Suchergebnisse

Objective: to determine the efficiency of postoperative 3-in-1 parenteral nutrition with Oliclinomel N8-800 in correcting protein-energy malnutrition in patients undergoing extended surgical interventions into the abdominal organs. Subjects and methods. Forty-one patients with gastric and pancreatic neoplasms treated in the intensive care unit, N. N. Burdenko Main Military Clinical Hospital, in January to October 2013 were examined. All the patients were males. The mean age was 63.5±11.87 years. The study design: a prospective controlled randomized trial. Group 1 (a comparison group) entered 21 patients. Conventional parenteral nutrition regimens with Oliclinomel N7-1000E 2000 ml were used on postoperative day 2. The intestine was lavaged with a glucose-electrolyte solution within the first postoperative hours. The glucose-electrolyte solution and standard enteral formula were intraintestinally administered as the absorptive and digestive functions of the small bowel recovered. On postoperative days 7 and 8, the parenteral nutrition was stopped and completely switched to enteral feeding. The dissimilarity of Group 2 (a study group) (n=20) was that it received parenteral nutrition with Oliclinomel N8-800 2000 ml.Results. Complete parenteral nutrition, then mixed parenteral-enteral nutrition stabilized protein metabolic parameters in the patients of both groups in a unilateral fashion, but more promptly in Group 2 than in Group 1. The nutritional support program in Group 2 caused significantly less reduction in the body' cellular weight than in Group 2 in the first and entire period of the follow-up, which appears to be related to the administration of large amounts of nitrogen.Conclusion. The results suggest that the use of Oliclinomel N8-800 for parenteral nutrition adequately corrects postaggressive nitrogen deficiency, promotes the normalization of protein and carbohydrate metabolism and a positive nitrogen balance and the resolution of hypermetabolism/hypercatabolism after extended abdominal surgery. ; Цель исследования — определить эффективность послеоперационного парентерального питания с использованием системы «3 в 1» — Оликлиномель N8-800 в коррекции белково-энергетической недостаточности у больных с обширными хирургическими вмешательствами на органах брюшной полости. Материалы и методы. Исследован 41 больной с новообразованиями желудка и поджелудочной железы, находившихся отделении реанимации Главного военного клинического госпиталя им. Н. Н. Бурденко с января по октябрь 2013 года. Все больные — мужчины. Средний возраст составил 63,5±11,87 лет. Дизайн исследования: проспективное, контролируемое, рандомизированное исследование. В 1-ю группу (группу сравнения) вошел 21 пациент. Начиная со 2-х суток послеоперационного периода парентеральное питание осуществляли по общепринятым схемам с использованием Оликлиномель N-1000E» 2000 мл. С первых часов послеоперационного периода проводили кишечный лаваж глюкозо-электролитным раствором. По мере восстановления всасывательной и переваривающей функции тонкой кишки переходили на внутрикишечное введение глюкозо-электролитного раствора и стандартной смеси энтерального питания. На 7—8-е сутки после оперативного вмешательства парентеральное питание прекращали и полностью переходили на энтеральное. Отличием 2-й группы (основной — 20 больных), было проведение парентерального питания Оликлиномель N8-800 в объеме 2000 мл. Результаты. На фоне полного парентерального питания, а затем смешанного парентерально-энтерального питания стабилизация показателей белкового обмена у больных обеих групп была однонаправленна, однако во 2-й группе происходила в более короткие сроки, чем у больных 1-й группы. На фоне программы нутритивной поддержки во 2-й группе снижение клеточной массы тела за первый и весь период наблюдения достоверно меньше, чем во второй (р<0,05), что, по-видимому, связано с введением большего количества азота. Заключение. Результаты свидетельствуют о том, что применение препарата Оликлиномель N8-800 для парентерального питания адекватно корригирует постагрессивный дефицит азота, способствует нормализации белкового и углеводного обмена, положительного азотистого баланса, разрешению синдрома гиперметаболизма-гиперкатаболизма после расширенных абдоминальных операций.

With an increase in the use of laparoscopic techniques for the treatment of abdominal wall hernias, this comprehensive book provides a detailed description of the most up-to-date techniques used in the laparoscopic repair of inguinal and ventral incisional hernias. Advances in Laparoscopy of the Abdominal Wall Hernia takes the reader step-by-step through two laparoscopic techniques used in inguinal hernia correction: Extraperitoneal (TEP) and Transabdominal (TAPP), and guides the reader through the fundamentals of ventral hernia repair. The authors aim to show methods of dealing with rarer hernias and those of atypical location. This book will also inform the reader of the various kinds of meshes used and provides knowledge on how to fix them, as well as the advantages, disadvantages and indications of this type of prosthesis. Written by experts in the field, Advances in Laparoscopy of the Abdominal Wall Hernia is a valuable reference tool to surgeons and medical practitioners working in this field.

The burden of surgical conditions and diseases is increasing in low-income and middle-income countries, but the capacity to meet the demands they present is not following pace. Ongoing initiatives, such as brief visits by surgeons from advantaged countries, sending surgical residents to spend time in a developing country as part of their training, or ships weighing anchor offshore and offering some limited on-shore or on-board services, have not proven successful. More comprehensive and sustainable solutions include the development of local training programs, better retention of trainees with adequate incentives particularly in rural areas, and engaging government and professional associations, as well as academic institutions, to develop and implement policies to address local training needs.

In elderly and senile patients, extracardiac surgery frequently leads to cardiovascular complications. For their prevention, it is necessary to early detect patients with a potentially poor postoperative period. Routine preoperative examination is of limited prognostic value and instrumental techniques are inaccessible. Objective: to reveal the predictors of cardiac complications of abdominal and small pelvic surgery in elderly and senile patients. Subjects and methods. The study covered 82 patients (63 men and 19 women) aged over 60 years who had undergone at least one-hour open operations on the abdomen and small pelvis at the A. A. Vishnevsky Central Military Hospital Three in 2008—2011. In addition to routine procedures, the preoperative examination comprised the calculation of the Lee, Goldman, and Detsky scores and, in 35 patients, determination of NT-proBNP concentrations. Results. The logistic regression method applying the values routinely measured prior to surgery was used to make a cardiac complication-predicting model that included the Detsky index and blood glucose levels. Its dividing capacity proved to be satisfactory – AUC 0.75. Inclusion of echocardiographic data in the model failed to substantially improve its prognostic capacity. The cardiomarker NT-proBNP was the most effective predictor of postoperative complications. As its value became higher, there was an increase in the frequency of cardiac complications (p<0.001); AUC was 0.96. Conclusion. NT-proBNP is a highly effective predictor of postoperative complications in elderly and senile patients and may be included into preoperative screening. Key words: elderly and senile age, abdominal surgery, heart failure, surgery risk assessment, natriuretic peptides, Lee index, Goldman index, Detsky index, NT-proBNP. ; У больных пожилого и старческого возраста внесердечные операции часто приводят к осложнениям со стороны сердечно-сосудистой системы. Для их предупреждения необходимо заблаговременно выявлять больных с потенциально неблагополучным течением послеоперационного периода. Рутинное предоперационное обследование имеет ограниченную прогностическую ценность, а инструментальные методы малодоступны. Цель исследования — выявить предикторы кардиальных осложнений операций на органах брюшной полости и малого таза у больных пожилого и старческого возраста. Материал и методы. В исследование были включены 82 больных (63 мужчины, 19 женщин) старше 60 лет, которым в 2008—2011 гг. в ЦВКГ №3 им. А. А. Вишневского были выполнены открытые операции на органах брюшной полости и малого таза продолжительностью не менее 1 часа. Предоперационное обследование, помимо рутинных методик, включало расчет оценки по шкалам Lee, Goldman, Detsky и у 35-и больных — определение концентрации NT-proBNP. Результаты. Методом логистической регрессии из показателей, рутинно измеряемых перед операцией, была составлена модель для прогнозирования кардиальных осложнений, включающая индекс Detsky и уровень глюкозы крови. Её разграничительная способность оказалась удовлетворительной — AUC 0,75. Включение в модель данных эхокардиографии не позволило существенно улучшить ее прогностическую способность. Наиболее эффективным предиктором послеоперационных осложнений оказался кардиомаркер NT-proBNP. По мере увеличения его значения отмечалось повышение частоты кардиальных осложений (р<0,001), AUC составила 0,96. Заключение. NT-proBNP является высокоэффективным предиктором послеоперационных осложнений у больных пожилого и старческого возраста и может быть включен в скрининговое предоперационное обследование. Ключевые слова: пожилой и старческий возраст, абдоминальные операции, сердечная недостаточность, оценка риска операций, натрий-уретические пептиды, индекс Lee, индекс Goldman, индекс Detsky, NT-proBNP.

Considering the growing organ demand worldwide, it is crucial to optimize organ retrieval and training of surgeons to reduce the risk of injury during the procedure and increase the quality of organs to be transplanted. In the Netherlands, a national complete trajectory from training of surgeons in procurement surgery to the quality assessment of the procured organs was implemented in 2010. This mandatory trajectory comprises training and certification modules: E-learning, training on the job, and a practical session. Thanks to the ACCORD (Achieving Comprehensive Coordination in Organ Donation) Joint Action coordinated by Spain and co-funded under the European Commission Health Programme, 3 twinning activities (led by France) were set to exchange best practices between countries. The Dutch trajectory is being adapted and implemented in Hungary as one of these twinning activities. The E-leaming platform was modified, tested by a panel of Hungarian and UK surgeons, and was awarded in July 2013 by the European Accreditation Council for Continuing Medical Education of the European Union of Medical Specialists. As a pilot phase for future national training, 6 Hungarian surgeons from Semmelweis University are being trained; E-learning platform was fulfilled, and practical sessions, training-on-the-job activities, and evaluations of technical skills are ongoing. The first national practical session was recently organized in Budapest, and the new series of nationwide selected candidates completed the E-learning platform before the practical. There is great potential for sharing best practices and for direct transfer of expertise at the European level, and especially to export this standardized training in organ retrieval to other European countries and even broader. The final goal was to not only provide a national training to all countries lacking such a program but also to improve the quality and safety criteria of organs to be transplanted.

Reflecting on the recent creation of the surgical technique of 'natural caesarean', this paper investigates how caesarean section, a major abdominal surgery, can be associated with 'natural childbirth' To understand the paradoxical creation of this concept, I look back at the history of obstetrics and at the evolution of the nature/culture dichotomy in European modern thought. The multiple meanings of these two concepts and the epistemological and social premises underpinning the formation of modern obstetrics are examined to unravel the complexity of current medical practices applied to women's bodies as well as women's attitudes. In light of these historical elements, natural caesarean is understood as a notion born from cultural and professional negotiations and fraught with contradictory meanings originating from different medical and cultural discursive traditions.

Abstract Background Surgical site infection is a major contributor to increased mortality and health care costs globally which can be reduced by appropriate antibiotic prophylactic use. In Palestine, there is no published data about preoperative antibiotic use. This study aims to find the pattern of antimicrobial prophylaxis use by evaluating time of the first dose, antibiotic selection and duration after surgery in three governmental hospitals in North West Bank/ Palestine during 2011. Methods After approval of Institutional Review Board, a prospective cohort study included a total of 400 abdominal, orthopedic, and gynecological operations which were performed during study period. Trained clinical pharmacists observed selected 301 operations and followed the patient's files for the three intended study parameters. Compliance of prophylactic antibiotic administration was evaluated according to published guidelines of the American Society for Hospital Pharmacist. Data were analyzed using SPSS version 16 applying descriptive methods. Relationship between guideline compliance and selected operation factors such as type of surgery, patient care unit, and hospital shift, in addition to provider's age, gender, experience, and specialization were examined applying chi square test. The statistically significant factors with p < 0.01 were further analyzed using logistic regression model. Results Overall compliance for the studied parameters was very low (2%); only 59.8% received their first dose in appropriate time, 18.5% had appropriate antibiotic selection, and 31.8% of patients received antibiotic in appropriate duration. The OBGYN department had much better compliance regarding timing and duration of antibiotic use ( P < 0.001), however the proper antibiotic selection was best adhered to for the abdominal surgeries (OR = 3.64, P = 0.002). Male providers were statistically significantly much less adherent to the timing of antibiotic dose (OR = 0.28, p < 0.001), but better adherent in antibiotic selection (OR = 0.191, p = 0.028). Anesthetic technicians showed higher compliance than nurses in timing and duration of antibiotic use. Conclusions Lack of guidelines explains the low adherence to appropriate surgical antibiotic prophylaxis in Palestine, with high rate of broad spectrum antibiotic use, long duration and inappropriate time of first dose .We recommend adopting guidelines for prophylaxis and training all health care providers accordingly.

We report the case of a four years-old female proceeding from rural nor-oriental Colombia, without previous medical history, who was admitted to our institution with an abdominal mass that was noted one month previous to the consult, associated to ictericia, weight loss and hiporexia. A bilateral Wilms tumor was documented on diagnostic images. The patient received preoperative chemotherapy and was treated with bilateral partial nephrectomy. ; En este artículo se reporta el caso de una niña de cuatro años de edad, sin antecedentes perinatales o patológicos de importancia, procedente de área rural, en la región nororiental de Colombia, quien ingresó al Hospital Militar Central de Bogotá, Colombia, remitida por un cuadro de cinco meses de evolución que inició con tinte ictérico, pérdida de peso e hiporexia. Posteriormente, distensión abdominal y masa palpable abdominal de un mes de evolución. Por imágenes diagnósticas se documenta tumor de Wilms bilateral, el cual se trata con quimioterapia preoperatoria y nefrectomía parcial bilateral.

Surgery is the gold standard treatment of colorectal liver metastases. Patients management had a dramatic evolution during the past years: more accurate diagnostic tools and more effective chemotherapy regimens have been introduced and surgical indications have been widely broadened. A multidisciplinary treatment is now mandatory, involving oncologists, radiologists an gastroenterologists. However, many topics are still debated. In the present book all aspects of surgical treatment of colorectal liver metastases are analyzed based on a systematic, updated analysis of the literature. Aim of thi.

Background: While robotic surgery for gynecologic indications received U.S. government approval in 2005, and has been rapidly and widely adopted, it is currently unclear how often this approach to hysterectomy is utilized. Objective: The aim of this research was to assess length of stay (LOS), mortality, indications, and current use of robotic hysterectomy, compared to other types of hysterectomy. Methods: A retrospective study of hysterectomies performed in New York State (NYS) in 2011 was performed. Data, including indication for surgery, age, procedure, LOS, and discharge status were obtained from the NYS Department of Health Statewide Planning and Research Cooperative System (SPARCS). Outcome Measures: LOS and mortality rate, were calculated according to institution, procedure, and indication for surgery. Results: For 22073 hysterectomies performed in NYS, the mean LOS was 2.9 days, and there were 29 (0.13%) deaths. The mean LOS for abdominal (12774 cases, 3.9 days) hysterectomies was longer than for laparoscopic (3927 cases, 1.6 days), robotic (2814 cases, 1.6 days), or vaginal (2558 cases, 1.7 days) hysterectomies (p<0.05). The adjusted mortality rates for abdominal (0.20%), laparoscopic (0.03%), robotic (0.07%), and vaginal (0.04%) hysterectomies were not significantly different. Overall, robotic surgery was performed in 29% of hospitals, by 11% of physicians and in 13% of cases. A robotic approach was utilized in 35% of patients with uterine cancer, 13% with endometriosis, 11% with excessive bleeding, 8% with leiomyomata, and 8% with pelvic relaxation. Conclusions: Despite the advantages in reduced LOS for robotic and other minimally invasive types of hysterectomies, the abdominal route is still predominant in most institutions. (J GYNECOL SURG XX:1)

This book will help the reader to recognize, diagnose, and efficiently treat most of the acute abdominal disorders that may be encountered in the pregnant patient, whether associated with or incidental to the pregnancy. A wide range of conditions are addressed, including some which are very rare as well as those more frequently seen, such as acute appendicitis and acute cholecystitis. The principles underlying diagnosis and therapy are clearly explained. Particular features in the clinical presentation of pregnant patients are highlighted, and specific diagnostic and therapeutic algorithms and protocols, described. Attention is drawn to the diagnostic difficulties that may arise from atypical presentations in these patients and to restrictions on the use of certain diagnostic imaging studies. The text is complemented by more than 200 figures relevant to clinical practice. Acute Abdomen During Pregnancy is designed to meet the needs of both the gynecologist and the general or abdominal surgeon, who together form the multidisciplinary team mandatory for effective treatment that will safeguard mother and baby.

Abstract Introduction Gossypiboma (foreign body granuloma) in the tooth socket as a complication of tooth removal is rare. Several cases of gossypiboma have been reported after orthopedic, abdominal, otorhinolaryngology, or plastic surgery, but there has been only one reported case after oral surgery. Case presentation A 42-year-old Caucasian German-speaking Swiss woman applied to our clinic for removal of her right mandibular first molar. Her right mandibular third molar had been removed seven years ago. Post-operatively, she complained of pain and foreign body sensation for six months in the area of the removed tooth. A panoramic radiograph of our patient showed a defined and oval radiolucent area in the socket of the right mandibular third molar evoking a residual cyst. An operation was planned to remove the cyst-like lesion. During surgery, a foreign body composed of gauze was found in the right mandibular third molar region. The histological findings were compatible with a foreign body reaction around gauze. Conclusion Retained gauze must be considered if patients complain of pain and foreign body sensation after tooth removal. The use of gauze with radio-opaque markers and extensive irrigation of the socket with saline to remove gauze fragments can avoid this mishap.

Anomalies of the inferior vena cava (IVC) are uncommon and most of them remain asymptomatic. Though rare, anomalies of IVC can lead to severe hemorrhagic complications especially during aortoiliac surgery. Prior knowledge of these variations facilitates proper interpretation of radiological images and safe performance of interventional procedures and surgeries. During routine anatomical dissection of abdomen in a female cadaver we observed the presence of right sided duplication of IVC. Both IVCs were present on the right side of abdominal aorta, one ventral and the other more dorsal in position and named ventral right IVC and dorsal right IVC. The ventrally and medially placed IVC, which appeared to be the main IVC was formed by the union of two common iliac veins in front of the right common iliac artery (Preaortic iliac confluence-"Marsupial Cava"). The right external iliac vein continued as the more dorsally and laterally placed dorsal right IVC. The right internal iliac vein after receiving a transverse anastomotic vein from the external iliac continued as the right common iliac vein. This transverse anastomosis was present behind the right common iliac artery. The narrower dorsal right IVC joined the wider ventral right IVC just below the level of renal veins to form a single IVC. The abdominal aorta presented a convexity to the left.