[Method of "discussional questioning"--one of many elements of problem-related teaching in the clinic of surgical diseases].
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Biomedical subjects
Publications and source records attributed to V V Ivashchenko.
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On the basis of treatment of 200 patients with diabetic angiopathy of the lower extremities, the authors have substantiated a differential approach to choice of a method for treatment depending on a stage of the disease. Use of quantum therapy, plasmapheresis, prolonged intraarterial infusion of the drugs together with conventional methods permitted to improve the functional results of treatment and avoid lethality during the recent five years.
The results of treatment of 28 patients with "appendicitis-like" form of the Crohn's disease are summarized. Diagnosis before the operation was supposed in 6 patients. Operated on were 25 patients. All of them underwent appendectomy. Differential diagnosis of acute appendicitis and Crohn's disease in difficult, of main importance are the data of clinical investigation. In diagnosis verification by the data of histologic conclusion, the performance of postoperative specific antiinflammatory therapy is mandatory. Danger of appendectomy under such conditions is exaggerated. The result of treatment at the period of from 3 to 20 years was studied in 22 patients operated on. Performance of postoperative treatment contributed to abatement of the disease, achievement of a satisfactory long-term result in all the patients.
It was found that clinical symptoms of the III degree ischemia were not reliable criteria of reversibility of ischemic disorders which requires additional information. The express-histochemical method of examination of bioptates of the ischemic extremity muscles is thought to be highly informative under such conditions as well as studying indices of the prekallikrein-kallikrein system of blood. The leading importance may be attached to the factor of time of severe ischemia when no additional information can be obtained. In patients with the III degree ischemia and its duration over 12 hours primary amputation of the extremity is indicated without an attempt being made to reestablish the blood flow.
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From generalization of experience in surgical and nonoperative treatment of 820 patients with acute thrombosis and embolism of the bifurcation of the aorta and the main arteries of the limbs the author claims that the following factors played a considerable role in improving the results of treatment and reducing the mortality: mastering and improving the techniques of operative intervention, elucidating the role of certain pathogenetic mechanisms of the origin of thrombosis and embolism depending on the character of the principal disease, preventing and treating the inclusion syndrome, and changing to active surgical tactics. The mortality fell to 13%. The possibility of predicting the outcome of the operation is shown. The prevention and treatment of diseases causing thrombosis and embolism are the further means of reducing the mortality.
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In a work, the retrospective analysis of the case records and materials of the postmortem studies in 42 patients with pathology of the major vessels, who died from pulmonary thromboembolism, is presented. A number of pathogenetic mechanisms of the development and ways for prophylaxis of this complication is considered.
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Restorative operations in patients with acute embologenic arterial obstruction of extremities with terms of the occlusion of the vessels longer than 7 days are thought to be not perspective due to pronounced morphological alterations developing in the vessel wall. Reconstructive-restorative operations are most effective under such conditions but the possibility of them is low because of a severity of the main embologenic disease and the character of the occlusive injury of the vessel. The performance of the timely little-traumatic operation of embolectomy with the help of balloon catheters is a reliable method for prophylactics of postembolic lesions of the vessels.
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