Biomedical subjects
Publications and source records attributed to A I Nechaĭ.
The article presents experimental grounds and clinical experiences for using a plasma device in 58 patients. Sufficiently high efficiency and safety of the method used during surgical procedures for arrest of bleedings from parenchymatous organs is proved.
Medical vagotomy with atropine allows two types of patients with duodenal ulcer to be distinguished--atropine-resistant and atropine-sensitive. A complicated course of the disease, high values of nocturnal gastric secretion before the operation, and positive Hollander's insulin test after vagotomy are encountered most frequently in atropine-resistant patients. The values of gastrin are significantly higher in these patients than in atropine sensitive patients. In 3-year follow-up periods, recurrence of the ulcer after vagotomy was revealed in 6.5% of atropine-resistant patients but in none of the atropine sensitive patients. Medical vagotomy with consideration for atropine sensitivity may be a reliable prognostic criterion in the choice of the operative intervention in patients with duodenal ulcer.
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The paper discusses data on 48 cases of Zollinger-Ellison's syndrome. Surgery was performed in 45 patients and ulcerated tumor (UT) found in 32. Tumor was detected in the pancreas (17 cases), duodenum, stomach, liver and parapancreatic fat tissue. Multiple tumors were detected in 3 patients. Twenty-seven percent of UT were genuinely or suspiciously malignant. A histological and clinical classification of gastrin-secreting neoplasms is presented. Surgical treatment for Zollinger-Ellison's syndrome presenting with UT and the results of surgery are discussed.
Gastric acidity was evaluated, using the histamine test (Key's test), measurement of nocturnal gastric secretion and gastric pH-metry, in 174 patients with gastric ulcers. Acidity proved to be lowered in 25% of gastric ulcers patients, normal in 30% and increased in nearly half of the patients. Intragastric proteolysis was studied in 48 individuals, including 27 patients with peptic ulcers and 21 normal controls. It was found to be normal in the overwhelming majority of peptic ulcer patients (74%). It is concluded that intragastric proteolysis can only be regarded as an aggressive factor, resulting in the formation of a gastric ulcer, when it is combined with high acidity.
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The work is based on the results of analysis of clinical material concerning patients who were treated by operation for duodenal ulcer 3-5 years earlier. Truncal vagotomy and pyloroplasty (TV + P) was performed in 166 and selective proximal vagotomy with pyloroplasty (SPV + P) in 195 patients. The authors found the long-term results to be similar in both groups and did not reveal any advantages of SPV + P over TV + P, in view of which they do not find it necessary in principle to decline from conducting TV + P at the present time.
Under investigation were results of gastric biopsies, tissues of ulcers dissected during operation and findings of an analysis of preparations in paraffin sections. Findings of all the three diagnostic methods were shown to be completely identical in 63 patients (chronic ulcer in 54 of them, malignant ulcer--in 9). Errors took place in 17 patients. Causes of the errors are discussed. Practical recommendations are given.
Gastric secretion indices were determined in patients with duodenal ulcers with 2-4 days intervals between the investigations. Considerable fluctuations in the gastric acid secretion levels were found in the first and second investigations. The findings were more stable in patients with pronounced hypersecretion. An analysis of results of the investigations performed in 109 patients with duodenal ulcer is presented.
Results of experimental application of plasma surgical device UMPR-20 in operations on the stomach, intestine and liver in acute and chronic experiments are described. Coagulating properties of the plasma jet were detected responsible for reliable hemostasis in dissection of the parenchymatous organs. As compared with other surgical devices (electroknife, ultrasonic scalpel, laser "Scalpel-1" device) the zone of injury of the underlying tissues is much less and makes up 0.2-0.3 mm. The plasma surgical device UMPR-20 has good prospects in using during operations on parenchymatous organs and for treatment of their injuries.
An analysis of results of studying proteolytic activity in the stomach of patients with ulcer of the duodenum with the help of an installation "Ferment-2MT" has shown the method to be undoubtedly objective. A direct relation between the clinical course of the disease and proteolytic activity in the stomach before and after the operative treatment has been established. Correlation of the proteolytic activity in the stomach with the gastric acid secretion has been found. The authors consider that the determination of the proteolytic activity in the stomach gives the information which can be used for the determination of indications to operative treatment, choice of the operative method and the assessment of effectiveness of the surgical treatment of the disease.
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An analysis of data concerning 37 patients with the Zollinger-Ellison syndrome (ZES) has been made, 36 of them were operated upon. Gastrinoma was found in 21 patients. Diagnosis of ZES was made in two steps: the first one is fulfilled in general medical institutions, the second one-in specialized clinics. The diagnosis of ZES must be either confirmed or rejected with certainty. When choosing the method of operative treatment several groups of patients must be born in mind: ZES without a gastrinoma detected, ZES with a gastrinoma, ZES with malignant ulcerogenic tumour. The main operation for ZES remains to be gastrectomy.
The functional significance of tumor of the adrenal cortex should be considered in determining the extent of surgery on the gland for Cushing's syndrome. The histologic patterns of tumor identified by the authors as well as response in Liddle's large test may serve differential diagnosis.
Under consideration were results of treatment of 71 patients with associated ulcers of the stomach and duodenum. Resection of the stomach was performed in 11 patients, various kinds of vagotomy--in 61 patients. Long-term results of operations in 69 patients were analyzed. Truncal vagotomy with an obligatory dissection of the gastric ulcer is a reliable method of treatment of the associated ulcers.
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Data concerned with two patients with pheochromocytoma are presented which convince the authors that urgent operation (a removal of the tumor) is expedient in uncontrolled catecholamine crisis.
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