Introduction: There is a problem of choosing the optimal method for eliminating choledocholithiasis in accordance with one The lack of satisfactory results from the use of existing methods of surgical correction explains the constant interest of specialists to this problem, requires the improvement of the commonly accepted and the search for new approaches to the treatment of this concomitant disease. The aim: To substantiate the use of individual assessment at the stage of preoperative preparation for the purposeful differential tactic of surgical treatment of the biliary sepsis. Materials and methods: The basis of our research was the results of the analysis of treatment of 112 patients with biliary sepsis who were on treatment from 2010 to 2017 in the surgical clinic № 2. An assessment of systemic inflammation performed according to the recommended criteria of the Chicago Interventional Conference on Intensive Care (USA, 1992). The systemic inflammatory response syndrome (SIRS) was determined in the presence of 2 or more symptoms: 1) t body> 38 ° C or <36 ° C, 2) heart rate> 90 / min; 3) breathing frequency> 20 / min; 4) white blood cell count> 12 × 109 / l or <4 × 109 / l; or> 10% immature forms (SOFA score 4, 27 ± 0.6 points). Results: Based on the received pre-operative score, we proposed to optimize the differentiated selection of individualized surgical tactics, taking into account the available baseline conditions, to radically eliminate the cause of biliary sepsis and evaluate the measures of initial conservative therapy. In the course of work, anamnestic unit, clinical unit, laboratory-instrumental block used. The initial severity of the condition of each particular patient is calculate according to the received sum of points for each information block, which allows at the stage of preoperative preparation to standardize all patients in accordance with their score. Conclusion: Thus, the ball assessment of the severity of the condition of patients allows us to determine not only the optimal tactics, the size and type of surgical correction, but also to determine the effectiveness of the selected composition of preoperative preparation and postoperative treatment, carrying out its dynamic assessment.
Ре зюме. У статті представлені результати вивчення мікроциркуляторних змін у 38 хворих з гнійно-некро-тичними ускладненнями цукрового діабету 2 типу, які достовірно вказують на ефективність їх корекції та регенерації ран за допомогою препаратів, що впливають на мікроциркуляцію. Ключові слова: цукровий діабет, мікроциркуляція, Пентоксифілін.
Резюме. У дослідженні проведено кількісну оцінку тканинної організації мезотелію парієтальної очеревини в умовах впливу на вегетативні центри судинної регуляції процесі репаративної регенерації. Результати вказують, що стимуляція симпатичної іннервації супроводжується зниженням мітотичної активності внаслідок порушення мікроциркуляції, транскапілярного обміну та дренуючих процесів тканинах очеревини. Поряд із спотворенням процесу колагеногенезу, це викликає гіперпластичний тип регенерації. Ключові слова: тканинна організація, репаративна регенерація, мезотелій, спайкова хвороба. POSTTRAUMMATIC HISTOGENESIS OF THE PERITONEAL MESOTHELIUM UNDER CONDITIONS OF REPARATIVE REGENERATION FOR ADHESIVE DISEASE Abstract. A quantitative assessment of the tissue organization of the parietal peritoneal mesothelium under conditions of influencing the vegetative centers of vascular regulation during reparative regeneration was carried out in the study. The results indicate that stimulation of sympathetic innervation is accompanied by a decrease in mitotic activity due to disorders of microcirculation, transcapillary exchange, and drainage processes in the peritoneal tissues. Along with the distortion of the process of collagenogenesis, this causes a hyperplastic type of regeneration.
Annotation. Among all internal organs, the liver is the organ that is most commonly affected by echinococcosis, and in more than half of the cases its right lobe is affected. Active migration of the population caused the spread of pathology beyond the endemic regions. In particular, more than 100 cases of echinococcosis among people are registered in Ukraine every year. The purpose of this study is to analyze a clinical case that demonstrates an echinococcal impression of the liver with interesting localization of the cyst near the liver gate, with compression of the cystic duct and the development of acute acalculous cholecystitis. When the patient was hospitalized, there was no expected eosinophilia in the blood test, but it appeared on 14 day of albendazole chemotherapy. In serological testing of the blood by ELISA, the determination of IgG for Echinococcus granulosus was doubtful. However, radiological findings clearly indicated signs of parasitic cyst genesis. Following all the principles of aparasitism, the patient underwent closed echinococectomy, microscopy of the native material confirmed the presence of numerous scolexes in cystic fluid.
The aim: To evaluate the effectiveness of the proposed method of surgical treatment of patients with acute purulent cholangitis. Materials and methods: The research is based on the analysis of the treatment results in 104 patients with acute purulent cholangitis. The volume of surgical interventions on the biliary tract in patients was as follows: endoscopic papillosphincterotomy (EPST) + naso-biliary drainage; EPST + laparoscopic cholecystectomy; cholecystectomy + choledocholithotomy + drainage of the common bile duct. Results: The APACHE-2 scale assessment for patients in the control group was 12,80 ± 1,73, with the SOFA scale - 4,32 ± 0,31 points. Accordingly, the assessment for patients in the main group with the APACHE-2 scale is 11.76 ± 0.81, with the SOFA scale - 4.33 ± 0.79 points. The results obtained in both the control and the main group indicate that the physiological reactions of the organism to the disease, treatment, development of organ dysfunction are reflected in the integrated severity assessment scales. Conclusion: The performed analysis of clinical and laboratory results of treatment in both groups established the high efficiency of the proposed treatment method in patients with acute purulent cholangitis, which promotes the more rapid medical and social rehabilitation in this category of patients.
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