The Value of Stress-Gated Blood Pool SPECT in Predicting Early Postoperative Period Complications in Ischemic Cardiomyopathy Patients: Focus on Mechanical Dyssynchrony.

(1) Objective: The objective of this study was to assess the prognostic value of stress-gated blood pool SPECT (GBPS) estimates in patients with ischemic cardiomyopathy (ICM) in the early postoperative period. (2) Methods: A total of 57 patients (age 59.7 ± 6.6, 47 men) with ICM and LV ejection fraction (30 [27.5; 35]%) were enrolled in the study. Before surgical treatment, all patients underwent GBPS (rest-stress, dobutamine doses of 5/10/15 µg/kg/min). Stress-induced changes in left ventricular (LV) ejection fraction, peak ejection rate, volumes, and mechanical dyssynchrony (phase histogram standard deviation, phase entropy (PE), and phase histogram bandwidth) were estimated. Two-dimensional transthoracic echocardiography was performed baseline. Serum levels of NT-proBNP were analyzed with enzyme-linked immunoassay. (3) Results: After surgical treatment, patients were divided into two groups, one, with death, the need for an intra-aortic balloon pump (IABP) or/and inotropic support with a stay in the intensive care unit for more than two days and two, without complications in the early postoperative period (EPOP). Complicated EPOP (CEPOP) was observed in 17 (30%) patients (death-2, IABP-4, extra inotropic support in intensive care unit-11), and 40 patients had no complications (NCEPOP). GBPS showed differences in LV EDV (mL) (321 [268; 358] vs. 268 [242; 313], p = 0.02), LV ESV (mL) (242 [201; 282] vs. 196 [170; 230], p = 0.005), and stress-induced changes in PE (1 (-2; 3) vs. -2 (-4; 0), p = 0.02). Aortic cross-clamp time and stress-induced changes in PE between rest and dobutamine dose of 10 µg/kg/min were the only independent predictors of CEPOP. An increase in LV entropy ≥ 1 on the dobutamine dose of 10µg/kg/min in comparison to rest investigation showed AUC = 0.853 (sensitivity = 62%, specificity = 90%, PPV = 71%; NPV = 85%; p < 0.0001). Conclusion: Stress-induced changes in PE obtained during low-dose dobutamine GBPS are associated with a complicated course of the early postoperative period after surgical treatment for ICM.

[Efficiency of balance training with stabilizing platform in early postoperative rehabilitation of patients after arthroplasty]. / Effektivnost' vklyucheniya balans-treninga s ispol'zovaniem stabiloplatformy v kompleksnye programmy rannei posleoperatsionnoi reabilitatsii patsientov posle endoprotezirovaniya.

OBJECTIVE: To evaluate the effectiveness of balance training on stabilizing platform (HUBER360) in early postoperative rehabilitation of patients after total knee arthroplasty. MATERIAL AND METHODS: We examined 60 patients after total knee arthroplasty. Mean age of patients was 69.1±9.8 years, mean postoperative period - 3.6±1.4 days. All patients were divided into 2 groups (main group (n=30) and control group (n=30)). All patients received a standard course of treatment, including therapeutic exercises, massage of affected lower in electro-static field limb using a drainage technique, magnetotherapy, mechanotherapy of affected limb in passive motor mode (Artromot device). Duration of rehabilitation course in a round-the-clock hospital was 7 days. In the main group, patients additionally received balance-training procedures on the HUBER 360 multiaxial platform in baseline sitting position. RESULTS: Treatment was followed by positive dynamics in all patients that correlated with significant regression of pain syndrome, edema, improvement of quality of life and 10-meter walk test with external support on crutches. However, additional balance training provided more effective regression of pain, as well as improvement of quality of life and walking after the first procedures. CONCLUSION: We can recommend balance training on stabilizing platform for early rehabilitation after total knee arthroplasty.

Aplicación de convexidad ligera y anillos moldeables en ostomía para evitar fugas en el postoperatorio precoz del paciente con ostomía digestiva: estudio CONAN / Application of slight convexity and moldable rings in ostomy to prevent leaks in the early postoperative period of patients with digestive ostomy: CONAN study

Objetivo: evaluar la seguridad y la efectividad de la cura CONAN, teniendo en cuenta la reducción del número de fugas, el estado de la piel periestomal y la calidad de vida percibida por el paciente. Método: estudio prospectivo no-randomizado de ámbito nacional, realizado en 54 unidades de estomaterapia, para evaluar la eficacia y seguridad de la cura CONAN consistente en el uso de dispositivo Easiflex® Confort Convex Light y de anillos moldeables Brava® en el postoperatorio precoz de pacientes con ostomía digestiva con pérdidas de efluente. La intención del estudio fue evaluar el efecto de esta estrategia para disminuir la pérdida, prevenir el deterioro de la piel periestomal y aumentar el bienestar de los pacientes al alta. Se compararon diferencias estadísticas entre estas variables empleando las pruebas t-test, Chi cuadrado, Mc Nemar y Bowker. Resultados: se evaluaron 257 pacientes y 244 completaron el estudio. Con la cura CONAN el número de fugas se redujo en el 56% de los pacientes y el número medio de fugas evolucionó de 3,4 ± 5,2 (V1) a 1,3 ± 2,3 (V2) (p< 0,0001). El 62% de los pacientes que tenía problemas en la piel dejó de tenerlos y la mejora en las condiciones de la piel fue muy evidente. La puntuación media DET cambió de 3,3 ± 3,3 (V1) a 1,6 ± 2,3 (V2) (p< 0,0001). La satisfacción media percibida por el paciente evolucionó de 5,1 ± 2 (V1) a 7,2 ± 1,7 (V2) (p< 0,0001). La proporción de pacientes con estoma protruido aumentó de 32,9% a 40% (p= 0,025). La mayoría de los pacientes retomó sus hábitos diarios: 67% pasear, 75% salir de casa, 55% descansar por la noche. El 92% de los participantes deseó seguir usando el dispositivo Easiflex® Convex Light. Conclusiones: los pacientes con ostomía digestiva y fuga de efluentes en el periodo postoperatorio temprano se benefician claramente del empleo del dispositivo convexo suave (Easiflex® Confort Convex Light) con anillo moldeable (Brava®). Se confirmó la seguridad y efectividad de este abordaje.(AU)

Objective: to assess the safety and efficacy of the CONAN cure, taking into account the reduction in the number of leaks, the status of peristomal skin, and the quality of life perceived by the patient. Method: a prospective non-randomized study at national level, conducted in 54 Stomal Therapy Units, in order to evaluate the efficacy and safety of the CONAN cure, consisting in the use of the Easiflex® Confort Convex Light device and Brava® moldable rings during the early post-surgical stage in patients with digestive system ostomy with effluent leaks. The study intended to evaluate the effect of this strategy on leak reduction, to prevent peristomal skin deterioration, and to increase the wellbeing of patients at discharge. Statistical differences were compared between these variables, using the t-test, Squared-chi, McNemar and Bowker tests. Results: there was an evaluation of 257 patients, and 244 completed the study. With the CONAN cure, the number of leaks was reduced in 56% of patients, and the mean number of leaks moved from 3.4 ± 5.2 (V1) to 1.3 ± 2.3 (V2) (p< 0.0001); skin problems disappeared in 62% of patients who presented them, and the improvement in skin condition was highly evident. There was a change in the mean DET score from 3.3 ± 3.3 (V1) to 1.6 ± 2.3 (V2) (p< 0.0001). The mean satisfaction perceived by the patient increased from 5.1 ± 2 (V1) to 7.2 ± 1.7 (V2) (p< 0.0001). The proportion of patients with protruding stoma increased from 32.9% to 40% (p= 0.025). The majority of patients resumed their daily habits: 67% going for walks, 75% going out of their house, and 55% resting at night; 92% of participants wanted to continue using the Easiflex® Convex Light device. Conclusions: patients with digestive system ostomy and effluent leak during their early post-surgical period could clearly benefit of using the soft convex device (Easiflex® Confort Convex Light) with moldable ring (Brava®). The safety and efficacy of this approach was confirmed.

Clinical efficacy of early postoperative intensity-modulated radiotherapy combined with Temozolomide chemotherapy in the treatment of patients with malignant glioma.

Objectives: To evaluate the clinical efficacy of early postoperative intensity-modulated radiotherapy (IMRT) combined with temozolomide chemotherapy in the treatment of patients with malignant glioma. Methods: In this retrospective cohort study 80 patients with glioma surgery admitted to Chengde Central Hospital from January 2019 to January 2021 were selected and divided into two groups according to postoperative treatment: the experimental group and the control group, with 40 cases in each group. Patients in the experimental group received IMRT combined with temozolomide chemotherapy postoperatively, while those in the control group received IMRT alone. The clinical effects of patients were analyzed before treatment and three months after treatment, and the incidence of adverse reactions such as bone marrow suppression, gastrointestinal reactions, fever, and liver dysfunction were analyzed in the two groups within one month after treatment. Before treatment and two months after treatment, MMSE scale, QOL scale and KPS were used to compare the cognitive function and health status of the patients. All patients were followed up for one year after treatment, and the difference of disease progression-free survival and overall survival rate between the two groups was analyzed. Results: The effective rate of the experimental group was 70% after treatment, while that of the control group was 43.3%, with a statistically significant difference (P=0.04). The incidence of adverse reactions was 50% in the experimental group and 40% in the control group, with no statistically significant difference between the two groups (P=0.25). After treatment, MMSE score, QOL score and KPS score of the experimental group were significantly improved compared with those of the control group, with statistically significant differences between the two groups (MMSE score, QOL, P=0.00; KPS, P=0.01). Moreover, the two groups of patients were followed up for one year after treatment. The disease progression-free survival rate of the experimental group was 70% and that of the control group was 47.5%, with a statistically significant difference (P=0.04), and the overall survival rate of the experimental group was significantly higher than that of the control group after treatment, with a statistically significant difference (P=0.03). Conclusion: Early postoperative IMRT combined with temozolomide chemotherapy is an effective treatment regimen for patients with malignant glioma, boasting a variety of advantages such as high efficiency, cognitive function, favorable recovery of health status, significantly improved progression-free survival rate and overall survival rate, and no significant increase in adverse reactions.

[Modern approaches to the rehabilitation of patients with chronic paraproctitis in the early postoperative period]. / Sovremennye podkhody k reabilitatsii bol'nykh khronicheskim paraproktitom v rannem posleoperatsionnom periode.

Along with the classical methods of surgical treatment of rectal fistulas, new minimally invasive technologies have appeared using video endoscopic support for processing the fistulous tract and closing the internal fistula opening, intrasphincter ligation of the fistulous tract LIFT, however, they do not exclude relapses in the late postoperative period. The FiLaC (Fistula Laser Closure) laser technology based on the use of a radial flexible laser light guide, which does not cause damage to the anal canal mucosa, pain in the postoperative period, rectal postoperative bleeding and strictures, is quite promising in the further development of outpatient minimally invasive surgery for anal fistulas. anal canal. However, even with this technique, complications and relapses were observed in 10-12% of cases, which dictates the need to develop not only a patient-oriented approach to the surgical treatment of patients with chronic paraproctitis, but also to develop postoperative rehabilitation programs in the early postoperative period. OBJECTIVE: To study the effect of complex rehabilitation programs used in the early postoperative period on the efficacy of the therapy in patients with pararectal fistulas. MATERIAL AND METHODS: The study included 90 patients with chronic paraproctitis, (the average age was 43±3.4 years, the average duration of the disease was 5.1±1.5 years), who underwent a surgery using the modified FiLac technology. The patients were divided into 3 groups (30 patients in each group) depending on the rehabilitation method used during the postoperative period (2 days after the surgery): 1st group underwent a 4-component rehabilitation complex (intravenous ozone therapy, rectal laser therapy, recto-tibialmyostimulation of the pelvic floor muscles and biofeedback therapy); 2nd group underwent a 2-component rehabilitation complex (intravenous ozone therapy and rectal laser therapy); 3rd group has received a standard medical complex, which served as a background in 1st group and 2nd group. Therapeutic efficacy was assessed according to the assessment of pain syndrome (on the VAS scale), the results of anal sphincterometry (the Peritron 9600 device), the incidence of postoperative complications and relapses at different follow-up periods (up to 5 years). RESULTS: A comparative analysis of the nature of the course of the postoperative period, depending on the type of postoperative rehabilitation was carried out. In multiple comparisons using the parametric ANOVA method, it was found that there were statistically significant differences between the 1st group and the 3rd group in terms of pain intensity, duration of pain, the timing of wound healing, the frequency of complications, and the timing of return to work. The results in the 2nd group were slightly lower than in the 1st group, but they also differed significantly from the data of the 3rd group. During the analysis of the early and late p/o complications and relapses in patients with chronic paraproctitis after surgery the most significant were obtained from the 1st group (only 1 case of early p/o complications and relapse within 1 to 5 years), while in the 3rd group there were 2 (6.6%) cases of early p/o complications, 2 cases (6.6%) of relapses within a period of up to 1 year and 6 (20%) cases in the period from 1 to 5 years. In patients of the 2nd group, results close to the results of the 1st group were obtained: 2 (6.6%), 2 (6.6%) and 3 (9.9%) cases respectively. CONCLUSION: The use of expanded rehabilitation complexes among the patients with chronic paraproctitis in the early postoperative period after surgery, including intravenous ozone therapy, rectal laser therapy, recto-tibialmyostimulation and bifidobac therapy, made it possible to significantly improve therapeutic efficacy, which was confirmed by faster pain relief, fewer early and late p/o complications. The data obtained indicate the need for the use of rehabilitation programs in the early postoperative period for the treatment and prevention of complications after surgery.

[Laser therapy effect on endothelial dysfunction in patients after the surgery for orthognathic disorders]. / Vliyanie lazernoi terapii na endotelial'nuyu disfunktsiyu u bol'nykh, operirovannykh po povodu ortognaticheskoi patologii.

OBJECTIVE: To optimize postoperative rehabilitation by applying low-intensity laser irradiation (LILI) with different wavelengths in the early postoperative period to prevent inflammatory complications. MATERIAL AND METHODS: After radiological examination and ultrasound diagnostics of the periodontal tissue vessels, surgical methods of orthognathic treatment were performed, after completion of which a course of LILI was carried out. The VEGF its receptors (sVEGF-R1; sVEGF-R2) content was measured by enzyme immunoassay using standard reagent kits. The laser therapy using 635 nm laser light was applied directly to the vestibular and oral surfaces of the gingival tissues and in the operation area, changeable by the scanning method, for 1.5 minutes (5 W power); the pulsed infrared laser therapy (PILT) with the 904 nm wavelength (light pulse duration 100 s, power 15 W, 1500 Hz) applied epicutaneously to the operation projective zones (four control points of the upper and lower jaw) through the skin of the cheek, in stable method (1.5 minutes) with a time range between red and infrared wavelength LILI not exceeding 100 s (1.5 minutes). RESULTS: Vascular and endothelial dysfunction after laser irradiation with different wavelengths is better controlled by increasing the microcapillary blood flow (66.7% gain; p<0.05) in arteriolar and 70.3% in venular sections of capillaries (p<0.01), which is associated by vasodilatation: diameter increased by 26.9% compared to that under the influence of red laser radiation (by 13.0%) and infrared laser radiation (by 7.2%); p<0.01). CONCLUSIONS: Early laser therapy using the low-intensity laser irradiation with different wavelengths improves vasoactive processes of hemoregulation in dental tissues associated with the elimination of vasospasm caused by operative stress, activation of arteriolodilatory effects, contributes to the prevention of development of inflammatory complications.

[Non-drug technologies in early rehabilitation of patients after hemorrhoidectomy]. / Nemedikamentoznye tekhnologii v rannei reabilitatsii bol'nykh posle gemorroidektomii.

Among all coloproctological diseases, hemorrhoids rank first among the reasons for visiting a proctologist. Its prevalence is 130-145 per 1.000 adults, and its proportion in the structure of colorectal diseases ranges from 34 to 41%. After hemorrhoidectomy, a long period of rehabilitation is necessary. There are long periods of incapacity for work (at least two weeks) and quite high complications rate, which generally leads to economic burden. Therefore, an urgent problem of current coloproctology and physiotherapy is the development of new approaches to medical rehabilitation of the patients after surgery for their fast recovery and prevention of complications. OBJECTIVE: To study effectiveness of comprehensive postoperative rehabilitation program including ozone therapy, laser therapy, recto-tibial myostimulation and biofeedback therapy in patients after hemorrhoidectomy. MATERIAL AND METHODS: The study included 90 patients 20-65 years of age (mean age 41.4±2.1years) with chronic stage III hemorrhoids with prominent external nodules (ICD-10 code: K64.2). All patients underwent Milligan-Morgan hemorrhoidectomy using an ultrasound scalpel by the same coloproctologist to exclude the influence of personality factors. The patients were assigned into two groups by random sampling. The main group consisted of 45 patients who received standard of care and the rehabilitation program, including intravenous ozone therapy, rectal laser therapy, recto-tibial myostimulation, and biofeedback therapy starting from the second day after the surgery. The control group consisted of 45 patients who received the same standard of care in the early postoperative period, including analgesics, local antibacterial ointments (Levomekol, etc.), and rectal suppositories (Relief Pro, etc.). RESULTS: In the early postoperative period, in the patients who received non-drug rehabilitation program, the pain was significantly less intensive, and it relieved faster after surgery, which indicated a strong analgesic effect of the rehabilitation program. Patients in the control group received analgesics (including narcotic drugs) for pain control in 68.9% of cases. Duration of postoperative incapacity for work in the main group patients was 12.9±2.4 days vs. 24.1±2.3 days in the control group patients (p<0.001). The analysis of the quality of life in the early and the late postoperative period by SF-36 scale showed a significant difference between the groups according to the physical health component and psychological component both in the early and in the late postoperative period (after six months), which indicates the higher quality of life in the main group patients. Assessment of the late period quality of life using the I. Yu. Alimzhanova and Yu.M. Sheptunov questionnaire showed good results in 43 (95.6%) patients of the main group. Only in 2 (4.4%) main group patients, anal stenosis was observed. Good results were shown in 38 (84.58%) control group patients. Seven patients had complications: cicatricial anal stenosis (5 [11.1%] patients) and pararectal fistulas (2 [4.4%] patients); in 3 (42.9%) of these 7 patients a persistent pain syndrome was developed. CONCLUSIONS: Introduction of the rehabilitation program in the early postoperative period after hemorrhoidectomy contributes to faster relief of pain and other signs and symptoms, a significant decrease of average postoperative wound healing time due to acceleration of adequate scar formation (according to ultrasound sonoelastography), improvement of life quality, reduction of hospital stay, a decrease of incapacity for work duration, and prevention of postoperative complications.

Treatment of acute exacerbation of liver-cirrhosis-associated portal vein thrombosis with direct-acting oral anticoagulant, edoxaban, used as an initial treatment in the early postoperative period after abdominal surgery: a case report.

BACKGROUND: Cirrhosis-associated portal vein thrombosis (CA-PVT) has been reportedly observed in 5-30% of cirrhotic patients. Moreover, the acute exacerbation of CA-PVT is likely to occur after certain situations, such as a status after abdominal surgery. Safety and efficacy of the direct-acting oral anticoagulant (DOAC) used for cirrhotic patients have been being confirmed. However, use of the DOAC as an initial treatment for CA-PVT appears still challenging especially in the early postoperative period after major surgery in terms of unestablished efficacy and safety in such occasion. CASE PRESENTATION: We herein report a case of the acute exacerbation of CA-PVT in the early postoperative period after abdominal surgery, which was successfully treated with DOAC, edoxaban used as an initial treatment. The patient was a 79-year-old Japanese male with alcoholic cirrhosis. The patient suffered choledocholithiasis and had a mural chronic CA-PVT extending from the superior mesenteric vein to the portal trunk. He underwent open cholecystectomy and choledochotomy. Early postoperative clinical course was uneventful except for abdominal distension due to ascites diagnosed on postoperative day (POD)7 when hospital discharge was planned. Contrast enhancement computed tomography (CE-CT) taken on POD 7 revealed the exacerbation of the CA-PVT. Despite recommendation for extension of hospital admission with low molecular weight heparin treatment, the patient strongly hoped to be discharged. Unwillingly, we selected DOAC, edoxaban, as an initial treatment, which was commenced the day after discharge (POD8). As a result, the remarkable improvement of the exacerbated CA-PVT was confirmed by the CE-CT taken on POD21. Any bleeding complications were not observed. Although a slight residue of the CA-PVT remains, the patient is currently doing well 4 years after surgery and is still receiving edoxaban. Any adverse effects of edoxaban have not been observed for 4 years. CONCLUSIONS: A case of successful treatment of the acute exacerbation of CA-PVT with edoxaban was reported. Moreover, edoxaban has been safely administered in a cirrhotic patient for 4 years. The findings obtained from the present case suggest that DOAC can be used as an initial treatment for CA-PVT even in early postoperative period after major abdominal surgery.

Unexpected success in early post-transplantation renal vein thrombosis: A case report and literature review.

BACKGROUND: Allograft renal vein thrombosis can cause graft loss during the early postoperative period. This diagnosis is sometimes elusive, requiring a strong suspicion. On the other hand, several authors have recognized risk factors for allograft renal vein thrombosis, but neither a preventive approach nor a treatment have been recommended for this complication. CASE PRESENTATION: We present a case report of early allograft renal vein thrombosis, preceded by femoral common deep vein thrombosis in a recipient of a third kidney transplant. Despite femoral common deep vein thrombosis treatment with low-molecular-weight heparin and progressive improvement of renal function to a nadir serum creatinine of 0.51 mg/dL, the patient experienced a sudden episode of anuria on postoperative day 5. Doppler ultrasonography strongly suggested the diagnosis of allograft renal vein thrombosis. The patient underwent balloon catheter and aspiration venous thrombectomy, followed by unfractionated heparin perfusion. After 4 days of anuria and multiple blood transfusions, when allograft nephrectomy was contemplated, diuresis suddenly resumed. After 1 year of follow-up, the patient still has a normal renal function. CONCLUSION: This case report shows successful treatment of allograft renal vein thrombosis associated with deep vein thrombosis in the first week of transplantation, using balloon catheter and aspiration venous thrombectomy followed by perfusion of unfractionated heparin. The authors suggest this technique as a treatment option for transplant renal vein thrombosis. However, they reinforce the importance of individualized treatment and they remind that a delay may jeopardize the potential benefit of the procedure.

Early changes in cell-free DNA levels in newly transplanted heart transplant patients.

Heart transplantation is a well-established therapy for end-stage heart failure in children and young adults. The highest risk of graft loss occurs in the first 60 days post-transplant. Donor fraction of cell-free DNA is a highly sensitive marker of graft injury. Changes in cell-free DNA levels have not previously been studied in depth in patients early after heart transplant. A prospective study was conducted among heart transplant recipients at a single pediatric heart center. Blood samples were collected from children and young adult transplant patients at three time points within 10 days of transplantation. DF and total cell-free DNA levels were measured using a targeted method (myTAIHEART ). In 17 patients with serial post-transplant samples, DF peaks in the first 2 days after transplant (3.5%, [1.9-10]%) and then declines toward baseline (0.27%, [0.19-0.52]%) by 6-9 days. There were 4 deaths in the first year among the 10 patients with complete sample sets, and 3 out of 4 who died had a late rise or blunted decline in donor fraction. Patients who died trended toward an elevated total cell-free DNA at 1 week (41.5, [34-65] vs 13.6, [6.2-22] P = .07). Donor fraction peaks early after heart transplant and then declines toward baseline. Patients without sustained decline in donor fraction and/or elevated total cell-free DNA at 1 week may have worse outcomes.

Endovascular Intervention for Early Postoperative Stenosis of Extracranial-Intracranial Bypass Graft: Case Report and Review of the Literature.

BACKGROUND: Bypass graft stenosis following extracranial-intracranial bypass surgery carries significant risks for morbidity and mortality. In case of graft failure, treatment options include surgical revision and endovascular intervention. Whereas endovascular intervention following coronary artery bypass is well established, the role of endovascular therapy in cerebral bypass conduits is rarely reported. We present a case of extracranial-intracranial bypass graft stenosis in the early postoperative period that was successfully treated by endovascular angioplasty and stenting. CASE DESCRIPTION: A middle-aged patient presented with a malignant skull base tumor with internal carotid artery invasion. Extracranial-intracranial bypass surgery was performed for flow preservation before tumor removal. Autologous radial artery was used as the bypass graft conduit. Symptomatic graft stenosis was encountered in the immediate postoperative period. Treatments in the form of intra-arterial vasodilator infusion and balloon angioplasty led to only minor flow improvement. The narrowing was eventually salvaged by endovascular stenting. Good clinical and radiologic outcomes were achieved at 6-month follow-up. CONCLUSIONS: Endovascular intervention is a feasible treatment option in management of graft stenosis after cerebral revascularization surgery. Our case adds evidence to the safety and role of endovascular intervention in early cerebral bypass conduit failure. In addition, endovascular stenting can be considered as a salvage option for cases that are refractory to angioplasty.

[Characteristics of postoperative cerebral dysfunction depending on the type and position of the implanted prosthetic heart valve]. / Osobennosti posleoperatsionnoi mozgovoi disfunktsii v zavisimosti ot tipa i pozitsii implantiruemogo proteza klapana serdtsa.

AIM: To study the prevalence and structure of postoperative cerebral dysfunction depending on the type and position of the implanted prosthetic heart valve in patients who underwent surgery for the acquired heart valve disease. MATERIAL AND METHODS: The study included 115 patients (70 men and 45 women; 64 [56; 72] years old), who underwent elective replacement or repair surgery for the acquired heart valve disease. RESULTS AND CONCLUSION: The postoperative cerebral dysfunction was diagnosed in 40.9% patients, including replacement in the aortic position (45.5%), in the mitral position (55%), in several positions (20%). Replacement surgery was accompanied by three clinical types of postoperative cerebral dysfunction and repair surgery - by deferred cognitive impairment only. Postoperative cerebral dysfunction after the replacement in the mitral position was more common (odds ratio 4.47, 95% confidence interval 1.21-18.35, p=0.041), including its acute clinical types - perioperative stroke and symptomatic delirium of the early postoperative period (p=0.029), compared to that after the repair heart valve surgery. After the replacement in the aortic position, acute clinical types of postoperative cerebral dysfunction were more common (p=0.036). After the replacement with biological prosthesis, symptomatic delirium of the early postoperative period was more common (p=0.047). The occurrence of the deferred cognitive impairment didn't depend on the type and position of the implanted prosthetic heart valve.

Graft rejection-like reactions in the early postoperative period after deep anterior lamellar keratoplasty for keratoconus: a retrospective study.

BACKGROUND: Deep anterior lamellar keratoplasty (DALK) is indicated to correct high astigmatism in patients with keratoconus (KC) and no evidence of Descemet's membrane rupture. However, some patients with KC experience graft rejection-like inflammatory reactions within 2 months (usually in the first week) after DALK. The aim of this study was to identify the characteristics and influencing factors of these reactions by reviewing the records of patients who underwent DALK or penetrating keratoplasty (PKP) for KC or other corneal problems. METHODS: We retrospectively reviewed the medical records of patients who underwent DALK for KC (DALK/KC), PKP for KC (PKP/KC), or DALK for other corneal problems (DALK/non-KC) at Ban Buntane Hotokukai Hospital between January 2006 and December 2015 and who were followed for more than 1 year. We collected data on the characteristics and incidence of severe inflammatory graft reactions in the early postoperative phase (ie, within 2 months after keratoplasty) and visual outcomes after these inflammatory reactions. RESULTS: Postoperative inflammatory reactions characterized by persistent epithelial defects, loose suture with infiltration, and vessel invasion occurred in seven of eleven DALK/KC patients, three of 50 DALK/non-KC patients, and none of five PKP/KC patients. These reactions were nonresponsive to topical steroids, and suture removal was required. Although a clear corneal graft in the pupillary area was obtained and best-corrected visual acuity was good after the resolution of inflammation, a risk of corneal astigmatism remained. CONCLUSION: The incidence of these reactions in the early postoperative period is high after DALK for KC. These reactions do not respond well to topical steroids, and suture removal may be required, which may cause high astigmatism after the inflammation subsides. Lamellar keratoplasty should be considered carefully for patients with KC.

Efficacy of catheter interventions in the early and very early postoperative period after CHD operation.

BACKGROUND: Catheter interventions for residual lesions in the early postoperative period after CHD operations are still not established as a reliable treatment option. METHODS: We retrospectively reviewed our institutional experience of cardiac catheterisations and catheter interventions performed in the early postoperative period. We classified our patients into two groups. The "hyper" acute phase group - operation to cardiac catheterisation of ⩽7 days - and acute phase group - operation to cardiac catheterisation from 7 to 30 days. RESULTS: Of the 47 patients, catheter interventions were performed in 38 patients (81%). The success rate of the intervention was 96% in the acute phase group and 90% in the "hyper" acute phase group. The overall success rate was 95%. There were two self-limited complications in the acute phase group, but not in the "hyper" acute phase group. There were four cases of catheter interventions performed for a newly reconstructed aortic arch, and those procedures were also safe and effective. CONCLUSIONS: Cardiac catheterisations and catheter interventions were safe and effective not only in the early postoperative period but also in the very early postoperative period. Catheter interventions for the left-sided heart in the early postoperative period were also safe and effective.

Posterior Reversible Encephalopathy Syndrome after Augmentation Cystoplasty in a Child with Neurogenic Bladder.

Posterior reversible encephalopathy syndrome (PRES) or leukoencephalopathy syndrome was introduced into clinical practice in 1996 by Hinchey et al., to describe unique syndrome, clinically expressed during hypertensive and uremic encephalopathy, eclampsia, and immunosuppressive therapy. Hyperperfusion with resultant disruption of the blood-brain barrier results in vasogenic edema, but not infarction, most commonly in the parieto-occipital regions. The severity of this clinical symptom varies. For example, the visual disturbance can manifest as blurred vision, homonymous hemianopsia, or even cortical blindness. Patients may be mildly confused or agitated but can become comatose. Other symptoms less commonly seen include nausea, vomiting, seizures, and brainstem deficits. Chronic kidney disease (CKD) and acute kidney injury are both commonly present in patients with PRES. We are presenting a rare case of neurogenic bladder who developed PRES after augmentation cystoplasty due to underlying CKD.

[Perioperative stroke in heart valve surgery: pathogenesis, clinical findings, diagnosis, prevention, treatment]. / Perioperatsionnyi mozgovoi insul't v khirurgii klapanov serdtsa: patogenez, klinika, diagnostika, lechenie i profilaktika.

AIM: To study risk factors, characteristics of clinical symptoms and diagnosis, and possibilities of prevention of perioperative stroke and other clinical types of cerebral dysfunction in main types of heart valve surgery. MATERIAL AND METHODS: The study included 83 patients, aged 63 (54; 70) years, undergoing heart valve surgery with cardiopulmonary bypass. RESULTS: Postoperative cerebral dysfunction was diagnosed in 37.3% of cases, including perioperative stroke in 3.6% of cases. In cases of aortic stenosis, the frequency of perioperative stroke was 9.5%. The cardioembolic subtype of perioperative ischemic stroke in cardiac valve surgery was most likely. The risk factors of the symptomatic delirium of the early postoperative period are: age over 75 years, preoperative frontal dysfunction, duration of artificial respiratory care more than 20 hours after the surgery. CONCLUSION: The results suggest the efficacy of preventive use of cytoflavin for reducing the frequency and severity of perioperative stroke and symptomatic delirium of the early postoperative period in heart valve surgery with cardiopulmonary bypass.

Bone tunnel change develops within two weeks of double-bundle anterior cruciate ligament reconstruction using hamstring autograft: A comparison of different postoperative immobilization periods using computed tomography.

BACKGROUND: The purpose of this study was to evaluate bone tunnel changes following anterior cruciate ligament (ACL) reconstruction during the early postoperative period using computed tomography (CT), and to understand the impact of postoperative immobilization on these changes. METHODS: Twenty patients who underwent double-bundle ACL reconstruction using hamstring tendon autografts were included. We subcategorized patients into two groups: patients who underwent isolated ACL reconstruction and had three days of knee immobilization (Group A, n=10); and patients with concomitant meniscus injuries who underwent ACL reconstruction and meniscus repair simultaneously (Group B, n=10) had their knees immobilized for two weeks after surgery. Bone tunnel enlargement was evaluated using CT imaging at one to three days, two weeks, one month, three months and six months after surgery. The cross-sectional area of the femoral and tibial tunnels was measured, and enlargement rate was calculated. The tunnel center location at two weeks after surgery was also evaluated. RESULTS: The mean cross-sectional area adjacent to the joint space of the femoral and tibial tunnels significantly increased immediately after surgery, especially in the first month (P<0.01). However, after one to six months they were not increased (P>0.01). There was no significant difference in tunnel enlargement rate between group A and B. Tunnel center location changed even in the first two weeks. CONCLUSIONS: Bone tunnel enlargement following double-bundle ACL reconstruction occurred at an earlier time point after surgery than anticipated. Postoperative immobilization could not prevent bone tunnel enlargement, but might prevent tunnel migration.

[Postoperative cerebral dysfunction]. / Posleoperatsionnaia mozgovaia disfunktsiia.

AIM: To study the structure, risk factors and methods of prevention of postoperative brain dysfunction on the example of coronary artery bypass surgery with cardiopulmonary bypass. MATERIAL AND METHODS: The study included 77 patients who undergone elective coronary artery bypass surgery at the beating heart (22 patients) or with cardiopulmonary bypass (55 patients, including 24 patients, who received cerebroprotective treatment with cytoflavin in the preoperative period). All patients underwent dynamic (pre- and postoperative) neurological, neuropsychological, instrumental examinations. RESULTS: The postoperative cerebral dysfunction was diagnosed in 34 (44,2%) patients. The frequency of the clinical types of postoperative cerebral dysfunction significantly differed: perioperative stroke - 3 (3,9%) cases, symptomatic delirium of the early postoperative period - 11 (14,3%) cases, delayed cognitive impairment - 28 (36,4%) cases. The risk factors of postoperative cerebral dysfunction after the coronary artery bypass surgery with cardiopulmonary bypass were identified. Preventive preoperative use of the neuroprotective drug cytoflavin reduces the severity of delayed cognitive impairment after the coronary artery bypass surgery with cardiopulmonary bypass and has a good safety profile. CONCLUSION: An analysis of the literature data and the results of our own studies show that postoperative cerebral dysfunction is the nosological entity with various etiological factors, pathogenetic mechanisms and the characteristic clinical types, which has an effect on the outcome of surgical treatment.

Statin therapy in the primary prevention of early atrial fibrillation after coronary artery bypass grafting.

OBJECTIVE: Assessment of the role of statin therapy in the prevention of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) in patients without prior atrial fibrillation. METHODS: A retrospective analysis of 206 patients, aged 57.2±7.9 years (mean±SD), who underwent isolated CABG is carried out. All patients are divided into two groups. The first group (nSt-patients) includes the patients who did not receive statin therapy prior to CABG (n=82). The second group (St-patients) includes the patients who received statin therapy prior to CABG (n=124). Both groups received the statin therapy from the first day after CABG. The risk of occurrence of POAF is evaluated using the Cox-regression model. RESULTS: The rate of POAF was 25.6% in nSt-patients and 6.5% in St-patients (P=0.020). On the 4th day after CABG, white blood cells (WBC) count was 11.0 (9.0, 13.0)×109/mL (medians with inter-quartile ranges) in nSt-patients and 9.0 (7.6, 10.2)×109/mL in St-patients (P<0.001). The peak WBC numbers occurred on the day of POAF onset. The Cox-regression analysis shows that only two factors (statin therapy and number of grafts) had significant influence on the POAF onset. Odds ratio of POAF event prediction by statin therapy was 0.20 (95%CI: 0.08-0.51), P<0.001. Each subsequent graft increased the risk of POAF in 2.1 times. CONCLUSION: Statin therapy carried out prior to the CABG is an effective approach to primary prevention of POAF in early postoperative period. Statin therapy after CABG in nSt-patients does not give prophylactic effect observed in St-patients.