Search

Despite the evolution in modern surgery and in pharmaceutical industry, purulent pathology of the hand is occupying a leading position for many years among all diseases with which patients are admitted to hospitals. Over the years, medical care for such patients has been improving. A high social and economic significance of this problem makes surgeons to continue searches of new directions not only in surgical techniques, but also in postoperative wound management to improve outcomes in patients with purulent diseases of the hand.The purpose of this work is to assess results of care of patients with purulent finger and hand diseases treated with laser light necrectomy and photodynamic therapy. A comparative analysis of wound process dynamics and treatment outcomes in 198 patients with hand purulent diseases who had been admitted to Moscow City Hospital No. 4 was made by the authors. All patients were divided into four groups depending on the curative modality. In Group 1 (n = 53), a wound was sutured after surgery, and a drainage-lavage system (DLS) was installed; in Group 2 (n = 50), a wound was not sutured because of contraindications to suturing; in Group 3 (n = 46), patients had laser necrectomy after which a wound was sutured and DLS was installed; in Group 4 (n = 49), a wound was not sutured because of contraindications like in Group 2, but it was treated with antiseptic dressings and photodynamic therapy at an early postoperative period. Various aspects of the effectiveness of laser techniques have been analyzed: dynamics of wound healing, changes in wound defect size, level of pain syndrome assessed by VAS, changes in clinical blood tests, changes in wound exudate cytological picture as well as changes in wound microflora. Acceleration of wound healing was noted in all patients who were treated with laser light what, consequently, shortened their inpatient stay. Laser light also changed cytological and microbiological patterns of wound exudate, as evidenced by the decrease of wound detritus and by the decrease of microbial content in the wound. In patients, who were treated with laser light, less pain syndrome was registered immediately after laser technique application.The obtained findings demonstrate a positive effect of laser necrectomy with DLS at wound process as well. Photodynamic therapy significantly improved results in patients with open wound management on the hand and fingers. Laser techniques have good perspectives in purulent surgery of the hand.

Despite the progress in modern surgery, the number of patients with purulent finger and hand diseases keeps growing these days in the clinical practice of surgeons. In recent years, there has been a tendency to develop more severe forms of panaritium and phlegmon in an increasingly young contingent of patients. Increasingly, doctors refuse to use the classical method of managing a postoperative wound of the hand involving the installation of drainage tubes. This phenomenon is polygenic and calls for special attention due to the frequent deplorable consequences of a treatment failure. The high urgency of this issue in Moscow Hospital No. 4 has become a rationale to study the effect of photodynamic therapy (PDT) on the course of the wound process in patients with this pathology.The purpose of this work is to develop a technique to advance the treatment outcomes for patients with purulent finger and hand diseases in case of open postoperative wound treatment.This study includes a comparative analysis of the wound process dynamics in 49 (49.5%) patients who underwent a photodynamic therapy session in the postoperative period and in 50 (50.5%) patients who received an open wound treatment after the operation. Photodynamic therapy was performed on the second postsurgical day by a laser apparatus “Atkus-2” (wave length 661 nm) with a gel form of the chlorinseries photosensitizer photoditazin in the form of an application at the rate of 1 g ml per 3–5 cm2 of the wound surface. The power density was chosen in the range of 0.1–1 W / cm2, and the time of exposure to the wound varied from 30 to 400 seconds, depending on the area of the wound.To assess the dynamics of the wound process in the postoperative period, we took measurements of all the patients’ wound areas on the 1st and 5th days, monitored the gross impression daily. In the patients who received PDT, we observed an earlier wound cleansing and remitting of the inflammatory process, acceleration of the edge epithelization, and earlier appearance of the granulation tissue by an average of 2 days. In the group of patients who were treated with PDT in the postoperative period, on the 5th day, the wound defect decreased by an average of 1 cm2, which amounted to 22.4%, in the control group – by 18%. The analysis of cytological and morphological patterns also revealed an accelerated switch from the inflammatory stage of the wound process to the reparative one - the reparative processes in the PDT group began earlier by 2 days. The microbiological analysis of wound exudate showed a downregulation of microflora after a PDT session - only in 6 cases pathogens were identified in the repeated seeding, which amounted to 12.24% of the group compared to 38% of the control group. After a session of photodynamic therapy, patients noted a significant reduction in pain, including during dressings. The pain syndrome immediately after the session decreased by 2–3 points. By the 5th day it became moderate – 4–5 points. In the control group, this indicator on the 2nd day was 8 points, decreasing by the 5th day to 6 points. For all analyzed indicators, the groups had statistically significant differences (p

Objective. To present the results of the author’s own series of transoral operations in patients with pathology of the thyroid and parathyroid glands. Methods. Transoral surgery was performed in women (n=20) and (n=1) man. All patients were operated on for the primary disease and met the selection criteria based on ultrasound and cytological examinations, hormonal levels, and somatic status. Indications for surgery were: nodular goiter in 17 cases, diffuse toxic goiter - in 2 cases, parathyroid adenoma - in 2 cases. The surgical technique included a three-port approach in the lower fornix of the vestibule of the mouth and a gas technique for maintaining the working cavity. Standard laparoscopic instruments and an energy based ultrasonic device were used for the operation. In the postoperative period, patients underwent a test for subjective assessment of the aesthetic result of the operation using the survey of thedermatology life quality index. Results. Thyroidectomy was performed in 4 patients, hemithyroidectomy - in 15 patients and parathyroidectomy - in 2 patients. In one patient, transoralparathyroidectomy was performed as a part of a simultaneous operation for multiple endocrine neoplasia type 1 syndrome. Papillary cancer T1N0M0 was verified in two patients after surgery. The mean operation time was 196.1 min (range 110 - 300 min). Average blood loss - 3 9.5 ml (range 10 - 300 ml). The nineth operation required the conversion due to severebleeding. In one case, the temporary recurrent laryngeal nerve(RLN)injury was reported, in one case - hematoma. After surgery, the median and average values of thedermatology life quality index were 1 (IQR 0-4) and 2.05, respectively, which indicates an insignificant effect on the quality of life. Conclusion. Transoral endoscopic surgery on the thyroid and parathyroid glands would be thepromising optimal choice in patients to avoid scarring on the neck.

For many years, the treatment of purulent diseases of the hand has stayed relevant. Despite the progress in modern medicine, this pathology retains its prevalence and, most importantly, is often found in patients of the working age, which determines the socio-economic importance of the search for new approaches to the treatment of purulent diseases of this localization. In the purulent surgery department of State Clinical hospital № 4, a study and treatment of two groups of patients were carried out: patients with phlegmons and felons of the hand with open management of postoperative wounds using traditional treatment methods (antibiotic therapy, immobilization, dressings with antiseptic solutions and ointments, the use of wound enzymes) and with the use of photodynamic therapy (PDT) in the postoperative period. PDT was performed on the second or third day after opening the phlegmon or felon using an ATKUS-2 semiconductor laser (AO “Poluprovodnikovye pribory”, Russia) with an output power of 1 to 2 W, an operating wavelength of 660 ± 0.03 nm and an energy density between 20 and 25 J/cm² after application of the photosensitizer based on chlorin e 6 to the treated wound area. The article describes the technique of PDT in patients with purulent diseases of the hand. It was found that it is optimal to perform PDT as early as possible after the operation period, but not earlier than on the second day after the operation, because earlier dressing is especially painful in the absence of sutures and can lead to bleeding from a postoperative wound when the dressing is removed. The effectiveness of treatment in the studied groups was evaluated: the terms of inpatient healing in the groups were compared; the dynamics of the course of the wound process was analyzed. When comparing the results of the two groups, a significant acceleration in the healing of the postoperative wounds was noted in patients for whom PDT was used – 5 days (1.4 times) faster compared to treatment according to the generally accepted technique. The early appearance of granulations and the antibacterial effect of this procedure are noted, which significantly improves the treatment outcome for this pathology. This makes the use of PDT relevant and appropriate in the complex treatment of purulent diseases of the hand

Cardiac involvement in sarcoidosis is considered quite rare, but it can cause the first significant disease manifestations and patient’s death. Timely disease detection improves the effectiveness of treatment and prognosis. The article presents modern approaches to the diagnosis and management of patients with cardiac sarcoidosisusing clinical case of a patient hospitalized by ambulance with a first revealed symptomatic third-degree atrioventricular block. We described methods of examining this patient, as well as difficulties in differential diagnosis.

To analyze own initial experience of transoral thyroid surgery.There were 7 patients thyroid nodules who underwent surgery for the period from March 2018 to May 2019. All patients signed an informed consent to be included in the study. Surgical approach was performed through three incisions in the lower arch of the vestibule of the mouth with deployment of 10 mm endoscope and two 5 mm tools. Gas insufflation was used. All patients were females aged 43.3±11.8 years. Thyroidectomy was performed in 2 cases, hemithyroidectomy - in 5 patients. Dimensions of nodules varied from 10 to 42 mm.Mean time of hemithyroidectomy and thyroidectomy was 206.4±63.8 and 232±37.5 min, respectively. Papillary carcinoma was histologically verified in 1 case. Injuries of recurrent laryngeal nerve, postoperative hypocalcemia and local complications were absent. Drainage was not applied. Postoperative hospital-stay was 3.7±1.1 days.Transoral approach to the thyroid gland is technically feasible with standard endoscopic instruments, safe for important anatomical structures and more precise due to the optical capabilities of endoscopic equipment. Any types of procedures are possible. Undoubtedly, aesthetic outcome is also favorable.Эволюция доступов в тиреоидной хирургии имеет богатую историю - от традиционного разреза на передней поверхности шеи к миниинвазивным и эндоскопическим вмешательствам. Собственный экспериментальный опыт и тщательный анализ мировых данных послужили основой для внедрения трансоральных операций на щитовидной железе в нашу клиническую практику. С марта 2018 г. по май 2019 г. после скрупулезного отбора, согласно критериям включения и оформления добровольного информированного согласия, оперированы 7 пациенток с узловыми образованиями щитовидной железы. Хирургический доступ осуществлен через 3 разреза в нижнем своде преддверия рта с установкой 10-миллиметрового эндоскопа и 25-миллиметровых инструментов. Рабочую полость поддерживали газовым способом. Средний возраст пациенток составил 43,3±11,8 года. Тиреоидэктомия выполнена у 2, гемитиреоидэктомия - у 5. Размеры узловых образований в удаленных препаратах варьировали от 10 до 42 мм. Время операции при гемитиреоидэктомии и тиреоидэктомии в среднем составило 206,4±63,8 и 232±37,5 мин соответственно. В 1 случае гистологически верифицирована папиллярная карцинома. Травм возвратного гортанного нерва и послеоперационной гипокальциемии не зафиксировано, как и местных осложнений. Дренирование раны не выполняли. Время нахождения в стационаре после операции 3,7±1,1 сут. Выводы. Выводы, полученные на экспериментальном этапе, их коррекция согласно мировому опыту позволили нам впервые реализовать в клинической практике трансоральную операцию на щитовидной железе. Трансоральный преднижнечелюстной доступ к щитовидной железе технически осуществим стандартными эндоскопическими инструментами, безопасен в отношении важных анатомических структур, более прецизионен благодаря оптическим возможностям видеоэндоскопа. Вмешательство на щитовидной железе возможно в любом объеме. И бесспорно, эстетический результат операции не вызывает сомнений.