For many years in ophthalmology there is a complex intractable problem associated with inflammation of the vascular membrane of the eye, the so-called uveitis. Experts around the world are trying to understand this heterogeneous pathology of the visual organ, in a short time, which can lead to a sharp decrease in visual acuity, the development of severe complications and further disability. The number of patients with inflammation of the vascular tract is growing rapidly every year, the age is younger. The clinical picture of this pathology has changed slightly. Often began to manifest itself in two radically different directions. It proceeds as a sluggish form or vice versa manifests itself more aggressively with the rapid development of clinical manifestations in a short time. Currently, there is evidence of endogenous causes of uveitis.The article provides a review of the literature summarizing modern views on the problem of autoimmune uveitis. New factors affecting the etiology, pathogenesis of the disease, some aspects of therapy are considered. In addition, the main experimental models of autoimmune diseases of the vascular tract of the eye are analyzed.
Aim. To compare the results of surgical treatment using bipolar hemostasis and traditional ligation of ligaments and blood vessels in vaginal hysterectomy.Material and methods. Fifty patients with benign uterine disease underwent vaginal hysterectomy using electrosurgery (n = 29) or conventional suture ligation (n = 21 controls).Results. Postoperative pain (especially on the fi rst day) was decreased in the electrosurgery group (5.50 ± 1.43 VAS points) as compared to the control group (7.64 ± 0.58 points), p < 0.001. Intraoperative blood loss was signifi cantly lower in electrosurgery group (82.86 ± 22.58 ml) than in the control group (226.36 ± 129.12 ml), p < 0.001. Operating time was signifi cantly shorter in the main group than in the controls (65.36 ± 20.9 min vs. 86.59 ± 40.19 min, p < 0.05). On average, 2.75 ± 1.11 suture packages were used with bipolar coagulation, 6.00 ± 1.93 in the controls (p < 0.001). Hospital stay was similar for both groups. Adverse event rates did not differ signifi cantly.Conclusions. Bipolar coagulation with the TissueSeal Plus proved to be more effi cient or identical to traditional suture ligation. Intraoperative blood loss, postoperative pain and the duration of the operation were less, while the complications were identical for both groups. In addition, bipolar coagulation was easier to use and cost effective. These fi ndings prove the feasibility and effectiveness of the use of electrosurgical techniques to perform hysterectomy and its further study
Показан успешный опыт применения вакуумно-аспирационной терапии при лечении спонтанного разрыва пищевода (синдром Бурхаве). Сложность диагностики обусловлена недостаточной информацией среди врачей об этом синдроме. В момент обращения пациентам с клинической картиной разрыва пищевода в первую очередь исключают острый коронарный синдром (ОКС), и при отсутствии данных, свидетельствующих об ОКС, дальнейшую диагностику не проводят, что и наблюдалось в данном случае. Хирургическая и эндоскопическая тактика, применённая у данного пациента, была правильной и своевременной.
Urinary tract infections are one of the most common inflammatory disorders of urinary tract that occurs in 40 % of all cases of nosocomial infections. This pathology more often occurs in women, 50 % of them have urinary tract infection at least once in a lifetime. Urinary tract infections are chronic, pluricausal and frequently recurrent diseases. During many decades E. coli was considered to be main pathogenetic flora plated from urine at the urinary tract. Statistically Proteus mirabilis is ranked number two in the degree of incidence. At the moment the researches pay closer attention to Candida pathogens. Urinary tract infections appear in consequence of ingress of microorganisms in urinoexcretory system by ascending, hematogenic and lymphogenic ways. Culture-based, microbiologic study of urine with pathogen isolation and estimation of the bacteriuria degree is the gold standard of diagnostics of urinary tract infections.
AIM: The aim of this study was to investigate the morphometric features of tissues after exposure to bipolar energy of various electrosurgical generators and surgical hemostatic instruments used in vaginal hysterectomy. MATERIALS AND METHODS: The study included 48 individuals who underwent a vaginal hysterectomy. The patients were divided in three groups based on the instrument used for sealing blood vessels: a BiClamp was applied in Group 1 (n = 16), a TissueSeal PLUS COMFORT in Group 2 (n = 16), and a Thunderbeat in Group 3 (n = 16). The maximum temperature of tissue measured using a Fluke FLK TIS 40 9HZ thermal imaging infrared camera was compared within the groups. RESULTS: The maximum tissue temperature between the branches on electroligation, the minimum tissue temperature, and the tissue temperature at the coagulation boundary were significantly lower when using a TissueSeal PLUS COMFORT clamp than when using BiClamp and Thunderbeat clamps (H value = 41.8, p 0.01). Morphometric parameters (prevalence, coagulation depth and area) were the smallest with a TissueSeal PLUS COMFORT clamp compared to other clamps. CONCLUSIONS: Using a TissueSeal PLUS COMFORT clamp during vaginal hysterectomy is effective and safe and has the best thermometric and morphometric characteristics when applied to the tissue, thereby reducing the risk of lateral thermal damage. The possibility of perifocal heat transfer varies with the type of tool and with the temperature at the coagulation boundary.
In recent studies, it has been established that extralevator abdominoperineal extirpation (ELAPE) of the rectum can improve the oncological results of treatment of distal rectal cancer compared to standard abdominoperineal extirpation. As a result of extralevator dissection, a large defect of the perineum is formed, which requires plastic closure. While performing ELAPE, the structures that form the pelvic diaphragm are affected. This increases the risk of pelvic organ prolapse in women and significantly affects the quality of life of these patients, which requires subsequent surgical treatment. Despite the fact that pelvic organ prolapse develops as a consequence of previous surgical treatment by an oncologist, they do not consider it as a complication in the long-term postoperative period. Such patients are not referred to the operating gynecologist. Currently, this problem is poorly understood and there are no standardized approaches to the surgical treatment of pelvic prolapse in this category of patients.
По данным литературы [1, 2] частота ущемленных бедренных грыж варьирует от 13,5 до 31% от всех ущемлений. Наиболее часто это осложнение случается у лиц старше 40 лет, преимущественно у женщин (82-88% случаев) [3]. Узость бедренного канала способствует быстрому развитию некроза органа. При ущемлении сальника явления непроходимости отсутствуют, однако часто отмечается острая боль в области грыжевого выпячивания. В лите-ратуре есть описание случаев ущемления в бедренном канале предбрюшинных жировиков и жировых придатков толстой кишки [4]. И.С. Василенко [5] описывает случай ущемления червеобразного отростка в бедренной грыже. Аппендикс в грыже диагностируют в 2-4% всех выполняемых грыжесечений. Причем 2 / 3 таких случаев наблюдаются при паховых грыжах, остальные приходятся на бедренные, пупочные, послеоперационные, грыжи запирательного канала, белой линии живота и другие [6].
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