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1.
In surgical treatment of hepatic amebic abscesses by means of extensive dissection and drainage the postoperative lethality remains high. The literature data and the author's own observations on 30 patients, who underwent puncture of amebic abscess of the liver together with specific and antibacterial therapy, which resulted in their recovery, permit to consider paracentensis as a method of choice, when there are no complications, such as a purulent discharge into the adjoining organs and tissues, which calls for surgical intervention.  相似文献   

2.
The effectiveness of treatment of acute purulent pyelonephritis in 2.256 pregnant women from 1986 to 1992 was analysed. 95-97% of them had diffuse purulent (nondestructive) pyelonephritis which was cured by drug treatment. Pyodestructive manifestations (apostematosis, carbuncle, abscess of the kidney) of uni- (84.8%) and bilateral (15.2%) pyelonephritis were found in 85 (3.8%) of the patients. Signs of pyoseptic intoxication predominated in the clinical picture. Antibacterial and detoxification therapy was applied in the pre- and postoperative periods. The choice of the surgical tactics and operative method was based on the peculiarities of the clinical course, the revealed complications, and the anatomical changes in the kidney. Nephrostomy and antibacterial therapy are sufficient for curing the apostematic form. Patients with a bilateral affection were treated by operative stage-by-stage kidney drainage (nephrostomy). When economical operations were ineffective clinically (9.4%), secondary nephrectomy was indicated. Primary nephrectomy is an adequate surgical intervention in cases of a total destructive process in the kidney, grave septic manifestations, and a toxic response of the liver. The high proportion of nephrectomies (37.6%) is explained by the clinicoanatomical severity of focal-purulent pyelonephritis and its complications (sepsis) which hazard the life in pregnancy. Pliant surgical tactics in the treatment of severe forms of pyodestructive pyelonephritis ensured clinical cure of 96.5% of patients and uneventful delivery in 91.8% of cases. Death occurred from sepsis and bacteriotoxic shock which developed due to purulent pyelonephritis of pregnancy.  相似文献   

3.
Factors influencing result of surgical treatment of patients with festered postoperative wounds have been studied. Algorythm of determination of tactics for examination and treatment of this category of patients was established. The results obtained are based on the analysis of personal surgical treatment autcomes in 1526 patients with decompensated ischemia of extremities and 57 patients with clinical symptoms of deep suppuration. Division of purulent complications into primary and secondary is suggested. Effectiveness of various modes of prophylaxis was studied--systemic and indirect endolymphatic route for introduction antibiotics, intraoperative application of pellicle ESBA, usage of antimicrobial vascular prosthesis "SISAN". The best results were obtained in the two latter methods. Various methods of surgical treatment in infected vascular prosthesis are reviewed.  相似文献   

4.
An analysis of the 35-years experiences with treatment of 621 patients with the IV-degree frostbite of hands and feet is presented. The surgical strategy of treatment of frostbite has undergone considerable evolution for these years. In addition to classical surgical treatment, the surgeons began to widely use methods of dermo-plastic surgery which allowed not only to save the maximum possible length of the extremity segment stump, but also to reduce the frequency of purulent complications and reamputations and thus to shorten the duration of hospital treatment.  相似文献   

5.
122 patients with purulent complications of open diaphyseal fractures of long bones were treated. Comparative analysis of different surgical methods for treatment of pyogenic complications has shown that the most effective method is one of active sanation of the area of inflammation with the use of combined drainage ensured successful and steady decrease of pyogenic process (follow-up up to 4 years, 89.7% of patients). The drainage provides stable fixation of bones fragments by dipped fixators until consolidation of the fracture. It also promotes repain of residual diaphyseal defects without application of complicated plastic methods.  相似文献   

6.
The aspects of acute purulent mediastinitis (APM) have been reported on the basis of the analysis of 14 cases treated in the last 5 years. The most frequent causes of APM were the complications after surgery on esophagus ad trachea (10 cases). The other group included patients operated on by sternotomy. Three patients survived. In both of them diagnosis was established within 12 hours from the beginning of APM and early re-thoracotomy was performed. The rest of the patients died because of sepsis and multiply organ failure (MOF). The conclusion is that only early diagnosis as well as aggressive surgical treatment give a chance to save life in such a dangerous severe complication.  相似文献   

7.
BACKGROUND/AIMS: The aim of this study was to clarify the surgical indications for patients with chronic respiratory insufficiency. METHODOLOGY: Fourteen patients with chronic respiratory insufficiency who underwent abdominal surgical procedures, were retrospectively studied. The surgical indications were carefully determined based primarily on the performance status (PS) of each patient and cardiopulmonary function tests. A PS of equal to or less than 3, which meant the patient's status required bed rest > 50% of the time, and the need for assistance in performing normal activities were all factors considered for surgical indications. RESULTS: During the period studied, two patients were excluded from the surgical indications due to the fact that one was at a terminal stage of pulmonary disease and was completely bedridden (PS = 4), while the other demonstrated active pneumonia with a considerable amount of purulent sputa. Regarding the pulmonary function tests for patients who underwent surgery, the lowest limits of those examinations were as follows: 810 ml of vital capacity (VC), 23.8% of predicted VC, 610 ml of forced expiratory volume in one second (FEV1.0), 38.6% of predicted FEV1.0, 50.5 mmHg of PaO2 while inhaling 4 liters of oxygen and 73.8 mmHg of PaCO2. No surgery related mortality or hospital death within 30 days after operation was observed. Only two patients had cardiopulmonary complications (consisting of pulmonary edema with atrial fibrillation in one patient, and acute myocardial infarction in another patient). However, neither pneumonia, prolonged ventilatory support for more than 2 days, nor the need for a tracheostomy after surgery was observed. CONCLUSIONS: Gastroenterological surgery is thus considered to be indicated even for patients with chronic respiratory insufficiency, as long as the PS can be maintained (PS of equal to or less than 3) and no active pneumonia with a considerable amount of purulent sputa is present.  相似文献   

8.
The article is devoted to the local application of high energy plasma flows in the complex treatment of wounds and wound complications. The new technology of physical action upon the biological tissues allows performing dissections, evaporation and carrying on local hemostasis and sterilization of the wound surface simultaneously. The shortening of the first phase of the wound healing process and earlier development of the second phase are due to the "biophysical isolation" of the wound surface by the thermal necrosis layer from unfavorable effects of the external medium. The healing goes on by the type of productive inflammation. The use of plasma flows during surgical treatment of purulent wounds reduces pains during the postoperative period and considerably improves results of the treatment.  相似文献   

9.
The results of clinical and laboratory studies on the use of augmentin in severe purulent complications after neurosurgical operations are presented. The laboratory studies carried out with the use of an automatic system Cobas Bact (Roch) showed that the numbers of the augmentin resistant strains of Staphylococcus and Enterobacteriaceae among the pathogens were 47 and an average of 64.5%, respectively. Gram-negative bacteria resistant to augmentin were 1.5 to 2 times less frequent than those resistant to amoxycillin. Still, they were much more frequent than those resistant to cefotaxime and ceftriaxone. Clinical efficacy of augmentin was studied in treatment of 39 patients with various affections of the brain such as tumors, trauma, vascular malformations and inflammatory processes. The postoperative complications were represented by meningitis, pneumonia, sepsis and their associations. The use of augmentin in the severe intra- and extracranial complications was favourable in 82.1% of the cases.  相似文献   

10.
Under analysis are specific features of the clinical course and treatment of infectious complications of the abdominal wall wounds in 209 patients after destructive forms of appendicitis. The microflora of the purulent wound contained gram-negative bacteria in combination with anaerobic nonclostridial flora. The electrochemically activated solution of potassium chloride EHAR-anolit and the endoscopic method were used in complex treatment of the purulent wounds. The recommended method of treatment makes the period of healing the wounds shorter and improves the results of treatment.  相似文献   

11.
For the last 10 years 5531 patients were operated on in clinic for purulent inflammatory diseases of soft tissues and bones, 1609 of them being treated by the routine open method with the drainage of purulent cavity and gauze tampons, rubber tubes and wicks (turundae) and 3922 patients being operated on with the use of drainage bathing system (DBS) and primary sutures of the wound. The use of an active, closed surgical method of treatment, including thoroughly done intraoperative necrectomy, the application of DBS of through, opposite or T-shaped construction as well as postoperative dropping or flowing fractional bathing of residual cavity by antiseptic solutions reduced the terms of treatment 2-3 times, comparing to the standard (open) method with good functional and cosmetic results.  相似文献   

12.
Comparison evaluation of the methods of treatment was based on the analysis of the results of management of 347 patients with general purulent decompensated peritonitis with polyorganic insufficiency. The efficacy of closed drainage in 98 patients, continuous flow irrigation (dialysis) in 126, stage programmed irrigation and inspection of the abdominal cavity in 99, and open drainage in 24 patients was compared. The causes of peritonitis were: complications after acute surgical diseases (in 156 cases), in planned operations (59), and in obstetrical and gynecological diseases (132). Most of the patients were brought to the clinic from other hospitals because of unsuccessful treatment of peritonitis and absence of means for performing hemodialysis and management of polyorganic insufficiency. The incidence of the last-named reached 71.0 to 91.0% in the different groups of patients. In monotypic complex treatment, stage programmed irrigation was marked by a much lesser number of abscesses and other complications and a lower mortality (20.2%) as compared to flow irrigation (30.0%, closed drainage (27.5%), and open (laparostomy) treatment (37.5%). Despite the very serious contingent of patients, total mortality (27.0%) in the application of the indicated methods was quite low.  相似文献   

13.
For the specific and unspecific treatment of purulent meningitis, penicillin, ampicillin and chloramphenicol are usually sufficient. Only resistant pathogens (Klebsiella, Pseudomonas among others) and meningitis in infants require other treatment. Cephalosporins and aminoglycosides only come into consideration for the treatment of very rare exceptional cases. The still relatively poor prognosis of purulent meningitis is largely independent of the efficacy of the treatment. Delay in beginning therapy, lack of intensive care, primary diseases and complications are principally responsible for this. Medicamentous prophylaxis is only possible for meningococcal meningitis. The distribution of antibiotics in the CSF is irregular. Also the antibacterial activity in the CSF is different from culture media.  相似文献   

14.
A case of rhinosporidiosis occurring in an immigrant from India is presented along with a review of the disease. Rhinosporidiosis most commonly involves the nose, and presents as a friable papillomatous mass causing nasal obstruction, epistaxis, purulent discharge, and headache may also occur. The treatment of choice is surgical excision with cauterization of the base.  相似文献   

15.
For treatment of two consecutively opened into abdominal cavity perforating fistulas of small bowel in conditions of purulent peritonitis the author successfully used funnel-shaped obturators by Kolchenogov. In the same patients in later adhesive intestinal obstruction, which could not be eliminated by common surgical mode, continuous introduction of semifluid food and intestinal chyme collected from enterostoma (located above the obstruction) were carried out through enterostoma located above the obstruction. After resorption of inflammatory infiltrate bowel continuity was restored. Based on favourable results of treatment for perforation fistulas opening into free abdominal cavity, the author more than once in conditions of purulent peritonitis successfully applied sutureless suspending enterostomies on the catheter of Petzer, which principally is an analogue of the obturator by Kolchenogov, using the same method as in perforation fistulas. Inflamed bowel wall thus is well accreted with abdominal wall, and after withdrawal of catheter by Petzer the developed tubular bowel fistula is rapidly healing spontaneously.  相似文献   

16.
The treatment of orbital complications of nasosinusal processes has seen numerous modifications. Traditionally, cases with purulent collections were treated by external drainage. Currently, the introduction of new optical systems allows such complications to be approached from within the nasal cavity. We report a case of a 3-year-old girl with a subperiosteal orbital abscess secondary to ethmoiditis, which was cured by minimally aggressive endoscopic management and medical treatment.  相似文献   

17.
BACKGROUND AND OBJECTIVE: The hypopharyngeal (Zenker's) diverticulum is a herniation of mucosa and submucosa on the posterior wall of the pharynx. The only treatment is surgical. STUDY DESIGN/MATERIAL AND METHODS: Between 1976 and 1993, 109 patients with a hypopharyngeal diverticulum were operated on at the Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, either transcutaneously combined with a cricopharyngeal myotomy (n = 76), or microendoscopically (n = 37) using the CO2 laser. Results and complications of both techniques were evaluated and compared. RESULTS: With both surgical procedures, > 90% of the patients were treated successfully. The rate of postoperative complications was generally low. In comparison to the microendoscopic procedure, serious complications were found to be more frequent in patients treated with the conventional transcutaneous diverticulectomy. CONCLUSION: The laser surgical tissue bridge dissection is a less invasive, quick, relatively safe, and effective procedure requiring only short hospitalisation. Therefore, the laser surgical tissue bridge dissection can be considered as the method of choice for the treatment of the hypopharyngeal diverticulum.  相似文献   

18.
The experience in treatment of 278 patients with extensive traumatic injuries of the shin complicated by purulent infection is represented. Multistage treatment typical for such category of patients in which reconstructive-restorative stage is performed late after elimination of inflammatory process is not optimal. Owing to the complex of treatment measures based on the principles of active surgical treatment of festering wounds primary operations were a success in 24.6% of patients. In 75.4% of patients early dermoplastic and osteoplastic operations were carried out to 1 month after primary surgical treatment. Good and favourable results obtained in 98.6% of patients demonstrate effectiveness of the above policy of treatment.  相似文献   

19.
P Klein  F Immler  P Sterk  F Schubert 《Canadian Metallurgical Quarterly》1997,122(7):528-32; discussion 533-4
The results of colonic resections were investigated in 356 patients in a retrospective analysis. Special attention was directed to the effectiveness of a transrectal tube, leading to decompression of the anastomosis for the first five days. Under elective conditions, the overall complication-rate was 12.7%. In emergency cases, these complications were 51.5% (one third of these cases had a decompression-tube). The clinical relevant leakage-rate under elective conditions ranged to 1.7%. Postoperative mortality related to surgical complications turned out to be 1.5% under elective conditions. The emergency operations had a high mortality which ranged to approximately 15.2%. No patient with leakage of a colorectal anastomosis died when the transrectal decompression-tube was applied. Such a safety in anastomotic healing of colon and rectum anastomoses can otherwise only be achieved by using the protection of a diverting colostomy or ileostomy. The use of the transrectal decompression-tube also avoids stomal complications and the second operation. There is no indication for the decompression-tube in emergency operations with purulent or faecal peritonitis. In these cases a fundamentally different treatment is mandatory.  相似文献   

20.
An unusual case of cervicofacial actinomycosis presenting as acute upper airway obstruction and demanding urgent tracheostomy is reported. Diagnosis was established by microscopic examination of the pus and culture of Actinomyces israelii. Repeated surgical drainage of the purulent foci and prolonged treatment with penicillin obtained resolution of the disease. Clinicians dealing with acute head and neck swellings should always consider actinomycosis as a possible diagnosis.  相似文献   

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