Relevance. Acute respiratory infection COVID-19 caused by the SARS-CoV-2 (2019-nCov) coronavirus is severe and extremely severe in 15—20% of cases, which is accompanied by the need for respiratory support. Hyperbaric oxygenation is recognized as an effective therapy for replenishing any form of oxygen debt.Aim of study. To study the safety of HBO use in patients with COVID-19.Material and metods. We examined 32 patients with the diagnosis “Coronavirus infection caused by the virus SARS-CoV-2” (10 — moderately severe patients (CT 1–2), 22 — patients in serious condition (CT 3–4), who received course of hyperbaric oxygenation (HBO). The procedures were carried out in a Sechrist 2800 chamber (USA) at a mode of 1.4–1.6 AT for no more than 60 minutes. In total, the patients received 141 HBO sessions. Before and after each HBO session, the subjective indicators of the patient’s condition were assessed and the blood oxygen saturation was measured.Results. An algorithm for HBO course management was developed, which consists in using “soft” modes (up to 1.4 AT) during the first session, followed by pressure adjustment (not higher than 1.6 AT) during the course to achieve maximum therapeutic effect and comfort for the patient. Against the background of the HBO course, the patients showed an increase in blood oxygen saturation in patients in both surveyed groups, as well as positive dynamics in the form of a decrease in shortness of breath, an improvement in general well-being.Conclusion. The inclusion of daily sessions (at least 4) of hyperbaric oxygenation in “soft” modes (1.4–1.6 ATA) in the complex therapy for COVID-19 has shown its safety and preliminary positive effect on the subjective state of the examined patients and the dynamics of blood oxygen saturation.
AIM OF STUDY: to improve the results of surgical treatment of patients with endocrine ophthalmopathy complicated by optical neuropathy. For this, medial orbitotomy and decompression of the optic nerve were performed for a patient with endocrine ophthalmopathy, CAS<3, OD=18 mm, OS=23 mm and visual acuity OD=1.0 OS=0.2, using transorbital transconjunctival endoscopic access. The first step was a retro caruncular incision. After that, we defined an access to the medial wall of the orbit with its subsequent resection. Then, we performed ethmoidectomy and approach to the optic nerve canal. Upon completion of bone decompression, we opened periorbitis.RESULTS. The postoperative period was uneventful. In the early postoperative period, regression of exophthalmos was observed OD=18 mm, OS=20 mm, improvement in visual acuity OD=1.0 OS=0.5 . No complications were recorded. A satisfactory result was obtained.CONCLUSION. Transorbital endoscopic medial orbitotomy and optic decompression can be effectively used in the treatment of patients with endocrine ophthalmopathy complicated by optic neuropathy, refractory to conservative therapy. The technique is promising and requires further randomized studies.
The study objective is to analyze the results of surgical treatment of patients with endocrine ophthalmopathy using minimally invasive transorbital approaches and intraoperative frameless neuronavigation.Materials and methods. The study was based on the results of examination and surgical treatment of 9 patients with endocrine ophthalmopathy (17 orbits) in the period from 2015 to 2017. At the first stage the preoperative computed tomography images of the orbits was imported into the navigation software program, and then the area of the proposed resection of the orbit walls was marked. Further, in the operating room, the patient head position was registered in the navigation system. To perform bone decompression of the orbit and lipectomy, we used preseptal, transcaruncular and lateral retrocanthal approaches. These approaches are transconjunctival and do not leave postoperative scars. Upon completion of the orbitotomy, its accuracy and dimensions were determined by the intraoperative pointer of the neuronavigation system.Results. The postoperative period was uneventful. In all patients, according to clinical examination and computed tomography, good cosmetic and functional results were achieved. Only 1 patient developed a simblypharon after transconjunctival access, which required additional intervention to reconstruct the lower eyelid. There were no other complications of surgical treatment. The minimum degree of regression of exophthalmos was 3 mm, the maximum 7 mm. Diplopia completely regressed in 2 patients. The observation period was 6 months.Conclusion. Minimally invasive transorbital approaches allow the transconjunctival view of all orbital walls to perform decompression of the orbit and lipectomy without cutaneous incisions, to achieve good cosmetic and functional results. The intraoperative use of the neuronavigation system ensures the bone decompression of the orbit in full.
Актуальность. Сохранение зрительных функций у пациентов с аденомой гипофиза (АГ) возможно при ранней диагностике компрессионной оптической нейропатии и своевременном проведении декомпрессии. Цель. Анализ ОКТ-А параметров у пациентов с АГ. Материал и методы. Обследован 21 пациент (42 глаза) с АГ и 10 здоровых человек (20 глаз), сопоставимых по полу и возрасту. Пациенты были разделены по результатам тестирования центрального поля зрения (ЦПЗ) на периметре Galaxypro(MS WestfaliaGmbH, Германия) с использованием стандартного протокола 30-2 на группы – без нарушений в ЦПЗ на обоих глазах (группа 1 – 22 глаза) и с нарушениями в ЦПЗ (преимущественно темпоральные дефекты) на одном или обоих глазах (группа 2 – 20 глаз). ОКТ-А проведена на спектральном томографе REVO nx/SOCT Copernicus REVO (OptopolTechnologyLtd., Польша). Результаты. В 1-й группе выявлено снижение: плотности сосудов (VD) радиального перипапиллярного капиллярного сплетения (RPC) в верхней перипапиллярной зоне (p=0,002), в верхнем (p=0,005) и верхневисочном (p=0,004) секторах; снижение показателя капиллярной перфузии (VP) поверхностного капиллярного сплетения (SRCP) в нижнем секторе наружного кольца по сетке ETDRS (p=0,009); VP глубокого капиллярного сплетения (DRCP) общего внутреннего кольца (p=0,003). Во 2-й группе выявлено снижение: VDRPC по сравнению с 1-й группой – в верхневисочном секторе (p=0,003), по сравнению с контрольной группой – во всех секторах (p <0,0001); VPSRCP по сравнению с 1-й и контрольной группой в нижнем секторе наружного кольца (p=0,003 и p <0,0001 соответственно). Выявлена корреляционная зависимость между толщиной слоя нервных волокон сетчатки (RNFL) и VDRPC у пациентов обеих групп (в нижнем и назальном секторах, соответственно), толщиной RNFL и VPRPC в нижнем секторе в 1-й группе; у пациентов 2-й группы – толщиной RNFL и VDRPC в верхнем секторе; между толщиной макулярного комплекса (mGCC) и VDSRCP общей; между показателем толщины сетчатки в макулярной области (ILM-RPE) и VPSRCP в верхнем секторе наружного кольца и VDDRCP в нижнем и VPDRCP в назальном секторе внутреннего кольца. Выводы. Результаты исследования позволяют предположить, что хиазмальная компрессия, вызванная АГ, приводит к прогрессированию микроциркуляторных нарушений в перипапиллярной и макулярной областях, диагностирование которых возможно до формирования изменений ЦПЗ.
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