A case report of appendicular abscess resulted in hernial sac phlegmon

An abnormal clinical case of break of appendicular abscess in incisional ventral hernia complicated phlegmon of anterior abdominal wall is reported. The observation is of significant importance due to rare frequency of occurrence in clinical practice, formation of a dangerous complication (phlegmon of anterior abdominal wall), difficult differential diagnostics (Richter’s strangulatoin bowel or epiploon in hernia with necrosis complicated hernial sac phlegmon or break of appendicular abscess in incisional ventral hernia). The surgical management was performed followed by a patient’s recovery

Evaluation of severity and prognosis of the disease course in ulcerative gastroduodenal bleeding

The systems of evaluation for severity and prognosis of the disease course constitute an important resource for the improvement of treatment parameters in patients with gastroduodenal bleeding. Although in practice more common methods with limited accuracy and high percentage of subjectivity are often used. The work shows the analysis of the situation and possible ways of resolution.</p

Evaluation of the operative and anesthetic risk for patients with ulcerative gastroduodenal bleedings

Aim: to specify operative and anesthetic risk during urgent and preventive operations for patients with ulcerative gastroduodenal bleedings, develop algorithm for prognosis of unfavorable outcomes after operations and point out possible ways to control risks in given pathology. Material and Methods. To specify factors of operative and anesthetic risk during urgent and preventive operations a comparative analysis of two groups of patients suffering from gastroduodenal bleedings, who were treated in the surgery department of "Saratov city clinical hospital Nr.6" was done. The first group consisted of 39 patients, who died after the surgery, the second group of 274 patients with a favorable outcome after the operation. The statistical analysis was done by use of the program Statistica 6.0. Results. The operative and anesthetic risk factors where determined with the help of parametric and non-parametric methods of statistical analysis. An algorithm of evaluation operative and anesthetic risk factors by a tree classification was devised through the use of multidimensional analysis. With the help of this one can predict the outcome of urgent and preventive operations and highlight the risk group with an expected lethality of about 40%. Conclusion. The division of patients according to degree of risk of bleeding relapses as a whole with complex evaluation of patient's condition severity and operative and anesthetic risk allows choosing the right treatment plan and by this as a result increases the chance for a favorable treatment outcome

Strategy and tactics of surgical treatment in elderly patients with ischemic form of diabetic foot syndrome

The article analyzes the Russian and foreign publications on the issue of treatment of elderly and senile patients with critical limb ischemia and diabetes mellitus. It is shown that the topic is relevant, and, despite its wide coverage in the press, does not have the final decision. Currently unresolved issues include the terms and indications for reconstructive surgery, the amount and the method of amputation, postoperative care.</p

Endoscopic hemostasis at colic bleedings

The article specifies possibilities of colonoscopy in diagnostics of reasons and intensity of colonic bleedings; complex evaluation of endoscopic methods efficacy of hemostasis is given at continued colonic bleedings; value of these methods in preventive maintenance of bleeding relapses is establishe

Probability of developing severe sepsis in patients of elderly and senile age with necrotic erysipelas

Objective: the probable determination of severe sepsis in patients of elderly and senile age with necrotic erysipelas based on a comprehensive assessment (clinical examination using systems — scales and determination of the level markers of SIRS). Material and methods. The analysis of peculiarities of necrotic erysipelas clinical course in 59 patients. The first group consisted of 17 patients with severe sepsis, the second — 18 patients with sepsis without multiple organ failure, in the comparison group —22 patients with local infection. We determined albumin, urea, creatinine, pro-calcitonin of plasma. The scale SAPS III was used to quantify SIRS, scale SOFA —to determine the extent of damage to organs and systems. Results. The most sensitive marker of developing sepsis in patients with necrotic erysipelas was procalcitonin. The second important indicator of SIRS severity in patients with necrotic erysipelas was the blood albumin. Scale SAPS III also allows to select a group of patients with high risk of developing severe sepsis. Use of the SOFA to predict the scale has been found out to be less important. Conclusion. A comprehensive assessment of the severity of the condition by scale SAPS III in combination with determining the levels of procalcitonin and plasma albumin is advisable to apply for prediction the probability of developing severe sepsis in patients of elderly and senile age with necrotic erysipelas. For the last indicator it is important to assess of absolute values and the decrease of its concentration

Comparative analysis of assessment methods for operational and anesthetic risks in ulcerative gastroduodenal bleeding

Aim of the investigation: to conduct a comparative analysis of methods of evaluation of surgical and anesthetic risks in ulcerative gastroduodenal bleeding. Materials and methods. A retrospective analysis ofthe extent of the surgical and anesthetic risks and results of treatment of 71 patients with peptic ulcer bleeding has been conducted in the study. To evaluate the surgical and anesthetic risks classification trees are used, scale ТА. Rockall and prognosis System of rebleeding (SPRK), proposed by N. V. Lebedev et al. in 2009, enabling to evaluate the probability of a fatal outcome. To compare the efficacy ofthe methods the following indicators are used: sensitivity, specificity and prediction of positive result. Results. The study compared the results ofthe risk assessment emergency operation by using these methods with the outcome ofthe operation. The comparison ofthe prognosis results in sensitivity leads to the conclusion that the scales ТА. Rockall and SPRK are worse than the developed method of classification trees in recognizing patients with poor outcome of surgery. Conclusion. The method of classification trees can be considered as the most accurate method of evaluation of surgical and anesthetic risks in ulcerative gastroduodenal bleeding

Endoscopic recanalization of colon at tumour impassability

In article value of a full or partial endoscopic recanalization of colon stenosing tumours in preoperative decompression and performance of delayed operative measure with applying a primary colic anastomosis is establishe

New Forms of Students’ Self-Work at Clinical Department in the Context of New Educational Standards

In this article the authors demonstrate the results of use the contemporary forms of students’ self-work organization

Monitoring of gastric secretion and early diagnostics of gastroduodenal ulcerative bleeding recurrences

The research goal is to develop a universal method of monitoring of intragastric medium dynamics. It allows diagnosing of bleeding recurrences and monitoring the effectiveness of gastric secretion suppression. In Saratov clinic of General Surgery use of probe-detector, dynamic endoscopy, laser Doppler flowmetry and methods of endoscopic hemostasis has reduced mortality: postoperative mortality has been decreased from 7,4 to 1,6%, while the general mortality — from 3,5 to 1,5%. The proposed devices can be used separately, and do not allow parallel assessment of pH of gastric juice, the microcirculation in the stomach wall and bleeding recurrences. 47 patients have been under the study. The changes in electroconductivity of intragastric medium have been proved in the suppression of intragastric secretion and the appearance of blood in gastric lumen. The received data have considered impedancemetry as the method of monitoring of intragastric medium in gastroduodenal bleeding