Strategies and techniques in the correction of the enteral insufficiency in peritonitis and acute ileus

The correction principles of enteral insufficiency, playing essential role in the infectional-toxical shock and polyorganic insufficiency occurrence were elaborated basing on the analyses of the surgical treatment of 257 patients with peritonitis and an acute ileus. Application of the proposed tactics of surgical aid for patients, including the original methods of the gut intubation, had permitted to lower the lethality from 30.2 to 18.5%, to improve the treatment results.     

The immunity index changes in patients with acute adhesional ileus and possibilities for its correction

In patients with an acute adhesional small intestinal ileus (AASII) the essential change of the organism immunoreactivity was noted, especially of the immunity cell link, the degree of which had depended on duration of intestinal obstruction, the presence of peritonitis and the disease course severity. The autoimmune reactions studying may be used as the prognosis marker for the recurrent adhesions forming occurrence. The immune reactions of postoperative period are correlating with presence of complications.     

Enteral correction in gastroduodenal hemorrhage of peptic ulcer etiology]

Among 115 patients with gastroduodenal hemorrhage 60 received nonoperative treatment, 30 of them underwent enteral correction with a monomer electrolyte solution. Emergency operation was carried out on 55 patients, 35 of them were subjected to enteral correction in the postoperative period. Enteral administration of the monomer electrolyte solution in the early posthemorrhagic and postoperative periods promoted filling up of the blood circulation volume and its components and stabilization of the values of central hemodynamics. It was established on grounds of the clinical data, studies of the volemic indices and central hemodynamics that enteral correction does not yield to the traditional intravenous infusion-transfusion therapy in efficacy.     

Enteral therapy of the syndrome of intestinal insufficiency in patients with peritonitis

Sixty five patients with peritonitis were examined and divided into two groups. The operative intervention in all the patients included transnasal intubation of the small intestine. The basic enteral therapy used in the first group of patients was made with the glucose-saline solution and transition to a balanced polysubstrate mixture "nutrient standard" with the increasing concentration. For the patients of the second group a special program was developed for enteral therapy in which glutamine and pectine were included in the glucose-saline solution as well as nutrient mixtures containing middle chain triglycerides. Active decompression of the small intestine followed by the enteral administration of the nutrient mixtures facilitated quicker correction of the intestinal insufficiency in patients with severe forms of peritonitis.     

Surgical correction of venous insufficiency following arteriovenous fistula for hemodialysis]

The percentage of venous insufficiency in the original Cimino-Brescia shunt is very low. In cases of venous insufficiency, early diagnosis is important; operative correction is then easily performed. Ligature of the distal venous limb next to the anastomosis is the treatment of choice, providing the proximal limb is still open. If the proximal limb is obstructed, the distal venous part is dissected and anastomosed to a more proximal vein. The result is an immediately functioning shunt for dialysis.     

Hemocoagulation disorder in patients with destructive pancreatitis: the role in pathogenesis and ways of its correction]

The dynamics of hemocoagulation system changes in patients with different clinical forms of destructive pancreatitis (DP) was evaluated. The necessity of use of directed hemocoagulation therapy and hemocorrection, in particular, the use of low-molecular weight heparins, in complex program of treatment of DP is proved.     

The structure of endogenous intoxication in acute intestinal obstruction and the methods for its correction]

The structure of endogenic intoxication by products of the intermediate metabolism was studied in 32 patients with intestinal obstruction. The leading components of the endogenic intoxication are: acetone, propionic aldehyde and ethanol. In cases of a complicated course of the intestinal obstruction the operative treatment by traditional therapy in the postoperative period proved to be insufficient. Sessions of the intravascular laser irradiation of blood reducing the concentration of acetone and propionic aldehyde were performed in 19 patients without any changes in the concentration of ethanol.     

Malignant neuroleptic syndrome associated with myocardial infarction, acute renal insufficiency and rhabdomyolysis]

We present a case of malignant neuroleptic syndrome in a 55 years old male diagnosed 3 years ago of alcoholic paranoid psychosis who was chronically treated with haloperidol, clothiapine, and phenobarbital. Twenty one days after neuroleptic drug withdrawal the patient was admitted to the recovery room because of hyperthermia (40.2 degrees C), left basal pneumonia, acute respiratory insufficiency, extrapyramidal rigidity, mutism, dysarthria, deep coma, hypotension, and tachycardia. Two days after he presented massive rhabdomyolysis, atrial flutter with hemodynamic deterioration which reverted to sinus rhythm and acute anterolateral and inferior myocardial infarction documented by enzyme rise and electrocardiographic alterations. Rhabdomyolysis and myocardial infarction were the precipitating factors of the renal insufficiency. A malignant neuroleptic syndrome was suspected and intravenous treatment with dantrolene sodium 1.5 mg/kg every 24 hours was initiated. Bromocriptine was not administered. The patient died 14 days after in the course of a sepsis and cardiogenic shock.     

Enterolith ileus complicating afferent loop syndrome simulating acute pancreatitis

Afferent loop syndrome after Billroth II gastrectomy is usually caused by those events that impair the evacuation of the afferent duodenal loop. The formation of an enterolith in an afferent loop is a rare but dangerous event. We present a unique report of a patient in whom a huge enterolith developed in the afferent loop of a Billroth II anastomosis, which led to intestinal occlusion. This migration occurred after a laparoscopic procedure, so we hypothesized that this procedure could be the cause of enterolith migration.     

Analysis of the lethality in cholecystitis and the ways for its decrease]

An analysis of lethality in cholecystitis has been carried out. The main complications, which had resulted in the death of 238 patients, were analysed. Purulent complications served as the most common cause of fatal outcome. The authors came to the conclusion on the necessity to broaden indication for an early surgical intervention in acute cholecystitis in elderly patients.     

Application of sorbilact in complex correction of enteral insufficiency syndrome in surgical patients

The most important teoretical aspects of the enteral insufficiency syndrome formation in an acute abdominal surgical diseases were suggested. Basing on the treatment results analysis of 19 patients with different abdominal surgical diseases, using hypertonic sorbitol solution, the authors confirm high therapeutic efficacy of the preparation, administration of which have had promoted the intestinal motor function restoration and optimization, as well as adapting action of the preparation in enteral probe nutrition conduction in patients during ealy postoperative period.     

Risk factors in acute ileus

Results of treatment of 335 patients with an acute ileus (AI) was analyzed. Application of the SAPS system (Simplified Acute Physiology Score) had permitted to estimate the severity of the patient's state with AI and of degree of the homeostasis disorder in any moment of therapeutic-diagnosis process. Three stages of AI are delineated: compensated (in 41.8% of patients), subcompensated (in 38.8%), decompensated (in 19.4%), which demand different approach to diagnosis and treatment.     

Anterior tibial syndrome resulting from acute arterial insufficiency

From the experience with 11 patients the authors show that in acute patency disorders of the iliac, femoral and popliteal arteries some symptoms of the injury mainly to the muscles and sometimes to the nerves of the anterior bed of the leg--"anterior tibial syndrome"--are likely to occur. An urgent reconstructive surgical intervention upon the artery, anterior fasciotomy is of a crucial importance in the treatment of this condition. Depending on the cause of the disease embol- and thrombectomy, circular suture or autovenous plasty of the artery were performed. 6 patients recovered, 3 patients developed a considerable functional disorder of the foot and toes extensors, in 2 patients the process resulted in the development of gangrene of the extremity.     

急性胰腺炎的肠内营养治疗

急性胰腺炎 ,尤其是重症急性胰腺炎 ,营养需求高 ,若病程延长 ,很容易出现营养不良。全胃肠外营养 (TPN)曾是急性胰腺炎营养支持的主要手段 ,但费用昂贵、并发症多 ;空肠内的肠内营养 (EN)能获得“胰腺休息” ,并能减轻急性胰腺炎的全身炎症反应综合征 (SIRS)和多器官衰竭 (MOF)。笔者就EN对AP的治疗意义作一综述     

Bouveret syndrome and gallstone ileus

Intestinal obstruction from gallstones is a rare complication of gallstone disease. These ectopic gallstones can cause obstruction anywhere from the duodenum to the colon and are accompanied by a cholecystoduodenal/enteric/colic fistula. We report an 81-year-old male who presented with gallstone obstruction of the duodenum who underwent attempted endoscopic fragmentation and extraction that eventually led to small bowel obstruction from an impacted fragment of the stone. He underwent successful enterolithotomy and has been asymptomatic from the cholecystoduodenal fistula. Surgery is the gold standard for the treatment of this condition but the extent of the operation remains a matter of debate.