Проблема хирургической инфекции у больных Сахарным диабетом, оперированных на аорто-подвздошном сегменте

The aim of the work: to analyze the frequency and causes of purulent-septic complications in patients who underwent endoprosthetic repair of the aorto-iliac segment. Analysis of purulent-septic complications in 54 patients who were operated for ischemic lesions of the vessels of the lower extremities in diabetes mellitus was conducted. All patients underwent interventions on the aorto-iliac segment using synthetic vascular prostheses. In accordance with the classification of purulent-septic complications of reconstructive operations 5 cases of complications available in our practice, we divided into 2 groups – prosthetic sepsis; infection of the graft without clinical and laboratory manifestations of sepsis. The frequency of purulent-septic complications 9.2 percent, almost all of these patients had grade III-IV ischemia and were operated on urgent indications. In 3 cases, infection of the graft without bacteremia patients were operated before the development of erosive bleeding, which allowed 2 patients to save limbs, and 1 patient was discharged after performing the high amputation of the limb. In two cases a partial resection of the infected portion of the bifurcation prosthesis from separate access and subsequent re-reconstruction. In one case in a patient with progressive limb ischemia removed the infected bifurcation prosthesis, and surgery was performed subclavianfemoral bypass grafting extraanatomical on the one hand, and high amputation of the contralateral limb. Prosthetic sepsis occurred in 2 patients, 1 patient died.Цель работы: проанализировать частоту и причины гнойно-септических осложнений у больных, которым выполнено эндопротезирование аорто-подвздошного сегмента. Проведен анализ гнойно-септических осложнений у 54 больных, которые были оперированы по поводу ишемических поражений сосудов нижних конечностей на фоне сахарного диабета. У всех больных были выполнены вмешательства на аорто-подвздошном сегменте с использованием синтетических сосудистых протезов. В соответствии с классификацией гнойно-септических осложнений реконструктивных операций 5 случаев осложнений, имеющихся в нашей практике, мы условно разделили на 2 группы: протезный сепсис; инфицирование трансплантата без клинических и лабораторных проявлений сепсиса. Частота гнойно-септических осложнений составила 9,2 %, почти все больные имели III–IV степень ишемии и были оперированы по неотложным показаниям. В 3 случаях инфицирования трансплантата без бактериемии пациенты оперированы до развития аррозивного кровотечения, что позволило у 2 пациентов сохранить конечности, и один пациент выписан после выполнения высокой ампутации конечности.В двух случаях выполнена частичная резекция инфицированной части бифуркационного протеза из отдельного доступа с последующей повторной реконструкцией. В одном случае у пациента с нарастающей ишемией конечности снят инфицированный бифуркационный протез и выполнена операция подключично-бедренного экстраанатомического шунтирования с одной стороны и высокая ампутация контрлатеральной конечности. Протезный сепсис имел место у 2 больных, умер один больной.Мета роботи: проаналізувати частоту і причини гнійно-септичних ускладнень у хворих, яким було виконано ендопротезування аорто-клубового сегмента. Проведено аналіз гнійно-септичних ускладнень у 54 хворих, які були оперовані з приводу ішемічних уражень судин нижніх кінцівок на тлі цукрового діабету. У всіх хворих були виконані втручання на аорто-клубовому сегменті з використанням синтетичних судинних протезів. Відповідно до класифікації гнійно-септичних ускладнень реконструктивних операцій 5 випадків ускладнень, наявних у нашій практиці, ми умовно розділили на 2 групи: протезний сепсис; інфікування трансплантата без клінічних та лабораторних проявів сепсису.Частота гнійно-септичних ускладнень становила 9,2 %, майже всі хворі мали III–IV ступінь ішемії і були оперовані за невідкладними показаннями. У 3 випадках інфікування трансплантата без бактеріємії пацієнти оперовані до розвитку арозивної кровотечі, що дозволило у 2 пацієнтів зберегти кінцівки, і одного пацієнта виписали після виконання високої ампутації кінцівки. У двох випадках виконана часткова резекція інфікованої частини біфуркаційних протеза з окремого доступу з наступною повторною реконструкцією. В одному випадку у пацієнта з наростаючою ішемією кінцівки знятий інфікований біфуркаційний протез, і виконана операція подключично-стегнового екстраанатомічного шунтування з одного боку, і висока ампутація контрлатеральної кінцівки. Протезний сепсис мав місце у 2 хворих, помер один хворий

FGF4 Independent Derivation of Trophoblast Stem Cells from the Common Vole

The derivation of stable multipotent trophoblast stem (TS) cell lines from preimplantation, and early postimplantation mouse embryos has been reported previously. FGF4, and its receptor FGFR2, have been identified as embryonic signaling factors responsible for the maintenance of the undifferentiated state of multipotent TS cells. Here we report the derivation of stable TS-like cell lines from the vole M. rossiaemeridionalis, in the absence of FGF4 and heparin. Vole TS-like cells are similar to murine TS cells with respect to their morphology, transcription factor gene expression and differentiation in vitro into derivatives of the trophectoderm lineage, and with respect to their ability to invade and erode host tissues, forming haemorrhagic tumours after subcutaneous injection into nude mice. Moreover, vole TS-like cells carry an inactive paternal X chromosome, indicating that they have undergone imprinted X inactivation, which is characteristic of the trophoblast lineage. Our results indicate that an alternative signaling pathway may be responsible for the establishment and stable proliferation of vole TS-like cells

Contemporary view to prophylactic salpingectomy

The research of 51 doctors opinions from different regions of the Russian Federation and the near abroad (Kyrgyzstan) with respect to prophylactic salpingectomy. This study demonstrated the awareness of doctors regarding the current views on prophylactic salpingectomy. According to the results of the main part of the questionnaire 35 of 51 (68.6%) responded that they made bilateral salpingectomy when performing a hysterectomy without oophorectomy for benign disease: 22 of 35 (62.9%) to reduce the risk of developing cancer, 16 of 35 (45.7%) to reduce the risk of formation of hydrosalpinx, 6 of 35 (17.1%) in order to reduce the risk of pelvic pain and 5 doctors (14.3%) to reduce the risk of reoperation. Some questions from the main part of the questionnaire suggests selecting one or more answers

Hysterectomy among obese patients

This article presents results of laparoscopic hysterectomy among obese patients. Technical aspects, complications rate, operative time, length of hospital stay in relation to BMI were analyzed. Also we present results of international surgical experience of extremely overweight cases

Drug therapy in the treatment of endometriosis

Clinical studies of medicine-based and surgical methods for the treatment of endometriosis are described. Although endometriosis was described as early as in the XIX century, the causes for its emergence and spread have not been fully investigated. Also, many questions regarding methods of treatment remain far from being solved. Due to the chronic and often relapsing nature of the disease, Practice Committee of the American Society for Reproductive Medicine (ASRM) has concluded the following: "endometriosis should be viewed as a chronic disease that requires a lifelong management plan with the goal of maximizing the use of medical treatment and avoiding repeated surgical procedures." Thus, treatment of endometriosis should not only be comprehensive but also adapted to the specifics of each woman's organism

IMMUNOLOGICAL ASPECTS OF ENDOMETRIAL DISEASE

Background: Immunological processes involving peritoneal macrophages could play a critical role in pathophysiology of external genital endometriosis.Aim: To assess levels of MCP-1, RANTES, and C-reactive protein and to identify their correlations with endometriosis.Materials and methods: Seventy two patients were evaluated: 26 healthy controls and 46 with endometriosis. Patients were divided into groups as follows: 17 with superficial endometriosis, 18 with endometriomas and 11 with deep infiltrative endometriosis. All patients underwent a laparoscopy during the proliferative phase of the cycle; levels of peritoneal and serum MCP-1, RANTES and C-reactive protein were measured using standard ELISA assays.Results: There were positive correlations between serum MCP-1 (p = 0.03) and C-reactive protein(p = 0.045) and severity of endometriosis, that could indicate malfunctioning of peritoneal macrophages in advanced stages of endometriosis. Conclusion: MCP-1 and C-reactive protein levels in peripheral blood can be used as markers of endometriosis activity

Characterization of the Genomic Xist Locus in Rodents Reveals Conservation of Overall Gene Structure and Tandem Repeats but Rapid Evolution of Unique Sequence

The Xist locus plays a central role in the regulation of X chromosome inactivation in mammals, although its exact mode of action remains to be elucidated. Evolutionary studies are important in identifying conserved genomic regions and defining their possible function. Here we report cloning, sequence analysis, and detailed characterization of the Xist gene from four closely related species of common vole (field mouse), Microtus arvalis. Our analysis reveals that there is overall conservation of Xist gene structure both between different vole species and relative to mouse and human Xist/XIST. Within transcribed sequence, there is significant conservation over five short regions of unique sequence and also over Xist-specific tandem repeats. The majority of unique sequences, however, are evolving at an unexpectedly high rate. This is also evident from analysis of flanking sequences, which reveals a very high rate of rearrangement and invasion of dispersed repeats. We discuss these results in the context of Xist gene function and evolution. [The sequence data described in this paper have been submitted to the GenBank data library under accession nos. AJ310127–AJ310130 and AJ311670.