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AN IMPROVED TRANSABDOMINAL PREPERITONEAL ALLOPLASTY FOR RECURRENT INGUINAL HERNIAS AFTER LICHTENSTEIN’S SURGERY
Get PDFThe aim. Improve results of the surgical treatment of recurrent inguinal hernias after Lichtenstein's surgery by using an advanced TAPP technique.
Materials and methods. An analysis of the surgical treatment of patients with recurrent inguinal hernias after Lichtenstein's surgery using traditional and improved preperitoneal transabdominal alloplasty (TAPP), for the period of 2012–2019, was performed. The traditional TAPP technique was performed for 52 patients who made up the 1st group. An improved TAPP technique was implemented for 53 patients who composed the 2nd group.
The features of the improved TAPP technique, which was different from the traditional one, were by additional mobilization of the parietal peritoneum by 3–4 cm along the upper edge of the defect, the mesh implant was used with a larger size in comparison to the classical one – 15×15 cm and fixed, besides the traditional points, additionally on the lower and lateral edges with medical glue Sulfacrylate.
Results. The results of surgical treatment in the early postoperative period were not significantly different and were comparable. During the long-term period, 51 patients from the 1st group, and 50 patients from the 2nd group were examined. Thus, in the first group in 4 (7.9 %) cases during 6 months period after the application of the traditional TAРР technique, chronic pain was observed on the site of the implanted mesh; among the 2nd group of patients chronic inguinal pain was not observed. In 5 (9.8 %) patients of the 1st group, the recurrence of inguinal hernia was diagnosed, instead of the 2nd group, where relapse was observed in 1 (2 %) case.
Conclusions. Thereby, the results of the traditional and improved TAPP techniques confirm the higher efficiency of the improved technique, due to the absence of the chronic inguinal pain and a lower rate of relapses, which is achieved by wider mobilization of the parietal peritoneum along the upper edge of the defect, and usage of the larger mesh and its additional fixation by gluing it at the lower lateral edge
MODERN ASPECTS OF THE PROBLEM OF FRACTURES OF THE PROXIMAL FEMULAR
Get PDFThe purpose of the study is to study the current global clinical and epidemiological features of proximal hip fractures and the risks of their development and spread. The paper identifies the main aspects of the spread and treatment of fractures of the proximal femur; main world modern epidemiological characteristics of hip fractures and levels of risks of their development and spread. The relationship between comorbidities in patients with proximal hip fractures and the risk of various treatment complications is shown. The main types of treatment tactics are identified, the groups of the most common comorbidities in such patients are given. As a result of the work it was established: the percentage of fractures of the proximal thigh is 9.00–45.00 % among all skeletal fractures in the older age group and among all age categories – 17.00–24.00 %; global annual morbidity is 1.7 million people, and mortality – 11.00–23.00 % in 6 months and 22.00–29.00 % in a year; increase in the frequency of these fractures with age with doubling after 50 years every ten years; average age of patients – 75–79 years; predominance of women over men in 2-3 times; the lowest annual age-standardized cases among women are in Nigeria, South Africa, Tunisia and Ecuador, and the highest are in Denmark, Norway, Sweden and Austria, which is also typical for men; significant economic burden of treatment and high levels of fractures with osteoporosis, cardiovascular disease, diabetes, chronic obstructive pulmonary disease and more; the advantage of surgical treatment over conservative
EFFECTIVENESS OF TREATMENT WITH MEBICAR IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION
Get PDFViolation of the heart rhythm is widespread at present. Anxiety-depressive symptoms and a tendency to chronic stress leads to the depletion of the body, which contributes to arrhythmia.
The aim of the study is to assess the severity of clinical and hemodynamic indices by using anxiolytic drug mebicar.
Materials and methods. Assessment of psycho-emotional status was studied using the psychosocial scale of stress by L. Reader, PSS-10 PHQ-15 and questionnaire identification of social factors that can affect health. Determination of cortisol level in serum was carried out by immunoassay (ELISA) on the ER-500 Microplate Reader. The concentration of N-terminal fragment of the brain natriuretic peptide precursor (NTproBNP) in serum was determined by ELISA using a Biosan PST-60HL shaker.
Results. The results of the survey showed a direct dependence of the manifestation of atrial fibrillation (AF) on the level of psychoemotional stress. We found that in group 1b (standard treatment+mebicar) there were complaints of increased excitability (p<0.001), (p-reliability difference of indices before and after treatment), fatigue (p<0.001), deterioration of memory (p<0.01), appetite loss (p<0.05), sleep disturbance (p<0.001), signs of severe sweating (p<0.001), indicating the appearance of astheno-vegetative syndrome. The reduction of manifestations of high stress (p<0.01) in patients of group 1b (standard treatment+mebicar) was noted. A similar pattern was detected in the severity of anxiety in men (p<0.01).
Conclusions. Application in the complex therapy of patients with stable coronary heart disease (SIHD) in conjunction with AF anxiolytics of the benzodiazepine series (mebicar) has allowed stopping anxiety-depressive disorders. Analyzing the level of cortisol, we observed its increase depending on the degree of anxiety and depression; NT-proBNT metrics are respectively
DISTRIBUTION OF STRONGYLOIDES STERCORALIS AMONG DOGS OF DIFFERENT HOUSING GROUPS IN KYIV AND KYIV REGION, CLINICAL MANIFESTATIONS AND DIAGNOSTIC METHODS
Get PDFStrongyloidiasis in dogs, despite its uncertain zoonotic status, is potentially danger for dogs owners. It is considered that strongyloidiases characteristic for tropical and subtropical regions, but in recent years it is increasingly found in non-endemic countries.
The aim. To determine the extent of the invasion, clinical signs and diagnostic methods of strongyloidiasis in dogs of different groups in Kyiv and Kyiv region.
Materials and methods. A total of 364 dogs were studied (130 animals lived in shelters (Group 1) and 234 in homes (Group 2). Diagnosis of strongyloidiasis was performed by native smear and Baerman methods. Additionally, the sensitivity of the modified string test was tested. Samples of venous blood were taken from dogs with confirmed strongyloidiasis for haematological and biochemical analysis.
Results. A study found that the extent of invasion (EI) in shelters and home dogs was 3.0±0.36 % (4/130; Group 1) and 2.5±0.25 % % (6/234; Group 2) respectively.
It was found that three repetitions of the Baerman method test increased its efficiency to 90.5 %. The sensitivity of the modified string test was 100 %.
Clinical manifestations included disorders of the respiratory (20 %: 2/10) and digestive systems (80 %: 8/10), weight loss (70 %: 7/10). Blood tests did not reveal changes specific to strongyloidiasis, eosinophilia was observed in only one dog in the acute stage of the disease.
Conclusions. The results of our studies indicate the presence of strongyloidiasis in dogs in Kyiv and Kyiv region and probability of the spread of the pathogen in the environment. Symptoms in dogs with strongyloidiasis were nonspecific and cannot be used for diagnosis. A modified string test and Baerman method has demonstrated high efficacy and may be recommended to clarify the diagnosis of a chronic invasion
IMMUNE STATUS OF PATIENTS WITH LUNG TUBERCULOSIS AND ALCOHOL CONSUMPTION
Get PDFTuberculosis is a great medical and social problem. An important risk factor for tuberculosis progress is the systematic use of alcohol. The relationship between alcohol intake and TB has been clear after numerous studies and meta-analyzes. However, there are still open questions about whether alcohol is the direct cause of TB development, which doses of alcohol have the greatest trigger value in progress of TB process, what kind of immunological reactions are significantly associated with alcohol intake and what immune background can determining role of alcohol in progression of TB infection. The features of the immune response in TB patients with different value of alcohol use remain poorly understood.
The aim of the research - to investigate the immune status in patients with firstly diagnosed pulmonary tuberculosis with various levels of alcohol consumption.
Materials and methods. We selected for participating in the study 102 males with tuberculosis and alcohol consumption. Examination of the patients included: clinical methods, chest X-ray, sputum tests, Alcohol Use Disorders Identification Test and immunological blood analysis.
Results. Patients with tuberculosis and alcohol consumption, have increase inflammatory response: higher level of stab neutrophils, CRP, ESR, as well as phagocyte activity, circulating immune complexes levels and medium molecular weight peptides levels. On the other hand we found decreasing of phagocytic number, index of phagocytosis completeness and differentiation clusters CD2+, CD3+, CD4+, CD8+ of T-lymphocytes` sub-populations. The highest changes were observed in the group of alcohol abusers.
Conclusions. Patients with tuberculosis and alcohol intake, even at low levels of its consumption, have a dysregulation of their immune response. On the one hand, there is an increase of non-specific inflammatory reactions, and on the other - a situation, when antigen-presenting cells cannot adequately to process and present the antigen to phagocytes. This prevents the immune system from responding quickly, correctly evaluating and suppressing foreign agents
PREOPERATIVE ENDOBRONCHIAL SANITATION AS PREPARATION FOR THORACIC INTERVENTIONS
Get PDFThe aim – to study the effectiveness of endoscopic photodynamic therapy as a preoperative preparation of the tracheobronchial tree in patients with lung cancer.
Materials and methods. The study included 181 patients with II-III stage of lung’s cancer. Diagnose of lung’s cancer was confirmed with a morphologically and concomitant endobronchitis. During the preoperative preparation, we used a technique developed by us introducing into the tracheobronchial tree an aqueous solution of brilliant green at concentration of 0.04 %, followed by irradiation of this solution with laser radiation with the wavelength of 0.63 μm (AFL-2 helium-neon laser) in an independent form and in combination with traditional anti-inflammatory therapy. Endoscopic endobronchial sanitation therapy was carried out by low-intensity radiation of the red part of the spectrum (λ=0.63–0.66 μm) in a pulsed mode, with a power of 12 mW.
Results. After 3–5 days of the start preoperative preparation and 1–2 sessions of endoscopic bronchosanation, the general state of patients was improved, the amount of sputum decreased and was changing from mucopurulent to mucous. To completely stop the clinical phenomena of endobronchitis, it was necessary to conduct 5-6 sessions of endoscopic photodynamic therapy according to our methodology, with the introduction of our method. In patients without pronounced clinical symptoms of concomitant chronic bronchitis, it was enough to complete only 3 sessions of bronchosanation.
Conclusion. Endoscopic photodynamic bronchosanation in the preoperative period in patients for correcting accompanying endobronchitis can significantly reduce or completely stop the clinical manifestations of endobronchitis in the shortest time and leads to a significant decrease in the number of endobronchial complications in surgical and combined treatment of lung cancer
MORPHOLOGICAL AND STRUCTURAL CHANGES IN MYOCARDIUM, LIPID AND CARBOHYDRATE METABOLISM DURING DIFFERENT OUTCOMES OF CHRONIC HEART FAILURE IN PATIENTS WITH ISCHEMIC HEART DISEASE AND DIABETES MELLITUS TYPE II
Get PDFDiabetes mellitus (DM) type II is an independent risk factor for cardiovascular system injury. To avoid progression of ischemic heart failure (IHF) it is important to find early signs of myocardial injury also as carbohydrate and lipid metabolism alterations.
The objective of the study: to establish features of structural and functional changes in myocardium, carbohydrate and lipid metabolism, in patients with different outcomes of chronic heart failure (CHF), caused by IHD and DM type II.
Material and methods. Examination of 100 patients who have CHF with IHF and DM type II was performed. Patients were divided in two groups, according to outcome: group I (n=66) – patients with favorable outcome, mean age 60.0 [55.8; 63.3] years, group II (n=34) – unfavorable outcome of CHF, mean age 58.0 [55.0; 60.3] years.
We analysed complaints, cardiologycal anamnesis, cardiovascular risk factors, and physical examination data. Transthoracic echocardiography (TTE), carbohydrate and lipid panel were assessed to find out early specific signs of myocardial injury.
Results. We find out statistically significant associations between TTE results, lipid panel and CHF progression in study population.
Conclusions. Comparative analysis showed that degree of CHF in patients with IHD and DM type II that have preserved LV EF is associated with: duration of DM and CHF, arterial hypertension (AH) level and degree of carbohydrate and lipid metabolism disturbances. Early TTE signs of unfavorable outcome are: increase of transmitral deceleration time (Dt), increase of mean PA pressure (PA MP) even in range lower the 20 mmHg
CLINICAL AND MICROBIOLOGICAL FEATURES OF EARLY-ONSET NEONATAL SEPSIS IN PRETERM INFANTS
Get PDFEarly-onset neonatal sepsis (EONS) remains the leading cause of morbidity and mortality, especially among premature infants. Conducting high-quality epidemiological monitoring is an important condition for effective tactics treatment neonatal infections and improving the quality of medical care for this category of newborn.
The aim. Determination of the value of microbiological triggers in the blood in various clinical options for EONS in preterm infants.
Materials and methods. Clinical and microbiological data on 50 prematurely born newborns with EONS were selected. The analysis of the frequency of detected bacteremia, the distribution of pathogenic microorganisms and the clinical characteristics of neonatal sepsis.
Results. In the study, sources of infection were detected in 94 % of cases. Positive blood cultures were obtained in 17 (34 %) newborns with EONS. 61.5 % of all cases of bacteremia were caused by coagulase-negative staphylococcus (CoNS). Gram-negative pathogens were detected in 23.5 % of positive blood cultures, representatives of this group were Escherichia coli and Klebsiella pneumonia. The overall mortality rate from EONS was 30 %.
Conclusions. The incidence of sepsis confirmed by a positive blood culture was 34 %. The most common cause of EONS is CoNS, low incidence of group B Streptococcus sepsis has been established. The most frequent septicopymic sources of infection were the lungs, which is expressed in the high incidence (94 %) of X-ray pneumonia in the structure of the EONS
DYNAMICS OF STRESS LABORATORY FINDINGS AND THEIR RELATION TO PSYCHOEMOTIONAL STATE DURING REGIONAL ANESTHESIA IN PATIENTS WITH LOWER LIMBS INJURIES
Get PDFThe choice of an adequate method of anesthesia for surgical treatment of lower limbs injuries remains a critical task today. Each method applied in this treatment has its advantages and disadvantages. In recent years, regional anesthesia has been the preferential method.
The aim of the study. To study the stress laboratory findings and their relation to the patients’ psychoemotional state in perioperative period while performing regional and combined anesthesia.
Material and methods. It was studied 60 patients aged 18-59 years, who underwent metal osteosynthesis operations due to lower limbs injuries. Surgical treatment was performed under regional anesthesia and regional anesthesia followed by sedation. The patients of both groups were conducted heamodynamics monitoring and determined the intensity of pain in accordance with visual analogue scale and stress indicators with a laboratory method. The psychoemotional state was assessed with the Spielberger-Hanin anxiety scale.
Results. According to the study it was determined, that in patients, who were planned to have surgery, significant psychoemotional stress and stress concentration of hormones in the blood and their interrelation was discovered. Patients about before surgery had a relationship between situational anxiety and cortisol r=0.7; p=0.00006 in group I; r=0.6; p=0.002 in the second group. The relationship between VAS and cortisol r=0.5; p=0.04 in groups I and II. After surgery, the connection was in group I patients between situational anxiety and cortisol r=0.4; p=0.02; the relationship between insulin and the HOMA index r=0.5; p=0.01.
Conclusions. Before the operation, all patients revealed significant psychoemotional stress and stressful changes in the concentration of hormones in the blood. Reliably pronounced dynamics of the indicators was with the use of combined conduction anaesthesia. Thus, the performed study allows to recommend combined regional anesthesia as the method of anesthesia choice, particularly in patients with high anxiety
INFLUENCE OF ACUTE CORONARY SYNDROME ON INTRAOPERATIVE DYNAMICS OF IL-6 DURING CORONARY REVASCULARIZATION
Get PDFPercutaneous x-ray endovascular angioplasty is one of the most modern methods of treatment of severe forms of cardiovascular diseases. In the pathogenesis of acute coronary syndrome, a special place is occupied by the proinflammatory reaction of the body. The main “secondary” marker is interlekin-6. The peak of its production occurs on the first day of damage and correlates with its size.
The aim of the study. To investigate the dynamics of interleukin-6 level in the perioperative period of coronary revascularization, depending on the presence of acute coronary syndrome.
Materials and methods. This study included 68 patients with coronary artery disease. The patients were divided into three study groups. Group 1 and 2 patients were diagnosed with ACS, and they underwent emergency stenting of coronary vessels in order to recanalize occlusion of the coronary arteries. 3rd group patients did not have ACS and they were recanalized as planned.
Results. Analyzing the results of the study, we found that the highest obtained values of IL-6 were in group 1 in comparison with the group of patients who were surgically treated as planned and after stent placement, the interleukin values were 24.8 % higher in group 1 than in group 2 and almost 4 times higher in group 3 (p<0.001). When comparing groups with acute coronary syndrome, interleukin-6 indices were significantly higher by 47.4 % before surgery in group 3 and by 24.9 % after stent placement, which once again confirms the severity of patients with acute myocardial infarction.
Conclusions. Intraoperatively proinflammatory interlekin-6 after coronary artery stenting tends to increase in groups with acute coronary syndrome, while in the group with stable angina, these indicators are significantly higher by 22.8 % (p <0.001). The dynamics of Il-6 levels clearly correlates with the severity of the patient's condition and increases in the presence of acute coronary syndrome, especially in the presence of acute myocardial infarction