Hepaticojejunostomy stricture is the disastrous complication of biliary surgery, if untreated can lead to intrahepatic stones, recurrent cholangitis, biliary cirrhosis and hepatic failure. Here, we report a case with the one-more year history of recurrent cholangitis, caused by late stricture of hepaticojejunal anastomosis after iatrogenic bile duct injury.
Case: 46-year old female patient underwent Roux-en Y hepaticojejunostomy (RYHJ) with transhepatic drain following iatrogenic bile duct injury during open cholecystectomy in rural hospital. After 11 year she represent re-stricture of hepatico-jejunal anastomosis with acute recurrent cholangitis attacks and intrahepatic lithiasis. Before admitting to our center it was tried to cross the stricture radiologically with the percutaneous transhepatic dilatation. As the multiple attempt of interventional radiology failed revision surgery required. Despite technical challenge we successfully managed the patient with the revision surgery by performing hepatic resection and creating double–barrel Roux-en Y hepaticojejunostomy with transhepatic transanastomotic stent placement.
Conclusion. Hepatico-jejunal anastomotic stricture is one of the challenging and serious complication of biliary surgery resulting multiple hospital readmissions and procedure. Recently, in many referral centers treatment of the re-strictures of hepatico-jejunal anastomosis can be achieved by nonsurgical methods such as stenting with endoscopic retrograde cholangiopancreatography and percutaneous transhepatic balloon dilatation. In cases of failure these methods, surgical treatment is considered. Nowadays in the surgical management of bilio-enteric anastomotic strictures the trend is not to drain anymore still in a number of situations this procedure cannot be avoided. In our case, double-barell hepaticojejunostomy on a transhepatic transanastomotic drain was the best choice of treatment.
Objective. To improve the results of endovideosurgical treatment of patients with acute destructive pancreatitis.
Material and methods. The research was carried out at the bases of the Nur-Sultan Multifunctional City Hospital №2 and the Nur-Sultan Multifunctional City Hospital №1. Statistical analysis of the results was carried out using the methods of variation statistics with the calculation of M ± SD. Differences between comparison groups were analyzed using the Wilcoxon-Man-Whitney test and were considered statistically significant at p≤ 0.05. From 2017-2021, 64 patients with acute destructive pancreatitis were treated according to the developed and implemented treatment algorithm:Of these: AP without organ failure and local or systemic complications -10 people. AP of moderate and severe form -54 people. Lethal outcomes-1; The average length of stay in the hospital is 20.8±1.2 days; The mean age was 43 ± 1.3 years. The control group - treatment of patients with moderate and severe acute biliary pancreatitis without the use of ulinostatin (hereinafter US) was n = 122;Lethal outcomes-8. An algorithm for the use of US was developed and implemented depending on the severity of the course of destructive pancreatitis in the complex treatment of patients with AP.
Results. 10 patients were treated conservatively. 54 - surgical treatment was combined with the appointment of US according to the developed scheme. Endoscopic surgery was performed in 51 patients; 3 patients were operated on by laparotomy. The average duration of hospital stay in the main group was 3.5±0.34 days less than in the control group.
Conclusion. The research results showed the high efficiency of the developed algorithm for endovideosurgical treatment of AP in combination with the use of the US. Received AC №14704 dated January 27, 2021 (www.kazpatent.kz).
Material and methods. The study is based on the results of diagnosis and treatment of 444 children with congenital obstructive diseases of the urinary tract. They were in the urology department of NRCMCH since August 2007. To differentiate organic and functional obstructive uropathy were conducted high-tech, informative and noninvasive imaging diagnostic methods. On the basis of which were provided a differentiated treatment.
Results. Children with functional hydronephrosis and vesico-dependent version of urodynamic disorders in obstructive megauretera received conservative treatment. In ureteral type of the functional form of obstructive megauretera and 2-3 stage of vesicoureteral reflux were provided mini invasive endoscopic treatment. Effectiveness of endoscopic treatment of obstructive megauretera was - 85%, while the vesicoureteral reflux of 2nd stage - 100%, grade 3 - 80%. The use of mini lumbotomy front-side access for hydronephrosis, allowed towork locally in the area of ureteropelvic segment, to avoid injury of the kidneys and paranephritis.
Conclusion. Thus, the use of an integrated approach to diagnosis using minimally invasive, highly informative methods made it possible to pathogenetically substantiate the choice of tactics for the treatment of obstructive uropathy in children and significantly improve the results of this complex category of patients.
In childhood, closing the pupil with the upper eyelid leads to the development of amblyopia in 20-70%. The main methods of surgical treatment of blepharoptosis in the absence of the function of the muscle that lifts the upper eyelid are suspension operations.
Material and methods. A 2-year-old child presented with congenital ptosis of the right upper eyelid. Palpebral fissure versus right narrowed by 0.5 cm. Excursion of the left upper eyelid 0.9 cm, right 0.3 cm. After the written consent of the parents, the child underwent an operation to eliminate ptosis of the right upper eyelid by implantation parts of the superficial flexor of the hand.
Results. The variety of suspension operations for blepharoptosis is associated not only with the many options for conducting a suspension suture (single and double diamond-shaped, triangular, U-shaped, etc.), but also with the materials used - biological and synthetic.
Conclusion. According to our research, synthetic materials allow you to get a more stable good result, but we used a tendon.
Keywords
congenital pathology, ptosis of the eyelids, tendon
Hypertrophic cardiomyopathy is a common hereditary heart disease with a heterogeneous clinical picture and a natural history. Recent advances in diagnosis and treatment methods have played an important role in reducing the incidence of adverse clinical events; however, the complete elimination of sudden cardiac death is still an unattainable achievement. Despite the heterogeneous clinical profile and complex pathophysiology, effective treatment strategies are available, including implantable defibrillators to prevent sudden death, medical and surgical myectomy (or, alternatively, alcohol ablation of the septum) to alleviate outflow obstruction and symptoms of heart failure, as well as pharmacological strategies (and possibly radiofrequency ablation) to control atrial fibrillation and prevent embolic stroke. Now, after more than 50 years, hypertrophic cardiomyopathy has been transformed from a rare and largely untreatable disorder to a common genetic disease with management strategies that permit realistic aspirations for restored quality of life and advanced longevity. This article discusses some aspects of this condition: epidemiology, clinic, diagnosis and surgery technique.
Objective. Evaluate the effectiveness of surgical treatment of patients with hypertrophic cardiomyopathy.
Material and methods. This literature review was carried out in accordance with the PRISM statement. The databases searched in this review included Pubmed, Web of Science, Scopus, and Cochrane for systematic reviews.
Conclusion. The diagnosis of HCMP is based mainly on echocardiographic variables including the dynamic parameters of LV, LVOT the distribution of increased muscle thickness, the mechanism and severity of MR as well as the degree of diastolic dysfunction.
Objective. An analysis of the study, in the mode of fast and slow blood exfusion, controlled clinical trials showed that the number of platelets was significantly reduced.
Material and methods. We have conducted a series of researches in 44 patients with cavitary blood loss, which is 34.3% of the total number of the examined patients (n-128), for whom an IOBR apparatus technology was used. The studies were also conducted during the surgery in the first 2 hours.
Results. Controlled clinical trials (CCT) have shown that blood exfusion after intraoperative blood reinfusion, the degree of destruction of erythrocytes and leukocytes with slow blood exfusion is 35%, and with fast - 48%. Osmotic resistance is reduced by 3 times. With rapid hardware exfusion, blood hemolysis is more than 28%, which should be taken into account when performing hardware intraoperative blood reinfusion. Controlled clinical trials have shown that the faster the machine exfusion is performed, the greater the decrease in protein and bilirubin content. In the blood collected in the mode of rapid apparatus exfusion, a higher concentration of K +, residual N and urea is noted. Controlled clinical trials have shown that platelet counts are significantly reduced, especially when using a rapid blood collection regimen. Against this background, the process of aggregation is reliably slowed down, and with a fast mode of blood collection - 2 times in comparison with the control. Plasma recalcification time is reliably reduced by 40% when using a high-speed blood collection mode in comparison with the control values, which is almost 3 times higher than when using slow blood aspiration.
Conclusion. The article provides an analysis of scientific research, CCT, experimental control, clinical control and practical work. The work is interdisciplinary in nature, written at the intersection of surgery and anesthesiology, to increase the effectiveness of emergency surgery and anesthesiology-resuscitation in critical abdominal and luminal blood loss based on the optimization of intraoperative infusion-transfusion therapy.
Treatment of complicated forms of purulent wounds is an actual problem of modern medicine. A serious problem of the preoperative period is purulent complications that develop in 15-35% of cases, mortality reaches 25-60%. It is known that the predominant pathological syndrome in complicated forms of purulent sepsis is the syndrome of endogenous intoxication (SEI).
Objective. In this regard, the desire of many researchers to study new methods of intensive care for the syndrome of endogenous intoxication is understandable [1,2,3,4,5,5,6,7,8]. The authors analyzed the effectiveness of the use of mediators (surfactant) of fetal hepatocytes in the complex treatment of purulent-septic wounds.
Material and methods. A prospective study method was carried out for the main group, which consisted of patients with purulent-septic wounds (PSW) - 50 people, in the complex treatment of which cellular mediators (CM) were used; control group - 50 patients with PSW treated according to the traditional scheme.
Results. The results of treatment with cellular mediators were evaluated in 50 patients who received this drug at a dose of 0.15 ml/kg. The control group consisted of 50 patients who received saline at a dose of 0.15 ml/kg as a placebo. Men 27, women 23. The study was conducted in accordance with the Clinical Protocol for Surgical and Diagnostic Intervention of Transplantation of Fetal Cell Mediators Recommended by the Expert Council of the RSE on REM «Republican Center for Health Development» of the Ministry of Health and Social Development of the Republic of Kazakhstan dated September 30, 2015 (Protocol №. 10).
Conclusion. The results of the study have been implemented in the practice of the PKP on the REM of the Nur-Sultan MCH №2 and the Nur-Sultan MCH №1 ; highlighted in the work of the poster session of the VII Congress of Surgeons of Kazakhstan with international participation in Almaty from 30.09.-01.10.2021. Received AC No. 18079 of the Republic of Kazakhstan dated May 27, 2021 (www. kazpatent.kz)
Coronary arteriovenous fistula (CAF) is a rare form of congenital heart disease. However, it is the most common type of congenital anomaly of the coronary arteries. [1] When there is the connection between the coronary artery and the chambers of the heart, it is called a coronary chamber fistula. The fistula may also be between a coronary artery and another adjacent vessel from the pulmonary or systemic circulation. An open fistula provides low-resistance flow by directing blood from an artery into a vein, heart chamber, or other low-pressure vessel such as the pulmonary artery. Patients with CAF may develop symptoms at birth or later in life, depending on the type of fistula and the presence of collateral circulation. Studies have reported an association between ventricular arrhythmias and sudden cardiac death syndromes in young adults and athletes with certain types of coronary anomalies, such as anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) [2-5]. The most common symptom is a myocardial ischemia. The purpose of this article is to present a clinical case of endovascular treatment of coronary pulmonary fistula. As a result of a modern diagnostic methods, such as CT angiography with three-dimensional reconstruction, it is not difficult to assess the degree and nature of the pathology. Having assessed the tactics, modern doctors are able to cope with coronary arteriovenous fistulas with great success using minimally invasive X-ray endovascular technologies.
Hepatocellular carcinoma (HCC) is a malignant tumor of the liver which accounts for up to 90% of all liver cancers. In recent years, there has been an increase in the incidence of HCC all over the world, including in Kazakhstan. Diagnostic issues are still important. Alpha-fetoprotein (AFP) is a specific marker most widely used in the diagnosis of HCC. The article describes of the features of the AFP expression level in immunohistochemical studies with different stages and gradation of hepatocellular carcinoma, as well as a correlation analysis with serum AFP.
Material and methods. A total of 50 patients with HCC were analyzed. Blood serum tests were performed to determine the level of AFP and an IHC study to assess the expression of AFP.
Results. When analyzing the serological AFP, it was found that in the vast majority of cases (n=33), values were between 10-20 units/ml. In 83% cases HCC, cytoplasmic and nuclear expression of AFP was determined in malignant cells in IHC. The expression of the AFP was high in 32% cases, moderate in 46% cases, and low or not detected in 22% cases. The area of AFP - immunopositive cells node averaged 37.25±15.47%. When conducting a correlation analysis, it was found that the overall Pearson correlation coefficient between serum AFP and the degree of AFP staining was r = +0.0089.
Conclusion. Critically high AFP values correlate with the degree of HCC differentiation. The results of IHC showed that in 83% of patients with HCC, cytoplasmic and nuclear expression of AFP, which indicates a high sensitivity of the marker regarding the definition of malignancy. Given the absence of a correlation, it can be assumed that the serum AFP value cannot be associated with AFP expression data in immunohistochemistry and can be used as a separate value for HCC differentiation.
The article reflects the role of non-steroidal anti-inflammatory drugs in postoperative period. The study was conducted on the data of 94 operations of children aged from 10 months to 15 years (mean age 4.4 years). All patients of our center with esophagocoloplasty in the postoperative period received the drug «Intrafen» in injectable form, intravenously. Name of manufacturer of drug: GEN ILAC VE SAGLIK URUNLERI SANAYI VE TICARET, A. S. (Turkey). The main active substance of this drug is Ibuprofen 400mg/4ml for intravenous injection. Patients were injected intravenous ibuprofen at therapeutically effective doses for a minimal period of time. After receiving positive reactions to the drug at the initial stage of treatment, the dose and frequency of taking the drug was adjusted individually for each patient.
Objective. This work is dedicated to evaluate the role of the intravenous Ibuprofen in the postoperative period in surgical practice.
Material and methods. The study included 94 pediatric patients with esophagocoloplasty. Age of patients: from 10 months to 15 years (mean age 4.4 years), of which: 90 (96%) patients had post-burn stricture of the esophagus; 3 (3%) patients with esophageal atresia; 1 (1%) patient with a short esophagus. The number of female children - 51 (54.3%) patients, male - 43 (45.7%) patients.
Results. The total number of patients receiving intravenous Ibuprofen in the postoperative period was 94. The optimal dose showed a good therapeutic effect. At the optimal dosage of 20 mg/kg/day, two patients experienced intra-abdominal bleeding. Follow-up time: 2 weeks after esophagocoloplasty.
Conclusion. In patients with esophagocoloplasty, preventive intravenous administration of Ibuprofen showed a good therapeutic result. Patients noted a decrease in pain, which in turn led to a decrease in the need for emergency analgesia.
