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Biomedical subjects

G I Vorob'ev

Publications and source records attributed to G I Vorob'ev.

At least 19 recordsLinked to original sources
PubMed2005

[Nerve-preserving operations in surgery of rectal cancer].

Forty-eight patients underwent surgery for rectal cancer. In all the patients total mesorectumectomy was combined with one of the types of nerves-preserving surgeries. Three groups were divided depending on types of this surgery: 1-- complete preservation of elements of autonomic nervous system (n=31), 2 -- partial preservation (n=16), 3 -- complete ablation (n=1). In 30 patients of group 1 normal urination recovered on postoperative day 2 to 4. In 2 patients of group 2 stable atony of urinary bladder was seen, and in 2 patients -- reflex ischuria. In patient of group 3 normal urination recovered on day 14 after surgery without vesical tenesmus. Long-term results were assessed in 1 to 12 months. No recurrences occurred. It is concluded that nerve-preserving surgeries improve functional results without loss of oncological radicalism.

Adenocarcinoma↗
PubMed2005

[Modification of Svenson's biopsy of rectal wall in diagnosis of malformations of intramural nervous system in adults].

Thirty-five autopsied specimens of rectum's distal part and anal canal part were studied. It was revealed that length of physiological hypogangliosis zone ranged from 7.5 to 50.0 mm (mean 24.4+/-10.9 mm). With regard to this wide range the modification of transanal Svenson's biopsy of rectal wall was proposed for diagnosis of malformations of intramural nervous system of the colon. The method was used in 21 patients with megacolon. The results demonstrate accuracy and safety of this diagnostic method.

Adult↗
PubMed2004

[Surgical treatment of hormone-resistant form of nonspecific ulcerative colitis].

From 1990 to 2002 seventy-nine patients with hormone-resistant form of nonspecific ulcerative colitis (NUC) underwent surgery. There were 37 men, 42 women, mean age was 34.4 +/- 3.8 years. Severe form of NUC was in all the patients, total lesion of the colon was in 60.8% cases, subtotal - in 25.3%, and right-sided - in 13.9%. Acute disease was seen in 21 (26.6%) patients, chronic recurrent - in 42 (53.2%), chronic continuous - in 16 (20.2%). Complex intensive treatment including glucocorticoids (prednisolon 2 mg/kg/day) was used in all the patients. Criteria of efficacy were clinical, laboratory and instrumental data (rate of stool, hemodynamics, hyperthermia, pain syndrome, hemoglobin, level of leukocytes and albumin, results of endoscopy and roentgenoscopy). Absence of positive results during 3 weeks was regarded as inefficacy of therapy and indication for surgery. Subtotal resection of the colon with ileostoma or sygmostoma was performed in 68 patients. Detection of resistance to hormones before development of NUC's intestinal complications (intestinal bleeding, toxic dilatation and perforation of colon) permitted to improve results of surgery: number of postoperative complications reduced from 60 to 8 - 9%, lethality - from 21 to 4.6%.

Adolescent↗
PubMed2003

[Transanal endoscopic surgical method of removing rectal tumors].

Experience in endosurgical removal of rectal tumors in 96 patients is presented. Performed from 1999, open non-gas method and closed method of transanal endomicrosurgery (TEM) have reduced rate of adenoma recurrences to 8.8%. Development of the open method increased it accessibility for hospitals using endoscopic techniques.

Adenocarcinoma↗
PubMed2001

[Ambulatory surgical interventions in patients with proctological diseases].

The results of 629 operations for the most frequent proctological diseases (hemorrhoid, anal scissure, rectal fistula, acute paraproctitis) were analyzed. 134 operations were performed in outpatient clinic, 225--in one-day hospital and 270 (control group)--in coloproctology department. The place of operation did not influence postoperative period and temporary disability time. The mean stay of patient in outpatient department and hospital surgical unit was 3.8 and 324 hours, respectively. Since the second day after operation in specialized department it is possible to perform therapeutic manipulations outpatient in coloproctology room without negative sequences for patient's health. Cost of the ambulatory operation constituted 28.4% of hospital stay for patients with similar interventions. Surgical treatment of the above diseases could be performed in outpatients setfing in more than 50% patients. The bed resources must be used for patients who need long-term and intensive treatment in specialized department.

Ambulatory Surgical Procedures↗
PubMed2001

[Determination of colon resection limits in diverticulosis].

Results of surgical treatment of 112 patients with colon diverticulosis are analyzed. It is established that during operation it is necessary to perform such scope of resection which permits to create anastomosis between colon parts without their discoordination. The risk of complications from anastomosis decreases to 3.7%. The creation of anastomosis with significant discoordination leads to high risk of its insufficiency. It is desirable to resect the colon's parts with moderate discoordination. When the extension of of resection margins due to parts with moderate discoordination is dangerous, it is possible to create the anastomosis with ileo- or colostoma. In this case the risk of inflammatory complications remains, but conservative treatment of these complications in the conditions of feces efflux is effective.

Adult↗
PubMed2001

[Laparoscopic rectum repair].

A reliable and simple method of allograft fixation in laparoscopic posterior-loop rectopexy (LPR) was developed. The study was carried out on 40 cadavers, peak effort of separation of the net fixed to the sacrum by various methods was evaluated. Effort of separation in fixation of the net by sutures was 10.1 +/- 2.12 kg, in fixation by hernial stapler--1.13 +/- 0.36 kg, stapler "Pro-Tack"--6.38 +/- 1.85 kg, in fixation of the net by the new device--8.9 +/- 0.75 kg. From 1995 till 1999 LPR was performed with the new device in 15 patients, the open posterior-loop rectopexy (OPR) with fixation of the net by non-absorbable sutures--in 16 patients. In LPR intraoperative blood flow was twice as small (146.0 +/- 79.2 ml) as in OPR (275.6 +/- 76.9 ml). Mean time of LPR was 183.1 +/- 69.8 min, OPR--211.3 +/- 57.9 min. Relief of pain after LPR enabled with reduction of narcotic analgetics requirement (58.3 +/- 1.5 mg). Mean dose of narcotic analgetics after OPR was 93.2 +/- 1.4 mg. The proposed method of allograft fixation and device for it realization are effective and meet all requirements.

Analgesics, Opioid↗
PubMed2000

[Short- and long-term results of sphincter preserving operations with creation of colonic J-reservoir].

The aim of this study was to evaluate short- and long-term results of sphincter preserving operations with forming a colonic J-reservoir. This study examined the results of the treatment of 63 patients with medioampullary carcinoma of the rectum. Sphincter preserving operations with forming a reservoiroanal anastomosis were made in 34 patients (test group), 29 patients had sphincter preserving operations with forming coloanal and supraanal colorectal anastomoses (control group). In the test group complications were observed in 6 (17.6%) patients and in the control group in 6 (20.7%) patients (p = 0.3962). The defecation frequency in the test group 3 months after the operation was 1.87 +/- (1-3) time a day, in the control group even through 12 months--3.0 +/- 1.5 times a day (p = 0.0001). In terms up to 6 months tenesmus, imperative desire to defecate and defecation's multistage more often disturbed the patients of the control group (p = 0.0005). The function of the faeces continence was satisfactory in both the patients' groups, however in the control group the events of the anal incontinence of I-II degree (p > 0.05) occurred more often. The negative aspect of the colonic reservoir's forming is frequent change of the evacuation function with constipation, however, the differences were statistically insignificant (p > 0.05). Creation of a colonic reservoir doesn't increase lethality and postoperative complications rate, allows to reduce clinical manifestations of a "low anterior resection" syndrome.

Adult↗
PubMed1998

[Aortoiliopelvic lymphadenectomy in surgical treatment of rectal cancer].

The results of aortoiliopelvic lymphadenectomy in macroscopic changes in lymphatic nodes being revealed intraoperatively in 73 patients with locally spread rectal cancer, are represented. Morphological examination of the removed tissues made it possible to reveal metastatic involvement of paraaortal and iliac lymphatic nodes in 57.3% of patients. In 36.9% of cases combined radical operations were performed. There were no lethal outcomes. Postoperative complications were detected in 37.9% of cases, among them atony of the urine bladder in 30.1% and inflammatory processes in pelvic cavity--in 8.2%. And in 9 men with normal sexual potency before the operation it resulted in impotency after surgery. 5-year survival made up 27.4% including cases with metastatic involvement of lymphatic nodes--19.3%, and without it--35.7%.

Aorta, Abdominal↗
PubMed1996

[Diagnosis and surgical treatment of recurrences of rectal cancer].

The authors present the analysis of the results of surgical treatment of 145 patients with recurrent rectal carcinoma in 1960-1990 at the State Scientific Centre of Proctology. A group of 304 patients who underwent radical operation for carcinoma of the rectum was also studied to determine the frequency of recurrences after radical surgery. It was found to be 30.9% (in 94 out of 304 patients). More than half of carcinoma recurrences (63.8%) were revealed in the first postoperative year and 85.1% in the first two years. The average term of their appearance was 13.4 months. A radical operation may be performed for a second time in only 22.3% of cases of recurrences. The study of factors considerably influencing the frequency of the recurrence made it possible to determine three groups of patients with various risks of the development and create a scheme of their regular medical examination. Repeated radical operations on the cavities were carried out in 90 patients with recurrences, in 55 patients local resection of recurrrent tumor was performed. The indications for repeated operations were elaborated. More than half repeated operations on the cavity (53.3%) were combined, extensive, and concomitant. The incidence of intraoperative (52.2%) and postoperative (62.2%) complications was significantly higher than in primary operations. The use of a complex of therapeutic and preventive measures usulted in relatively low postoperative lethality (6.7%). Five-year survival after repeated operations on the cavity was 29 +/- 5.5%, the frequency of repeated recurrences was 34.5 +/- 5.2%; the respective figures after local excision were 14.6 +/- 5.5 and 40.8 +/- 7%.

Combined Modality Therapy↗
PubMed1995

[Methodical aspects of formation of diagnostically related groups for inpatient therapeutic-prophylactic institutions].

The authors discuss problems concerning the methodology of the evolution of standard sets of therapeutic-prophylactic measures and diagnostically related groups (DRG) for in-patient hospitals. The peculiarities of the formation of DRG for colo-proctological patients in a proctological clinic are shown as an example and DRG of the surgical and therapeutic classes are indicated. The results of studying the frequency of combined pathology in diseases of the large intestine are discussed.

Colonic Diseases↗
PubMed1995

[Surgical policy in emergency proctology].

The article deals with 6-year experience of a department of emergency proctology accommodating 65 patients. Introduction into clinical practice of modern therapeutic tactics, highly effective medicaments, and top-duality anesthesiological service made it possible to cure radically 84.6% of patients with acute paraproctitis and 82.1% of those with acute hemorrhoidal thrombosis. Postponed radical operations are of undeniable advantage in the management of such patients. As a result of them complication incidence reduced from 10.7 to 2.2% in acute paraproctitis and from 39 to 6.1% in acute hemorrhoids. In this connection the achievement of the best end results seems logical--the absence of recurrences in surgical treatment of acute suppuration of an epithelial coccygeal passage and acute thrombosis of the hemorrhoids, and a low incidence of recurrences (1.8%) after operations for acute paraproctitis.

Acute Disease↗
PubMed1993

[Treatment methods in colonic diverticulosis].

The authors had 662 patients with diverticulosis of the colon under observation. Nonoperative treatment for clinically manifested diverticulosis was undertaken in 226 patients. A good effect was produced in 82.2% of them. An operative intervention was conducted on 146 patients. The indication for operation was clinically manifested diverticulosis in the absence of an effect of nonoperative management in 19 (13%) patients and complicated diverticulosis in 62 (41.3%) patients. Various types of reconstructive-restorative operations in many-stage treatment of diverticulosis of the colon were conducted in 64 (43.8%) patients. Postoperative complications were encountered in 29 (19.7%) patients. Ten (6.8%) patients died. The authors conclude that the choice of the volume and method of operation should be guided by the patient's general condition, the character of the developing complications, the spread of the diverticuli along the colon, and the existence or absence of signs of an inflammatory process in the diverticuli.

Adult↗