Khirurgiia
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The authors discuss the surgical tactics in multiple burn contractures of the palmar surface of the hand from experience in the treatment of 45 patients. The operation is conducted in one stage, with the manipulations performed in a definite order, which makes it much easier. ⋯ Plastics with trapeziform grafts in combination of the palm. Plastics with trapeziform grafts in combination with free skin grafting makes it possible to correct all contractures in one stage and restore the function of the hand.
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The authors had 21 patients with a rare disease, Madelung's lipomatosis. Vegetative disorders of segmental and suprasegmental levels were revealed in all patients. ⋯ The accompanying secondary scalenus syndrome produces a peculiar clinical picture of neuropathy. The existence of neurological disorders dictates the need for complex (surgical and medicamentous) treatment of patients with Madelung's lipomatosis.
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Comparative Study Clinical Trial
[Substantiation of the thoracic duct drainage in diseases of the liver and biliary tract].
Morphological study of the hepatic lymph vessels in 16 patients with diseases of the liver and biliary tract and the thoracic duct in individuals of different ages showed that the number and diameter of the lymphatic vessels and the diameter of the thoracic duct increase in the phase of inflammation, Proliferation of connective tissue in cirrhosis reduces the number of lymph vessels, induces valvular incompetence in the thoracic duct attended by ascites. Sixteen patients with diseases of the liver and biliary tract underwent operation for drainage of the thoracic duct. Biochemical parameters and the flow of lymph indicated that the diminished lymph issue is attended on the second day by decrease of the intoxication indices by one third, which is revealed by endotoxin--bile acids, bilirubin, the liver reduces in size and pruritus disappears. The results of the study substantiate the operation for drainage of the thoracic duct and show its importance as a method for the prevention of hepatic insufficiency and for detoxification.
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Perfection of firearms led to injuries of a more severe character and, consequently, to increased frequency of wound infections and to their poorer clinical course. In view of which the role of secondary surgical debridement for the removal of the suppuration substrate increases as the most effective method for the treatment of infection-purulent complications of gunshot wounds. However, to gain good results in this case the principles of surgical debridement of gunshot wounds must be strictly followed. Only with adequately accomplished secondary surgical debridement will the other additional surgical and therapeutic measures produce a good effect on the purulent wound and on the organism of the injured person.
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From experience in the treatment of 18 patients with Madelung's lipomatosis the authors suggest a system of designation of the spread of the disease embracing the possible localizations of the tumor. The system of recording the spread and marked character of the adipose tumors makes it possible to appraise the developmental stage of the disease. It is suggested that 4 stages of the disease are distinguished. ⋯ Systemic designation and the form of the tumor give a more complete idea of the disease and thus allow the optimal tactics of surgery to be chosen. Among the numerous terms suggested for the disease, the most appropriate, reflecting the essence of the disease is "Madelung's lipomatosis". The authors suggest it for unification of the designations of the disease and easier literature search and generalization of information on this rare disease.