RESUMEN

AIM: To improve the results of obstructive jaundice management by rational diagnostic and treatment strategies. MATERIAL AND METHODS: Outcomes of 820 patients with obstructive jaundice syndrome were analyzed. RESULTS: Diagnostic and tactical mistakes were made at pre-hospital stage in 143 (17.4%) patients and in 105 (12.8%) at hospital stage. Herewith, in 53 (6.5%) cases the errors were observed at all stages. Retrospective analysis of severe postoperative complications and lethal outcomes in patients with obstructive jaundice showed that in 23.8% of cases they were explained by diagnostic and tactical mistakes at various stages of examination and treatment. CONCLUSION: We developed an algorithm for obstructive jaundice management to reduce the number of diagnostic and tactical errors, a reduction in the frequency of diagnostic and tactical errors. It reduced the number of postoperative complications up to 16.5% and mortality rate to 3.0%.

Asunto(s)

RESUMEN

In the clinic of general and urgent surgery of Kazan Medical Academy in the period 1998-2002 operations were performed on 160 patients with great and giant postoperative ventral hernias. Four variants of autodermal-monophyl plasty were used: contact suturing of the hernia defect margins with strengthening the line of sutures with a autodermal-monophyl flap, autodermal lacing, skin flap armoured with an monophyl thread, and a skin flap crimped with an monophyl thread. The results of the operative treatment were complicated by lymphorrhea in 8 patients, thromboembolism in 4 patients (with lethal outcome in 2 cases). Recurrences were noted in 11% of the patients.

Asunto(s)

RESUMEN

In 60 patients with acute diffuse peritonitis 103 laparoscopic sanitations of the abdominal cavity were performed. The personal experiences, investigation of hydrodynamic parameters and peculiarities of redistribution of liquid in the abdominal cavity affected by pneumoperitoneum were used by the authors for developing a method of the sanitation using an irrigation-aspiration device "Brusan". Experimental investigations in 50 rats were carried out for studying the degree of traumatic action on the stomach of different variants of sanitation of the abdominal cavity. They have shown advantages of the apparatus method. The indications and contraindications for using the method were developed. The working classification of the sanitation laparoscopy is proposed.

Asunto(s)

RESUMEN

The authors propose a noval technique of computer electrogastroenterography to study motor-evacuatory gastrointestinal disorders in patients with pyloroduodenal ulcer (PDU). Bioelectrical activity of the stomach, proxymal and distal portions of the small intestine was compared in 78 patients with uncomplicated and complicated PDU. This activity was found to vary with acid-production function of the stomach, presence or absence of complications (subcompensated and decompensated pyloristenosis). The proposed method can be applied both for diagnosis of the motor-evacuatory disorders and control of therapy in patients with uncomplicated PDU, adequacy of preooperative preparation in complication of ulcer with pyloristenosis.

Asunto(s)

RESUMEN

Standard methods of treatment were analyzed in 228 patients with general peritonitis of different etiology: sanitation and drainage of abdominal cavity, peritoneal lavage, programmed laparotomy compared with laparoscopic sanitation (LS) performed in 60 patients. A significant decrease in the number of purulent-inflammatory complications, intestinal fistulas and broncho-pulmonary complications were seen after LS. It was most effective for treatment of peritonitis with Mannheim peritoneal index from 16 to 29 points (lethality 11.8%) compared with conventional treatment (p < 0.05). Indications and contraindications for LS, original device "BRUSAN" were developed. Abdominal LS is a highly effective and mini-invasive method of local treatment in general peritonitis.

Asunto(s)

RESUMEN

Results of clinical trial of the new pyrimidine derivative--ximedone are presented. The drug was administered per os 0.5 g x 4 times a day (0.5 h before meals). Total course dose achieved 60 g. Ximedone implementation for complex treatment of burns, trophic ulcer of lower limbs, different inflammations demonstrated positive results. Prophylaxy administration of the drug in abdominal surgery at acute appendix resulted with lower incidence of postoperative complications. High efficacy and good tolerability of the drug allows to recommend it for wide medical use.

Asunto(s)

RESUMEN

The results of surgical treatment of acute cholecystitis in 350 patients have been analysed. The role of concomitant diseases and age of a patients in choosing the method of surgical treatment is stressed. The advantages and shortcomings of the low-traumatic surgical methods are discussed. The way of choosing the proper surgical method in treatment of acute cholecystitis is proposed.

Asunto(s)

RESUMEN

Comparative analysis of the methods of extracorporeal detoxification in 168 patients was conducted. Endoscopic and surgical methods of treatment were applied in 40 patients without extracorporeal detoxification. Various types of extracorporeal detoxification were used along with endoscopic and operative methods in 168 patients: plasmapheresis (PP) in 72, thoracic duct (TD) drainage in 45, and hemosorption in 41 patients. In another 10 patients various types of detoxification were combined. TD drainage is indicated in prolonged obstructive jaundice, particularly when attended with cholangitis. TD drainage or PP is advisable in concomitant renal failure, PP and hemosorption have a good effect in obstructive jaundice as methods of emergency detoxification. Their efficacy increases if they are applied after endoscopic detoxification of the biliary tract.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)