Adequate Method Of Treatment Research Articles

Functional connectivity in burnout syndrome: a resting-state EEG study

Chronic occupational stress is associated with a pronounced decline in emotional and cognitive functioning. Studies on neural mechanisms indicate significant changes in brain activity and changed patterns of event-related potentials in burnout subjects. This study presents an analysis of brain functional connectivity in a resting state, thus providing a deeper understanding of the mechanisms accompanying burnout syndrome. The sample consists of 49 burnout employees and 49 controls, matched by age, gender and occupation (Mage = 36.15, SD = 8.10; 59 women, 39 men). Continuous dense-array EEG data were collected from a 256-channel EEG system. The difference in functional connectivity between burnout and control subjects was tested in the eyes-closed (EC) and eyes-open (EO) conditions using the resting-state paradigm. The results indicate significant differences in brain activity between the burnout and the control groups. The resting-state network of the burnout group is characterized by decreased functional connectivity in frontal and midline areas in the alpha3 sub-band (11–13 Hz) in an eyes-open condition. The most significant effect of decreased connectivity was observed in the right frontal brain area. For the first time, these analyses point to distinctive aspects of functional connectivity within the alpha3 sub-band in burnout syndrome. These findings provide insights into the neurobiological underpinnings of burnout syndrome and its associations with changed resting-state networks. The data on neural characteristics in burnout subjects may help to understand the mechanisms of decline in cognitive function and emotion regulation and to search for adequate methods of treatment.

Amplified pain and complex regional pain syndrome in children: clinical cases and literature review

BACKGROUND: Musculoskeletal pain is a common reason for visiting pediatric clinics. Causes of chronic musculoskeletal pain include various inflammatory or noninflammatory conditions. Amplified pain syndrome refers to a wide range of conditions manifested by chronic pain, the common feature of which is central and/or peripheral sensory amplification of pain. Complex regional pain syndrome is characterized by spontaneously occurring or provoked by irritating stimuli pain of high intensity, disproportionate to the actual injury or other stimulus, and the presence of several concomitant vegetative and motor disorders. CLINICAL CASES: This article presents three clinical cases of pediatric patients with chronic musculoskeletal pain and an analysis of the current literature on chronic pain in children. DISCUSSION: Complex regional pain syndrome is more common in adolescent girls, and conflict or psychological trauma is a common trigger. Symptoms of disproportionate burning pain (causalgia) with trophic changes may indicate complex regional pain syndrome. To date, there are no generally accepted pharmacological treatments recommended for children with complex regional pain syndrome. Nonsteroidal anti-inflammatory drugs (ibuprofen) and paracetamol and their combination are commonly administered in cases wherein symptoms of chronic pain first appear. CONCLUSIONS: Currently, a multidisciplinary approach, including physical, psychological, medical, and invasive methods, appears to be the most adequate treatment method for musculoskeletal pain. The use of analgesics should comply with approved protocols of pain management in pediatric practice.

Treatment options for impacted maxillary canines and occurrence of ankylotic and resorptive processes: a 20-year retrospective study

BackgroundThis 20-year retrospective study aimed to evaluate the treatment methods used in patients with impacted maxillary permanent canines and to determine the occurrence of ankylotic and resorptive processes and their association with potential risk factors.MethodsThe cohort consisted of 351 consecutive Caucasian patients (120 males and 231 females, mean age 18.4 and 19.9 years, respectively) with 420 impacted maxillary permanent canines. CT and CBCT findings were subsequently confirmed during surgery. Statistical analyses were performed by the generalized linear models, Pearson x2 and Fisher exact tests using the statistical programs R and Statistica v. 14.ResultsA total of 273 (65.0%) impacted canines were aligned in the dental arch by orthodontic traction after surgical exposure, this treatment was predominant in patients under 20 years of age. Surgical extraction was performed in 115 (27.2%) impacted canines and was more common in older patients. Ankylotic changes were recorded in 61 (14.5%) impacted canines. The probability of ankylosis increased with age, particularly after the patient’s 20th year of life (p < 0.001). Patients were 1.2% likely to develop ankylosis at age 15 years, 4.3% at age 20 years, 14.1% at age 25 years, and 96.8% at age 45 years. Invasive cervical root resorption (ICRR) was found in 8 (1.9%) canines. In 4 canines (1.0%), root ankylosis in addition to ICRR was observed. In contrast to ankylosis, whose frequency of occurrence increased with age, the occurrence of ICRR resulting from PDL damage during surgery was more typical in younger patients. Canines in a high position above the root apices of the adjacent teeth, with a horizontal inclination of the longitudinal axis, with the crown located deep in the center of the alveolar bone and with labiopalatal position, should be considered critically impacted canines with a high risk to failure of orthodontic traction.ConclusionIn conclusion, the treatment of impacted canines depends mainly on the age of the patient, and the position and inclination of the longitudinal axis of the impacted tooth. To select an adequate treatment method, we recommend CBCT examination, which allows a precise analysis of the position of impacted canines.

Characterization of biosurfactants' micelles formation using fluorescence measurements: sodium taurocholate as case of study.

The evaluation of micellization parameters of surfactants that aggregate gradually, such as bile salts, is not trivial. In this work, different probes and data treatment models are tested to set up an analytical method based on fluorescence measurements to determine the critical micelle concentration (CMC) and micellization range ((C) of biosurfactants. Sodium taurocholate (NaTc) is used as example. The fluorescence intensity of five fluorophores has been monitored upon the addition of a concentrated NaTc solution in two different media: water and a biorelevant buffer (maleic buffer pH 6.5, I = 120 mM). Four different data treatment methods have been tested. The micellization process can be evaluated satisfactorily using fluorescent probes such as propranolol and tetracaine, and also monitoring directly the intrinsic fluorescence of NaTc. However, the results obtained with nonpolar probes (pyrene and naphthalene) are more complex to evaluate due to the presence of confluent processes. Although the four models tested for the data treatment are commonly used for this purpose, Carpena's method is the most appropriate as it provides the most accurate CMC and ΔC values. The micellization process is faster in a biorelevant buffer than in water. The study of the micellization of bile salts is not an evident process. After the selection of adequate probes and data treatment methods, the CMC values for NaTC in water and maleic buffer reveal that the biorelevant conditions favour micellization, which in turn may allow faster solubilization of ingested compounds.

CURRENT ISSUES IN RADIOLOGICAL DIAGNOSIS OF SALIVARY STONE DISEASE: REVIEW ARTICLE

Relevance. Salivary stones, also known as sialoliths, pose a diagnostic and therapeutic challenge due to the lack of a definitive etiology and the limitations in preventive measures. Numerous studies have presented diverse and often conflicting explanations for the formation of salivary stones, hindering the development of effective preventive strategies.&#x0D; Objective of this study is to synthesize existing literature on the etiology, prevention, diagnosis, and treatment of salivary stone disease.&#x0D; Materials and methods. A systematic review of the available literature was conducted to explore current perspectives on salivary stone disease. The review synthesized and systematized contemporary views on the etiology of the disease, its pathogenesis, preventive strategies, and treatment approaches.&#x0D; Results. Most of the authors, analyzing the main causes and accompanying factors of the occurrence of salivary stone disease, suggest to use various radiological diagnostic methods for its diagnosis.&#x0D; Radiological methods of research are key in the plan of carrying out differential diagnosis of salivary stone disease with other diseases and determining an adequate method of treatment.&#x0D; Conclusion. The review of scientific publications allows us to state that currently there are a large number of diverse and contradictory opinions about the etiology of the occurrence of salivary stone disease, and its pathogenesis is poorly studied. The methods of diagnosis of salivary stone disease proposed by the authors of scientific publications are based on the desire to find optimal and minimally invasive methods of early and accurate diagnosis of the disease.

Značaj odabira dijagnostičkih i terapijskih modaliteta na ishod lečenja preloma dijafize tibije

Fractures of the tibial shaft are the most common fractures of long bones. Open fractures of the tibial shaft often lead to simultaneous severe soft tissue and bone damage. The absence of adequate soft tissue coverage, together with the specific blood supply to this region, makes these fractures susceptible to infection and non-healing. A thorough patient evaluation, including diagnosis of soft tissue and bone damage, is essential for the successful treatment of tibial diaphysis fractures. The medical importance of tibial diaphyseal fracture on the one hand, and the uncertainties that exist when it comes to treatment, on the other hand, impose the need to examine the best therapeutic modalities in patients with tibial diaphyseal fracture. In addition to conservative treatment, which is reserved for fractures without dislocation of fracture fragments, the most common approach is surgical treatment - with external fixators or intramedullary fixation with nails. Today, intramedullary fixation takes precedence in the treatment of most fracture types. Ilizarov external fixator is still the method of choice in patients with multiple traumas. Most studies did not observe a significant difference in the frequency of postoperative complications between the two methods, such as delayed healing and fracture nonunion, however, numerous studies indicate more frequent superficial infections in patients treated with an external fixator, or deep infections in patients treated with intramedullary pins. Each of the mentioned complications additionally burdens both the surgical team and the patient, i.e. the success of the treatment and functionality, together with the quality of life after the treatment is completed. Therefore, it is necessary to conduct larger, prospective, and multicenter studies on complication rates, which will help in choosing the most adequate treatment method for tibial diaphysis fractures.

A 4-year study of bovine reproductive hormones that are induced by pharmaceuticals and appear as steroid estrogenic pollutants in the resulting slurry, using in vitro and instrumental analytical methods

The main objective of the research was to study the environmental “price” of the large-scale, milk production from a rarely known perspective, from the mapping of the estrogenic footprint (the amount of oestrus-inducer hormonal products, and the generated endoestrogens) in the resulting slurry in a dairy cow farm. These micropollutants are endocrine-disrupting chemicals (EDCs) and can be dangerous to the normal reproductive functions even at ng/kg concentration. One of them, 17ß-estradiol, has a 20,000 times stronger estrogenic effect than bisphenol-A, a widely known EDC of industrial origin. While most studies on EDCs are short-term and/or laboratory based, this study is longitudinal and field-based. We sampled the slurry pool on a quarterly basis between 2017 and 2020. Our purpose was testing the estrogenic effects using a dual approach. As an effect-based, holistic method, we developed and used the YES (yeast estrogen screen) test employing the genetically modified Saccharomyces cerevisiae BJ3505 strain which contains human estrogenic receptor. For testing exact molecules, UHPLC-FLD was used. Our study points out that slurry contains a growing amount of EDCs with the risk of penetrating into the soil, crops and the food chain. Considering the Green Chemistry concept, the most benign ways to prevent of the pollution of the slurry is choosing appropriate oestrus-inducing veterinary pharmaceuticals (OIVPs) and the separation of the solid and liquid parts with adequate treatment methods. To our knowledge, this is the first paper on the adaptation of the YES test for medicine and slurry samples, extending its applicability. The adapted YES test turned out to be a sensitive, robust and reliable method for testing samples with potential estrogenic effect. Our dual approach was successful in evaluating the estrogenic effect of the slurry samples.Graphical

Chondroblastoma of the cervical-thoracic junction: global data and own experience

Chondroblastoma (CB) ‒ a rare benign tumor of the skeleton that is presented by proliferation of chondroblasts with islands of eosinophilic chondroid matrix. CB accounts for less than 1% of all bone neoplasms, while the spine is affected in only 1.4% of all CB cases. Publications devoted to CB of the spine are sporadic and therefore have a considerable scientific interest due to the rarity of the pathology. A clinical case of CB of the cervical-thoracic junction of a 38-year-old patient hospitalized to State Institution "Romodanov Neurosurgery Institute of the National Academy of Sciences of Ukraine" in November 2022 is presented. The anamnesis shows that in 2016 a pathological fracture of the Th2 vertebral body was diagnosed. In 2017, a surgical intervention - an open biopsy of the Th2 vertebral arch was performed in a private clinic, but the histopathological analysis, due to the insufficient amount of material and the absence of clinical data, was descriptive, with a certain diagnostic number of possible nosologies. Additional treatment was not performed. When applying in 2022 to the State Institution "Romodanov Neurosurgery Institute of the National Academy of Sciences of Ukraine", significant negative dynamics were noted: a fracture of the body of the Th1 vertebra, total destruction of the body of the Th2 vertebra, a change in the signal from the body of the Th3 vertebra, which indicated its focal lesion. The surgery was performed in two stages. The first stage included a ventral corpectomy of the Th1‒Th3 vertebrae with fusion using telescopic body replacement implant and a ventral rigid plate. During the second stage laminectomy of the Th1‒Th3 vertebrae with complete resection of the Th2 costotransverse joints and partial of Th1‒Th3 ones was performed. Stabilization system screws were installed transarticularly in the facet joints C6 and C7, transpedicularly in the bodies of the Th4‒Th6 vertebrae. To increase the fusion rigidity, additional fixation of the Th1 vertebra on the right and the Th3 vertebra on the left was performed through the remaining costotransverse joints. The patient was discharged with positive neurological dynamics. The uniqueness of this case, in addition to the rarity of the histological variant of the pathology, lies in the possibility of tracking the dynamics of the disease on the basis of both neuroimaging methods and pathohistological and immunohistochemical diagnostics. Features of the prevalence of spine CB in the population, the specifiс signs when performing a spiral computer and magnetic resonance imaging, macroscopic, histological and immunohistochemical characteristics of the tumor are considered in detail. The literature data on differential diagnosis, treatment methods and prognosis of disease are organized. The material is of interest to specialists, since the timely selection of an adequate treatment method and its volume determines both the probability of tumor recurrence as well as prognosis concerning the patient’s life expectancy.

Ectopic Eruption of the Maxillary Permanent First Molar: A Brief Review and Clinical Case Report

The Ectopic Eruption of the Maxillary Permanent First Molar (EEMPFM) is an eruption anomaly, characterized for the maxillary permanent first molar’s impaction in the distal surface of the deciduous second molar. The etiology is related with change of the axial axis of eruption of the permanent first molar associated with missing space in the maxilla. The diagnosis is the combination of clinical and complementary examination. There are two types of Ectopic Eruption: the reversible and the irreversible. The irreversible type requires orthodontics treatment, because it causes root resorption of the deciduous second molar, causing its premature loss. For the treatment, procedures can be used with the aim of promoting distal inclination of the ectopic first molar, using separator elastics, removable or fixed appliances. The aim of this work is to report a clinical case of a patient of 9 years and 6 months old, female gender, who attended the Clinic presenting EEMPFM of the maxillary right permanent first molar. The treatment was a removable appliance composed with an acrylic base plate with clasps and a finger spring activated against a resin button bonded on the mesiobuccal cusp of the maxillary right permanent first molar. The correction of this anomaly was obtained with 35 days of treatment. Therefore, the sequence of procedures from diagnosis to the indication of an adequate treatment method is fundamental to obtain satisfactory results.

Some aspects of the clinic, diagnostics and effectiveness of the treatment of solitary and primary multiple tumors of the nose skin and nosolabial folding (SPMTNSNF)

Aim . To study the features of the clinic, diagnose and evaluate the effectiveness of the treatment of solitary and primarily multiple tumors of the skin of the nose and nasolabial fold (SPMTNSNF). Material and methods . Work is based on a prospective analysis of clinical data of case histories of 74 patients with various solitary and primarily multiple tumors of the skin of the nose and evaluation of the treatment effectiveness in the State Institution “Republican Oncological Scientific Center” of the MoH and SPP of the RT 2015 to 2019. Results and its discussion . Evaluation of the effectiveness of treatment of 70 (100%) patients with malignant SPMTNSNF in 63 (90%) cases showed excellent result, in 4 (6%) - good results and in 3 (4%) cases unsatisfactory results. The quality of life of patients according to Karnowski scale improved from a minimum of 60% to 100%. Conclusion . Adequate treatment methods for SPMTNSNF made it possible to achieve satisfactory and excellent results in 96% of patients, which accelerated rehabilitation and improved the quality of life of these patients.

SCIENTIFIC ACHIEVEMENTS OF UKRAINIAN SCIENTIST IN DIAGNOSTICS OF TEMPOROMANDIBULAR JOINT DISEASES (LITERATURE REVIEW).

The aim: A systematic analysis and generalization of scienti!c information of Ukrainian scientists about planning of the stages of diagnosis of patients with TMJ diseases, which will allow to optimize the commonly accepted examination algorithm. Materials and methods: Scienti!c analysis and generalization of obtained data of literary sources of Ukrainian scientists articles with characteristics of planning stages of diagnosis of patients with TMJ diseases is based on such databases as Scopus, Web of Science, MedLine, PubMed, NCBI, the study of which does not exceed 6 years, including monographs and results clinical research. Conclusions: The results of scienti!c research by Ukrainian scientists are the basis for increasing the effectiveness of diagnosis of TMJ diseases by improving complex examination methods and implementing clinical algorithms, which will allow to choose adequate treatment methods.

Інвагінація кишечника в дітей: навчання та практика

Intestinal invagination is a mixed form of intestinal obstruction that occurs when one section of the intestine is telescopically immersed in the lumen of another and occurs mainly at the age of 3 months to 1 year, which is 90%, and mortality, according to the literature, ranges from 6 to 14.5%. Despite a sufficient number of scientific and clinical publications on the pages of medical journals regarding the diagnosis and treatment of intestinal intussusception, there are no fake simulators in the training of students and interns, which determines the relevance of this publication. Purpose - to improve the results of diagnosis and treatment of children with intestinal intussusception by analyzing domestic developments and visually studying the mechanism of its development with the help of a simulator both for the purpose of diagnosis and treatment - conservative disinvagination. Results. In today’s conditions, general practitioners and pediatricians are not trained to diagnose intussusception in children, that is, they do not have simple methods of examination. Hospitals usually do not have the equipment to examine and diagnose acute intussusception. In order to eliminate the gaps at the Department of Pediatric Surgery of the Bukovinian State Medical University, a dummy-simulator of intestinal intussusception «Garant» was developed and introduced into the educational process. Training on a simulator allows you to master the practical skills of diagnostics in the conditions of an X-ray room and conservative disinvagination followed by X-ray control. In turn, the development of skills by primary care physicians and pediatric surgeons in diagnosis and treatment will primarily improve the understanding of the onset of the disease and treatment methods. Conclusions. With certain and significant developments regarding the diagnosis and treatment of intestinal intussusception in children, the problem has not been solved, since some children seek help at the wrong time, and as a result of complications - necrosis, peritonitis with organ and multiple organ failure. The use of a scoring system for assessing the stage of invagination makes it possible to systematize the main prognostic indicators of sonographic and dopplerographic studies in order to determine an adequate method of treatment. Practicing the skills of diagnosis and treatment on the self-developed dummy «Garant» allows you to clearly understand the essence and purpose of the measures taken to establish and confirm the diagnosis of intestinal intussusception, evaluate the possibilities of various methods of conservative and surgical treatment and indications for them. No conflict of interests was declared by the authors.

Possibilities of radiation therapy for skin cancer in long-lived patients (over 90 years old)

Introduction. Skin cancer is one of the most common forms of malignant tumors in the Central Asian region and is frequently found in elderly and senile people. Often this pathology is also diagnosed in long-lived patients. Unfortunately, for long-lived patients the choice of adequate treatment methods presents particular difficulties due to the presence of concomitant diseases, a complex psycho-emotional state and expected complications. The inability to carry out specific antitumor treatment according to traditional programs leads to the progression of the tumor process and a significant decrease in the quality of life of patients.Aim. To determine the importance of radiation therapy in the treatment of skin cancer in long-lived patients (over 90 years old).Materials and methods. The study included 32 patients – 21 (65.62 %) men and 11 (34.38 %) women, all patients at the initial admission to a specialized medical institution were over the age of 90 years. Some patients were monitored and treated for several years in non-core institutions, they underwent various therapies for continued growth, relapses and metastases. Tumors affected various anatomical areas. Taking into account morphological and general clinical data, 5 (15.62 %) patients were diagnosed with skin cancer of stage T1N0M0, 6 (18.79 %) – T2N0M0, 14 (43.79 %) – T3N0–1M0–1, 7 (21.87 %) – T4N0–1M0–1, which indicates late treatment of patients to oncologists, despite the visual localization of skin cancer. Only 5 (15.62 %) of 32 patients underwent exclusively surgical intervention, telegammatherapy (TGT) as an independent type of treatment – 5 patients with disease in T1–2N0M0 stage. Patients with stage T3–4N0–1M0–1 disease received TGT in a single mode, probably due to the presence of contraindications or the inability to use other methods of treatment. Polychemotherapy in an independent variant was performed to 1 patient, combination therapy (TGT + surgery) – 9 (28.12 %), chemoradiotherapy – 3 (9.37 %), complex therapy (TGT + surgery + polychemotherapy).Results. Numerous scientific studies devoted to skin cancer, convincingly prove that this pathology mainly occurs in patients in the elderly and senile age (60–75 years). Our experience of treatment in 1049 patients with skin cancer confirms this fact. Standard approaches have been developed for the treatment of various forms of skin cancer, and clinicians achieve good results in the early stages of the disease. It is considered that the patient’s age is relative, and in some cases absolute, a contraindication for antitumor therapy. The assessment of the risk of skin cancer showed that it often occurs in long-lived patients (people over 90 years old) and accounts for 3.05 % of the total number of cases. During the treatment protocols of patients of this group, we were convinced of the reliably frequent localization of skin cancer in longlived patients in the head and neck (40.63 % of cases) and lower extremities (28.12 % of cases). It should be noted that in 4 out of 9 patients, the tumor developed against the background of various injuries and diseases. The majority of patients (21 (65.62 %) out of 32 patients), despite the visual localization of the tumor, turned to oncologists late when they had a locally advanced process or metastases (T3–4N0–1M0–1). The treatment in the form of combined and complex therapy was ineffective. At the same time, in the near term after treatment, signs of a residual tumor were detected in 6 (28.51 %) of 21 patients, relapses – in 4 (19.04 %), and metastasis to distant lymph nodes – in 3 (14.28 %). Probably, the aggressive course of skin cancer in long-lived patients is explained not only by the biological features of the disease, but also by the physiological characteristics of the body. Contrary to existing opinions, the majority of long-lived patients can undergo combined and complex therapy, including repeated courses of radiation therapy with their adequate use.Conclusion. Despite the advanced age, the presence of concomitant diseases, limited physical abilities, long-lived patients need adequate methods of specialized treatment. Age over 90 years is not an absolute contraindication for antitumor therapy, on the contrary, its adequate choice significantly improves the quality of life of patients. When relapses and metastases of skin cancer appear in long-lived patients, combined and complex antitumor therapy can be performed after a thorough assessment of their condition.

Guttural pouch empyema in a Mangalarga Marchador filly: Case report

Guttural pouch empyema is usually a consequence of upper respiratory tract infections, especially those caused by Streptococcus equi. In adult horses, empyema is a common disease, whereas considered rare in foals. The aim of this work was to report a case of unilateral guttural pouch empyema in a filly, with a focus on diagnostic and treatment approaches. A 1-month-old filly, 68 kg, Mangalarga Marchador, was admitted because of respiratory distress and enlargement caudally in the head. Clinical examination revealed dyspnea, dysphagia, lymphadenopathy, unilateral enlargement in the retropharyngeal area, and mucopurulent nasal discharge. Further, endoscopic examination confirmed the presence of purulent material inside the left guttural pouch and a diagnosis of empyema was arrived at. Drainage was performed surgically, a catheter was inserted for guttural pouch lavage. The animal received bromexin, dexamethasone, flunixin meglumine, ceftiofur, probiotics, vitamin complexes, and ringer lactate solution. Hematological evaluation performed every 24-72h, showed a decrease in total leukocytes, fibrinogen, platelets, total plasma protein, hematocrit, hemoglobin, and erythrocytes. Eleven days after drainage, the filly’s clinical condition was stable and the wound has healing. The animal was discharged following a good prognosis. Differential diagnoses can include other respiratory diseases, such as guttural pouch timpanism, strangles, and Rhodococcus, which are excluded due to the clinical signs and complementary examinations. In the present case early diagnosis, based on physical examination, hematological parameters, and radiography, combined with adequate treatment methods, including surgical procedures, lavages, antibiotics, and anti-non-steroidal inflammatory therapy, contributed to resolving the guttural pouch empyema in the filly.

ОСТРЫЙ ГНОЙНЫЙ ПИЕЛОНЕФРИТ ЕДИНСТВЕННОЙ ПОЧКИ

Background. One of the life-threatening diseases among patients with a single kidney is acute purulent pyelonephritis (APP). The disease is accompanied by oliguria or anuria and in many cases comes with the development of multiple organ dysfunction. Objectives. To present the features of the clinical manifestations of APP of a solitary kidney, the results of clinical and laboratory examination, the role of kidney imaging methods (USG, MRI and contrast-enhanced CT) in identifying foci of purulent destruction in the parenchyma, and the immediate results of treatment of patients with APP of a solitary kidney. Material and methods. 10 patients with APP of a solitary kidney were observed. The role of imaging methods (USG, CT and MRI) of the kidney in the detection of purulent destruction in parenchyma is shown. Methods of treating patients are considered: open organ-preserving surgery, nephrectomy; installation of an internal ureteral stent followed by antibiotic therapy and puncture nephrostomy followed by antibiotic therapy. Results. The best immediate results were noted in the group of patients who underwent open organ-preserving surgery in the volume of decapsulation of the kidney, excision of carbuncles, opening of abscesses and drainage of the calices-pelvis system of the kidney with nephrostomy. 3 out of 10 patients needed hemodialysis. Conclusion. Open organ-preserving surgery remains a reliable adequate method of surgical treatment of APP of a solitary kidney. In case of a single focus of destruction in the kidney parenchyma up to 3 cm in diameter or with signs of apostematous pyelonephritis, an effective method of treatment is the installation of an internal ureteral stent followed by antibiotic therapy. 30% of patients with APP need hemodialysis treatment.

Treatment of avascular necrosis of the humeral head \u2013 Postoperative results and a proposed modification of the classification

BackgroundAvascular necrosis of the humeral head after proximal humeral fracture i.e. type 1 fracture sequelae (FS) according to the Boileau classification is a rare, often painful condition and treatment still remains a challenge. This study evaluates the treatment of FS type 1 with anatomic and reverse shoulder arthroplasty and a new subclassification is proposed.MethodsThis single-center, retrospective, comparative study, included all consecutive patients with a proximal humeral FS type 1 treated surgically in a four-year period. All patients were classified according to the proposed 3 different subtypes.Constant score (CS), Quick DASH score, subjective shoulder value (SSV) as well as revision and complication rate were analyzed. In the preoperative radiographs the acromio-humeral interval (AHI) and greater tuberosity resorption were examined.ResultsOf 27 with a FS type 1, 17 patients (63%) with a mean age of 64 ± 11 years were available for follow-up at 24 ± 10 months. 7 patients were treated with anatomic and 10 with reverse shoulder arthroplasty. CS improved significantly from 16 ± 7 points to 61 ± 19 points (p < 0.0001). At final follow-up the mean Quick DASH Score was 21 ± 21 and the mean SSV was 73 ± 21 points. The mean preoperative AHI was 9 ± 3 mm, however, 8 cases presented an AHI < 7 mm. 4 cases had complete greater tuberosity resorption.The complication and revision rate was 19%; implant survival was 88%.ConclusionBy using the adequate surgical technique good clinical short-term results with a relatively low complication rate can be achieved in FS type 1. The Boileau classification should be extended for fracture sequelae type 1 and the general recommendation for treatment with hemiarthroplasty or total shoulder arthroplasty has to be relativized. Special attention should be paid to a decreased AHI and/or resorption of the greater tuberosity as indirect signs for dysfunction of the rotator cuff. To facilitate the choice of the adequate prosthetic treatment method the suggested subclassification system should be applied.

CURRENT APPROACHES TO PERIOPERATIVE MANAGEMENT OF PATIENTS WITH INGUINAL HERNIAS (LITERATURE REVIEW)

The article provides literature review on current approaches to perioperative treatment of patients with inguinal hernias (IH) based on the principles of enhanced recovery after surgery (ERAS). The ERAS algorithm includes all evidence-based perioperative elements that affect rapid recovery after surgery, reduce the incidence of complications and potential mortality. There are three stages of patient management: preoperative examination, selection of an adequate method of surgical treatment, anesthesia during surgery and in the postoperative period. Thorough examination of patients before surgery and identification of potential risk factors associated with comorbidities are important to reduce the risk of morbidity and recurrences. Effective dynamic perioperative pain management is a prerequisite for optimal recovery after surgery. The first step in managing pain under the ERAS concept is choosing the correct type of surgery. Preference should be given to the least traumatic operations, i.e., laparoscopic or endoscopic hernioplasty. According to PROSPECT recommendations, analgesics should be started before and continued during surgery, which will provide adequate analgesia in the early postoperative period. The combination of paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs) and a selective cyclooxygenase-2 inhibitor (COX-2) provides good analgesia and reduces opioid use. The transverse abdominal block (TAP block), as a type of regional anesthesia, is safe for patients with IH, reduces the postoperative need for narcotic analgesics, reduces the frequency of postoperative nausea and vomiting and pain intensity. Regional anesthesia reduces the length of a patient’s stay in the operating room and is associated with a lower risk of urinary retention in the postoperative period (compared to neuroaxial anesthesia). After the operation patient should be activated as soon as possible, and this is possible under conditions of sufficient analgesia, which is best achieved by combining systemic analgesics and TAP block. Antimicrobial prophylaxis should be performed in all patients undergoing elective surgery for IH. Since some patients experience significant limitations in daily activities due to chronic postoperative inguinal pain, it is necessary to consider all risk factors for chronic pain after surgery to prevent its development.

Early Bubble Continuous Positive Airway Pressure Therapy for Premature Neonates with Respiratory Distress Syndrome

Objective: To determine the outcome of preterm neonates with the early introduction of bubble continuous positive airway pressure (CPAP). Methodology: This observational study was conducted in NICU of Shifa International Hospital, Islamabad from March 2017 to August 2017. Ninety preterm infants were enrolled with a gestational age of 28 to 37 weeks and with the clinical features of Respiratory Distress Syndrome (RDS). Infant variables that were recorded were birth weight, gestational age, and severity of RDS and Fio2 requirement. Bubble CPAP was started at 5cm of water and FiO2 adjusted to maintain SpO2 of 87 to 95%. The SPSS 26 version was used to analyze data. The Chi square test was used, with a P value of &lt;0.05 considered significant. Results: The study included 90 neonates who were clinically diagnosed with RDS. To treat RDS, CPAP was started at the mean age of 5.27 hours of life with a standard deviation of 2.66 hours. 11 out of 90 (11.22%) babies had chest X-ray findings in favor of severe RDS; while X-rays of the remaining 79 (88.78%) showed mild to moderate RDS. Conclusion: CPAP is of valuable importance in low resource countries with a lack of ventilators and provides an adequate and conservative treatment method of mild to moderate RDS for preterm neonates. However, in cases of severe RDS, intubation and mechanical ventilation are often necessary.

Treatment of damage to the extensors of the fingers

The nature of operative and treatment methods depending on the terms of trauma and injury levels in 134 patients with injuries of hand finger extensors is established. The treatment method stereotype of injuries of hand finger extensors is developed. The internal splinting is typical and the most adequate treatment method for the 1st injury zone; the buried tendon sutures with temporal (to three weeks) fixation of the joint by the wire to accretion of the sutured ends of the injuried tendons are typical for the 2d zone; the primary and secondary tendon sutures with the palmar plaster bandage to accretion of tendons are typical for the 3d zone, the most favourable zone for recovery; the primary or secondary tendon sutures with the absence of defect butween tendon ends are typical for the 4th zone, and with defect more than 35 sm the free bridge-like plasty by autotransplant is typical. In chronic injuries of one two finger extensors when defect is more than 5 sm the transposition is advisable, that is switching the distal extensor end over to the new motor muscle.

Prelom vrata talusa - pregled kliničkih karakteristika i metoda lečenja

The talus transfers the weight of the whole body onto the foot and is therefore an important factor of stability and posture. The prerequisite for successful treatment of talus neck fractures is knowledge of anatomy, understanding of the mechanisms that lead to fractures of the talus neck, knowledge of the potential complications of all treatment methods, as well as knowledge of indications for surgical treatment. About 55% of the talus surface is covered with articular cartilage, and displaced fractures lead to the destabilization of several joints. Since fractures are caused by high energy trauma, the result can easily be comminution and/or dislocation (displacement). Fractures of the talus neck can occur as an isolated injury, as well as part of polytrauma (falls from height, traffic accidents). The X-ray is the basic diagnostic tool for making an accurate diagnosis, in case of suspect talus fracture. Multi-slice computerized tomography is the most useful method for studying fracture patterns and is indispensable in planning surgical treatment. The Hawkins classification of talus neck fractures, from 1970, has remained in use to this day, while recommended treatment methods vary depending on the type of fracture. The main goal of treatment is anatomical reduction. The anatomical characteristics of the talus, the particular blood supply, as well as the "high energy" mechanism of fracture, pose a challenge for clinical evaluation and optimal treatment of talus fractures. This paper highlights the necessity of the knowledge of surgical techniques for the selection of an adequate method of treatment, in order to prevent unwanted consequences for the patient, which in the case of suboptimal treatment can be severe.