The problem of improving the results of surgical care for patients with mechanical jaundice syndrome as a complication of pancreaticobiliary cancer and chronic pseudotumor pancreatitis is still being discussed. Purpose - to improve the results of radical surgical care for patients with pancreaticobiliary cancer and chronic pseudotumour pancreatitis complicated by mechanical jaundice syndrome. Materials and methods. The results of surgical treatment of 272 patients with mechanical jaundice syndrome were analyzed. The main group included 112 patients who were treated with our own developed prognostic and therapeutic algorithm. The comparison group included 160 patients who underwent preoperative preparation outside this algorithm. Results. Almost all the patients in the main group had single nucleotide genetic mutations in the PRSS 1 (Arg122His), SPINK 1 (Asn34Ser), TNF (G308A) and CFTR (Phe508del) genes. In patients of the main group, according to ultrasound elastography, the density of pathological focus for pancreatic cancer was 7.5±0.8 units, and for chronic pseudotumour pancreatitis - 5.6±0.5 units (p<0.05). The most significant differences were observed in the frequency of pancreaticodigestive anastomosis failure (2=6.95; p=0.008) and in the frequency of bleeding in the postoperative period (2=4.29; p=0.004). The amount of life-threatening postoperative complications was 42 (37.5%) cases in the main group and 102 (63.8%) cases in the comparison group (2=18.22; df=1; p<0.0001). In the main group 7 (6.3%) patients died, in the comparison group - 19 (11.9%). Conclusions. Prevention of the development of immediate postoperative complications in patients with focal pathology of the pancreatobiliary zone against the background of mechanical jaundice is achieved by combining molecular genetic studies with the determination of the patient's phenotype, ultrasound fibroelastography and mathematical modelling of patient status. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.
The results of research of performance factors of nonspecific defense of 116 patients with acute purulent inflammation of soft tissues were analyzed. The regularities of these parameters inhibition were detected depending on the severity of the inflammatory process. The use of the ultraviolet and laser radiation equally stimulates increase in the levels of factors of nonspecific host defense and promotes positive course of the disease.
Surgical infection is one of the most important and important problems of modern medicine. The lack of a universal remedy and method of wound treatment, the difficulty of choosing universal tactics of management of patients with chronic wounds determines the need for further search for new treatments that stimulate reparative processes in chronic wounds, including morphological research methods. The role of cellular regulation in the pathogenesis of the restoration of the morphofunctional state of a chronic wound in the conditions of its damage remains undisclosed. Therefore, the aim of our study was to evaluate the role of myofibroblasts in the healing of chronic purulent-necrotic wounds in the treatment of mesenchymal stem cells using immunohistochemistry. In the experiment we obtained a model of chronic purulent-necrotic wound, which meets all the requirements for quality indicators in the study of morphological changes in chronic wounds and can then be used as a basis for preclinical research. The condition of chronic purulent-necrotic wounds in 120 rats was studied by histological and immunohistochemical methods. Chronic wound was modeled according to the original method of the author: during the formation of a standard skin defect in the interscapular area of the rat with a diameter of 1 cm, the surrounding tissue was superimposed ischemic metal structure to reduce blood flow in the wound area, which significantly slowed the delay. Treatment was started from 28 days from the beginning of wounding, which clinically and histologically corresponded to the chronicity of the wound process. Statistical processing of morphometric parameters was performed using the standard software package “Statistica 6.1”. It was found that the positive dynamics of healing of chronic wounds, using 0.025 % decasan solution, was observed mainly in the early stages (3-7 days), while mesenchymal stem cells (MSC) and MSC cloned in inert gases (MSC-IG) were effective at all stages of the study. The use of MSC and MSC-IG creates favorable conditions for the normal course of regenerative processes and epithelialization of wounds, providing anti-edema and anti-inflammatory effects with activation of myofibroblasts, which increases the healing efficiency of chronic purulent-necrotic wounds. Prospects for the use of MSC in the treatment of chronic wounds are shown.
The aim: To detect the ultrasonographic signs of necrotizing fasciitis (NF) suitable for its early diagnosis. Materials and methods: Eigty two patients with soft tissue infection, including 14 with necrotizing faciitis, were examined by ultrasonography at the admission. Ultrasonografic features were compared to intraoperative findings by the same surgeon. Results: The thickening of subcutaneous tissue had high sensitivity (100%), but low specificity (5.8%). The hypoechoic and hyperechoic zones had the shape of “cobblestone” with sensitivity – 78.5%, specificity – 33.8%. Higher specificity (69.1%) had sign of “cobblestone separation” on two layers. The presence of fluid above the fascia (sensitivity – 71.4%; specificity – 69.1%), thickening of the fascia (sensitivity – 85.7%; specificity – 58.8%), indistinctness of the fascia edges (sensitivity – 85.7%; specificity – 66.1%) and loss of fascial homogeneity (sensitivity – 71.4%, specificity – 66.1%) were noted in early stages of NF. Advanced cases of NF were accompanied by the dissection of thick¬ened fascia with a strip of fluid (sensitivity – 57.1%, specificity – 92.6%) and accumulation of a fluid under the fascia (sensitivity – 28.5%, specificity – 95.5%). The muscles thickening (sensitivity – 28.5%; specificity – 67.6%), skin thickening (sensitivity – 57.1%; specificity – 58.8%), and loss of the skin’s lower edge clarity (sensitivity – 57.1%; specificity – 63.2%) don’t have diagnostic value without other signs of NF. Conclusions: Point-of-care ultrasonography allows visualization of soft tissue changes that may be hidden in the initial stages of necrotizing fasciitis and should be recommended for implementation as mandatory method of examination in patients with suspected surgical soft tissue infection.
ÂñòóïПротягом останнього десятиріччя структура трав-матизму і, відповідно, тяжкості уражень значно змі-нилася. Домінуючі місця посідають пошкодження, зумовлені дорожньо-транспортними пригодами, ката-травмами, побутовим травматизмом і терористичними актами [1].Одночасно медична громадськість привертає ува-гу до збільшення кількості людей із надмірною вагою та ожирінням, що становить певну медико-соціальну проблему. Згідно з дослідженнями Всесвітньої орга-нізації охорони здоров'я, питання надмірної ваги та ожиріння стосуються майже всіх країн світу, вікових категорій та соціальних станів населення [2]. Доведе-но, що в кожної людини, яка має зайву вагу, форму-ється підвищений ризик до виникнення таких захво-рювань, як цукровий діабет ІІ типу, ішемічна хвороба серця, артеріальна гіпертензія, остеоартрит, обструк-тивний синдром зупинки дихання уві сні та певні види онкологічної патології. Ожиріння є фактором ризику інфаркту міокарда та підвищеної смертності. Щороку в США приблизно 300 тисяч смертей можна пов'язати з ожирінням, а смертність через цю причину переважає тільки смертність від куріння [3, 4]. Відповідно клінічні прояви при різних видах ожиріння дуже схожі. Є лише відмінності щодо розподілу надлишку жиру в організ-мі, а також за симптоматикою захворювання нервової та ендокринної систем [2].Саме особливості перебігу захворювань у осіб на тлі ожиріння зумовлюють необхідність з'ясувати структу-рута характер пошкоджень при поєднаній травмі тіла в потерпілих із цією патологією. Адже надлишок маси
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