ABSTRACT
The authors investigate the results of prophylaxis of venous thromboembolic complications (VTC) during 24 years in onco- logical surgery. The multicentric study shows that common frequency of occurrence of such VTC was reduced due to period of routine prophylaxis of VTC to 3.4%. The strategy of active revision and escalation of preventive measures in the third period of study in comparison with the second period resulted in the decrease of VTC. Patients with moderate risk degree had the results from 3.2% to 1%, patients with high risk degree moved from 4.1% to 13%. The fatal thromboembolism of the lung artery was 0.1%.
Subject(s)
Anticoagulants/therapeutic use , Neoplasms/surgery , Postoperative Complications , Quality Improvement , Surgical Procedures, Operative/adverse effects , Venous Thromboembolism , Aged , Case-Control Studies , Chemoprevention/methods , Chemoprevention/trends , Female , Humans , Male , Middle Aged , Organizational Innovation , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Preventive Health Services/methods , Preventive Health Services/organization & administration , Quality Improvement/statistics & numerical data , Quality Improvement/trends , Retrospective Studies , Risk Assessment , Risk Factors , Russia/epidemiology , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & controlABSTRACT
Experience with 1633 surgeries performed in 1592 patients with inguinal hernia is analyzed. In the first period (1979-1987) choice of plastic surgery was empirical, recurrences were diagnosed in 19.6% of examined patients. In the second period (1988-1993) anterior wall was strengthened in simple inguinal hernias, posterior wall -- in difficult, recurrences were seen in 4.9%. In the third period (1994-2000) strengthening of the posterior wall with fascial-aponeurotic methods was performed in all types of hernias. Choice of the method depended on height of inguinal space. Recurrences were diagnosed in 0.5% of examined patients.
Subject(s)
Digestive System Surgical Procedures/methods , Hernia, Inguinal/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Secondary Prevention , Treatment OutcomeABSTRACT
In territorial medical association partial redistribution of medical care from hospital to ambulatory was realized. Department of ambulatory laparoscopic surgery and gynecology with day facility and home hospital were organized. Preparation to operation was made ambulatory. After surgery patients were observed in the day hospital during 15-18 hours, then they were transferred to home hospital. In 1998-1999 this policy was applied in 208 patients. 415.5 thousand troubles from the budget were saved.
Subject(s)
Ambulatory Surgical Procedures/trends , Adult , Ambulatory Surgical Procedures/economics , Cost Savings , Female , Gynecologic Surgical Procedures/economics , Gynecologic Surgical Procedures/trends , Humans , Laparoscopy/economics , Laparoscopy/trends , Male , Middle Aged , Russia , Time FactorsABSTRACT
A 10-year experience with the use of vagotomy with the organ-preserving intervention in the treatment of patients with a bleeding pyloroduodenal ulcer who were treated for urgent and emergency indications is presented. The postoperative mortality was 8.1%. An excellent and good long-term result was noted in 88% of the patients, an unsatisfactory one--in 12%.
Subject(s)
Duodenal Ulcer/complications , Peptic Ulcer Hemorrhage/surgery , Vagotomy , Adolescent , Adult , Aged , Aged, 80 and over , Duodenal Ulcer/epidemiology , Duodenal Ulcer/surgery , Emergencies , Female , Follow-Up Studies , Gastrectomy/statistics & numerical data , Hemostasis, Endoscopic/statistics & numerical data , Hemostasis, Surgical/statistics & numerical data , Humans , Male , Middle Aged , Peptic Ulcer Hemorrhage/epidemiology , Preoperative Care/statistics & numerical data , Pylorus , Vagotomy/statistics & numerical dataABSTRACT
It was established that in patients with perforative pyloroduodenal ulcer by the moment of operation there appear considerable changes in the immune system responsible for the development of pyo-inflammatory processes in 29% of the patients. Clinical results of the action of the CO2 laser ray on the visceral, parietal peritoneum and the laparotomy wound are described in patients with perforative pyloroduodenal ulcer. Especially favourable effect of the therapeutic correction of the immune system and laser ray during operation on the postoperative course is noted.
Subject(s)
Duodenal Ulcer/complications , Peptic Ulcer Perforation/surgery , Postoperative Complications/prevention & control , Antibody Formation , Duodenal Ulcer/immunology , Duodenal Ulcer/surgery , Humans , Immunity, Cellular , Immunotherapy , Laser Therapy/methods , Peptic Ulcer Perforation/complications , Peptic Ulcer Perforation/immunology , Postoperative Complications/immunology , Pylorus/surgery , VagotomyABSTRACT
Because of the unsatisfactory long-term results, closure of a perforative duodenal ulcer should be performed in exceptional cases, for strict indications. At the modern stage of the development of surgery, vagotomy with organ-preserving operation is the most substantiated method for treating a perforative pyloroduodenal ulcer. In choice of a method of vagotomy, it is expedient to form the clinical groups. Use of vagotomy at the toxic stage of peritonitis (up to 18 h from the moment of perforation) do not lead to deterioration of the immediate results of the operation and is substantiated pathogenetically. Total postoperative lethality was 4.6%. The main cause of death together with delayed performance of the operation was a pronounced character of concomitant diseases. After vagotomy with the organ-preserving operation, there were no lethal outcomes.
