Klinichna khirurhiia / Ministerstvo okhorony zdorov'ia Ukraïny, Naukove tovarystvo khirurhiv Ukraïny
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Changes in the hemostasis system in choledocholithiasis, taking into account the obturation jaundice severity and possibility of the correction conduction, using miniinvasive operative interventions, were studied. Dynamic of changes in the hemostasis system in patients preoperatively, in 1 and 3 days after endoscopic papillosphincterotomy were monitored, using the method of a low--rate piezoelectric thromboelastography. Basing on analysis of the results, the changes in hemostasis in obturation jaundice were classified, taking into account its degree of severity, what have permitted to select a correct tactics for prophylaxis of hemorrhagic complications intraoperatively and postoperatively.
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The results of treatment of 157 patients, suffering an acute adhesive ileus (AAI), were analyzed. Indications for laparoscopic and open adhesiolysis were substantiated. There was established, that laparoscopic adhesiolysis is effective in patients in adhesions process (AP) of I - II stages on the height of a seizure. Conduction of laparoscopic adhesiolysis after AAI elimination, using conservative methods in patients with AP I - III stages is effective and constitutes one of prophylactic methods for the adhesions disease recurrence and AAI.
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The rate of the opioids side effects (SE) occurrence, as well as their mutual connection with possible variants of a single-nucleotide polymorphism (SNP) of genes of a μ1-opioid receptor (OPRM1) 118A>G and catechol-O-methyltranspherase (COMT) 1947G>A were studied in patients after surgical interventions of large volumes in the first postoperative day the rate of the narcotic analgetics SE occurrence have constituted: nemesis--56%, vomiting--17%, dizziness--61%, cutaneous pruritis--17%. Occurrence of central SE of opioids may be caused by the SNP COMT 1947G>A genes: the sedation depth is two times more in the genes AA and GA carriers, in comparison with such in the gene GG carrier (p < 0.05). Gastrointestinal SE may be connected with genes SNP OPRM1 118A>G and COMT 1947G>A: the nemesis occurrence rate is more in the genes OPRM1 AG+GG, COMT GA and GG carriers (p < 0.05), vomiting--in 2,8 times more in the OPRM1 AG+GG genes carriers, than in the group OPRM1 AA (p < 0.05). The severity of cutaneous SE of opiates may be dependent on the variant of SNP COMT 1947G>A: in genotype GG the cutaneous pruritis rate is in 2.9 times more, than in the AA+GA group (p < 0.05).
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Clinical Trial
[Application of intravenous total anesthesia in "small" surgical interventions in children].
Results of operative treatment of 458 children, ageing 3 - 15 yrs, using various interventions with intravenous total anesthesia, were analyzed. Application of the anesthesia scheme proposed, consisting of propofol, ketamine and phentanyl combination, have had permitted to guarantee an adequate anesthesiological defense while performance of "small" operative interventions in children.