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.
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.
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.
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.
In modern abdominal surgery, one of the current areas for research continues to be the improvement of various options for plastic surgery of postoperative hernias. More than 2,100,000 operations for ventral hernia are performed annually in the world, and 42% of them are postoperative hernias. In recent years, there has been a clear trend toward the expanded use of various types of biological meshes in hernioplasty. “A pooled analysis of seven PCSTAR studies for incisional hernias using retromuscular mesh showed a hernia recurrence rate of 5.7%”[1]. The use of standard surgical interventions such as alloplasty in the onlay position does not solve the problem of early postoperative complications: seroma discharge, mesh migration, adhesive disease, high frequency of hernia recurrence, etc. At the same time, hernia repair with local tissue creates the problem of increased intra-abdominal pressure and late complications in the form of recurrent hernias. “An increase in postoperative intra-abdominal pressure leads to multiple organ failure, then abdominal compartment syndrome, and even death.” [2]. Currently, there is no consensus on the surgical approach for giant postoperative abdominal wall hernias, and therefore the need to continue to develop new technologies and improve There is no doubt about the tactics. In world practice, at present, the most relevant studies continue to be studies aimed at studying the morphological and functional aspects of recurrent postoperative ventral hernias; electron microscopy reveals ultrastructural destructive changes in skin cells, aponeurosis and muscles, which indicates morphofunctional insufficiency of abdominal wall tissues; issues of cell engineering are discussed new innovative materials, experimental studies are being carried out on animals testing the biotechnical properties, texture and elasticity of new polymers, research is being conducted on open approaches with division of the posterior component with the release of the transverse abdominis muscle and a retrograde mesh, robotic operations have begun. Modern aspects of the development of domestic healthcare include many measures aimed at improving the results of treatment of patients with postoperative ventral hernias and associated pathological conditions through the introduction of modern principles of intensive care and surgical tactics. The development strategy of New Uzbekistan for 2022-2026 in seven priority areas includes tasks to improve the quality of provision of qualified medical services to the population[3]. The implementation of these tasks, including by optimizing tactical and technical approaches to the choice of hernioplasty method, as well as the development of methods for the prevention of purulent-inflammatory complications in the field of alloplastic material, is one of the current areas of abdominal surgery and medicine in general, due to the high medical and social the significance of this pathology.
This dissertation research to a certain extent serves to fulfill the tasks approved by the Decree of the President of the Republic of Uzbekistan “On comprehensive measures to radically improve the healthcare system of the Republic of Uzbekistan” No. UP-5590 dated December 17, 2018, the Resolutions of the President of the Republic of Uzbekistan “On measures to transform the surgical service, improving the quality and expanding the scale of surgical operations in the regions" for No. PP-5254 dated October 4, 2021 and "On additional measures to ensure public health by further increasing the efficiency of medical prevention work" for No. PP-4891 dated November 12, 2020, and as well as other regulatory documents adopted in this area. Compliance of the research with the priority directions of development of science and technology of the republic. The dissertation research was carried out in accordance with the priority direction of development of science and technology of the VI Republic “Medicine and Pharmacology”. Review of foreign scientific research on the topic of the dissertation.[4] Research work aimed at improving the quality of therapeutic and preventive care for patients with ventral hernias, carried out by many leading scientific centers and higher educational institutions in the world, including the Department of Surgical and Perioperative Sciences, Umeå University, Umeå (Sweden), Department of Surgery, Kingston General Hospital, 76 Stuart Street, Kingston (Sweden). nada), Department of Surgery, Helsinki University Hospital, Helsinki ( Finland), Service de chirurgie digestive et oncologique, CHU d'Amiens (France), Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Tulsa (USA), Department of Surgery, Howard University College of Medicine, Washington (USA) , Yong Loo Lin School of Medicine, National University of Singapore (Singapore), Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA; University of Calgary, Calgary (Canada), Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia (USA), Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston (USA) , Department of Surgical Sciences, Uppsala University Hospital, Uppsala (Sweden), Department of Surgery, University of Texas Health Sciences Center at Houston, Houston (USA), Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam (Netherlands), Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka (Japan), National Medical Research Center for Surgery named after A.V. Vishnevsky" (Russia), Republican Scientific Center for Emergency Medical Care (Uzbekistan), Tashkent Medical Academy (Uzbekistan), Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov (Uzbekistan).
As a result of studies conducted around the world to increase the effectiveness of alloplasty for postoperative ventral hernias and reduce the risk of complications in the postoperative period, a number of scientific results were obtained, including: it was determined that patients who underwent reconstruction of the abdominal wall have an increased risk of postoperative respiratory failure, understanding the epidemiology of this complication can improve prevention (the Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health & Science University, USA); It has been proven that the larger the hernia, the higher the risk of early surgical complications, including such as respiratory decompensation, since hernias often increase in size over time, delaying surgery can lead to an increase in the size of the hernia and, therefore, a greater risk of complications (CentreforDigestiveDiseases, KarolinskaUniversityHospital, Stockholm, Sweden); it has been shown that the ratio of the hernia volume to the volume of the abdominal cavity <20% is an independent factor in tension-free closure, which justifies the interest in preoperative volumetry to adapt the tactics of surgical care (Servicedechirurgiegénérale, digestiveetendocrinienne, CHU LyonSud, HospicescivilsdeLyon, France); It has been determined that in patients undergoing elective laparoscopic hernia repair, predictors of mortality are older age and certain concomitant diseases: congestive heart failure, pulmonary circulatory disorders, coagulopathy, liver disease, metastatic cancer, neurological disorders and paralysis (Department of Surgery, College of Medicine, University of Oklahoma, Tulsa , USA); Older age, ascites, preoperative renal and pulmonary insufficiency have been found to be independent predictors of 30-day mortality, and in the presence of these risk factors, conservative treatment should be seriously considered (Department of Surgery, University of Kentucky College of Medicine, Lexington, USA); The American College of Surgeons (ACS) Universal Surgical Risk Calculator has been shown to accurately predict thirty-day outcomes, including major complications: venous thromboembolism, medical morbidity, surgical site infection, unplanned reoperation, mortality, and length of hospital stay (Department of Plastic Surgery, Brown University and Rhode Island Hospital, Providence, USA). At the present time in the world, the most relevant research in surgery continues to be the development of new methods of hernioplasty for large and giant ventral hernias, each of which has its own pros and cons depending on the complexity of implementation, the risk of postoperative complications and relapse, large randomized clinical trials are being conducted, comparing existing methods of traditional hernioplasty with laparoscopic access and robotic surgery, which has become increasingly widespread in the last 10 years, a search is being made for new synthetic and biological materials developed for the production and use of composite meshes that have the necessary strength and the ability to prevent fatal local complications in a contaminated environment. However, despite technical advances in this field, no modern hernia repair method or prosthesis meets all the requirements. One of the key problems is that existing synthetic endoprostheses do not have sufficient elasticity, resistance to infection, high mechanical strength and integrity over a long period of time. Further research into these clinical aspects will undoubtedly improve the current understanding of the capabilities of biocompatible endoprostheses and will make it possible to develop an optimal method for their placement during allohernioplasty. The degree of knowledge of the problem. The current period of development of abdominal surgery is characterized by an emphasis on the problems of the effectiveness of introducing new installation methods and techniques for attaching bioprostheses, options for various suture materials to determine the most promising directions for the development of these technologies [5]. Researchers led by BittnerR.[6] (2019) state that a giant postoperative abdominal wall hernia, the maximum diameter of which exceeds 12 cm or the ratio of the volume of the hernial sac to the abdominal cavity more than 20%, is difficult to treat, with a high recurrence rate and a large number of complications. One of the most challenging problems is that after the hernia contents return to the abdominal cavity, postoperative intra-abdominal pressure will increase, leading to multiple organ failure, then abdominal compartment syndrome (ACS), and even death. There is currently no agreement on the surgical approach for these giant incisional abdominal wall hernias. To prevent recurrences, some articles recommend placing the hernia mesh in the sublayer position and or linings (KirkpatrickAW.)[7]. According to CornetteB.[8], to prevent recurrence, it is recommended to place the hernia mesh in a sublayer or underlay position, and to achieve better mesh expansion, a component separation technique (CST) may be a suitable solution, but with a significant risk of complications and recurrence. JensenKK, et al. believe that truly successful giant hernia repair requires effective bridging or augmentation that will prevent recurrence with an acceptable risk of complications[9]. Another pressing issue in abdominal surgery is that patients with incisional hernias are extremely difficult to treat due to a number of factors including obesity, previous hernia repair, previous mesh placement, domain loss, and other variables.
The approach to patients with incisional hernias has changed significantly over the past 20 years due to both advances in mesh technology and surgical approaches. Key factors for successful outcome include modification of risk factors preoperatively, such as smoking cessation and weight loss, selection of mesh appropriate for the type of hernia and planned mesh location, and wide mesh coverage beyond the hernia defect. New techniques such as transabdominal muscle release and component separation with retrograde mesh placement and robotic approaches to abdominal wall hernia are increasingly being used in these patients[10]. Recent years have seen an increase in the number of biological meshes available for abdominal wall hernia repair. Biological meshes typically consist of materials obtained from humans, pigs, or cattle. The rationale for using biological meshes is that they can act as a scaffold for the growth of natural tissues. In addition, there are absorbable synthetic meshes that have properties similar to those of biological meshes, but with theoretically less risk because they are not derived from animal or human material. The choice of mesh for a ventral hernia depends on many factors, which include both the properties of the mesh and its location, for example, whether it should be placed intraperitoneally, preperitoneally, or retrorectus. BaierKF[11](2021) believes that the guiding principle should be to avoid placing uncoated polypropylene mesh in an intraperitoneal location where it may be in direct contact with internal organs. In addition, the type of hernia defect is another risk factor, such as whether the wound is clean or dirty, and whether the repair is performed with a bridge or abutment. Lightweight or biologic meshes to bridge the defect should be avoided due to increased recurrence rates. Holihan JL [12] (2016), Hodgkinson JD [13] (2018) believe that the principle of anatomical restoration to achieve a reliable, tension-free repair with reinforced mesh reduces the incidence of early postoperative complications and late recurrence of hernia compared with bridging mesh. The analysis of the literature concerning the theoretical aspects and clinical experience of using technologies for improving modern synthetic and biological prostheses that can provide a better plastic effect, as well as methods for preventing recurrence of ventral hernias, indicates that this is one of the priority areas in modern abdominal surgery. An unresolved issue remains the choice of the optimal endoprosthesis, which is highly effective and meets international standards for such properties as biological inertness and mechanical strength, as well as the method of positioning the mesh in relation to the layers of the abdominal wall. Considering that many of the allohernioplasty methods used today are not without drawbacks, the current direction is the development of new methods of repair for giant ventral hernias and methods for the prevention of postoperative complications in conditions of a contaminated wound, with justification of their effectiveness in a clinical experimental study. The connection between the dissertation research and the research plans of the research institution where the dissertation was completed. The dissertation research was carried out within the framework of the research work plan of the State Institution “RSNPMCH named after. acad. V. Vakhidov" under the project AL-422105574 "Development of new biocompatible mesh implants made of composite materials for reconstructive surgery of abdominal and diaphragmatic hernias" (2022-2024).
The purpose of the study is to improve the results of surgical treatment of large and giant postoperative ventral hernias by introducing new laser technologies and improving the tactical and technical aspects of surgical treatment. Objectives of the study: to study the structure of immediate complications after various types of prosthetic plastic surgery; to clarify the influence of obesity factors, primary or repeat hernioplasty on the incidence of immediate and long-term complications; to evaluate the role of the immediate complicated course of the postoperative period in the incidence of long-term complications of hernioplasty; to improve the technical aspects of alloplasty for large and giant postoperative ventral hernias (POVH); to improve the technique of photodynamic therapy (PDT) of the wound surface after prosthetic plastic surgery; to study in an experiment the effectiveness of using the proposed technique of alloplasty and PDT; evaluate the morphological features of the condition of tissues during prosthetic plastic surgery using the proposed method; in a comparative aspect, evaluate the clinical effectiveness of the proposed alloplasty options in the immediate and long-term periods. The object of the study was the results of allohernioplasty in 448 patients with extensive (large) and giant POVH, who were operated on at the surgical department of the 1st clinic of the Samarkand State Medical Institute in the period from 2012 to 2021, as well as experimental animals on which the effectiveness was assessed developed a technique for prosthetic repair of postoperative ventral hernias and applied the technique of photodynamic therapy.
The subject of the study is to analyze the effectiveness of the developed alloplasty of postoperative ventral hernias and intraoperative photodynamic therapy in abdominal surgery in experiments and in the clinic. Research methods. To achieve the goal of the study and solve the assigned problems, general clinical, instrumental, biotechnological, experimental, histomorphological, microbiological and statistical research methods were used. The scientific novelty of the study is as follows: it was established that the need for extensive tissue mobilization and, as a consequence, the intersection of lymphatic capillaries during implantation of the prosthesis in the onlay position, as well as the lack of sufficient resorption function of the hernial sac in the inlay position causes a high risk of the formation of clinically significant seromas; It was determined that with prosthetic hernioplasty, along with the volume of the defect, the type of plastic surgery and the degree of obesity, the most significant predictor of the risk of developing immediate complications is the factor of re-intervention in case of recurrent hernia with the presence of a “dormant infection” hidden in the remaining ligature granulomas or scar tissue; the structure and clinical features of the course of long-term complications of hernioplasty for giant and extensive hernias were clarified, taking into account the results of the immediate postoperative period, as well as the option of fixing the prosthesis, primary or repeated hernioplasty and the degree of obesity; the method of surgery for large hernias of the anterior abdominal wall has been improved, characterized by a combination of factors such as the formation of tension-free prosthetic repair, preservation of local resorptive function to prevent the development of fluid accumulations and reducing the risk of infection; the method of preventing the development or progression of wound infection during alloplasty of ventral hernias has been improved, aimed at enhancing the antibacterial effect and stimulating reparative activity through the photosensitizing and photodynamic effect of low-energy laser radiation; It was determined in an experimental model of prosthetic plastic surgery that the proposed method of fixing the prosthesis in combination with the use of the effect of photodynamic therapy through laser radiation helps to enhance reparative processes with a reduced risk of wound complications; It has been proven that all methods of antiseptic exposure and laser stimulation of the wound surface after prosthetic plastic surgery enhance preventive measures against the development of local infection, but are ineffective in the case of an already developed purulent-inflammatory process against the background of the use of alloplastic material. The practical results of the study are as follows: it has been determined that the implantation of synthetic materials for giant and extensive hernias is accompanied by a significant number of wound complications caused by both the surgical technique itself and the reaction of surrounding tissues to a foreign body, requiring improvement of tactical and technical approaches when performing hernioplasty; it was clarified that scar-degenerative changes in the tissues of the aponeurosis in giant and extensive hernias are a predisposing factor to the occurrence of post-prosthetic hernias, especially when implanting the prosthesis in the “inlay” position and, accordingly, require increasing the efficiency of their fixation and engraftment, as well as reducing the risk of developing local complications; it was determined based on the data of an experimental study that the proposed method of alloplasty for large ventral hernias makes it possible to achieve adequate reconstruction of the anterior abdominal wall, reduce the incidence of infection in the wound, and also use a smaller size of prosthetic material; it was determined that the proposed method of tension-free repair of large hernias of the anterior abdominal wall with strengthening of the aponeurosis with a mesh implant allows maintaining physiology, reducing the number of complications, shortening treatment time and reducing the risk of hernia recurrence; It has been determined that the proposed method for preventing the development or progression of wound infection during alloplasty of ventral hernias can reduce the frequency of suppuration, shorten the treatment time and the likelihood of relapse; It has been proven that the use of the proposed tactical and technical aspects of prosthetic repair for postoperative ventral hernias can reduce the incidence of specific complications, reduce rehabilitation time and the risk of hernia recurrence. Reliability of the research results. The reliability of the results is justified by the use of objective criteria for assessing the condition of patients, modern methods of diagnosis and treatment, the correct application of methodological approaches and sets of statistical analysis, methods for solving the problems discussed in the dissertation are based on modern scientific and practical concepts and approaches to the diagnosis and surgical treatment of patients with giant postoperative hernias. Scientific and practical significance of the research results. The results obtained make a significant contribution to the expansion of irradiation of existing ideas about the structure and clinical features of complications of hernioplasty for giant and extensive ventral hernias by identifying the morphological features of the development of a purulent-inflammatory process against the background of the use of alloplastic material, studying predictors of the risk of developing immediate complications, mechanisms for enhancing reparative processes through the use of an improved method of fixing the prosthesis in together using the effect of photodynamic therapy through laser radiation, which made it possible to enhance the antibacterial effect and improve the wound healing process. The practical significance of the study is that, based on the results obtained, the tactical and technical aspects of prosthetic hernioplasty have been optimized, the features of methods of antiseptic exposure and laser stimulation of the wound surface after prosthetic repair have been revealed, enhancing preventive measures for the development of local infection, and the method of surgery for large anterior abdominal hernias has been improved walls, characterized by a combination of factors such as the formation of tension-free prosthetic plasty, preservation of local resorptive function to prevent the development of fluid accumulations, thereby reducing the risk of developing postoperative complications, reducing the frequency of unsatisfactory results, length of hospitalization and the likelihood of relapse. Implementation of research results. According to the results of a scientific study to optimize the tactical and technical aspects of surgical treatment of large and giant postoperative ventral hernias: the “method for plastic surgery of giant hernias of the anterior abdominal wall” has been improved (invention patent No. IAP 2022 0148 dated April 18, 2022). The proposed method of tension-free repair of large hernias of the anterior abdominal wall with strengthening of the aponeurosis with a mesh implant made it possible to reduce the number of complications, shorten the treatment time and reduce the risk of hernia recurrence; the “method for preventing the progression of infection during alloplasty of infected hernias” has been improved (certificate of the Ministry of Health No. 08-32071 dated October 17, 2022). The proposed method made it possible to reduce the frequency of wound purulent-inflammatory complications and shorten the period of rehabilitation of patients after allohernioplasty; methodological recommendations “Tactical and technical aspects of prosthetic repair for large and giant postoperative ventral hernias” have been developed (certificate of the Ministry of Health No. 08-32071 dated October 17, 2022) . The developed recommendations made it possible to optimize the tactical and technical aspects of allohernioplasty in patients with large and giant postoperative ventral hernias; The scientific results obtained were introduced into the practical activities of healthcare, in particular, in the departments of surgery of the Khorezm and Andijan regional multidisciplinary medical centers, the clinic of the Samarkand State Medical University (certificate of the Ministry of Health No. 08-32071 dated October 17, 2022). Improving the tactical and technical aspects of prosthetic repair for postoperative ventral hernias has made it possible to reduce the incidence of specific immediate complications from 40.9% to 15.6%, to reduce rehabilitation time from 8.6±2.7 to 7.1±1.5 days, and also reduce the likelihood of long-term complications from 11.7% to 3.1%. Approbation of research results. The results of this study were discussed at 8 scientific and practical conferences, including 5 international and 3 republican ones. Publication of research results. 26 scientific works have been published on the topic of the dissertation, including 9 journal articles, 4 of which in republican and 5 in foreign journals recommended by the Higher Attestation Commission of the Republic of Uzbekistan for publication of the main scientific results of doctoral dissertations. Structure and scope of the dissertation. The dissertation consists of an introduction, seven chapters, a conclusion, conclusions, practical recommendations and a list of cited literature. The volume of work is 200 pages.
Topicality and demand of the theme of dissertation. In world practice of informatization, systems of electronic document interchange (EDIS) arc considered and introduced last years not only as systems for automation of manage processes but also as high-grade platforms for creation of uniform information field, so borders of their use, certainly, expands and scientists of the world raises interest to them. In researches of leading scientists of infocommunication technologies the demand of problems of authentic gathering, transfer, analysis, coding of information during formation of office-work documents is allocated for getting of effective technologies raising mobility and productivity of EDIS.
Complex measures undertaken by the Government of Republic of Uzbekistan on development of systems of region-territorial automated management and to creation of uniform information field arc directed on wide introduction of information systems, EDIS, databases (DB) on the basis of modern information-communication technologies. In this connection, working out of new methods to intelligent processing of information resources used for improvement of data transfer quality, allowing effectively to find out and correct errors in structure of electronic document interchange with least material and time expenses, differs a special urgency and, at the same time, remains the unresolved theoretical and applied problem having important economic value.
Requirements to information resources and streams of data transmission as the important factor of efficiency and quality of EDIS functioning arc expressed in providing of stability, integrity, safety and authenticity of the information. One of important among factors is the criterion of authenticity of the information, caused by distortion of transferred messages in infocommunication networks because of failures and refusals of means, any handicaps in communication channels, errors of operators, scanning and recognition systems.
Hence, construction of effective systems to control of information authenticity during transfer and processing represents special scientific interest as priority technology of data processing, characteristic for conditions of automated management and electronic document interchange at the enterprises and organizations.
For existing methods, despite of providing the high level of information transfer authenticity, some unsolved questions is typical, and as basic of them it is possible to allocate the following: at development technologies of electronic documents interchange in structure of modern data transfer packages the significant volume of resource is spent for headings, at the same time the most part of information in headings remains constant from package to package during stream of transfer of the whole frame (redundancy of the information arising at it and mechanisms to provide reliability of deliveries consisting, basically, in sending the appropriate message and repeated transfer of packages, - result to additional time and material expenses while errors detection and elimination); code and hardware methods of information transfer control arc focused, mainly, on elimination the transposition mistakes in managing fields of packages; however, at data transfer there arc also distortions in information fields, which frequently reveal as multiple text mistakes.
In this relation, the decision of tasks for providing of information transfer authenticity is reasonable to consider in two aspects.
Solutions of the first type tasks should taken into account errors of the man-operator, scanning and other devices intended for input of the information. These kinds of mistakes make greatest volume of distortions in text and arise at Applied and Representation levels of OSI model (Open System Interconnection reference model).
Solutions of second type tasks, devoted to control of the information reliability, take into consideration the probability of distortions which occur at stages of Transport, Network, Physical and Line of model OSI.
Demand of the dissertation is characterized by the fact that introduction of a wide range of IP-enabled technologies in electronic document interchange is connected to requiring close attention tasks of detection and correction of errors during preparation and processing of documents.
This research work is focused on providing realization of laws of the Republic of Uzbekistan «On informatization», «On electronic digital signature», «On electronic document», «On electronic commerce», «On electronic payments», Decree of the Cabinet of Ministers of the Republic of Uzbekistan № 126 on 05.04.2011 «About measures on installation and use of a single secured e-mail and system of electronic document interchange in the executive office of cabinet of ministers, bodies of government and economic governance, local government».
Following that, the solution of listed tasks requires carrying out the special researches and development connected to creation of methods and algorithms, capable to control the information authenticity in structure of data transfer packages at the expense of use the enclosed redundancy, and able to function in transport environment, eliminating existing lacks. This fact causes necessity of allocation of a special class algorithms for providing of information authenticity on the basis of new type of PR-rcdundancy (property redundancy), defined by depending on properties of processed object.
Purpose of research is development ol constructive methods, models, algorithms and systems of information authenticity control during transfer and processing of the data on the basis of mechanisms used PR-rcdundancy of various nature, and software and algorithmic realization of results for developing technologies of electronic document interchange.
Scientific novelty of disscrtational research consists in the following:
concept, methodology and software and algorithmic bases to construction methods, models and algorithms for the information authenticity control in systems of electronic document interchange arc developed, classes of objects characterized by PR-rcdundancy, applied to provide accuracy, integrity, efficiency, compression, availability of information resources in EDIS arc allocated;
methods and algorithms arc offered for control of information reliability at the expense of use the artificial redundancy on the basis of linear, modular, plane summing mechanisms and definition of belonging to the coded subsets;
methods and software complexes arc developed for control of information reliability at the expense of use the natural redundancy on the basis of algorithms in which procedures of statistical, arithmetic, parsing coding, n-gram structured description, statistical pattern recognition and hashing of text elements arc realized;
for control and correction of spelling mistakes in texts on Uzbek language methods and algorithms arc offered on the basis of models of multilevel morphological analysis and n-grams Grammatik description;
on the basis of enclosed logic criteria, database and knowledgebase in structure of the built-in expert systems methods and algorithms arc developed for the control of information authenticity at the expense of use the structural-technological PR-rcdundancy;
methods arc offered to synthesis algorithms of text information reliability control in interactive system of errors detection and correction for developing technologies of electronic document interchange.
Conclusion
1. Developed in the dissertation constructive methods, models, software and algorithms complexes to control of information authenticity by principles of using of PR-rcdundancy on the basis of concepts of system analysis, control and information processing allow to increase efficiency and productivity of EDIS.
2. The estimation of current state of the theory and practice of code, hardware and program methods of control of authenticity information transfer had shown insufficiency of existing types of redundancy for providing qualitative functioning of EDIS. Principles of use of PR-rcdundancy at electronic documents for working out applied methods, software and algorithmic complexes to providing of information transfer authenticity have allowed to design toolkit of development of existing technologies.
3. Methods of: linear, plane and modular summation; codings by rules of Haffman, Lempcl-Ziv-Velch, Barrousc-Willcr, arithmetic coding, statistical recognition, logic control form methodical bases of use of PR-rcdundancy for expansion possibilities of algorithms and software complexes to providing of the information authenticity during drawing up, transfer and processing of electronic documents texts.
4. Efficiency of developed algorithms is shown and solutions arc got for tasks of control the information authenticity on the basis of criterion of mistakes undctccting probabilities. It is established, that they find up to 92 % of all kinds of mistakes, capable to correct single, double and adjacent transpositional mistakes, in comparison with existing methods reduce labour content and cost of control in 2-3 times if probability of mistakes is accepted as P«4-10-3, and also raise the information authenticity up to three orders.
5. To solving tasks of control and correction of spelling mistakes in Uzbek texts methods, algorithms and systems arc developed included morphological and n-gram structured models. The developed technique of getting frequency characteristics of n-gram on the basis of distortions probability parameters statistics arc applied during systematization hash-codes for parsing coding.
6. Interpolation and extrapolation methods of construction the logic and arithmetic function of statistical recognition arc used for working out algorithms to control of text elements images authenticity. Methods arc developed to control authenticity of alarm characteristics of text elements images in ncuronctworking system to information processing which includes parts of automatic recognition and control of images signals. Methods and algorithms arc realized in the structure system to control of information authenticity for eases when information in EDIS is represented as metatext on the basis of belonging attributes and classification of metatext on fuzzy semantic hypcrnct.
7. Methods and algorithms of the control of the information authenticity, based on methods of dictionary, statistical and hash-codings provide effective applying of the hardware-software environment of parallel computations NVIDIA with use of standard libraries of numerical analysis, optimized data exchange between CPU and GPU for optimization.
8. It is determined that at realization of the system to control of spelling on the basis of developed ways of description and identification of the software shell, treelike representation of n-gramm grammar and architecture of framework Sfinks-4 focused on various language models used PR-rcdundancy, the number of undetected errors and cost of realization considerably decreases, and labour content in comparison with the spelling control system on the basis of morphological analysis decreases twice.
9. Developed simulating algorithms, complexes of software and systems to control of information authenticity on the basis of using PR-rcdundancy have found practical application in systems of: automated organization of educational environment in high schools; adapted data transfer, processing and analysis in infocommunication networks; EDIS of enterprises.
10. The developed software complexes to control the information authenticity in structure of EDIS and computer system of adapted transfer, handling and data analysis arc implemented in real working conditions in the Samarkand branch «UzTelecom» of the State committee or communication, for informatization and telecommunication technologies of the Republic of Uzbekistan and in Joint Venture «Tasty-Fuit». Appropriate certificates confirm cost of economical efficiency of dissertation results.
The purpose of the study is to determine the significance of genetic factors in the development of chronic nephritic syndrome in children and to clarify the features of the clinical course
The оbject of research were 129 children aged 4-15 years who were treated for chronic nephritis in the nephrology department of the Samarkand Regional Multidisciplinary Paediatric Medical Centre.
The scientific novelty of the study is as follows:it has been established that the severity of chronic nephritic syndrome in children is associated with clinical manifestations (gradual development, dyspepsia, abdominal pain) and an increase in the amount of Cystatin C in the blood;for the first time, it was revealed that the development of sclerotic lesions due to increased proliferation in patients with the presence of the MMP-9 (A-8202G) rs 11697325 genotypes in chronic nephritic syndrome leads to a worsening of the clinical course of the disease; established early diagnostic marker MMP-9 (A-8202G) rs 11697325 and its tissue inhibitor TIMP-2 (C536T) rs 11551797 in chronic nephritic syndrome in children in the diagnosis of the disease; for the first time, the prognostic value of the alleles of the MMP-9 (A-8202G) rs 11697325 genes and the homozygous G/G genotype in determining the risk of developing the disease in children with chronic nephritic syndrome has been proven.
Implementation of the research results. Based on scientific results of evaluation of the role of polymorphic genes of matrix metalloproteinase and its tissue inhibitors in chronic nephritic syndrome in children: methodological recommendation “The role of polymorphic genes of matrix metalloproteinase and its genetic inhibitors in the development of chronic nephritic syndrome in children” was developed and approved (reference of the Ministry of Health of the Republic of Uzbekistan No. 8n-r / 554 of 30.02.2022).
This methodological recommendation made it possible to predict the development of chronic nephritic syndrome in children and improve preventive measures; approved and developed on the basis of scientific results of research on early diagnosis and prognosis of chronic nephritic syndrome “Dynamics of clinical and laboratory parameters in nephritic syndrome in children”, (reference of the Ministry of Health of the Republic of Uzbekistan No. 8n-r / 555 of 30.02.2022).
This methodological recommendation made it possible to optimize the diagnosis and treatment tactics for various forms of nephritic syndrome in children;
The results obtained were implemented in the practice of health care, in particular, in the Republican Children's National Medical Center, in the 1st clinic of the Samarkand State Medical University, in the Samarkand Regional Children's Multidisciplinary Medical Center (conclusion No. 8 n-r/324 of 21.06.2022 of the Ministry of Health of Uzbekistan).
The application of the obtained results to practice has made it possible to reduce the frequency of recurrence of the disease in children, prevent complications of the disease, improve the quality of life of patients, diagnose and prevent the disease.
The structure and scope of the dissertation. The dissertation consists of an introduction, 4 chapters, conclusions, practical recommendations. The volume of the dissertation is 120 pages.
The purpose of the study was to determine and evaluate the features of morphological changes in the liver parenchyma of 5-month-old white outbred rats under the influence of anti inflammatory drugs under conditions of polypharmacy.
The object of study for experimental studies was taken 250 white male rats weighing 200-250 g.
The scientific novelty of the research is as follows: polypharmacy of anti-inflammatory drugs negatively affects all parameters of liver structures. Under the influence of polypharmacy, there is a decrease in the absolute mass of the liver, volume and morphological parameters of the liver parenchyma. The decrease in morphometric parameters depends on the number of drugs in polypharmacy; under conditions of polypharmacy, the state of the hepatic capillaries and internal bile ducts, as well as biological membranes, was studied, as a result of which the structural structure of the liver, the development of destruction of the hepatic tissue were studied, and the morphofunctional foundations of this condition were shown.
Implementation of the research results. Based on the obtained scientific results, the morphofunctional characteristics of the liver of rats in the norm and under the influence of polypharmacy were determined:
Approved methodological recommendations: "Methodology for determining the morphometric parameters of the liver during polypharmacy of anti-inflammatory drugs" (Conclusion No. 8n-r / 265 dated 14.03.2022 of the Ministry of Health of the Republic of Uzbekistan) and "Methodology for determining the morphometric parameters of the liver during polypharmacy of anti-inflammatory drugs" (Uzbekistan, Conclusion of the Ministry of Health of the Republic of Uzbekistan No. 8 n-z 180 of 2022), electronic program No. DGU 1038 "Program for studying the comparative characteristics of morphological changes caused by polypharmacy in the liver."
The scientific results obtained in the study of morphological and functional properties and morphometric changes in the structure of the liver under the influence of polypharmacy have been introduced into the practice of the Samarkand branch of the Republican Specialized Oncological and Radiological Scientific and Practical Medical Center of the Samarkand City Medical Association (Order of the Ministry of Health of the Republic of Uzbekistan dated March 14, 2022, 8n-r / 265-No. and conclusion No. 8 n-z 180 of 2022). The implementation of the obtained research data allows developing methods for early diagnosis, treatment and prediction of organopathology by morphological parameters, improving the quality of life and reducing the number of complications.
The structure and scope of the dissertation. The structure of the dissertation consists of an introduction, three chapters, a conclusion and a list of references. The volume of the dissertation was 103 pages.
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.
Актуальность проблемы диагностики и лечения гнойно-воспалительных заболеваний ЧЛО определяется необходимостью дальнейшего изучения и разработки принципиально новых способов прогнозирования характера течения и повышения эффективности лечения. Существующие методы диагностики, включая клинические, не всегда позволяют адекватно отслеживать патологический процесс, что не дает врачу своевременную, эффективную коррекцию лечения больного. В обзоре описаны современные основы комплексного лечения гнойно-воспалительных заболеваний челюстно-лицевой области. Поднимается вопрос о необходимости разработки новых лечебных мероприятий по борьбе с этим заболеванием.
Relevance of the problem.Despite the great successes of angiosurgery, the problem of surgical treatment of abdominal aortic aneurysms does not lose its relevance. World health statistics records a steady increase in the incidence of abdominal aortic aneurysm (ABA). According to L.J. Melton et al. (1984) and L.K. Bickerstaff et al. (1984) in the USA the number of patients with abdominal aortic aneurysm has increased 7 times in 30 years since 1951. In England and Wales, according to F.G. Fowkers et al. (1989) for the same period revealed a 20-fold increase in abdominal aortic aneurysms in men and 11-fold in women. According to the results of multicentre screening studies ABA was detected in 8% of the examined (E.S. Vourvouri, 2001), and in the age group of 64-69 years ABA was detected in 5.7% of the examined, and in the age group of 75-81 years - in 8.9% (R.A.P. Skott et al., 2001). A similar trend is observed in other countries. Accordingly, mortality from ABA is also increasing - aneurysm rupture in a number of countries is one of the ten most frequent causes of death among elderly and senile people (F.A. Lederle et al., 1990)
Currently, planned aneurysm resection has become a recognised standard of radical treatment of ABA patients and the number of these operations is steadily increasing. For example, about 40,000 ABA resections are performed annually in the USA (J.J. Grange et al., 1997). In Sweden during the period from 1987-89 to 1993-95 the number of ABA operations increased 5 times and currently 10 operations per 100,000 population are performed (A.Hallin et al., 2001), although this is 1.5 - 2 times less than the required number. However, postoperative lethality is still quite high and makes 5-7% (A.V.Pokrovskiy et al., 1992; Y.V.Belov et al., 1992; V.V.Vakhidov et al., 1992; A.W. Bradbury et al. Bradbury et al., 1997; A.Hallin et al., 2001).
E.W. Steyeberg et al. (1995) summarised the data of literature on 17238 ABA resection operations and gave an average mortality of 6.8%.
Multicentre studies in five major hospitals in the Netherlands found that only 74% of patients underwent ABA resection without complications; 26% had some complications, 9% of which were severe and 4.1% of which were fatal (G.J. Akkersdijk et al., 1998). Similar results were obtained in the Canadian Cooperative Study (K.W. Johnston et al., 1990). It was established that the peculiarity of complications in the majority of patients was their systemic character (L.L. Lau et al, 2001) The course of the postoperative period is most often complicated by cardiac, respiratory, renal, cerebrovascular, as well as complications associated with thrombosis and bleeding (W.E. Lloyd et al., 1996; R.D. Sayers et al., 1997; J.D. Blankenstein et al., 1998; R. Ayari et al., 1998). Ayari et al., 2001)
The undisputed leadership, without doubt, belongs to cardiac complications, the incidence of which varies from 10% to 20%. Moreover, cardiac complications account for 50-70% of total mortality. Cerebrovascular complications, although not uncommon, account for no more than 1-1.5%, but their mortality reaches 40%. Complications associated with thromboses and haemorrhages in the perioperative period reach 2-5% (M.M.Reigel et al., 1987; K.W.Johnson et al., 1990; N.Franklin et al., 1993; A.A.Milne et al., 1994).
Certainly, a large number of complications after resection of abdominal aortic aneurysms is caused by the initial severity of patients' condition, however, many unresolved tactical and technical issues of patients' preparation for the operation, stage of performance in case of combined lesions of several vascular basins play a practically significant role. Adequate management of the operation itself and the immediate postoperative period is no less important, taking into account the possibility of such dreadful complications as thrombosis and embolism, cerebral and cardiac death. Until now there is no unified complex analysis of the results of treatment of uncomplicated abdominal aortic aneurysms and, accordingly, recommendations for the prevention of possible complications.
All this determined our aim and objectives of the study.
The aim of the study is to improve the results of surgical treatment of ABA by developing an effective system for determining the main risk factors of surgical treatment and optimal surgical tactics to prevent possible complications.
Scientific novelty.For the first time a complex analysis of indications and contraindications to surgical treatment of abdominal aortic aneurysms was carried out
The most significant concomitant pathology capable to lead to formidable complications and lethality during the intervention and in the nearest postoperative period was revealed. Adequate measures of their prevention and treatment were proposed.
The algorithm of surgical treatment tactics for patients with combined pathology of coronary arteries and aortic arch branch lesions was developed
The state of haemostasis system at all stages of reconstructive surgery on abdominal aorta, starting from skin incision to wound closure, was studied for the first time.
Conclusions:
1. The proposed original classification of ABA, based on mutual dependence on the etiology of the disease, localisation, concomitant diseases, clinic and its course, allows to determine the strategy of early diagnosis, to estimate the most significant risk factors, the stage of intervention in combined lesions of adjacent and distant vascular basins and, ultimately, to determine the ways to reduce complications and mortality in patients with ABA.
2. The most informative methods of ABA diagnostics are duplex scanning and computed tomography. Non-invasive diagnostics capabilities are enough to determine the aneurysm size, its relation to the renal arteries, as well as to find out the state of visceral branches and aortic bifurcation. Abdominal aortography is indicated in patients with concomitant arterial hypertension to identify the state of the renal arteries.
3. Significant risk factors in these patients are ischaemic heart disease (44.1%), arterial hypertension (49%), haemostasis disorders (almost 100%).
4. The leading concomitant disease in the development of postoperative complications is ischaemic heart disease. Its share in abdominal aortic aneurysms is 40%. Postoperative cardiac complications reach 14.9%. Diagnostics of ischaemic heart disease should be based on the stage-by-stage detection of coronary lesions and its functional-compensatory abilities.
5. The main complications of the postoperative period after ABA resections are acute heart failure (14,9%), cerebral circulatory disorders (1,5%), acute renal failure (3,33%).
6. When significant coronary vascular channel lesions are detected in patients with ABA, it is fundamental to solve the issue of intervention staging. At 3-4 functional classes of circulatory insufficiency, appearance of new zones of hypo- or akinesia, decrease of ejection fraction below 40%, the first stage should be myocardial revascularisation surgery
7. In patients with combined lesions of brachiocephalic vessels in patients with ABA it is reasonable to assess the cerebral blood flow. In the presence of 70% or more stenosis of VCA, presence of embologenic plaque, bilateral haemodynamically significant stenosis it is necessary to perform carotid artery intervention as the first stage.
8. One of the most difficult problems of reconstructive operations in ABA is the contiguous lesion of renal and visceral branches of the abdominal aorta. The principle is their one-stage reconstruction. The types of reconstruction of these branches should be variable depending on the volume and extent of the pathological process.
9. Patients with aneurysmal lesion of abdominal aorta initially always have significant disorders of haemostasis system. In 30% of patients with occlusive diseases of aorta and its branches in the preoperative period the activity of thrombocytic-vascular link of hemostasis is increased, antithrombotic ability of vascular wall endothelium is decreased and blood rheological properties are disturbed. Activation of fibrinolysis was noted in patients with aneurysmal lesion of abdominal aorta.
10. During the operation for abdominal aortic aneurysmal lesion, after starting the blood flow the level of plasminogen increases additionally by 30%, which is a risk factor for haemorrhagic complications in the perioperative period. On the 1-3 day after the operation there is a significant decrease of blood anticoagulant potential - antithrombin-Sh by 25-27%, protein C by 23-25%. This period is the most dangerous in terms of thrombohemorrhagic complications development.
11. When using standard heparin during the operation there is a consumption of antithrombin-Sh by 30-45% and increase of platelet aggregation by 10%, which is a threatening condition for the occurrence of thrombosis of deep veins of the lower extremities with subsequent TELA. When using fraxiparin during reconstructive vascular surgeries the consumption of antithrombin-Sh and increase in platelet aggregation do not occur, prothrombin time, activated partial thromboplastin time, thrombin time are lengthened insignificantly that testifies to expediency of its use for prevention of thrombohemorrhagic complications.
12. Application of the diagnostic methods proposed by us to detect the main risk factors during the operation and in the nearest postoperative period, use of the algorithm of stage and volume of intervention allowed to reduce significantly the number of threatening complications, thus the lethality decreased 4 times, and the number of non-fatal complications - 4 times non-fatal complications - 1.5 times.
Topicality and demand of the subject of dissertation. In the world lat days chanchcd structures of trauma, increase the number of heavy combined traumas, which resulting in more heavy nature of simultaneous injuries of three , four or more anatomical regions, which creates difficulties in determining of the order of care and surgical tactics in patients with combined traumas of the facial skeleton bones (CTFSB). The syndrome of mutual burdening injuries of various anatomical regions, variety, hcavity and speed of the development of pathological process did difficulty of diagnosis of the CTFSB. Complexity of the clinical picture, features of the progress of post-traumatic shock, the development of traumatic disease cause difficulties which arise in the course of examination of patients and put tasks to the experts to find new ways of developing diagnostic algorithms and early surgical treatment of the CTFSB.
Frequency of CTFSB ranges from 34,8 to 63,3%. Fractures of orbit has been observed with an extremely high frequency (98%) in CTFSB, injury of the orbit is accompanied by damage of the eyeball and its subsidiary bodies has been observed in 66 % of eases. Consequences of eye injuries arc becoming the leading cause of disability and in 50% of eases could cause permanent loss of vision. By reason of death combined trauma take the third part after coronary heart diseases. Frequency of disfiguring defects and deformities of face occurs in 12 and 57%, disability in CTFSB reaches up to 23%. CTFSB, combined with TBI, causes up to 60% of deaths.
The causes of unsufficient results is non-availability of a diagnostic algorithm, which includes the most informative research methods, determining the order of interaction and priority of work of doctors of various specialties in CTFSB.
In some eases, requires specified an indications, character, scope, sequence and timing of surgical interventions, depending of the objective assessment of heaviness of injuries to various anatomical regions, prognosis criteria, the nature and heaviness of life-threatening consequences of combined trauma. The research work earned out within the framework of the achievement of the set by the Decree of the President of Republic of Uzbekistan “About measures on the further deepening reform the health care system” November 28, 2011, № PD-1652, maintenance of high-quality medical aid to the population under modem requirements and standards.In this regard the need for the development of algorithms of diagnosis and early methods of surgical treatment of patients with CTFSB constitute one of the important criteria demand the theme of dissertation.
Purpose of research is improvement of the diagnostic tactics and therapeutic interventions in patients with acute combined injuries of the facial bones according to the severity and location of the injury.
Scientific novelty of disscrtational research consists in the following: revealed the structure and features provide consistent care to patients with combined injuries in Republic of Uzbekistan;
The sequence of diagnostic and therapeutic measures, depending on the patient's general condition with CTFSB first determined by using created CT program "ADIL
developed innovative methods for early reduction and fixation of bone fragments in CTFSB;
identified endogenous factors, affecting on the wound process, disclosed the mechanisms of post-traumatic complications in CTFSB;
proved, that at 2 - 3rd days after the injury occurs the depression of cell and humoral immunity in the blood. Increases the level of proinflammatory cytokines, reduced the level of anti-inflammatory cytokine (in 2,8 at patients with heavy commonl condition. Increased levels of pro - and reducing anti - inflammatory cytokines is a poor prognostic factor in the development of inflammatory complications (bone wound suppuration, osteomyelitis of the jaw bones, soft tissue abscess);
patients with CTFSB at 2 - 3rd days after the injury occurs the depression of the content of protein and micronutrients (calcium, potassium and phosphorus) in the blood, which is a prognostic factor of the development of complications;
a scheme was developed for integrated medical correction of endogenous factors affecting on the development of posttraumatic complications;
1. CTFSB in 100% of cases combined with TBI, in 27.7 % with injuries of skeleton and internal injuries. In the diagnosis and treatment of patients with CTFSB should participate resuscitator, maxillofacial surgeon, neurosurgeon, ophthalmologist, and otolaryngologist. Primary debridement of wounds, reduction and fixation of bone fragments in patients in compensated state should be done within 3 hours after injury, while at subcompensated state - during the first day, and at the decompensated state - within 3 days.
2. With the CT program "ADIL" can determine the overall condition of patients in a short time. The most informative diagnostic criteria arc the general condition of patients, level of consciousness, hemodynamic stability, shock index and temperature gradient. The severity of the general condition of patients is directly dependent on the localization of the fracture of the facial bones. Multiple fractures of the upper and middle areas of the face arc the most serious injury in patients.
3. Patients with CTFSB in compensated and subcompensated state emergency surgical aid and diagnostic procedures should be performed in full volume (maxillofacial surgery, traumatology, neurosurgery, surgery, ophthalmology and otorhinolaryngologist), including the reduction and fixation of bone fragments in the first day. To patients with CTFSB in state decompensated should be performed at least diagnostic procedures, limiting the amount of emergency surgery. Reduction and fixation of bone fragments should be done after the restoration of function of vital organs and systems.
4. The method of choice for the treatment of depressed large bone fragments of facial bones is a titanium distractor, the use of which gives a good clinical and functional outcome.
5. When depressed fracture of the zygomatic arch application of the developed device will allow us to produce reduction and fixation of bone fragments in the early stages (within one day) with a good cosmetic result.
6. At patients with CTFSB in posttraumatic period (7- 14th day.) there arc a deep depression of CD3, CD4 cell composition, humoral factors and secretory immune system, increased necrosis factor CD95, increasing the levels of proin-flammatory (IL-6 ) and a decrease - anti- inflammatory (IL -10) cytokines. On 9-10th day reduced total protein, calcium, potassium and phosphorus in the blood .
7. Reduction of cellular and humoral immunity, increased proinflammatory cytokine and tumor necrosis factor, reducing the anti-inflammatory cytokine , the protein concentration in the blood, calcium, potassium and phosphorus arc predictors of complications.
8. Application of complex drug therapy within the 1-3 days after the injury with the inclusion of immune ( immunomoduline, ribomunil ), enzyme ( Voben-zym ) drugs osteoplastic materials allows to correct the violation of homeostasis, also used to prevent complications.
The purpose of the work: to study and analyze, based on the results of a clinical study, methods of complex treatment of flat feet. Material and methods of research: The research group included 40 children aged 6-7 years. Orthopedic shoes, massage, physiotherapy and drugs for the treatment of this pathology were used for treatment. Results of the study: 10 children participated in the first group of studies. For the treatment of flat feet, children used orthopedic shoes selected by a pediatric orthopedist. Orthopedic shoes allow the foot to develop without deformation due to the presence of a specially designed heel and sole. Orthopedic shoes differ from ordinary shoes by a high top, a hard back, and a polyurethane sole for the formation of a healthy foot
Subject of the inquiry: 298 patients with finn deformations of the larynx and trachea
Aim of the inquiry: early rehabilitation of patients with firm deformations of the larynx and trachea path optimization and creating clinical and pathogenic methods of complex treatment.
Methods of the inquiry: clinical examination, special examination: LOR-examination, endoscopy of air ways, X-ray, CT, MRI of larynx, trachea and bronchus, bacterial examination of larynx and trachea wounds; morphological examination, biochemical methods of examination: lipid peroxidation, antioxidant enzymes, activity of hepatic monooxygenase system (MOS); biophysical methods of examination: исследование electric damage of erythrocytes’ membrane (EDEM), blood viscosity (BV) and blood shift velocity (BSV); cytological examination.
The results achieved and their novelty: In patients with firm deformations of the larynx and trachea, firstly basing on complex investigation clinical and structural-functional parameters revealed pathomorphological changes in neck tissues as chronic inflammation with productive component. Despite, revealed disrupt balance of process lipid peroxidation and antioxidant system, hydroxylic function of liver, decrease of electoral penetrability of erythrocytes’ membrane and aggravate of hemorheology. With this, level of expression of changes depends on clinic form and load disease, correlate with stage of wound healing and after restore of functions of the larynx and trachea gradually becoming normal. Presented classification of the firm deformations of the larynx and trachea, permitting complexly counting etiologic factor and morphological variant of the damage of laryngotracheal tract. In scheme of the pathogenic complex conservative therapy before and after reconstructive operations included medicine, influencing on Hemodynamic, with ability membranotrope action, systemic enzymotherapy, immunostimulators, and correction of the tissue metabolism by laser. Created private and modified methods of reconstructive laryngotracheoplasty in case of cicatricle stenosis of glottic and subglottic parts, bilateral paralyses of the larynx, cicatricle deformations of pharyngolarynx, combination deformations and defects of the larynx and trachea, permitting single stage restore laryngotracheal ways.
Practical value: The investigation of pathogenic mechanism of developing of the firm deformations of the larynx and trachea on data of changes of main functional and metabolic processes will permit not only activating and improving of pathogenic therapy, and forecasting variant of development and course of postoperative period after reconstructive operations.
Use of proposed methods of complex conservative and surgical treatment of the firm deformations of the larynx and trachea allowed to provide whole volume of restoring means in more short time and with less quantity of stage operations, preoperative preparing till 3 days, hospital stay till 14-20 days, surgical operations in 1.9 time.
Degree of embed and economical effectivity: The results of investigation intruded in treatment practice of the First and Second Tashkent Medical Institutes, LOR-clinics of Samarqand territorial children hospital, territorial hospital of Karshi. Materials of the investigation using in study process of LOR - cathedra First Tashkent Medical Institutes during lectures and practice tutorials with students, magistracies, and clinic ordinators. Determined main economic effect in use of proposed complex therapy in connection with reduce of term of treatment and hospital stay (on an average 10 days) and taking off or decreased disability on 67% patients.
Sphere of usage: otorhinolaryngology, surgery, reanimation
This article discusses modern teaching methods. features of the role of education in higher educational institutions. Modern teaching methods allow you to apply all levels of learning. Creative and cognitive activity turns out to be more productive if it is preceded by reproducing and transforming activity, during which students more successfully master teaching techniques.
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.