Mittwoch, 26. Januar 2011

Endogenous mechanism

Place of somatostatin in the treatment of AS is determined by its main pharmacodynamic properties, which include:

1. suppression of secretion of acid and pepsin in the stomach (prevention of stress ulcers);
2. suppression of secretion of pancreatic function (prevention of pancreatic necrosis);
3. suppression of release of gastrointestinal hormones tissue;
4. reduction of pressure in the portal venous system;
5. tsitokinogeneza blockade.

Not being able to dwell in detail on other aspects of treatment of intestinal insufficiency syndrome, we stress that its success is impossible without adequate metabolic support and optimal oxygen transport - as an integral and splanhnicheskogo.

3. Antibacterial Therapy

Antibacterial therapy for the AU in its essence plays the same role as the cessation of bleeding in hemorrhagic shock. Of course, the antimicrobial agents do not affect the running mechanism of the systemic inflammatory response and explosive mediatoza. The problem of antibiotic therapy - etiotropic direction, blocking the systemic inflammatory cascade at the level of its exogenous microbial mediators. It is therefore ineffective antibiotic therapy 2 times increased mortality in the AU [7.16].

As shown by studies conducted in our clinic, inadequate antimicrobial therapy has a large pharmaco-economic value - increasing the cost of drug treatment by 89% and the total cost of hospital treatment increased by more than 30%.

Antibiotic therapy may be ineffective due to various circumstances.

After analyzing the reasons for failure of antibacterial therapy, we rubrifitsirovali them as follows:

1. Antibiotics have no effect on pathogens.

II. Lack of bioavailability of drugs at the source of infection and local dissemination of microorganisms.

III. Development side and toxic effects with antimicrobial agents.

In group 1 the causes of failures of particular importance is the fact that antibiotics are often prescribed without mandatory polymicrobial etiology of AS involving aerobes and anaerobes, focusing on incorrect data bacteriological studies, including those associated with the phenomenon of cultural resistance. Plays an important role and change of priority agents in the treatment of the AU and the development of antibiotic resistance during treatment. Appropriate to emphasize the clinical significance of enterococcal superinfection on the background of the original effective therapy AU aminoglycosides, cephalosporins, fluoroquinolones.

With regard to the development of resistance, our brand viagra studies have shown different frequency of this phenomenon during treatment with penicillins, cephalosporins, imipinema, fluoroquinolones and aminoglycosides: for semisynthetic penicillins, it is 9,2%; cephalosporins II-III generation - 8,6%; imipinema - 4 , 7%, ciprofloxacin - 11.8%; aminoglycosides generation III - 13,4%.

Failure of therapy may be related to the inclusion of an endogenous mechanism of translocation of bacteria and development of alternative foci of infection such as nosocomial pneumonia in patients with peritonitis. This circumstance, first, expanding and changing range of priority pathogens of sepsis, and secondly, the impact on the delivery of antibiotics in the foci of infection. Established that the fractional penetration of antibacterial drugs in different anatomical areas is significantly different, and this leads to a significant reduction in the effective bactericidal concentration at the source of infection [17].

Group II causes of failures due to lack of bioavailability of drugs at the source of infection. This may be due to:
1) the wrong mode of introducing drugs without regard to their kinetic properties;
2) changes in pharmacokinetics under the influence of fluid therapy, forced diuresis and syndrome of capillary leak, the use of extracorporeal detoxification;
3) lack of transport proteins (albumin);
4) violation of the systemic and regional blood flow, especially in the foci of infection;
5) formation of a protective "traps" for microbes (units, microthrombi, protein deposits).

The latter circumstance has played a leading role in the emergence against the background of the AU angiogenic foci of infection that is resistant to the ongoing antibiotic therapy.

Finally, III group of failures related to the toxic effects of antibiotics, exacerbating multiple organ failure characteristic of the AU. Unfortunately, antibiotics have a greater or lesser degree of side effects and organotoksichnostyu. Neither a clinical situation does not create more problems when choosing the most effective and most toxic antibiotic therapy than is the case in the surgical, in particular, abdominal sepsis.

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Donnerstag, 20. Januar 2011

Bleeding

At the present stage reduces the number of operations in ulcerative brand viagra online gastro-intestinal bleeding. The emergence of modern antisecretory farmakopreparatov and widespread implementation of endoscopic and endovascular methods of hemostasis has led to a decrease in the number of urgent surgical intervention in patients with high risk of rebleeding in 4 times. Decreased by 10 times the number of such minimal operations for ulcer bleeding, as suturing wounds. They do not give the expected hemostatic effect and are accompanied by high mortality. Modified surgical approach in elderly patients has led to a decrease in postoperative mortality from 15.8 to 5.8% and overall mortality from 15.8 to 9.6%.

Key words: peptic ulcer; elderly; gastrointestinal bleeding.
SUMMARY

At the present stage the number of operations is reduced at a ulcer gastroenteric bleeding. Occurrence modern antysecretor drags and wide introduction endoscopic and endovascular methods of hemostasis has led to decrease of urgent operative interventions in group of patients with high risk of rebleeding in 4 times. The number of such minimal operations was reduced in 10 times. They do not give expected hemostasis effect and are accompanied high mortality. Change of surgical tactics at elderly patients has led to decrease postoperative mortality from 15,8 up to 5,8% and the general mortality from 15,8 up to 9,6%.

Keywords: peptic generic viagra ulcer disease; advanced age; gastrointestinal bleeding.

For many years, diagnosis and treatment of peptic ulcer disease remains an urgent medical problems. The most frequent complication of peptic ulcer disease is gastrointestinal bleeding, in recent decades have seen an increase in the frequency of ulcers of gastrointestinal bleeding in the older age group to 48% compared to 2% in the seventies of last century. This is due to concomitant diseases and uncontrolled intake of aspirin or nonsteroidal anti-inflammatory drug (NSAID) elderly patients. According to statistics, in Russia at the end of XX century, pensioners made up about 21% of the population and 14-40% - in the structure of peptic ulcer disease. Results of treatment of complications of peptic ulcer in the elderly provide the highest mortality, gastrointestinal bleeding and 59% higher than in 3 or more of these indicators in young patients [1, 2, 3].

In recent decades, reviewed the issue of treatment of complicated forms of peptic ulcer in the direction of more conservative methods, such a tactic is particularly true in brand name levitra elderly patients.

Currently the world reducing the number of operations in ulcerative gastro-intestinal bleeding [4, 5, 6]. This is due to the progress of pharmacotherapy of peptic ulcer and the widespread introduction of endoscopic and endovascular stop bleeding ulcer. According to Alexander S. Ermolov, marked reduction of total mortality in the treatment of gastroduodenal hemorrhage in the clinics of Moscow, where operational activity cialis without prescription decreased from 24 to 17%, while the minimum mortality rate - 5.7% - says the clinics where operational activity does not exceed 10 %. [2]
MATERIAL AND METHODS

During the period 1990-2008. in the Clinical Hospital № 15 named. M. Filatov, Moscow treated 999 patients over 60 years with ulcerative gastro-intestinal bleeding. Of them operated only 197 (19,7%). Most elderly patients - 802 (80,3%) - were treated conservatively.

We adhere to the individually-differentiated strategy in patients with ulcerative gastro-intestinal bleeding.

All the patients with the clinic of gastrointestinal bleeding on admission performed emergency endoscopy with active interventions to stop the continuous bleeding or generic levitra prevent its recurrence. When continuous bleeding is carried out endoscopic hemostasis, which includes all available clinical methods: obkalyvanie alcohol-novocaine mixture, electrocoagulation, laser coagulation, radiokoagulyatsiyu apparatus "Surgitron.

In the absence of active bleeding at the time of the inspection is performed endoscopic prevention of rebleeding and evaluation of rebleeding in the light of clinical and endoscopic criteria for the classification of A. Forrest. While maintaining high clinical and endoscopic rebleeding after day after endoscopic therapy raises the question of urgent surgical treatment. In case of failure of endoscopic manipulation of patients treated in the emergency order.

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Sonntag, 9. Januar 2011

Circumcision

American corn magnate John Harvey Kellogg (the manufacturer of Kellogg's Corn Flakes) in late XIXveka decided to deal with masturbation. Being an influential politician, he has created in society "antimasturbatsionnuyu hysteria." How Were the doctors of that time, carried away by ideas of Kellogg, "the results of self-satisfaction may be the depletion of orgaznizma, paralysis and heart disease. Some masturbation causes lose one's mind, while others commit suicide »(Mary R. Melendy, MD, The Ideal Woman - For Maidens, Wives and Mothers, 1903).

Protect boys from the terrible consequences of Kellogg decided to surgically - cutting the foreskin. "To achieve good results, we can only remove large amounts of skin and mucous membranes of the penis. Then, after the surgical wounds healed, the skin will viagra can not at all sit tight on the penis ... that significantly restrict masturbation or even eradicate it. "

As stated by Kellogg himself, "a remedy for masturbation which is almost always helps - it's circumcision in infancy. Moreover, the operation should be performed without anesthesia to the pain accompanying the intervention affected the psyche. Well, if it is connected also with the idea of punishment. Women have to deal with the perverted forms of pleasure helps burning the clitoris carbolic acid. "

Paradoxical ideas Kellogg surprisingly quickly brand viagra adopted the American doctors. Moreover, circumcision in infancy has become popular in other English-speaking countries. If in Europe, this practice quickly abandoned in America circumcision is doing so far. Struggling not only with masturbation, and disease: doctors more than a hundred years by the information about the benefits of circumcision with new scientific evidence, and ordinary Americans continue to pay for "necessary" procedure.

Circumcision - an ancient rite that came to many cultures from ancient Egypt. This procedure is still experienced by children from Islamic or Jewish families. Of course, it is done with adequate anesthesia, and no one tries to call a child a sense of guilt.

Talking about the need for this ritual - a thankless job. But to understand the feasibility of mass circumcision "for medical reasons" decided to Australian researchers. Their results were published in the issue of the journal Sexually Transmitted Infections.

Circumcision and health

By the end of the 1970's in the U.S. and Europe have developed two doctors' lobby. Some have argued that circumcision - a good means of preventing infections and cancer, while others talked about the complications, which leads the procedure.

Medical benefits of circumcision is that the penis does not remain "pockets" that stores a variety of viruses and bacteria. This not only reduces the frequency of urinary infections, but the incidence of cervical cancer in women who have sex with circumcised men. In those encounters is greatly reduced likelihood of transmission of human papilloma virus that causes cancer. Male circumcision also saves you from cancer of the penis.

In addition, as Americans felt, circumcision can save 90% of funds spent for treatment of urinary infections in boys.

Meanwhile, opponents of circumcision believe that all this money will go to fight the complications of the procedure. Among them are the most common bleeding and infection of the wound. Sometimes complications end reoperation, including - amputation of the penis. In addition, this surgical procedure affects the nerves responsible for the sensitivity of the male genital organs.

In Africa, where circumcision of infants treated not only as a ritual, but also a means of preventing HIV infection rates are not reduced. In real conditions of developing countries the virus can Record the doctors themselves.

At the same time for circumcision are "absolute" medical testimony. One can argue about whether or not to remove healthy tissue. However, if the foreskin is damaged - the operation of circumcision is virtually no alternative method of treatment.

Circumcision and psyche

Because babies do not operate under general anesthesia, circumcision is painful for them and can hurt the psyche of the child. As a result of growing popular in the present state - post-traumatic stress disorder, which pursues the men throughout their lives.

At the same time, the doctors performing circumcision, are constantly improving this process and each year it becomes less painful. Along with the pain is reduced and the likelihood of mental trauma.

According to some scientists, in addition to psihotravmy circumcision leads to low self-esteem, unnecessary anger, or depression. Their negative emotions then men vent on others: the most likely father, has undergone circumcision, wants to make it to his son. For the same reason doctors have passed such a procedure would be during his practice to prove its benefit to all patients. That's why circumcision, once becoming a tradition that does not leave society for a long time.

Circumcision and sexuality

Circumcision, traumatizing the nerves of the penis, decreases its sensitivity. However, surgical techniques are improving all the time, and such injuries are minor.

According to researchers, male circumcision have been subjected to sexual problems still arise from the immobility of the skin of the penis.

According to some reports, male circumcision affects the sexual life of women: with a partner they have an orgasm occurs much less frequently. However, the results of other studies suggest that men circumcised in infancy, better than any other master the technique of sex.

Social effects

As the Australians selected publications, circumcised men were more likely to become drug addicts and alcoholics. Violations of the sexual sphere leads to the fact that they are less likely to marry. Moreover, such people are prone to violence, theft, and suicide.

Proponents of circumcision may rightly argue that the relationship of circumcision to all social problems is not proven, but their cause could be anything.

Ethical aspects

Violation of the viagra prolong intercourse rights of individuals now can be called anything. And, of course, there were those who questioned the right of parents to circumcise their children.

Given the right to freedom of religion in the UK found a kind of compromise: a doctor may refuse such an operation, if it considers this a violation of child rights. In turn, no one will blame the parents if they go to another surgeon.

In countries where circumcision is not common, have been cases where children accused their parents of "irreversible surgical change of healthy genitalia. As the Australians, the court acknowledged the parents' guilt.

Public opinion

While some countries abandon circumcision, others are going to make the practice popular. In Botswana, for mass circumcision are ready and doctors and ordinary people.

Apparently, the debate about whether such a procedure does not subside for a long time: the two sides will emerge all the new arguments.

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Sonntag, 2. Januar 2011

Our schemes

A new method of treating hepatitis tells PhD, CEO of the Moscow Institute of metabolic therapy Vladislav E. Pearls.


- What's new in the fight against hepatitis B?

- First of all - protected by patents regimen of viral hepatitis and urogenital infections. These include new drugs, called metabolic immunocorrectors. These drugs are transferred to the metabolism of our own cells to a higher energy level. As a result, they are better protected against infection. The second effect of these drugs is that they cause the death of damaged cells, for example, contain hepatitis viruses.

We are also witnessing the end of the virus, "banished" from the body. We have brand name viagra patients in whom it does not appear for more than a year. Statistics is that of the 100 patients treated by our methods of patients over 80 can not detect the virus with the most modern and sensitive methods. This method of treatment in the world today do not. - So, there was a cure-all viruses?

- It is impossible to say. Treatment of hepatitis - is complex. Most of our schemes include drugs, started in St. Petersburg, Professor LA Kozhemyakin. Chief among them - Glutoxim. He makes a very successful treatment of many infections, enhancing your own body's defenses. It is clear that we can not do drugs or vaccines from each bacterium or virus - their billions. The most productive, direct and cheap way - is to help the body of each individual to resist infection.

- In recent years, but has long studied the hepatitis A new science became known hepatitis viruses. How do you get them? - This is the so-called blood hepatitis. These pathogens are transmitted through blood or discharge associated with blood: lymph and other fluids. This hepatitis viruses B, C, D and G. The most common hepatitis B in recent years - S.

Hepatitis D, usually happens with in itself is rare. Incidence of hepatitis G in average 5-6% of hepatitis B and C. But they are equally dangerous and cause chronic diseases associated with changes in the liver. This leads eventually to dysfunction and cirrhosis of the liver. The perfidy of these diseases is that before the critical moment when the liver is almost nothing left, people do not feel if you do not fall into an extreme situation, when eaten, such as fatty pilaf cauldron or drink two bottles of vodka. Then, liver function rapidly asserting itself. The rest of the people live, suspecting nothing, although it can infect others.

- How?

- To become infected with hepatitis C, is sufficient to obtain mikrossadinu or hairline with separation of the lymph or blood. It could be some exotic or very active forms of sex. Very often, infected by a woman suffering from hepatitis, occurs either at the beginning of the month, or "the tail" when it is not clear if there are any monthly or no longer exists. Here is the blood carries the virus. Method of prophylaxis in this case - a condom. Another method of infection - the use of common razors, manicure sets, scissors. One of the most common ways - is the medical associated with blood transfusions, operations, dental treatment.

Often the virus is transmitted and the introduction of drugs. - Pregnancy is also one way of contracting the unborn child? - Infection of the fetus through the placenta - an extremely rare event. Nevertheless, the best before scheduling a child - is a comprehensive survey of the prospective parents. Parents themselves view of normal men should be more attentive to their children. Occasionally, hepatitis A, for example, may have a form of bluetongue type of sore throat or cold. Others are often under the guise of intestinal infections of unknown etiology, icteric forms are only a few percent. Regarding the "blood" of hepatitis, the first signs of illness - fatigue, weakness, loss of appetite and weight loss, discomfort in the liver. And when will light stools or dark urine - this is a serious reason for clinic visits.

- Does the sale of your use drugs?

- Yes, they've come to the pharmacy. But they should not be treated independently, since intervention in the immune system without taking into account all the characteristics of the patient can lead to unpredictable consequences. Immune system, among other things, not only fights infections but also destroys their own modified cells, eg tumor. She is also responsible for the mechanism of aging. Therefore, any intervention immunoactive drugs, including glutoxim, possible only after consulting your doctor.

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