[Management of surgical complications following prolonged warfarin therapy in a general surgical hospital]. / Lechenie khirurgicheskikh oslozhnenii prolongirovannoi terapiei varfarinom v obshchekhirurgicheskom statsionare.

OBJECTIVE: To analyze an effectiveness of algorithm for complex treatment of patients with surgical complications of prolonged warfarin therapy in a general surgical hospital. MATERIAL AND METHODS: The study included 138 patients with surgical complications of prolonged warfarin therapy. All patients received warfarin for at least 6 months (49.5% of patients - over 5 years). Warfarin therapy was indicated for deep vein thrombosis in 54 patients and various cardiac diseases in 84 patients. Examination included clinical and instrumental survey, laboratory tests and coagulation tests - thromboelastography (TEG) and thrombodynamics test (TT). RESULTS: Recurrent VTEC occurred in 24 out of 138 patients, hemorrhagic complications - in 114 patients. Therapeutic management was applied in 111 patients, 27 ones underwent surgery (emergency treatment - 25 patients, after two days - 2 patients). Ten patients underwent endoscopic hemostasis, two patients - ultrasound-assisted percutaneous drainage of hematoma. Recurrent VTECs were caused by inadequate laboratory control and violations of warfarin therapy. Most of these patients underwent therapeutic management (only 3 patients required surgery for life-threatening flotation in great veins). Treatment of 114 patients with hemorrhagic complications of prolonged warfarin therapy depended on features of bleeding and severity of warfarin-induced coagulopathy. Depending on these factors, warfarin was discontinued and intravenous administration of vitamin K / FFP / prothrombin complex concentrate was applied. This approach ensured successful therapeutic measures in 90 patients of this group. Twenty-four patients underwent surgery after correction of hemostatic disorders. TT was characterized by high efficiency in analysis of thrombotic predisposition and prediction of the risk of VTEC. TEG was valuable for assessment of warfarin-induced coagulopathy and treatment of patients with hemorrhagic complications of prolonged warfarin therapy. CONCLUSION: The developed clinical and diagnostic algorithm for management of hemorrhagic complications of prolonged warfarin therapy ensures positive clinical results even in a general surgical hospital.

[Optical sonography in differential diagnosis of thyroid nodes]. / Optosonografiya v differentsial'noi diagnostike uzlovykh obrazovanii shchitovidnoi zhelezy.

OBJECTIVE: To develop a non-invasive method for differential diagnosis of thyroid nodes. MATERIAL AND METHODS: Optical sonography was made in 623 patients with thyroid nodes including 374 women (60%) and 249 men (40%) aged 19-79 years (mean 64±15 years). All patients underwent ultrasound-assisted fine-needle aspiration biopsy. Cytological examination revealed cystic colloidal goiter (CCG) in 317 (51%) cases, follicular adenoma (FA) - in 197 (31.5%) cases, thyroid cancer - in 109 (17.5%) cases. All patients underwent surgery. Histological examination verified cystic colloidal goiter in 354 (56.8%) cases, follicular adenoma - 75 (12.0%) cases, thyroid cancer - 194 (31.2%) cases. Follicular cancer was diagnosed in 120 cases, papillary cancer - 70 cases, undifferentiated cancer - 4 cases. RESULTS AND CONCLUSION: Sensitivity, specificity and accuracy of optical ultrasonography in differential diagnosis of thyroid nodules were estimated. Sensitivity of ultrasonography in the diagnosis of thyroid malignancies was 0.75, specificity 0.62, accuracy 0.67. Sensitivity of ultrasonography in the diagnosis of thyroid adenoma was 0.85, specificity 0.62, accuracy 0.73. Sensitivity of optical sonography in the diagnosis of CCH was 0.62, specificity 0.61, accuracy 0.7. Optical sonography ensures differentiation of CCH and follicular adenoma, CCH and thyroid cancer, follicular adenoma and thyroid cancer. Sensitivity, specificity and accuracy of ultrasonography in differential diagnosis of FA and thyroid cancer are 0.85, 0.62, 0.73 and 0.8, 0.71, 0.7, respectively.

[Administration of the immunomodulatory drug aminodihydrophthalazinedione sodium for prevention of progression pneumonia induced COVID-19].

Aim to determine the efficacy of drug aminodihydrophthalazinedione sodium (Galavit) for prevention of progression of the coronavirus infection pulmonary complications: acceleration of regression of pulmonary infiltrates and resolution of COVID-induced pneumonia. 22 patients with medium and severe COVID-induced pneumonia were included in the study. The study included 8 men and 14 women, the average age was 62.17.4 years. Patients with more than one adverse prognostic factor made 82%. Average volume of pulmonary tissue affection (computer tomography CT-2, 2550% of lung volume) was registered in 13 (59.1%) patients, significant volume (CT-3, 5075% of lung volume), in 9 (40.9%) patients. All patients had progressive respiratory failure manifestations due to hypoxemia and related diseases. Aminodihydrophthalazinedione sodium was administered for 714 days from the beginning of disease, at the end of the course of standard complex therapy, in case of preservation of signs of intoxication, negative dynamics according to computer tomography data. Administration of aminodihydrophthalazinedione sodium had a positive effect on the dynamics of clinical scores. The progression of respiratory failure was halted and there was an increase in SpO2 values. According to the control computer tomography data the stabilization of the pulmonary parenchyma affection degree was noted, as well as reduction of the size of the compacted areas in the pulmonary tissue and formation of the picture of organising pneumonia that contributed to reduction of respiratory failure grade. The use of aminodihydrophthalazinedione sodium in complex therapy of COVID-induced pneumonia has a modulating effect on the immune system, prevents the progression of pulmonary tissue affection, promotes regression of infiltration foci, preventing the development of excessive pneumofibrosis and the progression of respiratory failure.

[Evolution of complex treatment of patients with non-specific pleural empyema]. / Évoliutsiia metodov kompleksnogo lecheniia bol'nykh s nespetsificheskoi émpiemoi plevry.

AIM: To analyze long-term own experience of NPE treatment in view of evolution of surgical sanitation of pleural cavity. MATERIAL AND METHODS: The analysis included 5115 patients with NPE for the last 39 years (1977-2015). Morbidity, features of microflora of purulent exudate, changes in the structure of surgical methods were assessed. The role of computed tomography in the diagnostic algorithm and treatment of NPE was studied. RESULTS: The evolution of NPE surgical management includes introduction of video technologies, thermal surgical instruments and widespread use of computed tomography in the diagnosis of pleural empyema. So, significant reduction of patients who were discharged with residual cavities was observed. Postoperative mortality was 19.5% for the period 1977-1996 when traumatic open surgery was used. At the same time there were no deaths within 1997-2015 due to introduction of VATS pleural drainage. Overall mortality decreased from 4.9% to 3.2% for the same period due to reduced postoperative complications. CONCLUSION: The introduction of minimally invasive technologies, new thermal surgical instruments changed management of NPE patients, reduced the number of traumatic open procedures. So, improved outcomes were achieved.