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Biomedical subjects

B I Miroshnikov

Publications and source records attributed to B I Miroshnikov.

At least 19 recordsLinked to original sources
PubMed2004

[Esophagoplasty in patients with the "waning" stomach or without the stomach].

An experience with 48 intrathoracic esophagoplasties in patients with "waning" stomach or its absence is generalized. The results obtained show that scarry-ulcerous damages of the pyloroduodenal and cardioesophageal portions, local surgical procedures, gastrostomy included, are not considered as deterrent factors for using the stomach as the plasty material for esophagoplasty. For the resected stomach or its absence the small intestine should be preferred in the formation of the anastomosis within the limits of the thoracic cavity and large intestine--when putting anastomosis on the neck. A complete clinical effect was obtained in 45 patients. Three patients died (6.25%).

Adult↗
PubMed2004

[Intrathoracic esophagogastroanastomosis: a problem and ways for its solution].

The investigation has shown that the due level of blood supply of the wound surfaces of the organs being sutured, the obligatory absence of a strain, perfect technique of the proper manual putting the end-to-end type anastomosis and the rational placing of the transplant in the posterior mediastinum with a strictly vertical rectilinear orientation, without bends and rotation, allowed to get a smooth course in 98.8% of the operated patients. Incompetent sutures took place in 1.2% of cases. It was also shown that the anastomosis of choice might be an invagination variant of the applying of it having not only high degree of reliability, but also the marked antireflux properties. The dynamic endoscopic control with the correction of forming anastomosis during 2-3 months allowed minimization of possibility of the development of scary stenosis. The results obtained suggest that the problems of intrathoracic esophageal anastomosis in clinic have been solved.

Adult↗
PubMed2003

[Possible complications of lymph node dissection in esophagus cancer and ways to prevent them].

The experiences with surgical treatment of esophagus cancer show that performing lymphodissection makes the operation more laborious and potentially results in the development of severe complications such as an injured recurrent nerve, chylothorax, higher risk of bleeding etc. Using their clinical experiences including 80 patients of the group of investigation and 194 patients of the control group, the authors describe methodological aspects of optimization of the operative intervention, possible complications and ways for their prevention. At the same time, the results of the treatment show that it is possible to avoid severe consequences of lymphodissection by means of adequate and purposeful prophylactics and timely elimination. The worked through links of the whole chain of the surgical intervention allow minimization of the potential negative phenomena of lymphodissection and so it can be considered as an integral part of the operation for esophageal cancer.

Abdomen↗
PubMed2002

[Carcinoma of the major duodenal papilla].

An experience with treatment of 62 patients with carcinoma of the major duodenal papilla during the period of 1989-1999 is generalized. Mean age of the patients was 62.4. Most of the patients admitted (85%) had jaundice. The most informative method of examination was FGDS, its sensitivity was 84%. All the patients were operated on. Transduodenal papillectomies (TDPE) were performed in 10 patients, pancreatoduodenal resection (PDR) in different modifications--in 42 patients, in 2 of them for recurrent carcinoma after TDPE, biliodigestive anastomoses--in 13 patients. Resectability was 80%, postoperative lethality--0%. Postoperative complications after PDR developed in 21% of the patients. Recurrent tumors after TDPE appeared in half of the patients. The actuarial five year survival after PDR was 50.6%. PDR is considered to be the operation of choice for cancer of the major duodenal papilla.

Adult↗
PubMed2001

[Methodological aspects of surgery of esophageal cancer].

Based on many years of clinical experiences including more than 400 patients operated on for carcinoma of the thoracic portion of the esophagus the author describes the methodological aspects of the succession of operation stages and rational modes of mobilization of the malignant area guided by the principles of observation of the maximum degree of ablastic character of the intervention and getting higher radicalism of it.

Anastomosis, Surgical↗
PubMed2000

[Long-term outcome of surgical treatment of patients with esophageal cancer].

Under study were the results of surgical treatment of 185 patients with esophageal carcinoma. One-year survival was 75.4%, 2-year survival was 49.6%, 3-year--43.4%, and 4-year survival--33.3%. Among the patients with tumors with the invasion degree T1, T2, T3 and having no metastases to the regional lymph nodes the resection of the esophagus in combination with the extended lympho dissection resulted in 4-year survival in more than 50% of the patients operated upon. In patients with tumors T3N1, T4N1 and especially with the simultaneous involvement of several lymph collectors the 4-year survival was 21.4%. The operative intervention at this stage of the disease should be considered as a palliative means in the greater part of the patients.

Adenocarcinoma↗
PubMed1999

[Functional risk factors of esophageal resection with one-stage intrathoracic esophagogastroplasty].

Functional values of cardiorespiratory complex influencing the survival after resection of the esophagus with one-stage intrathoracic esophagoplasty were examined in 94 cases. Risk factors of postoperative lethality were revealed, among which changes of cardiovascular system predominated over disturbances of function of external respiration. Among parameters of hemodynamics assessed by integral rheography with computer processing of the curve, variability of blood stroke volume at rest and its dynamics after exercise fest showed high significance.

Aged↗
PubMed1999

[Zenker's diverticulum].

An experience with treatment of 14 women and 15 men aged from 41 to 83 years with Zenker's diverticulum was analyzed. Most liable to the disease were people at the age from 50 to 70 years. The average duration of the disease was 3-4 years. All the patients were subjected to improved surgical interventions: resection of the diverticulum (11 patients), operations under the control of the endoscopic technique (18 patients). Resections of the diverticulum were combined with cryopharyngeal myotomy. No complications were noted. There were no lethal outcomes. So, wider indications to operative treatment in patients with Zenker's diverticulum, endoscopic methods used at all stages of treatment as well as improved methods of performing the operation enabled the authors to obtain good immediate and long-term results.

Adult↗
PubMed1999

[Lymph node dissection in esophageal cancer].

Results of surgical treatment of 70 patients with carcinoma of the thoracic part of the oesophagus were analyzed. The extended two-levels (intraabdominal and intrathoracic) lymphodissection is the necessary part of the operation. Postoperative lethality was 2.9%, one year and 2 years survival was 85.8 and 69% correspondingly. The data obtained show that it is expedient to introduce the extended two-levels lymphodissection into clinical practice.

Adenocarcinoma↗
PubMed1998

[Injuries the esophagus].

An experience with treatment of 30 patients with ruptures of the esophagus of different genesis is generalized. The differentiated approach to choice of the method of treatment and character of surgical procedures, wider indications to plastic interventions on the esophagus wound with its suturing layer-after-layer, wide disclosure of the mediastinum and its purposeful drainage, use of the modern detoxication means favoured the achievement of quite satisfactory results of treatment. Lethality was 6.7%.

Adult↗
PubMed1998

[Operability and resectability of esophageal cancer].

An experience with treatment of 193 patients with carcinoma of the thoracic part of the esophagus during the recent 7 years is generalized. A characteristic of oncological and functional operability in patients of this group is given. More than half of them were elderly (41.9%) and senile (12.4%) patients. Radical operative interventions were thought to be possible in 161 patients (83.4%). Resections of the esophagus in combination with esophagogastro-or esophagoenteroplasty were performed in 146 of them. Resectability was 90.6%. Postoperative lethality was 9.9%. For the last 2 years resectability had increased up to 96%, while the postoperative lethality had decreased to 4%.

Adult↗
PubMed1998

[The clinical assessment of central hemodynamics in patients over 70 undergoing the surgical treatment of calculous cholecystitis].

An analysis of the initial type of central hemodynamics and the postoperative period in 177 patients aged older than 70 years having calculous cholecystitis has shown that surgical treatment of patients with the normo- and hyperdynamic types of circulation even with concomitant diseases can give positive results. The least favourable regimen of blood circulation proved to be the hypodynamic type characteristic of patients with pronounced disturbances of homeostasis and/or with recent myocardial infarction.

Acute Disease↗
PubMed1997

[The factors affecting patient survival after esophageal resection with single-stage intrathoracic esophagogastroplasty].

Factors influencing the survival after resection of the esophagus with a one-step intrathoracic esophagogastroplasty were studied in 94 patients. In addition to the standard set of clinical data, under study were the parameters of central hemodynamics and external respiration functions. Risk factors of lethality were found. It was shown that the patient's age did not substantially influence the postoperative survival. Among the absolute contraindications to the one-step operation on the esophagus is the decompensation of cardiorespiratory functions and cachexia. The investigation of factors of risk of postoperative complications considered in groups allowed to pass to purposeful prophylactics of most probable of them.

Aged↗
PubMed1997

[Experience in 110 pancreatoduodenal resections].

An experience with 110 pancreatoduodenal resections is described. The possibility to fulfil the operation depended on the size of the tumor of the pancreas head (not more that 4 cm), on the width of the common bile duct (not more than 15 mm) and on the length of the not injured part of the hepatocoledochus (not less than 5 cm). The positive and negative features of ablation of the tumor in one or two steps are shown. It is thought to be expedient to save the gallbladder and the stomach with its pyloric sphincter. The restorative period after operations was performed by the Whipple method. Grounds for the expedience of transnasal drainage of the small intestine loop isolated after Roux are given. Postoperative lethality was 7.2%.

Adult↗
PubMed1996

[The characteristics of the clinical course and diagnosis of acute cholecystitis complicated by jaundice].

The clinical picture of acute cholecystitis complicated by jaundice has four main types: with the prevailing syndrome of inflammation of the gallbladder, of the pancreatic syndrome, of the cholangitis syndrome and of the profound pain syndrome by the type of renal colic. Echography is thought to be an informative preoperative method of diagnostics of the cause of jaundice, its significance being increased when combined with the percutaneous transhepatic cholangiography (94.4%). The patients must be operated upon within 24-28 hours. The intervention volume must be adequate to the type of the injury independent of the patient's age and of the degree of concomitant diseases.

Acute Disease↗