Background. Injury to the main vessels is often accompanied by life-threatening bleeding, permanent disability or death. In the modern literature, only isolated cases of reconstructive surgery for major vein injury are described, their long-term results are insufficiently studied, there is little information about the introduction of telemedicine technologies into the practice of emergency angiosurgical care. The aim of the study is to demonstrate the immediate and long-term results of the joint work of trauma surgeons and angiosurgeons in helping a patient with injury to the main femoral vessels. Case presentation. The results of treatment of the patient with the diagnosis: laceration of the upper third of the right thigh with rupture of the common femoral vein and superficial femoral artery and the development of threatening ischemia of the right lower limb; severe blood loss; hemorrhagic shock IV; severity of injury: VPH SP 33; MESS 7. Treatment of the patient took place in several stages. At the first of them, hemostasis was performed, the hemorrhagic shock was resolved. Further, the patient was consulted by an angiosurgeon through telecommunication technologies, after which it was decided to include an angiosurgeon in the surgical team. The prosthetics of femoral vessels was performed: the main venous and arterial blood flow was restored in the affected limb. The patient was discharged in a satisfactory condition with no signs of thrombosis. Conclusions. Compliance with consistent actions in helping a patient with a vascular injury prevents the development of a deadly triad and a fatal outcome. The use of telemedicine consultations provides the angiosurgeon with the opportunity to remotely assess the clinical picture, the severity of the injury, discuss the sequence and volume of necessary medical care at the place of primary hospitalization. Performing reconstructive surgeries using various types of grafts allows you to restore the main blood flow through damaged vessels with good immediate and long-term results.
AIM: To identify and describe micro- and ultrastructural thermally induced changes in Bakers cyst wall associated with the duration of unidirectional uniform heating at 70C. MATERIALS AND METHODS: We took one full-thickness fragment from each of the 15 Bakers cysts excised during the operation and divided each fragment into four parts: one was used as a control sample, and the remaining three fragments were placed with the synovial membrane on a thermostat heated to 70C, with exposure times of 60, 120, and 180 seconds. We used light-optical and electron microscopes for the histomorphological examination of the samples. RESULTS: Two layers of Bakers cyst wall were identified: inner (synovial) and outer (fibrous). In samples exposed to heat for 60 seconds, the synovial layer was undamaged. In samples exposed to heat for 120 seconds, thermal damage to the cells of the synovial layer and underlying collagen fibers of the fibrous layer was evident. With a heating duration of up to 180 seconds, histomorphological examination revealed signs of damage reaching the middle of the fibrous layer, and signs of deep disorganization of the collagen fibers of the cyst wall were determined at the electron-microscopic level. DISCUSSION: Using light microscopy of intact sections of the cyst wall, we, like other researchers, identified two layers (synovial and fibrous) of different densities, with blood vessels passing through them. The performed experiment suggests that a clinically significant result using Bakers cyst thermotherapy is achieved when spreading the zone of irreversible coagulation beyond the middle of the fibrous layer of the cyst wall. This, in turn, guarantees damage to the capillary network that provides trophism and proliferation of synoviocytes. The proposed hypothesis corresponds to the paradigm of similar studies on the coagulation of cysts of other localizations. CONCLUSION: The obtained results of the light-optical and electron-microscopic examination of Bakers cyst wall fragments indicate direct dependence of the depth of thermal coagulation on the duration of heating.
Число усечений нижних конечностей в группе больных с сахарным диабетом (СД) и его осложнениями выросло более чем на 25%. Однако за тот же период в Северном управленческом округе было отмечено снижение числа больных СД на 7%, а количества ампутаций нижних конечностей более чем на 1,5%. Заключение. На фоне увеличения числа лиц старшей возрастной группы в демографической структуре, а также ежегодного роста случаев СД в Свердловской области в период с 2017 по 2020 г. произошло повышение количества больших ампутаций конечностей на 5%. Для снижения частоты усечений конечностей требуются дальнейшие работы по изучению причин, приводящих к этим тяжелым инвалидизирующим операциям.Финансирование. Исследование не имело спонсорской поддержки.Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.
Introduction. The aim of the study was to analyze the provision of specialized medical care by vascular surgeons during the COVID-19 pandemic on the example of the Sverdlovsk Regional Clinical Hospital No. 1.Materials and methods. A retrospective analysis of the activities of vascular surgeons of Sverdlovsk Regional Clinical Hospital No. 1 in 2020 was conducted. In addition, an assessment was given of the organization of measures aimed at reducing nosocomial infection and the spread of a new coronavirus infection.Results. The number of outpatient visits to a vascular surgeon in 2020 decreased by about 10%, and the number of hospitalizations to the vascular surgery department decreased by more than a third compared to previous years. But in 2020, the number of consultations of a vascular surgeon with the use of telemedicine technologies increased almost 2 times. In the vast majority of cases, patients with abdominal aortic aneurysm underwent endovascular prosthetics, which significantly reduced the time spent in the hospital and minimized the risks of nosocomial infection with COVID-19. The preoperative preparation included: computed tomography of the lungs and determination of coronavirus RNA (SARS-CoV-2) by PCR. In addition, on the day of hospitalization, it was mandatory to conduct: thorough collection of an epidemiological history and characteristic complaints, thermometry. Also, in order to prevent the spread of a new coronavirus infection, isolators for temporary stay of patients with suspected COVID-19 were organized in the emergency room and hospital departments.Conclusions. All organizational measures at the Sverdlovsk Regional Clinical Hospital No. 1 have made it possible to minimize the risk of nosocomial infection and the spread of COVID-19, thereby ensuring continuous work on the provision of planned and emergency specialized medical care.
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