ABSTRACT
OBJECTIVE: To improve perioperative algorithm of prevention of complications in patients with ventral and incisional hernias via differentiated choice of mesh implants and hernia repair technique. MATERIAL AND METHODS: The study included 144 patients with abdominal wall hernia, who were divided into two representative groups. RESULTS: Original algorithms for choosing the method of hernia repair depending on type and position of mesh implant, as well as methods of perioperative prevention of complications are proposed. CONCLUSION: These algorithms significantly reduced the incidence of postoperative wound complications after sublay hernia repair and posterior separation with TAR.
Subject(s)
Hernia, Ventral , Incisional Hernia , Humans , Surgical Mesh/adverse effects , Hernia, Ventral/etiology , Hernia, Ventral/prevention & control , Hernia, Ventral/surgery , Incisional Hernia/diagnosis , Incisional Hernia/etiology , Incisional Hernia/prevention & control , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Herniorrhaphy/adverse effects , Herniorrhaphy/methods , RecurrenceABSTRACT
OBJECTIVE: To evaluate the role of various perioperative risk factors on the incidence of abdominal wound dehiscence. MATERIAL AND METHODS: A retrospective controlled randomized trial of the risk factors of abdominal wound dehiscence was conducted in 62 patients for the period 2013- 2018. The research was performed at the Perm City Clinical Hospital No. 4. All patients were divided into two groups: the main one (n=31) with abdominal wound dehiscence in early postoperative period and the control group (n=31) without this event. Both groups were comparable by gender, age and surgical abdominal diseases. Between-group differences in numerical indicators were analyzed using Mann-Whitney U-test, qualitative variables were analyzed using contingency tables. Differences were significant at p-value <0.05. RESULTS: Incidence of abdominal wound dehiscence was similar in patients who admitted in emergency and elective fashion (p=0.54). Anemia upon admission (p=0.71), diabetes mellitus type 2 (p=1.00), COPD (p=0.13) and obesity (p=0.76) were not significant predictors of abdominal wound dehiscence. There were significant between-group differences in CRP level (p=0.04). Among intraoperative risk factors, duration of surgery (p=0.78), surgical approach (p=1.00), aponeurosis suturing technique (p=0.39) and stoma (p=0.71) did not significantly affect the incidence of abdominal wound dehiscence. In early postoperative period, abdominal wound dehiscence correlated with peritonitis (p=0.04), SSI (p<0.01) and redo laparotomy (p=0.02). CONCLUSION: Despite the variety of pre-, intra- and postoperative risk factors, only infectious postoperative complications (SSI, peritonitis) and redo surgical interventions influenced the development of abdominal wound dehiscence. Thus, the concept of abdominal wound dehiscence prevention should be inextricably associated with the concept of prevention of postoperative infectious complications from the abdominal wall and abdominal cavity.
Subject(s)
Laparotomy/adverse effects , Peritonitis/etiology , Reoperation/adverse effects , Surgical Wound Dehiscence/etiology , Surgical Wound Infection/etiology , C-Reactive Protein/analysis , Humans , Randomized Controlled Trials as Topic , Retrospective Studies , Risk Factors , Surgical Wound Dehiscence/bloodABSTRACT
The authors herein share their experience gained in comprehensive treatment of patients diagnosed with lower-limb varicose disease treated by means of one the most state-of-the-art technologies, i. e., radiofrequency ablation. The work deals with the outcomes of managing a total of seventy-eight patients suffering from lower-limb varicose diseases with valvular insufficiency of the great saphenous vein. All the patients were subjected to radiofrequency ablation of the compromised great saphenous vein by means of the portable radiofrequency device "Surgitron" manufactured by the Company "Ellman International" (USA). Examination included ultrasonographic duplex and triplex scanning of the veins of the lower extremities. Intraoperative radiofrequency ablation of the great saphenous vein was performed by means of an original appliance consisting of a metallic probe whose length corresponded to that of the lower extremity concerned, with a figure-of-eight olive at the distal end and external plastic tube catheter. The construction of the probe made it possible to maximally free the great saphenous vein from blood through the lateral ports of the catheter, to reduce the risk of complications, to diminish the duration of the intervention, and to increase its effectiveness. Efficacy of radiofrequency ablation of the great saphenous vein amounted to 93.6%, with recanalization of the greater saphenous vein being established in five (6.4%) patients. Good functional and cosmetically pleasing therapeutic outcomes were observed in the majority of the patients (87.2%).
Subject(s)
Catheter Ablation , Saphenous Vein/surgery , Varicose Veins/surgery , Venous Insufficiency/surgery , Adult , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Patient Satisfaction , Polidocanol , Polyethylene Glycols/therapeutic use , Saphenous Vein/diagnostic imaging , Sclerosing Solutions/therapeutic use , Sclerotherapy , Time Factors , Treatment Outcome , Ultrasonography, Doppler , Varicose Veins/diagnostic imaging , Venous Insufficiency/diagnostic imagingABSTRACT
The article deals with the findings obtained in examining a total of 8,000 people presenting with varicose disease of the lower extremities. The examination included a clinical (physical) examination and coloured duplex scanning of the lower-limb veins. The examination was carried out in outpatient conditions, whereas surgical treatment was performed either out-patiently, or at a <
Subject(s)
Ambulatory Care , Lower Extremity/blood supply , Lower Extremity/physiopathology , Varicose Veins/physiopathology , Varicose Veins/therapy , Chronic Disease , Female , Humans , Male , Middle Aged , SclerotherapyABSTRACT
Results of studies of clonorchiasis in the region of the Upper Amur and its tributaries are presented. Biological features of the pathogen and its epidemiology are outlined. Clinical symptoms were studied in 112 patients. In case of death, a pathoanatomic picture is given.
Subject(s)
Clonorchiasis/epidemiology , Clonorchiasis/veterinary , Clonorchis sinensis/pathogenicity , Disease Reservoirs/veterinary , Fish Diseases/epidemiology , Adolescent , Adult , Animals , Animals, Domestic/parasitology , Animals, Wild/parasitology , Child , Clonorchiasis/diagnosis , Clonorchis sinensis/isolation & purification , Eosinophilia/etiology , Female , Fever/etiology , Fish Diseases/parasitology , Fishes , Humans , Liver/parasitology , Male , Middle Aged , Mollusca/parasitology , Risk Factors , Russia/epidemiology , Seasons , Serum Albumin/analysisABSTRACT
The authors analyze the results of conservative and operative treatment of 546 patients. The results of operative treatment (reconstructive operations on the arteries, osteo-trepanation) were shown to be considerably better in cases of critical ischemia than those of conservative treatment (infusion therapy, hemodilution, plasmapheresis).
Subject(s)
Arteriosclerosis/surgery , Ischemia/surgery , Leg/blood supply , Aged , Arteriosclerosis/diagnosis , Arteriosclerosis/therapy , Blood Vessel Prosthesis Implantation , Hemodilution , Humans , Ischemia/diagnosis , Ischemia/therapy , Laser-Doppler Flowmetry , Male , Middle Aged , Plasmapheresis , PrognosisABSTRACT
A methodology of estimating the professional level of physicians with the help of tariff scale is described. The tariff coefficients are determined by the correlation between the official salaries of physicians, having a qualification category, and a background monthly salary taken as a unity. The mean tariff coefficient of physicians can serve for public health bodies and insurance organizations as an assessment indicator of professional possibilities of an institution, complexity of the work performed, the cost and quality of medical services. For the leading staff of the institution the methodology is supplemented by the estimates of a number of intermediate indicators and their integral assessment which helps analyse the basic factors influencing the general level of physicians qualification.
Subject(s)
Physicians/standards , Fees, Medical , General Surgery , Models, Theoretical , Salaries and Fringe Benefits , WorkforceABSTRACT
The study is based on the analysis of the results of examination and operative treatment of 692 patients with atherosclerotic lesions of the aorta, its branches, and the limb arteries. The advantages of the extraperitoneal approach to the aorta over the transperitoneal approach in aorto-femoral reconstructions is proved. Stable postoperative intestinal paresis, peritonitis, intraabdominal bleeding, eventration, and adhesive disease do not occur with this approach. Such operations are not attended by a high incidence of coronary and cerebral vascular complications during and after the operation. The work gives the first appraisal of the results of postoperative plasmapheresis (21 patients) applied for normalization of hemorheological and lipoprotein disorders in different periods after the operation. The suggested complex approach to the treatment of atherosclerosis obliterans facilitates improvement of the immediate and late-term results of reconstructive operations on the vessels.
Subject(s)
Aortic Diseases/surgery , Arteriosclerosis Obliterans/surgery , Blood Vessel Prosthesis , Femoral Artery/surgery , Iliac Artery/surgery , Adult , Aged , Aorta, Abdominal/surgery , Female , Humans , Lumbosacral Region/surgery , Male , Middle Aged , Peritoneum/surgery , Ribs/surgery , ThoracotomyABSTRACT
Methodological approaches to the estimation of cost (prices, tariffs) of investigations and procedures of auxiliary curative and diagnostic service according to their technological and complex labour-consuming nature are provided. Using the unified norms of time and production for estimations would help define unified prices for medical services of analogical type and provide performance-related incentives for health workers.
Subject(s)
Health Services/economics , Public Health/economics , Costs and Cost Analysis , Diagnostic Services/economics , Health Personnel/economics , Models, Theoretical , USSRABSTRACT
A unique methodological approach is proposed which is used for the determination of "index of labour efficiency" of medical personnel and such associated with its elements of financial and economic activity as a saving of the number of posts and salary fund, the cost of health services according to their salary-consuming character and the amount of payment for the labour of health workers. The use of this index in the performance of in-patient institutions would facilitate the rational management of personnel, labour and salary.
Subject(s)
Efficiency , Medical Staff, Hospital , Work/standards , Costs and Cost Analysis , Humans , USSR , Work/economicsABSTRACT
Data are provided on labour norms, their functions and practical application at public health institutions. The role of labour norms setting under new economic conditions are considered; the determination of the cost of medical services, the number of personnel and salary fund. The necessity of scientific elaboration of the standard cost of medical care is substandiated on the basis of using stable and common economic standards.
Subject(s)
Health Services/economics , Public Health/economics , Work/standards , Costs and Cost Analysis , Humans , USSRABSTRACT
Reconstructive operations with the use of autologous veins were carried out on 154 patients with occlusive lesions in the femoropopliteal and femorotibial segments. Reversed autologous vein was used to form a shunt in 109 patients and autologous vein in situ in 45 patients. Patency of the shunts, both in the immediate and late-term periods, was higher in the in situ techniques than in the group with a reversed vein (93.3 and 88.8%; 78.9 and 72.4%, respectively). With the use of micro-surgical techniques the number of good results increased by 20.4%. In successful reconstructions in both groups the malleolobrachial index increased from 0.27 +/- 0.02 to 1.03 +/- 0.15. There were no statistically significant differences in the values of the malleolobrachial index in patients of both groups with functioning shunts in the late-term period (of up to 2 years).
Subject(s)
Arteriosclerosis/surgery , Leg/blood supply , Veins/transplantation , Follow-Up Studies , Humans , Microsurgery , Time FactorsABSTRACT
The article discusses the choice of operative methods and the stages in the treatment of patients with atherosclerosis of the abdominal aorta and lower limb arteries with consideration for the involvement of the coronary and cerebral arteries in the process. A total of 749 reconstructive operations were conducted on the abdominal aorta, its unpaired branches, arteries of the lower limbs, and coronary and extracranial arteries in 676 patients. The principle of extraperitoneal operations on the abdominal aorta was regarded as the basis in improving the results of treatment of patients with concurrent lesions. The authors substantiate the choice of a one-stage or many-stage type of operations on the vessels of different regions with due account for the localization of the affection, the degree of vascular insufficiency in each channel, and the life prognosis.