Gallstone disease is one of the most common surgical diseases of abdominal organs and is according to domestic and foreign authors, from 14 to 17% [1,2]. Since 1990, the increased incidence of injuries and strictures of the bile ducts associated with the expansion of the proportion of laparoscopic cholecystectomy [3,4]. For example, if the frequency of iatrogenic bile duct injury has been stable in recent decades and was 0,05-0,2%, then the application of laparoscopic cholecystectomy, it has grown to 0,3 - 3% [5,6]. Prevention, diagnosis and treatment of iatrogenic injuries of the hepatobiliary zone during laparoscopic cholecystectomy are far from the final decision remains high, and postoperative mortality in the treatment of these patients.
Among the complications that arise in the surgical treatment of cholelithiasis in our clinic, iatrogenic injuries of bile ducts, major blood vessels and hollow organs are rare and constitute 1.2% of all patients operated on laparoscopically. At the same time, it is the most severe cases of the nature of damages, moral and material losses.
It is believed that the main difficulties in treating patients with iatrogenic injuries - reconstructive surgery. But this is not the first nor the only difficulty. First, despite a small in absolute terms the number of these complications, they are nevertheless growing. Secondly, the tactics of treatment of patients at different periods from the time of the occurrence of complications is different and requires the provision of skilled care. Thirdly, this type of complications occur more frequently during the development of laparoscopic cholecystectomy as well as on the periphery, where surgeons work with limited experience of reconstructive surgeries at the biliary system.
The aim of our study was to study the features of iatrogenic injuries in the LCE, and their influence on the choice of tactics and methods of surgical correction.
Materials and methods
In the department of surgery of the digestive system of the Institute of Gastroenterology of Medical Sciences of Ukraine from 1993 to 2003. performed 4627 operations for calculous cholecystitis, including laparoscopic cholecystectomy - 3864 (83,5%). The proportion of laparoscopic cholecystectomy was 93.2%, while in calculous cholecystitis with chronic inflammation has 95,2% of operations and the operations performed on the calculous cholecystitis with acute inflammation was 4.8%. The results of treatment of 46 patients. with iatrogenic injury during laparoscopic cholecystectomy. 81.5% of patients were women, 18,5 - men. Age of patients ranged from 26 to 67 years and averaged 44 years.
Surgical tactics in each case determined by the type of damage and the time elapsed from the moment of its recognition.
Analyzing the reasons that contributed to the occurrence of iatrogenic injury during laparoscopic cholecystectomy, we identify clinical and anatomical features, the lack of individual skill and experience of the surgeon, the technical conditions of operation. Thus, the atypical location of the vascular-duct elements in the area of the gallbladder, in our observations were noted in 9 patients (19,6%), expressed in commissural and inflammatory infiltrative changes гепатопанкреатодуоденальной zone have caused damage - in 27 patients (58,7%) , underqualification surgery that is usually associated with the period of the development of a method or rare (<4 times per month) executing operations - contributed to the occurrence of iatrogenic injuries in 8 patients (17,4%), and finally equipment failure was the occasion to complications 2 patients (4.3%).
In the structure of trauma injuries duct brand viagra system was 71.7% (33 patients), vascular damage - 23.9% (11 patients), damaging the surrounding organs - 4,3% (2 patients: 12n-colon - 1 patient, the diaphragm - 1 patient).
The absence of sound criteria for selecting method of surgical correction is more than just damage to the bile ducts as often in the treatment of similar injuries and apply restorative and reconstructive surgery, as well as different ways to frame drainage.
Injury, recognized during laparoscopic surgery are subject to immediate removal. If the reason was zhelcheistecheniya small extra bile duct in the bed of the gall bladder and recognized complication during surgery, the latter are stitched or clipped, and the ductal system drenirovalyas through the stump of cystic duct.
hormones
use medications
careful monitoring
inhibitory effects
myocardial infarction
Thứ Tư, 26 tháng 1, 2011
Thứ Năm, 20 tháng 1, 2011
Giving way
American scientists from Worcester Polytechnic Institute have developed a unique technology to eliminate the badly damaged muscle tissue. The technology is based procedure for implanting microthreads, coated with human muscle cells, reports Informnauka.
Have proven the effectiveness of brand viagra online experiments with rodents, which had great wound. Filaments help cells to grow properly, delaying wound. According to the developer of technology, George Pins, cells migrate along the scaffold, which perform the role string. Implants are quickly incorporated into existing muscle and significantly reduce scar tissue formation.
Presented filaments are composed of fibrin - protein polymer used by the body to heal wounds. To obtain filaments scientists had to master the technology of simultaneous extrusion of fibrinogen (the building blocks of fibrin) and thrombin (an enzyme that catalyzes the reaction of synthesis of soluble protein fibrinogen to polymer) of two small tubes. The diameter of fibers was obtained from 500 to 100 microns, in 5 -10 times the size of the cell. Next, the scientists "seeded" the thread of human muscle cells derived from post-operative waste.
In rodents, specifically was removed about 30% of the tibialis anterior muscle for subsequent implantation there microthreads. Bottom line: the wound quickly tightened with a significant reduction of scarring. As specialists say, the thread replacing the natural signaling generic viagra system that controls the healing process. They are also attracted to the enzyme breaks the fibrin fibrinogen into individual proteins that make the surrounding cells to migrate and grow new tissue.
According to estimates, the cells were embedded in tissue injury in a few days. A week later, the thread begin to decompose, giving way to the muscle fibers. After ten weeks, the wound completely filled with human cells that look like mature muscle fibers. Now researchers are going to test the effectiveness of the grown fibers.
effectiveness
human relationships
thrombotic events
simple tips
Have proven the effectiveness of brand viagra online experiments with rodents, which had great wound. Filaments help cells to grow properly, delaying wound. According to the developer of technology, George Pins, cells migrate along the scaffold, which perform the role string. Implants are quickly incorporated into existing muscle and significantly reduce scar tissue formation.
Presented filaments are composed of fibrin - protein polymer used by the body to heal wounds. To obtain filaments scientists had to master the technology of simultaneous extrusion of fibrinogen (the building blocks of fibrin) and thrombin (an enzyme that catalyzes the reaction of synthesis of soluble protein fibrinogen to polymer) of two small tubes. The diameter of fibers was obtained from 500 to 100 microns, in 5 -10 times the size of the cell. Next, the scientists "seeded" the thread of human muscle cells derived from post-operative waste.
In rodents, specifically was removed about 30% of the tibialis anterior muscle for subsequent implantation there microthreads. Bottom line: the wound quickly tightened with a significant reduction of scarring. As specialists say, the thread replacing the natural signaling generic viagra system that controls the healing process. They are also attracted to the enzyme breaks the fibrin fibrinogen into individual proteins that make the surrounding cells to migrate and grow new tissue.
According to estimates, the cells were embedded in tissue injury in a few days. A week later, the thread begin to decompose, giving way to the muscle fibers. After ten weeks, the wound completely filled with human cells that look like mature muscle fibers. Now researchers are going to test the effectiveness of the grown fibers.
effectiveness
human relationships
thrombotic events
simple tips
Chủ Nhật, 9 tháng 1, 2011
Spinal diseases
In modern society, a society of information technology, people are becoming more vulnerable to disease. Why is this happening? Remember, you are again today spent a whole day at the computer. You were rich life, communicating with interesting people, but your body has remained fixed in his chair.
In the virtual world you can be an athlete, a brave warrior, but that your real muscles and spine become stronger and more mobile. Often, after brand viagra several hours spent at the computer, we feel stiffness and pain in his back. Because of the sedentary lifestyle our muscles become flabby, metabolic disturbances begin, begin to develop such diseases of the spine, as intervertebral hernia, scoliosis, osteochondrosis.
To prevent the development of diseases of the spine, you must first change the mode of work and rest, eat properly, restore emotional balance. Follow a few simple rules.
If you have a sedentary job, get up every hour to walk a little, pick a comfortable office chair that provides support in the lumbar region. If, however, have to stand for long, then change positions every 10-15 minutes, walk in place, do not stand in an awkward position, leaning over.
Try to eat balanced. Need to avoid foods that contain vitamins, calcium, magnesium - fish and seafood, legumes, nuts. Habitual cakes for dessert replace fruits and berries.
Try to make sure that your workplace has not been damp and drafts. Undercooling may cause exacerbation.
In no case can not lift weights in inform your doctor outstretched arms, bowing. Must be handled with weights something like weightlifters - squat, keep your back straight, lift, straightening his legs.
Women need to remember that under the ordinary domestic affairs also exists the risk of back pain, so you need to monitor the situation of the spine. Do not carry heavy bags in one hand, distribute their weight evenly on both hands. To raise a child, too, with a straight back, as heavy things. When cleaning, ironing, washing does not bend, use a vacuum cleaner extension handles, a variety of stands, an ironing board.
Make sure your posture and do not slouch, walk and sit with your back straight, his head should not hang.
Necessary to ensure full muscle relaxation during sleep. Sleep on the bed with a rigid foundation and an orthopedic mattress. You can and should use small pads by placing them in the field of physiological curvature of the spine. This will help avoid the intervertebral herniation.
To return to the backbone flexibility, and muscles - strength needed exercise. But in their implementation need to be careful. Start with small loads - vigorous walking, swimming, skiing. If you love sports such as soccer, volleyball, tennis, do not forget that sharp turns can provoke exacerbation of back pain.
Perform simple preventive measures can help you avoid the development of diseases of the spine.
State of a person
multivitamin complex
Hovered somewhere
In the virtual world you can be an athlete, a brave warrior, but that your real muscles and spine become stronger and more mobile. Often, after brand viagra several hours spent at the computer, we feel stiffness and pain in his back. Because of the sedentary lifestyle our muscles become flabby, metabolic disturbances begin, begin to develop such diseases of the spine, as intervertebral hernia, scoliosis, osteochondrosis.
To prevent the development of diseases of the spine, you must first change the mode of work and rest, eat properly, restore emotional balance. Follow a few simple rules.
If you have a sedentary job, get up every hour to walk a little, pick a comfortable office chair that provides support in the lumbar region. If, however, have to stand for long, then change positions every 10-15 minutes, walk in place, do not stand in an awkward position, leaning over.
Try to eat balanced. Need to avoid foods that contain vitamins, calcium, magnesium - fish and seafood, legumes, nuts. Habitual cakes for dessert replace fruits and berries.
Try to make sure that your workplace has not been damp and drafts. Undercooling may cause exacerbation.
In no case can not lift weights in inform your doctor outstretched arms, bowing. Must be handled with weights something like weightlifters - squat, keep your back straight, lift, straightening his legs.
Women need to remember that under the ordinary domestic affairs also exists the risk of back pain, so you need to monitor the situation of the spine. Do not carry heavy bags in one hand, distribute their weight evenly on both hands. To raise a child, too, with a straight back, as heavy things. When cleaning, ironing, washing does not bend, use a vacuum cleaner extension handles, a variety of stands, an ironing board.
Make sure your posture and do not slouch, walk and sit with your back straight, his head should not hang.
Necessary to ensure full muscle relaxation during sleep. Sleep on the bed with a rigid foundation and an orthopedic mattress. You can and should use small pads by placing them in the field of physiological curvature of the spine. This will help avoid the intervertebral herniation.
To return to the backbone flexibility, and muscles - strength needed exercise. But in their implementation need to be careful. Start with small loads - vigorous walking, swimming, skiing. If you love sports such as soccer, volleyball, tennis, do not forget that sharp turns can provoke exacerbation of back pain.
Perform simple preventive measures can help you avoid the development of diseases of the spine.
State of a person
multivitamin complex
Hovered somewhere
Chủ Nhật, 2 tháng 1, 2011
Advanced age
The first description of the disease, which is, apparently, multiple myeloma, belongs to Henry Bence Jones and William McIntyre. These two London physician reported medical history of Thomas McBean, who died in 1846 from an illness manifested bone pain and swelling. Bence-Jones and McIntyre noted the presence in urine of a particular protein, which when heated first precipitated and then dissolved. Bone marrow registers John Dalrymple - a surgeon who conducted the autopsy of the deceased. The term "multiple myeloma" was proposed in 1873 Rustitskim and only in 1900, Wright drew attention to the relationship of the disease with involvement of plasma cells.
Use after 1940 electrophoretic methods revealed a correlation between brand name viagra serum monoclonal protein and a malignant tumor composed of plasma cells. The study of monoclonal myeloma immunoglobulin played an important role in the development of common understanding about the molecular structure and function of immunoglobulins. These studies and related research using tissue culture techniques and cell labeling in vivo contributed to a better understanding of the origin and kinetics of myeloma cells.
Although chemotherapy and radiotherapy contribute to the increase in the duration and quality of life of myeloma patients, successful treatment of this disease lags behind the level achieved in relation to other malignant tumors of the hematopoietic system. Treatment of multiple myeloma and its many complications is still a difficult task for the physician.
This disease affects mainly the elderly. The possibility of family members of patient care at home is often limited, so it is very important aid society. In such circumstances it is difficult to overestimate the role of qualified geriatrics in long-term care for the patient.
INCIDENCE
Multiple myeloma - a disease of advanced age. Of all tumors, except for chronic lymphocytic leukemia, myeloma is most clearly associated with age. The average age of patients at the time of diagnosis is 62 years, the frequency of the disease increased steadily in the older age groups [Blattner, 1980], the share of persons under 40 years accounted for only 2% of all cases, and 80-year-olds suffer 10 times more in 1950 year-olds. In the general population incidence is 3 per 100 000, and among 80-year-olds - 37 per 100 000. A slight predominance of men. (61%) among patients. Among U.S. blacks disease occurs in 2 times more likely than whites [McPhedran et al., 1972]. Blacks have multiple myeloma is the most common malignant lesion of the hematopoietic system (33%) and whites, it ranks third (14%). It is assumed that in recent years, the frequency of the disease actually increased [Osserman, 1982].
Etiology and Pathogenesis
Myeloma arises from a malignant proliferation of plasma cells, which occurs mainly in the bone marrow, but occasionally in extramedullary foci. On models with the use of experimental animals have shown that the development of malignant plasma cells are involved both genetic and environmental factors. However, in humans the role of any of these factors has not yet been proved. In mice Compare Viagra and injections susceptible lines BALB / c and NZB plasmacytoma can induce by exposure to certain chemicals [Potter, 1973]. In mice of other lines such exposure does not cause the development of plasmacytoma.
There are anecdotal reports of familial cases with multiple myeloma (a disease, but reliable evidence of genetic susceptibility in humans do not. The hypothesis of "two strikes» [Salmon, Seligmann, 1974] postulates the role of two environmental factors in the etiology of myeloma. Benign monoclonal gammopathy is quite common among the elderly . It is the result of monoclonal proliferation of plasma cells that secrete immunoglobulin of the same idiotype. The number of cells (probably less than 1011) is quite stable and only a small number of cases there is a malignant tumor. In some patients with multiple myeloma paraprotein has a specificity to certain antigens (eg, streptolysin or g-globulin). Salmon, Seligmann (1974), based on the results of experiments in mice suggested that the myeloma begins with education, in response to antigenic stimulus, a clone of malignant B-cells (benign gammopathy ). Later, in response to an oncogenic stimulus may have a viral nature, this clone can undergo malignant transformation, and when the number of cells reaches 1011-1012 (myeloma), there is a clinical picture.
Scheme of maturation of B lymphocytes and the alleged target cells during the development of lymphoproliferative diseases of B-cell origin. CLL - chronic lymphocytic leukemia; HDLL - well-differentiated lymphocytic lymphoma; PDLL - poorly differentiated lymphocytic lymphoma; BTts - heavy chain disease; MB - Waldenstrom macroglobulinemia; MB - myeloma.
The cause of myeloma is largely unclear, but now a lot is known about the cellular substrate and the growth kinetics of this tumor. Maturation of normal B-lymphocytes and their evolution up to the antibody plasma cells can now be traced back to using antibodies to the light or heavy chains of immunoglobulin molecules (Fig. 21). Using immunofluorescent and immunoperoxidase techniques allows the identification of early pre-B cells, in the cytoplasm, which contained IgM. As the maturation of these cells lose their cytoplasmic immunoglobulin, but immunoglobulin (IgM and IgD) appears on their surface membrane. These "virgin" B cells are able to respond to specific antigens. Contact with antigen leads to maturation to the stage of lymphoblasts, which is accompanied by increased synthesis of surface immunoglobulin, and then to stage plazmatizirovannogo lymphocytes capable of synthesizing cytoplasmic immunoglobulins. Ultimately, these cells become fully mature plasma cells, which eventually lose their surface immunoglobulins, but are capable of secreting immunoglobulins of the respective division in the extracellular media.
Using the mentioned methods to identify cell markers, we can assume that many types of malignant tumors of lymphoid tissue are B-cell origin. For example, chronic lymphocytic leukemia (B-CLL) is caused by proliferation of cells at the stage of "virgin" B lymphocytes, whereas most non-Hodgkin's lymphomas originate from cells of the same stage of differentiation that B-CLL (well-differentiated lymphoma, HDLL), or lymphoblasts (poorly differentiated lymphoma, PDLL). When macroglobulinemia dominated plazmatizirovannye lymphocytes (along with plasmocytes), and clonal expansion of cells of this stage of differentiation leads to the secretion of IgM, which can be easily identified in the serum. When multiple myeloma in the process involved only the plasma cells, and clonal nature of their proliferation leads to the fact that both serum paraprotein and cytoplasmic immunoglobulin have the same heavy (g or a) and light chains.
Ability to identify the cellular phenotype has important diagnostic value. Cells in tissue sections can be painted using antibody-conjugated peroxidase. These dyes with the specificity of immunoperoxidase to heavy or light chains to help determine whether the plasma cell infiltrate reactive (polyclonal) or malignant (monoclonal).
Scheme
Special kind
Use after 1940 electrophoretic methods revealed a correlation between brand name viagra serum monoclonal protein and a malignant tumor composed of plasma cells. The study of monoclonal myeloma immunoglobulin played an important role in the development of common understanding about the molecular structure and function of immunoglobulins. These studies and related research using tissue culture techniques and cell labeling in vivo contributed to a better understanding of the origin and kinetics of myeloma cells.
Although chemotherapy and radiotherapy contribute to the increase in the duration and quality of life of myeloma patients, successful treatment of this disease lags behind the level achieved in relation to other malignant tumors of the hematopoietic system. Treatment of multiple myeloma and its many complications is still a difficult task for the physician.
This disease affects mainly the elderly. The possibility of family members of patient care at home is often limited, so it is very important aid society. In such circumstances it is difficult to overestimate the role of qualified geriatrics in long-term care for the patient.
INCIDENCE
Multiple myeloma - a disease of advanced age. Of all tumors, except for chronic lymphocytic leukemia, myeloma is most clearly associated with age. The average age of patients at the time of diagnosis is 62 years, the frequency of the disease increased steadily in the older age groups [Blattner, 1980], the share of persons under 40 years accounted for only 2% of all cases, and 80-year-olds suffer 10 times more in 1950 year-olds. In the general population incidence is 3 per 100 000, and among 80-year-olds - 37 per 100 000. A slight predominance of men. (61%) among patients. Among U.S. blacks disease occurs in 2 times more likely than whites [McPhedran et al., 1972]. Blacks have multiple myeloma is the most common malignant lesion of the hematopoietic system (33%) and whites, it ranks third (14%). It is assumed that in recent years, the frequency of the disease actually increased [Osserman, 1982].
Etiology and Pathogenesis
Myeloma arises from a malignant proliferation of plasma cells, which occurs mainly in the bone marrow, but occasionally in extramedullary foci. On models with the use of experimental animals have shown that the development of malignant plasma cells are involved both genetic and environmental factors. However, in humans the role of any of these factors has not yet been proved. In mice Compare Viagra and injections susceptible lines BALB / c and NZB plasmacytoma can induce by exposure to certain chemicals [Potter, 1973]. In mice of other lines such exposure does not cause the development of plasmacytoma.
There are anecdotal reports of familial cases with multiple myeloma (a disease, but reliable evidence of genetic susceptibility in humans do not. The hypothesis of "two strikes» [Salmon, Seligmann, 1974] postulates the role of two environmental factors in the etiology of myeloma. Benign monoclonal gammopathy is quite common among the elderly . It is the result of monoclonal proliferation of plasma cells that secrete immunoglobulin of the same idiotype. The number of cells (probably less than 1011) is quite stable and only a small number of cases there is a malignant tumor. In some patients with multiple myeloma paraprotein has a specificity to certain antigens (eg, streptolysin or g-globulin). Salmon, Seligmann (1974), based on the results of experiments in mice suggested that the myeloma begins with education, in response to antigenic stimulus, a clone of malignant B-cells (benign gammopathy ). Later, in response to an oncogenic stimulus may have a viral nature, this clone can undergo malignant transformation, and when the number of cells reaches 1011-1012 (myeloma), there is a clinical picture.
Scheme of maturation of B lymphocytes and the alleged target cells during the development of lymphoproliferative diseases of B-cell origin. CLL - chronic lymphocytic leukemia; HDLL - well-differentiated lymphocytic lymphoma; PDLL - poorly differentiated lymphocytic lymphoma; BTts - heavy chain disease; MB - Waldenstrom macroglobulinemia; MB - myeloma.
The cause of myeloma is largely unclear, but now a lot is known about the cellular substrate and the growth kinetics of this tumor. Maturation of normal B-lymphocytes and their evolution up to the antibody plasma cells can now be traced back to using antibodies to the light or heavy chains of immunoglobulin molecules (Fig. 21). Using immunofluorescent and immunoperoxidase techniques allows the identification of early pre-B cells, in the cytoplasm, which contained IgM. As the maturation of these cells lose their cytoplasmic immunoglobulin, but immunoglobulin (IgM and IgD) appears on their surface membrane. These "virgin" B cells are able to respond to specific antigens. Contact with antigen leads to maturation to the stage of lymphoblasts, which is accompanied by increased synthesis of surface immunoglobulin, and then to stage plazmatizirovannogo lymphocytes capable of synthesizing cytoplasmic immunoglobulins. Ultimately, these cells become fully mature plasma cells, which eventually lose their surface immunoglobulins, but are capable of secreting immunoglobulins of the respective division in the extracellular media.
Using the mentioned methods to identify cell markers, we can assume that many types of malignant tumors of lymphoid tissue are B-cell origin. For example, chronic lymphocytic leukemia (B-CLL) is caused by proliferation of cells at the stage of "virgin" B lymphocytes, whereas most non-Hodgkin's lymphomas originate from cells of the same stage of differentiation that B-CLL (well-differentiated lymphoma, HDLL), or lymphoblasts (poorly differentiated lymphoma, PDLL). When macroglobulinemia dominated plazmatizirovannye lymphocytes (along with plasmocytes), and clonal expansion of cells of this stage of differentiation leads to the secretion of IgM, which can be easily identified in the serum. When multiple myeloma in the process involved only the plasma cells, and clonal nature of their proliferation leads to the fact that both serum paraprotein and cytoplasmic immunoglobulin have the same heavy (g or a) and light chains.
Ability to identify the cellular phenotype has important diagnostic value. Cells in tissue sections can be painted using antibody-conjugated peroxidase. These dyes with the specificity of immunoperoxidase to heavy or light chains to help determine whether the plasma cell infiltrate reactive (polyclonal) or malignant (monoclonal).
Scheme
Special kind
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