scholarly journals Optimization of surgical treatment of rigid flat feet in children with posterior tibialis tendon dysfunction

2020 ◽  
pp. 72-80
Author(s):  
O.A. Danilov ◽  
◽  
A.V. Shulga ◽  
Keyword(s):  
Surgical Treatment ◽  
Diagnostic Methods ◽  
Long Term Results ◽  
Control Group ◽  
Navicular Bone ◽  
Bone Deformity ◽  
Tarsal Bones ◽  
Flat Feet ◽  
Subtalar Arthroereisis ◽  
Foot Mobility

The rigid form of static flatfeet occurs in 18 to 20% of cases of the musculoskeletal system pathology. To date, no objective diagnostic methods have been developed, no algorithms for treating the rigid form of flatfeet depending on the severity, deformity of the tarsal bones, foot mobility and dysfunction of the posterior tibialis tendon (hereinafter PTT). Objective. To develop objective evaluation methods for mobility in the joints and changes in the tarsal bones. Create algorithms for surgical treatment of rigid foot. Materials and methods. The effectiveness of the rigid form of static flatfeet treatment in 32 children (64 feet) aged 14 to 18 years, which were divided into main and control groups, was analyzed. Clinical and radiological diagnostic methods were used. Patients in the main group (15 patients) underwent surgery on bones and soft tissues.Patients in the control group (17 patients) were operated using subtalar arthroereisis method. Results. Surgical treatment was ineffective in the use of subtalar arthroereisis in cases of the tarsal bone deformity and significant impairment of foot mobility. Positive results were also achieved using two-joint arthrodesis with the formation of naviculo-tibial ligament with severe foot rigidity, stage III–IV of PTT dysfunction and navicular bone deformity. Conclusions. Treatment of rigid foot should take into account the severity, the compression ratio of the navicular bone, the mobility index, the stage of the posterior tibialis tendon dysfunction and the angle of its tension. Long-term results indicate the effectiveness of surgery on bones and soft tissues in the treatment of severe rigid flat feet. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: flatfeet, children, surgical treatment.

scholarly journals COMPARATIVE EVALUATION OF SURGICAL TREATMENT METHODS OF RIGID FLAT FEET IN CHILDREN WITH DYSFUNCTION OF THE POSTERIOR TIBIALIS TENDON

2020 ◽  
Vol 10 (4(38)) ◽  
pp. 46-52
Author(s):  
O. Shulga
Keyword(s):  
Surgical Treatment ◽  
Compression Ratio ◽  
Soft Tissues ◽  
Diagnostic Methods ◽  
Long Term Results ◽  
Navicular Bone ◽  
Bone Deformity ◽  
Flat Feet ◽  
Subtalar Arthroereisis ◽  
Foot Mobility

Introduction.The rigid form of static flat feet in children occurs in 18-20 % of cases of the musculoskeletal system pathology. Nowadays, neither objective diagnostic methods have been developed, nor algorithms for treating the rigid form of flat feet depending on the severity, deformity of the tarsal bones, foot mobility and dysfunction of the posterior tibialis tendon (PTT) have been found. Objective. To develop objective evaluation methods of rigid flat feet surgical treatment in children depending on the joints’ mobility, compression ratio,  and PTT dysfunction stage. Methods and materials. The effectiveness of the rigid form of static stage II-III  flat feet treatment was analysed in 15 children aged 14 to 18 years, who were divided into control and main groups. Clinical and radiological diagnostic methods were used. Patients of the control group (8 children) were operated using subtalar arthroereisis method. Patients of the main group (7 children) underwent surgery on bones and soft tissues. Results. Surgical treatment showed no effect using subtalar arthroereisis method in cases of the tarsal bone deformity, advanced stage of PTT dysfunction,  and significant impairment of foot mobility. Positive results were also achieved using two-joint arthrodesis with the formation of navicular-tibial ligament with severe foot rigidity, stage III-IV of PTT dysfunction and navicular bone deformity. Conclusion. During treatment of rigid flat feet in children it’s necessary to take into consideration severity, compression ratio of the navicular bone, the mobility index, the stage of the posterior tibialis tendon dysfunction and the angle of its tension. Long-term results indicate the effectiveness of surgery on bones and soft tissues in the treatment of severe rigid flat feet.

scholarly journals Evolution of diagnosis and surgical treatment of intra-abdominal infiltrates, abscesses of primary and postoperative origin in patients

2021 ◽  
pp. 15-29
Author(s):  
V.V. Skyba ◽  
◽  
V.F. Rybalchenko ◽  
A.V. Ivanko ◽  
R.М. Borys ◽  
...  
Keyword(s):  
Duodenal Ulcer ◽  
Gastric Ulcer ◽  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Postoperative Mortality ◽  
Multiple Organ ◽  
Long Term Results ◽  
Control Group ◽  
Study Group ◽  
Perforated Gastric Ulcer

Purpose – to improve the results of surgical treatment of patients with intra-abdominal infiltrates and abscesses through the introduction of the latest imaging methods and surgical technologies. Materials and methods. In the clinic of the Department of Surgical Diseases No 1, on the basis of the Surgery Center of the Kyiv City Clinical Hospital No. 1 from 2006 to 2019 218 patients with primary and secondary intra-abdominal infiltrates, abscesses and fluid formations were treated. The patients’ age ranged from 16 to 85 years. There were 107 (49.08%) male patients, 111 (50.92%) female patients. Depending on the time of hospitalization (by years), the patients were divided into two groups: the control group (CG) (2006–2012) 117 (53.67%) patients and the study group (SG) (2013–2019) 101 (46.33%) patients. The SG used the latest imaging technologies and improved methods of surgical treatment. Results. The patients were divided into two groups: primary in 191 (87.61%) and secondary postoperative infiltrates and abscesses in 27 (12.39%). The causes of primary infiltrates and abscesses were: complicated forms of appendicitis in 74 (33.94%), perforated stomach and duodenal ulcer in 48 (22.02%), complicated forms of cholecystitis in 69 (31.65%). Postoperative infiltrates and abscesses were observed in 27 (12.39%) patients who underwent urgent surgery: adgeolysis of adhesive ileus in 14 (6.42%) and complicated hernias of various localization in 13 (5.97%). Postoperative complications were diagnosed in 43 (19.72%) patients, of whom 34 (15.59%) from the surgical wound and 29 (15.18%) of the abdominal cavity, who required relaparotomy or laparoscopy, with destructive appendicitis in 10 (13.51%), perforated gastric ulcer and 12 duodenal ulcer in 6 (12.5%), destructive cholecystitis in 9 (13.04%), adhesive intestinal obstruction in 13 (19.12%) and with strangulated and complicated hernias in 14 (17.28%) of the examined patients. During relaparotomy, incompetence of the intestinal wall and intestinal sutures was established in 11 out of 32 patients, an ileostomy was imposed in 7, and cecostomy in 1 patient. Actually, in the control group, 8 (6.84%) patients died on the background of ongoing peritonitis, thrombosis of mesenteric vessels and multiple organ failure and concomitant ailments and in the study group 4 (3.96%) patients died. Conclusions. Surgical treatment is individualized depending on the disease, so with destructive appendicitis from 74 (38.74%) laparotomic in 42 (21.99%), laparoscopic in 32 (16.75%), and in 12 (6.28%) with conversion; perforated gastric ulcer and duodenal ulcer in 48 (25.13%) open laparotomy; with cholecystitis of 69 (36.13%) patients, 48 (25.13%) had laparotomy and 21 (11.00%) had laparoscopic examination. The use of the latest imaging and treatment technologies: Doppler ultrasonography, hydrojet scalpel and laparoscopy in 64 (33.51%), allowed to have better near and long-term results and to reduce postoperative mortality from 6.84% to 3.96%, with an average of 5.5%. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: destructive appendicitis, cholecystitis, perforated gastric ulcer and 12-duodenal ulcer, adhesive leakage, strangulated hernias, diagnosis and treatment.

Treatment Methods for Different Variations Syndrome Mirizzi

2021 ◽  
Vol 04 (04) ◽  
Author(s):  
Omarov N.B., Aimagambetov M. Zh. ◽  
◽  
◽  
Keyword(s):  
Surgical Treatment ◽  
Bile Ducts ◽  
Gallstone Disease ◽  
Main Group ◽  
Mirizzi Syndrome ◽  
Long Term Results ◽  
Control Group ◽  
Type Iii ◽  
Type Iv ◽  
Number Of Patients

The number of patients with complicated forms of cholelithiasis of cholelithiasis is progressively growing. One of the complications of gallstone disease is Mirizzi syndrome (SM). The reason for the development of which is the spread of the inflammatory - destructive process from the gallbladder to the bile ducts with the formation of pressure ulcers in the common bile duct, as a result of which the formation of a cholecystobiliary fistula occurs, through which stones from the gallbladder enter the main bile ducts. The analysis of the surgical treatment of patients with cholelithiasis (GSD) treated in the UH NJSC "MUS" was carried out. There were 3842 patients in total, Patients were in the period from January 2012. to July 2018 The analysis revealed that of all these patients with gallstones, Mirizzi SM type III and IV syndrome was diagnosed in 25 (0.7%). In 14 (56%) patients with type III SM and type IV SM, 11 (44%). The main group consisted of 10 (40%) patients and 15 (60%) patients included in the control group. The main group completed: 1) In type III SM (only 4 (40%) patients). One patient underwent hepaticojejunostomy according to the clinic method (2017/0423.1). In 3 patients, cholecystohepaticocholedochoplasty was performed with U-shaped interrupted sutures on the drainage according to Vishnevsky (2017 / 0980.1); 2) In type IV SM (a total of 6 (60%) patients). 4 patients underwent hepaticojejunostomy according to the clinic method (2017/0423.1). In 2 patients, cholecystohepaticocholedochoplasty was performed with U-shaped interrupted sutures on the drainage according to Vishnevsky (2017 / 0980.1). The developed and tested methods of surgical treatment of Mirizzi syndrome of types III and IV make it possible to improve the immediate and long-term results of surgical treatment of patients with this pathology. These methods of surgical treatment allow preserving the physiology of the bile outflow without postoperative complications typical for traditional hepaticojejunostomy (incompetence of the anastomotic sutures, stricture of hepaticojejunostomy).

scholarly journals Wound Complications After Multimodal Treatment of Soft Tissue Sarcomas

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 218s-218s
Author(s):  
M. Khanevich ◽  
A. Khazov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Radical Surgery ◽  
Soft Tissue Sarcomas ◽  
Endovascular Embolization ◽  
Main Group ◽  
Long Term Results ◽  
Wound Complications ◽  
Control Group ◽  
Quick Freezing

Background: Surgical removal of the tumor remains the only 1 radical treatment of patients with soft tissue sarcomas of the extremities. However, the parameters of total and disease-free survival after this type of treatment cannot be considered satisfactory. Currently the active search and introduction into clinical practice of additional impact methods that can improve the immediate and long-term results of treatment of such patients is being conducted. Aim: To evaluate the risk of the wound process complications after surgical treatment of soft tissue sarcomas using endovascular embolization and cryosurgery. Methods: We have assessed the quantity and quality of postoperative complications of wound process in 199 patients with soft tissue sarcomas and their recurrences. The study group consisted of 53 patients, who underwent radical surgery with selective preoperative endovascular embolization and intraoperative cryosurgery. The control group consisted of 146 patients who had radical surgery without any additional methods. Preoperative embolization and cryosurgery on the wound bed after tumor removal was used to prevent local recurrence of soft tissue sarcomas. Preoperative angiography with selective embolization of vessels feeding the tumor was performed 1-1.5 hours before the main surgical treatment. Cryosurgery was carried out by the method of “Olympic rings” with 3 minutes duration. The temperature of exposure was −186°C. In the course of cryosurgery we adhere to the principle of “quick freezing - an independent slow thawing”. All postoperative wounds tightly sutured with silicone drains by Redon, if necessary. Results: Complications of wound healing have been diagnosed in 15 (28.3%) patients of the main group and in 34 (23.3%) control group patients. Inflammatory-suppurative complications were observed in the remaining 8 (15.1%) patients of the main group and in 18 (12.3%) control group patients ( P > 0.05). Long lymphorrhea was observed in 6 (11.3%) patients of the main group and 11 (7.5%) control group patients. Bleeding in the postoperative period was observed in 1 (1.9%) case of main group patients and in 5 (3.4%) cases of control group. Conclusion: The additional using of selective preoperative endovascular embolization and cryosurgery is safe and does not worsen immediate results of surgical treatment of soft tissue sarcomas.

scholarly journals Structure, diagnosis, prevention and treatment of postoperative complications of childbirth perineal tears complicated by anal incontinence

2015 ◽  
Vol 96 (5) ◽  
pp. 779-783
Author(s):  
S G Sultanova
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Anal Canal ◽  
Anal Incontinence ◽  
Main Group ◽  
Long Term Results ◽  
Control Group ◽  
Perineal Tears ◽  
Second Degree

Aim. Improving the results of surgical treatment of complications of second and third degree perineal tears complicated by anal incontinence. Methods. The study included 248 patients aged 16 to 50 years. The patients were allocated to three groups: the first group - 40 women who underwent traditional surgery and conservative treatment; the second group - 128 women with second degree perineal tear; group III - 80 women who underwent sphincteroplasty (I option) and sphincteroplasty combined with levatorplasty (II option) in our modification (sphincter-saving surgery with precision sutures). The main group included 111 patients who additionally received conservative treatment [1 mL of 1% enoxaparin sodium intravenously and 1 ml of 30% vitamin E (alfa-tocopherol acetate) by intramuscular injection]; control group - 97 patients who underwent standard treatment. Long-term results were assessed by a survey, physical examination in the clinic, telephone and Internet surveys in 35 patients of the main group and 31 women of the control group. Results. In 91 (82%) patients of the main group, the pain intensity decreased after 7-10 days of treatment was antioxidants, 8 (7.2%) patients had pain in the perineum or anal canal, in 12 (10.8%) cases intense pain in the anal canal were still present. Long-term results were evaluated as good in 16 (51.6%) and 25 (69.4%) patients, as satisfactory - in 9 (29%) and 8 (22.2%) patients, as unsatisfactory - 6 (19.4 %), and 3 (8.3%) patients of the main and the control groups, respectively. The test group showed earlier formation of granulation tissue (3.1±0.3 days earlier compared to the control group). At sphincterometry on the 12th day, 6 patients of the control group had first degree anal incontinence, 3 - second degree anal incontinence compared with only 1 (1.8%) case in the study group (second degree sphincter incontinence). Conclusion. A proposed diagnostic strategy in women with anal incontinence due to perineal tears of II-III degrees after the labor trauma, allowed choosing the optimal method of surgical treatment and improving treatment outcomes.

scholarly journals STATE OF PROSTHETIC BED TISSUES AND LONG-TERM RESULTS OF DENTAL PROSTHETICS IN PATIENTS WITH DISEASES OF THE HEPATOBILIARY SYSTEM

2020 ◽  
Vol 16 (3) ◽  
pp. 147-154
Author(s):  
konstantin Koshelev ◽  
Nikolay Belousov ◽  
Ekaterina Pushkareva ◽  
Ilya Baranov
Keyword(s):  
Biliary Tract ◽  
Dental Treatment ◽  
Modern Medicine ◽  
Diagnostic Methods ◽  
Long Term Results ◽  
Control Group ◽  
Results Of Treatment ◽  
Hepatobiliary System ◽  
Biliary Tract Diseases

Background. Predicting the immediate and long-term results of treatment is an urgent problem of modern medicine. The prognosis of complex dental treatment is influenced by many factors. Among the main ones: features of the individual's anatomy and physiology, the type and method of the chosen treatment, the doctor's qualification, features of the patient's psychological profile, the presence of concomitant pathology, and so on. Each of the factors must be considered separately to understand the mechanism and the strength of its impact. Relevance. Finding out the influence of diseases of the hepatobiliary system on the prognosis of dental orthopedic treatment. Objectives. We studied the indicators of patients who re-applied for replacement of an existing dental prosthesis. The study group consisted of patients with liver and biliary tract diseases, and the control group consisted of patients without concomitant General somatic pathology. The terms of use of the prosthesis, the number and severity of treatment complications, and the state of the prosthetic bed were evaluated. Standard clinical and paraclinical diagnostic methods, corresponding pathology, cone-beam computed tomography and statistical analysis methods were used as research methods. Results. The correlation of the terms of use of various types of dentures with the presence of liver and biliary tract diseases in the anamnesis was determined. The dependence of the structure of bone tissue and its density on the presence of the considered pathology was revealed. Conclusion. The obtained data can be applied by orthopedic dentists in the near and long-term prognosis of the result of treatment of patients with partial loss of teeth and concomitant diseases of the hepatobiliary system.

scholarly journals Sphincter-preserving technologies in the surgical treatment of extrahepatic cholestasis in complicated cholelithiasis

2020 ◽  
Vol 24 (3) ◽  
pp. 433-443
Author(s):  
B.F. Shevchenko ◽  
A.V. Zelenyuk ◽  
A.M. Babiy ◽  
N.V. Prolom ◽  
O.P. Petishko
Keyword(s):  
Surgical Treatment ◽  
Balloon Dilatation ◽  
Standard Technique ◽  
Sphincter Of Oddi ◽  
Long Term Results ◽  
Control Group ◽  
Extrahepatic Cholestasis ◽  
Surgical Interventions ◽  
Intraoperative Diagnosis ◽  
X Ray

Annotation. Extrahepatic cholestasis (EHC), caused by functional or organic disorders, always plays a key role in the pathogenetic mechanisms of the development of complicated forms of cholelithiasis caused by impaired bile outflow. Purpose of the work: to improve the immediate and long-term results of surgical treatment of patients with complicated cholelithiasis by intraoperative diagnosis of EHC and determination of the optimal parameters of dosed balloon dilatation aimed at maintaining the functional and anatomical integrity of the sphincter of Oddi (SО). During the period from 2014 to 2020, 181 patients were examined, who were operated on in the department of surgery of the digestive system of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”. The first group of patients (n=81, 44.75%) consisted of patients who underwent sphincter-preserving interventions, both antegrade (when performing laparoscopic cholecystectomy – LHE) and retrograde (when performing retrograde cholangiopancreatography – RCPG), the second group of patients (n=79, 43.64%) consisted of patients who underwent traditional sphincter-destructive staged interventions (total and subtotal papillotomy before or after LHE). The control group consisted of 21 patients (11.6%), in whom structural and functional abnormalities of SО were not detected during manodebitometry with X-ray verification, so they underwent LHE according to the standard technique. During the operation, all patients underwent manodebitometry, the indicators of which were compared with the data of X-ray cholangioscopy. The use of the combined method of manodebitometry in the intraoperative diagnosis of the main causes of various types of of extrahepatic cholestasis in complicated cholelithiasis (CL), made it possible to diagnose an organic disorder as the cause of the development of EHC in 34 (18.78%) patients and functional disorders of SО in 38 (20.99%) patients. The indicators of the cause of EHC in complicated cholelithiasis, established before the operation and clarified during the operation by X-ray studies, were compared with the indicators of manodebitometry in both groups of patients, while the indicator of manodebitometric coefficient in the control group was within 2.35-2.60 (Ме Q25; Q75) and on average 2.51. The use of the proposed diagnostic criteria for the manodebitometric coefficient and parameters of dosed balloon dilatation of large duodenal papilla (LDP) makes it possible to reduce the need for two-stage treatment of EHC in complicated cholelithiasis, to preserve the physiological passage of bile into the duodenum, preventing the formation of postoperative biliary hypertension by preserving the integrity of the sphincter apparatus of LDP and to reduce the amount postoperative complications and the number of staged surgical interventions by 25.92%.

scholarly journals Hip Arthroplasty of the Destructive-Dystrophic Lesions

2018 ◽  
Vol 8 (1) ◽  
pp. 21-27
Author(s):  
B. S. Minasov ◽  
R. R. Yakupov ◽  
T. B. Minasov ◽  
M. M. Valeev ◽  
T. R. Mavlyutov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Connective Tissue ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
System Approach ◽  
Phase State ◽  
Long Term Results ◽  
Control Group ◽  
Hip Joints ◽  
Tissue Phase

Introduction. Hip arthroplasty is considered to be the most effective method providing social and household reintegration for destructive-dystrophic lesions. Goal of the study is to improve the results of surgical treatment using the technology of arthroplasty in patients with decompensated forms of destructive-dystrophic hip joint lesions. Material and methods. It was an open prospective, randomized study carried out on the base of traumatology and ortopaedics department of the Bashkir State Medical University including 710 patients with decompensated destructivedystrophic hip joint lesions. All patients (n=710, of which 6.1% were female) depending on the diacritic approach were divided into groups: the control group included (n=406) patients with hip joint trauma who were provided a conventional range of diagnostic and treatment procedures; the experimental group (n=304) included patients who had a range of diagnostics and treatment of destructive-dystrophic lesions of hip joints based on assessment of the connective tissue phase state. Results. Biometric indicators of stance and walking phase firmly improved in all groups 3 years after arthroplasty (p<0.05). Comparative analysis of arthroplasty results in the research groups showed effectiveness of the developed concept to surgically treat destructive and dystrophic lesions of hip joint on the basis of the system approach in the form of improved parameters of the components of the local and systemic level by 2.38% and 2.3% for osteoarthrosis (p<0.05), by 1.61% and 1.84% for aseptic necrosis of femoral head (p>0.05), by 5.62% and 4.37% for post-traumatic damage of hip joint (p<0.05). Conclusion. Analysis of short-term and long-term results of arthroplasty showed high efficiency of the developed concept of surgical treatment and monitoring of connective tissue phase state at destructive-dystrophic lesions of hip joints based on the system approach in the form of reduced pain syndrome, improvement of functional possibilities and patients life quality.

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