Biomedical subjects
Publications and source records attributed to T Sh Magdiev.
Out of 20,890 operations on the organs of abdominal cavity 405 operations were combined. 146 patients underwent elective surgery and 259 were operated urgently. In 88 patients who underwent elective operations the extent of surgical intervention was determined beforehand, in 58 patients it was unexpected. Simultaneous stage of the operation usually does not influence the course of post-operative period.
The authors studied the data concerning 101 patients who had undergone erroneous laparotomy for suspected acute surgical disease; these accounted for 0.4% of all the patients who were operated on for emergency indications in the same period. Eleven patients died. The operation was undertaken for an erroneous diagnosis of acute appendicitis (32 patients), acute cholecystitis (18), perforating gastric ulcer (15), peritonitis of unknown etiology (14), acute intestinal obstruction (5), strangulated hernia (3), destructive pancreatitis (3), tumor of the large intestine complicated by obstruction (3), abdominal abscess (2), thrombosis of the mesenteric vessels (1), ovarian apoplexy (1), closed abdominal trauma with injury to the viscera (4 patients). Diseases simulating the clinical picture of "acute abdomen" but not requiring an emergency operation were as follows: female reproductive (20 patients), pancreatic (11), renal diseases (11), hepatitis, cirrhosis of the liver (10), cardiovascular (9), pulmonary diseases (5), mesoadenitis (5), Crohn's disease (3), chronic colitis (3), carcinomatosis of the peritoneum (3), herpes zoster (3), and other diseases and injuries (20 patients). The main causes of the diagnostic and tactical errors were objective difficulties in the differential diagnosis due to similar symptomatology, as well as errors in the examination of the patient and haste in making a decision to make an operation.
The article analyses experience in treatment of 297 patients with gastroduodenal bleeding of ulcerous etiology. Operative interventions after arrest of bleeding and the appropriate preoperative management produce better results (the mortality rate, 3.3%) than those of emergency operations (the mortality rate, 15.7%). It is therefore advisable to start treatment of patients with gastroduodenal bleeding by means of nonoperative measures which proved effective in 61.6% of cases. In doubtful reliability of hemostasis, patients with moderate and severe bleeding should be operated on in the immediate days after hospitalization without waiting for a possible recurrent bleeding. Gastric resection is the main type of operative intervention in bleeding from a gastric ulcer. In a bleeding duodenal ulcer both resection of the stomach and economical operations--vagotomy, excision or closure of the ulcer, pyloroplasty--are equally competent.
The results of repeated operations in 165 patients were studied. A second operative intervention was indicated most frequently after closure of a perforating ulcer (h = 126). The character of the second operative intervention was determined by the method of the previous operation and the complication of the ulcer for which the operation had to be repeated, the patient's condition and age, and the urgency of the surgery. The mortality rate after repeated operative interventions was 3%.
An analysis of results of treatment of 476 patients with perforating gastroduodenal ulcers has shown that choice of the operative method must be differentiated with special reference to the patient's age, localization of ulcer and its morphological characteristics, time from perforation till operation, general state of the patient and availability of conditions for a certain operation.
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Results of the operative treatment of 1574 patients with acute cholecystitis are analyzed. Main factors responsible for the development of unfavourable results of operation are late operations on patients with the developed pyo-septic complications of cholecystitis, senility and severe concomitant diseases as well as some medical errors.
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Different medical errors were committed in 147 of 1029 patients (14.28%) operated for acute cholecystitis. Diagnostic errors were noted in 66 patients (44.90%). Diagnostic errors in patients older than 60 were committed much more often than in patients younger than 60. In men such errors were committed 2 times as often as in women. Tactical errors were revealed in 35 patients (23.81%). Some or other defects of the operation technique were noted in 46 patients (31.29%).
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