Vol 10, No 3 (2019)

Original Research
Hiatal hernia repair with Toupet fundoplication in surgical treatment of hiatal hernia, complicated by gastroesophageal reflux disease
Grintcov A.G., Ishenko R.V., Sovpel I.V., Sovpel O.V., Shapovalova J.A.
Abstract

Introduction. Hiatal hernia occupies a third place in the structure of the gastrointestinal tract pathology. The association of hiatal hernia with gastroesophageal reflux disease can lead to severe complications and requires a surgical treatment.

Objective. To analyze short-term and long-term results of a surgical treatment of patients with hiatal hernia complicated by gastroesophageal reflux disease (GERD).

Methods. A retrospective analysis of the short-term and long-term treatment results of 62 patients suffering from hiatal hernia complicated by gastroesophageal reflux disease was performed. All the patients underwent a laparoscopic hiatal hernia repair supplemented by Toupet fundoplication.

Results. The hospital stay duration was 7.2±1.6 days. The postoperative complication rate was 6.5%. Mild functional dysphagia was noted in 8(12.9%). Persistent long-term dysphagia in the late postoperative period was observed in 2(3.2%) patients. The recurrences of hiatal hernia or GERD were noted in 15(24.2%) patients in 5 years after the surgery. The total GERD-HRQL questionnaire score 5 years after the surgery was 5.7±3.9.

Сonclusion. Laparoscopic interventions are safe, less traumatic, provide the possibility of early rehabilitation of patients, can achieve positive functional results in 85% of patients and should be used in the treatment of patients suffering from hiatal hernia complicated by GERD.

Journal of Clinical Practice. 2019;10(3):5-12
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Laser vision correction among Kuzbass miners
Aksyonenko A.V.
Abstract

Background. In the structure of Kuzbass miners’ ophthalmopathology, disorders of refraction and accommodation occupy the first place. Excimer laser vision correction is the only acceptable method for correcting various refractive errors that allows miners engaged in the underground coal mining to remain in their profession and continue their career.

Objective. To assess the long-term results of excimer laser refractive surgery in miners to evaluate this method as a means of vocational rehabilitation.

Material and methods. A survey was conducted in the main group including 135 Kuzbass miners who underwent excimer laser vision correction for professional reasons. The comparison group consisted of 135 patients of various professions unrelated to coal mining who met the general selection criteria. All the patients underwent an extended range of ophthalmologic examinations.

Results. The visus in both eyes in the comparison group was 1.2 (1.0–1.2), in the group of miners — 1.0 (0.9–1.2), p<0.05. The values of the sphere and cylinder in the groups are mainly in the range of residual myopia. The clinically significant correlation of the index of contrast sensitivity was established with the visual acuity, age of patients, the period after the operation, and underground experience in the group of miners. In the group of miners, OCT-detected changes are twice as common as they are in the control group, and peculiarities of the anterior segment are 1.5 times more frequent, according to biomicroscopy.

Conclusion. The obtained clinical and functional results of excimer laser operations enable professional rehabilitation of miners engaged in the underground work, and provide a high level of occupational safety.

Journal of Clinical Practice. 2019;10(3):13-18
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Dynamics of structure and severity of dentoalveolar anomalies on the background of early orthodontic treatment during occlusion
Olesov E.E., Kaganova O.S., Fazilova T.A., Mirgazizov M.Z., Ilyin A.A., Shugailov I.A.
Abstract

Background. According to the statistics, the incidence of dentoalveolar anomalies, as well as the frequency of orthodontic visits, is constantly growing.

Objective. To analyze the efficiency of orthodontic treatment in children during the period of mixed dentition.

Methods. We have performed a study on the incidence and severity of dentoalveolar anomalies of the dental status in 7-9-year-old patients vs. 15-17-year-old adolescents after the completion of occlusion. The adolescents were divided into two groups – those who underwent orthodontic treatment during the mixed dentition period and those who did not. The evaluation of the children’s dental status was performed using a specialized WHO Map (2013), supplemented by the «Dental Maxillofacial Anomalies» section. We determined the following indices: DMF (Decayed-Missing-Filled Index), DMF-df, OHI-S, CPI, PAR, DAI, as well as the Little’s irregularity index. The need in the different types of dental and orthodontic treatment was estimated, including that per one examined person in a group.

Results. In the group of 7-9-year-old we have revealed a high incidence of premature teeth loss (17.0% of patients), dentoalveolar anomalies (73.9%) and their combinations (60.8%).

Discussion. Orthodontic treatment during the period of mixed dentition reduces the incidence of the teeth positioning anomalies (crowding and tooth displacement) and dental arch ratio anomalies (completely eliminating the cross-bite). At the same time, early orthodontic treatment does not have a significant influence on the tooth rotation, interdental spaces, deep, open, distal, mesial occlusions and the displacement of dental arches. The severity of dentoalveolar anomalies is reduced in this case.

Conclusion. Orthodontic treatment of children during the period of mixed dentition is indicated in the presence of teeth crowding and displacement, as well as in the presence of a cross-bite; concerning other types of dentoalveolar anomalies, early orthodontic treatment is justified only when the patient’s psychological and functional indices are reduced.

Journal of Clinical Practice. 2019;10(3):19-25
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Quality of life after gastrectomy by laparoscopic and open approach. Own experience and review of the literature
Ishenko R.V., Pavlov R.V., Pavlenko A.N., Kuznetsova O.A.
Abstract

Introduction. Gastrectomy is a surgical method for the treatment of gastric cancer patients, which is associated with the deterioration of the patient’s quality of life (QoL). This article assesses factors that have an impact on QoL, investigates the role of reconstructive operations and surgical accesses in the treatment outcomes. The clinical cases and patients’ follow-ups are also presented in this article.

Objective. The aim of our work is the assessment of the EORTC QLQ-STO22 questionnaire efficiency and its correlation with the status of patients.

Methods. In the three years from 2016 to 2019, operations were performed in 60 patients (37 male and 23 female). All the patients underwent total gastrectomy with D2 lymphadenectomy, with the use of laparascopic or open surgery. In the basic group (27 patients, 17 male, 10 female), laparascopic operation was performed. In the control group (33 patients, 20 male, 13 female), open surgery was performed. Each group was further subdivided into subgroups, in which anastomosis was performed either manually or mechanically: 19 and 9 patients in the first group, 24 and 9 patients in the second group, correspondingly. The assessment of the patients’ quality of life was conducted before the surgical intervention, 1, 3, 6 months and 1 year post-surgery. The control of the patients’ status in the form of a questionnaire was done via telephone or e-mail contacts.

Results. The literature review has shown a high importance of a correctly chosen method for the reconstruction. The manual methods in both groups showed better results regarding QoL of patients. In 1 month after surgery, in the laparascopic group the results were as follows: 77.5±7.2 (manual) and 72.0±2.5 (mechanical). In the group of open surgery: 69.6±5.5 (manual) and 61.0±3.1 (mechanical). 3 months post-surgery, in the laparascopic group the results were the following: 79.2±1.6 (manual) and 73.1±3.5 (mechanical). In the group of open surgery: 70.5±5.5 (manual) and 60.2±3.2 (mechanical). In 6 months, in the laparascopic group the results were as follows: 71.1±4.2 (manual) and 68.6±2.6 (mechanical). In the group of open surgery: 68.2±4.2 (manual) and 61.0±2.1 (mechanical). 1 year after surgery, in the laparascopic group the results were the following: 60.1±7.2 (manual) and 64.7±5.2 (mechanical). In the group of open surgery: 67.1±3.3 (manual) and 62.7±1.0 (mechanical).

Discussion. Such factors as comorbidities, staging of tumor, type of surgical intervention, volume of lymphadenectomy, type of reconstruction, postoperative complications, adjuvant and neoadjuvant chemotherapy have an impact on QoL.

Conclusion. The EORTC QLQ-C30 questionnaires of the STO22 module give an opportunity for clinicians and researchers to assess the patient’s status and analyze QoL in patients after gastrectomy with different methods of reconstruction and surgical access. The advantage of a reservoir formation in the reconstructive operation has been proven. Laparoscopic interventions have a number of advantages but should not be applied in the elderly and weakened patients.

Journal of Clinical Practice. 2019;10(3):26-34
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Analysis of the prevalence of STIs in Russia according to the federal laboratory network
Vladimirova E.V., Kovalyk V.P., Murakov S.V., Vladimirov A.A., Markova Y.A.
Abstract

Background. The incidence rate of sexually transmitted infections (STIs) in different countries has attracted the attention of specialists from all over the world. The official rates of STI incidence in Russia are significantly lower than those in the United States.

Objective. To assess the prevalence of STIs among patients in a network of federal laboratories.

Methods. The prevalence analysis of Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, Neisseria gonorrhoeae, human papillomavirus (HPV) types 16, 18 and herpes simplex virus (HSV) types 1, 2 was performed on the basis of anonymous data from 40 521 patients examined for sexually transmitted pathogens by real-time polymerase chain reaction (PCR). The studied biomaterial was delivered from 656 laboratory departments located in 284 settlements of all federal districts of the Russian Federation from January 2017 to June 2019.

Results. One and more of the eight pathogens were detected in 13.8% of patients, two or more pathogens simultaneously were detected in 1.4% of patients. The prevalence of viral infections was: 5.6% in HPV type 16, 1.8% in HPV type 18, 0.5% in HSV-1, and 1.6% in HSV-2. The highest percentage of patients in whom at least one infection was detected was in the age groups under 17 years (27.9%) and 18–25 years (19.8%). The distribution by gender in the groups varied, inversely: women predominated in the group under 17 years old (69%), men predominated in the group over 46 years old (71%). The prevalence of pathogenic bacteria was: C. trachomatis — 3.8%, M. genitalium — 1.5%, N. gonorrhoeae — 0.5%, T. vaginalis — 0.3%.

Discussion. The official incidence of STIs in Russia is significantly lower than that in the United States, which, in our opinion, may indicate not the stable situation in our country infection-wise, but inefficiency of registering STIs in Russia.

Conclusion. The data from the federal network of laboratories indicate a high prevalence of STIs in the Russian Federation. The existing STIs accounting system requires modernization. Introduction of the state national program for the Diagnosis, Treatment, and Prevention of STIs can be useful to reduce the spread of infections, improve the reproductive health of the population, and reduce the incidence of reproductive cancer.

Journal of Clinical Practice. 2019;10(3):35-41
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Extreme blood loss in cancer surgery: is it a verdict to the patient or a challenge to the staff?
Feoktistov P.I., Кarmanov I.E.
Abstract

Background. The development of anesthesiology allows performing combined operations in patients with locally advanced malignant tumors. A logical companion of aggressive cancer surgery is a massive blood loss, which can be so pronounced that it poses a threat to the life of the patient.

Objective. The presented experience is an example of transformation of a nearly fatal situation into a curable one and can be useful in choosing an active treatment strategy in most desperate situations.

Methods. This research includes 25 patients with the blood loss of 20 liters or more during surgery.

Results. The median ratio of infusion to blood loss was 133%, and the ratio of the infusion to all fluid losses amounted to 118%. In 100% of cases, catecholamines were used to support the blood circulation: one drug used in 12% of observations and two to five drugs used in 88% of observations. 2 patients died during the operation. 5 patients died in the early postoperative period from multiple organ failure. The cause of death of another 5 patients was septic complications before the 28th post-op day.

Discussion. Performing operations accompanied by acute massive blood loss requires an effective anesthetic support.

Conclusions. Enforcement of certain diagnostic and therapeutic conditions (stage construction of anesthesia, hemodynamic and laboratory monitoring, adequate venous access, rational infusion, timely use of catecholamines, using «cell-saver» device) in the majority of cases allows completing the operation with the surgical control of hemostasis and successfully enduring traumatic and complicated surgery in half of cases.

Journal of Clinical Practice. 2019;10(3):42-48
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Reviews
The strategy of surgical revascularization of coronary arteries in a multi-vessel lesion
Bocharov A.V., Popov L.V.
Abstract

This review presents the basic approaches for the surgical myocardial revascularization in patients with multivessel coronary lesions. The methods of coronary artery bypass grafting, balloon angioplasty, stenting using holometallic stents and drug-coated stents are discussed, the main studies comparing the above methods with each other and with the optimal drug therapy are presented. The concepts of complete and incomplete revascularization of the coronary bed are also explained.

Journal of Clinical Practice. 2019;10(3):49-54
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Magnetic resonanse imaging as a prognostic tool in encephalitis in children
Marchenko N.V., Voitenkov V.B., Skripchenko N.V., Kurzanceva O.O.
Abstract

We provide the data on the modern use of MRI of different modalities as a prognostic tool in the encephalitis diagnostics in pediatrics. According to the recent scientific knowledge, this implementation is possible, but its efficacy depends on the modality of MRI: structural, functional or MRI with contrast. Structural MRI efficacy in children with encephalitis is dubious and clearly depends on the etiology and phase of the inflammatory process. In the recent years, the implementation of the functional MRI methods (DTI & MRS) and MRI with contrast significantly changed the imaging practice; there are some reports that these modalities of MRI are more effective as a prognostic tool in encephalitis than the structural one. Thus, a future research in this field is needed.

Journal of Clinical Practice. 2019;10(3):55-60
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Minimally invasive methods of treatment of discogenic pain and facet syndrome in lumbar spine: literature review and own experience
Yarikov A.V., Denisov A.A., Dokish M.Y., Perlmutter O.A., Boyarshinov A.A., Pavlinov S.E., Lipatov K.S.
Abstract

This article presents modern methods for the treatment of the facet syndrome: chemical denervation, radiofrequency ablation, intraarticular injection of drugs into the cavity in the intervertebral joints. We analyze the contemporary approaches to the elimination of the disco-radicular conflict, such as chemical denervation of the disc, chemonucleolysis, mechanical decompression, intradiscal electrothermal therapy, laser nucleotomy, hydrodiscectomy, nucleoplasty, laser reconstruction of the disc. The pathogenetic substantiation of the above methods is discussed, and the positive and negative sides of each of them are described. Our own clinical results are also presented.

Journal of Clinical Practice. 2019;10(3):61-71
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Vibroarthrography, arthrophonography — methods for non-invasive detection of the knee cartilage damage
Akhpashev A.A., Fursenko G.V., Skvortsov D.V., Kaurkin S.N.
Abstract

Phonoarthrography, vibration arthrography are non-invasive methods for assessing the condition of cartilage and the knee joint as a whole based on the sounds made by the joint movement. Acoustic sensors (accelerometers, microphones) are attached to the knee to measure the knee joint noise both in control groups (young adults and elderly subjects) and in patients with knee osteoarthropathies. Different authors propose different methods for attaching sensors, documenting and analyzing the joint sounds. The identified specific features allowed distinguishing between asymptomatic knee joints and those with osteoarthropathies. Acoustic signals were recorded and processed, and their frequency characteristics were determined and classified. The classification effectiveness correlated with the existing diagnostic tests and hence phonoarthrography and vibration arthrography can be qualified as a useful diagnostic aid.

Journal of Clinical Practice. 2019;10(3):72-76
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Clinical case
First experience of simultaneous extrapleural lung resection with silicone plombage for widespread drug-resistant destructive pulmonary tuberculosis: a case report
Krasnikova E.V., Lepeha L.N., Aliev V.K., Tarasov R.V., Ergeshova A.E., Bagirov M.A.
Abstract

Background. The increase of the number of patients with drug-resistant forms of disseminated destructive lung tuberculosis dictates not only expansion of indications for a surgical treatment but development of new intraoperative techniques, which may reduce the risks of postsurgical complications and further progressing of tuberculosis. For a long-lasting chronic course of destructive drug-resistant tuberculosis, it is often impossible to reach the process stabilization necessary for a successful lung resection. Toracoplasty usually performed when the resection intervention is contraindicated is not only traumatic for a patient but also does not provide the proper lung compression.

Clinical case description. The clinical case is presented by disseminated fibrous-cavernous tuberculosis with a wide drug resistance of the pathogen, with the cavernous changes observed against the background of the pronounced lung tissue cirrhosis. To achieve the effect, we performed extrapleural lung resection followed by the immediate extrapleural silicone plombage in order to prevent overextension of the remaining part of the lung. The histological study data confirm the significant degree of the tuberculosis inflammation activity, in spite of the preceding long-term antituberculosis therapy.

Conclusion. Due to the low trauma and high efficiency, the operation of simultaneous extrapleural pneumolysis with silicone implant plombage may be used in the complex treatment of disseminated destructive pulmonary MDR/XDR TB with a chronic relapsing course of the disease.

Journal of Clinical Practice. 2019;10(3):77-82
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Treatment of giant follicular cyst of the upper jaw
Maximova N.V., Dulov F.V., Tkachuk M.F.
Abstract

Background. The article describes a clinical case of a successful surgical treatment of a large size follicular cyst pushing the anterior-inferior wall of the left maxillary sinus and the lower nasal concha, with the maxillary alveolar process osteoplasty.

Clinical case description. According to the results of cone beam computed tomography, the size of the follicular cyst before the treatment was 45.4–23.3–39.7 mm. After the endodontic treatment, cystectomy, cystostomy, plastic surgery of the alveolar process of the upper jaw, the bone defect is reduced by two times, disconnected from the oral cavity.

Conclusion. By the example of the presented clinical case, it has been shown that large jaw cysts require a multi-stage treatment with the participation of narrow specialists of related profiles.

Journal of Clinical Practice. 2019;10(3):83-90
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The role of computed tomography in the diagnosis of rare pelvic hernias on the example of strangulated hernia of the obturator canal: review
Egorov A.A., Donchenko N.S., Laypanov B.K., Koshelev E.G., Belyaev G.Y., Kurzantseva O.O., Melikhova M.V.
Abstract

Obturator hernia is a rare form of pelvic hernia that is more common in older women. The clinical diagnosis of hernia is difficult. This type of hernia cannot be visualized by a general examination, and it is also impossible to reveal it by palpation, that is why it is more often detected at the stage of complications and is accompanied by high mortality. This work presents observation of a strangulated hernia of the obturator canal in a 96-year-old patient diagnosed with computed tomography.

Journal of Clinical Practice. 2019;10(3):91-96
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A clinical case of hypertrophic cardiomyopathy and family hyperlipidemia
Dankovtseva E.N., Zateyshchikov D.A.
Abstract

Introduction of the next generation sequencing to the clinical practice made it possible to accurately diagnose a number of cardiac diseases, and to study accumulation of pathological variants of genes in families thus identifying individuals at risk of the disease much earlier. The authors present a patient with two genetically determined cardiological diseases — familial hyperlipidemia and hypertrophic cardiomyopathy.

Journal of Clinical Practice. 2019;10(3):97-101
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Giant retroperitoneal lipoma in a child: clinical case
Sagymbayeva A.A., Tursunov K.T., Jusupbekov E.А., Kaptagaev M.Е., Sagymbaуeva A.A.
Abstract

Retroperitoneal lipoma is extremely rare in pediatric practice. This article describes the diagnosis and treatment tactics of a clinical case of retroperitoneal lipoma in a 4- year-9-month-old child. The operative intervention is a rational method of this disease treatment.

Journal of Clinical Practice. 2019;10(3):102-105
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