Aim. To study diagnostic value of various diagnostic methods for patients with closed abdominal injury, to develop a diagnostic algorithm to make a reasonable conclusion about the amount and severity of injuries of the abdomen.Methods. Various diagnostic methods used in closed abdominal injuries from 120 patients admitted to Surgical Department №2 of Kazan city clinical hospital №7 from 2007 to 2015 were analyzed. Majority of victims (65%) with closed abdominal trauma were males aged 20 to 50 years.Results. Efficiency of diagnostic program for patients with closed abdominal injury used in clinical practice was studied. In a closed abdominal trauma, injury of abdominal organs was detected in 52.5% of patients. 71.4% of those injuries were isolated and 28.6% were concomitant. According to frequency of injuries liver took the first place 15 (23.8%), followed by spleen on the second place (14; 22.2%) and kidneys (12; 19.1%) and intestine (12; 19.1%) on the third, bladder on the fourth (7; 11.1%), and pancreas on the fifth place (3; 4.8%). Importance of radiological methods and laparoscopy was demonstrated. Clinical examination and laboratory diagnostic techniques allow making a timely diagnosis in only 40% of victims. Informativity of radiologic study was 64%. The accuracy of ultrasound in damaged kidneys was 100%, that in rupture of liver was 72%, of spleen, 69%, and of the intestine (0%). Diagnostic accuracy of laparoscopy was 98.9%.Conclusion. Experience and extensive acquaintance with modern literature allowed the authors to present the algorithm of examination of patients with suspected closed abdominal trauma.
Introduction. The recurrent course of an ingrown toenail remains a serious problem to this day, despite the centuries-old history of its study. Among outpatient patients, the incidence of this disease reaches 10% and does not tend to decrease, and among the population, the incidence of ingrown toenail is 3.4%. The aim of the work was to study the causes of recurrent ingrown toenail and the effectiveness of using a laser beam in the treatment of this pathology.Material and methods. The authors analyzed the causes of recurrent ingrown toenail in 66 patients after various surgical interventions for the period from 1990 to 2020.Results and discussion. The following causes of relapse of the disease were identified: removal of the entire nail plate not according to indications, carrying out marginal resection of the nail on the affected side with the preservation of the nail plate matrix, performing removal of granulations in the nail roller area with the preservation of the nail, underestimating the importance of anti-inflammatory drug treatment in the postoperative period, as well as the importance of correcting metabolic processes in patients with concomitant pathology. A clinical case is presented: a patient with a non-healing wound after four surgeries due to an ingrown toenail with a recurrent course. The patient underwent a Schmiden surgery with resection of the “ingrown edge” of the right first toe nail and removal of infected granulations using laser irradiation of the wound and careful treatment of the matrix area in the projection of the removed part of the nail. In the postoperative period, bandages with ointment based on chloramphenicol and methyluracil were used for local treatment. Recovery occurred on the fourteenth day.Conclusion. In order to reduce the number of relapses of the disease, it is recommended to perform a matrixectomy of the bed of the removed nail plate using laser or radio wave radiation.
Introduction. Synovial cyst or hygroma is a common disease that occurs in both children and adults, but it is most often observed in people 20–45 years old. More than 60% of patients who go to the polyclinic with complaints about the presence of tumor-like formations have hygroma.Goal. Analysis of the results of treatment of synovial cysts of the hand and wrist joint according to our own observations and literature data.Material and methods. We observed 54 patients suffering from hygroma of the hand and wrist joint, who were treated in polyclinic No. 2 and MEDEL multidisciplinary clinic in Kazan from 2005 to 2020. The treatment of hygrom was carried out using conservative (puncture) and surgical methods. Results. Our experience showed that after a single puncture of the hygroma with the evacuation of its contents (10 patients), relapse developed in all cases. After repeated puncture of the hygroma in 10 patients with evacuation of the contents and subsequent administration of 0.5 ml of betaspan solution, 6 of them did not relapse within 5–6 months, but 4 patients had a relapse in the nearest period (1–2 months). Of the 23 patients who underwent surgery to remove the hygroma, 15 of them had no relapses. In 8 patients in the postoperative period, recurrent hygroma occurred, which could be explained by the ineffectiveness of eliminating the communication zone between the hygroma and the joint.Conclusions. For the successful treatment of this disease, it is important to understand that for the occurrence and development of hygroma, its communication with the joint cavity or tendon vagina is of great importance. In the absence of a message, the successful use of puncture methods of treatment is possible. In the presence of such a message and its detection during preoperative examination, surgical treatment should be planned with mandatory ligation of the leg of the hygroma.
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