scholarly journals Risk stratification of postoperative complications in jaundiced patients with focal diseases of the biliopancreatoduodenal zone

2021 ◽  
Vol 11 (6) ◽  
pp. 309-319
Author(s):  
P. Muraviov ◽  
B. Zaporozhchenko ◽  
I. Borodaev ◽  
V. Shevchenko ◽  
M. Zaporozhchenko ◽  
...  

The risk stratification was performed by mathematical modeling taking into account genetic factors and the results of instrumental research as ultrasonic elastography. The results of 272 jaundiced patients’ surgical treatment as pancreaticoduodenal resection (PDR) for malignant tumors of biliopancreatoduodenal area (218 patients) and chronic pseudotumoral pancreatitis (54 patients) were analyzed. In the main group (n=112) the optimized algorithm of preoperative preparation and risk stratification was used and in the comparison group (n=160) preparation for PDR was carried out conservatively according to generally accepted standards. radical surgery is defined as inexpedient and too risky, while shunt decompression surgery is performed as a first step for pancreatoduodenal resection. Thanks to the preoperative preparation according to our algorithm, mental status evaluation in the main group compared to the comparison one was significantly better. By MoCA scale before surgery it was 24.9 ± 3.2 and 22.8 ± 2.4 points, and by the DSST test - 40.2 ± 3.8 and 23.6 ± 2.6 points in the main and comparison groups respectively. The level of bilirubinemia in patients of the main group on the day before PDR was 112.3±2.7 μmol/l, while in the comparison one it was 198.3±3.3 μmol/l (p <0.05). On the eve of the PDR, the activity of alkaline phosphatase was in the main group 104.8 ± 1.3 U / l, and in the comparison group - 270.8 ± 1.9 U / l (p <0.05). Before PDR, γ-glutamiltransferase activity significantly decreased to 529 ± 29 U / l in the comparison group and to 485 ± 33 U / l in the main group (p <0.05).

2021 ◽  
pp. 76-81
Author(s):  
S. I. Savolyuk ◽  
A. R. Dembitsky

The evaluation was done in the sphere of preoperative preparation trophic ulcer in patients with CVI using the proposed tactics of mechanochemical debridement and elimination of vertical venous reflux EVEZ method, in comparison with standard preoperative management tactics and EVLT of saphenous veins. It is established that the proposed tactics of preoperative preparation are more effective than classical approaches. Purpose. The use of the EVEZ method in combination with the proposed preoperative preparation of trophic ulcers in the treatment of CVI was determined to be effective. Materials and methods. An analysis of the treatment of 68 patients with CVI C6 clinical class was performed. The patient of the main group received the EVEZ treatment tributaries and perforating veins with preoperative trophic preparation ulcers, which includes: active mechanochemical debridement and control moisture balance in the wound, installation of negative pressure wound therapy system, platelet rich plasma therapy, application drugs based on diosmin and hesperidin. The proposed scheme of preoperative preparation has the following algorithm: Taking a smear from the sore to determine the bacterial spectrum and subsequent rational antibacterial therapy following the results of the antibioticogram; Active mechanochemical debridement with solutions of 0.1% polyaminopropyl biguanide + 0.1% surfactant, povidone-iodine + ethanol + glycerin + laureate 9 and control of moisture balance in the wound with modern hydrogel sore dressings; Installation of VAC system with a constant negative pressure of 120 mm Hg for 3 days for the first 3 performances of the system. Subsequently, VAC therapy was performed in a constant mode with a pressure of 80-120 mm Hg. in patients with insufficient wound cleanliness; After active cleaning, PRP therapy was performed, which involves the introduction of platelet-enriched plasma along the edge of the wound to a depth of 3 to 5 mm. The amount of PRP used depended on the size of the defect and ranged from 1 to 2 ml. All patients of the main group underwent correction of concomitant pathology with systemic use of capillary stabilizing drugs based on diosmin / hesperidin. Patients in the comparison group received standard preoperative preparation and EVLT. Patients of both groups were outpatient for 6 months. 39 of them (57.35%) were women and 29 (42.65%) were men aged 36 to 78 years. The duration of ulcers ranged from 3 months to 7 years. The following localization of venous trophic ulcers was observed: in the area of the medial bone - in 49 (72%) patients, 10 (14.7%) - on the anterior surface, 9 (13.3%) - on the lateral, posterior, anterior medial or anterolateral surface of the tibia. Results. Tactics of preoperative preparation that is offered allowed to achieve: reduction of redness and swelling in the main group on 7.3 ± 0.8 days (comparison group 10.2 ± 0.7 days); complete cleaning of the wound from fibrin and necrotic tissues at 9.1 ± 0.5 days (15.0 ± 1.1); the appearance of granulation tissues at day 12.6 ± 0.9 (18 ± 0.7); the appearance of marginal epithelialization at 15.3 ±0.7 days (20 ± 1.1). Conclusions. The proposed tactics can reduce the term by 1.7 times the preparation of the ulcer for surgery and 1.6 times the healing time of ulcers. The EVEZ method allows performing ablation efficiently and safely trunk great saphenous vein. The use of phlebotonic drugs, which is called Normoven, allows you to accelerate the healing of ulcers and prevent their recurrence.


2021 ◽  
Vol 11 (1) ◽  
pp. 49-54
Author(s):  
Aleksandr I. Neymark ◽  
Boris A. Neymark ◽  
Nikolay A. Nozdrachev ◽  
Michail Y. Gatkin ◽  
Yulia S. Fursa

INTRODUCTION: Phytopreparations are one of the leading medicines used as preoperative preparation and postoperative management in patients with urolithiasis. THE AIM of the study was to evaluate the nephroprotective effect of Renotinex in patients with urolithiasis after extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: The study included 86 patients (43 in the main and the comparison group) with urolithiasis with localization of the stone in the renal pelvis without disturbing the outflow of urine. All patients underwent extracorporeal shock wave lithotripsy (ESWL). After ESWL patients in both groups received spasmodic, anti-inflammatory, antibacterial therapy. Patients of the main group additionally received Renotinex 2 capsules 3 times a day for 14 days before and 14 days after surgery. RESULTS: During the observation a more effective discharge of calculus fragments was noted in patients of the main group while taking the phytocomplex Renotinex, as well as less pronounced damage and faster recovery of the renal parenchyma after ESWL according to the level of enzimuria. CONCLUSION: The results of the study indicate the feasibility of prescribing the phytocomplex Renotinex for nephroprotective and lithokinetic therapy in patients after ESWL.


Morphologia ◽  
2021 ◽  
Vol 14 (4) ◽  
pp. 7-15
Author(s):  
O. O. Bilyayeva ◽  
O. O. Dyadyk ◽  
V. I. Zaritsʹka ◽  
Ye. Ye. Kryzhevskyi

Objective. To prove experimentally the effectiveness of a new generation of application sorbent by studying the morphological changes during the wound process. Methods. Depending on the drug used to treat purulent wounds, we divided the animals into three groups. In the main group (group I) the study was performed on 20 rats, they used an application sorbent, which includes aerosil with immobilization on its matrix ornidazole (Patent of Ukraine for utility model № 115228). The comparison group (group II) consisted of 10 rats, which used the known sorbent "Gentaxan", which includes: gentamicin sulfate, L-tryptophan and zinc sulfate. The comparison group (group III) was 10 rats. In this group for the treatment of purulent wounds used 10% sodium chloride solution, followed by a transition to ointment "Levomekol", which includes chloramphenicol and methyluracil. Results. The results of the study show that in the main group already on the seventh day in comparison with the comparison groups was found granulation tissue with a large number of newly formed vessels of the microcirculatory tract and pronounced proliferation of fibroblasts, indicating acceleration of wound healing. In the comparison groups, the regeneration process was slower. Conclusion. Pathomorphological examination revealed that drugs with sorption properties contribute to a faster reduction of edema and inflammation, and treatment with application sorbent used in the main group, significantly accelerates the processes of connective tissue repair and wound epithelization, ie accelerates wound healing processes with comparison groups.


2012 ◽  
Vol 93 (5) ◽  
pp. 725-728
Author(s):  
Z M Toychuev ◽  
I G Gataullin ◽  
I R Aglullin ◽  
M R Khamitov ◽  
M R Kaji

Aim. To find an optimal way of end colostoma formation in patients with colorectal cancer following abdominoperineal extirpation of the rectum. Methods. Results of surgical treatment (rectum extirpation ended with sigmoidostomy) of 142 patients with malignant tumors of lower part of rectal ampulla treated from 2005 to 2012 are presented. Data of 101 patients (comparison group) were retrospectively analyzed, in whom the same approach of choosing the colostomy technique was applied. The main group consisted of 41 patients in whom the efficacy of authors-introduced technique of colostomy with alloplasty for colostomal wound consolidation from the abdominal cavity side was prospectively defined. Results. The prevalence of early post-operative stomal complications was 18,8% (in 19 out of 109 patients) in comparison group. Ileum volvulus around the stoma causing bowel obstruction was diagnosed in 2 cases, necrosis of stoma wall - in 2 patients, evisceration around stoma site - in 3 patients, perforation of sigmoid stoma - in 1 patient, stoma retraction - in 1 patient, bleeding at stoma site - in 3 patients, paracolostomal mass - in 1 patient. 14 patients from comparison group developed late post-operative stomal complications, including parastomal hernia - 8 patients, stoma prolapse - 3 patients, colostomal fistula - 1 patient, stomal stenosis - 2 patients. Treatment results in the patients from the main group were satisfactory. Early complications included 1 case of bleeding from stoma site, 1 case of partial necrosis of stoma wall. No late complications were registered. The gained data allows to provide successful rehabilitation to patients who underwent colorectal cancer surgery. The described technique is contraindicated in case of infected peritoneal effusion. Conclusion. The use of the method proposed by authors not only significantly improves colostomy results, but significantly decreases the rate of both early and late post-operative complications of stomas compared to standard methods.


Introduction. An important component of the treatment of gunshot wounds is antibiotic therapy. Unfortunately, due to the antibiotic resistance of many strains of microorganisms, there remains a risk of purulent- infectious complications even with prolonged antibiotic therapy. In recent years, methods of physical action, in particular, photodynamic therapy (PDT), have been used to accelerate bacterial decontamination of wounds. Gunshot wounds have their own characteristics that create certain difficulties for the application of the method of photodynamic therapy. Purpose. Аnalyzes the results of the application of the developed PDT method in the complex treatment of gunshot wounds of soft tissues. Materials and methods. A comparison was made of the main indicators of the wound healing process between the wounded of the main group who used PDT (n = 52) and the comparison group (n = 32) who used treatment with complex water-soluble ointments. To increase the effectiveness of the method, the «Photolon» photosensitizer was administered in two ways: by injection infiltration of tissues around the wound and by application directly to the wound surface. The wavelength of laser radiation is 660 nm. The dose of laser energy was 20 J/cm2. Results. The results of the study showed an improvement in the course of the wound process in all respects when using PDT: the period of regression of local edema in the main group on (3.7 ± 0.4) days in the comparison group (6.2 ± 0.5), the period of wound cleansing (4.7 ± 0.6) days (7.3 ± 0.8) days, respectively; the timing of the start of granulation (4.6 ± 0.5) days and (7.8 ± 0.6). At the beginning of treatment, 45 pathogenic strains were isolated in 38 (73.1 %) wounded main groups and 26 strains in 22 (68.7 %) wounded comparison groups. A day after the use of PDT, pathogenic wound microflora was isolated in 5 (9.6 %) wounded main groups — 5 strains and 23 strains in 19 (59.4 %) wounded comparison groups. Conclusions. The effects of PDT were observed: rapid inactivation of pathogenic wound microflora, reduction of edema, pain syndrome and stimulation of granulation growth, which contributes to early closure of wounds.


2018 ◽  
Vol 9 (4) ◽  
pp. 73-80 ◽  
Author(s):  
E. V. Pashchenko ◽  
A. I. Chesnikova ◽  
V. I. Kudinov ◽  
V. P. Terentyev ◽  
O. E. Kolomatskaya

Objective:to determine the cut-off of natriuretic peptide for optimization dyagnosis heart failure in comorbid patients with thyrotoxicosis, to assess the dynamics of this indicator during therapy.Materials and methods:111 patients (58,3±5,6 years) were divided into 4 groups. Te main group consisted of 25 patients with CHD, CHF II-III FC and thyrotoxicosis; the 1st group of comparison - 30 patients with CHD and CHF II-III FC, without thyrotoxicosis; the 2nd group — 30 patients with thyrotoxicosis without CHD, the 3rd group - 26 patients with thyrotoxicosis and CHD, with no signs of CHF. Te fnding of thyroid gland, the level of NT-proBNP was estimated at baseline and afer 6 months therapy. A new cut-off NT-proBNP for the diagnosis of CHF in comorbid patients was calculated by using ROC analysis.Results:the high concentration of NT-proBNP was detected in all patients (more then 125 pg/ml), in the 2nd comparison group — 225.5 (180.1, 376.1) pg/ml. Te NT-proBNP values in the patients of the 1st and 3rd comparison groups did not differ signifcantly. Te highest level of NT-proBNP was detected in the main group — 712.1 (434.3, 893.9) pg/ml. A cut-off of this marker for screening CHF in comorbid patients with CHD and thyrotoxicosis was calculated - 556.4 pg/ml (a sensitivity of 72 %, a specifcity of 100 %, an accuracy of 87.2 % (p <0.001)). Afer 6 months therapy in the 2nd comparison group the level of NT-proBNP decreased by 74 % (р<0,0001) and has reached the normal value (64,6 (42,2;76,3)); in the main group the level decreased by 43% and was 406,7 (309,1; 498,6) pg/ml.Conclusions:the patients of all groups showed an increased concentration of NT-proBNP. Te highest level of NT-proBNP was observed in the group of patients with CHF by CHD and thyrotoxicosis. Te level of NT-proBNP was determined - 556.4 pg/ml, which allows us to diagnose CHF in patients with a combination of CHD and thyrotoxicosis.


Author(s):  
O. H. Boychuk-Tovsta

Summary.The attention of scientists attracts the task of preserving the health of the mother and the fetus in general, as well as studying the oral cavity during pregnancy, in order to prevent the formation of a «dental chroniospermic hearth». The issue of dental morbidity in pregnant women with somatic pathology remains relevant. This is due to many factors, in particular: a significant prevalence of periodontal diseases among the population, an increase in the frequency of extragenital diseases in pregnant women, the influence of infection on the body of the pregnant woman and the fetus. Frequent complications of pregnancy are iron deficiency anemia (IDA), which ranks first among all the complications of the gestation period.The aim of the study – to learn the prevalence and peculiarities of the clinical course of generalized periodontitis of primary and grade I in pregnant women on the background of IDA.Materials and Methods. For solving our tasks, we examined 352 women in the 2nd–3rd trimester of pregnancy at the age of 18–35 years. The original form of generalized periodontitis were observed in 141 individuals with iron deficiency anemia medium and light that formed the core group. The comparison group comprised 98 pregnant women with generalized periodontitis of primary and grade I without concomitant iron deficiency anemia.Results and Discussion. According to research results, the main group generalized periodontitis initial degree met in (43.97±4.18) % of the patients, which was 1.3 times less than in the comparison group. However, the number of cases of generalized periodontitis of the 1st degree in the main group exceeded 1.4 times the similar indicator of the comparison group with values (59.18±4.96) % and (40.82±4.96) % respectively. At the age of 18–26 years, generalized periodontitis of primary level was diagnosed in 1.4 times less than in the surveyed comparison group (48.05±5.69) % vs. (67.92±6.41) %. In the age range of 27–35 years in the main group, generalized periodontitis of initial degree was registered in (39.06±6.10) % of the examined, which was 1.3 times lower than that of the comparison group (48.89±7.45) %. Generalized periodontitis of the degree 1 in patients of the main group aged 18–26 years was recorded in (51.95±5.69)% of the surveyed, which significantly exceeded this index of the comparison group by 1.6 times (32.07±6.41) %. With the increase in age to 27–35 years, the number of cases of generalized periodontitis of the degree 1 in the main group exceeded the similar number of comparison groups in 1.2 times: (60.93±6.10) % and (51.11±7.45) % respectively. In the main group at the age of 18–26, the number of cases of generalized periodontitis degree 1 was insignificantly higher than the number of diagnosed generalized periodontitis of initial degree: (51.95±5.69) % versus (48.05±5.69) %, respectively. However, in the age interval 27–35 years degree generalized periodontitis and generalized periodontitis prevailed entry level 1.6 times. The analysis of objective symptoms of the course of generalized periodontitis in the patients of the study groups showed that in pregnant women with iron deficiency anemia, the clinical picture of GP was significantly more pronounced than in women with uncomplicated pregnancy. In the main group, the expressive (63.12 %) bleeding gums in 1.8 times prevailed in the comparator group (35.71 %). Moderate bleeding in the main group was 1.8 times less (36.88 %) than in the comparison group (64.29 %). 66.67 % of the surveyed main group, against 40.82 % of the comparison group, pointed out the tenderness of the gums. The absence of pain in the gums was noted by 33.33 % of the patients with IDA and 59.18 % of the comparison groups under study. In pregnant women of the main group, severe hyperemia of the gums was 1.5 times more frequent compared to the comparison group (65.25 % versus 43.88 %, respectively). At the same time, a slight redness of gums determined 1.6 times more often in women without pregnancy complications than pregnant women with IDA (56.12 % vs. 34.75 %, respectively).Conclusions. Thus, as a result of the analysis of the parodontium tissue condition found that prevalence, intensity and expressiveness of clinical symptoms of generalized periodontitis were significantly higher in pregnant women compared to women with generalized periodontitis without complications of pregnancy. This fact indicates the negative effect of iron deficiency like physical disease, periodontal status in pregnant women.


Author(s):  
M. V. Gubanova ◽  
N. N. Kushnarenko ◽  
T. M. Karavaeva

Aim. The aim of the study was to develop the model for establishing early diagnosis of hypertension in patients with gout. The model was based on data of 24-hour blood pressure monitoring.Material and Methods. A total of 69 patients with gout were enrolled in a single-stage cross-sectional prospective study. Three study groups were assigned as follows: group 1 (main group) comprised hypertensive men with gout (n = 41); group 2 (comparison group) comprised normotensive men with gout (n = 28); group 3 (control) included relatively healthy men  (n = 30). Daily blood pressure monitoring was performed on an outpatient basis using a BPLab device (Peter Telegin, Russia).Results. The significant intergroup differences were found in the following parameters: lowest, mean, and highest 24-hour systolic blood pressure (SBP) values in patients of main and comparison groups (р < 0.001) and in patients of main and control groups (р < 0.001); mean and maximum 24-hour diastolic blood pressure (DBP) values in patients of main and comparison groups (р < 0.001) and in patients of main and control groups (р < 0.001); lowest, mean, and highest 24-hour pulse blood pressure (PBP) values in patients of main and comparison groups (р < 0.001) and in patients of main and control groups (р < 0.001); mean, and maximum 24-hour PBP values in patients of comparison and control groups (р < 0.001). Median values of the lowest, mean, and highest 24-hour SBP in hypertensive patients with gout were significantly higher than the corresponding values in normotensive patients with gout and healthy men of group 3 (p < 0.001). Median values of mean and maximum 24-hour DBP in main group were higher than the corresponding values in comparison group and control group (p < 0.001). Median values of the lowest, mean, and highest 24-hour PBP in hypertensive patients with gout exceeded the corresponding values of patients of control group (p < 0.001). Median values of the mean and maximum 24-hour PBP in main group exceeded the corresponding values of patients of comparison group (p < 0.001). Based on the binary logistic regression model, the prognostic algorithm for hypertension development in gout patients was created using the parameters of 24-hour blood pressure monitoring as predictors and the cut-off K value. If the value of K was > 0.54, then the hypertension development was predicted in gout patients. The sensitivity of developed diagnostic model was 0.84, and the specificity was 0.95.Conclusion. Тhe proposed model, based on the assessment of average-daily values of the lowest, mean, and highest SBP, allowed to establish early diagnosis of hypertension in patients with gout with the accuracy of up to 90%.


Author(s):  
P. T. Muraviov ◽  
◽  
B. S. Zaporozhchenko ◽  
I. E. Borodaev ◽  
M. B. Zaporozhchenko ◽  
...  

The aim of the current research was to compare the early results of pancreatoduodenal resection performing in patients with focal diseases of the biliopancreatoduodenal area complicated by obstructive jaundice syndrome, depending on the type of preoperative preparation. The results of surgical treatment of 272 patients who had been underwent pancreatoduodenal resection for focal diseases of the biliopancreatoduodenal zone complicated by the development of obstructive jaundice syndrome were analyzed. Patients, depending on the type of preoperative preparation, were randomized into two groups: the main group included 112 patients, who were prepared for surgery and predicted the course of the perioperative period in accordance with the original algorithm; and a comparison group (160 patients), in which the preparation was carried out only in a conservative way. Due to the original algorithm of detoxification with the use of biliary decompression in patients of the main group, the level of total bilirubin on the eve of pancreatoduodenal resection was 112.3 ± 2.7 μmol / L, while in the comparison group, where the preparation of patients for radical surgery was carried out without biliary drainage – 198.3 ± 3.3 μmol / L. The activity of alkaline phosphatase on the eve of PDR was 104.8 ± 1.3 U / L in the main group, and 270.8 ± 1.9 U / L in the comparison group (p <0.05). On the eve of PDR, the activity of γ-glutamyltransferase decreased insignificantly – to 529 ± 29 U / L in the comparison group and to 485 ± 33 U / L in the main group (p <0.05). The number of cases of life-threatening postoperative complications in the main group was 42 (37.5%), and in the comparison group – 102 (63.8%). Postoperative mortality in the main group was 6.3%, and in the comparison group – 11.9%.


2021 ◽  
Vol 56 (5) ◽  
pp. 538-551
Author(s):  
Soheil H. Salha ◽  
Naji Qatanani

The present study investigates the effect of mathematical modeling on conceptual understanding among student-teachers. Also, the study proposes relevant materials and activities in mathematical modeling. Two classes of 140 student-teachers participated in the study. Mathematical modeling instruction was used in the treatment group, while the comparison group was taught by a teacher-centered method. T-Test results showed a difference between the treatment and comparison groups in terms of conceptual understanding. Moreover, the mathematical modeling group showed improvement in the knowledge, comprehension, and application of geometry and measurement concepts. The results of this study are novel as they are introduced to student-teachers to facilitate teaching mathematics among children. The researchers suggested engaging student-teachers in rich modeling activities, which would deepen their students' mathematics learning.


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