AIMTo explore the outcomes and the appropriate treatment for patients with moderately severe acute pancreatitis (AP).METHODSStatistical analysis was performed on data from the prospectively collected database of 103 AP patients admitted to the Department of Surgery, Hospital of Lithuanian University of Health Sciences in 2008-2013. All patients were confirmed to have the diagnosis of AP during the first 24 h following admission. The severity of pancreatitis was assessed by MODS and APACHE II scale. Clinical course was re-evaluated after 24, 48 and 72 h. All patients were categorized into 3 groups based on Atlanta 2012 classification: Mild, moderately severe, and severe. Outcomes and management in moderately severe group were also compared to mild and severe cases according to Atlanta 1992 and 2012 classification.RESULTSFifty-three-point four percent of patients had edematous while 46.6 % were diagnosed with necrotic AP. The most common cause of AP was alcohol (42.7%) followed by alimentary (26.2%), biliary (26.2%) and idiopathic (4.9%). Under Atlanta 1992 classification 56 (54.4%) cases were classified as “mild” and 47 (45.6%) as “severe”. Using the revised classification (Atlanta 2012), the patient stratification was different: 49 (47.6%) mild, 27 (26.2%) moderately severe and 27 (26.2%) severe AP cases. The two severe groups (Atlanta 1992 and Revised Atlanta 2012) did not show statistically significant differences in clinical parameters, including ICU stay, need for interventional treatment, infected pancreatic necrosis or mortality rates. The moderately severe group of 27 patients (according to Atlanta 2012) had significantly better outcomes when compared to those 47 patients classified as severe form of AP (according to Atlanta 1992) with lower incidence of necrosis and sepsis, lower APACHE II (P = 0.002) and MODS (P = 0.001) scores, shorter ICU stay, decreased need for interventional and surgical treatment.CONCLUSIONStudy shows that Atlanta 2012 criteria are more accurate, reduce unnecessary treatments for patients with mild and moderate severe pancreatitis, potentially resulting in health costs savings.
Introduction. One of the most common and serious complications of near-postoperative surgery after colon resection with anastomosis is intestinal leakage with a frequency of 1 to 24%. Therefore, it is very important to evaluate the factors that may determine the development of this complication. One of the etiological factors behind the development of this complication is the intestinal microbiota, which is playing an increasingly important role in this process. Nevertheless, there is still a lack of comprehensive clinical evidence on the influence of the intestinal microbiota on postoperative complications such as anastomotic leakage. Purpose. To evaluate the influence of intestinal microorganisms on anastomotic leakage after elective intestines surgery. Methods. A prospective study was performed at the Lithuanian University of Health Sciences Hospital, Kaunas Clinics, Clinic of Surgery. There were included patients who underwent colon surgery (right hemicolectomy, left hemicolectomy, sigmoid resection and closure of ileostomy). Intestinal mucosal biopsy performed before restoring intestinal integrity and sent for microbiological and antibiotic examination. Patients were also observed postoperatively for anastomotic leakage. Results. The majority of patients were treated for colon cancer – 46 (92.0%). In 19 patients crop (38.0%) grown one microorganism, in 12 (24.0%) – 2 microorganisms, in 5 (10.0%) – 3 microorganisms, in 1 (2.0%) – 4 types of bacteria. In the most of the crops were observed growth by E. coli – 30 (60.0%), Enterococcus spp. – 12 (24.0%), Bacteroides spp. – 4 (8.0%), Klebsiella oxytoca – 2 (4.0%), Beta hemolytic streptococcus – 2 (4.0%) patients. Citrobacter fundii, Citrobacter brakii, Parabacteroides distasonis, Proteus mirabilis, Klebsiella pneumoniae, Enterobacteriaceae daacea grew only in 1 (2.0%) patients crop. Postoperative anastomotic leakage diagnosed in 2 (4.0%) patients. Conclusions. The major microorganisms that grown were E. coli. Due to the small sample, tendency can not be predicted, but microorganisms that promote small blood vessels thrombosis may be one of the factors that cause anastomotic leakage.
Reikšminiai žodžiai: endometriumo vėžys, limfadenektomija, dubens limfmazgiai, paraaortiniai limfmazgiai, stadijavimas. Nuo 1988 metų endometriumo vėžys stadijuojamas chirurgiškai, tačiau ir po daugybės atliktų tyrimų ir praktikos limfadenektomijos reikšmė esant ankstyvos stadijos endometriumo vėžiui kelia nemažai klausimų. Atlikus chirurginį stadijavimą galima atrinkti pacientes tolesniam adekvačiam adjuvantiniam gydymui. Deja, netikslingai atlikta limfadenektomija lemia didesnį sergamumą ir mirtingumą. Yra atlikta nemažai tyrimų, vertinančių limfadenektomijos reikšmę gydant endometriumo vėžį, vis dėlto rezultatai yra dviprasmiški ir tai kelia daug diskusijų. Pagrindiniai klausimai, susiję su limfmazgių pašalinimu, yra tokie: kaip nuspėti galimą navikinio proceso plitimą limfmazgiuose ir kaip tikslingai atrinkti tas pacientes, kurioms limfmazgių pašalinimas reikalingas. Nors atlikti tyrimai esant ankstyvos stadijos endometriumo vėžiui nepatvirtina limfmazgių pašalinimo naudos, tačiau jų rezultatai kelia nemažai diskusijų. Tikėtina, kad ateityje sarginio limfmazgio identifikavimas išspręs nemažai diskusinių klausimų. Yra žinoma, kad limfadenektomija lemia didesnį sergamumą ir ekonomines išlaidas, tačiau įtaka ilgalaikei gyvenimo kokybei lieka neaiški. Svarbiausi šio straipsnio tikslai ir būtų įvardyti parametrus, lemiančius navikinio proceso plitimą limfmazgiuose, įvardyti sarginio limfmazgio reikšmę bei suprasti netikslingos limfadenektomijos įtaką sergamumui.
Introduction. Liposuction is one of the most popular aesthetic surgical procedures. Liposuction is associated with weight loss, but the primary significance of this operation is body lines contouring. According to US plastic surgery statistics for 2018, liposuction surgery was ranked in the top five of cosmetic surgical procedures, and the most common area of suction in the body was the abdomen. One of the most difficult complications after this procedure is perforation of the small or large intestine, with a frequency of 0.014%. In order to avoid this complication, a comprehensive pre-operative, post-operative examination of the patient and ensuring the safety of the operation are important. We presenting a complicated clinical case of liposuction and literature review. Presentation of case report. In July 2019, a 49-year-old patient underwent surgery by plastic surgeons. Abdominal liposuction surgery was performed. On the first postoperative day, the patient complained of diffuse abdominal pain (VAS 7–8 points), but there were no clinical signs of peritonitis. The patient underwent urgent surgery following the development of a clinical picture of sepsis and peritonitis due to tomography. The operation started with diagnostic laparoscopy. On the left side of the abdominal wall, 4–5 mm abdominal wall defects were observed, and the intestinal cavity was rich in intestinal contents. No obvious injuries to the small intestine, colon or other abdominal organs were observed during laparoscopy. Therefore, a laparotomy was performed, during which two perforations of the small intestine were found and sutured. The postoperative period was smooth, with the patient discharged home after 11 bed days. Conclusions. Intestinal perforation after liposuction is a rare but dangerous complication. Although bowel injury is one of the most severe complications. Prevention is possible starting with a detailed clinical examination of the patient in the preoperative period. The postoperative period should be particularly important in light of the patient’s complaints and clinical symptoms. The presented clinical case shows what a complication of abdominal liposuction can be threatening and how important its early diagnosis and vigilance are.
Endometriozė -dažna reprodukcinio amžiaus moterų liga, sukelianti skausmą ir nevaisingumą. Chirurginis gydymas yra vienas iš svarbiausių endometriozės gydymo etapų. Tinkamas chirurginis gydymas palengvina endometriozės sukeliamus simptomus ir padidina pastojimo dažnį gydant nevaisingumą. Laparoskopinės chirurgijos technikų ir taktikų tobulėjimas lėmė, kad endometriozės chirurginis gydymas tapo svarbiu gydymo etapu, turinčiu pranašumų, palyginti su medikamentiniu gydymu. Skiriamos trys pagrindinės ligos formos: pilvaplėvės, kiaušidžių ir gilioji rektovaginalinės pertvaros endometriozė. Paprasčiausia atlikti paviršinių endometriozės židinių abliaciją, o gydant giliąsias ligos formas židinių ekscizijos būdu reikalinga chirurgo patirtis ir įgūdžiai. Endometriozės chirurginis gydymas yra tausojantis arba radikalus, jei šalinama gimda ir (ar) kiaušidės. Labai svarbu laparoskopijos būdu nustačius endometriozę pašalinti visus matomus pažeidimus. Pagrindinis šio straipsnio tikslas yra padėti suprasti chirurginio gydymo svarbą gydant endometriozę ir pateikti moksliškai pagrįstus įrody-mus, kaip tinkamai gydyti endometriozę chirurginiu būdu.
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