Наукові праці. Кафедра хірургії № 4

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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.
Clinical effects of ligation of left gastric artery and vein, splenic artery in patients with liver cirrhosis and secondary hypersplenism
(2023-09-25) Petiunin, Oleksii; Feskov, Volodymyr; Konoplia, Lina
Computational modeling and analysis of wound formation in gunshot injuries
(2023) Larin, Oleksiy; Tomashevskyi, Roman; Lurin, Igor; Gumeniuk, Kostyantyn; Nehoduiko, Volodymyr
This research aims to investigate the physical processes accompanying high-speed element penetration in gunshot wounds and understand the formation of wound channels, trajectory characteristics of bullets, and damaging effects on surrounding tissues. The study utilizes 3D computer modeling to simulate highspeed element penetration based on the 3D finite element method (FEM). The paper presents a methodology of computer simulation with mathematical basics and algorithmic descriptions. The approach uses direct explicit numerical integration over time for the impact of the metallic bullet into the gelatin block specimen that analyses within the framework of its plasticity considering the nonlinear pressure dependence in a shock wave. The algorithm of simulation incorporates the process of material destruction, where elements that reach critical strain values are removed from the model. The study provides insights into the behavior of different bullet types and their impact on tissue deformation from computational experiments that simulate the penetration into ballistic gelatin of two types of bullets, the 7H6M type, and the V-max type. The simulation results reveal the distribution of equivalent stresses in the wound channel at different moments in time. Additionally, the study analyses the penetration depth and diameter of the damaged material for both bullet types. The developed 3D computer modeling method can serve as a valuable tool for further investigations, facilitating the development of advanced medical treatments.
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.
Features of general surgery teaching to medical students
(ТДМУ, 2016-05) Tsyganenko, Oksana; Shevchenko, Stanislav
The subject «General Surgery» is one of the basic disciplines, laying foundation for study of surgical activity, which is required for every physician-clinician, regardless of his or her further specialization. In modern socioeconomic conditions, only a widely educated physician, who can  exibly rebuild direction and content of his or her activities taking into account changing requirements and the advent of new medical technologies is of the true value to health care service.
Features of the use of ladder myoplasty of a gunshot wound to the laryngopharynx: Case report
(2023-10-01) Lurin, I.; Makarov, Vitaliy; Khoroshun, Eduard; Nehoduiko, Volodymyr; Shypilov, Sergiy; Smolianyk, Kostiantyn
Introduction and importance: The laryngopharynx wound is considered to be one of the most severe wounds of neck both in war and in peace, as it may cause life threatening changes in the whole body (asphyxia, bleeding, shock). Important aspects of surgical treatment are to ensure full breathing, acceptable ways of feeding, and the use of reliable wound closure techniques aimed to prevent digestive tract failure and to maintain the framework and aerostasis of the laryngotracheal region. Case presentation: A case of unilateral multiple wounds of the laryngopharynx was described in the article. The features of diagnostics, surgical treatment and conservative therapy in the postoperative period with this injury were presented. The wounded man was urgently operated. During surgery the pharynx was mobilized. The metal fragment was removed. The wound of the pharynx was sutured with a two-row suture. The next stage of the surgical treatment was myoplasty. In the case of the patient, the purpose of myoplasty was additional sealing of the pharyngeal suture and myoplasty of the thyroid cartilage injury zone for the purpose of aerostasis. Because of the size of the wounds and their anatomical localization, we used the mobilized lower edge of the Musculus sternocleidomastoideus for myoplasty and proposed the method of ladder myoplasty developed by us. Clinical discussion: In myoplasty method the following criteria must be followed: the muscle flap must be of sufficient length and width, so as not to cause excessive tension in the myoplasty area; the flap must be thick enough to avoid necrosis that may cause subsequent infectious complications; when taking the flap, the most sparing operative access should be used to avoid functional and anatomical disorders; the volume of the taken muscle flap must not lead to functional and anatomical disorders. Conclusion: The proposed method of ladder myoplasty using Musculus sternocleidomastoideus is unique, and proves its high efficiency in unilateral multiple laryngopharyngeal injuries, and can be recommended for wide clinical implementation in such clinical situations.
Gunshot shrapnel wound of the thigh with damage to the superficial femoral artery (features of clinical manifestations, development of complications with late medical care and preservation of the limb)
(2023) Lurin, I.; Makarov, Vitaly; Nehoduiko, Volodymyr; Smolianyk, Kostiantyn; Chobey, S.; Ott, O.
The aim:To demonstrate the features of clinical manifestations and complications that occur with delayed medical treatment in cases of gunshot shrapnel through a wound of the thigh with damage to the superficial femoral artery. Materials and methods: The wounded individual, S., was 52 years old and had sustained a gunshot wound through a shrapnel wound of the left thigh with damage to the superficial femoral artery and soft tissue defect. Medical assistance was provided during the stages of medical evacuation. Results: The soldier sustained a gunshot wound through the upper third of the left thigh, resulting in damage to the vascular-nerve bundle and a soft tissue defect. First aid was provided at the scene, and surgical procedures were performed during the stages of medical evacuation, including primary surgical treatment of wounds in the upper third of the left thigh. On the second day following the injury, the wounded man was transferred to the Vinnytsia Military Medical Clinical Center and admitted to the vascular surgery department. After an ultrasound examination and repeated surgical treatment of the wound on the left thigh, damage to the superficial femoral artery was identified. Conclusions: The presence of features of blood circulation in gunshot wounds of the main vessels of the lower limbs can favorably affect the possibility of saving the limb, as evidenced by the case presented.
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
Mathematical Modelling of the Multifactorial Influence of Striking Fragments on the Dynamics of the Rehabilitation Processes of the Wounded.
(2023) Kolisnyk, Kostiantyn; Sokol, Yevgen; Shchapov, Pavlo; Nehoduiko, Volodymyr
The article analyses the possibility of solving an important scientific and technical problem that is relevant for the security and defence of any country where natural and man-made disasters, military conflicts and other emergencies occur, in which penetrating injuries of people occur. The article reports on the possibility of improving the efficiency of the rehabilitation technology for patients with penetrating gunshot wounds by reducing the rehabilitation period using modern methods of medical diagnostics, mathematical modelling and statistical methods for processing biomedical information. The scientific idea underlying the conducted research is that dynamic changes of a set of biomedical indicators depend not only on the time of their observation, but also on the levels of those physical factors that characterize physical parameters: temperature and dynamics of fragments. As a working hypothesis, in this case, it is possible to consider the inverse task, in which it is possible to solve the problem of assessing the levels of physical factors characterizing fragments using measurements of biomedical indicators during the initial examination of the wounded. In the paper, the authors substantiated the possibility of using primary biomedical measurements to assess the physical characteristics of fragments. This, in turn, makes it possible to take into account the characteristics of the physical impact of fragments on the dynamics of changes over time in biomedical indicators characterizing the treatment, and will lead to a reduction in rehabilitation time
Method for measuring X-ray reflections of microelements of inorganic compounds in soft tissues
(2023-07-25) Mikhailov, I.; Negoduyko, Volodymyr; Mikhaylusov, R.; Mikhailov, A.; Borisova, S.
An alternative method is proposed for measuring X-ray diffraction peaks from micro-impurities of inorganic phases in soft tissues. Unlike traditional XRD, each of the diffraction peaks corresponding to the interplanar spacing di , is measured using radiation with a wavelength of λi →2di . This makes it possible to register diffraction peaks at large θ angles, thereby increasing the angular resolution ∼tanθ. This approach made it possible to increase the beam angular divergence ∆θ from 0.05° (for standard XRD) to 3°, gain ∼(∆θ) 2 in the spectrometer luminosity, and reduce ∼(∆θ) -2 radiation load per unit area of soft tissue. A criterion for choosing the wavelength and beam divergence based on the micro-impurity structure is proposed. The results of measuring the diffraction peaks of micro-impurities of iron oxides in soft tissues damaged by a fragment wound are presented. The excess iron content in damaged tissues was certified by the XRF method with calibration using standard samples and did not exceed 0.4 mass%. Measurements of the main diffraction peaks of iron oxides Fe2 O3 , d=2.69Å, as well as Fe3 O4 , d=1.61Å and FeO(OH), d=1.71Å, were carried out in Cl- Кα ( . λ = 4 728 ) and Sc-Кα ( λ = 3. ) 031 , respectively. We used the scheme of a portable EDXRF spectrometer with a secondary KCl-Sc target and an angular beam divergence of ∆θ≈3°. Without radiation damage to soft tissues, the detection limits were reached: 0.12 mass% for Fe2 O3 , 0.059 mass% for Fe3 O4 and 0.034 mass% for FeO(OH)
Methodology and use of experimental techniques in analyzing wound dynamics of penetrating injuries
(2023) Tomashevskyi, Roman; Larin, Oleksiy; Kolisnyk, Kostyantyn; Zuev, Andrey; Gumeniuk, Kostyantyn; Lurin, Igor; Nehoduiko, Volodymyr
This research paper focuses on the experimental studies of the process of high-speed object penetration into human body simulators and the automated registration of physical phenomena parameters related with this process. It highlights the need for a comprehensive understanding of the physical processes involved and the challenges posed by the lack of biomedical information. It emphasizes the importance of studying the volume and characteristics of damage around the wound channel. The paper also proposes a methodology encompassing mathematical modeling, experimental studies using non-biological simulators, and data processing techniques to investigate wound dynamics. An experimental setup with a distributed information and measurement system is presented, enabling the collection and analysis of physical parameters during penetration impacts. The structure of a distributed information-measuring system has been developed that allows recording the parameters of physical processes that occur during the penetration of a high-speed object into the simulator. The issues of receiving and transmitting data from sensors using wireless communication channels are considered. The problem of synchronization of many distributed sensors, which is important for recording the parameters of short-term processes, is analyzed in detail. An example of obtaining data when launching a high-speed object into a simulator using an electric mass accelerator within the framework of the proposed system is given. The research aims to enhance medical practices, and protective equipment design, contributing to improved treatment outcomes and patient care.
Microbiological analysis of abdominal cavity exudate, blood and affected tissues samples from patients with intra-abdominal abscesses in complicated infection of abdominal cavity
(2023) Mozgova, Yulia; Mishyna, Marina; Syplyviy, Vasyl; Ievtushenko, Olexandr; Ievtushenko, Dmytro; Marchenko, Iryna; Mishyn, Yuriy
The aim: To conduct an analysis of the results of a microbiological examination of biological samples taken from patients with intra-abdominal abscesses. Materials and methods: Material for microbiological examination was collected from 60 patients during surgery and transported to laboratory at the same day. Isolation and identification of microbial pure cultures were performed by standard microbiological methods. Statistical analysis was performed using Statistica software. Results: Analyzing the microbiological research results indicated importance of the sample collecting time (first or repeated surgery). In patient’s blood taken during first surgery it was found a statistically significant predominance of no growth of microflora. In abdominal cavity exudates anaerobic cultures increased statistically significantly in repeated surgery. It was noted that in samples taken during first surgery mixed pathogens were represented mainly by facultative anaerobic cocci, then in repeated surgery anaerobic microorganisms were predominant. Examination of liver abscess content found that monoculture was isolated in 85.7 %. Blood and affected tissue samples in such patients were sterile. Investigation of samples from patients with multiple abdominal cavity abscesses revealed anaerobic microorganisms in 16.7 %. Blood samples of that patients in 40 % were sterile. Conclusions: An analysis showed that in appendicular abscesses content gram-negatives were predominant. Gram-positive bacteria dominated in paravesical abscesses with 65 % isolates from gallbladder and 66.7 % from the affected tissue samples. In liver abscesses gram-positive cocci were isolated in 57.1 %. In multiple abdominal abscesses due to bowel perforation rod-shaped microflora was predominant (76 %) and represented by either obligate aerobes or obligate and facultative anaerobes.
Migration of foreign bodies of fi rearms origin
(2023) Lurin, I.A.; Khoroshun, E.M.; Negoduyko, V.V.; Makarov, V.V.; Klapchuk, Y.V.; Buchneva, O.V. ; Verevkin, I.V.; Salyutin, R.V.
Objective. To analyse the results of diagnosis and treatment of wounded with gunshot combat trauma, in which foreign body migration was recorded, and to determine their optimal algorithm. Materials and methods. The data of anamnesis, objective clinical and general clinical and laboratory studies, as well as the results of instrumental diagnostics (radiological, endoscopic, ultrasound examinations) of 67 wounded with blind gunshot wounds of various localisations were analysed. Thoracic, laparoscopic and arthroscopic surgical interventions were performed on a video endoscopic stand, and surgical magnetic instruments were used to diagnose and remove ferromagnetic foreign bodies. Results. The main directions of foreign body migration are the respiratory tract, gastrointestinal tract, vascular bed, cavities (pleural, abdominal, joints) and soft tissues in case of suppuration. Foreign body fixation occurs in the place of narrowing of an artery or vein, distal parts of the respiratory tract, gentle parts of the pleural or abdominal cavity, in organs with structural features (heart, intestine, joint). Conclusions. Although the migration of foreign bodies of gunshot origin is rare, it requires appropriate attention and response. In case of gunshot penetrating wounds of cavities (thoracic, abdominal, large joints), to which foreign bodies may migrate, preference should be given to minimally invasive endoscopic methods of their removal using modern magnetic instruments.
Modeling of wound ballistics in biological tissues using engineering simulation software
(2022-11-04) Tsymbaliuk, V.; Lurin, I.; Gumeniuk, K.; Herasymenko, O.; Furkalo, S.; Oklei, D.; Negoduyko, Volodymyr; Gorobeiko, M.; Dinets, A.
Modern weapons cause severe damage, accompanied by high rates of complications and mortality. The investigation of such kinds of weapons is in high demand considering the ongoing active phase war against Ukraine since February 2022. In order to understand the pathological processes that occur in and outside the gunshot wound, we conducted an experimental study using mathematical simulation. The results presented in the article will help to choose the appropriate surgical management and improve the results of treatment. The aim of this study was to investigate and evaluate the damaging effect of a 5.45 mm 7N6M bullet and a 5.45 mm V-max expansive bullet using numerical modeling of wound canals in ballistic plasticine. The Ansys Explicit Dynamics engineering complex was used to simulate the dynamics of the bullet’s motion. The basic equations, solved by the explicit dynamic analysis, express the conservation of mass, momentum, and energy in Lagrange coordinates. Together with the material model and the set of initial and boundary conditions, they determine the complete solution to the problem. Taking into account that the initial velocity of the bullet is 1185 m/s at a mass of 3.9 g, we obtain energy 2740 J. All this energy acts at the area of the wound canal with a depth of 150 mm. Injury with a conventional 7N6M bullet is characterized by the fact that it passes through the block and loses only part of the kinetic energy. The simulation results showed that the velocity of the bullet at the outlet is 220 m/s. Taking into account the initial velocity of the bullet 918 m/s with a mass of 3.4 g, we obtain the kinetic energy acting on the walls of the wound canal with a depth of 200 mm of about 830 J. Mathematic analyses showed that the expansive bullet has a soft core that deforms and transfers all the kinetic energy to the tissues immediately after penetration into the tissues. The loss of kinetic energy of the bullet (ΔE, J) is defined as the difference between the kinetic energy at the time of injury (Ec, J) and the residual energy of the bullet when leaving the material (Er, J). Numerical modeling of wound ballistics in biological tissue simulators allows us to determine with high accuracy the features of wound canal formation and tissue response to damage of bullets having different kinetic energy, which contributes to the choice of adequate surgical management during surgery for gunshot wounds