The aim of the study is to improve the results of diagnosis and surgical treatment of victims with closed abdominal injury by developing a new approach to ultrasound assessment of the amount of hemoperitoneum, expanding and specifying indications for laparoscopy, taking into account the volume of free fluid in the abdominal cavity.
The object of the study were 160 patients with closed abdominal injury with stable hemodynamics, was hospitalized in the surgical Department of the Republican specialized scientific and practical center for emergency medicine of the Samarkand branch (clinical departments of surgical diseases № 2 and surgery postgraduate faculty of Samarkand state Medical Institute) for the period from 2010 to 2019.
The scientific novelty of the study is as follows: a fundamentally new approach to ultrasound evaluation of discrete volumes of free fluid in the abdominal cavity is proposed, based on taking into account the thickness of the fluid layer and its prevalence in the abdominal cavity zones; The expediency of using the ultrasound indicator "free fluid in the abdominal cavity < or >500 ml" in choosing the tactics of surgical treatment of patients with closed abdominal injury is substantiated; an algorithm for choosing surgical tactics for the treatment of patients with closed abdominal trauma was developed based on an ultrasound assessment of the volume of free fluid in the abdominal cavity.
Implementation of research results. Based on the results of a scientific study to improve the diagnosis and surgical treatment of patients with closed abdominal trauma:methodological recommendations "The choice of tactics for surgical treatment of closed abdominal trauma based on ultrasound assessment of the nature and severity of the injury" have been developed (certificate of the Ministry of Health No. 8n-z/1282 dated November 15, 2022). The proposed recommendations made it possible to increase the effectiveness of the diagnosis of intra-abdominal injuries in patients with abdominal trauma;
The results of scientific research on improving the diagnosis and surgical treatment of patients with closed abdominal injury have been introduced into medical practice, including the clinical practice of the Republican Scientific Center for Emergency Medical Care and its Samarkand, Surkhandarya and Navoi branches (conclusion of the Ministry of Health No. 8 n-z/699 dated December 21, 2022). The introduction of the obtained results into clinical practice allowed to improve the quality of high-tech surgical care provided to patients with isolated and combined abdominal injuries, to reduce the frequency of postoperative complications from 11.9 to 3.1% (p=0.144).
The structure and volume of the dissertation. The dissertation consists of an introduction, 4 chapters, conclusions and a list of cited literature. The volume of the text material is 107 pages.
The paper analyzes the features of transport injury in children, depending on the mechanism of injury. Children who were injured inside a car in an accident: "child passengers" and "children behind the wheel", were characterized by a relatively high frequency of injuries to the head, nasal bones and lower extremities. Also in this group of patients, damage to the bone, nervous and cardiovascular systems is noted, and in terms of quantity, damage to one or two systems is usually observed.
According to the structure of the severity of injuries, the first or second degree of severity usually prevails. In children who were injured outside the passenger compartment: "children pedestrians" hit by a car, the injury was characterized by a low incidence of head trauma and a high incidence of damage to the nasal bones and lower extremities. It should also be noted in these cases, mainly damage to the bone, respiratory and cardiovascular systems is observed, and in terms of quantity, damage to two or three systems is usually observed. According to the structure of the severity of injuries, the second and third degrees of severity usually prevail.
The aim of the research work is to improve the results of treatment of patients with combined injuries of the pelvis and femur, by developing tactical and technical aspects based on the severity of the injury and the severity of the condition.
The object of the study was 130 patients with injuries of the pelvic and hip bones with concomitant trauma, treated at the Republican Scientific Center for Emergency Medical Aid and its Samarkand branch for the period 2016-2021 years.
The scientific novelty of the research work is the following: the structure and frequency of combined injuries of the pelvis and femur in the general structure of injuries, in the structure of injuries to the pelvis and femur separately were evaluated. the risk factors for the development of unsatisfactory results of treatment of concomitant injuries of the pelvis and hip, based on traditional clinical and diagnostic standards, have been determined; a direct relationship has been proven in the dynamics of the condition of the victims and the prognosis, taking into account the type and nature of segmental injuries; the device for external fixation for stable functional minimally invasive osteosynthesis has been improved and the possibility of expanding the indications for surgical treatment for combined injuries of the pelvis and hip in the early period of traumatic disease has been proved; the technical advantages of a complete set of an improved rod device for external fixation have been proved, the pelvic and femoral versions of which make it possible to use them for effective stabilization of the pelvis and hip separately during anti-shock measures, and for the final reposition of bone fragments; the direct dependence of treatment results on the proposed tactics of providing trauma care at an early hospital stage, depending on the type, nature, severity of pelvic and hip injuries, and the severity of the condition has been proved.
The introduction of research results. Based on the results of scientific research to improve the surgical aspects of providing assistance to victims with concomitant injuries of the pelvis and femur: based on the results of the development of a device for the treatment of fractures, a patent for an invention was obtained from the Intellectual Property Agency of the Russian Federation "Apparatus for the treatment of combined fractures of the pelvic and hip bones" (patent No. 2749897 dated 06/18/2020). The results obtained made it possible to improve the tactics of surgical treatment of patients, to shorten the period of hospitalization and the period of postoperative rehabilitation, to ensure the possibility of patients with minimal economic costs; on the basis of the results of scientific research on the diagnosis and treatment of concomitant injuries of the pelvic and femur bones, methodological recommendations were approved "Method for the treatment of victims with concomitant injuries of the pelvis and hip, depending on the severity" (Conclusion of the Ministry of Health of the Republic of Uzbekistan No. 8 n-z / 288 dated August 31, 2021 of the year). The results obtained made it possible to improve the quality of wound diagnosis and rehabilitation of patients with injuries of the pelvic and hip bones in concomitant injury; approved methodological recommendations "Tactics of rendering assistance to victims with combined injuries of the pelvis and hip, taking into account the severity of the condition" (Conclusion of the Ministry of Health of the Republic of Uzbekistan No. 8 n-z / 288 of August 31, 2020). The results obtained made it possible to improve the tactical and technical aspects in the treatment of injuries to the pelvic and hip bones, based on the severity of the injury and the severity of the patient's condition.
Scientific results have been introduced into the practical activities of healthcare, in particular, the Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Traumatology and Orthopedics, the Jizzakh Branch of the Republican Scientific Center for Emergency Medical Aid, the Samarkand branch of the Republican Scientific Center for Emergency Medical Aid (certificate of the Ministry of Health No. 08-09 / 18979 dated December 02, 2021). The proposed tactics for the treatment of combined injuries of the pelvis and femur made it possible to reduce the incidence of postoperative complications of excellent and good long-term functional results from 66.1% to 92.6%.
The structure and scope of the dissertation. The dissertation consists of an introduction, five chapters, conclusions, practical recommendations, a list of referencesand applications. The volume of the text material of the work is 111 pages.
В структуре черепно-мозговой травмы краниофациальная составляет 6-7%, а от всех видов сочетанной черепно-мозговой травмы – 34%. Частота переломов орбиты при КФТ чрезвычайно высока – до 98%, что связано с особенностью строения глазницы. В 66% повреждения глазницы сопровождаются повреждениями глазного яблока и его вспомогательных органов. Повреждения зрительного нерва при черепно-мозговой травме встречаются в 0,5-5% наблюдений, при краниоорбитальных повреждениях – в 11,2%. Травматическая оптическая нейропатия, тяжелые травмы глаза в 50% случаев могут явиться причиной возникновения стойкой утраты зрения. Последствия травм органа зрения, наличие выраженных косметических дефектов, а также функциональных расстройств нарушают качество жизни больного и влекут за собой стойкую утрату трудоспособности. Краниоорбитальные повреждения в 16-30% остаются не диагностированными даже после проведения компьютерной томографии пациентам с тяжелой черепно-мозговой травмы. В настоящее время остается открытым вопрос о раннем выявлении офтальмологической симптоматики краниофациальных повреждений в остром периоде черепно-мозговой травмы. Несвоевременное и неправильное их устранение может приводить к нарушениям функций органа зрения, тяжелым косметическим дефектам и гнойно-септическим осложнениям.
The aim of the research work is to improve the results of surgical treatment of chronic anterior-medial dislocations of the radial head in children based on the improvement of the method of surgical treatment.
The object of the study was 83 patients with chronic antero-medial dislocations of the head of the radius, treated in the department of the consequences of childhood injuries of the Samarkand branch of the RSSPMC of Traumatology and Orthopedics for the period 2017-2020. The scientific novelty of the research work is the following: it is proved by histological examination that, in case of injuries from up to 1 month ago, the anterior wall of the joint capsule is thin and elastic, which is easily stretched, and from 3 months ago, it thickens, scars and forms fibrous tissue; the possibility of using a fibrous-modified joint capsule for annular ligament plasty in the surgical treatment of chronic antero-medial dislocations of the radial head from 3 months ago was proved; the tactics of surgical treatment of chronic antero-medial dislocations of the head of the radius depending on the deformity of the bones of the forearm were determined; a direct relationship between the results of surgical treatment of chronic antero-medial dislocations of the head of the radius, depending on the duration of the injury, has been proven.
The introduction of research results. Based on the obtained scientific results on the optimization of surgical treatment of chronic antero-medial dislocations of the radial head in children:
based on the results of the development of a method for annular ligament plasty, a patent for an invention was obtained from the Intellectual Property Agency of the Russian Federation “A method for the surgical treatment of chronic anterior medial dislocation of the radial head in children by capsuloplasty according” (patent № 2749870 dated 06/17/2021). The results obtained made it possible to improve the results of surgical treatment, to reduce the period of penetration in the hospital and after the surgical rehabilitation period; based on the results of scientific research on the surgical treatment of chronic anterior medial dislocations of the radial head, the guidelines “Surgical treatment of chronic dislocations of the radial head in children” were approved (Conclusion of the Ministry of Health of the Republic of Uzbekistan 8 n-z / 81 dated February 21, 2022). The results obtained have improved the quality of early diagnosis and treatment of patients with chronic anterior medial dislocations of the radial head in children; based on the results of scientific research on the surgical treatment of chronic antero-medial dislocations of the head of the radius, the methodological recommendations “Conclusion of the Ministry of Health of the Republic of Uzbekistan 8 n-z / 289 of August 31, 2021” were approved. The results obtained have improved the quality of early diagnosis and treatment of patients with chronic anterior medial dislocations of the radial head in children;
Scientific results have been introduced into the practice of healthcare (Conclusion of the Ministry of Health 08-32955 of October 24, 2022), in particular, the Samarkand branch of the Republican Specialized Scientific and Practical Medical Center for Traumatology and Orthopedics, the Bukhara branch of the Republican Scientific Center for Emergency Medical Care, and the Samarkand Regional Children's Multidisciplinary Medical Center. The proposed method for the treatment of chronic anterior-medial dislocations of the radial head in children allowed to reduce the frequency of relapses, increase excellent and good results from 75.6% to 92.9%.
The structure and scope of the dissertation. The dissertation consists of an introduction, 5 chapters, conclusion, conclusions, practical recommendations, a list of references and applications. The volume of the dissertation is 109 pages.
Черепно-мозговая травма - это повреждение черепа и головного мозга различными механическими агентами при травмах. Внезапное повреждение мозга при аварийных ситуациях приводит к необратимым процессам. Диффузное аксональное повреждение — вид черепно-мозговой травмы, возникающий в результате закрытой травмы головного мозга, с повреждением костей черепа. Черепно-мозговая травма является одним из главных причин смерти и инвалидности населения во всем мире.
Ҳаракатланаётган автомобиллар билан тўқнашувлар натижасида вафот этган 140 нафар пиёда-болаларга доир СТЭ хулосалари ва иш материаллари маълумотлари ўрганилиб таҳлил қилинди. Жабрланган пиёд- болалар орасида:ўғил болалар - 91, қизлар - 49. Ёши бўйича: 6-7 ёш - 53; 8-10 ёш - 41; 11-14 ёш - 37; ва 15 17 ёшда - 9 та ҳолатни ташкил этди.
АТнинг ушбу турида жабрланган 140 нафар пиёда - болаларда қўшма бош-мия жароҳатлари- ҚБМЖ (78%), кўкрак қафасининг қўшма жароҳати (ҚЖ) (40,6%), қорин бўшлиғининг ҚЖ (50,2%), умуртқа – орқа мия жароҳати - УОМЖ (25,7%) ва оёқ суякларининг синиши (55%) каби шикастланишлар кузатилди ва мазкур турдаги АТ лари учун хос ҳисобланди (R=0,73), шунга кўра тананинг айнан шу қисмлари жароҳатлари хусусияти асосида жароҳатлар механизмига ойдинлик киритилиши мумкинлиги аниқланди.
Пиёда-болаларнинг оёқ суяклари синишлари жойлашуви ва уларнинг хусусиятлари ўрганилганда, бўйи узунлиги140,0 смгача бўлган 6-12 ёшли болаларда синишлар энг кўп ҳолларда сон суяклари диафизар қисми юқори ва ўрта учлигида қайд этилган бўлса, бўйи узунлиги 140,0 см дан баланд 12-14 ёшдан ошган болаларда синишлар кўпинча болдир суяклари диафизар қисми ўрта ва пастки учлигида юзага келиши қайд қилинди.
По данным ВОЗ, паразитарными инфекциями на земном шаре страдает 4300 млн. человек, от 20 млн. до 1,2 млрд, по различным видам инфекций. Наиболее широкое распространение на территории Узбекистана из глистной инвазии принадлежит - гименолепидозу. Заболеваемость гименолепидозом находилась на уровне 174,8±2,4 на 100 тыс. населения. Минимальный показатель заболеваемости гименолепидозом, равный 160,2, был зарегистрирован в 2003 году, тогда как максимальный, составляющий 183,5, наблюдался в 2002 году. Среди заболевших преобладали дети возрастом от 3 до 5 лет, посещающие детские сады и младшие классы школы, с показателем 529,6 на 100 тыс. населения, и дети возрастом 6-14 лет с показателем 516,4 на 100 тыс. населения. Наименьший показатель заболеваемости был зафиксирован у детей до 1 года (49,8 на 100 тыс. населения) и взрослых (46,8 на 100 тыс. населения). Патогенное воздействие гельминтов на детей состоит из сенсибилизации организма с последующим развитием аллергических реакций, механического повреждения тканей и кровеносных сосудов, поглощения крови, некоторых пищевых веществ, а также инокуляции микробной флоры.
Wounds of the maxillofacial region has several special sighnes that distinguishes from injuries of the remain regions of the human body .This research includes the several dates given about chemical and physical features of the laser and its positive effect on the recovering process of the combinated wounds of the maxillofacial region.
The aim of the research work is determination of the prospects for the use of a domestic agent for the prevention of adhesion formation in thoraco-abdominal surgery on the basis of experimental and morphological studies.
Research objectives were white outbred rats in the amount of 62 individuals, in two experimental studies on the abdominal and pleural cavities, in each series of experiments the studies were carried out in 2 comparative groups, control and main. Experiments on the formation of adhesions in the abdominal and pleural cavities were carried out on the basis of the Republican Specialized Scientific and Practical Medical Center of Surgery named after acad. V.Vakhidov in the Department of Experimental Surgery for the period from 2019 to 2020.
The scientific novelty of the research consists of the followings: it is proved according to the data of experimental research that when modeling the adhesion process in the abdominal cavity, the local application of an anti-adhesion coating made of cellulose derivatives reduces the processes of adhesiogenesis and the development of changes in architectonics, bends and narrowings of the intestinal lumen; it was found in an experimental study that when modeling the adhesion process in the chest cavity, the local use of an anti-adhesion implant provides a significant decrease in the risk of adhesiogenesis in the form of the formation of coarse adhesions or planar adhesions; it was determined that when blood serum was applied over a powder implant, the quality of adhesion and the uniformity of its distribution on the surface of the experimental defect of the peritoneum or lung did not change, but, in contrast to activation by blood (to ensure a hemostatic effect), it was not accompanied by the development of cellular inflammation due to the resorption of thrombotic masses; it was found that the formation of a gel film over the area of damage to the peritoneum in the absence of cellular elements of blood makes it possible to achieve biodegradation of the coating without a pronounced cellular-inflammatory reaction, providing cicatricial replacement of defects with a significant reduction in the risk of developing a massive adhesive process; the morphostructural features of the formation of the adhesive process when using an anti-adhesive coating, characterized by regression in the dynamics of the number of connective tissue cells of the inflammatory infiltrate with scarring of the defect zone without the development of adhesive conglomerates with the surrounding tissues, have been determined.
Introduction of the research results. According to the results of a scientific study on a comparative analysis of the use of a domestic agent for the prevention of adhesion formation in thoraco-abdominal surgery: methodological recommendations were developed: "New technologies for the prevention of adhesions in thoraco-abdominal surgery" (certificate of the Ministry of Health No. 08-09/10055 of August 12, 2021). The proposed recommendations for performing surgical interventions on the organs of the abdominal and thoracic cavities will allow for sparing local hemostasis, as well as prevent the formation of a coarse adhesive process in the abdominal cavity.
The obtained scientific results on a comparative analysis of the use of the domestic remedy for the prevention of adhesion formation in thoraco-abdominal surgery have been introduced into the practical activities of health care, including in the Republican Specialized Scientific and Practical Medical Center for Surgery named after V.I. Academician V. Vakhidov, surgical departments of the clinics of the Andijan and Samarkand State Medical Institutes (certificate of the Ministry of Health No. 08-09/10055 of August 12, 2021). Based on the proposed results of experimental studies, it was shown that the use of an anti-adhesive coating made of cellulose derivatives made it possible to reduce the risk of adhesion formation from 60% to 20%, bowel deformation without manifestations of obstruction from 33.3% to 13.3% and the possibility of acute adhesive intestinal obstruction from 6.7% to 0%.
Structure and scope of the dissertation. The dissertation consists of an introduction, four chapters, conclusions, practical recommendations and a list of cited literature. The volume of work is 113 pages.