RESUMEN
The authors describe their first experience with using less invasive laparoscopic methods in patients with tumors of the rectum and the colon. Twelve operative interventions were performed. The method and technique of endovideosurgical operations on the colon are described. The intraoperative and postoperative complications are analyzed. The authors not rich experience with performing laparoscopic interventions on the colon shows the necessity of stepwise and thorough mastering the method and of using strictly individual indications for such operations.
Asunto(s)
Neoplasias Colorrectales/cirugía , Laparoscopía , Cirugía Asistida por Video , Colectomía , Colostomía , Femenino , Humanos , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Factores de TiempoRESUMEN
The authors describe 229 cases of carbapenem use in intensive care wards. Tienam was used in 205 cases since 1993, meronem in 24 cases since 1996. There were 149 men and 80 women aged 15-76 years (mean age 46.4 +/- 0.7 years). Carbapenemes were administered by 5-7-day courses in a daily dose of 2-6 g (2-4 g for tienam and 2-6 g for meronem). Carbapenemes were administered as monotherapy; in 196 cases nisoral was added to antibiotic therapy starting from day 3 as an antimycotic agent. Bacteriological studies were carried out in 367 patients (413 inoculations). Sensitivity of cultured microflora to disks with tienam (329 tests) and meronem (97 tests) showed their high activity towards gram-positive and gram-negative flora. The results were less demonstrative in cerebral abscesses, which is explained by specific pharmacokinetics of tienam. Analysis of the cost/efficacy ratio confirmed the economic efficacy of this group of drugs.
Asunto(s)
Quimioterapia Combinada/uso terapéutico , Tienamicinas/uso terapéutico , Adolescente , Adulto , Anciano , Cilastatina/efectos adversos , Cilastatina/economía , Cilastatina/uso terapéutico , Combinación Cilastatina e Imipenem , Análisis Costo-Beneficio , Enfermedad Crítica , Combinación de Medicamentos , Quimioterapia Combinada/efectos adversos , Quimioterapia Combinada/economía , Femenino , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/economía , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/economía , Humanos , Imipenem/efectos adversos , Imipenem/economía , Imipenem/uso terapéutico , Masculino , Meropenem , Persona de Mediana Edad , Tienamicinas/efectos adversos , Tienamicinas/economía , Factores de TiempoAsunto(s)
Transfusión Sanguínea , Volumen Sanguíneo , Hemorragia/terapia , Sustitutos del Plasma/administración & dosificación , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anticoagulantes/administración & dosificación , Pruebas de Coagulación Sanguínea , Cuidados Críticos , Dextranos/administración & dosificación , Femenino , Gelatina/administración & dosificación , Hemodinámica , Hemorragia/fisiopatología , Humanos , Derivados de Hidroxietil Almidón/administración & dosificación , Masculino , Persona de Mediana Edad , Succinatos/administración & dosificaciónRESUMEN
A third-generation cephalosporin, Ceftriaxone, was used in intensive care of patients subjected to elective and urgent surgery in the Regional Clinical Hospital, St. Petersburg. A total of 105 patients were divided in 4 groups: 1) a course of ceftriaxone in combination with aminoglycosides started before the intervention; 2) the same, with the disease course complicated by peritonitis; 3) patients with neurosurgical diseases and brain injuries complicated by secondary meningoencephalitis; and 4) abdominal surgical patients in whom the severity of illness was determined by the abdominal process of different localization. The treatment included general and local use of ceftriaxone under ultrasonic control. The results indicate that ceftriaxone is a broad-spectrum drug effective in the treatment of nosocomial infections and neuroinfections; it can be applied locally and is economic.
Asunto(s)
Profilaxis Antibiótica , Ceftriaxona/uso terapéutico , Cefalosporinas/uso terapéutico , Sepsis/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Amicacina/administración & dosificación , Amicacina/uso terapéutico , Antibacterianos/uso terapéutico , Ceftriaxona/administración & dosificación , Cefalosporinas/administración & dosificación , Cuidados Críticos , Quimioterapia Combinada/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/tratamiento farmacológico , Supuración/tratamiento farmacológicoRESUMEN
The article deals with combined endoscopic treatment of cholelithiasis complicated by pathological changes of the terminal part of the common bile duct in 104 patients: in 81 of them there was choledocholithiasis (5 of them had the Mirizzi syndrome). 15 patients had choledocholithiasis and papillostenosis, 8 patients had papillostenosis. Papillosphincterotomy with laparoscopic cholecystectomy was performed in 50 patients, in 4 senile patients only papillosphincterotomy was performed. Laparoscopic cholecystectomy and interventions on the common bile duct were fulfilled in 46 patients; in 27 cases the duct was drained by the method of Holsted-Pikovskii, in 13 cases--after Kehr, in 3--after Vishnevskii. In 2 cases the concrements were removed through the cystic duct, the common bile duct was not drained. The supraduodenal choledochoduodenoanastomosis was made in one patient. The open operation was performed in 4 cases (3.9%). One patient died (1%). The experience shows that the modern endoscopic technique allows the whole program of intraoperative revision and sanitation of the hepaticocholedochus and its drainage to be realized. Advantages of the combined endoscopic treatment of the cholelithic disease complicated by a lesion of the terminal part of the common bile duct as compared with traditional surgery are evident. They are: decreased postoperative pain syndrome, less amount of complications, good cosmetic affect, shorter period of reconvalescence, high economic effect.
Asunto(s)
Colecistectomía Laparoscópica/métodos , Colelitiasis/complicaciones , Colelitiasis/cirugía , Enfermedades del Conducto Colédoco/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Colangiografía , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía Laparoscópica/instrumentación , Colelitiasis/diagnóstico , Enfermedad Crónica , Enfermedades del Conducto Colédoco/diagnóstico , Enfermedades del Conducto Colédoco/etiología , Contraindicaciones , Femenino , Humanos , Cuidados Intraoperatorios , Masculino , Persona de Mediana EdadRESUMEN
The authors have performed 8 endoprostheses for aneurysms of the abdominal segment of the abdominal aorta. The open cellular stent of nitinol was implanted with diameter 32 mm, bringing system 9.0 F. The implantation was carried out without problems in 7 patients, in one patient there was dislocation of the distal fragment of the endoprosthesis which required surgical intervention. The average time of operations was (7.6 +/- 4.5) min. The open stent allowed the invasiveness of operation, its technical complexity and duration to be reduced.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Stents , Anciano , Aleaciones , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Implantación de Prótesis/instrumentación , Implantación de Prótesis/métodos , Radiografía IntervencionalRESUMEN
An experience with 139 radical one-step surgeries for esophagus cancer using transpleural or transmediastinal plasty with a gastric tube is presented. This type of surgery is a method of choice for malignant tumours of the esophagus since it provides the best radical operation and good functional results. The standardized approach to the anesthesiological maintenance of these surgeries and to postoperative intensive therapy is substantiated. The total postoperative mortality made up 26.2%; mortality from surgical complications-20.9%; 3-years survival was 24.5%; 102 patients (73.3%) were discharged from the clinic with good functional results.
Asunto(s)
Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Esofagoplastia/métodos , Gastroplastia/métodos , Linfoma/cirugía , Adenocarcinoma/mortalidad , Adulto , Anciano , Carcinoma de Células Escamosas/mortalidad , Neoplasias Esofágicas/mortalidad , Femenino , Humanos , Linfoma/mortalidad , Masculino , Mediastino , Persona de Mediana Edad , Pleura , Complicaciones Posoperatorias/epidemiologíaAsunto(s)
Quimioterapia Combinada/uso terapéutico , Adolescente , Adulto , Anciano , Cilastatina/administración & dosificación , Cilastatina/uso terapéutico , Combinación Cilastatina e Imipenem , Cuidados Críticos , Combinación de Medicamentos , Quimioterapia Combinada/administración & dosificación , Humanos , Imipenem/administración & dosificación , Imipenem/uso terapéutico , Persona de Mediana Edad , Factores de TiempoRESUMEN
The article makes an analysis of the surgical tactics used in 9 patients with congenital cysts of the choledochus. In 3 patients the cysts were removed, in 1 patient internal drainage of the cyst was performed, in 4 patients the cysts were excised and hepato-jejunal or hepatocholedochoduodenal anastomoses were formed. There were no lethal outcomes after the operation. Long-term results were followed-up during the period of from several months to 18 years. In none of the cases there were symptoms of cholangitis or disturbance of the bile outflow.