CC BY
78. Ismail AI, Sohn W. et al. The ICDAS: an integrated system for measuring dental caries. Community Dentistry and Oral Epidemiology. 2007; 35: 170-178.
9. Jaber MA, Allouch T. Dentofacial Abnormalities and Oral Health Status in Children with Cerebral Palsy. J. Interdiscipl. Med. Dent. Sci. 2015;Vol.3:164.
10. Козявшн В1, Качмар ОО, Волошин ТБ. Система класифшацш великих моторних функцш у дггей з церебральним паралiчем. Розширина та уточнена. Сощальна педiатрiя та реабштолопя. 2012; №2(3):74-82.
11. Левченкова ВД, Титаренко НЮ и др. Количественная оценка нарушений двигательных функций у больных детским церебральным параличом методом видеоанализа движений с использованием двухмерной биомеханической модели. Рос. педиатрический журн. 2014; 5: 20-27.
12. Мiрчук БМ, Савщка ТД. Оцшка стади зршосл постшних зубiв дiтей з дитячим
церебральним паралiчем у змiнному прикусi [Електронний ресурс]. Вiсник стоматологii. 2014; 4: 59-62. Режим доступу:
http://nbuv.gov.ua/UJRN/VSL_2014_4_19
13. Митропанова МН, Терещенко ЛФ, Павловская ОА. Оценка состояния твердых тканей зубов у детей-инвалидов с заболеваниями нервной системы краснодарского края [Електронний ресурс]. Международный журнал прикладных и фундаментальных исследований. 2014; 2: 126-131. Режим доступу: https://www.applied-research.ru/ru/article/view?id=4710.
14. Neeraj Gugnani, 1 IK Pandit,2 Nikhil Srivastava,1 Monika Gupta,3 and Megha Sharma International Caries Detection and Assessment System (ICDAS): A New Concept. Int J Clin Pediatr Dent. 2011 May-Aug; 4(2): 93-100.
15. Nouri Sumaya M, Alaki Sumer M, El-Ashiry Eman A Oral Health in Children with Cerebral Palsy. OHDM. 2014; № 13(4): 1067-1075.1
METHODS OF PARENCHYMAL DISSECTION IN LIVER SURGERY. THE FREQUENCY OF SPECIFIC POST-RESECTION COMPLICATIONS
Rusenov D.
Dr., Clinic of liver, biliary pancreatic and general surgery Acibadem City Clinic Tokuda Hospital EAD Sofia
Sofia
DOI: 10.5281/zenodo.7560312
ABSTRACT
Liver surgery is historically one of the "youngest" areas in abdominal surgery, but at the same time it marks very rapid progress and continuous development, which continues even today.
Development of liver resection surgery has been linked to a parenchymal dissection techniques and reliable hemostasis and biliostasis.
Keywords: methods of liver resections
INTRODUCTION:
There are different methods of parenchymal dissection in liver resection surgery- „crush and clamp", ultrasonic dissector (CUSA knife), Ultrascission and other devices for performing definitive hemo- and bili-ostasis.
The performance of parenchymal dissection by the method of "finger fracture" reduces operative time and allows control of bleeding from subsegmental vessels in the operative field, which in turn allows their ligation or clipping. Was first used by W. W. Keen and was later modified and popularized by the Vietnamese surgeon T.T.Tung in 1963 year.
OBJECTIVE:
After getting acquainted with as much information as possible on the matter and based on our previous research, we formulated the following goal:
Determination of a possible prognostic role of the type of liver resection (anatomic or atypical) together with other intraoperative characteristics (parenchymal dissection method) on the risk of occurrence, frequency and severity of early postoperative specific complications.
MATERIALS AND METHODS:
For the period from January, 2007 - March, 2018 in Clinic of liver, biliary pancreatic and general surgery, Acibadem City Clinic Tokuda Hospital ,1021 interventions were performed on the liver:
Cases of intervention other than liver resection by definition were excluded ISGLS, "removal of part of the liver parenchyma due to involvement by a disease process or traumatic injury resulting in devitalization of the parenchyma".
Thus, the study did not find the cases of:
• hepatotomy;
• cystotomies and cyst resections, practically without removal of functioning or pathologically altered liver parenchyma;
• liver biopsies, alcoholization of tumors. liver biopsies, alcoholization of tumors;
• interruption of trunk branches of the hepatic artery and/or portal vein with the aim of hypoperfusion of a given area (segments, lobe);
• suture of the liver in trauma;
Thus, a total of 852 cases of liver resections were included in the series
Method of parenchymal dissection - CUSA knife, "crush and clamp", Harmonic.
RESULTS:
Own Results
The „crush and clamp" technique is proving to be a reliable method in liver surgery.[1,2,3,4,5,6,7,8,9,10,11,12,] Modern modifications of these techniques are the use of an ultrasonic dissector (Cutting UltraSound and Aspiration = CUSA knife), Ultrascission, "water jet", laser and microwave tissue coagulator.
We mainly used a dissection method with CUSA and method „crush and clamp". Regardless of the method used, all visible blood and biliary vessels in the resection surface are ligated with free and suture
DISCUSSION:
In our study, only the CUSA, Harmonic and "crush and clamp" techniques for parenchymal dissection were applied.
The statistical analysis performed between the application of CUSA and the "crush and clamp" technique for parenchymal dissection and the frequency of specific complications between the two methods showed no significant differences. It is a matter of choice for the surgical team which one will be used.
CONCLUSION:
Various authors have investigated parenchymal dissection methods designed and applied with the idea of reducing bleeding during liver resection. Most studies found no significant differences in mortality and morbidity, laboratory indices of liver parenchymal injury, liver dysfunction, intensive care unit stay, and mean hospital length of stay.
The need for hemotransfusions was less frequent with the „clamp-crush" method compared to CUSA and hydrojet, while there was no difference between the clamp-crush technique and sharp dissection in this measure. The clamp-crush technique is faster than CUSA and hydrojet, but data on the difference between sharp dissection and the clamp-crush technique are lacking.
"Clamp-crush" technique is 2-6 times cheaper than other methods, depending on the number of operations/year.
In conclusion, the cited comparative study proves that "clamp-crush" is the "method of choice" for parenchymal dissection, as it does not require additional equipment.
ligatures.
After reviewing the operating protocols and other medical documentation, we found information about the method of dissection for 67.8% of Anatomic resections (n=156/230) and for 59.6% of Atypical resections (n=371/622). From these data, we performed an analysis between the use of CUSA or the "crush and clamp" technique for parenchymal dissection on the one hand and the incidence of specific complications after the application of both techniques on the other. Statistical analysis showed no significant differences between them[13-19].
References
1. Abdalla EK, Noun R, Belghiti J. Hepatic vascular occlusion: which technique? Surg Clin North Am. 2004;84:563-585.
2. Belghiti J, Hiramatsu K, Benoist S,et al. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg. 2000;191:38-46.
3. Bismuth H. Revisiting liver anatomy and terminology of hepatectomies. Ann Surg. 2013;257(3):383-6.
4. Delis.S, Bakoyiannis.A, Tassopoulos.N , et al. Clamp-crush technique vs. radiofrequency-assisted liver resection for primary and metastatic liver neoplasms. HPB (0xford).2009;11(4):339-44
5. Figueras J, Llado L, Ruiz D, Ramos E, Busquets J, Rafecas A, et al. Complete vs. selective portal triad clamping for minor liver resections: a prospective randomized trial. Ann Surg. 2005;241:582-590.
6. Kim.K and Lee.S .Usefulness of Kelly clamp crushing technique during hepatic resection. HPB (Oxford) 2008,1; 10(4): 281-284.
7. Lesurtel M, Selzner M, Petrowsky H, et al. How should transection of the liver be performed? A prospective randomized study in 100 consecutive patients: comparing four different transection strategies. Ann Surg. 2005;242:814-822.
8. Lin TY, Tsu K, Mien C, Chen C. Study on lobectomy of the liver. J Formosa Med Assoc. 1958;57:742-9.
9. Lin TY. Hepatic tumors, surgical treatment and its results. Jpn J Surg. 1977;7(4):189-98.
10. Lin TY. A simplified technique for hepatic resection: the crush method. Ann Surg. 1974;180(3):285-90.
11. Lin TY. Results in 107 hepatic lobectomies
Table. 1
Comparative analysis between the incidence of specific postresection complications depending on the method of _ parenchymal dissection - CUSA and „crush and clamp" method.___
Dissection method Complication Statistics Anatomic resection n=156 Atypical resection n=371 Total P
Crush and clapm No N 51 182 233 0.943
% 91.1% 91.9% 91.7%
Yes N 5 16 21
% 8.9% 8.1% 8.3%
CUSA No N 87 141 228 0.312
% 87.0% 81.5% 83.5%
Yes N 13 32 45
% 13.0% 18.5% 16.5%
with a preliminary report on the use of a clamp to reduce blood loss. Ann Surg. 1973;177:413-21.
12. Man K, Fan ST, Ng IO, Lo CM, Liu CL, Wong J. Prospective evaluation of Pringle manoeuvre in hepatectomy for liver tumours by a randomized study. Ann Surg. 1997;226:704-711.
13. Yo-ichi Yamashita, Takayuki Hamatsu, Tatsuya Rikimaru, et al. Bile Leakage After Hepatic Resection Ann Surg. 2001; 233(1): 45-50.
14. Gurusamy KS, Pamecha V, Sharma D, Davidson BR. Techniques for liver parenchymal transection in liver resection. Cochrane Database Syst Rev. 2009 ,21;(1)
15. Gurusamy KS, Kumar Y, Sharma D, Davidson BR. Methods of vascular occlusion for elective liver resection. Cochrane Database Syst Rev. 2007 ,17;(4):
16. Chi TY ,Yang ZY, Xue HD, et al Diagnosis and
treatment of primary hepatic angiosarcoma: a report of 7 cases with a literature rev. Zhonghua Yi Xue Za Zhi. 2011,28;91(24):1694-7.
17. Rusenov D. Is there a relationship between the method of parenchymal dissection and the frequency of specific postresection complications? Literature Review and Ourexperience. Modern medicine 12/2021 LXV
18. Rusenov D. Nonspecific Morbidity in Anatomic and Atypical Liver Resections, The scientific heritage (Budapest, Hungary) ISSN 9215 — 0365 No 104 (104) (2022)
19. Rusenov D. Liver Resections in Benign Liver Tumors. Statistical Data. Norwegian Journal of development of the International Science №99/2022 ,ISSN 3453-9875
PUBLIC OPINION ON COVID-19 VACCINES AND VACCINATION IN BULGARIA
Penchev D.,
Sofia Regional Health Inspectorate Zlatanova-Velikova R., Petkova D. DOI: 10.5281/zenodo.7560316
Abstract
Vaccination is the most certain and effective means of COVID-19 prevention and of limiting the spread of the causative agent - the SARS-CoV-2 virus. This article presents and analyses the public opinion on COVID-19 vaccines and vaccination in Bulgaria. The opinions of citizens on their readiness to get the vaccine, as well as on whether COVID-19 vaccination should be mandatory or recommended were studied. Their informedness on the effects of the COVID-19 vaccines was also studied.
Keywords: COVID-19, vaccines, public opinion, informedness.
On a global scale, the emergence of the COVID-19 pandemic necessitated inevitable changes in the lifestyles of individuals and society, in work conditions, crisis management, reconstructing different areas based on new information and communication technologies, in terms of the societal and business transition towards globalization processes. [1, 2, 3] This gave a strategic importance to the lessons learned, and the measures and actions taken to overcome the disastrous consequences of this worldwide cataclysm.
Vaccination is the most certain and effective means of COVID-19 prevention and of limiting the spread of the causative agent - the SARS-CoV-2 virus. COVID-19 vaccines demonstrated great effectiveness in clinical trials before being released for public use. After the introduction and mass use of the vaccines approved in the European Union (EU), a significant drop in the serious forms of COVID-19 and the fatal outcomes was observed on a global scale. The most convincing evidence of the COVID-19 vaccines' benefits was the significant reduction of the deaths in countries with large-scale vaccination.
The goal of this article is to present and analyze the public opinion on COVID-19 vaccines and vaccination in our country.
The following tasks were set in order to achieve this goal:
1. Presenting the benefits of COVID-19 vaccination
2. Studying the readiness of the respondents to get vaccinated.
3. Studying the opinions of the participants in the survey on whether COVID-19 vaccination should be mandatory or recommended.
4. Studying their informedness on the effects of the COVID-19 vaccines.
Methods. To ensure the objectiveness of the observed results a questionnaire survey method was used. The survey was conducted by the means of an anonymous questionnaire with 24 closed questions. The study was carried out for the duration of a month, in the period between 01.08.2022 and 01.09.2022 [5]. The participants were kept fully anonymous in accordance with all requirements and the confidentiality code of ethics. 1861 randomly selected people aged 18 to 60+ participated in the questionnaire.
The data was statistically processed with a MS Excel spreadsheet.
Results and discussion. The benefits of COVID-19 vaccination are felt by the vaccinated individual, but also by society and the healthcare system, since they limit the spread of the pandemic [4].
The benefits for the vaccinated individual are the following:
> Vaccination protects the vaccinated from a severe course of the disease and a fatal outcome
