scholarly journals Intensive therapy in patients with scar strictures of the esophagus

2018 ◽  
Vol 1 (1) ◽  
pp. 42-45
Author(s):  
V. O. Shaprynskyi ◽  
Y. V. Shaprynskyi ◽  
V. F. Kryvetskyi ◽  
Mustafa Bassam Hussein
Keyword(s):  
Postoperative Complications ◽  
Intensive Therapy ◽  
Diagnostic Algorithm ◽  
Infusion Therapy ◽  
Considerable Part ◽  
Plasma Albumin ◽  
Complete Obstruction ◽  
Surgical Interventions ◽  
Esophageal Strictures ◽  
Logistic Regression Method

The proposed medical tactics and intensive therapy of scar strictures of the esophagus we represent in this article. The causes of their occurrence: burns in the esophagus, surgical interventions on the esophagus, reflux esophagitis, and malignant genesis – esophageal cancer. A considerable part of patients with scar strictures of the esophagus is hospitalized at later stages of the stricture: with 4th and 5th degrees of obstruction. This leads to increasing of the number of exhausted patients and neglected cases, that contributes to increasing of levels of postoperative lethality and complications. The sults of surgical treatment of 116 patients with esophageal strictures at the period of 2003–2017 were analyzed. We used a logistic regression method to determine the risk factors for postoperative complications. It was established that the risk increases significantly with the presence of technical difficulties during operation, diabetes mellitus, blood plasma albumin levels less than 25 g/l, complete obstruction of the esophagus. The proposed program of treatment of patients with scar strictures of the esophagus reliably reduces the risk of postoperative complications. The diagnostic algorithm, the program of treatment of patients with preoperative infusion therapy and parenteral nutrition with “all in one” system were applied in patients of the main group. Due to the treatment program and intensive therapy, the number of postoperative complications has decreased from 27,27% to 12,0%, and mortality – from 6,06% to 2,0%.

scholarly journals Pediatric surgical sepsis: diagnostics and intensive therapy

2021 ◽  
pp. 34-42
Author(s):  
Elmira Satvaldieva ◽  
Gulchehra Ashurova ◽  
Otabek Fayziev ◽  
Abdumalik Djalilov
Keyword(s):  
Life Support ◽  
Intensive Therapy ◽  
Blood Gases ◽  
Tracheal Aspirate ◽  
Surgical Pathology ◽  
Diffusion Method ◽  
Infusion Therapy ◽  
Disk Diffusion Method ◽  
Surgical Interventions ◽  
Microbiological Monitoring

The aim: Optimization of diagnostics and schemes of pathogenetic intensive therapy of surgical sepsis in children based on clinical and laboratory criteria and bacteriological monitoring. Materials and methods: The research period is 2018-2020. The object of the study (n=73) – children with surgical pathology (widespread peritonitis, bacterial destruction of the lungs, post-traumatic brain hematomas, abdominal trauma, etc.). Research methods: microbiological monitoring to determine the sensitivity of the microorganism to antibiotics was carried out before and at the stages of treatment (sputum, urine, wound, bronchoalveolar lavage, tracheal aspirate, blood, contents from drainages, wound surface). Determination of the sensitivity of the isolated strains to antibiotics was carried out by the disk-diffusion method. To determine predictors of sepsis in surgical patients, clinical (mean arterial pressure (mAP), heart rate (HR), respiratory rate (RR), SpO2, etc. and laboratory parameters on days 1–2 (up to 48 hours) of sepsis identification, days 4 and 8 of intensive therapy. Procalcitonin was determined by immunofluorescence on a Triage® MeterPro analyzer (Biosite Diagnostics, USA). Blood gases and electrolytes were analyzed using a Stat Profile CCX analyzer (Nova Biomedical, USA). Results: studies have shown the effectiveness of complex intensive care in 86.3 % of cases. Mortality was found in 13.7 % of cases. Patients with severe surgical pathology died: widespread peritonitis, severe TBI + coma with irreversible neurological disorders, urosepsis against the background of chronic renal failure, after repeated surgical interventions, due to the development of refractory septic shock (SS). Conclusions. Early diagnosis of sepsis, rational early ABT under the control of microbiological monitoring, non-aggressive infusion therapy with early prescription of vasopressors (SS) with constant monitoring of the child's main life support organs contribute to an improvement in sepsis outcomes and a decrease in mortality

OPERATIONS FOR ANEURISM OF THE ABDOMINAL AORTIC DEPARTMENT - RESECTION WITH THE FOLLOWING PROSTHETICS AND ENDOPROSTHETICS: A COMPARATIVE ANALYSIS OF COMPLICATIONS

2020 ◽  
pp. 43-49
Author(s):  
Андрей Анатольевич Иванов ◽  
Александр Иванович Жданов ◽  
Максим Сергеевич Шевелин ◽  
Александр Сергеевич Брежнев
Keyword(s):  
Comparative Analysis ◽  
Postoperative Complications ◽  
Statistical Significance ◽  
Aortic Aneurysms ◽  
Surgical Interventions ◽  
Vein Thrombosis ◽  
Scientific Hypothesis ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
High Level

В статье представлены данные оригинального исследования по улучшению хирургического лечения аневризм брюшного отдела аорты. С этой целью произведен сравнительный анализ двух альтернативных друг другу операций: 1) резекции аневризмы с последующим протезированием аорты; 2) эндопротезирования аорты. Сформулировано научное предположение о том, что замена «классических» операций резекции аневризмы на «альтернативные» операции эндопротезирования приведет к принципиальному снижению уровня послеоперационных осложнений. В независимых группах пациентов с использованием сравниваемых хирургических вмешательств произведена точная качественная и количественная оценка послеоперационных осложнений: нетромботических - кардиальных, пульмональных, ренальных и тромботических - тромбозов глубоких вен и тромбозов браншей протеза. После реализации исследования было установлено, что замена «классических» операций на «альтернативные» достоверно приводит к принципиальному снижению уровня наиболее жизнеопасных осложнений - кардиальных (острых форм ишемической болезни сердца, нарушений сердечного ритма), пульмональных (пневмоний, тромбоэмболии легочной артерии, респираторного дистресс-синдрома взрослых) и ренальных (острой почечной недостаточности). Некоторое исключение составили менее жизнеопасные тромботические осложнения. Полученные результаты имеют высокий уровень статистической значимости, что позволяет рекомендовать их к рассмотрению к использованию в практике сосудистой хирургии The article presents data from an original study to improve the surgical treatment of abdominal aortic aneurysms. For this purpose, a comparative analysis of two alternate operations was performed: 1) aneurysm resection followed by aortic prosthetics; 2) aortic endoprosthetics. The scientific hypothesis is formulated that the replacement of the «classical» operations of resection of the aneurysm with «alternative» operations of endoprosthetics will lead to a fundamental decrease in the level of postoperative complications. In independent groups of patients using the compared surgical interventions, an accurate qualitative and quantitative assessment of postoperative complications was made: non-thrombotic - cardiac, pulmonary, renal and thrombotic - deep vein thrombosis and prosthetic jaw thrombosis. After the study was completed, it was found that the fundamental replacement of «classical» operations with «alternative» reliably leads to a fundamental decrease in the level of the most life-threatening complications - cardiac (acute forms of coronary heart disease, cardiac arrhythmias), pulmonary (pneumonia, pulmonary thromboembolism, respiratory distress syndrome of adults) and renal (acute renal failure). Some exceptions were less life-threatening thrombotic complications. The results obtained have a high level of statistical significance, which allows us to recommend them for consideration in the practice of vascular surgery

scholarly journals MODERN METHODS OF PREVENTION AND TREATMENT OF COMPLICATIONS OF CERVICAL ESOPHAGO-ORGAN ANASTOMOSIS AT ESOPHAGOPLASTY

2020 ◽  
Vol 73 (8) ◽  
pp. 1696-1699
Author(s):  
Volodymyr O. Shaprynskyi ◽  
Yevhen V. Shaprynskyi ◽  
Mustafa Bassam Hussein ◽  
Oleg O. Vorovskyi ◽  
Yaroslav V. Karyi ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Postoperative Period ◽  
Comparison Group ◽  
Postoperative Mortality ◽  
Diagnostic Algorithm ◽  
Main Group ◽  
Instrumental Method ◽  
Complication Risk ◽  
Esophageal Strictures ◽  
Bed Days

The aim: To improve the results of operative treatment of esophageal strictures by decreasing the rate of failure and stricture of cervical esophago-organ anastomoses. Materials and methods: There were 45 patients with post-burn corrosive gullet strictures, 17 patients with postoperative corrosive strictures, 10 patients with peptic strictures secondary to reflux-esophagitis, 42 patients with esophageal cancer strictures. The patients were divided into two groups: the comparison group – 55 persons and the main group – 59 persons. Patients of comparison group underwent surgical treatment of esophageal strictures according to classic protocols and standards. In the main group of patients we applied proposed diagnostic algorithm with prediction of complication risk and the designed method of esophago-organ anastomosis formation. Results: The results of operative treatment in patients with esophageal strictures showed the development of early postoperative complications in 59 individuals (51.75 %). In the postoperative period six patients died: four – in the comparison group and two – in the main group. Failure of cervical esophago-organ anastomosis and esophageal strictures occurred in 7 patients (11.86 %) of main group and 20 patients (36.36 %) of the comparison group (p<0.05). Conclusions: Application of method predicting the risk of complications of cervical anastomosis, treatment program and instrumental method of formation anastomosis resulted in reduced incidence of failure and strictures of esophago-organ anastomosis from 36.36 % to 11.86 % (p<0.05); decreased time of hospitalization - from 28.2 ± 1.1 to 21.5 ± 0.5 bed-days (p<0.001), postoperative period - from 20.5 ± 1.1 to 16.1 ± 0.7 bed-days (p<0.01); decreased postoperative mortality - from 7.27 % to 3.39 %.

scholarly journals Personification of infusion therapy in patients with ischemic stroke depending on the severity of the violation of energy-structural status

2020 ◽  
pp. 73-73
Author(s):  
K.V. Serikov ◽  
G.A. Shifrin ◽  
L.M. Smyrnova
Keyword(s):  
Ischemic Stroke ◽  
Intensive Therapy ◽  
City Council ◽  
Infusion Therapy ◽  
City Hospital ◽  
Non Profit ◽  
Results Of Treatment ◽  
Fluid Requirement ◽  
Consumption Index ◽  
Subsequent Administration

Objective. To determine the tactics of infusion therapy in patients with ischemic stroke (IS) depending on the severity of the violation of energy-structural status (ESST). Materials and methods. A study of 32 patients with severe IS on the National Institutes of Health Stroke Scale (16,7±1,5), who were in the department of anesthesiology with intensive therapy units of the Municipal Non-Profit Enterprise «City Hospital № 9» Zaporizhzhia City Council. Of these, 11 were men (34,4 %; the average age – 68,2±2,5 years), 21 were women (65,6 %; average age – 72,1±1,6). Results and discussion. In patients with IS, disorders ESST were defined as hyperergic damage at values of cardiac index (CI) of 4,45-5,09 L×min-1×m-2 and oxygen consumption index (IVO2) 186-210 ml×min-1×m-2, and at values of CI ≥5,10 L×min-1×m-2 and IVO2 ≥211 ml×min-1×m-2 – as hyperergic insufficiency. While hypoergic damage ESST occurred at values of CI 2,33-1,82 L×min-1×m-2 and IVO2 104-85 ml×min-1×m-2, and at CI ≤1,81 L×min-1×m-2 and IVO2 ≤84 ml×min-1×m-2 hypoergic insufficiency of ESST was observed. The daily fluid requirement of a patient with IS was calculated according to the formula 4+2+1: for the first 10 kg of weight – 4 ml×kg-1×h-1; from 11 to 20 kg – 2 ml×kg-1×h-1; from 21 kg – on 1 ml×kg-1×h-1 (Park G.R., Roe P.G., 2005; Netyazhenko V.Z., Halushko O.A., 2012). Infusion therapy in patients with IS and hyperergic damage ESST was performed with 0,9 % sodium chloride solution according to the formula 4+2+1 on the background of the use of esmolol intravenously bolus 250 mg and subsequent administration of 50 mсg×kg-1×min-1, and in hyperergic insufficiency 500 mg of esmolol intravenously bolus and subsequent administration of 100 mсg×kg-1×min-1. While in hypoergic damage ESST on the background of infusion therapy used dopamine or dobutamine 1-5 mсg×kg-1×min-1, and in hypoergic insufficiency, the dose of dopamine or dobutamine was increased to achieve the desired effect. Conclusions. The personification of infusion therapy depending on the severity of the violation of ESST can improve the results of treatment of patients with IS in the most acute period.

scholarly journals Modern aspects of surgical treatment of patients with adhesive small bowel obstruction

2021 ◽  
Vol 12 (4) ◽  
pp. 47-54
Author(s):  
Badri V. Sigua ◽  
Vyacheslav P. Zemlyanoy ◽  
Sergey V. Petrov ◽  
Diyora H. Qalandarova
Keyword(s):  
Small Intestine ◽  
Surgical Treatment ◽  
Small Bowel ◽  
Mortality Rate ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Diagnostic Algorithm ◽  
Diagnostic Methods ◽  
Adhesive Small Bowel Obstruction ◽  
Surgical Interventions

Despite the ongoing preventive measures aimed at reducing the formation of adhesions in the abdominal cavity with an increase in the number of surgical interventions on the abdominal organs, the number of patients admitted to surgical hospitals with adhesions of the small intestine is also increasing. It should be noted that annually about 12% of previously operated patients undergo treatment in surgical departments while the exceptional fact is that 5070% are patients with acute adhesive ileus of the small intestine and the mortality rate in this group ranges from 13 to 55%. In recent years the literature has been actively discussing the advantages of minimally invasive technologies in the treatment of adhesive small bowel obstruction since the use of traditional methods often leads to the development of complications with repeated (in 60% of cases) surgical interventions. The purpose of this study was the development and implementation of an improved therapeutic and diagnostic algorithm in patients with adhesive small bowel obstruction which made it possible to improve the results of treatment. A comparative analysis of 338 patients with adhesive small bowel obstruction who were treated in the surgical departments of the St. Elizabeth Hospital in St. Petersburg in the period from 2016-2019 was carried out. All the patients were divided into 2 groups: the main (I) group (2018-2019), which consisted of 198 patients who received the improved diagnostic and treatment algorithm as well as the comparison group (II) (2016-2017) which included 140 cases these are patients examined according to the standard protocol and operated on in the traditional way. Moreover, in 98 cases, it was possible to resolve acute adhesive small intestinal obstruction in a conservative way, and 240 patients underwent surgical treatment. The developed diagnostic algorithm is based on the consistent application of the most informative diagnostic methods. At the same time the indications and the sequence of their application were established which ultimately made it possible to shorten the preoperative time interval as well as to determine the optimal treatment strategy with the choice of the type of surgical treatment (laparotomy or laparoscopy). The proposed treatment and diagnostic algorithm allowed to reduce the complication rate from 46.5% (53) to 22.2% (28) (р 0,001), and the mortality rate from 14.9% (17) to 3.9% (5) (p 0,01).

scholarly journals Nosocomial infections in the Intensive care unit: global problem of modern medicine

2018 ◽  
Vol 1 (2) ◽  
pp. 5-19
Author(s):  
Zara Vezirova
Keyword(s):  
Nosocomial Infections ◽  
Metastatic Cancer ◽  
Intensive Therapy ◽  
Treatment Modalities ◽  
Critical Conditions ◽  
Special Treatment ◽  
Surgical Interventions ◽  
Hospital Acquired Infections ◽  
The Us ◽  
Hospital Acquired

Increased volume of surgical interventions, improvement of efficiency of special treatment modalities and modes of respiratory support, as well as development of new generation antibiotic medications has led to significant improvement of clinical outcomes of intensive therapy for critical conditions. At the same time, introduction of innovative and largely invasive interventions resulted in the emergence of new disease entities. Presently, the development of hospital-acquired infections (HAI) has become one of the riveting and serious problems of modern hospitals. These infections often lead to prolonged hospital stay, which in turn adds to the morbidity and mortality, worsen patient quality of life and also has significant economic consequences [1-5]. There are number of varying definitions of infections related to medical care [6]. According to the WHO, infections that develop 48 hours after hospitalization, excluding the incubation period, are called hospital-acquired or nosocomial infections. Some authors also include here infections that develop 4 weeks after patient’s discharge from hospital or 30 days after surgical interventions are also included in this category. Infections that develop within 30 days after last chemotherapy in patients with metastatic cancer are also included as additional criteria according to a medical literature [7]. Other authors conclude that readmission of patients with established infection that was the result of previous hospitalization as well as any infectious diseases of hospital employee that develops secondary to the work in the hospital, irrespective to the time of onset of symptoms (during or after the hospital visit or stay) shall also be regarded as the hospital-acquired infections (HAI) [8-10]. The average prevalence of HAI is around 3.5-10.5% or 9.0-91.7 cases per 1000 patient-days [11]. It is estimated that the probability of infectious complications increases after five days of hospitalization [12]. According to the modern medical knowledge, the prevalence of HAI of various causes among the hospitalized patients in North America and Europe is around 5-10% and those in Latin America and Asia is around 40% [13,14]. The mortality among patients with HAI is seven times higher than among other patients aligned based on age, sex, main disease and comorbidities and severity of disease. According to the official statistics, HAIs are fourth most common cause of mortality in the US leading to 90.000 deaths annually. Annual economic burden and additional costs associated with the treatment of HAIs in the US is about 2.4-4.5 billion US dollars [15-17].

scholarly journals A comparison of the effectiveness of the early enteral and natural nutrition after pancreatoduodenectomy

Medicina ◽  
2008 ◽  
Vol 44 (9) ◽  
pp. 678 ◽  
Author(s):  
Saulius Grižas ◽  
Antanas Gulbinas ◽  
Giedrius Barauskas ◽  
Juozas Pundzius
Keyword(s):  
Postoperative Complications ◽  
Enteral Nutrition ◽  
Infectious Complication ◽  
Gastrointestinal Surgery ◽  
Infectious Complications ◽  
Albumin Level ◽  
Early Enteral Nutrition ◽  
Class Iii ◽  
Plasma Albumin

The role of postoperative supplementary enteral nutrition after gastrointestinal surgery is controversial. Therefore, a randomized clinical trial with attempts to address the question of plenitude of routine application of postoperative enteral feeding on rate of postoperative complications following pancreatoduodenectomy was performed. Sixty patients undergoing pancreatoduodenectomy were blindly randomized into two groups: 30 patients in the first group received early enteral nutrition (EEN), while 30 patients in the second group were given early natural nutrition (ENN). The complications were evaluated according to definition criteria. All complications were further subdivided into infectious and noninfectious complications. Our data showed that patients in EEN group gained a larger amount of energy in kcal a day during the first five days after surgery in comparison to ENN group. There was a higher rate of postoperative complications in ENN group (53.3% vs 23.3%, P=0.03). This difference occurred mainly due to the higher incidence of infectious complications in ENN group (46.7% vs 16.7%, P=0.025). There were six cases of bacteriemia in this group of patients, while only one case was observed in EEN group (6 (20.0%) vs 1 (3.3%), P=0.1). The overall risk for the development of any type of infectious complication was 1.5 times higher in ENN group. In conclusion, this study suggests that supplementary postoperative enteral nutrition helps to decrease the rate of infectious complications in patients undergoing pancreatoduodenectomy, especially in those with a plasma albumin level of less than 34.5 g/L and/or ASA class III or higher, since natural nutrition is insufficient in this ca.

scholarly journals An analytical observational study on the prognostic implication of postoperative serial serum lactate level for complications and predicting length of intensive therapy unit stay after major abdominal surgery

2021 ◽  
Vol 9 (5) ◽  
pp. 1428
Author(s):  
Moumita Mondal ◽  
Sankari Santra ◽  
Rajat Choudhuri ◽  
Amartya Das
Keyword(s):  
Respiratory Failure ◽  
Postoperative Complications ◽  
Abdominal Surgery ◽  
Intensive Therapy ◽  
Wound Dehiscence ◽  
Serum Lactate ◽  
Serum Lactate Level ◽  
Intensive Therapy Unit ◽  
Significant Difference ◽  
Lactate Levels

Background: Post-operative microcirculatory alteration causes hypoperfusion, tissue hypoxia and organ dysfunction, resulting in significant morbidity and mortality. Increase in serum lactate level in response to tissue hypoxia may serve as a cost effective tool to assess status of all organ dysfunction being sensitive but not organ specific and may help in early prognostication. Aim of this study was to investigate the association of blood lactate levels during the first 24 hours after surgery with postoperative morbidity and mortality, with length of ITU stay and to correlate the lactate values at various time points with different postoperative complications (POC).Methods: 150 patients undergoing elective abdominal surgery were included. Blood lactate (mmol/lit) levels were measured immediately on admission to the Intensive Therapy Unit (ITU) and at 6, 12, and 24 hours of admission. The parameters of clinical outcome included were mortality, shock, Acute kidney injury (AKI), respiratory failure, wound dehiscence and length of ITU stay. Heart Rate, Mean Arterial Pressure, spo2, Temperature and Urine output were also measured.Results: There was statistically significant difference in the lactate levels measured at the above mentioned point of time (0, 6, 12 and 24h) in cases with death and without fatal outcome, with and without respiratory failure, with and without AKI, with and without shock and in cases with and without wound dehiscence (p<0.05). There was a statistically significant difference in urine output, duration of ITU stay and duration of intubation (p<0.05).Conclusions: Increased serum lactate levels were significantly associated with postoperative complications, mortality and length of ITU stay in patients undergoing major elective abdominal surgery.

scholarly journals The use of additive technologies in reconstructive maxillofacial surgery

2019 ◽  
Vol 1 (2) ◽  
pp. 29-39
Author(s):  
Sergey Tereshchuk ◽  
Sergey Ivanov ◽  
Daniil Korabelnikov ◽  
Vladimir Sukharev
Keyword(s):  
Postoperative Complications ◽  
Reconstructive Surgery ◽  
Maxillofacial Surgery ◽  
Bone Defects ◽  
Additive Technologies ◽  
Navicular Bone ◽  
Facial Skeleton ◽  
Surgical Interventions ◽  
Reconstructive Operations ◽  
Modern Technologies

Introduction. Modern technologies make it possible not only to plan reconstructive surgery virtually, but also to manufacture templates for resection and osteotomy, customized titanium plates based on the results of planning. Objective. To analyze the results of application of additive technologies for planning and performing reconstructive operations in the Maxillofacial Surgery and Stomatology Center at Burdenko Main Military Clinical Hospital Patients and Methods. 144 operations to eliminate different locations bone defects were performed in the Maxillofacial Surgery and Stomatology Center in 2007 - 2017. 136 patients (93%) had de-fects of the bones of the facial skeleton and the skull calvarium. In other cases, there were defects of the clavicle (2 patients), defects of the femur (2 patients), defects of the humerus (2 patients), a defect of the radius (1 patient), a defect of the navicular bone (1 patient). Results. Flaps were used to close the defects in 87% of cases (125 patients), and alloplastic implants were utilized in 13% of cases (19 patients). Additive technologies were used in 85% (n = 123) cases for planning the operation to eliminate defects, as well as for manufacturing surgical models and templates. Clinical cases are considered as examples of the use of the additive technologies for planning and performing reconstructive operations to close bone defects of different locations. The incidence of postoperative complications in the group of patients with facial skeleton and crani-al vault bones defects who underwent surgical interventions using templates was 26%, including minor complications - 17.5%, large - 8.5%. Among minor complications, hematomas (5%) and sup-puration (5%) of the recipient wound prevailed, less often similar complications were hematomas (4%) and suppuration (3%) of the donor wound. Large complications were represented by cases of complete (4%) or partial (5%) transplant necrosis. During surgical interventions without a template, it took significantly longer than the average time of grafting and graft formation (212 ± 18.7 min) than during operations with a template, including with a guide for drilling (136 ± 12.6 min, p <0.001) and without a guide for drilling (160 ± 16.3 min, p <0.001). Conclusion. The use of surgical models and templates during reconstructive operations shortens the time of the operation and reduces the number of postoperative complications.

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