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AIM: To assess the incidence of glucose metabolism disorders, administered hypoglycemic therapy and its effectiveness in a cohort of patients with previously diagnosed diabetes mellitus (DM) hospitalized for scheduled lower limb joint arthroplasty. MATERIALS AND METHODS: The study included 502 patients. Medical history, information about previously diagnosed DM and prescribed hypoglycemic therapy were collected in all patients according to medical documentation, as well as according to the patients' survey. Within the preoperative examination, the glucose level was measured, and in patients with previously diagnosed diabetes, measuremaent of the HbA1c level was recommended. RESULTS: The study population included 180 (35.9%) males and 322 females (64.1%). Among them, 99 (19.7%) patients had disorders of glucose metabolism [type 1 diabetes - 1 (0.2%) patient, type 2 diabetes - 90 (17.9%) patients, impaired glucose tolerance (IGT) - 8 (1.6%) patients]. In 8 patients, type 2 diabetes was newly diagnosed during the preoperative examination. HbA1c was measured before hospitalization in 26 patients with diabetes, the mean level was 7.0±1.4%. Regarding the analysis of hypoglycemic therapy, almost half of the patients with DM - 47 (47.5%) - received metformin monotherapy, 8 patients with IGT and 8 patients with newly diagnosed DM did not receive any drug therapy. Target glycemic levels during therapy were achieved in 36 (36.4%) patients, and target HbA1c levels were achieved in 21 patients. CONCLUSION: The cohort of patients hospitalized for elective lower limb joint arthroplasty is characterized by a relatively high incidence of glucose metabolism disorders, and in some patients, DM was newly diagnosed during the preoperative examination. Metformin is most often used as hypoglycemic therapy, and the target values of glycemia during treatment were achieved in less than half of the patients. The monitoring of the level of glycated hemoglobin is low and requires additional population analysis in order to determine the causes and optimize the strategy of patient management.
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Hemoglobina Glucada , Hipoglucemiantes , Humanos , Masculino , Femenino , Hipoglucemiantes/uso terapéutico , Hipoglucemiantes/administración & dosificación , Persona de Mediana Edad , Estudios Prospectivos , Hemoglobina Glucada/metabolismo , Hemoglobina Glucada/análisis , Anciano , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Glucemia/metabolismo , Trastornos del Metabolismo de la Glucosa/etiología , Trastornos del Metabolismo de la Glucosa/epidemiología , Trastornos del Metabolismo de la Glucosa/sangre , Federación de Rusia/epidemiología , Extremidad Inferior/cirugía , Artroplastia de Reemplazo de Rodilla/métodos , Procedimientos Quirúrgicos Electivos/métodosRESUMEN
OBJECTIVE: To analyze surgical strategy for nonspecific spondylitis of the craniovertebral region (CVR) taking into account clinical features and morphological signs of disease. MATERIAL AND METHODS: Eight patients with nonspecific spondylitis of CVR underwent surgery (4 women and 4 men aged 31-75 years). Three patients had pain syndrome, 5 ones - conduction disorders. Combined interventions were performed in 5 patients with neurological disorders. Of these, 3 patients underwent transoral decompression with subsequent occipitospondylodesis. In other cases, stages of surgical treatment were reverse. Four patients underwent simultaneous interventions, 1 patient - with 7-day interval. Patients with pain syndrome underwent occipitospondylodesis. RESULTS: In all patients, postoperative VAS score of pain syndrome decreased by 5-7 points (mean 5.5). Among 5 patients with conduction symptoms, regression of neurological disorders 1 year after surgery was achieved in 2 cases, and complete recovery was observed in 3 patients (Frankel E). In all cases, examination confirmed relief of inflammatory process and no compression of the spinal cord and medulla oblongata. One patient had a dehiscence of the wound edges of posterior pharyngeal wall, and another one had implant fracture in 3 years after surgery. CONCLUSION: Active surgical approach is reasonable for nonspecific spondylitis of CVR. Craniocervical fixation eliminates pain and risk of neurological complications following atlantoaxial instability. Conduction disorders require simultaneous transoral decompression and occipitospondylodesis in patients with nonspecific purulent craniovertebral lesions. Impaired head tilt complicates transoral stage. In this regard, it is more rational to carry out craniocervical fixation at the last stage.
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Espondilitis , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adulto , Espondilitis/cirugía , Espondilitis/diagnóstico por imagen , Descompresión Quirúrgica/métodos , Fusión Vertebral/métodosRESUMEN
AIM: To evaluate the changes in blood pressure (BP), the severity of pain syndrome and non-steroidal anti-inflammatory drugs (NSAIDs) use patterns in patients hospitalized for elective arthroplasty of large joints of the lower extremities during the postoperative period. MATERIALS AND METHODS: This study included 374 patients. In all patients, medical history, antihypertensive therapy and history of NSAIDs usage were collected, BP was measured, and the severity of pain was assessed via a 10-point scale before surgery, as well as 1 and 3 months after arthroplasty. RESULTS: The study included 132 (35.3%) males and 242 (64.7%) females. Among these, 289 (77.3%) patients had hypertension [grade 1 - 35 patients, grade 2 - 136 patients, grade 3 - 118 (25.0%) patients]; 280 (74.9%) patients were taking NSAIDs (121 - daily, 135 - 2-3 times per week). The median pain severity before surgery was 8 points [7; 9], 1 month after surgery - 2 points [1; 4], 3 months after surgery - 1 point [0; 3]. At 1 month after arthroplasty, 23 (7.9%) patients reported a decrease in BP. In 17 (5.9%) patients, correction of previously prescribed antihypertensive therapy with a decrease in drug doses was required. At 1 month after arthroplasty, 256 patients discontinued NSAIDs. The analysis of the relationship between the severity of pain, NSAIDs use and the level of BP revealed a significant effect of pain syndrome (p<0.0001) and the use of NSAIDs (p=0.014). CONCLUSION: In the population of patients with elective arthroplasty of large joints of the lower extremities, a significant incidence of hypertension and a high prevalence of NSAIDs use are noted. During the postoperative period, a significant trend towards a decrease in the severity of pain was found, as well as the relationship of pain and NSAIDs with a decrease in BP.
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Antihipertensivos , Hipertensión , Masculino , Femenino , Humanos , Presión Sanguínea , Dimensión del Dolor , Antihipertensivos/uso terapéutico , Antiinflamatorios no Esteroideos/efectos adversos , Dolor/tratamiento farmacológico , Artroplastia , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Extremidad InferiorRESUMEN
The authors report total resection of aggressive hemangioma of Th7 vertebra in a patient with severe conduction disorders in the lower extremities. Total Th7 spondylectomy (Tomita procedure) was performed. This method provided simultaneous en bloc resection of the vertebra and tumor via the same approach, eliminate spinal cord compression and perform stable circular fusion. Postoperative follow-up period was 6 months. Neurological disorders were evaluated using the Frankel scale, pain syndrome - visual analogue scale, muscle strength - MRC scale. Pain syndrome and motor disorders in the lower extremities regressed in 6 months after surgery. CT confirmed spinal fusion without signs of continued tumor growth. Literature data on surgical treatment of aggressive hemangiomas are reviewed.
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Hemangioma , Neoplasias de la Columna Vertebral , Humanos , Estudios de Seguimiento , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/cirugía , Columna Vertebral , Hemangioma/diagnóstico por imagen , Hemangioma/cirugía , Dolor , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/cirugía , Vértebras Torácicas/patología , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the effectiveness and safety of skip corpectomy in surgical treatment of cervical spondylotic myelopathy. MATERIAL AND METHODS: The study included 7 patients with cervical myelopathy following extended cervical spine stenosis. All patients underwent skip corpectomy. Clinical examination included degree of neurological disorders according to the modified scale of the Japanese Orthopedic Association (JOA) with assessment of recovery rate and Nurick score, as well as VAS score of pain syndrome. Verification of diagnosis was based on the data of spondylography, magnetic resonance and computed tomography. The indications for surgical treatment were conduction disorders and their spondylotic genesis confirmed by neuroimaging methods. RESULTS. VAS: Score of pain syndrome decreased by 2-4 points (mean 3.1) in long-term postoperative period. The JOA, Nurick scores and recovery rate (mean 42.5%) demonstrated significant improvement of neurological status in all patients. In all cases, the follow-up examination confirmed adequate decompression and spinal fusion. CONCLUSION: Skip corpectomy provides adequate spinal cord decompression in case of extended cervical spine stenosis and minimizes the risk of complications typical for multilevel corpectomy. Recovery rate indicates the effectiveness of this method in surgical treatment of cervical myelopathy caused by multilevel stenosis. However, further studies on sufficient clinical material are needed.
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Enfermedades de la Médula Espinal , Fusión Vertebral , Estenosis Espinal , Espondilosis , Humanos , Constricción Patológica/patología , Constricción Patológica/cirugía , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/cirugía , Descompresión Quirúrgica/métodos , Estenosis Espinal/diagnóstico por imagen , Estenosis Espinal/cirugía , Fusión Vertebral/métodos , Espondilosis/diagnóstico por imagen , Espondilosis/cirugía , Espondilosis/patología , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Vértebras Cervicales/patología , Dolor/patología , Dolor/cirugía , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
The authors describe surgical treatment of a patient with giant neuroma of thoracic spine. The patient underwent en-bloc resection of tumor via transthoracic extrapleural access. Technical nuances of surgery and operational capabilities of transthoracic extrapleural access for resection of neurogenic tumors of posterior mediastinum are demonstrated. Capabilities of transthoracic extrapleural access are comparable to thoracotomy. The first experience of transthoracic extrapleural access showed its effectiveness in resection of giant neuromas of thoracic spine. Indisputable advantage of this access is less surgical injury compared to thoracotomy. A brief literature review is presented.
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Neuroma , Neoplasias de la Columna Vertebral , Humanos , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/cirugía , Vértebras Torácicas/patología , Neuroma/patología , Neoplasias de la Columna Vertebral/cirugíaRESUMEN
OBJECTIVE: To analyze the results of herniated thoracic disc resection via transthoracic extrapleural approach. MATERIAL AND METHODS: The study included 16 patients with 18 symptomatic herniated thoracic discs wo underwent transthoracic extrapleural surgery. In 11 cases, clinical pattern of disease was represented by myelopathy with radicular or axial pain syndrome. Five patients had radiculopathy alone. Median localization of hernias was observed in 8 (44.4%) cases, paramedian hernias - in 10 (55.6%) cases. There were 10 (55.6%) ossified hernias, 5 (27.7%) giant, 10 (55.5%) large and 3 (16.6%) medium hernias. RESULTS: In most patients, VAS score of pain syndrome decreased by 2-6 points (mean 3.6). In 4 patients, this value remained the same. Among 11 patients with myelopathy, regression of conduction disorders in 1 year after surgery was achieved in 9 (82%) cases including complete recovery in 6 (55%) patients (Frankel E, Nurick - 0-I). In 2 patients, neurological status was equal to preoperative one. In all cases, the follow-up examination confirmed total removal of compressive substrate and found no signs of spine instability. Surgery time varied from 80 to 210 min (mean 161), blood loss - from 300 to 800 ml (mean 378 ml). Two patients had transient neurological deterioration. There was damage to dura mater in 4 cases. Intercostal neuralgia was observed in 3 patients. CONCLUSION: While retaining the advantages of open thoracotomy, transthoracic extrapleural approach is less traumatic, allows complete spinal cord decompression, minimizes the risk of iatrogenic spinal cord injury and avoids certain postoperative complications.
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Desplazamiento del Disco Intervertebral , Neuralgia , Enfermedades de la Médula Espinal , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/cirugía , Neuralgia/etiología , Estudios Retrospectivos , Enfermedades de la Médula Espinal/cirugía , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/cirugía , Resultado del TratamientoRESUMEN
Due to many negative and undesirable side effects from the use of permanent implants, the development of temporary implants based on biocompatible and biodegradable materials is a promising area of modern medicine. In the presented study, we have investigated complex-shaped iron-silicon (Fe-Si) scaffolds that can be used as potential biodegradable framework structures for solid implants for bone grafting. Since iron and silicon are biocompatible materials, and their alloy should also have biocompatibility. It has been demonstrated that cells, mesenchymal stromal cells derived from the human umbilical cord (UC-MSC) and 3T3, were attached to, spread, and proliferated on the Fe-Si scaffolds' surface. Most of UC-MSC and 3T3 remained viable, only single dead cells were observed. According to the results of biological testing, the scaffolds have shown that deposition of calcium phosphate particles occurs on day one in the scaffold at the defect site that can be used as a primary marker of osteodifferentiation. These results demonstrate that the 3D-printed porous iron-silicon (Fe-Si) alloy scaffolds are promising structures for bone grafting and regeneration.
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Hierro , Silicio , Implantes Absorbibles , Aleaciones/química , Humanos , Hierro/química , Porosidad , Impresión Tridimensional , Andamios del Tejido/químicaRESUMEN
The authors describe the result of combined surgical treatment of a patient with symptomatic multiple-level cervical spine stenosis following ossification of posterior longitudinal ligament. The first stage included decompressive laminectomy and cervical spine fusion using a screw. At the second stage, CIV-CV-CVI-CVII corporectomy with total resection of the ossified posterior longitudinal ligament and CIII-ThI corporodesis with a bone autograft were carried out. This approach was valuable to minimize the risk of iatrogenic damage to the spinal cord, eliminate long spinal stenosis and perform circular fusion of the cervical spine. These measures led to regression of cervical myelopathy symptoms. A brief review is presented.
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Osificación del Ligamento Longitudinal Posterior , Enfermedades de la Médula Espinal , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Descompresión Quirúrgica , Humanos , Laminectomía/efectos adversos , Ligamentos Longitudinales/diagnóstico por imagen , Ligamentos Longitudinales/cirugía , Imagen por Resonancia Magnética , Osificación del Ligamento Longitudinal Posterior/diagnóstico por imagen , Osificación del Ligamento Longitudinal Posterior/cirugía , Osteogénesis , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: The present study focuses on investigation of Intra-articular PDT mechanisms for OA treatment. Also, a search for determination of the most effective dose of chlorin e6 (Ce6) for anti-inflammatory PDT of OA was carried out. METHODS: The study was carried out on laboratory animals (11 Chinchilla rabbits, 1 year, 2.5 kg) with a gonarthritis model of post-traumatic OA. According to the instructions for using Photoditazin (Ce6 based PS) for PDT of human oncological and non-oncological diseases, the recommended dose is 0.7-1.2 mg/kg. For studies on rabbits, taking into account the conversion coefficient (3.2), the PS doses of 2.4, 3.2 and 6.4 mg/kg were selected. Fluorescence spectra were measured intra-articular before and after PDT using spectrometer with fiber-optic probe. The intrajoint PDT was carried out using a laser (662 ± 10 nm) and a fiber-optic catheter with a cylindrical diffuser inside a sapphire needle for a uniform distribution of the laser radiation. The immunohistochemical study was carried out by staining the samples with caspase-3. RESULTS: Histological and immunohistochemical analysis showed that the best PS dose for intravenous administration for PDT of rabbit gonarthritis is 3.2 mg/kg. The PS concentration directly in the synovial tissue was 0.5 mg/kg, and this was enough to achieve the most positive results to reduce the caspase-3 level. CONCLUSION: The caspase-3 level correlates well with other signs of inflammation in the synovial membrane (edema, etc.). Therefore, to assess the PDT effectiveness in the treatment of gonarthritis accompanied by synovitis, it is sufficient to analyze only for caspase-3. The efficacy of PDT with Ce6 showed that 3.2 mg/kg PS dose (1 mg/kg for a human) is the most effective.
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Osteoartritis , Fotoquimioterapia , Porfirinas , Animales , Caspasa 3 , Luz , Osteoartritis/tratamiento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/farmacología , Fármacos Fotosensibilizantes/uso terapéutico , ConejosRESUMEN
The objective of this study is definition of surgical treatment tactics of multilevel degenerative-dystrophic lesions of the lumbosacral spine in case of HIP-SPINE-syndrome. It was presented the experience of surgical treatment of multilevel degenerative-dystrophic lesions of the lumbosacral spine in 52 patients aged from 48 to 81 years. Lumbar stenosis prevailed in 38 (73.1%) cases. There was degenerative spondylolisthesis in 9 (17.3%) cases, and degenerative scoliosis was detected in 5 (9.6%) patients. Different types of decompressive-stabilizing interventions according to direction of compression and the presence of degenerative instability were performed in all patients. Evaluation of surgical treatment was done by using of visual analog scale and questionnaire Oswestry Disability Index. It was revealed significant improvement of life quality by reducing of pain and increasing of daily activity. Maximal time of observation was 36 months.