Khirurgiia
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The thoracic ultrasound for the detection of hemothorax and hemopericardium was performed in 655 patients with penetrating thoracic trauma. Ultrasound findings were compared with the results of surgical exploration. Sensitivity and specificity of ultrasound in detection of hemothorax was 72.1 and 90.1%; in detection of hemopericardium - 70.6 and 73.7%, respectively. ⋯ The isolated US investigation in supine position leads to the increase of false negative results. We consider that in hemodynamically stable patients the doutbtfull US data in detection of hemopericardium is the indication to videothoracoscopy. The lower-chest injuries with the US signs of hemothorax are considered to be the indication for VATS except for the obvious left-side thoracoabdominal injuries.
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Data of 379 patients with penetrating thoracic wounds were analyzed. The pathologic changes on X-ray of the thoracic cavity were registered 239 (63,1%) patients: the hemothorax was diagnosed in 44,3%, pneumothorax - in 26,8% and hemopneumothorax - in 28,9%. 154 patients had videothoracoscopic surgery and 225 patients were operated on using traditional open methods. Operative findings were compared with X-ray data. ⋯ Mistakes of interpreting X-ray data in diagnosing of low-volume hemo- or pneumothorax were defined. The computed tomography of the thorax proved to be the most precise means of intrapleural injuries diagnostics. The optimal algorithm of preoperative thoracic X-ray was suggested.
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84 patients with the acute appendicitis, complicated by the appendicular infiltrate were divided in 2 grpups: the first group consisted of 49 (58,3%) patients with periappendicular abscess; the second group included 35 (41,7%) patients, treated conservatively and were recommended the delayed appendectomy. Of all 84 patients, included in the study, the delayed appendectomy could had been performed in 51 (61%) cases, though only 27 (53%) of patients had the procedure. ⋯ The necessity of differential approach to the delayed appendectomy in patients with appendicular infiltrate was determined. The safety and efficacy of the laparoscopic appendectomy by the disease was demonstrated.
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Randomized Controlled Trial Comparative Study
[Antifibrinolitic therapy for the treatment of massive ulcerative gastro-intestinal bleedings].