[Severe course of gastroesophageal reflux disease caused by intra-abdominal tumoral compression].
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Biomedical subjects
Publications and source records attributed to V D Sheĭko.
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There was studied the traumatic disease course in 11 pregnant women with different variants of severe combined thoracic and abdominal trauma, constituting 1.6% of total number of injured persons, suffering polytrauma. Polytrauma have had caused severe course of traumatic disease in majority of pregnant women. In the early postshock period the complications had occurred in 90.9% of injured persons. Antenatal death of fetus was noted in 81.8% of pregnant women with polytrauma. All pregnant women after polytrauma are alive.
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Clinical significance and prognostical informativity of the hemodynamics indexes in an acute period of traumatic disease (TD) in severe combined thoracoabdominal trauma (SCTAT) were studied. The cardiac pump function, tone of vessels, their resistance, venous return were estimated. The pronounced and stable disorders of the hemodynamics indexes in injured persons with SCTAT were noted, their degree depended on the trauma severity, which had determined the TD outcome.
The course of traumatic disease (TD) was studied up in 415 injured persons with severe combined trauma. There were analyzed 82 parameters, reflecting peculiarities of anatomic traumatization, age of injured person, proceeding diseases, functional state of main systems of the life support. The data obtained were processed using multilevel statistical analysis. There were determined parameters, defining severity of the TD course and probability of syndrome of the polyorgan dysfunction (SPOD) occurrence, original scale of the SPOD prognostication was elaborated, permitting to prognosticate the TD course, to change the tactics and to improve the results of treatment of injured persons.
Disorders of external respiration, clinical significance and prognostical information of the gas exchange system indexes in an acute period of traumatic disease (TD) in severe combined trauma (SCT) were studied. Pronounced stable changes of the external respiration indexes in injured persons for all forms of SCT, constituting high prognostic information in dynamics of course of TD, were revealed.
Prognostic informativity some indexes of immune response in severe shockogenic combined thoracoabdominal trauma was studied. In 92 patients aged from 17 to 85 years (68 men and 24 women) in acute period of traumatic disease (TD) quantity of T-, B-, 0-lymphocytes, immunoregulating subpopulations, the main immunoglobulins classes concentration, circulating immune complex were determined. Significant disorders of the organism immune system of injured persons were revealed, but prognostic significance of the data obtained in determination of the TD course severity was not large.
Thoracoabdominal wounding in the shot gun polytrauma was revealed in 56 (25.6%) of injured persons, severe shock of III-IV degree--in 71.4%. Operative intervention on the abdominal cavity organs was done in all injured persons, on the thoracic one--in 92.9%, and on the other anatomical regions--in 55.4%.
Comparative estimation of the state severity in 427 injured persons with polytrauma according to B[symbol: see text]X-M[symbol: see text] (OP)--C[symbol: see text]6, ISS, PTS scales was done. The lack of their efficacy was established. The method of the polytrauma severity estimation, concerning the injuries mutual aggravation syndrome as the main pathogenetic cause, was proposed. Six criteria, determined with the help of factor analysis, are estimated: the injured anatomic parts quantity, the anatomic injury severity index, the level of consciousness, systolic arterial pressure, age of the injured person, the period before the onset of the antishock therapy conduction. The total account of the criteria values are inscribed in the formula and are noted in special form of the standardized scale. The method permits to estimate the politrauma severity, to prognosticate the complications, the syndrome of polyorganic dysfunction occurrence and the mortality rate with 95% accuracy.
In severe combined gun shot trauma the abdominal wound was noted in 73.1% of injured persons, the thoracic one--in 64.7%, of the upper and lower extremities--in 59.9%, of the head--in 41% and of pelvis--in 22.4%. In 132 injured persons there was diagnosed severe combined gun shot wound of the abdomen. Shock of III-IV stages was diagnosed in 70% of injured persons, the inner organs trauma--in 69.1%. Operative intervention was performed in all the injured persons, in 90.9% of them--the cavitary one. Mortality was 43.2%.
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An ulcer disease classification, basing on the disease clinical course criteria and the local changes characteristics, is proposed. An adequate estimation of the patient state and optimal tactics of treatment are guaranteed by the diagnosis formulation using the classification.
The surgical treatment tactics of patients with perforative gastroduodenal ulcer was substantiated, basing on the complex analysis done. Radical intervention, mainly organ preserving one, constitutes the operation.
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