Abstract

УДК 619:612.174:612.1:636.4

Abstract

The primary aim of the work was to study the peculiarities of the influence of endogenous factors (products of inflammatory processes occurring in the tissues of female genitals) in the biological system of type “environment (uterine-vaginal mucus) – substance (water, organic and inorganic substances)” on the indicators of mass (g, mg) of its components. The results of the experiments indicate that their harmful effect changes the color and density of mucus released during estrus (UVM); reduces the parameters of the mass content of H₂O and inorganic substances (IS), but increases – organic (OS). Under these circumstances, the distribution of the parameters of the mass of the components of the dry residue (DR, dried at 105 ^oC) of UVM of cows of the experimental group is presented in a row where the mass of ОS₁ (burn at 520–530 ^oC) ˃IS ˃ОS₂ (burn at 650 ^оС), but for control is another as well as mass of IS˃ОS₁˃ОS₂. This means that the harmful effects of inflammatory products on the genital tissues of females negatively affect the distribution of the mass of OS and IS in the system “environment-substance”.

Abstract
Objective. To evaluate the risk of venous thrombosis and embolism in urgently operated patients with acute abdominal surgical pathology and coronavirus disease. Materials and methods. The single–centre study was based on the analysis of 741 medical records of inpatients admitted to a surgery centre between April 2020 and February 2022. The study analysed 78 medical records of patients operated on for acute abdominal surgical pathology with confirmed COVID–19. 8.9% of patients died, including 5.1% from massive pulmonary embolism with the development of acute cardiovascular failure. Thromboembolic complications were diagnosed in 26.9% of patients.
Results. The scores that assessed the risk factors for venous thrombosis and embolism were determined. A score of up to 15 points corresponded to a low risk, 15–35 points to an average risk, and more than 35 points to a high risk. Conclusions. The incidence of venous thrombosis and embolism in patients with coronavirus disease in the postoperative period in the low risk group is 8%, medium – 25%, and high – more than 40%. The real risk of thromboembolic complications is underestimated and requires consideration of the specifics of the course of coronavirus disease in patients with acute abdominal surgical pathology.
Key words: venous thrombosis and embolism; COVID–19, thromboembolic complications; acute surgical pathology
of the abdominal cavity.

Abstract. The continuous wave-like morbidity increasing of coronavirus disease in 2019 (COVID-19), the emergence of different strains of the virus has contributed to the search for new ways in diagnostic algorithms and methods of treatment of such patients. Expert opinion of the International Society of Thrombosis and Haemostasis on the predictors of adverse COVID-19 encourages the search for modern ways to determine the degree of coagulopathy. Determination of prothrombin time clearance, D-dimer and platelet count in patients, whom was performed surgery, is one way to stratify the risk of venous thromboembolism. The results of surgical treatment of 504 patients in the surgical center of Lviv Emergency Medical Hospital for the 2019-2021 were analyzed. Slightly dominated by man – 52.7%. The age of patients ranged from 21 to 85 years (mean – 62.1±21.2). As a result of the scientific study, 36 (7.14%) patients operated on with abdominal pathology and confirmed diagnosis of COVID-19 were analyzed in detail. 27 (23.1%) patients were
in the intensive care unit, 14 of them (51.8%) with invasive lung ventilation – 11 (78.6%), the average bed-day in intensive care was 7.2 days. 14 (38.9%) patients died, and autopsies were performed in 13 (92.8%). Cause of death: multiple organ failure, pulmonary embolism, septic complications. Introduction. The continuous wave-like morbidity increasing of coronavirus disease in 2019 (COVID-19), the emergence of different strains of the virus has contributed to the search for new ways in diagnostic algorithms and methods of treatment of such patients. Since December 2019, more than 240 million patients and 4.8 million deaths caused by coronavirus SARS-CoV-2 have been registered, a third of whom, according to many authors, have been diagnosed with thrombosis in various locations. The development of coagulopathy and ICE syndrome in coronavirus-infected surgical patients is a special problem, because cytokine distress, hypoxia, endothelin dysfunction, hypercoagulation, thrombosis are potentiated [1,3,6,8]. Expert opinion of the International Society of Thrombosis and Haemostasis (ISTH) on the predictors of adverse COVID-19 encourages the search for modern ways to determine the degree of coagulopathy. Determination of prothrombin time clearance, D-dimer and platelet count in patients, whom was performed surgery, is one way to stratify the risk of venous thromboembolism (VT). And some publications on septic coagulopathy[2,3,5,6,7] additional monitoring of fibrinogen levels, especially their reduction, may be useful in calculating thrombosis risks in surgical patients with coronavirus disease. The aim of the study was to establish the diagnostic value of thrombosis markers in patients with acute abdominal surgical pathology infected coronavirus and to predict the course of the disease. The data of the study 1494 autopsies conducted in our clinic from 1990 to 2000 are noteworthy, as we note a certain change in the ratio of the causes of death of patients in a surgical hospital. Thus, during the SARS-CoV-2 pandemic, the predominant cause of death in patients with acute abdominal surgical pathology was respiratory failure and thromboembolic complications. However it should be noted that some caution of doctors who formulated the final diagnosis because more than half of the dead, sometimes unreasonably, in the concomitant diagnosis indicated pulmonary embolism. Taking into account the opinion of ISTH experts, we have studied certain indicators of coagulopathy during the postoperative period and created an algorithm for the
management of patients with COVID-19. The D-dimers dynamics, total fibrinogen, prothrombin time and platelet count were evaluated and subjected to multifactorial analysis by multiple regression. Thus, the significant difference between the groups of recovered and dead was: for D-dimers – an increasing of 3.4 times (p-0.193), for prothrombin time – an increasing of 2.3 times (p-0.454), for fibrinogen – a decreasing of 2.1 time (0.491) and for platelets – a decreasing of 1.7 times (p-0.567). According the studied data, the algorithm for predicting the unresponsive course of the postoperative period in patients with acute surgical abdominal pathology infected with coronavirus type SARS-CoV-2 was modeled. The risk group for fatal thromboembolic complications should include patients with significantly elevated D-dimer, prolonged thromboplastin time, platelet count <100*109/1 and fibrinogen < 2 g/l. In this case, in our opinion, it is advisable to use more aggressive therapeutic regimens, namely: observation in the intensive care unit, daily monitoring of coagulopathy, the use of therapeutic doses of anticoagulants and possible administration of blood products. Keywords: COVID-19, abdominal surgical pathology, predictors.

UDC 616.366-003.7:616-007.272]-07-08 

Abstract. Background. Gallstone ileus is a pathology characterized by a variety of clinical manifestations and types of the course. Therefore, it is difficult in the diagnostic and therapeutic aspect and leads to unsatisfactory treatment results. The aim of the work is to find out the features of diagnosis and treatment of patients with gallstone ileus. Materials and methods. A retrospective analysis was performed of 51 medical records of inpatients with gallstone
obstruction operated in the clinic from 1990 to 2020. Women aged 61 to 85 (median of 74.20 ± 12.95) years predominated — 44 (86.3 %). Most patients (81 %) had concomitant diseases, which in combination with gallstone ileus caused high surgical risk: coronary heart disease — 26 (51 %), essential hypertension — 11 (21.6 %), diabetes mellitus — 3 (5.9 %), obesity — 1 (2 %). Results. During the clinical, laboratory and instrumental examinations, the
following preliminary diagnoses were made, for which surgical treatment was performed: acute adhesive intestinal obstruction — 29 (56.9 %), gallstone ileus — 9 (17.6 %), acute bowel obstruction — 4 (7.8 %), acute mesenteric circulatory failure — 4 (7.8 %), acute cholecystitis — 3 (5.9 %), hernia — 1 (1.9 %), peritonitis — 1 (1.9 %). Gallstone obstruction was detected at different levels: in the duodenum — in 3 (5.9 %) patients, jejunum — in 17 (33.3 %), ileum — in 23 (45.1 %) and colon — 8 (15.7 %) patients. The cause of stones in the lumen of the digestive tract was cholecystoduodenal fistula — in 48 (94.1 %) and choledochoduodenal fistula — in 3 (5.9 %) patients. Diagnosis of biliary fistulas was performed during postoperative radiological and endoscopic examination. The scope of surgery was aimed at eliminating acute intestinal obstruction; enterotomy was performed 5–10 cm distal to the
site of obstruction with lithoextraction. In one patient with areas of focal necrosis at the site of stone entrapment, a loop of the small intestine was resected with entero-enterostomy “side-by-side”. In case of duodenal obstruction, lithoextraction was performed through gastrotomy. In the perioperative period, 43 (84.3 %) patients received antibiotic prophylaxis using cephalosporines, fluoroquinolones and metronidazole. Purulent-septic complications in
the postoperative period developed in 9 (17.6 %) patients: suppuration of the postoperative wound in 6, infiltrate of the abdominal cavity in 1 and bronchopneumonia in 2. Two patients died, postoperative mortality was 3.9 %. Conclusions. Gallstone intestinal obstruction is difficult to diagnose due to a variety of clinical manifestations and course, and, accordingly, it is accompanied by frequent complications and high mortality. Surgical treatment should
eliminate intestinal obstruction in conditions of high surgical risk without repair of biliodigestive fistula. Early detection and determination of indications for planned surgical sanitation of the biliary tract is a reliable way to prevent gallstone ileus.
Keywords: acute intestinal obstruction; gallstone; biliodigestive fistula; aerobilia; enterotomy; lithoextraction