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Nontmdn jie rnjgm jgstne y sus gdpegbnbgmoispnrn ie trntndgiotm ji ens arnbturns

B`rgstgno Judmotgir, DJ, S`J

Lunjiemupi

Srisiotntgmo gs nvngenfei nt

www.jgub`grurlgidngo.mrl

http://www.diuchirurgiemain.org/

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@ns nontmdy b`nolij ribiotey =

@gppmbrnti uo-ribmlogzij t`i arnbturi;

t`i kmgot jgsembntis

igt`ir dijgneey mr entirneey

Kino-Emugs Sitgt (>st jisbrgptgmo fy Smutinu (>:); ...Z`i gokury...`ns omt...fiio jisbrgfij...; gojiij t`i amrd ma t`ibnrpne ixtridgty ma t`i rnjgus wmuej rnt`ir gobegoi us tm quistgmo gts figol egnfei

tm n arnbturi. Z`i nfsiobi ma bripgtus noj mt`ir bmddmo sydptmds ma

arnbturi tmlit`ir wgt` t`i swieegol, w`gb` gostnotey nrgsis go t`gs, ns go mt`ir

gokurgis ma t`i wrgst, riojir t`i jgabuety ma nsbirtngogol t`i rine onturi ma t`i

bnsi viry bmosgjirnfei....

@gppmbrntiBenuji

Smutinu

Nfrn`nd

BmeeisLugeenudi

Jupuytrio

Kmsip`

ArnomgsDnelngloi

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Om, w`nt `nvi b`nolij nri;

Z`i ipgjidgb ma mstimpmrmsgs;

YRN; >:% dneis & :3% aidneis ? 93 yrs

wgee `nvi n pmrmtgb Ax.

Enti `inegol wgt` n pmmr dib`nogbne qunegty

ma t`i bneeus

Eiss stnfgegty ma t`i bneeus (`nrjwnri

angeuri)

!rgsh ma sibmojnry jgspenbidiot

Z`i gobrinsij ariquioby ma JVA

Ariquioby ma JVA gobrinsis anstir t`no t`ipmpuentgmo nlgol (63 tm 93% nbbmrjgol tm

sirgis)

Duetgpegij fy >33 amr aidneis mejir t`no :3

yinrs mej. Y

p tm >9% ma w`gti aidneis mvir

93 wgee `nvi n JVA

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Om, w`nt `nvi b`nolij nri;

Z`i (bemsi) rientgmo fitwiio ristgtutgmo ma n omrdne

nontmdy noj t`i begogbne mutbmdis

Ixpirgdiotne stujgis `nvi s`mwo;

Gobrinsi prissuri noj suranbi bmotnbt nrin

wgt` rnjgus s`mrtiogol

Zrnosentgmo ma suranbi bmotnbt nrin wgt` jmrsne

noluentgmo

Regjgol ma gostnot biotir ma rmtntgmo wgt`

s`mrtiogol noj jmrsne noluentgmo

Begogbneey; Jmrsne noluentgmo wgt` bnrpne

dnenegloidiot siids tm fi t`i dmst prijgbtgvi

anbtmr ma t`i auobtgmone risuets

Ysi ma embhgol pentis

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\`y nontmdy ma jgstne rnjgus sm gdpmrtnot ga wi usi embhgol pentis =

@iorys npprmnb` `ns omt b`nolij

Z`i wny ymu dnonli t`i prmontmr

qunjrntus dusbei `ns om begogbnebmosiquiobis

Srmfeid gs wgt` t`i fmoy nontmdy

O`m K@ it ne. Ixndgontgmo ma t`i prmontmr qunjrntus dusbei jurgol `nrjwnri ridmvne prmbijuris natir vmenr pentgol amr jgstne rnjgus arnbturis. Bego

Mrt`mp Rurl. 63>: Rip81(2);6116 Rip82010-

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Embhgol pentis `nvi fgmdib`nogbne

njvnotnjlis

Gotirone xntmr (B``nfrn) "om

oiij tm fi stubh tm fmoi

Yogqui rglgj systid - Inb` sbriw

njjs stnfgegty tm t`i w`mei systid

Ixpirgdiotne wmrhs sullist t`no

ipgp`ysine sbriws nri omt rglgj

iomul` tm sustngo t`i emnjs go n

pmrtgbm rnjgus ipgp`ysgs

Ixpirgdiots sullist t`i supirgmrgty

ma embhij pentis (tm bmoviotgmone) go

pmrmtgb fmois

Bmoviotgmone

Embhgol

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@mwivir; Z`i usi ma embhgol pentis jmis omt neemw

us tm amrlit t`i prgobgpeis ma mstimsyot`isgs

Fmoi arnldiots dust fi go

bmotnbt tm mftngo `inegol

noj rijubij fiamri xntgmo

Rbriws dust lm t`rmul`

fmt` bmrtgbis (mr nt einst

. Bmroiee, B. O.; Agxntgmo bmosgjirntgmos go mstimpmrmtgb fmoi arnbturis. Burr Mpgo Mrt`mp, 63398 >1; 2.

6. Jrmfitz @ it ne. Qmenr xij-nolei pentgol ma jgstne rnjgus ixtiosgmo arnbturis ; gostuiobi ma penti pmsgtgmo mo sibmojnry emss

ma rijubtgmo ; n fgmdib`nogb stujy go n bnjnvirgb dmjie. K @noj Rurl Nd 63318 2> ; 1>9-66.

2. \nee EF it ne. Z`i i"ibts ma sbriw eiolt` mo stnfgegty ma sgduentij mstimpmrmtgb jgstne rnjgus arnbturis xij wgt` vmenr

embhgol pentis. K @noj Rurl Nd. 63>682

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Ariquioby ma bmdpegbntgmos natir

JVA =; 6>-6,9 tm 6,1%

nri rientij tm t`i jivgbi, wgt`

3->6 % ma tiojgomus rupturis

Ma 623 sbriws bmotrmeeij wgt`

smomlrnp`y, t`i tgp ma 97 wns

3,9 dd mr mvir t`i jmrsne bmrtix(tiomsyomvgtgs >0 bnsis, rupturis

6 bnsis)

Gotrn-nrtgbuenr sbriws wiri

ripmrtij go >6 tm :9% ma bnsis

bmotrmeeij wgt` nrt`rmsbmpy

>. Rlo ZR it ne. Rbriw prmdgoiobis rientij tm pnednr embhgol pentgol ma jgstne rnjgus. K @noj Rurl Iur Qme 63>> 21;

263-26:.

6. Qnrgtgdgjgs RI it ne. Zrintdiot ma gotrn-nrtgbuenr arnbturis ma t`i jgstne rnjgus; stumrmsbmpgb mr nrt`rmsbmpgb rijubtgmo=K Fmoi Kmgot Rurl 6330873F;

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Nontmdy ma t`i notirgmr suranbi ma t`i rnjgus

Z`i notirgmr suranbi gs

stnt up tm > bd nfmvi

t`i kmgot egoi

g.i. up tm t`i jgstne eivie

ma t`i prmontmr

qunjrntus (>> dd nfmvi t`i

euontud amssn, >2 dd nfmvit`i sbnp`mgj amssn)

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Z`io bmobnvi notirgmrey up tm

t`i dmst notirgmr pnrt bneeij

t`i wntirs`ij egoi (t`i

dmst prmdgoiot pnrt)

Gs n penti prmkibts jgstneey tm t`i

wntirs`ij egoi, stixmr tiojmos

nri go jnolir ma nfutdiot noj

gt gobrinsis t`i rgsh ma gotrn-

nrtgbuenr sbriw penbidiot

AJSg & ASE nri 6.6 dd

notirgmr tm rnjgus, 2 dd

nfmvi t`i wntirs`ij egoi

Nontmdy ma t`i notirgmr suranbi ma t`i rnjgus

Nloiw RS it ne. Jnolir [mois amr Aeixmr Ziojmos go Qmenr Sentgol ma Jgstne Vnjgus Arnbturis. K @noj Rurl 63>9 (go priss)

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X 6

. . .

. . . .

.

.

@mwivir, t`i embntgmo ma t`i wntirs`ij egoi gs

`gl`ey vnrgnfei

Fitwiio gojgvgjunes

Fitwiio t`i rnjgne noj

ueonr sgji ma t`i ipgp`ysgs

Gdntnog it ne. No nontmdgbne stujy ma t`i wntirs`ij egoi mo t`i vmenr jgstne nspibt ma t`i rnjgus. K @noj Rurl 63>68 2993-:

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\ntirs`ij egoi gs jgaairiot armd prmontmr

qunjrntus gosirtgmo

Qiry bemsi tm t`i jgstne S^

entirneey (rij jmttij egoi),

Dmri jgstneey dijgneey

(feui jmttij egoi)

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X 6

. . .

Gdpmrtnot vnrgntgmos ma t`i s`npi ma t`i jgstne

rnjgus

Z`i ueonr sgji vnrgis go

sgzi noj s`npi

Gobegontgmo gs >:9 nt

t`i euonti amssn, vs

>99 mvir t`i sbnp`mgj

amssn (nvirnli >93)

Nee pentis nri jisgloij

wgt` n >99 nolei

X 9

. ..

X 2

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Mo t`i rnjgne sgji

Z`iri gs n pnepnfei virtgbne rgjli

N tmm entirne penti wgee fi prmontijnoj pnepnfei t`rmul` t`i shgo

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Z`i rnjgne styemgj

Gs omt go t`i sndi penoi

ns tm t`i notirgmr suranbima t`i rnjgus

Sentis s`muej gobeuji n

spibgne mrgiotntgmo amr t`isbriws go t`i rnjgne styemgj

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Ns n bmosiquiobi

Dmst ma t`i jisgloijembhgol pentis jm omt t

wgt` t`i nontmdy

(Fitwiio 2 tm 1% ma

bmotnbt zmois)

Fuzziee KI, \ighirt JV, \ntsmo KZ, Eii J@. Sribmotmurij xij-nolei vmenr jgstne rnjgus pentis; n

bmdpnrgsmo ma nontmdgb t. K @noj Rurl Nd 6330822;>>::96.

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Mo t`i entirne sgjiZ`i rnjgne siptud gs dnji fy t`i

>st bmdpnrtdiot noj t`i jgstne

tiojmo ma t`i frnb`gmrnjgnegs

Gt egdgts t`i surlgbne ixtiosgmo

entirneey

Go JVAx, t`i jgstne ipgp`ysgs gs

pueeij go supgontgmo noj prmxgdneeyfy t`i frnb`gmrnjgnegs tiojmo

\`io usgol notirgmr pentis, t`i

FV tiojmo dust fi igt`ir but mr

eiolt`io tm bmrribtey rijubi nojx t`i ipgp`ysgs noj t`i rnjgne

siptud dust fi jgvgjij (w`gb`

`ns om begogbne bmosiquiobis mo

t`i striolt` go supgontgmo)

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Qnsbuenr nontmdy

Qnsbuenrgzntgmo ma t`i jgstne ipgp`ysgs gs

dnji fy frnob`is ma t`i notirgmr noj

pmstirgmr gotirmssimus nrtirgis

Nvmgj gokurgis tm t`i dijgne pnrt ma t`i

rnjgus

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Jmrsne sgji

@gl`ey bmotmurij s`npi ma t`i

jmrsne sgji

Ixtiosmr tiojmos nri embntijgotm luttirs

Z`i `igl`t ma Egstirs tufirbei

vnrgis armd 2,2 tm 1,1 dd,noj t`i jipt` ma t`i luttir ma

t`i ISE dny fi ns jiip ns

2,6 dd !

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Qnrgntgmos go t`i jipt` ma t`i rnjgus armd

dijgne tm entirne

Z`i wgjt` ma t`i rnjgus nt t`i eivie ma

Egstirs tufirbei gs 66 +/- 6 dd (jm omt

usi sbriw emolir t`no 63 dd nt t`nt eivie)

Ekuolqugst HE it ne.Srijgbtgol n Rnai Rbriw Eiolt` amr Qmenr Senti Agxntgmo ma Jgstne Vnjgus Arnbturis;Euonti Jipt` ns n Dnrhir amr Jgstne Vnjgus Jipt`. K @noj Rurl Nd. 63>98:3(9);7:3i7::.

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Rurlgbne bmosiquiobis

N sbriw dust fi 1,9 dd

emolir t`no t`i bmrtgbne fmoi

go t`i rnjgne sgji, noj 2 dd

go t`i ueonr sgji tm fi siiomo t`i entirne vgiw !

Ga ymu jm entirne vgiw wgt`

prmontgmo noj supgontgmo, nsbriw s`muej fi nt einst 6-2

dd emolir t`no t`i bmrtgbne

fmoi tm fi siio

>. Dnsb`hi RJ it ne. Vnjgmlrnp`gb ivneuntgmo ma jmrsne sbriw pioitrntgmo natir vmenr xij-nolei pentgol ma t`i jgstne rnjgus;

n bnjnvirgb stujy. @noj 633:: >93.

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Rurlgbne bmosiquiobis

Ysi spibgne stumrmsbmpgb gobgjiobis

Rhyegoi vgiw (63>3).

Riosgfgegty, spibgbgty noj jgnlomstgb

pribgsgmo wns 02% amr sbriw emolir

t`no > dd (bmdpnrij tm . Vgjjgbh NS it ne. Nbburnby ma t`i shyegoi vgiw amr jitibtgol jmrsne bmrtgbne pioitrntgmo jurgol vmenr jgstne rnjgus

xntgmo. K. @noj Rurl. (Iur. Qme.) 63>68 2.

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Ixndpei; bnjnvirgb stujy wgt` t`i shyegoi vgiw

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Z`i jmrsne `mrgzmo vgiw

Ysgol t`gs gobgjiobi, Kmsip` noj

@nrviy `nj tm b`nolij 61% ma t`igrsbriws

>. Kmsip` RK, @nrviy KO. Z`i Jmrsne @mrgzmo Qgiw; Jitibtgol Rbriw Srmtrusgmo nt t`i Jgstne Vnjgus. K @noj Rurl63>>821N;>17>>172

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Dijgne sgji; t`i JVYK

Zrmb`mj kmgot

Neemws n omrdne rmtntgmo ma >:3->93

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Z`i JVYK gs `gl`ey uostnfei

Gt prisiots fmoy

rigoamrbidiots tm risgsts

sufeuxntgol amrbis

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Z`i JVYK gs pnrt ma t`i gokury

Vnjgus noj ueon amrd n

arndi

N jgspenbij JVA gdpegis

t`nt t`iri nri eisgmos mo t`i

ueon noj/mr eglndiots

Yp tm omw, dnonlidiot ma

ueonr styemgj arnbturis gs omt

bmrrientij wgt` mutbmdis

Rmuir KR it ne. I"ibt ma no uoripngrij arnbturima t`i ueonrstyemgjfnsi mo mutbmdi natir penti-noj-sbriwxntgmo ma n jgstne rnjgne arnbturi. K FmoiKmgot Rurl Nd. 6337 Npr87>(:);023-0

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Z`i nrtgbuenr suranbi

Armotne gobegontgmo gs

nfmut 66

Rnlgttne gobegontgmo gs

3

Go t`i armotne penoi,

t`i sbnp`mgj amssn gs

dmri bmobnvi t`no

t`i euonti amssn

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Nontmdy ixpengos w`y >6-23% ma jgstne sbriws

nri gotrn-nrtgbuenr !

Zm nvmgj dgs-penbidiot ma jgstne sbriws;

Rtnrt wgt` t`i dmst dijgne sbriws

Aeumrmsbmpgb bmotrme wgt` vnrgntgmo mo t`i

noluentgmo; NS wgt` >3 ma find gobegontgmo8

entirne wgt` >3 (dijgne sgji) noj 63 ma

gobegontgmo (entirne sgji)

=

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>3 noluentgmo

`ieps tm stujyt`i nrtgbuenr

suranbi go t`i

armotne penoi

63 noluentgmo

`ieps tm stujyt`i nrtgbuenr

suranbi go t`i

snlgttne penoi

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Noj amr t`i ristgtutgmo ma nrtgbuenr

suranbis =

Z`iri gs om nontmdgbne

enojdnrhs ymu dny usi

Moey vgsunegzntgmo igt`ir wgt`

n stumrmsbmpi (nbburnby >,9

dd) mr wgt` no nrt`rmsbmpi

Vistnurntgmo ma nrtgbuenrsuranbi uojir nrt`rmsbmpgb

bmotrme gdprmvis mutbmdis

Jmg H it ne. Gotrn-nrtgbuenr arnbturisma t`i jgstnenspibt ma t`i rnjgus; nrt`rmsbmpgbneey nssgstij rijubtgmobmdpnrij wgt` mpio rijubtgmo noj gotirone agxntgmo. K Fmoi Kmgot Rurl Nd. >777 Nul80>(0);>372->>3

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Bmobeusgmos

Nontmdy `ns omt b`nolij

Fut gt gs mur sinrb` amr gdprmvgol auobtgmone mutbmdis t`nt

prmdpt us tm jisglo oiw gdpenots

Z`i usi ma t`isi oiw gdpenots `ns b`nolij mur homweijlima t`i nontmdy w`gb` gs mfvgmusey dmri bmdpeix t`no

privgmusey t`mul`t