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1. Conservative Therapy of Pressure Ulcers Using Physical Methods (Review)

Author

E. G. Osmanov, А. M. Shulutko, A. A. Yakovlev, A. Y. Krylov, A. V. Yakovleva, E. L. Altuкhov, E. G. Gandybina, and I. A. Martynov

Subjects
pressure ulcer, bedsore, surgical technology, physical treatment, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

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

Published
2022
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2. Administration of the immunomodulatory drug aminodihydrophthalazinedione sodium for prevention of progression pneumonia induced COVID-19

Author

A. A. Svistunov, G. K. Makhnach, D. V. Bunina, T. V. Khorobrykh, M. V. Volgin, V. G. Agadzhanov, N. P. Mishchenko, and E. G. Gandybina

Subjects
sars-cov-2, covid-induced pneumonia, respiratory failure, pneumofibrosis, aminodihydrophthalazinedione sodium, galavit, Medicine
Abstract

Aim to determine the efficacy of drug aminodihydrophthalazinedione sodium (Galavit) for prevention of progression of the coronavirus infection pulmonary complications: acceleration of regression of pulmonary infiltrates and resolution of COVID-induced pneumonia. 22 patients with medium and severe COVID-induced pneumonia were included in the study. The study included 8 men and 14 women, the average age was 62.17.4 years. Patients with more than one adverse prognostic factor made 82%. Average volume of pulmonary tissue affection (computer tomography CT-2, 2550% of lung volume) was registered in 13 (59.1%) patients, significant volume (CT-3, 5075% of lung volume), in 9 (40.9%) patients. All patients had progressive respiratory failure manifestations due to hypoxemia and related diseases. Aminodihydrophthalazinedione sodium was administered for 714 days from the beginning of disease, at the end of the course of standard complex therapy, in case of preservation of signs of intoxication, negative dynamics according to computer tomography data. Administration of aminodihydrophthalazinedione sodium had a positive effect on the dynamics of clinical scores. The progression of respiratory failure was halted and there was an increase in SpO2 values. According to the control computer tomography data the stabilization of the pulmonary parenchyma affection degree was noted, as well as reduction of the size of the compacted areas in the pulmonary tissue and formation of the picture of organising pneumonia that contributed to reduction of respiratory failure grade. The use of aminodihydrophthalazinedione sodium in complex therapy of COVID-induced pneumonia has a modulating effect on the immune system, prevents the progression of pulmonary tissue affection, promotes regression of infiltration foci, preventing the development of excessive pneumofibrosis and the progression of respiratory failure.

Published
2020

3. TRANSORAL THYROIDECTOMY AND PARATHYROIDECTOMY: SERIES OF CASES

Author

A.M. Shulutko, V.I. Semikov, E G Gandybina, S. E. Gryaznov, G. G. Melkonyan, and E.G. Osmanov

Subjects
Parathyroidectomy, medicine.medical_specialty, Series (stratigraphy), business.industry, medicine.medical_treatment, Thyroidectomy, Medicine, Surgery, business
Abstract

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.

Published
2021
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4. [Optical sonography in differential diagnosis of thyroid nodes]

Author

V. I. Semikov, A V Gorbacheva, Alexander M. Shulutko, V.V. Bryndin, O.A. Sigal, Z.M. Sigal, A R Patalova, E G Gandybina, and O.V. Surnina

Subjects
Thyroid nodules, Adult, Image-Guided Biopsy, Male, endocrine system, medicine.medical_specialty, Goiter, endocrine system diseases, Adenoma, Biopsy, Fine-Needle, 030209 endocrinology & metabolism, Sensitivity and Specificity, Diagnosis, Differential, 03 medical and health sciences, Young Adult, 0302 clinical medicine, medicine, Humans, Thyroid Neoplasms, Thyroid Nodule, Thyroid cancer, Aged, Ultrasonography, business.industry, Thyroid adenoma, Thyroid, Cancer, General Medicine, Middle Aged, medicine.disease, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Female, Radiology, Differential diagnosis, business
Abstract

To develop a non-invasive method for differential diagnosis of thyroid nodes.Optical sonography was made in 623 patients with thyroid nodes including 374 women (60%) and 249 men (40%) aged 19-79 years (mean 64±15 years). All patients underwent ultrasound-assisted fine-needle aspiration biopsy. Cytological examination revealed cystic colloidal goiter (CCG) in 317 (51%) cases, follicular adenoma (FA) - in 197 (31.5%) cases, thyroid cancer - in 109 (17.5%) cases. All patients underwent surgery. Histological examination verified cystic colloidal goiter in 354 (56.8%) cases, follicular adenoma - 75 (12.0%) cases, thyroid cancer - 194 (31.2%) cases. Follicular cancer was diagnosed in 120 cases, papillary cancer - 70 cases, undifferentiated cancer - 4 cases.Sensitivity, specificity and accuracy of optical ultrasonography in differential diagnosis of thyroid nodules were estimated. Sensitivity of ultrasonography in the diagnosis of thyroid malignancies was 0.75, specificity 0.62, accuracy 0.67. Sensitivity of ultrasonography in the diagnosis of thyroid adenoma was 0.85, specificity 0.62, accuracy 0.73. Sensitivity of optical sonography in the diagnosis of CCH was 0.62, specificity 0.61, accuracy 0.7. Optical sonography ensures differentiation of CCH and follicular adenoma, CCH and thyroid cancer, follicular adenoma and thyroid cancer. Sensitivity, specificity and accuracy of ultrasonography in differential diagnosis of FA and thyroid cancer are 0.85, 0.62, 0.73 and 0.8, 0.71, 0.7, respectively.Разработка неинвазивного метода дифференциальной диагностики узловых образований щитовидной железы.Оптосонография выполнена 623 больным узловыми образованиями щитовидной железы, среди них 374 (60%) женщины и 249 (40%) мужчин в возрасте от 19 до 79 лет (средний возраст 64±15 лет). Всем выполнена тонкоигольная аспирационная биопсия под контролем УЗИ. При цитологическом исследовании в 317 (51%) наблюдениях верифицирован кистозно-коллоидный зоб (ККЗ), в 197 (31,5%) наблюдениях — фолликулярная аденома (ФА), в 109 (17,5%) наблюдениях — рак щитовидной железы (РЩЖ). Все 623 пациента прооперированы. При гистологическом исследовании в 354 (56,8%) наблюдениях верифицирован ККЗ, в 75 (12,0%) наблюдениях — ФА, в 194 (31,2%) наблюдениях — РЩЖ. Фолликулярный рак (ФР) диагностирован в 120 наблюдениях, папиллярный рак — в 70 наблюдениях, недифференцированный рак — в 4 наблюдениях.Рассчитаны чувствительность, специфичность и точность оптосонографии в дифференциальной диагностике узловых образований щитовидной железы. Чувствительность оптосонографии в диагностике злокачественных новообразований щитовидной железы составила 0,75, специфичность — 0,62, точность — 0,67, в диагностике аденомы щитовидной железы — соответственно 0,85, 0,62, 0,73, в диагностике ККЗ — 0,62, 0,61, 0,7. Оптосонография позволяет дифференцировать ККЗ и ФА, ККЗ и РЩЖ, ФА и РЩЖ. Чувствительность, специфичность и точность оптосонографии в дифференциальной диагностике ФА и ФР щитовидной железы составляют 0,85, 0,62, 0,73 и 0,8, 0,71, 0,7 соответственно.

Published
2020

5. Management of surgical complications following prolonged warfarin therapy in a general surgical hospital

Author

A Yu Krylov, A A Petrovskaya, A V Gorbacheva, E G Gandybina, A R Patalova, Alexander M. Shulutko, and S. E. Khmyrova

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Deep vein, Warfarin, Anticoagulants, Hemorrhage, General Medicine, medicine.disease, Prothrombin complex concentrate, Thrombosis, Hospitals, Thromboelastography, Surgery, medicine.anatomical_structure, Hematoma, Coagulation testing, Coagulopathy, Humans, Medicine, Blood Coagulation Tests, business, medicine.drug
Abstract

To analyze an effectiveness of algorithm for complex treatment of patients with surgical complications of prolonged warfarin therapy in a general surgical hospital.The study included 138 patients with surgical complications of prolonged warfarin therapy. All patients received warfarin for at least 6 months (49.5% of patients - over 5 years). Warfarin therapy was indicated for deep vein thrombosis in 54 patients and various cardiac diseases in 84 patients. Examination included clinical and instrumental survey, laboratory tests and coagulation tests - thromboelastography (TEG) and thrombodynamics test (TT).Recurrent VTEC occurred in 24 out of 138 patients, hemorrhagic complications - in 114 patients. Therapeutic management was applied in 111 patients, 27 ones underwent surgery (emergency treatment - 25 patients, after two days - 2 patients). Ten patients underwent endoscopic hemostasis, two patients - ultrasound-assisted percutaneous drainage of hematoma. Recurrent VTECs were caused by inadequate laboratory control and violations of warfarin therapy. Most of these patients underwent therapeutic management (only 3 patients required surgery for life-threatening flotation in great veins). Treatment of 114 patients with hemorrhagic complications of prolonged warfarin therapy depended on features of bleeding and severity of warfarin-induced coagulopathy. Depending on these factors, warfarin was discontinued and intravenous administration of vitamin K / FFP / prothrombin complex concentrate was applied. This approach ensured successful therapeutic measures in 90 patients of this group. Twenty-four patients underwent surgery after correction of hemostatic disorders. TT was characterized by high efficiency in analysis of thrombotic predisposition and prediction of the risk of VTEC. TEG was valuable for assessment of warfarin-induced coagulopathy and treatment of patients with hemorrhagic complications of prolonged warfarin therapy.The developed clinical and diagnostic algorithm for management of hemorrhagic complications of prolonged warfarin therapy ensures positive clinical results even in a general surgical hospital.Показать практическую эффективность разработанного алгоритма комплексного лечения больных с хирургическими осложнениями пролонгированной варфаринотерапии (ПВ) в условиях общехирургического стационара.В исследование включили 138 больных с хирургическими осложнениями ПВ. Все больные принимали варфарин не менее 6 мес (49,5% больных — более 5 лет). 54 пациента принимали варфарин по поводу тромбоза глубоких вен и 84 пациента — по поводу различной кардиальной патологии. Обследование включало: клинические и инструментальные методы, а также стандартные лабораторные показатели (СЛП) и глобальные коагулогические тесты (ГТ) — тромбоэластографию (ТЭГ) и тест тромбодинамики (ТТ).Из 138 больных у 24 диагностировали повторные ВТЭО, у 114 — различные по локализации и интенсивности геморрагические осложнения. 111 больных пролечили консервативно, 27 — оперировали (25 — в экстренном порядке, 2 пациента — через двое суток), 10 пациентам выполнили эндоскопический гемостаз, двоим пациентам — пункцию гематомы под УЗ-контролем. Причинами развития повторных ВТЭО явились неадекватный лабораторный контроль и нарушения режима приема варфарина. Большинство этих больных лечили консервативно (оперировали только 3 больных с развитием жизнеугрожающей флотации в магистральных венах). Лечение 114 больных с геморрагическими осложнениями ПВ зависело от клинической картины кровотечения и степени выраженности варфаринассоциированной коагулопатии (WAC). В зависимости от этих факторов отменяли варфарин и сочетали в/в введение витамина К/СЗП/КПК в различных комбинациях. Разработанная тактика позволила ограничиться консервативными мероприятиями у 90 больных этой группы, а 24 больным выполнить хирургическое вмешательство на фоне коррекции гемостаза. Высокую эффективность при определении состояния тромботической готовности и прогнозировании риска развития ВТЭО показал тест тромбодинамики (ТТ). При определении степени WAC и коррекции лечения больных с геморрагическими осложнениями ПВ высокую эффективность показала тромбоэластография (ТЭГ).Применение разработанного клинико-диагностического алгоритма при лечении осложнений ПВ позволяет добиться положительных клинических результатов даже в условиях общехирургического стационара.

Published
2021
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