Nowadays in Kazakhstan there is an active development of organ transplantation, particularly kidney transplantation. The main purpose is not only to save as much lives as possible but also improve the survival rates of graft. In this way, now we are investigating personalization and rationalization of immunosuppressive treatment. In our country as in whole world genetic factors, determinating long-term graft survival, represent a great relevancy in transplantation. According to the results of clinical trial, there is a strict association between CYP3A5 (сytochrome P450) genetic polymorphism and tacrolimus pharmacokinetics. The determination of genetic polymorphism of CYP 3A5 gives us the opportunity to predefine the changes in blood concentrations of tacrolimus, better control of immunosuppressive therapy, that will positively affect the long-term graft survival.
Timely urgent cholecystectomy in patients with ACC and ADCC, taking into account the possibility of using minimally invasive techniques using Immunofan, strengthens the immune system and significantly improves the results of surgical treatment. In the period from 2017 to 2018, 56 patients with various forms of acute calculous cholecystitis aged 15 to 86 years were hospitalized at the surgical clinic of the Azerbaijan Medical University. All 56 patients were divided into two groups: IA In the control group I entered 10 patients. II-In the main group, patients were divided into several subgroups. In subgroup A, 9 patients were operated on an emergency basis, for 5-6 hours with a diagnosis of destructive cholecystitis diffuse peritonitis. In subgroup B - 17 patients, after traditional preoperative preparation, with the addition of immunotherapy (immunofan), patients were operated on in an emergency order, within 12-48 hours. In the S-21 patients, perioperative therapy was carried out using immunotherapy (immunofan). All patients were examined according to the standard scheme: clinical examination, instrumental studies, laboratory tests.
Ultrasonography (US), which includes gray-scale scan, color and spectral Doppler investigation, is consid-ered as one of the leading methods of instrumental diagnostics and monitoring in liver transplantation.
Keywords
Ultrasound diagnosis, Doppler sonography of the blood, vessels of the liver, vascular complica-tions, vascular thrombosis of the graft
Thus, continuous increase in the number of patients suffering from gallstone disease and thyroid dysfunction and their combination, absence of a single idea with respect to diagnosis and surgical treatment in such contingent patients determines the relevance of the problem selected for the research. Research. materials and methods. 25 patients with goitrous forms together with gallstone disease was inpatient treatment in scientific centre of surgery named after M. A. Topchubashov. They are from 17 up to 63, 19 women (76%) and 6 (24%) men. Among those with different goitrous forms, those who were able to work were prevailed. All 25 patients, who constitute the material of this scientific study, were divided into two groups. The main group consisted of 17 (68%) patients that they were operated (joint cholecys-tectomy with thyroidectomy) using laparoscopic techniques and instruments (laser). 8 (32%) of patients constitute the control group that traditional surgical intervention was used in gallbladder and gallbladder pathways here jointly with thyroidectomy. All 25 patients with gallstone disease, with various goitrous forms, have undergone surgical treatment..
Results. It should be noted that in the last decade significant changes were observed in the structure of the thyroid gland dysfunction. Thus, if patients who previously suffered from thyroid gland with nodular and multiple goitrous were the majority and recently, the significant increase of chronic thyroiditis and cancer disease of thyroid gland was re-corded. While using less invasive techniques in the implementation of interventions postoperative complications were encountered in 1 (one) of 17 patients, 1 (5.9%) (seroma), whereas while using conventional methods, complications were occurred in 4 patients (50%) of 8 patients (seroma, irritation and subcutaneous bleeding). When analysing their characteristics it became apparent that while using less invasive technology, complications after thyroidectomy have been observed 2.5 times less than traditional operations; hemocoagulation complications were not found in any patient.
It is known that patients with rectal cancer belong to the category of cancer patients with the most pronounced degree of disability, which is primarily due to the high percentage of stoma operations in this pathology. In this situation, a comprehensive approach is needed to solve this problem. Thanks to the multi-component rehabilitation treatment in patients with rectal cancer with unnatural anus after radical surgery, including a certain algorithm when choosing the place of formation of the colonic terminal stoma, diet therapy, the use of funds and the order of care for the colostomy, methods of prevention and elimination of complications from the intestinal stoma, it was possible to achieve good functional results of treatment, expressed in a high coefficient of “labor rehabilitation”, which amounted to 71,3±4,9%. At the same time, every fifth stomic returned to the preoperative way of life independently, and the coefficient of “self-rehabil-itation”, which reflects the ratio of patients who returned to work without passing the MSEC, to the number treated for this localization, was 18,4±4,2%.
Keywords
oncology, rectal cancer, colos-tomy, quality of life
Clinical case of the recurrent renal cell carcinoma 27 years after contralateral nephrectomy. Patient 56 years old male, admitted to the hospital with gross haematuria. Patient was examined: on ultrasound and computed tomography neoplasm of solitary left kidney was revealed. Patient history: in 1991 patient underwent open nephrectomy on the right about renal cell carcinoma. Afterwards was under follow-up for 5 years and no signs of recurrence were revealed on control check-up. On computed tomography scans kidney has the dimensions 20,4х8.62 cm and neoplasm 10,5 х 8,3 cm extending from upper pole to the renal hilum. Considering that patient has only one kidney we decided to perform renal sparing surgery but it was unclear precisely the state of invasion of renal hilum, thus it was planned to attempt extracorporeal resection of kidney.
Adhesive disease of the abdominal cavity is one of the most common complications after abdominal and small pelvic surgery. This complication, in turn, leads to infertility, chronic pain in the abdomen and intes-tinal obstruction. Laparoscopy has become a “Golden Standard” for surgery of surgical abdominal organs. Laparoscopic surgery has a number of advantages over open surgery, including rapid recovery, reduction of hospitalization days, post-operative pain reduction, as well as cosmetic priorities. Further improvement of this branch of technology, the development of modern techniques and the development of special lapa-roscopic skills - expanded the spectrum of operations on the abdomen, such as the construction of intra-corporal stitches and anastomosis. Postoperative adhesions are directly related to abbot subsection of the abomasum, and are the major cause of intestinal obstruction. At present, anti-drowning barriers are widely propagated in the prevention of adhesions. Studies show that adherence to adhesion does not adversely affect intestinal anastomosis. However, anastomoses are not recorded correctly in the abdomen, regardless of the presence of anti-deposition barriers. The review provides information on the pathophysiology and prevention of abdominal strokes.
Transplantation of organs saves thousands of lives annually all over the world. Of all kinds of transplantation of organs the most well-developed, as in whole world so as in Kazakhstan, is kidney transplantation. Increas-ing number of patients, seeking for kidney transplantation lead to shortage of donors. In whole world there is a common problem of shortage of donors in different grades. According to local social, ethic, religious and other considerations deceased donor transplantations and living donor kidney transplantations are developed diversely.
The results of treatment of 25 patients with cholelithiasis, complicated by Mirizzi syndrome type III and IV, were studied. There were 6 men (24%) and 19 women (76%), 1: 3. The age of the patients ranged from 41 to 78 years. The average age of patients was 63.4±3.4 years. Of these, 14 (56%) patients were overweight: obesity degree I - 7, obesity degree II - 5, the degree of obesity III - 2. All patients were hospitalized as an emergency. All patients were divided into 2 groups depending on the method of elimination of hepatico-holedochus wall defects. The first group - 15 (60%) patients who underwent cholecystectomy, drainage of the common bile duct through the fistula defect by Kerr, hepaticojejunostomy with inter-intestinal anasto-mosis by Brown (with Shalimov’s plug) and Roux (additional drainage by Felker) to the resulting loop. The second group - 10 (40%) patients who underwent cholecystohepaticco-choledochoplasty with P-shaped interrupted sutures on the drainage by Vishnevskiy and hepaticojejunostomy (modelling of Roux technique) using the method of the University Hospital of Semey Medical University. Patients with alimentary obesity - Grades II-III are operated on with the use of “Universal delator Aimagambetov for patients with overweight”. Analysis showed us the reduction of postoperative complications in the second group of patients, which allows us to recommend this method as one of the options of choice for the correction in the treatment of Mirizzi syndrome III and IV types.
