To date, the problem of combat TBI is becoming one of the urgent problems of domestic health care. Peculiarities of pathogenesis, clinical picture, diagnostics of treatment of traumatic lesions of the nervous system make the works devoted to this topic in demand not only for neurosurgeons, but also for doctors of other specialties.
Traumatic brain injury (TBI) is a complex multidisciplinary problem due to high disability and mortality rates associated with it. What is more, due to a number of behavioral and social factors, the young working population is especially predisposed to this type of injury. In order to optimize preventive measures and treatment protocols it is crucial to have thorough understanding of TBI regional features. The research objective was to analyze the structure of surgical interventions and outcomes for adult TBI patients in Tyumen during 2016‑2020. The inclusion criteria were as follows: confirmed TBI diagnosis (S06 ICD-10 code), adult age (18 years old and over), and trauma acquisition during 2016‑2020. We analyzed 3,558 TBI cases. 641 (18.0 %) patients required surgical treatment, 826 surgeries were carried out in total. The average annual number of surgeries was 162.5. Most surgeries were due to subdural hematoma — 316 patients. Postoperative mortality rate was 15.6±3.2 %; 100 patients had polytrauma. The average surgeries-to-patient ratio was 1.3:1 and 3.4:1 for those who had more than one surgical intervention; 224 patients were operated on for TBI more than once. Our research indicated no statistically significant dynamics of the number of annual operations, outcome structure and mortality rates within the studied population and during the studied period.
Introduction. The occurrence of a brain abscess caused by a non-functioning ventricular catheter is a rare complication. This approach can be considered a preventive measure for the occurrence of infectious complications. Klebsiella pneumoniae, as an etiological factor in the occurrence of brain abscess, is relatively rare according to literature.Aim. To present our experience of treating a child with hydrocephalus who developed a brain abscess caused by a nonfunctioning ventricular catheter.Materials and methods. The material for the study was the clinical history of a 4-year-old patient with a brain abscess caused by a non-functioning ventricular catheter left after the replacement of the shunt system.Results. The prevention of such a complication is the complete removal of the elements of the ventriculoperitoneal shunting during its replacement. When an abscess is formed, the most appropriate method is its open removal along with a non-functioning catheter, since this allows the pathological focus to be sanitized as much as possible. This approach can be considered a preventive measure for the occurrence of infectious complications in the future. If a condition occurs when there is a combination of a brain abscess against the background of a non-functioning catheter, SPS and there are no inflammatory changes in the cerebrospinal fluid, it is advisable to remove the brain abscess along with the capsule and catheter, as well as removing the peritoneal catheter from the abdominal cavity. This tactic is also justified when the total removal of the abscess capsule is impossible, or there are already inflammatory changes in the cerebrospinal fluid and it is necessary to sanitize it.Of great clinical interest is also the study of the microbiological aspects of this pathology. Klebsiella pneumoniae, which was isolated during a microbiological study in this clinical example, as an etiological factor in the occurrence of a brain abscess, is rare according to the literature.Conclusion. The problem of the occurrence and treatment of infectious complications after liquor-reshunting operations during hydrocephalus is an urgent task in neurosurgery. Based on the analysis of the literature, it can be said that the rarity of publications on this topic makes even individual reports relevant, and today there is no way to propose a specific strategy for a non-functioning ventricular catheter.
The article presents data on the study of factors that contribute to the occurrence of repeated physical injuries in children aged 5—10 years. A model of risk factors for repeated injuries in children is proposed, which can be used in practice not only by a doctor, but also by a psychologist. We studied individual psychological characteristics of children, features of the social situation of the child’s development. It was found that a specific combination of these factors can actually cause repeated physical injuries in the child. In particular, the special role of conditions in the family was revealed, as well as the essential need to distinguish between true and false hyperactivity in children. It is shown that each individual child in the case of injury needs a person whose competence will help in preventive treatment of repeated injuries. The degree of responsibility of the person should be determined. The possibilities of a psychologist-consultant for the prognosis of risk factors and prospects for consultations are discussed.
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