The aim of the study is to improving the quality of treatment of ventral hernias in patients with morbid obesity by improving the tactical and technical aspects and optimizing the choice of hernioplasty method.
The object of the study were 121 patients with ventral hernias and morbid obesity who were hospitalized in the surgical department of the 1st clinic of the Samarkand State Medical University in the period from 2012 to 2021.
The scientific novelty of the study is as follows: a method was developed for preoperative preparation of patients with ventral hernia and morbid obesity using a modified pneumatic belt-bandage to adapt the cardiovascular and respiratory systems to intra-abdominal hypertension after hernioplasty; improved technical aspects of the reconstruction of the anterior abdominal wall in patients with morbid obesity; the surgical instrument "retractor" has been improved for technical optimization of the stage of suturing the anterior abdominal wall for fixing the prosthesis in patients with concomitant obesity and abdominal ptosis; clarified clinical and instrumental criteria for the specific unification of the scale for assessing the quality of life of patients after hernioplasty and abdominoplasty for ventral hernias and morbid obesity with differentiation of the value of physical, mental and social daily activity. The practical results of the study are as follows: According to the results of a scientific study to improve the diagnosis and surgical treatment of patients with ventral hernias and morbid obesity: improved "retractor". The use of the proposed tool made it possible to level the technical difficulties in fixing the prosthesis against the background of severe overweight with a reduction in the operation time; developed guidelines "Technical aspects of hernioplasty for ventral hernias in patients with morbid obesity" (certificate of the Ministry of Health 8n-r / 905 dated October 12, 2021), "Criteria for the choice of surgical treatment of patients with ventral hernias and obesity" (certificate of the Ministry of Health 8n-r /906 dated October 12, 2021). The proposed recommendations made it possible to optimize the choice of tactics for surgical treatment of patients with ventral hernias and morbid obesity; the obtained scientific results on improving the quality of diagnosis and surgical treatment of patients with ventral hernias and morbid obesity have been introduced into the practice of health care, in particular, in the departments of surgery of the 1st clinic of the Samarkand State Medical Institute, the Jizzakh Regional Multidisciplinary Medical Center and the Sh. Rashidov District Medical Association of the Jizzakh region (certificate of the Ministry of Health 8n-z / 368 dated October 22, 2021). The implementation of research results by improving the tactical and technical aspects of the surgical treatment of patients with ventral hernias and morbid obesity made it possible to reduce the overall incidence of postoperative complications from 14.8% to 8.9%, including wound complications from 11.1% to 4.5% and extra-abdominal from 7.4% to 4.5%, as well as significantly reduce the duration of surgical treatment and rehabilitation periods after various types of hernioplasty and abdominoplasty. The structure and scope of the dissertation. The dissertation consists of an introduction, five chapters, a conclusion, conclusions, practical recommendations and a list of cited literature. The volume of the text material is 107 pages.
Среди анестезиологических проблем, связанных с лапароскопией у детей, выделяют главным образом, влияние на организм ребенка внутрибрюшной гипертензии. При лапароскопических вмешательствах существенное повышение внутрибрюшного давления вызывает разнообразные патологические эффекты на органы и системы, в особенности, на гемодинамику и дыхание, а также на функцию печени, почек и кровоснабжение органов брюшной полости. Повышение ВБД приводит и к росту внутригрудного давления за счет смещения диафрагмы вверх, что уменьшает объём грудной клетки и дыхательный объём. При этом повышается пиковое давление в дыхательных путях, растет сопротивление легочных сосудов с нарушением соотношения вентиляция-кровоток.
Среди анестезиологических проблем, связанных с лапароскопией у детей, выделяют главным образом, влияние на организм ребенка внутрибрюшной гипертензии. При лапароскопических вмешательствах существенное повышение внутрибрюшного давления вызывает разнообразные патологические эффекты на органы и системы, в особенности, на гемодинамику и дыхание, а также на функцию печени, почек и кровоснабжение органов брюшной полости. Повышение ВБД приводит и к росту внутригрудного давления за счет смещения диафрагмы вверх, что уменьшает объём грудной клетки и дыхательный объём. При этом повышается пиковое давление в дыхательных путях, растет сопротивление легочных сосудов с нарушением соотношения вентиляция-кровоток.
Liver cirrhosis is associated with numerous cardiovascular disorders. They include increased heart function and lower blood pressure and total peripheral vascular resistance. In these patients, despite an increase in the work of the heart, systolic and diastolic function deteriorates in the framework of pharmacological, physiological and surgical stresses, as well as the electrical activity of the myocardium, most often in the form of lengthening the QT interval. These deviations are combined into the concept of cirrhotic cardiomyopathy. It is believed that cirrhotic cardiomyopathy contributes to the cardiac dysfunction that is seen in patients with intrahepatic portosystemic stent shunts and liver transplants. Insufficient contractile function of the heart may play a role in the pathogenesis of hepatorenal syndrome, which rapidly leads to spontaneous bacterial peritonitis.
Subjects of research: Object are vehicles for transportation of mineral oil through pass « Kamchik », a subject - increase of their reliability.
Purpose of work: Increase of efficiency of technical operation of vehicles by transportation mineral oil through pass « Kamchik » at the expense of perfection of a design and increase of operational reliability.
Methods of research: Researches are based on theoretical and experimental methods of the analysis of operational properties of a rolling stock and indicators of properties of reliability. Experimental researches were spent in real conditions of operation with use of methods of under control operation of cars and the mathematical statistics at processing of results.
The results obtained and their novelty: On the basis of the executed researches the scientifically-practical problem on perfection of a design and increase of operational reliability of autotractors is solved.
Practical value:
- The technique of an estimation of fitness of a design and a choice of a rolling stock is developed for transportation of mineral oil through pass « Kamchik », based on theoretical both experimental researches of operational properties and their definition numerical values for autotractors Ford Cargo - 1827, MAZ-642208-020 and ISUZU-EXZ5IK;
- Are defined indicators of properties of reliability and the card of reliability of autotractors Ford Cargo - 1827 and MAZ-642208-020 is developed;
- The rolling stock design is improved at operation in mountain conditions.
- Technological process of maintenance service and car repairs is improved.
Degree of embed and economic effectivity:
- Are introduced at factories "SamAvto" and «MAZ» offers on perfection of a design of autotractors.
- Are introduced in VTC «Avtonefttrans» Fergana Oil refining factory advanced technological process of maintenance service and car repairs.
- Economy efficiency of the work from its applications is 54.66 mln. Sum per year.
- Results of researches in educational process are introduced by preparation of masters on a specialty 5A521205 «Cars and an automobile economy» at discipline studying «Technological base of the enterprises of branch of motor transport» and also at courses of improvement of qualification of technical officers VTC «Avtonefttrans ».
Field of application: Automotive transportation.
Vitrum cardio Omega-3 a preparation for preventive maintenance thromboprophilia infringements at pregnancy. Hodzhimuratova G. А.
Включение в схемы профилактики и комплексного лечения беременных с тромбофилиями лекарственного препарата Витрум кардио Омега—3 (полиненасыщенная жирная кислота) способствует снижению ингибирования агрегации тромбоцитов,
снижению артериального давления у беременной, предотвращает угрозу преждевременных родов.
The resume: Inclusion in schemes of preventive maintenance and complex treatment of pregnant women with thrombophilia medicai product Vitrum cardio Omega-3 (polynonsaturated fat acid) promotes decrease in inhibition of aggregation trombocits, to decrease in arterial pressure at the pregnant woman, prevents threat of premature birth
The objective of this study was to assess the efficacy of a complex therapeutic approach, which included retrobulbar catheterisation and magnetic stimulation of the optic nerve, in patients with ChASN of diverse aetiologies. This was achieved by analysing the clinical and functional characteristics of the eye in these patients.
The methodology employed in this study is outlined below. A total of 105 patients (155 eyes) with a diagnosis of partial optic nerve atrophy of different genesis (PAN) were included in the study. These patients received conventional treatment, treatment by the method of retrobulbar catheterisation, as well as the method of retrobulbar catheterisation combined with MS for 10 days. The dynamics of OD, visual field parameters, electrophysiological studies, ophthalmoscopy and ultrasound Dopplerography were investigated.
The results demonstrated that the combined method of treatment was more effective than the conventional method alone. The analysis of the obtained data indicates that the effectiveness of the proposed methods of treatment depends on the degree of MN destruction. Therefore, the treatment is more effective in the second degree of ChASN. However, in the group of patients treated by the combined method, the efficiency is equally high in both the second and third degrees of ChASN.
The data on the dynamics of visual acuity of patients with II stage of ChASN during treatment indicates that if in the group of patients treated by the traditional method the effect was observed in only 64.3% of cases, in the group of patients treated by the method of retrobulbar catheterisation the efficiency was observed in 89.3%.
The efficacy of the combined method of retrobulbar catheterisation in combination with MS in treating patients with ChASN was also demonstrated by the observed improvement in OZ in comparison with the control group. In this group, the effectiveness of the treatment was 90.9%.
The visual field boundaries in patients with the II degree of ChASN of the II and III main groups expanded in comparison with the control group by more than 51-60° in the periphery. The number of absolute central and paracentral scotomas decreased in comparison with the control group by 4.7 and 5 conventional units.
In the group of patients with ChASN stage III, the borders of the visual field in groups II and III, in comparison with the control group, exhibited a peripheral widening of 69° and 70°. The number of scotomas decreased by 6 and 11.6 conventional units in comparison with group I.
The ocular fundus condition under the proposed methods of treatment underwent the following changes due to the short period of observation (2-3 weeks): dilation of CAC vessels, reduction of capillary tortuosity, reduction of retinal oedema, as well as appearance of foveal and macular reflexes distinctness.
The data from ultrasound Dopplerography demonstrated a significant improvement in haemodynamic parameters in the central artery of the retina (CAC) in patients with central artery syndrome of different aetiology in the early stages following treatment. An improvement in systolic pressure indices was observed. In each case of the examined patients, an improvement in haemodynamic resistance index (Ri) towards normalisation was revealed. Consequently, there was a significant increase in diastolic pressure.
Purpose of the study: to evaluate the results of complex therapy including retrobulbar catheterization and magnetic stimulation of the optic nerve in patients with ChASN of different genesis by studying clinical and functional features of the eye in this case.
Methods. 105 patients (155 eyes) with the diagnosis: partial optic nerve atrophy of different genesis (PAN) received conventional treatment, treatment with the method of retrobulbar catheterization, as well as with the method of retrobulbar catheterization in combination with MS for 10 days. The dynamics of OD indicators, visual field, electrophysiological studies, ophthalmoscopy and ultrasound Dopplerography were investigated.
Results. The analysis of the obtained data indicates that the effectiveness of the proposed methods of treatment depends on the degree of MN destruction, so the treatment is more effective in the 11th degree of ChASN. However, in the group of patients treated by the combined method the efficiency is equally high both at II and III degrees of ChASN.
According to the data of visual acuity dynamics in patients with II stage of Chasnosis in the course of treatment it follows that if in the group of patients treated by the traditional method the effect was observed only in 64,3% of cases, in the group of patients treated by the method of retrobulbar catheterization the efficiency was observed in 89,3%.
The dynamics of the ocular fundus state under the proposed methods of treatment due to the short period of observation (2-3 weeks) underwent the following changes: dilation of CAC vessels, reduction of capillary tortuosity, reduction of retinal edema, as well as the appearance of foveal and macular reflexes distinctness. The data of ultrasound Dopplerography indicate a significant improvement of hemodynamic parameters in the CAC in patients with ChASN of different genesis in early terms after treatment. Improvement of systolic pressure indices was noted. In each case of the examined patients the improvement of hemodynamic resistance index Ri towards normalization was revealed. Accordingly, there was a significant increase in diastolic pressure, indicating the strengthening of elastic-elastic properties of vessels under the influence of treatment.
In our opinion, the improvement of hemodynamic parameters after the course of the proposed method of treatment is associated with an increase in the volume of the microcirculatory channel in the area of direct influence on MN by retrobulbar catheterization and MS.
Purpose. To analyze optical and biometric indicators of children's eyes with various stages of congenital juvenile glaucoma (CJG) combined with myopia. Material and methods. We examined 17 patients (31 eyes) aged 11 to 17 (averagely 14.0 ± 0.2 years) diagnosed with CYG who underwent, prior to surgical or conservative treatment, a regular ophthalmological examination supplemented with the measurement of the central corneal thickness (on an automatic contactless tonometer-pachymeter by NIDEK, USA), and the index of corneal deformation (ICD) by the Shkrebets technique. Results. The analysis showed a possible correlation between 1) tonometric intraocular pressure (P) and the axial length of the eye, 2) P t and the ratio of excavation to optic disk diameter (E/ON), 3) axial length of the eye and the central corneal thickness at the terminal CYG stage, and 4) the axial length and the refraction at the initial stage of CYG. Conclusion. As the glaucomatous process progresses, children with CYG combined with myopia show an increase of myopic refraction, a decrease in fibrous membrane rigidity, pretrabecular and trabecular changes, axial elongation, increased IOP due to an imbalance between the production of intraocularfluid and its outflow, an expansion of the excavation of the optic disk and a decrease in the central corneal thickness.
To determine the hydrodynamic parameters of the uninjured fellow eye of children with combined injuries of the organ of vision. A prospective analysis of the hydrodynamic parameters of the fellow eye according to Friedenwald was carried out in 18 patients (18 eyes) aged 3 to 10 years 2–3 and 45–50 days after primary surgical treatment (PSD) of a penetrating wound of the cornea, who were hospitalized in the ophthalmological department of the clinic Tashkent Pediatric Medical Institute. Group I included 8 (44%) children with the following diagnosis: “Combined injury of the organ
of vision. Contusion of the eyeball severe. Complex penetrating wound of the cornea. Group II included 10 (56%) patients with complex penetrating wounds of the cornea. 2–3 days after PST of the wound, group I showed a statistically significant increase in Pt by 2.04±0.03 mm Hg. compared with the control group, while 1–2 days after the first measurement and 45–50 days after PST, the indicators decreased, on average, by 4.4±0.02 mm Hg. without the use of antihypertensive drugs. Changes in the hydrodynamics of the eye in children of group II were not statistically significant. The results of the examination of children revealed a transient increase in tonometric intraocular pressure in the paired uninjured eye 2–3 days after PST of a penetrating wound of the cornea with combined injuries of the organ of vision.