Видеоэндоскопические операции как метод «золотого хирургического стандарта» в лечении ущемленных паховых грыж у детей

Inguinal hernia in children is one of the most common diseases requiring surgical treatment. There are two methods of surgical interventions for inguinal hernia in children: open and laparoscopic. In international clinical practice, open hernia repair is widely used due to the simplicity of the technique which does not require special tools. However, the percentage of complications and relapse frequency remain high when open hernia repair is performed. The article presents the analysis of the treatment results in 209 children with strangulated inguinal hernia who underwent open and laparoscopic surgery in the period from 2003 to 2014. The open hernia repair (Krasnobaev or Martynov technique) was performed in 89 children. The following complications were registered: edema of the spermatic cord — in 34 patients, non-viable loop of the intestine — in 2; one child had a vermicular appendix with signs of striation in the hernial sac, 4 patients — a vermiform appendix with signs of inflammation. In 6 cases the contents of the hernial sac included the strand of the greater omentum, in 1 — the strand of the greater omentum with signs of acute ischemia. In 12 children, the hernial protrusion was absorbed to the abdominal, and therefore no revision was required. In 1 patient, the early postoperative period was complicated by peritonitis due to bowel wall necrosis. Laparoscopic hernioplasty was performed in 120 pediatric patients. The contents of the hernial sac in 86 cases included a loop of the small intestine, in 7 — an appendix and a site of the caecum, in 15 — the ovary and fallopian tubes, in 5 — the strand of the greater omentum. In 14 children, unobliterated internal inguinal rings previously not diagnosed were detected when examining the abdomen. Simultaneous appendectomy was performed when the cecum and the appendix were strangulated. Laparoscopic techniques omitting the disadvantages of an open repair method make it possible to remove a restrained organ from the abdominal sac, to assess its viability, to visualize the neck of the hernial sac avoiding mobilization of the elements of the spermatic cord, and to perform hernioplasty. The endosurgical technique allows diagnosing the obliteration of the peritoneum (processus vaginalis) from the contralateral side and performs interventions simultaneously from both sides.Паховые грыжи у детей — одно из распространенных заболеваний, требующих хирургического лечения. Существуют 2 вида оперативных вмешательств при паховой грыже у детей — открытый и лапароскопический. В мировой практике широко применяется открытое грыжесечение ввиду несложной методики оперативного пособия, отсутствия необходимости использования специальных инструментов. Однако, процент осложнений и частота рецидивов при выборе открытой методики хирургического лечения остаются высокими. В статье представлен анализ результатов лечения открытым и лапароскопическим способом 209 детей с ущемленными паховыми грыжами в период с 2003 по 2014 г. Открытые грыжесечения по Краснобаеву или Мартынову выполнены 89 детям. Выявлены следующие осложнения: у 34 пациентов — отек элементов семенного канатика, у 2 — нежизнеспособная петля кишки; у 1 ребенка в грыжевом мешке был червеобразный отросток с признаками странгуляции, в 4 случаях — червеобразный отросток с признаками воспаления. У 6 детей содержимое грыжевого мешка составляла прядь большого сальника, у 1 ребенка — прядь сальника с признаками острой ишемии. У 12 детей грыжевое выпячивание самостоятельно вправилось в брюшную полость, в связи с чем ревизия не потребовалась. У 1 пациента ранний послеоперационный период был осложнен перитонитом вследствие некроза стенки кишки. Лапароскопические герниопластики выполнены 120 детям. Содержимым грыжевого мешка в 86 случаях была петля тонкой кишки, в 7 — аппендикс и участок слепой кишки, в 15 — яичник и маточные трубы, в 5 — прядь большого сальника. У 14 детей при осмотре брюшной полости выявлены необлитерированные внутренние паховые кольца, ранее не диагностированные. При ущемлении слепой кишки и червеобразного отростка выполнялась симультанная аппендэктомия. Лапароскопические технологии, позволяющие избежать недостатков открытой методики использования эндовидеоскопической техники, дают возможность с абдоминальной стороны выполнить извлечение из грыжевого мешка ущемленного органа, провести визуальную оценку его жизнеспособности, полностью визуализировать шейку грыжевого мешка, избегая мобилизации элементов семенного канатика, и выполнить герниопластику. Эндохирургическая методика позволяет точно диагностировать облитерацию вагинального отростка брюшины с контрлатеральной стороны и провести вмешательства одновременно с обеих сторон

Visual Information Retrieval in Endoscopic Video Archives

In endoscopic procedures, surgeons work with live video streams from the inside of their subjects. A main source for documentation of procedures are still frames from the video, identified and taken during the surgery. However, with growing demands and technical means, the streams are saved to storage servers and the surgeons need to retrieve parts of the videos on demand. In this submission we present a demo application allowing for video retrieval based on visual features and late fusion, which allows surgeons to re-find shots taken during the procedure.Comment: Paper accepted at the IEEE/ACM 13th International Workshop on Content-Based Multimedia Indexing (CBMI) in Prague (Czech Republic) between 10 and 12 June 201

In search of the quickest way to disseminate health care innovations

RESEARCH QUESTION: Innovations in health care are slowly disseminated in The Netherlands and elsewhere. That's why the researchers defined their research question: What is the quickest way of disseminating health care innovations? RESEARCH METHOD: The design was a comparative, qualitative case study. The researchers invited a group of 52 authors to describe their 21 health care innovations. All case descriptions were published in a book of 261 pages [2]. RESULTS: Six types of innovations were distinguished. Most innovations simultaneously improved quality from the patient's point of view (18 out of 21 cases), professional pride (18/21) and speed of introduction (16/21). Clinical outcomes were better or comparable in 13 of the 21 cases. Brainstorm sessions took place with the innovators and the 22 experts on the quickest way to disseminate the innovations more widely in The Netherlands. These sessions looked for the critical success factors for the dissemination of the 21 projects and identified nine. The following factors were identified: 1. A clear distribution of responsibilities between professionals within the innovation (20/21) 2. Enough educational programs about the innovations for the professionals (18/21) 3. Adequate ICT support for the running of the innovations (15/21) 4. Suitable publicity for the innovations (12/21) 5. An adequate payment system for innovative care providers (7/21) 6. The right size of catchment's area for the innovations (6/21) 7. Enough professional freedom to adopt the innovation (5/21) 8. Fast managerial and public decision-making about the adoption of the innovation (3/21) 9. The embedding of the innovations in quality management assurance policy (1/21). DISCUSSION: The results of the study had some influence on the political health agenda in The Netherlands, leading to greater emphasis on innovations and quality of care

Definition of efficiency of different approaches in treatment of infertility for patients with polycystic ovary syndrome and hyperprolactinemia

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women. The clinical manifestation of PCOS varies from a mild menstrual disorder to severe disturbance of reproductive and metabolic functions with severe long-term health consequences. High-frequency of endocrine-metabolic disorder’s and anovulatory infertility and also frequent absence of effect from the use of traditional charts of medicament induction of ovulation resulted in the search of alternative ways of proceeding in fecundity. The aim of this study was to evaluate the clinical efficiency of different treatments cancellation and infertility in women with PCOS and hyperprolactinemia. We performed retrospective analysis of 502 consecutive case histories during 5 years of reproductive results of treatment of women is with anovulatory infertility, caused by different factors. Aim of the study was to determine the efficiency of conservative and surgical treatment. Differentiated application of conservative medical therapy allows to attain the effect of proceeding in a fertile function in 33, 8% of patients. It is found that surgical induction of ovulation by ovarian laparoscopic partial degradation is an option in the management of female infertility associated with PCOS, especially as a second-line treatment after the failure of clomiphene citrate treatment, enhancing the efficiency of complex infertility treatment to 40%. It is feasible to develop an algorithm differentiated use of infertility treatments in women with PCOS and hyperprolactinemia

AKUMC Annual Report : 1992

https://ecommons.aku.edu/akhs_report/1001/thumbnail.jp

Barrett's esophagus: endoscopic treatments I

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87170/1/j.1749-6632.2011.06049.x.pd

La splenectomia con tecnica mini-invasiva. Stato dell'arte

La tecnica della splenectomia laparoscopica è piuttosto recente, nasce nel 1991 con Bernard Delaitre in Francia; da allora la casistica in letteratura è aumentata progressivamente e da procedura sperimentale è diventata il gold standard nell’approccio chirurgico a questo organo. Rappresenta, tuttavia, una procedura di chirurgia mini-invasiva avanzata, e in quanto tale richiede, oltre ad una completa conoscenza dell’anatomia splenica da parte del chirurgo che la esegue,anche una adeguata abilità. Le tecniche mini-invasive hanno prodotto procedure sicure e gravate da minori complicanze, sia in caso di patologia benigna che maligna della milza, sia nel trattamento delle malattie che si accompagnano a marcata splenomegali

Clinical Application of Three-dimensional Printing and Extended Reality in Congenital Heart Disease

This PhD study investigates the clinical role of the two emerging techniques, which are 3D printing and virtual reality, to improve the visualisation and surgical planning of congenital heart disease. This research findings show that both of these technologies can enhance the users’ perception on the spatial relationship of the heart structures and defects, and therefore improving the management of congenital heart disease