HighlightsLaparoscopic adrenalectomy can be possible factors which decrease the immunity and can cause the activation of latent infection.For correct diagnosis having vague clinical picture of surgical pathology of abdominal cavity organs, CT with contrast is advised to be used.In case with clinical picture of pus-septical complications during the early postsurgical period without the diagnosis of infection source hotbed, it is worth conducting diagnostic laparoscopy with biopsy and the following cytologic study.Diagnostic laparoscopy and intraoperative histological tissue study of abdominal cavity are the main points in prescribing diagnosis of abdominal tuberculosis form.

Мета роботи: вивчити переваги та недоліки відеоасистованої паратиреоїдектомії. Матеріали і методи. У нашій клініці від лютого 2010 року до лютого 2019 року оперовано 103 пацієнти з приводу ПГПТ, з них було 84 жінки, середній вік хворих склав (58,2±12,1) року. Діагноз ПГПТ базувався на класичних симптомах, а саме наявності підвищених рівнів загального та/або йонізованого кальцію та інтактного паратгормону (ПТГ) у сироватці крові. Усіх пацієнтів розділено на дві групи: І група – 36 пацієнтів (35 %), яким виконано відеоасистовану паратиреоїдектомію, IІ група – 67 пацієнтів (65 %), яких оперували відкритим способом із двобічною експлорацією шиї. Результати досліджень та їх обговорення. У 35 % хворих виконано відеоасистовану паратиреоїдектомію, у яких за результатами топічних досліджень виявлено солітарну аденому ПЩЗ – ці пацієнти утворили І групу. У 59 (57 %) хворих ІІ групи виявлено супутню патологію щитоподібної залози, 4 пацієнти (4 %) в анамнезі мали операції на шиї в ділянці щитоподібної залози, ще у 4-х (4 %) – діагностовано рецидив або персистенцію ПГПТ. Обидві групи вірогідно не відрізнялися за віком та статтю, рівнями загального та йонізованого кальцію, ПТГ перед операційним втручанням. Тривалість операційного втручання була вірогідно меншою та довжина розтину коротшою у пацієнтів І групи. У двох (2 %) хворих ІІ групи та у жодного пацієнта І групи після операційного втручання розвинувся транзиторний парез поворотного гортанного нерва. Отримані результати дозволяють твердити, що відеоасистована паратиреоїдектомія у ретельно відібраних пацієнтів (35 %), за результатами ультрасонографії та сумнівних випадках сцинтиграфії із 99mТс-MIBI, є ефективним мініінвазійним методом операційного лікування хворих на ПГПТ, який дозволяє скоротити час хірургічного втручання та частоту післяопераційних ускладнень.

Objective. To determine efficacy of intraoperative visualization of biliary tree, using fluorescent cholangiography (FCH) and a high–energy visible laparoscopy vison (HEV LapVison) while laparoscopic cholecystectomy performance (LCHE). Маterials and methods. In 25 patients LCHE was performed. Preoperatively fluorescein was injected intravenously for guaranteeing of the FCH performance. HEV LapVison was applied for intraoperative visualization of fluorescence. Results. Visualization of the cystic duct and its inflow into common biliary duct was guaranteed in 90% patientsх. In 13 (52%) patients the anatomic picture was typical while in 7 (28%) some variants were observed: a parallel course of cystic duct and common biliary duct, and low level of the cystic duct inflow into hepaticocholedochus. Conclusion. FCH is a simple procedure for intraoperative navigation doing and guaranteeing of «critical view on security» while performance of LCHE. FCH together with HEV LapVison constitutes a new surgical procedure, making possible revealing of extrahepatic biliary ducts. This method may be applied as additional one while doing LCHE, preventing damage of biliary ducts.

The aim — to develop an integrated therapeutic algorithm and to evaluate its effectiveness for surgical treatment optimizing in patients with оrоstomas and pharyngostomas.Materials and methods. The treatment results of 90 (3 (3.33 %) women and 87 (96.77 %) men, mean age 56.98 ± 0.42 years) with orostomas and pharyngostomas that occurred in the postoperative period of radical treatment for malignant extracranial tumors of the head and neck. The localization of the primary tumor was as follows: 37 (41.11 %) had oral tumors, 29 (32.22 %) — different parts of the pharynx, 24 (26.67 %) had recurrent and residual tumors of the larynx after radical course of radiotherapy. Patients were treated with conservative and surgical methods. The quality of life was assessed using a specialized scale (Performance status scale for head and neck patients).Results and discussions. It is established that the application of the developed algorithm allows to optimize the medical process and statistically significantly improve the quality of life of patients in terms of «habitual diet completeness « and «the possibility of public food intake» in 1.8 and 2.5 times respectively (p < 0.05).Conclusions. The integrated algorithm with application of both conservative and surgical methods, in particular, plastic closure, allows to achieve stable healing of the orostomas and pharyngostomas and to improve the social adaptation of this category of patients.

Aim: To determine the frequency of NOD2 gene c.3019-3020insC (rs5743293) and c.2104C>T (rs2066844) allelic variants in the patients with Crohn’s disease (CD), colorectal cancer (CRC) and in the control groups and to study the association of these mutations with the onset time of the diseases, gender and surgical interventions. Materials and Methods: The diagnoses of CD and CRC were established based on standard clinical examination and laboratory tests. Molecular genetic study of a frameshift 3020insC mutations of NOD2 gene were performed in 54 patients with CD; missense R702W mutations of the NOD2 gene — in 41 CD patients and 38 healthy controls. In CRC group, 3020insC mutation was tested in 48 patients, R702W mutation — in 40 patients and 40 healthy controls. PCR-RFLP technique was used to identify the mutations. Results: The frequency of the minor allele (M) of 3020insC mutation of NOD2 gene in the patients with CD was significantly higher than in the control group (р = 0.01). The age at CD onset in females carrying 3020insC mutation was significantly lower (22.5 ± 1.6 years) when compared with females without the mutation (32.7 ± 2.5 years) (p = 0.002). There was no significant difference in the allele frequencies and genotype distributions of R702W mutation in the patients with CD in comparison with the controls. The mean age at CD onset in the patients carrying R702W mutation was significantly lower (28.4 ± 1.4 years) compared with the patients without the mutation (39.4 ± 2.8 years) (p < 0.01). Surgical interventions for CD was required in 40.0% of 3020insC mutation carriers. Among patients with CRC, only 4.2% carried 3020insC mutation and 20.0% R702W mutation. Our study suggests that R702W and 3020insC mutations are not associated with the risk of CRC in Ukrainian patients. There was no statistically significant difference in mean age at CRC onset in patients with/without R702W mutation. Only one patient with CRC had two mutations. Conclusion: The earlier age at CD onset was associated with 3020insC mutation, but only in female patients. The association between R702W mutation and the earlier age of CD onset was found. Patients with 3020insC mutation showed a trend to a higher frequency of surgical interventions for CD.