The WAST technique may have considerable value in evaluating the progression of DFS and the effectiveness of therapeutic interventions. The low cost of an individual test makes the WAST technique suitable for routine use in most healthcare facilities.
The paper covers the clinical case of successful simultaneous intervention in a patient with acute calculous cholecystitis, incisional hernia M2-5W3, Obese (Class III) (BMI 42 kg/m2), IV-degree ptosis of the anterior abdominal, pulmonary embolism in the anamnesis with a cava filter installed and high operational risk. After preoperative preparation, a simultaneous surgical intervention (laparoscopic cholecystectomy, transverse abdominoplasty, separation hernioplasty) was performed. The patient was discharged from hospital on the 10th day of the postoperative period. Long-term results were evaluated after 2 months. A cardiovascular, thromboembolic and wound complications was not recorded.
Peritoneal adhesion (PA) is still an actual surgical issue. It is known that any surgical intervention causes abdominal adhesion that, in its turn, induces a number of complications such as adhesive intestinal obstruction. There is registered a high lethality among patients with the developed acute adhesive intestinal obstruction. Adhesive intestinal obstruction hurts health of patients, leading to eight (on average) days of hospitalization and intrahospital lethality of 3 % per episode. The cause of the development of a significant number of lethal cases is imperfection of preventive, diagnostic, therapeutic measures; 20 to 30 % of patients with adhesive intestinal obstruction need surgical treatment. Heavy expenses in the system of healthcare are required for treatment of peritoneal adhesions. The review presents the data regarding modern state of the problem, advanced tendencies in diagnosis, prevention and treatment of patients with peritoneal adhesions, their use in practical studies.
The review covers the important aspects of complications in incisional hernia repair. The paper specifies the most relevant issues of modern herniology, its social and economical aspects, considers the preventive techniques for preoperative, intraoperative and postoperative complications. When describing the preoperative predictive and preventive methods in complications, the authors analyzed the existent classifications and integral grading scales for patients' state indicators, showed the benefits and drawbacks of current techniques of preoperative preparation.The part devoted to an intraoperative period presents the main current hernia repair techniques, mesh implants, and their characteristics. Much attention is given to the description of surgical options depending on mesh arrangement in relation to anatomical abdominal wall layers, and the assessment of mesh implant types, their selection for a specific clinical setting. The review considers the principles of component separation as one of the most promising directions of abdominal surgery. When studying the postoperative preventive methods, the emphasis was made on the description of fast-track principles. Currently, a fast-track technique is being widely used in surgery, and gaining popularity in herniology.
Introduction and purpose. The aim of investigation was to evaluate the possibility of using the method of wavelet analysis of skin temperature during the local heating test for the study of the microvascular tone regulation in patients with diabetic foot syndrome (DFS). Materials and methods. The study was performed in 15 healthy subjects and 10 patients with neuro-ischemic form of DFS complicated by trophic ulcers. The temperature of the plantar surface of the hallux was recorded by «Microtest» (Perm, Russia) with temperature resolution 0,002°C. Time-frequency analysis of temperature fluctuations was performed using wavelet analysis. For the reconstruction of the oscillations in endothelial (0.02-0.0095 Hz), neurogenic (0.05-0.02 Hz) and myogenic (0.05-0.14 Hz) frequency ranges we used inverse wavelet transform. Results. In healthy people, indexes of vasodilation (relative changes in the oscillation amplitudes) in the myogenic, neurogenic, and endothelial frequency ranges were 3.04, 4.01 and 2.25 respectively. In patients with DFS the values were significantly lower than in healthy subjects (0.60, 0.67 and 0.51, respectively). Conclusion. In contrast to healthy subjects, the combination of diabetic polyneuropathy with endothelial dysfunction and macroangiopathy in patients with neuro-ischemic form of DFS leads to the progression of mutually aggravating pathological processes and lower limb ischemia. Further implementation of the local heating test at the early stages of diabetic foot is of interest for the prognosis of the disease, evaluating the effectiveness of conservative treatment and endovascular interventions.
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