RESUMEN
We present successful treatment of a patient with tubular colonic duplication complicated by fecal impaction, perforation and fecal peritonitis. This anomaly is usually detected in children younger 2 years old. In adulthood, this diagnosis is of a precedent-setting nature. If the diagnosis was not confirmed in early childhood, the absence of typical clinical picture, long-term course of disease and difficult interpretation of clinical data complicate subsequent verification of congenital anomaly. Only infectious complications and emergency surgery in adults can make a correct diagnosis.
Asunto(s)
Enfermedades del Colon , Perforación Intestinal , Peritonitis , Preescolar , Adulto , Niño , Humanos , Colon/cirugía , Peritonitis/diagnóstico , Peritonitis/etiología , Peritonitis/cirugía , Perforación Intestinal/diagnóstico , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/etiología , Enfermedades del Colon/cirugíaRESUMEN
Rectal cancer occupies the leading position among cancers, and incidence of locally advanced recurrences is still high despite comprehensive treatment. Combined resections are usually associated with high perioperative risks. These procedures are technically complex interventions requiring further improvement. Virtual reality technology in surgical treatment of locally advanced rectal cancer recurrence has not been widely discussed. The authors present multidisciplinary construction of the matched topographic-anatomical virtual model and virtual planning of the combined surgical intervention. Intraoperative use of augmented reality allowed specifying topographic and anatomical features of surgical area, level of vascular ligation, localization of tumor fixation points and resection borders. These data ensured safety and quality of resection. Further research of augmented reality technology and improvement of its technical aspects will improve the results of surgical treatment of patients with locally advanced pelvic tumors and recurrences.
Asunto(s)
Realidad Aumentada , Neoplasias del Recto , Humanos , Recurrencia Local de Neoplasia/cirugía , Recurrencia Local de Neoplasia/patología , Neoplasias del Recto/cirugía , Neoplasias del Recto/patología , Recto/cirugíaRESUMEN
OBJECTIVE: To improve treatment outcomes in victims with kidney damage following blunt and stab abdominal trauma by using of minimally invasive methods of diagnosis and treatment. MATERIAL AND METHODS: About 1.2-3.5% of all victims arrived to the Dzhanelidze St. Petersburg Research Institute for Emergency Care have kidney injuries. We analyzed the results of treatment of 117 patients with isolated and combined blunt and stab abdominal injuries. The retrospective (2014-2017) group included 62 victims, and the prospective (2018-2021) group enrolled 55 patients who were treated according to the new algorithm. This algorithm included non-surgical and minimally invasive management for patients with systolic blood pressure >90 mm Hg after contrast-enhanced CT. Angiography with selective embolization was required for ongoing bleeding. We analyzed incidence of open interventions, organ-sparing procedures, complications, duration of treatment and mortality. Between-group differences were assessed using the χ2 test and Student's test. RESULTS: In both groups, kidney damage in most victims with abdominal trauma was due to road accident and catatrauma. Most patients had combined abdominal injuries, mainly in combination with head and chest lesions. Severity of injuries and clinical condition were similar in both groups. In the retrospective group, there were 9 laparotomies with nephrectomy. Nephrorraphy was performed in 8 cases, kidney vessel suture - in 4 patietns. In the prospective group, nephrectomy was performed in 3 patients with unstable hemodynamics and injuries AAST grade V. Nephrorraphy was performed in 4 victims. In one case, vascular suture was applied for tangential vein damage. All laparoscopies in both groups were diagnostic without nephrectomy. We used non-surgical treatment in 34 patients of the prospective group. One patient underwent angiography and selective embolization of renal artery branches. There were no significant between-group differences in the incidence of infectious and non-infectious complications. Mortality rate was 30.6% (n=19) and 27.3% (n=15) in the retrospective and prospective groups, respectively. CONCLUSION: The proposed algorithm for kidney injury made it possible to reduce the incidence of laparoscopies and laparotomies by 2 times, preserve the damaged kidney in 94.5% of cases and avoid invasive treatment in 62% of victims.
Asunto(s)
Traumatismos Abdominales , Heridas no Penetrantes , Heridas Punzantes , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/cirugía , Humanos , Riñón/lesiones , Estudios Retrospectivos , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/cirugía , Heridas Punzantes/complicaciones , Heridas Punzantes/diagnóstico , Heridas Punzantes/cirugíaRESUMEN
OBJECTIVE: To determine an optimal approach in the treatment of patients with intestinal fistulae. MATERIAL AND METHODS: We have used the above-mentioned algorithm in the treatment of 46 patients. The majority of patients (n=44, 96%) were transferred under supervision of our multidisciplinary team with severe water-electrolyte disturbances and signs of secondary protein-energy malnutrition (PEM) that required complex combined nutritional support. A two-stage approach was applied in all cases. The first one was conservative and included correction and prevention of infectious complications, nutritional and metabolic therapy, local wound treatment, and anatomical assessment of the fistula. The second stage was reconstructive and implied various reconstructive interventions not earlier than 3 months after formation of the fistula. RESULTS: Conservative approach was followed by fistula healing in 6 patients, surgery was required in 25 patients. Complications with subsequent redo surgery occurred in 4 cases. In all cases, favorable outcome was noted. All 25 patients were discharged. Three patients refused reconstructive surgery after development of fistula, they were also discharged. Mortality rate was 26% (n=12). CONCLUSION: A multidisciplinary two-stage approach can significantly improve treatment outcomes in patients with intestinal fistulae.
Asunto(s)
Fístula Intestinal/terapia , Apoyo Nutricional , Desnutrición Proteico-Calórica , Desequilibrio Hidroelectrolítico , Terapia Combinada , Tratamiento Conservador , Humanos , Fístula Intestinal/complicaciones , Fístula Intestinal/cirugía , Apoyo Nutricional/métodos , Grupo de Atención al Paciente , Desnutrición Proteico-Calórica/etiología , Desnutrición Proteico-Calórica/terapia , Resultado del Tratamiento , Desequilibrio Hidroelectrolítico/etiología , Desequilibrio Hidroelectrolítico/terapiaRESUMEN
OBJECTIVE: To identify the most important high risk criteria for predicting course of disease, as well as optimal preoperative preparation and surgical strategy in patients with secondary peritonitis. MATERIAL AND METHODS: A prospective study enrolled 43 patients with diffuse secondary peritonitis. RESULTS: Significant predictors were Charlson's comorbidity index (p=0.001) and SOFA score of organ dysfunction within 3 days after admission. Rapid regression of organ dysfunction (SOFA1 - p=0.0001, SOFA2 - p=0.012, SOFA3 - p=0.017) and reduced time of examination and preoperative preparation (threshold value - 520 min after admission) are predictors of favorable outcome in patients with diffuse secondary peritonitis. There was no reliable correlation between the treatment outcome and preoperative preparation (infusion volume p=0.23, duration p=0.37, absence/presence of antibacterial therapy p=0.26). Elimination or control of infection is the fundamental principle of the management of patients with diffuse secondary peritonitis.
Asunto(s)
Peritonitis/terapia , Sepsis/terapia , Comorbilidad , Hospitalización , Humanos , Puntuaciones en la Disfunción de Órganos , Gravedad del Paciente , Peritonitis/etiología , Peritonitis/cirugía , Cuidados Preoperatorios , Pronóstico , Estudios Prospectivos , Sepsis/etiología , Sepsis/cirugíaRESUMEN
Effectiveness of enhanced recovery program is being earnestly confirmed in various surgical areas. Certain aspects of fast track rehabilitation are analyzed in the article.
Asunto(s)
Protocolos Clínicos/normas , Atención Perioperativa/métodos , Complicaciones Posoperatorias/prevención & control , Procedimientos Quirúrgicos Operativos/rehabilitación , Urgencias Médicas , Humanos , Tiempo de Internación , Atención Perioperativa/tendencias , Complicaciones Posoperatorias/etiología , Recuperación de la Función , Estrés Fisiológico , Resultado del TratamientoRESUMEN
Rationale and feasibility of isolated pelvic perfusion (IPP) as a high-tech treatment modality for patients with pelvic malignancies was studied and analyzed based on the systematic review of the literature. Indications, techniques and regimens of IPP are reviewed. There is a focus on anticancer agents for IPP and methods of complete vascular isolation of the perfusated region. Data on the short- and long-term outcome of patients after IPP are presented. To the best of authors' knowledge this is the first Russian article regarding application of IPP in oncology practice.
Asunto(s)
Quimioterapia del Cáncer por Perfusión Regional , Neoplasias del Colon/tratamiento farmacológico , Neoplasias Pélvicas/tratamiento farmacológico , Neoplasias del Cuello Uterino/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Colon/patología , Femenino , Humanos , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/patología , Neoplasias Pélvicas/patología , Pelvis/patología , Federación de Rusia , Neoplasias del Cuello Uterino/patologíaRESUMEN
The percutaneous endoscopic gastrostomy takes an important place in operative endoscopy of the digestive system. At the same time it is the method of choice in patients who need a long-term administration of enteral feeding. Given article reflects the main indications, contraindications and complications of the percutaneous endoscopic gastrostomy and presents the basic stages of the method. The authors hope, that the data would be useful for both entry-lever surgeon-endoscopists and specialists who used the method.
Asunto(s)
Gastroscopía , Gastrostomía , Complicaciones Posoperatorias , Contraindicaciones , Nutrición Enteral/instrumentación , Nutrición Enteral/métodos , Femenino , Gastroscopía/efectos adversos , Gastroscopía/métodos , Gastrostomía/efectos adversos , Gastrostomía/métodos , Humanos , Cuidados a Largo Plazo/métodos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Resultado del TratamientoRESUMEN
Various contradictory definitions of "iatrogenicity" are considered. Bearing in mind the absence of the universally recognized interpretation of this concept, the authors believe it nappropriate to use the term "iatrogenic" in expert and juridical practice.
Asunto(s)
Testimonio de Experto/normas , Medicina Legal/normas , Enfermedad Iatrogénica , Terminología como Asunto , Testimonio de Experto/legislación & jurisprudencia , Medicina Legal/legislación & jurisprudencia , HumanosRESUMEN
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.
Asunto(s)
Abdomen , Cuerpos Extraños , Complicaciones Intraoperatorias , Errores Médicos/prevención & control , Complicaciones Posoperatorias , Procedimientos Quirúrgicos Operativos , Abdomen/fisiopatología , Abdomen/cirugía , Femenino , Cuerpos Extraños/diagnóstico , Cuerpos Extraños/epidemiología , Cuerpos Extraños/etiología , Humanos , Enfermedad Iatrogénica/prevención & control , Cuidados Intraoperatorios/efectos adversos , Cuidados Intraoperatorios/métodos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/etiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Medición de Riesgo , Procedimientos Quirúrgicos Operativos/efectos adversos , Procedimientos Quirúrgicos Operativos/métodos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Análisis de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
Although the relations between diabetes mellitus (DM) and breast cancer (BC) are lately widely discussed, the actual causes for cancer predisposition in patients with diabetes are currently unclear. This study was designed to define the frequency of DM immunological predictors occurrence and immune system function shifts in patients with breast cancer. Sixty four BC patients, 19 patients with benign breast conditions and 40 healthy individuals were included. The lymphocyte sensibilization with insulin suppressed by prostaglandin-synthesizing cells or cells with histamine receptor expression (DM predictor) is more common in BC patients than in control group (29 of 56 vs 5 of 37, p < 0.001). This is not a tumor marker, but rather is an objective factor reflecting higher occurrence of insulin resistance in this group. For BC patients is also characteristic the lower PHA-stimulated peripheral lymphocyte proliferation rate probably caused by increase in short-lived suppressor cell activity, a usual sign of the impairment of cell-mediated immunity. It is also possible, that the immunologic predictors of DM associated with insulin resistance, combined with the effects of short-lived suppressor cells, promote tumor cell proliferation.
Asunto(s)
Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/inmunología , Complicaciones de la Diabetes/inmunología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/inmunología , Factores Inmunológicos/metabolismo , Linfocitos/inmunología , Biomarcadores de Tumor/metabolismo , Enfermedades de la Mama/complicaciones , Enfermedades de la Mama/inmunología , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/metabolismo , Proliferación Celular , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/metabolismo , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Humanos , Inmunidad Celular , Resistencia a la Insulina , Persona de Mediana Edad , Posmenopausia , Valor Predictivo de las PruebasRESUMEN
Based on an experience with treatment of 269 patients with complicated peptic ulcer the authors came to a conclusion that the most sparing and radical operation was subdiaphragmatic truncal vagotomy with Finney pyloroplasty with lethality of 6.8%. Resection of the stomach and forced palliative interventions such as suturing of perforated and bleeding ulcers resulted in lethal outcomes in more than 50% of them.
Asunto(s)
Gastrectomía/métodos , Úlcera Péptica Hemorrágica/cirugía , Úlcera Péptica/complicaciones , Úlcera Gástrica/complicaciones , Vagotomía Troncal/métodos , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Úlcera Péptica/cirugía , Úlcera Péptica Hemorrágica/etiología , Úlcera Gástrica/cirugía , Resultado del TratamientoAsunto(s)
Hemorragia Gastrointestinal/etiología , Meningoencefalitis/complicaciones , Úlcera Péptica Perforada/complicaciones , Úlcera Gástrica/complicaciones , Enfermedad Aguda , Adulto , Hemorragia Gastrointestinal/cirugía , Humanos , Masculino , Úlcera Péptica Perforada/cirugía , Úlcera Gástrica/cirugíaRESUMEN
We introduce a distance (similarity)-based mapping for the visualization of high-dimensional patterns and their relative relationships. The mapping preserves exactly the original distances between points with respect to any two reference patterns in a special two-dimensional coordinate system, the relative distance plane (RDP). As only a single calculation of a distance matrix is required, this method is computationally efficient, an essential requirement for any exploratory data analysis. The data visualization afforded by this representation permits a rapid assessment of class pattern distributions. In particular, we can determine with a simple statistical test whether both training and validation sets of a 2-class, high-dimensional dataset derive from the same class distributions. We can explore any dataset in detail by identifying the subset of reference pairs whose members belong to different classes, cycling through this subset, and for each pair, mapping the remaining patterns. These multiple viewpoints facilitate the identification and confirmation of outliers. We demonstrate the effectiveness of this method on several complex biomedical datasets. Because of its efficiency, effectiveness, and versatility, one may use the RDP representation as an initial, data mining exploration that precedes classification by some classifier. Once final enhancements to the RDP mapping software are completed, we plan to make it freely available to researchers.
Asunto(s)
Algoritmos , Inteligencia Artificial , Gráficos por Computador , Sistemas de Administración de Bases de Datos , Bases de Datos Factuales , Almacenamiento y Recuperación de la Información/métodos , Reconocimiento de Normas Patrones Automatizadas/métodos , Interfaz Usuario-ComputadorRESUMEN
The authors made an analysis of the immediate and long-term results of truncal vagotomy for perforating gastroduodenal ulcers in accordance with the kind of the suture in operation of stomach drainage. In 282 patients pyloroplasty was performed with placing a two-row suture, in 239 patients a one-row suture was used. Lethality among the patients with the two-row sutures was 2.1% in those with the one-row suture--0.4%. The placing of one-row sutures was followed by a relatively smaller amount of complications at the early postoperative period. An analysis of long-term results has shown that the one-row suture gives much greater amount of excellent results as compared with the two-row suture. The authors recommend to use the one-row suture in all the cases of perforating pyloroduodenal ulcers irrespective of the phase of intraperitoneal inflammation.
Asunto(s)
Úlcera Duodenal/complicaciones , Úlcera Duodenal/cirugía , Úlcera Péptica Perforada/cirugía , Píloro/cirugía , Técnicas de Sutura , Estudios de Seguimiento , Gastroparesia/epidemiología , Humanos , Persona de Mediana Edad , Úlcera Péptica Perforada/complicaciones , Peritonitis/etiología , Peritonitis/cirugía , Complicaciones Posoperatorias/epidemiología , Vagotomía TroncalRESUMEN
Medical histories of 67 patients with perforation of gastroduodenal ulcers combined with gastroduodenal hemorrhage were analyzed. The frequency of this complication makes 7.5% of all patients with perforated peptic ulcers. High mortality rate is thought to result from wrong diagnosis and inadequate operation. Best results were obtained when truncal bilateral subdiaphragmatic vagotomy was used in combination with some pyloroplasty techniques. Resection of the stomach is known to be dangerous because of frequent complications often leading to death. Operations aimed at the arrest of hemorrhage and liquidation of peritonitis are indicated to patients in critical state. X-ray examination of the abdomen and fibrogastroduodenoscopy allowed the combination of perforation and hemorrhage to be diagnosed in due time in all the patients.
Asunto(s)
Úlcera Duodenal/complicaciones , Úlcera Péptica Hemorrágica/cirugía , Úlcera Péptica Perforada/cirugía , Úlcera Gástrica/complicaciones , Enfermedad Crónica , Úlcera Duodenal/diagnóstico , Úlcera Duodenal/mortalidad , Úlcera Duodenal/cirugía , Urgencias Médicas , Femenino , Gastrectomía , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Péptica Hemorrágica/mortalidad , Úlcera Péptica Perforada/diagnóstico , Úlcera Péptica Perforada/mortalidad , Complicaciones Posoperatorias/cirugía , Recurrencia , Reoperación , Estudios Retrospectivos , Úlcera Gástrica/diagnóstico , Úlcera Gástrica/mortalidad , Úlcera Gástrica/cirugía , VagotomíaRESUMEN
The article is devoted to surgical treatment of perforating gastroduodenal ulcers. An investigation of remote results of palliative and radical interventions for the perforation of the stomach and duodenum in patients of young age has shown that recurrent ulcers after suturing the perforation take place in 67.2% of the people operated upon against 21% of those subjected to bilateral truncal subdiaphragmatic vagotomy with pyloroplasty. A conclusion is made that for perforating ulcers it is expedient to perform radical operative interventions as a bilateral truncal subdiaphragmatic vagotomy with pyloroplasty.
Asunto(s)
Úlcera Péptica Perforada/cirugía , Adolescente , Adulto , Drenaje , Úlcera Duodenal/complicaciones , Úlcera Duodenal/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Cuidados Paliativos , Recurrencia , Reoperación , Úlcera Gástrica/complicaciones , Úlcera Gástrica/cirugía , Factores de Tiempo , Vagotomía TroncalRESUMEN
In several models of salt appetite in the rat, stimulated NaCl intake can be severely blunted by treatments associated with pituitary release of oxytocin (OT). Central administration of the potent dipsogen angiotensin II (ANG II) is known to elicit a limited salt appetite as well as thirst, but it has also been reported to stimulate pituitary OT secretion. These results suggest the possibility that the expression of ANG II-induced salt appetite in rats may be inhibited by a simultaneous central release of OT in response to this stimulus. To investigate this possibility, rats were given intracerebroventricular injections of OT-receptor antagonists before administration of 5 ng ANG II intracerebroventricularly in a 1-h two-bottle (water and 0.3 M NaCl) drinking test. This pretreatment resulted in a three- to fourfold potentiation of ANG II-induced saline ingestion, which was most prominent during the first 15 min of the test. OT-receptor antagonism did not, however, interfere with the dipsogenic properties of ANG II, nor did it stimulate saline ingestion alone in the absence of ANG II. Immunocytochemical studies demonstrated that central administration of ANG II at this dose caused pronounced c-fos expression in hypothalamic magnocellular OT and vasopressin neurons and also in OT neurons in parvocellular subdivisions of the paraventricular nucleus. These results therefore demonstrate that central administration of small doses of ANG II activates both magnocellular and parvocellular OT neurons in rats and indicate that some of the activated central OT pathway(s) may mediate an inhibitory effect that limits the salt ingestion induced by this treatment.