Biomedical subjects
Publications and source records attributed to A V Gnezdilov.
This article presents results of special science research on problem of quality of life of patients suffering from recurrent depressive disorders in advanced age. The authors emphasize the influence of some clinical characteristics of depression and type of personalities upon the rates of quality of life.
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Peculiarities of EMG-reactions of m. masseter to noxious homo- and heterotopic stimulation were studied on healthy volunteers. Homotopic noxious electrical stimulation of n. mentalis elicited several successive responses in m. masseter consisting of R-component, early exteroceptive suppression period, early excitation period, late exteroceptive suppression period, and late excitation period. Heterotopic noxious stimulation (forehead, ear lobe, index finger) induced only the late exteroceptive suppression period and late excitation period. It is concluded that the excitatory components have a reflex nature, and that the late exteroceptive suppression period is formed under the effect of central cerebral structures, which mediate their influence via the spinal-corticospinal return loop.
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The amplitude-temporal parameters of the nociceptive flexor reflex evoked in the upper and lower extremities by painful heterosegmentary electrical stimulation were studied in healthy volunteers. This reflex was detected bilaterally in the muscles of the upper and lower extremities independently of the site of painful stimulation. The maximum amplitude of the reflex was observed in the case, when the segmentary muscle innervation and the application site of painful stimulation coincided. The least latency of the nociceptive flexor reflex was observed after painful stimulation of the ear lobe. It was concluded that nociceptive flexor reflex is not an elementary polysynaptic spinal reaction, but involves also some supraspinal centers.
Examinations of 48 patients with the syndrome of "diabetic foot" (IV-V degree according to Wagner classification), have shown advantages of prolonged epidural anesthesia (EA) carried out during pre-, intra-, and postoperative (6-7 days) period. This method has relieved pain during postoperative period with minimal impact on carbohydrate metabolism and central hemodynamics. Moreover prolonged EA is a basic prophylactic method against the development of phantom painful syndrome in patients with amputated extremity. The prolonged postoperative EA is a reliable method for modification of surgical stress-response, being especially important in patient, afflicted with a severe form of diabetes mellitus who represent a high surgical and anesthesiological risk group.
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The authors carried out estimation of analgetic effect of tisanidin by double blind test in patients with phantom limb pain syndrome. 14 patients took the medicine in a dose of 12 mg/day and 5 patients took placebo at the same dose. Characteristics and intensity of pain were estimated in accordance with McGill pain questionnaire and visual analogue scale. Pain possessed more than one sensory characteristics in the majority of patients. Tisanidin had a significant analgetic influence on all type of phantom limb pain: "neuralgic"--acute, shooting, transitory, "causalgic"--hot, burning, searing, "cramping" pain. Pain sensation did not decrease only in one of 14 patients treated with tisanidin. The authors explain the effectivity of the drug for treatment of phantom limb pain of different sensory modality by variety of the mechanisms of its therapeutic action, the capacity to decrease the releasing of excitatory neurotransmitter amino acids and the influence on alpha 2-adrenoceptors.
The paper discusses certain problems involved in communication between physician, cancer patient and society. The authors suggest that information given to a cancer patient on his or her diagnosis should be determined by the patient's willingness to know and prognosis. Also, suggestions on improvement of treatment of cancer patients of clinical group 4 are made.
An original technique of the brachial plexus block from the axillary approach is presented. The recommended technique suggests introduction of a rigid catheter into the paraneural space of the plexus up to the level of the sternoclavicular triangle. This provides for a high efficacy of the anesthesia and prevents development of complications. The methodology was elaborated on the basis of anatomic (n = 20) and clinicoradiological (n = 29) studies. The clinical evidence was obtained from 115 anesthesias for long-term reconstructive and plastic operations on the upper limb. A protocol for conduction anesthesia maintenance by repeated administration of lidocaine, trimecaine, and bupivacaine solutions is offered.
An overall (at random) study of 183 patients with cancer of the stomach or rectum at an oncological hospital showed that all cases had certain psychogenic reactions, which differed both by their clinical expression and severity. The type and severity of psychogenic reactions correlated with the stage of treatment (diagnostic, preoperational, etc.) sex, age, education and the localization of the tumor and premorbid personality traits. The paper offers data on the use of combined treatment (psychopharmacological and psychotherapeutic impact) aimed at removal of psychogenic disorders.
The results of follow-up of 143 patients with malignant gastrointestinal tumors (stomach, 63 patients; colon, 13 patients; rectum, 67 patients) who have undergone radical operations are analyzed. The number of men and women among the examined patients was approximately equal, the age range was from 32 to 61 years, the length of follow-up was from three months to one and one-half years. The patients were regularly examined and questioned at the inpatient and outpatient departments by a surgeon and a psychiatrist. The analysis revealed marked psychogenic reactions, having different clinical forms, in patients of the oncological clinics in connection with a severe stress situation. In most of the cases these reactions were extremely extensive, and the patients were in need of specialized medical assistance (participation of a psychiatrist in their treatment). It is expedient to identify patients with marked psychogenic reactions for special treatment at the time of their acceptance to the clinic. The postoperative period of such patients was accompanied by complications in 58.5% of cases, in comparison with 12.5% in patients with mild psychogenic reactions. After discharge 31 of 62 patients found themselves in a conflict family situation, 24 patients were rather limited in their social contacts; the majority of these patients were not working after the operation. These findings indicate the need for psychotherapeutic support in oncology, plus psychopreventive measures and medical educational propaganda among the population as important components of rehabilitation programs.
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Efficiency of various methods of anesthesia in prevention of the CNS segmented structures hyperreactivity induced by surgical trauma ware studied in 554 patients during planned orthopedic operations and operations on the pelvic organs. Spinal anesthesia played the crucial role in prevention of induced hyperreactivity of nociceptive neurons of the posterior spinal horns. A notable alleviation of postoperative pain in patients operated on under spinal anesthesia was a clinical confirmation of this fact. Analysis of the time course of the amplitudes of the control and test H-reflexes before and after the intervention showed that spinal anesthesia largely prevented perioperative changes in the spinal neuromotor stimulation and, from this viewpoint, can be regarded as the optimal method of anesthesia in surgery on the lower part of the trunk.
The trial aimed at development of pathogenetically sound complex of therapeutic measures to prevent postoperative pain or relieve it significantly included 1912 patients after elective surgical interventions on the lower part of the body. It is shown that basic factors in postoperative pain prevention are the following: a) adequate relief of preoperative pain syndrome; b) use of spinal or spinal-epidural anesthesia as the leading anesthesia method; c) preoperative epidural administration of opioid analgetic drugs; d) pre-, intra- and postoperative administrations of drugs affecting N-methyl-D-aspartate-receptors (ketamine, magnesium sulphate) as well as inhibitors of kininogenesis and prostaglandinogenesis. The success lies in a multimodality approach to prevention of postoperative pain syndrome, i.e. maximal eradication of all the factors promoting onset of pain during pre-, intra- and postoperative period with a simultaneous impact on peripheral and central mechanisms of acute pain. Such an approach resulted in a complete prevention of postoperative pain in 46.2% patients while the rest patients had much less intensive pain.
The purpose of this study, carried out in 132 patients with intense acute radicular pain, was search for an optimal local anesthetic to be used in combination with a steroid for therapeutic epidural blockade. Comparative analysis of analgesia attained by epidural injections of 5 ml 2% lidocaine, 4 ml 0.5% bupivacaine, and 4 ml 1% ropivacaine showed the advantages of the latter drug in stable arrest of radicular pain immediately after injection. The duration of analgesia after blockade was 1.4 +/- 0.5, 3.1 +/- 0.3, and 9.5 +/- 1.2 h, respectively. Use of ropivacaine eliminated the main shortcoming of epidural blockade in the treatment of patients with radicular pain, consisting in temporary pain relapse after discontinuation of the local anesthetic effect before development of antiinflammatory effect of the steroid.