Vol 10, No 3 (2019)

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.

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.

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.

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.

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.

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.

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.