ОПЫÒ ЛЕЧЕНИЯ БЕРЕМЕННЫХ С «ОСÒРЫМ ЖИÂОÒОМ»Материалы и методы. Анализ результатов лечения 183 беременных с острыми хирургиче скими заболевани-ями в условиях двух многопрофильных стациона ров г. Красно дара. Наибо лее часто встречаемыми ургентными хирургиче скими заболевани ями у беременных являются ост рый аппендицит, желчнокамен ная бо лезнь и ее ослож-нения, острый панкреатит, острая кишеч ная непроходи мость.Результаты. Диагностика заболеваний, учитывая контингент боль ных, весьма затрудни тельна и нередко про-должается длительное время, суще ственно ухуд шая прогноз как для ма тери, так и для плода. Использование УЗИ брюш ной поло сти всем пациенткам позволяет уточнить диа гноз и скорректировать так тику лече ния. При сомне нии в диагнозе необходимо выполнять диагностиче скую видеолапароско пию.Заключение. Использование малоинвазивных технологий в лече ние беремен ных позволяют умень шить часто-ту хирургиче ских и связан ных с ними перинаталь ных осложнений, способ ствую т пролонгированию беременно сти и снижению показателей материн ской и перинаталь ной смертно сти. ABSTRACT Aim. To summarize the current experience of diagnosis and treatment of pregnant women with acute abdomen. Materials and methods. Analysis of treatment results of 183 pregnant women with acute abdomen in the conditions of two multidisciplinary hospitals in Krasnodar. The most common urgent surgical diseases in pregnant women are acute appendicitis, cholecystitis and its complications, acute pancreatitis, acute intestinal obstruction.Results. Diagnosis of diseases, providing the contingent of patients, is quite difficult, and often takes a long time, significantly worsening the prognosis for both the mother and the fetus. The ultrasound examination of the abdominal cavity in all patients makes it possible to clarify the diagnosis and adjust the treatment tactics. When doubting the diagnosis, it is necessary to perform diagnostic laparoscopy.Conclusion. The use of minimally invasive technologies in the treatment of pregnant women can reduce the frequency of surgical and associated perinatal complications, promote the prolongation of pregnancy, and reduce maternal and perinatal mortality.
Aim. This study was conducted to assess the possibility of ultrasound elastometry using the shear wave method in the preoperative assessment of the stiffness condition of the pancreatic parenchyma in order to predict the risk of complications and the choice of the method for the formation of pancreatoenteroanastomosis in pancreatoduodenal resection.Materials and methods. The study was performed in 10 patients operated in the volume of pancreatoduodenal resection. All patients underwent preoperative ultrasound pancreatic elastometry with transcutaneous shear wave access method. The results were compared with the intraoperative data obtained by the visual examination and palpation. Depending on the average "stiffness" indicators of the parenchyma in comparison with the intraoperative data, one of two ways of forming the pancreatic intestinal anastomosis was preferred: either end-to-side or pancreatoenteroanastomosis with a wide atraumatic peritonization of the pancreas stump cutoff by the jejunum according to the original technique.Results. The inconsistency of class A pancreatoenteroanastomosis was noted in 2 (20%) patients, it was transient, asymptomatic, did not require additional medical interventions and did not extend the duration of the postoperative period. There were no inconsistencies of classes B and C, pancreonecrosis of the stump, repeated surgical interventions, and lethal outcomes.Conclusion. Ultrasound pancreatic elastometry with the shear wave method can be used in the preoperative assessment of the "stiffness" of the parenchyma in order to predict the risk of the complications and the choice of the method for the pancreatoenteroanastomosis formation.
A clinical case demonstrates the potential of transabdominal ultrasound of the large intestine in diagnosis and follow-up in a patient with ulcerative colitis. It is shown that transabdominal ultrasound examination performed in seroscan mode (B-mode) with the use of Doppler color mapping allows to monitor the degree of resolution of inflammation in the mucosa of the large bowel, as well as to evaluate the effectiveness of conservative approach.
Background. Colorectal obturation is a fairly rare complication in patients with colorectal polyposis. Case descriptions of colonic obturation with underlying familial adenomatous colorectal polyposis have not been reported to date in national and foreign literature.Clinical Case Description. Patient G., female, 31 yo, was emergently admitted to a surgical unit with a preliminary diagnosis: acute intestinal obstruction, complaints of abdominal pain, nausea, vomiting, stool and gas outlet blockage, marked general weakness. Clinical and biochemical blood tests without peculiarities. Signs of intestinal obstruction in abdominal ultrasonic and X-ray examination. Obstructive right hemicolectomy performed as emergent surgery. Diagnosis: transverse colonic C-r T3NoMo, stage II, clinical group 2. Patient had routine fibrocolonoscopy in six months; polyps were revealed in all operated colon portions. APC genetic test was positive, total colectomy was decided with single-barrel ileostomy excretion on anterior abdominal wall. Definitive diagnosis: transverse colonic C-r T3NoMo, stage II, developed with underlying familial adenomatous colorectal polyposis, clinical group 2.Conclusion. Diagnosis of familial adenomatous colorectal polyposis with acute intestinal obturation is challenging due to forced urgent surgical intervention and lack of time for a detailed deeper examination in avoidance of baleful consequences. The case reported demonstrates that clinical manifestations of familial adenomatous colorectal polyposis extend beyond the routine complaints of abdominal bloating, stool blockage and rectal bleeding towards a formidable complication of acute colonic obturation of polypoid genesis.
Complex analysis of clinical, morphological and functional results before and after medical therapy allowed to define indications and optimal period for surgical treatment in patients with chronic decompensated colostasis.
Aim. Increasing of efficacy of special medical care to patients with inflammatory intestinal diseases by means of the new organizational approaches to diagnostics and treatment.Materials and methods. An analysis of treatment of 79 patients with inflammatory intestinal diseases in City clinical hospital Nr 2, Krasnodar from 2010 to 2012 and Regional clinical hospital Nr 2 Ministry of Health care of Krasnodar Region from 2012 to 2017 is presented. 46 patients (58.2%) had ulcerative colitis, and 33 patients (41.8%) had the Crohn’s disease.Results. The conservative therapy was administrated to all patients depending on inflammation severity after additional examination and diagnostics. Due to the absence of therapeutical efficacy, different kinds of surgery were carried out. 34 operations were performed on patients with ulcerative colitis (12 urgent ones and 22 elective ones), 22 operations were performed on patients with Crohn’s disease (17 elective ones and 5 urgent ones).Conclusion. An opportunely performed surgery with the use of the low-invasive technologies on the patients with inflammatory intestinal diseases allowed diminishing a frequency of surgical complications and decreasing of lethality
The aim of the study was to assess the influence of the types of attitudes to disease and depression on adherence to treatment of patients with duodenal ulcer.Material and methods: Adherence to treatment was evaluated in 43 patients with sub- and decompensated scar-ulcerative stenosis aged from 21 to 74 years old (the average age being 47,5±26,5 years old), who underwent surgical removal of stenosis in the amount of duodenoplasty. The compliance of duodenal ulcer patients was assessed on the basis of the questionnaire developed by us. Assessment of the level of depression in patients was carried out using the Russian version of the Beck questionnaire (BDI). The method “type of attitude to disease” was used for psychological diagnosis of the types of attitude to the disease, the method being developed in the laboratory of clinical psychology of the Institute named after V. M. Bekhterev.Results: all 43 patients according to the degree of adherence to treatment were divided into 2 groups: compliant (20 patients) and non-compliant (23 people); also the types of attitudes to the disease and the level of depression were assessed. It was found that adaptive types of attitude to the disease were found in 51.2% of patients. Adaptive responses to illness provide overall adaptive behavior due to the adequate assessment of patients’ condition, or due to the obsessive desire for active employment, which is typical for ergopathic type of attitude to the disease, or due to the negation of everything associated with the disease with anosognosic type of the relation to disease. In «non-compliant» patients, in comparison with “compliant” ones, both before and after the surgery, statistically significant differences in the severity of the diagnosed depressive disorder were revealed. For «non-compliant” patients significantly more often mild depression and moderate depression were revealed, requiring the reception of psychopharmacological drugs.
Aim. Optimization of the tactics of management of patients with liver cirrhosis who underwent Transjugular Intrahepatic Portosystemic Shunt – TIPS based on own experience and literature data. Materials and methods. From 2014 to 2019 years 51 Transjugular Intrahepatic Portosystemic Shunt procedures were performed. Results. The indications for Transjugular Intrahepatic Portosystemic Shunt procedure were detailed. The tactics of treatment in post-operative period was assessed. Shot-term and long-term results of the treatment were discussed. Especial attention was put to persons who included in patient list of liver transplantation. Conclusion. Transjugular Intrahepatic Portosystemic Shunt allows obtaining stable decompression in portal system that reduces frequency of bleeding relapse from gastric and esophageal veins. The mortality was decreased, and patients can wait till liver transplantation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.