Acute Management in Corrosive Ingestion

Corrosive ingestion is an important health problem and medical emergency worldwide. It occurs by accident or by intention. Acids cause coagulation necrosis, and alkalis cause liquefaction necrosis. In the acute period, stabilization of the patient is most important. Airway assessment and prompt management are a priority for severe cases. Caustic substance reflux into the esophagus resulting in further damage should be prevented. The initial evaluation should be performed by endoscopy and graded according to the Zargar classification. Computed tomography (CT) should be used to assess injury to the esophagus because CT is non-invasive. For Zargar 3b injuries, views from both endoscopy and CT scans should be considered. Post-corrosive esophageal stricture is a complication that responds poorly to treatment. Research and development for stricture prevention are ongoing, especially for Zargar 2b and 3a cases.

Effects of Noninvasive Low-Intensity Focus Ultrasound Neuromodulation on Spinal Cord Neurocircuits In Vivo

Although neurocircuits can be activated by focused ultrasound stimulation, it is unclear whether this is also true for spinal cord neurocircuits. In this study, we used low-intensity focused ultrasound (LIFU) to stimulate lumbar 4–lumbar 5 (L4–L5) segments of the spinal cord of normal Sprague Dawley rats with a clapper. The activation of the spinal cord neurocircuits enhanced soleus muscle contraction as measured by electromyography (EMG). Neuronal activation and injury were assessed by EMG, western blotting (WB), immunofluorescence, hematoxylin and eosin (H&E) staining, Nissl staining, enzyme-linked immunosorbent assay (ELISA), immunohistochemistry (IHC), somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), and the Basso–Beattie–Bresnahan locomotor rating scale. When the LIFU intensity was more than 0.5 MPa, LIFU stimulation induced soleus muscle contraction and increased the EMG amplitudes ( P < 0.05 ) and the number of c-fos- and GAD65-positive cells ( P < 0.05 ). When the LIFU intensity was 3.0 MPa, the LIFU stimulation led to spinal cord damage and decreased SEP amplitudes for electrophysiological assessment ( P < 0.05 ); this resulted in coagulation necrosis, structural destruction, neuronal loss in the dorsal horn by H&E and Nissl staining, and increased expression of GFAP, IL-1β, TNF-α, and caspase-3 by IHC, ELISA, and WB ( P < 0.05 ). These results show that LIFU can activate spinal cord neurocircuits and that LIFU stimulation with an irradiation intensity ≤1.5 MPa is a safe neurostimulation method for the spinal cord.

Rheosorbilact in complex intensive therapy of burn toxemia

Background. Thermal injuries primarily cause coagulation necrosis and cell death with vascular thrombosis in the areas of the deepest lesion.Objective. To study the effectiveness of rheosorbilact in infusion therapy during the period of burn toxemia.Materials and Methods. The results of monitoring the daily volume of the injected fluid, infusion therapy and renal excretory activity of 25 patients admitted to the Department of Combustiology of Republican Research Center of Emergency Medicine due to burn injury were studied.Results. The average daily volume of infusion therapy in group 1, FI – 119.4 ± 38.4 units at the age of 27.3 ± 5.6 years, was 76 ± 7 ml/kg per day, in group 2 (50.7 ± 7.1 years), FI – 92.5 ± 20.8 units, the introduction of 64 ± 9 ml/kg was effective, in group 3 (71.3 ± 7.0 years), FI – 86.7 ± 12.8 units, the introduction of an average of 48 ± 11 ml/kg per day was sufficient. In the nonlinear nature of changes in intravenous infusion, 4–5-day periods can be noted, probably due to the current factors that determined the need to increase or decrease infusion therapy. The introduction of rheosorbilact in a volume of 10 ml/kg per day increased the hourly renal excretory activity in all patients during the period of toxemia. The diuretic effect was more pronounced in patients of group 1, which corresponded to a greater volume of water load and the severity of burn injury.Conclusions. The introduction of rheosorbilact in a volume of 10 ml/kg per day increased the hourly renal excretory activity in all patients during the period of toxemia.

Estimation Of Pathomorphological Peculiarities Of Perivulnar Tissue After Ultrasonic Curettage Of Pilonidal Cysts Of Sacro-Coccygeal Region

The results of morphological research of operative wound’s tissue after ultrasonic curettage of acute pilonidal abscess are presented in the article. 13 patients were treated using the offered method, and of these, 11 patients underwent morphological research of the wound’s walls. Areas of the mucoid degeneration of the fibrous connective tissue and fragments of coagulation necrosis were identified, as a result of low-frequency ultrasound. The morphological substrates of recurrence pilonidal sinus, such as stratified squamous epithelium and hair follicles, were not found in any preparation, The offered method of treatment allows for ambulatory primary radical treatment in theacute stage of pilonidal illness. The offered method of ultrasonic curettage of the pilonidal sinus requires more scientific research and monitoring.

Comprehensive assessment of hemorrhoidectomy with lateral ultrasonic dissection in the “cut” mode

The effectiveness of the original technique of hemorrhoidectomy with lateral ultrasonic dissection in the cutting mode was analyzed from a clinical standpoint and studied according to pathomorphological changes in tissues during its use. A comparative assessment of the immediate results of treatment as well as pathomorphological changes in the tissue of removed hemorrhoids in two groups of patients was performed. The main group included 30 patients in whom the original hemorrhoidectomy technique with lateral ultrasound dissection in the cutting mode was used. The control group consisted of 30 patients who underwent Milligan Morgan hemorrhoidectomy using electrocoagulation. No significant difference was found between these groups in terms of the age and sex structure of patients, as well as the main clinical characteristics of the disease. In a comparative analysis of the immediate treatment results, the intensity of the pain syndrome and the incidence of postoperative complications were lower in the main group than in the control group. In the assessment of pathomorphological changes, the depth of coagulation necrosis and the severity of necrobiotic changes in the underlying layer after hemorrhoidectomy with lateral ultrasonic dissection in the cutting mode were significantly less than those after Milligan Morgan surgery using electrocoagulation. A significant difference was also revealed in the timing of tissue regeneration. The formation of active granulations in the postoperative wound area in the main group was noted on postoperative days 1416, while this process developed no earlier than on postoperative day 20 in the control group. As a result, complete epithelialization of wounds after hemorrhoidectomy with lateral ultrasound dissection in the cutting mode occurred much earlier, i.e., postoperative days 2630. A similar process after the Milligan Morgan hemorrhoidectomy using monopolar coagulation was completed only on postoperative days 3638. Thus, the use of the original technique of lateral ultrasound dissection provides a more sparing effect on tissues, which is the key to a favorable course of the postoperative period and rapid rehabilitation of patients.

Comparative estimation of a pain syndrome in patients after combined operations for coexistent pathology of anal channel and rectum with application of modern and standard surgical technologies

Objective. Comparative estimation of the pain syndrome in patients with concomitant pathology of anal channel and rectum after performance of combined operations, using modern high-frequency electro-surgical and radio-surgical apparatuses, as well as conventional scalpel. Materials and methods. The results of surgical treatment of 689 patients with concomitant pathology of anal channel and rectum, using apparatuses of a high-frequency electro-surgery and radio-wave surgery, were analyzed, using the pain syndrome estimation on 1-7th postoperative day. The patients were distributed into 4 investigation groups and a control group, consisting of 112 patients, operated on using metallic conventional surgical scalpel. Results. The pain syndrome on the first postoperative day was mostly expressed in patients of control group, for anesthesia they needed (4 ± 1) ml of 2% solution of promedol, while the patients of the first, third and fourth groups investigated, in which, accordingly, apparatus of radio-wave surgery «Surgitron» and high-frequency electro-surgical apparatuses «EFA» and «KLS Martin» were used, needed for anesthesia (2 ± 1) ml of 2% solution of promedol. While application of the electro-surgical high-frequency apparatus «ERBE ICC 200» the necessity for the 2% solution of promedol for anesthesia have constituted (3 ± 1) ml. Conclusion. Combined operations, using modern apparatuses of high-frequency electro-surgery and radio-wave surgery give significantly better results, than application of conventional surgical metallic scalpel, because it produces significantly reduced pain syndrome due to thin layer of coagulation necrosis, promoting formation of delicate elastic cicatrix and preventing development of cicatricial strictures of anal channel in postoperative period.

Pathomorphological changes in the organs of chickens infected spontaneously by the species Salmonella pullorum on private farms in Chernivtsi region

Commercial poultry production growth and the increase in the number of small farms specializing in raising broiler chickens, laying hens, quails, and other poultry contribute to the spread of infectious diseases. Non-compliance with the principles of biosafety during incubation and breeding results in mass deaths of poultry and, consequently, significant economic losses for farmers. Salmonellosis is one of the most dangerous anthropozoonotic diseases of poultry, which is most often registered in private farms. Age analysis of the poultry salmonellosis in the EU countries indicates the infection of adult laying hens most often, young poultry to a lesser extent, and chickens aged up to 10 days less frequently. Although the program for the prevention and elimination of poultry salmonellosis has been approved at the legislative level in Ukraine, monitoring studies are not carefully conducted. This is especially true for private homesteads and small farms, which greatly complicates the epizootiological situation in some regions of the country. The article describes the pathological and histological changes in the liver, heart, lungs, kidneys, and spleen. The changes were detected in chickens aged 10 and 14 days infected with microorganisms of the species Salmonella pullorum. Eggs for incubation were obtained from different family flocks, and incubation was performed in a single incubator. The initial clinical signs of the disease appeared in chickens aged 7 days and included diarrhea, increased water consumption, lameness, mass concentration of chickens near heat sources, nervous phenomena in the form of circle walking, and partial blindness in some cases. The pathological autopsy revealed hepatomegaly with sharp change in the organ colour, diapedetic hemorrhage under Glisson’s capsule, and diffuse miliary necrosis. Greyish-white nodular lesions of the lungs and heart, dystrophic changes in the kidneys, and deposition of uric acid salts in the ureters were also characteristic features. Diffuse coagulation necrosis, massive perivascular infiltration by heterophilic lymphocytes and stasis were observed in the liver. Changes in the heart were characterized by significant infiltration by mononuclear cells and heterophiles, which led to atrophy, necrosis, and replacement of cardiomyocytes by connective tissue cellular elements. Delymphatization and necrosis of the lymph nodes were pronounced in the spleen.

SURGICAL OPTIONS FOR NONPARASITIC SPLENIC CYSTS

Nonparasitic splenic cysts (NPSCs) are uncommon lesions of the spleen,clinically, they may be asymptomatic. Their classification includes two basic groups: the true cysts or primary cysts and false or pseudo cysts based on the presence or absence of an epithelial lining. The need for surgery of nonparasitic cysts is due to the development of complications: suppuration, hemorrhage into the cavity of the cyst and its rupture. Historically, the conventional surgical method was splenectomy, however, complete removal of the organ, especially at a young age, often led to life-threatening infectious complications. Spleen-preserving surgeryis considered to be analternative to classicalsplenectomy: partial resection of the spleen and fenestration with excisionof extra-hepaticcyst wall. However, as clinical practice has shown, these methods can be effectively used exclusively for the treatment of superficial cysts, and during the operation the ruptures of the capsule of the pathological focus with bleeding are observed. According to the general tendency in surgery to reduce the traumatization all patients were worked up with an ultrasound and X-Ray examination of the abdomen to look for the size and location of the splenic cysts. These operations include: drainage with sclerosing of the cyst and deepithelialization with superselective arterial embolization of the feeding vascular pedicle of the pathological focus. The study of these techniques revealed their weak points: the recurrence rate of cysts after sclerosis was 30-50%, and the use of embolizing agents in 50% of cases is complicated by ischemia of an organ segment with possible formation of an infarction zone in the early postoperative period. Nowadays the most promising method is considered to be a microwave ablation. Its thermal effect creates coagulation necrosis of the pathological focus and surrounding tissues with minimal toxic effects. This approach decidedly requires further research.

Ultrasound-Guided Radiofrequency Ablation of Chemodectomas in Five Dogs

Chemodectomas are low prevalence tumors with complex clinical management. Many present as an incidental finding however, in other dogs, they produce pericardial effusion and/or compression, leading to the appearance of severe clinical signs. There are currently several approaches: surgery, radiotherapy, stent placement and chemotherapy. This is the first description of percutaneous echo-guided radiofrequency ablation of aortic body tumors. This minimally invasive treatment is based on high frequency alternating electrical currents from an electrode that produces ionic agitation and generates frictional heat, causing coagulation necrosis. Five dogs with an echocardiographic and cytological diagnosis of chemodectoma underwent percutaneous echo-guided radiofrequency ablation. At the time of presentation, all the dogs showed clinical signs, such as ascites and/or collapse. There were no complications either during the procedure or in the following 24 hours. Rapid clinical improvement associated with a reduction in size and change in sonographic appearance of the mass were achieved with no complications. Six months follow-up was carried out in all dogs. A second percutaneous echo-guided RFA was performed eight months after the first procedure in one dog. Based on our experience, radiofrequency ablation seems to be a feasible and safe technique, making it a potential alternative therapeutic approach in the clinical management of aortic body tumors leading to severe clinical compromise.

Pulsed-Field Ablation in Ventricular Myocardium Using a Focal Catheter: The Impact of Application Repetition on Lesion Dimensions

Background - Pulsed-field ablation (PFA) is a rapid and nonthermal energy with higher selectivity to myocardial tissue in comparison to radiofrequency ablation (RFA). However, its effects on ventricular myocardium, and titration of lesion dimensions have not been well studied. This study examined the effect of PFA on ventricular myocardium, and the influence of application repetition on lesion dimensions. Methods - An 8Fr lattice catheter with a compressible 9 mm nitinol tip was used with a PFA generator (Affera Inc) applying a bipolar and biphasic waveform (±1.3-2.0 kV, 4 sec per application). We examined the impact of single applications (1x) vs four repetitive applications (4x) interspaced by 10 seconds. The latter was performed to determine whether repetitions of a similar electrical field can increase lesion dimensions. Experiments were performed in an in-vivo porcine model and a survival period of 24 hours (n=6) or 23±5.4 days (n=6) for evaluation of early and late histopathological effects. Results - PFA in ventricular myocardium showed repetition dependency. Acute lesion depth and volume increased from 5.6±1.43mm and 860±362mm 3 to 8.8±0.74mm and 2383±548mm 3 for 1x and 4x applications, respectively (P<0.001 for both comparisons). This effect was maintained in the chronic lesion phase with lesion depth and volume of 3.9±0.92mm and 655±286mm 3 compared with 7.3±0.83mm and 2170±488mm 3 , respectively (P<0.001 for both comparisons). Acute lesions showed well demarcated necrotic core without coagulation necrosis while chronic lesions showed tissue thinning with fibro-fatty replacement. Conclusions - PFA in ventricular myocardium exhibits repetition dependency as lesion dimension increases with consecutive applications of a similar electrical field.