The clinical case represents the surgical correction of postoperative complications in a patient with Peyronie's disease. The patient underwent flap corporoplasty using an autovein. The late postoperative period in the patient was complicated by extensive necrosis of the penile skin, which required repeated surgery as follows. The first stage of surgical treatment was performed by excision of necrotic tissues of the penile skin. Within 10 days of the postoperative period, chymotrypsin with an ointment containing dioxomethyltetrahydropyrimidine with chloramphenicol was applied to the penile wound surface to prepare the wound for subsequent skin autotransplantation. Further, within 5 days, the polymeric drainage sorbent «Aseptisorb DT» was applied to the wound surface until the wound was cleansed and granulation tissue was formed. The second stage of the surgical treatment performed penile skin replacement plasty with a free perforated skin graft taken from the patient's femoral surface.
Introduction. According to the literature, 5.0% of patients with urolithiasis are characterized by the presence of stones in the bladder. The issue of bladder stones for patients with benign prostatic hyperplasia remains relevant and requires further improvement of approaches to surgical treatment.Purpose of the study. To evaluate the safety and efficacy of energy-diverse percutaneous cystolithotripsy (and placement of a cystostomy catheter) in comparison with transurethral cystolithotripsy.Materials and methods. A retrospective analysis of 56 cases in patients (aged 54-82 years) with bladder stones was carried out. All patients were treated in the Urology Clinic of the Mechnikov North-Western State Medical University from 2019 to 2021. Two groups were formed: group I — 26 (46.4%) patients who underwent percutaneous cystolithotripsy, group II — 30 (53.6%) patients underwent transurethral cystolithotripsy. The duration of surgery, intraoperative and postoperative complications were assessed.Results. On average, the duration of surgery for the percutaneous approach was shorter than for transurethral access (35 vs 44 min). The stone-free rate in the case of the percutaneous approach was 100.0%, while in transurethral cystolithotripsy the stone-free rate was 90.0%. In the early postoperative period, in groups I and II, gross hematuria was observed for 2 (7.6%) and 4 (13.3%) patients, respectively. In the late postoperative period, 2 patients from group II had a urethral stricture.Conclusions. Percutaneous cystolithotripsy is a minimally invasive method of stone fragmentation, characterized by a minimal risk of intra- and postoperative complications.
The case of surgical treatment of giant sporadic angiomyolipoma of the kidney is presented. By definition, an angiomyolipoma is a highly active vascular benign tumor consisting of endothelial cells, smooth muscles and adipose tissue. The diagnostic standard includes ultrasound diagnostics and computed tomography. The presented patient has in the lower segment of the left kidney, a giant subcapsular lipoma with a pronounced angiomatous component, 64×40×82 mm in size. The main method of treatment for this disease is surgical. In this case, the minimally invasive surgical intervention was chosen as the first stage: superselective embolization of the branches of the left renal artery. Selective angiography revealed a symptom of pathological neovascularization. Through the microcatheter, embolization of the branches of the left renal artery by embospheres was performed. In the postoperative period, the patient noted a decrease in the intensity of the pain syndrome, up to its complete disappearance. In the case of formations larger than 4-5 cm in diameter, embolization can be considered as the first stage of the surgical operation. Further reduction of the education in volume can allow the second stage of surgical treatment to be performed — laparoscopic kidney resection. Angiomyolipoma of the kidney of this size is a rather rare pathology. Similar formations make up approximately 0.3–3% in the population and the methods of their treatment are not always unambiguous. Therefore, we believe that each clinical case is very important and interesting in its own way and is also valuable in terms of accumulating experience in the treatment of such patients.
On the 2018, the prevalence of kidney cancer is 3.9% of all cases of cancer in the Russian Federation. The 5-year survival rate patients with RP is approximately 60%, while in the presence of distant metastases, the 5-year survival rate is from 5 to 9%. The case presented of operational treatment of a patient with metachronous metastasis clear-cell renal cell cancer of the right kidney into the paranephric cellulose of the contralateral the only left kidney. In 1999, the patient underwent a radical nephrectomy on the right side regarding kidney carcinoma. No data for distant metastases were received, chemotherapy was not carried out for the patient, after surgery was observed on an outpatient basis by an oncologist. Removed from the register by an oncologist after 5 years. Since 2019, the patient began to notice relapses of renal colic, in March 2020 he was hospitalized in the urology department of the North-Western Medical University named after I.I. Mechnikov, according to emergency indications with a clinical picture of renal colic on the left. The patient underwent MSCT of the abdominal organs with intravenous contrast. The formation of retroperitoneal space on the left was revealed, measuring 11.0×10.1×9.2 cm, accumulating contrast and adjacent to the left kidney. There are no data for other focal formations in the abdominal cavity. The left kidney is located typically, increased in size. The patient underwent surgery in the amount of resection of retroperitoneal education. According to the results of histological examination: the picture more corresponds to with metastasis of clear cell renal-cell carcinoma of the kidney Grade 1. ICD-0 8310/3. The presented clinical case is valuable in that kidney carcinoma metachronic metastasis was detected only after 21 years, at the same time, it had an extraorgan arrangement in the retroperitoneal space, lying tightly on the kidney, but did not grow into the renal capsule. Based on this, we consider it important to continue monitoring patients after radical nephrectomy about a kidney tumor, even beyond the pale of 5 year survival.
A key role in the prevention of negative personal changes is played by the stable professional selfawareness of OMON officers. With a reduced level of professional self-awareness, either excess of official authority is possible, which in turn will provoke significant negative consequences, or untimeliness, instability in the implementation of professional skills, which will also reduce the performance of official tasks. To date, the problem of developing professional self-awareness among OMON officers remains poorly understood and requires further study. Psychological training can be one of the effective ways of developing professional selfawareness. The purpose of the study is to develop a socio-psychological training for the development of professional selfawareness of OMON officers. The article reveals the problem of finding ways to increase the professional self-awareness of employees of special units of the Russian Guard, using the example of a special mobile detachment. Based on the analysis of psychological and pedagogical literature, the authors formulated the definition of an employee’s professional self-awareness and described its structure. On the basis of the proposed model of professional self-consciousness, a training was developed and successfully tested, aimed at the formation and development of substructures of self-consciousness. The article presents data from an experimental study. An analysis of the leading methodological approaches to studying the phenomenon of «professional selfawareness» led to the conclusion that the effectiveness of the professional activities of OMON officers depends not only on professional knowledge, skills and abilities, but also on a number of psychological factors involved in the regulation of this activity. The effectiveness of the training program for increasing the professional self-awareness of employees is confirmed by the statistically significant development of its components, which allows us to recommend it for practical use.
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