Peculiarities of early diagnosis and tactics of treatment in an acute pancreatitis in pregnant women

Objective. Improvement of the treatment results of an acute pancreatitis in pregnant women, using enhanced early diagnosis and tactics of treatment. Маterials and methods. Analysis of the diagnosis and treatment results was conducted in 123 pregnant women, suffering an acute pancreatitis. In the main group (61 pregnant women) the elaborated algorithm of diagnosis and treatment for an acute pancreatitis in the period 2012 - 2018 yrs was applied, while in a comparison group (62 pregnant women) - the standard methods of diagnosis and treatment in an acute pancreatitis for the period of 2006 - 2012 yrs. Results. In the main group in 100% of the patients an acute pancreatitis was revealed on early stage. This have had guaranteed the effect obtaining from the conservative therapy in 27 (44.3%) pregnant women, using miniinvasive surgical interventions - in 31 (50.8%) and to prevent postoperative lethality. In a comparison group in 26 (41.9%) patients an acute pancreatitis diagnosis was established in (8 ± 2.1) days after the disease beginning. In a comparison group the conservative treatment effect was observed in 21 (33.9%) patients only. Two (3.2%) pregnant women died. Conclusion. Application of the diagnostic-treatment algorithm, comparing with standard methods, permits to diagnose an acute pancreatitis in pregnant women on early stage, to reduce the complications and lethality rate

Experimental and morphological justification of the prevention of wound complications during fixation of the mesh to the abdominal wall tissues with composite

The aim of the study is to justify the prevention of wound complications during fixation of the mesh to abdominal wall tissues with cross-linked polyurethane (CP) composite in experimental animals. Маterials and methods. An experimental study was conducted on 60 male laboratory rats, which were divided into 3 groups. In group I (n = 21), the mesh and wound edges were fixed with CP composite with an antiseptic, in group II (n = 24) – with ligatures, in group III (n = 15) muscle incision was performed and the wound was sutured with ligatures. The animals were observed for 30 days, wound healing and the presence of complications were evaluated. Morphological examination was performed on days 7 and 30. Signs of mesh germination by connective tissue and presence of tissue inflammation around the mesh were evaluated. Results. The observation results showed that in group I, the incidence of complications and the duration of wound healing were lower comparing to groups II and III. In group I, seroma was detected in 1 (5.3 %) animal, in group II – in 7 (33.3 %), in group III – in 3 (23.1 %), infection of the wound in 1 (5.3 %) animal of group I, in 4 (19.1 %) of group II and in 2 (15.4 %) of group III. The term of wound healing in group I was 7 (6; 8) days, in group II – 13 (12; 14), in group III –11 (10; 12) days (p < 0.05). The results of observation were confirmed morphologically, namely, in animals of group I, faster process of mesh germination with collagen fibers and wound healing were revealed, which was confirmed by the predominance of a fibrous component over the cellular one (р < 0.05), and the formation of a connective tissue capsule around the CP with the germination of collagen fibers deep into the capsule. Conclusions. The use of the cross-linked polyurethane composite with an antiseptic to fix the mesh implant to abdominal wall tissues in laboratory animals confirms its higher efficiency compared to traditional ligature fixation, by increasing the fibrous component of connective tissue and reducing the cellular component and hemodynamic disorders in dynamics, by the germination of collagen fibers deep into the capsule in the areas of mesh fixation, reduced occurrence of seroma and duration of wound healing, which justifies its use in clinical practice for prevention of wound complications in allogernioplasty

Endoscopic hemostasis in the ulcer gastro-duodenal hemorrhage, using high-frequency biological welding electro-ligature

Objective. To improve the efficacy of endoscopic hemostasis for the ulcer gastro-duodenal hemorrhage, using high-frequency biological welding electro-ligature. Materials and methods. In 2017-2020 yrs period the analysis of efficacy of endoscopic hemostasis was done in 160 patients, ageing 40-85 yrs old, for the ulcer gastro-duodenal hemorrhage. The patients were distributed into two groups: the main - 80 patients, in whom high-frequency biological welding electro-ligature was performed, and a control one - 80 patients, in whom monopolar thermal argon-plasm coagulation was conducted. Results. In the main Group a primary hemostasis was achieved in 77 (96.3%) patients. Early recurrence of hemorrhage have occurred in 3 (3.8%) patients. In a control Group a primary hemostasis was achieved in 66 (82.5%) patients. Recurrence of the hemorrhage have occurred in 14 (17.5%) patients. Conclusion. Endoscopic hemostasis for the ulcer gastro-duodenal hemorrhage, using high-frequency biological welding electro-ligature, is achieved due to the impedance action of modulated signal of a high-frequency current as well as the adaptive system of automatic guidance of the welding process and a contact between special endoscopic probe, owing a concave electrode, with bleeding vessel, leading to its complete obliteration. Application of welding electro-ligature for endoscopic hemostasis in the ulcer gastro-duodenal hemorrhage, using high-frequency biological welding electro-ligature, guarantees more secure residual hemostasis, than application of monopolar thermal argon-plasm coagulation, peculiarly in hemorrhage from vessels owing 2 - 4 mm diameter. As a result, the hemorrhage recurrence rate have had reduced down to 3.8% (in the control Group - 18.0%)