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Biomedical subjects

A F Chernousov

Publications and source records attributed to A F Chernousov.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Choice of the method of forming an isoperistaltic graft from the stomach for total esophagoplasty].

An anatomical experiment was conducted on 50 cadavers of human adults and an acute experiment on 50 unbred dogs to choose the most rational method for forming an isoperistaltic graft from the stomach for total esophagoplasty. The anatomo-experimental study was concerned with the peculiarities of angioarchitectonics and the merits and shortcomings of some methods for lengthening gastric grafts. The macro- and microcirculation in the modelled isoperistaltic gastric grafts of various width and configuration was studied in the animal experiments. It was shown that the best gastric graft was an isoperistaltic tube measuring 2.5 cm at the base, formed by the authors' suggested method of angular division of the gastric walls above the pylorus, and with a dilatation in the proximal part (beginning 4 cm below the level of division of the main vascular arcade) up to 3.5 cm in size. When the length of the greater curvature of the stomach from the lower pole of the spleen to the pylorus, measured in mild stretching of the tissues (before mobilization of the stomach) is less than 20 cm it is advisable that the vascular connections in the hilus of the spleen are included in the nutrient-supplying pedicle of the graft to improve the supply of blood to its proximal segment. The method for formation of the gastric graft along a broken line was used in the clinic in 300 operations for extirpation of the esophagus with one-stage esophagoplasty. Necrosis of the graft was not encountered. Total postoperative mortality was 3%. It is concluded that wider introduction of this operation into clinical practice is expedient.

Animals↗
PubMed1993

Tracheoesophageal fistulas.

Tracheoesophageal fistula is an uncommon clinical problem, and can be either congenital or acquired in origin. In this report, we present our experience in the management of 41 patients with tracheoesophageal fistula (28 male, 13 female; age ranging from 8 to 69 years) who were seen during the period spanning 1968 to 1989 at the National Research Center of Surgery, Moscow. During this time frame fewer malignant and correspondingly more posttraumatic and postoperative fistulas were observed. The most common clinical findings were cough associated with eating, production of sputum mixed with food, and weight loss with profound weakness. In the vast majority of patients, diagnosis was made using radiologic contrast studies, with endoscopic assessment being occasionally necessary. We classify our surgical approaches as "radical" (the isolation and ablation of the communication), "conditionally radical" (implying creation of a neoesophagus or thoracoplasty with muscle flap obliteration of the fistula and associated chronic empyema cavity), or "palliative" (usually entailing gastrostomy alone). Of the 32 patients undergoing surgical treatment in this series, 21 underwent radical or conditionally radical procedures; there was no operative mortality, and long-term follow-up shows that 19 of the 20 long-term survivors report satisfactory, good, or excellent status. This report summarizes the indications, timing, technique, and results of the various surgical approaches, and also delineates measures for the prevention of postoperative tracheoesophageal fistula.

Adolescent↗
PubMed1993

[Psychosomatic aspects of diagnosis and treatment of neuromuscular esophageal diseases].

The authors examined a group of 42 patients with neuromuscular diseases of the esophagus. They distinguished a group of patients who were not treated previously, a group with recurrent neuromuscular diseases of the esophagus in high tonues of the cardia, and a group of patients with a recurrence in normal or low tonus of the cardia. All patients underwent roentgenoscopy of the esophagus and stomach, esophagogastroscopy, and esophagomanometry, as well as clinico-psycho-diagnostic examination. Polymorphism of psychic reactions with predominance of anxiety and depression was revealed in the group of untreated patients, tendency to develop static forms of psychic and somatic responses and mild excitability were encountered in the group of patients with a recurrence in increased cardiac tonus. In patients with a recurrence in low tonus of physiological cardia the condition was determined by hystero-hypochondriac, alarming-depressive disorders. Clinocopsycho-diagnostic examination made it possible to develop averaged schemes of psychotropic therapy according to the groups of patients.

Adolescent↗
PubMed1993

[Removal of esophagus using a one-stage repair].

The article deals with the results of operations performed on 306 patients for extirpation of the esophagus and one-stage total esophagoplasty with the formation of the anastomosis on the neck. The operation was conducted on 178 patients with carcinoma and 128 patients with benign esophageal strictures. The authors claim this operation to be the operation of choice in esophageal carcinoma, cardioesophageal carcinoma, burn and peptic strictures, and in patients with stage IV cardiospasm. An isoperistaltic gastric tube or the large intestine is used for replacement of the esophagus. The postoperative mortality rate was 3.3%. The immediate and late-term results of this operation are much better than those of the other types of esophagoplasty. The authors recommend the operation to be used widely in the practice of specialized clinics for the management of the above mentioned diseases.

Adolescent↗
PubMed1992

[The technic of esophageal extirpation with one-stage esophagoplasty using a stomach tube].

The article deals with the technical aspects of operation for extirpation of the esophagus through a cervico-abdominal approach in carcinoma (133 operations) and benign esophageal strictures (117 operations) with one-stage plastics by means of an isoperistaltic tube formed from the greater curvature of the stomach. The relative safety (2.8% of patients died) and high efficacy of the described operation allow it to be recommended for wide introduction into the practice of institutions engaged in surgery of the esophagus.

Anastomosis, Surgical↗
PubMed1992

[The treatment of the sequelae of penetrating injuries to the esophagus].

On the basis of experience in the treatment of the sequelae of penetrating esophageal injuries in 79 patients the authors divided the patients into 3 groups: those in whom the perforation healed and stricture of the esophagus developed; patients with incurable purulent complications and esophageal fistulas; patients who underwent various operative interventions for acute perforation or its sequelae and needed a reconstructive operation. Recommendations on the choice of adequate therapeutic tactics for each group are given. The method of examination of the patients and the peculiarities of surgical treatment are described in detail. The most frequently encountered complications and the produced results are analysed. It is concluded that patients with sequelae of esophageal perforation must be treated at specialized clinics experienced in the management of this severe condition.

Adolescent↗
PubMed1991

[Repeated anti-reflux operations].

The authors had under observation 73 patients who underwent various antireflux operations with poor results, 68 of them were subjected to repeated interventions, fundoplication in most cases. The causes of failure of primary and repeated antireflux operations are analysed, the indications for and the techniques of reconstructive interventions are discussed. It is emphasized that patients with hiatal hernia and reflux esophagitis must be concentrated in specialized medical institutions.

Adolescent↗
PubMed1991

[Extensive lymph node excision in the surgical treatment of esophageal and gastric cancer].

Experience with 100 operations for carcinoma of the esophagus and stomach with expanded lymphadenectomy is analysed. The operative techniques are described and the necessity and expediency of expanded lymphadenectomy, the method of its performance, classification of the group of lymph nodes which must be removed are discussed. The postoperative mortality was 2%, complications in the postoperative period 25%. Metastases in the lymph nodes were confirmed histologically in 69% of cases. It is concluded that expanded lymphadenectomy is a necessary measure in surgical intervention in patients with carcinoma of the esophagus and stomach and improves the results of management of this group of patients.

Adenocarcinoma↗
PubMed1991

[One-stage total and intrapleural esophagoplasty in cancer and benign esophageal strictures].

The authors compared the results of one-stage intrapleural (114 patients) and total esophagoplasty (214 patients). The immediate postoperative results are better in total esophagoplasty both in carcinoma and in benign strictures of the esophagus. Incompetence of the esophageal anastomosis is much less dangerous on the neck than in the pleural cavity. The authors recommend wider performance of total plastics of the esophagus with its replacement by an isoperistaltic gastric tube.

Adult↗
PubMed1991

[Results of conservative treatment of short burn-induced strictures of the esophagus].

The authors had 135 patients with short esophageal burn strictures, 120 of them were treated by bougienage. The immediate and late-term results of treatment of this category of patients were studied. A complex of methods for the examination of patients with short burn strictures of the esophagus was defined concretely. Bougienage along a string-guide under ++roentgeno-television control is the main method for the treatment of this category of patients, it produced good results in 83.3% of cases. The optimal bougienage methods and operative treatment of such patients were elaborated.

Adult↗
PubMed1991

[Broncho-esophageal fistula].

The authors analyse experience in the examination and treatment of 69 patients with bronchoesophageal fistulas (33 males and 36 females aged from 13 to 66). The etiological factors, pathogenesis, and clinical symptomatology of bronchial fistulas are discussed. The modern methods for the diagnosis of this pathological condition are indicated, the main ones being radiological and endoscopic methods. The indications for radical and palliative operations in bronchoesophageal fistulas are determined and their techniques are described. The methods for the prevention of complications are discussed. The late-term results of nonoperative treatment and various types of operations were studied.

Adolescent↗
PubMed1991

[Prevention of incompetence of esophageal sutures].

Patients suffering from esophageal and gastric diseases were divided into 2 clinical groups: main (133) and control (115 patients) groups. In the main group particular attention was focussed on correct formation of the grafts, precision techniques of application of the sutures of the anastomosis, the use of laser, and adequate correction of the alimentary and immunological status. The incidence of incompetence of the esophageal anastomoses reduced from 12.2 to 0.8%. Fatal outcomes were not encountered in the main group, 9 patients died in the control group.

Esophageal Diseases↗
PubMed1991

[Clinical aspects, diagnosis and treatment of esophageal spasm].

Esophageal spasm Teschendorf 's syndrome) is rarely distinguished among neuromuscular diseases of the esophagus, which leads to improper treatment. Primary esophageal spasm and secondary esophageal spasm should be distinguished, the latter developing in cardiospasm or achylia of the cardia. Retrosternal pain and dysphagia prevail in the clinical picture of ++esophageal spasm . X-ray and esophagomanometry are the most informative among the objective methods of examination. In a group of 106 patients 49 had primary and 57 had secondary esophageal spasm . A complex of measures should be applied in the management of esophageal spasm+. Primary esophageal spasm is treated only by nonoperative measures (spasmolytics, tranquilizers, vitamins, acupuncture reflex therapy and psychotherapy according to a suggested scheme), a course of pneumocardiodilatation (no more than 5 sessions) is included in the management of secondary esophageal spasm+. Such treatment produced good and satisfactory results in 100% of patients with primary and in 72% of patients with secondary esophagitis. The management of secondary esophagitis is a more difficult problem which calls for further study.

Adult↗
PubMed1991

[Combined gastrectomy with extensive lymph node excision in the surgical treatment of cancer of the stomach].

The authors discuss experience in combined gastrectomy in 206 patients with gastric carcinoma. They encountered 72 various postoperative complications which were not fatal. Fourteen patients died, which made up a total postoperative mortality of 6.8%. The most frequent and threatening complication was incompetence of the esophago-intestinal++ anastomosis, which occurred in 17 cases (8.3%) and was the cause of death of 6 patients (42.9%). The incidence of purulent and pleuropulmonary complications was 19.9 and 3.4%, respectively. Extensive lymphadenectomy was performed in combined gastrectomy in 40 cases, which accounted for 42.6% of all combined interventions. The incidence of complication was lowest in this group of patients (15%), and there were only 2 fatal outcomes (5%). The authors believe that total gastrectomy with omentectomy, splenectomy, resection of the lower esophagus, and extensive lymphadenectomy is the method of choice in surgical treatment of gastric carcinoma.

Adult↗
PubMed1991

[Esophageal extirpation with one-stage esophagoplasty].

In the period from 1980 to June, 1989 the authors conducted operations on 128 patients for extirpation of the esophagus with one-stage esophagoplasty by means of an isoperistaltic tube formed from the greater curvature of the stomach. Fifty-four of these patients had benign esophageal strictures, 74 had malignant lesions of the esophagus. The authors claim this operation to be the operation of choice in carcinoma of the lower third of the esophagus and in carcinoma of the cardia extending to the thoracic esophagus. It may be carried out in carcinoma of the thoracic esophagus at any level, in benign strictures of the thoracic esophagus, and in stage IV cardiospasm in patients in whom operations had been performed earlier on the cardia. The abdominocervical approach can be supplemented by right thoracotomy in carcinoma of the midthoracic part of the esophagus. Four patients (3%) died after the operation. The authors recommend wider use of the operation.

Esophageal Neoplasms↗
PubMed1990

[Complex treatment of neuromuscular diseases of the esophagus].

Under examination there were 29 patients with neuromuscular diseases of the esophagus using clinico-psychodiagnostic investigations on the basis of the method of multilateral examination of the person. The treatment of patients also included a course of psychotropic therapy. The results obtained are discussed in different groups of patients with neuromuscular diseases of the esophagus. Immediate results of the treatment were satisfactory.

Acupuncture Therapy↗