ABSTRACT
The authors analyzed the data of 281 cases of iatrogenes of manipulator character in abdominal surgery in order to investigate the circumstances and character of origin. There were 187 cases of operative confirmation and 84 cases of unintentional intraoperative retained foreign bodies. It was detected, that primary planned intervention of higher category of complexity should be related to the high risk group of the development of the operative confirmation. Retained foreign bodies with soft fabric base were diagnosed in early postoperative period as the result of the beginning of postoperative complications. The retained foreign bodies with tough backer material as a rule didn't cause the complications in early postoperative period. They were diagnosed in long-term postoperative period in majority of cases.
Subject(s)
Abdomen , Foreign Bodies , Intraoperative Complications , Medical Errors/prevention & control , Postoperative Complications , Surgical Procedures, Operative , Abdomen/physiopathology , Abdomen/surgery , Female , Foreign Bodies/diagnosis , Foreign Bodies/epidemiology , Foreign Bodies/etiology , Humans , Iatrogenic Disease/prevention & control , Intraoperative Care/adverse effects , Intraoperative Care/methods , Intraoperative Complications/diagnosis , Intraoperative Complications/epidemiology , Intraoperative Complications/etiology , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Risk Assessment , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/statistics & numerical data , Survival Analysis , Time Factors , Treatment OutcomeABSTRACT
The article reports the questions, which are associated with the interpretation of disease pathogenesis. The data are based on an analytical generalization of the follow-up study of 59 patients with necrotizing fasciitis in 2003-2011. The main component is stressed: disorders of microcirculation of superficial fascia as a result of thrombosis on basis of the hypercoagulation with outcome to necrosis, which was accompanied with POI syndrome, which manifested with severe form of sepsis (Hardaway theory) and can be considered as main cause of fatal outcome. The cause of high lethality is the not timely diagnostics and late performed operation.
Subject(s)
Critical Care/methods , Fasciitis, Necrotizing/physiopathology , Microcirculation/physiology , Public Health/methods , Aged , Fasciitis, Necrotizing/therapy , Follow-Up Studies , Humans , Male , Retrospective StudiesABSTRACT
On the basis of literature data and personal investigations the authors discuss the questions of pathogenesis of critical states in sepsis and polytrauma taken as an example.
Subject(s)
Critical Illness , Emergencies , Multiple Trauma/complications , Reperfusion Injury/etiology , Sepsis/complications , Surgical Procedures, Operative , Humans , Multiple Trauma/surgeryABSTRACT
Pathogenetic parameters of abdominal and mesenchymal sepsis, traumatic and burn shock, acute pancreatits, ischemic-reperfusion syndrome by renal transplantation, blood flow restoration by reconstructive cardiac surgery, critical limb ischemia in patients with obstructive vessel diseases etc., such as endotoxicosis, cytokinemia, biochemic changes, laser Doppler flowmetry indexes and morphologic signs of tissue necrosis were analyzed. The study proved the pathophisiological universatility of ischemic-reperfusion syndrome as a generated evolutionally and genetically encoded response to superagression, such as iatrogenic blood flow restoration.
Subject(s)
Cytokines/metabolism , Diabetic Foot/physiopathology , Foot/blood supply , Regional Blood Flow/physiology , Reperfusion Injury/physiopathology , Diabetic Foot/metabolism , Fatal Outcome , Female , Humans , Middle Aged , Reperfusion Injury/metabolism , SyndromeSubject(s)
General Surgery/history , Military Medicine/history , History, 20th Century , Humans , USSRSubject(s)
Military Medicine/history , Neurosurgery/history , History, 19th Century , History, 20th Century , Humans , Leadership , RussiaSubject(s)
Military Medicine/history , Neurosurgery/history , History, 20th Century , History, 21st Century , Humans , RussiaABSTRACT
Severe mechanical and burn injury, generalized microbial or histiocytic vascular invasion (sepsis, peritonitis, pancreatitis, necrotizing fasciitis) are clinical models of critical states in surgical practice, in transplantology they are ischemia--reperfusion injuries, in therapy--myocardial infarction, in toxicology--poisoning with poisons, toxins. The determining manifesting sign is shock syndrome with the developing polyorganic insufficiency. Personal clinical observations of patients with peritoneal septic shock (n=145), experimental data confirming typical pathomorphosis of the microcirculatory bed and pathohistological data obtained in the clinic in patients with necrotizing fasciitis (n=50) were analyzed. Pathogenesis of critical states is suggested to be a universal process in etiologically different extreme clinical states, formed in the process of evolution of living system as a protective response to external (trauma, burn) or internal (endoexotoxins of the microbial and histiocytic origin) aggression on the basis of intercellular cytokine interrelations. The morphological locus of clinical manifestation of the critical state is the microcirculation bed of organs and tissues with typical signs of tissue perfusion on the basis of ischemical-reperfusion lesions of erythrocytes.
Subject(s)
Critical Care/methods , Critical Illness/therapy , Surgical Procedures, Operative/methods , Animals , HumansSubject(s)
General Surgery/history , Military Medicine/history , History, 19th Century , History, 20th Century , Humans , USSRABSTRACT
Pathogenesis of Fournier's disease was studied pathomorphologically and pathophysiologically. The underlying factor is thrombosis of the microcirculatory bed of the superficial fascia progressing into ischemic and hypoperfusion necrosis of the fascial structures manifesting with severe endotoxicosis and development of polyorganic insufficiency.
Subject(s)
Fasciitis, Necrotizing/pathology , Fournier Gangrene/pathology , Adult , Aged , Fasciitis, Necrotizing/microbiology , Fasciitis, Necrotizing/physiopathology , Fasciitis, Necrotizing/therapy , Fournier Gangrene/microbiology , Fournier Gangrene/physiopathology , Fournier Gangrene/therapy , Humans , Male , Middle AgedABSTRACT
Based on his clinical experience and analysis of literature the author considers shock as a monopathogenetical process which is universal in different critical states. The basis of its development is impaired microcirculation caused by disseminated intravascular coagulation of blood and development of polyorganic insufficiency.
Subject(s)
Critical Illness , Shock, Traumatic/etiology , Shock, Traumatic/physiopathology , HumansSubject(s)
Abdomen, Acute , Emergency Medical Services , General Surgery/organization & administration , Surgical Procedures, Operative/methods , Abdomen, Acute/epidemiology , Abdomen, Acute/etiology , Abdomen, Acute/surgery , Congresses as Topic , Emergency Medical Services/methods , Emergency Medical Services/organization & administration , HumansABSTRACT
The data of literature and results of treatment of 17 patients with necrotizing fasciitis are analyzed. Original conception of pathogenesis based on thrombosis of microcirculatory vessels of superficial fascia is described. Endotoxemia manifested with clinical picture of sepsis and septic shock. Successful treatment is possible in cases of early diagnosis, urgent surgical treatment and intensive antibiotic therapy. Urgent cryobiopsy of tissues is an important diagnostic point. Lethality was 50% (it reaches 75% according to the literature data), this can be explained by late hospitalization and delayed operation.
Subject(s)
Fasciitis, Necrotizing/physiopathology , Adult , Aged , Combined Modality Therapy , Fasciitis, Necrotizing/microbiology , Fasciitis, Necrotizing/therapy , Female , Humans , Male , Middle Aged , Venous Thrombosis/physiopathology , Venous Thrombosis/surgeryABSTRACT
Among 28 patients with necrotizing fasciitis 18 patients had the syndrome of infectious-toxic shock with clinically severe manifestations. Nine of them had the disease with most serious (lightening-like) clinical forms of severe sepsis that led to lethal outcomes within 1-3 days. This form is referred to as an irreversible septic shock and genetically is due to two factors: 1. Type of the pathogen (Streptococcus pyogenes) whose toxin is responsible for the septic shock syndrome. 2. Spacious zone of the superficial fascia necrosis, a massive source of endotoxemia resulting from generalized thrombosis of the microcirculation bed of the fascial structures. There is no alternative to the method of treatment of patients with necrotizing fasciitis but urgent (immediately after the diagnosis) and aggressive in volume and character operation as well as an adequate resuscitation management and antibiotic therapy.
Subject(s)
Bacterial Infections/microbiology , Fasciitis, Necrotizing/microbiology , Shock, Septic/microbiology , Aged , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Fasciitis, Necrotizing/drug therapy , Fatal Outcome , Humans , Male , Multiple Organ Failure , Shock, Septic/drug therapySubject(s)
Blood Coagulation Disorders/diagnosis , Buttocks/surgery , Hamartoma/surgery , Hemorrhage/surgery , Vascular Surgical Procedures/methods , Adult , Buttocks/pathology , Diagnosis, Differential , Hamartoma/complications , Hamartoma/diagnosis , Hamartoma/pathology , Hamartoma/physiopathology , Hemorrhage/etiology , Hemorrhage/physiopathology , Humans , Male , Recurrence , Treatment OutcomeABSTRACT
Protocols of diagnosis and treatment of acute pancreatitis are presented. Definition based on pathogenesis of the disease is given. Phases of acute pancreatitis, features of diagnosis and treatment in each phase are analyzed. Terms of surgical treatment, main principles of postoperative treatment are discussed.