Assessment

Justification of the choice of surgical tactics in practice and true sign of inefficiency of conservative treatment in theoretical medicine is very difficult. Most studies have ascertained the trends in these or other indicators, but say about 100% of the diagnostic value of simple and affordable for certain symptoms or syndrome is difficult. To solve this problem it is expedient to change some tactical approach to the formulation of schemes. It is advisable to assume that the treatment of any patient can be carried out semi-closed method. The question of choosing a method of treatment occurs intraoperatively. The main selection criteria are: the nature of exudates (including bacteriological data, bacterial contamination), the time of peritonitis, the degree of dysfunction of major organ systems. With a high degree of professional discipline and clinical laboratory equipment, all these signs, except the nature of the microflora can be determined in the first hours of admission and intraoperatively. The transition to the half-open method of surgical treatment is appropriate at a purulent RP (bacterial contamination above 5KOE / g), with signs of anaerobic peritonitis [18]. In the analysis of flow in the first stage RP study evaluated the results of treatment, timing of development (progression) of Poland. It is obvious that the time before surgery, as a reflection of the human factor is important for all patients (Table 2). Prognostic and momentary assessment of the severity of patients with APACHE II scales and MIP [12,16,21] has clinical and scientific value and is recommended by the Conciliation Conference Societies pulmonologists and intensive care specialists, as well as [6,10,16], during work of the Plenum of concern commissions "Emergency Surgery" and "Purulent surgery" (Rostov on Don, 1999) [16.21].

Subjective factors that contribute to the development (progression) of postoperative peritonitis can be considered: an erroneous assessment of peritonitis, an erroneous assessment of the sanitation of the abdominal cavity, erroneous intraoperative diagnosis, erroneous assessment of the consistency of the walls of the hollow body, an erroneous method of drainage, physical or biological leaks seam of the hollow body, poor hemostasis , traumatic manipulation in the abdomen, the underestimation of activity (virulence, bacterial contamination) microflora, inadequate prevention of infection. Objective factor is the imperfection of local and general immune responses, which occurs in 27-61% of cases of abdominal sepsis [2,7] and the discrepancy between body reserves the influence of intoxication in all its pathophysiologic clinical manifestations. A more detailed discussion of the results of treatment of patients with RP requires a prior explanation.

Firstly, for a better evaluation of treatment can be applied to the concept of abdominal sepsis [4,13,20], whereby the presence of two or more symptoms of these (body temperature higher than 38 ° C or below 36 ° C; tachycardia of more than 90 beats per minute; tachypnea over 20 breaths per minute (with IVL-pCO2 less than 32 mm Hg), white blood cell count over 12,000 cells in the MCL or less than 4000 cells ml or the number of immature (stab) forms of neutrophils, myelocytes, juvenile than 10%) is defined as a syndrome of systemic reaction to inflammation - SSRV (Systemic inflammation response syndrom - SIRS), which if proven focus of infection is defined as sepsis (in our case, abdominal sepsis). In the literature there are data that indicate that "sepsis, in essence, reflects a certain degree of severity of the patient" [13]. Developing such criteria as the result of years of research based on the detection of the generalization of inflammation in the form of dominance "of the destructive effects of cytokines" and "endothelial dysfunction of capillaries [9]. According to the same author, a diagnosis of "sepsis" is lawful if SSRV, signs of organ-system dysfunction (or the appearance of piemicheskih centers) in the presence of an infectious inflammation focus.

Secondly, the rationale for preoperative presence of multiple organ dysfunction syndrome (PAYG) will require brand viagra substantial effort. In addition, there are differences in the assessment criteria for PAYG [15,17] and in the terminology of [6]. Syndrome of multiorgan dysfunction is dysfunction of organs from terminally ill, whose homeostasis can not be maintained without intervention [12]. Most readily available for emergency determination SPO-deficiency symptoms are: heart rate <55/min, mean arterial pressure <50 mm Hg or systolic BP <60 mm Hg, respiratory rate> 49/min, the need for mechanical ventilation, leukocyte count <1000 ml-1, hematocrit < 21% of the sum score of Glasgow <7 [15]. More difficult, but not less informative is the definition of the level of total bilirubin, creatinine, blood pH, partial pressure of blood gases. Interest is the development of informative laboratory tests [3].

Analysis was performed in all groups on the basis of the scale of APACHE II, IIP. To determine the multiple organ dysfunction syndrome elected the following symptoms: heart rate (sinus rhythm)> 110 per minute, respiratory rate> 24 per minute, mean arterial pressure <71 mm Hg, the level of hematocrit <20%, the Glasgow Coma Scale <11. The presence of one of the symptoms characterized "monoorgannuyu dysfunction, the presence of two or more symptoms defines" multiple organ dysfunction. A feature of this concept is the distinction in the concept of "dysfunction" and "failure". Signs of multiorgan dysfunction, taken arbitrarily determined before surgery, so were not taken into account the level of creatinine, the state of blood gases, blood pH, urine output.

Case fatality rate 10.4% defines a set of the first group of patients whose treatment may have should be different. The main reasons for the negative results of treatment are underestimating the early signs of organ dysfunction, existing prior to the operation and development of thromboembolic complications. The most informative symptoms correlated with the nature of the exudate were mean arterial pressure, the rate of Glasgow coma scale and frequency of respiratory movements. The bulk of deaths observed in the purulent exudate (19%). With a score of APACHE II> 20 mortality was more than two-thirds (by APACHE II> 30 - 100%), resulting in these cases need to justify the refusal of the landmark renovation of the abdominal cavity, or their conduct. The effectiveness of total nasogastrointestinal intubation without landmark renovation at a purulent exudate can be estimated at 8-10% of deaths. Application of this technique in other types of abdominal exudate useful only to prevent insolvency mezhkishechnogo anastomosis or other processes leading to the destruction of the intestinal wall (Table 3).

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Lumen

Conclusion

1. In patients with initial low pressure in the NPC incomplete Toupet fundoplication in the modification does not create a reliable antireflux mechanism is the cause of disease recurrence and reduced quality of life in the postoperative period 20% of patients.

2. After the operation, with the formation of an artificial pump station in the area of esophageal-gastric junction is formed by high-pressure zone, and the relaxation of the cardia is reduced slightly, which is the prevention of dysphagia.
3. In patients with symptomatic disease zamykatelnoy function of the cardia substantially reduced as gastrointestinal index and indicators of quality of life for all categories. Noted positive changes in quality of life after surgical treatment of patients, as well as extend the life of early surgical intervention.

Effective control of burn brand viagra online shock and its effects in patients with severe burn injury reduces the risk dysproteinemia and intoxication, leading to trophic disorders gastrointestinal wall [34]. Ensuring adequate organ perfusion is vital for the prevention of bleeding [40]. Active support of hemodynamic parameters helps to restore adequate blood flow in the mucosa [46].

All patients with signs of bleeding into the lumen of the digestive generic viagra tract was also demonstrated hemostatic therapy, including well-known means of general and local effects on the source of bleeding. Control over the degree of hemorrhage and hemostasis are hemodynamic parameters, hemoglobin in peripheral blood, and the nature and amount of discharge by nasogastric tube. An invaluable role in this is also a dynamic endoscopy [7, 12, 30].

Method of choice for direct stopping erosive ulcer bleeding in endoscopic hemostasis is fired, which gives a good result in more than 90% of cases [5, 6, 8]. Endoscopic brand name levitra hemostasis was performed by electrocoagulation, diathermal, laser photocoagulation of bleeding erosions and ulcers, injection therapy using different materials [4, 8, 20, 21, 42, 46].

According to D. Klein et al. [29], with profuse bleeding from a deep ulcer in a patient with a burn of 70% body surface marked by a good result after embolization of the left gastric artery. By selective catheterization of the left gastric artery can be made prolonged (48-72 hours) infusion of vasopressin or embolization with use of the drug Gelfoam, charcoal or autologous cialis without prescription blood clot. But the use of different variants of angiographic techniques is often unsuccessful because of the rich submucosal network of blood vessels and pronounced collateral circulation in the gastric wall [46].

Surgical intervention may become necessary in situations where conservative treatment fails, and blood loss continues. Transactions in such observations are taken to generic levitra stop bleeding, reduce the likelihood of re-bleeding, reduce mortality rates. The operated patients are at extreme risk zone, so the best is the most fast operation [21, 46]. In life-threatening bleeding, not amenable to endoscopic control, you may need gastrectomy with vagotomy with or without [6, 8, 12, 21, 46].

The question of surgical treatment of burned with erosive ulcer bleeding is finally withdrawn after the disclosure of all the mechanisms of the pathogenesis of acute erosions and ulcers of the upper GI, which will effectively prevent these serious complications [5, 6].

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Several principles

"I donated blood twice and now I think whether to continue the case. Why I started to donate blood?" I wanted to check myself - if I can (I myself am a very bad feeling when told about the various terrible diseases, pools of blood, many people can not tolerate, when they take blood from a vein), and also from a practical point of view (as I understand it, threatens the future of benefits, and now - two days of rest and 50 rubles). But after two donations two or three days go my way, so to speak. In Specifically, there is fatigue, beating in his temples, lack of desire to do anything.'s parents and sister say that I, growing organism (18 years), to donate blood is not recommended and even harmful. So would like to ask you whether to continue to take blood or quit. And in general for all the other readers mailing will probably be interested to know about the rules of blood donation, as to adapt after the date of how the recovery process. "




Blood - a living tissue. Transfusion of blood or blood cellular components from the donor recipient (blood transfusion), is, in fact, transplantation (graft). In many cases, donated blood saves lives ppatsienta.

Who is a donor?

This is a person who voluntarily giving their blood for transfusion patients (recipients) as well as for the preparation of medicinal drugs.
Blood donation is based on several principles. Firstly, it is freely brand name viagra expressed in a voluntary act, and secondly, it can be donated and paid, and thirdly, blood and blood components used for medicinal purposes, can only be obtained from a person; Fourth, donor blood can be Every able-bodied citizen between the ages of 18 to 60 years, passed a medical examination and, finally, is taken from the donor's blood is admissible only on condition that the health of the donor would not be harmed.

Where blood is produced?

Basically, the blood transfusion stations (regional, district, etc.). Blood is taken in doses: 450, 400 and 200 ml. Before taking the donor receives a small breakfast, and after - dry rations. By the way, physicians have long noticed a pattern - the worse the living standards of people, the more willing to become donors. And about donating blood does not have to say. Often people come to donate blood in hopes to earn extra money. On the one hand, their desire is understandable. The time now is easy: pay overdue, prices are rising by leaps and bounds. Why not make a hundred - different. On the other hand, come here, and those whose blood is certainly not suitable. Many become a donor simply does not allow health because of diseases such as hepatitis, osteomyelitis, sexually transmitted and infectious diseases, and inflammatory processes, and low hemoglobin.

Coming to the station, many potential donors hide their illness, thereby depriving the time from the medical staff. Used unnecessarily expensive equipment: disposable test kits, needles, tubes, gloves and harnesses. High costs and to conduct tests for syphilis, HIV and hepatitis B and C.

How can check a potential donor?

Everyone who came to donate blood, carefully inspect the dermatologist, venereal diseases, a general practitioner. On a computer database checked by contact with patients with hepatitis, a sick man venzabolevaniyami (recover from a "French" disease, are rejected right away, gonorrhea - are allowed to give blood only five years after treatment).

There is no doubt that the donation brings moral satisfaction. Certainly nice to know that your blood - it's someone's life saved. Maybe even your friend, friend, relative, and maybe even your own. From adversity because no one is safe!

Lease on the station not only blood, but its components - plasma, separating it from the blood using special equipment, and the remaining red cells re-poured to the donor. Transfused plasma mainly severely ill, as fresh frozen plasma carries all that is in a "living" blood, just taken from a donor. You can donate Viagra what is the cause of impotence plasma twice a month, the blood of the same - once a month.

The people are still widely believed that none of giving blood for the donor is never harmless. They say, vision deteriorates, liver, kidney and spleen are suffering and stuff, stuff.

But all these opinions, by and large, are not unfounded. Conversely, there are even medical indications for blood donation. Useful bloodletting for those with high blood pressure, women during menopause. In favor of giving blood is the fact that since the Middle Ages to our century, many diseases were treated exactly bloodletting. Now widely advocated girudoterapija (treatment with leeches), which is essentially the same bloodletting that benefit the body.

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