[Torsion of the greater omentum].
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Biomedical subjects
Publications and source records attributed to N A Kuznetsov.
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A decision made by a surgeon in a risk situation differs basically from his action under condition of a necessity (extreme necessity). If the former situation is characterized by the existence of an alternative and a choice (the possibility of avoiding the infliction of harm to the patient), in the latter situation of extreme necessity (when there is no choice), in contrast, such a possibility is absent--the harm is inevitable. The property of the risk--the discrepancy between the objectively existing risk situation and its subjective evaluation--compels the surgeons to evaluate it mainly on the basis of their own experience--on the level of opinion. At present attempts are made to determine the value of the operative risk in the form of a matrix, estimation expressions, "tree of decisions", score counting and mathematical-statistical methods. An effective, sufficiently simple classification of operative risk criteria may promote the solution of an adequate scientific evaluation of the degree of the operative risk. The problem of the operative risk may be solved only on the basis of an interdisciplinary approach.
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The article generalizes the experience in treating 137 patients with diseases of the stomach and duodenum. The largest group included 82 persons with peptic ulcer; 45 had carcinoma of the stomach; 5 had benign tumors of the stomach, and 5 persons had chronic duodenal obstruction. The most common concurrent disease was cholelithiasis (102 patients), it was diagnosed before the operation in 70% of patients with peptic ulcer and in 85% of those with carcinoma of the stomach. Among the less predominant diseases were abdominal hernias (12 patients), cysts of various localization (7), varicosity (3), chronic appendicitis (3), atherosclerosis obliterans (2), ect. Organ-preserving operations were carried out as the main stage of surgery in most patients with peptic ulcer. The nature of the simultaneous operations corresponded to the concomitant surgical diseases. Most of the operations (125) were performed through a median laparotomy approach; superior median laparotomy was mostly resorted (115 patients). Four (2.9%) patients died after the operation. It is pointed out that patients with gastroduodenal diseases must be thoroughly to reveal concurrent surgical diseases.