Biomedical subjects
Publications and source records attributed to G I Perminova.
Changes in bile ducts in cholestasis are characterized by activation of proliferation and hypertrophy of cholangiocytes and degenerative and necrobiotic changes in ductal epithelium. Long-term cholestasis led to massive necrosis of cholangiocytes. Inflammatory changes in the choledochal mucosa were most pronounced in patients with choledocholithiasis.
In treatment of patients with diffuse peritonitis the authors have been using postoperative sanative laparoscopy which proved to provide a means not only for rapid evaluating the dynamics of peritonitis course, but also for carrying out a series of therapeutic manipulations aimed at proper management of infections and inflammatory complications. Sanative laparoscopy was accompanied by taking samples of peritoneal exudate to study sensitivity of microflora to antibiotics and antiseptic substances, ensuring rational antibacterial treatment of peritonitis. This therapeutic method was used in 38 patients who underwent 60 examinations. Sanative laparoscopy was of a planned character in 30 patients, and in 8 cases it was carried out for emergency indications. All the studies were performed within 12-23 hours. A single examination was carried on in 11 subjects, the rest of the patients demanding from 2 to 3 examinations. No complications related to sanative laparoscopy were observed. Positive outcome was noted in the majority of the patients, re-laparoscopy being indicated but for 3 patients. Two patients died due to causes not related to the pathology involved.
The article describes in detail a method for laparoscopy in patients in the early periods after surgical intervention on the abdominal organs. Definite indications for endoscopic intraoperative laparostomy are pointed out, a bushing specially designed by the authors is described, and the terms and indications for dynamic visual examinations of the abdominal cavity are determined. The suggested method does not cause harm to the patient and allows early postoperative complications to be recognized in good time and the course of the inflammatory-reparative process in the zone of the operation to be appraised visually.
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The results of the use of emergency laparoscopy in 78 patients are presented. Of 25 patients with clinical signs of acute ileus (AI), the diagnosis was confirmed in 12, of 42 with suspected AI--in 14. In 11 cases, AI was a laparoscopic finding. In 18% of the cases, no changes in the internal organs were revealed at investigation, in 30.8%--the other diseases of the abdominal organs were diagnosed. In 6 patients, AI was dynamic, in 8--strangulative, in 23--obstructive. Laparoscopic investigation performed in 94.9% of cases permitted to establish the accurate diagnosis.
In 14 patients with non-specific mesadenitis, the diagnosis was established at emergency laparoscopy, performed for suspected acute appendicitis. Laparoscopic semiotics of the disease is described. Conservative treatment with additional local administration of drugs was successful. The mean duration of the in-hospital treatment of the patients was 4.6 days.
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