Biomedical subjects
Publications and source records attributed to M E Shor-Chudnovskiĭ.
The possibility to correct postoperative dysbacteriosis in patients, who had their operation been completed with external drainage of the common bile duct, was studied. Resulting from the use of Normaze preparation in combination with Bifidumbacterin adsorbed on SKN carbon sorbent, the composition of intestinal microflora has restored, bile structure improved.
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When analysing the results of examination of 773 patients with obstructive jaundice (OJ) of benign genesis, purulent cholangitis (PC) was revealed in 323. In PC diagnosis, the ultrasound study is a valuable adjunctive method. In presence of the clinical signs of PC in patients and absence of the effect from conservative therapy, and as well in preservation of the high indices of bilirubinemia, the early operative treatment performed, as a rule, no later than 48 h after hospitalization is indicated. PC in patients with OJ is most frequently caused by choledocholithiasis. The causative agents of PC are represented by aerobic and anaerobic microorganisms, requiring the use of broad spectrum antibiotics before the operation and 6-12 h after it. Adequate restoration of bile passage and pathogenetically substantiated local influencing upon the inflammatory process in the bile ducts are tasks of operative intervention. Direct administration into the bile ducts of antibiotics and antiinflammatory preparations, in particular of quercitrol, via the external drain of the common bile duct is expedient.
The adsorbing activity of granulated carbonic sorbents SKN and KAU, as well as their oxidated forms, containing protogenic carboxylic and phenolic groups with respect to Shigella flexneri, Salmonella typhimurium, Escherichia coli, Streptococcus aureus and Pseudomonas aeruginosa pathogenic strains has been studied. As shown in this study, the process of interaction between microorganisms and carbonic sorbents has two stages. At the first stage the main role is played by long-distance electrostatic forces and at the second stage, by Van der Waals short-distance forces, as well as bonds formed between cell structures and surface groupings of carbonaceous materials. In the mechanism of interaction between microbial cells and carbons the geometry of carbon surface plays an important role. KAU(0)-1 exhibits the highest degree of adhesion with respect to pathogenic bacteria.
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To give sorbents the bactericidal action, a modification of the carbonic sorbents by the metals is suggested. Modification of the SKN and KAU sorbents by copper and zinc didn't reduce sorption by them of microorganisms and their toxins. Inhibitory effect of a sorbent was provided by the lower concentrations of the copper and zinc than by those which in the solution of metallic salts had only bacteriostatic effect.
The use of SKN P-1 and SKN P-2 carbonic enterosorbents in the complex treatment of the patients contributed to decrease in pronouncement of cholemic intoxication. A method is easy, noninvasive, its use is recommended in patients, the elderly and senile in particular, with obstructive jaundice.
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In the experiments on rats with modelled bile duct obstruction and hepatic failure, the pronounced detoxicative value of the SKN P-1 and SKN P-2 carbonic sorbents is proved.
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Debatable questions of indications to choledochotomy and placing bile-eliminating anastomoses are discussed on the basis of personal experiences and data of literature. It is supposed that the amount of choledochotomies should be restricted at the expense of wider use for the revision of extrahepatic bile ducts of the cystic duct stump. In cases when bile-elimination anastomoses are not supposed oblique choledochotomy should be preferred through the cystic duct stump. Indications to the creation of bile-elimination anastomoses should not be wider. In doubtful cases the question should be solved in favour of external drainage of the common bile duct.
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Errors and complications taking place in external drainage of the common bile duct were analyzed in 484 patients. They appear due to choice of a wrong drainage tube. The authors describe their method of fixation the drain when draining through the stump of the bladder duct. In the postoperative period it is necessary to perform intracholedochal therapy with antibiotics for treatment of purulent cholangitis and for preventing a secondary infection of the bile ducts. Time of the removal of the drain depends on the state of the pancreas and on the data of transdrainage cholangiography.
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