Impact of the allogenic tissue transplantation of the fetal cerebral large hemispheres and the оlfactory bulb tissue (OBT) on the healing processes after the brain contusion was studied in experiment. The investigation was performed on mongrel male rats: in laboratory animals of the first group in the first day after open penetrating local cerebral trauma (OPLCT) the allogenic fetal nervous tissue fragment was transplanted into the formatted tissue defect; for the second group – in the first day after cerebral trauma the allogenic OBT fragment was transplanted into the formatted tissue defect; and for the third group (control) - the OPLCT was done without further transplantation of tissues. The impact of the allogenic fetal nervous tissue transplantation was demonstrated by more active participation of glial cells during the healing process course, and the OBT transplantation was followed by activation of neoangiogenesis processes , mainly in the injured brain. The experimental simulation choosed permits to study the possibilities of application of neurogenic tissues in the brain contusion treatment, and to determine the therapy tactics.
THE CHANGES OF CLINICAL APPROACHES AND TACTICS OF TREATMENT IN ACUTE PANCREATITIS, TAKING INTO ACCOUNT THE REVIEWED ATLANTA 2012 CLASSIFICATION
Results of treatment of 124 patients, suffering locally-advanced oral and oropharyngeal cancer were analyzed. In these patients after wide excision of tissues the defect has occurred, which would be impossible to close using simple suturing. To these patients a primary plasty, using musculo-cutaneous or adiposo-cutaneous flap, was performed. The defect, occurring after resection of the oral cavity floor together with the mandibular anterior fragment, constitutes the most complex one for the plasty performance. The main principles of the defects plasty were determined. The plastic material choice depends on peculiar clinical situation, the surgical intervention volume, the defect localization and its size.
The changes in antibiotic sensitivity of the purulent-necrotic processes agents under the low-intensive laser irradiation impact were studied in experimental part of the investigation. There were 156 patients, suffering neuropathically-infected form of the diabetic foot syndrome, examined and treated, in 41 of them the iodine deficiency was revealed. Durable regional intaarterial infusion, low-intensive laser irradiation and preparations of iodine in a daily dose of 200 mcg were applied. High efficacy of the antibacterial therapy photomodification was proved, it have permitted to improve the results of treatment, to refuse from disabling operations in majority of the patients, to secure the foot bearing function. While the iodine deficiency presence the results of treatment are improved due to application of the iodine preparations.
Acute necrotic pancreatitis was followed by disorders of intestinal functions in 96.7% of patients and in 68% — its failure was occurred what had directly influenced on frequency of purulent—septic complication and mortality rate. It was proved that citrulline plasma level had been objectively reflected the severity of enteral failure and served as independent lethality criteria in patients with acute necrotic pancreatitis.
Results of diagnosis and treatment of 19 injured persons, suffering esophageal damage of various etiology, were analyzed.Peculiarities of clinical signs and diagnosis of esophageal injury on various levels and complications were investigated. Various methods of the injured persons’ treatment, concerning the damage character, terms of appeal for medical care, presence of complications and concurrent diseases, were adduced. Optimal ways of treatment for the injured persons, suffering esophageal damage, were proposed.
Hepaticojejunoanastomosis (HJА), using the HF-еlectric welding method, was formatted in 14 patients, suffering the bile outflow disorders along main biliary ducts, in 6 of them - with a common hepatic duct stricture, the HJA stricture, purulent cholangitis, iatrogenic injury of biliary ducts, and in 8 – with malignant tumours of periampullary zone. In all the patients the welding averting one-layer termino-lateral or latero-lateral HJА were formatted. Welding anastomoses were hermetic, quite hard, immediately after formation and so on. Comparative analysis of clinic-laboratory postoperative indices has confirmed the best results achievement of the method proposed.
The impact of implantation of synthetic matrix NeuroGelTM together with neurogenic stem cells (NSC) on the course of posttraumatic spasticity syndrome was studied. Тhe laboratory animals were white mongrel male rats (5 mo, 250 g); the trauma simulation – transsection of the left half of spinal cord (SC) on the ТХІ level. Experimental group 1 consisted of a SC trauma, homotopic implantation of NeuroGelTM together with NSC of fetal (Е17) mice hippocampus (n=20); while group 2 – a SC trauma, homotopic implantation of NeuroGelTM (n=20); and group 3 – a SC trauma (n=16). Investigation of the function index and the spasticity index of posterior ipsilateral extremity was done in accordance to Basso-Beattie-Bresnahan and Ashworth scales. Association of the function index and the spasticity index of posterior ipsilateral extremity in all groups in various variants of the samples formation is ambiguous, witnessing possibility of additional correlation between these characteristics of a movement system. The NSC xenotransplantation in conjunction with NeuroGelTM changes the spasticity syndrome course, creates conditions for its facilitation in remote period after a SC trauma.
Efficacy of the cognitive deficiency prophylaxis was studied in patients, suffering stenotic affection of carotid arteries. Application of intraoperative neuroprotection, using neoton, have permitted to reduce the reperfusion syndrome signs rate from 35.6 to 3.4%, аnd the cognitive deficiency level as well, causing the general occurrence risk of intraoperative or early morbidity lowering. It is expedient to apply the multidisciplinary approach for guaranteeing of adequate quality of clinical monitoring for cognitive functions.
The investigation objective was to improve the patients’ management, suffering a single cardiac ventriculus, in whom a total cavа-pulmonary connection (ТСРС) operation was performed together with correction of the atrio-ventricular valves (AVV) insufficiency, basing on analysis of immediate and middle-term results. From 2005 to 2015 yrs in the clinic the ТСРС operation was performed in 132 patients. Of them 24 patients were choosed , in whom moderate and pronounced insufficiency of systemic AVV was diagnosed. Good early and middle-term results were achieved in 92% patients. In 8 observations, while the AVV correcting, in every patient two and more procedures of plasty were applied. Complex approach, using combination of various procedures of plasty, has guaranteed the optimal result. Application of procedures for the fiber ring stabilization have promoted achievement of best results.
The complex of operative interventions on all levels of medical add was analyzed in 57 wounded persons, treated for the brachial bone gun-shot fracture and for the extremity affection on the humerus level in 2014 - 2015 yrs period. Primary and repeated surgical processing of the wounds was done in 94.7% wounded persons, the core аpparatuses of external fixation were imposed in 85.9%. Vacuum-therapy was conducted in 17.5% wounded persons, free autodermoplasty and autovenous prosthesis of artery was accomplished in 10.5%. Good functional results were achieved in 47.4% wounded persons, satisfactory - in 40.3%, bad - in 12.3%. The management and treatment-diagnostic faults were analyzed.
Structure of the gun-shot-explosive woundings (GSEW) of the peacetime, occurred in 35 children, was analyzed with refinement, concerning a weapon kind and motif of application, as well as clinic-epidemiological and clinic-nosological characteristics of injuries. Аnalysis of the data was conducted in accordance to criteria and demands of evidence-based medicine, using the methods of nonparametric statistics and computeric technologies. Clinic-epidemiological characteristic of the wounded persons have had witnessed, that due to the GSEW accidents suffer children, ageing (11.97 ± 0.68) yrs, mainly boys. The main causes of GSEW were: careless handling of weapons - in 52.6% observations, hooligan’s actions - in 28.9%. Clinical peculiarities of a peacetime GSEW in children have had depended upon the injury severity, caused by special kind of traumatic weapon and traumatic missiles applied.
The character and sequence of changes in the tissues structure of the gastrointestinal walls under the impact of the impulse and constant delivery of electric pressure with frequency 440 kHz were studied. The investigation object was squeezed, using the force, measured from 2 to 6 N/mm2. The ЕКВЗ-300 «Patonmed» apparatus was used as a source of supply. Еlectric parameters of the process was fixed, using the analogue-numerical digital converter LCard E20-10 and laboratory oscilloscope Tektronix TDS 3014C. There was established, that electric conjunction of stomach and small intestine include three elements: destroying and disappearance of mucosa, connective tissue and membranes; fusion of the collagen fascicles and the smooth muscle cells; the loss of the collagen fascicles and the smooth muscle structure and creation of homogenous еlectric welding suture. The first two elements of the electric welding anastomosis are occurring simultaneously, but not dependent one from the other. At the welding suture completion the nondestructive changes of the tissues are spreading on a distance not more than 1 mm beyond the borders of the electrods apposition.
