Biomedical subjects
Publications and source records attributed to V B Krasnorogov.
Protocols of diagnosis and treatment of acute pancreatitis are presented. Definition based on pathogenesis of the disease is given. Phases of acute pancreatitis, features of diagnosis and treatment in each phase are analyzed. Terms of surgical treatment, main principles of postoperative treatment are discussed.
The main criterion of severity of acute destructive pancreatitis (ADP) is the volume of pancreatonecrosis formed during the first 24 hours of the disease. A prognostic system is developed allowing to urgently detect the "risk group"--patients with the developing massive pancreatonecrosis by means of the assessment of clinical criteria. In the process of intensive therapy of the "risk group" patients there occurs arresting, "abruption" of the destructive process which greatly improves the results of treatment (the frequency of purulent complications decreases from 32% to 14%, lethality from 45% to 19%). Different methods of "abrupting" therapy are described, the best of them is a combination of curative plasmapheresis with the intraaortal perfusion of the splanchnic area with antienzymes, antihypoxants and antithrombotics. In the group of 17 patients with severe ADP treated by the method described suppuration was noted in 1 (6%) patient, and no lethal outcomes. The pressing problem is to increase the number of patients with severe ODP treated by the method of "abrupting" therapy as early as possible which can be achieved with the help of early hospitalization, with using prognostic systems and creation of a network of specialized pancreatological clinics with the corresponding equipment.
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The characteristics of specific features of acute and chronic processes in the caudal pancreatis and surrounding retroperitoneal fat is given on the basis of an analysis of 273 cases of pancreatitis with the predominant lesion of this portion. It was established that acute caudal pancreonecrosis at an early period had atypical symptoms and more favourable course than that of the proximal parts of the pancreas. Later periods of the development of this variant of the disease are characterized by great frequency and spread of pyo-necrotic lesion of the retroperitoneal fat. Specific features of the clinical course, diagnosis and treatment were formulated and their being taken into account allowed to reduce lethality of patients with caudal pancreatitis from 39.0% to 25.0%.
An analysis of results of 200 experiments, 100 autopsies after death from acute destructive pancreatitis and clinical observation of 2000 patients with necrotic forms of acute pancreatitis has given data on pathogenesis of fat necrosis, dynamics of its development, its interrelationships with alterations of the pancreas parenchyma. A concept of unity of proteolytic and steatonecrotic components of acute destructive pancreatitis is substantiated. The authors propose a classification of periods of development of fat necrosis, determine the clinical significance of alterations of the fat tissue at early terms of the disease, give recommendations for the surgical and conservative treatment.
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Peritonitis was found to develop in 250 (20,8%) out of 1200 patients with closed injuries of the abdominal organs and penetrating wounds of the abdominal cavity. The employment of different methods of prophylaxis and treatment of peritonitis at early terms permitted reducing its incidence 2-3 times.
On the basis of great clinical material (804 patients with pancreatonecrosis) the authors give clinico-morphological characteristics of main components of local pathological changes connected with acute pancreatitis. Debatable questions of the curative methods are described. More exact indications for early surgical interventions are considered in detail.
The authors describe their experience in the surgical treatment of 139 patients with critical forms of necrotic pancreatitis. Operations were fulfilled in 137 of 139 patients. Two non-operated patients died. The article describes in detail the operative technique depending on the character, volume and type of development of the necrotic process. The lowest lethality followed operations in the phase of melting and sequestration due to timely necrosequestrectomy.
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On the grounds of a great clinical material (4,800 cases) and autopsy findings (857 autopsies) it is emphasized that there is a pathogenetic relationship between thrombotic complications and hemorrhages common in acute pancreatitis and the main disease; the thrombohemorrhagic complications playing a tremendous part in the development of its most severe forms and fatal outcome. The authors divide these complications inherent in all the phases of pancreatitis into 2 groups: early and late ones, which differ from one another by peculiarities of pathogenesis, clinical picture and treatment. The diversity of the complications is stressed, and recommendations on their diagnosis, prevention and treatment are set forth.
The remote results of closed mitral comissurotomy were studied in 400 patients during a follow-up period of 7 years. The results were appraised on the basis of the stage of hemodynamic disorders (classification proposed by A.N. Bakulev and E.A. Damir), disability, and working capacity. Five years after the operation good remote results were noted only in 58% of patients, which is explained by inadequate correction of the defect by the closed method due to the frequently encountered gross morphologic changes in the valve cusps. For greater objectivity in the assessment of the remote results it is suggested to use the term "without objective improvement" instead of "satisfactory results" because the former reflects the patient's condition and the state of hemodynamic disorders in greater measure.
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