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Анализ эффективности лазерной вапоризации в сравнении с другими методиками лечения геморроидальной болезни на основе процента осложнений.

Геморрой является одним из наиболее распространенных колопроктологических заболеваний человека. Распространенность его так высока, что в хирургической оперативной помощи нуждается каждый третий больной. В работе проведен краткий анализ историй болезни пациентов с геморроидальной болезнью и осложнениями после геморроидэктомии. Всего проанализировано 1450 операций, ранние и отдаленные результаты хирургического лечения больных, оперированных в хирургическом отделении Корпоративного фонда «UniversityMedicalCenter». Проведено сравнение эффективности лазерной вапоризации в сравнении с другими методами хирургического лечения.

23.02.2024
RISK FACTORS FOR INFECTION DEVELOPMENT IN PATIENTS WITH DIABETIC FOOT ULCERS

The use of algorithms to assess the risk of diabetic ulcer infection and identify predictors of infection can be highly useful for sorting patients by the degree of diabetic ulcer complication risk, appropriate management, and the selection of suitable medical care. Timely detection of patients with uncomplicated diabetic ulcers may be extremely important for further adequate outpatient treatment, avoiding hospitalization. It is believed that effective intervention in diabetes foot syndrome treatment can prevent amputations, reducing the long-term burden on the economy and healthcare system.
Materials and Methods. Outpatient patients with diabetic foot ulcers were selected. After screening using the diabetic foot syndrome assessment form and risk stratification of diabetic ulcer infection using the developed algorithm, infection risk factors will be identified and patients with low risk of diabetic ulcer infection will be determined based on clinical signs. Subsequently, the risk of diabetic ulcer infection will be determined by laboratory and microbiological characteristics.
Results. At the initial screening, 33.1% of diabetic ulcers had clinical signs of infection. Independent risk factors for infection were identified, such as the depth of the diabetic ulcer r = 0.909, p <0.01, microbial load, and the level of leukocytes in the blood (r = 0.273, p = 0.032).
Conclusion. A structured strategy of monitoring and prevention of diabetic ulcer infection risk assists in treatment strategy selection and reduces the risk of diabetic foot syndrome complications.
Keywords: diabetic foot ulcer, risk factors, infections, wound healing

21.02.2024
Осложнения применения двухпросветной эндотрахеальной трубки и их лечение (клинический случай)

Женщине 46 лет, ростом 161 см и массой тела 75 кг во время эндоскопической резекции пищевода с восстановлением целостности желудочно-кишечного тракта желудочной трубкой (операция McKeown) произошло повреждение трахеи с разрывом мембранозной части, которое расценено как осложнение в результате установки двухпросветной эндотрахеальной трубки. Клинически разрыв не проявлялся в течение двух часов однолегочной левосторонней вентиляции легких, и был выявлен визуально во время торакоскопического этапа операции. Разрыв трахеи был ушит. В послеоперационном периоде пациенту была необходима продленная вентиляция легких, которая осуществлялась через ларингеальную маску. Неоднократная фибробронхоскопия проводилась для верификации состояния трахеального шва, его герметичности и санации трахеобронхиального дерева в отделении интенсивной терапии. Применение мультидисциплинарного подхода к диагностике и лечению такого жизнеугрожающего осложнения как разрыв трахеи, позволил в короткое время добиться стабилизации состояния и избежать развития дальнейших осложнений.

14.02.2024
MODERN BIOMARKERS – PREDICTORS OF EARLY CARDIOVASCULAR AGEING (literature review)

An analysis of the current state of the problem of studying biomarkers of human cardiovascular ageing was carried out based on an analysis of international experience. Ageing is an inevitable, constantly progressive systemic process, which is a significant risk factor for the development of most common chronic human diseases, including cardiovascular diseases. Therefore, studying markers of early cardiovascular ageing is a logical goal for developing measures to prevent the development of cardiovascular disease and improve the quality of life and prolong active longevity

14.02.2024
The strategy of mechanical ventilation during cardiopulmonary bypass as a predictive factor for pulmonary complications in the intensive care unit.

Pulmonary complications are the second most common after cardiac surgery with cardiopulmonary bypass (CPB). Atelectasis can result from intraoperative causes such as prolonged operation and anaesthesia time of more than 3-4 hours, use of a thoracic artery, use of cardiopulmonary bypass during surgery and failure to ventilate, and haemotransfusion of 4 or more units of packed red blood cells in the perioperative period. Impact of mechanical ventilation during cardiopulmonary bypass still unknown.
Methods: Prospective, randomised study at one centre. Adult patients undergoing cardiac surgery with a pump by sternotomy for coronary artery disease were included.
Patients were randomised into two groups – one group receiving mechanical ventilation and one group receiving no ventilation during cardiopulmonary bypass. The main endpoint was PaO2/FiO2 as a marker for the quality of ventilation and perfusion measured. Secondary endpoints were postoperative pulmonary complications such as atelectasis and prolonged mechanical ventilation of more than 72 hours.
Results 190 consecutive patients were included, 92 and 98 in each group. No significant difference was found in the PaO2/FiO2 ratio in the groups (p=0.6). A significant difference was found in the number of atelectasis during ultrasound investigation (USI) of the lungs with a p-value of 0.03 in the non-ventilated group.
Conclusion: On-pump cardiac surgery without mechanical ventilation can lead to atelectasis of the lungs.

02.02.2024
MODERN BIOMARKERS – PREDICTORS OF EARLY CARDIOVASCULAR AGEING (literature review)

An analysis of the current state of the problem of studying biomarkers of human cardiovascular ageing was carried out based on an analysis of international experience. Ageing is an inevitable, constantly progressive systemic process, which is a significant risk factor for the development of most common chronic human diseases, including cardiovascular diseases. Therefore, studying markers of early cardiovascular ageing is a logical goal for developing measures to prevent the development of cardiovascular disease and improve the quality of life and prolong active longevity

02.02.2024
NONINVASIVE DIAGNOSIS OF HEART REJECTION AS A PREDICTOR OF LONG-TERM TRANSPLANT SURVIVAL.

Currently, the issue of chronic heart failure (CHF) is increasingly relevant in Kazakhstan, with a significantly higher mortality rate from the terminal stage of CHF, especially among patients in FC III-IV. Heart transplantation is considered the “gold” standard for surgical treatment of terminal CHF; however, endomyocardial biopsy, used for monitoring the transplanted heart, is an invasive and inconvenient procedure. This study explores the potential of safe and accurate monitoring of acute transplant rejection using circulating donor-derived cell-free DNA (dd-cfDNA). The study involved 40 patients who had undergone heart transplantation. The results revealed that 60% of them had undergone repeat surgery, while 40% had undergone primary transplantation. The primary causes of terminal CHF included various cardiomyopathies, predominantly dilated and ischemic. The dd-cfDNA method shows promise in differentiating T-cell-mediated (ACR) and antibody-mediated (AMR) rejection, with distinct patterns of dd-cfDNA elevation. These differences have high clinical significance for diagnosis and treatment strategies. However, despite the prospects of using dd-cfDNA, further research is needed to establish threshold values and confirm its effectiveness in clinical practice. The study also raises important questions about the cost and accessibility of the method, requiring additional attention in the development of precision medicine methods in the field of heart transplantation.

02.02.2024
EXPERIENCE OF RESORPTION OF LUMBAR SPINE HERNIA

Summary: Low back pain is common among people between the ages of 30 and 65, and herniated lumbar discs are one of the main causes of this condition. In most cases, the reduction in pain and clinical manifestations is associated with a decrease in the size of the hernia or its resorption, which is the natural process of reduction or complete disappearance of the hernia without the need for surgical intervention. Currently, there are several intensive physical therapy methods that influence the process of hernia resorption, making conservative treatment preferable.
Purpose: demonstration of the results of experience in the use of high-intensity physiotherapeutic methods of influencing the process of resorption of herniated intervertebral discs of the lumbar spine.

Materials and methods: At the Expert Neuro clinic, as part of a dissertation research from 2023 to 2024, 30 patients with a confirmed diagnosis of “herniated intervertebral discs of the lumbar spine” were analyzed based on the results of magnetic resonance imaging (MRI). The main group of patients received conservative treatment using modern high-intensity physiotherapy methods, the control group received classical methods of conservative treatment.
Results and discussion: According to MRI of the spine, 3 patients developed resorption of a herniated intervertebral disc. In all patients, radiculopathy symptoms improved after 1 month and low back pain symptoms improved after 2 to 3 months.
Conclusion: According to our clinical experience and relevant literature, sequestered disc herniations have a high rate of resorption. Pathophysiological processes of inflammation and regeneration are the main mechanisms of this phenomenon. Conservative management of such patients in the absence of definitive surgical indications should not be underestimated.

01.02.2024
NONINVASIVE DIAGNOSIS OF HEART REJECTION AS A PREDICTOR OF LONG-TERM TRANSPLANT SURVIVAL.

Currently, the issue of chronic heart failure (CHF) is increasingly relevant in Kazakhstan, with a significantly higher mortality rate from the terminal stage of CHF, especially among patients in FC III-IV. Heart transplantation is considered the “gold” standard for surgical treatment of terminal CHF; however, endomyocardial biopsy, used for monitoring the transplanted heart, is an invasive and inconvenient procedure. This study explores the potential of safe and accurate monitoring of acute transplant rejection using circulating donor-derived cell-free DNA (dd-cfDNA). The study involved 40 patients who had undergone heart transplantation. The results revealed that 60% of them had undergone repeat surgery, while 40% had undergone primary transplantation. The primary causes of terminal CHF included various cardiomyopathies, predominantly dilated and ischemic. The dd-cfDNA method shows promise in differentiating T-cell-mediated (ACR) and antibody-mediated (AMR) rejection, with distinct patterns of dd-cfDNA elevation. These differences have high clinical significance for diagnosis and treatment strategies. However, despite the prospects of using dd-cfDNA, further research is needed to establish threshold values and confirm its effectiveness in clinical practice. The study also raises important questions about the cost and accessibility of the method, requiring additional attention in the development of precision medicine methods in the field of heart transplantation.

01.02.2024
Измельчители кости (литературный обзор) Сүйек ұнтақтағыштар (әдеби шолу) Bone Grinders (literature review)

Измельчители кости (литературный обзор)
Абстракт
Это первый систематизирующий обзор медицинских изделий, обладающих
функцией измельчения. Дана описательно-сравнительная характеристика основных видов
измельчителей кости. Поиск производился на официальных сайтах медицинских изделий и
в патентных базах, рассмотрены как коммерческие варианты, так и патенты на изобретения.
Выделены технические характеристики, которыми должны обладать обсуждаемые
приборы. Впервые дана классификация устройств медицинского назначения для
измельчения костей.
Ключевые слова: измельчители кости, костная мельница, костная дробилка,
медицинские изделия, классификация

Сүйек ұнтақтағыштар (әдеби шолу)
Аңдатпа
Бұл ұнтақтайтын функциясы бар медициналық құрылғылардың алғашқы жүйелі
шолуы. Сүйек ұнтағыштардың негізгі түрлеріне тән салыстырмалы сипаттамалық
қасиеттері берілген. Осы мақсатта арнайы іздеулер: медициналық құрылғылар жайлы
ресми сайттарда, патенттік деректік базада жүргізілген, сонымен бірге өнертабыс
патенттер мен коммерциялық түрлері қарастырылған. Талқыланатын құрылғының
міндетті түрде өзіне тән техникалық қасиеттері болу керектігі бөліп көрсетілген. Алғаш
рет, сүйектерді ұнтақтауға арналған медициналық құрылғылардың классификациясы
берілді.
Түйінді сөздер: сүйек ұнтақтағыштар, сүйек диірмені, сүйек ұсатқыш,
медициналық құрылғылар, классификация

Bone Grinders (literature review)
Abstract
This is the first systematic review of medical devices with a grinding function. A
descriptive and comparative characteristic of the main types of bone grinders is given. The
search was carried out on the official websites of medical devices and in patent databases, both
commercial options and patents for inventions were considered. The technical characteristics that
the discussed devices should have are highlighted. For the first time, a classification of medical
devices for crushing bones is given.
Keywords: bone grinders, bone mill, bone crusher, medical devices, classification

30.01.2024
SURGICAL TREATMENT OF EPITHELIAL COCCYGEAL PASSAGE

Annotation: Epithelial coccygeal passage (ECP) is one of the most discussed topics in proctology. Despite the fact that modern surgery presents numerous modifications of reconstructive operations, some surgeons adhere to the tactics of the excision of the passage with its primary closure, without plastic surgery.This work is aimed to demonstrate the results of the excision of ECP with primary closure in comparison with excision with the classical Limberg flap wound closure reconstruction. The research included 10 patients, 8 of which were men – 80% and 2 women – 20%. The average age of the patients is 37 years old. At the end of the work, one recurrence was received.

30.01.2024
The strategy of mechanical ventilation during cardiopulmonary bypass as a predictive factor for pulmonary complications in the intensive care unit.

Pulmonary complications are the second most common after cardiac surgery with cardiopulmonary bypass (CPB). Atelectasis can result from intraoperative causes such as prolonged operation and anaesthesia time of more than 3-4 hours, use of a thoracic artery, use of cardiopulmonary bypass during surgery and failure to ventilate, and haemotransfusion of 4 or more units of packed red blood cells in the perioperative period. Impact of mechanical ventilation during cardiopulmonary bypass still unknown.
Methods: Prospective, randomised study at one centre. Adult patients undergoing cardiac surgery with a pump by sternotomy for coronary artery disease were included.
Patients were randomised into two groups – one group receiving mechanical ventilation and one group receiving no ventilation during cardiopulmonary bypass. The main endpoint was PaO2/FiO2 as a marker for the quality of ventilation and perfusion measured. Secondary endpoints were postoperative pulmonary complications such as atelectasis and prolonged mechanical ventilation of more than 72 hours.
Results 190 consecutive patients were included, 92 and 98 in each group. No significant difference was found in the PaO2/FiO2 ratio in the groups (p=0.6). A significant difference was found in the number of atelectasis during ultrasound investigation (USI) of the lungs with a p-value of 0.03 in the non-ventilated group.
Conclusion: On-pump cardiac surgery without mechanical ventilation can lead to atelectasis of the lungs.

30.01.2024
NONINVASIVE DIAGNOSIS OF HEART REJECTION AS A PREDICTOR OF LONG-TERM TRANSPLANT SURVIVAL

Currently, the issue of chronic heart failure (CHF) is increasingly relevant in Kazakhstan, with a significantly higher mortality rate from the terminal stage of CHF, especially among patients in FC III-IV. Heart transplantation is considered the “gold” standard for surgical treatment of terminal CHF; however, endomyocardial biopsy, used for monitoring the transplanted heart, is an invasive and inconvenient procedure. This study explores the potential of safe and accurate monitoring of acute transplant rejection using circulating donor-derived cell-free DNA (dd-cfDNA). The study involved 40 patients who had undergone heart transplantation. The results revealed that 60% of them had undergone repeat surgery, while 40% had undergone primary transplantation. The primary causes of terminal CHF included various cardiomyopathies, predominantly dilated and ischemic. The dd-cfDNA method shows promise in differentiating T-cell-mediated (ACR) and antibody-mediated (AMR) rejection, with distinct patterns of dd-cfDNA elevation. These differences have high clinical significance for diagnosis and treatment strategies. However, despite the prospects of using dd-cfDNA, further research is needed to establish threshold values and confirm its effectiveness in clinical practice. The study also raises important questions about the cost and accessibility of the method, requiring additional attention in the development of precision medicine methods in the field of heart transplantation.

23.01.2024
Анализ эффективности лазерной вапоризации в сравнении с другими методиками лечения геморроидальной болезни на основе процента осложнений.

Геморрой является одним из наиболее распространенных колопроктологических заболеваний человека. Распространенность его так высока, что в хирургической оперативной помощи нуждается каждый третий больной. В работе проведен краткий анализ историй болезни пациентов с геморроидальной болезнью и осложнениями после геморроидэктомии. Всего проанализировано 1450 операций, ранние и отдаленные результаты хирургического лечения больных, оперированных в хирургическом отделении Корпоративного фонда «University Medical Center». Проведено сравнение эффективности лазерной вапоризации в сравнении с другими методами хирургического лечения.

19.01.2024
MODERN METHODS OF DIAGNOSIS AND TREATMENT OF CONGENITAL PATHOLOGY OF THE LACRIMAL TRACT IN CHILDREN. LITERATURE REVIEW

Congenital nasolacrimal duct obstruction is the most common ocular abnormality in children younger than 1 year. The disease occurs because of the dysgenesis of nasolacrimal pathways or their blockage, which leads to the violation of the tears outflow and its` stagnation in lacrimal sac. Most cases resolve on their own and do not require any treatment. However, in some cases, the disease can cause serious complications, such as development of purulent dacryocystitis, recurrent purulent eye infections and inflammation of the accessory structures of the eye. Treatment of congenital obstruction of the nasolacrimal duct in children should be personal, determined in accordance with the severity of the disease, and carried out under the supervision of an ophthalmologist. The review highlights the main aspects related to the diagnosis and treatment of congenital obstruction of the nasolacrimal duct in children.

19.01.2024
Измельчители кости (литературный обзор) Сүйек ұнтақтағыштар (әдеби шолу) Bone Grinders (literature review)

Это первый систематизирующий обзор медицинских изделий, обладающих функцией измельчения. Дана описательно-сравнительная характеристика основных видов измельчителей кости. Поиск производился на официальных сайтах медицинских изделий и в патентных базах, рассмотрены как коммерческие варианты, так и патенты на изобретения. Выделены технические характеристики, которыми должны обладать обсуждаемые приборы. Впервые дана классификация устройств медицинского назначения для измельчения костей.
Ключевые слова: измельчители кости, костная мельница, костная дробилка, медицинские изделия, классификация

Бұл ұнтақтайтын функциясы бар медициналық құрылғылардың алғашқы жүйелі шолуы. Сүйек ұнтағыштардың негізгі түрлеріне тән салыстырмалы сипаттамалық қасиеттері берілген. Осы мақсатта арнайы іздеулер: медициналық құрылғылар жайлы ресми сайттарда, патенттік деректік базада жүргізілген, сонымен бірге өнертабыс патенттер мен коммерциялық түрлері қарастырылған. Талқыланатын құрылғының міндетті түрде өзіне тән техникалық қасиеттері болу керектігі бөліп көрсетілген. Алғаш рет, сүйектерді ұнтақтауға арналған медициналық құрылғылардың классификациясы берілді.
Түйінді сөздер: сүйек ұнтақтағыштар, сүйек диірмені, сүйек ұсатқыш, медициналық құрылғылар, классификация

This is the first systematic review of medical devices with a grinding function. A descriptive and comparative characteristic of the main types of bone grinders is given. The search was carried out on the official websites of medical devices and in patent databases, both commercial options and patents for inventions were considered. The technical characteristics that the discussed devices should have are highlighted. For the first time, a classification of medical devices for crushing bones is given.
Keywords: bone grinders, bone mill, bone crusher, medical devices, classification

19.01.2024
Comparative Assessment of Surgical Treatment Outcomes in Patients with Sacroiliac Joint Injury

Abstract
The aim of the study is to evaluate the results of surgical treatment in patients with sacroiliac joint injury.
Methods. An analysis of the results of surgical treatment of 60 patients with sacroiliac joint injury was conducted at the Center of polytrauma and orthopedic surgery of the State Public Healthcare Institution “Emergency Hospital” in Abai Region, the Trauma and Endoprosthetics Department of the State Public Healthcare Institution “Multispecialty City Hospital No. 1” in the city of Astana, and the “Shymkent City Clinical Hospital No. 1” from June 2019 to August 2022.
Patients were divided into two groups. Patients in the control group underwent surgery using the standard technique, while patients in the experimental group underwent surgery using a device developed by us for minimally invasive locking osteosynthesis of sacroiliac joint injuries. The study was a randomized controlled trial by design.
Results. The use of the device for minimally invasive locking osteosynthesis of sacroiliac joint injuries leads to a significant reduction in the length of hospitalization for all types of sacroiliac joint injuries regardless of the patient’s initial condition (p=0.001). Correlation analysis revealed a correlation between the observation group and patient pain assessment at 12 months (p=0.001).
According to the Majeed Pelvic Score at 12 months, the maximum score in the experimental group was 98 points, while in the control group, it was 70 points. A satisfactory assessment on the Majeed Pelvic Score at 12 months was observed in 10% (n=3) of patients in the control group and none in the experimental group. There were no unsatisfactory responses in both groups (significant differences were found, p=0.001).
Conclusions. The use of the device developed by us for minimally invasive locking osteosynthesis of sacroiliac joint injuries reduces the length of hospitalization and the time to return to work (12 months in the control group and 8 months in the experimental group). The absence of pain in patients after 12 months in the experimental group was 86.7% (n=26) and 66.6% (n=20) in the control group. According to the Majeed Pelvic Score in the long term (3, 6, and 12 months), the frequency of excellent results increases from 13.3% to 90.0% in the experimental group and from 10% to 73.4% in the control group.
Keywords: trauma, sacroiliac joint, minimally invasive locking osteosynthesis.

16.11.2023
ХИРУРГИЧЕСКАЯ ТАКТИКА ЛЕЧЕНИЯ ЭПИТЕЛИАЛЬНОГО КОПЧИКОВОГО ХОДА.

Аннотация: Эпителиальный копчиковый ход (ЭКХ)является одной из самых дискутируемых тем проктологии. Не смотря на то что современная, хирургия представляет многочисленные модификации реконструктивных операций, часть хирургов придерживается тактики иссечения хода с его первичным закрытием, не прибегая к пластике. Данная работа нацелена на демонстрацию результатов иссечения ЭКХ с первичным закрытием в сравнении с иссечением с классической реконструкцией в стиле лоскута Лимберга. В исследование было включено 10 пациентов 8 из которых были мужчины-80% и 2 женщины-20 % Средний возраст 37 лет. По окончанию работы был получен один рецидив.

16.11.2023