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Current Issue. Articles

1(61) // 2017





NATO allied joint medical doctrine for vascular injury. Clinical practice guidelines

A. O. Bondarevskyi1, B. M. Koval2, V. M. Rogovskyi3

1 Ukrainian Military Medical Academy, Kyiv
2 O. O. Bogomolets National Medical University, Kyiv
3 National Military Medical Clinical Centre «The Main Military Clinical Hospital», Kyiv

The provisions of the clinical practical guideline of the NATO medical service for the treatment of injuries and injuries of the main vessels integrated into the joint injuries system and the register of injuries are reviewed (revised in 2016). The complexity of the problem is underlined in the conditions of modern combat operations, limited technical and human resources, which requires surgeons to possess the methods of vascular surgery and the ability to make the right decision regarding the provision of reduced or full volume of specialized angiosurgical care. The provisions of the clinical practical guidance of the NATO medical service as a whole can be used in the daily activities of general and vascular surgeons in the treatment of military and domestic vascular injuries. Separate provisions are given considering the analysis of publications in professional publications and own experience in the treatment of vascular injuries. The system of training general and vascular surgeons is needed, in particular, the preparatory period before leaving for medical institutions located in the area of the antiterrorist operation. Attention should be given to the development of technical methods of angiosurgery (access, vascular suture), widely using means of technical study and medical simulation, study in the anatomical theater, in vitro.

Keywords: damage and wounding of vessels, clinical practical guidance, temporary shunting, vascular reconstruction, joint injuries system.

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Original language: Ukrainian

2. Original researches


Statistical characteristic of gun-shot and mine-explosive femur injury during anti-terorist operation

S. O. Korol, B. V. Matviichuk, V. M. Kovalenko

Ukrainian Military Medical Academy, Kyiv

The aim — to analyze the structure of gunshot and mine-explosive wounds of the thigh in victims during the antiterrorist operation.
Materials and methods. A structure statistical analysis of the 979 gunshot and mine-blown wounds of the thigh was performed in 613 persons wounded during the anti-terrorist operation in the east of Ukraine in the period from 2014 to 2015.
Results and discussion. The share of hip injuries in the structure of the military trauma of the limbs was 29.13 %. Isolated wounds were diagnosed in 38.00 % of cases, multiple — in 35.03 %, combined — in 26.97 %. The fragmentation wounds frequency was 86.93 %, bullet wounds — 11.64 %, mine explosive — 1.43 %. Gunshot fractures of the femur accompanied 8.38 % of wounds, extremities detachments — 0.82 %. Most often, the anterior (41.77 %) and external (26.46 %) surfaces of the middle thirds of the femur were affected.
Conclusions. The results of the study should be considered when creating body armor modules to protect the limbs of servicemen.

Keywords: military trauma of extremities, gunshot wounds, hip injuries, bullet wounds, mine-explosive wounds, fragment wounds.

Original language: Ukrainian

3. Original researches


Laparoscopic tension-free framed versus lightweight mesh repair for giant hiatal hernias: early results of prospective randomized trial

. V. Malynovskyi, V. V. Grubnik

Odesa National Medical University

The aim — to research the remote results of the new tension-free framed repair method with lightweight polytetrafluoroethylene graft with peripheral nitynol frame Rebound — Hiatal (MMDI) and two-layer plasty with lighter implant, that is partially absorbed, by original technique for giant hiatal hernias (GHH) during prospective randomized trial.
Materials and methods. The GIANT trial ( NCT01408108, Clinicaltrials.gov) started in July 2013, and patient recruitment was finished in January 2015. Main inclusion criteria: 1) types II and III hiatal hernias, 2) HSA > 20 m2 (intraoperative). Main exclusion criteria: 1) ASA > II, 2) age < 20 and > 80 years, 3) BMI < 16 and > 39 kg/m2, 4) esophageal motility disorders, 5) esophageal peptic strictures, 6) shortened esophagus (intraoperative), 7) Barrett‘s esophagus. Initial enrollment was 50 patients; 2 patients did not match eligibility criteria, 1 patient refused; 47 were randomized in 2 groups: I group — «Sublay» (24 patients), II group — «Tension-free» (23 patients). The groups were statistically comparable in means of demographic and preoperative data. Long-term results were studied in 45 patients within 2-years follow-up period.
Results and discussion. The rate of anatomical relapse was significantly lower in the II group (22.7 % versus 0 %, p = 0.0216). At the same time, esophageal complications were absent in the both groups. Objective data also favored tension-free repair.
Conclusions. The new method of tension-free framed mesh repair for giant hiatal hernias significantly decreases the rate of anatomical relapse compared to sublay partially absorbable lightweight mesh repair, without increasing the rate of esophageal complications. The new method, and The principle of framed repair could be considered as the method of choice for giant hiatal hernias.

Keywords: hiatal hernia, tension-free framed mesh repair, PTFE mesh, nitinol, randomized controlled trial.

Original language: Russian

4. Original researches


Simultaneous abdominal laparoscopic surgery for anterior abdominal wall ptosis in patients with obesity

V. G. Mshalov, O. Yu. Kondakova, R. V. Bondarev, L. Yu. Markulan, S. O. Kondratenko

O. O. Bogomolets National Medical University, Kyiv

The aim — to develop the technique of laparoscopic simultaneous operations in patients with obesity for anterior abdominal wall ptosis correction.
Materials and methods. The study involved 102 patients with obesity, anterior abdominal wall ptosis, comorbidity of the abdomen and anterior abdominal wall, after abdominoplasty and simultaneous laparoscopic abdominal surgery (LS). The average age of patients was 51.2 ± 0.6 years; men were 3 (2.9 %), women — 99 (97.1 %). Concomitant diseases of the cardiovascular system were in 76.5 %. In patients in the comparison group (n = 52) the LS was done in the first stage: laparoscopic cholecystectomy (LCE, n = 46), laparoscopic adhesiolysis (n = 6), hernia and / or diastase m. recti repair and lipodermectomy (LDE) as the second phase. Patients of the main group (n = 50) was operated with laparolifting and pneumoperitoneum at 6 — 8 mm Hg. The first stage was skin-fat flap dissection, and it’s fixing to the horizontal bar. In the second stage the trocar through aponeurotic-muscular layer (under the flap) was set, then laparoscopic cholecystectomy (n = 45) or laparoscopic adhesiolysis (n = 5), the hernia and / or diastase recti repair was performed; and LDE as the third stage.
Results and discussion. In the postoperative the cardiovascular and respiratory complications were observed only in the comparison group — sinoatrial block — in 2 (3.8 %) patients, ventricular extrasystoles with a high graduation class — 3 (5.8 %), pneumonia — 1 (1.9 %). In addition, 2 (3.8 %) patients had a vein thrombophlebitis of the lower extremities and in 2 (3.8 %) — postoperative intestinal paresis. LDE surgical-site seroma was observed in 13.5 % and 14.0 %, hematoma in 1.9 % and 2.0 % patients of group I and II respectively. Infiltration, seroma, troacar wounds festering, abdominal infiltration was observed only in patients of group I, p = 0.019. Trocar postoperative hernia occurred in 5 (9.6 %) of patients in group I.
Conclusions. The developed laparoscopic simultaneous operations technique in patients with obesity, and abdominal wall ptosis allows to avoid intra- and postoperative cardiovascular and respiratory complications, significantly (p < 0.05) lower the incidence of postoperative inflammatory complications from 34.6 to 16.0 %, and trocar hernia from 9,6 to 0,0 % in long term postoperative period.

Keywords: simultaneous operation, laparoscopic cholecystectomy, laparoscopic adhesiolysis, anterior abdominal wall ptosis.

Original language: Russian

5. Original researches


Biliary decompression in patients with pancreatic cancer complicated with obstructive jaundice

A. V. Lukashenko1, O. O. Kolesnik1, N. S. Chona2

1 National Cancer Institute, Kyiv
2 P. L. Shupyk National Medical Academy f Postgraduate Education, Kyiv

The aim — to determine the optimal method of preparing patients with pancreatic cancer complicated by mechanical jaundice, to radical operative intervention.
Materials and methods. A data retrospective analysis of 189 patients prepared for radical surgery for pancreatic cancer complicated by mechanical jaundice was conducted at the clinic in 2009 — 2014.
Results and discussion. Cholangitis I stage have noted in 74 (39.2 %) patients, cholangitis II — in 93 (49.2 %), and III — in 22 (11.6 %). The need to conduct biliary decompression occurred in 125 (66.1 %) patients. Surgical decompression by performing biliodigestive anastomosis was performed in 21 patients (16.8 %) (the preoperative bile duct decompression was carried out in other hospitals in the prehospital phase), antegrade choledochal stenting — in 15 (12 %), biliary decompression by percutaneous transhepatic cholangiostomy — in 89 (71.2 %). Radical surgery (pancreatoduodenal resection) was performed in 74 patients, among them, primary radical surgery for obstructive jaundice and cholangitis I stage after a comprehensive preparation was conducted in seven (9 %) patients without prior biliary decompression; these patients underwent radical surgery without complications and were discharged in satisfactory condition. In the postoperative period after pancreatoduodenal resection, early complications have noted in 22 (29.7 %) patients, one of the patients died. Postoperative mortality rate was 1.4 %.The analysis of 115 patients, to whom radical surgery after biliary decompression was not implemented, showed that the main cause was the main disease progression in 49 (42.6 %) patients (in 34 (29.6 %) patients distant metastases were found, in 15 (13 %) the tumor was locally unrespectable), liver failure progression as a consequence of cholangitis was in 33 (28.7 %) patients. In the 8 (7 %) patients the concomitant diseases in decompensation stage were diagnosed, 25 (21.7 %) patients refused surgery in favor of conservative therapy.
Conclusions. Suggested algorithm of preoperative preparation in patients with pancreatic cancer complicated with obstructive jaundice to complicated radical surgery — gastropancreatoduodenal resection, can be effectively in patients with increased risk of complications.

Keywords: pancreatic cancer, obstructive jaundice, percutaneous transhepatic cholangiostomy.

Original language: Ukrainian

6. Original researches


Surgical aspects of diagnosis and treatment of pulmonary aspergillosis

M. S. Opanasenko, B. M. Konik, O. E. Kshanovsky, O. V. Tereshkovich, V. B. Bychkovsky, L. I. Levanda

SI «National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine», Kyiv

The aim — to present the clinical experience in the diagnosis and surgical treatment of pulmonary aspergillosis to physicians and thoracic surgeons.
Materials and methods. The treatment results of 12 patients with pulmonary aspergillosis were analyzed.
Results and discussion. In 10 (83.3 %) cases the pulmonary aspergilloma was diagnosed, in 2 (16.7 %) patients an invasive aspergillosis was diagnosed using VATS biopsy of the lung. In 7 (70.0 %) cases various radical surgical interventions were performed. In 3 (30.0 %) patients were denied from surgery in cause of significant respiratory failure.
Conclusions. The level of intraoperative complications in patients with pulmonary aspergilloma was 28.6 %, and postoperative — 42.9 %. The effectiveness of surgical treatment of patients with pulmonary aspergilloma was 85.7 %.

Keywords: aspergillosis, aspergilloma, pulmonary resection, thoracoplasty.

Original language: Ukrainian

7. Original researches


Reoperation in management of pulmonary tuberculosis postoperative complications and recurrences

Yu. F. Savenkov1, Yu. F. Koshak2, P. E. Bakulin1, I. V. Korpusenko3, Yu. O. Vasyunin4

1 MI «Dnipropetrovsk Regional Unit of Clinical and Preventive Medicine „Phthisiology“» of Dnipropetrovsk Regional Council, Dnipro
2 MI «Ternopil Regional TB Dispensary» of Ternopil Regional Council
3 State Establishment “Dnipropetrovsk Medical Academy of Health Ministry of Ukraine», Dnipro
4 MI «Kryvyi Rig Regional TB Dispensary» of Dnipropetrovsk Regional Council

The aim — to increase the surgical care efficacy in patients with complicated postoperative course and/or recurrence of pulmonary tuberculosis according to differential tactics, indications, surgery type and extension.
Materials and methods. 210 patients with postoperative complications and recurrence of pulmonary tuberculosis underwent surgical procedure in the period from 1987 to 2016, at the department of pulmonary surgery. 13 patients underwent repeat resection due to local or distant tuberculosis relapse: 33 patients with a full tuberculosis relapse underwent final one- or two-stage pneumonectomy, 10 patients with reticulated lung or pleural empyema underwent 3-stage surgery (thoracostomy with subsequent transsternal occlusion of the main bronchus and pulmonary artery branch and subsequent complete pulmonary resection and suturing of thoracostomy), 25 patients with relapse of limited cavernous tuberculosis who had contraindications to radical surgeries underwent extrapleural thoracoplasty, 94 patients with residual post-resection pleural cavity or encysted pleural empyema underwent different types of thoracomyoplasty, 35 patients with stump fistula after pneumonectomy underwent transsternal reamputation of the main bronchus stump.
Results and discussion. In patients with local or limited tuberculosis recurrence, surgery of choice is lung lobe anatomical resection in conjunction with correcting thoracoplasty (clinical efficacy — 77 %). If pulmonary resection or final pneumonectomy are contraindicated in patients with a cavity in the operated lung, then extrapleural thoracoplasty may be successfully performed (clinical efficacy — 72 %). In patients with full relapse, including cases complicated by pleural empyema, one-or two-stage final pneumonectomy is indicated (clinical efficacy — 82 %). Most attention in the performance of these operations should be given to the main bronchus stump formation to prevent bronchial fistula. After its appearance (in 18 %), half of the patients can undergo transsternal reamputation of bronchial stump. Patients with post-resection of residual pleural cavity without bronchial fistula can be treated with selective (4 — 5 ribs) thoracomyoplasty in 98 % of cases. When the residual cavity complicated by one or more bronchial fistulas, various modifications of thoracomyoplasty may be differentially used according to localization and size of fistula. The main reason for failure in this group of patients is recurrence of bronchial fistula. Patients with main bronchus fistula stump, regardless of the stump length, surgery side, and chest deformation should be managed with median transsternal reamputation at aorto-caval gap.
Conclusions. Surgical treatment of patients with pulmonary tuberculosis recurrent and postoperative complications should be used differentially according to the pathological process nature and stage in the presence of sufficient respiratory and circulatory system functional reserves.

Keywords: relapse of tuberculosis, reoperation, post-resection pleuro-pulmonary complications.

Original language: Russian

8. Original researches


Efficiency of endovenous laser coagulation with end-face fiber for great saphenous vien depending on its diameter

V. G. Mshalov, O. V. Kuzmenko, L. Yu. Markulan, A. O. Burka

O. O. Bogomolets National Medical University, Kyiv

The aim — to determine the largest diameter of the saphenous-femoral anastomosis (SFA) for effective ablation of a great saphenous vein (GSV) using a diode laser with a wavelength of 1470 nm and an end-face fiber.
Materials and methods. The prospective study included 112 patients (81 (72.3 %) women and 31 (27.7 %) men aged 20 to 67 years, mean age 39.03 ± 0.45) with lower limbs varicose veins and a chronic venous disease I — VI class according to the CEAP. Ostial reflux in 71 (63.4 %) spread to the lower third of the thigh, in 24 (21.4 %) — to the upper third of the calf, in 14 (15.1 %) — was total. The diameter of the SFA is from 5 to 21 mm, on average — 11.5 ± 0.3 mm. The severity of chronic venous disease according to the VSS classification was estimated as 10.72 ± 0.57 points. The length of the GSV segment treated with endovenous  laser coagulation (EVLC) was from 7 to 96 cm, the median was 38 cm. The observation period for patients was 1 year.
Results and discussion. Recanalization of GSV occurred in 14 (12.5 %) patients: in 3 cases at up to 5 cm from SFA, in 11 —  7 to 21 cm, on average — 13.6 ± 1.3 cm. GSV recanalization risk after EVLC in patients with a SFA diameter of more than 16 mm was 12.2 times greater than that in patients with SFA diameter ≤ 16 mm (relative risk: 12.2; 95 % confidence interval: 5.2 to 28.9). The severity of the chronic venous disease in patients with SFA diameter ≤ 16 mm decreased by 6.35 times, and with a diameter of more than 16 mm — by 1.39 times.
Conclusions. According to the logistic regression analysis, the limiting (largest) SFA diameter for effective GSV ablation with a diode laser with a wavelength of 1470 nm and an end-face fiber is 16 mm. The annual cumulative GSV recanalization incidence after EVLC in patients with SFA diameter ≤ 16 cm is 5.9 % (with a length of relapsing reflux up to 5 cm), with a diameter of more than 16 mm — 72.7 % (with a length of relapsing reflux more than 5 cm) And the CAD scale index was reduced by 6.35 and 1.39 times, respectively.

Keywords: endovenous laser coagulation, end-face fiber, great saphenous vein, varicose veins.

Original language: Ukrainian

9. Original researches


Enoxaparin in prevention of post-operative complications after laparoscopic cholecystectomy

M. Yu. Nichitaylo, I. I. Bulik

SI «O. O. Shalimov National Institute of Surgery and Transplantology of NAMS of Ukraine», Kyiv

The aim — assess the feasibility of specific prophylaxis of thromboembolic and infectious complications of laparoscopic cholecystectomy.
Materials and methods. A systematic analysis of observations in 60 patients with cholelithiasis after laparoscopic cholecystectomy was done. Two randomized groups of patients were formed: the main group included 26 patients, which in complex conservative therapy (lower limb elastic bandage for surgery and throughout the postoperative period,  blood rheology correction, adequate anesthesia during surgery and in the early postoperative period) used enoxaparin drug (Flenox, PAO Farmak) prophylactic dose of 0.2 ml (2000 anti-Ha IU), which was administered 2 hours prior to surgery and in the same dose for 5 days in the postoperative period and the comparison group — 24 patients, comparable at risk of thromboembolic complications treated with standard therapy without enoxaparin.
Results and discussion. In patients of the main group peristalsis renewed on average 36.0 ± 0.8 h after surgery, and in patients with a comparison group — in 42.0 ± 7.5 h. No thromboembolic complications in patients of the main group were found. In one patient from comparison group the deep vein thrombosis of the right leg was diagnosed on the 3rd day of hospital stay, needed conservative therapy in the hospital for 10 days. Length of hospital stay after surgery in patients of group averaged 72.0 ± 0.7 h, patients comparison group — 96.0 ± 0.5 h. Serviceability recovered an average of 14.0 ± 0.5 and 20.0 ± 0.5 days.
Conclusions. In patients with low risk enoxaparin 0.2 (2000 anti-Ha IU) in prophylactic dose should be used for 2 hours before surgery and in the same dose for 5 days in the postoperative period because the mandatory attribute for laparoscopic cholecystectomy is pneumoperitoneum, intubation anesthesia and Fowler’s position are risk factors of thromboembolic complications in the postoperative period.

Keywords: laparoscopic cholecystectomy, thromboembolic complications, specific prevention.

Original language: Russian

10. Original researches


Blood microcirculation dynamics in patients with severe burns treated with gecoton solution in complex infusion-transfusion therapy

V. I. Nahaychuk

Pyrohov Memorial Vinnytsia National Medical University

The aim — to study the dynamics of blood microcirculation indices in patients with severe burns treated with 5 % Gecoton solution in complex infusion-transfusion therapy.
Materials and methods. Twenty patients with flame burns on an body surface area of 40 — 60 %  were examined. Patients were divided into two groups: the first group included 12 patients, in the complex treatment of which the 5 %  Gecoton solution (Yuriya-Farm, Ukraine) was used at a dose of 15 ml/kg of body weight per day for 6 days, the second — 8 patients, in the complex infusion-transfusion therapy of which Gecoton was not used. Microcirculation parameters were also studied in 30 healthy male volunteers aged 20 to 25 years. In the microcirculation study, LAKK-02 apparatus was used. The dynamics of microcirculation parameters was evaluated. With the help of wavelet analysis, active and passive mechanisms of blood circulation regulation were studied.
Results and discussion. The microcirculation index for the 6th day in the first group was 1.31 times higher than in the second group, the coefficient of variation in both groups was almost the same. Wavelet analysis showed that the improvement in blood microcirculation in the first group was due to a decrease in the tone of the sympathetic part of the autonomic nervous system, which contributed to a decrease in the stiffness of the vascular wall, its dilatation and better filling of the nutritive bed with blood.
Conclusions. The drug Gecoton improves blood microcirculation, transcapillary exchange and tissues oxygenation  due to better blood filling of the nutritional bed and can be recommended for use in complex infusion-transfusion therapy for burn shock and acute burn toxemia.

Keywords: burns, burn shock, hypoxia, infusion therapy, Gecoton, microcirculation, laser Doppler flowmetry.

Original language: Ukrainian

11. Original researches


Hydraulic desobliteration of the infrainguinal arteries in patients with critical limb ischemia

K. V. Miasoiedov

Kharkiv National Medical University

The aim — evaluation of the arterial hydraulic desobliteration method in patients with chronic critical limb ischemia during revascularization.
Materials and methods. The study involved 106 patients operated for chronic critical limb ischemia. Patients were divided into two groups: the main group (n = 53) operated with hydraulic endarterectomy and the control group (n = 54) in which patients undergone classic open endarterectomy. In early postoperative period the operated segment patency, complications, ABI data were evaluated in each group. The histological study of the extracted atherosclerotic masses was performed. The speed parameters of the blood flow in the operated area of the main vessel (CFA mainly) were investigated.
Results and discussion. In postoperative period the ABI data was not significantly different between the two groups: 0.88 ± 0.11 in the main group and 0.85 ± 0.17 — comparison group. Postoperative complications in the main group were not observed. Time from arteriotomy to occlusive substrate secession was approx. 3.3 ± 1.3 and 5.2 ± 1.5 min respectively. Ultrasound Doppler study of the blood flow velocity in the common femoral artery near the wall of the vessel (Vct) (average 65.2 ± 7.7 and 47.9 ± 8.8 cm/s) and its relation to the blood flow velocity along the central axis of the artery (V4) (average 72.1 ± 8.1 and 62.0 ± 8.3 cm/s) showed that in the main group this parameter was higher than in the control group, that indicates the turbulence presence in CFA in the control group.
Conclusions. The proposed hydraulic desobliteration method is effective and forecast in the early postoperative period in patients with critical ischemia, and has a positive effect on the hemodynamic characteristics of blood flow in the desobliterated area.

Keywords: hydraulic endarterectomy, critical ischemia, desobliteration, parietal blood flow.

Original language: Ukrainian

12. Original researches


Photo-selective vaporization of prostate with the 120 W greenlight laser

S. V. Golovko1, O. F. Savytskyi2

1 National Military Medical Clinical Centre «The Main Military Clinical Hospital», Kyiv
2 Ukrainian Military Medical Academy, Kyiv

The aim — to analyse the treatment results in 200 patients with benign prostatic hyperplasia after photo-selective vaporization of the prostate with 120 W HPS-laser.
Materials and methods. 200 cases of treatment with HPS-laser photoselective vaporization of prostate in patients with lower urinary tract symptoms and benign prostatic hyperplasia were analysed. In most patients, the points count by the IPSS scale was more than 16. The conservative treatment was ineffective. The maximum urine flow rate was 10 ml/s, residual urine volume over 50 ml. Prostate volume was 64 — 115 cm3 according to transrectal study.
Results and discussion. The mean duration of catheterization was 1.3 ± 0.7 days, of hospitalization— 2.1 ± 1.6 days. The average amount of used energy was 372.5 ± 28.0 kJ, intraoperative haemostasis was used in 4 patients (2 %), which had a prostate hyperplasia over 100 cm3. Compared to the preoperative data a significant decrease in PSA levels and prostate volume was shown
Conclusions. Photo-vaporisation of the prostate is a safe and effective treatment for patients with lower urinary tract diseases caused by benign prostatic hyperplasia, provides better intraoperative and early postoperative outcomes, a shorter hospital stay length.

Keywords: benign prostatic hyperplasia, photoselective vaporization, laser.

Original language: Ukrainian

13. Original researches


Spontaneous rupture of the splenic artery aneurysm in the early postpartum period. Case report

N. O. Tupchiy

Kyiv Railway Clinical Hospital N 2 of Filial Agency of JSC Ukrzaliznytsia «Health Centre»

The clinical case of spontaneous splenic artery aneurysm (SAA) rupture in a young woman in the early postpartum period is presented. Spontaneous SAA rupture during pregnancy and the early postpartum periods is a rare event and is accompanied by a high percentage of mortality from both the mother and from the fetus. SAA are asymptomatic. Identification of this pathology is difficult enough and as a rule it is a finding for the physician. Identification of this pathology is possible with ultrasound assessment, computed contrast tomography. Limitation of ultrasound diagnostics capabilities depend on the doctor and on the ultrasonic waves attenuation degree passed through the fatty tissue or intestinal gases. It can be quite complex to identity strongly calcified SAA. Standard screening for all pregnant patients is not practical because the SAA detected percentage is low. The various factors etiological role, pathophysiological mechanism, disease course peculiarities, diagnostic measures are considered in the article.

Keywords: pregnancy, splenic artery aneurysm formation, rupture of the splenic artery, bleeding, hemorrhagic shock.

Original language: Russian

14. Original researches


Agenesis of the gallbladder (case report)

I. V. Kliuzko1, V. P. Slobodyanyk2, B. M. Koval3, K. V. Krynychka1

1 PI «Vyshhorod’s Central Regional Hospital»
2 National Military Medical Clinical Centre «The Main Military Clinical Hospital», Kyiv
3 O. O. Bogomolets National Medical University, Kyiv

Agenesis of the gallbladder is a rare congenital anomaly occurring in 13 to 65 people of 100.000 population. The rarity of the condition, combined with lack of clinical and radiologic features means that it is rarely diagnosed preoperatively,and patients undergo unnecessary operative intervention. This case report describes the case of a 54-year-old symptomatic woman who underwent laparoscopic cholecystectomy for suspected chronic cholecystitis, choledocholithiasis. Only intra-operatively during laparoscopy, the diagnosis of gallbladder agenesis and associated common bile duct stones was set. The preoperative diagnosis of this rare condition is difficult task, however, due to surgical circumspection with heightened awareness of this anomaly and advances in biliarytract imaging, patients will avoid an operation that carries a high risk of extra-hepatic duct iatrogenic injury for this biliary tract abnoramlity.

Keywords: gallbladder agenesis, biliary colic, choledocholithiasis, laparoscopic cholecystectomy, sphincterotomy.

Original language: Ukrainian

15. Reviews


Biomedical implants impact on surrounding tissues

K. A. Dzhuma, V. P. Prytula, V. V. Khrapach, A. V. Dinets, O. I. Zakhartseva, V. V. Sulik, O. V. Khrapach

O. O. Bogomolets National Medical University, Kyiv

Clinicians and researchers used biomedical implants in patients and experimental animals. A specific multicomponent response to the foreign device presence that has cells regulation level and ends with the fibroblasts migration to the implant’s surface with the fibrous capsule formation around is identified. This causes capsular contracture and implant migration. Therapeutic tactics, which are used to control capsule formation, and the prospects for further research in this field are analysed.

Keywords: fibrous capsule, breast implants, cellular signalling.

Original language: Ukrainian

16. Reviews


Sepsis and septic shock in patients with deep and extended burns: the modern definition

G. P. Kozynets1, O. Yu. Sorokina2, S. V. Slyesarenko2, G. V. Philip2

1 P. L. Shupyk National Medical Academy of Postgraduate Education, Kyiv
2 SE «Dnipropetrovsk Medical Academy of Health Ministry of Ukraine», Dnipro

Sepsis is considered to be life-threatening condition caused by infection and associated with a high risk of death. The sepsis risk factors group include patients with various skin integrity violations — wounds, burns, skin infections, etc. It is proved that the deep burn area, age of the victim and inhalation lesions associated with the risk of multiple organ failure syndrome, sepsis, and death. The complexity of differential diagnosis between SIRS and sepsis in patients with severe burns is well established. Many definitions and terms used now for sepsis, septic shock, and MOD syndrome, may lead to unclear diagnosis. The new sepsis and septic shock definitions are established in article. The main direction for sepsis and septic shock diagnosis and treatment are introduced.

Keywords: burns, sepsis, septic shock, MOD syndrome.

Original language: Ukrainian

17. Original researches


Modern diagnosis and treatment of visceral artery aneurysm

S. M. Genyk

Ivano-Frankivsk National Medical University

Visceral artery aneurysms are rare clinical findings, and majority of them are incidentally diagnosed on imaging studies during evaluation of patients with abdominal pathology. Splenic artery aneurysms are comparably frequent and mostly is diagnosed during abdominal examination. The most common are gastro-duodenal artery aneurysms, then ones of intrapancreatic arteries, rarest are gastroduodenal, pancreatoduodenal arteries, pancreatic arteries and even less frequent are superior mesenteric artery and celiac trunk aneurysms. The causes of true visceral artery aneurysms are atherosclerosis, fibromuscular dysplasia, degradation of collagen structure and smooth muscle decrease. Arterial pseudoaneurysms can develop after traumatic injury of vascular wall, and as result of iatrogenic injury, infection, inflammation or vasculitis. Clinical presentation of aneurysms is scarce and nonspecific. Patients complain of abdominal pain, different in location and character and abdominal discomfort. In such patients the initial diagnosis usually include the diseases of abdominal organs (acute or chronic pancreatitis, gallstone disease, tumors etc.). Spectrum of diagnostic modalities include ultrasound examination, contrast-enhanced multiphase computer tomography, selective angiography as determination of predictors of aneurismal wall weakness- serum matrix metalloproteinases MMP-2 and MMP-9. Taking into consideration the high risk of aneurysm rupture with life-threatening bleeding, treatment of symptomatic as well as asymptomatic visceral artery aneurysms is mandatory. Selection of treatment modality depends on the severity of patient’s condition, clinical presentation, and also the location of aneurysm and its morphology. Priority is given to endovascular techniques such as exclusion of visceral artery aneurysm from circulation, embolization of aneurysm cavity, arterial embolization distal and proximal to aneurysm neck, endografting and stent-assisted exclusion.

Keywords: visceral artery aneurysms, multiphase computer tomography, matrix metalloproteinase, endovascular treatment.

Original language: Ukrainian

Current Issue Highlights

1(61) // 2017

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Yu. F. Savenkov1, Yu. F. Koshak2, P. E. Bakulin1, I. V. Korpusenko3, Yu. O. Vasyunin4

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