scholarly journals ANTIBIOTIC PROPHYLAXIS OF PURULENT AND SEPTICAL COMPLICATIONS DURING SURGICAL TREATMENT OF COMPLICATED GALLSTONE DISEASE ON BACKGROUND OF LIVER CIRRHOSIS

2019 ◽  
Vol 42 (3) ◽  
pp. 41-45
Author(s):  
Khimich S. D. ◽  
Muravyev F. T.
Keyword(s):  
Liver Cirrhosis ◽  
Surgical Treatment ◽  
Antimicrobial Prophylaxis ◽  
Gallstone Disease ◽  
Mirizzi Syndrome ◽  
Acute Calculous Cholecystitis ◽  
Escalation Therapy ◽  
Group 2 ◽  
Calculous Cholecystitis ◽  
Group 1

Purpose of the study. The goal of this investigation was to determine the main risk factors in development of purulent and septical complications during surgical treatment of complicated gallstone disease on background of liver cirrhosis. Materials and methods. We retrospectively reviewed medical records of 247 patients who undergone treatment in minimally invasive surgery centre of Zhytomyr regional clinical hospital during 2009–2018. All patients with complicated gallstone disease were divided in two groups: group 1 – patients with concomitant liver cirrhosis – 79(31,98%), and group 2 – patients without liver cirrhosis – 168 (68,02%). The inclusion criteria were presents of complicated gallstone disease (acute calculous cholecystitis, choledocholithiasis with obstructive jaundice and Mirizzi syndrome), and verified liver cirrhosis. Patients with oncological history, immunodeficiency and morbid obesity were excluded. Liver cirrhosis was staged by Child-Тurcotte-Рugh system. In all cases patient’s condition was assessed by APACHE II scoring system and patients with cirrhotic lesion were additionally analyzed by MELD score. Acute calculous cholecystitis was diagnosed in 185 patients: group 1 – 68(Child A – 36, Child B – 31, Child C – 1), group 2 – 117 patients. The signs of cholodecholithiasis with obstructive jaundice were present in 49 cases: group 1 – 7 (Child A – 5, Child B – 1, Child C – 1), group 2 – 42. Mirizzi syndrome was verified in 9 cases: group 1 – 2 (Child A – 1, Child B – 1, group 2 – 7. Results and discussion. In all patients treatment was started in conservative way that included detoxic, antibacterial and hepatoprotective components. In group of control early operative tactic in cases with acute calculous cholecystitis was preferred. Antimicrobial prophylaxis was performed in cases of severe and moderate calculous cholecystitits with use of cephalosporines of 2 generation in moderate case, and protected cephalosporines of 3 generation in combination with metronidazol in severe. In main group providing of antimicrobial therapy was performed very carefully, because of higher risk of hepato-renal insufficiency. The early de-escalation therapy was mandatory performed. Purulent complications occurred in 13,2% of patient with liver cirrhosis in comparison with control group with 1,7% of complications. Conclusion. The treatment of complicated gallstone disease in patients with liver cirrhosis is very risky in case of postoperative purulent complications. In case of Child A stage of cirrhosis the treatment is safe, and the incidents of purulent complications is the same like in the absence of cirrhosis. Administration of antibiotics in cirrhotic should be very careful because of higher risk of hepato-renal insufficiency. The early de-escalation therapy should be mandatory performed. The «gold» standard of empirical antimicrobial therapy is the use of cephalosporines of 2 and 3 generation. Keywords: gallstone disease, cirrhosis, antimicrobial prophylaxis.

THE PRINCIPLES OF DIAGNOSIS AND SURGICAL TREATMENT OF COMPLICATED FORMS OF GALLSTONE DISEASE

Vestnik ◽  
2021 ◽  
pp. 391-394
Author(s):  
В.М. Мадьяров ◽  
М.М. Сахипов ◽  
Г.Р. Жапаркулова
Keyword(s):  
Surgical Treatment ◽  
Gallstone Disease ◽  
Pathological Process ◽  
Abdominal Complications ◽  
Acute Calculous Cholecystitis ◽  
Results Of Treatment ◽  
Calculous Cholecystitis

Проанализированы за последние три года результаты оперативного лечения 200 больных с осложненными формами желчнокаменной болезни. Доказано, что риск возникновения гнойно-деструктивных форм острого калькулезного холецистита зависит от характера патологического процесса в желчном пузыре. По поводу гнойно-деструктивных форм заболевания при острого калькулезного холецистита оперировано 79,7% больных и 38,9% при необструктивной форме холецистита. Риск интраабдоминальных осложнений зависит от наличия обструкции, выявленное у 18,1% больных с обтурационнной и 5,6% у пациентов с необтурационнной формой. Госпитализация при гнойно-деструктивных формах 63,5% пациентов в первые 2 часа и 85,7% в первые 6 часов от момента заболевания, дает возможность своевременно оперировать больных до развития его интраабдоминальных осложнений. The results of treatment of 200 patients with complicated forms of gallstone disease were analyzed. It is proved that the risk of purulent-destructive forms of acute calculous cholecystitis depends on the nature of the pathological process in the gallbladder. For purulent-destructive forms of the disease in acute calculous cholecystitis, 79.7% of patients and 38.9% of patients with non-obstructive form of cholecystitis were operated on. The risk of intra-abdominal complications depends on the presence of obstruction, identified in 18.1% of patients with obstructive and 5.6% in patients with non-obstructive form. Hospitalization with purulent-destructive forms of 63.5% of patients in the first 2 hours and 85.7% in the first 6 hours from the time of the disease makes it possible to timely operate patients before the development of its intra-abdominal complications.

scholarly journals Mortality risk estimation in acute calculous cholecystitis: beyond the Tokyo Guidelines

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ana María González-Castillo ◽  
Juan Sancho-Insenser ◽  
Maite De Miguel-Palacio ◽  
Josep-Ricard Morera-Casaponsa ◽  
Estela Membrilla-Fernández ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Propensity Score ◽  
Mortality Risk ◽  
Characteristic Curve ◽  
Chronic Obstructive ◽  
Tokyo Guidelines ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis ◽  
Non Surgical Treatment

Abstract Background Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment is the early laparoscopic cholecystectomy; however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patient for surgical treatment. The primary aim of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification. Methods Retrospective unicentric cohort study of patients emergently admitted with and ACC during 1 January 2011 to 31 December 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confounding factors comparing surgical treatment and non-surgical treatment. Results The overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P = 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P = 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66 95% CI 1.7–12.8 P = 0.001), dementia (OR 4.12; 95% CI 1.34–12.7, P = 0.001), age > 80 years (OR 1.12: 95% CI 1.02–1.21, P = 0.001) and the need of preoperative vasoactive amines (OR 9.9: 95% CI 3.5–28.3, P = 0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P = 0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%). Conclusions Mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME with a prospective multicenter study population could allow us to create a new alternative guideline to TG for treating ACC. Trial registration Retrospectively registered and recorded in Clinical Trials. NCT04744441

scholarly journals Neuropsychological development of children with biliary atresia after liver transplantation

2021 ◽  
Vol 23 (3) ◽  
pp. 66-72
Author(s):  
A. V. Syrkina ◽  
I. E. Pashkova ◽  
A. R. Monakhov ◽  
O. V. Silina ◽  
E. V. Chekletsova ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Surgical Treatment ◽  
Biliary Atresia ◽  
Psychomotor Development ◽  
Two Stage ◽  
Neuropsychological Development ◽  
One Stage ◽  
The Difference ◽  
Group 2 ◽  
Group 1

Background. In young children, the most common liver disease leading to transplantation is biliary atresia. Liver transplantation has fundamentally improved the survival rate of children with biliary atresia. Studies on developmental outcomes in children are mostly limited to small samples; there are no such studies in the Russian Federation.Objective: to determine the cognitive outcomes in children undergoing one-stage or two-stage surgical treatment of biliary atresia.Materials and Methods. 83 children were divided into groups: 36 children underwent transplantation without previous surgical interventions (group 1), 47 children underwent the Kasai palliative portoenterostomy (group 2). Inclusion criteria: 24 months of age or younger at the moment of transplantation, no medical history of neurological pathology. All children were examined before transplantation and at 1, 3, 6 and 12 months after liver transplantation. Psychomotor development was assessed using the Griffiths Psychomotor Development Scale for children under 24 months (translated by E.S. Keshishian), the Griffiths Intellectual Development Scale for children aged 2 to 8 years, and the Modified Checklist for Autism in Toddlers, Revised, for children 16-30 months old.Results. All children had developmental delays at the time of transplantation. Up to 50% of the children had signs of cachexia, with a shoulder circumference of less than 3 percentile. Only two children showed obvious hepatic encephalopathy in the form of depressed consciousness. After liver transplantation, 94% of group 1 children recovered their preoperative psychomotor development levels, and only 68% in group 2 made these gains. At 3 and 6 months after transplantation, about 80% of group 1 children showed normal psychomotor development, whereas in group 2, only 61% did. By 12 months after liver transplantation, the difference between the groups was more evident: 83.3% of group 1 children and only 53.2% of group 2 children were developing according to age. The difference between the groups was statistically significant (p < 0.05).Conclusion. Children who received one-stage treatment of biliary atresia and underwent liver transplantation have better neuropsychological development within a year after surgery than children with two-stage surgical treatment.

scholarly journals Can We Use the Silodosin as Second Line Treatment of Benign Prostate Hyperplasia?

2021 ◽  
Author(s):  
Bekir Voyvoda ◽  
Onur Memik ◽  
Onur Karslı ◽  
Murat Üstüner ◽  
Levent Özcan
Keyword(s):  
Surgical Treatment ◽  
Symptom Relief ◽  
Routine Practice ◽  
Prostate Hyperplasia ◽  
Blocker Therapy ◽  
Alpha Blocker ◽  
The Third ◽  
Voiding Symptoms ◽  
Group 2 ◽  
Group 1

Objective: We aimed to investigate the efficacy of silodosin in patients with lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) refractory to previous α-adrenergic receptor (AR) blocker therapy. Materials and Methods: Patients who did not benefit from alpha-blocker therapy but avoided surgical treatment constitute the population of our study. Seventy-five patients were studied in each group; Group 1 was given 8 mg of silodosin, while Group 2 continued the previous alpha-blocker treatment. Results: The initial mean international prostate symptom score (IPSS) was calculated as 20.81±0.97 in Group 1, in the third month there was a decrease of 17.12±1.25 (p<0.05). No significant change was observed in Group 2. In addition, a significant decrease was observed in IPSS subscores (storage and voiding symptoms) in Group 1 compared to baseline at the third month. There was an improvement in residual urine in the silodosin group and no improvement in the other group. Conclusion: In patients with BPH who refuse surgical treatment and could not achieve adequate symptom relief with other α-blockers in routine practice, silodosin was found superior in terms of LUTS recovery. Silodosin is also an effective option in patients who cannot undergo surgical treatment due to comorbidities.

scholarly journals Relationship between NT-proBNP and Cardio-Renal Dysfunction in Patients with Advanced Liver Cirrhosis

2014 ◽  
Vol 23 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Adriana Cavasi ◽  
Eduard Cavasi ◽  
Mircea Grigorescu ◽  
Adela Sitar-Taut
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Renal Dysfunction ◽  
Cardiac Dysfunction ◽  
Serum Levels ◽  
Qtc Interval ◽  
Advanced Liver Cirrhosis ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background & Aims: ProBNP is a sensitive marker of cardiac dysfunction. We assessed the concentration of circulating NT-proBNP in patients with liver cirrhosis in various stages of the disease and its correlation with markers of cardiac and renal dysfunction and with markers of liver disease severity.Patients and methods: A number of 88 patients with liver cirrhosis were included in the study, divided into 3 groups: group 1 - 18 control patients without ascites; group 2 - 35 non-azotemic patients with ascites; group 3 - 35 patients with hepatorenal syndrome. The cardiac dysfunction was assessed by measuring the NT-proBNP serum levels and the QTc interval. The markers of renal dysfunction were the estimated glomerular filtration rates - formulas involving creatinine and serum cystatin C. The Child-Pugh score was used to assess the liver disease severity.Results: The median NT-proBNP serum levels significantly increased in patients with advanced liver cirrhosis (group 3: 960 fmol/ml and group 2:  660 fmol/ml) as compared to group 1 (435 fmol/ml) (p<0.05). A significant direct correlation was found between the NT-proBNP concentration and the QTc interval (r=0.540, p<0.001). The NT-proBNP levels also correlated with the Child-Pugh score (r=0.501, p<0.01), proving the link between the cardiac dysfunction and the liver disease severity. The cardio-renal interrelation is supported by the relationship between the NT-proBNP concentration and the estimated clearances.Conclusion: The high NT-proBNP levels in patients with advanced cirrhosis indicate the presence of cardiac dysfunction, which has a role in the pathogenesis of the hepatorenal syndrome.Abbreviations: DP: diastolic pressure; GFR: glomerular filtration rate; HRS: hepatorenal syndrome; MAP:mean arterial pressure; NT-proBNP: N-terminal fragment of the prohormone B-type natriuretic peptide; proBNP: prohormone brain natriuretic peptide; SBP: spontaneous bacterial peritonitis; SP: systolic pressure; TIPS: tranjugular intrahepatic portosystemic shunt.

Application of femtolaser-assisted phacoemulsification in combined pathology of cataract and glaucoma

2021 ◽  
pp. 18-21
Author(s):  
A.P. Voznyuk ◽  
◽  
S.I. Anisimov ◽  
S.Y. Anisimova ◽  
L.L. Arutyunyan ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Biomechanical Properties ◽  
Mean Values ◽  
Long Term Follow Up ◽  
The Mean ◽  
Group 2 ◽  
Observation Period ◽  
Group 1

Purpose. To evaluate the efficacy and safety of femtolaser-assisted phacoemulsification in glaucomatous eyes in the long-term follow-up. Materials and methods. A retrospective analysis of the results of the surgical treatment of patients with combined cataract and glaucoma pathology was analyzed. The patients were divided into groups depending on the method of surgical intervention: 1) phacoemulsification with femtolaser support (26 eyes, 23 patients); 2) phacoemulsification (36 eyes, 30 patients); Results. Before surgery, there were no statistically significant differences in IOP and corneal hysteresis (СН) between groups 1 and 2. The mean values of IOP cc, IOP g and СН of group 1 before surgery were 22.7±6.1 mm Hg, 20.9±6.9 mm Hg, 8.5±1.6 mm Hg; 2 group – 22.9±8.7 mm Hg, 21.6±8.9 mm Hg, 8.9±1.6 mm Hg respectively. Average values of IOP cc, IOP g and CН 5 years after the surgical treatment in group 1 were 15.3±1.2 mm Hg, 14.4±3.4 mm Hg, 9.6±4.2 mm Hg; in group 2 – 18.0±4.2 mm Hg, 16.1±4.2 mm Hg, 8.8±2.2 mm Hg respectively. In both groups, stabilization of IOP and CH indices was noted, which remained throughout the entire observation period, which shows the normalization of the biomechanical properties of the corneoscleral membrane of the eye in the long-term postoperative period. Conclusion. Femtolaser accompaniment of phacoemulsification is an effective and safe method of cataract surgery for combined pathology. Key words: femtolaser, cataract, glaucoma, phacoemulsification.

Treatment Methods for Different Variations Syndrome Mirizzi

2021 ◽  
Vol 04 (04) ◽  
Author(s):  
Omarov N.B., Aimagambetov M. Zh. ◽  
◽  
◽  
Keyword(s):  
Surgical Treatment ◽  
Bile Ducts ◽  
Gallstone Disease ◽  
Main Group ◽  
Mirizzi Syndrome ◽  
Long Term Results ◽  
Control Group ◽  
Type Iii ◽  
Type Iv ◽  
Number Of Patients

The number of patients with complicated forms of cholelithiasis of cholelithiasis is progressively growing. One of the complications of gallstone disease is Mirizzi syndrome (SM). The reason for the development of which is the spread of the inflammatory - destructive process from the gallbladder to the bile ducts with the formation of pressure ulcers in the common bile duct, as a result of which the formation of a cholecystobiliary fistula occurs, through which stones from the gallbladder enter the main bile ducts. The analysis of the surgical treatment of patients with cholelithiasis (GSD) treated in the UH NJSC "MUS" was carried out. There were 3842 patients in total, Patients were in the period from January 2012. to July 2018 The analysis revealed that of all these patients with gallstones, Mirizzi SM type III and IV syndrome was diagnosed in 25 (0.7%). In 14 (56%) patients with type III SM and type IV SM, 11 (44%). The main group consisted of 10 (40%) patients and 15 (60%) patients included in the control group. The main group completed: 1) In type III SM (only 4 (40%) patients). One patient underwent hepaticojejunostomy according to the clinic method (2017/0423.1). In 3 patients, cholecystohepaticocholedochoplasty was performed with U-shaped interrupted sutures on the drainage according to Vishnevsky (2017 / 0980.1); 2) In type IV SM (a total of 6 (60%) patients). 4 patients underwent hepaticojejunostomy according to the clinic method (2017/0423.1). In 2 patients, cholecystohepaticocholedochoplasty was performed with U-shaped interrupted sutures on the drainage according to Vishnevsky (2017 / 0980.1). The developed and tested methods of surgical treatment of Mirizzi syndrome of types III and IV make it possible to improve the immediate and long-term results of surgical treatment of patients with this pathology. These methods of surgical treatment allow preserving the physiology of the bile outflow without postoperative complications typical for traditional hepaticojejunostomy (incompetence of the anastomotic sutures, stricture of hepaticojejunostomy).

Effect of Irradiation and Gentamycin on the Course of Experimental Peritonitis

1985 ◽  
Vol 1 (S1) ◽  
pp. 186-188
Author(s):  
T. Orlowski ◽  
S. Chabielski ◽  
A. Badowski ◽  
Z. Dumanski
Keyword(s):  
Surgical Treatment ◽  
Ionizing Radiation ◽  
Wistar Rats ◽  
Radiation Sickness ◽  
Simultaneous Action ◽  
Diffuse Peritonitis ◽  
Abdominal Organs ◽  
Male Wistar Rats ◽  
Group 2 ◽  
Group 1

The pathology of mixed injuries resulting from simultaneous action of several damaging factors on the organism is still insufficiently known. Peritonitis is the most frequent complication of injuries to the abdominal organs. Co-existence of peritonitis with radiation sickness impairs considerably the results of therapeutic management and prognosis. Surgical treatment is indicated in the latent period of radiation sickness or only in the period of recovery. In the case of diffuse peritonitis, the time of performing the operation is of essential importance for the prognosis. Thepurposeof the reportedinvestigationswas the study of the effect of ionizing radiation before exposure of the organism on the course of diffuse peritonitis and a trial of prolonging with an antibiotic the preliminary stage of the disease in which surgical treatment is effective. Investigations were carried out on 160 male Wistar rats weighing 250g on the average, divided into five groups. Group 1 served as control. In Group 2, the rats were only exposed to radiation.

Surgical treatment of acute calculous cholecystitis followed by one-day discharge of patients

2019 ◽  
pp. 32
Author(s):  
F. S. Kurbanov ◽  
M. A. Chinikov ◽  
Yu. G. Aliev ◽  
R. Kh. Azimov ◽  
L. R. Alvendova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis

Clinical study of thyroid cancer among a pediatric population born after Chernobyl (first report)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6069-6069
Author(s):  
M. B. Gorobeiko ◽  
O. S. Larin ◽  
S. M. Cherenko
Keyword(s):  
Thyroid Cancer ◽  
Surgical Treatment ◽  
Pediatric Population ◽  
Polluted Area ◽  
Follicular Variant ◽  
Regional Metastases ◽  
Radiation Induced ◽  
The Mean ◽  
Group 2 ◽  
Group 1

6069 Background: To evaluate the clinical and patologic results of surgical treatment of children born after Chernobyl and to compare these findings with well-known data of the group of patients who were children at the time of Chernobyl. To compare the clinical and pathologic features of thyroid cancer of children born after the Chernobyl versus those born prior to 1986. Methods: Comparison of clinical and pathologic result of surgical treatment of 141 patients born after Chernobyl (Group 1) and 589 patients (Group 2) aged 0–18 at the time of the disaster (1986) among the single institution clinical cohort within years 1995–2005. Results: In Group 1 there were 31 cancers (22%) vs. 243 (41%) in Group 2 (p<0.05 between Group 1 and Group 2). The rate of extrathyroid invasion was 69% vs. 36% (p<0.05 between Group 1 and Group 2). In Group 1, 17/21(80%) patients with extrathyroid invasion were found to have regional neck metastases (8 unilateral, 9 bilateral).The mean age in this subgroup was 13.4 ± 2.11 years but in the “benign subgroup” of Group 1 the mean age is 16.2 ± 0.77 years.In Group 2, 49/88 (55%) patients with extrathyroid invasion only had regional metastases. The mean age in this subgroup is 31.1 ± 4.7 years (p<0.05 between Group 1 and Group 2). We found cancer multifocality in 1 patient (3%, Group 1) vs. 55 (23%, Group 2).There were 19 cases (13.5%) of atypical adenomas in Group 1 vs. 46 (8%) in Group 2 (p<0.05 between Group 1 and Group 2). Histological types: solid follicular variant of papillary carcinoma (typical for radiation-induced children carcinomas with short latency) was found in 3 cases in Group 1 (9.5%) vs. 76 (31%) in the Group 2 (p<0.05 between Group 1 and Group 2). There was only one case of follicular thyroid cancer in Group 1 (3%) vs. 9% in Group 2. We did not find any relationship of cases of cancer in Group 1 to the Chernobyl-polluted area (only 3 patients − 10% from the nearest to Chernobyl regions) vs. 192 patients (80%) in Group 2 (p<0.05 between Group 1 and Group 2). Among patients with tumors of uncertain malignant potential 9 patients (6%) were from Chernobyl-polluted area vs.72% in Group 2 (p<0.05 between Group 1 and Group 2). Conclusions: Our data demonstrates higher likelihood of aggressive well-differentiated thyroid cancer among a pediatric population independently from Chernobyl irradiation and connected with another etiological factors of genesis of tumor.The solid-follicular variant of papillary cancer and multifocality are typical for radiation-induced carcinoma in children. No significant financial relationships to disclose.

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