Vognsenfrazier6720

Conclusion The use of titanium thread mesh implants in the treatment of postoperative ventral hernias is accompanied by a less inflammatory response of the body to the implant and does not lead to an increase in the frequency of postoperative complications.Objective To analyze the impact of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality of these patients. Material and methods Treatment strategy for destructive pulmonary tuberculosis de novo was developed in the Sechenov First Moscow State Medical University. This strategy was applied at the Surgical Department of the Regional Tambov Tuberculosis Dispensary in 2013-2017. We formed a register of patients with pulmonary destruction and bacterial excretion and developed a personal treatment plan. All patients were divided into 3 groups (group A - surgical treatment, group B - no surgery due to refusal or discontinuation of treatment, group C - patients with contraindications or no indications for surgical treatment). selleck Results Treatment efficacy considering closure of destruction cavities and abacillation was maximal in group A - 97.2%, 41.4% in group B and 39.8% in group C. The number of patients with pulmonary destruction and bacterial excretion has decreased by 3.3 times (from 516 to 158) or 69.8% for 4 years of extensive application of surgical treatment protocol. A significant reduction of 'bacillary core' interrupted infection chain and affected the main epidemiological characteristics. Short-term reduction of the incidence of tuberculosis may be expected. However, even more significant impact of this factor should be expected in the long-term period. Conclusion Surgical treatment of destructive pulmonary tuberculosis improves efficacy of the management of these patients and reduces mortality rate.Objective To evaluate an effectiveness of endobronchial valve treatment of patients with bronchopleural fistulas and prolonged air leakage. Material and methods Endobronchial valve treatment was analyzed in 115 patients with bronchopleural fistulas or postoperative air leakage. All patients were divided into 5 groups depending on disease bullous emphysema, acute purulent lung diseases, chronic purulent lung and pleural diseases, bullous emphysema complicated by pneumothorax with failed pleural cavity, other lung diseases associated with prolonged postoperative air leakage. Results Endobronchial valve treatment was effective in more than 70% patients. There were no intraoperative and postoperative complications. Conclusion Endobronchial valve treatment is a highly effective minimally invasive method for treating patients with bronchopleural fistulas and postoperative air leakage.Objective To estimate the possibility of diagnosis of malignant pleural effusion using convolutional neural networks of facies images of pleural exudates obtained by the method of wedge-shaped dehydration. Material and methods We studied 163 images of pleural fluid facies obtained by wedge-shaped dehydration in patients with various pleural effusions (10 nosological groups). Recognition and analysis were carried out using convolutional neural network. The images were divided into two groups - malignant effusion (n=65; 40%) and other diseases (n=98; 60%). Results There were 131 photos selected for further investigation after pre-processing of images by eliminating defective ones, turning them into black and white format, cleaning of 'noise', cutting out the facies. Then the images were standardized. The method of rigid transformations with rotation for every 10 degrees was used. As a result, their number increased up to 4,585. Self-taught neural network analyzed the images of facies independently by separation of the fragments consisting of black and white dots and comparison of them with each other. Self-teaching and training of each neural network were ensured by random sampling of 80% of images from the initial sample. Then the remaining 20% of the images were used as a control sample to assess the possibilities of recognition pleural effusion cause. Four options of convolutional neural networks were used. An accuracy of cancer detection ranged from 82% to 95.6%, benign diseases - from 84% to 94.7%. The neural network with the highest sensitivity was chosen. Conclusion Automated image analysis system of pleural effusion facies using convolutional neural network ensured an accuracy of diagnosis of malignant pleural effusion in 95,6% of cases and other diseases in 90% of cases. The method is simple, efficient, cheap and reagentless.Objective To evaluate bacterial flora in patients with deep sternal wound infection and the effect of negative pressure wound therapy on eradication of the pathogen. Material and methods There were 102 patients with deep wound infection after cardiac surgery. Mean age was 66.9±9.9 years. Diabetes mellitus was detected in 21 (20.5%) cases, chronic obstructive pulmonary disease - in 15 (14.7%). Wound debridement via daily dressings was performed in 64 patients; vacuum-assisted dressings were applied in 38 patients. Bacteriological analysis of discharge was carried out every week. Results. Mixed infection was observed in 38 (37.3%) patients. S.aureus was the most common pathogen (n=51, 50%), Gram negative bacteria were found in 36 (35.3%) patients. Negative pressure wound therapy ensured eradication of S.aureus within 3 weeks while dressings were associated with only 40% decrease of the incidence of positive analyses (p less then 0.05). Effectiveness of the method was not obtained for Gram negative bacteria. Conclusion Negative pressure wound therapy accelerates eradication of Gram positive pathogens but does not affect eradication of Gram negative microbes.Objective To identify the most important high risk criteria for predicting course of disease, as well as optimal preoperative preparation and surgical strategy in patients with secondary peritonitis. Material and methods A prospective study enrolled 43 patients with diffuse secondary peritonitis. Results Significant predictors were Charlson's comorbidity index (p=0.001) and SOFA score of organ dysfunction within 3 days after admission. Rapid regression of organ dysfunction (SOFA1 - p=0.0001, SOFA2 - p=0.012, SOFA3 - p=0.017) and reduced time of examination and preoperative preparation (threshold value - 520 min after admission) are predictors of favorable outcome in patients with diffuse secondary peritonitis. There was no reliable correlation between the treatment outcome and preoperative preparation (infusion volume p=0.23, duration p=0.37, absence/presence of antibacterial therapy p=0.26). Elimination or control of infection is the fundamental principle of the management of patients with diffuse secondary peritonitis.