Hepatocellular carcinoma is one of the most important problems of the oncological service of the world and Kazakhstan. The article describes the analysis of the main statistical indications of primary liver cancer (hepatocellular carcinoma, HCC) in the Republic of Kazakhstan in the period of 2007-2017. Describes the features of the spread of HCC in the world and in some regions of Kazakhstan. The places for the main indi-cators of HCC in the structure of oncopathology are identified. Dynamic changes in morbidity and mortality rates of HCC depending on gender, and we have the prognosis for the next 5 years. The incidence and mortality rates of hepatocellular carcinoma of men are higher than women.
One of the actual problems of contemporary medicine is the restoration of the tissue structure that has been impaired. Because today, with the rapid development of medical technology, the pathologies called “inoperabel” were brought to life by organ transplantation. Liver cirrhosis, malignant tumors without metas-tasis, chronic renal failure, and so on. liver and kidney transplantation has become a therapeutic tool for the treatment of illness. The experiments were performed on head white rats. Experiments were carried out in accordance with the rules set out in Protocol No. 31 of the Bioethics Committee of 21 April 2008. All weighing procedures and experimental extraction on animals have been accomplished through inhalation anesthesia. Anesthesia was given to animals to form a liver ischemia model, and the abdominal cavity was opened at full disinfection. The right part of the artery entering the liver has been mobilized and taken to the liver. By using the ligature, a reperfusion pattern has been created to relieve the ischemia.
Diabetes is one of the priority diseases in the health care system of all countries of the world, due to the high prevalence of this pathology in the population and the increase in socio-economic losses associated with the development of severe disabling complications. Every year, more than 1 million operations of ampu-tation of the lower extremities in diabetes are performed in the world, more than 600 thousand patients lose their sight, and approximately 500 thousand patients develop renal failure. Over 50% of all non-traumatic amputations are accounted for by diabetics. The article provides a literature review, covering foreign and domestic data. The review is devoted to modern approaches to various types of diagnostics and treatment of peripheral artery diseases caused by diabetes, comparative studies, as well as prevention methods.
A rare case is given in our article with 10 days old closed injury with isolated full intraperitoneal rupture of the bladder dome. In the surgical department of our hospital, with bladder ruptures, which are given according to literary data, but have met with such a case first. At the insistence of a linear medical assistant after 10 days, the patient was brought by train to us with a diagnosis cirrhosis, ascites. The intraperitoneal rupture of the bladder, complicated by 10 days of urinary peri- tonit, which is not found in the available literature. At the first catheteriza-tion the patient is exposed diagnosis. Due to the severity of the patient’s condition, the therapists showed vigilance and after consulting Stov in the intensive care unit held preoperative preparation, operation: rehabilitation of the abdominal cavity with drainage, suturing the wound of the dome of the bladder with the imposition of epicystostomy, postoperative care and ad-equate treatment, based on practical experience, led to a positive outcome. the results of surgical treatment, the patient lives, now on a well-deserved rest.
57 years old female was admitted to the hospital absolutely asymptomatic. Previously on ultrasound investigation 3 renal neoplasms were detected. Five years ago patient underwent nephrectomy on the left for renal cell carcinoma. Preoperatively laboratory tests were in reference range. Patient underwent renal sparing surgery - all neoplasms were fully excised. After each excision arterial circulation was temporarily restored for up to 10 min. We call this - “start-break” technique. Also after exci-sion it was better to assess hemostasis. Total warm ischemic time was 18 min. Total blood loss was 200ml. Patient’s condition was relatively stable and did not necessitate hemodialysis. She was discharged on 11th postop day. Renal cell carcinoma of the solitary kidney presents a great challenge either for the surgeons or patients, because it depends on what is the main purpose of treatment, because organ sparing surgery and radical surgery have mostly different outcomes in long-term period. The decision is made according to the clinical data, patient’s preference, safety and good quality of life for patient. But organ sparing surgery bears the risk of recurrence more than the radical surgery. So these aspects must be considered before the informed consent is taken.
Keywords
renal cell carcinoma, solitary kidney, excision, ischemic time
In the presence of anal prolapse, perform operations on the loose, ulcerated mucous membrane of the anal canal for its sagging is fraught with the danger of bleeding during and after surgery. It is also highly likely that cidiva disease. The purpose of this study is to compare the methods of surgery used for anal prolapse, which most often accompanies stage 4 hemorrhoidal disease. In our study 400 patients in the age group from 20 to 71 years old were operated on from 2006 to 2016. All sick were divided into 3 groups. The main group included 308 (77.0%) patients who underwent hemorrhoidectomy linear stapler. Control group I included 74 patients (18.5%), who produced a typical open. hemorrhoidectomy. The control group II consisted of patients who underwent surgery according to the method of Longo with use of a circular stapler PPH-18 patients (4.5%). For the duration of the operation using linear the stapler lasted 22.9 ± 0.4 min. The classic Milligan-Morgan operation lasted on average 34.9 ± 0.8 min. Operation Longo took an average of 29.3 ± 1.2 min. Bleeding during surgery was observed in 3 patients (1%) when using a linear stapler, in 6 patients (8.1%) during standard hemorrhoidectomy and in 2 patients comrade (11.1%) during the Longo operation. Long-term complications such as stricture and relapse in the main group one case is 0%; in the control group I, 6 patients had a relapse of the disease (8.1%), in 12 cases - a stricture Anal canal (16.2%); in the control group II, there were 2 cases of relapse (11.1%) and 2 cases of stricture (11.1%). Good quality of life was considered by 162 patients (76.4%) who underwent surgery using a linear stapler; 26 patients comrades (50%) who had open hemorrhoidectomy, and 6 patients (46.2%) after Longo surgery. Thus, when evaluating the immediate results of the treatment of anal prolapse, surgery using linear stapler has several advantages. The advantage is expressed in the relative simplicity of the technique, and from the absence of a long-term relapse. hemorrhoidectomy
Keywords
anal prolapse, linear stapler, Longo operation, anal mucosa
Hepatocellular carcinoma is the most common primary tumor pathology of the liver (> 85%), an aggressive course with an unfavorable prognosis.
Objective: To analyze the results of transarterial chemoembolization in the intermedi-ate stage of hepatocellular carcinoma.
Materials and methods: The study was conducted on the basis of the JSC “National Scientific Center of Surgery” named after A. N. Syzganov in the period 2013-2018. Statistical calculations were performed using Excel, SPSS Statistics by estimating the survival rate using the Kaplan-Meier method.
Results: The study included 58 patients with HCC in the B stage of BCLC. The average age of the patients was 60.4 years. The follow-up period was 6–64 months. In 42 patients, the test results for viral hepatitis were positive. 58 patients under-went 103 TACE interventions. After chemoembolization, 8 patients subsequently underwent surgery (liver resection). The one-year survival after TACE in the total cohort was 42%, 2-year - 15% and 3-year - 5%, respectively. In patients older than 60 and 70 years, the 3-year and 5-year survival rates were 0%, the one-year survival rate of the subjects studied in the group over 70 years old was 14.3%. The survival rate among patients in stage B on the Chile-Pugh scale was significantly lower to patients in stage A (82% versus 56% for 6 months and 50% versus 31% for the year, respec-tively). Statistically significant differences were found in the group with a substantial increase in AFP (> 1000 IU / ml), the Kaplan-Meier survival curve showed a survival rate of 0% after 18 months since the first TACE. Six months after TACE contrast enhanced CT was performed on 36 patients, of which 15 patients showed positive dynamics, in the form of a reduction in size or transformation of the formation, in 6 patients a negative dynamics in the form of an increase in the size of the formation.
Conclusion: Despite the small number of patients studied, TACE showed good results in the intermediate stage of HCC. Elderly and senile age, a high degree of liver dysfunction, as well as high AFP values are additional factors that dramatically reduce the life expectancy of patients after TACE with HCC in stage B-BCLC.
Kidney transplantation is the most effective and preferable treatment option of terminal stage of chronic kidney disease. Nowadays kidney transplantation is well-developed modality and early graft and patient survival rates overall the world greatly increased. But improvement of graft and patient survival rates in long-term period remains to be problem. Beside the immunologic factors that causes either acute or chronic graft rejection, there are another etiologic factors of graft rejection. Infections, particularly wide-spread in solid organ recipients - cytomegalovirus infection (CMV), appears to be one of this etiologic factors. Mechanism of injury of graft by cytomegalovirus remains to be unclear. Diagnostics of CMV is also a difficult. objective. In our institution we conducted an investigation aimed the detection of CMV by graft biopsy in patients with graft dysfunction. The main objective of this investigation is the demonstration of efficacy of biopsy in diag-nostics of CMV infection in graft dysfunction.
Mitral valve disease, including dysfunction of the mitral valve, is often accompanied by atrial fibrillation. Among the patients with prosthetic mitral valves, atrial fibrillation occurs in 30-50% cases. Development of atrial arrhythmias and incisional tachycardia in the early and late postoperative periods can significantly influence patients rehabilitation and prognosis. Our clinical case describes a patient with a mechanical mitral valve and incisional tachycardia, which led to progression of heart failure and reduced left ventricular systolic function. The patient underwent a catheter ablation with non-invasive myocardium mapping. The case reveals the potentials of treatment of incisional tachycardia and atrial fibrillation, which do not respond to drug therapy. Modern methods of visualization enable the cardiac surgeons to reduce possible intraop-erative risks and development of complications in this group of patients.
