Surgical perspectives in treatment of bleeding peptic ulcers (original) (raw)

[Approach to Patients with Gastrointestinal Bleeding]

Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti, 2015

In the developed Western countries, despite the accumulation of knowledge about the causes and treatment of gastrointestinal bleeding, as well as the experience of gastroenterologists-endoscopists using sophisticated endoscopic devices, the number of hospitalizations and mortality rates has not declined as expected. The most likely explanations are the following: aging population, increased prevalence of alcoholic liver cirrhosis, gastroesophageal reflux disease and obesity, Helicobacter pylori antibiotic resistance, using dual anti-aggregation therapy, anticoagulants, and excessive use of nonsteroidal anti-inflammatory drugs. The aim of this paper is to show the incidence and the most common signs and symptoms of gastrointestinal bleeding. The aim is also to present initial clinical evaluation, diagnostic methods, the main causes of gastrointestinal bleeding, endoscopic hemostatic modalities and treatment of bleeding from the upper and lower gastrointestinal tract. Using the MEDLIN...

[Chronic wounds as a public health problem]

Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2014

Chronic wounds represent a significant burden to patients, health care professionals and the entire health care system. Regarding the healing process, wounds can be classified as acute or chronic wounds. A wound is considered chronic if healing does not occur within the expected period according to the wound etiology and localization. Chronic wounds can be classified as typical and atypical. The majority of wounds (95 percent) are typical ones, which include ischemic, neurotrophic and hypostatic ulcers and two separate entities: diabetic foot and decubital ulcers. Eighty percent of chronic wounds localized on lower leg are the result of chronic venous insufficiency, in 5-10 percent the cause is of arterial etiology, whereas the rest are mostly neuropathic ulcers. Chronic wounds significantly decrease the quality of life of patients by requiring continuous topical treatment, causing immobility and pain in a high percentage of patients. Chronic wounds affect elderly population. Chroni...

Treatment of surgical wounds on the uterus after laparoscopic myomectomy

Srpski Arhiv Za Celokupno Lekarstvo, 2009

KRATAK SADRŽAJ Uvod Pred no sti la pa ro skop skog od stra wi va wa mi o ma u od no su na kla sič nu hi rur šku teh ni ku su kra će za dr ža va we bo le sni ce na le če wu u bol ni ci, br ži opo ra vak, ma wi ose ćaj bo la po sle ope ra ci je i ma wa uče sta lost ile u sa i trombo em bo lij skih kom pli ka ci ja. La pa ro skop sko od stra wi va we mi o ma se sa sto ji od če ti ri osnov ne fa ze: pre se ca we zida ma te ri ce, odva ja we mi o ma od zdra vog tki va ma te ri ce, za u sta vqa we kr va re wa i va đe we mi o ma iz tr bu šne du pqe. Po red ovo ga, neo p hod no je us po sta vi ti no vi in te gri tet zi da ma te ri ce, po seb no kod že na ko je pla ni ra ju trud no ću. Ciq ra da Ciq ra da je bio da se pri ka že po stu pak zbri wa va wa ošte će wa na zi du ma te ri ce to kom la pa ro skop skog od stra wi va wa mi o ma. Me to de ra da Is tra ži va we je ob u hva ti lo 96 že na kod ko jih je in di ko va na la pa ro skop ska mi o mek to mi ja. Is pi ta nice su svr sta ne u če ti ri gru pe pre ma vr sti teh ni ke he mo sta ze i zbri wa va wa ošte će wa zi da ma te ri ce (elek tro ko agu la ci ja, elek tro ko a gu la ci ja uz pri me nu ar gon-pla zme, po je di nač ni šav i pro du žni šav). Re zul ta ti Za za u sta vqa we kr va re wa naj če šće je ko ri šće na elek tro ko a gu la ci ja jed no po lar nom stru jom (kod 39,6% bo le sni ca). Za za u sta vqa we kr va re wa i zbri wa va we ošte će wa ma te rič nog zi da kod 21,9% bo le sni ca ko ri šćen je po je di nač ni, a kod 11,4% pro du žni šav. Na čin zbri wa va wa ošte će wa na ma te ri ci ni je sta ti stič ki zna čaj no uti cao na re zul ta te he ma to lo ških pa ra me ta ra (p>0,05), po tro šwu ugqen-di ok si da (p>0,05) i tra ja we ope ra ci je (p>0,05). Kod bo le sni ca kod ko jih je ošte će we le če no po sta vqa wem ša vo va na ma te ri ci sta ti stič ki su zna čaj no bi li ve ći prime na an ti bi o ti ka (p<0,05), tra ja we opo rav ka i bo lo va wa (p<0,01). Za kqu čak Za bo qu re kon struk ci ju ma te ri ce po sle la pa ro skop skog od stra wi va wa mi o ma pre po ru ču je se upo treba ša vo va. Kquč ne re či: la pa ro sko pi ja; mi o mek to mi ja; elek tro ko a gu la ci ja; su tu ra

Damage control surgery in abdominal trauma

Acta chirurgica iugoslavica, 2010

The damage control laparotomy is an advancement in the management of massively injured trauma patients. Massive liver injuries, pelvic trauma and some retroperitoneal injuries are some of the indications for this approach. The damage control laparotomy is the phased approach to severe abdominal injury that might best be described with the acronym STIR (Staged Trauma Injury Repair). The initial procedure requires rapid abdominal exploration with hemorrhage and contamination control, using suture repair combined with abdominal packing. Temporary abdominal wall closure without tension is recommended. After abrevated initial surgical procedure, the patient is transferred to the intensive care unit where continued resuscitation is performed. Careful replacement of blood and blood products along with correction of hypothermia, acidosis and optimalization of oxygen transport represents a critical phase in this management approach. Once the coagulation profile has normalized, planned re-int...

Persistant postoperative pain

Serbian Journal of Anesthesia and Intensive Therapy, 2013

bol nakon hirurgije i traume je često neprepoznat problem, javlja se nakon amputacije ekstremiteta, ingvinalne hernioplastike, hirurgije dojke i torakalne hirurgije. Hronični postoperativni bol (HPB) je složen multifaktorijalni problem koji se javlja kao posledica brojnih preoperativnih, intraoperativnih i postoperativnih faktora. Predložena terapija HPB podrazumeva multimodalnu analgeziju, primenu antihiperalgezika, antidepresiva, antagonista citokina, mikroglijalnih modulatora i kognitivne bihejvioralne terapije. Summary. Persistant postoperative pain (PPP) is serious, postoperative complication, unfortunately frequently unrecognized. Some surgeries like limb amputation, inguinal hernioplasty, mastectomy and thoracotomy are recognized as high risk for PPP. Multiple preoperative, intraoperative and postoperative risks are involved in PPP mechanism. PPP treatment studies suggest implementation of multimodal analgesia, medication with antihyperalgesic properties, antidepressants, cytokine antagonists, microglia modulators and cognitive behavioral therapy.

Surgical procedures in treating diabetic foot

Medicinska istrazivanja, 2013

Nowadays complications of diabetes mellitus are very often the main cause of the most serious diseases and disabilities. Changes caused by diabetes are the most common cause of lower limb amputations in adults. Surgical treatment of complications is usually a radical treatment chosen in complicated situations when there is no other possibility. Taking etiopathogenesis of diabetic foot into consideration, it is clear that surgery is present in every stage of the changes that appear on diabetic foot. Surgical techniques for treating the foot deformities which lead to ulceration or cause trophic changes are applied in order to prevent complications. The treatment of acute stages includes surgical procedures such as incision, drainage, necrectomy and debridement. Reconstructive procedures are applied in the case of remission in acute phases or in the case of chronic ulcers: surgical reconstructive techniques for closing or covering the persistent defect of the skin and foot parts. Today...

[Initial Experience with Topical Negative Pressure Therapy in the Treatment of Pediatric Burns]

PubMed, 2016

We are presenting the experience of the Referral Centre for Pediatric Traumatism of the Croatian Ministry of Health in the usage of topical negative pressure therapy (TNP) method for the treatment of pediatric burns. In the period of 20 months we have used negative pressure wound therapy method in eight children aged between 1.5 and 10 years. Burn injuries total body surface area ranged between 3% and 30%. TNP was used either for the wound bed conditioning or for the fixation of skin grafts. Average skin graft „take” was 86% eight days after surgery according to the evaluation by the senior author. Based on our initial experience, we can confirm that TNP is a very useful tool which enables good wound bed conditioning as well as a good fixation tool for skin grafts if the burned area does not exceed 30% of total body surface area.

Clinical recommendations for diagnosis, treatment and monitoring of patients with gastric cancer

Liječnički vjesnik, 2018

melihA solAk mekić 11 , slaVko GašparoV 12 , nAdAn rustemović 4 , ivicA sJekAvicA 13 , eduArd vrdolJAk 3 deskriptori: Adenokarcinom-dijagnoza, farmakoterapija, kirurgija, patologija; Želučani tumori-dijagnoza, farmakoterapija, kirurgija, patologija; tumorki stadij; gastrektomija-metode; disekcija limfnih čvorova; kombinirani protutumorski kemoterapijski protokoli-terapijska primjena; Adjuvantna kemoterapija; Adjuvantna kemoradioterapija; tumorske metastaze; Palijativna skrb-metode; ishod liječenja; smjernice; hrvatska sažetak. iako se učestalost najčešćega malignog tumora želuca, adenokarcinoma, posljednjih desetljeća smanjuje, raste učestalost proksimalnih lokalizacija raka želuca i ezofagogastričnog prijelaza. zbog uglavnom kasnog otkrivanja već uznapredovale bolesti rezultati liječenja oboljelih ne zadovoljavaju. dijagnoza se najčešće postavlja biopsijom učinjenom tijekom ezofagogastroskopije. liječenje lokoregionalne bolesti temelji se na kirurškom zahvatu u kombinaciji s perioperativnom kemoterapijom. Alternativno, ako nije primijenjena preoperativna kemoterapija, potrebno je provesti adjuvantnu kemoradioterapiju ili kemoterapiju. metastatska bolest liječi se palijativnom kemoterapijom i suportivnom terapijom. odluku o liječenju donosi multidisciplinarni tim individualiziranim pristupom svakom bolesniku. u tekstu koji slijedi sadržane su kliničke upute radi standardizacije dijagnostičkih postupaka, liječenja i praćenja bolesnika s rakom želuca u republici hrvatskoj.