Abstract:

Aim: was to demonstrate possibilities of timely radiological diagnosis and treatment of spinal tuberculosis in a patient with a single lung after pleuropneumonectomy for fibrocavernous pulmonary tuberculosis.

Materials and methods: patient, 26 y.o. female, country inhabitant, grocery store clerk. She was hospitalized to the National Medical Research Center for Phthisiopulmonology and Infectious Diseases of the Ministry of Health of the Russian Federation with a diagnosis: “Tuberculosis spondylitis Th12-L2, focal tuberculosis S2 of the single right lung in the infiltration phase. M.Tb(-). Pleuropneumonectomy for fibrocavernous tuberculosis of left lung (December 18, 2018)”. To clarify etiology and lesion volume and to determine surgical treatment tactics, multispiral computed tomography (MSCT) of lungs and thoracolumbar spine and subsequent percutaneous trephine biopsy of the L1 vertebra were performed.

Results: according to MSCT data, destruction of Th12-L1-2 vertebral bodies was revealed; in single right lung, medium-intensity focal lesion with a diameter of 5 mm in C1, a small calcinate in C2, and a subpleural focal lesion in C4 were visualized. Small-focal dissemination was observed throughout the entire length of single lung. Bacteriological study of biological material taken during trephine biopsy revealed the growth of Mycobacterium tuberculosis, confirmed by diagnostics of polymerase chain reaction (PCR). Taking into account the pulmonary pathology, operation was performed in the volume of resection of Th12-L1-2 bodies and antero-lateral spinal fusion with a Mesh body replacement implant with bone autoplasty from left-side access, transpedicular fixation (TPF) of Th11-L3 with a four-screw structure under intraoperative radiation control. As a result of treatment, patient was discharged in a satisfactory condition.

Conclusions: presented case report demonstrates the importance of timely radiological diagnosis in patients with combined infectious lesions of lungs and spine for obtaining of complete information about the state of respiratory and bone systems, using MSCT and interventional radiology methods and for determination of pathological process etiology. It made it possible to perform timely diagnosis and complex surgical intervention with the most sparing and light surgical access to affected vertebrae in tuberculosis spondylitis from the side of previous pleuropneumonectomy.

References

1.     Giller DB, Martel’ II, Imagozhev YG, et al. An experience of single lung resection and pneumonectomy after contralateral lung resection in treatment of tuberculosis. Khirurgiya (Mosk). 2021; (1): 15-21 [In Russ].

https://doi.org/10.17116/hirurgia2015935-42

2.     Giller DB, Giller GV, Imagozhev YG. Surgical collapse in the treatment of single lung tuberculosis. Khirurgiia. 2021; (1): 15-21 [In Russ].

https://doi.org/10.17116/hirurgia202101115

3.     Mushkin AYu, Vishnevskiy AA, Peretsmanas EO, et al. Infectious Lesions of the Spine: Draft National Clinical Guidelines. Khirurgiya pozvonochnika. 2019; 16(4): 63-76 [In Russ].

https://doi.org/10.14531/ss2019.4.63-76

4.     Sovetova NA, Vasileva GYu, Soloveva NS. Tuberculous spondylitis in adults (clinical and radiographic manifestation). Tuberkulez I bolezni legkikh. 2014; (10): 33-37 [In Russ].

5.     Dunn RN, Ben Husien M. Spinal tuberculosis: review of current management. Bone Joint J. 2018; 1(100-B(4)): 425-431.

https://doi.org/10.1302/0301-620X.100B4.BJJ-2017- 1040.R1

Abstract:

Aim: was to analyze domestic and foreign literature sources, reflecting the possibility of applying local ablation methods of focal liver tumors.

Material and methods: article presents an analysis of domestic and foreign 37 publications containing information on the use of methods of local ablation of nodular pathology of liver, deposited in resources of PubMed and information portal eLIBRARY.RU.

Results: most important aspects of performing of methods of chemical, cryo-, microwave, and radiofrequency ablations, used in treatment of local liver tumors were presented.

Conclusion: analysis of various publications on methods of local destruction of tumors does not give a clear answer to the question of which method is preferred, however, article describes each of ablation methods, highlighting positive and negative aspects of their effect on lesions of the liver. The question of the inclusion of minimally invasive methods in schemes of combined and complex antitumor therapy for focal liver lesions also remains open.

Modern approaches and improving techniques of treatment of liver malignancies, expand indications for the use of minimally invasive techniques. Competent selection of patients, selection of the optimal method of local ablation of tumor and subsequent dynamic monitoring of patients reduce the number of relapses, increase the percentage of overall survival of patients and improve their quality of life.

References

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9.     Elgindy N, Lindholm H, Gunvйn P. High dose percutaneous ethanol injection therapy of liver tumors: patient acceptance and complications. Acta Radiologica. 2000; (5): 458-463.

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11.   Siperstein AE, Berber E. Cryoablation, Percutaneous Alcohol Injection, and Radiofrequency Ablation for Treatment of Neuroendocrine Liver Metastases. World. J. Surg. 2001; (25): 693-696.

12.   Chu KF, Dupuy DE. Thermal ablation of tumours: biological mechanisms and advances in therapy. Nat. Rev. Cancer. 2014; 3: 199-208.

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Abstract:

Open surgery is a basis of treatment of major vascular injuries, although some of injuries can be treated by means of endovascular surgery

Aim: was to investigate the possibility of endovascular treatment of full transection of major arteries. Material and methods: а retrospective analysis of patients histories of 52 patients with limbs' vascular injuries was performed. Opinions of physicians of different surgical specialties about practicability of endovascular technologies use in trauma surgery were investigated. Using a created stand-desk, consisted with container filled with gelatin mass, simulating a hematoma in a zone of vascular rupture, plunged into gelatin ends of silicone tubes 6 mm in internal diameter, and a web-camera fixed above the stand, comparative analysis of efficacy of 6 different methods of vessel recanalization was done.

Results: еndovascular methods of treatment can be performed in 42,3% of patients with major arterial injuries. Of those, 13,5% of patients may need to undergo recanalization of full vascular transection followed by stent-graft implantation. Our study demonstrated the possibility of through-and-through recanalization of the full major vascular transection, and most effective methods of recanalization - methods with use of a special endovascular loop, a retrieval device, and a standard folded guidewire. Preliminary balloon inflation inside a proximal part of the artery should be considered in case of unstable hemodynamics of a patient.

The questionnaire showed that integration of endovascular surgical methods is perspective for the future of trauma surgery; however, there are some retaining obstacles such as organizational and fiscal issues. It is likely that training of general surgeons in basic endovascular skills is practical. 

References

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2.    Samokhvalov I.M. Boevye povrezhdeniya magistral'nykh sosudov: diagnostika i lechenie na etapakh meditsinskoj evakuatsii. Diss. doct. med. nauk [Wartime major vascular injuries: diagnosis and treatment on echelons of care. Doct. med. sci. diss.]. St.Petersburg. 1994; 389 [In Russ].

3.     White J.M., Stannard A., Burkhardt G.E. et al. The epidemiology of vascular injury in the wars in Iraq and Afghanistan. Ann. Surg. 2011; 263(6):1184-1189. 

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8.     Reva V.A., Samokhvalov I.M. Endovaskulyarnaya khirurgiya na vojne. [Endovascular surgery in the war]. Angiologiya i sosudistaya khirurgiya. 2015; 21(2):166-175 [In Russ].

9.     Reva V.A., Semenov E.A., Petrov A.N. et al. Endovaskulyarnaya ballonnaya okklyuziya aorty: primenenie na statsionarnom i dogospital'nom ehtapakh skoroj meditsinskoj pomoshhi. [Endovascular balloon occlusion of the aorta: the use at in-hospital and pre-hospital stages of emergency medical care]. Skoraya meditsinskayapomoshh,'. 2016; 3:30-38.

10.   Reva V.A., Kiselev M.A., Platonov S.A. et al. Selektivnaja embolizacija vetvej glubokoj arterii bedra pri koloto-rezanom ranenii. [Selective angioembolization of the branches of the deep femoral artery in its stab injury]. Vestn. chir. irn. Grekova. 2015; 174(3):67-69 [In Russ].

11.   Bocharov S.M. Angiograficheskaya diagnostika i endovaskulyarnoe lechenie pri travme arterij. Diss. kand. med. nauk [Angiographic diagnosis and endovascular treatment in arterial trauma. Cand. med. sci. diss.]. Moscow. 2008: 103 [In Russ].

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13.   Reva V.A., Petrov A.N., Samokhvalov I.M. Stentirovanie poverhnostnoj bedrennoj arterii pri ee bokovom povrezhdenii. [Stenting of superficial femoral artery in correction of its side damage]. Diagn. Intern Radiol. 2014; 8(3):105-108 [In Russ].

14.   Villamaria C.Y, Eliason J.L., Napolitano L.M. et al. Endovascular Skills for Trauma and Resuscitative Surgery (ESTARS) course: curriculum development, content validation, and program assessment. J. Trauma Acute Care Surg. 2014; 76(4):929-935.

15.   Brenner M., Hoehn M., Pasley J. et al. Basic endovascular skills for trauma course: bridging the gap between endovascular techniques and the acute care surgeon. J. Trauma Acute Care Surg. 2014; 77(2):286-291.

16.   Reva V.A. Obuchajushhie kursy po hirurgii povrezhdenij i endovaskuljarnoj hirurgii pri travmah v Jerebru (Shvecija). [Educational course on trauma surgery and endovascular surgery for trauma in Orebro (Sweden)] . Voen.-med. Jowrn. 2015; 336(12):78-81 [In Russ].

17.   Tsurukiri J., Ohta S., Mishima S. et al. Availability of on-site acute vascular interventional radiology techniques performed by trained acute care specialists: A single-emergency center experience. J. Trauma Acute Care Surg. 2017; 82(1):126-132.

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21.   Gilani R., Tsai PI., Wall M.J. Jr., Mattox K.L. Overcoming challenges of endovascular treatment of complex subclavian and axillary artery injuries in hypotensive patients. J. Trauma Acute Care Surg. 2012; 73(3): 771-773. 

Abstract:

Our experience of percutaneous vertebroplasty - one of the most up-to-date methods of vertebral tumors treatment - is presented in the article.

The purpose of the work was to assess vertebroplasty as a method, improving quality of life. In the years 2001-2007 235 vertebroplasty procedures (168 patients) were done in Blokhin's Cancer Research Center. The most common diagnoses were metastases of renal carcinoma, breast carcinoma or multiple myeloma. The main indications for vertebroplasty procedure were chronic pain due to vertebral tumor progression and the loss of vertebral supporting function. Quality of life is shown to improve in the majority of the operated patients.

Relative simplicity of the percutaneous vertebroplasty and high effectiveness of the method allow us to recommend its widespread adoption in clinical practice. 

Reference

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Abstract:

The aim of the study was to assess effectiveness and safety of ioversol (Optiray). The contrast media used for angiography and endovascular interventions in 286 patients with coronary disease, peripheral atherosclerosis, liver and biliary disease, hysteromyoma etal. Optiray provided good visualization in 100% of cases at all vascular territories; it did not cause significant hemodynamic changes and was shown to have low allergenic capacity. As a rule, Optiray also did not affect aminotransferases serum concentrations or renal function, but in 1,4% of patients, in preexisting renal function impairment or known risk factors (diabetes, arterial hypertension) a rise of blood creatinine level was seen.

The results allow the authors to conclude that Optiray (Ioversol) satisfies all the requirements for modern contrast media. 

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Abstract:

A case report of successful treatment of a penetrating stab injury of the superficial femoral artery ir the adductor canal using uncovered stent. While stenting is usually used in major arteries for an intimal defeat and/or dissection due to blunt trauma, sometimes this type of penetrating injury pattern allows performing uncovered stent implantation. In this case report, it was a small side injury of vessel with the impression of the arterial wall inside the lumen resulting less than 50% stenosis and the absence of active extravasation during angiography Prior to stenting, balloon angioplasty was not effective to affect the intimal tear completely Good final angiographic and functional outcome with fast complete recovery let us draw a conclusion of the possibility of usage of uncovered stents Г certain cases with specific penetrating injury pattern.

Refernces

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2.     Rasmussen T.E., Clouse W.D., Peck M.A. et al. Development and implementation of endovascular capabilities in wartime. J. Trauma. 2008; 64 (5): 1169-1176.

3.     Teixeira P.G., Inaba K., Hadjizacharia P. et al. Preventable or potentially preventable mortality at a mature trauma center. J. Trauma. 2007; 63 (6): 1338-1347.

4.     Bocharov S.M. Angiograficheskaja diagnostika i jendovaskuljarnoe lechenie pri travme arterij. Diss. kand. med. nauk [Angiographic diagnosis and endovascular treatment in arterial trauma. Cand. med. sci. diss.]. Moscow. 2008: 103 [In Russ].

5.     Sin'kov M.A., Murashkovski A.L., Pogorelov E.A. et al. Endovaskulyarnoe zakrytie jatrogennogo arteriovenoznogo soust'ja podvzdoshnoj arterii i veny. [Endovascular closure of iatrogenic arteriovenous anastomosis of the iliac artery and vein]. Angiologiya i sosudistaya khirurgiya. 2014; 20 (1): 80-84. [In Russ].

6.     Chernyavskiy A.M., Osiev A.G., Grankin D.S. et al. Endovaskulyarniy metod lecheniya anevrizmy podkluchichnoi arterii s pomoschiu stent-graphta. [Endovascular method of treatment of subclavian artery aneurysm with stent-graft implantation]. Angiologiya i sosudistaya khirurgiya. 2003; 3: 122-123. [In Russ].

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8.     Nicholson A.A. Vascular radiology in trauma. Cardiovasc. Intervent. Radiol. 2004; 27 (2): 105-120.

9.     Assali A.R., Sdringola S., Moustapha A. et al. Endovascular repair of traumatic pseudoaneurysm by uncovered self-expandable stenting with or without transstent coiling of the aneurysm cavity. Catheter. Cardiovasc. Interv. 2001; 53 (2): 253-258.

10.   Fox N., Rajani R.R., Bokhari F. et al. Evaluation and management of penetrating lower extremity arterial trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J. Trauma Acute Care Surg. 2012; 73 (5, Suppl. 4): S315-S320.

11.   Sofue K., Sugimoto K., Mori T. et al. Endovascular uncovered Wallstent placement for life-threatening isolated iliac vein injury caused by blunt pelvic trauma. Jpn. J. Radiol. 2012; 30 (8): 680-683.