Prevention of injuries in sports

Purpose: to determine the causes of injuries in sports and the factors that cause them. Material and methods: study of special literature and generalization of experience of preparation of sportsmen in various kinds of sports. Analysis of factors influencing sports injuries in order to develop measures for their prevention. Results: There are a large number of injuries that can be received during sports. In our article we will consider some of them. Trauma is a lesion of the surface of the body or internal organs, which arose under the influence of external factors, as a result of which one or another organ has lost the ability to perform its function. Depending on the nature of the injured tissue, there are skin (strokes, wounds), subcutaneous (ligament ruptures, bone fractures, etc.) and abdominal (hemorrhage, chest injuries, joints) injuries. Injuries are divided into direct and indirect, depending on the point of application of force. They can be single (eg, transverse femoral fracture), multiple (multiple rib fracture), combined (pelvic fracture with rupture of the bladder) and combined (hip fracture and frostbite, etc.). Injuries are open with a violation of integrity and closed, when the replacement of tissues and organs occurs with intact skin and mucous membranes. According to the level of severity of injuries are divided into mild, moderate and severe. Injuries to the extremities are most often observed in the localization of injuries in athletes, among them injuries of the joints, especially the knee and ankle, predominate. Upper limb injuries (70.0% of all injuries) are more common during gymnastics. Most sports are characterized by injuries of the lower extremities, such as athletics and skiing (66,0 %). Head and face injuries are typical for boxers (65,0 %), fingers - for basketball players and volleyball players (80,0 %), elbow joint for tennis players (70,0 %), knee joint - for football players (48,0 %). etc. Among sports injuries, as a rule, a high percentage of injuries of medium severity. Conclusion: analysis of the causes of injuries in sports, allows us to conclude that injuries in sports can be prevented. A coach in a certain sport plays a crucial role in injury prevention. Its activities should take place in close contact with medical staff. It is the physician's responsibility to systematically record all injuries. Not only severe injuries, but also moderate injuries must be carefully studied, the causes of their occurrence must be identified and the necessary measures to eliminate them must be developed.

Spontaneous Bladder Rupture after Normal Vaginal Delivery: Description of a Rare Complication and Systematic Review of the Literature

Objective: To identify the possible causes of spontaneous bladder rupture after normal vaginal delivery and to propose a diagnostic and therapeutic algorithm. Material and Methods: MEDLINE (PubMed), Web of Science and Scopus databases were searched up to August 2020. Manuscripts considered were published from 1990 and only English articles were included. The research strategy adopted included the following terms: (bladder rupture) AND (spontaneous) AND (delivery). 103 studies were identified. Duplicates were found through an independent manual screening. Subsequently, two authors independently screened the full text of articles and excluded those not pertinent to the topic. Discrepancies were resolved by consensus. Finally, thirteen studies were included. Results: PRISMA guidelines were followed. For each study, fetal weight, catheterization during labor, parity, maternal age, occurrence time, previous abdominal or pelvic surgery, symptoms complained of, diagnostic methods, and treatment were considered. Median age was 26.0 (range 20–34 years); median presentation time was 3.0 days after delivery (range 1–20 days); and median newborn weight was 3227.0 g (range 2685–3600 g). Catheterization during labor was reported only in four of the thirteen cases (30.8%) identified. The symptoms most frequently complained of were abdominal pain and distension, fever, oliguria, haematuria and vomiting. Instrumental diagnosis was performed using X-rays in five cases and computerized tomography in six cases. Ultrasound was chosen in five cases as a first diagnostic tool. In two cases, cystography was performed. Treatment was always laparotomic repair of the visceral defect. Conclusion: Abdominal pain, increased creatinine and other signs of kidney failure on blood tests should lead to suspicion of this complication. Cystourethrography is regarded as a procedure of choice, but a first ultrasound approach is recommended. The main factor for the therapeutic choice is the intraperitoneal or extraperitoneal rupture of the bladder. Classical management for intraperitoneal rupture of the bladder is surgical repair and urinary rest.

Features of the installation of a suprapubic cystostomy for laparoscopic treatment of patients with intraperitoneal bladder rupture

INTRODUCTION: In closed intraperitoneal bladder trauma, an alternative to laparotomy is laparoscopy. The rupture is closed with endoscopic sutures, and the bladder is drained with a urethral catheter. In the literature, the issue of the placement of a trocar cystostomy during laparoscopic treatment of patients with intraperitoneal bladder ruptures requiring prolonged drainage is insufficiently covered. PURPOSE OF THE STUDY: Determination of the optimal trocar cystostomy method during laparoscopic treatment of intraperitoneal bladder rupture. MATERIALS AND METHODS: Trocar cystostomy was performed in 8 patients with intraperitoneal bladder ruptures, among whom 7 had concomitant diseases of the prostate gland, and 1 had urethral stricture. Trocar cystostomy during laparoscopic surgery was performed in three different ways. Results. In the first method, the rupture of the bladder was initially sutured. Then, through the urethral catheter, the bladder was filled with saline. A trocar cystostomy was inserted through the suprapubic region. The second method consisted in the installation of a trocar cystostomy under the control of a laparoscope even before the suturing of the bladder rupture. In the third method proposed by us (patent No. 2592023), a Foley-type catheter with a balloon capacity of at least 200 ml was inserted into the abdominal cavity through the laparoscopic port. A catheter was inserted from the abdomen through an intraperitoneal rupture into the bladder. Inside the bladder, the catheter balloon was filled with saline. Then, through the suprapubic region, the anterior abdominal wall, the bladder and the inflated balloon of the catheter were pierced layer by layer with a trocar. Another catheter was inserted through the trocar into the bladder. After removal of the catheter with a ruptured balloon, the intraperitoneal rupture of the bladder was sutured. FINDINGS: According to the results of the study, the third method of inserting a trocar cystostomy turned out to be the most optimal and safe.

Comparison of surgical treatment of bladder rupture

Introduction. Еven though open bladder suturing is a traditional method of surgical treatment of intraperitoneal rupture of the bladder, laparoscopic bladder suturing is a prospective method for treating such injuries. Materials and methods. In N.V. Sklifosovsky Research Institute of Emergency Care during the period from January 2016 to April 2020, 22 patients with bladder injury were treated. 15 of them had an intraperitoneal rupture, 5 had an extraperitoneal rupture, and 2 had a bladder rupture. Among the affected men there were 15 (68%), women - 7 (32%), the average age of patients was 42 ± 18 years. The clinical picture was dominated by gross hematuria and pain in the lower abdomen. All patients underwent ultrasound examination (US) according to the FAST protocol, and cystography was performed in some patients. Results. 20 (91%) patients were operated and 2 (9%), with extraperitoneal rupture of the bladder, were drained by urethral catheters. Patients were divided by the method of surgical treatment into 2 groups. In the 1st group, 2 (10%) patients underwent laparoscopic suturing of the bladder with drainage of the bladder with a urethral catheter. 18 (90%) patients of the 2nd group underwent laparotomy with suturing of the bladder. Depending on the method of bladder drainage, patients were divided into the cystostomy group (group A) and the urethral catheter group (group B). Group A - 16 (73%) patients who underwent laparotomy, suturing a rupture or ruptures of the bladder, epicystostomy, drainage of the abdominal cavity and lower pelvis. Group B-4 (18%) patients after laparotomy, laparoscopy, as well as patients who underwent conservative therapy with the installation of an urethral catheter – 2 (9%). Discussion. In the world literature, there are few scientific articles on the laparoscopic method of treating bladder injury, and the presented works are based on a small sample of patients. But, despite this, the method seems to be a promising and effective method for treatment and can be used in patients with intraperitoneal rupture of the bladder with stable hemodynamics, without life-threatening concomitant injuries. Conclusion. Тhe use of open or laparoscopic suturing of the bladder without epicycostomy significantly reduces the hospital stay and allows to restore natural urination on average 7 days after surgery. Laparoscopic suturing of the bladder is an effective and alternative treatment for bladder rupture.

On the casuistry of independent extraperitoneal ruptures of the bladder

In 1908, I described a case of spontaneous intraperitoneal rupture of the bladder. Since then, in Russian literature, I have come across only one article by Belitsky devoted to this issue. In this detailed article Belitsky describes a case of intraperitoneal rupture of the bladder, operated back in 1909 by prof. I. A. Praksin, and reports statistics of both Russian authors - including my case - and foreign ones. From the data of Naumann cited by him in the article, it is clear that in the Salgram clinic for 12 years, for 20 thousand patients, bladder ruptures were observed only in 3 cases - in 2 intraperitoneal and in 1 extraperitoneal; Rokitsky for 15 years gives 12 cases, among which in 8 there was an intraperitoneal rupture and in 4 extraperitoneal rupture.

To the casuistry of childbirth with fused twins

On April 13, 1895, at 5 o'clock in the morning, a peasant woman, 23 years old, was admitted to the clinic with labor pains. When asked, it turned out that labor began at 2 am on April 13, that she was pregnant in the 4th section; the previous labor was completely normal; the last regulation was at the end of July. The study produced the following: The pelvis is almost normal: dis. sp. 24.5, dis. cr. 27, intertr. 31, conj. ext. 19. The uterus is ovoid. The heartbeat of the fetus is heard on the right below the navel, 132 beats per minute. Full throat opening. The bubble is intact. Head to be presented. The arrow-shaped suture in the right oblique size of the pelvis; a small fontanel is felt to the right posteriorly. The second position was established, the rear view. As soon as the women in labor had time to take a bath, the waters passed. The head, which was still in the entrance of the pelvis, began to descend little by little into the cavity. At 8 a.m. 40 m, that is, after 3 hours with more than a rupture of the bladder, the head began to press on the perineum, which lasted more than half an hour, and finally at 9 o'clock. 15 minutes. the head has erupted. The born head, having made a slight movement first to the left and then to the right, turned its face towards the symphysis. At this moment, the forward movement of the fetus stopped.

Indications and Contraindications for Cystography, Diagnostic Value of the Method

Diseases of the urinary system are quite common, both among adults and among children. If, in case of infectious and inflammatory diseases of the urinary organs, an assessment of the clinical picture and general analysis of the urine is sufficient to make a diagnosis, in a number of other situations — trauma and rupture of the bladder, abnormalities of its development, malignant neoplasms — visualization of the organ is needed. One of these diagnostic methods is cystography.

A minimally invasive approach to transperitoneal perforation of the bladder during bladder tumour resection

The authors present a case of intraperitoneal rupture of the bladder during transurethral resection of a bladder tumour (TURBT), which was managed conservatively. By passing a urethroscope — which was smaller in diameter than the perforation — through the hole, a small superficial burn was identified on the adjacent bowel and deemed benign, saving this patient with multiple comorbidities from having to undergo an open laparotomy. The bladder was drained with a Foley catheter to allow the perforation to heal and the patient was discharged without incident. By using this approach, a direct view of the neighbouring structures confirmed the integrity of bowel and prevented the need for increased risks associated with a laparotomy.