RESULTS OF INFLAMMATORY AND IMMUNOLOGICAL PARAMETERS OF THE ORAL CAVITY AFTER CYSTECTOMY WITH DIFFERENT METHODS OF CONNECTING THE EDGES OF THE OPERATED AREA.

OBJECTIVE: The aim: To analyze the results of inflammatory and immunological parameters of the oral cavity after cystectomy with different methods of connecting the edges of the operated area. PATIENTS AND METHODS: Materials and methods: The research was conducted in 87 patients who sought surgical treatment of odontogenic cysts of the jaws. Patients were divided into groups depending on the method of wound closure after surgery. We analyzed the results of laboratory tests (leukocytes, ESR, IL-1ß, IL-6, TNF-α, IL-8, NO synthase, MMP-9). RESULTS: Results: The analysis of the effectiveness of using different methods of approximation of the oral mucosa wound on inflammatory and immunological pa¬rameters showed that when using welding of the edges of the operated area using the EKVZ-300 "Patonmed" apparatus, we get positive results of laboratory indicators of inflammatory markers faster (leukocyte counts are normal on day 30, ESR, IL-1ß - on the 14th day, TNF-α - on the 7th day, IL-6, IL-8, NO synthase, MMP-9 - on the 30th day), that is, healing in such patients is faster than in patients with wound closure with classic suture material or laser. CONCLUSION: Conclusions: When comparing the methods of approximation of postoperative oral mucosa wounds by different methods, based on the results of these inflammatory and immunological parameters, the best results were obtained when using electric welding of tissues. Further research and use of the proposed method will facilitate and shorten the rehabilitation period of patients after surgery.

BILATERAL CRYPTORCHIDISM IN PEDIATRIC SURGEON'S PRACTICE: CURRENT TACTICS OF PATIENT MANAGEMENT.

OBJECTIVE: The aim: To provide best practices of disease management to improve treatment outcomes for this group of patients. PATIENTS AND METHODS: Materials and methods: The paper is based on first-hand experience in observing and treating 117 children aged from 6 months to 13 years with bilateral congenital cryptorchidism during a ten-year follow-up period, who were referred for surgical treatment, and 3 newborn boys with undescended testicles and testicular torsion. A complex of clinical and laboratory, instrumental, endocrinological, and genetic research methods was used for the survey of all patients. RESULTS: Results: Recognizing the action of a common causative factor for bilateral cryptorchidism, which is a consequence of primary endocrine disorders, makes it possible to predict bilateral identity of the location of testicles in this pathology, which we observed in 81 patients: bilateral inguinal cryptorchidism was registered in 49 (41.88%) children, bilateral abdominal cryptorchidism - in 32 (27.35%) children, a combination of inguinal and abdominal cryptorchidism - in 24 (20.51%) children. The following types of treatment were used in the studied group of children: 1 - primary surgical intervention - 4 children, representing 3.42%. 2 - observation and non-surgical treatment by an endocrinologist - 113 (96.58%) children. 3 - comprehensive treatment (surgical correction after hormone treatment) - 67 (59.29%) children. According to the research, hormone therapy had a positive effect on descent of the testicles in 89 (78.76%) patients: the testicles descended into the scrotum - in 22 (24.72%) children; the testicles descended in the inguinal canal - in 32 (35.95%) children; the testicles descended to the level of the opening to the inguinal canal - in 35 (39.33%) children. CONCLUSION: Conclusions: 1. All doctors, starting from the maternity hospital, polyclinic, children's unit, should identify children with bilateral cryptorchidism. All children diagnosed with bilateral cryptorchidism are referred to a surgeon or endocrinologist. The parents of a child with bilateral cryptorchidism should immediately consult a doctor. The study of the reasons for late admission of children to the surgical hospital revealed that 76.92% of patients sought medical advice late, after 1 year of life. 2. At the stage of diagnosis and determination of treatment tactics, an examination by an endocrinologist and a geneticist is necessary; ignoring them is considered an error in diagnostic and therapeutic tactics, since the process of descent of the testicles into the scrotum is hormone-dependent. 3. The indications for primary surgical treatment of a child with bilateral cryptorchidism involve a combination of cryptorchidism with inguinal hernia and pain syndrome, which might be caused by testicular torsion. 4. Hormone therapy provides better results of surgical intervention in bilateral cryptorchidism. The ineffectiveness of two courses of hormone therapy necessitates surgical treatment. 5. Comprehensive treatment of children with bilateral cryptorchidism (non-surgical hormone therapy and surgical correction) has led to good postoperative results in 71.64% of patients, satisfactory results - in 22.39% of children, recurrences - in 5.97% of patients. 7. A long-term follow-up observation should be carried out by a surgeon and endocrinologist until patients reach their reproductive years.

Use of a combination of dexmedetomidine and magnesium sulfate as a multimodal approach to the treatment of alcoholic delirium.

INTRODUCTION: The search for an effective sedation schedule in managing delirium tremens that would ensure an adequate sedation level and good safety profile is an urgent problem of modern intensive care medicine. In this respect, the use of dexmedetomidine combined with magnesium preparations seems to be promising. MATERIAL AND METHODS: A quasi-randomized prospective observational study was conducted on 80 patients with alcoholic delirium, who were divided into 4 groups. Assessment parameters were delirium duration, mean arterial pressure and heart rate, and plasma magnesium, urea, creatinine, transaminase, cortisol, and serotonin levels. The control-group patients underwent standard sedation therapy with benzodiazepines. In group 1, standard sedation was supplemented by magnesium sulphate. In group 2, dexmedetomidine infusion was used. In group 3, dexmedetomidine was supplemented by the correction of hypomagnesemia. RESULTS: The duration of delirium proved to be significantly shorter in all study groups (3.4 ± 0.6 days in group 1; 1.55 ± 0.61 days in group 2) as compared to the control (5.4 ± 1.48 days), P < 0.001, being the shortest in group 3 (1.1 ± 0.18 days), P < 0.001. Cases of hypotension were detected only in the control group (2 cases [10%]) and group 1 (4 cases [20%]). The patients of groups 2 and 3 showed significant improvement in plasma levels of cortisol (16.7 ± 2.25 nmol L-1; 15.62 ± 1.63 nmol L-1) compared with the control (18.77 ± 2.76 nmol L-1), P = 0.019; P = 0.003. Serotonin level was higher in the experimental group 3 (87.8 ± 7.32 ng mL-1) as compared to the control (62.81 ± 9.81ng mL-1) and group 2 (71.73 ± 9.61 ng mL-1), P < 0.001. CONCLUSIONS: Dexmedetomidine infusion combined with magnesium sulphate proved to be effective in the treatment of patients with alcohol delirium.