Introduction . Conducting intraoperative neurophysiological monitoring in pregnant patients presents a complex challenge, as planning its protocol and choosing the anesthetic management requires consideration not only of the impact on the stability and reproducibility of the recorded neurophysiological parameters but also the specifi cs of pregnancy physiology and potential risks to the fetus. However, information regarding its use and safety is extremely scarce and requires further study. Case description . This article presents a clinical case of a 29-year-old patient who underwent surgery at the Neurosurgery Department of the Irkutsk Order of the Badge of Honor Regional Clinical Hospital at 29 weeks of gestation for an intradural tumor of the cauda equina nerve roots (ependymoma G2) at the L2–L3 vertebral level, with the use of intraoperative neurophysiological monitoring (IONM). Anesthetic management included combined endotracheal anesthesia in conjunction with an erector spinae plane block. The IONM protocol included recording of somatosensory evoked potentials from the lower extremities, free-run electromyography, and stimulated electromyography. During direct stimulation of the nerve root intimately adhered to the tumor, M-responses were obtained from the left lower leg muscles; the nerve root was preserved, and the tumor was mobilized and removed en bloc. No new neurological defi cit was observed in the early postoperative period; at the time of discharge, the condition of both the mother and the fetus was satisfactory. Conclusion . Thus, the use of IONM in pregnant patients with neurosurgical pathology improves the neurological outcome of the disease and is safe for both the mother and the fetus.
BACKGROUND. The etiology of plasmacytomas in multiple myeloma (MM) remains unclear, whereas the pathogenetic mechanisms of extramedullary lesions are of particular importance because of extremely poor prognosis. The incidence of bone and extramedullary plasmacytomas complicating the course of MM as well as the efficacy of therapy for this disease are still underresearched. AIM. To assess the incidence of bone and extramedullary plasmacytomas in patients with newly diagnosed MM (ndMM) and analyze the overall survival (OS) rates depending on whether soft-tissue components were detected. MATERIALS & METHODS. This multi-center prospective study enrolled 3184 ndMM patients (1339 men and 1845 women) from 40 regions of Russia, aged 24–90 years and treated during the period from January 2015 to October 2018. The electronic patient records included demographic, clinical, laboratory, and instrumental documentation data accessible on MM diagnosis date. Bortezomib-based regimens were administered in the first-line therapy to 94 % of patients. RESULTS. Bone and extramedullary plasmacytomas were diagnosed in 763 (24 %) out of 3184 ndMM patients. At disease onset, the median hemoglobin concentration was significantly higher in patients with bone (105 g/L) and extramedullary (102 g/L) plasmacytomas than in patients without them (95 g/L; p < 0.05). The median percentage of plasma cells in the bone marrow was significantly lower in cases of bone plasmacytoma accounting for 25 % vs. 30 % in cases of extramedullary components, and it was 31 % in patients without plasmacytomas at MM onset (p < 0.05). Most commonly, plasmacytomas were detected in the thoracic spine (24.3 %; n = 132) and ribs (13.6 %; n = 74). The median OS of patients without plasmacytomas was 46 months (95% confidence interval [95% CI] 43–49 months) vs. 38 months (95% CI 42–46 months) in patients with them (p = 0.1245). The median OS was 17 months (95% CI 10–35 months) in patients with extramedullary plasmacytomas and 13 months (95% CI 1–69 months) if soft-tissue components were detected in the bones of the lower extremities. CONCLUSION. The course of ndMM is complicated by bone plasmacytomas in 23 % of cases and extramedullary plasmacytomas in 1 % of cases. The antitumor response rate as well as the OS rates are similar in patients with and without bone plasmacytomas. Extramedullary lesions in MM are associated with extremely low rate of OS with the median not exceeding 17 months.
Objective : to present a clinical case of laparoscopic sleeve gastrectomy (LSG) performed for morbid obesity following liver transplantation (LT). Materials and methods . A female patient (born 1968) with primary biliary cirrhosis underwent orthotopic LT in 2019. Three years later, she required anterior abdominal wall repair for a postoperative hernia. Subsequently, progressive weight gain and deterioration in quality of life were observed. Despite significant intra-abdominal adhesions, LSG was performed. The postoperative period was uneventful. Results . The patient demonstrated significant weight loss, improved quality of life, and preserved graft function. Conclusion . LSG is an effective treatment for morbid obesity and its associated complications following LT.
RELEVANCE. Postnecrotic pancreatic pseudocysts complicated by bleeding from branches of the celiac axis, primarily the splenic artery (SA), are accompanied by rapidly worsening anemia, hemorrhagic shock, and high mortality. Open surgery at the height of hemorrhage in the presence of a pronounced adhesive process is time-consuming and traumatic. An alternative is endovascular SA occlusion, a rare and severe complication of which is dislocation of the embolic material into the celiac axis. Timely removal of the implant prevents liver necrosis. AIM OF STUDY. To present a clinical case of two-stage treatment of a bleeding pancreatic pseudocyst and complications of endovascular splenic artery occlusion. CLINICAL OBSERVATION. A 33-year-old woman was admitted to the clinic 8 hours after illness onset with complaints of abdominal pain, vomiting, and dizziness. Four years ago, the patient underwent surgery for pancreatic necrosis. The extent of surgical intervention was unknown. Multispiral computed tomography of the abdomen: multiple cysts in the pancreas, one of which contained a blood clot. Superselective contrasting of the splenic artery identified extravasation into the cyst cavity at the spleen hilum. We implanted a 10 mm–10 cm Flipper coil which dislocated into the aorta. The coil was removed by a retriever via femoral access. Repeated embolization of the splenic artery allowed us to control bleeding. After 8 hours of preoperative management, median laparotomy was performed. The cyst contained 1,100 ml of lysed blood and clots. Corporocaudal resection of the pancreas and splenectomy were performed. On the second day after relaparotomy, necrosis of the II–III segments and ischemia of the right lobe of the liver were diagnosed. Segments II and III were resected. Revision of the hepatic artery with a Fogarty catheter showed the absence of thrombotic masses. However, during celiography, the hepatic artery was not contrasted because of coil visualized in the celiac trunk. The coil was removed through the splenic artery stump. Blood flow in the common hepatic artery was restored. RESULTS. The patient was discharged on the 65th day. Check-up in 5 months revealed no complaints. The female gained 4,5 kg of weight. She adhered to the recommendations of the endocrinologist and gastroenterologist. CONCLUSIONS. Endovascular occlusion of the splenic artery provided safe hemostasis, which allowed preoperative management and decrease in blood loss intraoperatively. During the pancreas mobilization, the Flipper coil dislocated into the celiac trunk and the orifice of the common hepatic artery, thus inducing liver ischemia. Access through the splenic artery stump allowed the removal of the foreign body and liver revascularization.
