Klinichna khirurgiia最新文献

Results of treatment of 276 patients, suffering the lower renalis calyx (LRC) calculi, hav'ing size (1.14 ± 0.35) сm, were analyzed. Depending on acuteness of іnfundibulo—pelvic angle (ІPA) the examined persons were divided on groups with blunt (n=118) andacute (n=158) IPA; 8 аnatomic parameters of the LRC were in total determined. Therewas established, that еxtracorporal shock—wave lithotripsy, in accordance to the cal'culated index of a LRC calculis elimination, is expedient to apply in a bigger ІPA, lesserіnfundibulo—lumbar angle, lesser length of the LRC neck; transcutaneousnephrolithotripsy is effective not depending from a calculi dimensions, length of theLRC neck, value of ІPA and infundibulo—lumbar angle.

Connection of the cytokins profile with experimental hepatic encephalopathy (HE) inrats was studied. Investigation was conducted on 20 laboratory rats, in which HE wassimulated, using СCl4 injection. The іnterleukins (ІL) level, including, ІL—1β, ІL—4, ІL—10 and interferon—γ(IFN—γ), was determined using immunoassay method with the help of polyclonal antibodies. Enhancement of the proinflammatory ІL—1β and ІНФ—γcontent in the rats blood serum while induced HE by 57.9 and 39.5% accordingly (p <0.05), comparing with such in a control and the compensation enhancement of the anti'inflammatory IL—4 and IL—10 level by 34.6 and 75.9% (p < 0.05) was established. Theresults obtained confirms the cytokins role in pathogenesis of HE, determination of theirlevel constitutes significant criterion for the posttransplantation complications prog'nostication. Inflammation and profile of cytokins constitute the main target in therapy ofHE in patients, suffering liver cirrhosis

Possibilities of application of preparations, containing biologically active substances(BAS) of fetoplacental origin, in systemic therapy of the wounds, were analyzed.Comparison of morphological characteristics of the cold wounds while application ofplacental extract (PE) and cryopreserved serum of the cord blood (CPSCB) was done.The pronounced stimulating impact on the wounds healing due to improvement ofmicrocirculation in tissues, bordering upon the cryodestruction zone, the local immuneprocesses stimulation, аctivation of the granulation tissue and epithelial wound defectformation were noted. Therapeutic effect of CPSCB is more significant than that of PE.The data obtained serve as a background for the BAS of fetoplacental origin applicationin complex treatment of the wounds.

Results of treatment of 71 patients, suffering an acute idiopathic deep veins thrombo'sis (DVT) of lower extremities,were analyzed. In 32 (45.1%) patients rivaroxaban wasapplied, in 39 (54.9%) — varfarin. The term of anticoagulant therapy was determined inaccordance to the D—dimers level. Recurrence of the DVT, of massive hemorrhage orpulmonary thromboembolism in the follow—up groups were absent. In 29 (74.4%)patientsa constant dose of varfarin was lined up during minimal recommended period.For reduction of the DVT occurrence risk a rivaroxaban may serve as an alternative tovarfarin.

Dynamics of the posttraumatic spasticity syndrome, a key component of spinal trauma,was investigated on simulation model of the open penetrating spinal cord (SC) traumaon adult male rats of aWistarline after half transection of the SC cross'section with itsdurable compression by biocompatible foreign body. Squeezing of the injured SC byforeign body potentiates formation of spasticity syndrome, and do not influence orrestricts a severe pain syndrome occurrence. Reduction of the SC squeezing due tothe foreign body elongation and reduction of its volume was accompanied by trustwor'thy rising of functional activity and the spasticity reduction in paretic extremity. Changesin activity of efferent chain of the movement system while formation of spasticity syn'drome in simulated trauma have occurred in both parts of SC ' in the injured one and inintact one as well, its severity did not correlate with presence of foreign body in zone oftrauma.

Examination and treatment of 70 patients, suffering an acute necrotic pancreatitits, wasconducted. Content of presepsin, procalcitonin, С—reactive protein and interleukin—6(ІL—6) in the patients' blood plasma was determined, and bacteriological investiga'tions, contrast—enhanced CT were conducted as well. Positive results of bacteriologi'cal investigations were noted in 43 patients. Level of presepsin and procalcitonin inpatients, suffering purulent—septic complications, in 3 — 4 times exceeded such in asterile pancreonecrosis. Presersin level,exceeding over 632 pg/ml, have permitted toconfirm the presence of local and systemic infection with high specificity and sensitivi'ty, and this have exceeded diagnostic possibilities of the procalcitonin content determi'nation. High level of ІL—6 and С—reactive protein is characteristic for the systemicinflammatory response syndrome (SIRS) of infective and noninfective origin.

Lethality, morbidity, survival indices and metabolic consequences of total pancreatec'tomy (TP), performed in patients, suffering pancreatic tumors, were analyzed. Therewere retrospectively analyzed 35 TP оperations, including 5— urgent, 30 — elective,performed in a single center. General lethality have constituted 20% (7 patients died),and after elective ТP — 6.7% (2 died). Complications rate after elective TP have consti'tuted 40%; survival mediana—18 mo; indices of a 3—year survival — 40%, and a 5—year one — 13.3%. Most frequently revealed metabolic changes after ТP — pancreaticexocrine insufficiency, pancreatogenic diabetes, changes in a lipid metabolism inhepatocytes. Our experience witnesses expediency of ТP introduction into surgicalpractice in specialized centers of Ukraine with results, which are matching a worldwide.

Efficacy of the ureteric stricture (UC) treatment, using energy of the Holmium (in 55%patients) and the diode (in 45%) lasers was analyzed. In 37 (77%) patient spositiveresults were achieved already after one session, in 4 (8.3%) — one more session wasperformed in terms up to 3 mo after the first one, in 3 (6.3%) — two sessions were per'formed. Positive results were achieved in total in 91.6% patients. Application of laserenergy in treatment of UC is effective and not dependent from the energy kind and con'stitutes a perspective method of the patient's endoscopic treatment.

Literature data and own experience of the treatment complications, occurring after tho- racic operations, using sternotomy access, were presented. Special attention was drawn to postoperative sternomediastinitis - most frequent infectious complication. Measures for the sternomediastinitis prophylaxis, methods of its diagnosis and treat- ment were presented.