Klinichna khirurhiia / Ministerstvo okhorony zdorov'ia Ukraïny, Naukove tovarystvo khirurhiv Ukraïny
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The authors had offered the original estimated system with the points calculation, basing on analysis of the examination and treatment results in 150 patients, suffering abdominal sepsis. The system, alike others, includes not only determination of the inflammation factors and indices of endotoxicosis, but as well as those, concerning intraabdominal pressure, the anterior abdominal wall rigidity and the tissues elasticity. Among the important indices, needed to determine, were considered those, which categorize the syndrome of intraabdominal, intrathoracic and microregional hypertension as well as the mechanisms of endotoxicosis pathogenesis. The authors recommend to use the indices of pathological consequences of this two factors while doing assessment of the abdominal sepsis severity.
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The results of surgical treatment of 687 patients, ageing 22-78 yrs old and suffering inguinal hernia recurrence, are analyzed. The operative intervention choice was established in accordance with presence of the certain hernia type as well as inguinal dehiscence height and degree of atrophic changes in musculo-aponeurotic structures of inguinal channel. ⋯ In 2 (0.3%) patients the operative wound suppuration have occurred. In 2 (0.36%) patients the hernia recurrence have occurred in far remote period as a consequence of the operative wound suppuration.
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Efficacy of systemic application of opiates (promedol) for the pain relief after big open abdominal operations, using visual-analogue scale (VAS), was estimated in 50 patients. During 36-48 h postoperatively analgesia was inadequate (VAS in a rest state more than 3 points and while movement--more than 4 points). Intensive pain (VAS 6 points and more) was noted in 58% of patients, while they are moving, and in 26%--in a rest state. Inadequate anesthesia may constitute one of causes of excessive systemic inflammatory reaction development in patients postoperatively.
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Clinical Trial
[Using surgical mesh of a new construction in laparoscopic treatment of inguinal hernias. Comparative study].
The results of laparoscopic transabdominal (transabdominal preperitoneal--TAPP) hernioplasty, using conventional polypropylene nets in 28 patients (group I) and nets, manufactured by firm MMDI in 22 patients (group II), were analyzed. The operation duration in group I had constituted (56 +/- 18) min at average and in group II--(38 +/- 7) min. The pain syndrome severity was lesser in group II patients by 40-50%. ⋯ While following up in 3, 6 and 12 months the recurrence of hernia was revealed in 2 patients of group I. Application of nets, manufactured by firm MMDI opens new perspectives in laparoscopic herniology. Cosy unfolding and installation in preperitoneal space without additional fixation constitutes their advantage.