Biomedical subjects
Publications and source records attributed to M I Davidov.
Twelve patients with exogenous foreign bodies (small chicken and fish bones, portion of wire, nail, cherry stone, piece of glass) of appendix (8) or adjacent zone of caecum (4) were treated. Based on experience of treatment of these patients authors analyze pathogenesis of appendicitis associated with foreign bodies, and other aspects of this problem.
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During the 22 years period there were 26 patients (23 men and 3 women) aged from 18 to 71 with foreign bodies in the rectum introduced through the anal canal. The main causes of the appearance of foreign bodies in the rectum were anal masturbation (in 12 patients) and forced introduction of the objects by other people (in 10 patients). Among the foreign bodies prevailing were plastic and glass bottles, cucumbers and carrots, wooden and rubber objects in the from of the phallus. Typical were large sizes of the most objects introduced (the diametrical size more than 6 cm and the length more than 15 cm) which was responsible for the development of complications and made the removal difficult. The symptoms of the presence of foreign bodies in the rectum were determined as well as the optimum methods of diagnosis. A classification of rectal foreign bodies is proposed for the solution of medico-tactical tasks. The transcanal removal of the foreign bodies was fulfilled in 23 patients. The standardized technique of the transcanal removal of the objects is thought by the authors to include 10 principal propositions. Open operative interventions (removal of the foreign body, suturing the rupture, drainage of the abdominal cavity or of the perirectal space, sigmostomy) were performed in 4 patients with penetrating injuries of the rectum wall. The results of the treatment including removal of all foreign bodies were good, without lethal outcomes.
66 patients (45 males and 21 females) who have swallowed 157 foreign bodies (fragments of wire, nails, needles, hafts of spoons, et were treated). If the objects were located in the stomach and the duodenum in the absence of complications endoscopic method of treatment was preferable, with the help of which 31 objects were successfully removed and the terms of treatment were significantly decreased. Conservative treatment (diet rich in fiber and protective substances, barium sulfate administration) resulted in elimination of 58 objects by vias naturals, 53 from which were not more that 8 cm long. Evacuation of the foreign bodies was carried out only during the first 3 weeks after the swallowing. Operative treatment was carried out in 21 patients, in whom 68 foreign bodies were extracted. An urgent operation in the first 6 hours in complications due to foreign bodies (perforation, incarceration, gastrointestinal bleeding) was carried out in 13 patients. An urgent operation in terms from 6 to 24 hours of hospitalization was carried out in 6 patients with large (more that 8 cm) swallowed objects, conglomerates and bunches of foreign bodies. Early removal of these objects prevented development of complications. Elective operation was carried out in failure of conservative treatment as was in 2 patients. No lethality was registered.
The data on the surgical treatment of 22 patients with tumors of the upper thoracic aperture at the Center's Clinic in 1986-1998 are presented. Transsternal access was made possible due to general broad approach used. The procedure had been designed and tested on 36 cadavers, particularly, with a view to locate the lymph nodes at the junction of the mediastinum and neck.
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Immediate and long-term results of prostate adenomectomy were studied in 1549 patients, 322 of whom being of old age. In 1499 (96.8%) patients concomitant diseases were revealed: ischemic heart disease (934 patients), cardiosclerosis after 1-3 myocardial infarction (185), hemiparesis after acute cerebrovascular disturbances (74), diabetes mellitus (88), chronic lymphoid leukemia (5), cirrhosis of the liver (15), cancer (22) and true diverticula (15) of the urine bladder, drug-related polyallergy (16). 628 patients were radically operated in conditions of circulatory insufficiency of stage I-II. In 631 (40.7%) patients surgical intervention was carried out as urgent because of acute dysuria (hampering of urination) or to bleeding from tumor. Transvesical adenomectomy was carried out with hemostasis by 2 semipouch string removable sutures. In 89.5% of patients uncomplicated course of postoperative period was observed. Postoperative lethality in patients with concomitant diseases made up 3.2%. Causes of death were postinfarction cardiosclerosis (6.5%), after-effect of cerebrovascular stroke (5.4%), diabetes mellitus (5.7%), cirrhosis of the liver (6.7%). 6 months to 11 years after the operation 91.2% of the patients achieved good follow-up functional results of surgical treatment, in majority of the patients medical and social rehabilitation was observed.
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Reinfusion of autologous blood in 22 patients with cancer of the kidney was used during nephrectomy. Intraoperative blood loss made up 1000-4000 ml (20-80% VCB). 800-3600 ml of blood was collected from the operation wound and reinfused. In spite of massive blood loss, 20 patients recovered. Lethal outcomes (2 patients) were not caused by blood reinfusion. In 19 patients of control group with renal cancer massive blood loss was compensated by preserved donor blood transfusion. It is shown that reinfusion of autologous blood promotes more stable hemodynamics during the operation, reduces the quantity of postoperative complications and lethal outcomes, provides qucker restoration of morphologic structure of the blood and results in less substantial changes in filtration of a single kidney. There were no statistically significant differences in 5-year survival rate of patients in the study (40.9%) and control (42.1%) groups, nor in the frequency of hematogenous metastasizing of cancer. Because blood reinfusion does not increase the risk of hematogenous metastases of cancer, it is not contraindicated in massive blood loss during nephrectomy in patients with renal cancer.
An investigation performed in 38 surgical and obstetrics-gynecology departments has established that during 20 years foreign bodies were forgotten in the abdominal cavity of 46 patients which makes up 0.03% of all laparotomies. In 30 patients they were forgotten in emergency operations and in 16 patients in elective operations. Among the victims there were 31 women. The textile foreign bodies such as gauze pads, tampons, towels were left most often (35 things), forgotten surgical instruments and other things were less frequent. The foreign bodies stayed in the abdominal cavity during the period from 6 hours till 15 years and in 26.1% of the patients they resulted in lethal outcomes. The main causes of accidental leaving the foreign bodies in the abdominal cavity during operative interventions are analyzed in detail. Means of prevention of such neglect of surgeons are proposed.
The purpose of this study was to work out an adequate operative technique for patients with malignant tumors who also need open heart surgery or procedures on major blood vessels. We had 8 such patients. In 6 of them, a tumor (3 cases hypernephroid cancer and 3 cases retroperitoneal sarcoma) had grown through the inferior vena cava (IVC) up to the right atrium. Two patients had lung cancer together with severe coronary artery disease. All of these patients were operated on using a heart-lung machine (HLM) and cell saver (CS). In 6 patients the intravascular portion of the tumor was extracted as much as possible through a right atrium approach (in 3 cases a nephrectomy was performed). Two patients had a one-stage coronary artery bypass graft (CABG) and a lobectomy. All of the patients had uneventful postoperative periods and were alive when checked on 1 year after the procedures. During cytological investigation after each operation, tumor cells were found only on the internal surface of the HLM arterial filters with 20 microns holes. We suggest that special cardiovascular devices such as the HLM and CS might be used in borderline situations in oncology without increasing the risk of hematogenous tumor dissemination.
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