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Biomedical subjects

A A Fokin

Publications and source records attributed to A A Fokin.

At least 19 recordsLinked to original sources
PubMed2000

Inhibition of needlestick-induced simulated viremia by local measures.

BACKGROUND: The possibility of confinement of simulated retrovirus to the inoculation site after needlestick injuries to enhance chances of local intervention and function of lymphaticovenous communications was investigated. METHODS: Using the canine model, technetium-99 m sulfur colloid particles were injected subcutaneously and into the vein and lymphatics. Blood and lymph were collected at a higher level from the femoral vein and the major lymphatic. Flow rates, particle arrival times, concentrations, and other variables were evaluated for 45 minutes by gamma counting. A tourniquet was used to slow dissemination after subcutaneous injection. RESULTS: After subcutaneous inoculation, particles arrived in the blood at 2.81 +/- 0.54 minutes and in the lymph at 6.0 +/- 1.47 minutes. Application of a tourniquet delayed appearance in the blood to 7.11 +/- 1.5 minutes and in the lymph to 40.0 +/- 5.1 minutes. Concentration of particles in lymph was 1,000 times higher than in the blood. Flux values were comparable in both pathways, but accumulation patterns were different. After intravenous injection, particles arrived in lymph at 25.4 +/- 6.44 minutes. After intralymphatic injection particles arrived in the blood within 4 seconds. CONCLUSIONS: There are functional lymphaticovenous communications at the peripheral level. The period between virus inoculation and blood and lymph invasion may be extended by application of a tourniquet; therefore, time could be gained for local intervention.

Animals↗
PubMed2000

Accidental injuries by HIV-contaminated instruments in health provider or research environments: can seroconversion be prevented?

The rate of seroconversion from percutaneous needlestick exposure to HIV infection is approximately 0.3 per cent. To investigate the possibility of local confinement of HIV, 100 to 200 nm Tc-99m sulfur colloid particles were injected in the canine model subcutaneously at the knee level and collected proximally at the groin from the cannulated femoral vein and lymphatic channel. Tourniquet compression (250 mm Hg) was used as an intervention to possibly restrict particle spread. It was found that particles arrived in the blood at 2.81 +/- 0.54 minutes, with later arrival in the lymph at 6.0 +/- 1.47 minutes. Tourniquet application delayed the appearance of the particulate matter in the blood up to 7.11 +/- 1.5 minutes and in lymph up to 40.0 +/- 5.10 minutes. The concentration of radioactivity in the lymph was higher than in the venous blood. The distribution of the particles reflected by flux was comparable in both pathways. The accumulation curves did not reach plateaus during 45 minutes in lymph and 15 minutes in blood. Radioactive scanning revealed that about 90 per cent of the injected particles remained locally with gradual release for at least 45 minutes. Our results suggest that HIV, introduced by needlestick injury, can be contained for possible viricidal treatment if the response includes rapid immobilization and tourniquet of the area.

Analysis of Variance↗
PubMed2000

Cleft sternum and sternal foramen.

Cleft sternum is a rare congenital defect of the anterior chest wall and is the result of a failed midline fusion of the sternum. Depending on the degree of separation, there are complete and incomplete forms. Its clinical significance is that it leaves the heart and great vessels unprotected. Association with craniofacial hemangiomas and omphalocele is common. Prenatal diagnosis by ultrasonography is possible. Surgical correction should be performed during the neonatal period when the direct suturing of the sternal halves is possible and the thorax can accommodate the thoracic viscera. At an older age, surgical repair is feasible, but it may require additional measures, such as sliding chondrotomies of the adjacent costal cartilages and notching of the sternal bars, to facilitate the approximation. Lung herniation at the base of the neck should be corrected by uniting the cervical muscles. The first postoperative day is the most critical because of acute reduction of the mediastinal space. Long-term results are satisfactory. Sternal foramen is a congenital oval defect at the lower third of the sternum that is asymptomatic and could be detected by CT scanning. The awareness of the anomaly is important in acupuncture practice because of the danger of heart damage.

Abnormalities, Multiple↗
PubMed2000

Pouter pigeon breast.

Pouter pigeon breast is a rare congenital deformity of the chest characterized by a protrusion of the manubriosternal junction and premature sternal ossification. The adjacent costal cartilages, usually from the second to fifth, also protrude. One third of the patients with pouter pigeon breast presented with concomitant depression of the lower third of the sternum. Several cardiovascular abnormalities have been associated with premature sternal ossification, with ventricular septal defect being the most common. All patients with pouter pigeon breast should undergo echocardiography in search of occult cardiac lesions. The measurement of the angle of Louis on lateral chest radiograms allows the objective assessment of the deformity and appreciation of the sternal fusion. Surgical correction includes the wide wedge transverse sternotomy at the angle of Louis and subperichondrial resection of the adjacent costal cartilages. When the deformity is part of a syndrome or in cases of severe depression of the lower sternum, we recommend the technique using Marlex mesh support as described by Robicsek. Preferable age for repair is 5 to 7 years old. Long-term outcomes are encouraging.

Humans↗
PubMed2000

Propagation of viral-size particles in lymph and blood after subcutaneous inoculation.

OBJECTIVE: We investigated the propagation of viral-size particles by lymph and blood after subcutaneous injection. METHODS: In the canine model, transport of [99mTc] sulfur colloid particles of different sizes was studied in different settings in venous blood and lymph for 45 minutes after inoculation. RESULTS: The mean arrival time of particles in the blood was 2.10+/-0.46 minutes and 8.87+/-1.72 minutes in the lymph. Lymph flow in the canine leg was 28.79 +/-2.09) microl/min and was increased by leg massage. The particle concentration was 1000 times higher in the lymph fluid than in blood. Particle flux values were comparable in blood and lymph. The accumulation of particles in blood initially rose faster than in lymph. Accumulation in lymph rises slower but continues longer and reaches higher values. Ninety percent of the inoculum remains at the injection site for at least 45 minutes. Particle size matters more in blood distribution. Leg massage enhances particle transport by lymph. CONCLUSIONS: After subcutaneous injection, viral-size particles initially arrive in the blood and later in the lymph. Accumulation in lymph and blood increases for a prolonged time after inoculation. Results suggest possibilities for limiting the spread of infectious matter by early local antiviral treatment.

Animals↗
PubMed1999

[The diagnosis and surgical treatment of neck wounds].

The authors share their experiences with treatment of wounds of the neck in 210 patients. Major vessels were injured in 85 of them (40.5%), arterial vessels being injured in 19 patients, venous vessels in 23 patients. 43 patients had wounds of the hollow, parenchymatous organs and nerves. All the patients with wounds of the hollow and parenchymatous organs recovered. Lethality among the patients with wounds of the major vessels was 11.9% and was due to a combination of injuries of the vessels and blood loss incompatible with life. Active surgical treatment of penetrating wounds of the neck with careful revision of the wound, use of emergency esophagogastroduodenoscopy, laryngotracheobronchoscopy, X-ray examination allow the amount of diagnostic errors and lethality to be reduced.

Adolescent↗
PubMed1995

[Use of cava-filter in the treatment of acute venous thrombosis in the end of pregnancy].

Cava-filters were implanted in 16 women suffering from acute thrombosis of the deep veins of the lower limbs in the third gestation trimester. Initial or relapsing thromboembolism of the pulmonary artery (TEPA) had place in 5 cases. Two types of filters were used, the REPTEPA ones being used more frequently. As a rule, a filter was implanted in the infrarenal segment of vena cava inferior. Complications occurred in two patients: perforation of right atrial wall and thrombosis of the filter. Pregnancy ended in delivery in all the cases, cesarean section was made in the majority of patients. No TEPA was recorded from the moment of cava-filter implantation. In remote period 15 women developed moderately expressed postthrombotic syndrome.

Adolescent↗
PubMed1991

[Surgical tactics in occlusive lesions of the brachiocephalic and coronary arteries].

Surgical management of combined arterial occlusions is a difficult problem. Combined lesions of the coronary arteries and brachiocephalic trunk are marked by significant mutual aggravation. The authors examined 48 patients with this pathological condition in the last 4 years, 32 of them underwent restorative surgical interventions. The direct effect was positive in 87% of patients. Four patients died after the operation. Comparative evaluation of the late-term results was carried out by the actuarial method. The authors believe a stage-by-stage character of the intervention to be expedient, except for cases of one-stage critical ischemia carried out simultaneously in two arterial channels and the possibility of simultaneous reconstruction of the sternotomy approach.

Arterial Occlusive Diseases↗
PubMed1991

[Replacement of infected vascular prosthesis by the femoral vein].

The article discusses restorative treatment of 12 patients with an infected prosthesis in the inguinal region after aortobifemoral, unilateral common iliofemoral, and submusculofemoral shunting. The infected segment of the prosthesis was removed 9 days to 5 weeks after the first operation by cutting it in tissues which were not involved in inflammation. The lacking segment of the shunt was replaced by the patient's femoral vein which was drawn through the infected wound. In 11 patients the wound in the inguinal region healed with maintained patency of the shunt. In 2 patients the extremity was amputated. Marked temporary venous insufficiency was encountered in one case.

Adult↗
PubMed1991

[Revascularization of avascular spongy bone].

There have been studied the state of blood circulation in proximal parts of femur of 24 dogs (48 hip joints with simulated aseptic necrosis). In the first group of joints there have been carried out revascularization of the head by caudal epigastric artery with commitant veins. The second group have been subjected to tunneling. The third group of joints served as a control. Microcirculation disturbances, ascertained by intraosseous contrast phlebography arteriography and microscopic examination of osseous tissue, indicated that aseptic necrosis of the head of femur in an experiment is accompanied by increased intraosseous pressure, revascularization of an avascular spongy bone causes stable normalization of intraosseous hemodynamics.

Angiography↗
PubMed1991

[Surgical correction of congenital heart defects in infants and young children].

The results of surgical treatment of congenital heart diseases in 595 children under 3 years of age are generalized. There were no fatal outcomes after correction of coarctation of the aorta (9 cases), patent ductus arteriosus (312), pulmonary and aortic stenoses (7). Among 62 patients who underwent removal of an atrial septal defect 3 (4.8%) died. Operations were performed on 140 patients for a ventricular septal defect with high pulmonary hypertension, 31 (22.1%) of them died from various causes. Operations for complicated heart diseases were acts of despair in children whose condition was critical.

Age Factors↗
PubMed1991

[Firearm wounds of the limbs].

In the article is analyzed treatment of firearm wounds of limbs in 161 victim. After antishock measures and primary surgical treatment with observation of its all elements, including application of delayed and tension sutures (31), the primary healing of wounds has been observed with 71, secondary--with 61, suppuration--with 23 and osteomyelitis--with 17 persons. 5 patients have been subjected to amputation of lower limb. 125 (77.5%) patients recovered and 33 (20.5%) became invalids. 3 patients have died. Successful treatment of these victims depends not only upon specialized but upon timely aid at pre-hospital stage as well. Sound primary surgical treatment of wounds is decisive measure in the prophylaxis of wound infection, the method of choice to immobilize a limb after operation is a liningless plaster bandage or skeletal traction in combination with plaster immobilization.

Adolescent↗
PubMed1991

[Freezing an acutely necrotized extremity for the purpose of preparing the patient for amputation].

102 patients of a high operative risk were prepared for amputation of a lower extremity with acute ischemic gangrene by its freezing and tourniquet application. A special portable freezing chamber was used in most cases which could be installed in any surgical hospital. The refrigeration ranged from 18 hours to 14 days. Purposeful intensive treatment of all disorders suffered by the patient was conducted at the same time. In 92 patients the condition improved and the extremity was amputated. As compared to the control group, the postoperative mortality due to refrigeration reduced from 41 to 18.4%. The method was found to be highly effective in cases with gangrene and diabetes mellitus.

Adult↗
PubMed1990

[The effectiveness of G. A. Ilizarov's method in treating patients with III- and IV-stage chronic ischemia of the lower extremities].

The method of treatment after Ilizarov was used in 28 patients with occlusion of lower extremity arteries, mainly of distal localization, with the III and IV degrees of ischemia. Osteotomy of mainly the tibial bone and distraction of the free osseous split was performed during 31-36 days. Two patients had fractures of the bone during operative interventions, after operation four patients had purulent complications or necrosis of the skin around the wire. The immediate positive result was noted in 20 patients. Their fate was followed-up in remote periods from 2 to 19 months, good results were observed in 18 patients. The use of the Ilizarov method was most justified in patients with the III and IV degrees of ischemia when other methods of treatment failed to give any effect and surgical reconstruction of the vessels is impossible. When treating patients with the IV degree, it is necessary to take into consideration the late appearance of revascularization and possibility of temporary deterioration. The use of the Ilizarov method foresees provision of the joint work of an angiosurgeon and a traumatologist-orthopedist.

Adult↗