Materials and Methods: The two case histories of patients (86 years and 80 years) with occlusion of the small intestine gallstone. Attention of researchers is accented on the clinical features and symptoms of abdominal sepsis and criteria for the scale of APACHE II.
Results: In the course of examination and treatment of two patients (MKSB № 4726-2001., MKSB № 2703-2002). With obstructive ileus caused by gallstone migration into the small intestine, it was found that the progression of the disease at its earliest stages was a mask of acute cholecystitis and pancreatitis (anamnesis morbi 7 days and 4 nights). Conservative treatment is conducted within, respectively, 40 and 15 hours did not lead to relief of pain, after which it was noted the progression of symptoms that characterize abdominal sepsis [BR Gel'fand, 2000] and intestinal obstruction. Set of criteria of systemic inflammatory reaction occurred, both before surgery and in the first three days after her. Preoperative APACHE II score was 18 and 16. Pain syndrome was intermittent in nature. The operation of the first patient started with a slash in the right upper quadrant, as obtained clinical and diagnostic data left no doubt in the diagnosis of "destructive cholecystitis. The diagnosis of small bowel obstruction gallstone was installed in both cases intraoperatively. Cholecysto-duodenal fistula (CDU) has a diameter of 4 cm, which ensured the migration of gallstone size 4.0? 3.5? 3.5 cm through tissue infiltrated duodenum into the small intestine. Obstruction of the small intestine occurred respectively in 40 cm and 150 cm from fl.duodenojejunalis. After moving the gallstone proximal obstruction in both cases made enterotomy and removal of gall stones. Cholecystectomy (destruction of the wall) and seam duodenum performed in the first patient. Infiltrated tissue in the area holetsistoduodenalnogo anastomosis dramatically hinders probe for intestinal decompression, which is made only in the second patient in tension resulting in the small intestine up to 6 cm and bacterial contamination of the corresponding purulent exudate of the abdominal cavity. Postoperative period in the first patient was complicated by duodenal fistula, development of which led to the progression of widespread peritonitis (APACHE II 21) it took remedial relaparotomy on the third day after the first operation. After the effective drainage of the abdominal cavity and restore peristalsis duodenal fistula itself was closed for 9 days (duodenal discharge up to 200 ml / day). As a method of detoxification were held on 3-4 sessions of HBO. Antibacterial therapy - klaforan, metronidazole, ampicillin. Patient spent in hospital 31 and 15 bed-days and were discharged with complete recovery.
Conclusions: The diagnosis of small bowel obstruction gallstone, usually installed intraoperative and differentiated with acute cholecystitis and pancreatitis. Intermittent nature of pain, nekupiruemy medication, is a characteristic but poorly recognizable symptom, which in the presence of clinical and sonographic brand viagra signs of cholecystitis may indicate a developing intestinal obstruction. Resistance criteria of abdominal sepsis and the lack of effect of conservative therapy are a reason to accelerate decision-making about the operation. Cholecystectomy is not feasible and should be enforced only when the nature of destruction of the gallbladder wall. The presence of the CDU should be regarded as a relative contraindication to perform intestinal decompression, which is shown only when absolutely purulent peritonitis and small bowel resection about its necrosis. Late diagnosis affects the prognosis of the disease, health and economic outcomes.
sensitivity to sodium
sympathetic activation
multivitamin
tactics
quantitative and qualitative
Thứ Tư, 26 tháng 1, 2011
Thứ Năm, 20 tháng 1, 2011
Life before and after
The developed technique of the operation includes a total demuskulyarizatsiyu narrowed esophagus with selective proximal vagotomy (SPV) and the formation of invaginated valve kardioezofagealnoy zone and in the following manner. Under endotracheal anesthesia, laparotomy was performed verhnesredinnuyu. After the audit produce PWV mobilization of abdominal, vnutrihiatusnogo esophagus. In the transition zone kardioezofagealnogo spend a total demuskulyarizatsiyu esophagus and cardia of the stomach throughout the restricted area by preserving the vagus nerves. To do this, perform cross-circular miotomnye incisions: one at 10 mm proximal to the narrowing and the other at 10 mm distal to kardioezofagealnogo transition serosa and muscle fibers to dissect submucosal layer. Speaking about the direction miotomnyh cuts should be made clear that, unlike the distal incision, which traditionally follows the contour kardioezofagealnogo transition, lying 10 mm below it, a proximal circular incision is located at an angle of 60-70 ° in the frontal plane (Fig. 3, a) .
With this direction of the cuts during a comparison of tissue cross-linking formed an acute angle branch block (closest to the anatomical), which is another constituent component of the antireflux mechanism. Without opening the lumen of the esophagus produce a complete removal of the circular muscle sheet, and adventive serous membranes of the esophagus and stomach, after which the lower edge of the muscular layer of the esophagus and the sero-muscular cialis without prescription layer of the stomach impose nodal-taped seams, and tying that produce alternate immersion submucosal mucus-box in lumen of the stomach, thereby forming invaginated areflyuksny valve (Fig. 3, b).
Formation of invaginated areflyuksnogo brand viagra online valve and restore the anatomical angle branch block in order to prevent the occurrence of complications associated with reflux of acidic gastric contents into the esophagus.
In all 39 patients had a favorable early postoperative period. Average length of hospital stay after surgery was 6,5 ± 1,2 days.
In the early postoperative period in 1 (2.6%) patients came paresis of the vocal cords in response to tracheal intubation, which was fully docked in the first 3 days after surgery using nootropics, vitamins of group B. No other complications associated with the technique of the operation , we have not observed. Enteral nutrition in all patients started on the third day after surgery, symptoms of dysphagia in response to receiving a liquid or solid food was observed.
All patients were examined during the period from 1.5 months to 5 years after surgery.
Recurrence of the disease have been reported. All patients were of working age return to former job in terms from 12 to 16 days. Duration of disability was on average 14,2 ± 1,3 days.
Fibroezofagogastroskopiya on day 6 after surgery: the esophagus was free to pass on the level of esophageal opening is invaginated valve to close, easy access, no mucosal defects. In the stomach, a small amount of liquid. When viewed from the cardiac portion of retrogradely visible characteristic invaginated circular fold up to 11-15 mm with moderate hyperemia, edema, mucosal defect was not determined.
These examination after 3 years and 5 years after surgery: esophageal mucosa throughout is not changed, cardia wink at his retrograde examination of visible characteristic invaginated circular fold up to 15 mm in the form of a cone, covering tightly tube endoscope - a pale pink, shiny , with no visible defects. Gastroesophageal reflux is not detected in any of the observation (Fig. 4).
X-rays in the late period (from 1 to 5 years): the contrast mass flow into the stomach through the esophageal-gastric junction portions. Expansion of the esophagus is not. Cardia opens up to 15-17 mm, completely bound generic viagra up in all patients. Gas bubble in the stomach is expressed well in all patients. In a study of patients in the Trendelenburg position casting of the contrast mass in the esophagus were observed (Fig. 5).
The study of quality of life before and after surgery on a scale GIQLI, showed a significant improvement in patients, especially in the late periods. So, if prior to surgery the average score on a scale GIQLI was 89,6 ± 6,9, a year after the correction - 121,9 ± 5,2. In this case, a positive result was observed for all five scales: overall subjective perception of their health, mental and physical condition, social and role functioning (Fig. 6).
Thus, the developed method of surgical treatment of achalasia cardia II-III stage, consisting in total demuskulyarizatsii restricted area without opening the esophageal lumen of the body, excluding the possibility of one of the most severe complications - anastomotic failure; shaped invaginated valve retains organic and functional consistency, ensuring the prevention of recurrence and a high level of quality of life of patients in the late postoperative period.
how to store insulin
obesity disorders
participate in meetings
iodine deficiency
With this direction of the cuts during a comparison of tissue cross-linking formed an acute angle branch block (closest to the anatomical), which is another constituent component of the antireflux mechanism. Without opening the lumen of the esophagus produce a complete removal of the circular muscle sheet, and adventive serous membranes of the esophagus and stomach, after which the lower edge of the muscular layer of the esophagus and the sero-muscular cialis without prescription layer of the stomach impose nodal-taped seams, and tying that produce alternate immersion submucosal mucus-box in lumen of the stomach, thereby forming invaginated areflyuksny valve (Fig. 3, b).
Formation of invaginated areflyuksnogo brand viagra online valve and restore the anatomical angle branch block in order to prevent the occurrence of complications associated with reflux of acidic gastric contents into the esophagus.
In all 39 patients had a favorable early postoperative period. Average length of hospital stay after surgery was 6,5 ± 1,2 days.
In the early postoperative period in 1 (2.6%) patients came paresis of the vocal cords in response to tracheal intubation, which was fully docked in the first 3 days after surgery using nootropics, vitamins of group B. No other complications associated with the technique of the operation , we have not observed. Enteral nutrition in all patients started on the third day after surgery, symptoms of dysphagia in response to receiving a liquid or solid food was observed.
All patients were examined during the period from 1.5 months to 5 years after surgery.
Recurrence of the disease have been reported. All patients were of working age return to former job in terms from 12 to 16 days. Duration of disability was on average 14,2 ± 1,3 days.
Fibroezofagogastroskopiya on day 6 after surgery: the esophagus was free to pass on the level of esophageal opening is invaginated valve to close, easy access, no mucosal defects. In the stomach, a small amount of liquid. When viewed from the cardiac portion of retrogradely visible characteristic invaginated circular fold up to 11-15 mm with moderate hyperemia, edema, mucosal defect was not determined.
These examination after 3 years and 5 years after surgery: esophageal mucosa throughout is not changed, cardia wink at his retrograde examination of visible characteristic invaginated circular fold up to 15 mm in the form of a cone, covering tightly tube endoscope - a pale pink, shiny , with no visible defects. Gastroesophageal reflux is not detected in any of the observation (Fig. 4).
X-rays in the late period (from 1 to 5 years): the contrast mass flow into the stomach through the esophageal-gastric junction portions. Expansion of the esophagus is not. Cardia opens up to 15-17 mm, completely bound generic viagra up in all patients. Gas bubble in the stomach is expressed well in all patients. In a study of patients in the Trendelenburg position casting of the contrast mass in the esophagus were observed (Fig. 5).
The study of quality of life before and after surgery on a scale GIQLI, showed a significant improvement in patients, especially in the late periods. So, if prior to surgery the average score on a scale GIQLI was 89,6 ± 6,9, a year after the correction - 121,9 ± 5,2. In this case, a positive result was observed for all five scales: overall subjective perception of their health, mental and physical condition, social and role functioning (Fig. 6).
Thus, the developed method of surgical treatment of achalasia cardia II-III stage, consisting in total demuskulyarizatsii restricted area without opening the esophageal lumen of the body, excluding the possibility of one of the most severe complications - anastomotic failure; shaped invaginated valve retains organic and functional consistency, ensuring the prevention of recurrence and a high level of quality of life of patients in the late postoperative period.
how to store insulin
obesity disorders
participate in meetings
iodine deficiency
Chủ Nhật, 9 tháng 1, 2011
Abdominal cavity
Abdominal sepsis
According to modern concepts abdominal sepsis is a systemic inflammatory response of the body in response to the development of the original destructive (inflammatory) and secondary infection in the organs with different localization in the abdominal cavity and / or retroperitoneal space [2]. Possible consequence of such a universal reaction as abdominal infections, and in the sterile necrosis (eg, pancreatic necrosis) is the formation of multiple organ failure of various severity and sepsis, including pancreatic shock. The source of infection during abdominal sepsis may not always be adequately remedied or delimited at one stage. In this regard, the selection of peritoneal, pancreatogenic and intestinal forms of abdominal sepsis is dictated by the following features of their development, diagnosis and treatment [2]:
Abdominal sepsis often occurs when multifocus, large-scale and / or common sources of degradation and infection in the abdominal cavity and / or retroperitoneal space, where the topography is brand viagra difficult to perform a perfect surgery.
There are long synchronous (abdominal cavity, gastrointestinal tract, the retroperitoneal space) and stretched in time metachronous (purulent wound pneumonic focus, pressure sores, catheters, sutures, swabs) sources of endogenous intoxication in abdominal sepsis.
Multiple sources of infection in all forms of abdominal sepsis have a powerful potential of intoxication.
Foci of destruction and infection with abdominal sepsis are characterized as manifest clinical course, and occult forms.
Significant difficulties of differential diagnosis between abacterial inflammatory and purulent processes (such as pancreatic necrosis, drug-disease and other systemic diseases).
The rapid development of potentially fatal manifestations of sepsis, septic shock and MODS nekorrigiruemoy.
Mandatory component of a treatment program of abdominal sepsis is timely visual disturbances and adequate antibiotic therapy.
Numerous operational and anesthesiology-reanimatologicheskie benefits are extremely aggressive interventions for extremely heavy contingent of patients with complicated intra-abdominal infection.
In this context, competent and individual antibiotic therapy, intensive care and anesthetic are also important components of a treatment program than surgery. The strategic objective is to ensure that patient survival to a point where surgical and drug rehabilitation will focus a crucial effect on the dynamics of complicated intra-abdominal infections.
Objective assessment of severity and prognosis of patients with abdominal sepsis
Abdominal sepsis in patients with complicated intra-abdominal infection manifested clinical signs of systemic inflammatory response syndrome, which include sufficiently clear symptoms of sepsis, severe sepsis and septic shock [4]. Objective assessment of severity of the condition of patients with abdominal sepsis is needed to study promising areas of medical tactics, determine the amount and intensity of therapy, as well as to evaluate the prognosis. Assessment of the severity of the patients with intra-abdominal infection is included as a mandatory criteria for the study of the efficacy of antibiotics, as reflected in the regulations in Europe and the USA [6].
The most widely used system of integral evaluation of the severity of the patient with surgical infections: APACHE II (1985), and APACHE III (1991) (USA) and SAPS (France). Great practical interest are two systems that are specifically designed to assess the condition of patients with sepsis and MODS: MODS (Canada) and SOFA (Belgium). Compared with the SAPS, APACHE II scale for abdominal sepsis has a higher sensitivity. Scale of assessment of multiple organ dysfunction SOFA is simpler to use than the scale of MODS.
Birth canal
without salt and sugar
Several principles
According to modern concepts abdominal sepsis is a systemic inflammatory response of the body in response to the development of the original destructive (inflammatory) and secondary infection in the organs with different localization in the abdominal cavity and / or retroperitoneal space [2]. Possible consequence of such a universal reaction as abdominal infections, and in the sterile necrosis (eg, pancreatic necrosis) is the formation of multiple organ failure of various severity and sepsis, including pancreatic shock. The source of infection during abdominal sepsis may not always be adequately remedied or delimited at one stage. In this regard, the selection of peritoneal, pancreatogenic and intestinal forms of abdominal sepsis is dictated by the following features of their development, diagnosis and treatment [2]:
Abdominal sepsis often occurs when multifocus, large-scale and / or common sources of degradation and infection in the abdominal cavity and / or retroperitoneal space, where the topography is brand viagra difficult to perform a perfect surgery.
There are long synchronous (abdominal cavity, gastrointestinal tract, the retroperitoneal space) and stretched in time metachronous (purulent wound pneumonic focus, pressure sores, catheters, sutures, swabs) sources of endogenous intoxication in abdominal sepsis.
Multiple sources of infection in all forms of abdominal sepsis have a powerful potential of intoxication.
Foci of destruction and infection with abdominal sepsis are characterized as manifest clinical course, and occult forms.
Significant difficulties of differential diagnosis between abacterial inflammatory and purulent processes (such as pancreatic necrosis, drug-disease and other systemic diseases).
The rapid development of potentially fatal manifestations of sepsis, septic shock and MODS nekorrigiruemoy.
Mandatory component of a treatment program of abdominal sepsis is timely visual disturbances and adequate antibiotic therapy.
Numerous operational and anesthesiology-reanimatologicheskie benefits are extremely aggressive interventions for extremely heavy contingent of patients with complicated intra-abdominal infection.
In this context, competent and individual antibiotic therapy, intensive care and anesthetic are also important components of a treatment program than surgery. The strategic objective is to ensure that patient survival to a point where surgical and drug rehabilitation will focus a crucial effect on the dynamics of complicated intra-abdominal infections.
Objective assessment of severity and prognosis of patients with abdominal sepsis
Abdominal sepsis in patients with complicated intra-abdominal infection manifested clinical signs of systemic inflammatory response syndrome, which include sufficiently clear symptoms of sepsis, severe sepsis and septic shock [4]. Objective assessment of severity of the condition of patients with abdominal sepsis is needed to study promising areas of medical tactics, determine the amount and intensity of therapy, as well as to evaluate the prognosis. Assessment of the severity of the patients with intra-abdominal infection is included as a mandatory criteria for the study of the efficacy of antibiotics, as reflected in the regulations in Europe and the USA [6].
The most widely used system of integral evaluation of the severity of the patient with surgical infections: APACHE II (1985), and APACHE III (1991) (USA) and SAPS (France). Great practical interest are two systems that are specifically designed to assess the condition of patients with sepsis and MODS: MODS (Canada) and SOFA (Belgium). Compared with the SAPS, APACHE II scale for abdominal sepsis has a higher sensitivity. Scale of assessment of multiple organ dysfunction SOFA is simpler to use than the scale of MODS.
Birth canal
without salt and sugar
Several principles
Chủ Nhật, 2 tháng 1, 2011
Tuberculosis
Patients with malignant lesions of the blood system is always considered as a group at risk of developing tuberculosis,
The purpose of the study was to examine the clinical symptoms of informativeness main methods of diagnosis and effectiveness of tuberculostatic treatment hemoblastoses in combination with TB.
Materials and methods. Analyzed 79 case histories of patients with a combination of acute tuberculosis with hematological malignancies brand name viagra from 1990 to 1999. among hospitalized in the Medical Sciences Research Center. 14 of them - patients with lymphosarcoma, 8 - lymphomas and limfotsitomoy, 27 - Hodgkin.
All patients used the histological and cytological methods for studying tissue samples from various organs and tissues, bacteriological, immunological (antibody detection of TB) research. In 59 patients studied bronchoalveolar fluid, sputum and blood by PCR (polymerase chain reaction) to detect DNA of Mycobacterium tuberculosis.
Results and discussion. The clinic patients with comorbidity dominated long feverish syndrome, which did not yield enhanced antibacterial, antifungal and antiviral therapy.
Active tuberculosis developed a mean of 2.6% - of patients with hematological malignancies, including 3% - of patients with LPZ (lymphoproliferative disease), 4% - in patients with Hodgkin. 2% - MPD (myeloproliferative disease) and 1% - AL (acute leukemia), which allows you to include this category of patients to a group of particularly high risk of joining a specific infection.
Difficulties in the diagnosis of tuberculosis that developed in patients with hematological malignancies, due to low informativeness of the most reliable methods of verification of this diagnosis. Positive results of bacteriological and histological methods of investigation were obtained in 28% of patients with different forms of hemoblastoses. The exception are the extrapulmonary localization of tuberculosis, in which the histological examination in 60% of the cases yielded positive results.
The complex clinical and radiological methods of investigation with a high suspicion for tuberculosis suspect allowed the development of this infection in 52% of hypertensive patients (64% with pulmonary localization), and confirm the accuracy of the diagnosis Viagra Is it possible Viagra will help you pronounced effect after the appointment of anti-TB therapy.
Conclusion. Difficulties in the diagnosis of tuberculosis that developed in patients with hematological malignancies, due to low informativeness of the most reliable methods of verification of the infection. Therefore, in addition to the targeted conduct a standard diagnosis of tuberculosis, bacteriological and histological - special attention should be paid to clinical methods of diagnosis, focusing on increased vigilance in respect of a substantial incidence of tuberculosis in these patients.
Labor pain
Recent conference
The purpose of the study was to examine the clinical symptoms of informativeness main methods of diagnosis and effectiveness of tuberculostatic treatment hemoblastoses in combination with TB.
Materials and methods. Analyzed 79 case histories of patients with a combination of acute tuberculosis with hematological malignancies brand name viagra from 1990 to 1999. among hospitalized in the Medical Sciences Research Center. 14 of them - patients with lymphosarcoma, 8 - lymphomas and limfotsitomoy, 27 - Hodgkin.
All patients used the histological and cytological methods for studying tissue samples from various organs and tissues, bacteriological, immunological (antibody detection of TB) research. In 59 patients studied bronchoalveolar fluid, sputum and blood by PCR (polymerase chain reaction) to detect DNA of Mycobacterium tuberculosis.
Results and discussion. The clinic patients with comorbidity dominated long feverish syndrome, which did not yield enhanced antibacterial, antifungal and antiviral therapy.
Active tuberculosis developed a mean of 2.6% - of patients with hematological malignancies, including 3% - of patients with LPZ (lymphoproliferative disease), 4% - in patients with Hodgkin. 2% - MPD (myeloproliferative disease) and 1% - AL (acute leukemia), which allows you to include this category of patients to a group of particularly high risk of joining a specific infection.
Difficulties in the diagnosis of tuberculosis that developed in patients with hematological malignancies, due to low informativeness of the most reliable methods of verification of this diagnosis. Positive results of bacteriological and histological methods of investigation were obtained in 28% of patients with different forms of hemoblastoses. The exception are the extrapulmonary localization of tuberculosis, in which the histological examination in 60% of the cases yielded positive results.
The complex clinical and radiological methods of investigation with a high suspicion for tuberculosis suspect allowed the development of this infection in 52% of hypertensive patients (64% with pulmonary localization), and confirm the accuracy of the diagnosis Viagra Is it possible Viagra will help you pronounced effect after the appointment of anti-TB therapy.
Conclusion. Difficulties in the diagnosis of tuberculosis that developed in patients with hematological malignancies, due to low informativeness of the most reliable methods of verification of the infection. Therefore, in addition to the targeted conduct a standard diagnosis of tuberculosis, bacteriological and histological - special attention should be paid to clinical methods of diagnosis, focusing on increased vigilance in respect of a substantial incidence of tuberculosis in these patients.
Labor pain
Recent conference
Đăng ký:
Bài đăng (Atom)