ABSTRACT
PURPOSE: To study the frequency of general surgical diseases development snd their features in patients after heart transplantation (HTx). METHODS: From January 2010 to December 2018 it was performed 112 HTx (mean age - 46.7±14.0 years old; 82 - male, 30 - female). During 30 days after HTx 9 patients died. After discharge all recipients (n=98) were included in dispensary observation list. We retrospectively analyzed patients (n=35) who underwent general surgery manipulations in more than 30 days after HTx. All surgical interventions have been done under the reduction of immunosuppression therapy. RESULTS: During 9 years of post-heart transplant follow-up 45 surgical interventions were performed, 7% (n=3) of them due to infectious complications, 31% (n=14) - oncology and others (62%, n=28). Most of manipulations were planned (39 from 45, 87%), the following general surgery interven- tions prevailed: laparoscopic cholecystectomy (n=13) and those to remove inguinal and umbilical hernia (n=12). During the 1st year the frequency of diseases required surgical treatment was 26% (n=11), infectious causes took place in 5 patients, non-infectious - in 6. Subsequently the incidence of infectious complications decreased that could be associated with the minimization of immunosuppressive therapy. Oncology was more frequent long-term after HTx - more than 3 years: among them the development of colon polyps prevailed and all recipients underwent polypectomy. There was no impact of age, gender, causes of chronic heart failure, obesity, immunosuppressive regimen (including the induction) on the frequency of general surgery diseases development (p>0.05). CONCLUSION: Based on our experience, we proposed an algorithm of examination, the features of surgical tactics and preparation for it in heart transplanted recipients are described. The important role of post-heart transplant follow-up in the timely detection of diseases requiring general surgical care is given.
Subject(s)
Heart Transplantation , Adult , Female , Humans , Immunosuppressive Agents , Incidence , Male , Middle Aged , Obesity , Retrospective StudiesABSTRACT
The authors developed and described an algorithm and technical aspects of lymphadenectomy performance in radical surgery based on structural variations of visceral vessels in 91 patients with stomach cancer. Preoperative helical computer tomography in regimen of angiography was carried out on 91 patients. Variant anatomy of visceral vessels was detected in 31 patients and that required change of surgical technique in order to minimize intraoperative risks of great vessel damage and allowed perforrming lymphadenectomy successfully.
Subject(s)
Algorithms , Angiography/methods , Celiac Artery/diagnostic imaging , Gastrectomy/methods , Lymph Node Excision/methods , Stomach Neoplasms/secondary , Stomach Neoplasms/surgery , Tomography, Spiral Computed , Humans , Lymphatic Metastasis , Retrospective Studies , Stomach Neoplasms/blood supplyABSTRACT
Standard methods of diagnostics haven't got a proper sensitivity and specificity concerning assessment of regional nodal involvement in case of rectal cancer. Therefore it is necessary to look for new method of diagnostics, detect risk factors and unfavorable prognosis in relation to lateral lymph node metastasis. At the same time, there should be a differentiated approach to the choice of therapeutic management in rectal cancer. Investigation of variability of blood supply of the rectum could be an additional method of diagnostics in rectal cancer.
Subject(s)
Lymph Nodes/pathology , Rectal Neoplasms/secondary , Risk Assessment/methods , Humans , Lymphatic Metastasis/diagnosis , Pelvis , Prognosis , Rectal Neoplasms/diagnosis , Risk FactorsSubject(s)
Colonic Neoplasms/surgery , Digestive System Surgical Procedures/methods , Neoplasms, Multiple Primary/surgery , Stomach Neoplasms/surgery , Vascular Malformations/complications , Viscera/blood supply , Colonic Neoplasms/diagnosis , Diagnosis, Differential , Endoscopy, Digestive System , Humans , Male , Middle Aged , Multidetector Computed Tomography , Neoplasms, Multiple Primary/diagnosis , Stomach Neoplasms/diagnosis , Vascular Malformations/diagnosis , Video RecordingSubject(s)
Adenocarcinoma/pathology , Colectomy/methods , Decompression, Surgical/methods , Colon, Sigmoid/diagnostic imaging , Colon, Sigmoid/pathology , Colon, Sigmoid/surgery , Humans , Intestinal Obstruction/etiology , Male , Middle Aged , Multidetector Computed Tomography , Neoplasm Invasiveness , Neoplasm Staging , Sigmoid Neoplasms/complications , Sigmoid Neoplasms/pathology , Treatment OutcomeABSTRACT
The authors made an analysis of specific skip-metastazing in gastric cancer (GC). Their own material was used: an experience with operative treatment of 55 patients was analyzed using the method of intraoperative mapping of lymphatic ducts. Nine cases of probable skip-metastazing were detected. The data of an analysis of this group of patients are given with special reference to the distribution in gender, age, TNM stage, localization of the primary tumor and its type by Borman classification, bed, histological structure of the tumor.
Subject(s)
Adenocarcinoma/secondary , Lymphatic Vessels/pathology , Stomach Neoplasms/pathology , Adenocarcinoma/diagnosis , Adenocarcinoma/surgery , Aged , Aged, 80 and over , Disease Progression , Female , Follow-Up Studies , Gastrectomy , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging , Prognosis , Retrospective Studies , Stomach Neoplasms/surgeryABSTRACT
A method of intraoperative mapping of the lymph outflow tracts was used in 32 patients for a detection of the signal lymph node in gastric cancer using a lymphotropic stain BLUE PATENT V. The test-sensitivity was 78%. The intraoperative mapping of the lymph outflow tracts allows the volume and zone dissection in operations for gastric cancer to be exactly determined. The detection of the "signal" lymph node and its immunohistochemical investigation increases the accuracy of postoperative staging of gastric cancer. The absence of metastases in the signal lymph node in gastric cancer is not a determining criterion for refusal to perform lymphodissection in D2 volume.
Subject(s)
Lymph Nodes/pathology , Monitoring, Intraoperative/methods , Stomach Neoplasms/surgery , Aged , Aged, 80 and over , Animals , Female , Follow-Up Studies , Humans , Immunohistochemistry , Lymph Node Excision , Lymphatic Metastasis , Lymphatic Vessels/pathology , Male , Middle Aged , Neoplasm Staging , Rabbits , Retrospective Studies , Stomach Neoplasms/secondary , Treatment OutcomeABSTRACT
Statistical analysis of 333 case histories has established main prognostic factors and their combinations determining general and recurrence-free survival of patients with locally spread rectal cancer. The one-factor analysis considered gender, age, prevalence degree, histological type of the tumor, operation volume, the presence of postoperative complications, non-adjuvant and adjuvant radiation therapy, chemotherapy, chemo-radiation therapy. Total survival in men was 51.3%, in women - 50.0% (p>0.05). In patients with local spread of rectal neoplasias the disease has systemic character and requires, when algorithm of treatment was determined for each patient, imperative use of schemes of combined and complex treatment including many components, since the surgical treatment only can not give satisfactory results.
Subject(s)
Rectal Neoplasms/pathology , Adult , Female , Humans , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , PrognosisABSTRACT
In order to optimize the technique of lymph dissection, a method of intraoperative mapping of lymph outflow tracts was used with a lymphotropic dye Blue patente V. It allowed better orientation during lymphodissection in operations for gastric cancer. The detection and investigation of the "signal" lymph node as the most probable object of lymphogenic metastazing can improve the accuracy of postoperative staging of gastric cancer. Visualization of the lymph nodes in the preparation made it possible to increase the number of lymph nodes sent for histological investigation.
Subject(s)
Lymph Node Excision/methods , Lymph Nodes/pathology , Stomach Neoplasms/surgery , Abdomen , Aged , Aged, 80 and over , Coloring Agents , Female , Follow-Up Studies , Humans , Lymphatic Metastasis/diagnosis , Lymphatic Vessels/pathology , Male , Middle Aged , Rosaniline Dyes , Stomach Neoplasms/secondary , Treatment OutcomeABSTRACT
Based on an analysis of 60 cases the authors have shown that identification and target investigation of signal lymph nodes using intraoperative staining with special dyes allows correct assessment of the stage of malignant disease. The method also allows treatment of the patient with an adequate, corresponding to up-to-date standards scheme of combined and complex treatment, gives possibilities of exact intraoperative diagnosis of lymphogenic metastasis and, as a result, allows extended operative intervention up to radical volumes.
