A total of 154 patients were recruited: 79 G17DT and 75 placebo. A final analysis of the intention-to-treat population, using a proportional hazards model, stratifying by disease stage and adjusting for interim analysis, gave a hazard ratio for mortality of 0.75 (95% confidence interval, 0.51-1.10, P = 0.138; G17DT/placebo). A conventional analysis without adjustment for disease stage or interim analysis, censoring for chemotherapy and excluding protocol violators, gave median survival periods of 151 (G17DT) and 82 days (placebo) (log-rank test, P = 0.03).Patients developing anti-G17DT responses (73.8%) survived longer than nonresponders or those on placebo (median survival, 176 vs 63 vs 83; log-rank test, P = 0.003). G17DT was well tolerated.
For the purpose of justification for the use of various minimally invasive interventions in the treatment of patients with moderate to severe acute pancreatitis, the authors retrospectively analyzed the data of medical documentation for the period from 2009 to 2017, shows the results of surgical and medicinal treatment, the structure of mortality and complications depending on the choice of surgical manual for patients with acute pancreatitis. The possibilities of minimally invasive methods of surgical treatment in comparison with traditional operations are presented. It is shown that the use of minimally invasive techniques in the treatment of pancreatic necrosis significantly reduces the level of mortality associated with complications of infected pancreatonecrosis, and also reduces the level of postoperative complications.
Background. In recent years, the lethality from acute pancreatitis in Russia has not undergone significant changes and according to various data is from 15% to 25%. Purpose. The evaluation of the performing minimally invasive interventions in the treatment of patients with moderate to severe acute pancreatitis. Materials and methods. The authors retrospectively analyzed the medical records of 169 patients, the structure of mortality and complications depending on the choice of surgical intervention for the patients with acute pancreatitis of moderate and severe degree. Results. Lethal outcomes in the group of patients using minimally invasive interventions amounted to 11.5%, in the group of patients using traditional operations 37.5%, p 0.05. Laparoscopic interventions were effective in 88.8% of the cases, and drug therapy had a positive effect in 81.2% of the cases, p 0.05. Conclusion. It is shown that the use of minimally invasive techniques in the treatment of pancreatic necrosis significantly reduces the levels of mortality, postoperative complications, which improves the overall results of acute pancreatitis treatment.
ДИАГНОСТИКА РАКА ЛЕВОЙ ПОЛОВИНЫ ОБОДОЧНОЙ КИШКИ, ОСЛОЖНЕННОГО ОСТРОЙ КИШЕЧНОЙ НЕПРОХОДИМОСТЬЮЗа 2003-2012 гг. в Александровскую больницу Санкт-Петербурга было госпитализировано 2200 больных раком левой половины толстой кишки, осложненным острой кишечной непро-ходимостью, в возрасте от 26 до 91 года. Мужчин было 44,2 %, женщин -55,8 %. Объектом исследования стали 1019 больных, у которых не были выявлены отдаленные метастазы. Про-веден анализ роли физикальных, лабораторных и инструментальных методов обследования пациентов с острой кишечной непроходимостью, обусловленной раком левых отделов толстой кишки. До 80 % больных поступают в больницу позднее 48 часов от начала острого периода заболевания, что определяет вариабельность клинических проявлений при острой кишечной непроходимости, обусловленной раком левых отделов толстой кишки. Из инструментальных методов наиболее информативным является рентгенологическое исследование. Фиброко-лоноскопия, при успешности ее выполнения, позволяет в 100 % случаев установить диагноз, но только в 13,7 % переходит в лечебную манипуляцию. Использование лапароскопии позво-ляет отказаться от длительного наблюдения за пассажем сульфата бария у пациентов с подо-зрением на острую кишечную непроходимость и является наиболее эффективным методом установления причины кишечной непроходимости в комплексе диагностических мероприя-тий. Она может носить диагностический, первоэтапный или окончательный характер в ле-чении кишечной непроходимости. Компьютерная томография, обладая чувствительностью в 97,4 %, является методом выявления метастазов, определения источника и распространен-ности опухолевого процесса. Библиогр. 10 назв. Табл. 9.Ключевые слова: рак ободочной кишки, диагностика, клиническая картина, рентген-диа-гностика, эндоскопия, лапароскопия.DOI Between 2003 and 2012 in the Alexandrovskaya Hospital of St. Petersburg, Russia 2200 patients were hospitalized with cancer of the left colon complicated by acute intestinal obstruction, ageing from 26 to 91 years. 44.2% were men, 55.8% were women. Th e subjects of the study were 1019 patients in whom distant metastases had not been identifi ed. Th is study is an analysis of the role of physical, laboratory and instrumental methods of examining patients with acute intestinal obstruction due to cancer of left colon. Conclusions: 1. Up to 80% of patients were admitted to hospital aft er 48 hours from onset of the acute period of the disease, aff ecting the variability of clinical manifestations in acute intestinal obstruction due to cancer of left colon. 2. From instrumental methods, the most informative is X-ray examination. When ultrasound is characterized by a tensile intestinal loops. 3. Fibrocolonos-© Санкт-Петербургский государственный университет, 2016
From 2011 to 2015, in the Alexander hospital, enrolled 656 patients with diverticular disease of the colon. 23 (3.5%) people were admitted as planned, in an emergency 633 (96.5%). Diverticulitis was detected in 504 (79.6%) patients. Of these, 124 (24.6%) were operated on urgently. Primary laparoscopy was performed in 73 (58.9%) patients, 24 (32.9%) of them were operated on in a delayed manner. 380 (75.4%) patients received conservative therapy, 16 of them (4.2%) after relief of acute diverticulitis were also operated on in a delayed manner. 23 patients were operated on as planned for diverticular colon disease. During the study, two equal groups of patients were formed. The results of treatment of patients with delayed surgical interventions (n=40) and planned operations (n=23) were compared. The duration of treatment, the frequency of complications and the number of observations were analyzed, when it was possible to complete a radical treatment without colostomy. According to the results of the study, we concluded that the implementation of delayed operations in diverticulitis of the colon allows to perform radical treatment during one hospitalization. At the same time, the results of delayed interventions are comparable to the results of planned operations with uncomplicated diverticulosis.
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