Treatment of acute esophago-gastric hemorrhage in children with extrahepatic occlusion of portal blood flow

An analysis of results of the conservative and operative tactics in the treatment of 89 esophago-gastric bleedings in children with extrahepatic blockade of the portal blood circulation has shown high effectiveness of the conservative therapy (78.7% of the observations). The optimal operative treatment of the bleedings is thought to be gastrotomy with suturing the veins of the submucosa plexus of the stomach and esophagus. The total positive result of using the conservative and operative tactics was noted in 93.3% of observations.     

Treatment of acute intracerebral hemorrhage

Opinion statement  Intracerebral hemorrhage (ICH) is a neurologic emergency associated with regular, early, ongoing hemorrhage, progressive clinical deterioration, severe deficits, and high mortality. Hence, it requires prompt recognition, diagnosis, and management. Initial monitoring and management of patients with ICH should occur in an intensive care unit. The overall approach to treatment mandates using therapies to stop or slow the initial bleeding acutely, removing blood from the parenchyma or ventricles (in eligible patients) to prevent secondary brain injury, addressing raised intracranial pressure, and providing good, comprehensive supportive care, including management of airways, oxygenation, blood pressure, circulation, glucose level, fever, and nutrition, as well as deep venous thrombosis prophylaxis.     

Treatment of the esophago-gastric junction adenocarcinoma

The aim of the work paper is to present the treatment methods of the esophago-gastric junction adenocarcinoma, (AC) based on our experience and literature data. The later reveal many novelties about AC prophylaxis through Barrett's esophagus (BE) treatment, using proton pomp inhibitors or antireflux surgical procedures, the progress of the endoluminal ablative methods for intestinal metaplasia, as well as a new surgical approach for advances tumors based on Siewert classification. Surgical procedure selection at patients with resectable tumours should be based on the tendency of esophago-gastric junction adenocarcinomas to extend on longitudinal axis, at the submucosa level and the possibility of abdomino-mediastinal lymph nodes metastasis. In located disease, tumoral resection R0 with abdominal and mediastinal lymph nodes dissection represents the optimal therapy, because it confers the best chance of cure. Preoperative radio-chemotherapy appears to increase the chance for a curative resection at the patients with advanced tumors. The main therapeutical purpose in non-responding patients is the palliation of dysphagia and malnutrition.     

Surgical tactics in acute gastrointestinal hemorrhage]

The results of treatment of 595 patients with acute gastro-intestinal bleeding are presented. Ulcer disease is the most frequent cause of bleeding. In its diagnosis, the use of gastroduodeno-fibroscopy is effective. In ineffective conservative therapy, the operative intervention is indicated.     

Treatment of acute mediastinitis]

The observations concern 41 patients with acute mediastinitis. 35 of them were operated upon; 28 of these patients recovered, and 7 (20%) died. 3 of 6 patients subjected to the conservative treatment died. The authors' experience proves that the possibility of improving the outcomes in acute mediastinitis correlates directly with an early diagnosis of this severe disease and an early surgical intervention.     

Treatment of acute pancreatitis]

The results of the treatment of 274 patients with acute pancreatitis are analysed. 221 patients were subjected to conservative treatment (mortality--5.4%) and 53 patients were operated upon (mortality--30%). The best results were obtained in conservative treatment with the use of fluorofur and fluorouracil (62 patients), which had no fatal outcomes.     

Therapeutic modality for esophago-gastric varices analyzed by endoscopic ultrasonography]

For 64 cases with portal hypertensive disease, we investigated the intramural and extramural structure of the stomach and esophagus by endoscopic ultrasonography (EUS). Variously developed intra- or extra-mural vascular structures had a relationship to the endoscopic variceal form, and the communicating (inflow) vessels to varices were found in 35 of 50 primary treated cases (70%). We classified the esophago-gastric varices into three types according to the vascular structure, such as the esophageal type, the esophago-gastric type and the solitary gastric type. From the analyses of these collateral structures, we should select a treatment as follows. In the esophageal type which has a few inflow vessels, it is easy to eliminate the varices by obturating the inflow vessels by endoscopic injection sclerotherapy (EIS). In the esophago-gastric type, which has many enlarged inflow vessels, the Hassab operation is effective to devascularize extramural inflow vessels, and the combination of EIS is necessary to sclerous the intramural varices. In the solitary gastric type which is a part of the downward porto-systemic shunt, Hassab operation is recommended to prevent the rupture of varices for the subtype with intramural running vessels, but conservative therapy is enough for the subtype without intramural running vessel.