[Complicated forms of cancer of the large intestine].
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Biomedical subjects
Publications and source records attributed to V Ia Babkin.
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Based on an analysis of lethal outcomes in 20 of 326 patients with perforated ulcers of the stomach and duodenum the authors recommend to perform planned operations more often in elderly and senile patients, to combine suturing the ulcer with truncal vagotomy, intensive therapy, administration of drugs, catheterization of the superior mesenterial artery.
The article analyzes the development of viewpoints to pathogenesis of acute intestinal obstruction and modern principles of treatment of the disease.
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The article presents results of treatment of 300 patients with acute cholecystitis, 285 of them (95%) being operated upon. Hepatic insufficiency was found to develop in 173 patients (57,6%). The operation of choice was cholecystectomy (97,1%). Cholecystostomy was fulfilled in 7 patients (2,4%), in 2 patients (0,5%) choledocholithotomy was made following a previous cholecystectomy. Lethality in patients with hepatic insufficiency was 4 times as high as in patients without it. In 34,1% of the operated patients hepatic insufficiency was the main cause of death.
During the recent years 202 patients with cholelithic disease and its complications have been treated in the clinic. In 135 patients admitted to the hospital an attack of severe pains was followed by jaundice and symptoms of hepatic insufficiency (HI). A compensated stage of HI was diagnosed in 68 (50.4%) patients, subcompensated stage--in 38 (28.1%), decompensated--in 25 (18.5%) and terminal stage of HI--in 4 patients (3%). The operative treatment was used in 142 patients (70.3%). The operation of choice was cholecystectomy. An intervention on the common bile duct was performed in 59 patients (41.5%). Operations were performed on 42 patients with the compensated stage of HI (one of them died), in 17 patients with the subcompensated stage (one patient died), in 16 patients with the decompensated stage (three patients died); with the terminal stage there were 4 patients operated upon. Two of them died.
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The authors analyze the application of the radioisotopic method for examining the liver in 413 patients; with acute cholecystitis (97), chronic cholecystitis (195), chronic pancreatitis (12) and cirrhosis of the liver (109). The scanning and functional investigations of the liver allowed detection of substantial disorders in the functional state of the liver in patients with acute cholecystitis and obturation jaundice which suggests a necessary correction of the liver function in the pre- and postoperative periods.
The authors report their observations of 164 patients with cancer of the colon, complicated by an acute intestinal obstruction, operated upon on urgent indications. Radical surgery was performed in 73 patients, the postoperative mortality being 31.5%. Palliative operations were performed in 91 patients, the mortality--60%. Rather short terms of the development of acute intestinal obstruction necessitate the accomplishment of one-movement operations with the mandatory decompression of the small intestine. In patients with long term intestinal obstruction the Zeidler-Schlotter operation should be preferred.
The problems of pathogenesis, clinic and treatment of general purulent infection and sepsis are discussed. 1045 patients with different purulent diseases were observed by the author. Sepsis was diagnosed in 18 patients, that made 1.7 per cent to a total number of observations. Among these septic patients 8 patients died.
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