — у середньому 5 (1–9), KOOS — 78,14 ± 19,78 (0–100), IKDC — A — 2 (12,5 %), B — 8 (50 %), C — 4 (25 %), D — 2 (12,5 %) — свідчать про істотне поліпшення функції колінних суглобів. Рентгенологічна оцінка показала прогресування остеоартрозу. Висновки. Оперативне лікування ушкоджень ЗХЗ автотрансплантатом із сухожиль згиначів гомілки транстибіальною технікою свердління каналу в великогомілковій кістці є ефективним методом, що дозволив отримати позитивні результати лікування пацієнтів.

Studied herein are the long-term results after surgical treatment of stage cT1 kidney cancer. The study includes 278 surgeries for kidney tumors. Partial nephrectomy was performed in 199 (71.6%) cases and radical nephrectomy in 79 (28.4%). Surgeries were performed using the open, laparoscopic, and robotic approaches. Surgical treatment and long-term oncological results were studied. Open approach for partial nephrectomy was used in 2.01% of cases, laparoscopic in 27.64%, and robotic in 70.34%; and radical nephrectomy in 2.53%, 87.34%, and 10.13%, respectively. Incidence postoperative complications after partial and radical nephrectomy were 16.58% and 3.8%, respectively. Сomplications (Clavien Dindo 3) occurred in 11.56% and 3.8% cases, respectively. Positive surgical margin occurred after partial nephrectomy in 1.51%, whereas undetermined for radical nephrectomy. The 5-year disease-free survival for partial and radical nephrectomy was 94.98 1.77% vs. 86.96% 4.11%; 5-year overall survival was 96.2% 1.55% vs. 88.15% 3.96%; 10-year overall survival was 90.82% 4.19% vs. 76.32 6.1%; and 5-year cancer-specific survival was 99.16% 0.84% vs. 94.09% 2.87%, respectively. Our study demonstrates that partial nephrectomy is a safe and effective method for surgical treatment in stage cT1 kidney cancer. A minimally invasive approach is a priority. The nephron-sparring technique demonstrates superior long-term results compared with radical nephrectomy.

Background There is still a disagreement on the postoperative rehabilitation concerning position of immobilization of the shoulder after arthroscopic anterior shoulder stabilization and its influence on the clinical outcome. The aim of this study was to evaluate the clinical results and the recurrence rate after arthroscopic anteroinferior shoulder stabilization and postoperative immobilization in internal rotation vs. external rotation. Methods Twenty-five patients (22 male and 3 female, mean age 28.5 years) were included in this prospective nonrandomized cohort study. In group I (11 male, 2 female, mean age 28 years), the postoperative functional immobilization was carried out in internal rotation of 60°, and in group II (11 male, 1 female, mean age 30 years), 15° of external rotation of the arm for 4 weeks in both groups. The clinical follow-up was performed at 2, 4, and 6 weeks as well as at 3, 6, and 12 months postoperatively including assessment of range of motion and functional shoulder scores (Subjective Shoulder Value, Constant score, Rowe score, Walch Duplay score, Melbourne Instability Shoulder Score). Furthermore, shoulder instability was evaluated using the apprehension, relocation, and surprise tests. Mid-term follow-up data were additionally assessed after a minimum of 4 years. Results Twenty patients (19 male and 1 female) with an average age of 28 years were followed up for 62 (53-72) months after arthroscopic stabilization. The comparison of both groups showed almost equal results regarding the range of motion without any significant differences (P > .05). The evaluation of the shoulder function scores also showed no significant differences with an average Subjective Shoulder Value of 95% vs. 91%, Constant score of 89 vs. 88 points, Rowe score of 96 vs. 94 points, Walch Duplay score of 86 vs. 89 points, Melbourne Instability Shoulder Score of 96 points, and Western Ontario Shoulder Instability Index of 88% vs. 84% (P > .05). There was no recurrent dislocation in both groups. Conclusion The type of immobilization after arthroscopic shoulder stabilization does not influence the clinical results after a mid- to long-term follow-up.

Introduction and objectives: There is scarce information available on the long-term outcomes of primary angioplasty (PA) in patients over 80 years of age. Our objective was to analyze the characteristics and results of PA in these patients and recognize the prognostic factors and long-term survival. Methods: Observational and retrospective single-center study of consecutive patients over 80 years of age treated with PA between January 2013 and September 2019. A long-term clinical follow-up was performed (mean follow-up of 29 ± 25 months). Results: The study included 133 patients (mean age 85.3 ± 3.8 years and 57 women [43%]). Seventeen percent of the patients were in Killip class III-IV at admission. The mean Charlson Comorbidity index was 2.3 ± 1.6. During the hospitalization, almost half of the patients developed heart failure and mortality rate was 18%. The overall mortality rate at the follow-up was 23%, yet 97.2% of the deaths were due to non-cardiac causes. The independent predictors of overall mortality at the follow-up were chronic kidney disease (HR, 5.7; 95%CI, 1.29-25.5; P = .022), and a Charlson Comorbidity index > 2 (HR, 2.57; 95%CI, 1.07-6.18; P = .035). Conclusions: Patients over 80 years of age treated with PA have high in-hospital and long-term mortality...

Chronic hand ischemia causes cold intolerance, intractable pain, and digital ulceration. If ischemic symptoms persist despite pharmacologic treatments, surgical interventions should be considered. This retrospective study evaluated the long-term results after ulnar and radial reconstruction using an interpositional deep inferior epigastric artery (DIEA) graft combined with periarterial sympathectomy. Patients who underwent this surgery from March 2003 to February 2019 were included. To evaluate variables influencing recurrence after the procedure, patients were divided into the recurred and non-recurred groups and their data were compared. Overall, 62 cases involving 47 patients were analyzed (16 and 46 cases in the recurred and non-recurred groups, respectively). The median DIEA graft length was 8.5 cm. The rates of rheumatic disease and female patients were significantly higher in the recurred than in the non-recurred group, without significant between-group differences in postoperative complication rates. In the multivariate analysis, underlying rheumatic disease and graft length had significant effects on recurrence. In Kaplan–Meier analysis, the 5- and 10-year symptom-free rates were 81.3% and 68.0%, respectively, with lower rates for cases with rheumatic disease. Thus, arterial reconstruction using an interpositional DIEA graft provides long-term sustainable vascular supply in patients with chronic hand ischemia, especially in those without rheumatic disease.

Objective. To assess the effect of neodymium laser radiation on the recurrence rate and continued growth of primary extramedullary tumors on the basis of clinical data obtained in the long-term follow-up period in operated patients with extramedullary tumors.Material and Methods. The long-term results of surgical treatment of two groups of patients (n = 412) with primary extramedullary tumors operated on from 1998 to 2014 were studied and systematized. Patients of comparison group (n = 277; 67.2 %) underwent removal of tumors using standard microsurgical techniques, and the neoplasms in patients of the study group (n = 135; 32.8 %) were removed with additionally used neodymium (Nd:YAG) laser.Results. The use of the developed laser technologies for the resection of extramedullary intracanal primary tumors made it possible to reliably reduce the relative number of recurrence and continued growth from 11.1 % to 1.2% compared with patients treated with standard surgery methods. The proportion of recurrences was 3.5 %, all of them were detected only in the group with the classical technique of tumor resection (p Conclusion. The use of a neodymium laser as an additional technology to the classical microsurgical resection of extramedullary tumors is effective for the prevention of their recurrence and continued growth.

Summary. Distal phalanx dorsal edge fracture is treated in a relatively simple closed manner during the first weeks after injury. The role of the distal interphalangeal joint in the upper extremity integral function reaches conventionally only a few percent. This may lead to insufficient attention and a large number of mistakes in diagnosis and treatment of such injuries, which in turn provokes complications that are much more difficult to treat than the primary injury. This article considers the most common problems of diagnosis and treatment of “mallet finger” fractures. Advantages and disadvantages of various techniques used in the treatment of such fractures in acute and neglected cases are considered and analyzed. Objective: to study the effect of distal phalanx dorsal edge avulsive fractures on function of the upper limb, quality of life, and depression rate in long term period after injury. Materials and Methods. Data from 11 patients (8 (88%) males and 3 (12%) females) with neglected cases of distal phalanx dorsal edge avulsive fractures were studied. QuickDASH questionnaire and visual analog scales were used to study impaired quality of life and depression rate in such patients. Indicators that lead to the need for surgery in long term period after injury have been identified. Results. It was determined that in long term period, in patients with a “mallet finger” fracture, function of the upper extremity suffered significantly and was 29.2±20.2 points (range 2.3-75) according to QuickDASH scale. This condition also significantly affected the general well-being of the patient. Average value of impaired quality of life was 43.6±24.6 (range 0-90 points), and depression rate due to upper extremity dysfunction was 44.6±22.7 (range 0-90 points). Conclusions. Despite the relatively minor injury, high rates of dysfunction, impact on quality of life and depression rate indicate the need to restore finger function even in long term period after injury.

BACKGROUND Helicobacter pylori (H. pylori) is a spiral-shaped bacterium responsible for the development of chronic gastritis, gastric ulcer, gastric cancer (GC), and MALT-lymphoma of the stomach. H. pylori can be present in the gastric mucosa (GM) in both spiral and coccoid forms. However, it is not known whether the severity of GM contamination by various vegetative forms of H. pylori is associated with clinical and morphological characteristics and long-term results of GC treatment. AIM To establish the features of H. pylori infection in patients with GC and their correlations with clinical and morphological characteristics of diseases and long-term results of treatment. METHODS Of 109 patients with GC were included in a prospective cohort study. H. pylori in the GM and tumor was determined by rapid urease test and by immunohistochemically using the antibody to H. pylori. The results obtained were compared with the clinical and morphological characteristics and prognosis of GC. Statistical analysis was performed using the Statistica 10.0 software. RESULTS H. pylori was detected in the adjacent to the tumor GM in 84.5% of cases, of which a high degree of contamination was noted in 50.4% of the samples. Coccoid forms of H. pylori were detected in 93.4% of infected patients, and only coccoid-in 68.9%. It was found that a high degree of GM contamination by the coccoid forms of H. pylori was observed significantly more often in diffuse type of GC (P = 0.024), in poorly differentiated GC (P = 0.011), in stage T3-4 (P = 0.04) and in N1 (P = 0.011). In cases of moderate and marked concentrations of H. pylori in GM, a decrease in 10-year relapse free and overall survival from 55.6% to 26.3% was observed (P = 0.02 and P = 0.07, respectively). The relationship between the severity of the GM contamination by the spiral-shaped forms of H. pylori and the clinical and morphological characteristics and prognosis of GC was not revealed. CONCLUSION The data obtained indicates that H. pylori may be associated not only with induction but also with the progression of GC.

The study of long-term results of coronary artery bypass grafting (CABG) in patients with different sexes has been a relevant problem of cardiology and heart surgery over the past thirty years. Female sex is an independent risk factors for worse outcomes in the long-term follow-up period after CABG according to many studies. However, there are publications suggesting that the results in women are better than in men in the long-term period after CABG. This literature review is devoted to studies of long-term complications and survival in patients after CABG depending on their gender. The evidence for gender differences after CABG is currently based on male-dominated studies. Most authors show that women have a higher degree of comorbidity. Another risk factor is age. Women undergo surgery at an older age. Besides, long-term survival is affected by the completeness of revascularization and multiarterial bypass grafting. Current diagnostic and treatment algorithms shift towards the assessment of coronary artery disease in men, which potentially may result in incorrect diagnosis or interpretation of existing disease and incorrect choice of treatment tactics in female patients. Despite large pool of accumulated data, this question remains open and requires new trials and continuing studies focusing on the impact of gender factor on the long-term survival.

Introduction: High energy tibial plateau fractures represent a challenge because of the combined bone and soft tissue injury. The iatrogenic impact can further increase the likelihood for crippling complications. Less invasive treatment protocols have been developed to improve the results. Objective: We present the long-term results of limited internal fixation combined with a small wire external fixator. Patients and Methods: Fourteen patients were followed for at least 10 years. Initial and final functional results, complications and presence of joint degeneration were registered according to validated rating scores. Results: Of all patients included in the study, thirteen showed an excellent initial rating and one had an average result at baseline. 10 years later, eight patients still showed excellent grading results, four – good ones, one – average and one – poor results. Ten knees (71%) had osteoarthritis. Postphlebitic syndrome was diagnosed in two cases. Three knees showed medio-lateral instability, one showed a varus and one – a valgus deformity. Knee arthroplasty was performed in one case. Conclusion: The limited internal fixation combined with a hybrid ex fix can be considered as an alternative to the ORIF, especially when the soft tissues are severely compromised. Despite the inevitable joint degeneration, the associated overall morbidity is low and the long term function is quite satisfactory.

BackgroundDegenerative rotator cuff tears are common in elderly patients. However, the treatment strategies remain controversial. While physiotherapy can lead to pain relief and improved shoulder function, spontaneous tendon healing will not take place and, thus, non-operative management bears the risk of tear progression. Surgical management is the only way to restore the tendon-to-bone interface in spite of a considerable number of retears.MethodsThe present study reviewed the data provided by randomized controlled trials (RCTs) that have compared physiotherapy with surgical rotator cuff repair. Systematic reviews of this kind have been published before; however, this paper re-analyzes the data, given that Moosmayer et al. recently published an RCT with 10-year follow-up. Such long-term data are comparatively rare in the field of musculoskeletal surgery and therefore a reconsideration of treatment recommendations seems necessary.ResultsThe results show a mean difference in the Constant and Murley score of 6.2 points (95% confidence interval, 2.6; 9.7,P P ConclusionIn summary, this review shows superior clinical results for surgical repair of small- to medium-sized degenerative rotator cuff tears especially in the long term compared to physiotherapy.

Мета дослідження: оцінити ефективність застосування трансплантації автологічних хондроцитів (АХ) у хворих після проведеної поперекової мікродискектомії у віддаленому періоді. Матеріали та методи. Проведено трансплантацію АХ 6 пацієнтам через 3 міс. після поперекової мікродискектомії. Оцінку клінічного стану проводили за шкалами VAS і NASS до операції та через 3 міс. після мікродискектомії, через 1 і 2 роки після трансплантації АХ. Також у ці періоди оцінювали магнітно-резонансні характеристики гідратації міжхребцевого диска. Результати. За даними магнітно-резонансної томографії встановлено відновлення гідрофільності пульпозного ядра у 4 із 6 пацієнтів (66,7 %), яким проводили АХ. Інтенсивність болю істотно знизилася вже в ранньому періоді після операції мікродискектомії, а через 3 міс. (на час проведення трансплантації АХ) зменшилася майже у 6 разів. Через 1 рік та 2 роки після трансплантації АХ цей показник продовжував поступово знижуватись. Функціональний статус та якість життя після операції мікродискектомії значно покращилися на момент проведення транс­плантації АХ, а після даної процедури істотно не змінились. Висновки. Автотрансплантація хондроцитів у пацієнтів після виконання поперекової мікродискектомії є безпечним методом хірургічного лікування дегенеративних захворювань хребта, що позитивно впливає на біомеханічні властивості оперованого міжхребцевого диска.

BACKGROUND The outcomes of Hodgkin´s lymphoma (HL) in México have not been widely reported. Simplified and affordable treatments have been adopted in middle-income countries. AIM The aim was to evaluate long-used therapies for HL in México in a long-term basis. METHODS In a 34-year time period, 88 patients with HL were treated at a single institution in México. Patients were treated with adriamycin bleomycin vinblastine and dacarbazine (ABVD) or mechlorethamine, vincristine, procarbazine, and prednisone (MOPP). Relapsed or refractory patients were given ifosfamide, carboplatin, and etoposide (ICE) followed by autologous or allogeneic stem cell transplants. RESULTS Thirty-seven women and 51 men were included; the median age was 29 years. Patients were followed for a mean of 128 mo. The 310-mo overall survival (OS) was 83% for patients treated with MOPP and 88% for those treated with ABVD. The OS of patients who received autologous stem cell transplantation was 76% (330 mo) vs 93% (402 mo) in those who did not. CONCLUSION HL may be less aggressive in Mexican population than in Caucasians. Combined chemotherapy renders acceptable results, regardless of clinical stage.

If it is theoretically and practically very important for a doctor-specialist to know not only the immediate results of sanatorium treatment, but also how long these results last, then for insurance organizations these issues acquire exceptional importance: depending on the duration of the results of sanatorium treatment, the questions of who and when are resolved. and for what time frame you need to send to the sanatorium, which technique is most effective, etc.

Acute aortic dissection is a formidable disease. Its prevalence increases due to the population aging, as well as wider awareness of physicians about this pathology. The aim. To analyze immediate and long-term results of surgical treatment of aneurysms of ascending aorta and aortic arch and to determine optimal methods of correction of these lesions in order to improve the results of surgical treatment. Materials and methods. This was a comparative analysis of immediate and long-term treatment outcomes in 419 patients with aneurysms of ascending aorta and aortic arch. A comparative analysis of the results of treatment of two groups of patients was performed: the comparison group of 157 people operated before 2013, and the main group of 262 patients operated since 2013 using modified methods of aortic surgery. Results. The study showed significant reduction in the left ventricular dilatation according to echocardiography and satisfactory postoperative course in patients of both groups. Patients with valve-sparing aortic prosthetics had better results than those who underwent valve replacement surgery. Hospital mortality decreased from 17.2% to 5.3%. Analysis of long-term results showed that supracoronary aortic prosthetics with aortic valve plasty and elimination of the intimal tear zone make it possible to carry out effective aortic reconstruction. Due to events in the long run, regular lifelong monitoring is required. The analysis also showed that individualized approach to the choice of surgical tactics for the correction of aortic insufficiency in patients with aortic root and ascending aortic pathology allows to achieve comparable results in the immediate and long-term follow-up. Despite the complexity of the applied correction methods, the developed methods of surgical treatment of ascending aortic aneurysm (AAA) and aortic arch aneurysm and methods of protection of brain and visceral organs allowed to keep hospital mortality and the number of complications at the same level corresponding to one of the best world results. This gives hope for a good result in the long-term follow-up. Conclusions. Aneurysm of ascending aorta and aortic arch is a formidable life-threatening disease, and its only non-alternative treatment option is surgery. The optimized approach to the treatment of patients in the main group allowed to obtain better immediate and long-term results of surgical treatment and reduce postoperative complications from 34.4% to 8.4% and hospital mortality from 17.2% to 5.3%. Comparative analysis of long-term results in the studied groups showed more encouraging indicators of quality of life and life expectancy in patients when using modified surgical techniques, protection of the brain and visceral organs. We hope to get a final assessment of these data in the further study of the condition of these patients in the long-term follow-up.

Purpose More long-term follow-up studies beyond 10 years after secondary sphincteroplasty for obstetric damage are warranted. This prospective study aimed to compare reported data on incontinence and satisfaction in a cohort of such patients examined at short-, long-, and very long-term follow-up. Methods Twenty out of 33 obstetric patients (61%) operated with secondary anterior overlapping sphincteroplasty during February 1996 to April 2004 were evaluated preoperatively and at short-, long-, and very long-term follow-up. Anal incontinence was scored by a combination of Wexner’s and St. Mark’s incontinence scores. The patients also reported degree of treatment satisfaction. Results Twenty patients were examined preoperatively and after a median (range) of 5 (2–62), 102 (64–162), and 220 (183–278) months. Corresponding incontinence scores were 11.5 (5–18), 5.5 (1–17) (p p > 0.05), and 12.0. (1–18) (p > 0.05). With increasing follow-up times, patients reporting a better outcome were 75%, 65%, and 45%. At very long-term follow-up patients, reports were more dismal than expected in those also reporting improved incontinence cores. Incontinence scores did not improve in patients with neuropathy (n = 5) or patients (n = 5) with more than 10 years of symptoms. Conclusion Initial improvement of anal incontinence attenuated with time, in particular from short- to long-term follow-up. Patients with neuropathy experienced no improvement of incontinence. Beyond stoma formation, in compliant patients, one should consider other treatment options like sacral nerve stimulation and neosphincter formation.