EXPERIENCE IN THE TREATMENT OF DEPRESSED FRACTURES OF BONES OF THE CRANIAL VAULT IN CHILDREN USING THE AUTHOR’S METHOD OF PROCESSING BONE FLAPS ACCORDING TO PSHENICHNIY

2021 ◽  
Vol 100 (4) ◽  
pp. 133-140
Author(s):  
I.I. Babich ◽  
◽  
A.A. Pshenichniy ◽  
M.S. Avanesov ◽  
Yu.N. Melnikov ◽  
...  
Keyword(s):  
Abdominal Cavity ◽  
Economic Effect ◽  
Skull Fracture ◽  
Main Group ◽  
Cranial Vault ◽  
X Ray ◽  
One Stage ◽  
Depressed Fracture ◽  
Results Of Treatment ◽  
Concomitant Injury

Objective of the study: to improve the results of treatment of patients with depressed fractures of the cranial vault with concomitant trauma by developing a new technique of depressed fracture treatment. Materials and methods of research: from 2015 to 2020 at the Regional Children's Clinical Hospital, Rostov-on-Don, 80 children have undergone reconstructive surgical interventions for damage to the skull bones. Thirty patients with a depressed skull fracture, who underwent a one-stage reconstructive operation according to the method developed by the authors (patent № 2017143056 dated 08/12/17), and concomitant trauma made up the main group. Fifty patients, who underwent reconstructive correction of skull bone defects using the standard technique (cranioplasty with an allograft – titanium plate), made up a comparison group to analyze the effectiveness of the author's method of treating a depressed fracture. All children with concomitant injury underwent X-ray computed tomography (CT) of the brain, cervical spine, chest organs, abdominal cavity, pelvic bones, which made it possible to quickly diagnose and begin the required treatment. Results: no inflammatory changes were observed in the early/late postoperative period among 30 children in the main group. Patients in satisfactory condition were discharged 10–12 days after surgery. Conclusion: the presented author's method of one-stage reconstructive surgery allows to improve the results of treatment of patients with depressed fractures of the cranial vault with concomitant injury and their quality of life in general. This method of correcting a depressed fracture of bones of the cranial vault in children has a significant economic effect due to reduction of the length of hospital stay of the inpatients and saves budgetary resources on alloplastic materials used for bone defect hiding. In the presence of a concomitant injury and the severity of the patient’s condition, it is necessary to perform an X-ray examination of the damaged organs and systems in order to quickly establish a diagnosis and prescribe appropriate treatment. In case of damage to several organs and systems requiring surgical treatment, at the first stage, surgical intervention for brain damage is recommended, in the second stage, in the absence of a life-threatening condition, on the same day or at delay, depending on the patient's condition, further surgical correction of other damaged organs and systems should be carried out.

scholarly journals CURRENT ASPECTS OF DIAGNOSTICS AND TREATMENT OF ACUTE BILLARIAN PANCREATITIS

2018 ◽  
Vol 14 (3-4) ◽  
pp. 74-79
Author(s):  
I.V. Kolosovych ◽  
B.H. Bezrodnyi ◽  
I.V. Hanol
Keyword(s):  
Acute Pancreatitis ◽  
Length Of Stay ◽  
Comparison Group ◽  
Abdominal Cavity ◽  
Main Group ◽  
Duct System ◽  
Results Of Treatment ◽  
Positive Clinical Effect ◽  
Number Of Patients ◽  
Comparative Group

Relevance. The article is devoted to the problem of diagnosis and treatment of acute biliary pancreatitis, which remains one of the most common surgical diseases of the abdominal cavity and accounts for 33.2% of the total number of patients with acute pancreatitis. Objective of the work is to improve the diagnosis and results of surgical treatment of patients with acute pancreatitis of biliary etiology. Materials and methods. The results of treatment of 264 patients with acute pancreatitis of biliary etiology are analyzed. Operative treatment was applied in 92 (34,8 %) patients: endoscopic operations were performed in 44 patients (16,7 %). Thus, in 10 (3,8 %) patients, endoscopic papilloprotectomy was performed with the auditory of the duct system and the extraction of concrements. In other cases, organo-preserving intervention was performed without disturbing the morphofunctional integrity of the sphincter apparatus of the duct system: the cannulation in 6 (2,3%) patients, mechanical (balloon) in 5 (1,9 %) cases, pharmacological (myogenic antispasmodic) dilatation of distal duct and a large duodenal papilla in 11 (4,2 %) patients. In residual choledocholithiasis, a technique of papillotomy under the control of choledochoscopy was proposed – 12 (4,54 %) patients. A comparative analysis of the effectiveness of the treatment of patients who used the "open" (comparative group) and noninvasive endoscopic interventions in the early disease (the main group) was performed. Results. So in the main group the length of stay in the hospital was 12±3,2 days, respectively, in the comparison group – 26±4,3 days. In 42 (95,4 %) patients who had undergone endoscopic surgery, a positive clinical effect, a rapid regress of the symptoms of acute pancreatitis was achieved. In two (4,5 %) patients in the main group, the course was complicated by the development of the abscess of the stuffing box, and puncture under ultrasound control was performed. In patients of the comparison group complications arose in 5 (41,6 %) patients, it is noteworthy that all of them had undergone operative interventions, which were limited only to the rehabilitation and drainage of the abdominal cavity, a stuffing box bag. The mortality rate among unopposed was 1,2 % (2 patients), and among the operated – 11,9 % (11 patients). Among prooperated patients who died, 81,8 % (9 people) were elderly patients. Conclusions. The use of minimally invasive endoscopic interventions in the early phase of the disease reduces the length of stay of patients in the hospital from 26±4,3 days (comparison group) to 12 3,2 days (main group) and the number of complications occurring by 37,1 % (P <0, 05). Application of the proposed method of papillotomy under the control of choledochoscopy makes it possible to reduce the risk of perforation of the wall of the duodenum with the development of peritonitis or retroperitoneal phlegmon by 1,2 % (P <0,05).

scholarly journals The Results of Duodenum-Preserving Resections of the Pancreas in Chronic Pancreatitis Using the Technology of Sealing the Pancreatic-Intestinal Anastomosis

2019 ◽  
Vol 4 (2) ◽  
pp. 122-126
Author(s):  
V. G. Lubyanskiy ◽  
V. V. Seroshtanov
Keyword(s):  
Chronic Pancreatitis ◽  
Intestinal Anastomosis ◽  
Abdominal Cavity ◽  
Main Group ◽  
Control Group ◽  
Cervical Anastomosis ◽  
Pancreatic Anastomosis ◽  
Drainage Fluid ◽  
Results Of Treatment ◽  
Cause Of Deaths

Background. The problem of chronic pancreatitis in recent years is acute, primarily due to the occurrence of complications and pain that forces you to turn to a surgeon. The main cause of deaths is the failure of the pancreatic anastomosis and the occurrence of bleeding into the cavity of the pancreatic intestinal anastomosis (40 %).Aims: to improve the results of duodenum-preserving resections by introducing the technology of sealing the pancreaticintestinal anastomosis.Materials and methods. The clinic operated 225 patients with chronic pancreatitis. All patients before the operation and in the postoperative period were carried out clinical and biochemical studies, the Frey operation was performed. Patients were divided into two groups. The first group, the group of comparison, included 184 (81.8 %) patients with pancreatoenteroanastomosis formed without additional sealing methods. The second group – the main one – consisted of 41 (18.2 %)patients in which the suture of the pancreatic anastomosis was strengthened with an adhesive composite or with the loop of the small intestine.Results. After the surgery, complications in the control group were recorded in 19 (8.4 %) patients: failure – in 6 (3 %), bleeding into the lumen of pancreatoenteroanastomosis – in 9 (4 %), mortality was 1.8 % (4 persons). There were no complications in the main group. The analysis of the amylase content in the drainage fluid revealed high values in the control group on the 3rd day – 916 ± 15 U/l, in comparison with the main group – 437 ± 16 U/l (p < 0.05). The data obtained indicate that the cause of insolvency of the pancreatic-intestinal anastomosis is the penetration of enzymes through the pancreatic-cervical anastomosis zone into the abdominal cavity. When analyzing the results, it turned out that the failure of the pancreatic-intestinal anastomosis was not detected in any case in patients with sealing.Conclusion. The escape of enzymes destroys the tightness of the superimposed fistula and is characterized by an increase in the level of amylase in the drainage fluid. The proposed sealing technologies decrease the number of postoperative complications and improve the results of treatment.

scholarly journals A case of pleuroperitoneal communication in which establishing a laparoscopic pneumoperitoneum was useful for the detection of a fistula

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Takehiko Manabe ◽  
Kenji Ono ◽  
Soichi Oka ◽  
Yuichiro Kawamura ◽  
Toshihiro Osaki
Keyword(s):  
Thoracic Surgery ◽  
Surgical Repair ◽  
Abdominal Cavity ◽  
Case Presentation ◽  
X Ray ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted ◽  
Pleuroperitoneal Communication ◽  
Small Pore ◽  
Chest X Ray

Abstract Background Pleuroperitoneal communication (PPC) is rarely observed, accounting for 1.6% of all patients who undergo continuous ambulatory peritoneal dialysis (CAPD). Although there have been several reports concerning the management of this condition, we have encountered several cases in which control failed. We herein report a valuable case of PPC in which laparoscopic pneumoperitoneum with video-assisted thoracic surgery (VATS) was useful for supporting the diagnosis and treatment. Case presentation The patient was a 58-year-old woman with chronic renal failure due to chronic renal inflammation who was referred to a nephrologist in our hospital to undergo an operation for the induction of CAPD. Post-operatively, she had respiratory failure, and chest X-ray and computed tomography (CT) showed right-sided hydrothorax that decreased when the injection of peritoneal dialysate was interrupted. Therefore, PPC was suspected, and she was referred to our department for surgical repair. We planned surgical treatment via video-assisted thoracic surgery. During the surgery, we failed to detect any lesions with thoracoscopy alone; we therefore added a laparoscopic port at her right-sided abdomen near the navel and infused CO2 gas into the abdominal cavity. On thoracoscopy, bubbles were observed emanating from a small pore at the central tendon of the diaphragm, which was considered to be the lesion responsible for the PPC. We closed it by suturing directly. Conclusions VATS with laparoscopic pneumoperitoneum should be considered as an effective method for inspecting tiny pores of the diaphragm, especially when the lesions responsible for PPC are difficult to detect.

Neue Cyclophosphazene mit Metallen der III. Hauptgruppe als Ringbausteine / New Cyclophosphazenes with Metals of Main Group III as Building Blocks

1994 ◽  
Vol 49 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Reinhard Hasselbring ◽  
Herbert W. Roesky ◽  
Andreas Heine ◽  
Dietmar Stalke ◽  
George M. Sheldrick
Keyword(s):  
Nmr Spectroscopy ◽  
Structure Determination ◽  
Building Blocks ◽  
Main Group ◽  
Ring Formation ◽  
Lewis Acidity ◽  
X Ray ◽  
Group Iii ◽  
Space Groups ◽  
Ring Compounds

Abstract Acylic silylated phosphazenes of the type HN(PR2NSiMe3)2 (1) react quantitatively with molecules MMe3 (M = Al, Ga, In) under ring formation and CH4 evolution. The ring compounds N(PPh2NSiMe3)2AlMe2 (2 a) and N(PPh2NSiMe3)2InMe2 (4 a) have been investiga­ ted by X-ray structure determination. 2a and 4a crystallize in the space groups P 1̄ and P 31, respectively; they show different conformations regarding the cyclohexane framework. NMR spectroscopy of the nuclei in the chelating phosphazene ligand indicates decreasing Lewis acidity of the metal containing fragments in the series AlMe2 ≥ GaMe2 > InMe2.

scholarly journals Potentiality for Efficacy Increase in Treat­ment of Diaphysial Shin Fractures Based on Ilizarov Technique

2005 ◽  
Vol 12 (1) ◽  
pp. 11
Author(s):  
A. G Guseinov
Keyword(s):  
Dynamic Compression ◽  
Axial Loading ◽  
Main Group ◽  
Control Group ◽  
Ilizarov Technique ◽  
New Techniques ◽  
X Ray ◽  
Ilizarov Apparatus ◽  
Duration Of Hospitalization ◽  
Bone Fragments

In treatment of 87 patients (main group) with diaphysial shin fractures new techniques and devices for optimization of transosseous extrafocal osteosynthesis by Ilizarov were applied. All techniques and devices, i.e. devices for the perfection of Ilizarov apparatus stability, for bone fragment reposition, console compression arrangement for extrafocal osteosynthesis in commi­nuted fractures, devices for damper compression of bone fragments, for prevention of lower extremity edema at extrafocal osteosynthesis, for provision of early axial loading in Ilizarov apparatus, for activization of osteogenesis using asymmetrical dynamic compression were elabo­rated by the author. Control group (108 patients) was treated by traditional Ilizarov technique. Treatment results were assessed at terms from 4 months to 2 years. Data of clinical, X-ray and functional examinations as well as terms of fracture healing, duration of hospitalization and terms of working ability restoration were better in the main group as compared to the control one. In the main group good results were achieved in 47.1%c, satisfactory — in 49.4%, poor — in 3.5% of cases, in control group — 30.6%, 63.0%, 6.4%, respectively. Author believes that further perfection of Ilizarov technique is reasonable.

scholarly journals A Prospective Study of Spectrum of Depressed Fractures of Skull and its Surgical Outcome

2015 ◽  
Vol 6 (4) ◽  
pp. 134-138
Author(s):  
Vishwanath Sidram ◽  
PC Chandra Kumar ◽  
Bellara Raghavendra
Keyword(s):  
Prospective Study ◽  
Neurological Deficit ◽  
Surgical Outcome ◽  
Skull Fracture ◽  
Clinical Profile ◽  
Care Hospital ◽  
Associated Injuries ◽  
Depressed Fracture ◽  
Case Series Study ◽  
A Prospective Study

ABSTRACT Background Depressed skull fracture is a very serious type of trauma occurring in 11% of severe head injuries, and there is a consistent association between the presence of cranial fracture and higher incidence of intracranial lesions, neurological deficit, and poor outcome. Depressed cranial fractures have to be treated aggressively because of their association with infection and late epilepsy. Objectives To study the clinical profile and surgical outcome of patients with depressed cranial fractures. Materials and methods A case series study of 44 patients with depressed fracture was conducted in a tertiary care hospital setting at the Department of Neurosurgery, Vijayanagara Institute of Medical Sciences, Bellary, Karnataka, during the period from June 2013 to January 2015. Among the selected patients, the clinical profile, radiological profile, and surgical interventions were undertaken and the outcomes were noted. Appropriate descriptive statistics were used to analyze the findings and to draw inferences. Results There were 30 males and 14 females. The mean age of the patients was 26.95 ± 14.87 years (6–65 years). The common cause of depressed fracture was road traffic accident (45%) and assault (40.9%); 63% of them had compound type and half of the fractures were located in the frontal region. Common associated injuries were extradural hematoma (50%) followed by dural tear (27.3%). Common complications were wound infection (9.1%) and cerebrospinal fluid leak (9.1%). Conclusion The management of depressed fractures should be individualized depending on factors like the degree of depression, communication with the exterior, neurological deficit and presence of associated injuries. How to cite this article Sidram V, Kumar PCC, Raghavendra B. A Prospective Study of Spectrum of Depressed Fractures

scholarly journals Results Of Treatment Of Acute Diffuse Purulent Peritonitis Using Laparostomy

2020 ◽  
Vol 02 (11) ◽  
pp. 66-71
Author(s):  
S. A. Ruziboev ◽  
◽  
A. A. Avazov ◽  
Sh. Kh. Sattarov ◽  
A. N. Elmuradov ◽  
...  
Keyword(s):  
Bacterial Translocation ◽  
Abdominal Cavity ◽  
Multiple Organ ◽  
The Body ◽  
Abdominal Pressure ◽  
Results Of Treatment ◽  
Abdominal Hypertension ◽  
Purulent Peritonitis ◽  
Intractable Problems ◽  
Cause Of Deaths

Currently, despite significant achievements in the field of surgery, anesthesiology and resuscitation, the results of treatment of patients with advanced purulent peritonitis remain one of the most intractable problems, almost every sixth patient with acute surgical diseases and injuries of the abdominal cavity is admitted to medical institutions with peritonitis [1,3] Common peritonitis in 17-29% complicates the course of most acute surgical diseases and is the main cause of deaths in surgical hospitals [3,7]. Lethality in advanced peritonitis remains extremely high and reaches 20-39% [1,2,4,5]. In recent decades, great importance has been attached to recording intra-abdominal pressure in purulent pathology of the abdominal cavity. It was found that intra-abdominal hypertension occurs in every third patient with acute surgical pathology and negatively affects the functioning of all organs and systems of the body [1,6,8]. Pathological changes that occur with acute and excessive increase in intra-abdominal pressure (IAP) are manifestations of abdominal compartment syndrome (ACS) with disorders of the cardiovascular system; urinary disorders, disorders of perfusion of internal organs and the development of intestinal ischemia, which contributes to bacterial translocation and endogenous infection [2,7,8]. Ischemic blood flow disorders of the splanchnic zone are fraught with the development of bacterial translocation and the development of systemic inflammatory response syndrome and multiple organ failure (PON). Unsatisfactoriness with such results gave rise to a fundamentally different approach to the surgical treatment of common forms of peritonitis-the introduction of an open abdominal management method based on the ideas of I. Mikulich (1881), Jean-Louis Faure (1928), N. S. Makoch (1984) and D. Steinberg (1979).

scholarly journals Minimally invasive combined surgical treatment of postcoital cystitis

2020 ◽  
Vol 21 (2) ◽  
pp. 20-25
Author(s):  
J. Sh. Inoyatov ◽  
O. V. Snurnitsyna ◽  
M. V. Lobanov ◽  
O. Yu. Malinina ◽  
Yu. L. Demidko ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Main Group ◽  
Control Group ◽  
Efficacy And Safety ◽  
Study Objective ◽  
Results Of Treatment ◽  
Main Disadvantage ◽  
Combined Technique ◽  
Treatment Profile

Introduction. Urethral transposition remains the most popular operation for postcoital cystitis, however, traumatism and complications, especially such as pudendal neuropathies, dyspareunia and anorgasmia, make us continue to search for effective, but safer techniques.The study objective is to evaluate the efficacy and safety of the proposed treatment of postcoital cystitis, including removal of urethrogymenal adhesions and subsequent paraurethral filler implantation, in comparison with isolated hymenoplasty.Materials and methods. Since 2013, 75 patients with postcoital cystitis have been treated. Patients were divided into two groups: main group – hymenoplasty (removal of urethral adhesions) with paraurethral filler implantation (n = 45), control group – hymenoplasty (n = 30). The gel was injected paraurethrically, fan-shaped, in the volume of 1–2 ml, from a point on the 6-hour conditional dial, creating a gel cushion and thus raising the meautus and distal urethra. To assess the quality of treatment, profile questionnaires were used.Results. In the main group of patient, the quality of life improved in 35 (78 %); in 5 patients, due to the process of biodegradation of the gel during 1 year, the cystitis recidivated, which required the filler reimplantation. In 5 patients, the operation was not effective. In the control group the efficiency of isolated hymenoplasty was noted in 3 (10 %) patients, relapse of cystitis occurred in 27 (90 %) patients, which later required the implantation of a filler. No complications were observed.Conclusions. The suggested combined technique allows to improve the results of treatment of patients with postcoital cystitis. The operation does not carry the risk of damage to the sprigs of the genital nerve, can serve as an alternative to traditional urethral transposition. The main disadvantage is the natural biodegradation of the gel, which may create the need for its reintroduction.

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