Biomedical subjects
Publications and source records attributed to A M Shcherbakov.
Video-assisted thoracoscopy for differential and improved diagnosis was successful in 245 out of 249 patients (98.3%) with various chest neoplasms. Video-assisted surgical procedures were performed in 50 (20%). Complications were reported in 4 (1.6%). The method proved highly-effective as well as fairly safe and sparing.
The data on 503 cases of ovarian malignancies were evaluated to work out indications for and clinical assessment of revision laparotomies. Second-look surgery was carried out in the following situations: (1) tumor elements found in the washings of the peritoneum in Douglas' space and high blood-serum levels of CA-125 (8 patients with stage I-II tumors, in clinical remission); (2) during remission, after 6-10 courses of polychemotherapy (13 patients with stage III-IV tumors); (3) during remission, after non-radical primary surgery (117); (4) suspected recurrence (144); (5) recurrence-free surgical pathology, e.g. ventral hernia, requiring laparotomy (22). Patients without repeated laparotomy (199) were in control. During remission, surveillance can be carried out using cytologic, ultrasound and immunoradiologic techniques since laparoscopy fails. The latter is useful, for diagnostic purposes, in case of discrepancy between clinical and ultrasound evidence as well as during monitoring in patients in clinical remission who show unfavorable levels of CA-125 and poor results of sonographic. Laparotomy is indicated prior to chemotherapy of inoperable tumors for morphologic verification of diagnosis. Indications for second-look operations can be significantly decreased considering the latest improvements in non-invasive monitoring technique. Laparoscopic examination can effectively serve the same purposes.
LCS was performed in 35 patients with mammary cancer, 59 patients with benign breast tumours and 35 healthy people. 39 samples were taken from inhabitants of Odessa, 89 from St.-Petersburg. Differences were discovered between blood plasma spectra of Odessa and St.-Petersburg residents. Spectra of blood plasma in patients with mammary tumours differed from those of healthy people. LCS may be used for screening, for forming the groups of risk and for diagnosis of mammary gland tumours.
222 electric polypectomies were performed in the course of fibrocolonoscopy carried out in 114 patients. The results of examination of 172 removed neoplasms testified to the high effectiveness of the procedure in identifying the morphological structure of colonic polyps. Due to application of endoscopic polypectomy, which is essentially a total biopsy, histological diagnosis obtained on the basis of aiming biopsy was improved or modified in 67% of cases. However, aiming biopsy should be used because more than 20% of resected polyps fail to be removed from colonic lumen.
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Various methods of total anesthesia for colonoscopy in cancer patients, carried out in a outpatient setting, are compared. Diprivane and dormicum were used as monoanesthesia and in combinations with ketamine and fentanyl. Diprivane anesthesia was the optimal as regards the velocity of recovery of psychophysiological functions. Ketamine was acknowledged inefficient because of long awakening and psychotic effects.
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Only two of the 75 patients with echinococcosis, treated with mebendazole in a dose of 50 mg/kg b. m. for 30 days (single course) and administered from 1 to 13 courses with intervals of 1 to 3 months, developed agranulocytosis eventuating in death in one female patient. Analysis of blood levels of mebendazole and its metabolites permits a hypothesis that high concentrations thereof may have a toxic effect on the bone marrow, inducing its hypoplasia, in subjects sensitive to these substances.
In 26 patients with hydatid disease interferons (IFN) blood levels by titration method and HLA-antigens by lymphocyte cytotoxicity microtest were estimated. In total group B5 antigen frequency was significantly (p = 0.007 after Fischer) higher than in the control group of 155 practically healthy persons: 38.5% and 14.7% respectively. The determination of possible correlation between IFN-alpha and IFN-gamma production, HLA-antigens specificity and the localisation of Echinococcus granulosus cysts showed that in hydatid disease A2 and B5 antigens carriers are significantly stronger producers of the cytokines as compared with patients having A3 and B13 antigens. The highest titers of IFN-alpha was found in A2 antigen carriers with the liver cysts, the highest level of IFN-gamma had B5 antigen carriers with the lung damage. A3 and B13 antigens carriers had low IFN titers independently of the character of damaged organ. Relatively high IFN-gamma blood titers in B5 antigen carriers with the lung cysts, persons predisposed to hydatid disease, permit supposing the stimulation of the cytokine production by the parasite for cysts formation in the lungs.
In 51 patients with Echinococcus granulosus infection, blood IF alpha and IF gamma levels were measured using vesicular stomatitis virus culture. In patients with progressing disease, the IF alpha and IF gamma levels were significantly lower than in the benign form of the disease--144 +/- 28.8 and 51.6 +/- 10.1 U/ml, respectively (in healthy controls the levels were 1024 +/- 28.8 and 187.7 +/- 16.9 U/ml). The lowest levels of IF alpha and IF gamma were found in patients with primary localization of cysts in the lungs and multiorgan damages affecting the lungs--160 +/- 38.5 and 44.4 +/- 13.5 U/ml; 146.7 +/- 80.1 and 89.5 +/- 19.2 U/ml, respectively. After 5-6 thirty-day courses of mebendazole therapy (50 mg/kg body weight) at 30-day intervals, the average levels of IF alpha and IF gamma were 4 and 5 times higher. Measurement of IF levels in echinococcosis may be of prognostic value for the estimation of the efficacy of surgical and/or specific treatment.
In 11 patients with Echinococcus multilocularis infection the blood levels of alpha-interferon (alpha-IF) and gamma-interferon (gamma-IF) were measured using vesical stomatitis virus culture. In patients with the disease the contents of alpha- and gamma-IF were significantly (p less than 0.01) lower than in healthy controls: 392 +/- 101.6 and 101.6 +/- 20.9 U/ml and 1024 +/- 83.2 and 187 +/- 16.9 U/ml, respectively. The lower levels of alpha- and gamma-IF were found in patients with multiorgan damages including the lungs, as compared with the liver and abdomen infestation: alpha-IF 160 +/- 56.6, gamma-IF 88 +/- 24.0 and 525.7 +/- 124.3 and 109 +/- 18.3 (p less than 0.01), respectively. The similar data have been found in patients with hydatid disease (S. N. Suntsov et al., 1990). After 5 to 6 courses of mebendazole therapy in a dose of 50 mg/kg body weight dai y for 30 days with 30-day intervals there was a tendency to a slight elevation of cytokines levels (S. N. Suntsov et al., 1990), as seen in hydatid disease. The estimation of IF levels in multilocular echinococcosis infection may be of prognostic value and perhaps for the evaluation of the efficacy of surgical and chemotherapeutic treatment.
The efficacy of and tolerance to fancimef in 49 patients was compared to the efficacy of and tolerance to quinine in combination with fansidar in 33 patients with moderate P. falciparum malaria. A good tolerance to and a high efficacy of fancimef have been shown, which was manifested in rapid fever arrest, disappearance of parasitemia, absence of the disease relapses, which were observed in 2 patients on quinine combined with fansidar. The advantage of fansimef is one-time administration of the total course dose.
The study was performed in the area of distribution of tropical malaria resistant to 4-aminoquinolines (Vietnam) on 30 patients receiving lariam (mefloquine). The results were compared to the standard therapy with quinine and fansidar. They indicate a high efficacy of and a good tolerance to the drug tested. The use of lariam leads to a more rapid (as compared to the standard treatment) elimination of parasitemia and complete eradication of the disease relapses. The findings make it possible to recommend lariam for the prevention and treatment of tropical malaria.
Fifty six patients suffering from echinococcosis and 155 healthy persons were examined. The examination revealed the predominance of HLA-B5 and HLA-B18 antigen carriers among the patients suffering from echinococcosis unilocularis, and HLA-A1 and HLA-B35 in a group of patients suffering from echinococcosis multilocularis. In the first group no HLA-B14 antigen carriers were found and there was only 1 patients with HLA-B27 antigen. The data obtained prompt that HLA-B5, B18, A1 and B35 antigen carriers present the high-risk group for developing echinococcosis while HLA-B14 and B27 antigens evidently determine certain resistance to these invasions. Some differences were also marked in distribution of HLA antigens depending on the site of involvement: high frequency of HLA-B5 carriers among patients suffering from hepatic echinococcosis and HLA-B18 carriers among patients suffering from pulmonary echinococcosis.
Increasing mebendazole bioavailability is one of the most important problems to be solved in echinococcosis chemotherapy. The method of mebendazole administration with sunflower oil, elaborated by the authors, serves to this purpose: drug concentration exceeding the minimal effective one was attained in 86% patients treated with mebendazole and sunflower oil and only in 40% patients treated with the drug alone.
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