About the possibility of using physiotherapy in the practice of a surgeon. Literature review

Physiotherapy is a field of medicine based on the study and application of natural and artificially created natural factors on the human body. Physical factors can have both local and systemic effects on the patient’s body. In the postoperative period, physiotherapy helps to solve the most important problems, such as accelerating the processes of tissue regeneration and reducing the risk of infection in the area of surgery. Physical factors, activating fibroblasts, accelerate the synthesis of collagen fibers and increase the regenerative capacity of damaged tissues. In addition, due to bacteriostatic and bactericidal action, microorganisms are destroyed and the risk of postoperative infectious complications is reduced. Understanding the key features of all stages of the wound process allows you to rationally affect the wound. The use of an integrated approach based on drug therapy and the use of physiotherapy procedures significantly increases the effectiveness of treatment and helps the patient to return to their usual level of life as soon as possible. This article is a review of the literature on the most commonly used methods of physiotherapy in the postoperative period. Based on the analysis of publications, the article presents the features and principle of operation of such techniques as electrophoresis, phonophoresis, magnetotherapy, ozone therapy, electrical stimulation, cryotherapy, shock wave therapy, galvanization, darsonvalization, as well as therapy based on the effects of ultraviolet radiation, laser, ultrasound, microcurrents. Examples of physiotherapeutic procedures that should be used at various stages of the wound process, depending on the impact, are given. It is the use of various methods of influence in combination with each other that helps to achieve the maximum effect of treatment in the postoperative period.

Approaches to the surgical treatment of cardiovascular diseases and complications in the background COVID-19

This article provides an overview of domestic and foreign literature on the relationship between cardiovascular diseases and COVID-19. Various approaches to the management and treatment of this group of patients are considered, such as: postponement of surgical treatment, immediate results of endovascular and cardiac surgery in patients with active COVID-19.

Clinical case of Fournier’s gangrene in a patient with adenocarcinoma

The article describes a clinical case of Fournier’s gangrene in a 65-year-old man with rectal mucinous adenocarcinoma. Given the presence of a malignant neoplasm, elderly age and the general severity of the patient’s condition, the widest empirical antibiotic therapy was prescribed, the spectrum of which overlapped the most probable pathogens. The patient was discharged from the hospital on the 32nd day. The article discusses the rational tactics of antimicrobial therapy in such difficult cases for treatment.

Interventional radiology techniques in the treatment of cholangiolithiasis: indications, efficacy, accessibility

Our days, the problem of treating complicated forms of cholelithiasis continues to be relevant despite the undoubted successes in the field of hepatobiliary surgery. Cholangiolithiasis is one of the most frequent and dangerous complications of cholelithiasis, it is detected in 8–26 % of patients with cholelithiasis. In some cases, it is impossible to perform an endoscopic retrograde method, these special situations require the development of new original minimally invasive methods for resolving cholangiolithiasis, which have all the advantages of «small access». The analysis of the treatment of 466 operated patients with cholelithiasis complicated by cholangiolithiasis and mechanical jaundice in the period from 2013 to 2019 was carried out. The patients were divided into 3 groups: 1 — the endoscopic retrograde method was used (n = 369), 2 — laparotomic access (n = 26), 3 — antegrade X-ray interventional method (n = 71). The results obtained allow us to conclude that the antegrade interventional radiology technique for the treatment of choledocholithiasis has a high clinical efficacy comparable to the endoscopic technique. The use of this treatment option avoids traumatic laparotomies and open interventions on the bile ducts. The use of method is justified in cases of impossibility of performing endoscopic intervention, or its ineffectiveness.

Lipogranulema of the hernia sac. Clinical case

Lipogranulomas in surgical practice, are the most often encountered in the mammary glands, penis and facial area associated with subcutaneous injections for cosmetic purposes of various types of fillers that cause chronic granulomatous inflammation. Atypical localization occurs due to the development of reactions to foreign bodies after traumatic injuries and reactions to suture material used in surgical interventions. The article presents a clinical case of revealing a large peritoneal lipogranuloma localized in the area of the hernial sac in a patient who 7 years ago suffered from endometrial cancer and underwent extirpation of the uterus using median incision access. Subsequently, the patient was treated for a long time in an outpatient care because of the ligature abscesses with the formation of fistulas; several rough ligatures were removed from the subcutaneous tissue. Lipogranuloma, found in the wall of the hernial sac measuring 15 × 6 × 5 cm, covered from all sides with an unaltered peritoneum, contained a cystic cavity with a light fluid, thick synthetic ligatures of a braided structure were present in the cyst wall. The use of large-diameter braided non-absorbable sutures for suturing the peritoneum does not meet modern requirements for the use of suture material and can cause complications.

Modern urology is a one-day surgery. Features of patient management

In our country, up to 27 % of inpatient surgical beds are occupied by patients who can be assisted in one-day surgery departments and clinics. This innovative method of organizing treatment improves the quality of medical care, creating a situation in which everything is organized around patients and their interests. The patient’s discharge on the day of surgical treatment makes high demands on the level of professionalism of doctors. Therefore, we have analyzed modern scientific and practical achievements in the management of patients on the principle of one-day surgery.

Giant condiloma of Bushke-Levenstein of anal canal and perianal skin. Clinical case

The article is devoted to a rare disease of the perianal region — Buschke-Levenshtein tumor. A clinical case and a literature review on the etiology, pathogenesis and experience of treating such tumors are presented. Evidence based sources show that currently there is no generally accepted tactics of managing patients with this pathology. In this regard, each case of treatment of such patients is of not only scientific but also practical interest. In this case, the tactics of staged treatment with the use of high-temperature dissectors and immunocorrection was chosen, which made it possible to achieve a good clinical result without the formation of extensive and long-term non-healing wound defects in the perianal region.

Immune cells of the epithelial ovarian cancer microenvironment

The article is a review of the literature, which analyzes the data on the role of cells of the immune system, cytokines and other biologically active substances secreted by them in the interstitial space of an ovarian tumor. The emphasis is made on the mechanism of realization by immune cells of the stimulating and suppressing action on the development of the tumor. Considerable attention is paid to the prognostic role of immune cells in the development of epithelial ovarian cancer.

Prevention and treatment of gerd in patients with obesity undergoing gastroplication

The aim of the study was to study the advantages and disadvantages of laparoscopic gastric plication with the prevention and treatment of gastroesophageal reflux disease in the treatment of patients with overweight and obesity. From 2018 to the present, 24 patients have been observed who underwent laparoscopic gastric plication with the prevention and treatment of gastroesophageal reflux disease, of which 19 (79.2 %) women and 5 (20.8 %) men. The average age of patients is 41 ± 3.5 years. Indication for surgery: BMI > 35 kg/m² and the presence of GERD with unsuccessful conservative treatment or BMI > 35 kg/m² and the presence of HH with symptoms of GERD. The experience of surgical treatment of these 24 patients allows us to speak about the effectiveness of the use of gastroplication surgery with the prevention and treatment of gastroesophageal reflux disease with a combination of obesity and GERD. Dyspeptic symptoms are expected in some patients and are stopped in the early postoperative period with medication. The return of BMI to baseline in 3 (12.5 %) patients requires further study.

Transcutaneous puncture of kidney cysts under ultrasound control

The article presents the results of the introduction of puncture drainage and sclerosis of kidney cysts under ultrasound guidance in the clinic. This technique refers to minimally invasive surgery, it is the least traumatic, does not lead to large material costs, is very reliable and effective. It is easy to perform in a hospital setting of any level. According to this method, 38 patients were treated in the hospital for five years.