Hirurg (Surgeon)最新文献

{"title":"Attributable risks of varicose veins in the population of a large region of the Central Federal District of the Russian Federation","authors":"M. P. Potapov, Y. Aleksandrov","doi":"10.33920/med-15-2303-04","DOIUrl":"https://doi.org/10.33920/med-15-2303-04","url":null,"abstract":"The article presents the results of a study of the attributable risks of varicose veins in the population of a large region of the Central Federal District of the Russian Federation. A retrospective study of statistical data from medical documents of patients with a diagnosis of lower limb varicose veins who underwent outpatient treatment in the private medical organization Yaroslavl Phlebology Center «Doktor Ven» from 2015 to 2021 was conducted. The homogeneity of the studied population was assessed by age and time criteria, and the analysis of risk factors for the development of varicose veins recorded by experts in patients with an established diagnosis of I83.0, I83.1, I83.2, and I83.9 according to the ICD-10 was carried out. It is known that the prevalence of varicose veins is at the level of 12–26 % among the adult population. This study made it possible to prove that socio-economic, socio-biological, and medical attributable risk factors are the key factors influencing the excessive incidence of varicose disease, its progression and recurrence. Stratification of risks from the perspective of their management capabilities is the first step towards the development of integrated approaches and measures aimed at preventing the varicose veins disease and reducing its prevalence in the population at all levels: from individual to state level. The analysis of attributable risks without taking into account the uncertainty factor and randomness in the data sample and determining the confidence interval in which the true value of the parameter of the general population is located with a certain degree of probability requires reliability correction. In this regard, further study of the pathoepidemiology of varicose veins using sufficiently reliable statistical research methods is of great scientific and practical interest.","PeriodicalId":437500,"journal":{"name":"Hirurg (Surgeon)","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127717295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of ctenterography and ultrasound elastography in detecting fibrous changes in the intestinal wall in patients with crohn’s stricture","authors":"A. Vardanyan, I. S. Anosov, V. A. Michalchenko, S. Achkasov","doi":"10.33920/med-15-2303-01","DOIUrl":"https://doi.org/10.33920/med-15-2303-01","url":null,"abstract":"The article presents an analysis of the sensitivity and specificity of CT enterography and ultrasound elastography in the diagnosis of a fibrous process in the intestinal wall in patients with the Crohn's stricture. The results obtained showed a very good quality of detection of fibrous changes in the intestinal wall using CT enterography, while US elastography demonstrated the unsatisfactory quality of the method used.","PeriodicalId":437500,"journal":{"name":"Hirurg (Surgeon)","volume":"814 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123252732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On the issue of surgical treatment of highly differentiated thyroid cancer. Case reports","authors":"G. Rodoman, T. I. Shalaeva, N. V. Sviridenko, I. R. Sumedi, P.B. Ustaalieva","doi":"10.33920/med-15-2303-05","DOIUrl":"https://doi.org/10.33920/med-15-2303-05","url":null,"abstract":"The article discusses the modern surgical tactics of treatment of differentiated thyroid cancer, with an emphasis on organ-preserving operations. The clinical cases in which preoperative diagnostics was not able to reveal the extent of tumor spread are presented. Non-radical surgical tactics in such situations inevitably leads to repeated surgery that is performed against the background of ongoing cancer progression, in which case the patient may be at a higher risk of recurrence than s/he would be with a timely radical operation and therefore may require further treatment.","PeriodicalId":437500,"journal":{"name":"Hirurg (Surgeon)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114269418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous drainage of liver abscess under ultrasound guidance combined with etiological antibacterial therapy: a successful case of patient treatment","authors":"G. Rodoman, S. Zyryanov, M. Ivzhits, G. Putsman","doi":"10.33920/med-15-2302-05","DOIUrl":"https://doi.org/10.33920/med-15-2302-05","url":null,"abstract":"The article describes a clinical case of successful treatment of multiple liver abscesses in a 43‑year-old man with severe comorbidity and history of aggravating factors. The patient underwent combined treatment: surgery, consisting in the abscess puncture, and antibacterial therapy, first empirical, then etiological, taking into account the data of bacteria culture test. The importance of rational combinations of surgical care and antibacterial therapy is also discussed.","PeriodicalId":437500,"journal":{"name":"Hirurg (Surgeon)","volume":"243 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122722389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"False-positive symptoms of recurrence of gastroesophageal reflux disease (gerd) in patients with hiatal hernia (hh) after anti-reflux videolaparoscopy","authors":"V. Oskretkov, E. A. Tseimakh, A. Andreasyan, M. Grigoryan, S. Maslikova","doi":"10.33920/med-15-2302-02","DOIUrl":"https://doi.org/10.33920/med-15-2302-02","url":null,"abstract":"We compared the results of remote survey of 213 patients with HH associated with GERD in the long term after anti-reflux videolaparoscopy, according to the GERD-HRQL, GIQLI, and SF-36 questionnaires (patients’ complaints) and special methods for studying the anti-reflux function of the cardia (X-ray endoscopy of the esophagus and stomach, daily esophageal pH monitoring, esophageal manometry). Based on the results of special studies, a generalized indicator of failure of the anti-reflux function of the cardia (GIFAFC) was developed. It was found that 57.3% of the examined patients had false-positive symptoms of GERD recurrence, which was manifested by pain in the epigastric region (31.2%), belching with air (4.1%), and heartburn (21.3%). There were no symptoms when bent over or lying down. The existing symptoms were mild, easily stopped by conservative treatment. The patients with false-positive GERD symptoms after surgery showed an improvement in GIFAFC by 7.9 times (p <0.001), but it was 5.4 times worse than in patients without recurrent GERD (p <0.001), and 6.3 times better in relation to patients with recurrent GERD (p<0.05). False-positive symptoms of GERD recurrence contributed to a decrease in the generalized indicator of quality of life, which, according to the SF-36 questionnaire, was 76% of the maximum desired result. Due to the absence of reliable clinical manifestations, all patients with HH who have certain symptoms of GERD after fundoplication should undergo an instrumental study of the anti-reflux function of the cardia. Patients with established false-positive symptoms of GERD are subject to dispensary follow-up.","PeriodicalId":437500,"journal":{"name":"Hirurg (Surgeon)","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129730894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic right hemicolectomy with intracorporeal ileo-transverse anastomosis (review)","authors":"E. M. Romanova, E. Surovegin, D. Shakhmatov, O. Sushkov","doi":"10.33920/med-15-2302-06","DOIUrl":"https://doi.org/10.33920/med-15-2302-06","url":null,"abstract":"Colon cancer is one of the most common malignant tumors worldwide. The main treatment for localized colon cancer is surgery. Nowadays laparoscopic colectomies for colon cancer have advantages over open ones, as they provide better short-term results. There has been a continuous improvement in the technique of the operation, and due to the widespread use of laparoscopic stapling and cutting devices, intracorporeal anastomosis is becoming more and more accessible. This article discusses the advantages and disadvantages of various methods for the formation of ileo-transverse anastomosis in laparoscopic right hemicolectomy.","PeriodicalId":437500,"journal":{"name":"Hirurg (Surgeon)","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132316252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemobiochemical profile and multiple organ dysfunction syndrome: a paradigm for objective assessment of small bowel fistula treatment","authors":"A. Larichev, K. N. Efremov, V. Kuzmin, M. G. Chetverov","doi":"10.33920/med-15-2302-03","DOIUrl":"https://doi.org/10.33920/med-15-2302-03","url":null,"abstract":"When organizing the treatment process for small bowel fistula, timely diagnosis of significant pathophysiological changes arising from intra-abdominal complications is relevant. We studied the results of the treatment of 41 patients with an unformed small bowel fistula, caused by the failure of the intestinal suture placed in connection with the violation of the integrity of the enteral wall in technically difficult viscerolysis,against the background of diffuse peritonitis, as well as the suture failure after bowel resection in open and closed abdominal trauma and in a strangulated hernia. At three stages of the study (initial — 1–2, intermediate — 5–7, and final — 28 days from the start of treatment), the functional state of vital organs and systems and electrolyte imbalance were assessed by monitoring 10 biochemical blood parameters (total protein and bilirubin, alkaline phosphomonoesterase, alanine and aspartate aminotransferase, urea,creatinine, glucose, amylase and potassium), thereby objectifying the nature of multiple organ dysfunction in its three-stage gradation. It has been found that in the presence of an unformed small bowel fistula at the time of its occurrence, there are multisystem disorders of varying severity. Against the background of the traditional complex of therapeutic measures, including conservative treatment and surgical technologies, there are changes in the evaluated criteria, which become especially clear within the framework of the concept of hemobiochemical profile in its graphical presentation. At the final time interval of follow-up, a third of patients have a critical level of the main clinical and laboratory parameters, including hemobiochemical parameters. Preservation of severe forms of multiple organ dysfunction — sub- and decompensation (from 47 to 69 % of patients), in the process of implementing a three-stage follow-up model, as well as a high level of mortality (41.46 %) indicate the low effectiveness of traditional tactics for the treatment of an unformed small bowel fistula.","PeriodicalId":437500,"journal":{"name":"Hirurg (Surgeon)","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116450914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features of diagnosis and treatment of false post-traumatic diaphragmatic hernias","authors":"N. I. Bogomolov, A. Kashafeeva","doi":"10.33920/med-15-2302-01","DOIUrl":"https://doi.org/10.33920/med-15-2302-01","url":null,"abstract":"Damage to the diaphragm domes followed by the formation of false diaphragmatic hernias (FDH) occurs with closed and open trauma to the chest and/or abdomen. In this case, the mobile organs of the abdominal cavity, being uncovered by the parietal peritoneum, move to the pleural cavity and, with a small defect in the diaphragm, can be infringed up to necrosis of the organ wall. The rare occurrence of such pathology, the paucity of clinical symptoms, explains the high error rate in diagnosis, especially in primary health care. We have experience in two clinics over 34 years in the treatment of 12 patients with FDH. The left dome was damaged in 10 patients, the right dome in two. The age of damage to the diaphragm ranged from several hours to 7 years. Five clinical examples are presented, combined with the late diagnosis of the disease, the difficulties of diagnosis, even in a clinic using modern imaging tools. All patients are operated on both as planned and as an emergency. Endovideosurgical technologies for diagnosis and treatment are used only in 2 patients. 2 (16.67 %) patients died with a false diaphragmatic hernia due to a severe closed injury against the background of traumatic and hemorrhagic shocks. Conclusions. A clear explanation of the origin of scars on the skin of the chest and abdomen, clarification of the mechanisms and severity of closed injuries in the https://panor.ru/articles/osobennosti-diagnostiki-i-lecheniya-lozhnykh-posttravmaticheskikh-diafragmalnykh-gryzh/92437.html","PeriodicalId":437500,"journal":{"name":"Hirurg (Surgeon)","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122762125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results of endoscopic hemostasis methods in treatment of gastrointestinal bleeding in patients with SARS-CoV-2","authors":"K. Medvedev, Y. Aleksandrova, T. E. Aksenova, R. A. Karpova, M. Korchak, M. A. Protchenkov","doi":"10.33920/med-15-2302-04","DOIUrl":"https://doi.org/10.33920/med-15-2302-04","url":null,"abstract":"The development of gastrointestinal bleeding from erosive and ulcerative defects of the mucous membranes of the upper gastrointestinal tract, which, according to the world literature, occurs in 2–13 % of hospitalized patients with COVID-19, is a multifaceted problem that is still relevant, but has not been adequately reflected in scientific publications. The aim of the work was to study the clinical characteristics of patients with gastrointestinal bleeding on the background of SARS-CoV-2 and evaluate the methods of endoscopic hemostasis. The article analyzed cases of bleeding from the upper gastrointestinal tract in 115 patients suffering from the novel coronavirus infection. The severity of the course of COVID-19 was assessed according to the criteria of the NEWS scale, the degree of respiratory failure, and radiological data. 114 out of 115 patients had comorbidities; the most common diseases were cardiovascular diseases, endocrine pathology, chronic kidney disease, and oncopathology. The most common sources of bleeding (82 %) were acute or chronic ulcers of the stomach and/or duodenum against the background of erosive hemorrhagic lesions of the mucosa. The following methods of endoscopic hemostasis were used: endoscopic clipping, endoscopic injections, applications of hemostatic agents and solutions, and combined methods which were used more often. Hemostasis was achieved in all cases. Repeated bleeding occurred in 22 cases (19.1 %) with subsequent achievement of endo-hemostasis. Mortality was 66.95 % (77 patients), with such causes of adverse outcomes as increasing multiple organ failure, respiratory distress syndrome, and septic shock.","PeriodicalId":437500,"journal":{"name":"Hirurg (Surgeon)","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127907216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemostasis disorders during extracorporeal detoxification and the possibility of their prevention. Literature review","authors":"Т. I. Shalaeva, Y. Golubeva, Z. F. Misikov","doi":"10.33920/med-15-2301-07","DOIUrl":"https://doi.org/10.33920/med-15-2301-07","url":null,"abstract":"A significant proportion of surgical patients requiring extracorporeal detoxification (ECD) initially have various hemostasis disorders and associated risks. Extracorporeal treatment can lead to the progression of such pathological conditions, including the development of clinically significant bleeding. The work analyzes modern literature, covering the development of hemostasis disorders during ECD and the possibility of their prevention. Currently, there is no consensus on the most significant causes and mechanisms of coagulation disorders in ECD, often leading to serious bleeding and deterioration in patient outcomes. Researchers agree that a significant influence on the risk of occurrence of coagulopathy is not exerted by the severity of the underlying disease, but by the presence of coagulation disorders before treatment. In patients who initially had coagulopathy and/or thrombocytopenia, bleeding after ECD sessions is observed in 40–50 % of cases. The role of heparin anticoagulation in the development of hemorrhagic complications has not yet received a final assessment. In the majority of publications in the literature, the authors conclude that citrate anticoagulation is effective and safe in various types of extracorporeal detoxification, noting that the use of citrate instead of heparin allows not only significantly extending the life of the filter, but also reducing the risk of developing coagulopathy and bleeding after the procedure. Questions of use, risks, and benefits of citrate anticoagulation over heparin for ECD in surgical patients with coagulopathy require further study.","PeriodicalId":437500,"journal":{"name":"Hirurg (Surgeon)","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117145990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}