ABSTRACT
The causes of the development of hepatic insufficiency in patients with obstructive jaundice after nondosed surgical decompression of the biliary tract are analysed. The high efficacy of preoperative hemosorption in prevention of this complication was demonstrated in experiments on 120 animals. Similar results were obtained in the clinic in 60 patients. Five-day treatment with solutions of glucose, contrycal (gordox), and sodium thiosulfate improved the results of treatment of obstructive jaundice in 600 experimental jaundice, whereas aldactone, prednisolone, sodium oxybutyrate and methacine were poorly effective. In experiments with prolongation of the preoperative therapy to 8 days the mortality increased. Glucose, contrycal (gordox), sodium thiosulfate, sodium oxybutyrate, and aldactone given in the postoperative period increased the survival of the animals. It is suggested that the 4-5-day preoperative management of patients with obstructive jaundice should include contrycal (gordox), sodium thiosulfate, and hemosorption applied 24 hours before the operation. Aldactone and sodium oxybutyrate are recommended in addition after decompression of the biliary tract. Such treatment in 162 patients reduced postoperative mortality to 4.4% in comparison with the control group in which it was 16%.
Subject(s)
Aprotinin , Cholestasis/therapy , Hemoperfusion , Animals , Antioxidants/therapeutic use , Cholestasis/mortality , Combined Modality Therapy , Glucose/therapeutic use , Humans , Postoperative Care , Preoperative Care , Sodium Oxybate/therapeutic use , Spironolactone/therapeutic use , Survival Rate , Thiosulfates/therapeutic use , Time Factors , Trypsin Inhibitors/therapeutic useSubject(s)
Neurilemmoma/surgery , Stomach Neoplasms/surgery , Adult , Female , Gastrectomy , Humans , Neurilemmoma/pathology , Stomach Neoplasms/pathologyABSTRACT
An analysis of treatment and examination of 80 patients with peritonitis and acute intestinal obstruction of different etiology has been made when hemosorption was used for struggle against intoxication. It has been shown that hemosorption possessing a potent detoxicating effect considerably facilitates activation of the non-gas-exchange functions of the lungs. However, losses of the surfactant synthesis components during hemocarboperfusion as well as absorption of oxygen by certain sorts of charcoal (SKN-4M, SKN-1K) results in arterial hypoxemia. For prophylactics and treatment of pulmonary disorders in patients with peritonitis and acute intestinal obstruction hemosorption must be supplemented with repeated sessions of spontaneous respiration with positive pressure at the end of breathing out.
Subject(s)
Hemoperfusion , Intestinal Obstruction/therapy , Lung Diseases/prevention & control , Peritonitis/therapy , Acute Disease , Combined Modality Therapy , Humans , Intestinal Obstruction/complications , Intestinal Obstruction/physiopathology , Lung/physiopathology , Lung Diseases/etiology , Lung Diseases/physiopathology , Lung Diseases/therapy , Peritonitis/complications , Peritonitis/physiopathology , Positive-Pressure RespirationABSTRACT
The article deals with problems of performing detoxication in complex treatment of acute ileus. A method of plasmapheresis is proposed for treatment of patients with a pronounced intoxication syndrome. Criteria for the estimation of the patient's state are presented which are considered as indications for extracorporal detoxication and for effectiveness of plasmapheresis both by clinical criteria of the estimation of the patient's state and by laboratory findings. High efficiency of the method is shown in complex treatment of patients with acute ileus with a pronounced intoxication syndrome.
Subject(s)
Intestinal Obstruction/surgery , Plasmapheresis , Toxemia/therapy , Acute Disease , Adult , Aged , Female , Humans , Intestinal Obstruction/complications , Male , Middle Aged , Postoperative Care , Toxemia/etiologyABSTRACT
The results of examination and treatment of 216 patients with acute intestinal obstruction of benign genesis are discussed. The values of blood plasma toxicity and the values of hemostasis determined before and after the operation were compared. Intoxication of patients was found to increase in the postoperative period. Its increase was appraised according to the duration of the disease. The causes of mortality were analysed and the risk factors of intoxication increase in the postoperative period were revealed. The authors suggest a classification of the phases of intoxication in patients with acute intestinal obstruction on the basis of the degree of intoxication and the condition of homeostasis.
Subject(s)
Intestinal Obstruction/complications , Intestine, Small , Sigmoid Diseases/complications , Toxemia/etiology , Acute Disease , Adolescent , Adult , Female , Hemoperfusion , Humans , Intestinal Obstruction/blood , Male , Middle Aged , Sigmoid Diseases/blood , Toxemia/therapyABSTRACT
Experiments were conducted on 75 rabbits to study the efficacy of endolymphatic administration of aceclidine, obsidan, and cerucal for stimulation of the intestine in its experimental paresis. The stimulating effect of the pharmacological agents was found to be of a longer duration in endolymphatic that in intravenous administration. This allowed endolymphatic pharmacological stimulation of the intestine to be suggested for the use in abdominal surgery.
Subject(s)
Abdomen/surgery , Gastrointestinal Motility/drug effects , Intraoperative Care/methods , Metoclopramide/administration & dosage , Propranolol/administration & dosage , Quinuclidines/administration & dosage , Animals , Drug Evaluation, Preclinical , Emergencies , Female , Injections, Intralymphatic , Injections, Intravenous , Male , Rabbits , Stimulation, ChemicalABSTRACT
On the basis of examination of 214 patients, it was established that the pronounced intoxication syndrome developing in peritonitis and acute ileus led to disorders in the non-respiratory pulmonary functions. This contributes to the development of arterial hypoxemia, hypocapnia and acute respiratory failure. In the complex of treatment of the patients, it is expedient to use extracorporeal desintoxication.
Subject(s)
Intestinal Obstruction/complications , Lung/physiopathology , Peritonitis/complications , Respiration/physiology , Toxemia/physiopathology , Acute Disease , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Toxemia/etiologyABSTRACT
The effect of postoperative hemosorption (HS) on the pulmonary functions in 55 patients with acute ileus was studied. The severity of the state of the patients was conditioned by intoxication leading to ++over-stress of the non-respiratory pulmonary functions and development of I-II stage acute respiratory failure. HS contributes to detoxication of an organism, but is accompanied by the mean 30-35% loss of the oxygen on the adsorbent resulting in development of arterial hypoxemia. Thus, HS should be added with spontaneous breathing with positive pressure at the end of expiration.
Subject(s)
Hemoperfusion , Intestinal Obstruction/surgery , Respiration/physiology , Respiratory Insufficiency/therapy , Toxemia/therapy , Acute Disease , Adult , Female , Humans , Intestinal Obstruction/complications , Intestinal Obstruction/physiopathology , Male , Middle Aged , Positive-Pressure Respiration , Postoperative Care , Respiratory Insufficiency/etiology , Toxemia/etiology , Toxemia/physiopathologyABSTRACT
An analysis of wound complications in 699 patients after operation has been made. Microbiological examinations of the wound exudate have shown that the content of "seromas" and "hematomas" is infected with aerobic and anaerobic nonsporulating microflora in 80% of the cases. "Seromas" and "hematomas" were proved to be typical cases of suppuration of operative wounds.
Subject(s)
Surgical Wound Infection/diagnosis , Abdomen/surgery , Bacteria, Aerobic/isolation & purification , Bacteria, Anaerobic/isolation & purification , Humans , Surgical Wound Infection/microbiology , Time Factors , Wound HealingABSTRACT
An experience with the treatment of 199 patients with different forms of peritonitis enabled the authors to recommend to include the moving-blood ultraviolet irradiation in the complex therapy followed by hemosorption. It reduced lethality two times.
Subject(s)
Blood/radiation effects , Hemoperfusion , Peritonitis/surgery , Ultraviolet Therapy , Adolescent , Adult , Aged , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Postoperative CareSubject(s)
Bandages , Carbon/therapeutic use , Leg Ulcer/therapy , Textiles , Wound Infection/therapy , Acute Disease , Humans , Wound Healing/drug effectsABSTRACT
The article discusses the results of complex surgical treatment of 108 patients with acute intestinal obstruction which was caused by benign lesions in 64 and by malignant tumors of the rectum in 44 patients. Twenty-three persons (21.2%) died after palliative and radical operations. The main causes of death were intoxication (52.2% of fatal cases) and peritonitis (26.1%). Hemosorption is the most effective measure for the prevention and treatment of the endogenous intoxication syndrome in the postoperative period. A brief therapeutic effect or inefficacy of hemosorption is evidence of persistence of the pathological process in the abdominal cavity.
Subject(s)
Intestinal Obstruction/therapy , Acute Disease , Adult , Aged , Aged, 80 and over , Combined Modality Therapy , Female , Humans , Male , Middle AgedSubject(s)
Housing , Occupational Diseases/etiology , Varicose Veins/etiology , Adult , Female , Humans , Male , Middle Aged , Occupational Diseases/surgery , Stress, Mechanical , Varicose Veins/surgerySubject(s)
Ambulatory Care , Hernia, Inguinal/surgery , Adolescent , Adult , Chronic Disease , Female , Hernia, Inguinal/diagnosis , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , RecurrenceABSTRACT
Contamination of the operative wounds with aerobic and nonsporulating anaerobic microflora is known to take place in the process of operation. Lower degree of the contamination of the operative wounds by the end of operations results in lower incidence of suppurations. It can be achieved in pure and conventionally pure operations of a less traumatic character by the application of preoperative gentamycin electrophoresis onto the operation field, while in conventionally pure operations of great traumatism and contaminated operations--by active irrigating drainage.
