RESUMEN
The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.
RESUMEN
The Russian consensus document on topical issues of the diagnosis and treatment of obstructive jaundice syndrome was prepared by a group of experts in various fields of surgery, endoscopy, interventional radiology, radiological diagnosis and intensive care. The goal of this document is to clarify and consolidate the opinions of national experts on the following issues: timing of diagnosis of obstructive jaundice, features of diagnostic measures, the need and possibility of conservative measures for obstructive jaundice, and strategy of biliary decompression depending on the cause and level of biliary block.
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Ictericia Obstructiva/diagnóstico , Ictericia Obstructiva/terapia , Consenso , Humanos , Federación de RusiaRESUMEN
OBJECTIVE: To define the informative value of qSOFA score in the prediction of outcomes in surgical patients admitted to the Intensive Care Units. STUDY DESIGN: Post hoc analysis of multicenter prospective observational study RISES. The following patient information was analyzed: gender, age, diagnosis, presence of infection, SIRS criteria, qSOFA and SOFA scores, outcomes. RESULTS: The study included data of 331 patients with surgical diseases. Infection was not observed in 174 (52.6%) cases, 157 (47.4%) patients had infection. In the group of patients without infection, area under ROC-curve for SIRS criteria was 0.519 (95% CI 0.429-0.610) and similar to that qSOFA (p=0.535). Area under ROC-curve for SOFA scale was 0.619 (95% CI 0.511-0.726) and did not significantly differ from this value for QSOFA (p=0.241). In the group of surgical patients with infection, area under ROC-curve for SIRS was 0.490 (95% CI 0.419-0.561), that was significantly lower than area under ROC-curve for qSOFA (p=0.016). Area under ROC-curve for SOFA scale was 0.803 (95% CI 0.681-0.924), that significantly exceeded area under ROC-curve for qSOFA (p=0.017). CONCLUSION: qSOFA scale is important in surgical patients with infection admitted to ICUs. Increased qSOFA score is associated with augmentation of mortality rate. qSOFA scale significantly exceeds the SIRS criteria, but is inferior to the SOFA in the prognosis of mortality in these patients.
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Unidades de Cuidados Intensivos/estadística & datos numéricos , Insuficiencia Multiorgánica/mortalidad , Puntuaciones en la Disfunción de Órganos , Procedimientos Quirúrgicos Operativos/mortalidad , Humanos , Insuficiencia Multiorgánica/terapia , Pronóstico , Estudios Prospectivos , Federación de Rusia , Resultado del TratamientoRESUMEN
AIM: To compare diagnostic value of molecular biomarkers of sepsis in patients with surgical infection in screening via Sepsis-2 (Surviving Sepsis Campaign 2012, SSC 2012) and Sepsis-3 (The Third International Consensus Definitions for Sepsis and Septic Shock) criteria. MATERIAL AND METHODS: Septic patients according to Sepsis-2 and Sepsis-3 criteria were identified from general population with surgical infection. Logistic regression models quality was the criterion for assessment of diagnostic value of molecular biomarkers. Risk factors importance was estimated via odds ratios (OR) calculation. RESULTS: Sepsis-3 ROC-AUC for procalcitonin increased up to 0.933, cut-off value 2.35 ng/ml (Sepsis-2 AUC 0.768 (p=0.004), cut-off 1.72 ng/ml). Sepsis-3 ROC-AUC for presepsin increased up to 0.932, cut-off value - 772 pg/ml (Sepsis-2 AUC 0.865, cut-off 567 pg/ml). The highest risk of sepsis was observed in systemic response to inflammation combined with organ dysfunction (OR 69.667, S 0.636; 95% CI 20.03-242.4) (Sepsis-2 - OR 9.25, S 0.548; 95% CI 3.2-27.1, p<0.001). Increased levels of both biomarkers significantly increased the risk of sepsis (OR 22.5, S 0.794; 95% CI 4.74-106.6 and OR 20.97, S 0.58; 95% CI 6.705-65.6, respectively). CONCLUSION: Organ dysfunction assessment by Sepsis-3 criteria improves diagnostic possibilities in patients with suspected sepsis. Maximum predictive value is observed for systemic inflammation response combined with organ dysfunction. In these patients procalcitonin and presepsin are characterized by equivalent high diagnostic potential for evidence of infectious nature of the disease. Increased level of these markers can serve as a basis for antimicrobial therapy administration.
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Antiinfecciosos/uso terapéutico , Calcitonina , Receptores de Lipopolisacáridos , Fragmentos de Péptidos , Sepsis , Procedimientos Quirúrgicos Operativos/efectos adversos , Infección de la Herida Quirúrgica/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica , Biomarcadores/análisis , Biomarcadores/sangre , Calcitonina/análisis , Calcitonina/sangre , Femenino , Humanos , Receptores de Lipopolisacáridos/análisis , Receptores de Lipopolisacáridos/sangre , Masculino , Persona de Mediana Edad , Selección de Paciente , Fragmentos de Péptidos/análisis , Fragmentos de Péptidos/sangre , Valor Predictivo de las Pruebas , Sepsis/diagnóstico , Sepsis/etiología , Sepsis/inmunología , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Síndrome de Respuesta Inflamatoria Sistémica/inmunologíaAsunto(s)
Aprotinina , Fibrinógeno , Hemostasis Quirúrgica/métodos , Osteomielitis/cirugía , Infecciones Relacionadas con Prótesis/cirugía , Trombina , Administración Tópica , Antioxidantes/administración & dosificación , Antioxidantes/farmacocinética , Aprotinina/administración & dosificación , Aprotinina/farmacocinética , Diáfisis/patología , Diáfisis/cirugía , Combinación de Medicamentos , Femenino , Fibrinógeno/administración & dosificación , Fibrinógeno/farmacocinética , Hemostáticos/administración & dosificación , Hemostáticos/farmacocinética , Prótesis de Cadera/efectos adversos , Humanos , Prótesis de la Rodilla/efectos adversos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Osteomielitis/patología , Trombina/administración & dosificación , Trombina/farmacocinética , Factores de Tiempo , Resultado del TratamientoRESUMEN
Combined approach (surgery and chemotherapy) have been acknowledged as the optimal treatment scheme in oncology. The purpose of this case study was to detect and compare the changes in metabolism emerging in combined treatment method for the purpose of working out, later, a therapeutic correction scheme to correct such changes. Two groups of patients, 20 subjects in each, were examined to establish a basic higher degree of the protein-and-energetic insufficiency and a changed immune response, due to which metabolism in patients with combined treatment normalizes slower than in patient with surgical treatment. Special scheme, worked out for the purpose, are needed to correct the progressing lesions.
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Gastrectomía/métodos , Desnutrición Proteico-Calórica/metabolismo , Proteínas/metabolismo , Neoplasias Gástricas/metabolismo , Anciano , Proteínas Sanguíneas/análisis , Composición Corporal , Terapia Combinada , Metabolismo Energético , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estado Nutricional , Desnutrición Proteico-Calórica/sangre , Desnutrición Proteico-Calórica/etiología , Neoplasias Gástricas/sangre , Neoplasias Gástricas/radioterapia , Neoplasias Gástricas/cirugíaRESUMEN
The authors describe the use of the fiber bronchoscopic method in the respiratory distress syndrome of adults (RDSA). The method permits visual assessment of bronchial status and allows obtaining cell elements and mediators which are regarded not merely as a result of bronchoalveolar involvement, but as markers of the degree of this involvement. Special attention is paid to cellular and chemical components of bronchial secretion and to detection of correlation with the identical values of arterial and venous blood. The authors classify the available data on bronchological methods of examination, define their role in the diagnosis and treatment of RDSA, and analyze correlation between these data and clinical stages in the course of the syndrome.