Background and Study Aims Biliary obstruction caused by food is a little known and rarely reported long-term complication of endoscopic sphincterotomy (ES). This retrospective study aimed to characterize patients diagnosed with this condition between 2012 and 2025 and to assess the outcomes of surgical therapy. Patients and Methods Patients were selected who were diagnosed with symptomatic duodenobiliary reflux of food (DBR-F) after earlier ES and who all underwent hepaticojejunostomy with partial resection or ligation of the common bile duct (CBD). DBR-F was diagnosed by pathologic examination of material extracted from the CBD during episodes of biliary obstruction. Data were assessed retrospectively using the hospital electronic patient record system. Long-term outcomes and satisfaction with treatment were also evaluated using a questionnaire. Results We identified 12 patients who had undergone multiple ERCPs for "stone" or "sludge" removal (presurgery median 9, IQR 7.3-10) with microscopic proof of DBR-F. Patients presented with (episodic) abdominal pain, often associated with cholangitis. Liver abscesses were diagnosed in two cases. The median diagnostic delay was 3.3 years. Medical (antibiotics, ursodeoxycholic acid) and endoscopic (repeat sphincterotomy, stenting) treatment were ineffective. Surgical complications were observed in 4/12 (33%) patients. Long-term patient satisfaction after surgery was excellent in 9/10 evaluable patients. Conclusions This single-center series suggests that DBR-F is a long-term complication of ES that must be more prevalent than is suggested by anecdotal literature. This diagnosis should be considered when patients present with recurrent "stones" or "sludge" after previous ES. In selected patients with recurrent significant symptoms associated with DBR-F, surgical therapy is an effective option.
Background and Study Aims Esophagectomy is the standard treatment for superficial esophageal squamous cell carcinoma (ESCC) but carries substantial morbidity. Endoscopic submucosal dissection (ESD) followed by adjuvant chemoradiotherapy (CRT) is an organ-preserving alternative, but its oncologic efficacy in T1aM3 disease with lymphovascular invasion (LVI) and in T1b disease remains uncertain. We compared ESD+CRT with esophagectomy for these lesions. Patients and Methods Medline, Embase, and Google Scholar were searched through June 2024 (PROSPERO CRD42024593581). Primary endpoints were the risk differences (RDs) between esophagectomy and ESD+CRT for 3-year disease-free survival (3y-DFS), 3-year overall survival (OS-3y), and 5-year OS (OS-5y); the secondary endpoint was serious adverse events (SAEs). Cumulative DFS and OS were estimated by Kaplan-Meier analysis and compared with the log-rank test. Results Six retrospective studies (16 centers; 306 patients treated 2002-2021; ESD+CRT n = 170, esophagectomy n = 136) were included; mean follow-up was 49.8 and 53.1 months, respectively. Baseline age, LVI, and tumor depth were comparable. Three-year DFS was similar between groups (86.4% vs. 92.6%; RD 0.92, 95% CI 0.85-1.00), as was OS at 3 years (RD -0.02, 95% CI -0.08 to 0.45) and 5 years (RD -0.09, 95% CI -0.18 to 0.01). SAEs were significantly less frequent with ESD+CRT than with esophagectomy (RD 0.55, 95% CI 0.35-0.86; p = 0.009). Conclusions In selected superficial ESCC, ESD+CRT achieved DFS and OS comparable to esophagectomy while significantly reducing SAEs. These retrospective data support ESD+CRT as a viable organ-preserving option, particularly for patients at high surgical risk.
Background and Study Aims A papilla located on the left wall of a periampullary diverticulum creates a mechanically unfavourable axis for biliary cannulation that is not readily corrected from the conventional endoscopist position. We describe the Extreme Anticlockwise Bileduct Cannulation Diverticulum (ABCD) technique, where "Extreme" qualifies the degree of anticlockwise rotation applied-an endoscopist-repositioning manoeuvre designed to address this constraint without additional instrumentation. Patients and Methods Following observations in two index cases, the technique was adopted pre-emptively in consecutive patients with a confirmed left-wall periampullary papilla. Twenty-four patients were prospectively enrolled between July 2021 and February 2026. The endoscopist repositioned to the patient's head end and applied extreme anticlockwise duodenoscope rotation to realign the instrument axis. The primary outcome was successful biliary cannulation. Adverse events were graded using the Cotton consensus criteria. Results Successful biliary cannulation was achieved in 23/24 patients (95.8%), all within 5 min of adopting the repositioned stance. Primary guidewire cannulation was achieved in 20/24 (83.3%); the remaining three required needle-knife fistulotomy, performed from the same repositioned stance. Trainees were involved in 22 cases and cannulated independently in 16 (72.7%). Then, 3 of 24 patients (12.5%) experienced post-sphincterotomy bleeding, graded as AGREE Grade I. No post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis or other major complications were observed. Conclusions The Extreme ABCD technique is a simple, equipment-independent repositioning strategy for ERCP in left-wall periampullary diverticular anatomy. In this prospective series, it was associated with a high rate of biliary cannulation without rescue accessories and was feasible in a supervised training environment. Multicentre evaluation is warranted.
Purpose Percutaneous drainage is the standard nonsurgical treatment for liver abscess. Recent retrospective studies suggest that endoscopic ultrasound (EUS)-guided drainage may be an effective and safe alternative. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of EUS-guided drainage as a stand-alone approach and in comparison, with percutaneous drainage. Methods PubMed, EMBASE, and Cochrane databases were searched from inception through November 2025. The primary outcome was clinical success; secondary outcomes included technical success, total adverse events, and abscess relapse. Sensitivity analyses using a treatment-arm continuity correction were performed to address zero-event cells. Results Eleven studies were included (EUS, n = 186; percutaneous drainage, n = 325). In single-arm studies, pooled technical and clinical success rates with EUS were both 1.00 (95% CI, 0.95-1.00 and 0.99-1.00, respectively). Pooled total adverse event and relapse rates were 0.02 (95% CI, 0.00-0.12) and 0.00 (95% CI, 0.00-0.01), respectively. Comparative studies showed no significant differences between EUS and percutaneous drainage in technical success (RR 1.00, 95% CI, 0.83-1.19) or clinical success (RR 1.02, 95% CI, 0.86-1.22). EUS was associated with a significantly lower risk of total adverse events (RR 0.34, 95% CI, 0.15-0.76), while relapse rates were similar (RR 0.83, 95% CI, 0.30-2.33). Sensitivity analyses yielded consistent findings across all outcomes. Conclusion EUS-guided drainage is an effective and safe treatment for liver abscesses primarily involving the left hepatic and caudate lobes. Although EUS was associated with a lower risk for adverse events, larger comparative studies are needed to define its role in right lobe abscesses.
Background and aims Severe submucosal fibrosis presents a major challenge during endoscopic resection (ER) of large colorectal polyps, often precluding standard endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). This challenge is particularly relevant in elderly or comorbid patients when procedural safety is paramount. We describe the safety and efficacy of the novel Polyp Excision with Thermal Ablation and avuLsion (PETAL) technique, a staged hybrid approach combining wide-field EMR, thermal ablation, and avulsion. Methods This retrospective cohort study included consecutive patients undergoing PETAL for benign-appearing colorectal polyps ≥20 mm with severe fibrosis between January 2015 and December 2024. Primary outcomes included adverse events and recurrence at follow-up. Secondary outcomes included eradication rates and the need for surgery. Results Sixty-nine patients were included (median age, 71 years; 38% ASA III-IV; 20% on antithrombotics). The median lesion size was 50 mm, with 13.0% recurrent lesions. Delayed bleeding occurred in 2.9%, with no perforations or deep mural injuries. Follow-up data were available for 61 patients (88%), with median duration 40 months. Recurrence at first follow-up was 45.9%, but typically small and amenable to repeat endoscopic therapy. Cumulative eradication rates were 91.1% and 98.2% at the second and third follow-ups, respectively. One patient required surgery. Conclusions PETAL is a safe and effective strategy for large colorectal polyps with severe fibrosis, achieving high rates of eventual eradication despite frequent early recurrence. Its staged, low-risk profile makes it particularly suitable for elderly or comorbid patients and may represent an alternative to higher-risk techniques such as ESD and full-thickness resection.
Background and study aims: Clipping is a simple conventional closure technique for gastric endoscopic submucosal dissection (ESD) defects. This study evaluated the technical feasibility and stability of mucosal defect closure using a novel hooking-jaw clip. In addition, we assessed the safety outcomes compared with a non-closure group. Patients and methods: This single-center retrospective pilot study assessed technical success (complete closure, ≥ 90% area reduction) and closure stability during second-look endoscopy (SLE) on postoperative day 1 in 41 patients. We compared the secondary outcomes with a non-closure group using propensity score matching (PSM) (n = 41 per group). Secondary outcomes included incidences of delayed bleeding and frequency of hemostatic interventions during SLE. Results: Hooking-jaw clip-closure achieved technical success in 92.7% (38/41) of patients; partial closure (50%–89% area reduction) occurred in 7.3% (3/41), and no closure failure (<50%) occurred. The median closure time was 10.0 minutes. Closure remained stable in 87.8% (36/41) of patients at SLE. After PSM, the delayed bleeding rate was 0.0% (0/41) in the closure group and 4.9% (2/41) in the non-closure group (P = 0.494). The closure group required a lower rate of hemostatic interventions during SLE (24.4% [10/41] vs. 58.5% [24/41]; P = 0.003). Conclusions: Hooking-jaw clip-assisted closure of gastric ESD defects is technically feasible and maintains stability. Closing reduced the frequency of hemostatic interventions during SLE. Given current guidelines that conditionally recommend omitting routine SLE, stable closure provides a physical rationale to support this practice. Future trials should evaluate this strategy for high-risk populations.
Background and aims Gastrointestinal telangiectasias are a recognised manifestation of hereditary haemorrhagic telangiectasia (HHT), but data on their nature and distribution throughout the entire gastrointestinal tract are limited. We aimed to evaluate gastrointestinal disease manifestations using pan-enteric video capsule endoscopy (VCE) and to assess its applicability in a non-selected group of patients with HHT. Methods In this cross-sectional study, patients aged ≥50 years with confirmed HHT residing in the Region of Southern Denmark were invited to undergo pan-enteric VCE. Telangiectatic lesions were recorded according to anatomic location and lesion burden. Feasibility outcomes included patient acceptance, completion rate, mucosal visibility and transit times. Associations between active gastrointestinal bleeding and haemoglobin concentration were analysed using multivariable linear regression. Results Of 52 eligible patients, 28 underwent VCE. One examination was lost due to technical failure, leaving 27 recordings available for analysis. Telangiectatic lesions were identified in 96.3% of evaluable examinations and were predominantly located in the stomach (74%) and the proximal small bowel (81.5%). Active bleeding was observed in 14.8% of patients, only in the upper gastrointestinal tract, and was independently associated with lower haemoglobin concentrations (β -2.84 g/dL, 95% CI -4.69 to -1.00; p = 0.004). Seven examinations (25.9%) were incomplete, and colonic mucosal visibility was frequently suboptimal. No capsule retention or procedure-related complications occurred. Conclusion Pan-enteric VCE demonstrated widespread gastrointestinal involvement in HHT, predominantly in the proximal gastrointestinal tract. Although active bleeding was infrequent, it was associated with lower haemoglobin levels. Practical limitations suggest that the role of pan-enteric VCE in routine evaluation of HHT requires further clarification.
Background Workflow interruptions are common in procedural medicine and may increase cognitive load, stress, and the risk of errors. While interruptions and flow disruptions have been studied in surgical settings, little is known about workflow interruptions in endoscopic environments. Objective evaluation of workflow interruptions requires a reliable measurement tool. This study aimed to develop a structured observation tool for recording workflow interruptions during endoscopic procedures and to evaluate its interrater reliability. Methods A structured tally-based observation tool for recording workflow interruptions was developed in an iterative process, and interruptions were categorized into predefined domains. Three independent observers underwent structured training and calibration. A predefined subset of endoscopic procedures was observed simultaneously by two independent observers. Interrater reliability was assessed using intraclass correlation coefficients (ICC) and Bland–Altman analysis. Results A total of 35 procedures were scheduled for double observation, and 33 procedures were included in the final interrater reliability analysis. Interrater reliability for the total number of interruptions was excellent for both observer pairs (ICC 0.995 for A-B and 0.995 for A-C). Reliability across interruption domains ranged from good to excellent. Bland–Altman analysis demonstrated small mean differences with narrow limits of agreement and no relevant systematic bias. Conclusion This methodological study demonstrates that workflow interruptions during endoscopic procedures can be measured reliably using a structured tally-based observation tool. The instrument provides a standardized methodological framework for future studies investigating workflow processes and workflow-focused interventions in endoscopy.
Background. Atrial fibrillation (AF), one of the most prevalent cardiac arrhythmias, has a substantial global morbidity and mortality rate. According to recent research, the pathophysiology of AF may be significantly influenced by changes in the lipid profile, macrominerals, and trace elements. In order to shed light on any potential correlations and clarify them, this study compared the levels of lipid profile parameters, magnesium (Mg), calcium (Ca), specific trace elements and some other markers in serum of patients with AF compared to healthy individuals. Materials and methods. The measured markers include lipid profile (cholesterol, triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein (VLDL)), macrominerals Mg, Ca and some trace elements — copper (Cu), chromium (Cr), selenium (Se), zinc (Zn), iron (Fe). The above markers were measured in 100 AF patients (50 males, 50 females) and 100 supposedly healthy subjects (50 males, 50 females). Results. Statistical data analysis revealed a significant elevation in serum levels of Cu and a decrease in Cr, Se, Zn, Fe, Mg, with non-significant differences in Ca in patients as compared to the control group and for both sexes. The study revealed a significant elevation in Cu levels in females versus males (P ≤ 0.05) and a significant decrease in Fe levels in females compared to males (P ≤ 0.05). In contrast, there was a significant elevation in the levels of cholesterol, TG, LDL-C and VLDL-C and a decrease in HDL-С in serum of patients with AF as compared to the control group for both sexes. Conclusions. There was no effect of sex on the studied markers except Fe, Cu.
Background. Armed conflicts have led to an increasing number of patients with retained metallic fragments, the surgical removal of which is often contraindicated due to high operative risks. These fragments may serve as a source of chronic lead exposure even in the absence of clinical symptoms, necessitating long-term medical surveillance. The role of primary care in coordinating such monitoring remains insufficiently explored. The purpose was to highlight the critical role of primary care in coordinating long-term monitoring in post-conflict patients who live with retained metallic fragments. Materials and methods. Due to the fragment’s high-risk anatomical location and the substantial potential for hemorrhagic and visceral complications, surgical removal was deemed contraindicated, and a conservative management strategy coordinated by a family physician was implemented, including periodic imaging surveillance to assess fragment stability and scheduled blood lead level (BLL) monitoring. Results. A structured active surveillance strategy was implemented. This included periodic imaging to assess fragment stability and annual BLL testing. The BLL was 2.2 µg/dL, remaining within the reference range (≤ 8.5 µg/dL) according to the private laboratory’s reference values. Conclusions. Retained fragments should be recognized as a potential source of chronic lead exposure, warranting proactive monitoring even in asymptomatic individuals. In post-conflict settings, primary care physicians play a pivotal role in ensuring continuity of care for patients with retained metallic fragments after acute surgical decision-making has concluded. Structured surveillance led by primary care may therefore represent a critical component of sustainable health system responses to armed conflict, particularly in countries facing large populations of veterans and former prisoners of war.
Non-erythematous forms of systemic tick-borne borreliosis, or Lyme disease (LD), are considered one of the most difficult to diagnose due to the lack of a pathognomonic (specific) marker of the disease — erythema migrans. In such a situation, the clinician should take into account the season, the patient’s residence or stay in a region endemic for LD, the possibility of an alimentary route of infection with Borrelia when consuming dairy products from sick domestic animals. The non-erythematous form of LD often proceeds as a common acute respiratory viral infection or flu and begins with the appearance of fever, weakness, headache, pain in muscles and joints. Sometimes the disease is masked as other pathologies: myocarditis, chorioretinitis, neurological disorders (facial nerve palsy, radiculopathy, meningoencephalitis), hepatitis. The appearance in a patient in a region endemic for tick activity of any symptoms without erythema migrans requires examination for LD, if these symptoms are not explained by other nosological forms. In order to identify specific antibody titers and assess their dynamics, serological blood testing is prescribed by the enzyme-linked immunosorbent assay, with a repeat after 2–4 weeks. The study of cerebrospinal fluid by polymerase chain reaction for the presence of Borrelia is diagnostically significant in cases of meningoencephalitis. Underestimation of the above-mentioned clinical and anamnestic data and laboratory criteria leads to diagnostic errors, delayed treatment and significantly increases the risk of developing chronic forms of the disease and complications.
Background. The relevance of social media addiction research is determined by rapid digitalization and the increasing integration of social networking platforms into the everyday lives of adolescents and young adults. During sensitive developmental periods of identity and self-esteem formation, this integration significantly increases the risk of polymorphic social media addiction with adverse psychological consequences. The aim of the study is to provide a theoretical justification and empirical investigation of polymorphic social media addiction as a psychological phenomenon and to determine its impact on psychosomatic risks in individuals with elevated levels of anxiety, as well as to identify the key psychological mechanisms underlying the development of addictive behavior and related psychosomatic health disorders. Materials and methods. A comprehensive battery of psychodiagnostic instruments (BSMAS, IAT, FOMO, DERS, INCOM, and DASS-21) was employed to provide a multidimensional assessment of social media addiction, capturing its behavioral, emotional, cognitive, motivational components, and also associations between addictive behavior, increased anxiety and psychosomatic risks. In line with DSM-5 and ICD-11 criteria, individuals with elevated anxiety levels, predominantly adolescents and university students, were classified as a high-risk group. The pilot study was conducted at the University Clinic of the Vinnytsia National Pirogov Memorial Medical University (clinical, educational, and research center). Results and conclusions. The results of the study indicate that polymorphic social media addiction has a systemic nature and encompasses behavioral, emotional, cognitive, motivational, physiological, and social levels of personality functioning. The identified profile of clinical well-being indicators substantiates the relevance of early diagnosis, prevention, and comprehensive psychocorrective interventions, particularly among adolescents and young people as high-risk groups. The empirical findings confirm that adolescents demonstrate greater vulnerability to polymorphic social media addiction, whereas among university students, the overall level of susceptibility is lower, but it still requires attention due to the existing stress background and the potential for professional-related online overinvolvement.
Background. Acute ischemic stroke remains one of the leading causes of mortality and disability worldwide. Metabolic disturbances, particularly diabetes mellitus and hyperglycemia, play a significant role in disease progression, as they are associated with more severe brain tissue injury and poorer clinical outcomes. Neuroimaging is a key tool for the early diagnosis of acute stroke and determining subsequent therapeutic strategies. The use of the ASPECTS and pc-ASPECTS enables objective assessment of morphological brain tissue changes and prediction of clinical course, highlighting the relevance of investigating the impact of carbohydrate metabolism disorders on the characteristics of ischemic stroke. Objective: to determine the features of neuroimaging changes in acute ischemic stroke depending on carbohydrate metabolism status. Materials and methods. A total of 124 patients with acute ischemic stroke were enrolled in this prospective study. According to glycemic status, they were divided into three groups: those with type 2 diabetes mellitus (n = 63), transient hyperglycemia (n = 31), and a control group without carbohydrate metabolism disorders (n = 30). The location of ischemic lesions and ischemic core volume were analyzed using the ASPECTS and pc-ASPECTS. Statistical processing was performed using the χ2 test; p < 0.05 was considered statistically significant. Results. The distribution of stroke according to vascular territories and arterial segments did not depend on glycemic status (p > 0.05). The middle cerebral artery territory was most frequently affected, with a predominance of distal M2 and M3 segments. Statistically significant differences were found in the ASPECTS among the groups (p < 0.001). The mean ASPECTS was highest in the transient hyperglycemia group (9.45), whereas lower values were found in patients with type 2 diabetes mellitus (8.40) and in the control group (8.50). Low ASPECTS (≤ 6 points) was predominantly observed in patients with type 2 diabetes mellitus. Conclusions. Glycemic status does not influence the topography of ischemic lesions but is associated with their volume. Chronic hyperglycemia in type 2 diabetes mellitus is linked to more pronounced early ischemic changes, whereas transient hyperglycemia is characterized by relatively more favorable neuroimaging parameters.
Despite the significant number of criminal proceedings initiated annually against healthcare professionals in Ukraine, clinicians remain insufficiently informed about the legal consequences of clinical and diagnostic failures. The article aims to familiarize clinicians with medical malpractice cases in anesthesiology and intensive care that resulted in severe adverse outcomes for patients and led to judicial verdicts. The article provides an analysis of court decisions from the Unified State Register of Court Decisions for the period 2011–2025, focusing on medical negligence involving anesthesiologists across various regions of Ukraine. Based on definite types of failures identified during anesthetic management or intensive care interventions, the authors present detailed case examples of harmful medical actions and their legal implications. Physicians who are aware of typical professional mistakes and their subsequent legal consequences might be better prepared to face and prevent medical errors.
Background. The problem of surgical treatment for secondary peritonitis complicated by septic shock is the subject of constant discussions, as it is due to the difficulty in choosing an effective selective surgery and is accompanied by a significant number of complications and high mortality. The purpose was to analyze the features of the course of secondary peritonitis complicated by septic shock and to conduct a comparative analysis on the effectiveness of surgical management with the expansion of indications for the use of programmed relaparotomies with vacuum-assisted closure (VAC). Materials and methods. The work is based on the analysis of the results of surgical treatment of 42 patients with secondary peritonitis complicated by septic shock. Depending on the strategy, the patients were divided into 2 groups: group 1 (comparison, n = 19) and group 2 (main, n = 23) in which improved surgical strategy was used with the expansion of indications for programmed relaparotomies with VAC. Results. The results of the analysis on the structure of surgical diseases in patients with secondary peritonitis complicated by septic shock revealed a perforating complication as the cause of peritonitis in 9 (47.36 %) patients of the first group and 12 (52.17 %) patients of the second group. This was due to perforated gastric ulcer in 2 (10.53 %) patients of the first and 2 (8.69 %) patients of the second group. In almost every third (7 people (36.84 %)) participant of the first group and almost half (10 people (43.48 %) participants of the second group, peritonitis with septic shock was caused by perforation of intestinal tumors, and almost half of the patients in both groups had acute vascular insufficiency of intestine. Eight (42.11 %) patients of the first group and 10 (43.48 %) patients of the second group were operated with MPI of 21 to 29 points, and in almost every third (6 people (31.58 %) patient of the first and second groups (9 people (39.13 %), peritonitis course exceeded 29 points on MPI. Improvement of diagnostic and treatment strategy in patients of group 2 with secondary peritonitis complicated by septic shock by expanding indications for the use of laparoscopy allowed performing perforated gastric ulcer suturing in 2 cases, and the combined use of programmed relaparotomy with VAC contributed to the restoration of the digestive canal during their performance in 10 (43.48 %) patients. Conclusions. Improvement of diagnostic and treatment strategy in patients of group 2 with secondary peritonitis complicated by septic shock allowed reducing the number of postoperative complications by 19.91 % and postoperative mortality by 19.68 %.
Background. Segmental defects of the tibia (critical defect: more than 2 cm long and loss of more than 50 % of bone mass) are divided into primary (due to high-energy trauma) and secondary, as a result of radical resection of necrotic and infected bone fragments, resection of bone tumors, etc. Within the framework of biomechanical studies of modern fixators, great attention is paid to the development of structural parameters that influence the stability of the construct, such as rigidity, maximum stress values at the control points of the system and performance of the pin-bone interface. The purpose of the study was to investigate the stress-strain state of a model of the lower leg with a tibial defect with different options for its extra-articular osteosynthesis under the influence of a bending load acting in the sagittal plane. Materials and methods. A defect 5 cm long was modeled in the middle third of the tibia. Stabilization of the tibia with an external fixation device was studied with three options for inserting rods with a diameter of 8 mm at angles of 30, 60, and 90°. Results. Under the influence of bending load in the sagittal plane, insertion of fixing rods at an angle of 30° creates a maximum stress in the bone tissue of 13.4 and 9.4 MPa around distal pair of rods, around proximal one — of 8.4 and 6.6 MPa, respectively; at an angle of 60°, compared to the previous model, it causes an increase in the level of stresses in the bone tissue almost around all fixing rods. Change in the distribution of stresses on the fixing rods inserted at an angle of 90°: on rods 1 and 4, the stress level decreases to 48.4 and 28.0 MPa, respectively, which are the lowest indicators for all previous models. Conclusions. With a bending load acting on the limb in the sagittal plane, the most favorable option for minimizing stresses in the bone tissue is the installation of the external fixation device with the fixing rods inserted at an angle of 30°.
Background. Platelets are highly sensitive to changes in the internal environment and play a key role in hemostasis, inflammation, and immune response. Burn injury is associated with significant alterations in platelet count and function, contributing to coagulopathy and adverse clinical outcomes. The purpose was to summarize current evidence on platelet hemostasis disorders in burn disease, with a focus on pathophysiology, biomarkers, and treatment approaches. Materials and methods. A literature search was conducted using CrossRef, Scopus, Google Scholar, and PubMed databases for the period from 2017 to 2026. The search strategy combined structured descriptive approaches with manual screening of relevant publications. Observational studies and reviews addressing platelet dysfunction in burn patients were included. Results. Thrombocytopenia in burn patients is primarily associated with increased platelet consumption and destruction due to inflammatory mediators, endothelial damage, and activation of coagulation pathways. Early decreases in fibrinogen may impair platelet aggregation. Several biomarkers demonstrate diagnostic and prognostic potential, including platelet count and its dynamics, mean platelet volume, platelet distribution width, immature platelet fraction, inflammatory markers (C-reactive protein, procalcitonin, interleukin-6), and coagulation parameters (D-dimer, fibrinogen, antithrombin III). Additional indicators include markers of endothelial dysfunction and organ failure. Severe thrombocytopenia (< 50 × 109/L) requires urgent clinical management. However, platelet transfusion in sepsis remains controversial due to potential risks such as hypercoagulability and thrombotic complications. Conclusions. Platelet dysfunction plays a central role in the pathogenesis of burn-related coagulopathy and sepsis. Further research is needed to improve diagnostic strategies and develop targeted therapies aimed at optimizing platelet function and reducing inflammation in burn patients.
Background. The conduct of modern warfare is significantly different from the world’s experience, which is related to new types of weapons. Treatment of victims with combat injury is very difficult. This is due to the destructive and complex influence of weapons, plasty of the massive defect and significant growth of antibiotic-resistant bacteria. It makes the application of physical methods the main part in treatment tactics. The purpose was to evaluate short-term results of the combined use of appropriate methods in the management of combat injury of the lower limb. Materials and methods. The study was based on the treatment outcomes of male patients with combat injury of the lower limb who underwent treatment at the Department of Surgery and Vascular Surgery from February 24, 2022, to August 20, 2025. Results. The mean age of patients was 27.95 ± 5.45 years. The mean number of using pulse lavage debridement — 2.90 ± 0.76 times. The average number of bandage changes with negative pressure wound therapy was 4.00 ± 0.83 times. Dermatoplasty was performed in 28.57 % cases, secondary suture closure — in 52.38 %, and 19.05 % of patients had their wounds healed by secondary intention. After rehabilitation, 33.3 % of patients returned to their duty. Conclusions. Combination of negative pressure wound therapy and pulse lavage system helped achieve adequate and high-quality debridement of affected areas, allowing for the preservation of significant tissue mass of traumatized limbs with the potential for further reconstruction and preparation for prosthetic fitting.
