[Test control in assessing the professional training of physicians in surgery].
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Certification↗
Biomedical subjects
G G Prokhorov
Publications and source records attributed to G G Prokhorov.
[The physiological aspects of the efficacy of reconstructive operations in arteriosclerosis obliterans of the lower extremities].
Reconstructive operations in the aorto-iliac and femoro-popliteal segments were performed on 281 patients with obliterating atherosclerosis. An attentive examination of the patients in the nearest postoperative period and within the first 5 years has shown different efficiency of the operation in different patients. Favorable changes took place in regional hemodynamics, while disturbances retained in microcirculation and function of the extremity. Another cause of insufficient efficiency of the interventions was an initial stable suppression of tissue respiration and oxygen utilization in the extremity tissues. The dynamics was positive during a year followed after that by new symptoms of progressing disease.
Adult↗
[Intraoperative changes in the peripheral circulation with different methods for reconstructing the arteries of the extremities].
An examination of 192 patients with obliterating atherosclerosis of lower extremities was made who had different reconstructive operation. Intraoperative measurements of oxygen strain in the foot skin and rheography of the shin have shown that temporary compression of large arteries when making vascular anastomoses cause ischemia of extremities, whose degree and duration is dependent on the technique of the technique of the intervention. Advantages of the method of transprosthetic aortotomy such as less duration and lower degree of ischemia were shown. The possibility was revealed to prognose nearest results of treatment for changing regional hemodynamics and oxygenation of tissues at the moment of termination of the operation.
Adult↗
[Regional blood circulation during stimulation of the sympathetic trunk against a background of arterial ischemia].
In dogs, the innervation of the sympathetic trunk by pulses 0.5 Hz caused a mild reduction in regional arterial pressure and an uprise in oxygenation of the shin muscle. General and local arterial pressure rose at 20-Hz pulses, and the oxygen level in tissues was lowered. The pulses rate of 20 Hz induced deep disturbances in regional circulation combined with severe and long-term hypoxia and development of metabolic acidosis. In chronic arterial impairment, the regulating influence of the nervous system on regional circulation grows, and the range of its possible functional fluctuations widens. Artificial intrusion in the autonomous nervous system function in arterial ischemia disturbs regional circulation.
Acid-Base Equilibrium↗
[Ergography of crural muscles in the diagnosis of arterial occlusive diseases of the lower extremities].
Under examination there were 280 patients with obliterating diseases of lower extremity arteries using the methods of selective ergometry of musculus gastrocnemius. It was established that initial stages of the disease were characterized by 10-fold decrease of working capacity of leg muscles. With progress of ischemia and longer duration of the disease and simultaneously decreased volume of work the strength of a single muscular contraction dropped, their average and maximum instantaneous power decreased which demonstrates the development of degenerative alterations in muscles. Bilateral lesion of the arteries was diagnosed in 85% of patients with complaints about ischemic pains in one extremity. Selective ergography may be used for diagnosing preclinical forms of the disease and objective evaluation of the results of treatment.
Adult↗
[Effect of lumbar sympathectomy on tissue blood flow in the extremities in arteriosclerosis obliterans].
Lumbar sympathectomy in patients with obliterating atherosclerosis of lower extremities in the nearest postoperative period results in acceleration of the intracutaneous blood flow and of intramuscular blood flow as well as in greater extra-tissue blood shunting. At remote terms the intramuscular bloodflow is also accelerated. Patients with the IV degree of ischemia should be divided into two groups according to results of special investigations: patients with traumatic and with ischemic necroses. It is of importance for choice of rational surgical methods and for prognosis of outcomes of the disease.
Adult↗
[Viability of tissues of the extremities and surgical tactics in stage IV arteriosclerosis obliterans].
Amputation of the extremity was performed in 26 of 52 patients with the IV stage obliterating atherosclerosis. Clinical severity of the disease was confronted with results of special investigations. Three groups of such patients are described: with traumatic necroses, with ischemic necroses and with necrotic ischemia (criteria of its irreversibility are presented). Surgical tactics of treatment in the first group of patients may include sympathectomy with necrectomy. The outcome of treatment of the second group patients is determined by the efficiency of reconstructive operations. Amputation of the extremity is indicated to patients of the third group.
Amputation, Surgical↗
[Evaluation of the effectiveness of sympathectomy using the skin oximetry method].
The use of the method of epicutaneous oxygenometry showed that it reflects objectively the condition of circulation in the extremity. Oxygen tension in the skin of patients with atherosclerosis obliterans of the lower extremities reduced with the gradual advancement of the disease. The operation of lumbar sympathectomy increases the level of skin oxygenation. The efficacy of the operation is highest in stage II but diminishes in stage III of the disease. Sympathectomy fails to improve regional circulation essentially in later stages of the disease.
Adult↗
[Acid-base equilibrium, tissue oxygenation and hemodynamics in arteriosclerosis obliterans after sympathectomy].
The authors have shown that operation of lumbar sympathectomy increases the skin oxygenation level, increases the volume blood flow in the main arteries and gives rise to positive shifts in metabolic processes in the extremity tissues. The operation is most effective at the 2nd stage of the disease but is getting less effective at the third stage. At the 4th stage of the disease the operation is indicated but with limited necroses of distal parts of the extremity, intact blood flow not less than 40% of the normal, the leg skin oxygenation level higher than 30 mm Hg, shift of blood pH to subcompensated acidosis.
Acid-Base Equilibrium↗
[The blood supply and oxygen balance of the different tissues of the extremities following experimental sympathectomy].
The experiments in dogs suggested an essential difference in terms of the rearrangement of regional blood circulation in the skin and muscles of the extremity after experimental sympathectomy. Ganglionectomy induced a reduction of general peripheral arterial resistance on the operated side, an increase in the skin tissue blood flow and its oxygenation rate, a deceleration of the process of biological oxidation reducing the capability of muscles to use blood oxygen and cutting down the maximum of oxidase cytochrome (a3) activity. There was no essential change in the regional acid-alkaline balance. The above changes were due to a disturbance of the neurotrophic sympathetic effect on tissues.
Acid-Base Equilibrium↗
[Research methods in vascular surgery].
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Angiography↗
[Diagnosis of obliterating diseases of the vessels of the lower extremities using an ultrasonic method].
The use of echographic apparatus of the latest generation for the ultrasound flowmetry has shown this method to be of value for the objective assessment of regional hemodynamics. It has shown a decreased volume rate of blood flow along the iliac artery in patients with obliterating atherosclerosis of the lower extremity vessels as the disease was progressing. The lumbar sympathectomy gives little effect in patients with severe ischemia of the extremity. The state of regional hemodynamics is most completely characterized by the regional circulatory index.
Adult↗
[Circulation, oxygen and acid-base balance in the extremities in response to stimulation of the sympathetic trunk].
The lumbar part of the dog right sympathetic trunk was stimulated with the 20 Hz current. This entailed a rise of general and regional arterial tension, a reduction of arterial lumen in the extremity, a decrease of volume blood flow and pulse blood content, a retardation of microcirculation, a decline of oxygen tension in tissues, a development of metabolic acidemia, a depression of oxidative process, an alteration of oxygen utilization in blood. Frequent recurrence of the stimulation brought about accumulation of the above changes.
Acid-Base Equilibrium↗
[Oxygen tension in tissues of the extremities during lumbar sympathectomy].
Measurements of oxygen tension in the lower extremity skin in patients with obliterating atherosclerosis has revealed the basal decrease of tissue oxygenation. Lumbar sympathectomy caused a temporary aggravation of regional hypoxia resulting from reflex responses to mechanical irritation of autonomic ganglions during operation. A preliminary injection of pentamine, blockade of lumbar ganglia with novocaine, sparing technique of ganglionectomy considerably reduced or even prevented hypoxic reaction of tissues. The efficiency of the operation is dependent on the degree of basal arterial ischemia, stage of the disease and technique of performing sympathectomy.
Adult↗
[Changes in the hydrodynamic resistance of collaterals after ligation of the femoral artery].
After ligation of the femoral artery in 12 dogs anatomical changes of the collaterals 1 month after the operation are accompanied with 18-fold decrease of hydrodynamic resistance in them as compared to the initial one. The shifts observed in 96% are the results of dilatation occurring in the intramuscular interarterial anastomoses. Dilatation of the intramuscular arteries, situating more distally to the anastomosis zone and experiencing a decreased arterial pressure, is also observed, as it is in proximal vessels, situating in the zone of an increased blood pressure. Despite the essential shifts, the blood flow capacity of the collaterals even 1 month after the operation is still 500 times as small as that of the intact femoral artery.
Animals↗
[Characteristics of development of collateral vessels after experimental ligation of the femoral artery under conditions of venous insufficiency].
Isolated ligation of the femoral artery and its combined ligation with the vein was performed in experiments on 62 dogs. Anatomical and physiological methods were used. It was stated that at the combined ligation collaterals developed sooner, number of anastomoses in muscles of the femoral posterior osseous-fascial case was greater, and their lumen was wider than at the isolated ligation of the femoral artery. However, the combined arterio-venous insufficiency was followed by a more severe postoperative course and noticeable biochemical disturbances. Thus, a certain discrepancy between the development of collaterals and the function of the tissue they feed was revealed. Analysing the data obtained it is possible to conclude that venous insufficiency, despite accelerating the transformation of the collaterals as a whole, aggravates conditions for collateral arterial circulation in the extremity.
Animals↗
[Anatomical and physiological assessment of the collateral circulation in experimental femoral artery ligation in venous insufficiency].
Peculiarities of collateral circulation following isolated and combined ligations of the femoral vessels were studied in experiments on 62 dogs through physiologic and anatomic investigation methods. It has been shown that the ligation of the vein prevents the exsanguination of the limb, arising from an injury to the main artery, favours an accelerated anatomic reconstruction of the arterial collaterals, but increases microcirculatory disturbances, aggravates tissue ischemia and disorder of the acid-base balance, which as a whole evidences a detrimental effect of concomitant venous insufficiency upon the process of the restoration of the circulation in the limb.
Animals↗
[Physiological characteristics of collateral circulation in experimental stenosis of the thoracic aorta].
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Animals↗