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Biomedical subjects

A F Chernousov

Publications and source records attributed to A F Chernousov.

At least 19 recordsLinked to original sources
PubMed2006

[Early cancer of stomach].

Results of surgical treatment of 170 patients with early cancer of the stomach are analyzed. There were 113 patients with tumor invasion within the bounds of the mucous membrane (m -- 113), the others had invasion within the bounds of the submucous membrane (sm -- 57 patients). Impressed and ulcered macroscopic types of early cancer (IIc + III) were diagnosed most often: 57% m+sm (97 of 170), 58.4% m+sm (97 of 170), 54.4% sm (31 of 57), respectively. Poorly differentiated tumors prevailed over moderate- and well-differentiated tumors - 68.8% (117 of 170) and 31.2 (53 of 170) patients, respectively. Subtotal distal resection of the stomach has been performed in 118 (69,4%) patients, subtotal proximal resection -- in 13 (7.7%), gastrectomy -- in 22 (12.9%), resection of 2/3 stomach -- in 14 (8.2%), resection of the cardia - in 3 (1,8%). Lymphadenectomy has been performed in 156 patients including 1 (0.6%) patient with D0-lymphadenectomy, 88 (56.4%) - D1, 62 (39.7%) -- D2, and 5 (3.2%) -- D3. Metastases to the regional lymph nodes have been revealed in 8 (5%) cases -- 2 m and 6 sm. Extended lymphodissections (D2 and D3) have improved significantly long-term results. Five-year survival among the patients who had undergone extended operations with D2 and D3 lymphadenectomies was higher compared with patients after limited and standard operations (D0 and D1) -- 96.0+/-2.5 and 87.0+/-3.5%, respectively.

Adult↗
PubMed2006

[Endoscopic hemostasis of erosive-ulcerous gastroduodenal bleeding with fibrin glue at critically ill patients].

Experience of endoscopic hemostasis of acute erosive-ulcerous gastroduodenal bleeding with fibrin glue at critically ill patients is described. This glue is adhesive substance based on high-concentrated solution of fibrinogen (concentration of protein not less 60 g/l). Application of adhesive permitted to stop the bleeding at 84 of 87 extremely seriously ill patients (mean point according to APACHE--II scale was 19.5+/-0.9). Prolonged endoscopic control with repeated application of adhesive permitted to avoid bleeding clinical recurrences, to stop repeatedly with endoscopy 4 of 6 recurrent bleedings, to avoid forced surgery at 80 of these patients. Adhesive accelerated significantly the healing of ulcers despite of hypoxic injury of mucosa. Endoscopic hemostasis permitted to avoid forced surgical aggression, to improve treatment results and to decrease lethality at critically ill patients.

Adolescent↗
PubMed2006

[Experience in fibrin glue application for the treatment of non-formed fistulas of the gastrointestinal tract].

Fibrin glue was used for conservative closure of non-formed fistulas of the gastrointestinal tract in 38 patients. The variant of fibrin glue produced with cryoprecipitation (concentration of coagulant protein not less than 60 g/l) was applied as reparation stimulator. Fibrin glue has been used for closure of 8 duodenal and 4 gastric fistulas with chime loss to 1.5 l per day. Surgeries for palliative arrest of the intestinal loop with a fistula and classical obturators were not performed. The fistulas have been closed in 36 patients, 3 patients died (only 1 of them due to fistula). Fibrin glue reduced surgical aggression and improved treatment results in critically ill patients.

Adult↗
PubMed2006

[The role of chronic gastric ulcer in carcinogenesis].

Results of prolonged conservative treatment of patients with stomach ulcer are analyzed. Two groups of patients have been studied. Group 1 consisted of patients with long-term disease, incidence of stomach cancer in this group was 6.4%. Group 2 consisted of patients operated for stomach cancer and followed-up in cancer dispensary, 12.9% of them had the history of stomach ulcer. Based on anamnesis and results of morphological studies, cases of malignant transformation of chronic gastric ulcer have been revealed. It is demonstrated that prolonged conservative treatment of stomach ulcer in combination with high-grade dysplasia lead to potential risk of malignant transformation. The role of stomach mucosa contamination with herpes viruses was also studied. It is demonstrated that viral contamination is associated with immunodeficiency, maintains chronic inflammation in ulcer and promotes dysplasia progress.

Adult↗
PubMed2005

[Treatment of a burn stricture of the esophagus complicated with a fistula].

The experience in the treatment of esophageal fistulas is analyzed. Necessity and expediency of bougienage of esophageal burn stricture in patients with fistulas are discussed, indications and contraindications to bougienage of esophageal stricture complicated with a fistula are formulated. Surgical treatment of these patients (disfunction of esophageal fistulas and different variants of esophagoplasty) are considered.

Adult↗
PubMed2005

[Experience in repeated esophagoplasty].

Experience in repeated esophagoplasty in 58 patients is analyzed. Fifty-four patients of them had reoperation because of incomplete plastic reconstruction, 4 patients -- because of artificial esophagus (cancer, papillomatosis, trauma) diseases. Primary esophagoplasty in 47 patients was performed due to burn stricture of the esophagus, in 9 -- due to cancer of the cardia and esophagus, in 1 -- due to peptic stricture, and in 1 -- due to leiomyoma of the esophagus. The causes of unsuccessful esophagoplasty were the following: necrosis of the transplant (28 patients), extensive obliteration of cervical anastomosis (6), insufficiency of intrapleural anastomosis (4), initially short length of the transplant (4), doubtful vitality of the transplant (1 patient). Subtotal repeated reconstruction of the esophagus was performed in 34 patients, total -- in 21, segmental (with a fragment of the intestine on a long vascular pedicle) -- in 3 patients. Left half of the colon was used as new material in 38 patients, small intestine -- in 12, ileocolon -- in 4, stomach -- in 3 patients. Repeated restrosternal esophagoplasty with left half of the colon was performed most often (27 patients). Reconstruction was completed in 55 patients. Complications were seen in 19 patients. There were no cases of hospital lethality. Long-term results were followed up in 49 patients, stricture of cervical anastomosis has diagnosed in 17 of them. Result of repeated esophagoplasty was good in 26 patients, satisfactory -- in 19, poor -- in 4 patients.

Adolescent↗
PubMed2005

[Completion of esophagoplasty by means of transplant's remobilization].

Experience in completion of esophagoplasty by means of old transplant's remobilization in 54 patients is analyzed. Primary esophagoplasty in 52 patients was performed for burn stricture, 1 -- for traumatic stricture, 1 -- cancer of the esophagus. In 26 patients the cause of incomplete esophagoplasty was deficient length, in 11 -- necrosis, in 8 -- doubtful viability of transplant, in 7 -- insufficiency of esophageal anastomosis, in 2 -- prolonged obliteration of it. Total remobilization was performed in 41 patients, partial -- in 13. Thirty-six colic, 17 intestinal and 1 gastric transplants were used repeatedly. Esophagoplasty was completed in 50 patients, in 42 of them by one stage. In the rest 4 patients delayed pharyngoplasty was performed in the ENT clinic. One (1.8%) patient died in hospital due to insufficiency of proximal anastomosis and phlegmon of the thorax. Long-term result was studied in 40 patients: it was good in 25 patients, satisfactory -- in 12, bad -- in 3 patients.

Adolescent↗
PubMed2005

[Prophylaxis of insufficiency of gastrointestinal anastomoses].

Experimental and clinical results of use of fibrin glue for strengthening "high risk" sutures of anastomoses in elective surgery of the esophagus, stomach and urgent abdominal surgery are presented. In experimental studies this glue permitted to increase mechanical strength and containment of anastomosis, to accelerate microbial elimination, activated reparative processes. In clinical practice fibrin glue permitted to avoid suture insufficiency of gastrointestinal anastomoses in the most unfavorable conditions (peritonitis, acute intestinal obstruction, oncological process, etc). It is concluded that fibrin glue is the high effective protective agent for gastrointestinal anastomoses.

Anastomosis, Surgical↗
PubMed2004

[Radical surgical treatment of early cancer of the stomach].

Results of radical surgical treatment of 86 patients with early cancer of the stomach are analyzed. Among revealed macroscopic types of early cancer of the stomach (B0), type I (elevated) was seen in 26 (31%) patients, type IIa (superficial raised) - in 8 (9%), type IIb (superficial plane) - in 7 (8%), type IIc (superficial excavated) - in 20 (23%), type III (ulcerated) - in 25 (29%) patients. Adenocarcinoma was the prevalent tumor - 84 (98%) patients, in 1 (1%) case undifferentiated cancer was revealed and in 1 (1%) - carcinoid tumor. Tumor invasion was limited by mucosa in 49 (57%) patients, in submucosa - in 37 (43%). Metastases to lymph nodes were diagnosed in 4 (5%) patients. Subtotal proximal resection performed in 6 patients, subtotal distal resection - in 60, gastrectomy - in 20 patients. Lymphadenectomy corresponded to D1 in 30 cases, to D2 - in 51, to D3 - in 5 cases. Complications after surgery were seen in 21 (24%) patients. Cancer in the gastric stump was diagnosed in 3 (4%) patients 2, 4 and 6 years after primary subtotal distal resection of the stomach with D1 lymphadenectomy. All these patients underwent extirpation of gastric stump. Radical surgery for early cancer of the stomach must include extended lymphadenectomy D2 or more.

Adenocarcinoma↗
PubMed2004

[Subtotal distal resection of the stomach in cancer: indications and immediate results].

Results of 193 subtotal distal resections of the stomach due to cancer are analyzed. Age of the patients ranged from 25 to 87 years (mean age 57+/-11 years). Reconstruction by Bilrot-I technique was performed most often (67% cases). When Bilrot-II technique was used, classical Gofmeister-Finsterer variant and method on "ultrashort" loop with transverse anastomosis were performed. Extended lymphadenectomy (LAE) was performed in the majority of patients -- 131 (68%) including in D2 volume -- 111 (58%), in D3 - 20 (10%). Combined surgeries were carried out in 23 (12%) patients. The following intraoperative complications were seen: trauma of the spleen (2 patients, splenectomy was performed) and an injury of the portal vein during removing of the lymph nodes of 8b group (1 patient, wound of the vein was sutured). Postoperative complications were seen in 37 (19,2%) patients. There was one case of insufficiency of gastric anastomosis due to surgical mistake. Two patients died (1 after stomach resection with LAE in D1 and 1 -- after one in D3), lethality was 1%. Mesenterial thrombosis and perforation of acute ulcer of the gastric stump were the causes of death. It is demonstrated that LAE in D2 scope doesn't influence immediate results of distal resection of the stomach in cancer. LAE in D3 scope compared with D2 is associated with increased number of complications.

Adult↗
PubMed2003

[One-stage esophagoplasty with pathologically changed or operated stomach in patients with benign esophageal strictures].

Results of surgical treatment of 71 patients who have undergone extirpation of the esophagus with one-stage plastic surgery with pathologically changed or operated stomach are presented. All the patients suffered from benign diseases of the esophagus: burn and peptic strictures, peptic esophageal ulcers, cardiospasm of degree IV, benign tumors. Fifty-one patients had been previously operated on the stomach, 10 patients had burn deformation of the stomach, 3--benign tumors of the esophagus involving the stomach, the others--gastric and/or duodenal ulcers. In all the cases an isoperistaltic gastric tube was used for plastic repair of the esophagus. Postoperative lethality was 1.4%.

Aged↗
PubMed2003

[Esophagoplasty with the colon in flap patients with burn strictures of the esophagus].

Results of coloesophagoplasty in 366 patients with long burn strictures of the esophagus are presented. The lesion was total in 74 (21.2%) of them. Inefficacy of bougieurage was indication for plastic surgery in 133 (36.3%) patients, complete obliteration of esophagus--in 53 (14.5%). Left half of the colon was used in 296 (80.9%) cases, transverse colon--in 48 (13.1%), right half of the colon--in 22 (6.0%) cases. Retrosternal shunting esophagoplasty was performed in 247 (67.5%) patients. Complications were in 84 (34.0%), necrosis of the transplant--in 4 (1.6%) patients. Extirpation of the esophagus with posteriormediastinoplasty was performed in 16 (4.4%) patients, in 14 of them--transhiatally. Complications occurred in 7 patients coloesophagopharyngoplasty was carried out in 52 (14.2%) patients with combined stricture of the esophagus and the pharynx, in 23 of them--simultaneously. Complications were in 28 (53.8%) patients. Intrapleural of coloesophagoplasty was performed in 51 patients. General hospital lethality was 3.3%. Long-term results were studied in 259 patients. Good results of esophagoplasty were seen in 135 (52.1%) patients, satisfactory--in 65 (25.1%), unsatisfactory--in 59 (22.8%) patients. Dysfunction of the artificial esophagus was seen in 22.0% patients, 12.7% patients underwent repeated reconstructive surgeries.

Adolescent↗
PubMed2002

[Surgical policy for patients with prolonged esophageal burn strictures].

Concept of early radical surgical treatment of prolonged esophageal burn strictures (PEBS) is presented. From 1980 to 2000 one-stage esophagoplasty was performed in 503 (62.0%) of 811 patients with PEBS. Bouginage was effective in 17.2% patients. Extirpation of the esophagus with posteriormediastinal plastic repair was performed in 119 patients. Mean age of patients was 48 years, mean anamnesis time--11 years. 13 (10.9%) patients had total PEBS. Combined burn of the stomach was revealed in 25 (21.0%), of the pharynx--in 4 (3.4%) patients. Isoperistaltic gastric tube was used in 102 (85.7%) patients, whole stomach--in 1 (0.8%), left half of the large intestine (antiperistaltic)--in 16 (13.4%) patients. Esophagectomy was performed transiatally in 114 (95.8%), from three approaches (+ right-sided thoracotomy)--in 5 (4.2%) patients. Transplant on the neck was connected with esophagus in 106 (89.1%) patients, with the pharynx--in 13 (10.9%). Combined operations were performed in 14 (11.8%) patients. Intraoperative complications were in 6 (5.0%), postoperative--in 39 (33.0%) patients. Insufficiency of cervical anastomosis was seen in 16 (13.4%), paresis of recurrent nerve--in 4 (3.4%) patients. Hospital lethality was 3.4% (4 patients). Good and satisfactory long-term results of esophagoplasty were achieved in 97 (97.0%) patients. PEBS is the indication for transhiatal extirpation of the esophagus with its one-stage plastic repair with gastric tube (or large intestine) during first 6 months after burn.

Adolescent↗
PubMed2002

[Local esophagoplasty in patients with burn strictures of the esophagus].

Local plastic reconstruction of short burn strictures of the esophagus (SBSE) was performed in 14 patients aged from 22 to 37 years, 9 were men, 5--women. Decreased body mass was revealed in all the patients, mass deficit over 20% was in 4 (28.6%) of them. SBSE located in the upper third of the esophagus in 9 (64.3%) patients, in middle third--in 5 (35.7%). Local esophagoplasty was performed from cervical approach in 9 (64.3%) patients, from right-sided thoracotomy--in 5 (35.7%). Dissection of SBSE with 3/4 anastomosis was performed in 5 (35.7%) patients; circulatory resection of esophageal stricture with end-to-end anastomosis--in 7 (50.0%); detour side-to-side anastomosis without stricture resection--in 2 (14.3%). There was no hospital lethality. Postoperative complications were seen in 14.2% cases. Long-term results were good in 10 (71.4%) patients, satisfactory (strictures of anastomosis)--in 3 (21.4%), unsatisfactory--in 1 (7.2%). Local esophagoplasty is indicated for patients with SBSE when bouginage and dilatation of stenosis are not effective.

Adult↗