Acute obstructive cholecystitis is a common disease with a significant risk of mortality and complications. Active surgical tactics, such as open and laparoscopic access, pose a significant risk for elderly patients with concomitant diseases on the background of acute cholecystitis. The aim of our study is to analyze the effectiveness of percutaneous transhepatic cholecystostomy (PTCS) in acute obstructive cholecystitis (AOC) and subsequent laparoscopic cholecystectomy (LCE)..
Materials and methods. Retrospectively, we analyzed 64 patients treated with AOC in the period from 2017 to 2021 at the NSCS named after A. N. Syzganov. We divided them into 2 groups depending on surgical treatment. The first group: patients who were performed PTCS (n=29) at the first stage. The second stage, LCE was performed during the waiting period from 3 days to 72 days. The second group: patients who underwent LCE without drainage of the gallbladder (n=35). Also, the patients of the first group were divided into 3 subgroups depending on the waiting time: group A - LCE was performed within 10 days after PTCS, subgroup B - LCE was performed after from 2 to 4 weeks (n=12), patients of the subgroup C, LCE were performed after 4 weeks after PTCS. Preoperative, intraoperative data and postoperative complications were analyzed..
Results. According to preoperative data, there was no significant difference in body temperature, laboratory data and concomitant diseases. The statistical difference was revealed only in the age of patients (65.3±9.0 vs 53.4±15.4). The duration of the operation in the second group of LCE was longer compared to the first group, but no significant difference was detected (108.1 ± 30.5 vs 117.9 ± 39.9). In the postoperative period after LCE, complications were observed in 5 (14.2%) cases: bleeding in 4 (11.4%) cases and suppuration of the postoperative wound in 1 (2.8%) case. Conversion was performed in 10 (15.6%) cases, and in one (1.5%) case, the choledochal wall was injured intraoperatively. There was no significant difference between groups A, B and C..
Conclusion. The use of two-stage treatment significantly reduces the conversion to open surgery, significantly reduces postoperative complications and hospital stay in the postoperative period. According to the results of our research, the most optimal interval between PTCS and LCE is a period of more than 4 weeks.
Tetralogy of Fallot (TOF) combined with major aortopulmonary collateral arteries (MAPCA) is a severe congenital heart defect due to the combination of a triad of cardiac malformation withan additional vascular anomaly of the small circulatory system. To date, there is no single accepted standard in which sequence and according to which criteria radical surgical correction of combined anomalies is indicated. This paper describes a clinical case of simultaneous opentreatment of TOF and endovascular occlusion of the MAPCA in an 8-month old child. Based on the evidence base of a large study, our patient belonged to the group where after TOF correction the therapeutic way of MAPCA treatment was used at first, which was ineffective in 38% and led to surgical methods of MAPCA occlusion. Choosing the way of simultaneous simultaneous surgical treatment of two pathologies allowed us to minimize postoperative risks and achieve good clinical results.
Keywords
Tetralogy of Fallot, major aortopul monary collateral arteries, clinical case, congenital heart disease
In this article, the study of the diagnostic effectiveness of ultrasound examination (ultrasound) in identifying signs of damage to the abdominal organs and a detailed description of the ultrasound semiotics of closed abdominal trauma (CAT).. Purpose. The study of the diagnostic effectiveness of sonography in identifying signs of damage to the abdominal cavity organs and a detailed description of the ultrasound semiotics of CAT..
Material and methods. Ultrasound was performed in 160 patients with blunt abdominal trauma as an initial method for diagnosing intra-abdominal injuries and was performed in the emergency department immediately upon admission to the clinic..
Conclusion. Among the diverse sonographic semiotics of intraperitoneal injuries in CAT, the presence of various volumes of free fluid in the abdominal cavity is the most constant ultrasound signs. The developed method of ultrasound assessment of the volume of free fluid in the abdominal cavity, based on taking into account the thickness of the fluid layer and its prevalence in the abdominal cavity zones, does not complicate or lengthen the FAST protocol procedure, allows to determine the critical volumes of hemoperitoneum, which are crucial in choosing the tactics of surgical treatment of CAT.
Critical limb ischemia (CLI) is the final stage of peripheral arterial disease which may lead to the chronic restpain, loss of tissues and limbs. Despite the active development of new technologies, including endovascular and open surgical methods of treatment, and the development of various type of guidelines, CLI still remains an unresolved burden of vascular surgery around the world. In the first part of this review, we described the problem of PAD, in particular, critical lower limb ischemia and the role of diabetes mellitus in the progression of these pathologies. In addition, we tried to reveal the statistics of «small» and «large» amputations in different regions of the world, as well as their social and economic significance.
The article summarizes a case from practice, which describes the comprehensive treatment of a patient with a deep contact burn of the face. Throughout the development of humankind, people have been faced with the need to treat severe wounds, with facial injuries being of particular importance. Ancient sources describe that facial injuries were very common in Ancient India and the countries of the Middle East. Patient S. was admitted to the Almaty City Emergency Hospital in 2019. She received a thermal injury at home, according to the patient, she lost consciousness while cooking and fell on a burning gas stove burner. Upon admission, the general condition of the patient was severe, due to the injury and the presence of somatic pathology. The postoperative period was uneventful. Thus, in order to obtain satisfactory results in the surgical treatment of deep burns of the face, one operation is not enough, complex treatment is required, which includes physiotherapy and corrective operations, this is the only way to achieve the optimal, i.e. desired result. The need to develop new recommendations and their practical implementation for the treatment of this pathology will improve the quality and optimize the treatment of victims.
Liver echinococcosis is a severe zoonotic disease of cosmopolitan nature caused by cestodes of the genus Echinococcus from the family Taeniidae that leads to cystic and alveolar echinococcosis that forms a significant problem in public health worldwide. The purpose of this work is to analyze a literature review of modern approaches in the diagnostics and treatment of liver cystous echinococcosis
Material and methods. We systematically searched the literature and selected sources from MEDLINE, PubMed, Scopus, Elsevier, E-library, Google Scholar as well as research papers and online educational publications in various languages. Forty three papers that met the inclusion criteria were included..
Results. The review article presents epidemiology, methods of diagnosis and treatment of cystic liver echinococcus..
Conclusion. Thus, among the modern approaches in diagnostics of cystic liver echinococcosis, ultrasound is the method of choice, also CT, MRI, ERCP are methods used for identifying complications. Morever, various surgical methods in combination with antiparasitic therapy decrease the risk and recurrence of cystic liver echinococcosis.
Hyperthyroidism (Graves’ disease (GD)), is a relatively rare disease in adults and children. Treatment options for adults and children are antithyroid drugs (ATD), radioactive iodine (RAI), or thyroidectomy, but the risks as well as benefits of each are different. IntroductionGraves’ disease is an autoimmune disease result-ing in generalized hyperfunction of the thyroid gland, i.e., hyperthyroidism. It is named after Robert Graves, the Irish doctor who described this form of hyperthyroidism about 150 years ago. It occurs 7-8 times more often in women than in men [1].
Objective. This research is meant to study the features of the clinical course and to develop an optimal algorithm for the diagnosis of autoimmune thyroid diseases..
Material and methods. The work is based on the examination and treatment data of 481 patients with autoimmune diseases of the thyroid gland, treated in the clinic. Diagnosis and treatment results of 481 patients were analyzed to develop an optimal algorithm for diagnosing autoimmune thyroiditis. The differential diagnostic capabilities of clinical, laboratory, and morphological examination methods of patients with autoimmune thyroid diseases have been specified. The study of long-term results of treatment was carried out on 340 patients, taking into account the various methods of treatment they underwent..
Results. The analysis of existing diagnostic tools and methods allowed us to develop an optimal algorithm for diagnosing autoimmune thyroid diseases, which is a complex of clinical, laboratory, and morphological methods that can reliably verify the diagnosis of autoimmune thyroiditis. Based on the examination results, it is possible to predict the likelihood of surgical treatment and to identify a group of patients in whom autoimmune processes can progress in the thyroid residue, contributing to the development of postoperative recurrence of the disease or causing its atrophy..
Conclusion. Based on the study’s results, a rational algorithm for diagnostic search has been developed. The proposed algorithm allows, in the shortest possible time, to identify the presence of a form of autoimmune thyroid disease and to determine the optimal tactics to treat patients with autoimmune thyroiditis based on clinical, laboratory, immunological tests and instrumental examinations.
Central venous catheters (CVCs), such as the tunneled catheters and the totally implanted ports, play a major role in general medicine and oncology. Thrombosis associated with CVCs is a common complication in cancer patients. Thus, in order to more widely study the problem of catheter-associated thrombosis in cancer patients, we initiated a study for 2022-2023 within one region.. Purpose. Evaluation of the efficacy and safety of thromboprophylaxis of catheter-associated thrombosis with rivaroxaban in cancer patients..
Material and methods. Prospective multicenter study, conducted since 01/05/2022 and planned to be completed by the end of 2022, on the basis of three centers. The subjects are divided into 2 groups to randomize 60 participants in each. The first group: receive DOACs (rivaroxaban) at a dosage of 20 mg per day the day before the inserting of the CVC. Second group: treatment of the underlying disease without the use of DOACs..
Results. None of the patients developed submassive or massive pulmonary embolism. There were no cases of CAT in the thromboprophylaxis group compared to the non-thrombotic prophylaxis group (0% vs 15.7%). The relative risk of developing CAT is 0.86, which indicates the effectiveness of thromboprophylaxis with rivaroxaban..
Conclusion. Our interim results show the efficacy of rivaroxaban at a dosage of 20 mg per day in cancer patients. The final results are planned to be published at the end of the study.
Keywords
central venous catheter, CVC, central venous catheter-associated thrombosis, central venous catheter-associated deep vein thrombosis, CAT, catheter-related thrombosis, CRT, culmonary embolism, PE, cancer
