ABSTRACT
The article discusses a complex of methods for the diagnosis of injuries to the duodenum in 18 patients. Laboratory and X-ray findings and laparocentesis with introduction of a "feeling" catheter into the abdominal cavity with lavage of the cavity facilitated the discovery of blood and intestinal contents and allowed the correct diagnosis to be established before the operation. In inspection of the duodenum mobilization after Kocher is insufficient, in rupture of the posterior wall in the region of the inferior horizontal part the duodenum must be mobilized for its whole length. It is advisable that the defect in the duodenum is closed with a double-row suture applied with an atraumatic needle (the first inner row of interrupted sutures). The methods for applying hemostatic sutures suggested by the authors by means of created devices provide reliable hemostasis in combined injuries to the parenchymatous organs. The operation was completed by leaving glove-tube drains. The postoperative mortality was 16.6%.
Subject(s)
Duodenum/injuries , Duodenum/surgery , Wounds, Nonpenetrating/surgery , Wounds, Penetrating/surgery , Adult , Aged , Drainage , Female , Hemostasis, Surgical/methods , Humans , Male , Middle Aged , Postoperative Complications/mortality , Surgical Procedures, Operative/methods , Suture Techniques , Therapeutic IrrigationABSTRACT
The disorders in immunologic reactivity in acute gastrointestinal bleeding were studied in dynamics in 160 patients. Pronouncement of disorders in the T-system of immunity, activation of the reactions of specific sensibilization and autoallergic phenomena depend on severity of the blood loss. In ulcer location in the duodenum, the performance of an organ-preserving operation with vagotomy and elimination of the ulcer which is a source of antigen stimulation is preferable.
Subject(s)
Duodenal Ulcer/immunology , Peptic Ulcer Hemorrhage/immunology , Stomach Ulcer/immunology , Adolescent , Adult , Aged , Duodenal Ulcer/complications , Duodenal Ulcer/surgery , Female , Humans , Male , Middle Aged , Peptic Ulcer Hemorrhage/etiology , Peptic Ulcer Hemorrhage/surgery , Stomach Ulcer/complications , Stomach Ulcer/surgery , Vagotomy, Proximal GastricABSTRACT
On the day of operation for acute destructive cholecystitis functions of external ventilation prove to be disturbed due to deterioration of pulmonary blood flow (2-6 times) and ventilation (1.3-3 times). The degree of these disturbances are in direct dependence on the degree of the inflammatory process in gallbladder and time of preoperative observation. At the same terms after emergency cholecystectomy the lung functions were reestablished considerably quicker and was more valuable than after operations on urgent indications. Inclusion of adrenoblocking agents into conservative treatment of acute cholecystitis before and after operation facilitates more effective and quicker recovery of lung functions.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Cholecystitis/physiopathology , Lung/physiopathology , Respiration/physiology , Respiratory Insufficiency/etiology , Acute Disease , Aged , Cholecystitis/complications , Cholecystitis/surgery , Female , Humans , Lung/drug effects , Male , Middle Aged , Postoperative Care , Respiration/drug effects , Respiratory Insufficiency/drug therapyABSTRACT
The assessment of external respiration during a 2-day management of acute pain attack produced by cholecystitis disclosed a 1.2-1.5-fold decrease in the parameters of the function resultant from poor ventilation of the pulmonary zones and loss of coordination between the ventilation and relevant blood flow. On day 3 of the attack treatment of external respiration returned to normal functioning though in patients over 60 this return took a week, as they had a 1.2-2-fold drop in the blood flow and pulmonary ventilation. The attempts of administration of adrenoblockers in combined treatment of acute cholecystitis succeeded in restoration of pulmonary function during 3 days and in more rapid attenuation of attacks in acute cholecystitis.
Subject(s)
Adrenergic alpha-Antagonists/administration & dosage , Adrenergic beta-Antagonists/administration & dosage , Cholecystitis/drug therapy , Respiration/drug effects , Respiratory Insufficiency/drug therapy , Acute Disease , Adult , Aged , Cholecystitis/complications , Cholecystitis/physiopathology , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Respiration/physiology , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathologySubject(s)
Abdominal Muscles/physiopathology , Appendicitis/physiopathology , Cholecystitis/physiopathology , Respiration , Acute Disease , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
By means of a method of rheography, in 74 patients with acute cholecystitis before and after the operation, and in 26 healthy subjects as well, the blood flow of the brain, lungs, liver and lower extremities under conditions of the use of benzohexamethonium, obsidan, aminazine and neostigmine methylsulfate was studied. Resulting from the use of sympathetic pharmacologic blockade, already by day 2, the indices of cerebral, pulmonary and hepatic blood flow normalized or exceeded the normal level.
Subject(s)
Autonomic Nerve Block/methods , Cholecystitis/therapy , Viscera/blood supply , Acute Disease , Adult , Aged , Aged, 80 and over , Humans , Middle Aged , Postoperative Care , Preoperative Care , Regional Blood Flow/drug effects , Time FactorsABSTRACT
The results of treatment of 235 sufferers with open (142) and closed (93) intestinal injuries are analysed. One hundred and twenty one patients had isolated, 114-combined intestinal injuries. Suturing of the small, large intestine and other hollow organs was performed in 192 sufferers, resection of the small intestine-in 28, resection of the large intestine-in 5, resection of the large intestine with unloading cecostomy-in 4, right hemicolectomy-in 3, colostomy-in 3. Twenty eight patients developed complications after the operation, 14 (6.4%) died.
