Lietuvos chirurgija
Not a member yet
718 research outputs found
Sort by
An Ileo-ceco-colo-colic Intussusception in a 12-Year-Old Female: A Case Report and Review of the Literature
Get PDFIntroduction. Intussusception is a leading cause of acute intestinal obstruction in young children, most commonly occurring between 6 months and 2 years of age. However, it becomes increasingly rare in older pediatric populations and often presents with atypical features. Among the uncommon variants, ileo-ceco-colo-colic intussusception – where the terminal ileum, cecum, and segments of the colon invaginate into the distal colon – represents an extremely rare and complex entity. Prompt recognition and timely intervention are essential to prevent complications such as bowel ischemia and necrosis. Case presentation. We present the case of a 12-year-old previously healthy female who arrived at the emergency department with acute onset abdominal pain, bilious vomiting, and rectal bleeding. Abdominal ultrasound and contrast-enhanced CT scan revealed a long-segment intussusception involving the terminal ileum, cecum, ascending colon, and extending into the transverse colon. Attempts at non-operative (pneumatic) reduction were unsuccessful. Due to clinical signs of peritonism and suspected bowel ischemia, an emergency exploratory laparotomy was performed. Intraoperative findings confirmed a non-reducible intussusception with segments of non-viable bowel. A right hemicolectomy with primary ileocolic anastomosis was carried out. Histopathological analysis demonstrated hypertrophied Peyer’s patches as a possible lead point, without evidence of malignancy or other pathological lesions. Conclusions. This case illustrates a rare and advanced form of intussusception in an older pediatric patient. Given its atypical presentation and increased likelihood of underlying pathology, older children with suspected intussusception warrant thorough evaluation and early surgical consideration. This report emphasizes the importance of maintaining a high index of suspicion, utilizing appropriate imaging modalities, and pursuing timely surgical management when non-operative reduction fails or complications arise
Traumatic Brain Injury: A Study from the Middle-East
Get PDFBackground. Traumatic head injuries represent one of the major causes of mortality and long-term disability worldwide. This main objective of this study was to explore the patterns, severity, and outcomes of these injuries. Methods. An observational, descriptive, retrospective study was carried out utilizing a validated data collection sheet, after attaining a proper ethical committee approval. Well-defined exclusion and inclusion criteria were applied. Results. There were 185 patients enrolled in the study, including 153 (82.7%) males and 32 (47%) females, with a mean age of 41.5 years. Road traffic accidents were the most frequent cause of injury, followed by falls, machinery-related accidents, and assaults. A conservative strategy was used to treat 101 (54.6%) of the patients, whereas various surgical procedures were performed on 84 (45.4%). Outcomes were related to Glasgow Coma score on presentation and favorable in 135 (73%) patients. Conclusions. Road traffic accidents and falls from heights are the leading causes of traumatic brain injury. As a result, preventive measures including road safety and workplace regulations must be addressed
Pilvo traumos gydymas taikant laparoskopiją
Get PDFObjective. To review scientific articles dealing with the use of laparoscopy in the treatment of abdominal trauma. Methods. The PubMed database was searched for scientific articles published between 2015-01-01 and 2024-09-01. The search keywords used were: laparoscopy, therapeutic laparoscopy, blunt abdominal trauma, penetrating abdominal trauma. Results. Four articles were included in the final evaluation. Methods, main findings, conclusions and recommendations are presented. Conclusions. Based on the results and conclusions of the published articles, the minimally invasive surgical technique of laparoscopy is an important and effective tool in the diagnosis and management of abdominal trauma. Laparoscopy has advantages over open surgery, including a lower risk of complications, faster recovery and better cosmetic results. It is important to consider the contraindications to laparoscopy and to select patients appropriately for this treatment. Adequate hospital infrastructure and qualified medical staff are also required to ensure the success of the operation. Laparoscopy is an effective treatment option for abdominal injuries, helping to reduce the risk of complications and the length of hospital stay.ikslas. Apžvelgti mokslinius straipsnius, kuriuose nagrinėjamas laparoskopijos taikymas gydant trauminius pilvo sužalojimus. Metodai. Atlikta mokslinių straipsnių, publikuotų nuo 2015-01-01 iki 2024-09-01, paieška PubMed duomenų bazėje. Paieškai naudoti reikšminiai žodžiai: laparoscopy, therapeutic laparoscopy, blunt abdominal trauma, penetrating abdominal trauma. Rezultatai. Į sisteminę apžvalgą įtraukti keturi straipsniai. Pateikiami atliktų tyrimų metodai, pagrindiniai rezultatai, išvados ir rekomendacijos. Išvados. Remiantis publikuotų straipsnių rezultatais ir išvadomis, galima teigti, kad minimaliai invazinis chirurgijos metodas – laparoskopija – yra svarbi ir efektyvi priemonė trauminiams pilvo sužalojimams diagnozuoti ir gydyti. Laparoskopija, palyginti su laparotomija, pasižymi šiais privalumais: mažesnė komplikacijų tikimybė, pacientas greičiau sveiksta, geresnis kosmetinis rezultatas. Svarbu atsižvelgti į laparoskopijos kontraindikacijas ir tinkamai atrinkti pacientus, kuriems taikytinas šis gydymo būdas. Siekiant užtikrinti operacijos sėkmę, taip pat svarbu tinkama ligoninės infrastruktūra ir kvalifikuoti medicinos specialistai. Laparoskopija efektyvi pilvo sužalojimams gydyti. Ji pasižymi maža komplikacijų rizika ir trumpa hospitalizacija
Intrathoracic Sewing Needle in an Infant: An Unusual Case of Foreign Body Migration
Get PDFForeign body incidents are common in children, primarily involving ingestion or inhalation. However, transcutaneous migration of sharp objects like sewing needles into the thoracic cavity is exceptionally rare and potentially dangerous. We report a unique case of an intrathoracic sewing needle in a six-month-old infant, highlighting the diagnostic challenges, imaging findings, surgical approach, and the clinical outcome
Aesthetic Correction of Gynecomastia with Liposuction and Limited Access Breast Excision – an Experience
Get PDFBackground. Gynecomastia is the most common breast disorder in males and is characterized by benign enlargement of glandular tissue. Surgical management options are adopted if it fails to resolve spontaneously or if conservative measures are ineffective in alleviating symptoms. Liposuction with limited access mammary gland excision is one such option. Aim of the study. This study was undertaken to study the outcomes of gynecomastia treated with liposuction and limited access mammary gland excision. Methods. The data related to the patients was analysed retrospectively and multiple variables were studied which included the demographics, grading, complications, and patient satisfaction. Results. 85.4% of patients were highly satisfied or satisfied with the outcomes, and 78.9% witnessed significant improvement in psychosocial distress. Minor complications were recorded in 35.4% of cases, and histopathological analysis of retrieved breast tissue specimens revealed benign features in all the patients. Conclusions. There are several surgical treatments for managing gynecomastia that either fails to resolve spontaneously or causes distressing symptoms. Liposuction with limited access mammary gland excision is one such option and is highly successful
Experience of Using NPWT Therapy in the Treatment of Combat Injuries of Soft Tissues
Get PDFAim. NPWT therapy (Negative-Pressure Wound Therapy) or VAC therapy (Vacuum-Assisted Clousure) – a modern method of wound healing, which significantly improves the course of all stages of the wound process and is relevant today due to the large number of wounded during hostilities in eastern Ukraine. Often these injuries are combined and lead to the formation of large soft tissue defects. The aim of the study. Improving the results of treatment of the wounded with extensive defects of the soft tissues of the torso and extremities through the use of NPWT therapy. Materials and methods. Under our supervision in the period from 2017 to 2023 there were 60 wounded who were hospitalized in the surgical departments of the Military Medical Clinical Center of the Southern Region, who received vacuum therapy in the treatment of wounds. 63.3% had gunshot wounds to the extremities, and 36.7% had soft tissue injuries to the torso. The age of the wounded ranged from 19 to 58 years, among them young people under 30 years of age. Before installing the device, it was necessary to perform surgical treatment with excision of necrotic tissue and removal of fibrin layers. Negative pressure was set at –125 mmHg (arterial) in the non-stop mode for soft tissue defects of the extremities and variable pressure in the –40 mmHg (arterial) mode; –70 mmHg (arterial) for wounds of the anterior abdominal wall. The duration of treatment with NPWT therapy was from 5 to 25 days. The systems were replaced at least once every 3–5 days. Criteria for discontinuation of NPWT therapy were: cleansing the wound of necrotized tissues and fibrin, improving clinical performance, filling the wound defect with granulation tissue. Results and discussion. The use of this method of treatment allowed to close wound defects by autodermoplasty in 35% patients, primary-delayed sutures in 18%, secondary sutures in 25% and local tissue plastics in 22%. Complications after NPWT therapy in the form of re-suppuration of the wound, bleeding or perforation of hollow organs and large vessels were not observed. Conclusions. The use of NPWT therapy can significantly increase the effectiveness of comprehensive treatment of the wounded with damage to the soft tissues of the torso and extremities. It allows you to quickly clean the wound surface, fill the wound defect with granulation tissue and prepare the wound for plastic closure
An Evaluation of Quality of Life after Ventral Hernia Repair Using the EuraHS-QoL Score: a Cross-Sectional Survey
Get PDFIntroduction. Recurrence rates for ventral hernia repairs are practically negligible because of advancements in surgical procedures. Pain and suffering, which significantly lowers patients’ quality of life, are currently the main concerns with ventral hernia repair rather than the possibility of recurrence. This study used “EuraHS-QoL” score for evaluating the quality of life of patients before and after ventral hernia repair. Methods. A prospective observational study involving patients with ventral hernias receiving surgery from May to December 2023. Using the EuraHS-QoL questionnaire, patients’ quality of life was evaluated both before and after surgery. Results. Of the 53 patients, 17 (32%) were men and 36 (68%) women, with a mean age of 49.71±10.9 years (range, 32–68 years). BMIs averaged 25.4±3.4 kg/m2, range (21.25 to 35.4 kg/m2). The majority of pain was from regular duties. By frequency, umbilical (22%), infraumbilical (43.3%), supraumbilical (5.7%), and numerous (19%) hernia sites exist. Three patients suffered surgery site infections and one had skin dehiscence. All patients showed overall improvement of QoL at the end of 90 days
Edukacinio 3D virtualiosios realybės vaizdo metodo įtaka ruošiant žarnyną kolonoskopijai: pirmieji rezultatai
Get PDFObjective. Adequate bowel preparation is essential for diagnostic, screening, surveillance, and therapeutic colonoscopy. 3D virtual reality (3D-VR) has the characteristics of depth, interactivity and visuality and is widely used in medicine, so it can be used for patient education and training. The aim of our study is to determine the impact of using 3D virtual reality video for patients education on bowel preparation before colonoscopy. Materials and methods. A prospective, blind, randomized clinical trial was launched at the Republican Vilnius University Hospital (RVUL) on 07.03.2021, which included 50 outpatients who had indications for colonoscopy until 28.02.2022. Patients were randomly assigned to control and experimental groups. The first group was given the bowel preparation information in the standard form used by RVUL – in writing, and the second – in a 3D virtual reality video. The content of the information provided to both groups was the same. The quality of bowel preparation was assessed based on the Boston and Ottawa bowel preparation scales. Results. Of the 50 outpatients who participated in the study, 26 were assigned to the control group, 24 to the study group. The patients of both groups were identical in terms of sex, age, body mass index, comorbidities. The mean (SD) BBPS score was statistically significantly lower in the control group compared to the 3D-VR video group (5.96(±1) vs. 7.58(±1.47); p < 0.001). The mean (SD) scores of OBPS were higher in the control group (6.58(±2.44) than in the study group 1.83(±2.32); p < 0.001). The rate of adequate bowel preparation in the 3D-VR video group was higher than in the control group (18(69.23%) vs. 23(95.83%); the difference was statistically significant (p = 0.024)). The rate of terminal ileum intubation in the control group was 50% compared to 83.33% in the 3D-VR video group (p = 0.02).The mean (SD) colonoscopy time was statistically significantly shorter in the 3D-VR video group 23.04(±3.66) minutes and 16.5(±4.28) minutes, p = <0.001. Conclusions. Patients who were informed by 3D-VR method before colonoscopy had statistically significantly better bowel preparation, as well as reduced procedure time and possibly increased detection rates of polyps and adenomas.Tikslas. Diagnostinei, atrankinei, stebėjimo ir terapinei (gydomajai) kolonoskopijai atlikti būtina tinkamai paruošti žarnyną. 3D virtualiajai realybei (3D-VR) būdingas gilumas, sąveika ir vaizdingumas, ji plačiai naudojama medicinoje, todėl gali būti taikoma pacientams informuoti ir mokyti. Straipsnyje aptariamo tyrimo tikslas – nustatyti 3D virtualiosios realybės vaizdo naudojimo edukacijai įtaką pacientų žarnynui paruošti prieš atliekant kolonoskopiją. Medžiaga ir metodai. Respublikinėje Vilniaus universitetinėje ligoninėje (RVUL) 2021-03-07 pradėtas perspektyvusis, aklasis, atsitiktinių imčių klinikinis tyrimas. Iki 2022-02-28 į šį tyrimą įtraukta 50 ambulatorinių pacientų, kuriems indikuota atlikti kolonoskopiją. Pacientai atsitiktiniu būdu suskirstyti į kontrolinę ir tiriamąją grupes. Pirmajai grupei informacija apie žarnyno paruošimą suteikta RVUL naudojama standartine forma – raštu, antrajai grupei – 3D virtualiosios realybės vaizdo įrašu. Abiem grupėms teikiamos informacijos turinys buvo vienodas. Žarnyno paruošimo kokybė vertinta remiantis Bostono ir Otavos žarnyno paruošimo skalėmis. Rezultatai. Iš ٥٠ tyrime dalyvavusių ambulatorinių pacientų 26 priskirti kontrolinei, 24 – tiriamajai grupei. Abi grupės buvo tapačios pagal lyties, amžiaus, kūno masės indekso, gretutinių susirgimų rodiklius. Vidutinis (SD) BŽPS balas buvo statistiškai reikšmingai mažesnis kontrolinėje grupėje, palyginti su 3D-VR vaizdo įrašą stebėjusių tiriamųjų grupe (plg.: 5,96(±1) ir 7,58(±1,47); p < 0,001). Vidutiniai (SD) OŽPS balai buvo didesni kontrolinėje grupėje (6,58(±2,44), palyginti su tiriamąja grupe (1,83(±2,32); p < 0,001). Tinkamo žarnyno paruošimo rodiklis 3D-VR vaizdo įrašą stebėjusiųjų grupėje buvo didesnis negu kontrolinėje grupėje (plg.: 18 (69,23 %) ir 23 (95,83 %); skirtumas statistiškai reikšmingas (p = 0,024)). Ileum terminale intubacijos dažnis kontrolinėje grupėje siekė 50 proc. (plg. 3D-VR vaizdo įrašų grupėje – 83,33 proc.; p = 0,02). Vidutinis (SD) kolonoskopijos laikas buvo statistiškai reikšmingai trumpesnis tiriamųjų, stebėjusių 3D-VR vaizdo įrašą, grupėje (plg.: 23,04(±3,66) min. ir 16,5(±4,28) min.; p = <0,001). Išvados. Pacientų, kurie prieš kolonoskopiją informuoti 3D-VR metodu, žarnynas buvo paruoštas statistiškai reikšmingai geriau. Taip pat minėtinas sutrumpėjęs procedūros laikas, galimai padidėjęs polipų (adenomų) aptikimo dažnis
