Journal of Experimental and Clinical Surgery

Introduction. The study of the data obtained by related specialists allowed assuming about the perspectives of using platelet-activated plasma in the treatment of burns in geriatric patients. The influence of growth factors contained in platelets, which are responsible for tissue regeneration, determines the course of processes such as proliferation, differentiation and angiogenesis. This effect has the potential to partially offset the deficit in the body’s regenerative capabilities observed due to age-related involution.

The aim of the study was to improve clinical outcomes in the elderly and senile patients with deep burns through the use of platelet-activated plasma at the stage of preparation for skin grafting.

Materials and methods. The study included data obtained during the treatment of 124 patients 60 years of age and older with third-degree burns (ICD-X) and was performed in the Department of Thermal Injuries of the Research Institute of Emergency Medicine named after. I.I. Dzhanelidze. Patients were randomized into the study after assessing inclusion and non-inclusion criteria. The patients included in the study were divided into 2 groups. During dressings after performing staged necrectomy on segments with wound bottom represented by conditionally viable tissue structures, patients of the main group (65 victims) were applied platelet-activated plasma, this followed by preparation of granulating wounds to accept plastic material.. In patients of the control group (59 patients), preparation of granulating wounds for plastic surgery was intensified by the applied antibacterial ointment “Levomekol”.

The study groups did not differ significantly in gender, age, total area of damage, prevalence of deep burns, or thermal injury severity index.

When assessing the results, a complex of clinical, laboratory, and instrumental methods was used. The results obtained were processed using SPSS23 and Microsoft Office Excel 10.

Results. It has been found that the problems of treating deep burns in the elderly, senile patients and long-livers are associated with the comorbidity of victims in the category, as well as their delayed visit for medical assistance at the specialized medical care facilities, the fact complicating the implementation of early surgical treatment principles. The use of platelet-activated plasma during conservative preparation of deep wounds for plastic closure in this group of burnt patients allows for a reduced area of the burn wound on average, by 16%, by the time of autodermoplasty, which is 2 times higher than the same parameter in the control group. The potential of platelet-activated plasma use is realised in its multiple application, as the skin defect is cleared of necrotic elements, the fact providing a reduced time of burn wound preparation for plastic surgery in patients of the main group by 6 days on average.

Conclusion. The use of platelet-activated plasma during the conservative deep wound preparation for plastic closure allows for a reduced area of the burn wound at the time of autodermoplasty by 16%, on average, which is 2 times higher than the same value in the control group, and a reduced time required to prepare burn wounds for plastic surgery in patients of the main group for 6 days, on average.

Relevance. The article presents a study and analysis of the effectiveness of the surgical treatment technique for benign epithelial neoplasms of the esophagus under the control of magnifying chromoendoscopy. Epithelial neoplasms of the esophagus and stomach are frequent diagnostic findings during endoscopic examination of the upper gastrointestinal tract. They are detected in 2% of patients, on average, during esophagogastroduodenoscopy. Notably, tactic of their management is not adequately standardized and often encounters challenges in clinical practice.

The aim of the study was to investigate the prognostic significance of individual macroscopic features that allow the morphological structure of epithelial formations to be determined during gastroscopy.

Methods. The study involved clinical data and analysis of the results of prehospital surgical interventions in patients with benign epithelial neoplasms of the esophagus, who made up the main group. Patients of the control group were exposed to endoscopic investigation and diagnosed using conventional techniques. Statistical analysis of the study results was carried out in two directions, namely: endoscopic and morphological diagnostic parameters and objective data on relapses and bleeding were compared using the nonparametric Mann-Whitney test in the main and control groups; the Spearman rank correlation coefficient was applied to assess the closeness of the statistical relationship between endoscopic diagnostic parameters and morphological criteria in order to evaluate the effectiveness of magnifying chromoendoscopy in the surgical treatment of benign epithelial neoplasms of the esophagus in patients of the main group.

Results. The use of magnifying video endoscopy provides beneficial perspectives for detailed assessment of the mucous membrane of the examined organs. Previously, chromo-endoscopy was used to identify the metaplasized epithelium, the boundaries of precancerous trasformations. However, this staining technique was quite time-consuming; it failed to determine microstructural changes in the lesion area and in the perifocal region with extreme accuracy. Currently,the use of magnifying narrow band imaging endoscopy allows visualizing the smallest changes in the tissue surface, assessing the architectonics of the vascular network in the study area and, most importantly, the prevalence of the pathological focus, which increases not only the level of diagnosis of precancerous changes, but also the effectiveness of endoscopic surgical treatment at the stage of primary health care.

In the control group, the percentage of adverse effects was 77.7% (14 cases) based on the results of 18 polypectomies of epithelial neoplasms. If compared with conventional endoscopic examination, we noted the following advantages of the narrow-band imaging endoscopy with optical magnification in the study of benign epithelial neoplasms of the esophagus: 22 cases of endoscopically detected signs of neoplastic changes in the esophageal mucosa were registered, which were morphologically confirmed in 20 patients, this amounting to 90.9%.

Conclusions. The results of the study can be useful for improving treatment approaches, developing surgical intervention protocols and making more informed clinical decisions.

Rationale. Currently, there has been developed a technique for managing enzymatic necrolysis of II-III degree burn wounds using the two-component drug NexoBrid; this treatment option is possible to apply only in the early terms, up to 72 hours, after injury. There are no indications for the use of the technology in later terms after the injury.

The aim of research was to study the potential and effectiveness of enzymatic necrolysis when using the drug NexoBrid in patients with burns of II-III degree at various stages after injury (before and after 72 hours).

Methods. The study included 23 patients. In 15 cases, enzymatic necrolysis with Nexobrid was carried out in first 72 hours after injury; in 8 cases, in 5-9 days after injury.

Results. In both groups, comparable results were obtained regarding the effectiveness of enzymatic necrolysis. The use of enzymatic necrolysis at the late stages (7 days) after injury was effective in the presence of moist necrotic tissue in the wounds, which allowed simultaneously, in the shortest possible time, cleaning burn wounds with uncomplete dermal necrosis (borderline burns of II degree and “mosaic” burns II-III degree) from necrosis, transforming wound process to second stage, creating conditions for regeneration of borderline and “mosaic” burns from the remaining skin derivatives with underlying use of dressings, thus creating a moist wound environment, and in the case of deep burns, reducing the time of their preparation and the area of autodermoplasty.

Conclusion. The use of enzymatic necrolysis with the drug NexoBrid in patients with burns of II-III degree is effective up to 7 days after injury in the presence of a moist scab in the wounds.

Liver abscess is a severe, multifactorial disease that occupies from 1 to 3% of the pathology structure of the hepatobiliary system. In the absence of proper treatment, the disease is accompanied by high mortality. Despite all the achievements of modern medicine, the problem of treating liver abscesses remains as relevant as ever. Approaches and techniques of diagnosis and treatment are changing, but such patients still require a versatile approach to treatment. This paper presents a brief overview of the history, modern ideas about the etiology and pathogenesis of liver abscesses, highlights the main tactical approaches in treatment, and the associated features of the course of the disease. A brief overview and comparative analysis of the most common, available and modern treatment options of liver abscesses is given. As an example of successful treatment of liver abscess, a clinical case of minimally invasive ultrasound-guided management of a post-traumatic liver abscess is given, the option is widely used in our clinic. The main stages of treatment, the therapy performed and the invasive interventions performed are described. This treatment option clearly demonstrates the effectiveness of minimally invasive techniques in the treatment of liver abscesses. Thus, the article is a brief insight on the main aspects of the liver abscesses treatment, illustrated by a clinical example of successful treatment of post-traumatic liver abscess.

The aim of the study was to investigate the main manifestations and pathological changes in the tissues under the sigmoid colon perforation in patients with COVID-19.

Materials. The study involved analysis of medical histories of 40 patients with sigmoid colon perforation associated with COVID-19. All patients showed similar symptoms (increasing respiratory failure, dyspnea, high body temperature), followed by the development of the sigmoid colon perforation due to the violation of intravascular hemostasis. In 25% of patients, perforation developed already on the second or third day from the onset of ARVI symptoms, in 75% - on the fifth or sixth day from the onset of the disease.

Results. The analysed case histories and the results of histological examination of biopsy or pathological material demonstrated similarities in the clinical presentation of the disease and morphological changes in the affected area of the sigmoid colon. The main symptoms and syndromes are presented using the example of a clinical case.

Conclusion. The patient developed complications at the final stage of COVID-19 disease and this was associated with inflammation of the mesentery arteriole walls and the formation of occlusive blood clots in their lumen, which led to the development of the sigmoid colon perforation.

Artificial intelligence is the study of algorithms that give machines the ability to "reason" and acquire cognitive functions to achieve human–level performance in cognition-related tasks such as, for example, problem solving, object and word recognition, and decision-making. Currently, there are a lot of studies proving that artificial intelligence can not only diagnose diseases on a par with doctors, but also spend much less time on it. Artificial intelligence has entered many areas of medicine, and recently its role has become more significant in the diagnosis and treatment of pancreatic pathology.

Over the past decade, the number and variation of methods for analyzing medical images has increased significantly due to the development of artificial intelligence, new programs for analyzing and systematizing objects.

The aim of this review is to analyze, summarize and evaluate data published in the scientific literature on the use of artificial intelligence techniques to diagnose pancreatic pathology based on the results of computed tomography. It is demonstrated further perspectives and the need to develop this area in medical practice.

A systematic literature search was conducted on the databases of the journals PubMed and eLibrary. The search for literature was carried out by Keywords"artificial intelligence", "pancreas", "computed tomography", "radiomics". The search interval was 2015-2023. The authors investigated all research studies of foreign and Russian scientists, which contain information on the use of diverse options of artificial intelligence techniques for differential diagnosis of pancreatic pathology, mainly based on computed tomography, and their assessment to demonstrate their further beneficial development in the field of medicine.

To date, artificial intelligence programs based on spiral computed tomography data allow differentiating the pathology of the pancreas with high accuracy, which greatly facilitates human efforts and allows applying them as an indispensable assistant in work. That is why it is necessary to introduce these technologies into the circulation of medical institutions as actively as possible in order to expand the database of artificial intelligence, which will achieve more accurate results in the diagnosis of pancreatic diseases and more.