Кафедра хірургії № 4
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Item A review of the artificial intelligence application as a guideline tool for the wound management(2024) Lurin, I.; Gorobeiko, M.; Sokol, Ye.; Usenko, O.; Khoroshun, Eduard; Makarov, Vitalii; Nehoduiko, Volodymyr; Gumeniuk, K.; Gorobeyko, B.; Dinets, А.he global interest and substantial challenges on this subject contribute to its relevance. This analysis centers on the implementation of artificial intelligence within the medical field, with a specific focus on its application in managing wounds. Through an examination of numerous online studies and publications, we can gain insight into how artificial intelligence is being employed to enhance the diagnosis, treatment, and monitoring of wound healing. The integration of artificial intelligence in this sector has the capacity to transform medical practice by improving precision, effectiveness, and individualized patient care. As a result, it is a leading area of research and advancement on a global scale. We used the PubMed and Google Scholar electronic databases of medical publications, searching for abstracts using the following key phrases: artificial intelligence and wound management, artificial intelligence and gunshot wounds, artificial intelligence and war medicine, artificial intelligence and surgery. Based on search results, a literature analysis was performed. Conclusions. It is necessary to create numerous working groups of highly qualified specialists from each discipline and direction of medical activity, where the specific weight of each symptom, laboratory indica-tor, each radiological and ultrasound examination result is determined based on the data of real cases. And such work should have no less discipline and structure than medical research, it is optimal to get a universal software tool for this stage of work, which can be used with certain variations for the whole variety of pathological conditions and processesItem Changes in the thyroid hormone status of the wounded depending on the volume of wound damage(2024) Misiura, K.; Lurin, І.; Seliukova, N.; Boiko, M.; Tykha, I.; Nehoduiko, Volodymyr; Kalashnyk, S.The wound process is considered to be the local and general organism’ responses which are developed to damaged tissues. The number of individuals with combat trauma was extremely increased due to Russia’s armed aggression against Ukraine started in February 2022. The wound healing and the course of wound process depend on large number of factors one of them is thyroid status. The impact of thyroid hormones on the particularities of combat traumas’ healing is the background of this investigation. The purpose of this research was to determine the link between wound sizes and thyroid hormones serum level at different period of the wound process. Material and methods. 30 militaries with wounds of soft tissues of different sizes have taken part in this study. The average age of wounded men was 34.2 ± 4.3. The average body mass was 78 ± 3.5 kg. Free T3 and T4, thyrotropic hormone (TTH) concentrations have been determined. Results. During investigation free T3 concentration was at level 3.4–5.2 pmol/L and hasn’t statistically changed in all the participants comparing to its concentration within 1–3 days. The concentration of free T4 did not differ in militaries with minimal as well as with mild injuries. The levels of free T4 hormones were signifi cantly (р < 0.05) higher in severely wounded men during the entire duration of the investigation. TTH levels considerably (р < 0.05) increased in wounded men with severe and mild wounds in compare with participants with minimal wounds on 1–5 days. However, the concentration of TTH significantly (р < 0.05) declined in the all groups of wounded on 14 day of the investigation. Conclusions. The concentrations of free T4 and thyrotropic hormone significantly increased in wounded men with severe and mild wounds on 1–5 days after wounding. The concentrations of free T3 haven’t considerably changedItem Clinical case: somatopsychic disorder in a female patient with multinodular euthyroid goiter(Kharkiv National Medical University, 2016-05-19) Tsopozidis, Christos; Borisenko, Anastasia; Telezhnyi, AndriiPsychogenic disorders referred to as nosogenies due to the influence of psychotraumatic events associated with somatic disorder. In case of combined impact of a number of adverse factors, the reaction to the disease can become so extreme that its management in the early stages of therapy seems no less important than the direct treatment of somatic condition.Item Clinical classification of liver cirrhosis - a way to plan individual definitive treatment(2024-12-01) Petiunin, Oleksii; Shevchenko, Rostislav; Brek, Ostap; Kolomensky, OleksiiAim: To develop clinical classification of liver cirrhosis, which can aid individualization and planning definitive treatment for this group of patients. Materials and Methods: Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: “liver”, “cirrhosis” and “classification”; or “liver”, “cirrhosis” and “complications”; or “liver”, “cirrhosis” and “treatment”; or “portal” “, “hypertension” and “complications”. Articles were independently evaluated by each author, the etiological, orphological and current clinical classifications of LC were analyzed, their advantages and disadvantages identified, and after discussion classification of LC was developed by consensus. Conclusions: The developed clinical classification of liver cirrhosis will facilitate the planning of therapeutic tactics for each patient, allow to personalize the treatment of patients with this pathology.Item Clinical effects of ligation of left gastric artery and vein, splenic artery in patients with liver cirrhosis and secondary hypersplenism(2023-09-25) Petiunin, Oleksii; Feskov, Volodymyr; Konoplia, LinaItem Computational modeling and analysis of wound formation in gunshot injuries(2023) Larin, Oleksiy; Tomashevskyi, Roman; Lurin, Igor; Gumeniuk, Kostyantyn; Nehoduiko, VolodymyrThis research aims to investigate the physical processes accompanying high-speed element penetration in gunshot wounds and understand the formation of wound channels, trajectory characteristics of bullets, and damaging effects on surrounding tissues. The study utilizes 3D computer modeling to simulate highspeed element penetration based on the 3D finite element method (FEM). The paper presents a methodology of computer simulation with mathematical basics and algorithmic descriptions. The approach uses direct explicit numerical integration over time for the impact of the metallic bullet into the gelatin block specimen that analyses within the framework of its plasticity considering the nonlinear pressure dependence in a shock wave. The algorithm of simulation incorporates the process of material destruction, where elements that reach critical strain values are removed from the model. The study provides insights into the behavior of different bullet types and their impact on tissue deformation from computational experiments that simulate the penetration into ballistic gelatin of two types of bullets, the 7H6M type, and the V-max type. The simulation results reveal the distribution of equivalent stresses in the wound channel at different moments in time. Additionally, the study analyses the penetration depth and diameter of the damaged material for both bullet types. The developed 3D computer modeling method can serve as a valuable tool for further investigations, facilitating the development of advanced medical treatments.Item Features of general surgery teaching to medical students(ТДМУ, 2016-05) Tsyganenko, Oksana; Shevchenko, StanislavThe subject «General Surgery» is one of the basic disciplines, laying foundation for study of surgical activity, which is required for every physician-clinician, regardless of his or her further specialization. In modern socioeconomic conditions, only a widely educated physician, who can exibly rebuild direction and content of his or her activities taking into account changing requirements and the advent of new medical technologies is of the true value to health care service.Item Features of the use of ladder myoplasty of a gunshot wound to the laryngopharynx: Case report(2023-10-01) Lurin, I.; Makarov, Vitaliy; Khoroshun, Eduard; Nehoduiko, Volodymyr; Shypilov, Sergiy; Smolianyk, KostiantynIntroduction and importance: The laryngopharynx wound is considered to be one of the most severe wounds of neck both in war and in peace, as it may cause life threatening changes in the whole body (asphyxia, bleeding, shock). Important aspects of surgical treatment are to ensure full breathing, acceptable ways of feeding, and the use of reliable wound closure techniques aimed to prevent digestive tract failure and to maintain the framework and aerostasis of the laryngotracheal region. Case presentation: A case of unilateral multiple wounds of the laryngopharynx was described in the article. The features of diagnostics, surgical treatment and conservative therapy in the postoperative period with this injury were presented. The wounded man was urgently operated. During surgery the pharynx was mobilized. The metal fragment was removed. The wound of the pharynx was sutured with a two-row suture. The next stage of the surgical treatment was myoplasty. In the case of the patient, the purpose of myoplasty was additional sealing of the pharyngeal suture and myoplasty of the thyroid cartilage injury zone for the purpose of aerostasis. Because of the size of the wounds and their anatomical localization, we used the mobilized lower edge of the Musculus sternocleidomastoideus for myoplasty and proposed the method of ladder myoplasty developed by us. Clinical discussion: In myoplasty method the following criteria must be followed: the muscle flap must be of sufficient length and width, so as not to cause excessive tension in the myoplasty area; the flap must be thick enough to avoid necrosis that may cause subsequent infectious complications; when taking the flap, the most sparing operative access should be used to avoid functional and anatomical disorders; the volume of the taken muscle flap must not lead to functional and anatomical disorders. Conclusion: The proposed method of ladder myoplasty using Musculus sternocleidomastoideus is unique, and proves its high efficiency in unilateral multiple laryngopharyngeal injuries, and can be recommended for wide clinical implementation in such clinical situations.Item Gunshot shrapnel wound of the thigh with damage to the superficial femoral artery (features of clinical manifestations, development of complications with late medical care and preservation of the limb)(2023) Lurin, I.; Makarov, Vitaly; Nehoduiko, Volodymyr; Smolianyk, Kostiantyn; Chobey, S.; Ott, O.The aim:To demonstrate the features of clinical manifestations and complications that occur with delayed medical treatment in cases of gunshot shrapnel through a wound of the thigh with damage to the superficial femoral artery. Materials and methods: The wounded individual, S., was 52 years old and had sustained a gunshot wound through a shrapnel wound of the left thigh with damage to the superficial femoral artery and soft tissue defect. Medical assistance was provided during the stages of medical evacuation. Results: The soldier sustained a gunshot wound through the upper third of the left thigh, resulting in damage to the vascular-nerve bundle and a soft tissue defect. First aid was provided at the scene, and surgical procedures were performed during the stages of medical evacuation, including primary surgical treatment of wounds in the upper third of the left thigh. On the second day following the injury, the wounded man was transferred to the Vinnytsia Military Medical Clinical Center and admitted to the vascular surgery department. After an ultrasound examination and repeated surgical treatment of the wound on the left thigh, damage to the superficial femoral artery was identified. Conclusions: The presence of features of blood circulation in gunshot wounds of the main vessels of the lower limbs can favorably affect the possibility of saving the limb, as evidenced by the case presented.Item Management of gunshot injury to the abdominal aorta and inferior vena cava: a case report of a combat patient wounded in the Russo-Ukrainian war(2024) Lurin, Igor; Khoroshun, Eduard; Makarov, Vitalii; Negoduyko, Volodymyr; Shypilov, Sergiy; Bunin, Yurii; Gorobeiko, Maksym; Dinets, AndriiBackground Russo-Ukrainian war is associated with severe traumas, including injuries to the major vessels. Penetrating aortic injury remains one of the most difficult injuries; the mortality rate is 90–100% in case of gunshot wounds, associated with frequent lethal outcomes due to uncontrolled bleeding. Of the three main abdominal veins, the inferior vena cava (IVC) is the most frequently damaged, which is required quick and appropriate surgical decisions to be made. Little is known about the management of gunshot injuries to such major vessels as the aorta and IVC. It is also worth mentioning about the importance to share our practical experience from the ongoing war for better understanding and future considerations by war surgeons of the vascular trauma management. The aim of the study was to demonstrate the specific features of the diagnosis and management of a gunshot shrapnel blind penetrating wound to the abdomen with injury to the aortic bifurcation level and the infrarenal section of the inferior vena cava. Case presentation A 44-year-old male soldier of the Armed Forces of Ukraine received a gunshot injury to the abdomen from a mortars’ explosive shelling. The patient was evacuated to the Forward Surgical Team (Role 1) and received primary surgical treatment within one hour after the injury according to the “golden hour” principle. Then, evacuated was performed to the Role 3 hospital in Kharkiv. At the Role 3 hospital, the patient underwent secondlook surgery as well as damage control surgery. At revision, no active bleeding was observed, and the surgical pads (packed previously by the Forward Surgical Team) were removed. Further revision showed a metal projectile within the aortic wall at the level of aortic bifurcation and wall defects were also detected for inferior vena cava. This metal projectile was removed by using the multifunctional surgical magnetic tool followed by suturing of the aortic wall defect as well as defects of the inferior vena cava. Conclusions Application of Damage Control Surgery is a useful approach in the management of severe vascular injury as well as useful to stop abdominal contamination by intestinal contents. The application of a surgical magnetic tool for the searching and removal of ferromagnetic foreign bodies reduces operative trauma and reduces the time for identification of foreign bodies.