ABSTRACT
AIM: To improve the quality of clinical and forensic examination and diagnosis of diaphragmatic injury (DI) from stab wounds by defining the boundaries of the thoraco-abdominal region and the topographic and anatomical characteristics of thoracoabdominal stab wounds. MATERIAL AND METHODS: Based on the results of forensic medical examinations of 81 corpses with stab wounds, the clinical and anatomical characteristics of thoraco-abdominal stab wounds were noted; and in anatomical dissections of 90 cadavers, the boundaries of the intercostal spaces and costophrenic recess were modeled. RESULT: The boundaries of the thoraco-abdominal region, and the location of stab wounds that make the probability of DI particularly high (10-50%) were clarified. A method for diagnosing DI was developed. The method was used to identify DI in 81 out of 411 victims with penetrating stab wounds to the chest and abdomen. The results of the study prove the feasibility of using computed tomography in the examination of living persons with a wound in the thoracoabdominal region. This study can assist in determining the features of a wound channel, in providing a correct assessment of the damage, and in the identification of undiagnosed DI.
Subject(s)
Abdominal Injuries/diagnosis , Diaphragm/injuries , Wounds, Penetrating/diagnosis , Wounds, Stab/diagnosis , Forensic Pathology , Humans , Soft Tissue Injuries/diagnosisABSTRACT
AIM: To develop the algorithm of optimal combination of conventional and minimally invasive procedures for surgical diagnosis and treatment of thoracoabdominal wounds (TAW). MATERIAL AND METHODS: The most common borders of TAW were analyzed in 81 bodies of victims. Typical borders of costodiaphragmatic pleural sinus were assessed in 90 male cadavers. There were 81 victims with TAW who were divided into two groups. The first group included 40 patients who underwent newly developed methods of treatment. Group II consisted of 41 patients who were treated earlier. RESULTS: The algorithm of invasive diagnosis of diaphragm wounds and the method of sequential determination of indications for conventional or endoscopic procedures were developed and applied in the first group. Minimally invasive operations alone or in combination with open surgery were applied in 80% of patients in group I and in 53.66% of patients in group II. Thirty-eight (97.5%) and 35 (85.37%) patients convalesced in groups I and II, respectively. CONCLUSION: Thoracotomy was required in 34.29% of cases for TAW correction, laparotomy - in 71.43% of cases. Minimally invasive operations were sufficient in other cases.
Subject(s)
Abdominal Injuries/diagnosis , Abdominal Injuries/surgery , Diaphragm/injuries , Diaphragm/surgery , Thoracic Injuries/diagnosis , Thoracic Injuries/surgery , Abdominal Injuries/complications , Algorithms , Cadaver , Humans , Laparoscopy , Laparotomy , Male , Minimally Invasive Surgical Procedures , Thoracic Injuries/complications , Thoracoscopy , ThoracotomyABSTRACT
Aim: The aim was to improved results of treatment of patients with threatened or held bleeding from esophageal varices on the background of liver cirrhosis. Materials and Methods: The analysis of the survey results and endoscopic treatment of 40 patients with liver cirrhosis complicated by threatened or held bleeding from esophageal varices. The effectiveness of the treatment was assessed by the dynamics of recourse degree esophageal varices, presence and character of postoperative complications and mortality. Results: Application of endoscopic ligation as primary and secondary prevention of bleeding from esophageal varices can improve the immediate and long-term results of treatment of patients with liver cirrhosis complicated by portal hypertension. Prevention of bleeding from esophageal varices is a dynamic endomonitoringe supplemented with repeated courses of endoscopic ligation.
