Khirurgiia
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The treatment results of 1540 patients with the incarcerated hernias of various localization were analyzed. It was revealed, that treatment results depend not only of the patient's age and concomitant diseases and operating time but the choice of surgical access and the type of intestinal anastomosis. The main postoperative negative factor proved to be the increase of the intraabdominal pressure, which severely impairs the lung ventilation. The factor can be excluded by using the prosthetic methods of hernioplasty, though.
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Treatment results of 203 patients with critical ischemia by neuroischemic form of the diabetic foot sindrome were analyzed. 45 patients had open, endovascular or hybrid vascular reconstructions. The method was decised basing on the results of angiographic studies. The support function was saved in 34 (75,6%) cases of 45 operated patients. Revascularization proved to be an effective and reasonable method of surgical intervention by critical ischemia caused by the neuroischemic form of the diabetic foot syndrome.
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210 cases of septic complications after blunt thoracic injuries were analyzed. Pleura empyem was observed in 172 (1,34%) of 12874 patients (overall number of the injuried), lung abscess - in 48 (0,37%) cases, pericarditis was diagnosed in 33 (0,23%) patients, costal and sternal osteomyelitis - in 21 (0,16%) and mediastinitis - in 14 (0,1%), thoracic wall phlegmona in 50 (0,39%) patients. Overall frequency of septic complication was 2,96%. ⋯ Lethality rate was 13,8% (29 patients). Adequate drainage of the wound allowed curation of the majority of patients. Chronic purulent forms, requiring major surgical treatment were registered by the pleura empyem in 9,3%, and by the lung abscess in 10,4%, by costal ostheomyelitis - in 52,4% of cases.
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The comparative analysis of different protocols of infusion therapy of the hemorrhagic shock stage III was performed. The infusion of the colloid solution of hydroxiethylstarch 200/0.5 and non-balanced crystalloid 0.9% solution of natrium chloride leads to the development of negative changes in homeostasis. Whereas infusion of the 4% solution of the modified gelatin and balanced crystalloid solition (sterofundin) allows to avoid the registered changes in electrolyte and alkaline balance.
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64 patients operated on the reason of complex regional hand pain syndrome were examined with the use of laser spectral Doppler flowmetry and thermography. 33 patients had thoracoscopic Th3 ganglion clipation; 16 patients had brachial artery and vein perivascular sympathectomy; 15 patients periarterial sympathectomy on the level of brachial artery. Desympathisation (microcirculatory hemodynamic improvement and trophotropic microcirculation regulatory changes) was mostly apparent after thoracoscopic clipation and perivascular desympatisation in comparison with isolated periarterial sympatectomy.