[Evolution of physical methods of hemostasis in surgery].
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Blood Loss, Surgical↗
Biomedical subjects
N N Malinovskiĭ
Publications and source records attributed to N N Malinovskiĭ.
[Use of implanted intravascular catheters with subcutaneous "ports" in the treatment of surgical diseases].
Special implanted vascular catheters with subcutaneous "ports" were used in 120 patients for infusions into arteries, veins and abdominal cavity. The results demonstrate high efficacy of this method in the treatment of surgical and cancer patients.
Blood Vessel Prosthesis↗
[Laparoscopy and puncture biopsy in diagnosis of focal lesions of the liver].
Based on the results of examination of 208 patients with different tumors of the liver it is concluded that in the majority of cases it is possible to avoid puncture biopsy of the liver and laparoscopy for diagnosis of focal lesion of the liver (FLL) before surgery because these invasive procedures don't improve efficacy of diagnosis. On the contrary it may lead to complications including implantation metastases (3.33%). Correct appliance of modern diagnostic algorithms permits to increase efficacy of FLL diagnosis to 82.27% without invasive procedures.
Adolescent↗
[Cytoreductive surgery of liver metastasis from colorectal cancer: principles of intra-arterial regional chemotherapy].
A significant number of patients with colorectal cancer have metastases (MTS) to the liver. Cytoreductive surgery (CRS) and new antitumor drugs provide promising results. The aim of the study was to evaluate clinical results of CRS in combination with modern antitumor drug irinotekan (kampto). Forty-seven patients suffering from colorectal cancer with MTS to the liver were treated. Primary focus was resected. All the patients were divided into 4 groups depending on combination of surgical treatment and chemotherapy: with liver resection and complete removal (or devitalization) of metastatic lesions in combination with postoperative intravenous (group 1) or intraarterial regional (group 2) injection of Irinotekan and without resection of the liver with implantation of a catheter to the hepatic artery with postoperative intraarterial (group 3) or systemic intravenous (group 4) therapy with Irinotekan. Mean dose of kampto was 350 mg per 1 m2 of body surface. It was demonstrated that intraarterial infusion was highly effective. The follow-up in group 1 was 9.5 +/- 3.75 months, in group 2--11.3 +/- 4.2, in group 3--6.5 +/- 5.3, in group 4--4.6 +/- 2.3 months. It is concluded that cytoreduction of the the liver with intraarterial intrahepatic regional chemotherapy is an effective method of treatment of patients with metastatic colorectal cancer of the liver.
Adult↗
[Is reliable prophylaxis of postoperative venous thromboembolic complications possible?].
Thrombosis of deep veins of lower extremities and pelvis is found in every third operated patient on the average, pulmonary embolism--in 0.5-0.8% cases. The results of nonspecific and specific prophylaxis of these complications are reviewed in the article. Intermittent pneumatic compression, compressive elastic stockings and standard or low-molecular heparin administration are most effective. Prophylactic measures do not exclude completely possibility of venous thromboembolic complications, but permit to control reliably this danger. The author has an experience of cavafilter implantation in 147 patients.
Anticoagulants↗
[Abnormalities of the pericardium].
By 2000 there have been at least 187 cases of rare pericardial malformations (of them there were 5 cases of the authors) and 1047 cases of celomic pericardial cysts (CPC) (43 cases of the authors) in the literature. Of them 18 (9.6%) patients were found to have no pericardium, the absence of its left half was in 76 (40.6%). No left pericardium was more common in men (61.04%) than in women (38.96%). The literature reports about the absence of the right pericardium only in one case. Partial pericardial defects were encountered in 30.48% of patients with rare pericardial malformations. In general, malformations in the left pericardium were 10 times more common often than those in the right one. The absence of the pericardium or its half most commonly requires no surgical correction. In partial defects, suturing or plastic closure must be performed due to a risk for strangulation and a possible fatal outcome. CPC are not clinically manifested in more than 50% of the patients with CPC, but in some cases dyspnea, dry cough, palpitation may be caused by other causes. Cystectomy yields good results.
Adolescent↗
[Prospects for surgical and combined methods for treating acute coronary syndrome].
From 1997 to 2000 diagnostic coronaroangiography was performed in 334 patients with acute coronary syndrome (ACS) which is the group of diseases with common pathophysiological mechanism, namely coronary artery thrombosis. ACS needs revascularization of the affected artery as quickly as possible. 26.6% patients underwent balloon angioplasty (BAP). 14.9% patients underwent emergency and urgent coronary artery bypasses with cold and pharmacological cardioplegia. Minimally invasive coronary bypass (MICB) was used in 4.2% patients. Combined BAP + MICB were performed in 2.1% patients. Indications, terms, sequence and future of ACS surgical treatment are discussed.
Angioplasty, Balloon↗
[Treatment of acute destructive alimentary pancreatitis].
The paper reports treatment of 52 patients with acute destructive pancreatitis for the period from 1993 to 1999. Up to 1997 conservative policy for management of such patients was used, operative treatment was carried on only in pyoseptic complications (43 patients, group 1). Later on early video-endoscopic procedures (9 patients) aimed at removal of toxic exudate from the abdominal cavity, its sanation and drainage with the use of not less than 5 drainage tubes were employed. From 43 patients of group 1 10 died. There were no lethal outcomes in group 2. The authors believe that early evacuation of the toxic purulent exudate with lavage and drainage of the abdominal cavity promotes more effective elimination of multiorganic insufficiency and decreases the risk for development of pyoseptic complications.
Ascites↗
[Analysis of mental functions in patients after coronary bypass surgery].
The neuropsychological examination was carried out in 18 men (study group), mean age 59.7 +/- 6.6 years, before and after aorto-coronary bypass. The neuropsychological tests were carried out 2-3 days before operation and 14-16 days after it. 12 non-operated men with coronary artery disease, mean age 60.0 +/- 6.7 years, were studied as a control group. In control group the neuropsychological tests were conducted with a 16-19 day interval. The tests examined short-term verbal and visual memory, semantic memory. At statistical analysis of the results the mean values and confidential intervals were calculated allowing for Student's coefficient. In control group at consecutive tests the negative dynamics of the results was not revealed. The comparison of the tests results in the study group patients before and after operation revealed the a decrease of neuropsychological parameters by 20-40% on the average irrespective of material modality. Features of cognitive changes revealed in early postoperative period, testifies to diencephalic type of the disorders.
Cognition Disorders↗
[Pulmonary artery embolism].
The authors have an experience in diagnosis and treatment of pulmonary embolism in 194 patients. Much attention is paid to diagnosis of thrombosis of the deep veins, phlebography and duplex scanning as the most informative methods. Due to regular unspecific and specific prophylaxis of deep phlebothrombosis in operated patients, pulmonary artery embolism occurred only in 2 patients for 12 years. Valid diagnosis of pulmonary artery embolism is thought possible only in application by pulmonary scanning and angiopulmonography. Mostly conservative method of treatment was used, only in 2 patients successful embolectomy was performed. Anticoagulation (heparin) and fibrinolytic (streptase) therapy was carried out. The results of streptase administration were superior to those of heparin injections. Recovery rate after fibrinolytic therapy made up 86.4%.
Adult↗
[An algorithm for differential diagnosis searching in space-occupying lesions of the liver].
The experience of examination of 584 patients with volumetric masses of the liver (VML) of various origin is presented. For successful differential diagnosis of VML and definition of rational surgical policy the algorithm of examination was considered with due regard for diagnostic stages, each of them being characterized by definite complex of tests. It is thought necessary to begin examination with noninvasive and highly informative tests. Complex of radioimmunologic evaluation of tumor markers level is advisable to include in diagnostic algorithm of patients with VML. The use of invasive methods of diagnostics is justified in complicated diagnostic situation. For evaluation of regional function of the liver radionuclear examination should be used. Liver puncture are feasible only whenever parasitic nature of cystic masses of the liver is excluded. If it is found to be impossible to determine the character of VML the question of advisability of diagnosis laparotomy should be resolved in its favour. The most efficient use of various methods of examination in 584 patients with VML of various genesis made it possible to increase accuracy of diagnosis of hepatic hemangioma, in nonparasitic cysts--1.7 times and in parasitic cysts--1.2 times.
Algorithms↗
[The results of treating stomach cancer at a medical center].
Results of diagnosis and treatment of gastric cancer according to the program of screening in permanently followed-up population group during 1980-1995 years, developed and introduced into practice of Medical Center of the President of Russia Administration, are analysed. According to the Cancer Register data through this period, total number of cases of this disease comprised 896 patients. Active revealing of cancer of the stomach made up 61%. The causes of advanced disease in patients with stage IV cancer have been thoroughly analysed, their share being high enough--23.5%. Due to achieved level of early diagnosis (I stage) the possibility of only radical surgical treatment rises up to 83.5%, allowing to receive a high percent of corrected 5-year (92-93%) and 10-year (83-88%) survival. Every third patient with cancer of the stomach succumbs due to causes unconnected with the progression of the disease.
Adult↗
[The clinical picture and treatment of destructive pancreatitis].
The results of treatment of 319 patients with acute pancreatitis are analyzed, 48 from them (15.1%)--with pancreanecrosis. Etiologic factors in destructive pancreatitis were alcohol addiction (41.67%), cholelithiasis (37.5%), hyperlipidemia (10.41%), hypercalcemia (4.17%), postoperative (4.17%). Location of the necrosis in parapancreatic fat cellular tissue was detected in 6 patients, in pancreatic head--in 8 and both in pancreatic head and corpus--in 11, in corpus and in tail--in 10; total pancreo-necrosis was observed in 5 patients. Therapeutic measures were conservative and only in cholelithiasis cholecystectomy was performed as well as drainage of the choledochus and abdominal cavity. Intensive care was aimed at blocking pancreatic and gastric secretion, inhibition of pancreatic enzymes ferments and suppressing mediators of inflammation, immunocorrection, prophylaxis of infection in the necrotic tissues. Desintoxication was carried out by combination of infusion therapy with forced diuresis, usage of extracorporeal methods and laparoscopic sanation of the abdominal cavity with subsequent lavage. Surgical interventions were carried out in far-off period only for complications of pancreanecrosis. Mortality rate in pancreanecrosis made up 20.85% and in total number of patients with acute pancreatitis--3.13%.
Combined Modality Therapy↗
[Abdominal endoscopic surgery: brief history and present-day state].
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Abdomen↗
[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↗
[Reoperations for recurrent atrial septal defect].
The authors discuss seven cases of recurrent atrial septal defect (ASD) without an inferior border which were treated by surgery. A typical clinical picture of the anomaly with arterial hypoxemia being the leading symptom was encountered in all cases. The main cause of the complications was overestimation of the indications for Lewis' operation, i.e. ASD suturation. A good clinical result was produced in all cases of a repeated intervention with ASD repair with a graft.
Adolescent↗
[Clinical aspects and therapy of cholelithiasis in elderly patients].
The article analyses the results of surgical treatment of 110 patients aged over 70 with acute cholecystitis. All of them underwent cholecystectomy with intraoperative cholangiography: choledocholithiasis was found in 26.4% and stricture of the distal choledochus in 10.0% of cases. Postoperative complications developed in 19% of patients, the mortality rate was 5.45%. Simultaneously, 72 elderly and old-aged patients were operated on for chronic calculous cholecystitis after thorough examination and preoperative management. Postoperative complications occurred in 13.9% of cases, none of the patients died. The authors conclude that in adequate preoperative management, careful choice of the method of anesthesia, and substantiated postoperative management, cholecystectomy is the operation of choice in acute calculous cholecystitis in patients over 70 years of age. Planned operations are very advisable in chronic calculous cholecystitis in patients of this age group for the prevention of severe complications, if adequate treatment of concomitant diseases is applied.
Acute Disease↗
[Specific plasma sorption of proteinases--a new approach to the treatment of acute pancreatitis].
The authors treated destructive forms of acute pancreatitis for the first time by means of specific plasma sorption of proteinases with the use of a proteinase plasma sorbent which is an acid-stable proteinase inhibitor immobilized on sepharose (ASI-Sepharose). Specific plasma sorption of proteinases on ASI-Sepharose was applied to the treatment of 29 patients with various forms of acute destructive pancreatitis. At the end of specific plasma sorption procedure the activity of blood plasma proteolytic enzymes in the patients reduced by 60-75%, which was attended by marked improvement of the condition in most cases; aggravation of the patients' condition was not encountered. The mortality in this group was 20.7% and was due to complications occurring during the development of the main disease. The mortality rate among patients treated by specific proteinase plasma sorption is much lower than that recorded in the USSR for destructive forms of acute pancreatitis which ranges from 30 to 75%.
Acute Disease↗