Science and Innovations in Medicine

The study of the morphofunctional features of various structures of the head and the neck, as well as their congenital and acquired changes, enables a better understanding of conditions that influence performance of endotracheal intubation. Knowledge of the patient’s individual anatomy enables one to forecast and to minimize incidence of intubation failure that might lead to adverse consequences, including dental trauma, damage to respiratory tract, hypoxic brain damage, and even death. As early as on the stage of collecting the patient’s history, the anesthesiologist has to anticipate possible complications and identify the factors that might lead to complicated intubation and provision of anesthetic support.

This study analyzes the functional peculiarities of the anatomical structures influencing the process of endotracheal intubation, that are considered in the scales for the assessment of difficult airways and that cause complications for the visibility of the glottis. The article also dwells on various diseases that could cause difficult intubation of the trachea. The generalized results of these studies may be instrumental in the development of new methods and approaches towards the tracheal intubation procedure.

Aim – to identify various structural variants of the bifurcation of the common carotid artery using the ultrasound imaging method, taking into account the age characteristics of patients.

Material and methods. We examined 1,061 patients (the average age was 57.0±10.7 years). Using ultrasound imaging, the anatomical variant of the bifurcation of the common carotid artery was determined, taking into account the location of the external and internal carotid arteries at the visualization level. The results were grouped according to the age and gender of the patients, statistically processed.

Results. 2,122 vascular complexes were studied (1,396 in women and 726 in men). Five main types of bifurcation structure of the common carotid artery (types A – E) were identified. Type A was the most common among all participants (up to 42%). Type B was detected in up to 35% of men and 27% of women. Type C accounted for 15-19% of cases. Other options were estimated at 4-7%. Taking into account the age, four groups were formed for men and women. At the same time, type A was 41-43% for women, regardless of age, and 31-40% for men. Type B in men in the age group 1 was detected in 48%. Type С was 2-4% more common among women in the age groups 2 and 3. In the older age group of men, type C was 31% and type E was 12% (the most common). In other age groups, D and E types accounted for 4-7%.

Conclusion. The results obtained contribute to the development of personalized directions in the treatment of vascular diseases and help to improve minimally invasive surgical interventions.

Aim – to study the correlations between age, disease duration, concomitant chronic non-infectious pathology and the risk of developing hypoglycemia in patients with type 2 diabetes mellitus (T2DM).

Material and methods. The study involved 90 elderly women (mean age 70.5 ± 6.2 years) with T2DM. The medical history of all study participants collected during the interviews was supported by the following analysis of their medical documentation. Additionally, we analyzed the results of clinical and biochemical blood tests and calculated the Charlson comorbidity index for all participants.

Results. The prevalence of hypoglycemia among patients with T2DM was: 47% in patients aged 65–74 years, and 75% in older patients (75–85 years). The significant correlation was found between the indicators “Patient’s age” and “Presence of hypoglycemia” r = 0.2489 (p = 0.018). When calculating χ² (chi-square), the value obtained was χ2 = 5.513 (p = 0.018). One-way analysis of variance of these values resulted in F-ratio = 5.811 at the significance level p = 0.018, which confirmed a significant relationship between the two variables. The significant correlation was found for the indicators “Existing cases of hypoglycemia” and “Duration of diabetes mellitus” (r = 0.3512 with a significance level of p = 0.0007). The data allowed us to draw a conclusion about the statistical dependence of these values. The result of the χ² test for the trend was χ² (trend) = 10.982 (p = 0.0009). The data obtained might indicate the relationship between these variables. The correlation between the indicators “Existing cases of hypoglycemia” and “Charlson Comorbidity Index score” was confirmed by the value r = 0.4020 (p = 0.0001). The relationship between these variables was revealed by calculating χ² = 16.336 (p = 0.0059). Based on the χ² test for the trend, the value χ² (trend) = 14.544 (p = 0.0001) was obtained. One-way analysis of variance for these indicators presented F-ratio = 3.734 (p = 0.004).

Conclusion. The patient's age, duration of T2DM and multimorbidity were significantly associated with the risk of hypoglycemia in patients with T2DM.

Aim – to develop a multivariate weighted assessment model for analyzing the influence of individual risk factors for acute ischemic cerebrovascular accidents on the course of ischemic stroke with concurrent carotid stenosis of varying severity.

Material and methods. The study involved 606 in-patients receiving treatment for the acute ischemic stroke. The patients were divided into three groups according to the NASCET scale for severity of carotid stenosis. In all patients, we identified the risk factors for the stroke development, the size of the ischemic locus according to the CT imaging, the patient’s condition at admission and discharge from the hospital using the NIHSS, Rankin, and Rivermead scales.

Results. The estimated indicators were represented by different measurement scales, so there was a need to bring them to the universal basis. A weighted assessment model required assigning weights for each component of the new index. A multivariate weighted assessment was modeled in order to identify the main factors influencing its variation. We selected the risk factors for acute ischemic cerebrovascular accidents, built the regression models, performed the statistical analysis and assessed their quality.

Conclusion. The regression models are helpful in covering a wide range of factors and mathematically expressing their relationship with performance indicators. The developed logistic regression models demonstrated the degree of positive or negative influence of various risk factors on the course of ischemic stroke in the studied groups of patients.

Colorectal cancer (CRC) with synchronous liver metastases remains a complex problem in modern oncology. Minimally invasive simultaneous surgeries are increasingly considered as an effective approach to treating this category of patients.

The article describes a clinical case in which laparoscopic simultaneous surgery was performed for rectal cancer with solitary liver metastasis. The patient successfully underwent simultaneous laparoscopic-assisted intra-abdominal rectal resection, with left hemihepatectomy, with resection of SV and SVIII of the right lobe of the liver.

The presented case demonstrates the effectiveness of laparoscopic access in performing simultaneous surgeries in patients with CRC and synchronous liver metastases. Further work in this direction will allow us to define more clearly the place of laparoscopy in performing simultaneous operations in surgical oncology.

Aim – to evaluate the long-term results of complex treatment of patients with locally advanced tongue cancer (T3-4N0-3M0) using modified selective intra-arterial polychemotherapy and systemic polychemotherapy.

Material and methods. Depending on the polychemotherapy regimen, taking into account the designated classifications, all patients were divided into two groups. The study group included 51 patients who received intra-arterial polychemotherapy according to the PF regimen, followed by radiation therapy. The control group included 50 patients who received intravenous polychemotherapy according to the PF regimen, followed by radiation therapy. With positive dynamics in the study group and the control group (partial tumor regression), surgical treatment was performed in the amount of hemiglossectomy. In case of complete tumor regression, the 2nd stage of the telegammatherapy course on the tongue was performed up to a total dose of 60 Gy. In case of oncological process stabilization, the 2nd stage of the telegammatherapy course on the tongue was performed up to a total dose of 60 Gy, followed by palliative courses of systemic polychemotherapy. In case of disease progression, palliative courses of systemic polychemotherapy were performed.

Results. Three-year survival in the study group was 80.1±6%, while in the control group it was 56.6±7% (p<0.05). Five-year survival among patients in the study group was 39.4±7%, while in the control group it was 2 times lower – 18.9±5% (p<0.05). About 7% of patients in the study group survived for more than 8 years.

Conclusions. The treatment regimen we developed for patients with locally advanced tongue cancer, which includes selective intra-arterial polychemotherapy followed by radiation therapy to the primary tumor and areas of regional metastasis, increased the median survival, three- and five-year survival.

Aim – to study predictors of successful performance of comprehensive genomic profiling and prescription of molecular targeted therapy for patients with advanced solid tumors.

Material and methods. We performed a retrospective single-center study of data of 104 patients who underwent comprehensive genomic profiling by targeted sequencing in the period of 2019 to 2023. The assessment of clinical significance of the identified genome alterations was performed using the scale for clinical actionability of molecular targets of the European Society for Medical Oncology (ESCAT). Analysis were performed of the mutation spectrum, efficiency of molecular targeted therapy, and its effect on survivability. Methods of logistical regression were used for the statistical analysis.

Results. Comprehensive genomic profiling was successfully performed in 87 patients (83.7%). Potentially targeted alterations were found in 44.8% patients, of which 11 persons received molecular targeted therapy. The main predictors of successful performance of comprehensive genomic profiling were the sufficient volume of tumors and lower number of revisions of biological material. Among the patients who received molecular targeted therapy, the overall median survival in the groups was 58 weeks as compared to the 35 weeks in the group of patients without molecular targeted therapy (р=0.097). In three patients, extraordinary response was noted.

Conclusion. The findings show clinical relevance of comprehensive genomic profiling in personalized treatment of solid tumors. The obtained data emphasize the need for careful selection of patients for comprehensive genomic profiling to improve its efficiency and availability.

Aim – to evaluate and analyze postoperative complications that occurred after joint-preserving operations and arthrodesis of the 1st metatarsophalangeal joint in combination with resection of the small ray heads on the forefoot in patients with rheumatoid arthritis.

Material and methods. Patients with rheumatoid arthritis (n-143) were divided into 2 groups depending on the surgical technique. 63 patients were included in group 1 (main group), 80 patients were included in group 2 (control group). Joint-preserving surgical techniques were used in group 1, and arthrodesis of the 1st metatarsophalangeal joint and resection of small rays were performed in the second group. The number of postoperative complications and their types in both groups were assessed, as well as the parameters influencing the occurrence of complications.

Results. There were 25 cases of complications in both groups, 13 cases (20.58%) in group 1, 12 cases (15%) in group 2. The distribution in groups 1 and 2 was as follows: recurrence of deformities of 1 finger (9.52% and 0%), recurrence of deformities of 2-5 fingers (3.17% and 5%), pain in VAS ≥ 60 mm (4.76% and 5%), formation of pseudoarthrosis (0% and 1.25%), instability of metal structures (3.17% and 2.50%), trophic disorders (0% and 1.25%), respectively. A correlation was found between the activity of rheumatoid arthritis ≥ 3.98 points on the DAS28 scale and an increased incidence of postoperative complications.

Conclusion. The results obtained in both groups indicate that joint-preserving techniques for surgical correction of deformities of the forefoot in patients with rheumatoid arthritis, as well as standard ones, are recommended for use in compliance with indications and contraindications.

Aim – to develop a three-stage algorithm for maxillary reconstruction with the Autoplan software suite to improve the results of surgical treatment.

Material and methods. 110 patients with maxillary defects were included in the study and were divided into the main (60) and control (50) groups. The three-stage algorithm and the Autoplan software suite were used to perform reconstructive procedures only in the main group. All the postoperative results were assessed in a period of six months after the surgery.

Results. Good aesthetic result was noted in 29 (48.33%) cases in the main group and in 17 (34%) cases in the control group (p<0.001). The differences between the main and control groups in functional results are statistically significant (p<0.05): good speech quality: 31 (86.11%) in the main group, 22 (78.57%) in the control group (p=0,047). Diet without limitations: main group, 26 cases (72.22%), control group, 18 cases (64.29%) (p=0,042). The mean time of the reconstructive stage using scapular flap: main group, 210 (35) minutes, control group, 300 (35) minutes (time reduction by 30 (13.4)%; fibular flap: main group, 180 (16) minutes, control group, 260 (36) minutes (time reduction by 30.77 (11.2)%; ALT flap: main group, 175 (17) minutes, control group, 220 (33) minutes (time reduction by 20.45 (13.3)%; radial flap: main group, 130 (12) minutes, control group, 170 (12) minutes (time reduction by 23.53 (8.1)% (p<0,001).

Conclusion. It can be concluded that incorporation of additive technologies, personalized attachment systems, and preoperative planning are crucial components of contemporary reconstructive surgery. This approach not only helps to streamline surgical procedures but also contributes to favorable functional and aesthetic outcomes.