THE AIM of the study was to develop a minimally invasive technique that does not have the disadvantages of traditional surgical treatment, does not have any restrictions in patients with external hemorrhoids as in HAL-RAR method. Technique that is more effective than HAL-RAR and isolated laser destruction methods, in the treatment of patients with chronic hemorrhoids stage II-III. MATERIALS AND METHODS. We developed a combined method of treatment of the patients with hemorrhoids, that unites artery ligation under the ultrasound control with Doppler effect and submucous subdermal laser destruction of internal and external hemorrhoids. We studied the safetiy and effectiveness of the developed method. The study included 100 patients with chronic hemorrhoids stage II and III, the patients were treated with the use of combined methodology HAL-laser (study group), the method HAL-RAR (1 control group) and closed hemorrhoidectomy linear stapler (control group 2). RESULTS. The analysis showed that the combined method HAL-laser has higher efficiency than the method HAL-RAR, and thus is as safe and well tolerated in patients. Its not so efficient compare to conventional hemorrhoidectomy because of the risk of a cosmetic defect, but does not increase the risk of recurrence of the disease, reduces the risk of complications and more endurable for the patients, it also allows to reduce the time of disability.
Combined method overcomes the drawbacks of traditional surgical treatment and limitations in external components elimination which are inherent for HAL-RAR. Moreover, it has a higher efficiency in treating of hemorrhoids stage II-III compared with HAL-RAR and is equally safe and well tolerable for patients. This method does not increase the risk of recurrence, reduces incidence of complications and time of disability.
The concentration of albumin and the state of its binding centers in the serum and abdominal exudate from patients with acute pancreatitis were evaluated using a fluorescent technique. The total albumin concentration was below normal by 33%. The ratio of effective to total concentration also decreased attesting to conformational changes in the albumin molecule. Albumin molecules are released into exudate in its native form, but sometimes albumin in the exudate is dramatically changed probably due to bursa omentalis seal failure and its concentration sharply decreased probably due to proteolytic degradation. Key Words: pancreatitis; exudate; albumin; fluorescent techniqueRecently developed fluorescent technique allows to evaluate both total albumin content [3,4] and changes in its binding centers [5,6]. Changes in albumin molecule observed in many diseases [1,2] can be described by three parameters: total albumin concentration (TAC), effective concentration (EAC) characterizing molecular conformation, and the EAC/TAC ratio. Under normal conditions EAC and TAC are equal and EAC/TAC = 1, while in various pathologies EAC usually decreases; the greater changes in albumin molecule, the more EAC/TAC ratio deviates from 1 [1,2].We used a fluorescent technique to investigate albumin concentration and properties in exudate in comparison with the corresponding parameters in the blood.
A significant proportion of surgical patients requiring extracorporeal detoxification (ECD) initially have various hemostasis disorders and associated risks. Extracorporeal treatment can lead to the progression of such pathological conditions, including the development of clinically significant bleeding. The work analyzes modern literature, covering the development of hemostasis disorders during ECD and the possibility of their prevention. Currently, there is no consensus on the most significant causes and mechanisms of coagulation disorders in ECD, often leading to serious bleeding and deterioration in patient outcomes. Researchers agree that a significant influence on the risk of occurrence of coagulopathy is not exerted by the severity of the underlying disease, but by the presence of coagulation disorders before treatment. In patients who initially had coagulopathy and/or thrombocytopenia, bleeding after ECD sessions is observed in 40–50 % of cases. The role of heparin anticoagulation in the development of hemorrhagic complications has not yet received a final assessment. In the majority of publications in the literature, the authors conclude that citrate anticoagulation is effective and safe in various types of extracorporeal detoxification, noting that the use of citrate instead of heparin allows not only significantly extending the life of the filter, but also reducing the risk of developing coagulopathy and bleeding after the procedure. Questions of use, risks, and benefits of citrate anticoagulation over heparin for ECD in surgical patients with coagulopathy require further study.
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