Background. Important part of orthopedic surgery is endoprosthetics of hip joints, which eliminates pain syndrome, restores the amplitude of movement and the support ability of lower limbs. But some complications usually take place; venous thromboembolism is leading among them. Objective. The aim of the study was to investigate endothelial dysfunction and activity of the hemocoagulation system at different levels of VTEC risks and thus to work out the strategy of thromboprophylaxis in patients with osteoarthrosis of the hip joint and femoral neck fracture combined with non-specific dysplasia of the connective tissue. Methods. 219 patients of a mean age of 64.7±3.8 years old underwent surgery. In 137 (62.1%) cases, a total cement hip replacement was performed for osteoarthritis. 82 (37.4%) patients underwent total and unipolar cement hip replacement for cervical femoral neck fractures. Results. Clinical manifestations of non-specific connective tissue dysplasia were detected in 83 (37.9%) patients that was confirmed by the laboratory determination of the level of general, bound and free oxyproline. In the postoperative period, the thrombotic process in the venous system of the inferior vena cava was diagnosed in 23 (10.5%) cases. The level of indicators of endothelium status dysfunction was much more significant in the patients in cases of nonspecific dysplasia of connective tissue. Operative intervention on the hip joint in the patients with nonspecific dysplasia of connective tissue in 11 (13.3%) cases was complicated by development of venous thrombosis. In the patients without non-specific connective tissue dysplasia, postoperative thrombosis in the system of the inferior vena cava was diagnosed in 12 (8.8%) cases. Conclusions. Patients with osteoarthrosis of the hip joint and the femoral neck fracture accompanied by the non-specific dysplasia of the connective tissue are characterized by high levels of endothelial dysfunction and increased activity of the blood-coagulation system.
Infective endocarditis (IE) is a multisystem disease that results from an infection, usually a bacterial one, on the endocardial heart surface. A clinical case of a patient admitted to the department of cardiovascular surgery with a diagnosis of active infectious endocarditis of the aortic and mitral valves with concomitant chronic urosepsis is described. According to the bacteriological study an etiological relationship between the origin of heart pathology and chronic urosepsis was established. The results of current methods of visual diagnostics on the basis of which the preoperative diagnosis was formed are also described. Prosthetics of the On-X 19 aortic valve and On-X 27/29 mitral valve was performed. The postoperative period and the features of its course were assessed, taking into account the etiological nature of infective endocarditis. This clinical case clearly shows that any chronic infectious process can cause damage to the endocardium, even with slowly developing processes of atypical origin, for example, the urinary system. Thus, this case indicates that it is necessary to examine a patient with acute and chronic infectious processes carefully and comprehensively for infective endocarditis, since in the early stages the disease manifests itself gradually; and this helps prevent serious complications in the future.
Introduction. Number of patients with obliterating lesions of the aorta and main arteries of the lower extermities has been steadily increasing every year. When choosing the scope of surgical treatment all the features of the multilevel stenotic-occlusive process of the infrainguinal arterial bed should be taken into account. Purpose. To improve the results of revascularization of the infrainguinal arterial bed by applying surgical intervention on profound femoral artery and endovascular methods to restore permeability of the outflow arteries. Materials and methods. The work is based on the results of examination and surgical treatment of 264 patients with stenotic-occlusive process of the infrainguinal arterial bed. There were four groups of patients. The basis of revascularization interventions on the infranguinal artery was shunt surgery. Bypass surgery was performed using a reverse autovein. The combined shunt was used for localization of the distal anastomosis at the level of the popliteal, shin arteries, tibioperinel trunk. Results. In atherosclerotic stenotic-occlusive lesions of the infrainguinal arterial bed of the lower extremity, the volume of surgical treatment depends on the level of the occlusive process, the functional state of the PFA and the blood flow pathways. And the method of surgical intervention in shunt interventions is determined by the type of distal lesion and the level of imposition of distal and proximal anastomoses. Conclusion. The use of endovascular methods of revascularization and reconstructive interventions on PFA in combination with femoral-distal shunt operations contributes to good and satisfactory results of surgical treatment of stenotic-occlusive processes of the infrainguinal arterial bed.
Êàôåäðà õ³ðóð㳿 ç óðîëî㳺þ òà àíåñòåç³îëî 㳺þ ¹ 1 (çàâ.-÷ë.-êîð. ÀÌÍ Óêðà¿íè Ë.ß.Êîâàëü÷óê) Òåðíîï³ëüñüêîãî äåðaeàâíîãî ìåäè÷íîãî óí³âåðñèòåòó ³ìåí³ ².ß.Ãîðáà÷åâñüêîãî Ðåçþìå. Åêñïåðèìåíòàëüíî äîâåäåíî, ùî ðåôëþêñíà õâîðîáà ïðèçâîäèòü äî âèðàaeåíî¿ ñòðóêòóð-íî¿ ïåðåáóäîâè àðòåð³é äð³áíîãî êàë³áðó äèñòàëüíîãî â³ää³ëó ñòðàâîõîäó, ÿêà õàðàêòåðèçóºòüñÿ ïîòîâùåííÿì ¿õíüî¿ ñò³íêè, çâóaeåííÿì ïðîñâ³òó, óðàaeåííÿì åíäîòåë³àëüíèõ êë³òèí, ¿õ äèñôóíêö³ºþ, çíèaeåííÿì ñèíòåçó îêñèäó àçîòó, ïîã³ðøåííÿì êðîâîïîñòà÷àííÿ, ã³ïîêñ³ºþ, äèñòðîô³÷íèìè òà íåêðîá³îòè÷íèìè çì³íàìè. Êëþ÷îâ³ ñëîâà: ðåôëþêñíà õâîðîáà, ãàñòðîåçîôàãåàëüíèé ðåôëþêñ, ñòðàâîõ³ä, ðåìîäåëþâàííÿ àðòåð³é.
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