DUNBAR SYNDROME: CLINICAL MANIFESTATION IN ADULTS, DIAGNOSTIC PROBLEMS (CASE REPORT).

In this case we used CBC and biochemical tests, ECG, ultrasound of the abdominal cavity and heart, CT scan with and without IV contrast. Women with complains on recurrent severe abdominal pain in epigastric region and right part of the abdomen radiating to the back, nausea, vomiting. Making laboratory and instrumental tests for confirmation of the diagnosis. Surgical treatment of DS was performed and after one year of the follow up there were no complications. DS may mimic other medical conditions such as gallbladder diseases, gastritis/peptic ulcer, appendicitis, colorectal malignancy, hepatitis, atherosclerotic diseases etc. That is why DS is a diagnosis of exclusion. This case illustrates pathway to find correct diagnosis and improve management tactic.

RESULTS OF ACUTE PURULENT CHOLANGITIS TREATMENT WITH GENETIC ENGINEERING ANALOGUE OF DORNAZE-ALPHA NATURAL ENZYME.

OBJECTIVE: The aim: To evaluate the effectiveness of the proposed method of surgical treatment of patients with acute purulent cholangitis. PATIENTS AND METHODS: Materials and methods: The research is based on the analysis of the treatment results in 104 patients with acute purulent cholangitis. The volume of surgical interventions on the biliary tract in patients was as follows: endoscopic papillosphincterotomy (EPST) + naso-biliary drainage; EPST + laparoscopic cholecystectomy; cholecystectomy + choledocholithotomy + drainage of the common bile duct. RESULTS: Results: The APACHE-2 scale assessment for patients in the control group was 12,80 ± 1,73, with the SOFA scale - 4,32 ± 0,31 points. Accordingly, the assessment for patients in the main group with the APACHE-2 scale is 11.76 ± 0.81, with the SOFA scale - 4.33 ± 0.79 points. The results obtained in both the control and the main group indicate that the physiological reactions of the organism to the disease, treatment, development of organ dysfunction are reflected in the integrated severity assessment scales. CONCLUSION: Conclusion: The performed analysis of clinical and laboratory results of treatment in both groups established the high efficiency of the proposed treatment method in patients with acute purulent cholangitis, which promotes the more rapid medical and social rehabilitation in this category of patients.

Choice of surgical tactics at the stage of preoperative preparation of patients with biliary sepsis.

OBJECTIVE: Introduction: There is a problem of choosing the optimal method for eliminating choledocholithiasis in accordance with one The lack of satisfactory results from the use of existing methods of surgical correction explains the constant interest of specialists to this problem, requires the improvement of the commonly accepted and the search for new approaches to the treatment of this concomitant disease. The aim: To substantiate the use of individual assessment at the stage of preoperative preparation for the purposeful differential tactic of surgical treatment of the biliary sepsis. PATIENTS AND METHODS: Materials and methods: The basis of our research was the results of the analysis of treatment of 112 patients with biliary sepsis who were on treatment from 2010 to 2017 in the surgical clinic № 2. An assessment of systemic inflammation performed according to the recommended criteria of the Chicago Interventional Conference on Intensive Care (USA, 1992). The systemic inflammatory response syndrome (SIRS) was determined in the presence of 2 or more symptoms: 1) t body> 38 ° C or <36 ° C, 2) heart rate> 90 / min; 3) breathing frequency> 20 / min; 4) white blood cell count> 12 × 109 / l or <4 × 109 / l; or> 10% immature forms (SOFA score 4, 27 ± 0.6 points). RESULTS: Results: Based on the received pre-operative score, we proposed to optimize the differentiated selection of individualized surgical tactics, taking into account the available baseline conditions, to radically eliminate the cause of biliary sepsis and evaluate the measures of initial conservative therapy. In the course of work, anamnestic unit, clinical unit, laboratory-instrumental block used. The initial severity of the condition of each particular patient is calculate according to the received sum of points for each information block, which allows at the stage of preoperative preparation to standardize all patients in accordance with their score. CONCLUSION: Conclusion: Thus, the ball assessment of the severity of the condition of patients allows us to determine not only the optimal tactics, the size and type of surgical correction, but also to determine the effectiveness of the selected composition of preoperative preparation and postoperative treatment, carrying out its dynamic assessment.