The use of intranasal glucocorticosteroids in patients with chronic rhinosinusitis in the preoperative period

Introduction. Chronic rhinosinusitis is a disease that occurs everywhere, characterized by inflammation of the mucous membrane of the paranasal sinuses and nasal cavity. If it is impossible to eliminate the causes of the recurrent disease with medical therapy, the use of surgical treatment help to recover the normal functioning of the ostium, including the ostiomeatal complex to improve ventilation and drainage of the paranasal sinuses and recover nasal breathing to relieve chronic inflammation.Purpose of the study. Assessment of the degree of intraoperative bleeding in patients with chronic rhinosinusitis.Materials and methods. On the basis of the FGBU SPB Research Institute of ENT of the Ministry of Health of the Russian Federation in the period from 2020 to 2021. the study of the effect of local intranasal glucocorticosteroids (INGKS) in the intraoperative period in patients with chronic polypous rhinosinusitis was carried out. The total amount of blood loss during surgery for chronic polypous rhinosinusitis in patients who used mometasone furoate preoperatively and in patients not taking topical hormonal drugs was analyzed.Results. In the study group, the average blood loss per operation was 257 ml, in the control group – 401 ml. In patients who took intranasal glucocorticosteroids during surgery, the intensity of bleeding is less pronounced. Undoubtedly, there are many reasons that affect the intensity of bleeding in general, however, a decrease in the inflammatory response in the nasal cavity and a decrease in inflammatory metabolites have a beneficial effect on the state of the nasal mucosa.Conclusion. The use of intranasal glucocorticosteroids in the preoperative period has a positive effect on reducing the inflammatory process in the nasal cavity, which helps to reduce the intensity of intraoperative bleeding.

To Evaluate the Effectiveness of Plasmapheresis as a Method for the Graft Disease Prevention in Patients with Keratoplasty

Purpose: to evaluate the effectiveness of plasmapheresis as a method for preventing and treating the graft rejection reaction in corneal transplantation.Patients and methods. The study involved patients with surgical pathology of the cornea, who underwent a prophylactic course of plasmapheresis procedures and underwent penetrating keratoplasty (Main group); and patients with surgical pathology of the cornea who underwent penetrating keratoplasty, but did not undergo plasmapheresis (Comparison group), whose data were analyzed retrospectively. The control group consisted of conditionally healthy individuals of both genders. Subgroups of patients with high and low risk keratoplasty were also identified within the Main group and the Comparison group.Results. Patients with keratoplasty who received a course of therapeutic plasmapheresis in the perioperative period demonstrated a statistically significant increase in the number of cases of a decrease in the level of C-reactive protein and a statistically significant decrease in the median values of the mean stimulated cytochemical index and the mobilization coefficient. Depending on the risk group for keratoplasty, the patients showed different dynamics of the levels of the studied interleukins after the course of plasmapheresis and keratoplasty. In patients of the Comparison group who did not receive a course of plasmapheresis in the preoperative period, over a period of 1.3 years, 22 cases (24 %) developed graft disease, while patients of both subgroups of the Main group who received a course of therapeutic plasmapheresis in the preoperative period, didn’t demonstrate any cases of graft disease. In patients of the Comparison group (in total for two subgroups), the maximum number of cases of graft disease (n = 24) was observed in the first 500 days after surgery. At the same time, the patients of the Main group who underwent plasmapheresis had the best graft survival rates: during the observation period, there were no cases of graft disease (in both subgroups).Conclusion: the obtained data indicate the ability of plasmapheresis, performed in the perioperative period, to prevent the development of graft disease in patients with keratoplasty.

Local Anesthesia and Conscious Sedation Does Not Affect Patient's Mood and Anxiety Levels during Percutaneous Endoscopic Lumbar Diskectomy: A Prospective Study

Background and Study Aims Undergoing a surgical procedure can be very stressful for patients and can lead to high anxiety levels during both the preoperative and the postoperative period. Levels of anxiety and fear may depend on multiple factors including the type of anesthesia to be used. The objective of this study is to evaluate whether patient's awareness of the surgical environment in the operating room under local anesthesia and conscious sedation (LACS) affects their mood and anxiety levels. Methods We performed a prospective study for a series of consecutive patients who underwent transforaminal percutaneous endoscopic lumbar diskectomy (PELD) for the treatment of lumbar disk herniation. The patients completed Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) forms in the preoperative period and in the early postoperative period. We divided the patients into two groups according to the type of anesthesia applied during surgery: LACS and general anesthesia (GA) groups. We compared the preoperative and postoperative POMS and STAI scores between groups and the change of these scores between the preoperative and postoperative periods in each group. Results In this study, we included 30 patients who underwent PELD between May and December 2019 and met the inclusion criteria. The GA group consisted of 16 patients and the LACS group consisted of 14 patients. In each group, POMS and STAI scores decreased in the early postoperative period compared with the preoperative period. We found no significant difference in percentage of POMS and STAI TX-1 score changes between the LACS and GA groups. Conclusion The results of our study show that patients' awareness of the surgical environment in the operating room under LACS does not significantly affect their mood and anxiety levels and patients do not seem to endure increased emotional stress during the PELD operation, as compared with PELD operation under GA.

Relationship between the Preoperative Albumin Levels and Postoperative Complications in Carcinoma Stomach Patients

Background: Malnutrition in gastrointestinal cancer patients adversely affects the surgical outcomes. low serum albumin and postoperative complications were associated with one another. Objectives: To find out the relationship between preoperative albumin levels and postoperative complications among carcinoma stomach patients. Materials and Methods: The present study was a single institution retrospective study carried out in the department of general surgery, Saveetha medical college and hospital between February 2021 to July 2021. Fifty patients diagnosed with carcinoma stomach and electively posted for surgery during the study period were included into the study. The data was collected using structured proforma. Preoperative albumin and haemoglobin levels were estimated using blood samples. All the data collected were analysed using SPSS version 23. Results: The preoperative albumin levels among those who had reported complication was 3.04±0.19 g/dl while those who had no complication in the postoperative period had preoperative albumin level of 3.82±0.31g/dl. The preoperative mean haemoglobin level among those who developed complications in the post operative period was 9.68±0.95 mg/dl and the mean haemoglobin level among those with no complication was 11.46±1.89 mg/dl. Albumin and haemoglobin values were found to be negatively correlated with duration of stay in hospital. Conclusion: Malnutrition in the preoperative period would increase the probability of occurrence of postoperative complications and increased duration of stay in hospital. Attending to malnutrition of the admitted patients in the preoperative period would help in decreasing the postoperative complications and duration of stay.

Treatment of primary molar utilizing lesion sterilization and tissue repair: a case report

Aim: Non-instrumental endodontic therapy has stood out for being a minimal intervention approach that uses a mixture of antibiotics to disinfect the root canals. The purpose of this case report was to describe the treatment and 36-month follow-up of a deciduous necrotic molar using the modified technique of “Injury Sterilization and Tissue Repair” (LSTR). Methodology: A 5-year-old female patient sought dental care complaining of pain in the region of tooth 85 whose oral clinical examination revealed the presence of caries with pulp involvement. In the preoperative period (T1), the patient presented with fistula, abscess and edema. Endodontic treatment was performed using the LSTR technique with triple antibiotic paste. In the follow-up, due to radiographic aspects, a large interradicular lesion was observed in T1 and at the end of the follow-up (T4 / T5), complete bone regeneration was observed in the region. Conclusion: Due to the high antibacterial efficacy of the paste used, the LSTR technique showed satisfactory results in the pulpectomy of a deciduous necrotic molar. Clinical significance: This technique shows the potential to be used in cases to being performed in a shorter operative time, which can be useful in the treatment of children with negative behavior.

Psychosocial characteristics of alcoholic and non-alcoholic liver disease recipient candidates in liver transplantation: a prospective observational study

Background There are long-standing controversies about the transplant indications for alcoholic liver disease (ALD), because of the recognition that ALD is fundamentally self-inflicted. However, it is unclear whether psychosocial characteristics of ALD are different from that of non-alcoholic liver disease (NALD) in the selection of liver transplantation (LT) recipients. We aimed to clarify the psychosocial characteristics of ALD recipients (ALD-R)/ALD recipient candidates (ALD-RC) and NALD recipients (NALD-R)/ NALD recipient candidates (NALD-RC). Methods From 2011 to 2019, 75 patients were enrolled in this prospective observational study (ALD-RC, n = 19; NALD-RC, n = 56), LT were carried out as follow; ALD-R, n = 6; NALD-R, n = 52. We evaluated psychosocial characteristics in the preoperative period and 3, 12 months after LT (ALD-R, n = 3/3; NALD-R, n = 28/25). The following scales were used to evaluate psychosocial characteristics: Visual Analogue Scale, Alcohol Use Disorders Identification Test, Hospital Anxiety and Depression Scale, Beck Depression Inventory, Brief Evaluation of Medication Influences and Beliefs, Social Support Questionnaire (SSQ), Temperament and Character Inventory, Parental Bonding Instrument (PBI), the Short Form Health Survey (SF-36). Results When evaluating on the basis of abstinence rule, a comparison of ALD-RC and NALD-RC in the preoperative period identified similar patterns of psychosocial characteristics, except that the NALD-RC scored higher on the PBI item “overprotection from mother” (P < 0.05). The only significant difference between ALD-R and NALD-R after liver transplantation was in SSQ scores at 3 months. Conclusion The psychosocial characteristics of ALD-RC and NALD-RC may be similar when evaluated on the basis of Japan’s abstinence rule. This result also imply that the psychosocial characteristics of ALD-RC may differ from the previously reported psychosocial characteristics of alcohol dependent patients. These findings have the potential to provide helpful information for the evaluation of ALD-RC.

Colorectal anastomosis in rectal cancer surgery: methods of anastomotic leakage prevention

One of the most serious complications after low anterior resection is the failure of sutures of colorectal anastomosis, which is the most common surgical complication that results in patient’s death. Promptly diagnosed anastomotic leakage in postoperative period is challenging. Nevertheless, elimination of risk factors in preoperative period can significantly reduce complication rates.The purpose of this review article is to analyze possible risk factors and methods for preventing colorectal anastomosis leakage.An important area of prevention and optimization of treatment options for anastomotic leakage is the development of prognostic measures to eliminate risk factors. We see the prospects for this direction in the introduction of a nomogram, which allows the surgeon to assess the possible outcomes of the operation, to choose the optimal tactics with a minimum risk of complications, as well as the introduction of methods to avoid or prevent the development of complications of colorectal anastomosis.