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Section 7. Medical science
ment of labour conditions in workplaces where most often there are accidents. The statistical analysis method is based on studying of quantitative indices of reports about accidents at entities and in organizations. At the same time frequency coefficients and severity of an injury rate are used generally. The frequency coefficient (Cf) determines a number of accidents on 1000 workers for an accounting period and is calculated by a formula:
Cf=An1000/Aw, where are
An — a number of accidents for an accounting period with disability over three days;
Aw — an average number of workers.
A coefficient of injury rate severity (Cs) shows an average number of disability days, happens by one accident for an accounting period and identified by a formula:
Cs= Dt/An, where are
Dt — total days quantity of disability because of accidents;
An — a number of accidents for an accounting period.
Conclusions: Based of a comprehensive analysis of labour
conditions ofJSC "Ferganaazot" implementation of preventive actions for injury prevention in the following directions is necessary: organizational and technical, sanitary and hygienic, treatment-and-prophylactic. Carrying out these actions in the production shall be included: observance of requirements of regulatory legal acts for labor protection; corresponding sanitary consumer services of workers; a constant control and automation of production processes in the most life-threatening workers sites; providing and an operating control behind serviceability of the equipment, ensuring protection with individual protective equipment, overalls, etc.; to bring the standard indicators by KMK 2.01.05.-98 illumination levels, noise, microclimate parameters in a workplace. Obligatory in the production to organize training and knowledge examination again gone to work workers, workers of especially hazardous occupations by the main methods of a safe labour conditions organization in the field of labor protection, carrying out introduction training in a workplace, periodic (repeated), unplanned and current instructing of workers in safe engineering.
2.
References:
Судак С. Н. Анализ производственного травматизма в России и Мурманской области за 2005-2009 годы//Вестник Мурманского Государственного технического университета - Мурманск, 2011. Выпуск № 4, Т. 14, - С. 860-867. Производственный травматизм и профессиональные заболевания.
Khudaybergenov Shukhrat Nurmatovich, Republican Specialized Center of Surgery named after academician V. Vahidov, Doctor of medical sciences Irisov Ortikali Tulaevich, Republican Specialized Center of Surgery named after academician V. Vahidov, Doctor of philosophy e-mail: tulaevich@mail.ru Tursunov Nasriddin Toshtemirovich, Republican Specialized Center of Surgery named after academician V. Vahidov Mustafaev Azizjon Toshmuhammadovich, Republican Specialized Center of Surgery named after academician V. Vahidov E-mail: aziztm25@gmail.com
Algorithm of diagnosis and surgical treatment of postoperative chylothorax
Abstract: The analysis of 14 patients with postoperative chylothorax. Evaluated the effectiveness of the treatment of chylothorax. Developed an algorithm for the treatment of postoperative chylothorax.
Keywords: thoracic surgery, postoperative complications, triglycerides in pleural fluid, VTS.
Actuality of the problem. Chylothorax — a pathological condition characterized by the accumulation of lymph in the pleural cavity ofvarious etiology. The phenomenon was first described Bar-tolet in 1633 [5]. Chylothorax often a postoperative complication of thoracic surgery, catheterization subclavian vein [1; 2; 3], the frequency of which is from 0 1% to 2.5% of the patients with thoracic pathology. Less commonly, it can be due to malformation of the lymphatic system of the lungs or chest cavity. Also chylothorax may be a manifestation of malignancy, trauma of neck or thoracic cavity.
Remain not fully developed approaches to the treatment of
chylothorax: indications for conservative and surgical approaches, terms and methods of surgical interventions [4].
Objective: to develop the optimum tactics of surgical treatment of postoperative chylothorax.
Material and methods studied the results of examination and treatment of 14 patients with postoperative chylothorax: 12 of them among the 6895 operated patients in Center for thoracic surgery of the Krasnodar Regional Clinical Hospital from 2003 to 2008 were 0.17% and 2 patients in the RSCS named after acad. V. Vahidov among 1899 operated on for different diseases
Algorithm of diagnosis and surgical treatment of postoperative chylothorax
of the lungs and mediastinal organs in the period from 1999 to 2010. In all patients, the diagnosis is confirmed by laboratory and instrumental methods. Men were 11 (78.57%) and 3 women (21.43%), the average age was — 45.5 ± 4.34 years (range, 23-72 years). Pleural effusions were unilateral in all patients by surgery. The cause of chylothorax in all patients had surgery on the chest. These procedures included thoracotomy with resection of lung and mediastinal lymph node dissection (9 patients), lung resection without lymph node dissection (2 patients), the removal of mediastinal tumor (2 patients), and pneumonectomy with in-trapericardiac treating vascular lung root. The average concentration of triglycerides was 13.7 ± 2.12 mmol/L.
Results and discussion.
It should be noted that in all these cases, the allocation of a large quantity of discharge from the drainage prompted suspicion on lymph expiration. In all 14 cases, the first day of the drains was allocated more than 1.5 liters of fluid. Pleural effusion is rated as milk in 4 (28.6%) patients, in all other cases serohemorrhagic fluid. All patients started after the detection of chylothorax treated with conservative measures. All patients were prescribed a diet with a
decrease in the amount of fat. In 5patients in the conservative treatment measures was included Sandostatin (20-100 mg per day intravenously with 400 ml saline solution).
Conservative measures were effective in 2 patients. The two patients after conservative therapy started the selection of lymph decreased by 2 times, reduced to 50-100 ml over the next 2-3 days, on the 7th day completely stopped. After a preliminary X-ray control of the chest drainage tube removed. 12 patients were operated on, 11 is clipping VATS thoracic duct, in one case conversion and ligation of thoracic duct.
At January 1 patients despite the behavior of conservative treatment of discharge from the drainage had a tendency to decrease, and they are subject to repeated surgical procedures. 1 patient made PTS sanitation inspection of the pleural cavity, conversion, ligation of thoracic duct. Following the reoperation was observed complications. Drainage tubes are removed at 3-4 hours.
Based on our experience of treatment of postoperative chylothorax and literature data we offer our algorithm of surgical treatment of postoperative chylothorax.
Fig.1. Algorithm of the diagnosis and surgical treatment of postoperative chylothorax
In this way, our data suggest a high performance combina- of conservative measures during the first 3 days and significant tion of conservative and military-technical cooperation in the losses lymph surgical treatment. treatment of postoperative chylothorax. In the absence of effect
References:
1. AshcraftK. U., Holder T. M. Pediatric Surgery. Saint Petersburg, 1996 Vol. 1. P 220-221.
2. Spiridonov A. A., Arakelyan V. S., Malinin A. A., Pirtshalaishvili Z. K., Abalmasov K. G.//Annals of Surgery. - 2003. - № 2. - P. 44-45.
3. Beghetti M., La Scala G., Belli D., Et al.//J. Pediatr. - 2000. - Vol. 136, - № 5. - P. 653-658.
4. Fahimi H., Et al.//Ann. Thorac. Surg. - 2001. - Vol. 71. - P. 448-450.
5. Maldonado F., et al.//Mayo Clinic Proceedings. - 2009. - Vol. 84, - № 2. - P. 129-133.
