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.
