Наукові праці. Кафедра хірургії № 4

Permanent URI for this collectionhttps://repo.knmu.edu.ua/handle/123456789/1519

Browse

Now showing 1 - 18 of 18

A rare case of blast injury of the chest and spine on the background of a congenital malformation in the form of a complete mirror image arrangement of internal organs
(2024) Khoroshun, Eduard; Makarov, Vitaliy; Nehoduiko, Volodymyr; Shypilov, Serhii; Tertyshnyi, S.; Slesarenko, K.
The aim is to demonstrate a clinical case of blast injury of the chest and spine against the background of a complete mirror image arrangement of internal organs. Clinical case. The injured S., 37 years old, received a blast injury during mortar shelling. Upon admission, the injured person complained of aching pain in the area of the X rib on the left and in the lumbar region. The pain worsened during movement. He has known about the malformations of internal organs since childhood, but only about the right-sided location of the heart. The final established diagnosis is combined blast injury of the chest and spine. Closed chest injury on the left, closed fracture of the X rib on the left. Closed fracture of the lumbar processes L3–4 on the right. Congenital malformation. A complete mirror image arrangement of internal organs. The injured person was taken to a territorial hospital base for further treatment, where he received painkillers, anti-inflammatory therapy, and prescribed multivitamins. The total bed-day was 7 days. The injured was taken to the Military Medical Commission and discharged in satisfactory condition to implement the decision of the Military Medical Commission. Conclusions. A congenital malformation in the form of a complete mirror image arrangement of internal organs is a rare pathology. Diagnosing a complete mirror image arrangement of internal organs is not difficult and is an accidental finding during the examination for the injury in this case. Anamnestic data help in the diagnostic search. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of a participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.
A rare case of endoscopic removal of the metal fragment from the segmental bronchus after gunshot injury to the chest in combat patient injured in the war in Ukraine
(2024) Lurin, I.; Khoroshun, Eduard; Makarov, Vitalii; Nehoduiko, Volodymyr; Cherniavskyi, Ye.; Gorobeiko, M.; Marchenko, О.; Dinets, А.
Introduction and importancе: Russo-Ukrainian war is associated with severe injuries to the chest. Isolated chest injuries are associated with high mortality or advanced invalidization due to the severity of the trauma. The aim of the study was to demonstrate the experience and the challenges in diagnosis and management of the combat patient with gunshot injury to the lungs with subsequent migration of the shrapnel projectile to the segmental bronchus and its bronchoscopic removal by using forceps. Case presentation: A male patient 44 years of age was injured at an artillery strike in East Ukraine. The patient was evacuated to the Forward Surgical Team (Role 1) facility within one hour after the injury. The bronchoscopy was performed and to our surprise, the metal fragment in the lumen of the right segmental S2 bronchi was visualized at bronchoscopy, indicating its migration from the first place. The decision was made to attempt to remove the metal fragment endoscopically. At bronchoscopy, the metal fragment was caught by the endoscopic forceps and therefore removed endoscopically. The time of endoscopic removal of the metal fragment was 8 min. Clinical discussion: Removal of a foreign body (metal fragment) of gunshot origin from the lumen of a segmental bronchus by using bronchoscopy with endoscopic forceps is a rare phenomenon. Conclusions: The use of minimally invasive technologies in the treatment of gunshot blind penetrating wounds of the chest contributes to the reduction of operative trauma and shortens the time of operative treatment.
A review of the artificial intelligence application as a guideline tool for the wound management
(2024) Lurin, I.; Gorobeiko, M.; Sokol, Ye.; Usenko, O.; Khoroshun, Eduard; Makarov, Vitalii; Nehoduiko, Volodymyr; Gumeniuk, K.; Gorobeyko, B.; Dinets, А.
he global interest and substantial challenges on this subject contribute to its relevance. This analysis centers on the implementation of artificial intelligence within the medical field, with a specific focus on its application in managing wounds. Through an examination of numerous online studies and publications, we can gain insight into how artificial intelligence is being employed to enhance the diagnosis, treatment, and monitoring of wound healing. The integration of artificial intelligence in this sector has the capacity to transform medical practice by improving precision, effectiveness, and individualized patient care. As a result, it is a leading area of research and advancement on a global scale. We used the PubMed and Google Scholar electronic databases of medical publications, searching for abstracts using the following key phrases: artificial intelligence and wound management, artificial intelligence and gunshot wounds, artificial intelligence and war medicine, artificial intelligence and surgery. Based on search results, a literature analysis was performed. Conclusions. It is necessary to create numerous working groups of highly qualified specialists from each discipline and direction of medical activity, where the specific weight of each symptom, laboratory indica-tor, each radiological and ultrasound examination result is determined based on the data of real cases. And such work should have no less discipline and structure than medical research, it is optimal to get a universal software tool for this stage of work, which can be used with certain variations for the whole variety of pathological conditions and processes
Changes in the thyroid hormone status of the wounded depending on the volume of wound damage
(2024) Misiura, K.; Lurin, І.; Seliukova, N.; Boiko, M.; Tykha, I.; Nehoduiko, Volodymyr; Kalashnyk, S.
The wound process is considered to be the local and general organism’ responses which are developed to damaged tissues. The number of individuals with combat trauma was extremely increased due to Russia’s armed aggression against Ukraine started in February 2022. The wound healing and the course of wound process depend on large number of factors one of them is thyroid status. The impact of thyroid hormones on the particularities of combat traumas’ healing is the background of this investigation. The purpose of this research was to determine the link between wound sizes and thyroid hormones serum level at different period of the wound process. Material and methods. 30 militaries with wounds of soft tissues of different sizes have taken part in this study. The average age of wounded men was 34.2 ± 4.3. The average body mass was 78 ± 3.5 kg. Free T3 and T4, thyrotropic hormone (TTH) concentrations have been determined. Results. During investigation free T3 concentration was at level 3.4–5.2 pmol/L and hasn’t statistically changed in all the participants comparing to its concentration within 1–3 days. The concentration of free T4 did not differ in militaries with minimal as well as with mild injuries. The levels of free T4 hormones were signifi cantly (р < 0.05) higher in severely wounded men during the entire duration of the investigation. TTH levels considerably (р < 0.05) increased in wounded men with severe and mild wounds in compare with participants with minimal wounds on 1–5 days. However, the concentration of TTH significantly (р < 0.05) declined in the all groups of wounded on 14 day of the investigation. Conclusions. The concentrations of free T4 and thyrotropic hormone significantly increased in wounded men with severe and mild wounds on 1–5 days after wounding. The concentrations of free T3 haven’t considerably changed
Classification of gunshot foreign bodies migration
(2024) Lurin, I.; Khoroshun, Eduard; Makarov, Vitaly; Nehoduiko, Volodymyr; Tertyshnyi, S.; Veryovkin, Igor; Vastyanov, R.
The purpose of the study was to provide the classification features of the gunshot foreign bodies migration. We analyzed 90 cases of gunshot shrapnel blind wounds of different localization for a certain period, where there was a foreign body migration in different ways. The wounded which were admitted to the Military Medical Clinical Centre of the Northern Region of the Command of the Medical Forces of the Armed Forces of Ukraine, were examined by X-ray and, as indicated, using videoendoscopic methods. We distinguish the following classification features: the localization of the entrance hole; the place of migration initiation; the direction of migration; the number of foreign bodies; the structure of foreign bodies; the migration distance; the process of migration occurrence; the time of migration; the cause of migration; the frequency of migration; the foreign body fixation during migration; the volume of referral of migration surgical treatment. The identification of following three landmarks (the entrance hole, the place of migration starts and the place of detection), two stages (the wound channel and the migration corridor) and the direction of gunshot foreign bodies migration form a complete conception. The authors state that gunshot foreign bodies migration represents a separate type of a gunshot wound manifestation. The proposed original classification of gunshot foreign bodies migration allows to sort the data of clinical observations, which is of great importance for adequate and rapid diagnosis, determination of direct foreign body migration and its direction, and for effective treatment of gunshot wounds with phenomena of gunshot foreign body migration
Clinical classification of liver cirrhosis - a way to plan individual definitive treatment
(2024-12-01) Petiunin, Oleksii; Shevchenko, Rostislav; Brek, Ostap; Kolomensky, Oleksii
Aim: To develop clinical classification of liver cirrhosis, which can aid individualization and planning definitive treatment for this group of patients. Materials and Methods: Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: “liver”, “cirrhosis” and “classification”; or “liver”, “cirrhosis” and “complications”; or “liver”, “cirrhosis” and “treatment”; or “portal” “, “hypertension” and “complications”. Articles were independently evaluated by each author, the etiological, orphological and current clinical classifications of LC were analyzed, their advantages and disadvantages identified, and after discussion classification of LC was developed by consensus. Conclusions: The developed clinical classification of liver cirrhosis will facilitate the planning of therapeutic tactics for each patient, allow to personalize the treatment of patients with this pathology.
Features of diagnosis and treatment of a polytrauma victim with predominant closed chest trauma with lung and diaphragm rupture. Clinical case
(2024-07-23) Khoroshun, Eduard; Makarov, Vitalii; Negoduyko, Volodymyr; Shypilov, Sergiy; Borodai, O.; Petiunin, O.
The article describes a clinical case and presents clinical signs of traumatic rupture of the diaphragm and lung on the background of a wave-like course of the postoperative period. Open diaphragmatic injuries are more common than closed ones. In this case, the closed chest and abdominal trauma was sustained as a result of a road traffic accident. The injury was combined and severe, with signs of traumatic shock. The location of the diaphragmatic injury was on the right side, which is less common. The severe condition of the patient with respiratory failure (respiratory rate over 30 per minute) was an indication for artificial lung ventilation, which made it impossible to take complaints and anamnesis. The individual spatial topography of the diaphragm depends on the size and location of the abdominal organs, body structure, and depends on the line of examination. The movement of internal organs into the pleural cavity indicates a diaphragmatic rupture, but in this case, the extrahepatic location of the diaphragmatic defect was covered by the liver, the lower lobe of the right lung, and adhesions, which led to the cover up of the diaphragmatic defect. Increased abdominal size due to polytrauma and mechanical ventilation in case of closed chest and abdominal trauma; increased air discharge through pleural drainage during video laparoscopy or increased abdominal size during video thoracoscopy; clamping of the pleural drainage with a spiral computed tomography of the chest and abdominal organs allows detecting pneumoperitoneum and pneumothorax, which indicates the presence of a defect in the diaphragm and lung. The use of video thoracoscopy, video laparoscopy, and spiral computed tomography does not always provide complete information about the existing damage to the diaphragm, so dynamic observation with control radiological examinations is preferred.
Management of gunshot injury to the abdominal aorta and inferior vena cava: a case report of a combat patient wounded in the Russo-Ukrainian war
(2024) Lurin, Igor; Khoroshun, Eduard; Makarov, Vitalii; Negoduyko, Volodymyr; Shypilov, Sergiy; Bunin, Yurii; Gorobeiko, Maksym; Dinets, Andrii
Background Russo-Ukrainian war is associated with severe traumas, including injuries to the major vessels. Penetrating aortic injury remains one of the most difficult injuries; the mortality rate is 90–100% in case of gunshot wounds, associated with frequent lethal outcomes due to uncontrolled bleeding. Of the three main abdominal veins, the inferior vena cava (IVC) is the most frequently damaged, which is required quick and appropriate surgical decisions to be made. Little is known about the management of gunshot injuries to such major vessels as the aorta and IVC. It is also worth mentioning about the importance to share our practical experience from the ongoing war for better understanding and future considerations by war surgeons of the vascular trauma management. The aim of the study was to demonstrate the specific features of the diagnosis and management of a gunshot shrapnel blind penetrating wound to the abdomen with injury to the aortic bifurcation level and the infrarenal section of the inferior vena cava. Case presentation A 44-year-old male soldier of the Armed Forces of Ukraine received a gunshot injury to the abdomen from a mortars’ explosive shelling. The patient was evacuated to the Forward Surgical Team (Role 1) and received primary surgical treatment within one hour after the injury according to the “golden hour” principle. Then, evacuated was performed to the Role 3 hospital in Kharkiv. At the Role 3 hospital, the patient underwent secondlook surgery as well as damage control surgery. At revision, no active bleeding was observed, and the surgical pads (packed previously by the Forward Surgical Team) were removed. Further revision showed a metal projectile within the aortic wall at the level of aortic bifurcation and wall defects were also detected for inferior vena cava. This metal projectile was removed by using the multifunctional surgical magnetic tool followed by suturing of the aortic wall defect as well as defects of the inferior vena cava. Conclusions Application of Damage Control Surgery is a useful approach in the management of severe vascular injury as well as useful to stop abdominal contamination by intestinal contents. The application of a surgical magnetic tool for the searching and removal of ferromagnetic foreign bodies reduces operative trauma and reduces the time for identification of foreign bodies.
Management of thoracoabdominal gunshot injuries by using minimally invasive surgery at role 2 deployed field hospitals in Ukraine
(2024) Lurin, I.; Vorovskiy, О.; Makarov, Vitalii; Khoroshun, Eduard; Negoduyko, Volodymyr; Ryzhenko, А.; Chobey, S.; Gorobeiko, M.; Dinets, А.
The Russia-Ukraine war is associated with critical and severe thoracoabdominal injuries. A more specific approach to treating patients with thoracoabdominal injury should also include minimally invasive technologies. It remains unclear about the utility of using video-assisted thoracoscopic surgery (VATS) and laparoscopy in patients with thoracoabdominal injury. The aim of this study was to investigate and evaluate the utility of video-assisted thoracoscopic surgery, laparoscopy as well as magnetic tool applications for the management of severe thoracoabdominal injury in combat patients injured in the ongoing war in Ukraine and treated in the Role 2 deployed hospital. Patients and methods 36 male combat patients thoracoabdominal injury were identified for the study during the first 100 days from February, 24 2022. These individuals were diagnosed with thoracoabdominal GSW in the Role 2 hospital (i.e. deployed military hospital) of the Armed Forces of Ukraine. Video-assisted thoracoscopy surgery (VATS) and laparoscopy with application of surgical magnetic tools were applied with regards to the damage control resuscitation and damage control surgery. Results In 10 (28%) patients, VATS was applied to remove the metal foreign body fragments. Both thoracotomy and laparotomy were performed in 20 (56%) hemodynamically unstable patients. Of these 20 patients, the suturing of the liver was performed in 8 (22%) patients, whereas peri-hepatic gauze packing in 12 (33%) patients. Massive injury to the liver and PI 2.0–3.0 were diagnosed in 2 (6%) patients. Lethal outcome was in 1 (2.8%) patient. Conclusions Thoracoabdominal gunshot injuries might be managed at Role 2 hospitals by using video-assisted thoracoscopy (VATS) and laparoscopy accompanied by surgical magnetic tools. Damage control surgery and damage control resuscitation must be applied for patients in critical and severe conditions. Keywords Thoracoabdominal injury, Chest war injury, Abdomen war injury, Video-assisted thoracoscopy, Minimally invasive surgery, Russia-Ukraine war, Russo-ukrainian war
Mortality analysis in blunt combined trauma and polytrauma
(2024) Panasenko, S.; Nehoduiko, Volodymyr; Nizar Kerbazh
Introduction. Modern traumatism from the standpoint of clinical epidemiology meets the classification criteria of a global pandemic. Important factors triggering the global clinical and epidemiological picture are the unsatisfactory state of prevention of all types of injuries in developing countries, traffic injuries in industrialized countries and the progressively increasing number of armed conflicts. The aim of the study. To conduct a comparative clinical and epidemiological analysis of mortality in blunt combined trauma and polytrauma. Materials and methods. A retrospective single- center cohort 10-year clinical and epidemiological study of 933 fatal clinical cases of blunt combined trauma on the basis of polytrauma department of the Kyiv City Clinical Emergency Hospital has been conducted. Clinical diagnoses and forensic medical conclusions were transformed into Hannover Polytrauma Score scale codes. The clinical and epidemiological experiment was based on the clustering of the research array according to the severity of the injury. Results. As a result of the clinical and epidemiological experiment, 5 stable clusters which can be characterized as separate randomized clinical- epidemiological groups were obtained. Clinical profile was determined by the dominant injury: cluster-1 (patients with an extremely severe thoracic profile), cluster-2 (patients with a severe thoracic profile), cluster-3 (patients with an extremely severe abdominal profile), cluster-4 (patients with a severe neurosurgical profile), cluster-5 (patients with an extremely severe neurosurgical profile). Conclusions. Lethal blunt combined injury has a clear hierarchical structure based on the severity of the injury and the presence of dominant damage to the corresponding anatomical and functional area. The results obtained during the current study indicate the need to find new technological approaches to the treatment of extremely severe injuries, as well as treatment and prevention of the development of complications of severe injuries in order to reduce mortality in polytrauma.
Non-operative treatment of gunshot wounds of soft tissues
(2024) Khoroshun, Eduard; Makarov, Vitaly; Nehoduiko, Volodymyr; Shypilov, Sergiy; Tertyshnyi, S.; Veryovkin, I.; Vastyanov, R.
The purpose of the study was to analyze own experience of soft tissues gunshot wounds non-operative treatment. Clinical observations were performed on 829 wounded which were admitted to the Military Medical Clinical Centre of the Northern Region of the Command of the Medical Forces of the Armed Forces of Ukraine. All of the wounded were men. The wounded were randomized on 3 groups according to the needs for primary surgical treatment of the wound. All wounded received the same treatment. Foreign bodies (metal fragments) were partially removed with the help of a modern surgical magnetic tool. A third of all soft tissue gunshot wounds were proved do not require primary surgical treatment. The criteria for primary surgical treatment not performing are soft tissues gunshot wounds of small sizes, of different localization and number without signs of inflammation. Non-operative treatment of soft tissues gunshot wounds includes antibiotic prophylaxis, anti-tetanus toxoid administration, anesthesia, treatment of wounds with antiseptic solutions, aseptic wound dressings. Non-operative treatment of wounded with soft tissue gunshot wounds using the magnetic detection turned out to be highly effective in modern conditions for a significant number of people due to the acceleration of diagnostic process, treatment and recovery and due to entirely medical accompanying advantages.
Objectivization of surgical tactics in case of covering tissue gunshot defects restoration
(2024) Lurin, I.; Khomenko, I.; Kashtalyan, M.; Nehoduiko, Volodymyr; Vastyanov, R.; Tertyshnyi, S.; Stepanov, G.; Solodyanikova, O.; Tanasichuk-Gazhieva, N.
The article presents the results of the objectification of surgical tactics in the restoration of defects in the integumentary tissue due to gunshot wounds in 126 soldiers. For this purpose, all the wounded were divided into 2 groups: Group I included 68 wounded, in whom 75 reconstructive operations were performed under dynamic angiographic multimodal control. Group II consisted of 58 wounded patients who underwent 96 surgical operations using conventional tactics. Rapid restoration of damaged anatomical structures and their aesthetic appearance, reduction of scars showed good results of operations in group I of patients. The results of the work show that dynamic monitoring improves the quality of surgical reconstructive operations and can be recommended at all stages of medical care.
Pathomorphological features of confirmed bronchogenic cyst with atypical localization
(2024) Khoroshun, Eduard; Nehoduiko, Volodymyr; Vorovskyi, O.; Makarov, Vitalii; Bunin, Yu.; Smolyannіk, Konstantin
Among all formations of the mediastinum in the adult population, cysts make up about 20 %, of which more than 60 % are bronchogenic cysts, where up to 50% have an asymptomatic course, and therefore in most cases are detected accidentally. Regardless of the course and origin, cysts are subject to complete surgical removal. In connection with the clinical and radiological polymorphism of bronchogenic cysts, histological confirmation of the origin of the cysts does not lose its relevance. The purpose of the work is to study and highlight the pathomorphological characteristics of a cyst localized in the pericardium. Using video-assisted thoracic surgery (VATS) and thoracotomy approaches, 16 people aged 28 to 62 with cystic lesions of the mediastinum were operated on. The patients underwent radiographic examination, computed tomography with intravenous contrast injection and, in 2 cases, magnetic resonance imaging. Ultrasound examination was performed on 6 patients in whom cystic lesions were a diagnostic finding. The location of the cyst, maximum diameter, density, and calcification were evaluated. Clinically and radiologically, asymptomatic pericardial (coelomic) cysts were detected in 2 persons in the prevascular department. In the visceral part of the mediastinum, 3 patients had a pericardial cyst, 10 patients were diagnosed with 10 bronchial cysts with parenchymal and perihilar localization, among which one patient was diagnosed with an asymptomatic bronchial cyst with an atypical localization in the pericardium. In the paravertebral part of the mediastinum, 1 paraesophageal cyst was established, which was intimately connected with the lower third of the thoracic part of the esophagus. All types of cysts were histologically confirmed. Statistical processing of the obtained results was carried out using the Excel program. After a clinical examination of a patient with a pericardial cyst of the visceral mediastinum, right VATS surgery and removal of the cyst was performed. Histological examination of fragments of the cyst wall showed the presence of multi-rowed ciliated cylindrical epithelium, pronounced infiltration by lymphoid elements with hemorrhages and foci of fibrotization in separate areas. The histological structure of the removed pericardial cyst confirmed its bronchogenic origin. So, we discovered a rare form of abnormality of embryonic growth of the ventral part of the foregut with localization of a bronchogenic cyst in the anterior-inferior mediastinum on the right, which significantly expanded the understanding of the disease
Place and role of soft tissue ultrasound examination in tourniquet syndrome
(2024) Lurin, I.; Khoroshun, Eduard; Nehoduiko, Volodymyr; Makarov, Vitalii; Tertyshnyi, S.; Tiron, O; Vastyanov, R.
The purpose of the study was to demonstrate and analyze the possibilities of ultrasound diagnosis of tourniquet syndrome. All wounded were admitted at the Military Medical Clinical Center of the Northern Region of the Command of the Medical Forces of the Armed Forces of Ukraine from advanced surgical groups at different times from the wound with an existing tourniquet on the limb at different times after the tourniquet was placed (from 5 to 72 hours, on average 8.2±0.6). There were 32 male wounded. The average age of the wounded was 39.4±2.6 years. According to the location of the tourniquet, the wounded are distributed as follows: shoulder – 5 (15.6 %), thigh – 24 (75 %), leg – 3 (9.4 %) patients. All the wounded underwent an ultrasound and elastographic examinations. We used an average result after 12 measurements of each muscle group. When studying the data of muscle elastography against the background of the existing tourniquet, a significant difference in the elastography indicators of healthy superficial and deep muscles being under the tourniquet due to compression is noted. Elastography indicators in deep muscles are always higher than in superficial muscles. Changes in muscle elastography are localized by the location of the tourniquet. The use of ultrasound examination of soft tissues in tourniquet syndrome has an additional character. According to the data of elastography of soft tissues in the case of tourniquet syndrome, it is possible to determine the extent of soft tissue damage, which is important for determining the size of surgical intervention
Place and role of soft tissue ultrasound examination in tourniquet syndrome
(2023-02-20) Лурін, I.А.; Хорошун, Едуард Миколайович; Негодуйко, Володимир Володимирович; Макаров, Віталій Володимирович; Тертишний, С.В.; Тірон, О.І.; Вастьянов, Р.С.
The purpose of the study was to demonstrate and analyze the possibilities of ultrasound diagnosis of tourniquet syndrome. All wounded were admitted at the Military Medical Clinical Center of the Northern Region of the Command of the Medical Forces of the Armed Forces of Ukraine from advanced surgical groups at different times from the wound with an existing tourniquet on the limb at different times after the tourniquet was placed (from 5 to 72 hours, on average 8.2±0.6). There were 32 male wounded. The average age of the wounded was 39.4±2.6 years. According to the location of the tourniquet, the wounded are distributed as follows: shoulder – 5 (15.6 %), thigh – 24 (75 %), leg – 3 (9.4 %) patients. All the wounded underwent an ultrasound and elastographic examinations. We used an average result after 12 measurements of each muscle group. When studying the data of muscle elastography against the background of the existing tourniquet, a significant difference in the elastography indicators of healthy superficial and deep muscles being under the tourniquet due to compression is noted. Elastography indicators in deep muscles are always higher than in superficial muscles. Changes in muscle elastography are localized by the location of the tourniquet. The use of ultrasound examination of soft tissues in tourniquet syndrome has an additional character. According to the data of elastography of soft tissues in the case of tourniquet syndrome, it is possible to determine the extent of soft tissue damage, which is important for determining the size of surgical intervention
Quantitative morphometry of compensated liver cirrhosis can aid to predict the outcomes of surgical treatment
(2024) Petiunin, Oleksii; Makarov, Vitaliy; Feskov, Volodymyr; Smolianyk, Kostiantyn; Shpytalna, Y.
Objective — to define quantitative morphometric characteristics of hepatic parenchyma lesions at compensated liver cirrhosis (CLC), which will allow more accurately to assess its functional reserves and predict the outcomes of surgical treatment. Materials and methods. Intraoperative marginal liver biopsy was performed for 74 patients with CLC, who underwent surgical treatment. Morphological examinations with quantitative morphometry of intraoperative liver biopsies were done with the use of cytological analyzer with software «Integral-2MT» produced by the association «Kvant» (Kyiv). The connective tissue area (CTA), unchanged hepatocytes area (UHA), stromal-parenchymatous ratio (SPR), the volume of hepatocytes in the state of necrosis and/or necrobiosis (VHSNN), the volume of hepatocytes in the state of division (VHSD) were determined. The statistical analysis was performed by use of Statistica 12 software package. Results. Three types of morphological pattern of CLC were isolated. Type I (type A) portal cirrhosis with weakly pronounced signs of parenchymatous and stromal reaction (mono-multilobular type, portal cirrhosis). The CTA was 66.73 ± 1.71 m2, SPR was 0.285 ± 0.019, UHA was 234.13 ± 11.5 m2, VHSNN was 11.21 ± 0.74 %, VHSD was 10.23 ± 0.57 %. Type II cirrhosis (type B) — cirrhosis of mono-multilobular type with moderately expressed signs of parenchymatous and stromal reaction. The CTA was 126.69 ± 12.5 m2, SPR was 0.617 ± 0.031, UHA was 205.34 ± 13.8 m2, VHSNN was 17.32 ± 0.63 %, VHSD was 15.43 ± 0.48 %. Type III cirrhosis (type C) — cirrhosis with pronounced signs of parenchymatous and stromal reaction, more often of multilobular type. The CTA was 240.16 ± 13.4 m2, SPR was 1.344 ± 0.089, UHA was 178.69 ± 18.7 m2, VHSNN was 23.97 ± 0.75 %, VHSD was 11.07 ± 0.58 %. Analysis of immediate results of surgical treatment demonstrated, that no one patient with A-type CLC died, while 9.5 % of patients with B-type and 25.0 % of patients with C-type CLC died in the early postoperative period. Conclusions. Quantitative morphometry demonstrated that pathological changes in the liver at CLC are heterogeneous and can be categorized in to 3 types (A, B, C). Three types of morphological pattern at CLC, which were isolated, are characterized by significant differences in CTA, UHA, SPR, VHSNN, VHSD parameters. At transition of A-type cirrhosis into C-type, volume of hepatic parenchyma becomes to be decreased, while volume of connective tissue becomes to be increased. This is accompanied by decrease in UHA, increase in CTA, SPR and VHSNN. Surgical intervention in patients with type C morphological pattern of cirrhosis is associated with a high risk (25 %) of poor outcome, which indicates the need to limitations for indications to elective surgical operations in this category of patients. Thus, quantitative morphometry of liver biopsies in CLC patients can aid to predict the outcomes of surgical treatment.
The role of adipose tissue cell elements in the regulation of the nitroxidergic system and possible ways of pharmacological modulation
(2024-03-13) Bielenichev, I.; Maslennikov, S.; Dobrelia, N.; Khromov, O.; Holovakha, M.; Ryzhenko, V.; Brek, Ostap
Endothelial dysfunction is characterized by a decrease in the bioavailability of the vasodilator – nitric oxide (NO), and an increase in the level of vasoconstrictor substances. This imbalance leads to vasoconstriction, leukocyte attachment and inflammatory reactions in the vascular wall, atherosclerosis and thrombosis. The aim: to evaluate the role of adipose tissue elements in the regulation of parameters of the nitroxidergic system under hypoxia conditions. Materials and methods. The studies were carried out on 30 adult white male Wistar rats. All animals were randomly assigned and divided into groups: a control group (15 rats), type 2 diabetes mellitus (T2DM) was induced in the animals of the second group (15 rats). Isolated fragments of the popliteal arteries (PA) and intrapulmonary artery (IPA) were cleared of perivascular adipose tissue (PVAT-) or left uncleaned (PVAT+) and cut into rings. The simulation of acute hypoxia with further study of medical agents were performed. Results. The PA and IPA with PVAT responded to acute hypoxia with vasoconstriction – an increase in the amplitude of contraction in the first and second phases, and after removing PVAT, they responded with a decrease in the maximum amplitude of contraction by 3.4 times in the 1st phase and an increase in amplitude by 1.8 times in the 2nd phase. Perfusion with Angiolin reduced 2nd phase of HV of the PA and IPA. Adding a combination of Thiotriazoline and L-arginine (1:4) to a solution for perfusion of fragments of arteries of animals with T2DM, causes a significant increase in constrictor reactions in both the 1st and 2nd phases of HV, regardless of presence of perivascular adipose tissue. Conclusions. The presence of PVAT affects the HV of arteries, both in normal and in T2DM. The possibilities of ways of pharmacological modulation of the nitroxidergic system depending on the state of PVAT were determined.
Spontaneous longitudinal rupture of the thyroid cartilage: A management of the rare clinical case
(2024-02-28) Lurin, Igor; Makarov, Vitaly; Nehoduiko, Volodymyr; Smolianyk, Kostiantyn; Gorobeiko, Maksym; Dinets, Andrii