Objective. Assessment of long-term results of surgical treatment of closed ruptures of the extensor tendons of the hand according to the method used in the clinic of JSC National Scientific Center for Surgery named after A. N. Syzganov (Innovation patent RK №19373).
Material and methods. From 2020 to 2022, 149 patients were operated on the basis of the “A. N. Syzganov National Scientific Center of Surgery” JSC. The age of patients ranged from 17 to 68 (mean age 36±12) years, men were 84 (57%), women – 65 (43%), 115 patients had fresh damage, 34 patients had long–standing damage to the extensor tendons of the hand in the I-zone. 87 people had an injury on the right hand, 62 on the left.
Results. According to the criterion of distal phalanx extension deficiency (V. I. Rozov), only 13 (46.5%) patients had excellent results: complete flexion – 25 distal phalanx extension. In 15 (53.5%) cases, there were poor results: a deficit of distal phalanx extension from 7 to 32°. According to the results of the DASH questionnaire, the situation is somewhat better: 21.3 ± 5%.
Conclusion. In this article, it is possible to use the improved Cuneo tendon suture. In 149 patients with tendon injuries with reflectors, we received the award of the proposed suture. The use of a modified tendon suture makes it possible to increase the surface slip in the observation zone, which opens the exit of the tendon through the bone-fibrous canal and the significant trauma of the surgical operation and the duration of the operation.
Varicocele is a pathology characterized by dilation of the venous veins of the seminal canal. Currently, the incidence of varicocele among adolescent men aged 12-20 years is 10-20%, and among men suffering from infertility, it is detected in 45%. In clinical practice, there are several methods of treating varicocele: open or microsurgical laparotomy, surgical embolization and laparoscopic varicocelectomy. However, the frequency of relapses of varicocele varies and depends on the method of its treatment. Embolization performed using venography helps to accurately determine the condition of the vessels of the testicles. Therefore, in our article we will describe the advantages and possibilities of modern minimally invasive treatment of varicocele embolization, possible complications and results.
Increasement in the diameter of the thoracic aorta ≥ 50% of the norm of 40 mm in men and 34 mm in women (99 percentile) is considered to be an aneurysmal expansion. The risk of rupture is proportional to the size of the aneurysm and is associated with the development of fatal complications. Diagnosis is usually verified by computed tomographic angiography (CTA), magnetic resonance angiography (MRA), or transesophageal echocardiogram. Treatment consists of endovascular stent graft placement or open surgery in combination with optimal medical therapy. The article presents the experience of treating a patient with a dissecting aneurysm of the thoracic aorta type IIIB according to DeBakey using a stent graft modified by a doctor “on table” by forming a fenestration modeled after the anatomy of the left subclavian artery orifice. The aim of the work was to evaluate the short-term and medium-term results and prognosis of treatment using the technique of endovascular prosthesis with a modified graft. Such modifications on the table or in situ make it possible to model the prosthesis according to the variant of the anatomy of a particular patient, which allows optimizing the apposition of the prosthesis, eliminating additional stages of complex surgical treatment, reducing the undesirable effects of standard approaches, including preliminary endovascular occlusion of the left subclavian artery and/or the formation of a carotid-subclavian shunt, reduce the time of stationary observation. The use of the described technique will reduce the radicalness of surgical treatment of patients with dissecting aneurysms and increase economic efficiency. This technique is a promising direction in the development of endovascular and surgery and requires further study to assess long-term results and prognosis in a large number of patients. Thoracic aortic aneurysm (TAA) is an abnormal enlargement of the aorta above the diaphragm. TAA account for 1/4 of all aortic aneurysms, occurring in 40 people per 100,000 population. Men and women get sick equally.
Keywords
thoracic aorta, aneurysm, TEVAR, Stent-graft, endovascular surgery
Tetralogy of Fallot (TоF) is a congenital heart disease that includes ventricular septal defect (VSD), right ventricular outflow tract obstruction, aortic root dextraposition, and right ventricular hypertrophy. TоF occurs in 3 out of 10,000 live births and accounts for 7–10% of all congenital heart defects. The etiology of TоF is multifactorial and may include untreated maternal diabetes, phenylketonuria, and retinoic acid intake. Associated chromosomal abnormalities include trisomies 21, 18, and 13, but recent studies indicate a much higher association with microdeletion of chromosome 22. The familial risk of TоF is 3%. The article presents the results of scientific publications about ToF. In particular, modern and topical issues of genetic predisposition, morphology, diagnosis, indications for surgical treatment, including radical and staged, are considered. Фалло тетрадасы: ағымдағы деректер. Әдебиет шолуы
Keywords
tetralogy of Fallot, morphology, diagnostic, correction
Objective. Identify the frequency of occurrence of various morphological types and different degrees of severity of anemia in patients with autoimmune thyroiditis.
Material and methods. Were analyzed 97 case histories of patients operated for autoimmune thyroiditis (AIT)in 2012. When assessing hematological parameters, two groups were identified: group 1 – patients with AIT with mild anemia (n = 72), age 45.7 ± 1.6, men - 5 (6.9%), women - 67 (93, 1%); group 2 - patients with AIT with moderate anemia (n = 25), age 40.0 ± 2.3, men - 1 (4%), women - 24 (96%). In the clinical analysis of blood, hemoglobin, hematocrit, the number of erythrocytes and erythrocyte indexes of MCV, MCH, MCHC were determined.
Results. By morphological type in patients with AIT with mild anemia, the hypochromic type was observed in 56 (77.8%) patients, normochromic - in 16 (22.2%) patients. In moderate anemia, this tendency was more pronouned: hypochromic type of anemia was detected in 23 (92%) patients, normochromic type - in 1(4%) and hyperchromic in 1(4%). Thus, in patients with AIT, mild anemia was more often determined (in 72.4%), then moderate anemia (in 25.7%). With moderate severity of anemia, microcytic (84%) and hypochromic (92%) types of anemia were more often observed. With mild anemia, the same types of anemias were observed, but with a lower frequency (76.4% and 77.8%, respectively).
Conclusion. The hemogram in patients with AIT was characterized by a more frequent development of mild anemia (72.4%). With mild anemia, hematological disorders were characterized by microcytic (76.4%) and hypochromic (77.8%) types of anemia. Similar, but more pronounced disorders were observed in moderate anemia: microcytic 84% and hypochromic 92%, which is characteristic for iron deficiency anemia.
Keywords
autoimmune thyroiditis, anemia, severity of anemia
Fibrinogen is an important protein of hemostasis. In blood plasma, its concentration is the highest of all coagulation proteins - clotting factors. When coagulation cascade activated, thrombin splits fibrinogen and triggers fibrin polymerization to the form required for efficient clot formation. In acute blood loss, dilutional coagulopathy may develop, causing decreasing fibrinogen levels, which is critical for clot formation. Recently, there has been emerged and rapidly increased the interest in fibrinogen replacement during acute bleeding as a point of the bleeding treatment and prevention, especially in the perioperative patients. This study reviews current data on relevant plasma fibrinogen levels and dosing in various clinical settings, as well as clinical experience with the use of fibrinogen concentrate in patients with dilutional coagulopathy and disseminated Intravascular coagulation syndrome is described.
Most of the classification of pancreatic epithelial tumors in the 5th edition remains unchanged from the previous edition. In the new classification, precancerous lesions are classified according to two levels of dysplasia. Intraductal papillary tumors and intraductal papillary tumors associated with invasive carcinoma are separated from the other subtypes. Some changes have occurred in the TNM classification. IntroductionSince the release of the 4th edition of the WHO classification of digestive tumors in 2010, there have been important developments in the understanding of their etiology and pathogenesis, taking into account their molecular phenotype and histological characteristics. In April 2019, the International Agency for Research on Cancer (IARC) working group on digestive system tumors met in Lyon. As a result, the classification of tumors was revised and published in 2019 as part of the WHO Classification of Tumors series, 5th edition [1]. Most of the classification of pancreatic neoplasms
Objective. To assess the process model of development of the triad of health sub systems: clinical and inpatient care (K-SP), «outpatient care (A-PP), medical and social assistance» (M-SP). The results of the assess ment of the process model for the development of such health sub systems as» clinical and inpatient care», «outpatient and polyclinic care», «medical and social assistance» are presented. «A-PP» takes asignificant part of the load of «K-SP» on itself, inc on necti on with which, for the development of stationary replacement technologies, it is necessary to seek a redistribution of funding from «K-SP» to «A-PP».
Keywords
clinical and inpatientcare, outpatient and polyclinic care, medical and social assistance, quality of medical care
