Modern approaches to carrying out profound medical examination of servicemen of Security Service of Ukraine.

The study found that the regulatory framework for prophylactic medical examination in the Security Service of Ukraine (SSU) is not fully regulated, this required the development and validation of a new organizational model to improve its efficiency. In the coursw of study proposals for the introduction of a modern model of profound medical examinations of the personnel of the SSU were prepared, their main elements are: first developed and implemented model of a motivated individual responsibility of SSU serviceman for their own health, its conservation, inclination to treatment of identified pathological conditions; development and implementation of military health passport, health passport of managers, health passport of agency, division, institution of the SSU; the definition of the various bulks of the annual medical examination of personnel, depending on age (with expansion of screening tests, depending on the age group); introduction of personal responsibility of heads (managers) of bodies (departments and agencies) of the SSU for the timely undergoing of profound medical examinations by subordinate personnel a clear definition of heads’ responsibilities of health care organs (doctors and medical staff) of the SSU in the profound medical examinations; the development and implementation of a unified system of analysis of the results of medical care facilities of SSU for carrying out of medical examination and definition of its efficiency, the introduction of optimized system for monitoring of undergoing medical examination, reporting on undergoing of profound medical examinations by personnel of agencies, departments, institutions of the SSU. This allowed not only to justify organizational model on improvement of clinical examination of the SSU personnel but to introduce it into the work of all health facilities of the SSU, to significantly optimize conducting clinical examination and improve its performance indicators

Organization of sorting and surgery of wounds with soft tissue defects during the joint force surgery

Introduction. The experience of providing medical care during the Anti-terrorist operation in eastern Ukraine showed that in the structure of modern combat surgical trauma gunshot wounds with soft tissue defects are between 64.9-68.2%, of which 36.4-37.5% are small and medium, 28.5-30.7% are large and very large defects.Aim: To improve the results of providing surgical care to the wounded with soft tissue defects by introducing a variety of surgical tactics of wound closure to the medical care levels.Material and Methods. The total array of the study was 2537 wounded with shrapnel, bullet and mine injuries from April 2014 to September 2018. The determination of surgical tactics for closing soft tissue defects was performed at the basis of metric classification taking into account the area, volume and anatomical areas of the lesion.Results. The combination of metric characteristics of wound defects by area, volume with localization of wounds in a single classification allowed the offer of a comprehensive approach to sorting the wounded at the level of medical care and to determine further surgical tactics to close soft tissue defects. In accordance with the sorting and evacuation purposes, the wounded with gunshot wounds to the foot and hand (third zone of injury) were treated in specialised centres to the fourth level of medical care. In the case of medium and large wounds of the thigh, leg, shoulder and forearm, medical care was provided at the second and third levels. And in the case of large and very large wounds of the specified localisation was provided in specialised clinics of the fourth level.Conclusions. The introduction of differentiated surgical tactics in the wounded with soft tissue defects at the levels of medical care has improved functional results: increase the proportion of good from 46.9% to 53.7%, reduce the relative number of unsatisfactory from 18.8% to 11, 6%

Lymph node dissection impact on long-term survival rate of gastric cancer patients in Ukraine

Over a period of 2007-2011 188 stomach cancer (SC) patients have been included in the research in abdominal oncosurgical department of Odessa oncological center. Volume of lymph node dissections differed by quantity of lymph nodes to be removed. All patients were divided into three groups. Patients with D1 or D1+ lymph node dissections have been performed, totally 90 patients are included in group of historical control. In all cases so-called lymph node dissections for principal reasons have been executed. The multifactorial analysis of patients survival is implemented depending on a type of a lymph node dissections, a stage of the cancer, number of involved lymph nodes, involvement of the tumoral microcirculatory net (ly is carried out, v) signs of a perinevral invasion (Nev), availability of residual tumoral tissue (R), degree of a differentiation (G). Regardless of a disease stage, SC at 60 % of patients, represented with initially hematologicaly disseminated disease. 40 % of SC`s had no signs of intratumoral microcirculatory net involvement even in case of more than 15 regional lymph nodes are involved

Conceptual principles of the wounded combatants’ evacuation, suffering military surgical trauma on the medical support levels

Objective. To improve the results of treatment of the wounded persons, suffering a combat surgical trauma, elaborating and introducing of objective scales of the trauma severity estimation into the medical evacuation system while conduction of Antiterroristic operation / Operation of Joint Forces. Materials and metods. Complex medical-statistical investigation was performed, in which 684 wounded persons, suffering a combat surgical trauma were included. Dynamical medical control and determination of the trauma severity degree in accordance to AdTS (Admission trauma Scale) were applied on all levels of medical support. Results. In the beginning of conduction of Antiterroristic operation / Operation of Joint Forces a mortallty have had occurred during transportation of wounded persons in unstable state (more than 9 points) to military-medical clinical centers. The wounded persons in a traumatic shock state were transported on forth level of medical support, what have been considered an organization defect in the help deliver process, which leaded to death of military persons. At the same time an unjustified delay of transportation of servicemen, suffering wounds of the wrist and foot (up to 5 points), on the first and second levels of medical support, leading to development of severe complications, have occurred. Taking into account the above mentioned, the authors have provided a differentiated approach for medical evacuation of wounded persons, suffering a combat surgical trauma, depending on its severity degree. Conclusion. Evacuation of wounded persons, suffering a combat surgical trauma, constitutes an integral part of the medical support system of Antiterroristic operation/Operation of Joint Forces, closely connected with a medical support process during transportation. Medical evacuation of wounded persons with injuries of the vision organ, the wrist and foot must be accomplished urgently to specialized clinic of the fourth level of medical support

Experimental investigation of animals survival adequacy and efficacy in case of their soft tissues gunshot wounds using the thermometry technique

The problem of gunshot wounds treatment is one of the urgent and incompletely resolved issues of modern surgery. Diagnosis of gunshot wounds is currently not efficient enough. There was a need to improve the content and scope of medical care with the possibility of strengthening its diagnostic chain. The aim of the work is to substantiate experimentally the feasibility and effectiveness of using diagnostic infrared thermometry in gunshot wounds of the soft tissues of the extremities. Experimental studies were performed under the chronic experimental conditions on Shinshilla breed rabbits which were subjected to gunshot wounds followed by laboratory, morphological and functional examination for 5 days. The animals were divided into 3 groups depending on the type of gunshot wound that was inflicted. The animals were removed from the experiment by the introduction of chloroethyl anesthesia on the 1st, 3rd and 5th days, after which the soft tissues with the capsule surrounding the fragment were subjected to histological and electron microscopic examination. On the 1st day of the study, a significant decrease in the diameter of the blood vessels of the affected area was determined in the group of animals that were subject to injury with firearms and metal fragments from the explosion of a grenade and an improvised explosive device. It was in these groups that the highest mortality rate was registered. Under the specified conditions of injury to the limbs of animals, as well as when injured by a pneumatic weapon with a temperature of fragments of 100 oC, pronounced changes in pulse and respiratory rate were noted. In further studies on rabbits on the 3rd and 5th days of the experiment, the actual results did not differ from those obtained 24 hrs after injury. Those rabbits that survived after the reproduction of various gunshot wounds had the greatest value. The results of their thermometric measurements were evaluated in the dynamics of experimental gunshot wounds and revealed the dependence of animal survival after gunshot wounds on the temperature of the limb in the area of the wound. There are the following leading criteria in favor of animals further survival after gunshot wounds - the presence of a perforating vessel in the area surrounding the affected space; the size of the diameter of the vessels in the adjacent area; no hemorrhage in the muscle tissue located near the affected area; comparable with normal data of the functional parameters of the animal's body – heart rate, blood oxygen pressure and respiration; thermometry results. The limb thermometry has the important prognostic value after their gunshot wound in terms of experimental animals survival. The correspondence of high thermometry indexes after a gunshot wound vs the higher risk of an animal death is statistically reliable and, accordingly, insignificant thermometric dynamics throughout the experiment is in favor of a positive outcome after injury. It is extremely important to evaluate thermometry data during the first 24 hours after receiving gunshot wounds, since we found out the maximum validity of this method in the early time intervals. All this, with adequate clinical testing and verification, has the most important medical prospects, aimed primarily at saving time for diagnostic measures and procedures. Thermometry allows to judge the activity and severity of connective tissue inflammation or sclerosis in the lesions of each wound and provides the possibility of clinical application of remote thermography as a noninvasive method of diagnosis and prediction of complications in wounded with gunshot and explosives in various wounds

Novel data according Will Roger`s phenomenon in stomach cancer patients

Mostly Will Roger`s phenomenon means existence of so-called "jumping" or "jumping over the stages" regional metastases in the stomach cancer patients. N1 in the 6th edition means 16 regional lymph nodes involvement, while the N1 seventh edition – only 1-2 of regional lymph nodes involvement. This means that T1N1Mo \ 6th and T1N1Mo \ 7th - not quite the same, and the survival of the two groups will be different. The study, made on the abdominal oncosurgical department of Odessa Regional Oncology Center, included 188 patients operated for gastric cancer in the period 2007-2011. The study included only radically treated patients. Comparison of survival in patients with gastric cancer between 6th revision groups of 7th has been reviewed. The classification mission is to provide differences in the survival rates between the groups. Regression multivariate Cox analysis showed that 7th UICC classification showed different capability of stratifying survival groups of UICC N classification (P \ 0.01)

Organ–preserving operations for the gun–shot thoraco–abdominal and abdominal woundings with splenic injuries

Objective.To determine the expediency of the spleen–preserving operations performance for its injury due to gun–shot thoraco–abdominal and abdominal woundings. Materials and methods. Of 51wounded persons with the gun–shot penetrating abdominal woundings with splenic injuries 8 (15.7%) were operated on the II level of the medical help delivery, while on the ІІІ level – 43 (84.3%). Of 43 wounded persons, operated on the ІІІ level of the medical help delivery, in 35 (81.4%) splenectomy was performed, while in 8 (18.6%) – the organ–preserving operations. All the splenic injuries have been characterized as a shrapnel woundings. The splenic damage degree was estimated in accordance to Moore, taking into account its structure. In 5 (62.5%) wounded persons the open laparotomy organ–preserving operations were performed, and while using video–laparoscopic system– in 3 (37.5%). Results. Ultrasonographic investigation in accordance to the FAST–protocol was done in all the wounded persons, what have permitted to determine the blood abdominal outpouring volume as well as the splenic injury presence. The affection volume and further tactics were determined using video–laparoscopy. The Stage I splenic affection in accordance to Moore was diagnosed in 4 (50%) wounded persons, the Stage ІІ – in 3 (37.5%), and the Stage ІІІ – in 1 (12.5%). In all the patients, in whom organ–preserving interventions were performed, the surgical help volume consisted of coagulation, using the radiofrequency therapy apparatus MEDTRONICAEX and the hemostatic sponge application with drainage of the left subdiaphragmatic space, using silicone tube. Conclusion. Organ–preserving operations in splenic injury are expedient to be performed on ІІІ level of the medical help delivery, while presence of local conditions, such as the organ injury degrees І and ІІ,determined in accordance to Moore, as well as adequate time and equipment

The first results of the programme fast track rehabilitation use in the colorectal patients

Авторами описаны первые результаты внедрения в повседневную клиническую практику новой реабилитационной программы fast track rehabilitation у больных раком толстой кишки (РТК). 89 больных были разделены на 2 группы: 58 проведена программа fast track rehabilitation, 31 больной составил группу контроля. Различия между группами по койкодню и срокам активизации были статистически достоверны (р< 0,01). Применение методики ускоренного пути у больных РТК приводит к уменьшению количества общих осложнений (р=0,03126).У статті розглянуті перші результати використання у клінічній практиці нової програми реабілітації хворих на рак товстої кишки. 89 хворих були поділени на 2 групи: у 58 застосована нова програма прискореного шляху – fast track rehabilitation, 31 хворий склав групу контролю. Різниця між групами по ліжко-дню та строкам активізації статистично достовірна (р<0,01). Використання методіки прискореного шляху веде до зменьшення загальних ускладнень (р=0,03126).First results of implementation novel colorectal cancer patient rehabilitation programm in clinical rutine have been discussed. 89 patients were divided by 2 groups. Fast track rehabilitation (FTR) programm were engaged in the first group, 58 patients. 31 patients with conventional treatment were included in control. Math difference between them from point of in-patient terms and discharge was statisticaly significant (р<0,01). Implementation of fast track rehabilitation programm reduces general complications in colorectal cancer patients

Алгоритм оцінки перфузії м'яких тканин у схемі «закриття» вогнепальних дефектів

The purpose of the study was to determine indicators for the soft tissue perfusion evaluation in the scheme of gunshot defects “closure” using a variety of flaps from V–Y and Keystone till “propeller” and free flaps. A thermal imaging camera FLIR C2 with an integrated temperature gauge was used to obtain thermometric images together with a digital photograph of the scanned anatomical area. Microcirculation in damaged tissues plays an important role in wound substrate and the future flap in certain anatomical structure viability ensuring. That’s why its important to determine the features of the soft tissues perfusion fire transformation and the place of the corresponding blood supply from where it is possible to “raise” the flap in the future. The original dynamic multimodal concept using DDT and sonographic evaluation of soft tissue perfusion allows to look at the specific gunshot wound changes in a new way and to plan strategically the optimal path of reconstructive-plastic recovery. The thermographic and sonographic criteria uniqueness for soft tissue perfusion assessing in the context of large gunshot defects closing are reliable and objective, allow to assess the condition of the future wound bed and edges. They can be used not only to evaluate the wound before closing the defect but also to correct further tactics in the large defects or wounds treatment that do not heal for a long time.Метою дослідження є визначення показників перфузії м'яких тканин в схемі «закриття» вогнепальних дефектів під час використання різноманітних клаптів від V–Y та Кейстоуна до пропелерних та вільних клаптів. Для отримання термометричних зображень разом із цифровою фотографією сканованої анатомічної ділянки автори використовували тепловізійну камеру FLIR C2 з вбудованим датчиком температури. Мікроциркуляція в ушкоджених тканинах відіграє важливу роль у забезпеченні життєздатності ранового субстрата та майбутнього клаптя у вказаній анатомічній структурі, і тому існує необхідність визначити особливості вогнепальної трансформації перфузії в м’яких тканинах, місця відповідного кровопостачання, звідки в майбутньому можливо «піднімати» клапоть. Запропонована нами оригінальна динамічна мультимодальна концепція за рахунок ДЦТ та сонографічної оцінки перфузії м’яких тканин дозволяє по-новому подивитись на специфічні зміни, притаманні вогнепальному ураженню та стратегічно спланувати оптимальний шлях реконструктивно– пластичного відновлення. Унікальність термографічних та сонографічних критеріїв оцінки перфузії м'яких тканин в контексті закриття великих вогнепальних дефектів є надійними та об’єктивними, дозволяють оцінити стан майбутнього ложа та країв рани. Вони можуть бути застосовані не тільки для оцінки рани перед закриттям дефекту, але і для корекції подальшої тактики при лікуванні великих дефектів або ран, що довго не загоюються