Vol 8, No 3 (2015)
- Year: 2015
- Articles: 10
- URL: https://vestnik-surgery.com/journal/issue/view/28
Original articles
Features of a Clinical Current and Diagnostics of Acute Pancreatitis at Patients with Virus Hepatitis
Abstract
The purpose of the study To study peculiarities of the clinical course, diagnosis and treatment outcomes of acute pancreatitis in patients with viral hepatitis.
Materials and methods The study is based on an analysis of 133 cases of acute pancreatitis. Of these 82 patients with acute pancreatitis have viral hepatitis and 51 patient developed acute pancreatitis without concomitant viral hepatitis.
Results and their discussion Septic complications of destructive forms of acute pancreatitis was significantly more frequently encountered in patients with concomitant viral hepatitis (in 15 patients of the study group (18.3%) and two patients of the control group (3.9%)). Bacteremia was registered in 9 patients of the study group (10,9%). There were no cases of bacteremia in a control group. The incidence of liver failure in patients with a combination of acute pancreatitis and viral hepatitis was significantly higher than among patients of the control group (24,3% and 1.9% respectively).
Conclusions Our study demonstrated a high incidence of septic complications of acute pancreatitis in patients with viral hepatitis. It was found that the presence of viral hepatitis in patients with acute pancreatitis is an adverse prognostic factor contributing to the high incidence of septic complications and mortality
Journal of Experimental and Clinical Surgery. 2015;8(3):256-262
256-262
Observations of Diagnosticis and Treatment of Acute Pancreatitis
Abstract
Relevance There are common mistakes of diagnosis pancreonecrosis, statistical calculation extends from 2% to 10%, as for
postoperative mortality it's from 21% to 29,3%.
The purpose of the study To improv the results of treatment patients with acute pancreatitis by well-timed diagnostics and optimization
of surgical treatment methods for patients with pancreonecrosis.
Materials and methods We analyzed the results of examinations and treatment of 1536 patients with acute pancreatitis. Patients had
got all complex of examinations including laboratory analyzes, X-rays, ultrasonography, endoscopy.
Results and their discussion Edematous form of pancreatitis which didn't require surgery was observed among 1135 (73,8%)
patients, destructive form was observed among 401 (26,1%) patients. There were revealed diagnostic mistakes connected with
untimely detection of pancreatitis with destructive forms, it had been among 17 (1%) patients. In general 1170 (76,2%) patients
got conservative treatment, amongst them lethality was 35 (2,2%), 366 (23,8%) patients needed surgery. Totally 439 surgeons
were made such as 159 (10,3%) minimally invasive percutaneous drainage of purulent cavities controlled by ultrasonography, 141
(9,2%) laparoscopic sanitations and abdominal cavity drainage, 139 surgery including laparotomy and lumbotomy with framed
bursoomentostomy on purpose to make programmed sanitations of omental bursa and retroperitoneal area which were added with
cholecystectomy and drainage of extrahepatic biliary tract in 20 cases. The postoperative lethality level reduced from 18% in 2010
till 10,4% in 2014, the general lethality level lowered from 6,3% to 4,7%.
Сonclusion It's necessary to use differential access to improve treatment results of pancreonecrosis complications
Journal of Experimental and Clinical Surgery. 2015;8(3):263-268
263-268
Membranostabilization Component in Preventions of the Hepatic Disfunctions of Acute Pancreatitis
Abstract
Relavance Despite on considerable achievements of the contemporary medical sciences one is the actual problems in abdominal surgical of the present time to be problem on acute pancreatitis.
The purpose of the study Is established in experimental of the pathogenetics mechanisms a affects of hepar for acute pancreatitis; established on effectiveness of the antioxidant etoxidoli in their preventions.
Material and methods The study is based on materials of experimental studies. The acute pancreatitis is a simulated by the method of V.M. Buyanov et al. (1989). The adult mongrel dogs performed a median laparotomy, punctured gallbladder, bile were taken with followed by ligation of the puncture site. Bile then injected into the parenchyma of the vertical parts of the pancreas of 0,6 ml in 5 points. It the control periods of the investigation (the first, third and fifth day) animals collected the blood, biopsy of the hepar.
Results and their discussion The exposed that on the background of acute pancreatitis a occurring affects on contiguous organs and systems of organism, in our incident – hepar. One of causes a advances and generalizations on a inflammatory processes in abdominal cavity and formation of hepatic insufficiency the project at disbalances on lipid metabolisms in cellular structures of present organs.
Development of membranodestructions processes in hepatic tissue on dependent at the uncontrolled flow a clearradical reactions, leading to initiation of lipid peroxidations at the cells membranes and activation on lipolytic enzymes where the greatest significance have a phospholipase A2. At the present changes proceed on background of deep depressions for antioxidants enzyme systems.
Conclusion Established of experimental that antioxidant of etoksidol causing a fast (already the first day on applications) and a significant inhibition on the processes of lipid proxidations of the hepar tissue structures. The important pathogenetic effects of preparations to be reduce the activity of phospholipase A2 of study tissue and increase its own antioxidant protections that and bring pronounced of a membranoprotectors action of etoxidoli
Journal of Experimental and Clinical Surgery. 2015;8(3):269-276
269-276
Clinical Observation Syndrome Bouveret (Biliary Ileus)
Abstract
Background Biliary ileus is a rare cause of acute intestinal obstruction and is 1-4% of all cases of small bowel obstruction.
Objective: to Analyze the current data of the world medical literature on the problem of biliary ileus, basic medical diagnostic techniques aimed at improving the provision of health care to patients with this pathology.
Materials and methods the authors review the literature and 1 the author nablyudeniya Bouveret syndrome.
Discussion Bouveret's Syndrome is a rare form of obstructive ileus due to obstruction of the biliary calculus in the presence of biliodigestive fistula output Department stomachs or 12-p K-CI. The main clinical sign is the presence of signs of intestinal obstruction. The final diagnosis is established during surgical intervention. Mortality after enterotomy with extraction of ureteral stones is about 12%, after an extended intervention - up to 30% Completed surgical treatment, enterotomy, anterolateral.
Conclusions despite the fact that the variation of the biliary ileus, Bouveret syndrome, a rare pathology, it is necessary to remember about this cause intestinal obstruction. Special attention should be given to elderly patients with clinic intestinal obstruction.
Journal of Experimental and Clinical Surgery. 2015;8(3):277-280
277-280
The Possibilities of Conservative Treatment in Patients with External Colonic Fistulas
Abstract
Among patients with severe surgical diseases of abdominal cavity, the patients with external intestinal fistulas have a special place, and the problem of their treatment is to date not resolved.
Aim of study: development and implement a safe and effective method for conservative treatment in patients with colonic fistula.
Materials and methods In surgical departments 422 Military Hospital of the Defense Ministry and the City Hospital №35 of Nizhny Novgorod. The study included 22 patients with colonic fistulas 3 types of V.I.Belokonev score. In the first group (n = 8) used an original method of medical treatment, including the use nitrogen monoxide flow and EHF - radiation (RF patent №2538175). In the second group (n = 14) did not use the above procedure. Both groups of patients were comparable in age, sex, primary and comorbidity. In statistical analysis, we use the Mann - Whitney test.
Results Closure time of fistulas were significantly low in the first group than the second group (25.38 ± 4.07 and 38.64 ± 3.84 days, respectively, p = 0.0001). In the first group did not require surgical intervention and general anesthesia (p = 0.02). Application of the method discussed in the framework of this study, it seems more reasonable to colonic fistula. Content passage violation is far less important in colonic fistula etiology and pathogenesis. Therefore, in this group of patients the conservative treatment should be used much as possible.
Conclusion. Application of the nitrogen monoxide flow and EHF - therapy is an effective component of conservative treatment in patients with colonic fistulas external three types of V.I.Belokonev score. This reduces treatment time and surgery frequency
Journal of Experimental and Clinical Surgery. 2015;8(3):281-286
281-286
The Role of Some Immune System Parameters in Forecasting Development Acute Mesenteric Ischemia Experiment
Abstract
Relevance Acute mesenteric ischemia currently holds a leading position in terms of mortality in acute surgical diseases.
The purpose of the study The aim of our study was to investigate limfogrammy blood correlated with the morphological structure of the bowel wall at different stages of acute arterial mesenteric ischemia in the experiment.
Materials and methods The study was performed on 24 male albino rats weighing 0,2-0,22 kg. limfogrammy to examine correlation with the blood in the gut morphological changes in different stages of acute arterial mesenteric ischemia. The latter is achieved by ligation of the cranial mesenteric artery at the base of the root of the mesentery. All animals were divided into three groups on blood taken at animals immunogramm to ligation, and then after 2, 6, and 8 hours in each group, respectively.
Results and their discussion It was established that the first hours of the cranial mesenteric artery occlusion in the general circulation is progressively reduced the total number of lymphocytes, mainly due to the decrease in B cells and NK- cells. The largest decrease in the number of lymphocytes was observed in necrotic stage of the disease (p <0.05).
Conclusion Results of the study indicate that the progressive reduction in the number of lymphocytes central venous blood in animals confirmed for acute arterial mesenteric ischemia and may be a factor in the adverse outcome.
Journal of Experimental and Clinical Surgery. 2015;8(3):287-290
287-290
Some Features of the Micrometastasis Arrangement in Ileal Lymph Nodes at the Cancer of Cervix Uteri
Abstract
The purpose of the study To study structure features of the lymph nodes removed from patients at a cer-vival cancer without metastasises. Materials and methods The ileal lymph nodes without metastasises removed from patients at cervival can-cer in the time of a Wertheim hysterectomy or a radical trachelectomy were studied by method of a light microscopy. Results and their discussion Small oval or elliptic micrometastasises of a high-differentiated adenocarcinoma up to 105 μm2 in 2 ileal lymph nodes from one patient from 56 surveyed were found. Tumoral struc-tures were present only in 3-4 serial organ cuts made through 50 μm in a row, and metastasises were never located in the plane of the maximal area of a lymph nodes which are usually studied by pathomorphologists during establishment or specification of the clinical diagnosis. These metastasis-es were located in the surface departments of a cortical plateau, practically on border with a subcap-sular sine or a nodular capsule. In both organs with the found micrometastasises the phenomenon of a paracortical and follicular hyperplasia were noted. That is characteristic for nodes without metasta-sises, but not for organs at early stages of development of metastasises, thus on indirect signs it is impossible to judge existence or absence of small tumoral structures in lymph nodes. Conclusion For detection of micrometastasises in lymph nodes it is necessary from all organ to make serial cuts with an interval no more than 100 microns. Besides, the lymph nodes with mi-crometastasises of a malignant tumor have a paracortical and follicular hyperplasia, the reference for nodes without metastasises that can testify to antigenic stimulation of these organs, activation of their protective functions directed against as well as the tumor and its metastasises. |
Journal of Experimental and Clinical Surgery. 2015;8(3):291-295
291-295
Reserves to Reduce Mortality from Malignant Neoplasms in a Specialized Oncology Service Link
Abstract
On the basis of official cancer statistics proved reserves to reduce mortality from malignant neoplasms in the specialized link Oncology service: improved monitoring of patients II clinical group, improving the efficiency of working with refused treatment, increasing the share of combined and complex treatment, shortening detailed diagnostics in the Oncology center, commission approach to determining contraindications to special treatment, increasing of the volume of outpatient radical treatment. The presented algorithms conversations with cancer patients at the failure of an examination, control system for radical treatment of cancer patients II clinical group.
Journal of Experimental and Clinical Surgery. 2015;8(3):296-300
296-300
Sepsis: Modern Paradigm
Abstract
The article presents the current guidelines for the diagnosis and treatment guidelines for severe sepsis (SS) and septic shock (SSh), reflecting the interdisciplinary experience of experts in more than 30 associations, united in the movement «Surviving Sepsis Campaign».
For the diagnosis of sepsis is recommended to focus on advanced clinical and laboratory criteria and is not recommended to use a higher level of procalcitonin or other biomarkers as a diagnostic tool for the verification of the vehicle.
With regard to the treatment program accented allocated an initial and subsequent stages of treatment. The purpose of the initial phase is to achieve the target parameters of hemodynamics and oxygen status, which is implemented by hemodynamic and respiratory support, adequate surgical control of the focus of infection and the choice of the optimal mode of antibacterial therapy.The highest level of reliability has a number of provisions of the treatment program at SS and SSh: crystalloid infusion solutions are the choice; hydroxyethyl starches should not be used for infusion therapy; norepinephrine is the vasopressor of choice; dobutamine is regarded as the drug of choice to increase cardiac output; restrictive strategy in relation to the use of corticosteroids, blood products, and muscle relaxants; expansion of recommendations for respiratory support; the need for hypo- and normokaloric combined with enteral nutritional support regime; glycemic control should start at the level of blood glucose above 180 mg / dL, in order to achieve the target level of ≤110 mg / dL; continuous renal replacement therapy and intermittent hemodialysis are equivalent in patients with acute renal failure; obligatory daily pharmacoprophylaxis venous thromboembolic complications with the preferred use of low molecular weight heparins and stress gastric ulcer proton pump inhibitors.
Journal of Experimental and Clinical Surgery. 2015;8(3):301-309
301-309
Method of Strengthening the Posterior Wall of the Inguinal Canal with Direct Inguinal Hernias, the Transverse Fascia is Superimposed Endo-loop
Abstract
Purpose of the study is to determine the effectiveness of our proposed method of strengthening the posterior wall of the inguinal canal with direct inguinal hernias. Further complications such as hemostasis and seroma in early postoperative period after laparoscopic hernia repair on direct inguinal hernias due to the fact that nonliquidated cavity is formed between the mesh endoprosthesis, and the transverse fascia. Our proposed method is as follows: while performing a laporoscopic hernia repair on a direct inguinal hernia, after dissection of tissues in the periperitoneal space, elements of the inguinal gap are distinguished. We find stretched prolapses in
the transverse fascia of the inguinal gap, in the projection of the medial inguinal fossa. Then, by an endoscopic clamp we grab the bottom of the stretched transverse fascia, pulling it in rotational movements in the periperitoneal space. On the basis of the formed cone elongated in the periperitoneal space, the transverse fascia is superimposed endo-loop and tightened, thereby eliminated prolapsed of the transverse fascia which in turn strengthens the posterior wall of the inguinal canal. The next step is setting up and fixing the mesh prosthesis with its subsequent peritonization.
Conclusion Publication experience in this study confirms that the proposed method can be used in the treatment of direct inguinal hernias.
Journal of Experimental and Clinical Surgery. 2015;8(3):310-313
310-313