Bulletin of RSMU

ISSN Print 2500–1094 ISSN Online 2542–1204

Bulletin of RSMU

BIOMEDICAL JOURNAL OF PIROGOV UNIVERSITY (MOSCOW, RUSSIA)

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Krasenkova EA, Ovechkin AYu, Pyregov AV

Postoperative cognitive dysfunction (POCD) is a disorder that develops in the early postoperative period, persisting for several days or weeks and leading to decrease in higher cortical functions (speech, memory, attention, etc.). POCD is often associated with anesthetic techniques and drugs. This paper studied the effect of general, neuraxial and combined anesthesia on POCD development in elderly women undergoing gynecological surgery. The study featured 43 patients (mean age 65,0 ± 2.2 years). There were 12 women in the general anesthesia group, 23 in the neuraxial anesthesia group, and 8 women in the combined anesthesia group. Intraoperative monitoring included electrocardiography, non-invasive blood pressure measurement, determination of blood oxygen saturation level (rSO2) and determination of bispectral index (BIS monitoring). A day before surgery and on the 5th day after the surgery, neuropsychological tests were carried out through tracking test, Mini-Mental State Examination and frontal assessment battery. All intraoperative indicators were normal in all the patients. POCD was diagnosed in 3 women who were under general anesthesia, in 7 women under neuraxial anesthesia and 2 under the combined group (25, 30 and 25 % relative to the total number of patients in the groups, respectively). The average rSO2 value was below the initial level in all groups: below by 6 % in the general anesthesia group, by 15 % in the neuraxial group, and by 10 % in the combined group. However, the differences were statistically insignificant (p >0.05). The study found no relationship between anesthetic techniques and POCD.

Received: 2016-06-09

Published online: 2017-01-05

DOI: 10.24075/brsmu.2016-04-08

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VIEWS 5520

Kakhkharov RA, Flegontov AN, Mokhov NV

The emergence of modern neuroimaging techniques has allowed for effective identification of patients with Chiari malformation. It is now possible to create a more accurate picture of this anomaly. Different surgical treatments can now be developed but this has led to standardization issues and lack of uniform recommendations for treatment of patients with Chiari malformation. A study conducted by the authors found that surgery involving the opening of the dura mater and subsequent plastic reconstruction by autoplastic graft was the optimal surgery option (with respect to volume of surgical treatment of such patients).

Received: 2016-06-10

Published online: 2017-01-05

DOI: 10.24075/brsmu.2016-04-09

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VIEWS 6098

Belous AS, Biryukova YuK, Zatolokina MA, Lavrinenko KI, Loyko EA, Mal GS, Shevelev AB, Trubnikova EV

For many patients with lower limb ischemia, surgical treatment is not beneficial. We have studied the efficacy of combination therapy with sildenafil (Viagra) by Pfizer, France, and cerebrolysin (Ever Neuro Pharma, Austria) for lower limb ischemia in the Wistar rat model. The animals were divided into 6 groups (20 rats each): intact animals; sham-operated animals; rats with ischemia and no treatment administered (controls); rats with ischemia who received a 28-day monotherapy with sildenafil (2.2 mg/kg orally); rats with ischemia who received a 28-day monotherapy with 0.005 ml cerebrolysin; rats with ischemia who received a combination therapy with 2.2. mg/kg sildenafil for 7 days and 0.005 ml i. m. cerebrolysin for 10 days. Microcirculation in shin muscles was evaluated on days 21 and 28 of the experiment. On the same days, rats were overdosed with anesthetics and sacrificed in tens. Then, histological sections of shin muscles were prepared. Regional blood flow was significantly higher (p <0.05) in three experimental groups, compared to the controls; however, the combination therapy was far more effective than monotherapy, regardless of the medication used. Macroscopically, the muscles of the animals included into the experimental groups did not differ from the muscles of the intact animals; microscopically, no necrotic lesions were observed in the experimental groups that were typical for the ischemized rats who had received no treatment. Neovascularization was also observed in the experimental groups.

Received: 2016-08-20

Published online: 2017-01-05

DOI: 10.24075/brsmu.2016-04-10

Comments 0

VIEWS 5618

Shtilman MI

The review describes the use of biomaterials (polymeric biomaterials in particular) in the development of medical and biological products and devices, such as implants and endoprostheses; components of bioactive and pharmaceutical agents; carriers for bioengineering applications; sorbent agents and membrane systems used for the purification and separation of biological media; artificial biocatalysts, and general purpose biodegradable products. This review is provided with a short reference list of relevant monographs and reviews predominantly by Russian authors.

Received: 2016-10-21

Published online: 2017-01-05

DOI: 10.24075/brsmu.2016-05-01

Comments 0

VIEWS 6209

Razumovskiy AYu, Mokrushina OG, Shumikhin VS, Schapov NF, Petrova LV

Congenital diaphragmatic hernia (CDH) is an absolute indication for surgical treatment. In case of extensive defects of the diaphragm, such as diaphragmatic aplasia, the use of implants is required. So far, there is no unanimous opinion on the type of the implant. The article presents a comparative analysis of treatment of 40 newborns with left pseuso-CDH. All patients received thoracoscopic repair of the diaphragmatic cupula. The patients were divided into two groups according to the type of the implant: 16 newborns received Ecoflon synthetic implants (Ecoflon Scientific and Production Complex, Russia) and 24 newborns received Permacol biologic implants (Tissue Science Laboratories, UK). The study demonstrated superiority of the biologic implant. The use of this type of material allowed for the repair of the diaphragm and ensured a long-term positive outcome. In our opinion, the use of the biologic implant prevents inflammation in the area of repair and decreases relapse rates in patients with extensive diaphragmatic defects.

Received: 2016-10-18

Published online: 2017-01-05

DOI: 10.24075/brsmu.2016-05-02

Comments 0

VIEWS 5313

Demidov AA

The treatment of urinary incontinence in epispadias, which is malformation of the lower urinary tract, is a pressing problem due to the severity of congenital anatomic and functional pathology and the lack of a universal treatment to achieve urinary control. The aim of the study was to develop basic principles of surgical treatment of epispadias-related urinary incontinence. Additionally, we aimed to introduce into clinical practice the use of synthetic implants (synthetic slings) and evaluate treatment outcomes. The total of 20 boys aged 7–15 years received surgical treatment for subtotal and total epispadias. The first stage of surgical reconstruction was Cantwell’s phallo-urethroplasty followed by the placement of synthetic slings TVT, TVT-O, and AdVance. The children began to accumulate up to 250–550 ml of urine in any position of the body at relative rest and on effort, and were able to hold urine for up to 3 hours and to empty the bladder completely with normal flow. The total loss of urine per day decreased 10-15 times and did not exceed 10–30 ml. The lower urinary tract was evaluated using urodynamic (uroflowmetry, urethral profilometry) and electrophysiological (electroneuromyography) methods. Restoration of urethral anatomy leads to improved accumulative ability of the detrusor, and use of synthetic slings is a low-invasive and highly effective surgical method for treating urinary incontinence.

Received: 2016-10-12

Published online: 2017-01-05

DOI: 10.24075/brsmu.2016-05-03

Comments 0

VIEWS 5817

Alexandrov AV, Rybchenok VV, Lvov NV, Aleksandrova NE, Palinkash AM

Two-stage repair is a well-developed method that is commonly used to repair chronic ruptures of flexor digitorum profundus tendons. However, its use in pediatric hand surgery is limited due to the absence of tendon implants adapted for children. The article describes a modified Paneva-Holevich/Hunter technique for two-stage tendon reconstruction using original, oval, Lavsan-reinforced silicone prosthetic implants of four sizes (depending on patients’ age). The surgery was performed in 34 children aged 1.5–17 years. Long-term outcomes were assessed in 12 patients (8 boys and 4 girls) using the Total Active Motion scale. The follow-up period was 30 months. The average active range of motion accounted for 178.8° in boys and 218.8° in girls. The results of treatment (TAM %) were considered good in all the girls (average score of 84.3 %), and in those boys who received surgery for fingers IV and V (average score of 80.0 %). The boys who received tendon repair for fingers II and III had “good” and “poor” results (average score of 67.0 %). The proposed method of two-stage tendon repair of chronic tendon ruptures in fibro-synovial channels in children was shown to provide good results with minimal complication rates and acceptable donor site deficiency.

Received: 2016-09-28

Published online: 2017-01-05

DOI: 10.24075/brsmu.2016-05-04

Comments 0

VIEWS 6433

Khagurov RA, Alexandrov AV, Rybchenok VV, Glukhovskij EM, Velskaya YuI, Lvov NV, Koval SYu

The article describes the treatment of children with vast scar deformities and extensive benign soft tissue neoplasms. The method is presented in a clinical case of successful skin restoration using balloon skin expansion. The opinion and recommendations of the authors on optimal treatment of these defects and decrease of possible complications using laser Doppler flowmetry for evaluation of the state of microcirculation in the skin flap are based on the results of the long-term use of this method in the Department of Reconstructive and Plastic Microsurgery of Filatov Children’s Municipal Clinical Hospital No. 13.

Received: 2016-09-26

Published online: 2017-01-05

DOI: 10.24075/brsmu.2016-05-05

Comments 0

VIEWS 5246