Biomedical subjects
Publications and source records attributed to A G Pugachev.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
A new ureterosigmoidostomy (USS) procedure in exstrophy of the bladder in children comprises establishing a long submucous channel (SC) in the upper or middle third of the sigmoid. This is done by tenial, atraumatic for the mucosa, cut of the sigmoid wall followed by mucosal dissection along the length 2-3 mm larger than the diameter of previously immobilized ureter. After that a special instrument creates upwards an oblique SC, the ureter is placed into the SC opening made in the wall musculoserous layer. Finally, the shunt is established. The same USS procedure was conducted on the other ureter 3-4 cm above the previous shunt. The openings are intubated. Follow-up conducted for 6 years at best showed a complete urine retention existence in 7, a partial one in 1 cases. Radiologically, renal function improved in all the patients. Neither enteropelvic reflex, nor urolithiasis were observed.
The authors followed up 125 children with hydronephrosis aged 4-15. The diagnosis was based on ultrasound, radiological, x-ray, pelvic electromyography. Vitaiker's test findings. Postoperative follow-up covered 91 patients and lasted 1-5 years. Histological evidence provided data on 3 types of changes in the ureteropelvic segment. This necessitates not only Andersen-Hynes operation, but also graft plastic surgery contraindicated in the small-size segment, in extended stricture of the small-diameter segment, in existence of an accessory vessel, in the segment thin wall. Poor surgical outcomes were often the result of renal functional failure. In patients with renal functional loss up to 25% positive results were achieved in 91.1% of the cases, in the loss 26-50% in 81.8% of the patients, in the loss 51-75% in 79%, in that 75-100% in 61.5% of those surgically treated.
113 hydronephrosis children underwent Andersen-Hynes operation, 62 Calp de Werd operation. The ureteropelvic segment was examined morphologically. 3 macroscopic variants of ureteral structure and 5 variants of leiomyocyte presence in the muscular lining of the ureter are defined. Long-term follow-up results (1-10 years) are available. Resection gave positive results in 80%, graft plastic repair was effective in 92% of cases.
A rare case of double penis in a 4-year-old child is reported. The defect was successfully corrected surgically.
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The method of extracorporeal shock-wave lithotripsy (ESWL) is widely practiced in urology as effective and less traumatic. Utilization of x-ray and video control during ESWL sessions raises the problem of radiation protection of the patient and medical personnel as well as registration of the exposure dose for estimation of further permissible doses. The examination covered 48 patients of different age suffering from urolithiasis. All of them received ESWL treatment using units URAT (Russia) and LITOSTAR (Germany) having x-ray positioning. It was found that mean effective dose load for LITOSTAR unit was higher than for URAT unit. The larger part of the dose is generated while localizing the stone and focusing. URAT is furnished with logements protecting vital organs. This is of particular importance for children. ESWL departments with TV x-rat system should meet the requirements for jobs with occupational hazards. In multisession lithotripsy dynamic monitoring should be performed by ultrasound X-ray examination should be employed only in growing dilatation of the renal pelvis, prodromal signs of acute pyelonephritis and failure of the effects to eliminate concrements.