Экстравазальная коррекция аневризмы брюшного отдела аорты у лиц пожилого возраста.

ГБОУ ВПО Саратовский ГМУ им В.И Разумовского Минздрава России, кафедра госпитальной хирургии лечебного факультета.

Резекция аорты при угрозе разрыва аневризмы у лиц пожилого возраста всегда сопряжена с риском тяжелых осложнений, связанных с ишемией, потерей крови у больных, отягощенных сопутствующей патологией.

Цель исследования: Разработка метода и изучение эффективности создания прочного каркаса вокруг аневризмы брюшного отдела аортыпри угрозе разрыва у больныхпожилого возраста.

Материалы и методы: Отобраны 30 больных старших возрастных групп с субренальной симптомной аневризмой аорты. У всех пациентов были спонтанные боли и боль при пальпации аневризмы брюшного отдела аорты, что свидетельствовало об угрозе ее разрыва.

Во всех случаях аневризма была ниже почечных артерий, захватывала брюшную аорту. Все пациенты страдали сопутствующей патологией (ИБС у 18, постинфарктный кардиосклероз, сердечная недостаточность у 6, гипертония у 18, сахарный диабет у 4, ожирение, хронический бронхит у 14, язва желудка у 2)

28 больным выполнена, разработанная в клинике (патент на изобретение № 2332939 от 28.12.06) операция создания прочного каркаса вокруганевризмы аорты, для предупреждения ееразрыва. Изучены ближайшие иотдаленные результаты.

Результаты: Для снижения операционного риска у лиц с высоким операционным риском и грозой разрыва брющного отдела аорты разработан способ операции создания прочного циркулярного каркаса вокруг аневризмы. Создание такого каркаса предупреждает главное осложнение аневризмы ее разрыв. Достоинства метода: несложность техники операции, нет необходимости пережимать аорту, сосуды, нет потери крови, сохраняются поясничные артерии, нет угрозы ишемии спинного мозга, отсутствует ишемия нижних конечностей, сохраняется проходимой нижней брыжеечной артерии. Летальных исходов, каких либо тяжелых осложнений у всех 28 больных не было. Операцию больные переносили легче, чем после резекционных вмешательств. Грубых метаболических нарушений не выявлено.

Выводы: операция создания каркаса вокруг небольшой аневризмы у пожилых больных не сопровождается ишемией, кровопотерей, легче переносится больными и предупреждает главное осложнение разрыв аневризмы.

Ключевые слова

экстравазальная коррекция, аневризма

Англоязычная секция

Shatylko T.V.

Uroflowmetry in diagnosis and evaluation of treatment efficiency

Saratov State Medical University, Department of Urology

Importance. Micturition disorders may severely impact the quality of life by affecting personal hygiene, social adaptation and sleep quality. Since such patients’ complaints rarely may be evaluated objectively and precisely, a diagnostic tool which allows the physician to determine urination quality comes in handy. This diagnostic tool is called uroflowmetry and it is widely used, though its diagnostic potential may not be fully recognized yet.

Goal. To determine the potential of uroflowmetry in diagnostics of various diseases.

Materials and methods. Uroflowmetry protocols and corresponding registry data for 2010 2011 were extracted from the computer database of urodynamics laboratory in urology clinic of Saratov SMU. Statistical analysis was performed on the extracted data. Raw mathematical models of uroflowmetry curves for different types of urodynamic impairment were built.

Results. Total number of patients was 1292; total number of uroflowmetry studies – 1618. This means that some of the patients had their urination evaluated continuously to determine the outcome of initial treatment. Uroflowmetry control before and after treatment was performed on 129 patients suffering from benign prostatic hyperplasia: Qmax became normal in 71 patient (55,04%), Qave became normal in 61 patient (47,29%), both parameters became normal only in 55 patients (42,66%). Lack of micturition improvement during repeated uroflowmetry studies in patients who receive conservative treatment for benign prostatic hyperplasia tells the urologist that more aggressive forms of treatment are justified. Also of interest was an attempt to calculate several indexes which mathematically describe the shape of an uroflowmetry curve. First group included patients with benign prostatic hyperplasia (728 patients), second group included patients with other causes of infravesical obstruction (493 patients), such as narrowing of distal urethra. Mean TQmax/TQ was 0.347 for the first group and 0.384 for the second group (p<0.1), mean Qave/Qmax was 0.321 for the first group and 0.379 for the second (p<0.05).

Conclusion. Uroflowmetric control of treatment results in benign prostatic hyperplasia allows switching tactics properly. Uroflowmetric curve shape and the mathematical indexes describing it have a diagnostic value.

Key words

uroflowmetry, urodynamics, benign prostatic hyperplasia

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Saratov State Medical University, Department of Surgery & Oncology, Clinical Hospital n.a. S.R. Mirotvorcev

Scientific curator: Mescheriakov V.L.

Importance: The scar quality has very important place in patients life after surgery, being on the apparent place defines aesthetic peculiarity and even can cause emotional drama. Significant scar improvement is a very real problem

Goal: To determine optimal terms of forming and ways of improving cosmetic effect postoperational scar after operations on the thyroid gland.

Material & methods: For the research 100 patients from 30 to 50 ages were taken. In all cases similar suture material on the cutting needle was used. Base dynamic settings were: the height of the incision of the skin on the level of the jugular notch, incision's length, mass of subcutaneous tissue, performed coagulation, thread's diameter. The assessments carried out on 1st and 14th day with Vancouver Scar Scale, which has following criteria: pliability, height, vascularity, pigmentation. Total 0 points equal normal skin, 13 points equal gross not aesthetically acceptable scar

Results: Based on the research on the 14th day,with an average length of scar 7.5 cm (variation from 6 cm to 10 cm) following groups were formed:

1st (11 patients) it is impossible to estimate the scar as of the 1st day, and on the 14 th in mind of the poor quality of haemostasis during the operation and the formation of a dense crust along the scar. Assessment of the scar will be held later.

2nd (74 patients) – pliability 1, height 0, vascularity 1, pigmentation 2, total 4 points.

3rd (15 patients) with expressed hypodermic fatty cellulose, and over 45 years: due to the tension of the tissues because of the incision close to jugular notch deformation of the form of the scar. It is expected to increase the width of the scar, vascularization, pigmentation and density. Assessment of the scar will be carried out later.

Conclusions: It can be concluded that the large part of the assessment of scars depends on the level of the incision of the skin in the presence of an accompanying factor of obesity. Also, during the qualitative haemostasis, regardless of the drainage of the wound, you can achieve the best cosmetic effect. State of the postoperative scar in no small degree depends on suture material, overlay intracutaneously: thread 4 0 does not affect the height of a scar, but worse holds the edges of the wound under tension, which affects the width, thread 2 0 gives a good comparison of the edges of the wounds and their retention, but has prognostically unfavorable cosmetic outcome, leaving thickened scar. The Vancouver scale figures are not stable over time and may change before the moment of the final formation of the scar.

Key words

aesthetic, thyroid gland surgery

Morphine Addiction in Classic Literature (According to “Morphine” by M.Bulgakov)

Saratov State Medical University n.a. V.I.Razumovskiy

Supervisor: Mikheeva N.V.

Morhine addicted characters are not often met in classic literature. Predilection for opium is described in the book “Morphine” by Mikhail Bulgakov. Young country doctor Polyakov first took morphine to relieve an abdominal pain. The injection helped him a lot – “That terrible pain has stopped 7 minutes after the shot”, he says. Also doctor found that it also relieved his despair over the loss of his lover, an opera singer in Moscow. At the initial stage of a morfinizm addicts experience euphoria, feeling of pleasure and elation alternating with pleasant hallucinations positive mental inclination is formed. That’s why it’s hard for Polyakov to realize he needs to stop using morphine, it relieved his loneliness and improved his work. Further the stage of a negative mental inclination develops: Dr.Polyakov needs morphine to get rid of low mood and feeling sick. “All unpleasant feelings stop", he assures. However, the doctor is not aware that the

disturbing sad condition, irritability, memory easing, and hallucinations". Therefore stage of development of somatic pathology is being developed. The drug doesn’t cause euphoria and only plays role of obstination reliever. His appearance changes, he loses a lot of weight

he gradually increased the dose until he became hopelessly dependent on the substance. Eventually there is nothing in his life but the drug and Polyakov suicides.

Key words

Drug addiction

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