Biomedical subjects
Publications and source records attributed to V M Mel'nik.
The paper gives a brief analysis of the existing social and medical problems and factors, which determine poor trends in the development of the tuberculosis epidemic situation in the Ukraine.
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The tuberculin sensitivity of the skin was studied in children with tuberculosis, whose age was under 7 years, in relation to the age, the form of tuberculosis, the phases of a process, its severity, the presence of complications and concomitant disease. It was established that in infants the rate of negative reactions was 13.2 times higher and that of hyperergic reactions was 5.8 times less than those in children aged 3 to 7 years. Negative reactions were most common in the complicated and severe forms of tuberculosis and in comorbidity. Hyperergic reactions were more frequently encountered in ocular tuberculosis (44.5%), helminthic invasion (30.4%), and pulmonary tuberculosis first detected in the phase of resolution (32.4%).
The main tuberculosis epidemiological parameters in the Ukraine are analyzed. The present epidemic of tuberculosis has been found to be characterized by the predominance of mortality rates over morbidity ones along less efficiency of treatment and abnormal stabilization of the incidence of recurrent tuberculosis. The efficiency of treatment (ceased bacterial isolation and healed decay cavities and caverns) is of epidemiological value. The range of these parameters, whose achievement may significantly affect immunological parameters is to be defined. It is concluded that it is necessary to make a large-scale epidemiological study of tuberculosis to establish many causal correlations of the present-days epidemic of tuberculosis.
The contingents followed up at the dispensaries in the Ukraine are analyzed. These include as high as 15.42% of patients with tuberculosis, 5.03% with questionable tuberculosis, 67.13% with inactive tuberculosis or infections, and 12.42% of persons contacting with patients. A total of 4.84% of the appropriations are used to follow up the contingents. A new procedure for grouping TB dispensary contingents is proposed.
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The tuberculosis epidemiological situation in the Ukraine is analyzed. The causes of its deterioration and outstanding problems in tuberculosis control are presented. A prediction of the epidemiological situation in the coming 10 years is given, ways of improving the tuberculosis epidemiological situation in the Ukraine are outlined.
The indications for relaparotomy in cases of bleeding, peritonitis, acute ileus and abdominal abscess were determined. Using the indications gave a possibility to perform the relaparotomy on 1-st postoperative day right after first signs of those complications. The mortality dropped from 46% to 20.5%.
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In the period from 1977 to 1987, after 13,306 operations carried out on the abdominal organs in the clinic, intra-abdominal hemorrhages occurred in 34 (0.25%) patients which had to de managed by emergency relaparotomy. From analysis of case records (28 taken from the archives and 6 of patients who were under observation) of the relationship between the large number (195) of signs represented by a block of clinico-laboratory and radiological data, an integral diagnostic criterion of intra-abdominal hemorrhages was obtained. The diagnostic significance of the criterion was 98.6%. Its practical application comes to recognition of intra-abdominal hemorrhage by identifying the symptoms and syndromes found in the patient with this early postoperative complication with the symptoms and syndromes composing the integral criterion. A revealed integral diagnostic criterion is a concrete indication for undertaking emergency relaparotomy.
For the period of 1977-1987, operations on the abdominal organs were performed in 13,306 patients. Of them, 115 (0.86%) developed 1 to 21 days after the operation acute ileus requiring the performance of emergency relaparotomy. Lethality in this complication was 33.9%. A retrospective analysis of 103 case records and observations on 12 patients who underwent at the early postoperative period emergency laparotomy for acute ileus were performed. The data were entered on a formalized card. The material was processed by means of a computer. The integral criteria for diagnosis of acute postoperative ileus which permitted to predict with an accuracy of 99% the complication serving an indication for relaparotomy were developed.
In the clinic at the period of from 1977 to 1987 after 13,006 operations on the abdominal organs, 185 patients (1.4%) ranging in age from 16 to 89 years developed peritonitis. The lethality after relaparotomy performed within the first 24 hours of the complication development was 15.9%, later on--73.7%. In spite of the large extent and trauma of radical relaparotomy, the lethality after it was 56%, after palliative one--90%. Timely is the performance of relaparotomy within the first 6 h from the moment of the complication development, in prolongation of the time to 7-12 h, the lethality was 12.5%.
The syndrome approach to diagnosis of the postoperative intraabdominal complications was used. Analysed were 170 case records and 15 observations of the patients with postoperative peritonitis. The data were registered in a specially compiled for every patient formalized card. Materials were computer-processed. The integral criterion for diagnosis of postoperative peritonitis has been obtained.
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