RESUMEN
OBJECTIVE: To analyze learning curves and appropriate experience on the features of mini-bypass surgery in 341 obese patients. MATERIAL AND METHODS: A total of 341 laparoscopic mini-gastric bypass surgeries performed by one surgeon were studied. The median age of patients was 40.5 [34; 48.3] years. There were 284 (83.2%) women and 57 (16.8%) men. The median BMI was 45 [40;52] kg/m2. RESULTS: The period of MGB development consisted of 138 interventions. Surgery time was 120 [100; 130] min and 90 [82.5; 100] mins after development of this technique (p=0.001). Complications occurred in 5 (1.5%) patients (1 patient with Clavien Dindo grade IIIA and 4 ones with grade IIIB). Of these, there were 3 patients with stapler suture defects. There were no complications only in the 4th quartile of surgeries. Surgical experience significantly affects postoperative outcomes. Surgery time was more influenced by surgical skill rather technique of anastomosis imposing. CONCLUSION: Polynomial regression objectively characterizes development of surgical skills lasting 138 interventions. MGB is safe for morbid obesity with a complication rate of 1.5% and no mortality.
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Derivación Gástrica , Laparoscopía , Curva de Aprendizaje , Obesidad Mórbida , Tempo Operativo , Complicaciones Posoperatorias , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Derivación Gástrica/métodos , Derivación Gástrica/efectos adversos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Laparoscopía/métodos , Laparoscopía/efectos adversos , Competencia Clínica , Índice de Masa Corporal , Federación de Rusia/epidemiología , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine the training period for imposing hepaticojejunostomy for bile duct repair. MATERIAL AND METHODS: Reconstructive surgery on the bile ducts was performed in 53 patients. We analyzed the learning curves based on the incidence of anastomotic leakage after hepaticojejunostomy. RESULTS: The learning curve has a downward nature. The number of anastomotic failures decreases by 2 times after 42 procedures. Surgeon had to perform 39-42 operations to reduce the incidence of this complication. CONCLUSION: Treatment of patients with iatrogenic intersections of the bile ducts should be provided in appropriate hospitals.
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Conductos Biliares , Procedimientos Quirúrgicos del Sistema Biliar , Humanos , Conductos Biliares/cirugía , Anastomosis Quirúrgica/efectos adversos , Fuga Anastomótica , HospitalesRESUMEN
OBJECTIVE: This work is to develop and use a new approach to the analysis of differences between the velocity profiles of registered light signals in groups of patients with schizophrenia and healthy donors. MATERIAL AND METHODS: The present study involved 62 patients (all female) with schizophrenia or schizoaffective disorders in the acute period (observational study - 2016-2017). 44 patients were diagnosed with paranoid schizophrenia with an attack-progredient type of course (F20.01 according to ICD-10) or with a continuous type of course (F20.02). The fibrinodynamics test (FD) was performed on the T-2 thrombodynamics device (Hemacore LLC, Moscow), which makes it possible to monitor the processes of coagulation and fibrinolysis in the cuvette channels filled with fresh blood plasma. The result of the test are the brightness profiles of the clot. RESULTS: In the proposed approach, each profile is characterized by a vector of distances between it and other analyzed profiles. At that the distances between the profiles are calculated as the sum of the modules of differences at different points of the observation interval. This method makes it possible to overcome a certain loss of information that occurs when using a standard method based on the calculation of several parameters that characterize the analyzed velocity profiles. The method includes the construction of all kinds of statistically significant piecewise linear regression models that link the distances to two profiles. The velocity profiles corresponding to the points lying on opposite sides of the break point of such models have significantly different shapes. In practice, it turns out that for many piecewise linear regression models, the break points also significantly separate the velocity profiles for the compared groups of donors and patients with schizophrenia. Statistically significant deviations at the level p≤0.01 exist for 16.1% of 3143 statistically significant piecewise linear models. CONCLUSION: The developed method makes it possible to visually establish the relationship between the shape of the velocity profile and the presence of the disease.
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Hemostasis , Trastornos Psicóticos , Humanos , Femenino , Modelos Lineales , Coagulación Sanguínea , Esquizofrenia ParanoideRESUMEN
OBJECTIVE: To assess the diagnostic efficiency of transcutaneous laryngeal ultrasound. MATERIAL AND METHODS: Ultrasound examination of the larynx and laryngoscopy was performed in 103 patients with thyroid disease. 26 (34.21%) patients who underwent surgery on the thyroid gland direct laryngoscopy and ultrasound of the vocal folds were performed twice, before and after the operation. RESULTS: Voice folds were visualized in 76 (73.8%) people. Of the 24 men, these anatomical structures were visualized in 8 (33.3%) and in 68 (86.1%) women out of 79 cases. Violations of the function of the vocal cords during laryngoscopy were detected in 5 people, sonographically in 6 people. The coincidence of the revealed pathology with ultrasound was in 4 patients, in 3 - with sonography the diagnosis was erroneous, in 1 patient it was falsely negative and in 2 cases it was falsely positive. CONCLUSIONS: In connection with the diagnostic capabilities of the method, it is advisable to use it as a screening study in the perioperative period in patients with diseases of the thyroid gland. Laryngoscopy is indicated for patients with non-visualized vocal folds, with identified pathology with ultrasound, and with clinical signs of dysfunction of the vocal cords.
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Laringe , Enfermedades de la Tiroides , Parálisis de los Pliegues Vocales , Femenino , Humanos , Laringe/diagnóstico por imagen , Masculino , Enfermedades de la Tiroides/diagnóstico , Enfermedades de la Tiroides/diagnóstico por imagen , Ultrasonografía/métodos , Parálisis de los Pliegues Vocales/diagnóstico , Parálisis de los Pliegues Vocales/etiología , Pliegues Vocales/diagnóstico por imagenRESUMEN
OBJECTIVE: To identify relationships between thrombodynamic values and the severity of the condition in patients with schizophrenia spectrum disorders (SSD) before and after treatment. MATERIAL AND METHODS: The study included 92 patients in an acute state of schizophrenia or schizotypal disorder, aged 16 to 57 years (median age [Q1; Q3] - 25 years). All patients received complex psychopharmacotherapy adequate to their psychopathological state. The PANSS was used to assess the severity of symptoms in patients. The coagulation parameters were determined by the thrombodynamics test, in which the growth of fibrin clots in platelet free plasma are observed from special activator. The patient population was divided into two groups with weak and strong response to treatment. Data analysis included machine learning (ML) techniques: logistic regression, random forests, decision trees, support vector machines with radial basis functions, statistically weighted syndromes, permutation method. RESULTS: An analysis using permutation method revealed statistically significant different thrombodynamics values between groups of patients with weak and strong responses. There are significant differences between thrombodynamics values: T1D, T2D, T2Tlag and DTlag, and values characterizing the severity of positive symptoms before and after treatment (T1PposTot, T2PposTot), severity of psychopathological symptoms before treatment (T1Ppsy1, T1Ppsy6, T1Ppsy13). All ML techniques showed the relationship between thrombodynamics values and response to treatment. The best statistical significance was for statistically weighted syndromes method. CONCLUSION: The combination of the results of different ML techniques at a high level of statistical significance identifies the thrombodynamic predictors of weak effect of treatment of SSD.
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Esquizofrenia , Coagulación Sanguínea , Plaquetas , Humanos , Aprendizaje Automático , Esquizofrenia/diagnóstico , Esquizofrenia/tratamiento farmacológico , Resultado del TratamientoRESUMEN
OBJECTIVE: To analyze assistants` influence on duration of surgery and learning period in minimally invasive video-assisted hemithyroidectomy. MATERIAL AND METHODS: The same surgeon performed 67 minimally invasive video-assisted hemithyroidectomies. Duration of surgery was analyzed in assistants with various number of interventions. Learning curves were designed using logarithmic function. RESULTS: Eight specialists with the same professional skill assisted to surgeon. Each of these specialists performed certain number of operations. Learning period made up 19, 26 and 44 procedures for mean numbers of assistances 21, 8 and 3, respectively. Duration of surgery in the group with 21 assistances was 63.96±2.94 min, for 3 assistances - 80.53±7.07 min in each of 6 assistants (z= -2.38; p<0.017). CONCLUSION: Constant surgeon`s assistants is a factor reducing surgery time. Higher number of operations with the same assistant has a reliable inverse correlation with surgery time and duration of learning period.
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Curva de Aprendizaje , Tempo Operativo , Tiroidectomía/métodos , Competencia Clínica , Conducta Cooperativa , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Cirujanos/normas , Tiroidectomía/normas , Cirugía Asistida por Video/métodosRESUMEN
OBJECTIVE: Analysis of national and foreign trials investigating accumulation of experience in innovative technologies using the learning curves. MATERIAL AND METHODS. S: Earching for Russian-language manuscripts was carried out within the references of the articles and in the ELIBRARY database. Foreign trials were selected from the PubMed database according to the keywords «learning curves in surgical practice¼. The discovered publications were studied for accordance with the objectives of this study. RESULTS: Accumulation of experience in new technologies by using of learning curves is valuable to improve the training, determine duration of development of new technology and the factors affecting its characteristics. CONCLUSION: The method is high-quality for comprehensive analysis of experience accumulation in new surgical technologies.
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Invenciones , Curva de Aprendizaje , Procedimientos Quirúrgicos Operativos/educación , Humanos , Federación de RusiaRESUMEN
OBJECTIVE: To determine validity and adequacy of the assessment of experience acquisition in video-assisted hemithyroidectomy, to compare surgical outcomes at the learning stage and in delayed period. MATERIAL AND METHODS: Experience acquisition was studied via assessment of the duration of video-assisted hemithyroidectomy in 67 patients who were operated by the same surgeon. Time of surgery was analyzed through between-group comparison of surgical outcomes. These groups were defined arbitrarily, in exponential fashion, using the logarithm method and moving average. Risks of failure regarding duration of surgery and postoperative complications were investigated using CUSUM analysis. RESULTS: Minimum period of experience accumulation in video-assisted hemithyroidectomy (26 procedures) was determined using logarithmic analysis, maximum period (66 interventions) - using CUSUM analysis. Other approaches also showed sharp nature of the learning curve.CUSUM analysis of failures at the learning stage showed 2-fold decrease of their probability after 66 operations. However, even experience acquisitiondoes not exclude risk of failures in hemithyroidectomy. CONCLUSION: Arbitrary division of the cohort of patients seems to be unreasonable because clear number of operations necessary to achieve sustainable results does not follow it.Mathematical methods adequately reflect experience accumulation and allow determining the required number of interventions for stable results and minimum complication rate.
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Curva de Aprendizaje , Enfermedades de la Tiroides/cirugía , Tiroidectomía/métodos , Cirugía Asistida por Video/métodos , Estudios de Cohortes , Humanos , Tiroidectomía/efectos adversos , Tiroidectomía/estadística & datos numéricos , Cirugía Asistida por Video/efectos adversos , Cirugía Asistida por Video/estadística & datos numéricosRESUMEN
AIM: To analyze the ways and terms of training for laparoscopy-assisted reconstruction operations via learning curves analysis and to compare the outcomes obtained both during training for technique and after that. MATERIAL AND METHODS: There were 93 reconstructive laparoscopic procedures in 58 (62.36%) patients with terminal colostomy. All patients were operated by the same surgeon. Learning curves have been created and analyzed. RESULTS: Analysis showed that all surgical features are achieved by the 30th intervention indicating the end of learning period. Significantly less surgical trauma has been observed along with development of surgery. CONCLUSION: Improved results are achieved by reduced dissection of adhesions, the use of mechanical suture for intestinal anastomosis and increased number of anastomoses made in intracorporeal fashion.
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Competencia Clínica/normas , Colectomía , Colostomía , Laparoscopía , Colectomía/efectos adversos , Colectomía/educación , Colectomía/métodos , Colostomía/efectos adversos , Colostomía/educación , Colostomía/métodos , Femenino , Humanos , Laparoscopía/efectos adversos , Laparoscopía/educación , Laparoscopía/métodos , Curva de Aprendizaje , Masculino , Persona de Mediana Edad , Mejoramiento de la Calidad , Federación de RusiaRESUMEN
AIM: To assess the risk of thrombotic events in patients with schizophrenia and schizoaffective disorder based on 'fibrinodynamics' technology. MATERIAL AND METHODS: A group of 76 women, including 38 with paranoid schizophrenia (F20.0), 18 with schizoaffective disorder (F25.1) in the acute stage, and 20 healthy controls, participated in the study. The technology includes the study of coagulation and fibrinolysis, Karmin author software, and calculation of peak time and hemostasis potential of spontaneous clots. Growth and lysis of fibrin clots were studied in plasma purified from platelets. All preanalytic procedures were conducted within 30 minutes after blood sampling. Blood serum was studied separately using the neuroimmunological test. Dynamic of brightness profiles of the clots was determined and a number of parameters (peak time and hemostasis potential of spontaneous clots) were calculated using the Karmin software. RESULTS: In patients with schizophrenia, the dynamic brightness profile of the clots has two peaks: the first peak is formed as a result of the growth and lysis of the clot initiated by the activator, the second peak is due to the growth and lysis of spontaneous clots in the volume of the measuring cuvette far from the activator. In healthy donors, the second peak under experimental conditions is absent. In the group of schizophrenic patients, a strong negative correlation is observed between the peak time of the second peak and the activity of leukocyte elastase (Spearman R = -0.75, p<0.0001), i.e. the greater the activity of elastase, the earlier the maximum of the second peak is formed and vice versa. In the control group, there is no such correlation. Evaluation of the potential of hemostasis of spontaneous clots showed that in 42% of schizophrenic patients this parameter is shifted above the norm, which indicates an increased risk of thrombosis of small brain arteries in these patients. CONCLUSION: The developed technology of 'fibrinodynamics' has a good potential for introduction into personalized medicine to identify increased risks of thrombosis of small cerebral vessels in patients with acute schizophrenia leading to the development of cognitive disorders and to control the normalization of hemostasis with antiplatelet or anticoagulant drugs.
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Fibrina/análisis , Trastornos Psicóticos/sangre , Esquizofrenia Paranoide/sangre , Trombosis/diagnóstico , Adulto , Anticoagulantes/farmacología , Anticoagulantes/uso terapéutico , Coagulación Sanguínea/efectos de los fármacos , Plaquetas/efectos de los fármacos , Femenino , Fibrinólisis , Hemostasis/efectos de los fármacos , Humanos , Persona de Mediana Edad , Trastornos Psicóticos/complicaciones , Medición de Riesgo , Esquizofrenia Paranoide/complicaciones , Programas Informáticos , Trombosis/complicaciones , Trombosis/prevención & controlRESUMEN
It was performed comparative analysis of results of reconstructive operations in 116 patients with terminal colostomy after urgent obstructive resection of colon. Damage of reconstructive operations which differ by only access was estimated. Midline access was used in 49 patients, parastomal - in 51 cases. Laparoscopic operation was applied in 16 patients. The most traumatic method was middle laparotomy for restoration of colonic integrity. Laparoscopic operations and parastomal access are less invasive. Laparoscopic operations are accompanied by longer duration, greater blood loss and later restoration of intestinal motility pattern in comparison with surgery through parastomal access. It is associated with duration and damage of adhesiotomy stage.
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Anastomosis Quirúrgica , Colon/cirugía , Colostomía/rehabilitación , Laparoscopía , Laparotomía , Complicaciones Posoperatorias , Adulto , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Anastomosis Quirúrgica/mortalidad , Colectomía/métodos , Colon/patología , Colostomía/métodos , Investigación sobre la Eficacia Comparativa , Femenino , Humanos , Obstrucción Intestinal/cirugía , Laparoscopía/efectos adversos , Laparoscopía/métodos , Laparotomía/efectos adversos , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Periodo Posoperatorio , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Under analyses there were reparative operations on 79 patients with end colostomies performed using medial access in 42 patients and parastomal access in 37 patients. The investigation of prevalence of the adhesive process in 61 patients has shown that marked adhesions were formed in the area of the medial scar in 41 (67.2%) patients, the stump of the suppressed gut--in 31 (50.9%) patients and colostomy--in 27 (44.3%) Reestablishment of intestine continuity from the parastomal access allowed avoidance of adhesions in the zone of the medial postoperative scar which shortened the time of operation and decreased the level of intra- and postoperative complications.