Methods. The study was performed on 240 male laboratory rats after preliminary modeling of alloxan diabetes mellitus, paw ischemia by ligation of the femoral artery, formation of a trophic ulcer by intradermal injection of 0.6 ml of 10% calcium chloride. The developed wound dressings were used in all animals, which were divided into four groups. A clinical assessment of the wound was carried out, the sampling of granulation tissue was performed on the third, seventh and 14th days. Histological material was stained with hematoxylin-eosin and trichrome MSB according to the standard method. A semi-quantitative histological evaluation was used to assess reparative processes. Results. When applying a wound dressing without an antibacterial agent (first group), there is abundant infiltration with neutrophils, coagulation necrosis during the entire observation period. The presence of immature granulation tissue by day 14 indicates the absence of regeneration in the ulcer. The addition of gentamicin to dressing reduces inflammatory responses. Granulation tissue matures by the 7th day. Signs of epithelialization in the edges of wounds with the absence of inflammation are noted by the 14th day. With the addition of gentamicin and methyluracil to dressing, the presence of granulations was noted by the 7th day, and complete epithelization of wounds by the 14th day. Conclusion. The addition of gentamicin and methyluracil to the composition of wound dressings statistically significantly (p<0.0001) stimulates regeneration in ulcers compared to the control group and wound dressings without gentamicin and methyluracil, and also reduces inflammatory reactions in the defect zone, stimulates the growth of granulations and their transformation into collagen (p<0.0001), which is an objective criterion for early healing.
Objective. The determination of the necessary damage energy and anatomical landmarks for modeling severe blunt closed liver injury by the «impact» mechanism using developed device. Material and Methods. The experiments were carried out on male Wistar rats (n=42) weighing 379 ±23 g. It was necessary to get a liver injury of III-IV according to J.M. Cox and J.E. Kalns: ruptures from 2 to 3.5 cm and more . At the first stage, the optimal height of the fall (mass 425 g) in the epigastrium at the level of the base of the xiphoid processus was determined, at which liver damage of more than 2 cm is achieved without damage of the inferior vena cava. The rats were randomized into 3 groups according to the height of the load drop: I-I (n=4) – height 40 cm, I-II (n=4) – 20 cm, I-III (n=5) – 28 cm. At the second stage, the search for anatomical landmarks for the impact was carried out to avoid damage to other organs of the abdominal and thoracic cavity. 4 zones were selected on the anterior abdominal wall of the animal to focus the impact: in the left hypochondrium (group II-I, n=5), in the right hypochondrium 5 mm below and 10 mm to the right of the tip of the xiphoid process (group II-II, n=5), in the epigastrium at the level of the tip of the xiphoid process (Group II-III, n=5), 5 mm to the right and above the tip of the xiphoid process (group II-IV, n=14). A device developed by the authors implementing the «impact» mechanism was used to inflict injury. Considering that the number of animals in the groups is small, a median with a 95% confidence interval (CI) was used for the average value of the liver rupture length. Results. The height of the load drop of 40 cm turned out to be excessive, since the inferior vena cava was injured, and the height of 20 cm was insufficient, since the length of the liver rupture did not reach 2 cm in length. The optimal height was 28 cm for a load of 425 g – the impact energy was 1.17 joules. Only in group II-IV, focusing the impact 5 mm above and to the right of the tip of the xiphoid process led to extensive damage to the parenchyma of the right and left median lobe, upper and lower caudate lobe of the liver with a median [95% CI] rupture length of 5.5 [2.49;7.8] cm, without injuries of the thoracic and abdominal organs, and also the inferior vena cava. Conclusion. The developed device with selected landmarks and impact energy allows it to be used as experimental model of a closed liver injury. Stable achieving of homogeneous liver injuries III-IV is becoming.
Objective. Тo improve the results of surgical treatment of Crohn’s disease of the colon by applying the modern diagnostic methods and adequate surgical tactics. Мethods. The study included 84 patients who underwent conservative and surgical treatment in the proctological department of the 1st Republican Clinical Hospital of the Ministry of Health of the Republic of Uzbekistan. for the period from 2010 to 2022 for Crohn’s disease of the colon. 53 patients (63%) were men, 31 (37%) women. The age of the patients ranged from 15 to 61 years. The average age was 37.1+1.2 years. Results. Indications for surgery for Crohn’s disease of the colon are a total lesion of the inflammatory-ulcerative process, the presence of intestinal and extra-intestinal complications, the ineffectiveness of conservative therapy and the progression of the disease.
Objective. To investigate the frequency of Val174Ala polymorphism in SLCO1B1 gene in patients with toxic goiter (TG) and to evaluate the influence of the revealed mutations on the efficacy of substitutive hormonotherapy and adequacy of the choice of the extent of TG surgery. Methods. The study of Val174Ala polymorphism in 41 patients operated on TG was carried out. The mean age of patients was 48.2±13.0 years; 7 men and 34 women. Toxic diffuse goiter (TDG) was diagnosed in 19 patients, toxic multinodular goiter (TMG) – in 22; thus thyroidectomy (TE) was performed in 21 cases, subtotal thyroid resection (STR) – in 20 cases. Results. The study revealed polymorphism in 16 patients (39.02%): heterozygous (CT type) – in 15 patients (36.59%); normal homozygous / mutant type (CC type) – in 1 patient (2.44%). Normal homozygous / wild type (TT), indicating the absence of polymorphism, was detected in 25 patients (60.98%). When L-T4 was administered based on the dose specified in clinical recommendations, in 6 of 16 patients with polymorphism in the postoperative period subclinical thyrotoxicosis symptoms (TSH from 0.38 to 0.02 mMe/l) were observed, in 4 patients - partial return of thyrotoxicosis symptoms (TSH – 0.01 mMe/l). All these patients underwent TE. As a result, the Thyroxine dose of 125 mcg was reduced to 75 mcg in 6 patients, and in 4 patients – to 100 mcg per day. The remaining 6 patients with preoperative polymorphism underwent STR with Thyroxine administration considering this factor. Conclusion. Significant relationship between the daily dosage of L-T4 and the presence of SLCO1B1 polymorphism has been revealed in the study. When prescribing substitutive hormonotherapy, its necessary to consider the results of genetic testing of SLCO1B1 polymorphism, which was detected in 39% of patients. In case of polymorphism detection, the STR should be preferred in order to prevent adverse reactions of substitutive therapy and adequate dose selection.
Objective. The aim of the study was to examine the dynamics of microelements (cobalt, chromium, copper, selenium, zinc) and the need for their correction in patients with sepsis and multiple organ failure syndrome (MODS) after abdominal surgery. Methods. A prospective observational study was conducted in 45 patients who had surgical pathology of the abdominal organs requiring surgical treatment. All patients were divided into 2 groups: group 1 (n=18) – with the absence of sepsis and MODS; group 2 (n=27) – with the presence of sepsis and MODS. During the 1st day of admission to the anesthesiology and resuscitation department (1st stage), as well as on the 5th (2nd stage) and 10th day (3rd stage) from admission, venous blood was take for determination of cobalt, chromium, copper, selenium, zinc. Results. The level of cobalt was statistically significantly reduced in group 1 compared to group 2 at all stages: in group 1 at stage 1 – 0.4 (0.27-0.66) μg/l, at the 2nd stage – 0.31 (0.24-0.44) µg/l, at the 3rd stage – 0.35 (0.26-0.61) µg/l. Chromium levels were within normal limits in all patients in the study groups. The copper content was statistically significantly lower in group 2 compared to group 1 at all stages: in group 2 at stage 1 – 819.3 (721.5-949) μg/l, at stage 2 – 1st stage – 825.2 (762.5-977.4) µg/l, 3rd stage – 819.7 (759.2-981.5) µg/l. Selenium levels were below normal in group 1: stage 1 – 52.3 (41.5-67.7) µg/l, stage 2 – 51.9 (38.8-63.7) µg /l, stage 3 – 54.8 (33.8-66) µg/l; and in the 2nd group: 1st stage – 47.6 (33.8-66.2) µg/l, 2nd stage – 57.5 (42.7-68.7) µg/l, 3 stage – 47.4 (40.2-57.8) µg/l. A decrease in zinc levels was noted in patients of both groups below normal in group 1: stage 1 – 5624.3 (4911.2-6293.5) mcg/l, stage 2 – 5709.7 (5057.6 -6038.7) µg/l, stage 3 – 5438.5 (4998.8-6168.7) µg/l; and in the 2nd group: 1st stage – 5298.7 (4554.3-6011.4) µg/l, 2nd stage – 5519.5 (4702.4-6315.4) µg/l, 3 stage – 5370.6 (4528.8-6014.8) µg/l. Conclusion. Analysis of the dynamics of the level of concentrations of trace elements showed that the level of copper was lower and the level of cobalt was higher in patients with abdominal sepsis in the postoperative period compared with the comparison group.
Objective. To study the dynamics of changes in the level of glucose, C-peptide and the composition of native lipoprotein complexes in the blood of patients 1, 3 and 5 years after kidney transplantation. Material and methods. The study group included 15 men (36-60 years old) and 15 women (36-55 years old) 1, 3 and 5 years after kidney transplantation. The control group included 15 healthy men and women of the same age. Fasting venous blood was collected in vacutainers with 3.8% sodium citrate. Native blood lipoprotein complexes were isolated by preparative ultracentrifugation. The amount of protein in native blood lipoprotein complexes was determined using the Lowry method, the amount of cholesterol, apoproteins A/B, cholesterol esters and triacylglycerides, glucose, creatinine and urea were determined using biochemical kits. The amounts of proprotein convertase subtilisin kexin 9 and C-peptide were determined using enzyme immunoassay kits. Statistical analysis was performed in the application package R version 4.0.5 (2021-03-31). Results. At all times after kidney transplantation, an increase in the concentration of C-peptide and glucose was observed. Gender differences characteristic of healthy people in the content of VLDL cholesterol, LDL cholesterol, total protein and apoprotein-B100 are leveled out, equalizing them with the values characteristic of healthy men; no significant effect on the composition of HDL was found, however, the amount of their main protein – apoprotein A1 and cholesterol esters – increases in blood plasma. Conclusion. The findings regarding changes in C-peptide and glucose levels may indicate that renal allograft recipients treated with tacrolimus may have compensated insulin tolerance, which may ultimately lead to post-transplant diabetes mellitus. Changes in lipid transport system indicate the proatherogenic effect of immunosuppressive therapy in women.
Objective. Congenital anal stenosis (CAS) is a rare form (2%) of anorectal malformations (ARM). All authors acknowledge the presence of the anal canal, but there are different ideas about the pathological anatomy and physiology of the CAS. Some believe that stenosis occupies a short distance between the wall of the anal canal and the anus. Others claim a long taper up to the dentate line. The volume of the operation depends on this. In the first case, the stenosis is dissected, and in the second, a pull-through operation is performed that destroys the anal canal. Methods. To detail the anatomy of the CAS, we analyzed X-ray studies of the CAS from our own experience and from literature sources to determine the length and location of the narrowed segment, as well as the width of the rectum, using our radiometric method. Results. A total of 7 X-ray studies of patients with CAS were analyzed, as well as 82 X-ray studies of different types of ARM. It has been shown that all forms of ARM, except for the true cloaca, develop in the embryological period in the same way with the formation of the anal canal because of the advancement of the internal anal sphincter (IAS) in the craniocaudal direction. The absence of the anus indicates that the exogenous rudiment of the anal canal does not move upward to meet the endogenous one. Therefore, penetration of the IAS beyond the anal canal leads to the formation of a narrow, rigid ring. If IAS penetrates through the subcutaneous tissue and skin, then CAS is formed. In other cases, the anus moves forward and upward, emerging outward or into any cavity, forming an ectopic anus onto the perineum, vestibule, urethra, or into the vagina. Conclusion. Congenital anal stenosis is one of the forms of ARM, characterized by the presence of a normal anal canal, where the stenosis of the normally located anus has a length of 2 to 5 mm. X-ray examination provides an accurate anatomical and physiological characteristic of the defect. Treatment should be carried out as early as possible to prevent the development of megacolons. Dissection of the rigid ring and insertion of a tube into the anal canal can lead to complete recovery. A hypothesis of the embryological development of ARA is described.
Acute purulent destructive pneumonia (APDP) is focal or confluent pneumonia of various etiologies, characterized by necrosis and purulent melting of lung tissue with the addition of pleural complications. The severity of the disease is due to a combination of respiratory and heart failure against the background of a pronounced intoxication syndrome, and a high mortality rate (2 - 13%). In children of the first year of life, mortality can reach from 22 to 51%. At the same time, hospitalization periods, according to various literature sources, can vary from 15 to 47 bed days. The study analyzed domestic and foreign literature data on surgical treatment of destructive pneumonia in children, published over the past 10 years. The search was carried out using Keywords in such search engines as: eLibrary, PubMed, Medline, Scopus, Google Scolar. The article presents a review of 49 literature sources, which contains studies on the epidemiology, classification, diagnosis and treatment of destructive pneumonia in children. The work separately emphasizes the importance of early thoracoscopy in children with pulmonary-pleural forms of destructive pneumonia. The problem of treating destructive pneumonia in children currently remains extremely relevant. Despite the development of medical technologies and the introduction of new treatment methods, mortality in childhood remains at a fairly high level. The length of hospitalization due to the development of pulmonary-pleural complications can reach 47 bed-days. The issue of radical relief of bronchopleural fistulas, according to the authors remains open and requires the development of new treatment methods.
Objective. To determine the dynamics of changes in cortisol, prolactin, and thyroid-stimulating hormone (TSH) during cardiac surgery with artificial circulation under general multicomponent endotracheal anesthesia and to assess their potential use as markers of endocrine monitoring. Methods. The study included 30 patients who underwent planned cardiac surgery under artificial circulation. For anesthesia maintenance, general multicomponent endotracheal anesthesia based on sevoflurane (before and after artificial circulation), propofol (during artificial circulation), fentanyl, and pipecuronium were used. For endocrine-metabolic monitoring, cortisol, prolactin, and TSH in blood serum were controlled at the stages of the study: before the onset of the operation (1st stage), 15 minutes before the start of artificial circulation (5th stage), and after suturing the skin (7th stage). Results. Cardiac surgeries with artificial circulation under general multicomponent endotracheal anesthesia are accompanied by endocrine changes at the 5th and 7th stages of the study in the form of an eleration in the level of cortisol (by 1.6 (1.1; 1.9) and 2.6 (2.1; 3.7) times), prolactin (by 2.7 (1.4; 4.1) and 3 (1.6; 4.9) times) and TSH (by 1.2 times (1.0; 1.9) and 1.2 (0.9; 1.9) times)? respectively. Conclusion. Indicators of endocrine-metabolic monitoring of cortisol, prolactin, glucose, and lactate characterize the effectiveness of patient analgesia during cardiac interventions with artificial circulation.
The use of anticoagulants and disaggregant agents in patients with peripheral atherosclerosis has been an integral part of therapy for many years. . The role and their combination has undergone numerous changes with the development of understanding of their mechanisms of action and influence on peripheral hemodynamics. In addition, the use of anticoagulants and disaggregant agents plays a decisive role in patients with critical lower limb ischemia who underwent reconstruction of the peripheral arterial bed. In the postoperative period in many cases the precisely well-chosen tablet therapy can be the very “key link” in saving the limb. Besides, atherosclerosis is multi-organ disease that usually affects the coronary and cerebral pools. Pathological processes in these systems can significantly affect the health and quality of life, are often disabling nature, often threatening the patient’s life. Today the inconsistency of clinical and practical information about the effectiveness of various schemes of antiplatelet and anticoagulant therapy is beyond doubt. For example, the required duration of tablet therapy is not supported by reliable studies. A large number of outdated studies, their insufficient “scale” are consided to be a stumbling block for determining the current unified standard of perioperative therapy for patients with peripheral atherosclerosis. The identification of the “ideal” scheme will allow improving the immediate and remote results of surgical interventions, but also to carry out an effective prevention of formidable complications of the cardiovascular system as a whole.
Objective. To analyze and evaluate the effect of solutions for storage and storage times on the morphological characteristics of the human great saphenous vein. Methods. 202 specimens of human saphenous veins obtained during phlebectomies or during CABG. The obtained samples immediately after harvesting from the patient were randomly placed into a sterile cardioplegic solution and a physiological solution with heparin and papaverine for further storage in a refrigerator at a temperature of +4°C. Histological, morphological, and immunological studies of the obtained samples were carried out within a period from 1 day to 1 month. To study the effect of varicose transformation, the studied samples were divided into 2 groups: group 1 - 120 sections of the great saphenous vein with varicose transformation; group 2 - 82 veins without varicose transformation. Depending on the solution in which the samples were stored, the veins of the first group were subdivided into 2 subgroups: 40 veins were stored in 0.9% sodium chloride solution with the addition of papaverine and heparin (subgroup 1p) and 80 veins, which were stored in cardioplegic solution (subgroup 1c). Results. The use of cold cardioplegic solution makes it possible to achieve complete decellularization of the saphenous vein within a period of 1 day to 1 week, while decomposition and homogenization of the conduit wall is observed within a period of two to three weeks, in the case of unchanged conduits, and within three weeks for veins with varicose veins deformation. Preservation of the collagen framework is observed in the period from the first days to three weeks of observation, which correlates with the preservation of the strength characteristics of venous conduits exposed to cold storage in cardioplegic solution. The loss of collagen fibers from their initial amount within 3 weeks for varicose veins is 8.6%, for veins without varicose transformation - 13.5%. Conclusion. The use of this method of storage of venous conduits makes it possible to achieve an adequate level of vascular decellularization already on the first day of storage, which helps to reduce the likelihood of subsequent rejection of the conduit and inducing of graft rejection reaction of the recipient, and the preservation of the collagen framework within a period up to three weeks makes it possible to use these conduits in vascular tissue engineering and for reconstructive vascular surgery. What this paper adds For the first time, the influence of storage periods and solutions for storage on the morphological properties of the human great saphenous vein has been studied. It has been established that use of cold cardioplegic solution for vein graft up to three weeks makes it possible to preserve the morphology of the extracellular matrix of the vascular network, when decellularization is achieved after one day of exposure (absence of the intimal layer of the vein).
Objective. To evaluate the diagnostic methods and surgical treatment results in children with sacrococcygeal teratomas (SCT) in the Republic of Belarus during 1994 - 2020 yrs. Methods. The study included (n=73) patients with SCT, 55 girls (75.3%), 18 boys (24.7%), correspondently. Ultrasound examination, survey radiography of the abdominal cavity and pelvic bones, computed and magnetic resonance imaging, determination of alpha-fetoprotein have been used for diagnostics. Results. In the Republic of Belarus, SCTs occur with a frequency of 1:37 173 newborns. Antenatally, pathology was detected in 45 (61.6%) cases with gestational age from 20 to 34 weeks (24.7 ± 4.9). I and II types of SCT were detected in 58 (79.5%) patients, III - in 10 (13.7%) and IV - in 5 (6.8%) patients. Mature SCT was diagnosed in 68 (93.2%) patients, immature - in 3 (4.1%) ones , malignant - in 2 (2.7%) patients. 14 patients out of them (19.2%) had multiple congenital anomalies. Radical surgery was performed in 68 children in the first two weeks of life (93.2%). At the age of 2 months 3 children were admitted, at 6 months - 1 child (with recurrent SCP), at 10 months - 1 child, and at 14 months - 1 child. Functional disorders of the pelvic organs (fecal incontinence) were observed in 5 patients. Dysuria disorders were recorded in 16 patients, in the early postoperative period in 9 ones, in the long-term period in 7 patients developed a clinical picture of a neurogenic bladder. Recurrence of SCT was noted after 6 months in one patient (1.4%). Mortality rate out of 72 operated patients died was 4.16%, individuals - 3, morphologically immature tumor was revealed during histological examination of the formation. Conclusion. With timely diagnosis and radical removal of the SCP, the prognosis is considered to be favorable. However, according to our data there are some problems with functional disorders of the pelvic organs ( 9.58%). What this paper adds The incidence rate of sacrococcygeal teratomas in children in the Republic of Belarus has been firstly studied; the results of diagnosis and treatment have been evaluated; the recommendations for follow-up in the postoperative period have been given.
Breast augmentation with implants is one of the most popular plastic surgery procedures. Experience and clinical observations have revealed an association between breast augmentation with implants and a special type of lymphoma that occurs around them - breast-implant-associated anaplastic large cell lymphoma (BIA-ALCL), which resulted in changing of the selection criteria for implant and restrictive measures in several countries. The authors present the first case of breast-implant-associated anaplastic large-cell lymphoma in Belarus. Breast implant augmentation-mastopexy for cosmetic reasons had been performed 9 years before the diagnosis of lymphoma made. The implants of the 3rd group of texture according to ISO classification were used. The disease manifested with seroma of the right breast. Prior the surgery (capsulectomy and reaugmentation with implants) due to the patient’s refusal to undergo the surgical treatment, several aspirations to obtain fluid for analysis to diagnose were performed. Final diagnosis was BIA-ALCL, stage 1a. The patient has been followed up for 1,5 years and there was no recurrence. This study provides a literature review of recent scientific publications concerning this issue and testifies an increase in the number of cases, the majority of them manifest themselves only as seroma, and total capsulectomy is a sufficient and final treatment. Today the presence of breast implants without definite symptoms is not an indication for implant removal or replacement. The authors consider it rational to create a national registry of implants with the aim of an analytical approach to possible associations with pathological conditions.
Objective. To analyze and systematize the results of ultrasound scan in patients with acute complications of diverticular disease of the colon. Methods. The results of ultrasound scan of the intestine were analyzed in 57 patients who complained of acute abdominal pain, flatulence and stool abnormalities, who had diverticular disease of the colon. Of these, 31 (54,4%) were women and 26 (45,6%) were men. In 49 (86%) patients, diverticula were located in the left side of the colon, in 6 (10,5%) patients, diverticula were located in the right side of the colon and 2 (3,5%) patients, diverticula were found all over colon. Result. A preliminary ultrasound classification of acute complications of diverticular disease of the colon according to the severity of the course (4 degrees) has been developed. The first degree indicates an inflamed diverticulum with/without pericolitis, with/without abscess ≤2 cm in diameter regardless of localisation in relation to the mesenteric and anti-mesenteric margins. The second degree indicates an inflamed diverticulum with an abscess >3 cm in diameter or with a diverticulum perforation along the mesenteric margin, as well as with an abscess >2cm and with a perforation along the anti-mesenteric margin. The third degree is characterized by focal or generalized purulent peritonitis. The fourth degree - development of faecal peritonitis. Conclusion. Ultrasound is safe, non-invasive, easy and affordable, It allows at once visualize not only the entire gastrointestinal tract, but also other organs and systems, in parallel interpret both clinical and ultrasound data, classify patients into outpatient and inpatient depending on the severity of complications of diverticular disease of the colon.
The main cause of the development of trophic ulcers is the insufficiency of the venous system of the lower extremities. Venous trophic ulcers (VTU) occupy up to 80% of the structure of trophic lesions of the skin and soft tissues. This pathology is more common in elderly and senile people, when the incidence of the lesion reaches 5% in the population. Without a doubt, in order to achieve complete and rapid healing, surgical treatment is necessary, which would eliminate the etiological factor of the development of VTU. However, in most cases, surgical correction of venous insufficiency is not feasible. Conservative treatment should be multidirectional, and recently more and more attention has been paid to physiotherapy methods of influence. The analysis of the literature data confirms the possibility of using various types of physiotherapeutic methods of exposure as additional therapy for patients suffering from trophic ulcers of mainly venous etiology. It was found that the combination of methods based on various physical factors of influence has the most favorable effect on the healing of VTU. It is not possible to talk about the preferential effectiveness of any one method of physiotherapy, since the studies of individual authors are not identical, which does not allow them to be compared. Thus, we consider further research in this direction to be promising, since these studies will optimize the treatment process and improve the quality of life of patients with VTU.
Objective. The aim of the study is to determine the effectiveness of the standard complex treatment of acute purulent periostitis of the mandible on the basis of morphological changes in experimental conditions. Methods. The study was performed on 47 rabbits (acute purulent periostitis of the lower jaw was simulated on 45). Series 1 - 12 animals that received only surgical treatment after the model was created. Series 2 - 7 animals that underwent surgery and received antibacterial therapy. Series 3 - 26 rabbits that were not treated. Series 4 served as a control and consisted of 2 animals without pathology. Micro-preparations were prepared according to the standard method. Morphological changes were evaluated in the analysis of periosteal pathology and expressed in points depending on their degree. The obtained data were processed statistically. Results. The surgical method of treatment of periostitis in combination with antibiotic therapy made it possible to localize the inflammatory focus 2 days earlier than with isolated surgical treatment. An integrated approach contributed to optimization both in the focus of inflammation and in adjacent tissues. However, the prolonged persistence of inflammation was accompanied by reactive bone resorption and substitutive sclerosis which violated the anatomical relationship of structures in the area of examination. Conclusion. Standard treatment of experimental acute purulent periostitis of the lower jaw does not give the desired result. It can lead to a chronic course of the disease and severe complications. This is the basis for the development of new complexes for its treatment. What this paper adds Morphological descriptive and morphometric confirmation of the creation of a new experimental model of acute purulent periostitis of the lower jaw in a Chinchilla rabbit is presented for the first time. It is proved, firstly, that the surgical treatment of experimental periostitis in combination with antibiotic treatment made it possible to localize and limit the inflammatory focus 2 days earlier than with isolated surgical treatment and, secondly, that standard complex treatment does not allow to achieve full recovery in the specified period of time.
Цель. Улучшить результаты лечения пациентов с язвенным колитом с помощью персонифицированной антибактериальной терапии, подобранной на основании микробиологического исследования биоптатов слизистой толстой кишки. Материал и методы. Работа основана на анализе результатов лечения 80 пациентов, у которых была диагностирована тяжелая атака язвенного колита. В основной группе пациентов (n=40) комплексное лечение дополняли назначением антибактериальной терапии с учетом чувствительности к ней микроорганизмов, полученных из биоптатов стенки толстой кишки. В контрольной группе пациентам (n=40) назначали общепринятое лечение. Ближайшие результаты лечения у пациентов групп сравнения отслежены в течение 30 и 90 дней. Отдаленные результаты проанализированы через 6 и 12 месяцев. Результаты. Через 2 недели у всех пациентов основной группы стул нормализовался, у пациентов группы сравнения нормализация стула была отмечена лишь через 1 месяц от начала лечения. У 24 (60 %) пациентов основной группы на 7-е сутки лечения уровень лейкоцитов крови был в пределах нормы, тогда как в группе сравнения этот показатель нормализовался только у 4 (10 %) пациентов. На 7,5 % чаще пациенты в контрольной группе подвергались хирургическому лечению. В контрольной группе у 6 (15 %) из 7 оперированных пациентов случились осложнения в стационаре. В основной группе лишь у 1 (2,5 %) пациента зарегистрирован рецидив заболевания через 6 месяцев после проведенного лечения, тогда как в контрольной группе рецидив возникал в 4 раза чаще. Заключение. Использование персонифицированной антибактериальной терапии, подобранной на основании результатов микробиологического исследования биоптатов слизистой толстой кишки, улучшает результаты лечения пациентов с тяжелыми формами язвенного колита, позволяя добиться скорой ремиссии заболевания с увеличением ее сроков, а при хирургическом лечении пациентов уменьшить количество периоперационных осложнений.
Spontaneous rupture of the spleen is a rare incident and occurs without visible external mechanical injury. However, the mortality rate is 2-5 folds higher than that of a traumatic rupture, which is usually associated with the underlying disease. In most of these pathological conditions, proliferative processes within the organ, vascular thrombosis, heart attacks and hematomas cause a rapid enlargement of the spleen volume measured by size. At some stage, this volume begins to exceed the permissible volume of the organ, limited by the stretch limit of its capsule. Then breakup occurs. Two observations are of great interest in the sense of spontaneous rupture of the spleen with massive bleeding (III degree) occurred against the background of complete well-being and was the first symptom of a neglected proliferative blood disease. Before the spontaneous rupture, both patients had no complaints about the general condition of the body and led an active lifestyle. One rupture occurred during diagnostic performance of a contrast-enhanced CT-scan. It was diagnosed not only violation of the integrity of the organ, but also ongoing intra-abdominal arteriovenous bleeding. The second rupture occurred during sleep, when any, even the most insignificant, mechanical injury is completely ruled out. Timely diagnosis and surgical treatments (splenectomy and hemostasis) have prevented the adverse outcomes.
Although abdominal drainage is a routine method of completing abdominal surgery, the feasibility and validity of this approach are widely discussed. The opponents of using drainages argue that they have low efficiency and may cause negative consequences, thereby prolonging the hospitalization period and increasing the risk of complications. In most cases, these complications do not pose any danger, but sometimes they may pose an immediate threat to the patient’s life and require repeated interventions. It is believed that abdominal drainage should be performed according to strict indications and if necessary in compliance with techniques that exclude the occurrence of adverse events. The care of drainages in the postoperative period is equally important. The presented rare case of herniation gallbladder reminds us that such hernias may form at the sites of abdominal drainage. According to the literature their frequency does not exceed 3.4%. These hernias are often subject to insidious and diagnostically difficult strangulation because of the narrow gates. Ultrasound is consided as a good help highly, but the informative method of choice in the diaguosis is multispiral computed tomography (multigpiral ct) of the abdominal organs.
Strictures of hepatico-jejunal anastomosis (HJA) are a topical problem in the biliary surgery. This pathology is often complicated by recurrent cholangitis, cholangiolithiasis, liver failure and cirrhosis. This observation presents a clinical case of minimally invasive treatment of a 56-year-old patient with cicatricial stricture of hepatico-jejunal-anastomosis, recurrent cholangitis, cholangiolithiasis. The patient underwent gastropancreatoduodenal resection with resection of paranephric tissue and mesocolon for locally distributed stenosing duodenal cancer (T4N0M0-moderately differentiated adenocarcinoma with an average degree of differentiation). In connection with the developed cicatricial stricture of HJA, an attempt to perform the antegrade Rendezvous technique: double-balloon endoscopy has been made. The latter attempt due to the adhesion process around the Roux loop was failed. The percutaneous transhepatic cholangiostomy (PTC) was performed through the left lobe of the liver under US and X-rays control, HJA recanalization, balloon dilatation of the HJA stricture, external - internal bile drainage. Subsequently, second endoscopic balloon dilatation of the HJA stenosis was performed. More later repeated balloon dilation of HJA, mechanical lithotripsy, and lithoextraction were carried out. Cholangiography revealed a rigid HJA stricture. Biliary stenting was performed with a self-expanding nitinol stent «SX-Ella» with a diameter of 8 mm and a length of 40 mm for internal bile drainage. At the control examination after 10 months no complaints were recorded.
