Our experience of meronema in patients with AS against the backdrop of widespread peritonitis to determine the effectiveness of this drug and its place in the pharmacotherapy of the AU. According to our observations, clinical efficacy meronema (cure and improvement) in patients with the severity of SAPS 20-25 points (which corresponds to a projected 61-67% mortality) was 81% in patients with the severity of SAPS 15-19 points (projected mortality 34-42%) - meron was effective in 91% cases, the severity of the condition of patients by SAPS no more than 15 points (forecast mortality 25-30%) - 94%. Of course, adequate antibiotic therapy plays a supporting, role of adjuvant (relative to surgery) in saving lives of patients. However, our results suggest meron very promising drug. It should be noted that the loss of only 3 patients we observed was associated with continued sepsis, the remaining Post-mortem signs of sepsis were not.
Thus, we can determine the location meronema in the treatment of surgical AU as a drug I turn in a special clinical situation (post-operative period, multiple organ failure, need to combine with KFOR, and resistance to other drugs) and how the drug provision (II-III line) with multi-antimicrobial therapy . It should be noted the role of another new antibiotic - cephalosporin Generation IV - Kate (tsefpirona) in the treatment of AS [10]. Our own experience of using this drug in the treatment of AS and nosocomial pneumonia can draw some conclusions. A wide range of Keita against Gram-positive aerobes and gram enables its effective priority application, but only in combination with antianaerobnym drug (metronidazole or clindamycin). Keith activity against enterococci makes it the drug of choice in the treatment of superinfections caused by these microorganisms. This is especially important after aminoglycoside therapy.
In addition, the antistaphylococcal action spectrum Keita (eg S.aureus and S.epidermidis) enables its effective use in the "catheter" sepsis - a common complication of sepsis of other origin [1]. As regards the application by Keith nosocomial brand viagra pneumonia, the treatment results of our 32 patients with evidence of its efficiency - in 31 patients the treatment was successful.
Describing this publication new antibiotics in the treatment of AS, we do not in any way diminish the importance of a relatively "old", already known antimicrobial agents. We believe that a rational approach to long-term and multi-stage treatment of the AU makes effective use of drugs of different groups.
In modern conditions, with full availability of high-tech pharmacological agents (but, unfortunately, limited financial resources), each clinic, dealing with emergency surgery, and planned, too, must have a "bank" of antibiotics, including: penicillins (including - unazin, tazotsin), cephalosporins (including - Mandola, klaforan, Fortum, tsefobid, Rocephin, Kate), carbapenems (especially Meron), aminoglycosides (tobramycin (nebtsin), amikacin, netromitsin) linkosamidy (including clindamycin ), fluoroquinolones (tarivid, pefloksatsina, ciprofloxacin), antifungal drugs (Diflucan, amphotericin B), etc.
Some remarks on the prevention of fungal colonization and pathological superinfection during prolonged antibiotic therapy. Unfortunately, recent years have revealed the lack of effectiveness in this regard polyene drugs (nystatin, levorin) [9, 15]. Very effective means of prevention was Diflucan (fluconazole) in a daily dose of 50-100 mg.
Numerous comparative studies show that the Diflucan and effectively prevents colonization of the fungi Candida, and better tolerated. Our clinical experience fully confirms these observations. Moreover, we have included an alternative mode of Diflucan in KFOR.
In conclusion, I would like to recall the words of AN Bakulev (spoken by about peritonitis): Optimization of treatment of abdominal sepsis is "still ageless problem surgery."
tactics
hormones
once a day
baroreflex activity
opposite effect
miércoles, 26 de enero de 2011
jueves, 20 de enero de 2011
First 6 days
Conclusion: The study on the treatment Loseke 40 mg iv, the drug was administered 3 hours before the start of the study. Notes the effective action of the drug for 15 hours, zones of acid production in pH> 4 observed 87% of time pH> 6-78% of the time. Period giperatsidnyh observed at the end of the drug lasting about 3 hours. In antral alkalinization compensation 69% of the time of the study.
It should be noted that hydrochloric brand viagra online acid and pepsin in the bleeding has developed to inhibit clot formation and cause lysis of already formed blood clots. Vascular-platelet hemostasis occurs only at pH ? 6. Therefore, the goal of antisecretory therapy in patients with HMC - to maintain pH ? 6 in the stomach for 80% of the time of day. We compared the nature of gastric secretion in patients with high risk of rebleeding against anisekretornoy therapy of H2-blockers and proton pump inhibitors (Figs. 4, 5).
Conclusion: The study on the treatment zantakom 40mg x 2 times / in the drug was administered at 19.00, giperatsidnyh celebrated throughout the night of the study period, in areas of acid production pH> 4 observed only 27.3% of the time studies, pH <6-86% of the time. Effect of the drug is ineffective.
As can be seen on the presented pH-grams, the use of proton pump inhibitors can maintain a pH> 6 in the stomach over 78% of the time of the study even after a single dose, and the generic viagra use of H2-blockers - no. It was probably connected with it a greater number of recurrences of gastrointestinal bleeding on the background of antisecretory therapy of H2-blockers in the period 1990-2000.
The number of recurrent hemorrhages in patients over age group during treatment with proton pump inhibitors was reduced in 2,5 times - 13 (28,3%) - compared to the time period 1990-2000. - 33 (61,7%) (Fig. 6).
It is believed that the recurrence of bleeding in elderly patients, firstly, associated with reduced elasticity of the vascular wall due to atherosclerosis, and secondly, on the nature of antisecretory therapy [45, 89; 166; 195]. In our study, these provisions have been confirmed: 8 out of 46 patients with recurrent bleeding was pronounced brand name levitra atherosclerosis, all of these ulcers were located in the body and subkardialnom of the stomach. 42 (68,8%) patients with recurrent bleeding received antisecretory therapy with injectable forms of N, - blockers and 19 (31.2%) had received antisecretory therapy with injectable forms of proton pump inhibitors.
Recurrence of bleeding ulcers in the stomach is an absolute indication for surgical treatment, all of rebleeding from gastric ulcers developed in the first three days of admission to the clinic and were associated with inadequate endoscopic hemostasis or misjudgment of the risk of rebleeding. If in 1990-2000. operated on 19 (76%) of patients with recurrent bleeding from duodenal ulcers, in 2001 - 2008. operated 4 (40%) of 10 patients. 6 patients treated conservatively. Rebleeding in all cases was stopped endoscopically. Patients were cialis without prescription assigned to inject the form of proton pump inhibitors.
Most critical for the occurrence of rebleeding from ulcers are the first 6 days of treatment, recurrence of bleeding during this time frame occurred in 44 (95%) of 46 patients. Rebleeding in the first three days in 10 elderly patients was associated with inadequate endoscopic hemostasis and initial misjudgment of the risk of rebleeding. Rebleeding in 4-day 6 was 34 patients. It should be noted that these days are critical for the treatment of ulcer bleeding, as it was at this time there is lysis of thrombus within a lesion [67, 96; 101]. Elderly patients with recurrent bleeding was associated with decompensation of comorbidity and the growth of OPA, which is associated with the reaction of the organism to blood loss. 23 of 34 elderly patients were operated. 11 patients in this group of rebleeding were associated with generic levitra inadequate antisecretory therapy, all patients received injectable forms of H2-blockers, they had changed the regime of antisecretory therapy and underwent endoscopic hemostasis. Outcome favorable repeated recurrence of bleeding was not.
help the body
thrombotic events
using diet
blood reaches
It should be noted that hydrochloric brand viagra online acid and pepsin in the bleeding has developed to inhibit clot formation and cause lysis of already formed blood clots. Vascular-platelet hemostasis occurs only at pH ? 6. Therefore, the goal of antisecretory therapy in patients with HMC - to maintain pH ? 6 in the stomach for 80% of the time of day. We compared the nature of gastric secretion in patients with high risk of rebleeding against anisekretornoy therapy of H2-blockers and proton pump inhibitors (Figs. 4, 5).
Conclusion: The study on the treatment zantakom 40mg x 2 times / in the drug was administered at 19.00, giperatsidnyh celebrated throughout the night of the study period, in areas of acid production pH> 4 observed only 27.3% of the time studies, pH <6-86% of the time. Effect of the drug is ineffective.
As can be seen on the presented pH-grams, the use of proton pump inhibitors can maintain a pH> 6 in the stomach over 78% of the time of the study even after a single dose, and the generic viagra use of H2-blockers - no. It was probably connected with it a greater number of recurrences of gastrointestinal bleeding on the background of antisecretory therapy of H2-blockers in the period 1990-2000.
The number of recurrent hemorrhages in patients over age group during treatment with proton pump inhibitors was reduced in 2,5 times - 13 (28,3%) - compared to the time period 1990-2000. - 33 (61,7%) (Fig. 6).
It is believed that the recurrence of bleeding in elderly patients, firstly, associated with reduced elasticity of the vascular wall due to atherosclerosis, and secondly, on the nature of antisecretory therapy [45, 89; 166; 195]. In our study, these provisions have been confirmed: 8 out of 46 patients with recurrent bleeding was pronounced brand name levitra atherosclerosis, all of these ulcers were located in the body and subkardialnom of the stomach. 42 (68,8%) patients with recurrent bleeding received antisecretory therapy with injectable forms of N, - blockers and 19 (31.2%) had received antisecretory therapy with injectable forms of proton pump inhibitors.
Recurrence of bleeding ulcers in the stomach is an absolute indication for surgical treatment, all of rebleeding from gastric ulcers developed in the first three days of admission to the clinic and were associated with inadequate endoscopic hemostasis or misjudgment of the risk of rebleeding. If in 1990-2000. operated on 19 (76%) of patients with recurrent bleeding from duodenal ulcers, in 2001 - 2008. operated 4 (40%) of 10 patients. 6 patients treated conservatively. Rebleeding in all cases was stopped endoscopically. Patients were cialis without prescription assigned to inject the form of proton pump inhibitors.
Most critical for the occurrence of rebleeding from ulcers are the first 6 days of treatment, recurrence of bleeding during this time frame occurred in 44 (95%) of 46 patients. Rebleeding in the first three days in 10 elderly patients was associated with inadequate endoscopic hemostasis and initial misjudgment of the risk of rebleeding. Rebleeding in 4-day 6 was 34 patients. It should be noted that these days are critical for the treatment of ulcer bleeding, as it was at this time there is lysis of thrombus within a lesion [67, 96; 101]. Elderly patients with recurrent bleeding was associated with decompensation of comorbidity and the growth of OPA, which is associated with the reaction of the organism to blood loss. 23 of 34 elderly patients were operated. 11 patients in this group of rebleeding were associated with generic levitra inadequate antisecretory therapy, all patients received injectable forms of H2-blockers, they had changed the regime of antisecretory therapy and underwent endoscopic hemostasis. Outcome favorable repeated recurrence of bleeding was not.
help the body
thrombotic events
using diet
blood reaches
domingo, 9 de enero de 2011
Cavernous fibrosis
Identification of the cavernous fibrosis presents no difficulties: the penis is sealed, its thickness is reduced. Virtually absent all kinds of erections, sometimes there is a deformation of the penis. Cavernous fibrosis of the penis - the process of sclerosis of the normal erectile tissue of penile fibrosis with complete or partial loss of erectile function.
Causes of cavernous fibrosis is a prolonged brand viagra abnormal erection, and inflammation of the cavernous bodies. Peyronie's disease is rarely the cause of cavernous fibrosis as a pathological process usually occurs in the tunica albuginea.
Two-stage prosthetic penis in cavernous fibrosis
Okolovenechnym access is carried out skeletization penis. Vascular grafts cut out along the length of the penis, the ends sutured tightly. Then, vascular grafts are fixed to the tunica albuginea in their distal and proximal to the lateral side of the cavernous bodies of the thread shed 3-0. Cavernous body is not opened. To create a layer of soft tissue between the skin of the penis and pay attention vascular grafts requires complex tissue transplantation. As a transplant using a free site rectus abdominis muscle. Adrectal incision exposed rectus sheath. Aponeurosis is opened and the medial portion of muscle is taken of such length and width, so that you can wrap the penis in the form of coupling. As the vascular pedicle is used inferior epigastric artery. After this section the muscles moving under the skin of the penis, through the established subcutaneous channel. Muscle is fixed to the distal part of penis on vascular prostheses.
The patient is released for 2-3 months for outpatient treatment. During this period there is some convincing test complete wound healing. In the absence of complications, the patient holds the second stage surgery - implantation of penile prostheses. Through an incision in the "root" of penile vascular grafts are opened and implanted them in semi-rigid prostheses. Vascular grafts and the skin sutured tightly over them without leaving graduates or drainages. Thus, vascular grafts, fixed from the outside to the cavernous bodies, imitate intrakavernoznye space and keep the rod prosthesis, preventing their migration. Soft-woven layer of the rectus abdominis muscle fragment prevents the formation of pressure sores and erosion of the skin over the prosthesis.
On the other hand, in the presence of latent infection in the cavernous bodies is possible to avoid the development of periproteznoy infection in the postoperative period due to the fact that the cavernous body remain intact.
Advantages of the method
The method of two-stage penile prosthesis for total cavernous fibrosis using a fragment of the rectus abdominis muscle on the axial blood flow allows, above all, to minimize postoperative complications associated with the development of periproteznoy infection, erosion of the skin over the prosthesis and its migration, which leads to inflammation and graft rejection. This is achieved by ensuring that the modified fibro-cavernous body remain intact, and in the case of inflammatory etiology of cavernous fibrosis (cavity) there is no activation focus dormant infection. Soft-woven layer of the rectus abdominis muscle fragment prevents the formation of pressure sores and erosion of the skin over the prosthesis.
Powerful effect
pre-eclampsia
Advanced age
Causes of cavernous fibrosis is a prolonged brand viagra abnormal erection, and inflammation of the cavernous bodies. Peyronie's disease is rarely the cause of cavernous fibrosis as a pathological process usually occurs in the tunica albuginea.
Two-stage prosthetic penis in cavernous fibrosis
Okolovenechnym access is carried out skeletization penis. Vascular grafts cut out along the length of the penis, the ends sutured tightly. Then, vascular grafts are fixed to the tunica albuginea in their distal and proximal to the lateral side of the cavernous bodies of the thread shed 3-0. Cavernous body is not opened. To create a layer of soft tissue between the skin of the penis and pay attention vascular grafts requires complex tissue transplantation. As a transplant using a free site rectus abdominis muscle. Adrectal incision exposed rectus sheath. Aponeurosis is opened and the medial portion of muscle is taken of such length and width, so that you can wrap the penis in the form of coupling. As the vascular pedicle is used inferior epigastric artery. After this section the muscles moving under the skin of the penis, through the established subcutaneous channel. Muscle is fixed to the distal part of penis on vascular prostheses.
The patient is released for 2-3 months for outpatient treatment. During this period there is some convincing test complete wound healing. In the absence of complications, the patient holds the second stage surgery - implantation of penile prostheses. Through an incision in the "root" of penile vascular grafts are opened and implanted them in semi-rigid prostheses. Vascular grafts and the skin sutured tightly over them without leaving graduates or drainages. Thus, vascular grafts, fixed from the outside to the cavernous bodies, imitate intrakavernoznye space and keep the rod prosthesis, preventing their migration. Soft-woven layer of the rectus abdominis muscle fragment prevents the formation of pressure sores and erosion of the skin over the prosthesis.
On the other hand, in the presence of latent infection in the cavernous bodies is possible to avoid the development of periproteznoy infection in the postoperative period due to the fact that the cavernous body remain intact.
Advantages of the method
The method of two-stage penile prosthesis for total cavernous fibrosis using a fragment of the rectus abdominis muscle on the axial blood flow allows, above all, to minimize postoperative complications associated with the development of periproteznoy infection, erosion of the skin over the prosthesis and its migration, which leads to inflammation and graft rejection. This is achieved by ensuring that the modified fibro-cavernous body remain intact, and in the case of inflammatory etiology of cavernous fibrosis (cavity) there is no activation focus dormant infection. Soft-woven layer of the rectus abdominis muscle fragment prevents the formation of pressure sores and erosion of the skin over the prosthesis.
Powerful effect
pre-eclampsia
Advanced age
domingo, 2 de enero de 2011
Women health
"Two years ago I was successfully treated by chlamydia. But now, with examination for pregnancy doctor again found chlamydia, and chronic. Is this disease curable?"
Valentin, K., Dedovsk
Responsible physician dermato Medical Center Diamed-clinics "Tatyana TORCHITSKAYA.
- Diseases, sexually transmitted diseases, which include chlamydia, in fact, treatable. And chronic brand name viagra forms they take only later finding out incorrect diagnosis and wrong, a random treatment.
- But how to find them, if the doctors themselves call them
The Invisible Disease?
- One must be very attentive to myself and to see a doctor at the slightest suspicion of infection. Especially if you do not have regular sexual partner. Most diseases occur without any symptoms and do not come when it is already developed complications. For example, the urogenital chlamydia often becomes a cause of female infertility. Ectopic pregnancy, miscarriage, intrauterine fetal infection - the cause of all these troubles is often detected late in the disease.
- That there should be surveyed even with thrush?
- Certainly. After all, it is not so harmless, as many women. Firstly, it can be combined with other urinary tract infections, particularly chlamydia. This is a sign that a woman has lowered immunity or have hormonal problems. The exact cause can only be set after the test is not only a gynecologist, and endocrinologist. Moreover, yeast can be transmitted sexually and by men and rarely - through the items of personal gigieny.Da to tell the truth - even syphilis sometimes goes unnoticed if the sores are not located on the outside and on the cervix. Some time later, a rash, which is too many take for an allergic. Many cases when it is revealed only when a random survey - such as pregnancy.
- How dangerous these infections?
- They are harmful to the health of women, because cause and pyelonephritis, and endometritis, adhesions, urinary incontinence, and that the worst - affect women safely carry and give birth to a healthy malysha.Poetomu any discomfort, redness, itching or rash should be a cause for Treatment in a good clinic. Desirable - in profile. Because such infections, and they, believe me, a great many, not always correctly defined, even by laboratory methods.
- And if you use the most accurate PCR diagnosis?
- Its accuracy is also not absolute, and depends heavily on what system is used tests. Affect the reliability and performance technique, and tools used by the doctor.
PCR-diagnostics detects the presence of DNA of a pathogen in blood smears. And for the investigation takes a superficial layer of cells lining the thickness of a strictly defined - nothing more and nothing less. After all, if a fence could damage the mucous and open the gates of infection.
In our centers for these purposes are used only disposable brush, Swiss, and Italian mirrors, comfortable, and for the physician and woman. Yes, and system tests - also the highest accuracy. Because of errors in diagnosis and practically does not exist.
Never need to save money on diagnostics. Especially when it comes to infections, sexually Viagra help with premature ejaculation transmitted diseases. They are too cunning of its "stealth" and grave consequences.
- Many women prefer to be treated yourself. Why is it dangerous?
- Desultory, chaotic treatment - not the best assistant in the struggle for health. Because it is unlikely to reach the goal. The process will go into a chronic, complications arise. After all, only a doctor can determine at what stage the disease, how the spectrum of microbes caused it and what organs affected. Usually need complex treatment includes physical therapy and immunotherapy, as well as a thorough local treatment. According to incomplete data, registered in the world each year to 89 million patients with urogenital chlamydial infection.
Fluorography
Exterior of a man
Valentin, K., Dedovsk
Responsible physician dermato Medical Center Diamed-clinics "Tatyana TORCHITSKAYA.
- Diseases, sexually transmitted diseases, which include chlamydia, in fact, treatable. And chronic brand name viagra forms they take only later finding out incorrect diagnosis and wrong, a random treatment.
- But how to find them, if the doctors themselves call them
The Invisible Disease?
- One must be very attentive to myself and to see a doctor at the slightest suspicion of infection. Especially if you do not have regular sexual partner. Most diseases occur without any symptoms and do not come when it is already developed complications. For example, the urogenital chlamydia often becomes a cause of female infertility. Ectopic pregnancy, miscarriage, intrauterine fetal infection - the cause of all these troubles is often detected late in the disease.
- That there should be surveyed even with thrush?
- Certainly. After all, it is not so harmless, as many women. Firstly, it can be combined with other urinary tract infections, particularly chlamydia. This is a sign that a woman has lowered immunity or have hormonal problems. The exact cause can only be set after the test is not only a gynecologist, and endocrinologist. Moreover, yeast can be transmitted sexually and by men and rarely - through the items of personal gigieny.Da to tell the truth - even syphilis sometimes goes unnoticed if the sores are not located on the outside and on the cervix. Some time later, a rash, which is too many take for an allergic. Many cases when it is revealed only when a random survey - such as pregnancy.
- How dangerous these infections?
- They are harmful to the health of women, because cause and pyelonephritis, and endometritis, adhesions, urinary incontinence, and that the worst - affect women safely carry and give birth to a healthy malysha.Poetomu any discomfort, redness, itching or rash should be a cause for Treatment in a good clinic. Desirable - in profile. Because such infections, and they, believe me, a great many, not always correctly defined, even by laboratory methods.
- And if you use the most accurate PCR diagnosis?
- Its accuracy is also not absolute, and depends heavily on what system is used tests. Affect the reliability and performance technique, and tools used by the doctor.
PCR-diagnostics detects the presence of DNA of a pathogen in blood smears. And for the investigation takes a superficial layer of cells lining the thickness of a strictly defined - nothing more and nothing less. After all, if a fence could damage the mucous and open the gates of infection.
In our centers for these purposes are used only disposable brush, Swiss, and Italian mirrors, comfortable, and for the physician and woman. Yes, and system tests - also the highest accuracy. Because of errors in diagnosis and practically does not exist.
Never need to save money on diagnostics. Especially when it comes to infections, sexually Viagra help with premature ejaculation transmitted diseases. They are too cunning of its "stealth" and grave consequences.
- Many women prefer to be treated yourself. Why is it dangerous?
- Desultory, chaotic treatment - not the best assistant in the struggle for health. Because it is unlikely to reach the goal. The process will go into a chronic, complications arise. After all, only a doctor can determine at what stage the disease, how the spectrum of microbes caused it and what organs affected. Usually need complex treatment includes physical therapy and immunotherapy, as well as a thorough local treatment. According to incomplete data, registered in the world each year to 89 million patients with urogenital chlamydial infection.
Fluorography
Exterior of a man
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