Choice Of Treatment Method Research Articles

Role of ultrasound diagnostics in pediatric septic shock intensive care: a review and a clinical case

The article is devoted to the use of ultrasound diagnostics methods to assess the functional state of the cardiovascular system in critical conditions in children and the choice of optimal hemodynamic support. The need for careful detailed monitoring in patients in pediatric intensive care units has been demonstrated, the low sensitivity and specificity of the currently widely used clinical signs are reflected, which limits their use in the choice of treatment methods. As an alternative, it is proposed to use ultrasound diagnostics that assess cardiac output, allowing you to make an informed decision on medical measures taking into account the current clinical situation. The wide possibilities and numerous advantages of ultrasonic navigation in providing assistance to patients with a wide variety of life-threatening conditions are described. The main advantage is the possibility of obtaining information in real time, directly at the bedside. A clinical case of a target-oriented intensive therapy of left ventricular systolic dysfunction in a nine-year-old child against the background of a septic process using methods of ultrasonic assessment of hemodynamic status is presented. The use of ultrasound imaging methods made it possible to identify the cause of the deterioration of the condition and conduct a reasonable treatment correction, which ensured the fastest regression of hemodynamic disorders and contributed to a favorable outcome of the disease. The simplicity and accessibility of the Teicholz estimate of the ejection fraction was noted, which allows it to be used in routine practice to select the optimal hemodynamic support and assess the effectiveness of treatment over time.

Mental Disorders of the Female Reproductive Cycle

Background: Mental disorders associated with the female reproductive cycle (premenstrual period, pregnancy, lactation, infertility, perimenopause) have been a clinical reality throughout the history of the study of psychosomatic health factors in women. The most recent ICD-11 classication distinguishes an independent categories, “Mental or behavioral disorders associated with pregnancy, childbirth and the puerperium, with/without psychotic symptoms”. The clinical and etiological variety of mental disorders associated with female reproductive cycle (MDFRC) requires an integrated approach to diagnostics and choice of treatment methods. Objective: to analyze the results of the main scientic studies concerning pathogenetic and clinical characteristics of MDFRC. Material and methods: the key words “mental disorders, premenstrual syndrome, pregnancy, infertility, lactation, perimenopause, involution” were used to search the databases of articles of domestic and foreign authors (PubMed, eLibrary, Scopus and ResearchGate) published over the past 25 years. Conclusion : The presented review analyzed the results of studies showing that a variety of psychoemotional stresses and endocrinological abnormalities at different stages of the female generative cycle are risk factors for the development of psychiatric disorders. MDFRC include heterogeneous and polymorphous anxiety, affective, dysmorphic, and psychotic symptom complexes. However, the lack of a clear understanding of their pathogenesis leads to persistent disagreement as to whether MDFRC (postpartum psychosis, involutionary melancholia/hysteria, etc.) are independent psychiatric disorders or provoked exacerbations of other psychiatric diseases in predisposed women. The presented review allows to improve understanding of MDFRC, their risk factors and clinical variants, which has important practical value in diagnostics and choice of treatment methods.

Many years of experience in the treatment of recurrent cervical cancer

Background. The incidence of cervical cancer (CC) in the world is 500,000 new cases per year. In the structure of mortality from malignant neoplasms in women under 45 years of age, CC ranks 1st. Aim. To conduct a multivariate analysis of CC relapses, taking into account the results of primary treatment of CC patients for the subsequent choice of treatment methods for CC recurrences.Methods. Retrospective analysis of 105 case histories of patients for the period 2011–2021 who were treated at the Meshalkin National Medical Research Center and received therapy for recurrences of CC. Results. Stage I — 19 (18.1%), II — 32 (30.5%), III — 50 (47.6%), IV — 4 (3.8%). Primary methods of treatment: combined radiotherapy — 51 (49%), surgical method — 18 (17%), chemoradiotherapy — 18 (17%), surgery in combination with adjuvant radiotherapy — 15 (14%), polychemotherapy (with palliative purpose) — 1 (1%). In the structure of types of relapses: locoregional relapses — 42 (39%), local relapses — 31 (29%), metastatic hematogenous — 22 (20%), metastatic lymphogenous — 13 (12%). Late relapses (more than 12 months) — 65 (62%), early (6–12 months) — 22 (21%), progression (up to 6 months) — 18 (17%). Localizations for the occurrence of distant cervical cancer metastases: bones — 11 (39.3%), lungs — 10 (35.7%), brain — 3 (10.7%), liver — 4 (14.3%), lymphogenous metastases: supraclavicular lymph nodes — 5 (35.7%), inguinal lymph nodes — 8 (57.1%), abdominal lymph nodes — 1 (7.2%).Conclusion. In 62% there were late relapses, in 48% — in patients with initial stages, more frequent and longer follow-up with an oncogynecologist is indicated. Patients need treatment by an oncologist, radiologist, neurosurgeon, chemotherapist regardless of the stage, timing of occurrence, localization of relapses.

Circulating Tumor Cells as an Indicator of Treatment Options for Hepatocellular Carcinoma Less Than or Equal to 3 cm in Size: A Multi-Center, Retrospective Study.

BackgroundThe status of circulating tumor cells (CTCs) is related to the recurrence of hepatocellular carcinoma (HCC), which is also one of the reasons for the poor prognosis of HCC. The purpose of this study was to explore whether CTCs can help guide the choice of treatment methods for HCC.MethodsThis study is a multicenter retrospective study, including 602 patients with HCC. CTCs were detected in the overall cohort before operation. There were 361 patients in the training cohort and 241 patients in the validation cohort. Patients were divided into CTC-negative group (CTCs = 0/5 mL) and the CTC-positive group (CTCs ≥ 1/5 mL) according to CTCs status. Subgroup analysis was performed according to CTCs status. We compared overall survival, and recurrence outcomes for HCC patients with different CTC statuses after undergoing radiofrequency ablation (RFA) or surgical resection (SR)ResultsThere was no significant difference in overall survival (OS) and recurrence-free survival (RFS) between the RFA group and SR group for CTC-negative patients in both the training cohort and the validation cohort (P > 0.05). However, among CTC-positive patients, the clinical outcome of patients in the SR group was significantly better than those in the RFA group. CTC-positive patients who underwent RFA had increased early recurrence compared to those who underwent SR. RFA is an independent risk factor for survival and recurrence in CTC-positive HCC patientsConclusionsThe CTC status could serve as an indicator to guide the choice between surgical resection or radiofrequency ablation for early hepatocellular carcinoma. Surgical resection is recommended for CTC-positive patients.

Fractures of the condyle head of the humerus in children and their treatment

The study included 64 children with fractures of the head of the condyle of the humerus. Three groups of patients were identified depending on the ratio of the shoulder condyle head to the radial head. Treatment methods are clearly described for each group. Long-term results tracked in 41 patients indicate the correct choice of treatment methods: the vast majority of children received good and satisfactory results.

111 Fluid levels of estradiol and CA 125 from ovarian cystic masses in young girls

Objective: Needle aspiration of ovarian cystic masses and measurement of fluid levels of estradiol and CA 125 can be successfully used in pretreatment or intraoperative diagnosis and choice of treatment method. Study design: The present study determined the levels of estradiol and CA 125 in the adnexal cysts fluid of 122 patients aged newborn to 19 attending the Department of children and adolescent gynecology of Pediatric Hospital and ST Medica Hospital in Belgrade between January 2006 and December 2019.

Acute urinary retention: causes, risk of complications, treatment methods (literature review)

Acute urinary retention (ischuria) is a pathological condition caused by the impossibility of emptying the bladder. The ischuria prevalence in men prevails over the prevalence of this pathology in women. The leading causes of acute urinary retention (AUR) in men are benign prostatic hyperplasia, early postoperative period, prostate cancer, and medications. AUR patients need emergency care, which consists of bladder decompression. The first stage of treatment (decompression) can be performed in three ways: catheterization, suprapubic capillary puncture, or epicystostomy. The second and third stages consist of the diagnosis and treatment of the underlying disease. The choice of treatment method depends on the patient's condition, his underlying disease and possible complications.

Personality traits and alcohol consumption: Secondary analysis of the Self-Match Study.

BackgroundThis secondary analysis of the Self‐Match Study explores whether personality traits affect the treatment outcome for alcohol use disorders (AUD). We designed the Self‐Match Study to investigate whether clients choosing between treatment options improves treatment outcomes. The primary outcome report revealed no difference in the outcome, whether treatment allocation was based on clinician matching or self‐matching. Because willingness to choose, choice of treatment method, and compliance with treatment may be related to personality, this exploratory sub‐study investigated the influence of personality traits on treatment outcome.MethodWe enrolled 402 consecutive clients (female 46.7%, mean age 47.4) seeking treatment at the outpatient alcohol treatment center in Odense, Denmark. Clients were randomized to treatment by expert‐match or self‐matching. Data on alcohol consumption (Timeline Follow Back), personality traits (NEO‐FFI‐3), and retention in care were collected at baseline and 6‐month follow‐up. Outcomes were compliance, sensible drinking (alcohol intake below National Recommendations), and the number of heavy drinking days at follow‐up.ResultsA high neuroticism score was negatively associated with treatment completion. Further, clients with a high score on neuroticism, openness, and extraversion, or a low score on conscientiousness were less likely to reduce their drinking to a sensible level at follow‐up. We also found that low scores on conscientiousness were associated with having more heavy drinking days at follow‐up. The personality traits neuroticism and openness were associated with treatment preferences.ConclusionsPersonality traits influence 6 months drinking outcomes for people receiving AUD treatment.

Prediction and influence of comorbid conditions on the degree of severity of acute intestinal infection caused by opportunistic pathogens in elderly and patients against the COVID-19 background

Analysis of comorbid conditions in elderly and senile patients with COVID-19 and acute intestinal infection (AII) caused by representatives of opportunistic flora, conducted on 71 patients of the infectious disease department, including 42 women (59.15%) and 29 (40.85%) men. In patients, acute intestinal infection was caused by enteropathogenic bacilli ‒ 38 (53.52%) patients, bacteria of the genus Pseudomonacea ‒ 10 (14.09%), and St. aureus ‒ 23 (32.39%). The average age of the patients was 71.48±7.53 years. Analysis of comorbid conditions and prediction of disease progression was performed according to the severity of the disease and using the Charlson comorbidity index, the ABCD scoring system, the COVID-19 severity index, and the NEWS questionnaire. It was established that the examined patients have a high propensity for a severe course of diseases with their comorbid burden. A reliable lack of relationship between the comorbidity index and the degree of severity of AKI has been proven. Patients with AII had a low to moderate risk of developing infectious complications and also required continuous supplemental oxygen support and intensive care. According to the results of a survey on the NEWS system, patients who have a constant supply of oxygen have a higher probability of the formation of severe AII (OR=7.50; CI (1.28‒43.84); p=0.02), and a lower probability in relation to the average degree of severity (OR=0.13; CI (0.02‒0.78); p=0.02). Predicting the degree of severity of an acute intestinal infection that has developed against the background of COVID-19 affects the choice of treatment methods, in particular oxygen therapy, accelerates decision-making and the effectiveness of therapy. Keywords: acute intestinal infection, coronavirus disease COVID-19, dysbiosis, comorbid pathology, infectious complications, intestinal microbiocenosis.

General principles of orthodontics in dogs: Review

The aim of this work was to carry out a literature review on the general principles of orthodontics in dogs, in order to provide a reference for veterinarians interested in this type of treatment. Dental care is necessary to provide good health and improve the quality of life of animals, as diseases of the untreated oral cavity are painful and can contribute to local and systemic diseases. The reason for any orthodontic treatment in animals is to alleviate the pain of malocclusion and restore tooth function, not being performed for aesthetic reasons. The choice of treatment method should be based on the dog's age and temperament, the cost of treatment, the owner's ability to adhere to the treatment protocol as a mentor, and the veterinarian dentist's skill and knowledge in using the appropriate device and methodology for each case. It is considered that a normal dental occlusion is essential for the health and comfort of the animal. Malocclusions can have a hereditary or acquired origin and their diagnosis must be made as soon as possible. For this, the tutor's cooperation is essential to achieve the desired results.

Modern approaches to surgical treatment of patients with colorectal cancer liver metastases

Hepatic resection has become the treatment of choice for metastatic colorectal cancer, and this treatment technique increases the five-year survival of cancer patients up to 40–58%. More recently, the criteria for resectability have been revised and expanded to include any patient in whom all metastatic deposits can be removed with a negative surgical margin and with sufficient residual liver parenchyma. Currently, resectability is determined mostly by the minimum functional liver remnant volume. Under this new paradigm, the number of patients with potentially resectable oncological process can be increased. However, there are no widely accepted concepts and criteria for resectability, which further complicates the choice of treatment methods and directly affects the patients’ survival. The literature search for this review was performed using PubMed, Cochrane Library, Google Scholar, and eLibrary systems. We included publications that characterized the modern possibilities of liver surgery aimed at increasing resectability and improving cancer outcomes in patients with colorectal cancer liver metastases.

Assessment of 2 Treatment Methods for Ulna Fractures With an Intact Radius in Raptors: Conservative Management and Surgical Fixation With a Type I External Skeletal Fixator Intramedullary Pin Tie-in.

Several methods have been reported for treating avian antebrachial fractures, yet the quantitative information regarding their success is limited. This retrospective study applied data from raptors admitted to a wildlife rehabilitation center to provide metrics associated with the treatment of ulna fractures with an intact radius by either conservative management or a single surgical method: a type I external skeletal fixator tied in to an intramedullary pin (ESF IMP tie-in). Postfledging wild raptors with an ulna fracture admitted to The Raptor Center at the University of Minnesota College of Veterinary Medicine (St Paul, MN, USA) between January 1, 2007, and December 31, 2017, that survived for at least 7 days after admission were included in the study. Information regarding signalment, fracture characteristics, treatment method, outcome, and complications were recorded. The study included 110 raptors representing 15 species. The majority of birds (69%, 76/110) were treated with conservative management. Conservative management was used more often in cases of chronic (P = .02) and closed (P = .02) fractures, whereas fractures with poor alignment at the time of admission were frequently treated through surgical means (P=.001). Alignment was more likely to improve with an ESF IMP tie-in (P=1.01 ×10-9). The majority of cases (65%, 72/110) had a successful outcome. Birds with closed fractures were more likely to have a successful outcome (P=.03). Birds in which fracture alignment became exacerbated with either treatment method were more likely to have a poor outcome (P=.002). The results of this retrospective study found that conservative management and surgical fixation by the ESF IMP tie-in technique are both viable treatment options for ulna fractures with an intact radius in raptors. The choice of treatment method is dependent on the clinician's assessment of the fracture characteristics and individual patient.

Актуальність унормування діяльності лікарів загальної практики - сімейних лікарів щодо визначення та оцінки якості життя пацієнтів при наданні паліативної допомоги

Актуальність. Доступ до паліативної допомоги та полегшення симптомів хворих з невиліковними та тяжкими захворюваннями залишається актуальним питанням для систем охорони здоров’я багатьох країн світу. За оцінками, у світі щороку понад 40мільйонів хворих на важкі захворювання і стани, що загрожують та обмежують життя, потребують паліативної допомоги (ПД). Більшість пацієнтів, які потребують ПД, перебувають удома, тому ПД, яка може полегшити більшість страждань пацієнта та членів його родини, надають лікарі загальної практики. Урегулювання нормативно-правової бази є важливим чинником надання якісної паліативної допомоги. Мета роботи – запропонувати внесення змін до нормативних документів, що регламентують надання паліативної допомоги, щодо визначення та оцінки якості життя пацієнтів. Матеріали та методи. Наукова література, документи ВООЗ, опитувальник EORTC QLQ-C30 та результати анкетування пацієнтів (п=219). Використали методи системного аналізу, синтезу, соціологічний та медико-статистичний методи. Результати. Проаналізували літературні джерела щодо пацієнт-сім’я-орієнтованого підходу в системі охорони здоров’я. Вивчили рекомендації ВООЗ з визначення якості життя (ЯЖ) пацієнтів. Визначили прогалини в чинних документах, що регламентують надання ПД, щодо оцінки ЯЖ пацієнтів. У результаті залучення пацієнтів (п=219) до самостійної оцінки ЯЖ з використанням опитувальника EORTC QLQ-C30 та в подальшому забезпечення суб’єктивних потреб пацієнтів встановили покращення їхньої ЯЖ. Запропоновали внесення змін до наказів МОЗ України, що регламентують надання первинної медичної допомоги та ПД, з метою досягнення основної мети такого виду медичної допомоги – забезпечення максимально досяжної ЯЖ. Висновки. 1.Показано, що нормативно-правова база з питань надання ПД регламентує забезпечення найбільш досяжної ЯЖ пацієнта як основну мету цього виду медичної допомоги. Проте, використання засобів для визначення рівня ЯЖ та її складових лікарями при наданні ПД в амбулаторних умовах, у тому числі вдома, законодавчо не урегульовано. 2. Доведено, що використання опитувальника EORTC QLQ-C30 для визначення ЯЖ пацієнтів, що отримують ПД, дозволяє оцінити їх загальний та психоемоційний стани, а також рівень функціонування пацієнта з його суб’єктивної точки зору. Це забезпечує партнерство пацієнта в мультидисциплінарній команді, його відповідальність та участь у процесі лікування. Одночасно задовольняється ключова потреба пацієнта в залученні до прийняття рішень щодо діагностики та вибору методів лікування відповідно до особистих переконань та сподівань. 3. Показано необхідність внесення змін до наказу МОЗ України від 04.06.2020 №1308 «Про удосконалення організації надання паліативної допомоги в Україні» щодо порядку надання ПД та наказу МОЗ України від 19.03.2018 №504 «Про затвердження Порядку надання первинної медичної допомоги» щодо переліку медичних послуг з надання первинної медичної допомоги у частині використання опитувальників для визначення ЯЖ та досягнення основної мети ПД.

Effectiveness of the choice of the optimal method for surgical treatment of genital prolapse

AIM: This study aimed to evaluate the effectiveness of the choice of surgical method for treating genital prolapse, depending on the intensity of pelvic floor tissue perfusion.
 MATERIALS AND METHODS: The study assessed the relationship of extragenital pathology, medical history of women operated for genital prolapse and medical history of women without genital prolapse during peri- and post-menopause (control group, n=67) with indicators of vaginal perfusion intensity. Overall, 328 patients with pelvic organ prolapse (IIIV degree) underwent surgery according to the Pelvic Organ Prolapse Quantification system. Of these, 287 patients were examined after 2 years to diagnose disease recurrence; these patients were included in the main study group (n=287). For statistical processing of the obtained results, the STATISTICA 10.0 and EViews 12.0 software packages were used.
 RESULTS: Correlation analysis revealed an inverse relationship between vaginal microcirculation intensity with age (rs=0.187; р=0.025), menopause duration (rs=0.390; р=0.001), genital prolapse duration (rs=0.245; р=0.046), and surgical menopause (rs=0.442; р 0.001). The study of microcirculation intensity in the anterior and posterior vaginal walls, depending on the presence of somatic diseases, revealed an inverse correlation with diseases such as hypertension (rs=0.291; р 0.001), coronary heart disease (rs=0.169; р=0.044), and diabetes mellitus (rs=0.223; р=0.008). When choosing a method of surgical treatment that minimizes the contact of mesh prosthesis with native tissues in women with comorbid pathology, a relapse of the disease after 2 years was detected in only 2.4% women.
 CONCLUSION: The choice of the optimal method for treatment in patients with somatic burden and low perfusion capacity of pelvic organs and tissues can reduce the number of complications after surgical treatment of pelvic prolapse.

Universal Long Bone Defect Classification

Introduction: Treatment of long bone defects is a challenging problem in orthopedics that requires a robust and comprehensive classification system to guide diagnosis and management. The Universal Long Bone Defect Classification (ULBDC) is an alphanumeric system detailing the size and location of the defect. It is designed to describe the bone defect and indicate the appropriate treatment for both diaphyseal and articular long bones defects. Methods: The location, size, and morphology of the bone defect are the main criteria used in the treatment of both extra-articular and intra-articular bone defects. The proposed classification system utilizes the following nomenclature for both periarticular defects and diaphyseal defects: location (bone and segment) and morphology (type, group, and subgroup). Discussion: The ULBDC is based the same principles of coding as the “gold standard” AO/OTA Fractures Classification system with alpha-numeric coding “from simple to complex.” The choice of treatment method depends on the type, group, and subgroup of the defect as described. The principles of treatment of diaphyseal defects, as well as the principles of treatment of extra-articular fractures, are based on the restoration of the alignment, length, and rotation of the segment. Bone shortening and deformity are considered bone defects because their treatment requires the use of the same principles (osteotomies, bone grafting, bone transport, or combination of these methods) as treating real bone defects. Conclusion: The proposed classification is an attempt to classify all types of long bone defects and its use in clinical practice and research will allow for optimal and standardized treatments for the various types of bone defects to improve the treatment outcomes.

Surgical treatment of visceral and renal abdominal artery aneurysms of various etiology

Visceral artery aneurysms are detected when complications occur or accidentally during examination for other diseases gastrointestinal tract, aimed at determining the functional significance. Over the past 10 years, we have observed 31 patients with abdominal visceral artery aneurysms, 10 patients had renal aneurysms, 15 had splenic arteries, hepatic artery and pancreatoduodenal artery aneurysms – in one case. The combination of aneurysms – in 2 cases: in one case – the renal artery with the splenic artery, in the other – the renal artery and the abdominal trunk. The patients ranged in age from 24 to 78 years, the average age is 43±6.5. Previously, infection was considered the most common cause of splenic artery aneurysms in 10 cases, with most patients complaining of fever, abdominal pain and a pulsating mass in the abdomen. And two patients with splenic artery aneurysm noted abdominal trauma. 3 had atherosclerotic changes. The causes of renal artery aneurysms are atherosclerosis in 6 cases, fibromuscular dysplasia in 2 cases, and Nonspecific aortoarteritis in 2 cases. Also, atherosclerotic etiology is present in aneurysms of the external iliac arteries aneurysms. Reconstructions on hepatobiliary aneurysms were performed in 6 (20%) cases, in 5 cases - resection with end-to-end anastomosis and in 2 cases - resection of splenic artery aneurysm, resection of splenic artery aneurysms with autovenous patch, clipping of splenic artery aneurysms – in 2 cases (6.5%), endovascular techniques were applied in 18 cases (58%). In 2 cases, nephroectomy was performed due to the spread of the aneurysm into the kidney gate and the lack of conditions for reconstruction. In the immediate and long-term (after 6 months and 3 years) postoperative period, the preservation of organ function in reconstructive and ligating methods of surgical treatment is the same. Signs of ischemia and impairment in the immediate postoperative period were not observed with reconstructive and ligating methods of surgical treatment. The choice of treatment method depends on the severity of the patient’s condition, clinical manifestations, as well as the localization of the aneurysm and its morphology. Preference is given to endovascular techniques, which are not traumatic enough and provide a good long-term result. However, in each case, the patient’s management tactics are individual, the choice of the optimal method of treatment of visceral artery aneurysms is based on data from the entire spectrum of possible diagnostic manipulations.

Emergency interventional endovascular treatment for early disorder of arterial blood flow in the liver graft

Introduction. Liver transplantation is considered the most effective treatment for patients with end-stage liver disease. X-ray endovascular interventions show good results in the treatment of vascular complications after transplantation. The timing, indications and choice of treatment methods require clarification.Objective. To evaluate the safety and efficacy of emergency X-ray endovascular interventions for arterial complications in the early period after liver transplantation.Material and methods. In the period from October 2016 by July 2021, 88 liver transplants were performed. The graft was obtained from a posthumous donor in 75 cases, and from a living donor (right lobe of the liver) in 13 cases. Arterial complications were registered in 10 cases: thrombosis of the hepatic artery in 7 (8.0%), constriction in 3 (3.4%); 4 patients underwent retransplantation due to thrombosis. This analysis included 6 patients aged 27 to 51 years, including 4 men and 2 women. In the early postoperative period (0–14 days), according to laboratory parameters, ultrasound Doppler, and computed tomography with a contrast agent, an impairment of the arterial blood supply of the graft was revealed, for which the patients underwent emergency X-ray image-guided surgical endovascular interventions.Results. Restoration of adequate arterial blood supply to the liver graft was achieved in all six patients. At the time of this writing, the graft function and patency of the hepatic artery were preserved at follow-up periods of 6, 11, 12, 22 (in two patients), and 26 months with a median of 17 months. Four patients developed biliary complications that required surgical correction.Conclusion. X-ray image-guided endovascular interventions can be considered effective and relatively safe in the treatment of patients with arterial complications after liver transplantation. The period of graft arterial ischemia should be minimized as much as possible in order to prevent biliary complications.

Choice of treatment method of obstructive jaundice in patients with tumors of the hepatopancreatobiliary region

The leading criteria for choosing minimally invasive surgical treatment of mechanical jaundice of tumor origin in the hepatopancreatobiliary zone are substantiated, which increase the effectiveness of surgical intervention and reduce the number of complications and mortality. The examination and surgical treatment results of 325 patients with mechanical jaundice of tumor origin, who underwent minimally invasive decompression of the biliary tract after clinical and laboratory diagnostics following national clinical recommendations, were analyzed. Based on the treatment results, the leading criteria that affect the selection of the method of minimally invasive drainage surgery are identified. The main criteria influencing the choice of minimally invasive intervention to decompress the bile ducts were as follows: level of bile duct block, severity of mechanical jaundice (according to the classification of E.I. Galperin), and the operability of the patient. Endoscopic stenting was the method of choice in inoperable cases at the level of block I with mechanical jaundice of classes A and B. Moreover, endoscopic stenting was the most successful intervention with a minimum number of complications in people with block II level. The indication for percutaneous transhepatic biliary drainage was a level III biliary tract block, as well as the ineffectiveness of endoscopic stenting. Cholecystostomy is the safest and most effective in patients with block level I with class C mechanical jaundice and in operable cases with the same block level. In general, results of surgical interventions aimed at eliminating mechanical jaundice of tumor origin, conducted using modern examination methods of patients and taking into account the assessment of criteria such as the block level of the bile ducts, severity of mechanical jaundice, and general condition allow us to justify the choice of the most successful and safe option for its elimination.

Effect of precise partial scab removal on the repair of deep partial-thickness burn wounds in children: a retrospective study.

BackgroundThe choice of treatment methods for children with deep partial-thickness burn wounds (DPBWs) is an issue that requires careful consideration from surgeons. The purpose of this study was to evaluate the efficacy of precise partial scab removal (PPSR) in the treatment of DPBWs in children.MethodsWe retrospectively analyzed the clinical data of 78 children with DPBWs. The children were divided into a PPSR group (n=37) and a routine dressing change (RDC) group (n=41). In the PPSR group, an electric dermatome was used to cut the scab in the early post-injury period. The thickness scale of the electric dermatome was set to 0.1 mm. The scab was removed to the base with scattered bleeding points. There was still a small amount of necrotic tissue in the base of the wound. For the acellular dermal matrix, the first dressing change was about 1 week after surgery. The RDC group was given conventional wound-dressing treatment. The wound dressing was changed with epidermal growth factor, silver-zinc antibacterial cream, and dressing change. The frequency of dressing change was adjusted once a day or once every other day depending on the condition of wound secretions. The hospitalization time, wound-healing time, fever duration, antibiotic use time, number of subsequent operations, and overall hospitalization expenses were compared between the two groups.ResultsThe wound-healing time of the PPSR group was 19.86±6.4 days, and the wound-healing time of the RDC group was 24.15±7.12 days (P=0.0068). The duration of fever in the PPSR group and RDC group was 2.62±1.99 and 4.44±3.10 days, respectively (P=0.0032). The antibiotic use time in the PPSR group and RDC group was 4.0±1.33 and 4.83±1.88 days, respectively (P=0.0292). The overall hospitalization cost of the PPSR group and RDC group was yuan renminbi ¥37,852.84±10,894.64 and ¥38,047.46±19,450.37, respectively (P=0.9573).ConclusionsPPSR can shorten wound-healing time, reduce the frequency of dressing changes, shorten the time of fever in children, lower the frequency of antibiotic use, and decrease number of dressing changes on the wound.

Review of the literature on the use of MRI in psychiatry with a focus on schizophrenia and bipolar and unipolar affective disorder

Objectives. Broad neuroimaging studies currently play an important role in the understanding of the principles of the functioning of the central nervous system (CNS). This applies not only to the healthy nervous system, but also to many pathological processes responsible for neurological and psychiatric disease entities. Magnetic resonance imaging (MRI) as a diagnostic imaging method has been used in medicine since the 1970s. Currently, the diagnosis of mental disorders and the choice of treatment methods are based primarily on the patient’s history, a structured interview and ancillary psychological tests. However, there is still a lack of more objective methods that can solve many diagnostic problems. Literature review. The aim of this paper is to present the methods of diagnosis by means of magnetic resonance imaging, helpful in many aspects of work with a patient diagnosed with a mental disorder. The paper reviews the literature on specific MRI techniques, such as volumetry, proton magnetic resonance spectroscopy, diffusion-weighted MR (DMR), fMRI (functional magnetic resonance imaging), MRI with magnetisation transfer coefficient, and tractography, which may open up new possibilities, also for psychiatry. Because of the large number of papers in this field, the focus was on three psychiatric disorders, i.e. schizophrenia and unipolar and bipolar affective disorder. Conclusions. It seems likely that in future magnetic resonance imaging of the central nervous system may make it possible not only to differentiate between mental disorders or to forecast their course, but also to determine the effectiveness of treatment of mental disorders and to predict possible side effects of the applied pharmacotherapy or electrotherapy.