Vol 12, No 2 (2023): XVI ВСЕРОССИЙСКИЙ ФОРУМ С МЕЖДУНАРОДНЫМ УЧАСТИЕМ «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ХИРУРГИИ»
- Year: 2023
- Articles: 19
- URL: https://new.vestnik-surgery.com/index.php/2415-7805/issue/view/199
Full Issue
Хирургические дисциплины
BIOLOGICAL ADHESIVE FOR SEALING SURGICAL ANASTOMOSES - PRIMARY EXPERIMENT RESULTS
Abstract
This work was carried out as part of a study on the development of a biological adhesive for sealing surgical suture anastomoses.
Purpose: experimental study of the effectiveness and safety of the author's surgical glue, consisting of two mixing components - a 40% solution of human albumin and a fixing epoxy compound.
Methods: fixed and non-fixed organocomplexes with large arteries, with performed punctures of walls with surgical needles of different diameters; experimental operations on rabbits, consisting in suturing of abdominal aorta incision. The areas of suture punctures were treated with three types of surgical glue: the original prototype, an experimental copy of the prototype, and the author's product. A comparative analysis of the hydraulic tightness of the seam holes was carried out.
Results: the original prototype provided complete tightness of the suture holes on the arteries of the organocomplexes and in the experiment on animals; an experimental copy of the prototype did not provide sufficient tightness of the seams; the use of author's glue in the experiment on fixed cadaveric organocomplexes, non-fixed animal organocomplexes and in the experiment on rabbits, sufficient tightness was obtained, however, a lower quality of adhesion was noted in comparison with the original prototype.
Conclusions: the developing biological glue for sealing surgical anastomoses in an acute experiment proved to be a good adhesive with satisfactory adhesive properties. To conduct a full-fledged preclinical test of the glue, it is necessary to refine its composition.
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EVALUATION OF THE RESULTS OF VSD CORRECTION USING TRANSCUSPIDAL ACCESS IN CHILDREN UNDER 1 YEAR OF AGE
Abstract
Relevance: Ventricular septal defect (VSD) is one of the most common congenital heart defects in children and occurs in 32% of patients with congenital heart disease.
Objective: To evaluate the results of surgical correction of VSD in children under 1 year of age.
Methods: We performed a retrospective documentation analysis of 48 patients under 1 year of age who were operated for perimembranous VSD in the cardiac surgery department of VRCH No.1 from 2016 to 2022. Patients were divided into 2 groups: in group 1 (n=22) the standard method of VSD closure was used; in group 2 (n=26) the technique of temporary TV septal flap dissection was used. Assessment of treatment outcomes adequacy was performed based on the criteria (presence of residual shunt, rhythm and conduction disturbances, presence of valve regurgitation) immediately before discharge and 36 months later. To account for distant results we used information from examinations conducted by pediatric cardiologists at the place of residence and at "VRCH №1". Objectivity of the evaluation was achieved due to the medical effectiveness index for each group.
Results: The duration of artificial circulation and aortic clamping between the groups differed insignificantly (p<0.05). At the time of hospital discharge, according to echocardiography, residual shunts greater than 3 mm in group 1 were in 3 children (13.6%) and in group 2 in 4 children (15.4%). Moderate tricuspid regurgitation in group 1 was observed in 10 patients (45.5%), and insufficiency of TV 2 was determined in 8 (36.4%) patients. In the 2nd group, moderate insufficiency of TV in 11 (42.3%) patients, insufficiency of TV of the 2nd degree in 11 (42.3%) patients.
In the early postoperative period, implantation of permanent ACP was required in 1 (3.8%) patient in group 2 (complete AV-blockade). In the long-term period the patients did not require cardiac insufficiency therapy, no endocarditis of any etiology or rhythm disturbances requiring ACP inmplantation. No clinically significant TV insufficiency was detected in the groups. There were no lethality of cardiac pathology during the follow-up.
Adequacy of correction: at discharge in 1 - 86.4%, in 2 - 80.8%; after 36 months in 1 - 100%, in 2 - 96.2%.
Conclusions: The main result of VSD surgical treatment in the early and distant postoperative period is adequately performed correction. The use of transcuspidal access is effective in the surgical correction of VSD, the immediate and long-term results of which are comparable with the standard procedure in infants.
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COMPLICATIONS OF THE TREATMENT OF INGUINAL HERNIAS IN THE POSTOPERATIVE PERIOD IN CHILDREN IN THE CITY OF VORONEZH
Abstract
Purpose: to choose a rational type of surgical treatment of inguinal hernia, taking into account all possible anamnestic and clinical features of the patient.
Methods. Over the past 5 years, 1,853 children with a diagnosis of inguinal hernia have addressed to the Children's Clinical Hospital No. 2. Among them, 164 children were operated on by laparoscopic method: 143 patients - by purse-string method, 21 - by needle methods. To most accurately determine the feasibility and relevance of this work, we identified 4 clinical cases (with postoperative complications) that accurately describe the importance of an individual approach in the treatment of inguinal hernia. Among them: failure of the surgical node, cyst of the spermatic cord, subjective discomfort due to the surgical node palpable under the skin and pulling pains due to the strong tension of the tissues in the direction of the inguinal canal. By the method of analysis and individual approach, a rational treatment was carried out, which made it possible to eliminate all the complications that arose.
Results. The causes of relapses and complications of inguinal hernias can be completely different factors. It is not always possible to choose the most accurate method of surgical intervention, which 100% avoids relapses and complications. However, taking into account such factors as: age, gender, body constitution, weight, can significantly reduce the number of adverse effects in the postoperative period and choose the most appropriate technique.
Findings. In the practice of a pediatric surgeon, it is important to apply an individual approach to each clinical case with a diagnosis of inguinal hernia in order to select the most rational method of treatment.
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COMPARATIVE EVALUATION OF THE OTOTOXICITY OF CISPLATIN AND CARBOPLATIN IN THE EXPERIMENT
Abstract
Relevance: Platinum-based chemotherapeutic drugs are widely used in the treatment of malignancies. Representatives of this group of drugs such as cisplatin and carboplatin have side effects such as nephrotoxicity, myelosuppression, neurotoxicity and ototoxicity. Ototoxicity is manifested by unilateral or bilateral hearing loss, which can be accompanied by tinnitus. Hearing damage depends on the dose and cumulative capacity of the drug. In experimental animal models, cisplatin was found to lead to the death of external and internal hair cells. Carboplatin is an analogue of cisplatin, the mechanism of action is similar to cisplatin, but the side effects of carboplatin are less pronounced.
Objective of the study: To evaluate the ototoxic effect of platinum-containing chemotherapy drugs in laboratory rats using objective methods of hearing examination.
Study materials and methods: A series of experiments were conducted on 30 laboratory rats of albinos weighing 190gr to 210 gr. Laboratory animals were divided into three groups, which were given three courses of chemotherapy. Before and after the chemotherapy course, laboratory animals underwent functional hearing examination.
Results: After a series of experiments, it was found that cisplatin was administered in a group of animals at therapeutic doses, and an increase in hearing thresholds was noted. The studies performed in laboratory rats treated with carboplatin did not differ significantly from the control group treated with saline.
Conclusion: After a series of experiments, our results show that there is a difference in the manifestation of ototoxicity of chemoperapes containing platinum.
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MODERN METHODS OF MEASURING THE AREA OF WOUND SURFACE AND THEIR COMPARISON WITH EACH OTHER
Abstract
Relevance. Soft tissue wounds remain a pressing issue in modern surgery. According to Elibrary, more than 1,500 articles on wound defects are published annually, and according to PubMed, more than 60,000 articles, which indicates an active search for ways to treat them. During the study of the topic, it turned out that at the moment there is no single standard and recommendations for wound surface planimetry. Correct measurements of the wound defect are necessary to assess the course of the wound process, the rate of regeneration and the assessment of the treatment being carried out.
Purpose. Conduct a comparative analysis of the methods of soft tissue wound planimetry in phantom models of various geometric shapes.
Materials and methods. The study was carried out on phantom wounds of various geometric shapes - round, oval, square, rectangular, triangular and trapezoidal. The simulation of the wound surface was carried out on flat, spherical and cylindrical surfaces. Mobile applications V2F, + WoundDesk and ImitoWound and computer programs Universal Desktop Ruler and ImageJ were used as measurement methods.
Results. According to the results of measurements of the area of a wound defect on phantom wounds, the best result among computer programs was shown by Universal Desktop Ruler, among mobile applications - ImitoWound and + WoundDesk.
Conclusion. According to the results, it is currently recommended to use the Universal Desktop Ruler computer program and the ImitoWound and + WoundDesk mobile applications. The use of these methods is justified due to the high accuracy of their measurements.
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CONGENITAL URETHRAL HYPOSPADIA IN INFANTS
Abstract
Annotation. In recent years, there has been a deterioration in the reproductive health of the population. According to WHO, 3.2% of infants have at least one congenital deformity. According to statistics, an increase in the number of diseases of the genitourinary system under the age of 14 years has been registered. Against this background, the growth of congenital anomalies was noted. One of the most common forms of lower urinary tract abnormalities is hypospadias.
Goal. review and analysis of modern literature devoted to current data on the etiology, forms of hypospadias, as well as the treatment of this pathology in infants.
Methods. review and analysis of domestic and foreign publications, examination of 5 patients with various types of hypospadias.
Results. one of the most common forms of hypospadias is cephalic, accounting for about 73% of the total incidence in infants. The most effective results of treatment are presented by surgical.
Conclusion. Hypospadias is a widespread pathology that occurs as a result of the following etiological factors: genetic mutations, as well as hormonal disorders of pregnant women in the first and second trimesters.
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USE OF HYDROGEN WATER IN THE TREATMENT OF EXPERIMENTAL WOUNDS
Abstract
Relevance. Soft tissue defects are diagnosed annually in 5.5 million patients worldwide. Wound suppuration is the cause of half of the cases of patients seeking surgical care in the Russian Federation.
Purpose. Improvement of wound process relief results due to application of hydrogen water in complex treatment of experimental wounds.
Materials and methods. Studies were conducted in 2 blocks. Block I studies were conducted in 150 rats with aseptic wounds in 5 study groups: 3 control and 2 main ones. The 1st control group was animals without treatment. In the 2nd and 3rd control groups, applications and hydropressive sanitization of the wound surface were performed using 0.9% sodium chloride solution, in the 1st and 2nd main groups - 0.9% sodium chloride solution enriched with molecular hydrogen. Block II studies were conducted in 150 rats with purulent wounds in 4 study groups: 2 main and 2 control groups. No treatment was performed in Control Group 1. Hydropressive wound sanitization of 0.9% sodium chloride solution was performed in the 2nd control group. In the 2nd and 3rd main groups - applications and hydropressive treatment of the wound surface with 0.9% sodium chloride solution enriched with molecular hydrogen, respectively.
Results. In all experimental groups where hydrogen water was applied, an acceleration in the timing of the relief of inflammation symptoms was observed, including a decrease in hyperemia and edema in the damaged area. The reduction of inflammation and wound healing in the experimental groups, compared with the 1st control, occurred most efficiently.
Conclusion. Application of hydrogen water in the treatment of purulent soft tissue wounds accelerated the duration of the 1st and 2nd phases of the wound process by an average of 1.1-1.7 and 1.1-1.3 times, respectively, compared with the data obtained in the 1st control group. Applications with hydrogen water in the treatment of clean wounds demonstrated better treatment indicators compared to control groups and 2 experimental ones, due to the anti-inflammatory and antioxidant properties of H₂ water. Hydropressive treatment with H₂ water (2 trial groups) showed better results in the treatment of purulent wounds, compared with application and treatment with 0.9% of NaCl p-rum, due to better wound cleaning during GIS. The use of hydrogen water in the experiment showed in the treatment of "pure" soft tissue wounds the highest activity of reparative processes. In the treatment of purulent wounds - faster relief of swelling, acceleration of the formation of fibrin and collagen, epidermis and restoration of muscle tissue. Preliminary studies have shown the safety and effektiv¬nost of the application and hydropressive use of hydrogen water in the complex treatment of soft tissue wounds.
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IN-HOSPITAL TREATMENT OUTCOMES OF PATIENTS WITH COVID-19-RELATED THROMBOTIC EVENTS
Abstract
Arterial and venous thrombotic events are common complications of COVID infection. Thrombotic complications of various location severely exacerbates course of infection disease and it’s prognosis and could be a competing cause of thanatogenesis. An absence of accurate predictors of thrombotic events necessitates comprehensive assessment and analysis of clinical and laboratory issues for development of diagnostic algorithms and prophylactic procedures.
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PREVENTION OF POSTOPERATIVE COMPLICATIONS IN THE VERTEBRAL BODIES OF THE MODIC TYPE AFTER DISCECTOMY ON THE BACKGROUND OF ANTIBIOTIC THERAPY
Abstract
There is a hypothesis from which it follows that some Modic changes (H.B. Albert, C. Manniche, J.S. Sorensen, B.W. Deleuran) may occur as a result of activation of bacterial infection in the end plates of the vertebrae (Mari Kuisma, Jaro Karppinen, 2006). It is known that there are virulent anaerobic and aerobic microorganisms in the human body. ( Pappou IP , Cammisa FP Jr , Girardi FP . 2007), which often invade the circulatory system and when they migrate into the cavity of the disc or the cavity of the spinal canal, they provoke a reaction of macrophages, which in turn provoke a slow development of infection. In intervertebral discs exposed to the degenerative process, the so-called avascular environment develops (Jaakko Niinimäki, MD; Mauno Kurunlahti, MD), which is an ideal zone for the growth of anaerobic bacteria and local inflammation in the discs and adjacent bone closure plates. Due to the low response of inflamed tissues, it is poorly visualized on MRI. The development of nonspecific spondylitis often leads to persistent pain syndromes that reduce the quality of life of the patient, prolonging the rehabilitation period and the patient's stay on the sick list.
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CHRONIC TONSILLITIS IN PATIENTS WITH DIABETES MELLITUS
Abstract
Relevance: the number of inflammatory diseases of the pharynx is currently steadily increasing. At the same time, diabetes mellitus occupies a leading place among the pathologies of the endocrine system. It is known that 59% of diabetic patients also face pathology of ENT organs. All these facts substantiate the urgency of the problem of the combination of chronic tonsillitis and diabetes mellitus.
Objective: to evaluate the data of a bacteriological study of the contents of the crypts of the palatine tonsils in patients with diabetes mellitus as an etiological factor of chronic tonsillitis.
Materials and methods: 27 patients with type I and II diabetes mellitus who were treated in the otorhinolaryngological and endocrinological departments of the Voronezh Regional Clinical Hospital No. 1 were examined. anamnesis of life and present disease was collected in all patients, an otorhinolaryngological examination and bacteriological studies of the contents of the crypts of the palatine tonsils were carried out.
Results: a bacteriological study of the microflora of the crypts of the palatine tonsils in patients with chronic tonsillitis complicated by diabetes mellitus revealed: Staphylococcus aureus, Klebsiella rheimopiae, Pseudomonas aeruginosa, Escherichia coli, and saprophytic microflora were also found. It was found out that the prevailing microflora was Staphyllococcus aureus. Conclusion: the combination of chronic purulent infections of the pharynx and diabetes mellitus aggravates the course of both chronic tonsillitis and type I and II diabetes mellitus and, consequently, reduces the quality of life of patients with these diseases.
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DEVELOPMENT OF NEW GLUE FOR SEALING SURGICAL ANASTOMOSES. SELECTION OF CHEMICAL COMPONENTS IN EXPERIMENTS ON CADAVER AND FRESH ORGANOCOMPLEXES
Abstract
Relevance. Intra - and postoperative bleeding is one of the most frequent complications when performing complex surgical interventions. One of the alternative methods of stopping bleeding is the use of surgical adhesives. The properties of currently existing surgical adhesives do not fully meet all the requirements imposed on them, which creates prerequisites for the development of new products in order to improve the effectiveness of surgical interventions.
Goal. Development of an original biological adhesive for sealing surgical anastomosis.
Materials and methods. A study on the development of a new surgical adhesive for sealing surgical anastomosis was conducted at the Department of Specialized Surgical Disciplines of the N.N. Burdenko VSMU. Databases of medical literature and patents have been analyzed, functional evaluation of various surgical adhesives and their components has been carried out, physico-chemical properties of adhesives in a chemical laboratory have been evaluated.
Results. The components of surgical glue were selected: a solution of CA 40% and DEE 10%.
Conclusions. The selected adhesive formulation ensures the tightness of the surgical suture anastomosis. It is necessary to refine the modes of using surgical glue on biological tissues. To assess the effectiveness and safety, it is necessary to conduct a series of long-term experiments on animals.
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THE USE OF IMMUNOMODULATORY THERAPY FOR THE TREATMENT OF DEFORMING COXARTHROSIS IN COMBINATION WITH TOTAL HIP REPLACEMENT
Abstract
Introduction: Osteoarthritis is detected in 10-20% of the world's population, being the most common pathology of the musculoskeletal system, leading to permanent disability from 38% to 71% of patients. Endoprosthetics of large joints is the "gold standard" for the treatment of patients with destructive osteoarthritis, as it improves the quality of life, the volume of movements, the ability to support the limb, relieves chronic pain syndrome, lameness and shortening of the limb. At the same time, the altered immunological background in patients before surgery, associated with comorbital pathology, destructive processes in the joint, operational stress and other causes contributes to the formation of secondary immunodeficiency.
Methods: The result of treatment of 120 patients with deforming coxarthrosis using total endoprosthetics with subsequent use of drugs with redox potential and immunophane was analyzed.
Results: The best long-term results were achieved in groups of patients with the combined use of non-catholyte-based drugs and subsequent use of immunomodulatory drugs. When evaluated on the Harris scale, at the 6th month after the study, excellent results were observed 5% more often compared to the isolated use of each of the methods, at the 12th month, "excellent" results on the Harris scale were achieved in 30% of patients, "good" in 50% of patients. In the 3rd year, the evaluation of the results in patients with the combined use of catholyte and immunophane was 50%, which is 10% higher compared to the isolated use of each of the methods and 20% higher compared to the isolated hip replacement. At the same time, the occurrence of long-term complications with the combined use of catholyte and immunophane was observed only in 2.5% of patients.
Discussion: The proposed method of treatment of deforming coxarthrosis of stage 3-4 has an undoubted advantage over isolated total endoprosthetics and allows achieving the best long-term treatment results.
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ON THE PREVENTION OF VARICOSE VEINS OF THE LOWER EXTREMITIES
Abstract
Relevance. Varicose veins are the most common disease of peripheral vessels, in which the superficial veins of the lower extremities are most often affected due to the failure of their valves, dilation of veins, the formation of local venous congestion.
It occurs everywhere, but more often in elderly women.
Gradually progressing, varicose veins leads to the development of chronic venous insufficiency, the appearance of trophic ulcers of the distal parts of the legs and is a potential threat of thromboembolic complications.
Purpose: to analyze the awareness of the population about the need to prevent varicose veins of the lower extremities.
Materials and methods. Materials: printed sources and Internet resources, developed questionnaire. Methods – questionnaire, search, analytical, descriptive, statistical processing of the results obtained.
Results. Prevention of varicose veins of the lower extremities includes a whole range of measures based primarily on universal components of a healthy lifestyle, which, however, in the context of this pathology are of paramount importance. They can be formulated in the form of a memo:
1. Move! Walking, running, cycling are useful, swimming is especially recommended. Walk more often and avoid using the elevator if possible. 2. Do sports! 3. Eat right! Include more raw vegetables and fruits in your diet. Limit fatty, spicy and salty dishes. Use bread made from coarse flour with bran, buckwheat, vegetable oils. 4. Limit excess fluid intake! Excess fluid puts additional strain on the veins, but its lack leads to constipation, which exacerbates chronic venous insufficiency. 5. Control the weight! Strive to get rid of excess weight. 6. When sitting for a long time, try to change your posture more often. 7. During rest and sleep, try to keep your legs in an elevated position. 8. Take a contrast foot shower, alternating warm and cold water. 9. Wear a heel no more than 5 cm. 10. Use compression knitwear and orthopedic insoles.
Conclusion. Varicose veins are a common, slowly progressing disease of the valvular vein apparatus, most often affecting the superficial veins of the lower legs, having pronounced clinical manifestations and serious complications. Both the disease itself and its progression can and should be prevented by regularly carrying out a set of preventive measures aimed at increasing the tone of problem veins and eliminating blood stagnation in them.
KEY WORDS: varicose veins, population, prevention.
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ANALYSIS AND COMPARATIVE CHARACTERISTICS OF DELAYED EFFECTS OF LAPAROSCOPIC AND OPEN METHODS IN THE TREATMENT OF PERITONITIS IN CHILDREN
Abstract
Relevance. Almost every day, a pediatric surgeon faces the question of choosing a treatment method for such a complex pathology as peritonitis. Since in addition to eliminating the source of peritonitis and a favorable course of the postoperative period, the doctor's goal is to have good delayed consequences of surgery, taking into account the age of patients. The purpose of the work was to evaluate the effectiveness of the use of endovideosurgical technologies in the treatment of peritonitis in children, namely, the analysis and comparative characteristics of the delayed effects of laparoscopic and open methods in the treatment of diffuse and total forms of childhood peritonitis in the CSTO No. 2 Voronezh in the period from 01.2017 to 01.2021. Methods. Using data from the hospital archive of the CSTO No. 2 in Voronezh, a sample of case histories (in the amount of 100 pieces) of patients treated for peritonitis was taken. One of the criteria for including a medical history in the sample included the use of a specific treatment technique, namely 50 histories – laparoscopic intervention, 50 - laparotomy. Then, according to the phone data, we sent questionnaires, the answers to which served as the basis of this study. During the evaluation of the results, statistical analysis methods were used using the statistical software package "IBM SPSS". As a result, we were able to compare these methods in the issue of delayed consequences of surgical intervention. Results. During the study, questionnaires of 62 patients were obtained and analyzed, the results of which are presented in this paper. Conclusion. Based on the data of our work, we can conclude that by examining and comparing the catamnesis of patients who underwent surgical treatment for peritonitis, a greater number of delayed negative consequences occur after laparotomy, which indirectly suggests that the laparoscopic technique is more gentle and suitable for children.
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TAXONOMICAL APPROACH TO ASSESSMENT, EARLY DETECTION, PREVENTION AND TREATMENT OF CRUZARTHROSIS
Abstract
Introduction. Vascular disorders that cause changes in the trophism of the subchondral layer of the tibial bone lead to changes in the trabecular bone tissue system and loss of cartilage elasticity. Hematomas form at the early stages of acute trauma, leading to separation of cartilage from bone. The aim of the study was to determine the degree of influence of different available surgical treatment methods on patients with acute and chronic vascular disorders and cruralgia. Materials and methods. 33 patients underwent examination and treatment using arthroscopy, X-ray diagnostics, and MRI. 12 patients had a history of injury of more than 1 year and/or a disease manifested as chronic vascular disorders of the tibial bone, while 21 patients had a history of injury from 3 weeks to 1 year ago. Statistical methods were used, including statistical observation, grouping of statistical observation materials, absolute and relative statistical values. Results. Patients were divided into three groups depending on the time of injury. The first group was up to three weeks, the second group was from three weeks to a year (divided into two subgroups), and the third group had injuries over a year ago with chronic vascular disorders in the tibial bone area. Patients in the first group were treated on an outpatient basis and were not included in the study. In the second group, 13 people were in subgroup A, and 8 people were in subgroup B. No significant limitations of daily activities were found. After surgery, patients in subgroup A were able to walk a distance of at least one kilometer without discomfort but complained of pain when descending stairs. In the third group, 12 patients all complained of a deterioration in the quality of life and nocturnal cruralgia. Arthrodesis was performed to improve the quality of life of patients in the third group and did not cause complications. Discussion. Debridement is effective in injuries up to 1 year ago, improving the quality of life, delaying radical operations, reducing cruralgia, and increasing joint range of motion. Arthrodesis improves the quality of life of patients with injuries over 1 year ago. Delayed treatment of joint cartilage defects leads to arthrosis and disability. MRI and arthroscopy are recommended for diagnosing joint pathology. Conclusion. Arthroscopic interventions improve the life and functioning of damaged joints, delaying radical operations. The mechanism of improved blood circulation requires further investigation.
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Hemotransfusion complications in surgical practice
Abstract
Relevance. The provision of care to surgical patients is inextricably linked with an increase in the number of transfusions of blood components. With the development of immunohematology and the improvement of the quality of research, the role of many antigens of erythrocytes, leukocytes and platelets in the sensitization of the patient's body and the associated development of immune hemolytic and non-hemolytic reactions and complications has been clarified. However, despite the achievements in the field of prevention and treatment, it is not possible to completely prevent the morbidity and mortality of recipients from posttransfusion complications. Thus, the study of the reactivity of the body during blood transfusion remains an urgent task.
The aim of the work is to study the main hemotransfusion complications, their prevention and long-term consequences.
Materials and methods in the course of this issue, a theoretical analysis of articles, scientific literature and publications of the elibrary and pubmed databases was carried out, an assessment of the validity of the selected material and, as a result, a generalization and structuring of the data obtained.
Results. Hyperthermic nonhemolytic reactions and allergic reactions are most common, pulmonary edema, acute hemolysis, and anaphylactic shock are less common. The most rare, but life-threatening, is transfusion-induced acute pulmonary injury.
Conclusion. Transfusion of blood and its components is an integral part of medical practice and is a multifaceted treatment method that allows not only to reduce mortality and the development of complications as a consequence of the disease, but also to prevent high risks during the implementation of intensive therapeutic effects on the patient – transplantation measures, drug effects on cancer, surgical interventions. In surgical practice, hemotransfusion in the realities of modern medical organizations has become nothing more than a routine. The implementation of many surgical manipulations is impossible without donor blood prepared by certain methods of preservation.
It is impossible to ignore the progress in medical research concerning the study of new techniques for testing the compatibility of erythrocyte antigens of a blood donor and a recipient. The use of new technologies for the production of erythrocyte mass is actively underway, the blood service is gaining momentum in automating the registration system. All of the above measures are aimed primarily at reducing the risks of posttransfusion complications. However, it is worth remembering that it is completely impossible to avoid and prevent their development. This can be attributed to the biological nature of transfusion, which is essentially the transplantation of allogeneic tissue into the recipient's body. This manipulation is a potentially dangerous way to correct and replace the deficiency of blood components. That is why the medical staff conducting transfusion therapy is obliged to know possible complications, notify the patient about the ways of their development, have the skills and appropriate qualifications to prevent and treat metabolic disorders in the body associated with blood transfusion.
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Tactics for the treatment of soft tissue injuries in the first and second phases of the wound process
Abstract
Along with burns, wounds are the most common type of damage to the integrity of soft tissue. In peacetime, the wound remains a common type of injury, occurring in everyday life and at work, and patients with wound pathology make up 35-45% of the total structure of surgical patients. The wound process is a complex pathophysiological process and is characterized by staged development.
Purpose: to study the features of tactics for treating soft tissue injuries depending on the phase of the wound process.
Materials and methods: a review of data in PubMed, Cochrane Library, ScienceDirect, eLIBRARY was carried out using the keywords “wound process”, “wound healing”, “treatment of wound process”, “wound process”, “wound healing”. Sources such as documents, case reports, and comparisons of treatment outcomes were excluded.
Results: The main methods of treating wounds in the first (inflammatory) phase of the wound process is the use of antiseptics, such as hypertonic sodium chloride solution; 3-5% boric acid solution; 20% glucose solution; 5% sodium chloride solution; 30% urea solution; Miramistin; povidone-iodine; chlorhexidine; silver sulfathiazole solution and other methods such as water-soluble ointments; proteolytic enzymes; physical methods; NO therapy. In the second (regenerative) phase of the wound process, gel dressings Apollo-PAK and Apollo-PAA with miramistin and anilocaine, and fat-soluble ointments are most often used; hydrogels; dressings with oils, ointments, aerosols.
Conclusion: today there is no single universal method of treating wounds due to differences in the pathophysiological development of the phases of the wound process. When choosing treatment tactics, it is necessary to take into account not only the nature and depth of the damage, but also the characteristics of the course of the wound process and the presence of concomitant somatic pathology. The most optimal is to develop personalized treatment for soft tissue wounds for each individual patient.
Keywords: wounds; soft tissue damage; phases of the wound process; wound treatment
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Search for the most perfect technique of mesh implant placement during ventroplasty of the anterior abdominal wall in the experiment
Abstract
The aim of the study was to conduct a comparative evaluation of the results of prosthetic ventroplasty experiment using mathematical and algorithmic research methods. The study of digital material was carried out by classical mathematical and algorithmic research methods using a package of applied programs in the programming language scipy python. Based on the results of mathematical and algorithmic studies the compatibility of biological implants and tissues of the anterior abdominal wall was shown. For the first time in an experimental study, the advantages of separation ventroplasty using sublay technology were substantiated.
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Arterial orthotopic heart transplantation. The current state of the problem
Abstract
The high morbidity and mortality of patients with chronic heart failure remains a serious problem of modern medicine. Heart transplantation is the most effective method of treating patients with end-stage heart failure.
Goal. To study the main aspects of performing biarterial orthotopic heart transplantation, to evaluate the effectiveness of its application at the present stage.
Materials and methods. A review of the data in PubMed, Cochrane Library, ScienceDirect, eLibrary was carried out using the keywords "heart transplantation", "heart transplant", "biarterial orthotopic transplantation". In addition, a manual search for articles in journals was carried out. Criteria for exclusion from the analysis: description of individual clinical cases; books and documents; comparison of treatment results. The final analysis included 15 sources out of 48 that were initially identified.
Results. The biatrial technique is one of the most common. Biarterial orthotopic heart transplantation has the main advantage over other, more modern, methods – the minimum time of the operation. This makes it possible to reduce the duration of transplant ischemia, which is a decisive factor if the time of transportation of the donor organ to the medical center where the transplant will be performed has reached 5-6 hours. The disadvantage of biarterial orthotopic heart transplantation is the preservation of significant areas of both the donor and recipient atria. This can lead to serious rhythm disturbances due to the preservation of a large number of pacemaker cells of different origins - it is possible to form two rhythm drivers at once.
Conclusion. Biarterial orthotopic heart transplantation is a modern surgical procedure that allows to transplant the heart of a patient suffering from severe cardiovascular diseases, while preserving both vascular trunks. This technique is a significant breakthrough in the treatment of heart failure and has potentially high efficacy. The use of this technique in clinical practice allows us to get as close as possible to restoring normal blood circulation in patients with severe heart defects and other cardiovascular diseases. The prospects for the use of biarterial orthotopic heart transplantation in clinical practice are very encouraging. Every year, the experience in carrying out such transplants is growing, as well as the tools and techniques are being improved. In the future, we can expect an increase in the number of successful transplants and thereby improve the quality of life in a large number of patients with cardiovascular diseases.
Keywords: cardiovascular system; heart; transplantation; biarterial orthotopic heart transplantation
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