Biomedical subjects
Publications and source records attributed to L A Ender.
A procedure of transcutaneous draining of bile ducts through a guided replaceable drain using the gallbladder and formation of cholecystostomy and cholecystohepatico-, gastro entero- and enteroenteroanastomoses is suggested for palliation of pancreatic cancer patients. The procedure offers a good clinical effect assuring a significantly longer survival as compared to standard palliative operations used for pancreatic cancer treatment.
The influence of the cascade filtration exchange plasmapheresis on the central and organ haemodynamics was studied in 15 patients in the terminal phase of diffuse purulent peritonitis. The procedure was found to be followed by the activation of the cardio-vascular system function if it was initially depressed and by its weakening in cases of excessive strain. The worse functional state of haemodynamics 1 day after plasmapheresis is the earliest symptom of progressing endotoxemia and is though to be an indication for redetoxication.
The report is based on the results of treatment of 116 patients with severe purulent-destructive abdominal cavity diseases and 320 patients with liver failure due to bile ducts obturation. Along with surgical operations, methods of organism extracorporeal detoxication-haemosorption, exchange plasmapheresis, autoblood ultraviolet irradiation--were used in all patients either in isolation or in combination with each other. Toxical metabolites concentration, blood integral toxicity, peptids with mean molecular weight concentration, liver profile enzimes activity, lipid metabolism indices, general and liver haemodynamics and electroencephalogram were studied. On the basis of correlations between indices obtained by the method of extreme grouping factors-syndromes were formed, and then in accordance with a special program summary evaluation of detoxication was calculated in marks. A drop in lethality by 28.3% was ensured, as well as a drop in postoperatyonal liver failure by 51.4%.
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Hemofiltration was for the first time used in multiple-modality treatment of 26 patients with peritonitis in the terminal phase with symptoms of organic and multi-organ insufficiency. Indications to and contraindications against this treatment modality were developed, as was the optimal scheme of hemofiltration in peritonitis patients. This method was found the most effective in patients with symptoms of multi-organ insufficiency (respiratory distress syndrome, nephropathy, hypodynamic syndrome, toxic and hypotoxic edema of the brain). Inclusion of this method into the complex of therapeutic measures has helped prolong the intensive care of peritonitis patients in the terminal phase in the majority of cases. Fourteen patients died, the death rate has made up 53.8 percent.
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Changes in the liver structure and morphology have been examined by means of light optic and transmissive electron microscopy in 12 patients with obstructive jaundice before and after blood purification. The findings permit a conclusion that in mechanical jaundice the methods for extracorporeal purification of the blood do not directly influence the pattern of the underlying condition of the liver, though promote a stabilization of the structural changes in the hepatocytes and prevent their augmentation; this recommends an earlier employment of extracorporeal purification of the blood in this condition.
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