In the surgical treatment of glaucoma in children under anesthesia protection, the maximum reduction in intraocular pressure (IOP) is required. Otherwise, there is a possibility of a dangerous complication - vitreous prolapse. In this article the combined use of inhalation anesthetic sevoflurane in the surgical treatment of glaucoma in children is discussed as a method of improving the anesthetic protection of children.
The monograph presents data on the level of stress hormones in dynamics before, during the main surgical intervention and on the 3rd day after it, depending on the selected operative access according to the developed program for choosing surgical tactics for the treatment of patients with acute destructive cholecystitis, taking into account the individual characteristics of the body. There are also data on the use of an improved surgical instrument - a "Wound Expander" for safe cholecystectomy from a minilaparotomy access, which allows to level the risk of intraoperative bleeding and iatrogenic damage to the biliary tract and an optimized specific scale for assessing the quality of life of patients who have undergone cholecystectomy, taking into account the verification of factors affecting the course of the postoperative period and the likelihood of postcholecystectomy syndrome. The monograph is intended for surgeons, anesthesiologists, resuscitators, as well as doctors of all specialties and students of medical institutes.
Currently, despite significant achievements in the field of surgery, anesthesiology and resuscitation, the results of treatment of patients with advanced purulent peritonitis remain one of the most intractable problems, almost every sixth patient with acute surgical diseases and injuries of the abdominal cavity is admitted to medical institutions with peritonitis [1,3] Common peritonitis in 17-29% complicates the course of most acute surgical diseases and is the main cause of deaths in surgical hospitals [3,7]. Lethality in advanced peritonitis remains extremely high and reaches 20-39% [1,2,4,5]. In recent decades, great importance has been attached to recording intra-abdominal pressure in purulent pathology of the abdominal cavity. It was found that intra-abdominal hypertension occurs in every third patient with acute surgical pathology and negatively affects the functioning of all organs and systems of the body [1,6,8]. Pathological changes that occur with acute and excessive increase in intra-abdominal pressure (IAP) are manifestations of abdominal compartment syndrome (ACS) with disorders of the cardiovascular system; urinary disorders, disorders of perfusion of internal organs and the development of intestinal ischemia, which contributes to bacterial translocation and endogenous infection [2,7,8]. Ischemic blood flow disorders of the splanchnic zone are fraught with the development of bacterial translocation and the development of systemic inflammatory response syndrome and multiple organ failure (PON). Unsatisfactoriness with such results gave rise to a fundamentally different approach to the surgical treatment of common forms of peritonitis-the introduction of an open abdominal management method based on the ideas of I. Mikulich (1881), Jean-Louis Faure (1928), N. S. Makoch (1984) and D. Steinberg (1979).
Tuberculosis remains a global public health problem, especially in the South Aral Sea region. The COVID-19 pandemic has exacerbated the TB epidemiological situation in the region. Because of the violation of the regimen in 2020, there was a decrease in the incidence of tuberculosis by 27%, in the success of treatment by 3% and growth in number of violations of the treatment regimen by 1.8 times, compared to 2019. In order to improve the quality of controlled treatment of tuberculosis, patients during the COVID-19 pandemic, the implementation of a pilot project "treatment under video surveillance" (LVN) has been launched. Currently, this project includes 30 patients. It is necessary to conduct an in-depth analysis of the effectiveness of the implemented measures, including treatment under video surveillance.
Any epidemic and pandemic that is a great stress or emergency leads to disruptions in the psycho-neurological system and human behavior. Psycho-emotional excitement in patients with severe Covid-19 dramatically reduces the effectiveness of non-invasive ventilation. Purpose of the study: to assess the efficacy, safety and impact on the quality of life of patients with dexmedetomidine and propofol against the background of a decrease in need for oxygen. The study included 21 patients with severe and extremely severe Covid-19. In the first group of patients with fear of death, a combination of drugs propofol + sibazone + fentanyl was used. In the second group, dexmedetomidine and promedol. Conclusions: in patients with a severe course of coronavirus infection, dexmedetomidine is more effective in reducing psycho neurological arousal and improving cognitive functions, which leads to an effective supply of oxygen and to their faster recovery.
Drug Treatment Courts (DTCs) have emerged as an alternative approach to traditional criminal justice responses for individuals with substance use disorders. This quantitative study examines the post-sentencing and reoffense outcomes of a Drug Treatment Court in a Western Canadian city. The study analyzes data from a sample of individuals who participated in the DTC program, comparing their post-sentencing outcomes to a matched comparison group of individuals who went through the regular criminal justice process. Outcome measures include recidivism rates, substance use patterns, treatment completion rates, and social reintegration outcomes. The findings provide insights into the effectiveness of the Drug Treatment Court in reducing recidivism, improving treatment outcomes, and facilitating successful community reintegration among individuals with substance use disorders. The implications of these findings for policy, practice, and future research are discussed.
Subjects of the inquiry: patients with acute intestinal obstruction.
The aim of the inquiry: improvement of treatment results of the patients with acute bowel obstruction by means of the perfection of the methods of intestinal decompression and enteral correction of metabolic disturbance of the organism with nutritive blend “Perative”.
Methods of inquiry: general clinical laboratory investigations, roentgenological studies, statistical technologies, clcctrocntcrography.
Novelty of inquiry: In complex treatment of the patients with acute bowel obstruction the improved intestinal tube has been used for intraoperative decompression of the gastrointestinal tract and it has been demonstrated of its effectiveness. The active intra- and postoperative decompression of the gastrointestinal tract, gut lavage, enteral [tube] feeding effectiveness in complex treatment of the patients with acute bowel obstruction has been proved. The necessity of addition of the complex treatment of the patients with acute bowel obstruction the enteral correction of metabolic disturbance of the organism has been proved and the balanced nutritive blend “Perative” efficacy has been defined.
Practical value: The application of the improved intestinal tube allowed accomplishing of the adequate evacuation of the toxic contents of the gastrointestinal tract and reducing of the enteric pressure. It has contributed to earlier recovery of the all gastrointestinal tract function and it has created the favourable conditions for enteral [tube] feeding. Carrying out of the enteral [tube] feeding with semi - substrate nutritive blend “Perative” has promoted to earlier replacement of the loss of power and plastic material needs. Clinical application of the developed patients management with acute bowel obstruction has promoted to the reduction of the complications rate (from 33,9% to 6,0%) and mortality (10,7% to 0%).
Degree of embed and economical effectivity: The main regulations of the dissertation have been applied in practical work of the urgent surgical department of the second clinic of the Second Tashkent State Medical Institute and it is used in process of 4-6 years students teaching in the Second Tashkent State Medical Institute.
Sphere of usage: urgent surgical help.
The results of surgical treatment of 126 patients with acute obstructive calculous cholecystitis were analyzed. Depending on the nature of performed operations all patients were divided into 2 groups: control group - 50 patients who underwent traditional cholecystectomy and main group - 76 patients who underwent LCE.
In the main group in case of impossibility to identify the elements of the gallbladder neck the author developed an original technique of LCE performance, which was performed in 37 patients, that allowed to perform even technically difficult operations by laparoscopic way, reducing the percentage of conversions to a minimum.
The author developed a technique of gallbladder and its bed sanation with 0.4% EVR of sodium hypochlorite and ozonized solutions, which allowed to prevent contamination of the abdominal cavity with infected gallbladder contents, and sanation of its bed and subhepatic space with ozonized solution, spread of the pathological process into the abdominal cavity.
The author developed the tactics of management and surgical treatment of patients with acute obturation cholecystitis, which allowed to improve the results of treatment of this category of patients and reduce the frequency of postoperative complications and lethality.
Based on the analysis of clinical results, indications and contraindications for laparoscopic interventions on the gallbladder in acute cholecystitis were developed.
The developed method of LCE, sanation of the gallbladder cavity and its bed by the proposed antiseptics, application of the developed tactics of treatment of patients with acute obturation cholecystitis allowed to reduce the treatment time from 18.2 + 5.6 to 6.1 + 1.9 days, to reduce the incidence of postoperative complications from 26% to 1.3%.