Khirurgii͡a
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For a period of 13 months (from April 1993 till May 1994) 14 patients (5 men and 9 women) have been examined intraoperatively with transesophageal echocardiography. Nine of the patients were with mitral valve lesion, three of them with mitral valve lesion, complicated with tricuspidalisation, one patient with mitral-aortic valve lesion and high grade tricuspid regurgitation and one patient with aortic valve disease. The purpose of the intraoperative transesophageal echocardiography was to surgical valve repair by measuring the residual stenosis and regurgitation. ⋯ The results of both echocardiographic examinations, correlate to a great extent. The existing difference in assessment of the degree of valvular lesions is due to the specific intraoperative haemodynamic situation. Intraoperative transesophageal echocardiography is a valuable method in assessment of surgical valve repair.
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Combined spinal and epidural analgesia is a new concept in the field of regional anesthesia. It combines the positive qualities of spinal and epidural analgesia, and is performed by the "needle-in-needle" technique, described in the paper. This type of analgesia is practically implemented in the Clinical Center of Urology over the past few months, and shows encouraging results. ⋯ The block induced is with 4-hour duration, and lends itself to prolongation through an epidural catheter. This renders the method variable and suited for postoperative analgesia too. The Espokan set technical devices used make puncture of the spinal-epidural space readily practicable.
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Twelve patients presenting postoperative acute renal failure (ARF), developing after peritonitis, are subjected to follow-up study. A comparative assessment of the renal function and anemic syndrome is done during three different periods: immediately after the operative intervention, after renal failure development, and at treatment completed. ⋯ As demonstrated by the results, erythropoietin (Epo) deficiency is the underlying cause of concurrent anemia occurring in postoperative ARF; the anemia syndrome develops parallel to renal failure development. In patients given rHuEpo the anemia lends itself readily to control, renal failure subsides completely within shorter periods of time, and the incidence of hemorrhagic accidents is reduced.
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A review of the literature is made, in the attempt to establish the principles of the diagnosis and treatment in emergency surgery. They are listed as follows: 1. To preserve patient life and evaluate the functional capacity of the organism; 2. ⋯ To choose the method of treatment; 4. Method of operation. The guidelines in emergency surgery is to develop and perfect new methods of operation and new technical facilities, to raise the professional skill of the surgeon and to improve the organization of work in surgical clinics and departments.
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Based on literature data and personal clinical experience with twenty patients presenting sex organ oleogranuloma, summed up inferences are reached about the choice of a rational therapeutic approach. The conservative treatment in both acute and chronic stage of the disease proves ineffective. Operative treatment is the basic one, and is aimed at radical removal of the granulation tissue and injected lipid material deposits. The resulting skin defect may be covered using diverse procedures, briefly outlined in the paper.