[The history of endocrine surgery in Russia].
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Endocrinology↗
Biomedical subjects
N A Maĭstrenko
Publications and source records attributed to N A Maĭstrenko.
[The diagnosis and treatment of chromaffinomas].
The results of examinations and surgical treatment of 117 patients with chromaffin tumors are shown: one-sided localization in the adrenal in 88% of the patients, bilateral localization in 4.3%, and extraadrenal in 7.7%. An analysis of the possibilities of the laboratory-instrumental diagnosis of chromaffinomas has shown that the method should be used in case of valid need. The absence of changes to the level of catecholamines and their metabolites in urine does not exclude the presence of chromaffinomas. The optimal access for the ablation of chromaffinoma of the adrenal larger than 5 cm in diameter is thoracofrenotomy in the tenth intercostal space. Endovideosurgical interventions in the adrenals can be used for the size of chromaffinoma less than 5 cm in diameter and with the absence of signs of malignisation and marked hemodynamic disorders. The superior medial laparotomy is expedient for extraadrenal pheochromocytoma of the abdominal area and for bilateral localization in the adrenals.
Adrenal Gland Neoplasms↗
[A rare form of primary-multiple synchronous colorectal cancer].
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Adenocarcinoma↗
["Silent" pheochromocytomas].
The results of surgical treatment of 126 patients with "hormonally inactive" and catecholamine secreting tumors of the adrenals were studied. Among them 2 cases (1.6%) of "dumb" pheochromocytoma were diagnosed. The clinical observations have shown the difficulties in the diagnosis of "dumb" pheochromocytoma before operation, risk of performing adrenalectomy and necessity to correct hemodynamic disorders during anesthesia in connection with latent catecholamine activity. The laboratory and instrumental means of examination of patients with suspected "hormonally inactive" tumor of the medullary substance of the adrenal are proposed. The variants of prevention and arrest of hemodynamic disorders during ablation of the "dumb" pheochromocytoma were considered. When the "dumb" pheochromocytoma had the diameter less than 5 cm and the adequate preparation was conducted the authors propose a laparoscopic access for adrenalectomy on the right, and retroperitoneoscopic access on the left. The detection of the catecholamine secreting tumor of more than 5 cm diameter, when problems with the clipping of the central vein of the adrenal take place, open accesses should be preferred--mainly thoracophrenotomy in the X intercostal space. If it was not possible to prove "dumb" pheochromocytoma before operation and it was started with endovideosurgical intervention during which it was not possible to first clip the central vein of the adrenal and the risk of hemodynamic disorders was high, the early transition to open operative intervention is thought to be expedient.
Adrenal Gland Neoplasms↗
[Laparoscopic splenectomy through a lateral access].
The investigation included 35 patients with diseases of blood and spleen pathology (30) and wounds and traumas of the abdomen with injuries of that organ (5), treated by laparoscopic splenectomy through a lateral access. The technique and stages of the operation and advantages of the lateral access are described. The laparoscopic splenectomy was shown to be possible in 90% of cases if patients were selected with special reference to the main disease, size and degree of pathological alterations in the spleen. An adequate approach to selections of patients with injuries of the organ allowed to make operations in more than a third of the patients and casualties. When using the lateral access laparoscopic splenectomy is thought to be more convenient, gives better visualization of the anatomical structures and reduces risk of injury of adjacent organs, thus resulting in less frequency of complications and conversions.
Abdominal Injuries↗
[Non-epithelial tumors of gastrointestinal tract: diagnosis and surgical treatment].
Non-epithelial tumors of the gastrointestinal tract (GIT) are rare diseases, their rate is less than 2.6% of all tumors of this localization. Analysis of 271 clinical cases of non-epithelial tumors demonstrated that most of them (n = 174) belonged to smooth muscle tumors. Features of growth and localization of benign and malignant non-epithelial tumors were demonstrated. It was revealed that only morphologic study (frequently with histochemical methods) verified the diagnosis of neoplasm. The choice of the scope of surgical intervention depends on the localization, spread and morphology of tumor. Difficulties of verification before surgery lead to active surgical policy for non-epithelial GIT tumors.
Adult↗
[Physical methods of dissection and coagulation in surgery].
The paper presents 20-year experience in using various devices for tissue dissection and coagulation of such as electrosurgical ones EN-57M, Efa-0201 (Russia), Karl Storz-endoscope (Germany), Force-300, Force-FX, LigaSure ("Valley-lab", USA), Erbotom ICC 350 ("Erbe"), Argo-3000 ("Soring", Germany), a Surgitrone radioknife ("Ellman", USA), ultrasonic Auto Sonix devices ("Auto Suture", USA), a harmonic Ultracision scalpel ("Ethicon Endo-Surgery", USA), laser Scalpel-1 and Romashka-1 devices (Russia), plasma Fakel-01 and Prometey devices (Russia). The results of 424 experimental studies and clinical application of different energies in 1683 patients are analyzed. The influence of different types of energy on tissue and reparative processes were revealed, morphological changes were studied. Advantages and shortcomings of each type of energy are demonstrated, recommendations for their optimum application are formulated.
Dissection↗
[Diagnosis and surgical treatment of nonepithelial tumors of the small intestine].
The article is devoted to an analysis of 51 cases of nonepithelial formations of the small intestine. Benign tumors were diagnosed in 22 of them (leiomyomas, lipomas, fibromas). Malignant tumors were found in 29 cases (leiomyosarcomas and fibrosarcomas) The article describes the clinical picture, diagnosis and surgical treatment of nonepithelial formations of the small intestine.
Adult↗
[Vagotomy in patients with chronic duodenal ulcer complicated by bleeding].
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Duodenal Ulcer↗
[Optimization of the method of laparoscopic hernioplasty].
Based on the results of treatment of 800 patients after laparoscopic transabdominal preperitoneal hernioplasty the authors have revealed typical complications of this operation. A program of optimization of the operation method was developed and introduced into practice. It was confirmed by the results of treatment of the second group of patients consisting of 173 patients. Using original technical modes, visualization of the nerve trunks, preperitoneal drainage, little-gas laparoscopy with the local lifting, combined ablation of the hernial sac in patients with inguinoscrotal hernias allowed the results of treatment of such patients to be improved. There were no intraoperative complications. The total number of complications was 3 timed less and made up 8.09%.
Adolescent↗
[Lengthy epidural blockade and intestinal motor function in the early postoperative period].
The telemetry method of registration of the intraintestinal pressure was used for the investigation of the motor function of the intestine under condition of continuous epidural blockade (CEB) with Trimekain at early terms after operations on the stomach for ulcer disease. It was found that the motor cycle structure of the small and sigmoid bowels within the first three days after resection of the stomach and truncal vagotomy was not substantially changed under the influence of CEB. A pronounced stimulating effect of the epidural blockade manifested itself as an improvement of the main quantitative parameters of intestinal motility. The character of these changes in the small and sigmoid bowels was the same and did not depend on intactness of vagus nerves. The combined mechanism of the influence of CEB on intestinal motility includes analgesia, improved respiratory function, greater volume of mesenterial circulation and the influence on the intramural nervous system and muscle apparatus of the intestine.
Anesthesia, Epidural↗
[Transanal intervention for malignant nonepithelial rectal tumors].
The authors have analyzed their observations of 30 patients. Nonepithelial tumors were shown to be rare. Complex employment of endoscopic and X-ray methods of examination should be used for their diagnosis and differential diagnosis. Transanal interventions are thought to be palliative and can be used in patients with a high operative rick.
Anal Canal↗
[Clinico-anatomic rationale for the access and technique in video-endoscopic adrenalectomy].
The results of surgical treatment of 60 patients with tumors of the adrenals with the help of endovideosurgical techniques were analyzed and described. The article also presents the data of experimental investigations performed in 31 corpses of subjects of different constitution and topography of the adrenals in the retroperitoneal space and different accesses to them with the help of endovideosurgical technique. The most effective and safe accesses and the method of endovideosurgical adrenalectomy have been developed, substantiated and approbated in clinical practical work. In most cases the right laparoscopic and left retroperitoneoscopic adrenalectomies should be considered the operations of choice in treatment of patients with tumors of the adrenals. It was proved that the decision for the optimal endovideosurgical access and the corresponding adrenalectomy should be made individually for each patient with special reference to the clinicoanatomical criteria found. The endovideosurgical adrenalectomy should not be opposed to open methods of surgery which are expedient in patients with large size of the tumor, signs of malignancy and possible intraoperative complications.
Adrenal Gland Neoplasms↗
[Ganglionic blockers in abdominal surgery: facts and hypotheses. I. Benzohexonium and motor function of the gastrointestinal system in the early postoperative period].
The method of registration of the intraluminal pressure was used to study the function of the stomach, small intestine and sigmoid colon under conditions of partial ganglionic blockade in the first days after truncal vagotomy and resection of the stomach. It was found that benzohexonium in doses 0.1-0.3 mg/kg failed to substantially decrease the frequency of early functional motor-evacuation disorders of the "operated" stomach, but the results of using N-cholinolytic was better after truncal vagotomy than after resection of the stomach. Benzohexonium in doses 0.1-0.2 mg/kg failed to considerably stimulate the motor function of the small intestine while the doses of 0.3-0.4 mg/kg resulted in a decrease of its contractile activity. No reliable changes in the qualitative and quantitative parameters of the sigmoid colon motor function were found against the background of ganglionic blockade. So, for prevention and correction of early postoperative motor-evacuation disorders of the gastrointestinal tract the ganglionic blockade with N-cholinolytics should not be taken as a method of choice or a variant of monotherapy.
Animals↗
[Oncologic markers in the diagnosis of malignant tumors of the digestive tract].
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Bile Duct Neoplasms↗
[Ganglionic blockers in abdominal surgery: facts and hypotheses. 2.Clinical, pathophysiological and pharmacological aspects of ganglionic blocker use].
The authors discuss facts and hypotheses on the effects of benzohexonium upon the motor activity of the intestine and the significance of N-cholinolytics for prophylactics and treatment of postoperative pareses of the gastrointestinal tract. The ganglioblockers possess antistress effect, reduce the degree of pathological vegetative reactions and facilitate realization of the mechanisms of selfregulation of functions of the small and large intestine. Using benzohexonium during operation and in the first days after it makes the intestinal pareses less frequent. N-cholinolytics however do not have a considerable stimulating influence on the contracting activity of the gastrointestinal tract that accounts for their not high effectiveness in treatment of early functional motor evacuatory disorders. The points of action of gangliolytics, those at the level of the intestinal wall included, can not be considered to be completely established, as well as the mechanisms of their indirect effect. The ganglionic blockade should be considered as the basic method of prophylactics of the postoperative paresis of the intestine.
Abdomen↗
[Differential diagnosis and surgical treatment of colorectal nonepithelial tumors].
An analysis of results of the examination and treatment of 92 patients with nonepithelial colorectal tumors has shown that the correct diagnosis can be made in 82% of the cases on the basis of using complex X-ray, ultrasonic and endoscopic methods. Of decisive significance in determination of the tumor tissue character is the morphological investigation. Extensive surgical interventions were performed due to suspected malignization on 21 patients with benign nonepithelial tumors. In other cases (n = 49) the organ-saving operations were fulfilled. The decision between the volumes of the surgery for malignant nonepithelial tumors (n = 24) was not difficult in most cases and depended on the spread of the oncological process. The 5-year survival in this group of patients was 57%. No recurrences were noted after ablation of benign tumors.
Adult↗
[Preoperative diagnosis of metastatic involvement of perirectal lymph nodes].
Condition of perirectal lymph nodes was examined by endorectal sonography in 93 patients with rectal cancer prior to surgery. Precision of diagnosis of involvement by endorectal sonography was 62.5% and depended on the size of lymph node. There was a sizable correlation between the sensitivity of the procedure and the number of involved lymph nodes: it reached 80% when 3 or more nodes were involved. Preoperative assessment of the perirectal lymph nodes helped correct the extent and procedure of operation.
Adult↗