3. The main methods of treatment of boils and carbuncles. General and local, conservative and surgical methods of treatment Treatment can be divided into general and local, specific and non-specific.

3. The main methods of treatment of abscesses. General and local, conservative and surgical methods of treatment At the very beginning of the disease, when the abscess has not yet formed, but there are anamnestic data that suggest the possibility of its occurrence, it is permissible

6. The main methods of treatment of phlegmon. General and local, conservative and operative methods of treatment Treatment is similar to that described earlier for abscesses. The only difference can be the need for immediate antibiotic therapy and surgical treatment with

3. The main methods of treatment of erysipelas. General and local, conservative and surgical methods of treatment The issue of hospitalization is decided depending on the general condition of the patient. With the erythematous form, treatment at home is possible. But anyway

3. The main methods of treatment of tetanus. Specific and non-specific treatments Non-specific treatments include a number of activities. First of all, this is the hospitalization of the patient in a specialized hospital with mandatory placement in a separate ward.

3. The main methods of treatment of peritonitis. General and local, conservative and surgical methods of treatment Emergency hospitalization in a surgical hospital and a surgical method of treatment are absolutely indicated. If examination on admission suggests the presence of

2. Methods This goal is served by a homeopathic anamnesis, which complements and deepens the main anamnesis. In the Organon, in §§ 83-104, the basic principles of "individualized evaluation of a case of illness" are presented. Everyone should read the original for himself and think it over. Nothing

Barrier methods These include condoms, caps and diaphragms. These methods are less effective, but they do not affect the ability to conceive in any way and do not cause any changes in the body. Therefore, they can be used immediately before the planned conception. Olga with

2. Psychophysiological Methods Taijiquan teachers make extensive use of Taoist terminology, or at least that part of it referring to "internal alchemy" ("hei dan") (79), in describing the appropriate exercises. In any case, in both disciplines

Breathing Techniques For more on the breathing techniques used in gymnastics and to achieve concentration, see Chapter 5. Breathing Exercises. To perform this exercise, you need to know the following: in breathing it is important

7.5.3. Surgical methods 7.5.3.1. Vital pulp extirpation Vital pulp extirpation (pulpectomy) is the most common method of pulpitis treatment in world practice. The indications for pulp extirpation are as follows:? any form of inflammation of the pulp;

Invasive from the Latin invasio - penetration, invasion, penetration.

Invasive research methods- these are methods based on the introduction of substances into the body cavity - intramuscularly, intravenously or with damage to the skin, mucous membranes.

Also, instrumental methods can be attributed to invasive methods - deep penetration into the body's natural pathways, for example, colonoscopy. Visualization of the internal structures of the body, obtaining tissue or cell samples for research (biopsy) is the main purpose of invasive methods. Their use may be accompanied by the risk of bleeding, infection, mechanical damage to organs.

In this regard, modern medicine tends to move towards replacing invasive methods with minimally invasive, non-invasive ones.

Invasive diagnostic methods are used in prenatal diagnostics - placentobiopsy, biopsy of fetal tissues, amniocentesis - obtaining amniotic fluid, cordocentesis - taking fetal blood; in the diagnosis of respiratory diseases - bronchoscopy, bronchography, pleural puncture, pleural biopsy, lung biopsy and others; as well as in cardiology, urology, gastroenterology.

Invasive diagnostic methods allow you to make a reliable diagnosis, they provide high diagnostic accuracy.

The information provided on the site is for informational purposes only. To make the correct diagnosis and choose the right treatment tactics, you need to seek help from a doctor.

Pleurisy: stages and diagnostic methods

Pleurisy - inflammation of the pleura sheets, at first glance, a simple disease is a clear sign of serious and even insidious diseases, like oncology. Because it refers mainly to secondary lesions, due to structural and functional disorders in the surrounding organs. It proceeds in the form of dry (fibrinous) and exudative (effusion) pleurisy.

Classification of pleurisy - causes

According to the causes, they are divided into:

pleurisy of infectious origin, resulting from the penetration of the pathogen between the sheets of the pleura (by contact, through the lymph and blood):

• bacterial (tuberculosis, bacterial pneumonia (pneumonia), syphilis, brucellosis, tularemia)
• viral and rickettsial (atypical viral pneumonia, psittacosis, Q fever)
• fungal (coccidioidomycosis, blastomycosis, candidomycosis)
• protozoan (amebiasis)
• helminths (echinococcus, trematodes).

non-infectious pleurisy, due to pathological processes in other organs:

• heart diseases
• oncological processes
• kidney dysfunction
• diseases of the gastrointestinal tract (cirrhosis of the liver, pancreatitis, alimentary dystrophy)
• autoimmune connective tissue diseases
• blood pathology (thrombocytopenia, leukemia)
• lung atelectasis
• ovarian fibroma (Meigs syndrome)

Questioning and physical data - the basis of a correct diagnosis

The set of characteristic complaints of the patient is the main symptoms, they will differ in different forms of pleurisy:

Dry pleurisy is manifested by intense, stabbing, more often, one-sided pain in the area of ​​the affected lung, associated with a change in body position; when coughing, sneezing, inhaling as deeply as possible and moving in the opposite direction, it intensifies; lying on the sore side the pain decreases; shallow breathing. Perhaps fever, sweating, weakness, loss of appetite.

Exudative pleurisy is characterized by heaviness in the chest cavity, shortness of breath, cough, cyanosis. Pain is present in carcinomatous lesions of the pleura. Signs of purulent pleurisy are febrile (38 ° C and above) temperature, pain when breathing, symptoms of general malaise, severe sweating and chills.

The collection of an anamnesis of the disease is an important diagnostic step, due to the secondary nature of pleurisy. The doctor carefully asks the patient:

where the patient lives and works (to exclude infection with fungi, rickettsia and viruses in the course of personal and professional activities);

nutritional features (exclude protozoal infections and helminthiases);

about contacts with sick people (tuberculosis, syphilis) and past infectious diseases;

complaints and possible ailments from the cardiovascular system, gastrointestinal tract, kidneys, blood, ovaries (for women), connective tissue.

Physical findings include examination of the patient, palpation, percussion and auscultation.

In a patient with dry pleurisy, on examination, asymmetry of the chest during breathing is visible, and in a patient with exudative pleurisy, a decrease in chest excursion during breathing and expansion of the intercostal spaces on the affected side.

Dry pleurisy is detected by palpation behind the pleural friction noise and voice trembling disorders, pain in the trapezius and pectoral muscles is characteristic of the apical localization of dry pleurisy.

The sound during percussion (when tapping) may remain unchanged in a patient with dry pleurisy. Exudative pleurisy is manifested by a dull or dull sound, the upper line of which is called Sokolov-Ellis-Damuazo.

Auscultation (listening) of a patient with dry pleurisy reveals a pleural friction noise, which is the same on inhalation, exhalation and raising and lowering the chest without inhaling air, persists after coughing (as opposed to moist rales in pneumonia). Exudative pleurisy - weakened (above the site of effusion) and bronchial breathing (above the compressed lung tissue, above the exudate).

At the initial stage, after a detailed survey of the patient, taking into account the localization of pain (where does it hurt?), its irradiation (where does it spread?) and the data of the physical examination, the doctor forms an opinion about the form of pleurisy, its nature (infectious or non-infectious). This knowledge will help in the appointment of the following laboratory and instrumental methods of research and the correct diagnosis.

What laboratory tests are needed to diagnose pleurisy?

A general blood test for pleurisy of inflammatory origin is characterized by leukocytosis, a shift to the left of the leukocyte formula, sometimes anemia, an increase in ESR and monocytosis and eosinopenia inherent in tuberculous lesions.

In the analysis of urine, a small amount of protein can be determined, erythrocytes and epithelial cells are found.

A biochemical blood test reveals an increase in the level of sialic acids and fibrinogen in combination with a normal amount of total protein. There may be a decrease in albumin levels and an increase in globulins in the acute phase of the disease. Given the complaints and the patient's condition, determine the levels of glucose, cholesterol, rheumatic factor, liver tests.

With the possible tuberculous nature of pleurisy, a Mantoux test is prescribed - a specific intradermal test for sensitivity to Mycobacterium tuberculosis.

To exclude syphilis, a blood test is performed for RW (Wasserman reaction).

The results of laboratory tests help to determine the cause (etiological factor) of pleurisy and to choose the right instrumental research methods.

Diagnostic capabilities of non-invasive research methods

Using instrumental methods, the area (scale) of the lesion and the nature of the inflammatory process are determined.

Non-invasive research methods include X-ray, ultrasound, ECG, FVD.

1. fluoroscopy - the most common and mandatory, shows the presence of fluid in the pleural cavity, according to the type of uniform darkening with a clear and oblique line from above. When there is little fluid, it is visually manifested by a thickening of the costal margin, in case of a massive lesion, the mediastinum moves to the healthy side. Provides an opportunity to see the movement of fluid with free pleural effusion due to a change in the position of the body and breathing of the patient. Dry pleurisy manifests itself: the diaphragmatic dome is high, lags behind at maximum inspiration, the lower borders of the lungs do not have adequate mobility, they are compacted.
2. radiography - carried out in 2 projections: a survey in direct projection can miss the disease with a fluid volume of up to 300 ml. The laterogram (lying the patient on his side) allows you to determine the presence of effusion up to 100 ml and distinguish it from adhesions, previously transferred inflammatory processes.
3. x-ray computed tomography - is characterized by high diagnostic value: it qualitatively determines the state of the lung tissue (parenchyma), mediastinum, pleural cavity and the pleura itself, already at the initial stage of the disease detects the presence of effusion. The use of contrast helps to identify encysted pleurisy with local effusions, differentiate with lung tissue damage, and determine the nature of pleural neoplasms. Knotty thickening of the pleura with diverging circles indicate the malignant nature of the changes.
4. Bronchography is a contrast method for studying the cavity of the bronchi, used for the purpose of differential diagnosis to identify oncological processes in the bronchi.
5. Ultrasound examination - allows you to identify a small amount of pleural fluid (5 ml), distinguish it from thickening and fibrosis of the pleura, detect a hidden diaphragmatic dome under the effusion, a fairly informative and convenient method for puncture, biopsy and drainage.
6. ECG (electrocardiography) - in order to differentiate pleurisy on the left side and myocardial infarction, given the possible displacement of the mediastinal organs and the axis of the heart with massive pleurisy and adhesions.
7. FVD (function of external respiration) - the vital capacity of the lungs (VC) is reduced due to restrictive violations of the pleura.

The above methods of non-invasive diagnostics have their advantages and disadvantages. Given them, you need to correctly use the capabilities of the method for different forms of pleurisy. So, fluoroscopy plays a major role in the diagnosis of exudative pleurisy. If necessary, it is necessary to combine the use of X-ray with other studies to improve the diagnostic accuracy of the method.

Invasive methods - a combination of diagnosis and treatment

Invasive diagnostic methods include pleural puncture thoracoscopy.

Pleural puncture: manipulation consists in puncturing the chest and pleura for the purpose of diagnosis and treatment. Before the procedure, the patient's morale and premedication (preparation for anesthesia) are carried out. During its implementation, the patient sits with his back to the doctor, hands on the table, in severe cases - it is allowed in the supine position. Under sterile conditions, observing the rules of asepsis, first disinfect the site of the proposed puncture with iodine and chlorhexidine and dry it with a napkin. The skin is anesthetized with a 0.5% novocaine solution. The syringe is connected to a thin puncture needle using a rubber tube with a clamp, it will not allow air to enter the pleural cavity. The doctor performs a puncture in the seventh-eighth intercostal space along the upper edge of the rib (excludes nerve damage) in order to remove the accumulated fluid. Fills the syringe slowly, transfers the effusion into a sterile dish for further research. The skin around the wound is compressed, disinfected and sealed. To prevent the development of complications, the patient stays under the supervision of medical staff for a day.

The resulting fluid is examined by studying biochemistry, cytology and flora.

Visually, one can distinguish a transparent yellowish transudate (non-inflammatory congestive effusion) and the following types of inflammatory exudate:

• Serous - similar to transudate, transparent and odorless;
• Purulent - thick, cloudy from grayish to yellow-green, mostly odorless, only fetid with gangrene;
• Hemorrhagic - color from slightly pink to intense brown, which depends on the amount and duration of blood penetration into the pleural cavity, contains red blood cells (erythrocytes) with changes and unchanged structure, corresponds to oncological processes of the pleura and lungs, tuberculosis and traumatic lesions of the pleura, rarely pneumonia ;
• Chylous - milky with a large amount of fat, associated with impaired lymph circulation in the thoracic duct due to neoplasms, enlarged lymph nodes, or its rupture;
• Cholesterol - from rich yellow to brown, quite thick, indicates long-standing localized processes.

In a biochemical study:

• in transudates, a small amount of protein is determined up to 25 g / l and, accordingly, the density is in the range of 1.002-1.015;
• for exudates, a high level of protein ≥ 30 g / l (for purulent up to 70 g / l), a relative density of 1.015 and above, a positive Rivalt test is inherent;
• the amount of glucose up to 3 mmol / l is determined in tuberculosis, malignant neoplasms, violation of the integrity of the esophagus, inflammation of the lungs, autoimmune diseases (rheumatoid arthritis, early stage of pleurisy in lupus);
• high amylase levels occur in effusions due to pancreatitis, esophageal rupture, lung adenocarcinoma (rare);
• rheumatoid (rheumatoid arthritis) and antinuclear factor (systemic lupus erythematosus) can be detected by immunological methods.

Microbiological (cytological) examination is carried out:

• native (unstained) smears for studying the qualitative and quantitative composition of cells (erythrocytes, lymphocytes, tumor cells, fat drops, cholesterol, etc.);
• stained smears to determine the percentage of individual types of lymphocytes, a detailed study of the structure of cells. The presence of eosinophils is characteristic of allergic processes in the lungs and pleura, and mesothelium is found in the initial stage of an inflamed reaction and in neoplasms (mesothelioma).

The study of the pleural fluid for the presence of flora allows you to identify the causative agent of the disease and identify its antibiotic resistance (sensitivity).

Thoracoscopy is a modern invasive endoscopic method of diagnosis and treatment. Manipulation is carried out under anesthesia lying with the patient side up, the telescope is inserted into the 4.5 intercostal space along the middle axillary line for the most complete examination. The use of a fiberscope allows you to examine the chest cavity, the condition of the lung and pleura, select biopsy specimens (material for research) from all places suspicious for pathological changes. For therapeutic purposes, it is used to evacuate pleural effusion, destroy and cauterize adhesions, pleural lesions in pneumothorax and neoplasms. The advantages compared to open surgery on the organs of the chest cavity include less trauma, less pain, less complications (adhesions), the patient recovers faster after the manipulation.

Thanks to invasive research methods (pleural puncture and thoracoscopy), it is possible to obtain high-quality material for studying and making the correct diagnosis with deciphering the cause of the disease (establishing the etiological factor). Also improve the patient's condition by evacuating the pleural fluid.

Learn more about pleurisy from the video.

Thus, for the diagnosis of pleurisy, it is important to adhere to the stages in the conduct of research. It is necessary to conscientiously carry out a clinical examination of the patient using the skills of a doctor (questionnaire and physical data). The second stage is the use of modern instrumental diagnostic methods available in medicine and their combination with laboratory tests will help diagnose pleurisy, deciphering its cause, which will ensure high-quality treatment and recovery of the patient.

Invasive cardiology

Invasive cardiology

The use of cardiac catheterization for therapeutic purposes gave rise to a whole direction - invasive cardiology. Now with IBS. In patients with acquired and congenital heart defects, instead of open heart surgery, endovascular methods are increasingly being used - balloon coronary angioplasty and balloon valvuloplasty.

The fact that balloon coronary angioplasty is difficult in bifurcation stenoses, calcified, eccentric and complicated plaques (plaques with a thrombus) has led to the appearance of stents. atherectomy and laser angioplasty. They have entered clinical practice since the early 1990s; in many clinics, they already account for 30-40% of endovascular interventions for coronary artery disease. These methods are quite safe and reliable (including long-term results - the risk of re-stenosis), which largely compensates for their higher cost compared to conventional balloon coronary angioplasty.

In the treatment of congenital heart defects in pediatric invasive cardiology, there are a number of radical and palliative endovascular treatments. In addition to balloon valvuloplasty for congenital heart defects, many other methods are used: balloon angioplasty for coarctation of the aorta, balloon angioplasty for stenosis of the branches of the pulmonary artery, embolization of aortopulmonary anastomoses, installation of stents for coarctation of the aorta. stenoses of the branches of the pulmonary artery and after creating a variety of anastomoses, balloon atrial septostomy, closure of the ventricular septal defect. closure of an atrial septal defect and closure of the patent ductus arteriosus.

Cardiology in Israel. Heart treatment in Israel

Diseases of the cardiovascular system are, according to WHO, the leading cause of death and disability in the world. In Israel, where the treatment of heart disease is one of the priority areas of medicine, this figure has been significantly reduced.

To provide effective medical care for CVD, highly qualified doctors are required, as well as the availability of modern equipment at their disposal, which is now equipped with the cardiology departments of the Ichilov clinic.

The level of development of cardiology in Israel makes it possible to save even those patients who were recognized as incurable in other countries, as well as to treat patients from the "risk groups" - those with diabetes. obesity, hyperlipidemia or hypertension.

Diagnosis of heart disease in Israel

To study the cardiovascular system and make an accurate diagnosis, our clinic uses:

• Ultrasound of the heart (echocardiography, Doppler diagnostics)
• CT, MRI
• cardiac catheterization.
• coronary angiography (performed under local anesthesia)
• Isotope Scan
• Invasive hemodynamic monitoring and assessment of pulmonary hypertension
• Endovasal fiberoptic diagnosis of small vessels.
• Holter cardiography is a round-the-clock recording of the heart rate using a portable device that does not require the patient to be in the clinic.

The Best-Ichilov Coordination Center will ensure that you get a quick diagnosis without having to wait in long queues, which can be quite long in public hospitals.

Treatment of heart diseases in Israel at the Ichilov clinic

Therapeutic treatment of heart disease in Israel is characterized by a high percentage of effectiveness. Israeli cardiologists skillfully treat coronary disease, heart attack, arrhythmias, angina pectoris, heart failure, including acute and chronic forms, and other diseases of the cardiovascular system.

The cardiology department of the Ichilov hospital consists of a cardio hospital, an intensive care unit, a diagnostic and rehabilitation unit, and subspecialty departments, which employ dozens of world-class doctors and nurses. Among them are professors and teachers of medical faculties, well-known in the world of medical science.

In the Department of Thoracic Surgery of the Ichilov Hospital, cardiosurgical operations of any complexity are performed.

The Best-Ichilov Coordination Center will help you get diagnosed and treated by the best hospital specialists, professors and heads of departments. Among them:

• Professor Gadi Keren is the head of the cardiology department.
• Professor Shmul Banai is a specialist in coronary angiography.
• Professor Sami Wiskin - head. laboratory of electrocardiography and ergometry.
• Dr. Bella Koifman - head. Department of Diagnostics and Rehabilitation
• Dr. Dov Wexler - Senior Physician, Diagnostic and Rehabilitation Department

In addition to surgery and drug treatment, water procedures, diets, physiotherapy exercises, cardio equipment, physiotherapy and other methods of treatment and rehabilitation of the heart are used in the cardiology departments of our hospital.

In Ichilov, preventive treatment is also carried out at a high risk of developing cardiovascular diseases.

Invasive cardiology

Invasive methods are used for both diagnostic and therapeutic procedures that require penetration into the body. Among them:

Stenting for blockage of blood vessels. With the development of atherosclerosis or other problems that lead to narrowing or squeezing of the vessels, a cylindrical frame (stent) made of wire of various metal alloys is inserted into them, which prevents re-narrowing of the vessels and ensures normal blood flow. In addition to the usual ones, special stents impregnated with drugs or stents made of soluble material are used. Which dissolve in about a year when the condition of the vessel returns to normal. Catheterization for replacement or reconstruction of heart valves. This crucial operation today can be performed without opening the chest - a new valve is inserted into the heart through a catheter, under X-ray and echocardiography control. This procedure allows you to help patients who are contraindicated in radical surgery. Probing of vessels - allows not only to perform an examination of the internal cavities of the heart and blood vessels, but also to eliminate blood clots, atherosclerotic plaques, to dissect places of constriction.
1. Probing of the heart.
2. Ablations in cardiac arrhythmias.

Ablations are used to block impulses that cause an arrhythmia. To do this, small areas of cardiac tissue are destroyed, and the resulting scar tissue ceases to conduct pathological nerve impulses. Ablation can be carried out by various methods:

Surgical, when incisions are made on the heart; Heating a section of the heart tissue through an electrode inserted into the body Freezing (cryoablation); Laser ablation; Radiofrequency ablation is the most popular due to the minimal risk of complications and high efficiency.

Ablations of the heart can be performed both during a radical operation and through catheters inserted into the blood vessels. Ablations are especially useful in cases where the patient has contraindications to taking pharmaceuticals.

Every year, Israel, including our clinic, is visited by tens of thousands of patients from other countries who want to receive high-quality and professional treatment from our doctors. If you need the help of Israeli cardiologists or cardiac surgeons, you can contact the specialists of the Best-Ichilov coordination center using any contact that is convenient for you from those listed on the site.

Cardiac surgery in Israel: invasive cardiology

Invasive cardiology - beauty and beauty and pride of Israeli medicine. The spectrum of diseases of the heart and blood vessels that can be treated by endovascular methods through blood vessels is quite wide.

It is customary to refer to invasive cardiology diseases of the cardiovascular system. requiring the intervention of a cardiac surgeon who owns endovascular methods of treatment. They are understood as surgical manipulations performed on blood vessels using visualization tools (X-ray, computed tomography, etc.) and special surgical instruments.

Invasive cardiology in Israel is one of the most successful directions of the famous Israeli medicine both in the field of diagnostics and treatment of diseases of the heart and blood vessels.

One of the main areas of application of invasive cardiology is angiography or its special case - aortography. We are talking about the study of the state of blood vessels or specifically the aorta. A radioactive contrast agent is injected into the coronary arteries. Tracking its distribution in the circulatory network surrounding the heart using X-ray, the cardiac surgeon sees the structure and, accordingly, disturbances in the work of the heart, its vessels and valves, determines the presence of blood clots and cholesterol plaques. Directly during the study, the surgeon can perform invasive procedures to restore blood flow.

Stenosis of the coronary arteries, detected with the help of coronary angiography, is corrected with the help of stenting - the installation of a stent, which ensures the maintenance of the lumen of the vessels and the normal level of blood flow in them. In the case when a lesion of three or more coronary vessels is diagnosed, a cardiac surgeon may prescribe a major cardiac surgery to perform bypass surgery - artificial blood flow bypassing the blocked areas of the coronary network.

Methods invasive cardiology in Israel treatment of some heart defects in children and adults, such as valvular stenosis or some defects of the interatrial and interventricular septum, bifurcation arterial stenosis, as well as the treatment of coronary heart disease, heart attacks and strokes in an acute state, postinfarction cardiosclerosis, unstable angina pectoris, chronic occlusions etc.

The following is a partial list of the main methods of invasive cardiology:

• heart valve replacement
• catheterization and expansion of the main vessels and heart
• aortic prosthesis
• vascular stenting. carotid artery, coronary vessels, bifurcation stenoses, pulmonary arteries, as well as stenting and angioplasty of the iliac and femoral arteries.
• implantation of permanent pacemakers
• embolization of cerebral aneurysms

Modern stents, widely used by Israeli cardiac surgeons, have special coatings that prevent recurrent vascular stenosis. The substances that make up the coating have antitumor, wound healing, and immunosuppressive effects, which makes it possible to achieve good engraftment of stents without a rejection reaction and other side effects.

As a rule, endovascular operations are performed under local anesthesia, they have a minimal risk of bleeding and do not cause infection of the surgical wound. Invasive cardiology is characterized by rapid recovery and an almost complete absence of side effects.

Israeli medicine is rightly proud of its staff - world-famous specialists who work in conditions of brilliant technical equipment.

Anyone who is interested in treatment should contact the consultant of the Medserver portal. You are guaranteed comprehensive assistance in organizing treatment in Israel with leading doctors, at a convenient time and at reasonable prices.

The center of invasive cardiology in Simferopol will be renovated and equipped with the latest equipment

Minimally invasive surgeries

Hemorrhoids are a rather unpleasant thing that can happen to anyone. This disease can affect anyone, regardless of gender or age. It is important to remember that the sooner you turn to a specialist for help, the sooner you can recover from this unpleasant disease without resorting to surgical intervention. In the initial stages of the disease, when the formation of external hemorrhoids has not yet occurred, it is much easier to cope with the disease.

Hemorrhoids, the treatment of which should be carried out under the supervision of a specialist, provides for two methods of treatment - conservative (includes the use of ointments, suppositories, physical education, following a special diet) and radical, which involves getting rid of hemorrhoids depending on the stage of the disease. The latter, in turn, is divided into minimally invasive and surgical intervention. This article will focus on minimally invasive methods of treating hemorrhoids.

Minimally invasive options for the treatment of hemorrhoids involve minimal surgical intervention with the maximum level of comfort for the patient. This combination is achieved through the use of the latest medical technologies.

• Sclerosis of hemorrhoids is performed using a special needle, through which a special substance is introduced into the hemorrhoids, leading to wrinkling and reduction of the nodes.
• Photocoagulation. This method is used at the initial stage of the disease, and consists in the effect of a laser on the hemorrhoidal tissue. It literally “evaporates” the tissue of the hemorrhoid, as a result of which the disease can be crushed at the very beginning.
• Cryodestruction consists in the effect of extremely low temperatures on the tissue of the hemorrhoid, as a result, the inflamed areas are frozen and rejected. This method shows quite good results in the first and second stages of hemorrhoids, when the formation of external hemorrhoids has not yet occurred.
• vacuum ligation. In this case, the node itself is sucked into a special apparatus using a vacuum tube, and a special latex ring is applied to the base of the leg that feeds the node. After a while, tissue necrosis and rejection of the hemorrhoid occurs. This method is also effective in the initial stages, when the formation of external hemorrhoids has not yet occurred.

There are two more methods of mini-invasive treatment of hemorrhoids - the TND method (carried out under the control of a special ultrasonic sensor, and consists in flashing the vessels above the node, which nourish the tissues and contribute to the growth of the hemorrhoid) and the Longo method (in this case, the mucous membrane, which is located above the node , incised). Both of these methods are aimed at stopping the blood supply and nutrition of the hemorrhoid. However, as practice shows, the node can also be fed from other sources, therefore, with such treatment options, relapses of the disease are possible. That is why these methods have not found wide application in modern medicine and are gradually disappearing into history.

As you can see, at the initial stages of the development of the disease, it can be defeated without surgical intervention. Minimally invasive methods of treating hemorrhoids are not suitable for all patients, so before proceeding with radical treatment, you should consult a specialist.

Invasive methods for examining the heart

Invasive research methods - probing and puncture of the heart cavities, angiocardiography - are widely used in cardiology and other branches of medicine, due to the need to establish anatomical and functional diagnosis of heart disease and its consequences. These data are necessary for the selection of rational methods of treatment and evaluation of their effectiveness. Currently, the diagnosis of most congenital and acquired malformations, heart tumors, diseases of the myocardium and great vessels cannot be considered reliable without confirmation by data from invasive research methods. In the absence of data from these studies, it is difficult to solve the fundamental issues of treatment tactics.

Cardiac catheterization has been developed and widely used in connection with the surgical treatment of congenital and acquired heart defects. It is used to measure pressure in the chambers of the heart, pulmonary artery, to determine the amount of blood discharge through pathological shunts, cardiac output in order to clarify the nature of the defect and its severity, record intracardiac electro- and phonocardiograms, perform contrast studies of the heart and blood vessels.

Most often, special research methods are used for combined heart defects to clarify the degree of stenosis and insufficiency, combined defects to identify concomitant pathology, for aortic valve defects to determine their severity, as well as to monitor the effectiveness of medical and surgical treatment.

Invasive methods are not advisable to use with a low severity of defects and hemodynamic disorders, the absence of hypertrophy of the heart (according to ECG data) and small deviations from the norm in the size and configuration of the heart, according to x-ray data.
The risk of using invasive research methods is increased in patients with heart defects in the stage of severe respiratory and circulatory failure. With a positive iodine test and acute intercurrent diseases, studies are contraindicated.

For a contrast study of blood vessels, heart cavities and pathological communications between them, 60-76% solutions of verografin or urotrast are used in an amount of 5-40 ml, which are injected using an automatic syringe at a rate of 25-30 ml / s. On the x-ray, a clear image of the heart and blood vessels is obtained.

In children of preschool and primary school age, examinations are carried out under anesthesia; in children of senior school age and adolescents, under local anesthesia.

Invasive research methods are currently quite well mastered, safe, highly informative and therefore are used quite often for diagnostic and therapeutic purposes due to the need for pathophysiological studies of intracardiac, pulmonary and systemic hemodynamics, as well as to monitor the effectiveness of treatment. Simultaneously with the clarification of the diagnosis of the defect, the degree of its severity and consequences, the minute volume of the large and small circles of blood circulation, the pressure in the pulmonary artery and in the chambers of the heart, as well as the change in these indicators after medical and surgical treatment, are determined.

Catheterization of the right heart is performed to diagnose defects of the right atrioventricular valve, pulmonary valve, differential diagnosis of acquired and congenital defects, to determine the degree of pulmonary hypertension.

Under local anesthesia, from a small skin incision (1-2 cm), the medial saphenous vein of the left arm is exposed in the elbow bend or in the shoulder area, it is tied up proximal to the ligature, the lumen is opened with a transverse incision, and a special catheter filled with isotonic sodium chloride solution with heparin is inserted. The solution is administered drip, continuously, which prevents spasm of the vein, thrombosis of the catheter, which, under the control of the X-ray machine, is passed through the innominate and superior vena cava, the right atrium and the ventricle into the pulmonary artery until wedging in one of its branches. Record the pressure curve in the pulmonary capillaries, take blood to determine the gas composition. After that, the catheter is removed under the control of the X-ray machine. At the same time, pressure is measured and blood is taken sequentially from the pulmonary artery, right ventricle, right atrium and vena cava to determine its oxygen saturation.

If it is necessary to conduct a contrast study through the same catheter, a contrast agent is injected into any part of the pulmonary artery or heart chamber in accordance with the task of the study.

Then the catheter is removed, the vein is ligated, and the skin is sutured with 1-2 interrupted sutures.

Probing of the left atrium (transseptal puncture of the left atrium according to Manfredi and Ross using the Seldinger technique) is performed to diagnose defects of the left atrioventricular valve and diseases of the left atrium (thrombosis, tumors).

Under local anesthesia with a special needle with a diameter of 1.5-2 mm, the right femoral vein is punctured. A special metal conductor is inserted through the needle into the lumen of the vein at a distance of 10-15 cm. Then the needle is removed and a catheter is inserted into the vein along the conductor, as if along a rod, after which the conductor is removed.

Under the control of the x-ray machine, the catheter is placed in the right atrium in the region of the oval fossa. After that, a special long mandrin-needle with a pointed end is inserted into it, which in the initial position for puncture of the interatrial septum protrudes 1 cm from the catheter. In the direction of the inside and back at an angle of 45 ° (with the patient in a horizontal position on the back), the interatrial septum is punctured and the catheter is advanced, and the mandrin is pulled back and removed. The position of the catheter in the left atrium is monitored and confirmed by recording the pressure curve and the degree of blood oxygen saturation. If necessary, the catheter can be passed into the cavity of the left ventricle, the pressure in it and the pressure gradient on the left atrioventricular valve can be measured, and contrast can be performed in the left cavities of the heart and aorta.

Transthoracic puncture of the left atrium according to Bjork in the area of ​​the angle of the right scapula was widely used in the 60-70s. Now, due to frequently occurring complications (pneumothorax, hemoptysis, pulmonary edema, hemopericardium), this method is not used.

Retrograde catheterization of the aorta and left ventricle (according to Seldinger) is used to diagnose diseases and malformations of the aorta, malformations of the aortic and left atrioventricular valves, as well as for the purpose of differential diagnosis of malformations of the left atrioventricular valve and defects of the heart septum.

One of the femoral arteries is used to pass the catheter into the aorta. During the study, the patient lies on his back. The skin in the groin area is treated with an antiseptic. At the site of the proposed puncture, anesthesia is performed with a solution of novocaine. The skin is incised with an eye scalpel at the site of the needle and catheter, and the femoral artery is punctured at an angle of 45 °. After removing the mandrin from the needle, scarlet blood is poured out under pressure, which confirms the presence of the needle in the lumen of the artery. Through the needle, a special mandrel guide is inserted into it at a distance of 10-15 cm, the needle is removed, and the place where the guide is inserted into the artery is pressed with a finger. A catheter is strung on the conductor, which is inserted along the conductor through the channel formed by the needle into the lumen of the femoral artery, and then, under the control of the X-ray apparatus, together with the conductor, retrograde against blood flow into the ascending aorta.

The main dangers and complications of invasive research methods. The most frequent and transient complications are heart rhythm disturbances in the form of atrial and ventricular extrasystoles, tachyarrhythmias.

Bundle branch block, atrioventricular block, atrial fibrillation, and ventricular fibrillation are rare. If the research technique is violated, damage to the walls of the heart and blood vessels, hemopericardium, probe nodulation in the heart cavities, thrombosis and embolism of the pulmonary artery, and pulmonary edema are sometimes observed.

With a methodically correctly performed study, constant monitoring of the patient during the procedure, it is possible to prevent and promptly eliminate the complications that have arisen.

Data of special research methods in the diagnosis and assessment of the severity of congenital heart and vascular diseases. The main methods for diagnosing congenital heart defects are auscultation, phonocardiography, electrocardiography, echocardiography, fluoroscopy, and radiography of the heart and pulmonary vessels. Important, often mandatory research methods are probing the cavities of the heart and blood vessels, puncture of the heart, angiocardiography, rheography and radiocirculography. Ballistocardiography, sphygmography, tachooscillography in the diagnosis of heart defects are not very informative and their importance should not be exaggerated. The variety of congenital heart defects consists of several anatomical variants, among which narrowing of the left and right atrioventricular orifices and vascular orifices (stenosis), pathological communication between the chambers of the heart and blood vessels (defect) and a combination of stenosis with a defect can be distinguished. In these cases, characteristic pathophysiological disorders, mechanisms of compensation and decompensation are observed.

With the help of invasive research methods, it is possible to clarify the anatomical features of the defect, identify pathophysiological disorders and functional reserves, determine the location and nature of the narrowing with the calculation of the pressure gradient, the size of the heart chambers, and the diameter of the vessels. These data make it possible to establish the severity and severity of heart disease, the possibility and options for surgical treatment, the mode of behavior and physical activity, if surgical treatment is not used.

Probing and angiocardiography are necessary for stenosis of the aortic orifice, pulmonary artery, right and left atrioventricular orifices, coarctation of the aorta, Fallot group defects, Ebstein anomaly and other anomalies, when questions about indications for surgical methods of treatment are being resolved.

With an isolated narrowing of the lumen of the vessels, the severity of the disease is determined by the magnitude of the blood pressure in the ventricles. In this case, the pressure in the pulmonary artery or aorta is maintained at the level of normal or subnormal values. So, for example, with narrowing of the mouth of the pulmonary artery and an increase in systolic pressure in the right ventricle to 8.0 kPa (60 mm Hg), stage I of the defect is diagnosed. In this case, surgical treatment can be refrained from.

At II and III stages of the defect and systolic pressure from 8.0 to 13.3 kPa (from 60 to 100 mm Hg) and more, surgical treatment is absolutely indicated.

Angiocardiography makes it possible to determine the place of narrowing - subvalvular, valvular, supravalvular, anatomical features of the output section of the ventricle and the excretory vessel.

This makes it possible to choose the optimal variant of surgical intervention.

With a systolic pressure in the ventricle above 40.0 kPa (300 mm Hg), a pronounced concentric hypertrophy of the heart muscle is observed with a decrease in the ventricular cavity to 20-30 ml. At the same time, diastolic pressure in the ventricle increases, the minute volume of the heart decreases, and small ventricular syndrome develops. Severe dystrophic changes in the hypertrophied myocardium, coronary blood flow deficiency, low functional reserves limit the physical activity of patients and the possibilities of surgical treatment.

In case of heart defects with the presence of pathological messages between the chambers, sounding and angiocardiography data make it possible to establish the localization of a septal defect. The place of the pathological message is determined by detecting the discharge of arterial blood, the change in the oxygen capacity of the blood in the chambers, the flow of a contrast agent from the high pressure chamber into the low pressure chamber. The same information can be obtained by thermodilution and contrast echocardiography.

For example, the oxygen capacity of the blood of the right atrium was 14 vol. %, and the right ventricle - 16 vol. %, blood oxygen saturation, respectively - 75 and 85%. In the presence of such data, it can be concluded that at the level of the ventricles there is a discharge of blood from left to right through a septal defect. The difference in the oxygen capacity of the blood in the chambers of the heart is up to 1 vol. % is considered unreliable and therefore, in the absence of other data, a diagnosis of heart disease cannot be made.

Absolutely reliable for the diagnosis of pathological communication between the chambers and vessels can be the passage of a radiopaque probe through the defect, followed by an analysis of the position of the catheter, blood and pressure.

Based on the sounding data and the Fick principle, it is possible to calculate the resistance of the vessels of the large and small circles, the work of the left and right ventricles, their performance. With septal defects, as a rule, hypervolemia of the pulmonary circulation is observed, the minute volume of which can be 15-20 l / min or more.

With septal defects, as with stenosis, it is imperative to measure the pressure in the chambers of the heart and the main vessels, determine the degree of pulmonary hypertension, which is a frequent and characteristic complication of defects in this group.

Special research methods in the diagnosis and evaluation of acquired heart defects in children. Puncture and probing of the heart, aortocardiography are used to clarify the degree of stenosis and insufficiency in combined defect, differential diagnosis of acquired and congenital defects, study of pathophysiological changes in intracardiac and pulmonary hemodynamics.

It is known that the left atrioventricular valve is affected most often. One of the early hemodynamic signs of malformation is an increase in pressure in the left atrium. At the same time, characteristic changes in the configuration of the curve are revealed, which have a differential diagnostic value.

The left atrial blood pressure curve consists of two positive waves and two negative ones.

The level of pressure in the left atrium and the magnitude of the diastolic pressure gradient between the left atrium and the left ventricle can be used to judge the degree of narrowing of the left atrioventricular orifice. Normally, the pressure difference is 0.1-0.3 kPa (1-2 mm Hg), and with stenosis it can reach 2.7-4.0 kPa (20-30 mm Hg). However, there is no linear relationship between the degree of narrowing and the magnitude of the diastolic pressure gradient. This indicator is influenced, in addition to a decrease in the area of ​​the left atrioventricular orifice, by the contractile function of the myocardium, changes in rhythm and cardiac output, and the presence of concomitant mitral insufficiency stenosis.

It should also be noted the possibility, according to the sounding of the pulmonary artery and the level of pulmonary capillary pressure, to determine the area of ​​the left atrioventricular orifice according to the Gorlinykh formula.

When comparing the size of the area of ​​the left atrioventricular orifice, calculated according to the Gorlinykh formula, with the area measured during the operation, the high information content and value of this method are confirmed.

Ventriculo- and angiography provide important data for the differential diagnosis of defects and their severity when deciding on surgical treatment.

Most often they have to be used in children with the differentiation of mitral insufficiency and ventricular septal defect. The flow of a contrast agent during systole from the left ventricle into the left atrium indicates mitral insufficiency. If the contrast agent enters the right ventricle, then there is a ventricular septal defect.

By the amount of incoming contrast agent from one chamber or vessel to another chamber, the time of its retention in the chamber and the expansion of the cavities, the severity of the defect is determined.

Special methods for studying the cardiovascular system - probing, radiocirculography are widely used to determine the consequences of a defect and the functional reserves of the heart. All children with stage III and IV mitral stenosis and many children with mitral regurgitation have pulmonary hypertension. Often, systolic pressure in the pulmonary artery is very high and reaches 13.3-18.7 kPa, or 100-140 mm Hg. Art.

During the study of cardiac output, it turned out that even with severe heart defects, but without circulatory decompensation of IIB-III degree, there are no deviations from normal values.

Therefore, at the present stage, only with the use of invasive methods (according to indications), the diagnosis and treatment of congenital and acquired heart defects and some other diseases of the cardiovascular system can be optimal.

Sufficient technical equipment of the leading medical institutions, the safety of studies that have been mastered and tested by practice, allow surgeons to use them in accordance with the developed indications.

It should be noted that X-ray endovascular surgery has emerged and continues to develop on the basis of invasive research methods. This is a new direction in the treatment of defects and diseases of the heart and blood vessels. With the help of special probes and devices that are introduced into the vascular bed, it is possible to improve the blood circulation of organs. Creation or expansion of an atrial septal defect, dilatation of narrowing of the pulmonary and renal arteries and aorta facilitate the course of defects. The introduction of special microspheres and spirals through the probes allows you to stop bleeding, eliminate or reduce the tumor. Endovascular surgery can be used independently, as well as in combination with other methods of treating sick children.

INVASIVE METHODS OF PRENATAL DIAGNOSIS

Prenatal (in other words, prenatal) diagnostics is one of the youngest and most rapidly developing areas of modern reproductive medicine. Representing the process of detecting or excluding various diseases in the fetus located in the uterus, prenatal diagnosis and genetic counseling based on its results answer vital questions for every future parent. Is the fetus sick or not? How can the detected disease affect the quality of life of the unborn child? Is it possible to effectively treat the disease after the birth of a baby? These answers allow the family to consciously and timely resolve the issue of the future fate of pregnancy - and thereby alleviate the mental trauma caused by the birth of a baby with an incurable, disabling pathology.

Modern prenatal diagnosis uses a variety of technologies. All of them have different capabilities and degrees of reliability. Some of these technologies - ultrasound screening (dynamic observation) of fetal development and screening of maternal serum factors are considered non-invasive or minimally invasive - i.e. do not provide for surgical intervention in the uterine cavity. Practically safe for the fetus, these diagnostic procedures are recommended for all expectant mothers without exception. Other technologies (chorionic biopsy or amniocentesis, for example) are invasive - i.e. suggest a surgical invasion of the uterine cavity in order to take the fetal material for subsequent laboratory testing.

It is clear that invasive procedures are not safe for the fetus and therefore are practiced only in special cases. Within the framework of one article, it is impossible to analyze in detail all the situations in which a family may need invasive diagnostic procedures - the manifestations of hereditary and congenital diseases known to modern medicine are too diverse. However, a general recommendation to all families planning the birth of a child can still be given: be sure to visit a medical genetic consultation (preferably even before pregnancy) and in no case ignore ultrasound and serum screening. This will make it possible to timely resolve the issue of the need (and justification) for an invasive study. With the main characteristics of various methods prenatal diagnosis can be found in the tables below.

AMNIOCENTESIS

The vast majority of the methods listed below prenatal diagnosis congenital and hereditary diseases today is widely practiced in Russia. Ultrasound screening of pregnant women is carried out in antenatal clinics or medical genetic services.

In the same place (in a number of cities), screening of maternal serum factors (the so-called "triple test") can also be done. Invasive procedures are carried out mainly in large obstetric centers or interregional (regional) medical genetic consultations. Perhaps in the very near future all these types of diagnostic assistance in Russia will be concentrated in special centers prenatal diagnosis. At least, this is how the Ministry of Health of the Russian Federation sees the solution to the problem.

CHORION

Well, as they say, wait and see. In the meantime, it would not hurt for all residents of cities and villages of the fatherland planning to replenish the family to ask in advance what opportunities in the region prenatal diagnosis has local medicine. And if these opportunities are insufficient, and the need for quality prenatal diagnosis objectively available, you should immediately focus on the examination of the expectant mother outside the native locality.

CARDOCENTESIS

Moreover, part of the financial costs in this case may well be borne by the very local health care, in the arsenal of which there is no type of diagnostic service necessary for the family.

Fetal tissue biopsy as a diagnostic procedure carried out in the second trimester of pregnancy under ultrasound control. To diagnose severe skin lesions (ichthyosis, epidermolysis), a biopsy of the fetal skin is taken, followed by a pathomorphological study. Fetal muscle biopsy is performed to diagnose Duchenne dystrophy. The biopsy is examined by the immunofluorescence method. Such methods, in these and in a number of other cases, give more correct results, which allows you to make an accurate diagnosis or confidently reject it.

Fetoscopy(probe insertion and examination of the fetus) with modern flexible optical technology does not present great difficulties. However, the method of visual examination of the fetus to detect congenital malformations is used only for special indications. It is carried out at the 18-19th week of pregnancy. Fetoscopy requires insertion of an endoscope into the amniotic cavity, which can cause pregnancy complications. Miscarriages occur in 7-8% of cases. At the same time, almost all congenital malformations that can be seen with the help of fetoscopy are also diagnosed with the help of ultrasound. It is clear that the ultrasound procedure is simpler and safer.

Literary References:

http://www.medichelp.ru/posts/view/5863

http://www.9months.ru/press/10/13/index.shtml

Obstetrics. National leadership, Ed. E.K. Ailamazyan, V.I. Kulakova, V.E. Radzinsky, G.M. Savelyeva.

All about pregnancy and childbirth S. Zaitsev

Obstetrics and gynecology A brief guide to practical skills Kostyuchek D.F.