RESUMEN
The H-shaped mesenteriocaval shunt with the autovenous transplant was made in 22 patients with the intrahepatic form of portal hypertension. An original method developed by the authors was used. Two patients died after the operation. The rest of the patients were found to have decreased portal hypertension, retained hepatopetal circulation along the portal vein, no encephalopathy and no recurrent bleedings from the varicose veins of the esophagus.
Asunto(s)
Hipertensión Portal/cirugía , Derivación Portosistémica Quirúrgica/métodos , Várices Esofágicas y Gástricas/complicaciones , Várices Esofágicas y Gástricas/cirugía , Estudios de Evaluación como Asunto , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Humanos , Flujometría por Láser-Doppler , Síndrome , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
The literature data and original experience (11 relevant cases) have provided evidence in support of marked diagnostic benefit of ultrasonography and transcutaneous transhepatic portography employed in suspected esophagogastric hemorrhage due to isolated thrombosis. Splenectomy and disconnection of pathological portocaval shunt through short gastric veins present surgery of choice.
Asunto(s)
Várices Esofágicas y Gástricas/complicaciones , Hemorragia Gastrointestinal/etiología , Vena Esplénica , Trombosis/complicaciones , Adulto , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Vena Esplénica/cirugía , Trombosis/cirugíaRESUMEN
From study of the results of exclusion of the spleen in 87 patients with portal hypertension by ligation of the splenic artery (47) or its truncal embolization (40) with a Gianturko-type spiral, the authors conclude that in some cases these operations reduce portal pressure, manifestations of hypersplenism, and risk of bleeding, but do not guarantee that they will not develop. Ligation of the splenic artery or its truncal embolization is justified as an independent operative intervention when decompression anastomoses cannot be formed or the risk of their performance is extremely high.
Asunto(s)
Embolización Terapéutica , Hipertensión Portal/terapia , Arteria Esplénica , Adolescente , Adulto , Anciano , Ascitis/etiología , Ascitis/terapia , Terapia Combinada , Femenino , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Humanos , Hiperesplenismo/etiología , Hiperesplenismo/terapia , Hipertensión Portal/complicaciones , Ligadura , Masculino , Persona de Mediana Edad , Arteria Esplénica/cirugía , Factores de TiempoRESUMEN
An investigation of ADP-induced aggregation of thrombocytes in 62 patients with the portal hypertension syndrome has revealed pronounced functional alterations of blood platelets characterized by a lower aggregation rate, lower rate and degree of thrombocyte deaggregation. More profound alterations were found in patients with cirrhosis of the liver. It was established that the decreased rate and degree of the thrombocyte deaggregation with the growing aggregation rate, change of the aggregation into the irreversible form is a very dangerous portent of gastrointestinal bleeding.
Asunto(s)
Enfermedades del Esófago/sangre , Hemorragia Gastrointestinal/sangre , Hipertensión Portal/sangre , Agregación Plaquetaria , Gastropatías/sangre , Enfermedades del Esófago/etiología , Enfermedades del Esófago/cirugía , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Humanos , Hipertensión Portal/complicaciones , Hipertensión Portal/cirugía , Cirrosis Hepática/sangre , Cirrosis Hepática/complicaciones , Recuento de Plaquetas , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/etiología , Recurrencia , Gastropatías/etiología , Gastropatías/cirugía , Factores de TiempoRESUMEN
Based on an examination of 105 patients with cirrhosis of the liver with the syndrome of portal hypertension complicated by gastroduodenal bleedings who were subjected to splenectomy (in 86 patients there were proximal splenorenal anastomoses) the authors make a conclusion that infectious complications in the postoperative period in the group under analysis were developing against the background of the concomitant and predisposing conditions and can be compared in their incidence with infectious complications after other similar in severity operative interventions on organs of the abdominal cavity. In remote terms after operation the normalization of the indices of both cellular and humoral immunity was noted.
Asunto(s)
Síndromes de Inmunodeficiencia/complicaciones , Cirrosis Hepática/cirugía , Complicaciones Posoperatorias/etiología , Esplenectomía/efectos adversos , Adulto , Femenino , Humanos , Cirrosis Hepática/inmunología , Masculino , Persona de Mediana Edad , Peritonitis/etiología , Neumonía/etiología , Infección de la Herida Quirúrgica/etiologíaAsunto(s)
Várices Esofágicas y Gástricas/cirugía , Hemorragia Gastrointestinal/cirugía , Derivación Portosistémica Quirúrgica/métodos , Várices Esofágicas y Gástricas/complicaciones , Esófago/irrigación sanguínea , Hemorragia Gastrointestinal/etiología , Humanos , Derivación Portocava Quirúrgica/métodos , Derivación Esplenorrenal Quirúrgica/métodosAsunto(s)
Enfermedades de la Médula Ósea/cirugía , Hiperesplenismo/cirugía , Viremia/cirugía , Enfermedades de la Médula Ósea/sangre , Enfermedades de la Médula Ósea/microbiología , Várices Esofágicas y Gástricas/sangre , Várices Esofágicas y Gástricas/etiología , Várices Esofágicas y Gástricas/cirugía , Hemorragia Gastrointestinal/sangre , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Humanos , Hiperesplenismo/sangre , Hiperesplenismo/microbiología , Hipertensión Portal/sangre , Hipertensión Portal/complicaciones , Hipertensión Portal/cirugía , Cuerpos de Inclusión Viral/ultraestructura , Recuento de Leucocitos , Agregación Plaquetaria , Recuento de Plaquetas , Esplenectomía , Viremia/sangre , Viremia/microbiologíaRESUMEN
The ultrasonic investigation has established patency of splenorenal anastomoses in 13 of 19 patients examined. When the examination failed to surely estimate the patency the percutaneous transhepatic portography is indicated.
Asunto(s)
Hipertensión Portal/cirugía , Derivación Esplenorrenal Quirúrgica , Grado de Desobstrucción Vascular , Adulto , Humanos , Persona de Mediana Edad , Cuidados Posoperatorios , Venas Renales/patología , Vena Esplénica/patología , UltrasonografíaRESUMEN
Under study were long-term results of the treatment of 356 patients with the syndrome of portal hypertension complicated by gastroesophageal bleedings. Various surgical interventions were performed on 147 of them. The authors made a conclusion that the selective "drainage" of the portal system (splenorenal anastomosis) had a number of advantages as compared with its total shunting.
Asunto(s)
Várices Esofágicas y Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Hipertensión Portal/terapia , Adolescente , Adulto , Várices Esofágicas y Gástricas/etiología , Femenino , Estudios de Seguimiento , Hemorragia Gastrointestinal/etiología , Técnicas Hemostáticas , Humanos , Hipertensión Portal/complicaciones , Ligadura , Hígado/cirugía , Masculino , Persona de Mediana Edad , Epiplón/cirugía , Derivación Portocava Quirúrgica , Esplenectomía , Arteria Esplénica/cirugíaRESUMEN
The state of the cellular and humoral immunity was studied in patients with acquired valvular disease of rheumatic etiology who were subjected to closed commissurotomy. It was established that the patients whose postoperative course was complicated by a suppuration of the wound had low levels of T-lymphocytes, immunoglobulins in their peripheral blood in the postoperative period. A dramatic elevation of the content of immunoglobulins of all classes on the 7th day of the postoperative period is considered to be the evidence of the development of an infectious process.
Asunto(s)
Formación de Anticuerpos , Inmunidad Celular , Válvula Mitral/cirugía , Adulto , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estenosis de la Válvula Mitral/inmunología , Estenosis de la Válvula Mitral/cirugía , Periodo Posoperatorio , Cardiopatía Reumática/inmunología , Cardiopatía Reumática/cirugíaRESUMEN
Under analysis was the course of the postoperative period in 216 patients subjected to closed mitral commissurotomy. The risk of local infectious complications was found to be higher in patients with the IVth stage of mitral stenosis having lymphopenia, hypopotassemia, hyponatremia, hypochromic anemia, higher ESR in the postoperative period who had malaria and infectious hepatitis in the medical history.
Asunto(s)
Estenosis de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Infección de la Herida Quirúrgica/epidemiología , Adolescente , Adulto , Enfermedades Transmisibles/complicaciones , Femenino , Fibrinógeno/análisis , Humanos , Leucopenia/complicaciones , Masculino , Persona de Mediana Edad , Estenosis de la Válvula Mitral/sangre , Estenosis de la Válvula Mitral/complicaciones , Complicaciones Posoperatorias , Riesgo , Infección de la Herida Quirúrgica/sangreRESUMEN
Coagulation properties were studied thromboelastographically in 76 patients with acute gastroduodenal hemorrhages due to ulcerous disease of the stomach and duodenum, hemorrhagic gastritis and Mallory-Weiss syndrome. A certain regularity was revealed, i. e. the more profuse the hemorrhage the more frequent hypocoagulation associated with high fibrinolysis rate. With this in view transfusion therapy should be aimed not only at the replacement of circulary blood bolume but also at the suppression of high fibrinolytic activity of blood.