ABSTRACT
OBJECTIVE: To evaluate efficacy and safety of hypoxic-hyperoxic therapy in rehabilitation after SARS-CoV-2 pneumonia. MATERIAL AND METHODS: There were 44 patients aged 49-75 years in early recovery period after previous SARS-CoV-2 pneumonia (ICD-10 U07.1 and U07.2). Patients were divided into 2 groups depending on treatment strategy: group 1 (n=23) - rehabilitation treatment with therapeutic exercises, massage and physiotherapy; group 2 (n=21) - basic procedures with hypoxic-hyperoxic therapy. RESULTS: At initial evaluation, we found positive tendencies of rehabilitation in both groups. There were no side effects associated with hypoxic-hyperoxic therapy in the second group. Patients positively perceived this method of rehabilitation. There were significant between-group differences in exercise tolerance (p<0.05). These data indicate more favorable physical recovery in the second group and similar improvement of psycho-emotional status in both groups. CONCLUSION: Hypoxic-hyperoxic therapy is effective and safe approach in rehabilitation of patients with previous SARS-CoV-2 pneumonia. It is necessary to continue searching for effective methods of rehabilitation and develop accurate rehabilitation methods for various groups of patients.
Subject(s)
COVID-19 , SARS-CoV-2 , Exercise Therapy/methods , HumansABSTRACT
OBJECTIVE: To analyze the efficacy and safety of therapeutic exercises and chest hardware massage in electrostatic field in patients with COVID-associated viral pneumonia. MATERIAL AND METHODS: We retrospectively analyzed 1551 patients admitted to the Clinical Hospital No. 1 (MEDSI Group JSC) with COVID-associated pneumonia between April 01, 2020 and June 15, 2021 (ICD-10 U07.1 and U07.2). Considering inclusion and exclusion criteria, we enrolled 153 patients. All patients were divided into comparable groups and subgroups depending on the methods of rehabilitation treatment and CT stage of viral pneumonia. Lung damage was assessed semi-automatically using Philips Portal v11 COPD software. Rehabilitation measures included therapeutic exercises and chest hardware massage in electrostatic field. therapeutic exercises. RESULTS: Therapeutic exercises significantly reduced severity of lung damage in patients with viral pneumonia CT-2 and no oxygen support (from 28.05% [28; 29.5] at admission to 15.3% [14.2; 19.3] at discharge). It was not observed in patients without rehabilitation treatment and in patients undergoing therapeutic exercises and massage in electrostatic field. CONCLUSION: Therapeutic exercises in patients with COVID-19 and baseline lung damage > 25% and < 50% (CT-2 stage) significantly reduce severity of lung damage at discharge compared to the control group.
Subject(s)
COVID-19 , Pneumonia, Viral , Humans , Lung , Massage , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Retrospective Studies , SARS-CoV-2 , Static ElectricityABSTRACT
A case of a mature anterior mediastinal teratoma with a predominance of the pancreatic component (80% of the tumor) and signs of nesidioblastosis in a 46-year-old woman is presented. During histological examination, all components of the pancreatic parenchyma were determined - acini with interlobular and intralobular ducts, endocrine cells and islets of Langerhans of various sizes and shapes, as well as islet-duct complexes scattered in the acinar tissue. In addition to pancreatic tissue, cartilage, bronchial respiratory epithelium, small intestine tissue, hair follicles, and sebaceous glands were found in the neoplasm. Immunohistochemical examination revealed signs of focal nesidioblastosis. In the islets, insulin-positive ß-cells (80.0% of the volume of the islets), as well as endocrine cells expressing glucagon and somatostatin (10.0% of the volume of the islets) were determined. By 2020, only 4 such cases have been published in the English-language literature.
Subject(s)
Islets of Langerhans , Mediastinal Neoplasms , Nesidioblastosis , Teratoma , Female , Humans , Mediastinum , Middle Aged , Pancreas , Teratoma/diagnosisABSTRACT
According to the published data, the rate of fistula formation in the postoperative period ranges from 0.3% to 29%. Currently, due to the high risk of suture failure in the postoperative period and tracheal and esophageal fistulas formation, the options for fistulas treatment by the regenerative rehabilitation methods are under consideration. The frequency of fistula healing and reduction of scar deformities after adipose tissue autografting ranges from 43% to 55%. OBJECTIVE: To develop the minimally invasive technology for postoperative fistulas treatment and describe the real-world experience of its use in terms of hospital stay reduction and patients' quality of life improvement. MATERIAL AND METHODS: Patients were selected as part of a pilot research project (Development of Personalized Approaches to Regenerative Rehabilitation for Surgical Patients, # 0394-2020-0011). Patients' quality of life was assessed using the Russian version of the EQ-5D-5L questionnaire (Russian version for Russia). This article presents a clinical example of successful repair of a cutaneous tracheal fistula by autografting of adipose tissue three months after fistula formation. RESULTS: In one month after autografting of adipose tissue, the tracheobronchial secretion through the fistula has stopped. According to the follow-up computed tomography of the neck and tracheobronchoscopy, the fistulous passage is not observed. CONCLUSION: The presence of a fistula worsens the patient's quality of life and increases the risk of secondary infection. When treating patients with tracheal fistulas of high and extremely high surgical risk, the method of autografting of adipose tissue can be a safe and effective alternative to conventional surgery. Further study of this method of regenerative rehabilitation is required.
Subject(s)
Fistula , Quality of Life , Adipose Tissue , Humans , Technology , Transplantation, Autologous , Treatment OutcomeABSTRACT
OBJECTIVE: To improve the outcomes in children with hepatoblastoma. MATERIAL AND METHODS: There were 160 children with focal liver lesions who underwent surgery at the department of liver transplantation in 2008-2019. Patients with malignant tumors made up 77% (n=123). Hepatoblastoma (HB) prevailed (86%, n=106). Liver transplantation was performed in 19 (18%) patients with HB. Median follow-up after transplantation was 24.3 months by December 2019. Follow-up period did not exceed 4 years in more than 2/3 of patients. RESULTS: Overall and disease-free 10-year survival was 87.1% and 82.7%, respectively. Similar values were observed after resections (91.1% and 86.6%). At the same time, actuarial 4-year survival after liver transplantation for HB was 68%. CONCLUSION: Improvement of treatment outcomes may be achieved through multidisciplinary interaction ensuring timely drug therapy and liver transplantation.
Subject(s)
Hepatoblastoma , Liver Neoplasms , Liver Transplantation , Child , Combined Modality Therapy , Hepatectomy , Hepatoblastoma/surgery , Humans , Infant , Liver Neoplasms/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
Aorto-esophageal and aorto-bronchial fistulas are rare and life-threatening diseases if emergency treatment is absent. The most of publications devoted to this problem are case reports describing successful treatment of patients with aorto-esophageal and aorto-bronchial fistulas by using of endovascular or open transthoracic surgery. However, we did not find reports of several aortic fistulas in a patient after previous aortic stenting. It is presented case report of patient with aorto-esophago-bronchial and aorto-pulmonary fistulas in postoperative period after thoracic endovascular aortic repair (TEVAR).
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Bronchial Fistula/etiology , Endovascular Procedures/adverse effects , Esophageal Fistula/etiology , Lung Diseases/etiology , Vascular Fistula/etiology , Aortic Aneurysm, Thoracic/complications , Aortic Diseases/etiology , Aortic Diseases/surgery , Bronchial Fistula/surgery , Endovascular Procedures/methods , Esophageal Fistula/surgery , Humans , Lung Diseases/surgery , Respiratory Tract Fistula/etiology , Respiratory Tract Fistula/surgery , Vascular Fistula/surgeryABSTRACT
AIM: To analyze in-hospital infection in oncology center within 2012-2016. MATERIAL AND METHODS: There were 98 patients with nosocomial infection who underwent surgery for malignancies. Microbiological examination of biological materials was carried out by appropriate laboratories according to generally accepted methods. RESULTS: Mono- and polymicrobial infection was observed in 58 and 42% of cases. Staphylococcus aureus was the most common agent in patients with microbial infection. Minimal inhibitory concentration of vancomycin (MIC) ≥1.0 µg/ml was revealed in 60% of microbes. Microbial agents isolated were resistant to antibacterial drugs used to prevent postoperative infectious complications. CONCLUSION: In-hospital infection was accompanied by staphylococci as a rule. Causative agents of nosocomial infections are usually resistant to conventional antibacterial drugs. Moreover, 60.1% of microbes had minimal inhibitory concentration of vancomycin ≥1.0 µg/ml that indicated the need for alternative therapeutic agents.
Subject(s)
Cross Infection/microbiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Neoplasms/surgery , Staphylococcal Infections/drug therapy , Anti-Bacterial Agents/therapeutic use , Cross Infection/etiology , Humans , Microbial Sensitivity Tests , Neoplasms/complications , Staphylococcal Infections/microbiology , Vancomycin/therapeutic useABSTRACT
The paper describes a case of solitary epithelioid hemangioendothelioma concurrent with nodular parenchymal AL amyloidosis of the lung and Rosai-Dorfman disease in a 70-year-old woman. The core of the tumor was represented by bone tissue with dendriform ossification, as well as by amyloid that showed green apple birefringence at polarized light microscopy. The peripheral portions of the tumor and the myxohyaline stroma exhibited slit-like structures, epithelioid and fusiform cells with small cytoplasmic vacuoles. These cells expressed CD31, CD34, factor VIII, and cytokeratins 7 and 18. The Ki-67 proliferation index was 10%. S100- and CD68-positive histiocytes with the phenomenon of emperipolesis were revealed in the tumor and in the lymph nodes of the mediastinum and lung hilum. There was a positive reaction to immunoglobulin lambda light chains in the lymphocytic infiltration around amyloid clumps. The frequency of epithelioid hemangioendothelioma was less than 1 case per million people annually. We found only one case of its concurrence with pulmonary amyloidosis in the English-language literature. No relationship could be revealed between this tumor and Rosai-Dorfman disease.
Subject(s)
Amyloidosis , Hemangioendothelioma, Epithelioid , Histiocytosis, Sinus , Aged , Amyloidosis/complications , Amyloidosis/diagnosis , Cytokines/analysis , Female , Hemangioendothelioma, Epithelioid/complications , Hemangioendothelioma, Epithelioid/diagnosis , Histiocytes , Histiocytosis, Sinus/complications , Histiocytosis, Sinus/diagnosis , Humans , Lymph NodesABSTRACT
AIM: To justify and develop the indications for thoracoscopic procedures in patients with complications after advanced cardiothoracic surgery including combined and simultaneous operations. MATERIAL AND METHODS: From 2013 to 2017 was performed treatment of complication in 27 patients undergoing various cardiothoracic intervention with the use of thoracoscopic technology. RESULTS: We have analyzed immediate results of thoracoscopic operations in 27 patients with various intrapleural complications after advanced cardiothoracic surgery. Satisfactory results of these interventions confirm safety of thoracoscopic technologies and serve as an argument in favor of this direction in thoracic surgery.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Pleural Diseases , Postoperative Complications , Thoracic Surgery, Video-Assisted/methods , Cardiac Surgical Procedures/methods , Female , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Pleural Diseases/diagnosis , Pleural Diseases/etiology , Pleural Diseases/surgery , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Reoperation/methods , Russia , Tomography, Spiral Computed/methodsSubject(s)
Intra-Aortic Balloon Pumping/methods , Intraoperative Complications/prevention & control , Lung Neoplasms , Myocardial Ischemia , Pneumonectomy , Aged , Counterpulsation/methods , Female , Humans , Lung/diagnostic imaging , Lung/surgery , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Myocardial Ischemia/complications , Myocardial Ischemia/diagnosis , Myocardial Ischemia/physiopathology , Myocardial Ischemia/therapy , Neoplasm Staging , Pneumonectomy/adverse effects , Pneumonectomy/methods , Risk Adjustment/methods , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
AIM: To analyze advisability of cardiopulmonary bypass in thoracic surgery. MATERIAL AND METHODS: We estimated early and long-term results of CPB-assisted thoracic interventions in 31 patients with malignant and benign thoracic diseases and invasion into vital mediastinal structures or with concomitant cardiovascular pathology. RESULTS: Acceptable rates of mortality and morbidity confirm safety of CPB in thoracic surgery while satisfactory long-term outcomes are arguments in favor of this direction of thoracic oncology.
Subject(s)
Cardiopulmonary Bypass , Long Term Adverse Effects , Postoperative Complications/epidemiology , Thoracic Neoplasms , Thoracic Surgical Procedures/methods , Cardiopulmonary Bypass/adverse effects , Cardiopulmonary Bypass/methods , Cardiopulmonary Bypass/mortality , Female , Humans , Long Term Adverse Effects/epidemiology , Long Term Adverse Effects/etiology , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Outcome and Process Assessment, Health Care , Russia , Thoracic Diseases/diagnosis , Thoracic Neoplasms/pathology , Thoracic Neoplasms/surgerySubject(s)
Aortic Valve Stenosis/surgery , Intraoperative Complications , Intubation, Intratracheal , Postoperative Complications , Reoperation/methods , Trachea , Transcatheter Aortic Valve Replacement/methods , Aged , Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/physiopathology , Blood Loss, Surgical , Female , Hemostasis, Surgical/methods , Humans , Intraoperative Complications/diagnosis , Intraoperative Complications/physiopathology , Intraoperative Complications/surgery , Intubation, Intratracheal/adverse effects , Intubation, Intratracheal/methods , Postoperative Care/methods , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/therapy , Rupture , Severity of Illness Index , Trachea/diagnostic imaging , Trachea/injuries , Trachea/surgery , Treatment OutcomeSubject(s)
Burns, Chemical/complications , Colon/transplantation , Esophageal Stenosis , Esophagoplasty , Plastic Surgery Procedures/methods , Postoperative Complications , Tracheal Stenosis , Tracheostomy , Aged , Esophageal Stenosis/chemically induced , Esophageal Stenosis/diagnosis , Esophageal Stenosis/physiopathology , Esophageal Stenosis/surgery , Esophagoplasty/adverse effects , Esophagoplasty/methods , Esophagus/diagnostic imaging , Esophagus/surgery , Female , Humans , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Radiography/methods , Reoperation/methods , Trachea/diagnostic imaging , Trachea/surgery , Tracheal Stenosis/chemically induced , Tracheal Stenosis/diagnosis , Tracheal Stenosis/physiopathology , Tracheal Stenosis/surgery , Tracheostomy/adverse effects , Tracheostomy/methods , Treatment OutcomeSubject(s)
Anti-Bacterial Agents/administration & dosage , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation , Hemothorax , Pleurisy , Surgical Wound Infection , Acinetobacter baumannii/isolation & purification , Aged , Aorta, Thoracic/pathology , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/physiopathology , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/methods , Combined Modality Therapy , Enterobacter cloacae/isolation & purification , Female , Hemothorax/etiology , Hemothorax/physiopathology , Hemothorax/surgery , Humans , Pleurisy/etiology , Pleurisy/physiopathology , Pleurisy/therapy , Radiography , Reoperation/methods , Severity of Illness Index , Surgical Wound Infection/etiology , Surgical Wound Infection/physiopathology , Surgical Wound Infection/surgery , Treatment OutcomeABSTRACT
The article deals with a clinical case demonstrating that patient's elderly age is not an absolute contraindication for complex surgery in spite of high risk of postoperative complications. Early diagnostics, target treatment of the infection cite with vacuum-assisted therapy for wounds and the treatment of infectious complications based on individual characteristics of elderly patient with sepsis as an outcome of prosthetic thoracoabdominal aortic repair allowed avoiding multiple organ dysfunctions in the patient.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Empyema, Pleural/therapy , Multiple Organ Failure/prevention & control , Sepsis/therapy , Surgical Wound Infection/therapy , Aged , Empyema, Pleural/diagnosis , Empyema, Pleural/etiology , Female , Humans , Multiple Organ Failure/diagnosis , Multiple Organ Failure/etiology , Sepsis/diagnosis , Sepsis/etiology , Surgical Wound Infection/complications , Surgical Wound Infection/diagnosis , Treatment Outcome , Wound HealingSubject(s)
Arteriovenous Malformations , Pneumonectomy/methods , Pulmonary Artery/abnormalities , Pulmonary Veins/abnormalities , Thoracoscopy/methods , Adult , Angiography/methods , Arteriovenous Malformations/blood , Arteriovenous Malformations/diagnosis , Arteriovenous Malformations/physiopathology , Arteriovenous Malformations/surgery , Female , Humans , Oxygen/analysis , Pulmonary Artery/diagnostic imaging , Pulmonary Veins/diagnostic imaging , Tomography, Spiral Computed/methods , Treatment OutcomeSubject(s)
Aorta, Thoracic/surgery , Blood Vessel Prosthesis Implantation/methods , Lung Neoplasms , Neoplasms, Squamous Cell , Pneumonectomy/methods , Pulmonary Artery/surgery , Aorta, Thoracic/pathology , Humans , Lung Neoplasms/pathology , Lung Neoplasms/physiopathology , Lung Neoplasms/surgery , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Neoplasms, Squamous Cell/pathology , Neoplasms, Squamous Cell/physiopathology , Neoplasms, Squamous Cell/surgery , Pulmonary Artery/pathology , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Dissection/methods , Intraoperative Care/methods , Mediastinum/surgery , Thoracic Surgical Procedures/methods , Thymoma , Thymus Neoplasms , Adult , Biopsy, Needle/methods , Humans , Lung/pathology , Lung/surgery , Male , Mediastinum/pathology , Neoplasm Invasiveness , Pericardium/pathology , Pericardium/surgery , Pulmonary Artery/pathology , Pulmonary Artery/surgery , Thymoma/pathology , Thymoma/physiopathology , Thymoma/surgery , Thymus Neoplasms/pathology , Thymus Neoplasms/physiopathology , Thymus Neoplasms/surgery , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
The authors own the experience of 4157 operations on the reason of malignant lung tumors, of them 429 (10.3%) operations were combined. The extracorporeal membrane oxygenation is considered to be reasonable by extended thoracic resections. Surgical lung volume reduction by emphysema shows good functional results, which allows to use its principles in oncologic patients with low functional repiratory reserves. The overall multidisciplinary approach in thoracic oncology allows better treatment results and gives hope to the earlier inoperable patients.
