Annotation. The aim of the study was to evaluate the immediate and long-term results of valvular prostatectomy and simultaneous peritoneal hernioplasty in patients with benign prostatic hyperplasia and inguinal hernia and assess the quality of life of patients. The article presents the treatment results of 152 patients with benign prostatic hyperplasia. All individuals were divided into two groups. The general group consisted of 32 (21.1%) patients with benign prostatic hyperplasia and inguinal hernia, who underwent one-stage retropubic prostatectomy and simultaneous preperitoneal hernia repair. The comparison group consisted of 120 (78.9%) patients with benign prostatic hyperplasia who underwent only a one-stage retropubic prostatectomy. Assessment of the life quality of patients after simultaneous preperitoneal inguinal hernia repair was performed according to the EuraHS - Quality of Life scale in 6 and 12 months after surgery. The obtained quantitative data were processed by the variation statistic methods with the calculation of t-Student criteria. The data were considered reliable at a significance level of 0.95 (p<0.05). The average age of men in the comparison group was 68.0±7.2 years, in the general group – 67.1±6.9 years; the average prostate volume in the comparison group was 94.4±42.3 cm3, in the general group – 91.2±32.6 cm3; 44 (36.7%) patients of the comparison group and 4 (12.5%) patients of the general group were admitted to the department urgently (due to acute urinary retention or chronic complete urinary retention). The inguinal hernia was found in all 32 patients of the general group, among them in 4 men – on both sides. The average time of ciliary prostatectomy in the general group and in the comparison group was the same (82.8±25.6 and 80.1±17.4 minutes). The simultaneous inguinal hernia repair on the one side lasted 55.0±17.4 minutes. Neurological complications in the general group were noted in 2 (6.25%) patients, in the comparison group – in 9 (7.5%); urological complications took place in 11 (34.2%) and 40 (33.3%), respectively. The average postoperative inpatient stay in the general group was 9.5±1.7; in the comparison group – 9.8±2.9. It was statistically better due to these periods after surgery when compared with preoperative life quality.
Вінницький національний медичний університет ім. М. І. Пирогова 1 Вінницька обласна клінічна лікарня ім. М. І. Пирогова 2 Лікування гнильної флегмони шиї, ускладненої медіастинітом, у хворого з гіпоергічною імунною відповіддю Мета роботи: описати правильний метод лікування пацієнтів із гнильною флегмоною шиї, ускладненою медіастинітом, на прикладі випадку успішного лікування хворого з ускладненим шийним некротизуючим фасціїтом та гіпоергічною імунною відповіддю. Гнильна флегмона шиї, ускладнена медіастинітом, -досить рідкісне захворювання з високим рівнем летальності (40-85 %). У статті представлено випадок успішного лікування хворого з ускладненим шийним некротизуючим фасціїтом та гіпоергічною імунною відповіддю на фоні ревматоїдного артриту, тривалий час лікованого глюкокортикостероїдами. Раннє хірургічне втру-чання з максимально широким розкриттям і наскрізним дренуванням всіх уражених клітковинних просторів з адекватною анти-бактеріальною терапією є єдиним правильним методом лікування таких пацієнтів.Ключовi слова: гнильна флегмона шиї; медіастиніт; цервікотомія.
Annotation. A well-chosen tactic for the prevention and treatment of infectious complications in patients with purulent-inflammatory processes of the mediastinum is important in reducing the colonization of the biotope by pathogens, contributes to the reduction of inflammation and accelerates recovery. The aim of our work was to conduct a comparative study of the antimicrobial efficacy of antiseptic drugs (decasan, myramistinum, chlorhexidine, povidone iodine and polyhexamethylene guanidine) on 278 clinical strains of microorganisms (S. aureus, E. coli, K. pneumoniae, Enterobacter spp.), which cause purulent-inflammatory complications of the mediastinum in patients. For the comparative characterization of the antimicrobial action, the method of double dilutions was used; calculated antiseptic activity index (AAI); a quantitative suspension test was performed to evaluate the decontamination effect of antiseptics. Standard methods of descriptive statistics and special and office programs “STATISTICA 6.0”, “Microsoft Excel 2010” were used. Staphylococci showed the highest level of sensitivity to most of the antiseptics under study. The mean MBSC values of S. aureus clinical strains for decasan, myramistinum, chlorhexidine was respectively 1.75±1.27 µg/ml, 3.25±2.27 µg/ml, and 5.53±3.74 µg/ml. The AAI of myramistinum and chlorhexidine before the Pseudomonas was 4.5, which is the threshold for clinical activity. The clinical activity of a solution of povidone iodine against infections caused by P. aeruginosa is doubtful, based on the activity level of 2.6. The studied antiseptics provided a full decontamination effect against most strains at 5 min exposure, the decontamination effect lasted for 15 min, followed by 30 min. There were found single microorganisms, the number of which gradually increased and after 1 hour reached 1.9×104 and 1.5×102 CFU/ml, respectively. The high sensitivity of gram-positive and gram-negative pathogens to decasan and polyhexamethylene guanidine hydrochloride substantiates their high antimicrobial effectiveness and opens wide prospects for their use in the prevention and treatment of infectious complications in modern conditions.
Objective. To analyze the results of revascularization of the shin and foot arteries in patients with diabetes mellitus in accordance to the angiosome concept. Materials and methods. Results of roentgen-endovascular interventions on 71 lower extremities, performed in 48 patients, suffering diabetes mellitus and ischemia, menaced for the extremity loss, were analyzed. All the patients had purulent-necrotic affections of the foot Degree III-IV in accordance to classification of WIFI (Wound, Ishemia and Foot Infection). In accordance to anatomic zones of revascularization all roentgen-endovascular interventions were divided into three groups: Group I - 24 (33.8%) direct angiosomic revascularizations, Group II - 38 (53.5%) indirect angiosomic revascularizations, Group III - 9 (12.7%) nonangiosomic revascularizations. Results. There was established, that following the angiosome concept raises possibility of preservation of the lower extremity (92.9%) comparing with nonangiosomic revascularization (77.8%). Conclusion. Efficacy of revascularization of the shin arteries with occlusion-stenotic lesions is significantly higher while restoration of the blood flow in accordance to the angiosome concept.
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