ABSTRACT
An analysis of 72 criteria was made which include 5 main (hectic fever, tachycardia, leukocytosis with a neutrophilic shift to the left, decreased index of the relation of total protein to the amount of values of urea and creatinin less than 0.94 c.u., male sex), 3 additional (anemization, hypoproteinemia, decreased index of the relation of temperature to pulse rate less than 0.5 c.u.) and 1 determinant (the presence of liquid in the abdominal cavity and/or in the omental bursa and/or in the retroperitoneal space. In the presence of three of the main and one of additional signs the indications to operation are determined with probability 90.2%, and in the presence of three main and one additional and determinant--100%.
Subject(s)
Abdominal Abscess/diagnosis , Amylases/blood , Drainage/methods , Endoscopy, Digestive System/adverse effects , Pancreatectomy/adverse effects , Pancreatitis, Acute Necrotizing/complications , Video-Assisted Surgery/methods , Abdominal Abscess/etiology , Abdominal Abscess/surgery , Diagnosis, Differential , Endoscopy, Digestive System/methods , Female , Follow-Up Studies , Humans , Male , Pancreatectomy/methods , Pancreatitis, Acute Necrotizing/enzymology , Pancreatitis, Acute Necrotizing/surgery , Retrospective StudiesABSTRACT
An analysis of treatment of 260 patients with acute destructive pancreatitis (ADP) has shown that the main factors responsible for the development of purulent complications in the reactive phase of ADP are the following: pronounced and prolonged paresis of the gastro-intestinal tract, reduced function of the liver and open operations at the early stage of ADP. Prophylactic antibacterial therapy is indicated in patients having these signs as early as in the fermentative phase. If these signs are absent, prophylactic antibacterial therapy fulfilled in the fermentative phase has no effects on the frequency of the development of purulent complications in the reactive phase.
Subject(s)
Pancreatitis, Acute Necrotizing/complications , Peritonitis/etiology , Anti-Bacterial Agents/therapeutic use , Follow-Up Studies , Humans , Peritonitis/prevention & control , Risk Factors , Suppuration/etiology , Suppuration/prevention & controlABSTRACT
A detailed algorithm of the diagnostic methods of investigation for injuries of the colon is presented. The authors describe the data on the value of certain methods of investigation and shortcomings of the others.
Subject(s)
Abdominal Injuries/diagnosis , Auscultation/methods , Colon, Transverse/injuries , Colonoscopy/methods , Radiography, Abdominal/methods , Colon, Transverse/pathology , Diagnosis, Differential , Humans , Palpation/methods , Reproducibility of Results , Trauma Severity IndicesSubject(s)
Colon/injuries , Rectum/injuries , Wounds and Injuries/epidemiology , Wounds, Stab/epidemiology , HumansABSTRACT
Three corpses of humans and 24 organocomplexes were used to study specific features of the structure of peritoneal-fascial space of the retroperitoneal area. The determined specific features helped to establish certain regularities of spread of the pathological process in 92 patients with acute destructive pancreatitis.
Subject(s)
Intra-Abdominal Fat/anatomy & histology , Intra-Abdominal Fat/pathology , Pancreas/anatomy & histology , Pancreas/pathology , Pancreatitis, Acute Necrotizing/pathology , Retroperitoneal Space/pathology , Adult , Aged , Disease Progression , Female , Humans , Male , Middle AgedSubject(s)
Duodenal Ulcer/complications , Peptic Ulcer Hemorrhage/therapy , Stomach Ulcer/complications , Age Factors , Aged , Clinical Trials as Topic , Emergencies , Endoscopy , Hemostatic Techniques , Humans , Laser Coagulation , Middle Aged , Patient Selection , Peptic Ulcer Hemorrhage/diagnosis , Peptic Ulcer Hemorrhage/surgery , Recurrence , Risk FactorsABSTRACT
Patients with acute destructive pancreatitis were found to have pronounced changes in the immune system manifesting themselves by reduced general amount of lymphocytes mainly at the expense of T-lymphocytes with helper and suppressor activity and in less degree--at the expense of B-lymphocytes, increase of poorly differentiated O-cells, reduction of immunoglobulin C. Hemosorption on the sorbent SKN promotes more rapid recovery of indices of the immune system in the group of patients with the area of injured pancreas less than 50% and is practically ineffective for its total injury.
Subject(s)
Hemoperfusion , Pancreatitis/immunology , Pancreatitis/therapy , Acute Disease , Combined Modality Therapy , Evaluation Studies as Topic , Hemoperfusion/methods , Humans , Immunity, Cellular , Leukocyte Count , Pancreatitis/complications , Time FactorsSubject(s)
Cholecystectomy , Cholecystitis/surgery , Diuretics/administration & dosage , Sorption Detoxification/methods , Toxemia/therapy , Acute Disease , Adult , Aged , Cholecystitis/blood , Cholecystitis/complications , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Preoperative Care , Toxemia/etiologyABSTRACT
Enterosorption on the carbon material Vaulen was performed in experiments in albino rats with the model of acute pancreatitis. The application of enterosorbents was shown to increase the percentage of survival of the animals, to decrease the activity of pancrease enzymes in the blood, components of the Kallikrein-Kinin system, proteolysis products. The clinical observations support the expediency of using this detoxication method.
Subject(s)
Charcoal , Pancreatitis/therapy , Acute Disease , Adsorption , Amylases/metabolism , Animals , Dogs , Duodenum/metabolism , Intestinal Absorption , Kallikreins/metabolism , Kinins/metabolism , Lipase/metabolism , Pancreatitis/metabolism , Rats , Trypsin/metabolismABSTRACT
One of important components of endogenous intoxication in acute pancreatitis is considered to be middle-mass molecules possessing high toxicity. Hemosorption improves results of complex therapy and reduces postoperative lethality by 10% at an average. The positive effect of hemosorption in focal pancreanecrosis is associated with sorption of lipase, trypsin, middle-mass molecules and other metabolites. In total pancreanecroses the effect of hemosorption was minimal. In hemosorption on the sorbent SKN the oxygenation and regional heparinization of the sorbent is indicated.
Subject(s)
Endotoxins/blood , Hemoperfusion , Pancreatitis/complications , Toxemia/therapy , Acute Disease , Animals , Cats , Charcoal , Humans , Male , Mice , Middle AgedSubject(s)
Endotoxins/blood , Toxemia/blood , Toxins, Biological/blood , Acute Disease , Adolescent , Adult , Aged , Animals , Dogs , Humans , Middle Aged , Molecular Weight , Rats , Toxemia/etiologyABSTRACT
During the recent years 202 patients with cholelithic disease and its complications have been treated in the clinic. In 135 patients admitted to the hospital an attack of severe pains was followed by jaundice and symptoms of hepatic insufficiency (HI). A compensated stage of HI was diagnosed in 68 (50.4%) patients, subcompensated stage--in 38 (28.1%), decompensated--in 25 (18.5%) and terminal stage of HI--in 4 patients (3%). The operative treatment was used in 142 patients (70.3%). The operation of choice was cholecystectomy. An intervention on the common bile duct was performed in 59 patients (41.5%). Operations were performed on 42 patients with the compensated stage of HI (one of them died), in 17 patients with the subcompensated stage (one patient died), in 16 patients with the decompensated stage (three patients died); with the terminal stage there were 4 patients operated upon. Two of them died.
Subject(s)
Cholelithiasis/surgery , Liver Diseases/etiology , Adult , Aged , Bilirubin/blood , Cholelithiasis/complications , Combined Modality Therapy , Female , Humans , Liver Diseases/surgery , Liver Function Tests , Male , Middle AgedSubject(s)
Endotoxins/blood , Toxemia/diagnosis , Humans , Molecular Weight , Severity of Illness Index , Toxemia/bloodABSTRACT
The article presents results of treatment of 300 patients with acute cholecystitis, 285 of them (95%) being operated upon. Hepatic insufficiency was found to develop in 173 patients (57,6%). The operation of choice was cholecystectomy (97,1%). Cholecystostomy was fulfilled in 7 patients (2,4%), in 2 patients (0,5%) choledocholithotomy was made following a previous cholecystectomy. Lethality in patients with hepatic insufficiency was 4 times as high as in patients without it. In 34,1% of the operated patients hepatic insufficiency was the main cause of death.
