Abstract. Aim. Modern surgical approaches to the treatment of anal fistulas involve operations that least damage the sphincter complex of the rectum. The essence of the operation is a complete excision of the anal fistula, which is often accompanied by a significant number of recurrences depending on the chosen method of operation. Failure is likely the result of inflammation that persists after surgery, and cytokines play an important role in these processes. The aim of the study: evaluate local production and determine the role of IL-6 and TNFα in the formation of rectal fistulas. Materials and methods. The tissue of the fistula tract was obtained in 90 patients of both sexes with transsphincteric fistula of cryptoglandular origin in the period from September 2018 to February 2020, who underwent surgery (fistulotomy, modified technique LIFT, use of biowelding technique of the fistula tract). Results. The frequency of IL-6 producing cells was highest (32.0±4,0) specimens in the field of view not only in inflammatory infiltrate, but also in granulation tissue and immature connective tissue of the fistula tract. The lowest rates of IL-6 producing cells were (23.0±3,0) specimens in the field of view. The frequency of TNFα receptor-producing cells ranged from (17.0±1,0) specimens in the field of view to (24.0±3,0) specimens in the field of view. Conclusions. A large number of IL-6 and TNFα-producing cells has been identified not only in inflammatory infiltration but also in granulation and immatureconnective tissue, indicating the active role of these cytokines in the formation of rectal fistulas.
Background and Aim of Study: Rectal fistulae make 20% of all proctologic pathology. Despite numerous methods of surgical treatment of rectal fistulae, percentage of recurrence does not tend to decrease. Complicacy of surgical correction consists in balance between radical surgery with total resection of fistulae and minimal damage of anal sphincter. Development and implementation of novel mini-invasive methods of surgical treatment remains actual in surgery. The aim of the study: to compare and analyze results of treatment of transsphincter rectal fistulae using standard methods and using biowelding. Materials and Methods: We carried out retro-and prospective research of surgical treatment of 57 patients with transsphincter rectal fistulae. All patients were treated in surgical development during September 2018 to November 2019. All patients were divided into two groups. First group included 30 patients, treated with standard methods (resection of fistula with sphincterectomy and incision of rectal fistula with sphincteroplasty). Other group included 27 patients, who were treated with biowelding. Results: According to data, satisfactory result of treatment in first group was observed in 66.7% of cases; in second group success was in 96.3%. Usage of biowelding for removal of intrasphincter part of fistula allowed both decreasing of surgery duration and preventing damage of sphincter apparatus. Conclusions: Excision of rectal fistulae using biowelding can be effective for treatment of such patients. Usage of this method allowed avoiding damage of sphincter apparatus, shortening time of wound healing and number of hospital stay, decreasing expression of pain syndrome in postoperative period.
Background. The search for and development of new minimally invasive methods for the surgical treatment of anal fistulas is a relevant area of surgery. Such methods combine less traumatization and preservation of the sphincter's complex. Employment of such methods for surgical treatment of anal fistulas reduced the time of stay of patients in the hospital and improved their quality of life. Subjects and methods. A retro-and prospective study involved 58 patients with uncomplicated transsphincteric anal fistulas. All patients were treated in the hospital from January 2014 to April 2019. The patients were divided into two groups: the first group included 32 patients who were operated on according to the standard procedure using fistulotomy and Seton procedure; the second group consisted of 26 patients who were operated on using the modified LIFT method. Results. Most of these patients (72.4%) were men at the age of 42.53 6.79. The median of BMI was 25.7 kg/m2. There wasn't mortality after operations. The median follow-up was 21 (6-48) weeks. In the first group there were 3 cases (9.3%) of anal sphincter insufficiency and 7 cases of recurrent fistulas (21.9%) at different times after surgery. In the second group there were no anal sphincter failure following administration of the modified method LIFT, but there were 15.4% of recurrent anal fistulas. Conclusion. The proposed modified method of ligation of intersphincteric fistula tract is an effective method for the treatment of anal fistulas. The results obtained suggest that the developed method can be used to treat other types of anal fistulas.
Abstract. Introduction. Preoperative determination of the functional state of the sphincter apparatus of the rectum is an important part of the treatment of patients. Assessment and analysis of the functional viability of the anal sphincter are necessary for the choice of tactics for surgical correction of rectal fistulas. This approach makes it possible to assess the effectiveness of a specific surgical method and determine the degree of sphincter insufficiency in the postoperative period. The aim of the study: to assess the normative values of neurophysiologicsl parameters of the sphincter apparatus of the rectum and pelvic floor muscles by using the method of electrosphincteromyography. Materials and methods. The study included 93 patients who were treated in the surgical department of the Kharkiv Regional Hospital for rectal fistulas. Indicators of the contractile function of the sphincter apparatus were determined by the method of interference electrosphincteromyography in the preoperative period. The comparison group consisted of 28 volunteers who did not have rectal diseases associated with impaired intestinal retention function (0 points on the Wexner incontinence scale). Results. The standard values of the bioelectrical activity of the sphincter apparatus were obtained by examining a group of volunteers by the method of interference electrosphincteromyography. The analysis of the results obtained demonstrates a slight decrease in the initial indicators of the bioelectric activity of the sphincter complex in the postoperative period. Conclusions. Minimally invasive methods of surgical treatment of rectal fistulas are preferred, because during the study, patients showed a decrease in the initial parameters of the contractile viability of the anal sphincter.
The article describes the reminiscences of Oleksnadr Bozhko, Ambassador Extraordinary and Plenipotentiary of Ukraine to Armenia. Having arrived to Yerevan as the first Ambassador of independent Ukraine, the author became a witness to the events that initially led to a long-lasting political crisis, and subsequently to the unconstitutional change of Armenian government. The article analyses the tumultuous events that Ukrainian Embassy faced immediately after its opening in September 1996. At that time, the Armenian society, which for years had been patiently overcoming numerous abuses of power, the arbitrariness of oligarchs, bureaucratic corruption and bribery at courts, broke out with a riot of peaceful disobedience. It was the time when the reminiscences of the fierce Armenian-Azerbaijani War for Nagorno-Karabakh of 1991–1994 were still in minds of people when society had been drawn into an exhaustible internal political confrontation on the eve of the presidential elections. The more electoral confrontation grew, the more dissatisfying was the population with the leadership of the state. Eventually the state of emergency was introduced in the country. These factors affected further activities of Ukrainian diplomats. It was important to quickly find premises suitable for a diplomatic mission and to carry out the diplomatic procedures necessary for the launch of Embassy’s activities. The author states with sorrow that the Ministry of Foreign Affairs of Armenia did not even find money to fuel a car and bring Ukrainian delegation to Yerevan. Shattered roads that have long been unrepaired, queues near bakeries and kerosene selling points, semi-empty store shelves and even faded eyes of those, with whom the author communicated, – those were sad realities of the Armenian life in the mid-nineties. The formation of the diplomatic services in both countries was carried out under difficult conditions, likewise the maintenance of diplomats’ activity in Ukraine was similarly poor then. The article also describes that the stumbling point in Ukrainian-Armenian relations was an issue of Nagorno-Karabakh. The principle of territorial integrity was one of the fundamental in security sphere of Ukraine, whereas Armenia, which acted as guarantor of Nagorno-Karabakh security, adhered to the principle of self-determination of the nation. In this respect, Armenian politicians considered everything related to the Nagorno-Karabakh issue. This dramatic problem was originated from 1921, when Nagorno-Karabakh was included to the Azerbaijani SSR. The policy of displacing the Armenians from their ancestral lands, which was deliberately carried out by the authorities of Soviet Azerbaijan, caused frustration of Armenians, dozens of thousands of whom had lived in that territory for centuries. The author analyses the cooperation with the Directorate for Political Analysis and Planning of the Ministry of Foreign Affairs of Ukraine regarding the defining Ukraine’s possible position in the Armenian-Azerbaijani conflict. The author emphasizes that the article is not just a diplomatic memoirs but also an attempt to comprehend what has happened to us over the past two decades, looking back at the past experience. Keywords: Armenia, Embassy of Ukraine, Nagorno-Karabakh, Ukrainian-Armenian relations.
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