RESUMEN
An analysis of 72 criteria was made which include 5 main (hectic fever, tachycardia, leukocytosis with a neutrophilic shift to the left, decreased index of the relation of total protein to the amount of values of urea and creatinin less than 0.94 c.u., male sex), 3 additional (anemization, hypoproteinemia, decreased index of the relation of temperature to pulse rate less than 0.5 c.u.) and 1 determinant (the presence of liquid in the abdominal cavity and/or in the omental bursa and/or in the retroperitoneal space. In the presence of three of the main and one of additional signs the indications to operation are determined with probability 90.2%, and in the presence of three main and one additional and determinant--100%.
Asunto(s)
Absceso Abdominal/diagnóstico , Amilasas/sangre , Drenaje/métodos , Endoscopía del Sistema Digestivo/efectos adversos , Pancreatectomía/efectos adversos , Pancreatitis Aguda Necrotizante/complicaciones , Cirugía Asistida por Video/métodos , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Diagnóstico Diferencial , Endoscopía del Sistema Digestivo/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pancreatectomía/métodos , Pancreatitis Aguda Necrotizante/enzimología , Pancreatitis Aguda Necrotizante/cirugía , Estudios RetrospectivosRESUMEN
An analysis of treatment of 260 patients with acute destructive pancreatitis (ADP) has shown that the main factors responsible for the development of purulent complications in the reactive phase of ADP are the following: pronounced and prolonged paresis of the gastro-intestinal tract, reduced function of the liver and open operations at the early stage of ADP. Prophylactic antibacterial therapy is indicated in patients having these signs as early as in the fermentative phase. If these signs are absent, prophylactic antibacterial therapy fulfilled in the fermentative phase has no effects on the frequency of the development of purulent complications in the reactive phase.
Asunto(s)
Pancreatitis Aguda Necrotizante/complicaciones , Peritonitis/etiología , Antibacterianos/uso terapéutico , Estudios de Seguimiento , Humanos , Peritonitis/prevención & control , Factores de Riesgo , Supuración/etiología , Supuración/prevención & controlRESUMEN
A detailed algorithm of the diagnostic methods of investigation for injuries of the colon is presented. The authors describe the data on the value of certain methods of investigation and shortcomings of the others.
Asunto(s)
Traumatismos Abdominales/diagnóstico , Auscultación/métodos , Colon Transverso/lesiones , Colonoscopía/métodos , Radiografía Abdominal/métodos , Colon Transverso/patología , Diagnóstico Diferencial , Humanos , Palpación/métodos , Reproducibilidad de los Resultados , Índices de Gravedad del TraumaRESUMEN
Three corpses of humans and 24 organocomplexes were used to study specific features of the structure of peritoneal-fascial space of the retroperitoneal area. The determined specific features helped to establish certain regularities of spread of the pathological process in 92 patients with acute destructive pancreatitis.
Asunto(s)
Grasa Intraabdominal/anatomía & histología , Grasa Intraabdominal/patología , Páncreas/anatomía & histología , Páncreas/patología , Pancreatitis Aguda Necrotizante/patología , Espacio Retroperitoneal/patología , Adulto , Anciano , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Úlcera Duodenal/complicaciones , Úlcera Péptica Hemorrágica/terapia , Úlcera Gástrica/complicaciones , Factores de Edad , Anciano , Ensayos Clínicos como Asunto , Urgencias Médicas , Endoscopía , Técnicas Hemostáticas , Humanos , Coagulación con Láser , Persona de Mediana Edad , Selección de Paciente , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Péptica Hemorrágica/cirugía , Recurrencia , Factores de RiesgoAsunto(s)
Peritonitis/diagnóstico , Peritonitis/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Enfermedad Aguda , Terapia Combinada , Cuidados Críticos , Humanos , Lavado Peritoneal , Peritonitis/etiología , Complicaciones Posoperatorias/etiología , ReoperaciónRESUMEN
Patients with acute destructive pancreatitis were found to have pronounced changes in the immune system manifesting themselves by reduced general amount of lymphocytes mainly at the expense of T-lymphocytes with helper and suppressor activity and in less degree--at the expense of B-lymphocytes, increase of poorly differentiated O-cells, reduction of immunoglobulin C. Hemosorption on the sorbent SKN promotes more rapid recovery of indices of the immune system in the group of patients with the area of injured pancreas less than 50% and is practically ineffective for its total injury.
Asunto(s)
Hemoperfusión , Pancreatitis/inmunología , Pancreatitis/terapia , Enfermedad Aguda , Terapia Combinada , Estudios de Evaluación como Asunto , Hemoperfusión/métodos , Humanos , Inmunidad Celular , Recuento de Leucocitos , Pancreatitis/complicaciones , Factores de TiempoAsunto(s)
Colecistectomía , Colecistitis/cirugía , Diuréticos/administración & dosificación , Desintoxicación por Sorción/métodos , Toxemia/terapia , Enfermedad Aguda , Adulto , Anciano , Colecistitis/sangre , Colecistitis/complicaciones , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Toxemia/etiologíaRESUMEN
Enterosorption on the carbon material Vaulen was performed in experiments in albino rats with the model of acute pancreatitis. The application of enterosorbents was shown to increase the percentage of survival of the animals, to decrease the activity of pancrease enzymes in the blood, components of the Kallikrein-Kinin system, proteolysis products. The clinical observations support the expediency of using this detoxication method.
Asunto(s)
Carbón Orgánico , Pancreatitis/terapia , Enfermedad Aguda , Adsorción , Amilasas/metabolismo , Animales , Perros , Duodeno/metabolismo , Absorción Intestinal , Calicreínas/metabolismo , Cininas/metabolismo , Lipasa/metabolismo , Pancreatitis/metabolismo , Ratas , Tripsina/metabolismoRESUMEN
One of important components of endogenous intoxication in acute pancreatitis is considered to be middle-mass molecules possessing high toxicity. Hemosorption improves results of complex therapy and reduces postoperative lethality by 10% at an average. The positive effect of hemosorption in focal pancreanecrosis is associated with sorption of lipase, trypsin, middle-mass molecules and other metabolites. In total pancreanecroses the effect of hemosorption was minimal. In hemosorption on the sorbent SKN the oxygenation and regional heparinization of the sorbent is indicated.
Asunto(s)
Endotoxinas/sangre , Hemoperfusión , Pancreatitis/complicaciones , Toxemia/terapia , Enfermedad Aguda , Animales , Gatos , Carbón Orgánico , Humanos , Masculino , Ratones , Persona de Mediana EdadAsunto(s)
Endotoxinas/sangre , Toxemia/sangre , Toxinas Biológicas/sangre , Enfermedad Aguda , Adolescente , Adulto , Anciano , Animales , Perros , Humanos , Persona de Mediana Edad , Peso Molecular , Ratas , Toxemia/etiologíaRESUMEN
During the recent years 202 patients with cholelithic disease and its complications have been treated in the clinic. In 135 patients admitted to the hospital an attack of severe pains was followed by jaundice and symptoms of hepatic insufficiency (HI). A compensated stage of HI was diagnosed in 68 (50.4%) patients, subcompensated stage--in 38 (28.1%), decompensated--in 25 (18.5%) and terminal stage of HI--in 4 patients (3%). The operative treatment was used in 142 patients (70.3%). The operation of choice was cholecystectomy. An intervention on the common bile duct was performed in 59 patients (41.5%). Operations were performed on 42 patients with the compensated stage of HI (one of them died), in 17 patients with the subcompensated stage (one patient died), in 16 patients with the decompensated stage (three patients died); with the terminal stage there were 4 patients operated upon. Two of them died.
Asunto(s)
Colelitiasis/cirugía , Hepatopatías/etiología , Adulto , Anciano , Bilirrubina/sangre , Colelitiasis/complicaciones , Terapia Combinada , Femenino , Humanos , Hepatopatías/cirugía , Pruebas de Función Hepática , Masculino , Persona de Mediana EdadRESUMEN
The article presents results of treatment of 300 patients with acute cholecystitis, 285 of them (95%) being operated upon. Hepatic insufficiency was found to develop in 173 patients (57,6%). The operation of choice was cholecystectomy (97,1%). Cholecystostomy was fulfilled in 7 patients (2,4%), in 2 patients (0,5%) choledocholithotomy was made following a previous cholecystectomy. Lethality in patients with hepatic insufficiency was 4 times as high as in patients without it. In 34,1% of the operated patients hepatic insufficiency was the main cause of death.