Immunosuppressive therapy with the use of tacrolimus is one of the main ones in kidney transplantation. The survival and maintenance of satisfactory graft function in a technically perfect operation depends in most cases on immunological factors. At the same time, there is a question of a personal approach to im-munosuppressive therapy of kidney recipients in patients of the Kazakh population before and after surgery. The genetic polymorphism of CYP3A5 is an important link affecting the concentration of tacrolimus and potentially able to predict the optimal dosage of tacrolimus in kidney recipients in the Kazakh population We examined 80 kidney recipients for the presence of CYP3A5 genetic polymorphism. All the pa-tients studied were selected from the ethnic population. Out of the total number of recipients: 37-men and 43-women. The median age was 37±8 years. All the studied patients underwent a related kidney transplant. The induction was performed using basilixamab or anti-thymocytic globulin (ATG). Immunesupressive regi-men was Tacrolimus + Mycophenolic acid + corticosteroids. Postoperatively tacrolimus concentration was taken at 2, 5, 7, 10 and 14th day after the surgery.
Purpose of the study. To justify and confirm the differentiated approach to choosing the volume of surgical inter-vention in benign nodular goiter..
Materials and methods. A prospective analysis of 180 patients who underwent thyroid surgery was performed; 11 (6.1%) were men and 169 (93.9%) were women aged 20-65 years. The duration of the patients’ disease was 8 months to 12 years. All patients with benign non-toxic goiter underwent a thorough evaluation of changes in the level of thyroid hormones in serum, ultrasound of the thyroid gland, and aspiration biopsy of the thyroid gland..
Results. In laboratory studies, a high level of malignancy is observed in patients with higher levels of TSH and antibodies, TG and antibodies, TPO. There were no significant differences in the values of T3 and T4. In the ultrasound study, the average and maximum diameter of malignant nodes were significantly smaller than that of benign ones (1.99 ± 1.88 cm; p < 0.001). The difference between surgical procedures described as subtotal, total, and hemi-thyroidectomy was statistically significant. In 128 (71.1%) patients nodes were located in one lobe, 68 (37.8%) patients had multiple nodes, and 52 (28.9%) had solitary nodes in one of the thyroid lobes. In-traoperatively, 68 (37.7%) patients underwent cytomorphological examination of removed thyroid tissue. Hemithyroidectomy was performed in only 57 (31.6%) patients. Subtotal thyroidectomy was performed in 78 (43.3%) patients, and total thyroidectomy was performed in 45 (25%) pa-tients. With the development of hematoma, one patient was re-operated after total thyroidectomy. Hypoparathyroidism was diagnosed in 2 (4.4%) patients after thyroidectomy, and in 1 (1.3%) patient after subtotal thyroidectomy. 3 patients had transient laryngeal paresis after thyroidectomy. Hypothyroidism developed in 14 (24.6%) patients after hemithyroidectomy, in 50 (64.1%) patients after subtotal thyroidectomy and in 45 (100%) after thyroidectomy..
Conclusion. The decision of surgical intervention should be differentiated with respect to the choice of surgical intervention tactics.
Relevance:Lung cancer still leads in morbidity and mortality among other cancers. In 2018, 2.094 million new lung cancer cases and 1.8 million deaths from lung cancer were registered globally. The study aimed to evaluate the effectiveness of surgical treatment for lung cancer depending on the extent of surgery. Material and
Methods: The article provides a retrospective analysis of 137 patients operated for lung cancer at Almaty Oncology Center in 2014-2018. The database was created in Microsoft Excel. IBM SPSS Statistics, package 19 (trial version) mathematical data processing software was used for statistical processing. The survival rate was measured from the commencement of treatment till the patient’s death for any reason or to the last observation date. The cut-off date was January 1, 2019.
Results: Most of the patients (91/137, 69.3%) had a locally advanced Stage IIb-IIIb process. Localized forms of the disease were diagnosed in 21.1% of cases. R0 resection was achieved in 83.9%, R1 – 13.1%, R2 – 2.9% of patients. The post-surgery mortality amounted to5.8%. One-year survival amounted to 70% SE4 for lobectomy, 87% SE9 for segmental resections, 79% SE8 for bronchoplastic, lobar resections, and 67% SE10 for pneumonectomy. The difference in median survival was statistically significant: χ2 = 9.7, р = 0.045.
Conclusion: We consider the extent of surgery a risk factor. The organ ectomies should be minimized since our data and the literature report high one-year mortality and low 5-year survival after such surgeries.
Keywords
lung cancer, lung cancer surgery, lobectomy, pneumonectomy, sleeve lobectomy, segmentectomy
From 2015 to 2019 32 patients (14 men, 18 women), aged 15-65 years, underwent surgical treatment for old Achilles tendon rupture. In all cases correct diagnosis was made not earlier than 1 month after injury and sonographic examination for diagnosis of Achilles tendon rupture is underlined. For the restoration of Achilles tendon V-Y plasty was used. Surgery was performed in a period of 1 to 13 months in patients with subcutaneous Achilles tendon ruptures. Follow-up results of patients in the postoperative period ranged from 6 months to 10 years (mean follow-up 1 year 7 months). Date of observation in the postoperative pe-riod ranged from 6 months to 19 years. Marginal necrosis wound occurred in 3 (10%) patients, re-rupture of the Achilles tendon to tendon suture zone - in one patient, even in one patient on day 14 became infected. Violations of the foot innervation were no detected.
Keywords
rupture of the Achilles tendon, ultrasound examination
The analysis of the results of a comprehensive clinical and instrumental examination of 104 women who were treated in the day hospital of the Department of Gynecology in JSC “National Scientific Center of Surgery of A. N. Syzganov” in the period from September 2019 to December 2020 was carried out. In order to evaluate the effectiveness of the tech-nology of bipolar “mini” resectoscopy in intrauterine pathology in women with various forms of infertility, 104 patients were examined, which were divided into two groups: Group 1 – patients with primary infertility (41);Group 2 – patients with secondary infertility (63). The study included women aged 21 to 45 years, the average age of patients was 31.5 years. The main complaint of all patients was the absence of pregnancy with regular sexual activity for 1-10 years. Menstrual disorders were observed in 61 women, which was 59%. The analysis of clinical and anamnestic data of 104 women showed the presence of pri-mary infertility in 40.0% of patients, and secondary infertility in 59%. In women with primary and secondary infertility after mini-hystero resectoscopy (GDS), the lowest percentage of intrauterine pathology was endometrial hyperplasia (0.9%) and frequent or complete intrauterine septa (0.9%). Submycous uterine fibroids were diagnosed in 3.2% of patients, and in 12% of cases there were intrauterine synechiae. The largest number of patients encountered patholo-gies - chronic endometritis (45%), endometrial polyp (38%). Thus, in the study groups, we determined and established the frequency of intrauterine pathology in women with various forms of infertility after mini-GDS. All surgical manipula-tions of bipolar mini-hysteroscopy with resection were performed without anesthesia in 43.2% of cases and under local anesthesia in 56.8%.
Keywords
mini hystero resectoscopy, intra-uterine pathology
Damage to the tracheobronchial tree often occurs due to severe bruising or crushing of the chest. We describe a case of surgical treatment of a rare and complex surgical pathology-post-traumatic scar stenosis of the right main bronchus. This article presents the course of the patient’s treatment and diagnosis, de-scribes the stages of the operation and gives recommendations to surgeons.
Today, in the age of modern technologies, despite advances in reproductology and improvements in methods of assisted reproductive technologies( ART), the frequency of infertile marriage has not only not stabilized, but also increases from year to year, reaching 25-30% in the population. Tubal-peritoneal infertility is one of the lead-ing places in the frequency of occurrence of various factors leading to the absence of pregnancy. The female factor in infertile marriage is 40%, the share of the male factor is determined in 40% of cases, and in other cases of infertility there is a combined factor, both female and male. In this regard, the search for new methods and their improvement, as well as reducing the cost of infertility treatment, seem very relevant. Inflammatory lesions of the fallopian tubes are the leading cause of infertility. As a result of the chronic inflam-matory process that occurs with the defeat of the fallopian tubes, the risk of developing tubal-peritoneal infertility is high. Every fifth woman with a history of chronic inflammation of the appendages suffers from infertility, while 70% of them have a fourth degree of adhesion in the pelvis, in which the damage to the fallopian tubes is irrevers-ible even with the help of surgical treatment.
Keywords
infertility, tubal-peritoneal factor, proxy obstruction of the fallopian tubes, selective hysterosalpin-gography, transcatheter recanali-zation of the fallopian tubes
Modern medicine has made a great stride forward, but despite all the achievements, the problem of finding reliable criteria, concepts, definitions of sepsis remains relevant. Sepsis is potentially fatal in nature. The pronounced biological and clinical heterogeneity of patients with sepsis: age, premorbid background, drugs taken, different sources of infection create a high variability in the onset and course of the pathologi-cal process. New definitions of sepsis have refocused the focus on rethinking the clinical manifestations of this syndrome and have emphasized the importance of organ dysfunction as a key diagnostic feature. An unexplained organ failure in a patient should alert the physician to the possibility of sepsis. And the final result will depend on how quickly we can respond to changes, rationally and targeted therapy. The reasons for the dysregulation of the body’s response and delayed return to homeostasis in patients with sepsis are poorly understood. Growing interest is focused on a subpopulation of leukocytes called myeloid suppressor cells (MDSC). MDSC are involved in the regulation of the immune response in many pathological situations, the most studied of which is cancer. A number of comprehensive reviews have discussed MDSC in the context of cancer, autoimmunity, and infectious diseases. Interestingly, recent evi-dence suggests that MDSC are involved in the immune dysfunctions seen in sepsis. T regulatory cells
The aim of the study is to determine the significance of the use of mineral spring waters in the sanato-rium-resort therapy of type 2 diabetes mellitus. The article discusses the main indicators of the prevalence of diabetes in the world and in Kazakhstan. It has been shown that the problem of diabetes mellitus is one of the most pressing world problems of modern medicine. The scientific novelty of the work lies in the ap-proach to the study of macro- and microelements in the composition of mineral waters, their effect on the composition of blood, as well as their ability to control the state of the body through various mechanisms of action. The article focuses on the process of activation of various systems and mechanisms of the body when using mineral waters. complex treatment
Keywords
type 2 diabetes mellitus, preva-lence of diabetes, mineral water
