RESUMEN
OBJECTIVE: To assess the efficacy of treatment of cricopharyngeal insufficiency in chronic critical illness caused by severe brain injury using non-invasive magnetic stimulation with endoscopic navigation. MATERIAL AND METHODS: Thirty patients (19 men and 11 women, mean age 50±12 years) were studied. The exposure was carried out by a bipolar alternating magnetic field using an inductor located in the projection of the hyoid bone. The study compared the standard therapy and the complex of therapeutic measures, in which the proposed non-invasive magnetic stimulation method with endoscopic navigation was included. The procedure was carried out daily without regime changes, with objective control 1 time in 10 days. The duration of the first course was 10 days, followed by a decision to extend the course for another 10 days, depending on the objective dynamics. Evaluation was performed with the Rosenbek Penetration and Aspiration Scale (PAS), the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), The Mann assessment of swallowing ability (MASA) and the Functional oral intake scale (FOIS). RESULTS AND CONCLUSION: Improvements of swallowing function were observed in both groups, but qualitative changes were more pronounced in the main group. The use of the proposed method made it possible to obtain a more stable and predictable result.
Asunto(s)
Enfermedad Crítica , Trastornos de Deglución , Adulto , Deglución , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Femenino , Humanos , Fenómenos Magnéticos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The combined method of hernioplasty with the use of biologic and sunthetic implants has been worked out. 12 patients have been operated on: the "open" technique was used in 5 patients, the rest 7 have been operated on laparoscopically. The use of dura mater as an implant for hernioplasty allows avoiding tissue tension by muscle sheath plasty. By the combined use of the synthetic implant and dura mater plate, the latter assumes the mechanical load, preventing the hernia recurrence. Besides, the dura mater plate isolates the synthetic implant from the abdominal cavity and subcutaneous fat. No postoperative complications or lethal outcomes were registered.