Subjects of research: 815 patients with the various forms acute pancreatitis, 235 patients with primary erronous diagnosis of acute pancreatitis.
The purpose of research: improve the treatment results of the patients with acute pancreatitis by upgrading existing and developing new diagnostic methods in the treatment complex.
Methods of research: clinical, biochemical investigation.
The results achieved and their novelty. On the basis of the analysis of occurance frequency of various clinical symptoms, diagnostics system of the acute pancreatitis is offered, the criteria of the laboratory and ultrasonic diagnostics for given disease arc advanced, for a quantitative estimation of severity of a condition of the patients the ball scale is offered; the complex conservative therapy is advanced, the technique of realization of long intraarterial catheter therapy is optimized, the optimum indications to realization of retrograd and pcrcutanc endobiliar interventions in treatment of acute biliar pancreatitis arc determined, drainage and sanation of omental bag for open operative interventons is offered, the technique of treatment of the patients in postoperative period is advanced and the algorithm of medical measures is offered at acute pancreatitis.
The developed diagnostic and treatment complex has allowed to reduce frequency of diagnostic errors from 28,4% to 16,8%, to increase efficiency of conservative therapy from 89,8% up to 95,3%, long intraarterial catheter therapy -from 72,0% up to 82,8%, to reduce mortality from 7,4% to 3,4%.
The practical importance. The offered clinical system for diagnostics and the advanced criteria of laboratory diagnostics promote to increase reliability of diagnostics, the systematized ultrasonic criteria allows verify the form of acute pancreatitis. The offered scale of definition of severity of the acute pancreatitis allows quantitatively characterize a condition of the patients, dynamical changes of pathological process and efficiency of used of a complex of medical measures. The advanced complex conservative therapy, technique of realization long intraarterial catheter therapy, definition of the indications to performance retrograd and pcrcutanc endobiliar interventions, advanced draining method and sanation of omentum bag at pancrcanccrosis, combined treatment in postoperative period allow to improve results of treatment of the given category of the patients.
Degree of introduction and economic efficiency: the received results arc introduced into practical activity of surgical branches of second clinics TMA.
Area of application: emergency and abdominal surgery.
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.
According to the World Health Organization, in recent years there has been an increase in the incidence of acute respiratory viral infection. In this regard, the attention of pediatricians and otolaryngologists is attracted by acute stenosing -laryngotracheitis (ASLT). According to the data of many years of research, the number of patients with ASLT ranges from 0.1 to 0.4% of all children hospitalized with a diagnosis of acute respiratory viral infection. The development of stenosing laryngotracheitis in acute respiratory viral infection (AR.VI) dramatically aggravates the condition of sick children, and sometimes the life of a child depends on its attachment to the underlying disease.
Since the first days of independence , large-scale reforms have been consistently implemented in our country in order to improve the quality of medical care for the population . Thus, effective medical care for children ensured timely detection, early diagnosis and treatment of patients with ASLT, which made it possible to reduce the duration of their treatment in the hospital by 3-4 days.
Despite numerous scientific studies devoted to the study of the patterns of the infectious process in stenosing laryngotracheitis, the role of dysbiocenosis of the mucous membranes of the upper respiratory tract, the process of endogenous intoxication (El), which develops as a result of illness in children and its relationship with the course of the disease, as well as the state of the system of local and general immunity dictate the need to improve the methods of their correction in the light of modern requirements. At the same time, the causes of recurrence of acute stenosing laryngotracheitis have not been fully determined; an important task is to develop prognostic criteria for assessing the outcomes of OSLT.
Given the dissertation research to a certain extent serves to solve the problems provided for in the resolutions of the President of the Republic of Uzbekistan No. PP-2133 dated February 19, 2014 “On the State Program" The Year of a Healthy Child ’’and No. PP-2221 dated August 1, 2014 “On the State Program for Further Strengthening reproductive health of the population, protection of the health of mothers, children and adolescents in Uzbekistan for the period 2014-2018”, as well as in other legal documents adopted in this area.
Scientific research aimed at improving the methods of complex diagnostics, treatment and prevention of stenosing laryngotracheitis in children was carried out in many leading medical centers, such as the Schneider Children's Medical Center (Israel), Giessen University Hospital (Germany), St. Mary's Children's Clinic (Germany), Center of Innovative Medicine Interbalkan (Greece), Generale Clinic (Switzerland), Royal Clinic (Great Britain), Queens Medical Center (Great Britain), IDIBAPS Clinic (Spain), St. Luke's Hospital (Japan), Federal Scientific and Clinical Center of Otorhinolaryngology FMBA of Russia (Russia) , as well as the Tashkent Pediatric Medical Institute and the Republican Specialized Scientific and Practical Medical Center for Pediatrics (Uzbekistan).
As a result of the studies, criteria for assessing the risk of occurrence and recurrent course of OSLT were developed, the mechanisms that determine the sensitivity of the respiratory tract were identified (Freiburg Clinic, Germany); established endocrine dysfunction in children with primary and recurrent acute stenosing laryngotracheitis (Children's Hospital, Ireland); the influence of the composition of the microflora of the main loci of the body, connective tissue dysplasia, regulatory systems on the function of external respiration, the formation of threshold sensitivity and reactivity of the respiratory tract in children with recurrent stenosing laryngotracheitis (RSLT) was proved (Melbourne University, Australia).
At present, the goal of many studies in the world is to further determine at the immunomolecular level the role of specific and non-specific factors of immune protection in the pathogenesis of acute stenosing laryngotracheitis; assessment of the state of non-specific protection during OSLT; study of significant changes in the cellular link of immunity, changes in T-suppressors and partially B-lymphocytes; as well as the prevention of relapses and the improvement of methods for diagnosing and treating the disease.
As the analysis of special literature showed, a number of researchers studied the role of the allergic component and the autonomic nervous system in the pathogenesis of the development of primary and recurrent OSLT. According to the results obtained, more than 90% of sick children in the pathogenesis of primary and recurrent acute stenosing laryngotracheitis is dominated by allergic component with the identification of common and allergen-specific IgE . In addition, it has been proven that the development of OSLT in parainfluenza infection is associated with a significant increase in IgE titer and specific IgA in nasopharyngeal secretions in children with ARVI. The mechanisms of OSLT recurrence based on a significant change in the immunological reactivity of the body, which are associated with its allergization by both infectious and non-infectious agents, including adverse environmental, seasonal, meteorological and even social conditions, have been studied. It has been proven that OSLT proceeds with vegetative disorders, which, in turn, have a significant impact on the course and outcome of the underlying disease. An improved treatment of OSLT at the height of the disease is proposed, based on the use of drags, taking into account the type of initial vegetative tone of the body.
Despite numerous works devoted to the study of acute stenosing laryngotracheitis, its diagnosis and methods of treatment, the trend towards an increase in the recurrence of the disease persists, which dictates the need to study the general patterns of the infectious process in stenosing laryngotracheitis, assess the significance of the microbiocenosis of the mucous membranes of the upper respiratory tract, disorders of the immune and interferon statuses and development of ways to correct them, predict the disease on the basis of a prognostic map, as well as improve the effectiveness of treatment and preventive measures.
Subjects of the inquiry: patients with acute intestinal obstruction.
The aim of the inquiry: improvement of treatment results of the patients with acute bowel obstruction by means of the perfection of the methods of intestinal decompression and enteral correction of metabolic disturbance of the organism with nutritive blend “Perative”.
Methods of inquiry: general clinical laboratory investigations, roentgenological studies, statistical technologies, clcctrocntcrography.
Novelty of inquiry: In complex treatment of the patients with acute bowel obstruction the improved intestinal tube has been used for intraoperative decompression of the gastrointestinal tract and it has been demonstrated of its effectiveness. The active intra- and postoperative decompression of the gastrointestinal tract, gut lavage, enteral [tube] feeding effectiveness in complex treatment of the patients with acute bowel obstruction has been proved. The necessity of addition of the complex treatment of the patients with acute bowel obstruction the enteral correction of metabolic disturbance of the organism has been proved and the balanced nutritive blend “Perative” efficacy has been defined.
Practical value: The application of the improved intestinal tube allowed accomplishing of the adequate evacuation of the toxic contents of the gastrointestinal tract and reducing of the enteric pressure. It has contributed to earlier recovery of the all gastrointestinal tract function and it has created the favourable conditions for enteral [tube] feeding. Carrying out of the enteral [tube] feeding with semi - substrate nutritive blend “Perative” has promoted to earlier replacement of the loss of power and plastic material needs. Clinical application of the developed patients management with acute bowel obstruction has promoted to the reduction of the complications rate (from 33,9% to 6,0%) and mortality (10,7% to 0%).
Degree of embed and economical effectivity: The main regulations of the dissertation have been applied in practical work of the urgent surgical department of the second clinic of the Second Tashkent State Medical Institute and it is used in process of 4-6 years students teaching in the Second Tashkent State Medical Institute.
Sphere of usage: urgent surgical help.
Endogenous toxins are protein molecules whose content in the blood is determined by the destruction of cells. Not being normal components of blood plasma, they are subject to elimination from the bloodstream. Due to the accumulation of endogenous toxic substances, endogenous intoxication is a frequent complication of many acute and chronic diseases of the respiratory system. The present study revealed a significant increase in the markers of tubular lesion in children with pneumococcal pneumonia, even against the background of an uncomplicated course of the disease, which reflects the renal link of endotoxicosis syndrome.
Objective: to study the relationship between hematocrit indicators during the first 6 hours after the patient's hospitalization and the development of complications of acute pancreatitis.
Materials and methods. The study included 243 patients with acute pancreatitis. All patients were examined for hematocrit at admission. The multivariate analysis made it possible to determine whether there was a correlation between the presence of hemoconcentration in patients (hematocrit ≥43) at the time of admission with the development of complications of acute pancreatitis. The predictive effectiveness of this marker was estimated by the area under the ROC curve.
Results. Severe acute pancreatitis was observed in 36 (14.8%) patients. Average hematocrit values were 43.2 ± 6.4% (P0,01). In the first 6 hours after admission, hemoconcentration was observed in 72.2% of patients with acute pancreatitis who later developed complications of this disease.
Acute appendicitis is a common surgical emergency characterized by inflammation of the appendix. While the condition primarily affects the appendix, it can lead to systemic effects and potential complications. The liver, being an important organ involved in various metabolic processes, may be affected by the inflammatory response associated with acute appendicitis. This study aims to evaluate the impact of acute appendicitis and its complications on liver function test parameters. Liver function tests (LFTs), including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin (TB), and direct bilirubin (DB), were measured in patients diagnosed with acute appendicitis. The LFT results were compared between patients with uncomplicated appendicitis and those with complications such as perforation or abscess formation. Statistical analysis was performed to identify any significant differences in the liver function parameters between the two groups. The findings of this study provide insights into the potential effects of acute appendicitis and its complications on liver function, which may aid in the early detection and management of hepatic abnormalities in patients with this condition.
Viral hepatitis (VH) belongs to the category of infectious diseases of the human body that develop under the influence of viruses, which are diverse in nature, in the ways of their spread and transmission from a patient to a healthy person and have one identical attribute - liver damage. VG is an atroponous infection, which means that their pathogens in natural conditions can only be present in the human body.
In hepatitis of viral origin, pathogens have a selective similarity (tropism) to liver cells. For this reason, the early location of viruses and their replication (reproduction) are manifested mainly in the liver tissue, primarily in liver cells (hepatocytes).
According to the nature and duration of development, hepatitis of viral origin is divided into acute and chronic. The threshold among these two types of disease is relatively taken into account 6 months from the onset of the disease or in certain patients from the onset of infection (if the disease does not develop) and up to 6 months - acute hepatitis B or acute virus carrier, after 6 months - chronic hepatitis or chronic virus carrier. [4; 8].
According to WHO, in different countries of the world more than 2 billion people are infected with viral hepatitis (VH), while about 350 million are carriers of hepatitis B and 500 million of hepatitis C [3; 5].
All known hepatitis viruses are present in the CIS countries. In relation to parenteral infections of viral hepatitis, the CIS countries belong to the region with a moderate incidence rate (35.2 cases per 100,000 people). In Tatarstan, the share of viral hepatitis "B" and "C" in the total number of viral hepatitis is 80%. According to some authors [1], the number of so-called "virus carriers" of infection is growing in our republic, more than 10,000-12,000 primary carriers of hepatitis B and C viruses are registered annually. However, the registered incidence is only a part of the true incidence and only the visible part of the "iceberg". This is due to the fact that most cases of hepatitis B occur outside the scope of medical diagnosis, without jaundice and with minor clinical symptoms. However, the anicteric form of parenteral hepatitis is less dangerous than the icteric form in terms of infection and consequences [10].
Viral hepatitis B and C belong to the group of viral hepatitis with a parenteral transmission mechanism. These pathogenic viruses are taxonomically distinct. Common features are the parenteral transmission mechanism and the obligatory circulation of the virus in the blood [7].
Viral hepatitis B is a strictly parenteral infection caused by the IIBV virus, including CMV; IIBV is highly resistant to cold, heat, chemical and physical attack. It persists for 3 months at room temperature and 25 years in dried plasma; a direct correlation has been demonstrated between IIBV duration and blood levels. [6].
The source of transmission of the virus (HBV) can be all forms of acute and chronic HBV, as well as virus carriers. More important as the main source of infection for the epidemic potential are chronic forms of HBV infection than acute ones. An important role is played by chronic carriers of HbsAg and patients with clinically icteric form of IIBV; the ability of IIBV to persist for a long time, often for life, in the human body is considered as an ecological form of its existence [3; 5].
The most fully studied artificial (artifacial) ways of HBV infection as a result of various parenteral therapeutic, diagnostic, therapeutic and non-medical manipulations, leading to a violation of the integrity of the mucous membranes and skin. The source of infection can be contaminated blood products, medical equipment and instruments, transplanted organs and tissues; transfusion of blood or blood products containing HBV can also cause infection (post-transfusion hepatitis) [8; 11].
In addition to medical procedures, non-medical parenteral injections are of paramount importance in the transmission of IIBV infections. This is especially true of intravenous administration of drugs, which has become widespread in recent years. According to a number of authors [2], it has been shown that in recent years there has been a rapid increase in the number of patients with acute viral hepatitis "B", which is associated with the use of intravenous drugs, and a quantitative increase in the incidence is observed among young men aged 15 to 30 years. . Below is a list of the most common causes of acute viral hepatitis B.
The purpose of this study is to substantiate the functional features of periodontal tissues in chronic hepatitis B, C and mixed infection B + C.
Aim of the work: assessment of laboratory characteristics in patients with type 2 diabetes, depending on the risk of developing CI-AKI.
Materials and methods: The study included 56 patients with type 2 diabetes, the average age of the patients was 58 years, the CG consisted of 20 healthy volunteers. In most patients, the reason for which the endovascular radiopaque procedure (EVRCP) was performed was associated with atherosclerotic lesions: coronary artery disease, chronic lower limb ischemia (CLLI), atherosclerosis of the brachiocephalic arteries (BCA). EVRCP was performed on the vessels of the coronary basin, BCA, abdominal aorta and its branches, lower extremities. A retrospective analysis included a comparative analysis of two groups of patients with type 2 diabetes who underwent EVRCP: 29 patients who developed CI-AKI (CI-AKI+ group) and 27 patients in whom the post-procedure period was uneventful.
Results: The CI-AKI+ and CI-AKI- groups did not differ in nosological distribution: in both groups, half of the patients with EVRCP were performed due to the presence of coronary pathology (51.72% and 48.15%, respectively), the rest in patients it was comparable for CCI and CVD (27.59% and 20.69% in the CI-AKI+ group and 25.93% each in the CI-AKI- group).
Conclusion: Thus, based on the results of this study, it was possible to identify risk factors for the development of CI-AKI in patients with DM in the post-procedure period and to develop a scale that allows identifying DM patients predisposed to the development of CI-AKI as a hospital complication of endovascular interventional procedures, which is especially often observed in patients with DM.