PREVENTION OF INTESTINAL ANASTOMOTIC LEAKAGE IN CASE OF PERITONITIS (EXPERIMENTAL RESEARCH)

Background. The problem of development of postoperative complications after operations on the organs of the gastrointestinal tact is extremely important. Failure of intestinal suture, formed in the presence of peritonitis develops from 2.8 to 32 % of patients. Aim. To improve immediate outcomes in the formation of a small intestine anastomosis in conditions of purulent peritonitis. Materials and methods. We conducted immunohistochemical examination of biopsy specimens of the small intestine of 20 patients died of peritonitis and compared the area of the vascular bed in different types of intestinal wall section. The experimental operations were performed in 100 Wistar rats. On the background of established models of peritonitis we performed different variants of small bowel anastomosis, including one with the use of photodynamic therapy. On the 6th day after the surgery, animals were sacrificed, and histological examination of the anastomoses was conducted. Results. Suture strip in the section of the small intestine made at the angle of 60° is supplied substantially better than in the section made at the angle of 90°. The experiment confirmed that the suggested method of anastomosis showed the best results. Conclusion. When one forms the "end-to-end" anastomosis in the small intestine in conditions of purulent peritonitis, it is reasonable to cross the intestinal wall at the angle of 60° and to perform photodynamic therapy on the formed anastomosis

Клинический случай тяжелого дефицита декарбоксилазы ароматических L-аминокислот

We present a case of a rare disease, aromatic L-amino acid decarboxylase deficiency (AADCD), with delayed diagnosis even after a pathogenic mutation indicative of AADCD was found. In most cases, AADCD causes marked impairment of motor and psycho- speech development and is accompanied by severe episodes of dystonia – oculogyric crises. The careful attention of neurologists, pediatricians, geneticists, gastroenterologists, and pulmonologists in cases of a complex set of diverse symptoms determines the success of early diagnosis and the earliest possible prescription of modern gene replacement therapy for AADCD.Представлен случай редкого заболевания – дефицита декарбоксилазы ароматических L-аминокислот (aromatic L-amino acid decarboxylase deficiency, AADCD) с задержкой диагноза даже после того, как была обнаружена патогенная мутация, указывающая на AADCD. Чаще всего AADCD вызывает выраженные нарушения моторного и психоречевого развития и сопровождается тяжелыми эпизодами дистонии – окулогирными кризами. Настороженность внимания неврологов, педиатров, генетиков, гастроэнтерологов, пульмонологов в случаях сложного комплекса разнообразных симптомов определяет успех ранней диагностики и максимально раннего назначения современной генозаместительной терапии AADCD