Кафедра хірургії № 4
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Item 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.Item 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.Item 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 processesItem 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 changedItem 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 migrationItem Clinical case: somatopsychic disorder in a female patient with multinodular euthyroid goiter(Kharkiv National Medical University, 2016-05-19) Tsopozidis, Christos; Borisenko, Anastasia; Telezhnyi, AndriiPsychogenic disorders referred to as nosogenies due to the influence of psychotraumatic events associated with somatic disorder. In case of combined impact of a number of adverse factors, the reaction to the disease can become so extreme that its management in the early stages of therapy seems no less important than the direct treatment of somatic condition.Item Clinical classification of liver cirrhosis - a way to plan individual definitive treatment(2024-12-01) Petiunin, Oleksii; Shevchenko, Rostislav; Brek, Ostap; Kolomensky, OleksiiAim: 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.Item 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, LinaItem Computational modeling and analysis of wound formation in gunshot injuries(2023) Larin, Oleksiy; Tomashevskyi, Roman; Lurin, Igor; Gumeniuk, Kostyantyn; Nehoduiko, VolodymyrThis 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.Item 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.Item Features of general surgery teaching to medical students(ТДМУ, 2016-05) Tsyganenko, Oksana; Shevchenko, StanislavThe 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.Item 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, KostiantynIntroduction 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.