[Postoperative complications in acute cholecystitis in middle-aged and elderly patients].
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Biomedical subjects
Publications and source records attributed to V V Rodionov.
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Broncho-pulmonary-pleural complications in elderly and senile patients operated for acute cholecystitis make 20,6%. The most effective means for prophylaxis and treatment of complications on the respiratory organs are considered to be ultrasonic inhalations in combination with sanitary-therapeutic fibrobronchoscopies.
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Improvement of external respiration, acid-base balance and gas composition of blood was noted after application of a complex of therapeutic measures in combination with hyperbaric oxygenation. The fact that positive changes in external respiration were less pronounced in patients with stenosis of the left venous orifice than in those with mitral incompetence may evidently be explained by the presence of long-term and high pulmonary hypertension and certain increase in the volume of blood in pulmonary circulation in noncorrected stenosis of the left venous orifice. A decrease in metabolic acidosis is noted, which is a complication leading to deterioration of systemic and peripheral hemodynamics, inhibition and myocardial function and blood supply to the brain.
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The continuous suture of the common bile duct was used in 304 patients. It was used with the curative, curative-diagnostic and diagnostic purposes in mind. The indications for this suture were a complete removal of all stones from the bile ducts and a good passability of the distal portion of ductus choledochus. The authors analyze complications of the continuous suture of the common bile duct, such as "forgotten" stones in the ducts, incompetence of its sutures, peritonitis etc. Their causes are disclosed and the means of prevention are recommended. It is concluded that the continuous suture of the common bile duct is the most physiological method for the completion of choledochotomy with the corresponding indications. Peritonitis, pancreatitis and suppurative cholangitis are believed to be contraindications for using the continuous suture.
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The authors discuss remote results of choledochoduodenostomy in 105 patients examined clinically, rentgenologically and endoscopically for 1--7 years. Good and excellent remote results were obtained in 87,6% of patients. Poor and staisfactory results were shown by patients with stenosis of anastomosis and recurrent pancreatitis. One of the causes of jondice and cholangitis is an obstruction of the ducts with food masses in patients with anastomosis of less than 0,5 cm size, believed by the authors to be critical.
Seventy-seven patients with chronic ischemic heart disease were treated in single-seater oxygen hyperbaric chambers; 52 patients had angina pectoris of effort or angina of effort and at rest while 25 patients with macrofocal postinfarction cardiosclerosis had insufficiency of pulmonary or systemic circulation. Treatment consisted of 12--15 procedures. The use of hyperbaric oxygenation in a complex with drug therapy makes it possible to alleviate or arrest the attack of angina pectoris and relieve considerably the symptoms of cardiac decompensation. The initial condition of central hemodynamics affects greatly the results of barotherapy. Normal parameters of hemodynamics hardly change after treatment. At the same time, in patients with markedly reduced myocardial contractility hyperbaric oxygenation causes evident positive changes in hemodynamics. The combination of hyperbaric oxygenation with drug therapy improves the effect of treatment significantly.
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