Subject(s)
Delivery of Health Care/trends , Hospitals, Military/organization & administration , Hospitals, Veterans/organization & administration , Veterans , World War II , Adult , Aged , Female , Hospital Departments/organization & administration , Hospitals, Military/trends , Hospitals, Veterans/trends , Humans , Male , Middle Aged , RussiaABSTRACT
The problem of sepsis and septic shock (SSH) is known to be very actual due to peak-shaped growth of the number of such patients and unsatisfactory results of treatment. The occurrence of SSH is different--from 10% in the structure of infectious complications after polytrauma to 50% in patients with gram-negative sepsis in patients with burn disease. An analysis of treatment of 165 patients with SSH developed against the background of peritonitis has revealed high level of lethality (64%). In the pathogenesis of SSH an important role is played by immune disorders resulting in the development of generalized inflammation and polyorganic insufficiency. Treatment of patients with SSH must be necessarily supplemented with immuno-correcting techniques: use of medicines of nonspecific anti-cytokine action (pentoxyphillin) and regulators of the immune response (ronkoleukin, blood perfusion through the donor porcine spleen). The timely performed immunomodulating therapy allowed lethality of patients with SSH to be reduced to 32%.
Subject(s)
Shock, Septic/therapy , Abdominal Injuries/complications , Abdominal Injuries/therapy , Adjuvants, Immunologic/therapeutic use , Anti-Bacterial Agents/therapeutic use , Blood Transfusion , Enzyme Inhibitors/therapeutic use , Humans , Immunotherapy , Interleukin-2/therapeutic use , Pentoxifylline/therapeutic use , Peritonitis/complications , Peritonitis/immunology , Recombinant Proteins/therapeutic use , Shock, Septic/diagnosis , Shock, Septic/etiology , Treatment OutcomeABSTRACT
The authors analyze results of the investigation of hemodynamics in the abdominal cavity vessels by the method of duplex scanning in 30 patients with acute cholecystitis, in 30 patients with mechanical jaundice and cholelithiasis and in 30 healthy subjects. It was found that these patients had less blood flow along the upper mesenterial artery and the portal vein. As a compensation the blood flow increased along the hepatic artery.
Subject(s)
Cholecystitis/physiopathology , Cholestasis/physiopathology , Splanchnic Circulation , Acute Disease , Adult , Cholecystitis/diagnostic imaging , Cholestasis/diagnostic imaging , Female , Hepatic Artery/diagnostic imaging , Hepatic Artery/physiology , Humans , Liver Circulation , Male , Mesenteric Arteries/diagnostic imaging , Mesenteric Arteries/physiology , Middle Aged , Portal Vein/diagnostic imaging , Portal Vein/physiology , Ultrasonography, Doppler, DuplexSubject(s)
Abscess/etiology , Appendicitis/complications , Cecal Diseases/etiology , Shock, Septic/etiology , Abscess/diagnosis , Abscess/surgery , Acute Disease , Adult , Aged , Appendicitis/diagnosis , Appendicitis/surgery , Cecal Diseases/diagnosis , Cecal Diseases/surgery , Colectomy , Female , Gangrene , Humans , Male , Reoperation , Shock, Septic/diagnosis , Shock, Septic/surgerySubject(s)
Ileal Diseases/complications , Intestinal Obstruction/etiology , Peritonitis/etiology , Shock, Septic/etiology , Sigmoid Diseases/complications , Acute Disease , Colon, Sigmoid/pathology , Colon, Sigmoid/surgery , Combined Modality Therapy , Humans , Ileal Diseases/pathology , Ileal Diseases/surgery , Ileum/pathology , Ileum/surgery , Intestinal Obstruction/pathology , Intestinal Obstruction/surgery , Male , Middle Aged , Necrosis , Peritonitis/pathology , Peritonitis/surgery , Reoperation , Shock, Septic/pathology , Shock, Septic/surgery , Sigmoid Diseases/pathology , Sigmoid Diseases/surgeryABSTRACT
An analysis of observations of 747 patients with peritonitis is presented, 94 of them had toxico-septic shock. A classification of severity of the shock is proposed in the article as well as principles of making diagnosis and treatment at different steps of management of such patients.
Subject(s)
Peritonitis/complications , Postoperative Complications/etiology , Shock, Septic/etiology , Acute Disease , Combined Modality Therapy , Female , Humans , Male , Peritonitis/therapy , Postoperative Complications/classification , Postoperative Complications/therapy , Shock, Septic/classification , Shock, Septic/therapyABSTRACT
On the basis of experimental and clinical investigations the authors showed immunity depression in complicated forms of cholelithiasis. Thymogene appeared to be efficient for immunocorrection that permitted to lower the frequency of postoperative complications and lethality.
Subject(s)
Adjuvants, Immunologic/therapeutic use , Cholelithiasis/therapy , Dipeptides , Peptides/therapeutic use , Acute Disease , Animals , Antibody Formation/drug effects , Cats , Cholecystectomy , Choledochostomy , Cholelithiasis/complications , Cholelithiasis/immunology , Combined Modality Therapy , Drug Evaluation , Drug Evaluation, Preclinical , Humans , Immunity, Cellular/drug effects , Postoperative Care , Postoperative Complications/prevention & controlABSTRACT
Experimental (86 experiments) and clinical investigations (in 300 patients) have shown that under conditions of complicated cholecystitis the general hepatic blood flow is decreased and the oxygen regimen of the liver and its detoxicating function is disturbed. Intraportal infusions of adenosine and riboxine increase the hepatic blood flow.
Subject(s)
Cholecystitis/physiopathology , Liver/physiopathology , Oxygen Consumption , Acute Disease , Adenosine/administration & dosage , Adult , Animals , Cats , Cholecystitis/complications , Cholecystitis/drug therapy , Cholecystitis/metabolism , Cholestasis/drug therapy , Cholestasis/etiology , Cholestasis/metabolism , Cholestasis/physiopathology , Female , Hemodynamics/drug effects , Humans , Inosine/administration & dosage , Liver/drug effects , Liver/metabolism , Liver Circulation/drug effects , Male , Middle Aged , Oxygen Consumption/drug effects , Peritonitis/drug therapy , Peritonitis/etiology , Peritonitis/metabolism , Peritonitis/physiopathologyABSTRACT
In 165 patients with the different forms of cholelithiasis, a level of the circulating immune complexes (CIC) was measured in the blood serum and bile from the common bile duct at the postoperative period. In associated purulent-resorptive and cholemic intoxication, the CIC level in the blood serum and bile increases. This, in turns, enhances the likelihood of the development of purulent-septic complications at the postoperative period, and requires performance of target immunocorrection.
Subject(s)
Antigen-Antibody Complex/metabolism , Bile/metabolism , Gallstones/metabolism , Postoperative Complications/metabolism , Acute Disease , Chronic Disease , Female , Gallstones/immunology , Gallstones/surgery , Humans , Male , Middle AgedSubject(s)
Adenosine/administration & dosage , Hemodynamics/drug effects , Inosine Diphosphate/administration & dosage , Liver/drug effects , Peritonitis/drug therapy , Animals , Cats , Female , Hemodynamics/physiology , Injections, Intravenous , Liver/physiopathology , Male , Peritonitis/physiopathology , Portal VeinABSTRACT
Acute destructive cholecystitis in cats is attended by the development of metabolic acidosis. Reduction of pH is marked in the portal vein blood. The liver contributes to the compensation of metabolic acidosis by vascular reactions comprising limitation of portal blood flow and intensification of blood flow in the hepatic artery. This made it possible to maintain pH of blood flowing from the vein on the level of arterial pH and led to increased production of bicarbonate by the liver into systemic circulation.
Subject(s)
Acid-Base Equilibrium/physiology , Cholecystitis/physiopathology , Liver Circulation/physiology , Portal System/physiology , Acute Disease , Animals , Cats , Female , MaleSubject(s)
Abnormalities, Multiple/surgery , Common Bile Duct/abnormalities , Gallbladder/abnormalities , Abnormalities, Multiple/diagnostic imaging , Aged , Cholangiography , Cholecystectomy , Cholecystography , Choledochostomy , Common Bile Duct/diagnostic imaging , Common Bile Duct/surgery , Female , Gallbladder/surgery , HumansABSTRACT
The authors made an analysis of early operations on 6076 patients. This tactics used in 84.3% of the patients allowed to reduce postoperative lethality up to 2.5%.
Subject(s)
Cholecystectomy/methods , Cholecystitis/surgery , Acute Disease , Aged , Cholecystectomy/mortality , Cholecystitis/mortality , Emergencies , Humans , Middle Aged , Time FactorsABSTRACT
Among the patients with acute cholecystitis, those at the age of 20-45 years account for 12.6%. Of them, 50.9% develop complications: choledocholithiasis, obstructive jaundice, cholangitis, pancreatitis etc. The main method for treatment of the patients is the operation within 24-48 hr from the moment of their admission with intraoperative diagnosis of pathology of the extrahepatic bile ducts. There were no lethality, postoperative complications were noted in 9.3% of the patients.
