[The use of the hemostatic preparation Kaprofer in emergency surgery].
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Biomedical subjects
Publications and source records attributed to M V Grinev.
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Clinical approbation of human recombinant yeast human interleukin-2 (rIL-2) was carried out in 10 patients with III-IV stages of tumor that have undergone 65 intravenous drop by drop infusions of the drug as a course of 5-11 injections in the dosage of 1-8 mln/un. The drug toxicity was shown in 4 mln and especially, in 8 mln/un dose administration. That's why the dose of 1-2 mln/un is recommended. This dose was not followed by any serious complications, and the number of slightly complicated cases was significantly decreased as compared to similar rIL-2 drug made by the "Cetus Corporation" firm. Immunostimulating effect of yeast rIL-2 was found which appeared to be able to reach it's maximum by 3-4 administrations, with it's following disappearance or inversion, which may cause immunosuppression.
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Results of treatment of 24 patients with neglected colorectal tumors in the period from 1988 till 1994 are presented. Six patients had stage C and 18 patients had stage D after Dukes. Methods of combined action on the tumor including dissection of the tumor and its metastases, using immunoadoptive therapy as extracorporal connection with the donor porcine spleen, intravenous infusions of interleukin-2 and chemotherapy were employed. All the patients with stage C according to Dukes are alive: the average period of observations was 1143 +/- 206 days with intervals within the limits of 4,5-1,5 years. Seven patients of 18 with stage D after Dukes are alive with the average period of observations 1331 +/- 216 days and an interval of observations within the limits from 6 to 2 years. Dead patients with stage D after Dukes lived 525 +/-98 days on the average, i.e. about 1,4 year. The employed method of combined treatment of colorectal tumors improves survival, prolongs the lifetime of patients with neglected forms of the disease.
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An experience with treatment of acute ileus is presented. Operations were performed on 499 patients. Postoperative lethality from small intestine obstruction was 12.5%, from the colon obstruction--32.4%. The methods of treatment of different forms of intestinal ileus are described.
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The authors observed 3 patients with the Ogilvie syndrome. The Ogilvie syndrome is a peculiar form of acute intestinal obstruction characterized by acute dilatation of the colon without obstruction of its distal portions and often developing against the background of other grave diseases. For a timely diagnosed pathology the conservative treatment including a colonoscopic decompression of the colon and epidural anesthesia++ proved to be effective. In cases of ineffective conservative measures a cecostomy was put, resection of the injured portion was used for necrosis and perforation of the over-stretched++ gut.
An investigation of specific course of the disease in 911 patients operated upon for acute cholecystitis with bilirubinemia has shown that mechanical jaundice resulting from choledocholithiasis takes place in a third of the patients. Obstruction of the bile duct was confirmed in 27.1% of the patients during cholangiography. Prevalence of a number of factors was noted indicating of a toxic lesion of the liver (destructive forms of acute cholecystitis in 81.0% of the patients, higher level of bilirubinemia in long terms of the disease, the presence of coexistent pancreatitis in 30.5%, cholangitis--in 39.3%). An investigation of 207 bioptates of the liver in acute cholecystitis has revealed fatty degeneration of hepatocytes in 56.5%, pericholangitis--in 43.0%, cholestasis--in 21.3% of the cases. The cause of jaundice in acute cholecystitis mainly is an alteration of the hepatic cells due to pyo-resorptive intoxication manifested as cholestasis and hepatitis.
Under study were 56 observations of posttraumatic cholecystitis and pancreatitis in patients with polytrauma without a direct injury of the gallbladder and pancreas. Diagnostics of posttraumatic cholecystitis and pancreatitis is based on data of laparoscopic and ultrasonic examinations. Treatment of acute cholecystitis in the postshock period of trauma disease is operation, while treatment of posttraumatic pancreatitis must be started with intensive therapy.
Experience in operative treatment of 228 patients for acute acalculous cholecystitis is analysed. This disease differs from acute calculous cholecystitis essentially in the main clinical and morphological signs. Four types of acute acalculous cholecystitis were distinguished according to origin: vascular, enzymatic, enzymatic-vascular, and obturative. The clinical forms are shown: primary vascular, emphysematous, posttraumatic, gallbladder torsion, enzymatic, obturative. It is pointed out that acute acalculous cholecystitis is characterized by rapid destruction of the cystic wall and frequent and severe involvement of the liver and bile ducts, in view of which the tactics of early operations is justified in this pathological condition.
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An experience with the operative treatment of 12 patients with injured vena cava is analyzed. Traumas of the vena cava are a comparatively rare pathology characterized by catastrophic deterioration of the clinical course with the underlying massive internal hemorrhage. Injuries of the vena cava are difficult not only for preoperative but also for suboperative diagnosis. They are characterized by difficulty of surgical procedures and high percent of unfavorable outcomes due to special severity of blood loss and shock.
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The shockogenous trauma is followed by a considerable accumulation of lipid peroxidation products in the patient's organism. The most effective of all the measures used for the detoxication was found to be extracorporal use of the donor spleen which resulted in lower content of lipid peroxidation products in blood plasma immediately after the procedure. The maximum effect was observed 1 hour later and persisted during one day after treatment.