RESUMEN
Abdominal aortic aneurysm rupture (AAAR) is a fatal complication and results high mortality rate (40-70%). To date, open surgery remains the method of choice for AAAR in the Russian Federation. Various complications can occur after surgery for RAAA. Typical adverse events are hemorrhagic complications. The authors describe open surgical treatment of RAAA. In postoperative period, hypertensive crisis was followed by distal anastomosis failure and bleeding into the cavity of sutured aneurysmal sac. This complication was successfully eliminated by installation of stent graft.
Asunto(s)
Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Humanos , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/etiología , Rotura de la Aorta/cirugía , Federación de Rusia , Procedimientos Endovasculares/métodos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Implantación de Prótesis Vascular/efectos adversos , Resultado del Tratamiento , Stents/efectos adversosRESUMEN
OBJECTIVE: To determine the most optimal period of surgical treatment after previous stroke. MATERIAL AND METHODS: There were 186 patients with significant ICA stenosis and previous unilateral stroke for the period 2008-2014 at the Pletnev Hospital (Moscow). Surgical approach was used in 136 (73.1%) patients (group I), conservative treatment at the neurological department - in 50 (26.9%) patients (group II). We analyzed neurological and cognitive status in both groups, regression of symptoms depending on the period after stroke, early and long-term postoperative outcomes. RESULTS: In early postoperative period, 7 (5.1%) cerebral ischemic events (transient ischemic attack (TIA) and stroke) occurred in the 1st group. No correlation of neurological complications and type of intervention was revealed. In long-term period, stroke occurred in 3.6% in the first group and in 14% in the second group over the same period. Surgical treatment was followed by more complete recovery of neurological functions (NIHSS score 6.2±0.5 versus 7.0±0.8; modified Rankin score 1.5±0.2 versus 2.1±0.5, p<0.05) and cognitive mechanisms (MoCA score 22.04±1.48 versus 20.04±1.48, p<0.05). CONCLUSION: Carotid endarterectomy and carotid artery stenting are effective for prevention of recurrent stroke. Carotid artery repair accelerates recovery of cognitive functions and regression of neurological symptoms in these patients.
Asunto(s)
Implantación de Prótesis Vascular , Estenosis Carotídea , Endarterectomía Carotidea , Ataque Isquémico Transitorio , Accidente Cerebrovascular , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/cirugía , Tratamiento Conservador , Endarterectomía Carotidea/efectos adversos , Humanos , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/etiología , Factores de Riesgo , Stents , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología , Resultado del TratamientoAsunto(s)
Fístula Biliar , Colecistectomía , Colecistitis Aguda , Cálculos Biliares , Anciano , Fístula Biliar/diagnóstico , Fístula Biliar/cirugía , Pancreatocolangiografía por Resonancia Magnética , Colecistitis Aguda/diagnóstico , Colecistitis Aguda/cirugía , Femenino , Cálculos Biliares/diagnóstico , Cálculos Biliares/cirugía , Humanos , Laparotomía , Resultado del TratamientoRESUMEN
Twenty-seven patients operated on the lungs and heart (aortocoronary bypass surgery) were examined. Cellular immunity parameters were studied in venous blood, and the function of immunocompetent cells, status of the surfactant system, and albumin level were assessed in the bronchoalveolar washings off. An impairment of the T-component of cellular immunity (T-suppressors), reduced level of alveolar macrophages and of their phagocytic activity, reduced activity of the surfactant system, and increased albumin content in the bronchoalveolar lavage fluid were revealed in patients with a complicated course of the postoperative period. In patients with a smooth course of the postoperative period these shifts were less expressed. The data indicate the necessity of antibacterial and immunomodulated therapy in such patients before and after surgery.
Asunto(s)
Pulmón/inmunología , Cirugía Torácica , Adolescente , Adulto , Anciano , Líquido del Lavado Bronquioalveolar/inmunología , Procedimientos Quirúrgicos Cardíacos , Femenino , Humanos , Inmunidad Celular , Pulmón/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Pronóstico , Surfactantes Pulmonares/inmunología , Estrés Fisiológico/inmunologíaRESUMEN
The content of immunocompetent cells, activity of lipid peroxidation processes, function of the surfactant system, and levels of prostacyclin and thromboxane were studied in 9 patients with resected lungs in the perioperative period separately for the intact and operated on lung. The function of immunocompetent cells deteriorated in both lungs after surgery. The levels of albumin and thromboxane were increased in the bronchoalveolar washings from the lung operated on reliably more than in those from intact lung, and the surface active characteristics deteriorated. Eight patients developed hypoventilation of the operated on lung in the postoperative period.
Asunto(s)
Hipoventilación/etiología , Neumonectomía , Complicaciones Posoperatorias/etiología , Líquido del Lavado Bronquioalveolar/química , Líquido del Lavado Bronquioalveolar/citología , Humanos , Hipoventilación/inmunología , Hipoventilación/metabolismo , Inmunidad Celular , Peroxidación de Lípido , Pulmón/inmunología , Pulmón/metabolismo , Complicaciones Posoperatorias/inmunología , Complicaciones Posoperatorias/metabolismo , Surfactantes Pulmonares/análisisAsunto(s)
Broncodilatadores/uso terapéutico , Dobutamina/uso terapéutico , Cuidados Posoperatorios , Surfactantes Pulmonares/efectos de los fármacos , Enfermedad Aguda , Líquido del Lavado Bronquioalveolar/química , Evaluación de Medicamentos , Interacciones Farmacológicas , Humanos , Compuestos Orgánicos , Neumonectomía , Complicaciones Posoperatorias/prevención & control , Insuficiencia Respiratoria/prevención & controlRESUMEN
Pulmonary surfactant has been investigated in the postoperative period in 68 patients. Acute postoperative respiratory failure develops in patients with marked disturbances of respiratory mechanics. In patients with shock changes in surface-active substances develop on the 2nd-5th day after its onset.
Asunto(s)
Complicaciones Posoperatorias/fisiopatología , Surfactantes Pulmonares/fisiología , Insuficiencia Respiratoria/fisiopatología , Choque Hemorrágico/fisiopatología , Adulto , Humanos , Persona de Mediana EdadRESUMEN
Pulmonary surfactant system was examined in 67 patients after surgery. Acute postoperative respiratory insufficiency was parallelled by manifest injury to the surfactant. Measurements of the surface tension of a washing off, based on the use of a small amount of lavage fluid, are recommended as a criterion of pulmonary surfactant surface activity.