No. 2 (2020) Journal of hepato-gastroenterology research

Мақолалар

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  MODERN TACTICAL APPROACHES IN THE TREATMENT OF TRAUMATIC LIVER INJURIES The proposed active multi-stage surgical tactics as "damage control" in severe traumatic liver injuries in SFRNTSEMP has been used since 2006 as the only method of saving the lives of patients with severe traumatic liver injuries of IV and V degrees (according to E. Moore, 1986). In emergency surgery departments SFRNTSEMP for 2008-2018 operated 127 victims with liver injury. Among the 19 (14.96%) victims, severe liver injuries of IV and V degree of damage according to E. Moore were observed. The effectiveness of multi-stage tactics was assessed by the level of mortality and the number of purulent-septic complications. The results of surgical treatment of 19 patients with severe liver injuries, the age of patients from 17 to 50 years were analyzed. The median age was 26 years. There were 11 men and 8 women. The average assessment of the severity of damage on the ISS scale was 34 points (17-76), according to E. Moore IV and V degree of damage. The average blood loss was 2850 ml (1750-3850 ml). All patients underwent a multi-stage laparotomy with gauze (film) tamponade, the average number of operations per 1 person 2.7 (2-5), suturing the liver wound with tamponade (13), extensive hepatotomy and vascular ligation (3), atypical resection (2), stitching large main vessels with taponade (1). The average bed / day in the intensive care unit is 13 (3- 16) and the average bed / days in the clinic is 25 (3-28). Mortality was 26.3% (5 out of 19), mainly purulent-septic complications and multiple organ failure. Multi-stage active surgical tactics "damage control" in isolated and combined severe liver damage is an effective method in unstable patients with the risk of coagulopathy and multiple organ failure. The use of the "damage control" technique helped to reduce the mortality rate from severe liver injuries by 26.3%.

  Ishnazar Mustafakulov, Khushvakt Umedov

  48-51

  94   27

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  SURGICAL TACTICS IN TREATMENT OF ELDERLY AND ADDITIONAL PATIENTS WITH GASTRODUODENAL ULTRA DUODENAL BLEEDING The authors proposed a tactic based on the prognosis of recurrent bleeding, which made it possible to carry out rational regrouping in the framework of urgent surgical interventions, which cannot be achieved using the traditional active-expectant approach. In the course of work, the introduction of individually-active surgical tactics based on the prognosis of recurrent bleeding in the treatment of patients over 60 years of age with UHDH, has reduced the number of recurrent bleeding from 32.1 to 17.7%, respectively, to reduce the number of emergency operations from 90 to 50% and, thus, as a result, reduce the incidence of postoperative complications (from 38.8 to 22.9%) and mortality (from 24.5 to 12.5%).

  Dilshodbek Khakimov , Bekzodbek Karaboev , Nosir Kasimov

  81-84

  322   22

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  SEPTIC-PURULENT COMPLICATIONS OF URGENT ABDOMINAL SURGERY. A NEW LOOK IN PREVENTION AND TREATMENT The authors demonstrate a clinical and experimental morphological rationale for an aprobation helium-neon laser beam to reduce and prevent after complications of surgery. In the clinic, the method was used in 235 patients (with gastric resection, cholecystectomy, small and large intestine operations). The effectiveness of the proposed method is revealed. A decrease in postoperative purulent complications was noted.

  Kamoliddin Salakhiddinov

  78-80

  119   56

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  FEATURES OF THE DIAGNOSIS OF OBSTRUCTIVE JAUNDICE, ACCOMPANIED BY CIRRHOSIS OF THE LIVER This article presents the results of a study of 66 patients with obstructive jaundice caused by gallstone disease, concomitant with cirrhosis of the liver (LC). All patients were divided into 2 groups: the first group included 46 patients with obstructive jaundice with LC, and the second - only 20 patients with obstructive jaundice. Obstructive jaundice in 64% of patients was caused by cholelithiasis treated in this surgical clinic, of which 20.4% of them were identified as concomitant diseases with various stages of liver cirrhosis. Compared were the complaints of patients of both groups, the clinical course, the results of objective observation, laboratory research, the results of additional instrumental examination and their specificity.

  Shukhrat Urakov, Laziz Kenzhaev , Sanjar Ruziboev

  72-77

  66   23

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  SURGICAL TREATMENT OF PATIENTS WITH GАNGRENOUS FURNIER Results of surgical treatment of 13 patients with scrotum gangrene (Fournier's disease) admitted to the proctology department of the 1st SamMI Clinic are observed in the article. The early diagnostics and active management are used for radical surgical treatment of the purulent necrotic focus in combination with necrectomy in step-by-step maneuver. Complex system of the local treatment of the wound, purposeful and multiple component correction of systemic and metabolic disorders of the homeostasis are the real way to improve treatment results.

  Murodulla Rustamov , Salim Davlatov, Zayniddin Saydullaev, Inoyatullo Rustamov

  69-71

  111   22

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  RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH ACUTE GANGRENOUS - NECROTIC PARAPROCTITIS The article discusses the results of treatment in 767 patients operated on in the proctology department of clinic № 1 of SamMI in the period 2005-2020, among whom patients with necrotic forms of the disease accounted for 36 (4.7%) patients. Among them, 731 (95.3%) had an aerobic etiology of lesions of peri-rectal tissue. The average age of the patients was 63.1 ± 4.9 years. The research results showed that a timely and radical operation, supplemented with antibacterial and detoxification therapy, led to recovery.

  Murodulla Rustamov , Salim Davlatov, Zayniddin Saydullaev, Inoyatullo Rustamov

  65-68

  80   18

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  POSSIBILITIES OF APPLYING MINIMALLY INVASIVE TECHNOLOGIES IN TREATMENT OF SEVERE ACUTE PANCREATITIS To explore the possibilities of laparoscopic methods in the surgical treatment of severe acute pancreatitis, were selected two groups of surgical patients, depending on the method of surgery that were produced various types of open and laparoscopic operations. To assess the effectiveness of the applied treatment methods, in the postoperative period, we used the following laboratory and physiological parameters: progression or regression of a systemic inflammatory response syndrome (SIRS), pO2 level, neutrophil-lymphocyte ratio (NLR), as well as integrated scales of severity Ranson, APACHE II and BISAP. These results demonstrate the advantages of laparoscopic surgical procedures.

  Sanzhar Ruziboev, Abduraxim Avazov , Masrur Mukammadiev, Utkir Khdoynazarov

  61-64

  86   19

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  SELECTION OF MEDICAL TACTICS IN PATIENTS WITH CIRRHOSIS OF THE LIVER IN A LONG PERIOD AFTER PORTHOSYSTEM SHUNTING The development of common approaches to the treatment and rehabilitation of patients with cirrhosis is based on the etiopathogenesis of liver diseases and the systematization of existing knowledge. A rehabilitation program in patients with cirrhosis after portosystemic shunting should be aimed not only at improving survival, but also improving the quality of life of patients. In this article, the authors tried to set out the main directions and standards for the rehabilitation of patients with cirrhosis after portosystemic shunting.

  Sanjar Ruziboev, Andrey Devyatov, Azam Babazhanov

  56-60

  99   25

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  THE SYNDROME OF ABDOMINAL HYPERTENSION WITH CONCOMITANT ABDOMINAL INJURIES As is known, intra-abdominal hypertension develops as a result of severe closed trauma of the abdominal organs, inflammation of the peritoneum, severe pancreonecrosis, as well as other diseases of the abdominal organs and after surgical interventions. Intra-abdominal hypertension syndrome is a symptom complex that develops as a result of increased pressure in the abdominal cavity and proceeds with an increase in signs of multi-organ failure. In 2008-2018, the study of intra-abdominal pressure in 76 patients with concomitant abdominal trauma was carried out in SFRNCEMP. The age of the studied victims ranged from 18 to 70 years (30,5_+8,9), while most of the victims were persons of working age (up to 50 years), mainly men (n=61). In 37 (48.6%) of the victims, combined abdominal injuries were accompanied by TBI. The cause of injury in most cases was a traffic accident (n=61-80, 2%), in 10 (13.1%) – an illegal injury, in 7 (9.2%) catatrauma. Alcohol intoxication was observed in 41 (53.9%). In those patients in whose cases the operation is completed by suturing the abdominal wound tightly, there is a high risk of developing IAD and a high probability of developing intraabdominal hypertension syndrome (SIAG). In the same group of patients, signs of organ failure are significantly expressed, one of the causes of which may be increased intra-abdominal hypertension. SIAG is a rather unfavorable complication in terms of prognosis Intraabdominal pressure greater than 12 mmHg. mortality is a "borderline" indicator, the increase of which leads to an increase in mortality.

  Ishnazar Mustafakulov, Khushvakt Umedov

  52-55

  55   16

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  FEATURES OF MORPHOLOGICAL CHANGES OF A STOMACH AT SMOKING "NAS" SICK OF A CHRONIC GASTRITIS TOBACCO Research is spent at 60 patients with stomach ulcer disease. As a result of researches shows that degree of expressiveness and weight of structural changes, depth and prevalence of process are closely connected with smoking “nas’’.

  Ravshanbek Abdullaev , Abdugofur Dusanov

  5-10

  94   29

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  ACUTE BILIARY PANCREATITIS AND FEATURES OF ITS COURSE DEPENDING ON THE TACTICS TAKEN The authors conduct a comparative analysis of the severity of the condition of patients with acute pancreatitis and the reasons for the unsatisfactory outcome of the tactics of treatment of acute pancreatitis of biliary etiology - 438 patients from the total sample of patients according to the Ranson and APACHE II rating scales. The authors conclude that the dynamics of the severity of acute biliary pancreatitis during treatment is characterized by the possibility of progression of the pathological process with a significant increase in the proportion of destructive forms of the disease from 16.5% upon admission to 33.8% (p <0.001), including an increase in sterile from 13, 9% to 21.9% and infected from 2.5% to 11.8% pancreatic necrosis (p = 0.027) with various purulent-septic complications.

  Ravshan Ibadov , Azam Babazhanov, Bakhrom Abdullajanov

  41-47

  132   30

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  ALGORITHM OF INTEGRATED HEALTH STATE OF CHILDREN OF CHILDREN, TAKING INTO ACCOUNT MICROELEMENTAL IMBALANCES IN THE SYSTEM "MOTHER - CHILD" The aim of the work is to study the state of health of the child depending on the state of health of the mother, taking into account the deficiency of micronutrients, through a questionnaire and a comprehensive examination of the state of health of the mother, followed by the development of an action plan for the provision of medical and social assistance to prevent micronutrient deficiency. 465 mothers and their children in 6 districts of the Samarkand region. In mothers during pregnancy, it was revealed: anemia - 67.9%, toxicosis - 64.2%, threatened condition - 27.3%, increased blood pressure - 25.5%, 57.6% use of various medications - 57.6 %. chronic diseases - 19.4%; during the feeding period were noted: little use of grain and legumes - 61.2%, vegetables, fruits and herbs - 60%, dried fruits, fruit juices up to 68%, milk and dairy products - 55.8%, meat products - 60.6 %, fish products - 75.6%; frequent use of refined sweets - 85.7%, tea up to 100%, as well as insufficient provision of the family in 44.2%, low knowledge of caring for a child in 52.1% of mothers. An action plan has been developed consisting of three stages.

  Zilola Dzhuraeva, Otamurod Muminov, Nozima Kurbonova

  37-40

  70   19

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  THE INFLUENCE OF THE HEALTH STATE OF A NURSING WOMAN ON THE MICROELEMENTAL COMPOSITION OF MOTHER'S MILK Purpose of the study. Study of the content of microelements in breast milk to clarify the indirect dependence of the health status and morbidity of children depending on the health status of the mother and the biogeochemical conditions of the place of residence. Material and methods. 400 mothers and 400 children were examined by questionnaires. Determined the content of 22 elements in breast milk in 69 lactating women using atomic absorption and neutron activation analysis. Results. In mothers, risk groups are identified - the presence of many signs of dysmicroelementosis, the cause of which is the mother's unbalanced nutrition, a low level of culture, and a violation of nutritional rules. The content of macro- and microelements in breast milk varies greatly. Our data can be used as standard indicators for the content of 22 macro- and microelements in breast milk in the Samarkand region of the Republic of Uzbekistan. Conclusions. Conducting a multielement analysis of breast milk makes it possible for a nursing mother to promptly recommend preventive measures for micronutrient deficiency, as well as monitor the condition and corrective measures for the baby if there are signs of micronutrient deficiency.

  Zilola Dzhuraeva, Saidullo Rasulov, Otamurod Muminov

  30-36

  138   21

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  CHOICE OF SURGICAL TACTICS OF TREATMENT OF PATIENTS WITH ACUTE PARAPROCTIVITIS 303 patients with different forms of acute paraproctitis were treated. All patients have undergone a radial operation. The treatment tactics and surgical method was different in patients with various clinical forms of acute paraproctitis, which deponded on localization of pyogenic abscess, primary purulent motion toward anal sphincter fibers, degree of development of cicatrical process in pararectal tissue of rectum wall. The designed complex of tactical and medical actions allow to reduce the time of staying in hospital, considerably decrease percentage of relapses, improve the functional results of treatment

  Salim Davlatov , Murodulla Rustamov , Zayniddin Saydullaev, Inoyatullo Rustamov

  26-29

  78   20

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  OBESE CHILDREN: CLINICAL AND METABOLIC ASSESSMENT Were comprehensively examined 50 children with obesity and hypertension. It was revealed that this category of children is tall, accelerated the rate of sexual development, a decrease in the quality of life and a high frequency of pathology from the cardiovascular system in the form of functional disorders and increased blood pressure. Biochemical studies have shown that in one third of children with abdominal obesity, the pathology of carbohydrate and lipid metabolism was observed, which was accompanied by an increase in the level of uric acid in the blood.

  Lilya Garifulina

  22-25

  90   21

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  INNOVATIVE METHOD FOR DIAGNOSTICS AND TREATMENT OF SECONDARY CHRONIC PYELONEPHRITIS IN CHILDREN The proposed modified treatment helps prevent renal inflammation, frequent recurrence and the formation of renal failure. Objective: to evaluate the modified treatment of chronic pyelonephritis in children. Material and methods. We examined 85 children with chronic secondary non-obstructive pyelonephritis developing against the background of dysmetabolic disorders (oxalate crystalluria) at the age from 4 to 15 years. The patients were divided into 2 groups depending on the methods of therapy used. Group I included 48 children who received traditional methods of treatment. Group II - 37 patients who received modified treatment (antibiotics were administered regionally lymphotropically in combination with viferon and vitamin A). Results and discussion. The study of urine cytokines, depending on the method of chronic pyelonephritis therapy, showed that in children of group I, before discharge from the hospital, the amount of IL-1, IL-6, IL-8, IL-10 in urine remained elevated (P1> 0.1. Conclusions: In CP in children, there was an increase in pro-inflammatory (IL-1, IL-6, IL-8) and a decrease in anti-inflammatory cytokines (IL-10) in the urine.

  Nargiza Akhmedzhanova, Ismoil Akhmedzhanov, Oblakul Akhmatov

  18-21

  77   23

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  GENOTYPES OF SALMONELLA RESISTANCE ISOLATED FROM PATIENTS WITH OKA AND FROM BROILER CHICKEN CARCASES Salmonellosis is unmatched in its epidemiological complexity and difficulty in controlling it. The biology of salmonella serovars varies so widely that it inevitably makes it difficult to discuss issues related to salmonellosis, the ways and mechanisms of infection with Salmonella and contamination with Salmonella. At the end of the 20th century, a significant contribution to the spread of multiple resistance in many countries was made by the epidemic spread of multidrug-resistant strains of S. Typhimurium 104, which caused diseases in humans and were isolated from animals. We examined 31 samples from carcasses of broiler chickens and 40 strains of Salmonella isolated from patients with acute intestinal infections, hospitalized in the clinic NIIEMIZ MH RUz. Having carried out genotyping of Salmonella spp strains isolated from patients with AEI and from carcasses of broiler chickens, we see a variety of resistance genes, however, the resistance genotypes isolated from the carcasses of broiler chickens bla NDM-1, CTX-M, -TEM, -SHV, which amounted to 6.5 %. These strains carry a gene resistant to antibiotics belonging to the reserve group - carbopenems (imipenem).

  Gulnora Abduxalilova , Amir Bektimirov , Nargiza Otamuratova, Ildar Axmedov , Mubarakhon Akhmedova , Dono Mirzadzhanova

  11-17

  102   23

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