Pelvic organ prolapse (PTP) - pelvic floor and organ omission syndrome pelvic floor in isolation or in combination, which is extremely negatively affected by the quality of life of patients. According to world data, between 2.9 and 53% of women report some form of PTP. Up to 47% of pelvic organ prolapsed patients are women of working age. According to the Women Health Initiative Study, among 16,616 women of perimenopaus age, the incidence of uterine prolapsed was 14.2%, cystocele was 34.3%, and reconcile was 18.6%. In most cases, PTP is almost asymptomatic, which indicates its greater prevalence in the population.
Swap and domino organ transplantation represents a groundbreaking approach to address organ shortages by facilitating organ exchanges among incompatible donor-recipient pairs or utilizing organs from deceased donors to trigger multiple transplant chains. This paper explores the socio-cultural and political implications of swap and domino organ transplantation, transcending traditional boundaries and challenging existing norms in the field of organ donation and transplantation. Through a multidisciplinary lens, it examines the ethical considerations, legal frameworks, and societal attitudes surrounding swap and domino transplantation, highlighting both the opportunities and challenges inherent in this innovative approach. By fostering collaboration and cooperation across sociocultural and political divides, swap and domino transplantation offers a promising pathway to expand access to life-saving organ transplants and promote global health equity.
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.
Relevance of the problem. The difficulties of diagnostics of orbital diseases are well known. Especially difficult is intraspecies differentiation among the multitude of tumour, pseudotumour, inflammatory, vascular, endocrine and other diseases occurring here, manifested by the symptom complex of unilateral exophthalmos [Beradze I.N., 1978; Brovkina A.F., 1993].
Malignant intraocular neoplasms are the main cause of death of patients with diseases of the organ of vision, with 45-48% of patients dying from metastases in the first 5 years after enucleation [Alekseeva I.B., 1990, Barkhash S.A.1978, Brovkina A.F..1991, 1997; Keizer R.W.. Viclvoyc G.L.,1986],
Retinoblastoma is the most frequent malignant neoplasm in children. According to different authors, the frequency of its occurrence is 1 case per 14000 - 35000 newborns. [Bobrova N.F. and Vit V.V., 1993; Brovkina A.F., 1997; Provenzale J.M., et al., 1995; Skulski M., et al., 1997; Weber A.L., Mafee M.F, 1992; Wilms G., et al., 1989]. The frequency of patients with the most malignant intraocular tumour in adults - uveal melanoma has recently reached 7-9 people per 1 million population [Brovkina A.F., 1997; Kotslyansky E.O., 1989; Yushko N.A., Peskova L.I., Kalenich L.A., 1989; Peyster R.G., Augsburger J..I., Shields J.A., 1988; Romani A.. Baldeschi L., ct al 1998; Scott I.U., 1998].
The fundamental difference in treatment tactics, depending on the stage of development, size and topography of the tumour, as well as the seriousness of the prognosis in retinoblastomas and melanomas sharply increase the requirements for the accuracy of their differential diagnosis. At the same time, the number of diagnostic errors in ocular tumours continues to be 10-30% even when complex clinical and instrumental examination is applied in specialised ophthalmological centres [Ternovoy S.K., Panfilova G.V., Rogozhin V.A., 1979; Friedman F.E., Malyuta G.D., Kodzov M.V., 1995; Song G.X., 1991].
Widely used in ophthalmological practice traditional diagnostic methods (ophthalmoscopy, gonioscopy, diaphanoscopy, fluorescence angiography, laboratory tests) are insufficient to obtain comprehensive information about the localisation, nature of growth and prevalence of volumetric pathological formations of the eye and orbit. This circumstance and not quite satisfactory results of surgical treatment are the causes of high mortality of patients [Muratova T.T., Nigmanova N.H., Kozlovskaya G.M.. 1989, Naches A.I., 1980; Cheremisin V.M., Trufanov G.E., Kholin A.V., 1991]. Untimely or erroneous recognition of pathological processes of the orbit leads to a sharp deterioration of visual functions, up to blindness, and in some cases to the death of the patient [Yuzhakov A.M., Travkin A.G., Kiseleva O.A., 1991]. All this determines the importance of timely and accurate diagnosis of diseases of the orbit, on the one hand, and the difficulty of such diagnosis - on the other [Gabunia R.I., Kolesnikova E.K., Tumanov L.B., 1982].
The fact that the orbit is closed from direct inspection and palpation by bone walls and the eyeball, indicates the advantage of radial diagnostics in comparison with other methods of examination. In the arsenal of clinicians there is a great variety of methods of clinical-radial diagnostics of orbital pathology, however, at present the information in the literature about their resolving capabilities and significance in comparative aspect is incomplete and not fully studied. The priority of using one or another instrumental investigation, their sequence and expedient combination have not been determined yet. This makes it difficult to choose the optimal standardised approach for diagnosis and adequate treatment [Cheremisin V.M., Trufanov G.E., 1993, Weber A.L., Sabates N.R., 1996; Wenig V.M., Mafee M.F., 1998].
Thus, the study of these and other questions, contributing to the improvement of diagnostics and treatment of patients with neoplasms of the eye and ocular cavity, should be recognised as urgent urgent.
Purpose of the study. Comparative evaluation of magnetic resonance tomography capabilities and development of algorithms for complex radial diagnostics of volumetric formations of the visual organ. To solve this goal we set the following tasks.
1. To study the normal picture of the magnetic resonance image of the visual organ in comparison with other methods of visualisation.
2. To find out the possibilities of magnetic resonance tomography, ultrasound and computed tomography in detection and evaluation of intraocular neoplasms.
3. To determine the role and place of magnetic resonance tomography in differential diagnostics of volumetric pathological formations of the eye cavity in comparison with other radial methods of research.
4. To determine the indications and to develop an algorithm for the complex application of radiography, ultrasound, computer and magnetic resonance tomography for diagnostics of volumetric formations of the eye organ.
Scientific novelty.
The present work is the first to give a detailed and detailed description of the complex clinical and radiation examination, with generalisation and standardisation of magnetic resonance, computer and ultrasound semiotics of volumetric pathological formations of the eye and eye cavity. The conducted clinical and instrumental investigations allowed to determine the diagnostic value and resolving capabilities of each of the applied methods. The ultrasound, CT and MRI signs of volumetric formations of the eye organ were studied, clarified and supplemented taking into account the use of low-field magnetic field and general-purpose ultrasound apparatus. The developed standardised diagnostic algorithm of examination of patients with this pathology is new, thanks to which the pre-oppositional diagnosis of tumour and other diseases of the visual organ is improved and the total radiation load on the patient is reduced.
Conclusions
1. MPT will provide an opportunity to study the weight of the soft tissue and anatomical components of the ocular cavity, up to the optic nerve sheath and perineural liquor space, the orbital apex and chiasmal-sellar region, as well as to assess the condition of adjacent structures of the brain and facial skull. The method is limited in the evaluation of changes in the bony walls of the orbital cavity.
2. MRI is inferior in detecting characteristic signs of retinoblastoma (presence of calcification). The sensitivity of MRI was 66.6%, while for ultrasound and CT these values were 96.1 and 100%, respectively. But when the tumour spreads rstrobulbarly outside the eyeball (at 3-4 stages) the informativeness of MRI increases significantly. In uveal melanoma the sensitivity and specificity of MRI reaches 100%.
3. Both MRI and CT have a high detection rate (98.1% and 95.8% respectively) of benign orbital tumours of both primary and secondary origin. However, MRI is the preferred method of investigation. MRI is especially informative when a cranioorbital tumour and pseudotumour are suspected. The sensitivity of the method is 90.9% and 91.6%, respectively
4. In some cases ultrasound can be used to differentiate between encapsulated and diffuse neoplasms, which facilitates the diagnosis. However, when the pathological process is localised near the orbital apex, the diagnostic value of ultrasound decreases. In such cases it is advisable to use MRI.
5. In detection of primary and secondary malignant tumours of the orbital cavity both MRI and CT are quite informative (sensitivity 97,2% and 95,4% respectively), but the most comprehensive information about the state of bone walls will be provided by CT. When the process spreads intracranially, the value of MRI increases significantly, especially with the use of contrast enhancement.
6. The developed algorithm of complex clinical and radiation examination of patients with the use of ultrasound, CT and MRI is the most effective in the diagnosis of volumetric pathological formations of the eye and eye cavity, allowing to reduce to an adequate minimum the total radiation load on the patient and diagnostic period, excluding duplication of research techniques and choosing the most informative in each case, which in turn allows to develop appropriate treatment tactics and reduce the level of disability of the patient.
Parenteral nutrition (PN) is the most complex and technological variant of clinical nutrition, carried out by intravenous administration of nutrients into the body. It is intended for patients in whom it is impossible or insufficient to use other methods of nutrition and occupies the highest level in the hierarchy of clinical nutrition options, since it is considered the most difficult both in terms of technique and in terms of the variety of decision-making when prescribing it in clinical practice in the most difficult contingent of patients. . One of the main causes of death in patients with multiple organ failure is the development of an immune and inflammatory response. A number of studies have shown a decrease in the severity and incidence of septic complications in patients on enteral nutrition, after severe mechanical and thermal injuries, after major surgical interventions, it also allows you to maintain and maintain the barrier function of the intestine, which prevents the translocation of microflora. Based on the foregoing, it can be assumed that enteral nutrition will have a positive effect on the course of multiple organ failure.
To determine the hydrodynamic parameters of the uninjured fellow eye of children with combined injuries of the organ of vision. A prospective analysis of the hydrodynamic parameters of the fellow eye according to Friedenwald was carried out in 18 patients (18 eyes) aged 3 to 10 years 2–3 and 45–50 days after primary surgical treatment (PSD) of a penetrating wound of the cornea, who were hospitalized in the ophthalmological department of the clinic Tashkent Pediatric Medical Institute. Group I included 8 (44%) children with the following diagnosis: “Combined injury of the organ
of vision. Contusion of the eyeball severe. Complex penetrating wound of the cornea. Group II included 10 (56%) patients with complex penetrating wounds of the cornea. 2–3 days after PST of the wound, group I showed a statistically significant increase in Pt by 2.04±0.03 mm Hg. compared with the control group, while 1–2 days after the first measurement and 45–50 days after PST, the indicators decreased, on average, by 4.4±0.02 mm Hg. without the use of antihypertensive drugs. Changes in the hydrodynamics of the eye in children of group II were not statistically significant. The results of the examination of children revealed a transient increase in tonometric intraocular pressure in the paired uninjured eye 2–3 days after PST of a penetrating wound of the cornea with combined injuries of the organ of vision.
The visual organ injuries in diabetes mellltus are an urgent problem-of ophthalmology to investigate. However, in our»Republic the studies of this kind are infriquent and do not use epidemiologic approach. Six hundred patients with diabetes mellltus of types I and II were examined, they being the residents of Tashkent and our examination revealed the visual organ changes. The eye fundus was injured in 83.68% of patients with dieletes. type I and in 84.53% of those with type II, the extent of the eye fundus injury being greater in IDDM (Insulin Dependent Diabetes Mellltus) than in IIDM ( Insulin Independent Diabetes Mellltus). The clinical analysis showed that the frequency of the lens clouding in patients with diabetes mellltus increased with the .age of the patients, duration of the disease and its severity. Me had developed the classification of the injuries of the eve fundus in patients with diatetes mellltus which-allows to choose the proper tactics of treatment and succession of specialists and measures at various stages of the treatment course. The integral assessment of the risk factors of diabetic retinopathy revealed that the risk factors in IDDM and IIDM are similar,but their influence on development of the disease is different. To improve prophylaxis of the retina injuries in patients with dia-betes mellltus-, we selected the following risk groups: "favourable prognosis", "attention", and " unfavourable prognosis". We also developed the criteria of time and frequency of examination of patients in these groups. The analysts of dynamics of morbidity rate for diabetes melli- tus by 2005 showed the further increase of this rate - in 1.4 times. Blindness in patients with I DOU is 5.65% and in those with IIDM - 11.11%. On the basis of the material described above, the neccessery conditions for organising the ophthalmo-diabetic service were formulated.
Purpose. An analysis of complications in case of penetrating injuries of visual organ in children and methods of their elimination.
Material and methods. There were in the follow-up 36 patients (36 eyes) aged from 6 to 14 years with various ocular injuries: boys - 70% of cases, girls - 30% of cases. All children underwent ophthalmic and clinical examinations.
Results. The primary surgical treatment (PST) was performed in all patients at the place of residence in different regions of the Republic. The secondary surgical treatment (SST) was carried out according to the following indications: swelling cataract, filtration of corneal and scleral injuries, local endophthalmitis, iris incarceration, hypotension, secondary glaucoma, sutures failure, torpid uveitis, deformation of eyelids, abruption of lacrimal canaliculi, non-sutured scleral wound, suspect intraocular foreign body, the destruction of the eyeball, suspected intraocular foreign body, the destruction of the eyeball. Causes of PST complications were: the severity of injuries (47.2%), an unskilled first aid (41.7%), a late appeal of patient (47.2%).
Conclusion. As a SST result the inflammatory response was stopped and the eyes were maintained as an anatomical organ in 99.6% of cases, visual functions were preserved in 67.4% of cases. It is necessary to intensify educational work among the population, to improve the quality of emergency eye care and the adequate rehabilitation of patients.
Trauma, particularly traumatic impairment of vision organ, is one of the most common percentage in the structure of diseases. Analysis of structure of traumatic impairments of vision organ was performed among the population of Fergana valley by the using archive materials of hospitals of Andijan. Fergana and Namangan regions for period 2006- 2009yy. Patients with the gender of Male, age of pre-school and school, active working age are the most sensitive for trauma of eyes. In-time diagnostics, primary medical and special ophtalmological aid are actual in the prevention of complication of traumatic impairments of vision organ
Parenteral nutrition (PN) is the most complex and technological variant of clinical nutrition, carried out by intravenous administration of nutrients into the body. It is intended for patients in whom it is impossible or insufficient to use other methods of nutrition and occupies the highest level in the hierarchy of clinical nutrition options, since it is considered the most difficult both in terms of technique and in terms of the variety of decision-making when prescribing it in clinical practice in the most difficult contingent of patients. . One of the main causes of death in patients with multiple organ failure is the development of an immune and inflammatory response. A number of studies have shown a decrease in the severity and incidence of septic complications in patients on enteral nutrition, after severe mechanical and thermal injuries, after major surgical interventions, it also allows you to maintain and maintain the barrier function of the intestine, which prevents the translocation of microflora. Based on the foregoing, it can be assumed that enteral nutrition will have a positive effect on the course of multiple organ failure.
In the treatment of patients with acute surgical diseases, even in the presence of multiple organ disorders and sepsis, prolonged artificial lung ventilation (ALV) through a tracheostomy is often required.