Pseudomembranous colitis as a complication in Covid-19.

OBJECTIVE: Aim: To improve the results of treatment of patients with pseudomembranous colitis against the background of coronavirus infection. PATIENTS AND METHODS: Materials and Methods: The study presents the results of a retrospective analysis of 96 patients with pseudomembranous colitis, who were treated in the infectious Covid department at the base of the Uzhhorod City Clinical Hospital since 2020 to 2022. The average age of patients was 55.2 years, there were 38 (39.5%) men and 58 (60.5%) women. Diagnosis of complications - pseudomembranous colitis (PMC) - was based on clinical data, ultrasound and CT of the abdominal organs, fibrocolonoscopy, laparoscopy. RESULTS: Results: The frequency of PMC from the total number of patients who were in hospital treatment (8205 patients) due to COVID-19 was 1.17%, and this indicator was 0.62% in 2020, and 2.28% in 2021. Indications for operative treatment were: colon perforation - 9.4% of patients; peritonitis (diffuse, widespread) without obvious perforation of the colon wall - 85.5% of patients; mesenteric thrombosis - 4.1% of patients. In the case of perforation of the colon, resection of the colon was performed with the formation of a proximal colostomy and ileostomy. In case of mesenteric thrombosis, resection of the affected part of the small intestine was performed. In case of peritonitis without clear intraoperative detection of perforation of the colon wall, intraoperative lavage was performed. CONCLUSION: Conclusions: 1) The frequency of detection of PMC in patients with COVID-19 in 2020 was 0.62%, and in 2021 - 2.28%. 2) The sensitivity of CT in the diagnosis of surgical complications of PMC was 72%, and the specificity was 58%. 3) Conservative treatment was effective in patients with PMC in 88.8% of cases, 21.2% had complications that required emergency surgical interventions. 4) The total mortality in patients with PMC was 11.36%, although this indicator was significantly higher in the event of surgical complications and operative treatment (22.4%).

Endoscopic and morphological features of chronic gastritis in patients with lumbar spine osteochondrosis.

OBJECTIVE: Aim: of the study is to determine the endoscopic and morphological features of chronic gastritis (CG) in patients with lumbar spinal OC. PATIENTS AND METHODS: Materials and Methods: 102 patients with lumbar spine OC and CG were examined. The patients were diagnosed with Helicobacter pylori (HP) infection, according to which the patients were divided into two groups: the first group included 92 HP-positive patients, the second group consisted of 10 HP-negative patients. RESULTS: Results: Among HP infected patients with lumbar spine OC, erosive gastropathy was most often diagnosed (in 40 (43.5%) of the examined), as well as erosive-papular and erosive-hemorrhagic gastropathy (in 14 (15.2%) and in 16 (17, 4 %) of patients, respectively), while erythematous gastropathy was more often diagnosed among HP-negative patients (in 7 (70.0 %) cases, respectively). CONCLUSION: Conclusions: 1. 90.2% of patients with lumbar spine OC and CG have been diagnosed with HP infection. 2. Endoscopically, the lesion of the stomach MM in patients with lumbar spine OC corresponds mainly to erosive and erosive-hemorrhagic forms of gastropathy. 3. During histological examination of stomach MM, mainly 2nd and 3rd degrees of inflammation were established, especially in patients with erosive, erosive-papular and erosive-hemorrhagic forms of gastropathy.

HYPERACTIVE BLADDER SYNDROME SECONDARY TO BAROTRAUMA AND CHRONIC STRESS.

OBJECTIVE: The aim: To improve the results of treatment of hyperactive bladder syndrome in men of working age on the background of barotrauma and stress, as a consequence of combat trauma. PATIENTS AND METHODS: Materials and methods: An analysis of the questionnaire and the results of the clinical examination of 32 patients, injured servicemen and people who were injured in combat zones was carried out. The drug solifenacin succinate was used in the treatment complex, which is a specific antagonist of M3 subtype cholinergic receptors. Its influence allows you to achieve relaxation of the bladder detrusor and reduce the contractility of hyperactive bladder. RESULTS: Results: The main criterion for the effectiveness of the treatment was a decrease in the number of urgent cases, the frequency of urination and manifestations of nocturia by 50% or more, which was considered a positive effect. At the same time, the positive effect was differentiated as follows : an improvement of these parameters by 75% or more from the initial value which is a good result; reduction of symptoms in the range of 50-75% is satisfactory; less than 50% is an unsatisfactory result. A positive effect from the treatment after 8 weeks was observed in 88% of patients, of which 52% had a good result and 36% had a satisfactory result. CONCLUSION: Conclusions: The proposed complex of treatment of hyperactive bladder syndrome as a result of combat trauma against the background of barotrauma with neurological consequences and chronic stress allows to achieve a pronounced clinical effect in the vast majority of male patients of working age. And the diagnostic complex allows you to emphasize aspects of clinical vigilance, both for doctors of a specialized branch and of doctors of a general direction.

EARLY DIAGNOSIS OF ASYMPTOMIC CHRONIC ISCHEMIA OF THE LOWER EXTREMITIES.

OBJECTIVE: The aim: To assess the possibility of using a questionnaire and determining the Ankle Brachial Index(ABI) for early diagnosis of asymptomatic ischemia of the lower extremities in patients with various somatic diseases. PATIENTS AND METHODS: Materials and methods: The study involved 294 patients who were receiving inpatient treatment at Communal Non-Profit Enterprise «Uzhgorod Central City Clinical Hospital¼,Communal Non-Profit Enterprise «Transcarpathian Regional Clinical Hospital¼ and Communal Non-Profit Enterprise «Uzhgorod District Clinical Hospital¼. The study was conducted in 36 patients of pulmonological, 52 - neurological, 22 - endocrinological, 28 - rheumatological, 67 - general therapeutic and 89 - surgical patients. In order to detect hidden ischemia, the patients were surveyed according to the Edinburg questionnaire, regional systolic pressure was measured on the tibial arteries of the lower extremities and calculation of the Bone-humerus index (ABI)at rest and after physical exertion (walking), also non-contact skin temperature was measured on the lower leg and thigh. RESULTS: Results: During the study, (ABI) less than 0.9 was found in 108 (36.7%) patients, while in 47 (43.5%) cases, (ABI) decreased only after exercise.In the majority of cases, 98 (90.7%) a decrease in (ABI) was observed on one lower limb. A decrease in the skin temperature of the lower extremities was observed in 141 (48%) patients, 134 (95.1%) of which were diagnosed with diabetes.Symptoms of hidden ischemia, according to the questionnaire, were found in 99 (33.7%) patients.Smoking was observed in 61 (56.5%) patients with symptoms of hidden ischemia. CONCLUSION: Conclusions: As a result of our study, it was found that the specificity of the Edinburg questionnaire in detecting the preclinical stage of ischemia of the lower extremities reaches 88.2%, and the sensitivity - 91.6%. The obtained results indicate the expediency of using the questionnaire in the complex of diagnostics of vascular pathology in patients of various profiles. False-negative results of(ABI)in people with diabetes are associated with mediacalcinosis. In such cases, it is necessary to assess the state of blood flow by measuring the pressure on the back of the foot after physical exertion.

EXPERIENCE OF THE TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS.

OBJECTIVE: The aim: To improve the results of treatment of patients diagnosed with acute pancreatitis. PATIENTS AND METHODS: Materials and methods: The materials of the work are based on the clinical examination and treatment of 301 patients with acute pancreatitis, in the treatment of which, along with classical treatment, a therapeutic and diagnostic complex was used, which allows predicting and preventing the development of abdominal compartment syndrome (ACS). RESULTS: Results: Managed to reduce the number of cases of infected pancreatic necrosis, effectively predict and prevent the development of abdominal compartment syndrome (ACS), reduce the average length of stay of patients in the hospital. CONCLUSION: Conclusions: The use of the proposed management algorithm for patients with acute pancreatitis allows to shorten the treatment period by effectively predicting and preventing the development of pancreatic necrosis, its septic complications and abdominal compartment syndrome.

EXPERIENCE USING LASER IN THE TREATMENT OF POLYPES OF THE EXTERNAL URETHRAL ORIFICE.

OBJECTIVE: The aim: To improve the results of treatment of patients with polyps of the external urethral orifice by using minimally invasive surgery. PATIENTS AND METHODS: Materials and methods: The materials of the work are based on clinical examination and treatment of 22 patients with polyps of the external urethral orifice in the treatment of which, along with classical treatment were used minimally invasive methods of removal of polyps of the external urethral orifice using high-intensity laser. RESULTS: Results: We managed to reduce the duration of surgery and treatment twice less, to avoid typical complications, which accelerated the regeneration process and the rehabilitation period. CONCLUSION: Conclusions: The use of minimally invasive surgical methods to remove urethral polyps can reduce the duration of treatment by reduction of the thermal and mechanical load on the surrounding tissues and reducing the time of surgery.

Use of technomolecular silver preparations in complex treatment of infected wounds.

OBJECTIVE: The aim: To improve the results of treatment of infected wounds. PATIENTS AND METHODS: Materials and methods:The clinical material is based on clinical observation and treatment of 29 patients with in fected wounds, whose treatment included combination drugs of local action on the basis of techno-molecular silver (in particular «Cadefort-Spray¼), by application to the wound surface. RESULTS: Results: Wound microbial factor, dynamics of wound process, indicators of immune status were evaluated: localadaptive immunity, atopic reactions. CONCLUSION: Conclusions: High efficiency of treatment was observed regardless of the phase of the wound process, which allowed to accelerate wound repair and stimulate the processes of regeneration, strengthen local adaptive immunity, prevent atopic reactions.

[Bipolar electroexcision and endoscopic laser photocoagulation colon polyps].

OBJECTIVE: Introduction: An important problem in the prevention of colon cancer is the diagnosis and treatment of its precancerous diseases, in particular polyps. The aim: The purpose of the study is to conduct a comparative description of the treatment outcomes using different methods of excision of polyps. PATIENTS AND METHODS: Materials and methods: The study included 134 patients with clinical manifestations of colon disease. Polyps of the colon have been diagnosed in 86 patients. In 45 (52.3%) patients endoscopic laser polypectomy was performed, in 41 (47.7%) patients electroexcision using a bipolar coagulator was performed. At control colonoscopies, after 6 months, the relapse of the disease was diagnosed in 4.65% of patients. RESULTS: Results: Relapses occurred in patients after laser coagulation as well as after electroexcision, due to technical difficulties in performing endoscopic surgery because of the form of the polyps. Conducting a comparative analysis of the rate of healing of postoperative defects as a consequence of the removal of polyps by different methods, we came to the conclusion that no significant difference was found between the methods of polypectomy. But attention is drawn to the fact that after the removal of polyps on a broad basis by the method of laser polypectomy, wound healing is significantly faster (p≤0.05) compared with the method of bipolar electroexcision. CONCLUSION: Conclusion: Polypectomy with fibrocolonoscopy is an effective method of diagnosis and treatment of benign tumors of the large intestine in ambulatory conditions. When removing polyps on a broad basis, the advantage should be given to the method of laser coagulation because healing of the wound occurs faster compared with the method of bipolar electroexcision.