Objective: To study the sepsis markers informativeness to assess the role of monocytes in the pathogenesis of generalized peritonitis (GP). Methods: The study included 160 patients with GP, who were divided into 3 groups, according to the stages of the disease. To establish the activity of monocytes was made a determination of the level of cytokine TNF-α and presepsin in the blood. Results: Studies showed that the level of TNF-α in patient with septic shock was reliably lower (24.5±13.3 pg/ml) than in patients with endogenous intoxication and abdominal sepsis. The value of TNF-α in deceased patients also was low – 4.8±0.9 pg/ml. This indicates a decrease in the ability of monocytes in GP at the stage of septic shock to exude a sufficient amount of pro-inflammatory cytokines in response to endotoxin aggression. The level of presepsin increased by stages and amounted to 355.6±8.6, 783.4±24.0 and 1587.7±70.5 pg/ml, respectively. This indicates the circulation in the blood of the CD14 receptor, which is able to express on monocytes, converting them into endothelial progenitor cells. Conclusions: Monocytes as endothelial progenitor cells contribute to the regeneration and restoration of endothelial function in its dysfunction that develops in GP and abdominal sepsis. In consequence of developing immunosuppression and suppression of monocyte function in the stage of septic shock, the process of renewal of endothelial cells is weakened, the secretion of pro-inflammatory cytokines, in particular TNF-α, decreases, which can contribute to an increase in mortality in septic shock. Keywords: Monocytes, abdominal sepsis, septic shock, endothelial dysfunction, progenitor cells.
The incidence of acute destructive pancreatitis is steadily increasing worldwide and, according to the recent literature, is 300-900 patients/mil per year. The increased lethality rate of acute destructive pancreatitis in recent decades, which according to global statistics, ranges from 5% to 20% depending on the severity of the disease, is a cause for concern. It should be noted that most patients with acute destructive pancreatitis are working-age patients, which significantly increases the socio-economic aspect of the problem and urgently requires an active search for ways to solve it. It has been established that the leading pathogenetic mechanism of acute destructive pancreatitis development is enzymatic autolysis of pancreatic parenchyma by its enzymes with their subsequent release into the bloodstream and damage of other organs.
Aim. To improve the results of surgical treatment of patients with acute intestinal obstruction of tumor genesis during radical surgery. Material and methods. Results of observation and treatment of 31 patients with acute colonic obstruction of tumorous genesis at the age from 34 till 72 years are presented. The most frequently observed was rectosigmoidal location of the tumor. The study group included 14 patients (45,2 %), in the control group - 17 (54,8 %). For diagnostic purposes general clinical and biochemical blood tests, ultrasound, MRI, CT, colonoscopy, rectoromonoscopy and video laparoscopy when indicated as well as pathohistological examination of biopsy specimens, taken from macro preparations of removed celiac tumor were carried out. Results and discussion. It was found out that more expressed decrease of inflammatory processes and intoxication indexes is observed in the patients of the main group, which were preoperatively prepared according to the method suggested in the clinic; early normalization of the laboratory and instrumental indexes in the postoperative period in comparison with the control group of patients, in which preoperative preparation was performed according to the traditional schemes. In 2 (11,8 %) cases of the control group patients suture inconsistency was revealed, in 3 (17,6 %) cases - purulence of the postoperative wound. In 1 case (5.9 %) lethal outcome was registered due to myocardial infarction. Inflammation of the postoperative wound was observed only in 1 (7,1 %) case among the main group patients. Conclusion. Decompression of the upper section of the bowel loop in combination to enterosorption in the preoperative period is the effective method of the bowel preparation for the radical surgery and promotes to decrease the frequency of the early postoperative purulent-inflammatory complications.
Aim. To optimize the surgical treatment of recurrent postoperative ventral hernias using synthetic alloplastic materials. Material and methods. The study was conducted among 139 patients with recurrent postoperative ventral hernias. According to the indications, all patients underwent abdominoplasty using mesh biologically inert alloprostheses using the “onlay” method and according to the original method with the displacement of the vaginal leaves mm. recti abdominis. Results and discussion. Recurrence of ventral hernias after the first year of follow-up was detected in 6 (4.3 %) patients. The causes of relapses in large hernias are dystrophic processes in the soft tissues of the anterior abdominal wall, caused both by the activation of fibroblasts upon contact with the polypropylene mesh, and directly by the defect of the mesh as a result of its rupture. In the event of a recurrence, reconstructive surgeries were performed in the scope of a modified technique with component separation to eliminate additional tissue tension. Conclusion. The developed method of surgical treatment of postoperative ventral hernias involves dissection of the anterior walls of the sheath of the rectus abdominis muscles along the the muscles, suturing the aponeurotic edges of the defect, connecting the rectus muscles along the midline, followed by fixing the mesh implant to the outer edges of the dissected aponeurosis of the rectus abdominis muscles, which makes it possible to prevent the occurrence of cicatricial degeneration and defect of functional activity, as demonstrated by monitoring the function of the rectus abdominis muscles.
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