Interrupted inferior vena cava is a rare condition that can occur either in isolation or in combination with asplasia or polysplasia syndromes. Abnormal development of systemic veins is closely related to atrial situs. In levocardia, there are signs of abdominal organ inversion, which is called visceral situs. The present paper describes a clinical case of a infant with a large interventricular septal defect combined with interrupted inferior vena cava with azygous continuation of visceral situs ambiguous heterotaxy. The defect plasty was performed at the operation, and the complete venous cannulation required for artificial circulation was performed by the correctly chosen method of drainage of the superior venous system - through the auricle of the right atrium and the inferior venous system - through a separate hepatic vein cannulation, with a good clinical result.
Keywords
interrupted inferior vena cava, heterotaxy, case report, congenital heart disease
Computed tomography volumetry is the standard method for preoperative estimation of liver volume. Despite the development of various software, the trend towards discrepancy in the calculation of liver volume compared with any of the methods and intraoperative graft weight remains. The aim of the study was to optimize the manual method of CT volumetry donor’ liver, determine its accuracy and compare it with the standard method..
Material and methods. A single-center prospective study including data from 60 liver donors who underwent computed tomography, CT volumetry and liver transplantation at the National Scientific Surgery Center named after A. N. Syzganov for the period 2018-2022..
Results. The Pearson correlation between the right liver lobe volume estimated by the standard method and the graft weight was 0.730 (p<0.01), the Pearson correlation between the liver volume calculated by the optimized method (-10 HU) and the graft was 0.757 (p<0.01), and the correlation between the optimized method (-20 HU) and graft weight – 0.860 (p<0.01). The Pearson correlation coefficient of the optimized method (-20 HU) is statistically significantly higher than the correlation coefficient of the standard manual method (p=0.026), the difference between the correlation coefficient of the optimized method (-10 HU) and the standard one is statistically insignificant (p=0.375). The degree of discrepancy between the optimized method (-20 HU) was 8.4%, manual method - 12.7%. There is a statistically significant difference between the degree of discrepancy between the standard manual and optimized method (-20 HU) (p=0.029). Conclusions. Optimization of the manual CT volumetry method with a decrease in the liver density threshold by 20 HU demonstrated a statistically significantly high correlation coefficient with the graft weight, and also significantly reduced the degree of discrepancy.
Objective: To compare the immediate outcomes of thoracoscopy and median sternotomy in patients undergoing ventricular septal defect repair. Materials and мethods. We analyzed 59 patients diagnosed with VSD who were operated on at the SCCCST from 2012 to 2021. All patients were divided into two groups: group 1 included patients in whom thoracoscopic access was used (n=27), group 2 included the method of complete median sternotomy (n=32)..
Results. There were no statistically significant differences in complications in the postoperative period and no in-hospital mortality. The duration of the procedure and the duration of cardiopulmonary bypass in the thoracoscopy group were longer than in the sternotomy group. Blood loss during and after surgery was lower in the thoracoscopy group than in the sternotomy group. Hence, less blood and plasma transfusion was required in the thoracoscopy group than in the sternotomy group. The length of stay in the intensive care unit, the time spent on mechanical ventilation, bed days after surgery, the use of analgesics were statistically lower in the thoracoscopy group than in the sternotomy group. It should be noted that the length of the skin incision in patients in the thoracoscopy group was significantly less than in the second group..
Conclusion. Thoracoscopic approach for VSD correction is an effective and low-traumatic method that does not increase the risk of surgical complications. Routine use of this technique requires a study on a larger sample of patients.
The aim of the study is to determine the levels of the S100B protein in patients with ischemic stroke and evaluate its relationship with the size of brain tissue damage, stroke severity, and clinical outcomes..
Materials and methods. The study included 113 patients with acute ischemic stroke, hospitalized within the first day after its onset and subjected to invasive treatment. 101 men and 12 women were examined, including 32 at the age of 50-60, 64 at the age of 61-70, 17 at the age of 71-80. parameters and degree of functional deviations according to the NIHSS scale..
Results. The content of S100B during the initial determination on average for the group significantly exceeded the level determined in the control by 3.22 times (p=0.025). There was a direct dependence of the content of S100B on the size of the stroke. A moderate increase in the indicator on the 3rd day relative to the determined one on the 1st day and a decrease on the 7th day after the development of the stroke were revealed. There was no significant dependence of S100B content on the presence of comorbidities. The influence of the studied parameter on the degree of neurological deficit was determined only in patients with a large stroke size.
Purpose of the study: comparative assessment of hematological and autoimmune status of patients with Graves’ disease (GD)..
Materials and methods. 43 GD patients aged between 19 and 64 years, 26 of which were women and 17 were men, have been examined. Assessment of hemograms of examined patients helped to reveal anemia in 28(65.1%) examined patients (group I). In 15 (34.9%) patients (group II) anemia was not detected. Mild anemia was diagnosed in 25 (89.3%), moderate anemia – in 3 (10.7%) patients. Hemoglobin, hematocrit, erythrocyte count and erythrocyte indices MCV, MCH, MCHC, serum Fe and ferritin status was chaecked in clinical analysis. The immune status was assessed by the level of CD3+, CD4+, CD8+, CD19+, CD4+/CD8+, CEC, Ef, TSHRAb and hormonal status by the level of TSH, T4 free..
Results. Microcytic anemia was determined in 15 (53.6%) patients, normocytic - in 12 (42.8%), macrocytic - in 1 (3.5%) patient due to volume of erythrocytes’ MCV. According to morphological criteria of МСН (mean content of hemoglobin in erythrocyte) anemia hypochromic type of anemia was noted in 15 (53.6%) patients, normochromic - in 12 (42.8%), hyperchromic - in 1 (3.5%) patient. In 15 (53.6%%) patients in the group I microcytic - hypochromic anemia was diagnosed, which is characteristic for iron-deficient anemia; in 12 (42.8%) patients was verified normocyticnormochromic anemia, which has morphological parameters of anemia of chronic diseases and in 1 (3.5%) patient macrocytic-hyperchromic anemia. Comparative assessment of HGB level and indicators of iron metabolism in GD patients with anemia detected decreasing of HGB by 20%, serum Fe by 20%, ferritin by 29% compared to the corresponding control values. More pronounced depletion of the iron depot (ferritin) due to the fact that the development of anemia is preceded by a “latent iron deficiency”, an indicator of which is ferritin. Conclusions. GD is characterized by high frequency of anemia (65.1%), mostly mild form (89.3%), microcytichypochromic (53.6%), characteristic of iron deficiency anemia. The severe hematological disorders, detected among GD patients with anemia are accompanied by deep autoimmune changes and hyperfunction of the thyroid gland.
Keywords
Grave’s disease, autoimmune disorders, anemia, rates of severity of anemia, morphological types of anemia
Many countries have actively implemented reforms over the last two decades to incrеase the productivity of their healthcare systems and the effectiveness of treatment and prevention activities. And the classical indicators of hospital performance such as the use of hospital beds and the quality of hospital care are the main indicators of good management in a hospital..
Material and methods. The object of the study is the medical and statistical performance indicators of the surgical department and the surgical day hospital of the multidisciplinary hospital in Almaty for 5 years (2017–2021). As a source of information, an electronic database of the statistical department of the hospital was used. Medical statistical analysis was applied as a method of study. This type of study is a cross-sectional study based on a retrospective descriptive analysis of official statistics..
Results. In terms of dynamics, the structure of those treated in the surgical department does not change. However, there is a significant decrease in the amount of planned surgical pathology compared to the slight drop in hospitalization (a decrease of -40%), possibly due to a decrease in the volume of government orders (a decrease of -43.4%). Within the framework of the state order, the indicator of the average length of stay of a patient in a hospital, in general, tends to decrease from 8,5 in 2017 to 8,2 in 2021. A higher level of surgical activity in the surgical department (76,4% vs. 62,6% in surgical departments in 2021), a lower postoperative complication rate (0,2% vs. 0,3%), and a lower postoperative mortality (0,7% vs. 1,1%) were stated as positive indicators of surgical service. In 2021, the frequency of emergency operations in the surgical department was roughly the same, at 19,1%; the total share of outpatient surgery (for all profiles) in the structure of all surgery was 11,3%..
Conclusion. The identified deterioration in the use of hospital beds in the surgical department (decrease in bed turnover, increase in the average duration of one case of hospitalization, decrease in the planned number of bed days) requires improvement of the planning and control system for hospitalization. Perhaps this problem is relevant for many multidisciplinary hospitals.
Keywords
indicators, surgical department, multidisciplinary hospital, outpatient surgery
Since the beginning of the spread of coronavirus infection in the world, the number of infected has exceeded 102.5 million people, and more than 2.2 million people have died. In Kazakhstan, according to the world statistics of COVID-19, the 59th place in the number of detected cases of COVID-19 and the 68th place in deaths from coronavirus was noted. The vast majority of patients with COVID-19 have a mild or moderate illness, but 5% of those with a critical course of the disease require treatment in an intensive care unit. The length of stay in the intensive care unit averages 10.8 days, however, in 22.7% of patients, the duration of treatment in the ICU exceeds 30 days. In order to improve treatment outcomes, many clinics use a team work methodology that requires a sufficient number of highly qualified medical personnel. However, due to the shortage of personnel in intensive care units, measures are being taken to retrain medical personnel of other specialties. At the same time, short training courses do not always improve the results of treatment in a high quality and lead to a deterioration in the results of most patients.
Keywords
COVID-19 pandemic, critical care, intensive care service organization
Without the development of clinical toxicology, the population is doomed to suffer great losses in the event of the use of chemical weapons or man-made disasters, since the national health structure will not be able to provide the necessary symptomatic and antidote care to the affected people. The development of clinical toxicology is necessary today because of the threat of latent methods of chemical attack, when prevention and chemical control structures become ineffective and the consequences of poisoning with an unknown poisoning agent have to be dealt with.
Keywords
chemical safety, military clinical toxicology, weapons of mass destruction, antidotes
The purpose of the study is to analyze the effectiveness parameters of the radiological service on the example of Almaty in 2022. Literature review of foreign and domestic literature concerning the issues of organization of radiology service for the period from 2005 to 2022 was carried out..
Conclusion. Thus, to increase the value of imaging, cost management is required, in addition to improving quality and outcomes. Radiologists should be involved in calculating the costs of radiology examinations, and a review of the parameters for assessing the effectiveness of the radiology service is necessary.
Keywords
radiology, computed tomography, guaranteed volume of free medical care
