Saratov JOURNAL of Medical and Scientific Research

surgical treatment

Comparative retro- and prospective analysis of treatment outcomes in patients with SCI and cervical spine injuries in acute and early periods of traumatic disease

Year: 2017, volume 13 Issue: №3 Pages: 710-715
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Bazhanov S.P., Ulyanov V.Yu., Chibrikova Yu.A., Biryukova A.V., Norkin I.A., Gulyaev D.A., Salihu H.
Organization: Almazov National Medical Research Centre, Saratov State Medical University
Summary:

The aim: to conduct comparative retro- and prospective study of treatment outcomes in patients with cervical spine and SC injuries on the basis of assessment scale analysis. Material and Methods. 217 patients with closed cervical spine and SC injuries commeasurable by age, degree of neurological deficit, acute physiological and chronic state disorders were enrolled into the study. 177 patients comprised the main group (prospective study) and 40 — comparison group (retrospective study). To compare treatment outcomes we used Karnofsky score (Karnofsky, 1949), a quantitative assessment score for general patient status scales, APACHE II, Acute Physiology and Chronic State Evaluations (Knaus — Draper, 1985) and SCIM II, Spinal Cord Independence Measure Scale. Results. Comparative analysis based on the quantitative values of assessment scales, indicates an improvement of short-term treatment outcomes in patients with SC and cervical spine injuries in the main group. Conclusion. Complex approach to differentiated surgical treatment management and unique neuroprotection methods significantly improves short-term treatment outcomes having positive effect on general patient status, severity of acute physiological and chronic state disorders and patients' independence in the post-surgical period.

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Evaluation of the effectiveness of antiglaucomic operations with the use of the Ex-Press mini glaucoma shunt and Repegel-1 drainage in patients wi

Year: 2017, volume 13 Issue: №2 Pages: 394-400
Heading: Ophtalmology Article type: Original article
Authors: Kamenskikh T.G., Veselova E.V., Filatova V.S., Lyakhovich V.V., Golub' L.K., Karpenko A.A., Alekseyeva E.l., Kamenskikh I.D.
Organization: Saratov State Medical University
Summary:

The purpose of study is to evaluate the effectiveness of antiglaucomic operations with the use of the Ex-Press mini glaucoma shunt and Repegel-1 drainage in patients with primary open-angle glaucoma. Material and Methods. 65 patients (65 eyes) with an established diagnosis of uncompensated primary open-angle glaucoma of Stage III were observed. All patients underwent anti-glaucoma surgery. Patients of group 1 (15 patients, 15 eyes) underwent penetrating deep sclerectomy with implantation of the Ex-Press mini shunt under the scleral flap. Patients of group 2 (25 patients, 25 eyes) — penetrating deep sclerectomy with Repegel 1 drainage. Patients of group 3 (25 patients, 25 eyes) underwent sinus trabeculectomy without drainage. Results. In the early postoperative period, a good hypotensive effect was obtained in patients of all three groups. The most persistent antihypertensive effect was obtained in patients who underwent anti-glaucoma surgery with Repegel-1 drainage implantation. In patients who were implanted with the Ex-Press mini shunt, there was a significant decrease in the perimetrical MD index for 3 months. Conclusions. 1. Improvement of the photosensitivity of the retina in patients who underwent an antiglaucoma operation with Ex-Press shunt implantation, possibly due to the low invasiveness of the intervention and the absence of a sharp drop in IOP level. 2. Preliminary results (analysis 3 months after the operation) indicate a lower number of postoperative complications in the implantation of Repegel-1 drainage and a persistent hypotensive effect. 3. Patients who underwent antiglaucoma operations with implantation of drainage systems showed improvement of hemodynamic parameters in the pool of posterior short ciliary arteries in the postoperative period.

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A comprehensive evaluation of cervical spine surgery outcomes

Year: 2017, volume 13 Issue: №2 Pages: 266-273
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Ostrovsky W, Schanitsyn IN, Bajanov SP, Fedonnikov AS.
Organization: Saratov State Medical University
Summary:

Aim: study of diagnostic value of different assessment scales to evaluate outcomes of surgeries in degenerative and post-injury deformities of cervical spine. Material and Methods. Between January and December 2015, 110 consecutive patients with degenerative and traumatic lesions of cervical spine were selected for surgery and results of treatment were followed. Preoperatively and 12 months postoperatively the patients filled in a questionnaire that included a VAS, Odom's scale, NDI, modified JOAand the Zung Depression Scale. To assess the results of the intervention, the concept of "effect size" was used. Distribution of different scores classified according to Odom's criteria as excellent/good and fair/poor. Results. All scores improved in all group of patients. For VAS, NDI and modified JOA scores the effect size was largest. NDI, JOAand ZDS seemed to correlate well with the classification of outcome by Odom. Conclusion. It is suggested many scales to assess the outcomes of the cervical spine surgery based on different criteria; nevertheless, there are no generally accepted and validated methods that can be used to analysis the outcome of cervical spine surgery. We conclude that investigated

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Towards the causes of secondary post-traumatic deformations of thoracic and lumbar spine

Year: 2015, volume 11 Issue: №4 Pages: 570-575
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shulga А.Е., Zaretskov V.V., Ostrovsky V.V., Arsenievich V.B., Smolkin A.A., Norkin I.A.
Organization:
Summary:

The purpose of the study is to analyze and systematize main causes of secondary spine deformations forming in patients who had operations due to thoracic and lumbar spine damages. Material and Methods. The analysis of poor surgical results of 155 patients previously operated due to various thoracic and lumbar spine damages has been conducted. All patients had complications associated with secondary spinal column deformations at various time after the intervention. Standard investigation included the analysis of patients' complaints, their previous history, somatic, neurological and orthopedic status. Results. The intensity of spinal column deformation was defined due to the character and level of primary trauma structurally characterized predominantly by unstable damages. However as it has been found in this research the main cause of this complicated pathology lied in the number of tactical and technical pitfalls of primary surgical treatment. Conclusion. Surgical operations due to secondary post-traumatic deformations in most cases are laborious and are accompanied by significant surgical trauma therefore systematization and analysis of the main causes of poor results of primary spine surgery may contribute to the preventive treatment of this type of pathology.

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Intraoperative neurovisualization in the surgical treatment of peripheral nerve injuries

Year: 2015, volume 11 Issue: №2 Pages: 178-182
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Aitemirov Sh.M., Ninel V.G., Korshunova G.A.
Organization:
Summary:

Objective. The present study examines the value of intraoperative neurovisualization as an imaging tool for decision making in the management of traumatic nerve injuries. Materials and methods. 43 patients with traumatic nerve lesions were examined by electrodiagnostic study, ultrasonography and contrast neurography. Results. A complex intraoperative examination have been used to guide surgical decision making in patients with peripheral nerve injuries of limbs. Conclusion. The results of complex intraoperative examination became the basis of diagnosis and treatment algorithm for surgical treatment of peripheral nerves injuries.

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The dynamics of main indicators for the treatment of ulcerative gastroduodenal bleedings — the analysis of several years studies

Year: 2014, volume 10 Issue: №3 Pages: 456-460
Heading: Surgery Article type: Original article
Authors: Shapkin Y.G., Potahin S.N.
Organization: Saratov State Medical University
Summary:

The research goal is evaluation of influence of changes in diagnostic & treatment possibilities and surgical approach on the results of treatment of patients with ulcerative gastro-duodenal bleedings (GDB). Material and methods: An analysis of the treatment results of 1885 patients suffering from ulcerative GDB, which have been treated in the surgery department of the "State clinical hospital No.6" in Saratov has been done. The information about the patients suffering from GDB has been retrieved from the digital archives, which were filed from 1991 to 2009. The patients have been divided into five groups according to five periods of work, each one differ by its own diagnostic & treatment possibilities and approaches. The evaluation was based the amount of operations, the number of different types of operations, the efficiency of endohemostasis, the amount of bleeding relapses and the lethality. Results: The introduction of computer prognosis for bleeding relapse, the increase in the number of endoscopic hemostatic methods, the application of Laser Doppler Flowmetry (LDF) for the evaluation of reliability of hemostasis, the use of dynamic endoscopy and testing probe for bleeding relapse in the state of prerelapse syndrome with the combination of preventive measures on the source of bleeding and antisecretory therapy have led to the decrease of overall lethality from 6,5% to 1,9%, and the postoperative lethality from 9,1% to 1,7%. Conclusion: The analysis of treatment results by periods made it possible to have an overview on different factors as they undergo changes during these periods, evaluate weak points in the current treatment tactic and set a direction for further investigations.

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The modern principles in treatment of Legg – Calve – Perthes syndrome in children

Year: 2013, volume 9 Issue: №4 Pages: 729-734
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Rubashkin S.A., Sertakova A.V., Gerasimov V.A., Anisimov D.I., Vasilieva G.A, Bakhteeva N.Kh.
Organization: Saratov State Medical University, Belgorod Regional Clinical Hospital
Summary:

The aim: to improve the results of treatment of degenerative hip’s diseases in children by means of pathogenetic pattern. Methods and Materials. 56 children with Legg — Calve — Perthes syndrome aged from 4 to 12 years and 20 children of control group without hip’s diseases have been studied. Results. The modern principles of surgical treatment of Legg — Calve — Perthes syndrome in children have been identified. Conclusion. The results of surgical treatment of patients with a different degree of pathological process depending on a type of surgery (osteoplastic surgery, formation of vascularizing autotransplant, varus osteotomy, rotational intertrochanteric osteotomy) have been presented.

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Influence of socio-psychological status peculiarities on patients with obstructed inguinal hernia while concerning surgical treatment

Year: 2013, volume 9 Issue: №2 Pages: 328-332
Heading: Surgery Article type: Original article
Authors: Tolstokorov A.S., Lyakishev V.V., Selezneva T.D.
Organization: Saratov Road Clinical Hospital, Saratov State Medical University
Summary:

The research goal is to confront the duration of withholding operative therapy of obstructed inguinal hernias with peculiarities of medical and social and psychological status of patients. Materials and methods: 186 patients with inguinal hernias aged from 25 to 60 years were examined. Duration of withholding operative therapy was determined from the moment of officially established diagnosis to the moment of admission to surgical hospital. Results: Medical aid to patients with inguinal hernias who went to the hospital by themselves is no more than 29% and in most cases (53,6%) diagnosis is officially established while staying in health care institutions with other diseases, 94,6% of patients realized the fact that full recovery from inguinal hernias was possible only after surgical procedures. Conclusion: In the first year after establishment of diagnosis consent to surgical treatment of inguinal hernias is associated with the age under 30, higher education, the presence of partially or entirely unreduced inguinal hernia, prevalence of such qualities of charac-
ter as psychasthenia, paranoia, hypomania. In five-six years after official establishment of diagnosis patients aged over 50 years with higher education and prevailing of such qualities of character as hypohondria, depression, psychasthenia give their consent to surgical treatment of inguinal hernia regardless of its type and size.

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The long term results of pediatric esotropia surgery performed according to new scheme of muscle recession / resection

Year: 2011, volume 7 Issue: №4 Pages: 857-859
Heading: Ophtalmology Article type: Original article
Authors: Zhukova О.V., Stepanov V.K., Zolotarev А.V.
Organization: Samara State Medical University, Samara Clinical Ophthalmologic Hospital n.a. T.I. Eroshevsky
Summary:

The purpose of the investigation is to evaluate the long term results of surgical treatment in children with esotropia, operated according to new scheme of muscle procedures. Materials. The retrospective analysis of surgical treatment in 50 children with esotropia was made. The new scheme of muscle recession / resection was used. Results. The duration of monitoring was 1-5 years. More then half of all patients has ortotropia, even in cases with 25° primary deviation angle. Almost 40% of patients has increasing of visual acuity of amblyopic eye and binocular functions. Conclusion. The new scheme of muscle recession / resection allows to receive ortotropia after surgical treatment in large esotropia and avoid the reoperations. Using of the new scheme of strabismus surgery don't increase the quantity of secondary exodeviation

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Surgical treatment of equinus foot deformity in children with cerebral palsy (review)

Year: 2011, volume 7 Issue: №3 Pages: 699-703
Heading: Traumatology and Orthopedics Article type: Review
Authors: Krasnov A.S.
Organization: N. Novgorod Scientific Research Institute of Traumatology and Orthopedics
Summary:

The review presents data about etiology and pathogenesis of cerebral palsy in children and its clinical manifestations. The effectiveness analysis of main surgical methods to correct equinus foot deformity in children with cerebral palsy has been conducted. The article comes to conclusion that at present surgical methods eliminating all pathologic deformity units are incompletely presented. In this connection high recurrence frequency after using traditional treatment methods is registered. Development of surgical intervention adequate to pathologic foot state in children with cerebral palsy is a perspective direction in treatment of given category of patients

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