Como os filhos

Continuei para baixo e notou que, passo a passo a gama de minha lanterna estava diminuindo. Agora eu podia ver apenas sete passos à frente ... seis ... cinco ... quatro.

De repente, a escuridão impenetrável tinha apenas dois pés na minha frente, uma massa negra que parecia pulsar na expectativa do meu avanço final em seu abraço. Parecia vivo.

Eu ainda não tinha chegado ao pé da escada, pois ouvi os sussurros de novo, muito abaixo, eo som, oleosa oozing que trouxe para meus braços arrepiados.
Cheguei a cialis preço frente com uma mão trêmula. Ele desapareceu na escuridão, que foi muito frio.
Meu coração martelava e minha boca estava seca e de repente azedo. Deixei escapar um grito de criança, e eu fugi para a cozinha e da luz.

Naquela noite no restaurante, eu recebeu os convidados e sentou-los. Mesmo após todos esses anos, eu gasto quase todas as noites na porta da frente, conhecer pessoas, jogar o anfitrião. Geralmente, eu gosto. Muitos clientes viagra generico portugal têm vindo a nós por uma década, são membros honorários da família, velhos amigos. Mas naquela noite, meu coração não estava nele, e várias pessoas me perguntaram se eu estava me sentindo bem.

Tom Gatlin, meu contador, parou para jantar com sua esposa. Ele disse, Jess, você está cinza, pelo amor de Deus. Você está três anos atrasada para um período de férias, meu amigo. O que é o ponto de acumular o dinheiro se você nunca ter tempo para apreciá-la?

Felizmente, o pessoal do restaurante nos reunimos é de primeira qualidade. Além de Carmen e eu e nossos filhos-Stacy, Heather, eo jovem Joe existem 22 funcionários, e cada um deles conhece o seu trabalho e executa-lo bem. Embora eu não estava no meu melhor, havia outros a tomar as providências.

Stacy, Heather, e Joe. Nomes muito americano. Engraçado. Minha mãe e pai, sendo imigrantes, agarrou-se ao mundo que eles deixaram, dando todos os seus filhos nomes tradicionais do México. Carmen pessoas eram da mesma maneira: Seus dois irmãos são Juan e José, eo nome de sua irmã é Evalina. Meu nome realmente foi Jesus Gonzalez. Jesus é um nome comum no México, mas eu tinha que mudou com os anos Jess atrás, embora, ao fazer isso eu te machuquei meus pais. (A pronúncia espanhola é Hay seuss, embora a comprar viagra na net maioria dos norte-americanos pronunciá-lo como se referindo ao salvador cristão. Há apenas nenhuma maneira que você pode ser considerado como qualquer um dos caras ou um empresário sério quando sobrecarregados com tal apelido exótico.) É interessante como os filhos de imigrantes de segunda geração americanos como Carmen e eu, costumam dar seus próprios filhos o mais popular atual nomes americanos, como se estivesse tentando esconder o quão recentemente os nossos antepassados ​​saíram do barco ou em caso disso, cruzaram o Rio Grande. Stacy, Heather, e Joe.

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Muscle atrophy

The main method of treatment of hernia is a musculo-aponeurotic plastic. With this method, the strengthening of the abdominal wall defect is not only the aponeurosis. and muscles. This principle of treatment is the basis of a huge number of operational methods. Most popular in the inguinal hernias were ways Girard, Spasokukotsky, Bassin, Postemskogo, Kirchner, with the umbilical - a way to Mayo, with postoperative abdominal and white line - way Sapezhko and its numerous modifications.

Also widely used plastic, with additional biological and synthetic materials.

Grafts, depending on their origin are divided into:

1. autologous (taken within the same organism);
2. allogeneic (taken in the body of the same form as the body of the recipient);
3. xenogeneic (taken in the body of another species);
4. explants (non-biological tissue);
5. combined transplants (a combination of biological, most autologous and non-biological tissue).

Indications for the use of plastic materials for ventral hernia are:

1. recurrent, especially multiple recurrent hernias;
2. primary hernias of large size at a flabby abdominal wall due to the atrophy of muscles, fascia and aponeurosis;
3. postoperative hernia with multiple hernial when herniorrhaphy with local tissues does not give complete confidence in their solvency;
4. huge hernia the size of the defect of the abdominal wall more than 10x10 cm;
5. "Difficult" inguinal hernia - long lines, oblique to the direct channel, sliding and combined with pronounced muscle atrophy, razvolokneniem aponeurosis, ligaments hypoplasia.

From biological tissues most widely used in hernia surgery were: autologous transplants of skin, allogeneic transplants of dura mater and xenogeneic grafts of peritoneum.

Numerous experimental studies suggest that any biological graft during implantation undergoes a pronounced inflammatory and destructive changes, the extent of which varies from mild degeneration to necrosis, is directly dependent on the nature of the plastic material, its antigenicity and mode of treatment.

Most favorable to replace the defect of the abdominal wall are undoubtedly autologous tissue. Biological relationship with this kind of transplant brand viagra can achieve the most reliable engraftment of plastic cloth. However, in this case, marked structural changes in the graft, which are caused by denervation and blood circulation disorders: a histologically in the early period after transplantation, there are marked inflammatory changes, and the remote - the phenomenon of partial atrophy and fibrosis.

Allogeneic transplantation and, moreover, xenogeneic tissue really is always accompanied by the reaction of transplantation immunity, which leads to the death of foreign tissues. However, in cases where the plastic fabric is not highly antigenic strength, the process of destruction of the graft occurs very slowly and slightly, and simultaneously with the destruction of developing regenerative processes, replacing lost parts of the graft. Ultimately, the graft is completely replaced by recipient tissues. This is the most favorable way of morphological transformation alien plastic tissue in the body of the recipient, ensuring the success of transplantation. In those cases where the plastic fabric has a high antigenic activity, the destruction of the graft is much faster than it is replaced by tissue of the recipient. As a rule, change ends divergence of postoperative wound and exclusion of necrotic remnants of the plastic fabric.

All plastic materials used in reconstructive surgery of the anterior abdominal wall, have these or other advantages and disadvantages. The study of long-term results indicate that with the help of transplants can dramatically reduce the number of relapses. And if now it is possible to deny the usefulness of a plastic material, to reject the method at all - it means not to notice those positive qualities that lie at its core. This is primarily a decrease traumatic operations and increase its reliability.
The clinical picture of hernia strangulation is very characteristic and is generally typical.

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Mesh tape

Development and implementation of new polymeric materials and medical products largely determine the progress of modern surgery.

In this context, the relevance of the polymer implant, in particular, suture material, the use of which the most rational in any surgical situation.

We have developed a body nonabsorbable brand viagra online monofilament surgical conditioned rooms on USP 5 / 0 to 1 (metric size to EP 1 to 4) based on polypropylene (PP), polyvinylidene fluoride (PVDF) and poly (PKA). Suture materials in the form of filaments, owing to solidity and smoothness of the surface except the penetration of infection threads inside, allow them with little effort and minimal damage to even the most delicate fabrics as well as provide a good cosmetic effect and reduce the discomfort when removing sutures.

Most biological inertness of them have PVDF monofilament. However, in order to improve the hemocompatibility and thromboresistance suture material used, such as cardiovascular surgery, we developed a method for forming on the surface of the nanocoating linear-chain carbon-carbyne (RF Patent 2287623).

Since the braided or twisted sutures along with good manipulative properties are characterized by high wick that creates the danger postoperative infection seams, and also "sawing" effect during a tissue, we developed a technology application to Mylar and nylon filament hydrophobic fluoropolymer coating. Received "psevdomononiti" have zero wick, reliability, assembly and good flexibility.

Clinical trials have shown that such filaments are convenient to manipulate, reliable tally surgical sites, atraumatic not absorb wound discharge and did not become infected.

For the prevention or treatment of surgical sepsis can bring substantial benefits to antimicrobial sutures.

We obtained the nylon filament containing immobilized ionic chemical bond gentamicin (RF patent 1241553 and 1241554).

The results of microbiological and preclinical generic viagra studies received sutures showed that for effective and prolonged antimicrobial action is necessary to introduce a string of at least (5-7)% antibiotic.

Clinical trials of antimicrobial suture materials have shown high efficiency in the prevention of septic complications after surgery in this complex patient population, as patients with cancer of the gastrointestinal tract.

For the first time in Russia we have developed and put into mass production of plastic mesh implants for hernia and other soft tissue defects in the support of PVDF and PP-filaments, Mylar complex yarns with fluoropolymer coating. To cialis without prescription improve the biocompatibility in PVDF-coated grids formed carbyne (RF Patent 2288304).

Properties of yarns and knitted weave features provide endoprostheses high biocompatibility, mechanical strength, dimensional stability in all directions, resistance to blooming and shedding edges, resistance to infection, resistance to biodegradation, gentleness, minimum material consumption.

Based on the same mesh cloths are designed mesh tape (slings) for use as a urethral lonno-loop in the surgical treatment of stress incontinence treatment (RF Patent 2297808), and implants for reconstructive surgery of the pelvic floor.

For the prevention of adhesions after operations on organs and tissues with serous layer (the abdominal cavity, tendon sheath, joint, pleural cavity, pericardial, spinal cord membranes, middle ear cavity), designed and produced protivospaechny gel.

The gel acts as a temporary artificial "barrier" between the damaged serous surfaces, ensuring their effective separation in the healing time, and then dissipates. Reduction of adhesion surfaces of organs and tissues contributes to the preservation of their mobility and prevents the formation of adhesions.

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Thrombosis hemorrhoids complicated by inflammation of their indication for anticoagulation of local action in the form of suppositories and combined preparations containing analgesics, thrombolytic and anti-inflammatory components. This group includes Proctosedyl and gepatrombin G. Pharmacodynamics gepatrombina F lies in the fact that heparin binds the plasma coagulation factors and prevents blood clots, reduces inflammation and swelling, and polidokanol has analgesic and local sclerosing effect. Prednisolone has anti-inflammatory effect, reduces the itching and burning. Preferable to use gepatrombina T is that he has a strong antithrombotic and anti-inflammatory effect.

When hemorrhoidal thrombosis also demonstrates the use of anticoagulants local action. This group of drugs brand viagra include heparin and troksevazinovaya ointment. In 70-80% of cases, thrombosis of hemorrhoids complicated by inflammation of the transition to subcutaneous tissue and the perianal region. In this case, the above-mentioned drugs are used in combination with water-based ointments, possessing potent anti-inflammatory action. These include levosin, levomekol, mafinid.

Ongoing bleeding for one hour is a sign of an acute process and to eliminate it you can use candles containing epinephrine. In addition, use these local hemostatic materials, such as adrokson, beriplast, tahikomb, spongostan consisting of fibrinogen and thrombin. When introduced into the anal canal, they dissolve, forming a fibrin film.

General treatment

The basis is a common treatment is the use of flebotropnyh drugs that affect the increase in venous tone, improve micro-circulation in cavernous cells and normalization in their blood. This group includes many products, but in our opinion, the most effective is diosmin. Study of the effectiveness of the drug conducted in a prospective randomized study carried out on 120 patients with acute hemorrhoids. Compared with patients receiving placebo, in patients of the group are almost in 2 times reduced the need for non-narcotic analgesics. In 98% of treated diosmin is stihaniya inflammation and the rate of annual exacerbations decreased by 2,2 times.

It should be noted that in spite of the use of modern effective drugs, medical treatment, carried out mainly in the acute phase of illness, is only a palliative measure, and provides short-term positive effect. Resumption of constipation, errors in diet, increasing physical activity, usually lead to another escalation that requires re-conservative treatment. Therefore, the ineffectiveness of this type of treatment, especially in the later stages of the disease, there should be a combined treatment, including conservative and minimally invasive techniques or conservative and traditional surgical methods.

Minimally invasive treatments

In recent years, due to the development of new technologies in the medical industry, creating new sclerosing agent, becoming more common so-called minimally invasive treatments for hemorrhoids, it is suitable for use in an outpatient setting. These include infrared photocoagulation of hemorrhoids sclerotherapy, ligation, latex rings, ligation of the hemorrhoidal vessels under the control of Doppler, etc. In most countries, America and Europe, typical hemorrhoidectomy currently operates in only 17-21% of patients, and the rest is used minimally invasive treatments .

In patients with initial stages of hemorrhoids with a predominance of symptoms of bleeding should be infrared photocoagulation and sclerotherapy. To speed up the regenerative processes of these treatments is desirable to supplement the therapeutic laser. Ligation of hemorrhoids latex rings can be carried out in the third stage of hemorrhoids, for which the main symptom is Viagra what is the cause of impotence loss of hemorrhoids. Contraindication for minimally invasive treatments for hemorrhoids is thrombosis, acute and chronic paraproctitis, anal fissure, and other inflammatory diseases of the anal canal and perineum.

Infrared photocoagulation for domestic use photocoagulator Svet1 or Redfield (USA). Focused reflector light output from the halogen lamp is directed into the fiber. Through anoscope tip of the fiber is fed to hemorrhoidal node to contact. Thermal energy flow passing through the optical fiber coagulates the surface of the haemorrhoid. Such coagulation is carried out in 26 locations closer to his leg. Manual switch allows dosing duration of the procedure from 0,5 to 3 seconds and provide the depth of coagulation of 34 mm. At the initial stages of the cessation of bleeding was achieved in 67-72% of patients. At later stages of this procedure is only effective to stop the bleeding as a temporary measure, with the subsequent application of another, more radical treatment.

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