No abstract

Sepsis-3: renewed determinations, potential problems and further practical foot steps

Вищий державний навчальний заклад України "Буковинський державний медичний університет", м. Чернівці ЕНДОТЕЛІАЛЬНА ДИСФУНКЦІЯ ТА АРТЕРІАЛЬНА ГІПЕРТЕНЗІЯ (ОГЛЯД ЛІТЕРАТУРИ) Резюме. Наводяться дані літератури про функції ендотелію, механізми розвитку ендотеліальної дисфункції у хворих на артеріальну гіпертензію.

Summary. The aim of the study was to improve the quality of diagnosis of chest injuries and to optimize surgical tactics through the use of spiral computed tomography. Material and research methods. The work is based on prospective analysis of the results of spiral computed tomography of patients with chest injuries for the period from 2014 to 2020. Results and its discussion. The results of SCT make it possible to objectify the choice of surgical tactics and the most rational type of access. The use of SCT has become expedient for chest injuries both before surgery in patients with stable hemodynamics and in the postoperative period to identify early complications. Conclusions. Based on the study, it was concluded that the use of SCT in patients with chest wounds makes it possible to choose rational treatment tactics, optimal access for surgery and drainage area, as well as apply minimally invasive treatment methods. Conducting CT studies in dynamics allows us to assess the effectiveness of conservative and surgical treatment and promptly make adjustments to the treatment.

Objective. To determine the treatment tactics for varicose dilation of veins, complicated by thrombosis of subcutaneous veins and the shin deep veins, using miniinvasive methods. Маterals and methods. The results of treatment in the IGUS named after V. Т. Zaytsev NAMS of Ukraine in 2015 - 2017 yrs of 80 patients, suffering varicothrombophlebitis, were analyzed. The patients were divided into two groups. In Group I 38 patients, suffering varicothrombophlebitis and/or the shin deep vein thrombosis (DVT), were included, who were treated in accordance to the algorithm proposed. In Group II 42 patients with the same pathology were included, to them a standard treatment was conducted. Results. Immediately after the operation in the Group I patients a severe morbidity, connected with the operation technique (DVT, pulmonary thromboembolism, hemorrhage) were absent. Rate of cutaneous neurological disorders in distal parts of the extremities in patients, to whom endovenous laser coagulation was performed, have constituted 5.2%, and in radiofrequency ablation (RFA) – 2.6%. Due to differentiated approach applied for determination of the operative intervention volume for varicose dilation of veins, complicated by varicothrombophlebitis and/or DVTH of the shin, it became possible to perform operative intervention of lesser traumaticity and to achieve good immediate result in majority of the patients. In Group II in 1 patient postoperative period have complicated by DVT. Of the local complications lymphorrhea was observed in 5% patients, and in 2 patients – the extended femoral hematomas. Conclusion. Operative treatment in the RFA volume or endovenous laser coagulation of the stem on the level of reflux with ligature/ablation of perforant veins after conduction of anticoagulant therapy on stage of total recanalization are indicated in patients, suffering thrombosis of the big subcutaneous vein or small subcutaneous vein and deep veins of the shin. In the patients, suffering thrombosis of stem, the deep shin veins after conduction of operative treatment it is mandatory to administer anticoagulant therapy in the treatment dosage during 7 - 14 days, depending on indices of soluble complexes of the fibrin monomers and/or D-dimer.