No abstract

Sepsis-3: renewed determinations, potential problems and further practical foot steps

Вищий державний навчальний заклад України "Буковинський державний медичний університет", м. Чернівці ЕНДОТЕЛІАЛЬНА ДИСФУНКЦІЯ ТА АРТЕРІАЛЬНА ГІПЕРТЕНЗІЯ (ОГЛЯД ЛІТЕРАТУРИ) Резюме. Наводяться дані літератури про функції ендотелію, механізми розвитку ендотеліальної дисфункції у хворих на артеріальну гіпертензію.

Objective. To determine the treatment tactics for varicose dilation of veins, complicated by thrombosis of subcutaneous veins and the shin deep veins, using miniinvasive methods. Маterals and methods. The results of treatment in the IGUS named after V. Т. Zaytsev NAMS of Ukraine in 2015 - 2017 yrs of 80 patients, suffering varicothrombophlebitis, were analyzed. The patients were divided into two groups. In Group I 38 patients, suffering varicothrombophlebitis and/or the shin deep vein thrombosis (DVT), were included, who were treated in accordance to the algorithm proposed. In Group II 42 patients with the same pathology were included, to them a standard treatment was conducted. Results. Immediately after the operation in the Group I patients a severe morbidity, connected with the operation technique (DVT, pulmonary thromboembolism, hemorrhage) were absent. Rate of cutaneous neurological disorders in distal parts of the extremities in patients, to whom endovenous laser coagulation was performed, have constituted 5.2%, and in radiofrequency ablation (RFA) – 2.6%. Due to differentiated approach applied for determination of the operative intervention volume for varicose dilation of veins, complicated by varicothrombophlebitis and/or DVTH of the shin, it became possible to perform operative intervention of lesser traumaticity and to achieve good immediate result in majority of the patients. In Group II in 1 patient postoperative period have complicated by DVT. Of the local complications lymphorrhea was observed in 5% patients, and in 2 patients – the extended femoral hematomas. Conclusion. Operative treatment in the RFA volume or endovenous laser coagulation of the stem on the level of reflux with ligature/ablation of perforant veins after conduction of anticoagulant therapy on stage of total recanalization are indicated in patients, suffering thrombosis of the big subcutaneous vein or small subcutaneous vein and deep veins of the shin. In the patients, suffering thrombosis of stem, the deep shin veins after conduction of operative treatment it is mandatory to administer anticoagulant therapy in the treatment dosage during 7 - 14 days, depending on indices of soluble complexes of the fibrin monomers and/or D-dimer.

Literature data devoted to metabolic disorders in patients with Hypertensive Disease, or Chronic Obstructive Pulmonary Disease separately and in combination were analyzed.

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.

Among the features of surgical care for patients with COVID-19 are the need for strict compliance with the epidemiological regime, minimizing the number of staff in the operating room, the possible minimization of surgical interventions and reducing their duration. The most important task in these conditions is the safety of personnel. Materials and methods. The results of surgical treatment of 85 pa-tients with acute surgical pathology are presented, and the presence of the virus was confirmed by the results of laboratory tests in 75.3 %. 24.7 % of patients had a clear picture of pneumonia of viral etiology with a high probability. All operations were performed in compliance with the epidemiological regime by pre-trained and instructed per-sonnel in compliance with the rules of asepsis and antiseptics. Discussion of results. There are no fundamental changes in the tac-tics of management of patients with acute surgical pathology. Howev-er, in the presence of the patient, in addition to acute surgical disease, COVID-19 and viral pneumonia of varying severity, it is necessary to take into account the increased risk of both bacterial and thrombo-embolic complications. Conclusions. Given the limitations caused by the spread of COVID-19, emergency surgical care should be provided to all pa-tients in a timely, highquality and complete manner. Any action of the emergency surgical service must be justified by the specific situa-tion, with the absolute priority of public and patient safety.

The aim: To assess of pro-inflammatory IL-8 and anti-inflammatory IL-10 serum concentration in patients with T2DM with intraabdominal postoperative abscesses in perioperative period. Materials and methods: The 48 participants, aged 40 – 75 years, among them 24 males and 24 females. All patients were divided into groups: group 1 – 12 patients with T2DM and intra-abdominal postoperative abscesses, group 2 – 12 patients without T2DM but with intra-abdominal postoperative abscesses and 24 healthy individuals. The level of IL-8and IL-10 serum was determined on the day before surgery, on the 2-3rd and 5-7th day after surgery in patients with type 2 diabetes and intra-abdominal postoperative abscesses. Results and conclusions: The trajectories of the level of interleukins in patients with type 2 Diabetes mellitus were different from the trajectories of their level in patients without diabetes, which indicates a special immune response to nosocomial infection and surgical trauma. The mechanism of changes in serum levels of IL-8 and IL-10 in patients with type 2 Diabetes mellitus and postoperative intra-abdominal abscesses should be further studied in future studies on the specific causative agent of nosocomial infection and the cytokine response to it.