ВступГнійний медіастиніт (ГМ) -одна з найбільш тяж-ких форм гнійної інфекції, що зустрічається у хірургіч-ній практиці. ГМ має відношення до практичної роботи загальних, торакальних хірургів, стоматологів, отола-рингологів, лікарів інших спеціальностей і виникає як ускладнення багатьох захворювань [1]. За останні роки кількість хворих із ГМ не зменшується, а високі по-казники летальності спонукають науковців приділяти особливу увагу діагностиці та лікуванню даної патоло-гії. Гнійний медіастиніт характеризується агресивним клінічним перебігом, швидким розвитком синдрому системної запальної відповіді, тяжкого сепсису з полі-органною недостатністю [2, 4]. Тяжкість перебігу ГМ зумовлена наявністю в середостінні важливих органів і анатомічних утворень -центральних симпатичних та парасимпатичних нервів, кровоносних та лімфа-тичних судин. Крім цього, клітковина середостіння інтенсивно всмоктує продукти розпаду тканин, що сприяє швидкому розвитку тяжкої інтоксикації [5, 8]. За повідомленнями ряду клініцистів, сепсис у хворих на низхідний гнійний медіастиніт (НГМ) розвивається у 45-100 % випадків, а летальність становить від 17 до 80 % [3, 5].Разом із цим можливості клінічної діагностики ГМ доволі обмежені, особливо на ранніх стадіях захво-© «Український журнал хірургії», 2017
Background. We have previously described an algorithm APhiG (Age of patients, Prostate health index and Gleason score), for staging of prostate cancer before treatment. The algorithm was developed by logistic regression on a training dataset and validated on a validation dataset (VD). Objective. Validation of threshold decision rules and a program for APhiG calculation on the VD.Materials and methods. ROC curve analysis on VD (83 cases).Results and conclusion. It was shown that sensitivity, specificity, positive and negative predictive value, diagnostic accuracy threshold decision rules and area under the curve (AUC) for APhiG in the VD (n = 83) not significantly different from those indicators in the training dataset (n = 337), which was the basis for the algorithm APhiG development.
The use of immunotherapeutic drugs as monotherapy and in various combinations for metastatic renal cell carcinoma has revolutionized the treatment of this disease. Thanks to the breakthrough studies carried out, the standard in the first line of therapy for metastatic renal cell carcinoma is now a combination of checkpoint inhibitors, as well as an immuno-oncological agent with a tyrosine kinase inhibitor.This article presents updated data from the CheckMate 214 study with a minimum follow-up of 42 months. A review of studies on the efficacy of nivolumab in patients with renal cell carcinoma in the first line of therapy with the possibility of adding ipilimumab in case of progression of the disease on the background of monotherapy is carried out, as well as data on the use of a combination of nivolumab and ipilimumab in the second line of treatment.Monotherapy with nivolumab has a certain effectiveness in a specific category of patients, for example, with potential intolerance to ipilim-umab or first-line tyrosine kinase inhibitors, as well as in patients with a favorable prognosis.The combination of drugs nivolumab + ipilimumab is a highly effective treatment option in the first line of therapy with the potential for a sustained response in patients with RCC with an poor and intermediate risk, and in the second and subsequent lines requires further study.
Introduction. Some studies have shown that urolithiasis is much more common in the group of patients who underwent radical cystectomy (RC) with intestinal plastic bladder than the average for the population. The aim of this study included the search of the frequency of urinary stones formation in patients after RC, depending on the type of intestinal plasty of the bladder and the type of urinary diversion, the analysis of risk factors for lithogenesis, the search for metabolic lithogenic disorders in this category of patients, and the assessment of the severity of the identified changes. Materials and methods. The work analyzed the data of 214 patients (169 men and 45 women) who were operated from 2008 to 2021 with a diagnosis of bladder cancer. Patients underwent RC with the formation of a hetero- or orthotopic ileoconduit. We analyzed the indicators of general urine analysis, biochemical blood test, bacteriological analysis of urine for flora, performed both before RC and in the late postoperative period. Also The results of ultrasound of the kidneys, bladder (reservoir), MSCT of the kidneys performed before RC and in the late postoperative period were studied. We selected 37 patients from the general group in random order, who prospectively underwent a biochemical blood test, a biochemical analysis of daily urine, and an assessment of the acid-base composition of venous blood. Statistical analysis was performed by calculating the relative risk, as well as calculating the t-test for independent groups using the computer program Statistica 10.0 (StatSoft USA). Results. Urinary stones of the upper urinary tract after RC, ortho- and heterotopic intestinal plastics of the bladder in the late postoperative period (more than 1 year) were diagnosed in 27 out of 214 patients (12.6%). The relative risk of urolithiasis in patients with pyelectasis before surgery is 3.87 times higher than in patients without changes in pelvicalyceal system at the preoperative stage (p=0.0004). In patients after RC with impaired renal function in stages III-V (GFR 60 ml/min (p=0.005). RC patients with a BMI >30 had a 2.431-fold higher risk of urinary stone formation than those with a BMI 7.0, diagnosed after surgical treatment (p=0.003). The relative risk of developing urolithiasis in patients with urine pH >7.0 detected before surgery is 4.85 (p<0.0001). There was a trend towards an increase in the number of urolithiasis cases in patients who underwent RC with bacteriuria diagnosed after surgery according to urine culture (in patients with identified Enterococcus spp., Enterobacter cloacae, Providencia rettgeri (p<0.05)) compared with patients in of which sterile urine was detected. In patients suffering from urolithiasis after undergoing RC, compared with the control group of patients in the biochemical analysis of blood, there is a statistically significant difference between the level of creatinine (p=0.033), a decrease in the level of GFR from 79.9 to 68.7 (p=0.046). There was a statistically significant increase in the pH level of the urine (p=0.0025), an increase in the level of oxalates in the daily urine (p=0.0035), a decrease in the concentration of uric acid (p= 0.039), calcium (p=0.024) in urolithiasis patients after RCE compared with patients in the control group in biochemical analysis of daily urine. Conclusion. The presence of an expansion of the pelvicalyceal system before surgery, the patient's BMI> 30, urine pH> 7.0 both before and after the operation, a decrease in the patient's GFR <60 ml / min and the presence of bacteriuria in the general analysis of urine after RC are the risk factors for the urolithiasis after RC, intestinal plasty of the bladder.
Background. Prostate cancer is currently one of the most challenging problems in urological oncology due to its constantly increasing incidence and mortality in Russia. Surgery remains one of the most radical treatment options for patients with localized and locally advanced prostate cancer of any risk. Multiple studies have compared long-term and functional outcomes of surgeries performed using different surgical approaches. All studies have demonstrated similar long-term and functional outcomes of open, laparoscopic, and robot-assisted surgeries. Objective: to review the existing literature on this problem and analyze outcomes of surgical treatment in patients who had undergone open or laparoscopic prostatectomy in one of three federal centers of the National Medical Research Radiology Center.Materials and methods. This retrospective study included 2,772 patients with localized and locally advanced prostate cancer who had undergone surgery in one of the three federal centers.Results. We evaluated short-term and long-term outcomes of laparoscopic and open radical retropubic prostatectomy (RRP) performed at three federal centers of the National Medical Research Radiology Center. We found that laparoscopic RRP was associated with a longer surgery, lower blood loss, and fewer lymph nodes removed compared to open RRP. Long-term oncological and functional outcomes (prostate-specific antigen relapse-free survival, time to urination recovery) did not significantly differ between patients who had laparoscopic or open RRP.Conclusion. Both open and laparoscopic RRP are equally effective surgical methods for patients with localized and locally advanced prostate cancer.
Проведено вивчення системи гемостазу у 43 хворих похилого віку на гострий некротичний панкреатит, які перебували на лікуванні в Івано-Франківській обласній клінічній лікарні з 2013 до 2016 року. Чоловіків було 27 (62,7 %), жінок -16 (37,2 %). Вік хворих складав від 60 до 81 року, в середньому (66,2±1,18) року. В першу добу після госпіталізації лапароскопічні втручання виконано у 36 (83,7 %) хворих. Лапароскопічне дренування черевної порожнини з причини поширеного ферментативного перитоніту проведено у 27 (62,7 %) хворих. Лапароскопічну холецистектомію і дренування черевної порожнини при поширеному ферментативному перитоніті виконано у 9 (21 %) пацієнтів. У 7 (16,2 %) хворих проведено ранні відкриті операційні втручання. У 24 (55,8 %) пацієнтів проводили профілактику тромбоемболічних ускладнень низькомолекулярними гепаринами. Групу порівняння склали 19 (44 %) хворих, у яких профілактику тромбоемболічних ускладнень не проводили. У пацієнтів похилого віку із гострим некротичним панкреатитом переважали процеси гіперкоагуляції. Застосування низькомолекулярних гепаринів для профілактики тромбогеморагічних ускладнень у хворих похилого віку забезпечувало швидке усунення порушень гемокоагуляції та сприяло поліпшенню показників судинно-тромбоцитарної ланки гемостазу. The study of the system gemostazis in 43 patients of elderly age with the acute pancreatitis who were treated in Ivano-Frankivsk Regional Clinical Hospital from 2013 to 2016 was conducted. Among them there were 27 мen (62.7 %), and 16 (37.2 %) women. Age of patients made from 60 to 81 years, on the average 66.2 ± 1.18 years. In the first days after hospitalization laparoscopic interventions were performed in 36 (83.7 %) patients. Laparoscopic drainage from abdominal cavity due to widespread enzymatic was peritonitis performed in 27 (62.7 %) patients. Laparoscopic cholecystectomy and drainage of the abdominal cavity in advanced enzymatic peritonitis was performed in 9 (21 %) patients. In 7 (16.2 %) patients was conducted completed early laparatomy. 24 (55.8 %) patients underwent prevention of thromboembolic complications. Comparison group consisted of 19 (44 %) patients in whom the prevention of thromboembolic complications wasn't performed. In elderly patients with acute necrotizing pancreatitis hypercoagulable processes dominated. The use of low molecular weight heparin for the prevention of trombohemoragge complications in elderly patients provided hemocoagulation rapid elimination of violations and contributed to improvements in vascular-platelet hemostasis level.
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