Ukrainian Interventional Neuroradiology and Surgery最新文献

{"title":"Ways and methods of closing tissue defects of the middle zone of the facial skull after removal of malignant tumors with intracranial spread (case from practice)","authors":"T. Morozov, M. Kvasha","doi":"10.26683/2786-4855-2022-1(39)-40-49","DOIUrl":"https://doi.org/10.26683/2786-4855-2022-1(39)-40-49","url":null,"abstract":"A clinical case of locally advanced basal cell skin cancer with bone destruction is presented. Patient Ya., born in 1936, was under the supervision of doctors for basal cell skin cancer since 1982 (for 38 years). She was hospitalized in the department of extracerebral tumors of Romodanov Institute of Neurosurgery NAMS of Ukraine 09.27.2019. Multispiral computer and magnetic resonance imaging were performed.Considering the duration and spread of the tumor, the patient was offered an operation to remove the tumor within healthy tissue with resection of the auricle and parotidectomy. When receiving informed consent for surgical treatment, the patient put forward conditions regarding the scope of the operation: preservation of symmetry of the face, appearance of the face and integrity of the auricle. Surgery was performed, followed by symptomatic treatment. Reconstructive technologies for closing defects of the soft tissue of the facial skull were applied. She was operated on on October 4, 2019. The postoperative period was uneventful. Healing occurred by primary tension. The patient was discharged from the hospital in satisfactory condition on the 18th day (October 22, 2019). Postoperative distant gamma therapy was performed on the projection area of ​​the primary focus and the predominant anatomical routes of lymph drainage (total focus dose ‒ 45 Gy). Catamnesis postoperative ‒ 13 months. After 37 years, a relapse occurred with the tumor process involving all branches of the facial nerve, bones of the skull, metastasis to regional lymph nodes. The treatment was carried out at the Romodanov Institute of Neurosurgery NAMS of Ukraine. The patient did not consent to the extended scope of the surgical intervention, setting the condition of preserving the appearance. In this regard, the removal of affected tissues was carried out along the edge of the tumor invasion (without a reserve of healthy tissues) while preserving the trunk and branches of the facial nerve, i.e. in violation of the generally recognized principles of ablastics. The presented case of the course of the disease proves that timely radiation therapy at the first signs of a skin tumor contributes to a good clinical effect, which made it possible to achieve a long relapse-free period with a decent quality of life and full socialization. The progressive course of the disease (recurrence) justifies the feasibility of replacing large facial skull tissue defects after radical removal of parotid skin cancer with intracranial spread using the method of combining local plastic surgery and free skin flap transplantation, developed and implemented in the Department of Extracerebral Tumors.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115946113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The course of intracerebral hypertensive hemorrhages depending on age and gender","authors":"A. Kaminskyi","doi":"10.26683/2786-4855-2022-1(39)-22-26","DOIUrl":"https://doi.org/10.26683/2786-4855-2022-1(39)-22-26","url":null,"abstract":"Objective ‒ to analyze the clinical course of patients with intracerebral hypertensive hemorrhages depending on age and gender.Materials and methods. An analysis of the treatment of 238 patients with hypertensive intracerebral hemorrhages, who were treated at the Kyiv City Clinical Hospital of Emergency Medical Care from 2018‒2019, was conducted. The majority of patients were men (163).Results. The average age of patients was 60 years. Patients are divided into age groups according to the WHO classification (2016). Young age (18‒44 years) ‒ 25 (23 men and 2 women), average age (45‒59 years) ‒ 91 (74 men and 17 women), old age (60‒74 years) ‒ 90 (52 men and 38 women), old age (75‒90 years) ‒ 32 (14 men and 18 women). There are no long-lived people (>90 years). 84 patients were operated on, and 94 surgical interventions were performed. Patients with lobar and lateral hematomas, as well as with significant hemorrhages with a breakthrough in the ventricular system, who underwent fluid-draining surgical interventions, were operated on. The total mortality was 39.5 %. Surgical mortality rate was 46.4 %.Conclusions. According to the conducted analysis and the data of the Center for Medical Statistics of the Ministry of Health of Ukraine, the incidence of hemorrhagic stroke is many times more frequent in men, which is most likely due to a more aggressive lifestyle, lack of control over arterial hypertension, bad habits (alcohol consumption and smoking). The highest mortality rate was observed in elderly patients (47 %) and young patients (48 %), regardless of the patient’s condition at the time of admission.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116076307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revascularization in the treatment of acute ischemic stroke","authors":"M. Tonchev, A. O. Nos, V.M. Muzhevska, V. Plokhikh, V.M. Mitchenok, D. Shchehlov","doi":"10.26683/2786-4855-2022-1(39)-27-33","DOIUrl":"https://doi.org/10.26683/2786-4855-2022-1(39)-27-33","url":null,"abstract":"Objective ‒ to analyze the experience of providing care to patients with acute stroke in the conditions of the multidisciplinary neurosurgical department of Poltava Regional Clinical Hospital named after M.V. Sklifosovsky.Materials and methods. In the neurosurgical department in 2020 treated 1,148 patients aged 18 to 83, among whom 49 % were patients with acute stroke. Ischemic stroke was observed in 54.7 % of people, and hemorrhagic stroke in 45.3 %. A total of 173 patients with a diagnosis of acute ischemic stroke were hospitalized in 2020, of which 54 patients were delivered within 4.5 hours from the onset of the disease and received thrombolytic therapy and 20 patients within 6 hours who underwent mechanical thrombectomy, with of them, bridging was used in 5 patients. To determine the presence of signs of a stroke and pre-notification, the following scales were used: FAST and «МОЗОК-ЧАС». Neuroimaging was performed as an emergency using native SCT and SCT-angiography or MRT and MRT-angiography in 100 % of cases. To evaluate the results of neuroimaging, the ASPECTS scale was used for stroke in the anterior hemisphere and pc-ASPECTS – in the vertebrobasilar basin. The NIHSS scale was used to determine the severity of the patient; the following scales were used to determine the presence of occlusion of a large vessel: RACE, BRAIN2. A modified Rankin scale was used to assess the patient’s functional status. In the treatment of ischemic stroke, we divided all patients into 2 groups: the first – 41 % patients, who are subject to revascularization treatment, the second – 59 % patients, who are shown only optimal drug therapy. Revascularization had 2 treatment options. The first option provided for thrombolytic therapy in case of detection of small vessel occlusion, the second – mechanical thrombectomy in case of detection of large vessel occlusion. In cases where the patient was admitted within the therapeutic window, bridging therapy was performed, i.e. intravenous administration of plasminogen activator and simultaneous endovascular thrombectomy. In case of simultaneous detection of a stroke and a heart attack in a patient, the Canadian Stroke Best Practice Recommendations for Acute Stroke Management (2018) were used as a basis, according to which the specifics of the management of patients undergoing revascularization treatment are defined. The following EVT techniques were used in our study: ADAPT – in 5 % of patients, Solumbra – in 10 % of patients and SAVE – in 85 % of patients during endovascular thrombectomy.Results. Thrombolytic therapy was carried out – 31 % of the total number of treated patients with ischemic stroke, mechanical thrombectomy – 10 % of the total number of treated patients. Decompressive craniectomies were performed in 6 % of patients with ischemic stroke.Conclusions. Analysis of the results of treatment of patients with ischemic stroke using the above methods indicates a good result at discharge from the medical institutio","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123631747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and treatment of chronic subdural hematomas in elderly and senile age patients (own experience and current global trends)","authors":"L. Borovyk","doi":"10.26683/2786-4855-2021-4(38)-37-49","DOIUrl":"https://doi.org/10.26683/2786-4855-2021-4(38)-37-49","url":null,"abstract":"Objective ‒ to improve the treatment of chronic subdural hematoma (CSDH) in older people.Materials and methods. Retrospective analysis of the results of diagnosis and treatment of patients with CSDH treated in the Department of Neurotrauma of Romodanov Institute of Neurosurgery NAMS of Ukraine and Zaporizhzhya City Hospital for Emergency and Emergency Medicine in 2010–2019 was performed. The distribution by age was as follows: elderly patients – 80, patients senile age – 32, long-lived – 6. Multislice computed tomography was made in 86.7 % of patients, magnetic resonance imaging ‒ in 13.3 %. In 118 cases different types and volumes of surgical intervention were performed, in 58 ‒ conservative treatment.Results. The indication for surgery in elderly and senile patients with CSDH is the presence of hematoma ≥100 cm3 in the absence of dislocation syndrome. Concomitant somatic diseases were revealed in 95 % of cases. Treatment efficacy was monitored by dynamic magnetic resonance imaging studies (in 73.5 % cases) and multislice computed tomography (in 26.5 %). A comprehensive clinical and neurological examination was performed according to the modified Rankine scale, the Glasgow extended consequences scale, calculation of the Barthel index, after 1, 3 and 6 months. Postoperative complications: CSDH recurrence in 10 (6.0%) patients, mostly older than 60 years, pneumocephalus ‒ in 1 (0.84 %), meningoencephalitis ‒ in 1 (0.84 %) patients. Postoperative mortality was 6.8 % (8 cases). Conclusions. When choosing a method of treatment should be considered etiopathogenetic factors of hematoma formation, the severity of neuroimaging characteristics of CSDH, the degree of displacement of midline structures and neurological symptoms, somatic risks and the patient’s consent. The choice of treatment tactics for the elderly and senile is based not only on the Glasgow consequences scale and Markwalder grading score, but also on the scale of A.K. Thotakura et al. (Displacement of median structures and hematoma density (on the Hounsfield scale)). Removal of the hematoma is the main method of treating CSDH, aspiration of CSDH through burr holes followed by passive drainage is the method of choice. Conservative treatment of CSDH according to clear indications can be used both alone and in combination with surgical treatment.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125513126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction of a large scalp defect using a subcutaneous expander in a patient with the consequences of a cranio-brain injury and combined treatment of a head tumor","authors":"M. Tonchev, A. O. Nos","doi":"10.26683/2786-4855-2021-4(38)-59-66","DOIUrl":"https://doi.org/10.26683/2786-4855-2021-4(38)-59-66","url":null,"abstract":"The features of the treatment of a patient with a traumatic brain injury after radiation therapy were highlighted. It was demonstrated the need for choose a phased treatment for a patient with a combined pathology (cancer skin disease, traumatic brain injury, features of wound healing after a course of radiation therapy). A significant skin defect, radiation damage to the tissues of this area, and the presence of infection did not allow to solve the problem at once, so the method of choice was sequential staged treatment. The importance of the patient’s psycho-emotional state in the treatment process was shown. Since the pre-sence of concomitant pathology, the age of the patient, repeated surgical interventions over a relatively short period of time, infectious complications at the previous stages, led to a depressed psycho-emotional state of the patient, which affected the final result and led the patient to refuse plastic surgery of the skull defect. The authors note the need to involve a psychotherapist in the recovery process to improve the psycho-emotional state of patients with combined pathology and the possibility of conducting the final stage of treatment of the underlying pathology.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115143668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of results determination of level of vascular endothelial growth factor, receptor for vascular endothelial growth factor and big endotelin-1 in structure of arteriovenous malformations","authors":"I. Altman","doi":"10.26683/2786-4855-2021-4(38)-14-24","DOIUrl":"https://doi.org/10.26683/2786-4855-2021-4(38)-14-24","url":null,"abstract":"Objective ‒ to assess the diagnostic significance of angiogenesis factors based on the study of the level of angiogenesis factors (vascular endothelial growth factor (VEGF-A), specific receptor for vascular endothelial growth factor (VEGFR-1), endothelial inflammation factor (Big Endothelin-1)) in arterial and venous blood of patients with arteriovenous malformations (AVM) and healthy individuals without AVM. Materials and methods. In 2019–2021 a study according to the data of enzyme-linked immunosorbent assay the level of VEGF-A, VEGFR-1 and Big Endothelin-1 in the plasma of arterial and venous blood of 50 (19 (38.0 %) men and 31 (62.0 % women)) with AVM of different localization was carried out. The age of patients ranged from 3 to 51 years, the mean age ‒ (27.79 ± 2.19) years. The control group consisted of 35 healthy individuals (20 men and 15 women) without AVM. Patients with AVMs were divided into two groups: with small and medium-sized AVM in the stage of compensation (n=32) and with large and giant AVM in the stage of subcompensation or decompensation (n=18). Results. A significant (p < 0.05) difference was proved between the concentration of VEGF-A, VEGFR-1, Big Endothelin-1 in the plasma of arterial and venous blood of patients with AVM. This fact proves that the processes of pathological angiogenesis occur precisely in the structure of AVM. The value of VEGF-A, VEGFR-1 and BE-1 in patients with small and medium AVM was higher than in healthy individuals. The VEGF-A level was significantly (p < 0.05) in 2.4 times higher than in the control group, the VEGFR-1 level ‒ in 1.4 times, and the ET-1 level ‒ in 1.5 times. The value of VEGF-A, VEGFR-1 and BE-1 level in patients with large and giant AVM was significantly (p < 0.05) higher than in healthy individuals: VEGF-A ‒ in 7.2 times, VEGFR-1 ‒ in 2.36 times, and BE-1 ‒ in 1.7 times. Conclusions. The data obtained make it possible to statistically reliably state that the processes of pathological angiogenesis occur directly in the structure of AVM. A statistically significant dependence of the level of VEGF-A, VEGFR-1 and BE-1 in the blood plasma of patients on the size of the AVM and the stage of its compensation was revealed.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126907504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current experience of the treatment of multiple cerebral aneurysms (literature review)","authors":"D. Shchehlov, O.P. Gnelyca, M. Vyval, O. E. Sviridyuk, S. Konotopchyk","doi":"10.26683/2786-4855-2021-4(38)-50-58","DOIUrl":"https://doi.org/10.26683/2786-4855-2021-4(38)-50-58","url":null,"abstract":"Multiple cerebral aneurysms are found in one among four patients with aneurysmal subarachnoid hemorrhage. Nowadays, there is no clear consensus regarding the optimal treatment of multiple cerebral aneurysms. The papers published up to December 2021 containing the results of endovascular treatment of multiple cerebral aneurysms. Treatment strategy, surgical methods, complications associated with the procedure, and mortality rates were analyzed. The treatment of multiple cerebral aneurysms remains an unresolved problem of vascular neurosurgery, in particular, there is no consensus on the optimal method of treatment and timing. Current evidence-based data indicate the advantage of minimally invasive techniques in the treatment of multiple cerebral aneurysms due to the low risk of complications and the possibility of one-session procedure. The question of treat or not to treat of unruptured aneurysms in the presence of multiple aneurysms is a matter of debate. The choice between surgical methods (microsurgical clipping or endovascular coiling) or observation requires a multidisciplinary approach, taking into account the risks of rupture and the corresponding procedures.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122219553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The results of treatment of patients with tandem occlusions in the acute period of ischemic stroke","authors":"S. Konotopchyk, F.G. Rzayeva, O. Pastushyn, D. Shchehlov, M. Mamonova, O. Svyrydiuk, O. Kovalenko","doi":"10.26683/2786-4855-2021-4(38)-25-36","DOIUrl":"https://doi.org/10.26683/2786-4855-2021-4(38)-25-36","url":null,"abstract":"Objective – to evaluate the efficacy and safety of endovascular treatment in patients with acute ischemic stroke due to tandem occlusions.Materials and methods. The results of the examination and treatment of 237 patients with acute ischemic stroke due to large vessel occlusion who underwent endovascular reperfusion were analyzed. Tandem occlusions (internal carotid ‒ middle cerebral artery) were diagnosed in 65 (27.4 %) cases. Patient age ranged from 29 to 84 years (mean age ‒ 64.8 years). Men predominated among the patients (46 (70.8 %)). Among patients with ischemic stroke due to tandem occlusion, 29 (44.6 %) were diagnosed with atherothrombotic stroke subtype, 27 (41.5 %) had cardioembolic. In 9 (13.9 %) cases the cause of thrombosis was spontaneous dissection of the wall of the internal carotid artery. To assess collateral blood flow, the ACG scale proposed by the American Society for Interventional and Therapeutic Radiology was used. The quality of reperfusion was assessed using the eTICI scale. Analysis of the functional results of patients after 90 days from the onset of the disease was carried out according to the modified Rankine scale (mSR).Results. According to our study, a good angiographic result (eTICI 2b-3) was achieved in 54 (83.1 %) patients. Intraoperative complications were registered in 8 (12.3 %) cases. An analysis of the dependence of the quality of reperfusion on the severity of collateral compensation of a thrombosed artery showed that in patients with developed (ACG 3-4) collaterals (35 (53.8 %)) good reperfusion was achieved in 33 (94.3 %) cases, in patients with mild (ACG 0-2) collateral compensation (30 (46.2 %)) the quality of eTICI 2b-3 reperfusion was achieved only in 21 (70.0 %) cases. It was found that out of 40 (61.5 %) patients with tandem occlusion, in whom arterial puncture was performed within 6 hours after the onset of neurological symptoms, 15 (37.5 %) had 0-2 points for mSR after 90 days. When puncturing the artery later than 6 hours (25 (38.5 %) cases), a good result after 90 days was registered only in 7 (28.0 %) patients. Analysis of the influence of collaterals on the dynamics of changes according to multislice computed tomography revealed that patients with well-defined collaterals (35 (53.8 %) cases) during the control examination had ASPECTS scores from 1 to 9 points (average ‒ 5.3 points). Patients with mild collaterals (30 (46.2 %) observations)) on the ASPECTS scale during the control examination had from 0 to 6 points (average ‒ 2.2 points). During the first day or at the time of discharge, a statistically significant decrease in neurological deficit was observed in the group with successful restoration of cerebral blood flow findings.Conclusions. Many factors influence the clinical efficacy of endovascular reperfusion techniques: hypoperfusion area and area of brain damage according to computed tomography during hospitalization, quality of endovascular reperfusion, time from the onset of the d","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123739663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary approach to the diagnosis and treatment of hemobilia (Clinical case)","authors":"S.V. Plemyanik, A.D. Dembyk, S. Vereschagin, B. Bondarchuk","doi":"10.26683/2786-4855-2021-3(37)-77-81","DOIUrl":"https://doi.org/10.26683/2786-4855-2021-3(37)-77-81","url":null,"abstract":"Today, thanks to the development and implementation of new modern instrumental research methods in the daily practice of doctors, such as computed tomography with angiography, multispiral computed tomography, ultrasound examination of vessels with duplex scanning, celiacography, upper and lower mesentericography, etc. Every year, the information content of the above examination methods is growing, which will certainly lead to an increase in the frequency of detecting rare vascular pathologies that cause hemobilia. The method of treatment for this vascular pathology is endovascular embolization using embolizing coils and substances. A clinical case of a multidisciplinary approach to diagnosis and endovascular treatment is presented. a. gastroduodenalis with the formation of a pseudo-aneurysm (40 × 20 mm) with antegrade blood flow along a.pancreaticoduodenalis superior and a.gastroepiploica dextra distal to the aneurysm of a 28-year-old patient who was urgently hospitalized in the surgical department of Kyiv Regional Clinical Hospital. After the surgical treatment against the background of conservative treatment, the patient’s general condition improved and the hemoglobin level increased. A multidisciplinary approach helps to choose the right tactics for managing a patient, even with such a rare vascular pathology that has led to hemobilia. The gold standard for diagnosis and treatment hemobilia is angiography and endovascular embolization, which can be an alternative to open surgery, minimizes the risk of postoperative complications and reduces the rehabilitation period. If it is impossible to carry out the above technique or its ineffectiveness, further treatment is surgical.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128346406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting sustainable development goals and the challenge of reusing of the single use instruments in interventional radiology","authors":"M. Vyval, D. Shchehlov, S.V. Chebanyuk","doi":"10.26683/2786-4855-2021-3(37)-89-94","DOIUrl":"https://doi.org/10.26683/2786-4855-2021-3(37)-89-94","url":null,"abstract":"Interventional radiology has traditionally been at the forefront of the modern medicine, offering minimally invasive alternatives to surgical treatment with reducing of the length of hospital stay. The problem of medical waste and the recycling of medical supplies to support sustainable development goals in the health sector has entred a “green revolution” that aims to overcome global warming and fight with environmental pollution. Operating waste accounts for 20 to 70 % of all hospital waste, and many of them require special disposal. On the other hand, revenues for health care companies continue to rise, as do patient care costs, which are a huge burden for families and health systems, especially in low-income countries during COVID-19 pandemic. The issue of disposal and reuse of unique, expensive disposable radiological profile instruments is not widely reported in the scientific literature, but surveys among interventionists indicate that reuse exists even in countries where it is officially prohibited. Despite the emergence of regulations on the reuse of disposable instruments, it is largely carried out outside the quality standards. Also, manufacturers are not interested in reusing disposable instruments and often refuse to provide information on how they can be properly recycled and sterilized. Although well-remanufactured tools have significant promise, both for reducing healthcare costs and environmental pollution, and for spreading modern interventional technologies to the critical places where resources are limited and they can save lives.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128642932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}