卷 11, 编号 3 (2019)

Background. The prognosis of the difficult tracheal intubation remains an essential problem. The effectiveness of using predictors does not allow to foreseen such situation accurately.

The purpose of the study was to develop a predictive system and evaluate its effectiveness in difficult tracheal intubation based on facial image analysis combined with the most significant predictors of difficult intubation.

Materials and methods. A database based on the registration of difficult intubation predictors was developed. It was based on the patient’s face images with marked reference points. It allowed to estimate the information signs associated with the difficult tracheal intubation. The degree of intubation severity was determined directly during the intubation process according to the proposed original scale of severity.

Results. The classifier was synthesized by using the self-organization neural network method. The trained neural network was the basis of the classifier model implemented as a computer application. The sensitivity of the difficult tracheal intubation prognosis was 90.90%, specificity was 97.02%, the prognostic value of the positive result was 58.82%, the negative one was 99.56%.

Conclusions. The proposed decision support system allows patients to be stratified into groups according to the degree of difficult tracheal intubation risk. In addition, the self-learning process of the system continues as the new data become available. This allows to improve its efficiency continuously.

The article analyzes the treatment of patients in older age groups with colon cancer complicated by perifocal inflammation. It is shown that the treatment modality for this category of patients depends largely on the severity of paracancrosis inflammation. A large number of postoperative complications and a high level of postoperative mortality accompany traditional operations performed for colon cancer complications. The introduction of laparoscopic technology allows improving the treatment results in patients of elderly and senile age.

The authors developed an original set of tools and a method of carrying out end-to-end anastomosis on major vessels, without stopping blood circulation in the vascular segment being repaired. The proposed set of tools includes 10 tubes (temporary vascular grafts) made of medical silicone with external diameters from 8 to 26 mm. The length of each tube is not less than 10 cm, and the wall thickness is 1.2 mm. A spiral notch with a step of 1.2 mm is made on the outer surface of the tubes, to a depth of 1 mm. The set of tools also includes a set of metal hollow half — cylinders with a through hole made in the middle, designed to extract the temporary shunt of the appropriate diameter. Before the formation of a vascular anastomosis, a silicone tube is selected, the outer diameter of which corresponds to the inner diameter of the damaged vessel. It is necessary to cut off a length of the tube, so that 2–3 cm of it could be introduced into the lumen of the proximal and distal segments of the damaged vessel. A stay-suture is laid in the center of the temporary bypass, on a site of its wall between two neighboring spiral notches. The ends of the temporary bypass, pre-filled with saline solution, are introduced into the distal and proximal ends of the divided vessel and are firmly fixed in the lumen of the vessel with two elastic bands. After placing the temporary bypass in the lumen of the damaged vessel, the blood flow is restored. Using the intraluminar temporary shunt as a scaffold, the edges of the vessel are approximated and stitched to its entire circumference, tying the first and last stitches of this seam. The last additional suture is placed in the area of the stay-suture overlying the wall of the temporary vascular shunt and is not tightened. A half-cylinder is placed above the untightened vascular suture and a stay-suture is placed at its opening. After that, tightly pressing the metal hollow half-cylinder to the vascular wall, and applying traction to the ends of the stay-suture the mechanical destruction of the silicone tube along the line of the spiral incision ensues. As a result, the tube is transformed into a double silicone rod, which is pulled through a through hole in the metal half-cylinder floor. After the extraction of the tube, the anastomosis is completed by tying a knot on the provisional suture. To simulate the proposed method, 10 operations were performed using a closed experimental circuit that completely simulates the real situation of restoring a damaged major vessel. The time of the operation, the technical features of the intervention, as well as the volume of “blood loss”, which was estimated by reducing the volume of blood circulating in the experimental circuit, were evaluated. Experimental testing with the use of a model simulating the situation of restoring a damaged major vessel, demonstrated the effectiveness of the developed method of applying a vascular end-to-end anastomosis with the use of a destructible temporary bypass; the average time of the operation was 10 minutes, and the volume of blood loss did not exceed 5 ml. The proposed set of tools and method can be effectively used in case of major vessels injury. The technique completely excludes the need for interrupting blood flow through the sutured vessel; it allows to reduce the volume of blood loss in vascular trauma, minimizes the time of ischemia in the area of blood supply to the damaged artery or venous stagnation of the drained segment (when suturing a vein), as well as to facilitate the imposition of a vascular suture to surgeons who do not have sufficient qualification in vascular surgery.

Dystonia is the debilitating movement disorder of central nervous system, often inherited, appearing as involuntary movements that occur due to deficiency or excess of neurotransmitters. The penetrance of dystonia is 30%, which means, that inherited dystonia is manifested only in 30% of mutating gene carriers, while the rest suffer from latent forms, so called “forms frustes” of this disorder. Until now only few mutations responsible for dystonia, had been unveiled, but we expect to exist up to 100 such mutations. Unless we uncover all mutations responsible for dystonia, we require reliable test for diagnosing latent forms of dystonia; and this necessity explains the importance of present study. The purpose of this research was to elaborate discrimination of dystonia on the basis of biogenic amines exchange peculiarities. The study presents the observational case — control study. The control group was randomly composed of those patients, who were checked for neuroglial tumors. We checked catecholamines and serotonin metabolites in plasma and urine of 12 dystonia patients main group by means of chromatography method and compared the results obtained from these two groups by means of the decision tree method, discriminant analysis, and factor analysis. We revealed increased serotonin turnover in dystonia, and on the base of those increased metabolites in plasma, such as 5-hydroxytryptophane and 5-hydroxiindolacetic acid, by means of advanced statistical methods we eleborated sensitive and specific test for diagnosis of dystonia. We recommend introducing into clinical practice of diagnostic tests for dystonia on the base of analysis of diagnosing level in plasma of 5-hydroxytryptophane and 5-hydroxiindolacetic acid by means of discriminant analysis and classification tree method due to high sensitivity and high specifity of those methods.

The purpose to study the risk factors for elderly women with left breast cancer at the stage of chemotherapy and radiotherapy in the context of daily clinical practice for early detection of possible cardiovascular complications and optimization of therapy.

Material and methods. 69 women with HER2 neu negative left breast cancer without severe cardiovascular disease were examined. The first group included 39 elderly patients (67.7 ± 3.8 years). The second group consisted of 34 middle-aged patients (49.8 ± 5.7 years). In addition to the risk assessment according to the Score scale, additional factors including psychosocial factors were studied. The examination was carried out before the start of treatment, after the end of the course of doxorubicin in a cumulative dose of up to 360 mg/m² and after the completion of radiation therapy 3D conformal radiation therapy SOD 39 Gr.

Results. In elderly patients, risk factors such as obesity, increased cholesterol, and hypertension were significantly more common. In both study groups, low physical activity was revealed associated with both cancer itself and the treatment. All examined patients had moderate reactive anxiety on the Spielberger-Hanin scale. Elderly patients showed high level of personal anxiety; the number of points scored — 49.3 ± 3.6. According to the Score scale, a moderate risk was detected in 18 (58.1%) and a high risk in 13(41.9%) elderly patients. After doxorubicin treatment asymptomatic systolic dysfunction was detected in 8 (20.5%) patients (decrease in EF<50%), 21 (75%) diastolic dysfunction with relaxation slowdown (E/A<1). In 9 (23.1%) of the women without reducing the EF fibrotic changes in the myocardium of the left ventricle was revealed. In 8 (20.5%) women a thickening of the pericardial layer was revealed.

Conclusion. The findings suggest the need for a personalized approach and assessment of risk factors in patients of different age groups with left breast cancer at the stage of preparation and conduct of chemoradiotherapy. This highlights the need for enhanced history collection and consideration of not only key but also additional risk factors. The results of the study can be used in the work of practical health care institutions for the planning, development, implementation and control of chemoradiography safety in terms of preventing cardiovascular complications.