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Biomedical subjects

M I Perelman

Publications and source records attributed to M I Perelman.

At least 19 recordsLinked to original sources
PubMed2000

Tuberculosis in Russia.

Various aspects of tuberculosis in Russia, including epidemiology, means of prevention, diagnosis and treatment, have been widely discussed in the last few years in the medical literature and by the general media. A certain amount of controversy has been generated on some of these subjects. This review is an attempt to objectively analyze the true situation of tuberculosis in Russia, including the issues of control measures, as viewed by the public health authorities and by the majority of Russian tuberculosis specialists. The data presented and their analysis reflect the official position of the Russian Federation Ministry of Health. These views became a basis for the concept of the national anti-tuberculosis program to serve the needs of the population, which was approved by the Scientific Council of the Ministry of Health of Russia in February 2000.

Communicable Disease Control↗
PubMed1997

Surgery for pulmonary tuberculosis.

During the period 1990-1994 a total of 578 operations were performed in 502 patients with various forms of tuberculosis. Most of the patients (68%) were men aged 20 to 50 years (70%). Sputum cultures were positive in 55% of the patients. More than half of all patients were chronic smokers, and about 10% were alcoholics or drug addicts. There were no human immunodeficiency virus-infected patients, and none with acquired immunodeficiency syndrome. The most frequent surgical interventions were, according to the classification adopted in Russia, for cavernous or fibrocavernous tuberculosis (196 cases) and tuberculomas (161 cases). The main operative procedures used were pulmonary resection (n = 280) and pneumonectomy or pleuropneumonectomy (n = 80). Diseased intrathoracic lymph nodes were ablated in 62 patients. Thoracoplasty or thoracomyoplasty were performed in 46 cases, thoracostomy in 37, closure of a thoracic wall defect in 27, and reamputation of the main bronchial stump in 6. Postoperative complications arose in 20% of the patients. More than half occurred in the pleural cavity or bronchi and were associated with tuberculous infection. The postoperative hospital case-fatality rate was 2%. The overall clinical efficacy by the time of discharge was 82.7% (95% in tuberculomas). Reactivation of tuberculosis over the first 3 years after discharge occurred in 6.6% of the patients. Most patients with large or multiple caverns, tuberculomas, intrathoracic caseous lymphadenitis, or various complications of pulmonary tuberculosis cannot be cured (or are not amenable to care in principle) by means of antibacterial therapy because of irreversible morphologic changes in the lungs, bronchi, pleura, lymph nodes, or thoracic wall. For this reason, indications for surgical management of pulmonary tuberculosis should be generally expanded. Excessively long antibacterial therapy for tuberculosis is often inadvisable. Although the availability of standardized regimens of antibacterial therapy is strategically essential, each patient must be treated according to an individual plan. In certain cases thoracic surgeons should be enlisted to participate in the development of such plans.

Adult↗
PubMed1996

Primary tracheal tumors.

A 33-year study (from 1963 through 1995) was conducted on 144 patients who underwent surgery for primary tumors of the trachea: 70 females and 65 males aged between 7 and 69 years. In 77 patients the tumor was in the thoracic trachea, in 26 in the cervical trachea, and in 41 at the tracheal bifurcation. The tumor was benign in 24 and malignant in 120. The most frequent malignant tumors were adenoidcystic carcinoma (more than 50%), squamous cell carcinoma, and carcinoid. The main diagnostic methods used were lateral and oblique roentgenography, tracheobronchoscopy and in the last 10 years, CT scans. One hundred forty-six operations were performed (2 patients underwent surgery twice). In 60, sleeve resection with anastomosis was made; in 37, different kinds of carinal resections were performed. Total hospital mortality was 15%. After resection for malignant tumors, 3-year, 5-year and 10-year survival rates were 47.5%, 35.9%, and 27.1%, respectively.

Adolescent↗
PubMed1994

[Arterial pulmonary thromboembolism as a cause of mortality in thoracic surgery].

Analysis of hospital mortality showed that thromboembolism of the pulmonary artery was a cause of lethal outcomes in thoracic surgery in 0.4% of hospitalized patients, in 0.7% of those who underwent operation, in 14.8% of all patients who died, and in 15.6% of those who died in the postoperative period. The principal causes of death in thromboembolism of the pulmonary artery were various diagnostic errors (79.5%), severity of the patient's initial condition (14.1%), and defective treatment (6.4%). Prevention of thromboembolism of the pulmonary artery is based on timely detection of its sources by wider use of ultrasonic and radionuclide methods, rarer application of invasive diagnostic methods, and the use of anticoagulant therapy after operations in the risk groups.

Adolescent↗
PubMed1994

[Bleeding as a cause of mortality in thoracic surgery].

Analysis of hospital lethality showed that hemorrhage was the cause of lethal outcomes in thoracic surgery among 0.5% of all hospitalized patients, 0.8% of those who underwent operation, and 17.3% of all patients who died. Among all fatal hemorrhages 28.6% were surgical and 71.4% were erosional. Surgical hemorrhage was due to injury inflicted to the large vessels (atria) during the operation. Erosional hemorrhages were caused by postoperative infectious-septic complications, progressive malignant tumors and pyo-purulent diseases, and exacerbation of peptic ulcer or the formation of an acute gastric ulcer. Among the principal causes of fatal hemorrhages are defective treatment (32.9% of cases), methodical and technical errors during the operation (28.6%), erroneous diagnosis (25.3%), initially severe condition of patients (6.6%), and progressive malignant tumor (6.6%). Intraoperative prevention of fatal surgical hemorrhage is based on personal experience, knowledge and skill of surgeons, and the use of modern technology in the control of blood loss. The prevention of erosional hemorrhage in patients who are not operated on consists in timely surgical treatment and early diagnosis in the postoperative period and active treatment of infectious-septic complications.

Adolescent↗
PubMed1993

Tracheoesophageal fistulas.

Tracheoesophageal fistula is an uncommon clinical problem, and can be either congenital or acquired in origin. In this report, we present our experience in the management of 41 patients with tracheoesophageal fistula (28 male, 13 female; age ranging from 8 to 69 years) who were seen during the period spanning 1968 to 1989 at the National Research Center of Surgery, Moscow. During this time frame fewer malignant and correspondingly more posttraumatic and postoperative fistulas were observed. The most common clinical findings were cough associated with eating, production of sputum mixed with food, and weight loss with profound weakness. In the vast majority of patients, diagnosis was made using radiologic contrast studies, with endoscopic assessment being occasionally necessary. We classify our surgical approaches as "radical" (the isolation and ablation of the communication), "conditionally radical" (implying creation of a neoesophagus or thoracoplasty with muscle flap obliteration of the fistula and associated chronic empyema cavity), or "palliative" (usually entailing gastrostomy alone). Of the 32 patients undergoing surgical treatment in this series, 21 underwent radical or conditionally radical procedures; there was no operative mortality, and long-term follow-up shows that 19 of the 20 long-term survivors report satisfactory, good, or excellent status. This report summarizes the indications, timing, technique, and results of the various surgical approaches, and also delineates measures for the prevention of postoperative tracheoesophageal fistula.

Adolescent↗
PubMed1993

The study of histamine H1- and H2-receptors in human lung cancer.

Data on human lung histamine H1- and H2-receptors in cancer and chronic inflammatory processes are reported. It has been found that the number of histamine H1-receptors significantly increases both in cancer and chronic pneumonia and does not practically change in tuberculosis lung parenchyma. The binding parameters of histamine H2-receptors both in cancer and inflammatory processes were similar to those obtained for the normal tissue. The important role of parenchymal histamine H1-receptors in the neuromodulation of airways in human lung adenocarcinoma is discussed.

Adenocarcinoma↗
PubMed1993

Alterations in human lung adrenergic receptors in cancer.

Data on human lung alpha 1- and beta-adrenoceptors and the alpha 1/beta adrenergic ratio in cancer and chronic inflammatory processes are reported. The number of alpha 1-adrenergic sites markedly increased in lung cancer parenchyma, giving a ratio of alpha 1/beta binding sites of 12/1 in cancer but almost 1:1 in control specimens. The alpha 1/beta adrenergic ratio obtained both for mild and severe chronic pneumonia and tuberculosis lung parenchyma was similar to that demonstrated for normal tissue. The above findings suggest the cancer-induced enhancement in parenchymal alpha 1-adrenergic activity.

Adenocarcinoma↗
PubMed1992

Human lung adrenergic and muscarinic cholinergic receptors in cancer and previous airways diseases.

In the present study adrenergic and muscarinic cholinergic receptors have been investigated in human lung parenchyma in cancer and previous airways diseases (chronic pneumonia, tuberculosis). It has been found that the number of muscarinic sites significantly increases in cancer and does not change both in chronic pneumonia and tuberculosis lung parenchyma in comparison with the normal tissue; the number of beta-adrenergic sites decreases in cancer, chronic pneumonia, as well as severe tuberculosis lung parenchyma. The important role of beta-adrenergic and muscarinic receptors in the formation of human lung adenocarcinoma is discussed.

Adenocarcinoma↗
PubMed1984

[Surgery of lung carcinoma].

The author's review comprises cases with a total of 2452 patients who had suffered from lung cancer; most of them above 60 years of age. Overall mortality rate came up to 5.2%. The variations of surgical technique are dealt with in detail. In addition, preoperative irradiation in combination with surgery is referred to.

Aged↗
PubMed1977

[Combined therapy for lung cancer (author's transl)].

During 1963 to 1975, 188 patients were operated following pre-operative irradiation on a betatron with 25 MEV energy. The irradiation was conducted for 2 to 3 weeks from 2 or 3 fields daily. The total focal dose ranged 2500 to 4500 rad. Radical interventions were performed in 159 patients (pneumonectomy in 80, bilobectomy in 13, lobectomy in 60, lobectomy with main bronchus resection in 6). Th lethality rate comprised, 6,7%. Over 3-years survival was achieved in 69.1%, over 5-years survival in 57.3%. Preoperative irradiation on a 25 MEV betatron favours an improvement of the patient's state and produces a favourable effect on the clinical and radiological manifestations of lung cancer. A comparative study of the morphology in the diagnostic biopsy material and in the lung specimens removed following irradiation demonstrated a varying degree of pathomorphism of cancer, down to a complete disappearance of the tumour and radial sclerosis development.

Adenocarcinoma↗
PubMed1977

[Reconstruction in bronchial stenoses of tuberculous origin (author's transl)].

Most of all bronchogenic stenoses are not caused by tumours but by tuberculosis. To diagnose stenoses of the bronchi bronchoscopy and bronchography are extremely helpful. The information the give is of decisive influence concerning adaquate reconstructive surgical measures. Early and late results of 108 patients operated on for tuberculous bronchial stenoses are reported. No mortality.

Adult↗
PubMed1976

[Surgery of expiratory stenosis of the thoracic part of the trachea and main bronchi (author's transl)].

Expiratory stenosis of the trachea and the main bronchi is caused first of all by slackening of the pars membranacea in rarer cases by tracheomalacia or tracheomegalia. Often it is associated with other respiratory diseases above all tracheobronchitis, emphysema and pneumosclerosis. Predominant clinical symptoms are dyspnoea, barking cough and attacks of suffocation. X-ray-pictures in several diameters and levels and bronchological examinations are crucial for securiting the diagnosis. Among 95 patients of all age groups 14 were operated on predominantly according to the method of NISSEN. Operation is contradicted in stages of severe emphysema with respiratory insufficiency of bilateral pulmonary tuberculosis or of chronic bronchitis. In 10 patients a good result was achieved by the operation.

Adolescent↗
PubMed1976

[Method and technique of experimental autotransplantation of a lung and a lung lobe].

The authors have accumulated an experience of 350 canine autotransplantations of a lung and its lobe. The peculiarities of the operative technique are described, and special emphasis is laid on its technical details that largely determine the success of a lung autotransplantation. The described method and technique permit the performance of orthotopic autotransplantation of a whole lung and of its lobe, and of heterotopic autotransplantation of the lower lobe of the right lung into the left pleural cavity in place of a removed lower lobe or whole lung. The first stage of autotransplantation of a lung or its lobe consists in applying an atrio-venous or venous anastomosis and that of the pulmonary artery with continuous U-shaped eversion sutures, with a re-establishment of the circulation, thus reducing the period of lung ischaemia. Upon restoring the blood flow in the lung, a bronchial anastomosis is applied with interrupted or continuous sutures, and the ventilation is restored. The vascular and bronchial anastomoses are applied with synthetic suture material (Orsylon) on atraumatic needles. The extensive experience of the authors in long-term follow-up of the animals after transplantation (up to 5 years) demonstrates that the described technique and method of lung autotransplantation ensures good competence and patency of the vascular and bronchial anastomoses, without any stenoses observed in the late postoperative period. As shown by histological examinations, the inflammatory reaction around the suture material is minimal.

Animals↗